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Home My WebLink About0048 GUNSTOCK ROAD - Health S Gunstock Road, Osterville A=, �I �r I B i �! r a RECEIVED Commonwealth of Massachusetts Executive Office of Environmental Affairs MAY �' 9 1997 ' HEALTH DEPT. Department of T� bFBAMSTABLE Environmental Protection William F.Weld Trudy Coxe Governor secretary Argeo Paul Celluccl David B.Struhs U.Governor C nVrA@loner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION propertyAddresa; 48 Gunstock Rd, Osterville, MA Addressofowner, John Hostage Date of Inspection: y °Ly_?17 (If different) 14 Rosemary Ct Name of Inspector. W.E. Robinson SR Nahua, NH 03062 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 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: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: A i, y Date: e/'��a 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: AJ SY9 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) 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. 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,cracked, structurally unsound, shows substantial infiltration or exfiltratioh,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-SM iJ Printed on Recycled Paper ` r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address 48 Gunstock Rd, Osterville, MA Owner. John Hostage Date of Inspection: L�-• S 1 7 III SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pips(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(s)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 pipes). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed CI 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 aoliform 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 kiss than 5 ppm. OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: 48 Gunstock Rd, Osterville, MA Owner. John Hostage Date of Inspection: /-/-g,S ') 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. E)LAR E SYSTEM FAILS: e following criteria apply to large systems in addition to the criteria above: 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 U of a public water supply well) The o r or operator of any such system shall bring the system and facility into hill compliance with the groundwater treatment program require ents 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 a I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddrsss: 48 Gunstock Rd, Osterville, MA owner. John Hostage Date of Inspection: Check if the following have been done: ,jAunping information was requested of the owner,occupant,and Board of Health. �ne 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. LIAa 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 _kT a site was inspected for signs of breakout. 1/1 system components,excluding the Soil Absorption System, have been located on the site. ®e 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. he 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 PropertyAddresa: 48 Gunstock Rd, Osterville, MA Owner. John Hostage Date of Inspection: ��—� .i�' `7 FLOW CONDITIONS RESIDENTIAL- Design now: 33 a sauons Number of bedrooms: 3 Number of current residents: Garbage grinder(pen or no): Laundry connected to system(yes or no): ` Seasonal use(yes or no):VC 5 Water meter readings,if available: 1 9 9 6 — 38 , 000 gals 1995 - 49 , 000 gals Last date of occupancy: COMMERCIAL/INDUSTRIAL• Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non4anitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) O If yea,volume pumped: gallons Reason for pumping: TYPE O"YSTEM (/Septic tank/distribution box/soil absorption system Single cesspool Overflow 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: Sewage odors detected when arriving at the site: (yes or no)�0 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Gunstock Rd, Osterville, MA Owner. John Hostage Date of Inspection SEPTIC TANK:L (locate on site plan) Depth below grader Material of construction:�oDnce ete_metal_FRP_other(explain) ` Dimensions: 1, 4C Sludge depth: T` 1 Distance from top of sludge to bottom of outlet tee or baffie&d Scum thickness: v l Distance from top of scum to top of outlet tee or baffle: L 1 J Distance from bottom of scum to bottom of outlet tee or baffle:_I J Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liguid level in relati2p to outlet invert,structural integrity, evidence of leakage,etc.) -6 0114� a.,C/. /o 6 G E TRAP._ (locate on a plan) Depth below e: Material of eo n:_concrete_metal_FRP_other(ezplain) Dimensions: nsio : Scum . Distance m top of scum to top of outlet tee or baffle: Distance m bottom of scum to bottom of outlet tee or baffle: Comments: (recommenda' 'on for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of ,etc.) (revised 11/03/95' 6 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Gunstock Rd, Osterville, MA Owner. John Hostage Date of Inspection: C/ SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan,if passible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number: leaching chambers,number:_ leaching galleries,number: leaching trenches, number,length: leaching fields, number,dimensions: overflow cesspool,number: Cots: ( con ition of soil,signs of hydraulic failure,level)'pon condition of vegetation,etc.) tJ d / v� 6d R' lC��-- c1�� ,� CWkFOOLs: (locate site plan) L r d configuration: -top f liquid to inlet invert: of lids layer. Depth of layer: of cesspool: Mate ' of construction: Indication f groundwater: (cesspool must be pumped as part of inspection) Comments:(n condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY:_ (locate on site Ian) Materials of oo Dimensions: Depth of so' Comments: (n condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 r J 1 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrees: 48 Gunstock Rd, Osterville, MA Owner. John Hostage Date of Inspection: G j_a':5�_a SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' i 35 � DEPTH TO GROUNDWATER Depth to groundwater—La-4-feet method of determination or approximation: b y (revised 11/03/95) 9