The URL can be used to link to this page

Home My WebLink About0345 HOLLY POINT ROAD - Health (3) 24 Vine Street Centerville P 232 067 t �I TOWN OF BA NS i ABLE LOCATIONS 2 V S _ _ SEWAGE # VILLAGE CA> erk 11e- ASSESSOR'S MAP & LOT 232�OL7 :NAME&PHONE NO. f_;�n . K•�: l �sa$�2Ss-S3y3 SEPTIC TANK CAPACITY 15-00 LEACHING FACILITY: (type) (size) G X 6 W/2 �S2 NO.OF BEDROOMS BUILDER OR OWNER &1191J P6"-rl5 PERMTTDATE: 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 Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 2002 4t�ono ,2 o03 3S,coo 20v j 13,coo J ZIP � A 8 �co p � 2 nn2 112 C�P1� Z 28 0 2 os Iv PP. / 3 f 't 4 -3 32 61rb Pik tr3-3 30' �_� *30 Nor To SC►L� -.3 a -`� COMMONWEALTH OF MASSACHUSETTS R v EXEcunvE OFFICE OF ENviR 3NMENTAL AFFAIR r 4✓ DEPARTMENT OF ENVIRONMENTAL PROTECT l ON L.J � i AAP TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE(DISPOSAL SYSTEM FORM PART A (24 Wine-S4.) y CERTIFICATION Property Address: _JJ hlolleyPt• ,gct Ct&4L . Owner's Name: rnaler Pgwlg Owner's Address: W1 S _ .Mck, Date of inspection:_ Name of inspector•( lease print) �r tan K. : (kon Company Name: -1 t14 1.3. o% i5INte4ew Sne Mailing Address: 2,657 C inct L a S+V a Kek r??.to%4 2 Telephone Number: CER'ITMCATION 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.i am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CIMR 15.000). The system. Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Rite: e /& C> The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments -5 v s" u 5c a tzg (,, M t[. mi s4-a u AtD Pvv,Pt'n! P-PtoIdS 575" oK. t2tc9>6+ne" t?u,,p,rt9 iqf- tk;s -Fir►tt - Sys" is rr�swc�+o+nin, AtotrMai do StgnS railur+t. ****This report only describes conditions at the time of inspections and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection norm 6/15/2000 page I Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . 11 CERTIFICATION(continued) ��1 Property Address:J"7-J�ITo)(1tY ?I• t. CvA �t� Owner i r es Date of Inspection: gi tO 1n! _ Inspection Summary: Check A,B,C,ID or E/ALWAYS complete all of Section D A. System Passes: �! I have not found any information which indicates that any of the failure criteria described in 310 CM R 15.303 or in 310 CMR 15304 exist.Any failure criteria not evaluated are indicated below_ Comments: B. System Conditionally Passes: 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 Healt u 1 pass. Answer yes,no or not determined(Y,N ND)in the for the following statements. not determined'please explain. The septic tank is metal and over 20 years old*or the septic tan vhether metal or not)is structurally unsound,exhibits substantial infiltration or extiltmtion or tank fail is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as ap d by the Board of Health. *A metal septic tank will pass inspection if it is structural ound,not leaking and if a Certificate of Compliance indicating that the tank is Iess than 20 years old is av - le. ND explain. Observation of sewage bac or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a n,settled or uneven distribution box.System will pass inspection if(with approval of Board of He broken pipe(s)are replaced obstruction is removed _ distribution box is leveled or replaced ND expla' . The system required pumping more than 4 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 ND explain: Title 5 Inspection Form 6I1 s12000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SENVAOE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIEICATIOi!(continued) Property Address: Owner: Bate of Inspection: C. Further Evaluation is Required by the Boar Health; Conditions exist which require forth evaluation by the Board of Health in order to determine if the system is failing to protect public health,safe the environment. 1. System will pass ut.le oard of Health determines in accordance with 310 CMI R 15.303(1)(b)that the system is not fan ° nmg in a manner which will protect public health,safety and the environment-. _.__ Cess or privy is within 50 feet of a surface water _ C ool or privy is within 50 feet of a bordering vegetated wedand or a salt marsh 2. System will fail unless the Board of Health(and PabMe Water Sapp' ,if any)determines that the system is functioning in a manner that protects the public health,sa and environment. _ The system has aseptic tank and soil absorption systen S)and the SAS f is within 100 feet o a surface water supply or tributary to a surface water Sapp The system has a septic tank and SAS and AS is within a Zone I of a public water supply. The system has a septic tank and S and the SAS is within 50 feet of a private water supply well. The system has as septic tan d SAS aced.the SAS is less than 100 feet but 50 feet or more from a private water supply we11p�. ethod used to determine distance "This system passe ' the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and vol 'e organic compounds indicates that the well is free from pollution from that facility and the presence ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure c � 'a are triggered.A copy of the analysis must be attached to this form. 3. Otber. Title 5 inspection Form 6/1512000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F®RMT PART A CgRTIFICATION(continued) Property Address:_ 401111 4-u Vil I k- MCA- Owner., Airgell �16 :Date of Inspection: 4 t o D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓!Backup of sewage into facility or system component due to 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 iLiquid depth in cesspool is less than 6"below invert or available volume is less than i%day flow t,,// 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 SAS,cesspool or privy is below high ground water elevation. �/ Any portion of 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_ _ ny 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.[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] ® (Yes/No)The system fads.I have determined that one or more.of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria abo yes no _ the system is within 400 feet of a surfaces drink water supply the system is within 200 feet of a tub ry to a surface drinking water supply the system is located in a n pen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a public w supply well If you have answered" "to any question in Section E the system is considered a significant threat,or answered "yes"in Section ove the large system has failed.The owner or operator of any large system considered a significant th under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office ofthe Department. Title 5 Inspection Form 61I5/2000 4 1 Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARS'B CHECKLIST Property Address: 345 floIll, P4 . - C�n f�li Owner: Atrt_,00_W VA +6 Date of Inspection: Vto_/041 Check if the following have been clone_You must indicate'`yes"oe r®n6'as to each oft4e follow4j Yes No �! P ing information was provided by the owner,occupant,or Board of Health _ arty t�f t4�e syst fn ec>��l a�en€s 1�a33�ped.out ia�the previous two weeks? — lip the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection'! Were as built plans of the system obtained and examined?(If they were not available note as NIA) a/ Was the facility or dwelling inspected for signs of sewage back up" ✓ Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site'' Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the ba es or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum:' 7Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of aloe Soll Absorption System(SAS)on the site has been determined based on:. Yes T / Existing inf'ormatinn.For example,a plan at the Board of Health. a Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) Title 5 Inspection Forth 6/1512000 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: $t✓ S /l �E- •G Ni t� Owner: ir Date of Inspection: lei lot 0 -------— FLOW CONDITIONS RESIDluN1'IAI, 3 Number of bedrooms(design):� Number of bedrooms(actual): rr DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 5q9 Y P t)• 1Vumber of cr�rrent residents. Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system es or no):j LQ[if yes separate inspection required] Laundry system inspected(yes or no): Pliq !!2 Seasonal use:(yes or no):,'5 200? PA Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COMM1uRCIAVINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): d Basis of design glow(seatstpersons/sgft, Grease trap present(yes or no): Industrial waste lroldr`ng .present(yes or no): Non-sanitary was charged to the`Title 5 system(yes or no): _ Water mete ings,if available: Last . of occupancyluse: . OTHER(describe). GENERAL INFORMATION Pumping Records Source of information: 0 W in e ir N ty e'r o wn reA_ Was system pumped as part of the inspection(yes or no):JOO If yes,volume pumped:_____gallons—How was quantity pumped determine& a l k Reason for pumping: T Y YSTE1Vff eptic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy —Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank -_,_Attach a copy of the DEP approval —Other(describe): Approximate a e of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):Lo Title 5 Inspection Forfar 6/1512000 6 Page 7 of I 1 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION,(continued) Property Address: Owner: Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron 40 PVC---othe ex lain): Distance from private water supply well or suction line: Comments(on condition of joints,venting.evide cc of leakage etc 1Yl� �Jrc6_nw t (was e� Lai rr�� SEPTIC TANK:_i (locate on site plan) li Depth below grade: f Material of construction: ✓concrete metal,___fiberglass polyethylene _other(explain} If tank is metal list age. Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) J I if Dimensions: Sludge depth: 45 !� Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: _ !! Distance from top of scum to top of outlet tee orbaffle: Distance from bottom of scum to bottom of o tlet tee or baffle: a!! 7`AP�/K�Shc How were dimensions determined:�l��r- �7, aa.0 SR—� Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid Levels as related tp outlet invert,evidence of No l- leakage,etc): Pv.µ d ea . onalq rue a i 4- ne#4�. V" M,s -t,,Ke, GREASE TRAP:(locate on site plan) Depth below grade:_ Material of construction:concrete metal fiberglass—po en�other (explain): Dimensions: Scum thickness: Distance from top of scum to top of et tee or baffle: Distance from bottom of s ttom of outlet tee or baffle: Date of last pumping: . Comments(on peinvegr�jtvidence commendations,inlet and Nutlet tee or baffle condition,structural integrity,liquid levels as related ro o of leakage,etc.): Title 5 Inspection Form 6/1512000 7 Page 8 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 2 SYSTEM I NIFOR IMAT ON1 (continued) Pronerty Address: 3 i�t!1 N.Rd- C4-. Owner° A f t..is4( AI;5 Date of inspection: 1 — TIGHT or HOLDING TANK: (tank must be pumped at time of ction)(locate on site plan) Depth below grade: Nfaterial of construction: concrete znctal berglass_�polyethyiene other(explain): Dimensions: Capacity: ohs Design Flow: lons/day Alarm present(yes or Alarm level: Alarm in working order(yes or no): Late of l _ camping: Co :its(condition of alarm and float switches,etc.): DISTRIBUTION BOX:Zofpresent must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leaks a into or out of box,etc.): p4 is Lsvr- No Sisns Or �e�+_T� cDr 6odid Carryovei- _ PUMP CHAMBER:_(locate on site *---� Pumps in working ord or no): Alarms in Wo rder(yes or no.): C omriienote condition of pump chamber,eondition of pumps and appurtenances,etc.): Title 5 inspection Form 6/15,2€00 8 Page 9 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PANT C SYSTEM INFORMATION(continued) Property Address: V5 �! A A ch Owner: A at'g Date of Inspection. o SOIL ABSORPTION SYSTEM(SAS):Zoocate on site plan,excavation not required) If SAS not located explain why. 'rype leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name-of technology: Comments(note condition of soil,signs of hydraulic failure,level ofponding,damp soil,condition of vegetation, etc.): >aR- (eX 6 P, -0.ter a, i,t)C ho - »t fleea ua-6a CESSPOOLS: (cesspool must be pumped as part of inspecti ' cafe on site plan) Number and configuration: Depth—top of liquid to inlet invert. Depth of solids layer. Depth of scum layer: Dimensions of cess Materials of c ction: Indicati groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of pouding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solid - -Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title 5 Inspection Form 6/1512000 9 Page 10 of 11 OFFICIAL INSPECTION FORM,-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Iris PaR: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet Locate where ublic water supply enters the building. !! r 2 Z61 6-2 �t ram- 66- 12' `64,w cnu- 3 3 Nm wQ�x. �.tinLdst�y� P. TTZ l l�flT I-® SCALE- Title 5 Inspection Form 6f 15,20N f 0 Page 11 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOM4,TION(continued) Property Address: ►� � - . 0 &-%4 Owner: rnol quis Date of Inspection: E=� SITEEXAM Slope Surface water Check cellar Shallow wells Estimated depth to bound water A�f eet Please indicate(check)all methods used to determine the high ground water elevation: twined from system design plans on record-If checked,elate of design plan reviewed:1192' Observed site(abutting propertylobsenvation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) T_Accessed USGS database-explain: You inatst describe you esta8li bed thefight ground wl er elevation: �ot� _�►-�--t,,,�-tom. �eneo�r�-M-�.e.�. —____ Titic 5 inspection Form 6115/2000 l THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA ` _...n- Ma..,......................�_.v ..eeba.i-1'^"�1MA'ef_..�._ ._._.__...,....ues��•lws=c. '... �r Spa��, -1_ 1 ..; AS ' .S.�AJ7 -Ty pIc 41, UI`��?1bU'1"1C,r1 �C`1C To rat A e. C �..1.Y7E �^ fl +�iVT.n.S t8a',s d4sAt> 1�� CzA:. QC3,�i�.0 Yr4 T/G it/ � Fa'/Y5 \ ��..a-<`cvt.�:.r:, �•�.r�, ,;:. � ,e....,.�. �a ��e �.c...�; t-c�w�. .aF�COLA 7"/OA/ O—ATir' = ,Z d B:sE C Y•s 7/ory 5 6 y: [ �T �?04 -W r2�t�'. Bo,a.0 O a.- A 4 7"AV i Frt%• 0' f' i yk ��try•-� ,;�_.- tti�e. F-A44� g� _ _ sir pR Qpoi ' t'l <L O F 114 _��, •._..,- .�ea.��i:a Gcu��"duc � ��,�� , R��t�.�� S G�,rrm D 1 5PrC��aa NL. 0,5 see a��,-.a�.�..lr�-; •_ .. �.A��e,1+as P k-0 p a s F- --�--" N0. 11i05� 3,o q �1St� `drfo M�� ORAWN BY: CHKO 6Y:.. APPO/@��Y: AJ,.JD i-j THk tN - I it �" 1� IS7' iZ-0" c3e '5C— =0 .4E ALL -vf A,j-, ,a —p c" T�v AI T t k C"-)-V L • tj MOTa-ACe-'C" MaaiMQlc oqo .r,Cr PT i C n fte IDViLT kPP TO IS.C L C, Ll r F k4 rs C,*: PC eve To"4 v e_47y_'2 wce 0- A 0 of d Ism 6 AN I- 0 0 00 STAV L Cprf L V5 TbI I CA LAC r AC-" cl T P 4C 45, W-i r5U TI C, %A TO $-C VA TIOAJ 75 o A,1 4A IT 61: ZEQAYA"Ltrn�1 [, ACA Z r .................. fv coo ra,k, illy El,a N. 14. IL 7-/d --,6---77=- j