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HomeMy WebLinkAbout0007 NORTH WEST LANE - Health 7 North West Lane Centerville A= 189—046 INISMEA No. H163OR UPC 10259 smead.com • Made in USA i4?,ecYc(p, 2J �Za Wm. E. Robinson, Jr. Septic Inspections 43 Tomahawk Drive Centerville, MA 02632 (508) 775-7986 Pager 978-622-8700 Location } 7 North West Ln. Centerville, Ma. 02632CO M.L. Riley CD f-- CD M J ► w�Jv�Y p �� T3 z'd 31U1S3-1aAUM0W9903T23 WdaS:TO 66, ti0 100 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIROMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECION ONI;.WINTER STREET, BOSTON MA 02108(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PROPERTY ADDRESS: 7 North West L.n.Centerville, Ma.02632 ADDRESS OF OWNER: DATE OF INSPECTION: 9-18-09 - NAME OF INSPECTOR : W. E.Robinson I am a DEP approved system inspector pursuant to Section 15.340 of Title B 9310 CMR 15.000) COMPANY NAME: W.E.Robinson SO&Inapectlons MAILING ADDRESS: 43 Tomahawk Dr.CenterAlle Me.028Z TELEPHONE NUMBER: (S0g)7(*--ra 8 CERTIFICATION STATEMENT I certify that I haw personaly,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 Lased on my training and experience in the proper function and maintenance of on-We sewage disposal systems. The system: % PASSES NOW:2.woddng cesspo ft (no septic tank) CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE., �A DATE: 4-21-89 The system Inspector shall Submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP) within thirty(30) days of completing this inspection. If the system Ise ahSred system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner ehall submit the report to the epproprtate regional office of the Department or Environmental Protection. The original shoutd be sent to the system owner and copies sent to the buyer,if applicable and the approwng authority. NOTES AND COMMENTS: System is made up of two B'X6' block cesspools In working condition at time of Inspeation.Main pool pumped after inspeotlon (ground water inspection)overflow pool dry at time.Water meter readings show very little use at time of inspection.(no stain lines on cesspool walls). revised 9/2/98 I H I S�1N71HM[IIJIiliCl 1Z77 WHTq:TR 10 MO T ' f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM / PART A CERTIVICATION(continued) Property Address: 7 North West Ln. Centerville Mo. 02032 Owner: M.L. Riley Data of inspection: 9.18.99 INSPECTION SUMMARY: Check A,B, C,orD. A] SYSTEM PASSES: X I hive not found any Inform gon which indketes that the system violates any of the failure criteria as defined In 310 CMR f 5,303. Any failure criteria not evaluated are indicated below, COMMENTS: SITE OVER ALL PASSES INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION,THERE IS NO t3 ARANTEE ON THE UF9 OF THE SYSTEM. B SYSTEM CONDITIONALLY PASSES:NIA One or more system components as described to the"Conditional Pass"section treed to be replaced or repaired, The system,upon completion of the replacement or repair,as aPpmved by the Board of Health win pose, Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination In all ln*unces, 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)indlcating that the tank woo installed within twenty(20) years prior to the date of the Inspection:or the septic tank,whether or not metal,Is eraolced,stivchually unsound,shvM embWantial infiltration or eAftration,or tank Is failure Is Imminent. The system will pass In on tr the edstlng septic tank 13 replaced wim a conforming septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level Observed In the d rIbutlon box is due to broken or obstructed pipe(s)or due to a broken,settled or Uneven distribution box. The system YAH pa Paws Inspection 9(With approval of the Board of Health), bmkLr pipes)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year duo to broken or obstructed pipe(s). The eystam will pass Inspection it(with approval of the Board of Health): broken pipe(s)are replaced obstruction W removed revised 9/2/98 2 17' I q 1 H 1 gg1N'AHMf1KI990-)T.7"1 IJAT(C--T.Gt r C,. T.GI MO SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 North West Ln. Centerville Ma. 02632 Owner: M.L.Riley Date of Inspection: 946-99 Cj FURTHER EVALUATION IS REQUIRED 6Y THE BOARD OF HEALTH: NIA Conditions exist which require further evaluation by the Board of Health In order to determine If the system is Falling to protect the public health,safely and the environment 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303 (1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMVNT: Cesspool or privy Is within 50 feet of a surface water Cesspool or privy is within$0 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WALL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT; The system has a UP11C tank and Soil absorption system(SAS)and the SAS Is within 100 feet of a surhoe water supply or tributary to a aurface water supply. The system has a septic tank and soli absorption system and the SAS Is within a Zone 1 of a public water supply well. The system has a septic tank and soli absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absoption System and the SAS Is lase than 100 feet but 50 feet or more from a pttvate water supply well,unless a well water ane"s for ediform bacteria and volatile organic compounds indicates that the well Is free from pollution from that fadity and the presence of ammonia nitrogen VM nitretoe nkMen and Is equal to or less than 5 ppm. Method used to datermine dlsWnce (approoxineation W valid). a) OTHER revised 9/2/98 3 q•A ':1 i H i q-A7NAHMnWRRnnT7n w,izCZ:zR to Mn S�7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address; 7 North West Ln. Centerville Ma. 02032 Owner: M.L.Riley Date of Inspection. 9.18.49 D3 SYSTEM FAILS: N/A You must indicate either"Yes°or'No' to each of the following: I have determined that one or Aim of the following failure aondifforis"fit as described in 310 CMR 6.303. The basis for this determination is Idwitlfled below, The board of Health should be contacted to Determine what will be necessary to correct the fallurn. Ye2 No Backup of aewo9e into fatuity 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 over- Loaded or clogged SAS or cee9pool. Static liquid level in the distribution Dolt above o"Invert due to an overloaded or clogged SAS or cesspool. Liquid depth In cesspool Is Isss than 6-below invert or available volume is lees than A day flow Required pumping more than 4 dmes in the last year N=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 surface water supply or tributary to a Surface water supply. Any portion of a cesspool or privy Is within a Zone 1 of a pubilo Well. Any portion of a oesapod or privy Is within 50 feet of a private water supply well. Any portion of a ocaspool 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 anayala for collfi m bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: NIA You must indicate efflw'Yes'or'No,as to each of the following: The following critefla apply to large ayatenm in edditieon to the feria above: The system serves a facility whh a design flow of 10,000 gpd or greater(Large System)and the system Is a signirmunt threat to public health and safety and the environment bemuse one or more of the following conditions edst: Yes No the system 19 within 400 feet of a surfdoe drinking water supply the system Is within 200 feet of a tribut"to a surface di lnidng water supply Me system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or Mapped Zone II of a public water supply weft The owner or operator of any such syam shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional ofAce of the Department for further Information. revised 9/2/98 4 9'd 311J1S3-1aAUM0N91300Z20 WdzS:TO 66, TO 130 r' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 North West Ln. Centerville Ma. 02632 Owner; M.L. Riley Date of Inspection: 9-15 99 Cheok if the following have been done:You must indicate either'Yes•or'No'as to each of the following: Yea No x Pumping information was provided by the owner,occupant,or Board of Health. x None of the system components have beer+pumpod for at least two weeks and the system has not been receiving normal flow rates during that period. Large volumes of water have not been introduced Into the syateee recently or as part of this inspection. WA As twig plans have been obtained and examined. Nato if they are not available with N/A. X The facility or dealing was inspected for signs of sewage backup. x The system does not receive non-sanitary or induabtal waste flow. X The site was Inspected for signs of breakout. X All system components,Including the Sod Absorption System,have been located on the site. N/A The septic tank trtenhoies were unwitered,opened,and the Interior of the septic tank was Inspected for condition of baffles,or tees,malarial of xror rib uction,dimensions,depth of liquid Depth of sludge,depth of scum. 11%size and location of the Sall Absorption System on the site Has been determined based on: X E)deting Inforrnatlon.Ex.Plan at B.O.H. X Determined In the held(f any of the failure criteria related to Part C Is at issue,apprwdmetion of dislance is unacceptable)11 5.302(3)(b)] X the(Welty owner(and occupants,If different from xwrrwr)wand provided with information on the proper maintenance of SubaSurfim Disposal SyvWn, revised 9/2198 5 L'd 31ti1S3-1dAUM0WH903T23 Wd2S:ti0 66, ti0 130 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 North West Ln. Centerville Ma. 02032 Owner: M.L.Riley Date of Inspection: 9.1849 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 8 Number of bedrooms(actual): a Total DESIGN flow I Number of current residents: 1 Garbage grinder(yes or no): No r Laundry(separate system) (yes or no): No If yes,separate inspection required Laundry system Inspected(yes or no): seasonal use pies or no) No Water meter readings,If available(last two(2)year usage(gpd): 97-14k 98-2ek very low readings Sump Pump(yes or no): No Last date of occupancy: 9-99 COMMERCIAUINDUSTRIAL: N/A Type of establishment: Dealgn.now, Gpd(Sassed an 18.2ea) Basis of design flow Grease trap present:(yes or no): Industrial Walt®Holding Tank present:(yes or no) Non sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last data of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: $46 Sam.DPW mein pool Pumaed for Inspection System pumped as part of mspection:(yes or no) If yes,volume pumped: Gallons Reason for pumping TYPE OF SYSTEM Septic tank/diatribution boWaoll absorption ayotem Single cesspool X Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous Inspection records,if any) I/A Technology etc.Attach copy of Lip to date operation and maintenance contract. . Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: 30+years Homeowner Sewage odors detected when arriving at the alto:Q=or no) No revised 9/2/98 t3 8'd 31d1S3-1dAUM0NSg03TFD WdZS:TO 66, TO 130 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addrees: 9 North West Ln. Centerville Ms. 02682 Owner: M.L. Riley Date of Inspection: 9-18-99 BUILDING SEWER: (Locate on site plan) Depth below grade: 3019 Material of construction X cast iron _ 10 PVC _ other(explaln) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK; NONE (Locate on site plan) Depth below grade: Material of oon*uction X concrete _ metal Fiberglass polyethylene _ other(explain) If tank Is metal,list age Is age confirmed by Certificate of Compliance (YeWNo) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined Comments: (recommendation for putnpirig,Condition of inlet and outlet tees or baffles,depth of liquid level in relation to outtst invert,structural Integrfly,evidence of leakage,etc.) GREASE TRAP: NONE (locate on site plan) Depth below grade: Materiel of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thicknesu: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of Wet pumping: 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.) revised 9/2/98 7 r,'1 1 H I 1;-�-INAHMOWRROnTPD WHPq:TA F,F,, TA 100 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 North West Ln. Centerville Ma. 02532 Owner: M.L.Riley Date of Inspection: 9-1649 T03HT OR HOLDING TANK: NONE (Tank must be pumped prior to,or at time,of Inspection) (Locate on site plan) Depth below grade: Material of eonstructlon _ concrete — metal Fiberglass Polyethylene other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm In working order Yes; No Date of previous pumping: Comments: (condition of Inlet tee,condition of alarm and float switches,eto.) DISTRIBUTION BOX: NONE (locate on slh plan) Depth of liquid level above outlet Invert: Comments: (note if level and distribution Is equal,evidence of solids cArryoveer,evidence of leakage irtto or eut of boot,etc,) PUMP CHAMBER:NONE (ioeate on site plan) Pumps In worldng order:(You or No) Alarms in worldng order(Yes or No) Gommww (note condMlon of pump chamber,condition of pumps and appurtenanoes,etc.) revised 9/2/98 8 LAT. I H I S"a1?I'AHMnti99n-)z7n WAPc:TO f;C, TO I-)n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 North West Ln. Centerville Me. 02632 Owner: M.L. Riley Date of Inspection_ 9.18.99 SOIL ABSORPTION SYSTEM (SAS): (locate on ode plan,If possible;excavation not required,but 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,dim�e.pnsions; Over flow cesspool 1-t7 A I Altematrm system. _ Name of Technologr- ter. Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soll,condition of vegetation,etc.) 1.4)O'Nock cesspool(dry)at time of inspection with no stain line on walls. CESSPOOLS: (locate on site plan) Number and configuration: 2- Degth-top of liquid to Inlet Invert:1 T' Depth of solids layer: 1" Depth of scum layer: .1^ Dimensions of cesspool: owl Materials of construction, Gear Indication of groundwater! None Inflow(cesspool must be pumped as part of Inspection) yes Comments:: (note condition of soil,signs of hydraulic failure,,lave!of ponding,condition of veaetatlon,etc.) Main cesspool Is 61a6'block eesstxxol full at time in working condltlon.lniet line has been replaced with a d°'klne. PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) revised .9/2/98 9 TT 'd 31d1S3-1aAHM0N9903T23 WdES:TO 66, TO 100 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addrm: 7 North West Ln. Centerville Ma. 02632 Owner: M.L. Riley Date of Inspection: 9-18-99 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include firs to at least two permanent references landmarks or benchmaft locates all v 116 within 100'(locate where public varier supply conies into house) Nogw wav pR. pFrOO O e P D. Cesspool ©look CecSPaci (ouEeFtoa) (BAY) �,• , = 36' g �,= 19' 6'` Pofh pools Hdlve she( lwEtS revised 9/2/98 10 2T 'd 31d1S3-1�JAHMOW990OT20 WdES:TO 66, TO 130 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 7 North West Ln. Centerville Me. 02632 Owner: M.L. Riley Date of Inspection: 9-18-99 NRCS Report name Sall Type Typical depth to groundwater USGS Date webstte visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plana on record w, Observation of Site(Abutting property,observation hob,basement sump etc.) X Determine It from local conditions X Check with local Board of healM Check FEMA Maps Check pumping records Check local excavahvs,Installers x use US=Deis Describe in your own words haw you established the High Groundwater Ewmtbn.(Must be completed) Hand auger hole 13' No Water Pumped inflow cesspool at time of inspection. revised 9/2/98 "19 ET 'd 31d1S37dAHM0W9900TZ0 WdbS:TO 66, TO 130 THE_ CO ONWEALTH OF L�SSACHUSETS . DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT William E. Robinson.. . Jr. CE w Has satisfied the De aranent's • P qualifications as required and is hereby 3 0 authorized to use the title 0 CERTIFIED TITLE 5 SYSTEM INSPECT R U 0 as provided in 310 CMR 15.340 and Section 13 of Chapter 21 A of the 0- General Laws, Issued by The Department of Environmental ' 7 p ninental Protection: m . m Apri130. 1995 V 0 Acting Director of the ' iunof Watcr Pollution Control