HomeMy WebLinkAbout0123 STANLEY WAY - Health 123 STANLEY WAY, CENTERVILLE
EcvctEo
UPC 12534 �a
No.2153LOR °on.GONs°�
NASTINGS.MN
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TOWN OF BA.ItNSTAB:LE
LOCATION ' SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY `� �
LEACHING FACU ITY: (type) o�. (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Fa 'lity (If any wetland xist
within 300 fee f lea g f li Feet
Furnished b
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D AT E:_-61-4199----
PROPERTY ADDRESS:
-----------------------
Centerville, Ma.
------------------------
On the above date, I Inspected the septic system at the above address.
This system consists of the following:
1 . 2-6X8 Cesspool and 1 -1000 gallon Leaching Pit
Based on my Inspection, I certify the following conditions:
2 . This not a title five septic system. /
3. This is a sewage system.
4 - The sewage system is in proper working order
at the present time .
5 . Main cesspool at operating level . Second cesspool
is dry .The added leaching pits waste water is
38" below invert .
SIGNATURE:1 _
Name:_,�z�L Macomber jr,�......
Company: Jose2h_P. _Macomber_& Son, Inc .
Address: Box 66
Centerville , Ma. 02632-0066
Phone: 508-775-3338
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
A
1� 9
JOSEPH P. MACOMBER & SON, INC.
Tan ks-Cesspools-LeachfleIds
Pumped & Installed JUL
Town Sewer Connectlons 3 �999
P.O. Box 66 Centerville, MA 02632-0066 ?040.,� y
775-3338 775-6412 ,p
i
• B
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVII3ONMENTAL PROTECTION
ONE WINTER STREET, B03TON MA 02108 (617) 292.5500
s
?RUDY COX
Sacret.a
ARGEO PAUL CELLUCCI DAVrD B. STRU
Governor Co.r_ss:oo,
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECT10N FORM
PART A
CERTIFICATION
No9-m Address: 121 Stanley Way Narna of Owrser William Amoroso
Centerville Address of owns• came
Dau of{nspecrow, qq�
Name of lrupector'(�ILVF�% Joseph P., Macomber Jr.
I am a DEP approved system Inspector pursuant to Seddon 15.340 of Tittle 6 (310 CMR 15.000)
Company Name: Joseph P. Macomber & Son, Inc.
µaang Address: Box 66, n ryi 1 1 e, Ma _ 02632-0066
Telepiwne Number:511 f3—7 7 5_���R
CERTIFICATION STATEMENT
I cardfy that I have personally Inspected the sewage disposal system at this address and that the Informadon reported below is true, accurate
and complete as or the time of Inspection. The Inspection was performed based on my training and experience in the proper function and
maintenance of on-site s wage disposal systems. The system:
on-she
Conditionally Passes
Needs Further Evalua on By the Local A roving Authority
Fails
Inspector's Sigrsaasre: , Date:
The System Inspect all submit a copy of this Inspection rep t to the Approving Authority (Board of Health or DEP)whhin thirty (30) days of
' completing this Inspection. It the system Is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner
Mall submit the report to the appropriate regional office of the Department of'Environmental Protection. The original should be sent to trss
system owner and copies sent to the buyer, If applicable, and the approving authority.
NOTES AND COMMENTS
revised 9/2/98 Page Iof11
urj? Printed on Rayclad Paper
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
P►orertyAddr—: 121 Stanley Way, Centerville
Owner: William Amoroso
Date of kupection: 6/4/9 9
INSPECTION SUMMARY: Check A, B, C, of D:
A. SYSTEM PASSES:
�I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are Indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
da One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon
completion of the replacement or repair,as approved by the Board of Health, will pass.
Indicate yes po, 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, unless the owner or operator has provided the system Inspector with a copy of a Certificate of
Compliance(attached)Indicating that the tank was installed within twenty (20) years prior to the date of the Inspection; or
the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipes)
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 yeardue to broken or obstructed pipe(s). The iystam wi hm s--
inspection if(with approval of the Board of Health): -
broken pipes)are replaced
obstruction Is removed
revised 9/2/98 Page 2of11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (con-dr )
Prop« Addrau: 121 Stanley Way, Centerville
°wr-ed-. William Amoroso
Darts o*Vapoc"V 6/4/9 9
C. FURTHER EVALUATION LS REQUIRED BY THE BOARD OF HEALTH:
Condldons exist which require further evaluation bytho Board of Health In order to datermino If the system Is falling to protsct ma
public health, salary and the environment.
1) SYSTEU WILL PASS UNLESS BOARD OF HEALTH DETE WINES W ACCORDANCE YM-H 310 CJAR 16.303 (1)(b) THAT THE SYS
LS NOT FUNCTIONINO W A MANNER WWCKWILLPROIECT THE PUBLIC UZ.ALTH.AND SAFM AND THE ETI\aElOk141 .
Cesspool or privy Is within 60 feet of surface water
Cesspool or privy Is wlWn 60 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FALL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER. IF ANY)DETE WINES THAT THE SYS-M
FUNCTIONING W A MAMER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
aThe system has a septic tank and aoll absorption system(SAS) and the SAS Is within 100 lest of a surface waist supply
tributary to a surface water supply.
The system has & &optic tank and soU►bsorptJon system and the SAS Is wIWn a Zone I of a public waist supply weu.
The system has a septic task and &oil absorption system and the SAS Is within 60 lest of a private water &uppty w•u.
The system has a ►optic tank and &oil absorption system and the SAS Is less than 100 feet but 60 loot or more trom a
private water supply well, unless a wsU water►n&Jy&ls for collform bacteria and vol&Ulo org"c compounds indicate, tr,a
well Is free horn pollution from that facility and the pr once of•mmonJ&nitrogen and niu&to nitrogen Is equal to or If,,
than 6 ppm. Method used to determine distance, A _ (approxJmadon not valid).-
3) OTHER
The sewage s stem consists of two 6 ' x8 ' blocks
Ce.sspOol s and 1 -1 000 gallon precast leac in¢ pit
revised 9/2/98 Paee3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (con-dnued)
PropertyAddresa: 121 Stanley Wayr Centerville
Owns : William Amoroso
Date of Inspection:6/4/9 9
D. SYSTEM FAILS:
You m st Indicate either "Yes' or 'No" to each of the following:
�� I have determined that one or more of the following failure conditions exist as described 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.
Yes Now
1' Backup o!•"wage irno lecility-or•*yatem component,due qo an overloaded orclegged-SAS-orscesspool, ---�- •
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
_MltJL_/� Static ll�vellii the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
l' 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 60 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. -
E. LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
The following criteria apply to large systems In addition to the criteria above:
4 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:
Yes No
��
�! the system is within 400 feet of a surface drinking water supply
the system-is-witWn 200 feet o(-e-t+iisutery•iloe surfaoadrinkiwg watercuPPly - ---
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 or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further Inforjnation.
revised 9/2/98 ` Page 4ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PropenyAdaeu: 121 Stanley .Way, Centerville
Owrser: William Amoroso
Date of Inspection: 6/4/9 9
Check if the following have been done: You must Indicate either 'Yes' or 'No' as to each of the following:
Yes No /
Pumping information was provided by the owner, occupant, or Board of Health.
..None of the system compocants.k&4iajx en puaved4orst,Jeast tivo•Lvea"an&tbe•aystem ha4b"a,4vca1Qiwg wsWal tto%
rates during that period. Large volumes of water have not been Introduced Into the system recently or as pan of this
Inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
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.
_ All system components,.00cluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the Interior of the septic tank was inspected for condition of baffle
or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System orrthe site has been determined based on:
Existing information. For example, Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C Is at Issue, approximation of distance is unacceptable:
(15.302(3)(b))
The facility owner.(and.acculpants,1f difiaraW frorzt_ourner)-w8raprnWded.with1a1,= Lotion rh___ ���a•�naint_a��.i�t
SubSurface Disposal Systems.
revised 9/2/98 plate 5of11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
PropanyAddreu: 121 Stanley Way, Centerville
Owner: William Amoroso
Date of Inspection: 6/4/9 9
FLOW CONDITIONS
RESIDENTIAL:
Design flow: Zo g.p.d.lbedro m.
Number of bedrooms( esig ): Number of bedrooms(actual):#
Total DESIGN flow
r
Number of current residents:
Garbage grinder(yes or no):
Laundry(separate system) as or4o:_ If yes, sepamte Impaction.required _
Laundry system inspected or no) T7�o 0oq, GllonSG,�'
Seasonal use(yes or no): _
Water meter readings,If available (last two year's usage(gpd): — , 3(4
Sump Pump(yes or no):�
Last date of occupancy:
COMMERCIALANDUSTRIAL:
Type of establishment:
Design flow: d ( Based n 15.203)
Basis of design flow . .l�
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 avails le:
Last date of occupancy: JJ,'
OTHER:(Describe) y�
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of inform ti ( Q�
M�
System pumped as part of inspection: (yes or no)
If yes, volume pumped: d gallons
Reason for pumping:
TYF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
-- Overflow cesspool AC)11;l
Privy
r Shared system(yes or no) (if yes, attach previous inspection records,if any)
I/A Technology etc Attach copy of up to date operation and maintenance contract
Tight Tank W� Copy of DEP Approval
Other
APPROXIMATE AG9of I comgd�hep, dot �t 9
d4if kSawn)end source of information: -
Sewage odors detectedrwhen•arriving at the site:(yes or no)
I�
revised 9/2/98 P2ye6OfII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
PropertyAddrasa: 121 Stanley Way, Centerville
Owi1e : William Amoroso
Dau of Iron: 6/4/9 9
BUILDING SEWER:
(Locate on site plan)
Depth below grade:A
Material of construction:, cast lion X410 PVC_other(explain)
Distance tro private water supply well or auction line
Diameter `/ _ _.•
Comments:(condition of joints, venting, evidence of leakage,-etc.)
Join
s c AN ?louse vent .
ted
(locate on site plan)
Depth below grade: /v,9
Material of construction concrete/metal lbarglass4l*olyethylene/,other(explain)
TA
It tank is (metal, list age A26 ls.age.confumad by Certificate of Compliance (Yes/No),_.
Dimensions: AM
Sludge depth: _.
Distance from top of sludge to bonom of outlet tea orbaffle:,AIA
Scum thickness:A_
Distance from top of scum to top of outlet tee of batfle: VA
Distance from bottom of scum to bottom of outlet toe or baffle: A214
How dimensions were datermined:
Comments:
(recommendstion for pumping, condition of Inlet and outlet tees or-baffles, depth of liquid level In relation to outlet invert, suuctura�-;ntegrity
evidence of leakage, etc.)
Septic tank is not Pri-qPU,t1 _
GREASE TRAP: A/
(locate on site plan)
Depth below grader
material of conatrucdonOF! concretl4mete FlborglassA/�Polyethylene other(explain)
Dimensions:
Scum thlcknass:
Distance from top of scum to top of outlet%as or baffler
Distance from bottom of scum to bonom of outlet too or baffler
Date of last pumping: ,(!�
Comments:
(recommendation for pumping, condition of inlet and outlet teas or baffles, depth of liquid level In relation to outlet invert, structural intagrit�
evidence of leakage, etc.)
Grease tray
revised 9/2/98 Page 7of11
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropenYAd&&": 121 Stanley Way, Centerville
Owrw: William Amoroso
Data of Inspection: 6/4/9 9
TIGHT OR HOLDING TANK(Tank must be pumped prior to, or at time of, Inspection)
(locate on site plan)
Depth below grade:-ie&
Material of construction; concretelometalf&iberglass4,�*olyethylene4e!gbther(explain)
AIX
Dimensions: AN
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm In orking order:Yes�f No�
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
Tigrit or hoiding tanks arp not pracant
DISTRIBUTION BOX:Aive
(locate on site plan)
Depth of liquid level above outlet invert:_
Comments:
(note-if level and distribution is equal, evidenoo of solids carryover, evidence of leakage Into or out of box, etc.) — —
Distribution hnY is nnk prosont
PUMP CHAMBER:44m,
(locate on site plan) ,
jd
Pumps in working order:(Yes or No
Alarms In working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
ump c amber is not prey nt
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (corrdnued)
PropenyAd&o": 121 Stanley Way, Centerville
Owrw: William Amoroso
Data of Impecton: 6/4/9 9 1
SOIL ABSORPTION SYSTEM(SAS). VV e'l7 avalat
(locate on site plan,It possible; excavation not required,location may be approximated by non intrusive methods)
If not located, explain:
Type: `.
leaching pits, number:
leaching chambers, number:
leaching galleries,number:_
leaching trenches, number,length:
leaching fields, number, dimen ions:
overflow cesspool• number-
Alternative system:
Name of Technology: jV
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.)
Loamy sand to M"J "M canrl to fine 88F:d—Ne si-gfls of hydratilic
II r n n n!I � ,�i B_
CESSPOOLS:_
(locate on site plan) , R
Number and configuration:
Depth-top of liquid to Inlet invert:
Depth of soll'di"Csyei:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of Inspection)
Did not numn _inflnw rP�=inni �y9Sfl♦IJ Q98s-peal--ibis 4FY .
Nn�yi��nreGf {J���������8���.
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding,condition of,vegetation, etc.)
M//Y-I r,E
Same as above_
PRIVY:
(locate on site plan)
Materjals of construction: Dimensions:
Depth of solids:_
Comments:
(note condition of soil, signs of hydraulic failure, revel of ponding, condition of vegetation,etc.)
Priyjr icnnt�������
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPEC-nON FORM
PART C
SYSTEM INFORMATION (COML-sod)
Fly opoMAddrw: 121 Stanley Way, Centerville
Owr.e: William Amoroso
Ofuorv"Poc'6�: 6/4/99
SKETCH OF SEWAGE.DISPOSAL SYSTEM;
Include des to st'Iesst two permanent reference landmarks or benchmarks
locate all wslls wlWn 100' (Locate wham public water supply comas Into house)
Centerville Osterville Marstons Mills
Water Company
428-6691
i
Reo
iIle
\ >
revised 9/2/98 P<<< loorll
l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 121 Stanley Way, Centerville
Owrw: William Amoroso
Date of Inspection: 6/4/9 9
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep _
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater V5 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
_Obtained from Design Plans on record
Observed.Site(Abutting property observation hole, basement sump etc.)
determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
_ZChecked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
Used water contours Map .
Gahrety & Miller Model
12/ iblq�l
revised 9/2/98 Page 11 of 11
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,I'ONN OF —RARNSTAR19 BOARD OF HEALTH
SUBSURFACF SEWAGE I)Isr'OSAL SYSTEM INSI'FCTION FORM - PART D .- UwrIFICATION
`^ �^•Tf1^T•t •.:,—T.IIR^.T.TT1Jnrw1'If.7I1nRlRI i'T.RTY•Tx1'!51R.RR'R'����TT I\>nnT>TI7T,TT>">'.�>'rT'.r.�T'�•� .�•.�
—TYPE OR PRINT CLEARL1'—
PROPERTY INSPECTED
STREET ADDRESS 121 Stanley Way, Centerville
ASSESSORS MAP , BLOCK AND PARCEL
OWNER' s NAME William Amoroso
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P . Macomber Jr .
COMPANY NAME Joseph P . Macomber & Son , Inc .
COMPANY ADDRESSBox 66 , Centerville , Ma . 02632-0066
Street Town or City Stat• LIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 ) 790 -1578
-
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system nt
this nddress and that the information reported is true , accurate , and
complete as of the time of ,inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
CheckY ne :
v S s teui PASSED
The'. inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 , 303 , Any failur-e
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection which I have conducted has found that the system fails to
protect the public health and the environment in accordance with Title
5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this ins;pectio f rm .
Inspector Signature ► Date
One copy of this certification must be provided to the OWNER, the BUYER
( Where applicable ) and the I30ARD OF .HEAL7'll.
If the inspection FAILED, the owner or "o^ orator shall u• p pgradotho oyetem
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3,10 CMR 16 . 306 .
partd . doc
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