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Home My WebLink About0030 DEERFIELD ROAD - Health 3 I DEERFIELD 40- i 0 7-3 Commonweaith of Massachusetts Executive Office of Environmental Affairs apartment of - r Environmental Protection Wllllam F.Weld Trudy Coxe A 9" Paul Celluccl David B. Struhs tL G NOMXN canxnh11br»r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A - CERTIFICATION 30 Deerfield Road Thomas Noone Property Address: U s t e r v i l l e, MA Address of Owner. Date of Inspection: 9-21 -9 6. (If different) Name of Inspector. W.E. Robinson SR. Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 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 Wormation reported below-is-true-accurate and complete as of the time of inspection. The inspection was performed based on m t "e o \pe y raining and experience in the proper function,;aad- maintenance of on-site sew ge disposal systems. The system: s s t Passes �t/►�,�t� Conditionally Passes ��j `tC'/`j� _ Needs Further Evaluation By the Local Approving Authority x Fails t. ��% 1> 4 x 0e, Inspector's Signature: y ` Date: �^ �'^ (..4 �� > O" / e � 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: Check A, B, C, or D: A] SYS 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 YSTEM CONDITIONALLY PASSES: One... . ore_item components need to be mpla�l or repaired. The.,:ti.:. :completion of the. '---...m-ent or. .:Y... ^a p vyolr, po.:c. 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 enfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 10 1 03/95) 1 One Winter Street a Boston, Massachusetts 02108 a FAX(617) 556-1049 a Telephone(617)292-MM i J Printed on Recycled Paper I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) PropertyAddresx 30 Deerfield Rd. , Osterville Owner. Thomas Noone Date of Inspection: 9-21 -9 6 B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed 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(&)are replaced obstruction is removed distribution box 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. 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 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 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address; 30 Deerfield Road, Osterville Owner. Thomas Noone Date of Inspection: 9-21 -9 6 D SYSTEM FAILS: 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. 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 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 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 coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El GE 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 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 owns or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirem nts of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 30 Deerfield Rd. , Osterville, MA Owner. Thomas Noone Date of Inspection: 9-21 -9 6 Check if the following have been done: ping information was requested of the owner, occupant, and Board of Health. -'None of the system components have been pumped for at least two weeks 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. _v As built plans.have been obtained and examined. Note if they are not available with NJA_ lzT 'facility or dwelling was inspected for signs of sewage back-up. !'he system does not receive non-sanitary or industrial waste flow _ Ae site was inspected for signs of breakout. (✓All system components, excluding the Soil Absorption System, have been located on the site. V 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. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The 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, 30 Deerfield Road, Osterville Owner. Thomas Noone Date of Inspection: 9-21 -9 6 FLOW CONDITIONS RESIDENTIAL Design flow:33 0 gallons Number of bedrooms:, Number of current residents:L Garbage grinder(yes or nc):_,dLO _ Laundry connected to system(yes or no):—�z Seasonal use(yes or no): Afd Water meter readings, if available: Last date of occupancy: - MMERCIAL INDUSTRIAL: Typ of establishment: Des' IIow:_galloWday G trap present: (yes or no)_ Indust • . Waste Holding Tank present: (yes or no)_ Non terry waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available: 1 9 9 4— 50 , 000 g a l s Last to of occupancy: O (Describe) date of occupancy: GENERAL INFORMATION PUMPING RECORDS an arcs of information: System as part of inspection: (yes or no)_ If yes,volume pumped: gallons Reason for pumping: , TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool LOverflow cesspool Privy Shared system(yes or.no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: =. 15 �� s Sewage odors detected when arriving at the site: (yes or no) A 0 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 . Deerfield Rd. , Osterville Owner. Thomas Noone Date of Inspection:9—21 —9 6 SEPTIC TANK:_ ( to on site plan) Depth low grade: Ma of construction:_concrete_metal_FRP—other(explain) Dime ns: Sludg. pth Distan from top of sludge to bottom of outlet tee or baffle: Scum 'ckness: Distan from baffle: top of scum to top of outlet tee or bae: Distan from bottom of scum to bottom of outlet tee br baffle: Cowmen (recomme tion for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence o leakage, etc.) GREAS TRAP:_ (locate site plan) Depth ttion : Materiuction:_concrete_metal_FRP—other(explain) Dimens Scum t Distanc of scum to top of outlet tee or baffle: Distantom of scum to bottom of outlet tee or baffle: Cowme (recomor pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidenetc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Deerfield Rd. , Osterville Owner. Thomas Noone Date of Inspection: 9_21 -9 6 TIGHT OR HOLDING TANK: ( on site plan) Depth w grade: Mate ' of construction:_concrete_metal_FRP_other(explain) - Dime Capacity: ors Design fl w: gallons/day Alarm 1 1: t Comma ts: (conditio of inlet tee, condition of alarm and float switches, etc.) DISTRIB ON BOX:_ (locate on ite plan) Depth 'quid level above outlet invert: Comments: .(note if level d distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP C BER:_ (locate on s' plan) Pumps in wo order:(yes or no) Comments: (note conditio of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address. 30 Deerfield Rd. , Osterville Owner. Thomas Noone Date of Inspection: 9—21 9 6 SOIL ABSORPTION SYSTEM (SAS):z (locate on site plan,if le;excavation not poasib required, but may be approximated by non-intrusive methods) , If not determined to be present, explain: Type: leaching pits, number: y leaching chambers, number:_ leeching galleries, number: leaching trenches,number,length: leaching fields, number,dime ions: overflow cesspool,number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.) CESSPOOLS: (locate on site plan) Number and configuration:. Depth-top of liquid to inlet invert: Depth of solids layer. _L� Depth of scum layer: Dimension of cesspool: f-2 4- Materials of construction: /c a K S Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note ndition of soil, signs of h ulic failure, level of ponding, condition of vegetation, etc.) � C C>U&_' o E'— '% ec,f/ ,. i s i.-s P oca _ (lte •n site plan) Mate ' of construction: Dimensions: Depth f solids: Co nts: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) PropertyAddrese: 30 Deerfield Rd. , Osterville Owner. Thomas Noone Date of Inspection: 9—21 —9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' S{ a � U l f � DEPTH TO GROUNDWATER Depth to groundwater:1+ feet l method of determination or approximation: 6.0 J (revised 11/03/95) 9 C9(ll- -2L� 4+-7 CP N /v - i N n a -7 7/y MAN-.._ y o -- �ahx/ Ls y d-hv - y 8x-e - e 29 �I el � ry/-7/.5L�2 C12�/1 +-�� '-•�S/�,�� O'O,.mil/ '� ?,��- �-�c j .g x� 5 "PC I (►/-3 vo : H-2v-v 2 1� 07h Nx of 7 j �9 ,-"9ad _ cv/rv�d '7CyQ7„/7 ?J_ n o d 1S. (,►o N97 911 r01L 314 NO - � 1 �;v �i-7Y3L9 /m hol. Q X 77d, pl �XL° do-j-v oil -- -- woo w N o ' k` I