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Home My WebLink About0006 COACH LIGHT ROAD - Health G Coach Light Road, Centerville x A= IIII J�0.ECYCLEO Smeaae� � z UPC 12543 No. 53LOR n.cONS° HASTINGS, MN S� ,`,�"..�� . r,7`"+'"�'k��aR+x�`�.'��_ � f � 3 x rx .� y 3 �� '�''�'�?ti• `F 7 � _. ; i, Commonwealth of Massachusetts - - _ John Grad _ Executive Office of Environmental-McOirs D.E.P. Tit1e.V Septic Inspector �i t1 rtl� e nt of P.O. Box 2119 r • Teaticket,MA Q2536 • Environmental Protection _ (508)_564-6813 _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - - - PART A ..- ----. .. - _Y - CERTIFICATION � �`�A Cfig,�. �r Property Address: 6 Coach Light Rd.,Centerville Address of Owner: - u5 4k' 'r Date of Inspection:9103196 .(If different) d- t1A fie„_ Name of-Inspector:John Graci - Coach Light Beatty Trust ( 44/ Company Name,Address and Telephone Number. j CERTIFICATION STATEMENT I certify that I`have personally inspected the sewage disposal system at this address and that the information reported below is true..accurate and complete as of the time of inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes _ Conditionally Passes Needs Further Eval tion By the Local Approving Authority —. Fails i. Inspector's Signature: Date: 913196 The System,Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report-to the appropriate,regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B.C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired.. The system, upon completion of the replacement or repair,passes inspection. indicate yes,no,or not:determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfittration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1- r" '7'.� "` s, a'"`�aza au>'" •L.< --S 5� � $y.0 •'.��n'Z^ Y .L jn. A�+J F�+'idb S,� '�N&,,�,y .. l - SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) . Property Address: 6 coach Light Rd.,Centerville Coach Light Realty Trust Owner. Date of Inspection:9103196 - _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box.-The system will pass inspection if(with approval of the Board of Health): _. broken.pipe(s)are_,replaced. obstruction is removed distribution box-is-leveled or replaced _The system required pumping more than four times a year due-to broken or obstructed pipe(s). The -. system will pass inspection if(with approval of the Board of.Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the - system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD.OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of.a surface water. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS:THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. free from pollution for that facility and the presence of 3) OTHER D] SYSTEM FAILS: y I have.determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of sewage in facility or system component due to.an everioaded or clogged SAS or cesspool. _ Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Coach Light Rd.,Centerville' -owner:_ Coach Light Realty Trust. _ -Date of Inspection:9103196 _ DI SYSTEM FAILS(continued) Static distribution above outlet liquid level in the distribuon box -invert due to an overloaded or clogged SAS or.cesspool. Liquid depth in cesspool is less than 6°below invert or available volume is less than i/2 day flow.- Required pumping more than 4 times in-the last year NOT due to clogged or obstructed pipe(s). _ Numbers of times pumped _ portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any P Any portion of a cesspool or privy is within 100 feet of a surface-water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ onion of a cesspool or privy is within 50 feet of a private water supply well; Any P Of well water analysis for nalp I l s s. If the well 0 t but greater private has beenanalyzedto beaacceptabler Any portion of a cesspool attach copy water supply well with no acceptable water quality a y coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems.in addition to the criteria:' _ serves a facility with a.design flow of 10,OOfl gpd or greater(Large System)and the system is a significant threat to The system public health and safety and the environment because one or more of the following conditions exist: _ the system is within 400"feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ ensitive area(Interim Wellhead Protection Area (IWPA)or a ma the system is located in a nitrogen s pped Zone II of a public water supply well) r and compliance with th The owlity into wat ner suit to or operator of any such system shall bring the systemcal re f aciial office oll the Department foefurtherd ntoemtationnent program M requirements of 314 CR 5.00 and 6,00. Please con ! r k 1 ii I i i (revised 1 ill 5195) i, 3 i r - SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTIONFORM PART B CHECLIST Property Address: 6 coach Ught Rd.,Centerville Owner: - Coach Light Realty Trust Date of Inspection:9103196 _ Check-if the following have been done: - X Pumping information was requested of the owner,occupant, and Board of Health.... X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or-as part of this _ - inspection. n1aAs built plans have been obtained and examined. Note if they,are not available with N/A X The facility or dwelling was inspected for signs of sewage back-up. x The system does not receive non-sanitary or industrial waste flow: - X The site.was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site.. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge, depth of scum. X The slz and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System: (revised 11115195) 4 ON SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C - SYSTEM INFORMATION Property Address:_ 6 Coach Llght Rd,Centerville - Owner: Coach Light Realty Trust Dat e ofinspectio n:9103196 _ _ - _ FLOW CONDITIONS - - - RESIDENTIAL = -.. Design flow: 330 gallons Number of bedrooms: 3 Number of current-residents: 1 Garbage grinder(yes or no): No - -Laundry connected to system-(yes or no): Yes - - Seasonal.use(yes or no): No - Water meter readings,,if.available: Na - Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL: Type of establishment: n/a _ Design flow:a gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No- Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: n/a Last date of occupancy: n1a OTHER:(Describe)Ida Last.date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped in the spring of 1996 System pumped as part of inspection: (yes_ or no)No If yes,volume pumped: 0 gallons Reason for pumping: n/a TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool - Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 1974 Sewage odors detected when arriving at the site:(yes or no) No (revised 11115115) 5 . _ + "' �_. `_.,�," y, .. -� 'ter-� .�'SqA- �' .�'- .d�S"� '�'.�'....-•....,-. SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATI.ON-.(continLied) Property Address: 6 Coach Light Rd.,Centerville Owner: Coach Light Realty Trust - .._.Dsiie of Inspection:9103196 SEPTIC TANK: X._ µ . -- (locate on site plan) Depth below grade: 2' Material of construction:X concreate_metaf_FRP other(explain) Dimensions: L 8'6'H 5'7'W 4'10' Sludge depth:2' _ Distance from top of sludge to bottom of outlet tee or.baffle: 25' Scum thickness:0 Distance from top of scum to top of outlet tee or baffle:6' Distance form bottom of scum to bottom of outlet tee or baffle: 0 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity;, evidence of leakage, etc.) Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade:.Na Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle: n1a Comments. (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) n1a (revised 11115195) 6 r SUBSURFACE SEWAGE_DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM`INFORMATION-(continued) Property Address: 6 Coach Light Rd.,Centerville - - .Owner: Coach Light Realty Trust - Date of inspection:9103196 TIGHT OR HOLDING TANK: - _:(locate on.-site.plan) Depth below grade: Na Material of construction:_concrete_metal FRP_other(explain) _Dimensions: nla-. Capacity: n/a - - gallons : Design flow: n1a gallons/day Alarm level: Na Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Na _ .. _... DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) Na PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes orno) Comments: ; (note condition.of pump chamber,condition of pumps and appurtenances, etc.) Na (revised 11115195), 7 _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - - PART C SYSTEM.INFORMATIO,N (continued) Property Address: 6 Coach Light Rd.,Centerville- Owner: Coach Llght Realty Trust - - Date of Inspection:9103196 _ SOIL ABSORPTION-SYSTEM.(SAS):X - (locate on site plan,if possible; excavation not required, but may be approximated by non-intrusive methods) - - If not-determined,to-be present, explain: _ - - - nla Type: leaching pits,number, 1,000 gallon leach ptt leaching chambers,number:n1a leaching galleries, number: nfa - - leaching trenches,number, length: Na leaching fields, number, dimensions:n/a. overflow cesspool, number:n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding;condition of vegetation, etc.) The leach pit had 1l'of water hat the time of the inspection.it is structurally sound and functioning property. CESSPOOLS:_ (locate on site plan) Number and configuration: nla Depth-top of liquid to inlet invert: nla Depth of solids layer: r9a Depth of scum layer: n/a Dimensions of cesspool: n1a' Materials of construction: nla Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection) Na Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) nla PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of.vegetation, etc.) PrivyComments (revised 11115195) - '3+ - �.'�•,' }�� n^T �`L '�«�GSi�`3} -r ,P 9tv.:a A<e. S �' `�=�}'.�4'°"F- � _''P..Y't.`�' t't - _ - rat ' - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' , _ PART.C SYSTEM INFORMATION(continued) PropertyAddreSs: 6 Coach Light Rd.,Centerville- Coach UghtReWTrust - Date of Inspection:9103198. SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks _ locate all wells within 100' 6 AA Ir bl Oq GNP � DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or.approximation: 11SGS Maps and Charts. (revised 11115195) 9