HomeMy WebLinkAbout0044 NOBADEER ROAD - Health _
44 Nobadeer Road
A=250-137 Hyannis
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Cormnonwealth of Massachusetts
Executive Office of Envirolunental Affairs
Dept. of Environmental Protection
.Jt►lut Grad
One winter Street Boston Ma. 02108
'^ D.E.P. Title V Septic Inspector
P.O. Box 2119
Teaticket, MA 02536
WILLIAM F.WELD (508)564-6813
Governor
ARGEO PAUL CELLUCCI
Lt.Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM tit
PART A
CERTIFICATION
,"
Property Address: 44 Nobadeer Rd.Centerville ( ? Oddress of Owner: 9�0� (S
Date of Inspection: 3/12/98 (If different) C„ , <fyo9g2 �9 +e01'
Name of inspector: John Grad Foil:18 Dwight Ave.Natick MA 01 6l1 `.>% 9�
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) !F
Company Name,Address and Telephone Number- b
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:
x Passes - o - This Inspection Is based on criteria donned In Title V '
i' COndl110na11 P8556S .f code 310 CMR 16.303.My findings are of how the system is
y performing at the time of the inspection.My Inspection does
— Needs Further valuation By the Local Approving Authority not Imoty any warranty or guarantee of the longevity of the
Fails ` - septic system and any of Its components useful life.
Inspector's Signature: `. +" Date: 3112198
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10-1000 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] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
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, 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 inspection4 the existing septic tank is replaced with a conforming septic tank h
as approved'by the Board of Health'. f'
(revised 04127)97)
One Winter Street a Boston,Massachusetts 02108 . FAX(617),556-1049 6 Telephone(617)292-5500.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 44 Nobadeer Rd.Centerville
Owner: Nancy Foil:18 Dwight Ave.Natick MA 01760.
Date of Inspection:3112199
_ Sewage backup or.hreakout.or. high static water level observed.in.the distribution box is due to a broken.
or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
4; r ,
—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] FURTHER 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) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to'a surface water supply.
The system has a septic tank and`soil absorption system Fand is within a Zone 1 of a public watersupply 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 the SAS is less than 100 feet but 50 feet or more from a
private water supply well,-unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
I have determined that the system violates one or more of the,following failure criteria as defined 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 No
_ Backup of sewage in 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
_ — cesspool.
_ — SAS is in hydraulic failure.
(revlsed 04127197)
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SUBSURFACE SEWAGE,DISP.OSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 44 NobadeerRd.Centerville .
Owner: Nancy Foil:18 Dwight Ave.Natick MA 01780
Date of Inspection:9112198
D]SYSTEM FAILS(continued)
Yes No
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 Iastyear.NOT due to clogged or obstructed pipe(s).
Numbers 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 t 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.
E] LARGE SYSTEM FAILS: #
You must indicate either"Yes"or"No"as to each of the following:
The.following criteria apply to large systems in addition to the criteria:
_ 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 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 or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 0427)97)
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 44 Nobadeer Rd.Centerville
Owner: Nancy Foil:18DwightAve.Natick MA01760
Date of Inspection:311219s
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Check if the following have been done:YoU must indicate either"Yes"or"No"as to each of the following:
_x_ — Pumping information was requested of the owner, occupant,and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this
inspection.
x As built plans have been obtained and examined. Note if they are not available with N/A.
x — The facility or dwelling was inspected for signs of sewage back-up.
x The system does not receive non-sanitary or industrial waste flow.
—x— = The site was inspected for signs of breakout.
x All system components,excluding the Soil Absorption System, have been located on the site.
x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected
for condition of baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge,depth of scum..
x _ The size and location of the Soil Absorption System on the site has been determined based on
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is "
unacceptable)[15.302(3)(b))
(revised 04127)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 44 Nobadeer Rd.Centerville
Owner: Nancy Foil:18 Dwight Ave.Natick MA 01760
Date of Inspection:3/12198
' FLOW CONDITIONS
RESIDENTIAL:
Design flow: g•p•d./bedroom for S.A.S. .
Number of bedrooms: ,
Number of current residents: 2
Garbage grinder(yes or no): No
Laundry connected to system(yes or no):,Yes' '
Seasonal use(yes or no): No
Water meter readings,if available:(last two(2)year usage(gpd):
rJa
Sump Pump(yes or no): No
Last date of occupancy: nla
COMMERCIAL/INDUSTRIAL: ,
Type of establishment: Na
Design flow:0 gallons/day
Grease trap present: (yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) Na
Water meter readings, if available: Na
Last date of occupancy: n1a
OTHER:(Describe) Na
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Na '
System pumped as part of inspection: (yes or no)ves
If yes,volume pumped: 1500 gallons'
Reason for pumping: maintenance < ,
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow'cesspooF h
Privy
Shared system(yes or no) ( if yes, attach previous inspection records, if any)
I/A Technology etc.Copy of up to date contract?
Other:
APPROXIMATE AGE of all components, date installed(if known)and source information:
12 years
Sewage odors detected when arriving at the site:(yes or no) No
frevlsed 04127/9T1
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 44 Nobadeer Rd.Centerville _
Owner: Nancy Foil:18 Dwight Ave.Natick MA017,60_"
Date of Inspection:3112198
SEPTIC TANK: x
(locate on site plan)
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Depth below grade: z'
Material of construction:x concreate metal ` FRP Polyethylene-other(explain)
If tank is metal, list age n1a . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: Le'6^H6T'w4-10^
Sludge depth:3„
Distance from top of sludge to bottom of outlet tee or baffle: za^
Scum thickness:z.•
Distance from top of scum to lop of outlet tee or baffle:s^
Distance form bottom of scum to bottom of outlet tee or baffle: 16"
How dimensions were determined: measured
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.) .
Septic tank and all components are structurally sound and functioning property.Recommend pumping now.
GREASE TRAP:.
(locate on site plan)
Depth below grade: rda
Material of construction: concrete metal FRP Polyethylene_other(explain)
Dimensions: rya
Scum thickness:nra
Distance from top of scum to top of outlet tee'or baffle:rda
Distance from bottom of scum to bottom of outlet tee or baffle: rua
Date of last pumping,
,ra
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.)
nfa - -, - -
BUILDING SEWER:
(Locate on site plan) f
Depth below grade: TV
Material of construction: cast iron x 40 PVC other(explain)
Distance from private water supply well or suction linePwn3
Diameter: a
(;gmments:(conditions of joints,venting,evidence of leakage, etc.)
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(revlsed M7197)
SUB5URF.A6 'SE AGE DISPOSAL SYSTEM INS ECTIONFORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 44 Nobadeer Rd.Centerville
Owner: Nancy Foil:18 Dwight Ave.Natick MA 01700 '
Date of Inspection:3/12198 ,• .
TIGHT OR HOLDING TANK: ,
locate on site plan)
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Depth9 below grade:
e:
nfa
Material of construction:—concrete—metal' FRP—Polyethylene_other(explain)
Dimensions: rva
Capacity: rda gallons
Design flow: Na gallons/day
Alarm level:_nra Alarm in working order? -Yes No.
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
We
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n1a
Comments:
(note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) `
Na
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PUMP CHAMBER:
(locate on site plan)
Pumps in working order.(yes or no)No
Alarms in working order(yes or no)_Ye:
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
nfa - -
- (rev1aed04117)97l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C.
SYSTEM INFORMATION(continued)
44 Nohadeer Rd.Centerville
Nancy Foil:18 Dwight Ave.Natick MA 01760
3112198 a.
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
pec�
on
(revmed04n719� Page ! o! Ito 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 44 Nobadeer Rd.Centerville
Owner: Nancy Foil:18 Dwight Ave.Natick MA 01760
Date of Inspection:3/12198
SOIL ABSORPTION SYSTEM (SAS):x s
(locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Na -
Type:
teaching pits,number: one:1 AGO gallon leach,pit .
leaching chambers, number:Na
leaching galleries,number: nla
leaching trenches, number,length: nta
leaching fields, number, dimensions:Na „
overflow cesspool,number:nla
Alternate system: Na Name of,Technology:_Na
Comments: (note condition of soil,signs of hydraulic failure,'level of ponding, condition of vegetation, etc.)
Leach pit and all components are structurally sound and functioning properly.System has solids In @.system never had more than 3'of water In it.
CESSPOOLS:_
(locate on site plan)
Number and configuration: Na
Depth-top of liquid to inlet invert: Na
Depth of solids layer: rUa
Depth of scum layer: Na
Dimensions of cesspool:. Na
Materials of construction: Na
Indication of groundwater: rda
inflow(cesspool must be pumped as part of inspection)
Na
Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
Na
PRIVY:
(locate on site plan) _
Materials of construction: rue Dimensions: Na
Depth of solids: Na
Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.).
Na -
(revised 0A V97)
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
4
44 Nobadeer Rd.Centerville
Nancy Foil:18 Dwight Ave.Natick MA 01780
3112198
Depth of groundwater 12*
Please indicate all the methods Used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property,observation hole, basement sump etc.)
Determine it from local conditions.
IF Check with local Board of Health
I Check FEMA Maps
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Check pumping.records µ
Check local excavators, installers
x Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS maps and charts
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(rev1aed04)27197) page 10 a 10