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Home My WebLink About0114 KING ARTHUR DRIVE - Health 14 KING ARTHUR DRIVE, OSTERVILLE A= 145 045 Commonwealth of Massachusetts q rmm. r Executive Office'of Enviroiunental'Affair's' ° Dept.'of Environmental°Protection Jo1ui G>I AC1 One winter Street,Boston,Ma. 02108 r t } D.E.P. Title V Septic Inspector s P.O.'Box-2-1 Zv 'Teaticket MA O 53 WILLIAM F.WELD ' (�508)564-6813 . GovernorQi '� . ARGEO PAUL CELLUCCI f ,� LCE'2�/L'O eJ LL Governor - ,y _. '.,' i °*"F - .n s.r= . r f�' s f a '�' �� C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM" 16' x PART A z` y Tp - a CERTIFICATION " . YJ O�tig9N 1998 i Property Address: 14 KingArtherDr:OstervilleMapl4iPar4i•Lot14'yt Address of Owner, ;' •� �:�' ��' '" *° ` x ',+ Date of 'Inspection: 6/18/98 P q '� "°�� = �� ..(if different) ., Name of Inspector: John Graci * ' Estate of Smith C/O,Ted Smith 11 Middle St.S.Attleboro Ma.02703 I am a DEP approved system.inspector pursuant to Section 15 340 of Title%(310 CMR.15.000) Company Name,Address and Telephone Number 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 a x Passes �> This Inspection Is based on criteria defined In Title V Conditionally Passes t` f code 310 CMR 16.303.My findings are of howthe system is performing at the time of the Inspection.My inspection does Needs urt er Evaluation By Local Approving Authority not Impyany warranty or guarantee of the longavltyofthe _ F811s k g , septic system and any of its components useful Ilia. 4 Inspector's Signature: • " r / j 1 The System Inspector shall submit a copy of this inspection report to the Approving Authorityjwithin'thirty(30)days of completing this: > inspections. 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 theapproving authority. INSPECTION SUMMARY: Check A, B, C,or D r a o < r k "" A] SYSTEM PASSES s *� ¢ , x I have not found any information which indicates that the system violates any of the failure criteria , k14' „• defined as in 310 CMR 15.303. Any failure criteria not evaluated are'indicatedbelow: COMMENTS: B] SYSTEM CONDITIONALLY PASSES: �. One or more system components need to be replaced_ or repaired. The system,upon completion' ;� r, I of the replacement or repair,passes inspection. .", _` ;, f Indicate yes no or not determined(Y N or ND):'Descnbe basis of determination in all instances >If "not determined",explain why not.The septic tank Is metal ;unless the.owner of operator has provided the system,inspector•witn acopy of a Certificate of r' s Co7hpl)ance(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 its cracked, structurally'unsound,shows substantial infiltration or e'xfiltration or tank-� t + e., . `failure is imminent.The system will pass inspection if the existing septic tank is replaced'with a conforming septic tank L, as.approved by the Board of Health. (revised,04i27197) One WlnterStreet ,. Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14Kin ArtherDr.OstervilleMa 145Par45 Lot14 P Y 9 P .. Owner: Estate of Smith C/O Ted Smith 71 Middle St.S.Attleboro Ma.02703 Date of Inspection:6N9199 , _ Sew.arze 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 _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 wetlandpor 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. w The system has a septic tank and soil absorption system and 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) 1 3)Other , D] SYSTEM FAILS: k 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.r The basis for 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 stirface wetcrs due to.an overlofded qr cluyy�d cesspool_ ,a SAS is in hydraulic failure. (revised 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 CHECLIST:,y', Property Address: 14 King Arther Dr.Osterville Map 145 Par45 Lot 14 Owner: Estate of Smith CIO Ted Smith 71 Middle St S.Attleboro Ma.02703. Date of Inspection:6119199 Check if the following have been done:You must indicate either"Yes"or'No"as to each of the following t _c_ — 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 inspectional 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. ;, 4 x The septic tank manholes were uncovered„o pen ed,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 an failure criteria,related to Part C is at issu x (' y e, approximation of distance is - ' — — unacceptable)[15.302(3)(b)1 j (revised 04127)97I - c SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION, Property Address: 14 King Arther Dr.Ostervilie Map 145 Par45 Lot 14 Owner: Estate of Smith CIO Ted Smith 71 Middle St.S.Attleboro Ma.02703 . Date of Inspection:6118f9E FLOW CONDITIONS RESIDENTIAL: Design flow: ago g•p'd./bedroom for S.A.S. Number of bedrooms: , Number of current residents: o 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)` *, nfa .. - Sump Pump(yes or no): No t Last date of occupancy:2 months ago COMMERCIAL/INDUSTRIAL: Type of establishment: nfa Design flow:o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No u Non-sanitary waste discharged to the Title 5 system`.(yes or no) No Water meter readings,if available: nfe Last date of occupancy: nfe OTHER:(Describe) We Last date of occupancy: - 3 GENERAL INFORMATION... PUMPING RECORDS and source of information: s A System pumped as part of inspection: (yes or no)No If yes,volume pumped:8 gallons Reason for pumping: nfa TYPE OF SYSTEM s x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) .( if yes, attach previous inspection records,if an I/A Technology etc.Copy of up to date contract? ` - Other: APPROXIMATE AGE of all components,'date Installed(if known)and source Information: 1983 Sewage odors detected when arriving at the site:(yes or no) No (revised 04117)971 SUBS - , URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ; PART C SYSTEM INFORMATION(continued) a ' Property Address: 14 King Anther Dr.Osterville Map 145 Par45 Lot 14 t: Owner: Estate of Smith CIO Ted Smith 71 Middle St.S.Attleboro Ma.02703 " Date of Inspection:6119198 SEPTIC TANK: x - x (locate on site plan) Depth below grade: 4' Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: I-e'6"H5'T•w4.10 Sludge depth:6' Distance from top of sludge to bottom of outlet tee or baffle:29" a ' Scum thickness:l' Distance from top of scum to lop of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 1r P 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 properly.Recommend pumping now and then maintained every two years. GREASE TRAP:_ <. t n (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_oth er(explain) Dimensions: rda n _ Scum thickness:rda 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: rye Date of last pumping,,(. Comments: y (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.) We BUILDING SEWER: _ (Locate on site plan) Depth below grade: 44^ s Material of construction: cast iron_40.PVC_other(explain) Distance from private water supply well or suction'line?o Diameter: We Qmments;(conditions of joints,venting,evidence of leakage,,etc.) (rerlaed04l27)87) ` k SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 King Arther Dr.Osterville Map 145 Par45 Lot 14' Owner: Estate of Smith C/O Ted Smith 71 Middle St.SAAttleboro Ma.02703 Date of Inspection:6119199 , TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rya . Material of construction:_concrete_metal_FRP_Polyethylene=other(explain)' Dimensions: n1a Capacity: n1a gallons Design flow: Na gallons/day Alarm level:_nia Alarm in working order?_Yes—No., Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Ma ' DISTRIBUTION BOX: (locate on site plan) r' Depth of liquid level above outlet invert: era Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) Na PUMP CHAMBER (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_ve: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 04127)91j SUBSURFACE SEWAGES OS , R DISPOSAL AL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION (continued) Property Address: 14 KingArtherDr.Osterville Map 145 Par45 Lot 14 Owner: Estate of Smith CIO Ted Smith 71 Middle St.S.Attleboro Ma.02703 Date of Inspection:6119199 d SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required, but maybe approximated by non-intrusive methods)P If not determined to be present,explain: Na i Type leaching pits,number: 1000 gallon leachpit „ leaching chambers,number:Na leaching galleries, number: Na leaching trenches,number,length: n1a leaching fields,number, dimensions:nla overflow cesspool, number:nra Alternate system: Na Name of Technology:: Na ` Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pit was structurally sound and functioning property.The pit had 1•of leaching left In the system at the time of the Inspection. _ CESSPOOLS:_ (locate on site plan) M Number and configuration: Ntt , Depth-top of liquid to inlet invert: We Depth of solids layer: Na Depth of scum layer: nla .: # Dimensions of cesspool: Na Materials of construction: Na Indication of groundwater: Na 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.) N8 i PRIVY: (locate on site plan) a ,� Materials of construction: Na Dimensions: Na f Depth of solids: n!a - _r Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation etc.) Ne _ - s (revised 04127)97) " U• - .. a SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ',k 14 King Anther Dr.Osterville Map 145 Par 45 Lot 14 Estate of Smith C/O Ted Smith 71 Middle St.S.Attleboro Ma.02703 6118198 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) , ' �� r• ,{ V�I'l/,� jVM � ♦ I M1 III n PC � , M r a , x .. (revlped04f27197) Page ! of 10 � k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 14 King Anther Dr.Ostervllle Map 145 Par 45 Lot 14 Estate of Smith C/O Ted Smith 71 Middle St.S.Attleboro Ma.02703 u 6118f98 � r - 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" Y r Check with local Board of Health ' r Check FEMA Maps - Check pumping records. Check local excavators, installers X Use USGS Data r u Describe in your own words how you'established the High Groundwater Elevation.(MUST be.completed) USGS Maps and Charts e (ravlsadO4127197) rate 10 of 10