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Home My WebLink About0016 HADRADA LANE - Health 16 Hadrada Lane, Centerville A= IIIIOry� 0.ECVClFOC IIII UPC 12543 ' No. 53 0R ��b57-CONSJJ�o- HASTINGS, MN ti 3 :f hem, Commonwealth of Massachusetts 0 Executive Office of Environmental Affairs MAR '�, �aavof 6 199? ae Department of Hftt Environmental Protection od WII"In F.WOW 6 ciov.n,a Arr o Paul Cellucci Dwld B.Struhs u.(ioraeor C 1T0rA9 brrer SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: 1'6' Hadrada Ln, Centerville, MA Addressofowner. Estate of Odile R Morin Date of Inspection:A—;L V_—9�7 (If different) c/o Peter Mulcahy, : Name of Inspector. W.E. Robinson SR Trustee Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 20 Sawmill Ln W.E. Robinson Septic Service P.O. Box 1089 Centerville MA Marshfield, MA 02050 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-siteage disposal systems. The system: _ Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: /tj, �. ( Date-- The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. 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] PASSES: 7ve not found any information which indicates that the system violates any of the failure criteria as defined 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 enfiltration,.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 11/03/95) 1 One Winter Street a Boston,Massachusetts 0210E a FAX(617)556-1049 a Telephone(617)292.5500 i Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddrem 16 Hadrada Ln, Centerville, MA Owner. Estate of Odile R Morin Date of Inspection: ;L-X g-q ? BI SYSTEM CONDITIONALLY PASSES continued Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pips(s) or 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 levelled 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] THER 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) BYSTEM WILLFAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLER,IF APPROPRIATE) ETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND AFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I 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,unleu a well water analysis for ooliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) O I (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: 1 6 Hadrada Ln, Centerville, MA Owner. Estate of Odile R Morin Date of Inspection DI SYSTEM FAILS: have determined that the system violates one or more of the following failure criteria as defined in 310 CNR 16.303. The basis for determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE YSTEM FAILS: following criteria apply to large systems in addition to the criteria above: system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public 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 _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner r operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program require of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST properiyAddrem 16 Hadrada Ln, Centerville, MA owner. Estpte of Odile R Morin Duce of Inapsotiow„L`�r 9 Check if the following have been done: _AKumping information was requested of the owner,occupant,and Board of Health. _'/0ne of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates V!7 that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _As built plans have been obtained and examined. Note if they are not available with N/A. z The facility or dwelling was inspected for signs of sewage back-up. _?The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. JZ All system components,excluding the Soil Absorption System, have been located on the site. 1'he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of banes or tees, material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. f_The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 .j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 16 Hadrada Ln, Centerville, MA Owner. Estate of Odile R Morin Date of Inspection: FLOW CONDITIONS RESIDENTIAL, Design fiowj2P_jpl1onx Number of bedrooms:3 Number of current residents:%� Garbage grinder(yes or no):_O Laundry connected to system or no):�-1 Seasonal use(yes or no): Water meter readings,if a le: 1 9 g 5 a 7, n n n qa1 1996 47 ,000 gals Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) - Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and pource of information: System pumpedas part of inspection: (yea or no)- 13 If yes,volume pumped: gallons Reason for pumping: TYPE QF SYSTEM �/ Septic tank/distribution box/soil absorption 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 of information: 1 tom- /d S Sewage odors detected when arriving at the site: (yes or no) 0 (revised 11/03/95) b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Hadrada Ln, Centerville, MA Owner. Estate Of Odile R Morin Date of Inspection: �7--,1V-1 I SEPTIC TANK (locate on site plan) k1 Depth below grader Material of construction:�ooncepte_metal_FRP_other(explain) Y � Dimensions: A, 4ficl �k Sludge depth: ) - f Distance from top of sludge'to bottom of outlet tee or baffle:3 Scum thickness: S—1 6 Distance from top of scum to top of outlet tee or baffle:_ , i Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: _ (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, .ructnral�ntegrity, evidence of leakage,etc.) .a t.. 49 D 3 / s,& A- A G E TRAP:_ (locate site plan) Depth ow grade: Material of construction:_concrete_metal_FRP_other(e:plain) Dime no: Scum from top of scum to top of outlet tee or baffle: Distan from bottom of scum to bottom of outlet tee or baffle: Commen (reeomm ndaticn for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence f leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Hadrada Ln, Centerville, MA Owner. Estate of Odile R Morin Date of Inspection: a. �"�'7 TIGHT OR HOLDING TANK:_ ( on site plan) Depth grade: of construction:_poncrette_metal_FRP_other(esplain) Dime ns: Ca ty: gallons flow: gallon/day Alarm evel: Comme ts: (condi ' n of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etcJ !2 PUMP HAMBER:_ (locate site plan) Pumps working order.(yes or no) ts: (note on of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 1 k6 Hadrada Ln, Centerville, MA Ow1er Estate of Odile R Morin Date of Inspection: Z—fig—01 ) SOIL ABSORPTION SYSTEM(SAS):V (locate on sits plan,if possible;excavation rat required, but may be approximated by non-intrusive methods) U not determined to be present,explain: Type: leaching pits,number: leach chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) Y'i `) I"A 0 t CESS rite: _ (locate OII its plan) Number configuration: Depth-top f liquid to inlet invert: Depth of lids layer. Depth of layer: Dimensio of cesspool: Mate of construction: of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: (locate site plan) Materials f construction: Dimensions: Depth of Comments: note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) te- (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) P opertYAddresa: 16 Hadrada Ln, Centerville, MA Owner. Estate of Odile R Morin Date of Inspection: v'P--XZ fQi 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' P DEPTH TO GROUNDWATER Depth to groundwater: )o`=` feet method of determination or approximation: 61� r (revised 11/03/95) 9 l� N�4✓c�cPa (,n . CQ.� . � y8 �ay�; - - - --- - - - � ---- -- - - - f THE COMMONWEALTH OF MASSACHUSETTS BOARD �HE�Ta -oF . . ........ . . ............ I Appliration -fur Mopood Workii Tottotrurtiun Vautit Application is h reby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: J I .............- --- --------------1�P.........!..-............................ ........................ - .................................. -••------------- _ .._.. __ .....ocat.n•Address' �� or.L�.. Wner Addre W •--- -----•---•-•-----•--•-•-•- a Installer Address ti QType of Building Size Lot__ �_ `5...._Sq. feet U Dwelling—No. of Bedrooms............. ......................... Attic ( ) Garbage Grinder ( ) a, Other—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures /� c��'' -,. ........•----- W Design Flow.......... ^� P P P Y Y Cj o gall-... �..............................gallons per person per day. Total daily flow---------------- gallons. WSeptic Tank—Liquid capacity4W.gallons Length................ Width........... .... Diameter---------------- Depth_.-.______--- xDisposal Trench—No. .................... dtli.............__.. otal Length------- _--------- otal leaching area-----yl _! . .sq. ft. Seepage Pit No.._. a --------------- -- n e __-_---------- __- Total leaching area------------------sq. ft. Z Other Distribution box ( Dosing tank (. ) � � W Percolation Test Results Performed by.......................................................................... Date...........................------------. Test Pit No. 1................minutes per inch Depth of "Pest Pit...--____-_-_______- Depth to ground water.-..___--__-___.__.____- rz., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 ----------- f T ------------------ O Descri ion f Soil 20 ti 1 ? ��. ez,e �� / —"' �``f - `- _ -- � �g`�`= /'� F.f'�!&�'--�-----77_-'-.�.$_�.....°��ii l .{�.t�c �� ._ U ---------- - .......................................................... WU U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------------_________............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a"Certificate of Compliance has been issued by the board of health. / // . igned� ... ...... .......•---......... ... •........ •--•- --•--- /- --- ��,/ ��g � Date Application Approved By...... l' .... "C ----------- ------ = Date Application Disapproved for the following reasons-...............................----------................._..----------------------------------------------•-. -------------•--•-------------------•-----------------------------•---------.......................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date 1 No..-• .�L/Y"`..... Fps..... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF -HEA,TH� fff1 .,voF....... ,�-'� ''. fir'/.� CSC' ApplirFatiun -fur BhiVoii al Works TonRtrurtiun Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ,%l tom'� ram'- �_ " l� _-_'_ t ....................................... Locati Address� J -- Lot N9r w•ner Add es .......... C-.- �.(K::�:L.__•�•-3'.^K __••��,,_C=�!............................ .....................:�Y ............_....._..__.................... e of v --Address � r Installer / Address " -- U Type Building Size Lot..... feet Dwelling—No. of Bedrooms.... Attic ( ) Garbage Grinder ( ) per, Other—Type of Building -._-.---.-_---------------- No. of persons............................ Showers ( ) — Cafeteria ( ) A' Other fixtures ------- -- w Design Flow......----- ~- - ------_--.-•--..-._---gallons per person per day. Total daily flow................�_..._.---...............gallons. WSeptic Tank—Liquid capacity/U�i ! .gallons Length................ Width.------ ........ Diameter_-----_------_ Depth.__...-----_--- x Disposal Trench—No- ------- ----------- /idth------------------- tal Length-__ /-••------ otal leaching area---....�/�� -sq. ft. Seepage Pit No.... C�_G.. pz->oft ...... �r�/•��fl•---t�l� ' -tamet r_____ - - m e _______________ ___ Total leaching aren_.....___________.sq. ft. z Other Distribution box ( )� Dosing tank ( ) Q�/� �C -- S'- 7-7t� aPercolation Test Results Performed by------------ ......................................................... Date---••---------------•--••--------_------ Test Pit No. I_______________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------:---.----.... W --------- --------------- ----=-----�__. ____ ! . _ ___.._.. ' .._l._.. ___ J . _ ____ _ _ ___________________ __ F G Description of Sol]------ = �P ��5� .... . — ``..__ . .. _ j.. .... ...............� q� 7 -��-�r� ll ----------- x 4_ �`�' --------5-- ,------------------------------------------------ .. 7 -/l ��`--.- --- w V Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------..--..-._.._-..-----.--. ---------------------------_----------------•--•-------------------•----------------.-.------.----.--.--------•----------------------------.----------.------------------------------.-----........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. tgned- - -`------- • ...................;q--f .. `. r/ //J6 Date / Application Approved By------ Date Application Disapproved for the following reasons:----••-------------------------- ............----•----------•-•--•-------------•-------...------... ...................................................... ------••-•..._..---•-----•--•-----•-••-------••-••.......--•--•------•..............••---.--------------_.._....------------...------------•--•--. Date PermitNo......................................................... Issued---------- ----------- ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD /OF HEALTH ............ lf`-!{i� j..� ..OF...... 1itv_ '.-........L ..................... Q,ertifirate of 0.1,11ntlaliatntr THIS IS—TO CERTIFY, Th t the•Individual Sewage Disposal System constructed ( ) or Repaired ( ) by._..... t. �-carC �-P li! -------� -----------------------, 3 > �, ,/�, nst IIer -- f / I ' at... .... L . �....... -------------- has been installed in accordance with the provisions of Ar8c, XI of The State Sanitary C de as descri/bed in the application for Disposal Works Construction Permit No --- /��---__•___----- dated-..1 THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM V N C ION SATISFACTORY. lDATE Inspector--- y --------------------------------- = THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH— `! ......... ...f�,� ^r�..OF........ No.... FEE•% i� u tt1 urk dun tr/ tionArmit Permission is hereby granted........... -•--•Pi(i�-try=t--•-----•-••---.;................'Z2 jC�--- ,.._..---�-- --------�.�__-.__,>-.•�!--•---•---.. to Construct (/ or Repair ( ) an ndividual Sewage Disposal System�/ J ._�L,. �d.�- v Gf Street / as shown n the application for Disposal Works Construction Permit No,///._.______v_. 1,d_--._ ......... DATE................................................................................ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I � i I I � i % i t j i i + s 1 � i � t S + i II _ .'�^1.+f../ C.•✓ y'd�t:i �� 4t,/ /Ca LO6F3i? Oss/ 774r ''�== 4�^,+ 01 —j�f-�•=:� GGiLIF-'OCP✓J i"� Ti-s/G �O./✓/t'✓G �`;':� ��` �\'• `tea C� "✓t.Y G�.� i'!/: i C✓"✓A.1It S t C/d/L C•/✓C/.cJC-G•G'J �y�`��•v t--��\�/t'�� i �UC1�"C- 6q"��ds-�G-''/'��C�'Y'"6-✓D �,��✓S. �F-77'C- G'Ev. Ld-3A./� v^[�.='d. Y�G � j i i