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Home My WebLink About0033 KEARSARGE AVENUE - Healthr 33 Kearsarge Avenue 226-146.004 Centerville No. 4210 1/3 ORA oft rendaflexo 10% 0f / Commonwealth. of Massachusetts o! � l0 f 4 , d o Executive Office of Environmental Affairs Department of Environmental Protection WWlarn F.WeW Trudy Corn Ga mar 111011 ty AIW Paul uluoal DwW B.8&%" LL Goratnor Com+tlrrloew SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 33 Kearsage ve CERTIFICATION W. Hyann' rt Ed Kurker Property Address: 3-25-97 Address of Owner. Date of Inspection: (If different) Name of Inspector. W.E. Robinson SR ( 5 0 8 )7 7 5-8 7 7 6 Company Name,Address and Telephone Number. W.E. Robinson Septic Service P.O. Box 1089 Centerville MA, 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: _ Pasm — Conditionally Passes Ndeds Further Evaluation By the Local Approving Authority ✓Fails/ Inspector's Signature: t Date: 3 oZ 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: C A,B, C,or D: A) PASSES: I have 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) CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,pasess inspection- Indicate .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 atSltration,-or tank Lilure is imminent. The system will pans inspection if the existing septic tank is replaced with a yonforming septic tank as approved by the Board of Health. (revis 11/03/95) i One Whrter Street • Boston,Massachusetts 02108 • FAX(617)SWI049 • Telsomw(617)202-SM 40 Printed an Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 33 Kearsage Ave W. Hyamisport Properly Addrew Ed Kurker Owner. 3-25-97 Date of Inspection: B CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obebmx*ed pipe(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 b=is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe($). 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) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) EI'ERMINES 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 leas than 100 feet but 50 feet or more from a private water / supply well,unless 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 leas than 5 ppm. 9) O (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) 33 Kearsage Ave W. Hyannisport property Address: Ed Kurker owner. 3=25-97 Date of DI FAQ : ' I haw determined that the system violates one or more of the following failure criteria as defined in 310 MIR MMS• Tba Um for this dettermination is identified below. The Board of Health should be contacted to determine what will be necessary to coned the failure/ a �, L% !2 1— 0 6 L- '* j 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 cesepooL 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 ooliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The 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 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 drink mg water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped 2cme II of a public water supply well) The r or operator of any such system shall bring the system and facility into NU compliance with the groundwater treatmNA Program nts of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Anther information.. •tidy_:1' O vised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Pam,Addriew 33 Kearsage Ave W. Hyanni.sport p„aW. Ed Kurker Dab of Lupecum 3-25-97 Cheek if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. _414one of the system oomponents have been pumped for at least two weeks and the system has been reosiving normal flow raw during that period. Large volumes of water have not been introduced into the eye=recently or as part of this inspection. L/M built plans have been obtained and examined. Note if they are not available with N/A. ru/ facility or dwelling was inspected for signs of sewage back-up. t/rhe system does not receive non-sanitary or industrial waste flow site was inspected for signs of breakout. ✓All system components,excluding the Soil Absorption System,have been located on the site. _VThe septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of bafnea or tees,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. VThs size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. LThe 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 33 Kearsage Ave W. Hyamlf-A mtt Owner. Ed Kurker Date of Impeotion: 3-25-97 FLAW CONDITIONS RE SMENTIA L' Design flow aLfflzons Number of bedrooms: 4 Number of current residents:-I-"1 Garber grinder(yea or no): A- o ' Laundry connected to system(yes or no): Seasonal use(yea or no):-.A—., ° 1994 160,000 gals Water meter readings,if available s g gals Last date of occupancy: COMMERCIAL/INDUSTRIAL• Type of establishment: Design flow:_ sallons/day Greens trap present: (yes or no)_ industrial Waste Holding Tank present: (yes or no)— Non-sanitary wants discharged to the Title 5 system: lees or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: ,d System pumped as part of inspection: (yes or no)Ae D if yes,volume pumped:--------PllOrts Reason for pumping: TYPE OF TEM Septic taayddistri1rAion bWsoil absorption system Si,nsis cesspool Overflow cesspool privy attach previous inspection records,if any) Shared system(yes or no) (if yes, Other(explain) APPRO7aMATE AGE of all components,date installed(if known)and source of information: >Q S Sewage odors detected when arriving at the site: (yea or no) 1L 0 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addrem 33 Kearsage Ave W. Hyamisport Owner. Ed Kurker Date of Iospeotioa: 3-25-97 SEPTIC TANG: (lama on ate plea) Depth below purls: Material at o Instruction:Concrete_metal_FRP_other(upLin) Dim.naon.: '� 3. 7pa �' Shulp depth: -/—6 - ti Distance f cm top of sludge to bottom of outlet tee or baffle: Swim thickness: Z--3 •- Distance from top of scum to top of outlet tee or bafkle:�_ � � Distance from bottom of scum to bottom of outlet tee or baf le:_�, Comments: (recommendation for pumping,condition of inlet and outlet tees or bef sm,depth of liquid relation` to outlet invert. is 9. evidence of leakage,etc.) o o o •�. e.` n 4 l ! E TRAP-_ (lo _ate site plan) tpth� 7- ftmde: structi=_c=mvte_metal_FRP_otlier(asplaia) op of ecum to top of outlet too or bafflottom of@ um to bottom of outlet tee or baf�e:n for pumping,condition of inlet and outlet tees or befnes, depth of liquid level in relationto outlet insert,s:avcpusal integrity, age,oft.) 6(revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 33 Kearsage Ave W. Hyamisport Properly Addreew Ed Kurker Owner. 3-25-97 Date of Inspection: TI metal OR HOLDING TANK:_ . (beats .its plan)prs Depth ds: Material oonstavcti�am: cone is FRP other(ezplain) Ca ®11ons _ __gallorWday Alarm :�_ Comme ( n of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of lupud level above outlet invert:Yd Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of ban,etc.) P P CHAMBER_ ( on site plan) Pum in working order:(yss or no) ( condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Adder 33 Kearsage Ave W. Hyamisport Owner. Ed Kurker Date of Inspection: 3-25-97 SOIL ABSORPTION SYSTEM(SAS)._Z (loots on no plan,if possible;aznvation not raquu44 but may be approszmatd by non-intrusive methods) If not determined to be present,explain: leaching pits, number lesching chambers,number._ lsaehin galleries,numbs: Lsching trenches,number length: lsachinQ fields,number,dimensions: w 9ow cesspool,number Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,stc.) /O O jLS•_ate lea) d configuration: f liquid to inlet invert. lids layer:um layerof cesspool: f Construction: f groundwater.flaw(cesspool must be pumped as part of inspection) Comme (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (bate site plan) Materials construction: Dimensions: Depth of Commsata:( condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc) (revised 11/03/95) 8 �0 -7 7 S— -7 G SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) 33 Samasge Ave W. H; t Property Address: Ej KXjar der. 3-25-97 Date of Inspeotioo: SiiS' B OF SEWAGE DISPOSAL SYSTEMS melnde tiM to at Lest two permanent r&renm landmarks or benchmarks lorste all welt within 100, P S ' Y� l � f v 'J t DEPTH TO GROUNDWATER Depth to poind b.� method of&w mination or aPP�Uon (revised 11/03/95) 9 C E� o 351 f 3 V L N Ply? , `r �l DQ J z . �S • F�s