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HomeMy WebLinkAbout0103 MILNE ROAD - Health 103 MILNE ROAD, OSTERVILLE A = 119 112 n i jeol LOC&TION 5EW&C,E PERMIT 1JO. VILLAGE IWSTQLLER5 U&III -ADDRESS BUILDER 5 1J & E ADDRESS - - - - - - - - DATE PERKA T 15SUED DATE COMPLI &&ICE ISSUED , �� . �.. { i �_ ^ � �� � . c ®�/ k;, ,► __a i r v F1 1( � I( I I r l k � 0 c r m � � � Q ��mti , r-a z r - v �`" _ _ -�:s-•a—: r ----— —SEtBSU AC SEYr/ACx DtSEC AL ` EM 1f�4SPEETIC W€bRW_ �— ,. - ---,----ter PA Property"Address. T03 Milne Rti:Ostetvitle Addrass"of owner! 30 Date of Inspection:lVA4l9fi ;:,(If different) *t Vincent Byrne 17'Wlnsor Av Watertown Ma Name of Inspector:John Graci �t7 Company Name,Address and Telephone`Number CERTIFICATION STATEMENT '. a " ... �.•••: !.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'in"speciion. The:inspection:was performed-based.on my training and experience in..the proper function and maintenance of on-site sewage disposal systems., The system: y: a ' x_'Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails : Date 111419fi Inspector's is Si 9 nat ure , The System Inspector shall submit a copy of this inspection report to the'Approvng Authority within thirty(30)days of completing this nspections. If the system is a shared system or has a design flow of 10,000 gpd'or.greater, the inspector a d,the system.ownershall 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,Cr or D, A] SYSTEM PASSES: f z 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.' 8] 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.'; ; N or ND). Describe basis of.determination in all instances If `'not determined ,;explain why not.); Indicate yes;no,or not determined'(Y The se ptic tic tank is metal cracked,structurally unsound, shows substantial infiltration or exfiitration, or tank failure is imminent."The system will pass irispectioh if the existing septic tanKls replaced with,a conforming septic approved tank by the Board of:Health., (revised 11115I95) One Winter Street Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 - ._`_ z—`may .-- •' :�_.,-. _ _ - .-.e.. --, sue._._-.... _;.�� —F..•-'^ _- _ _ -- -- SUBSURFACE SEWAGE-DISPOSAL-SYSTEM INSPECTIQN FORM — C Fes- �• _ Eroperty,Address 103 Milne Rd;Osterville, Y - Owner Wnserd.Bytne.lrlAflnsorAv Watertown,-Ma_ se e - broken_ i e s -.are-replace - -= stior is, --emoved -- --- - — — - _ distribution box is leveled or replaced _The system required pumping-more'than four times a'year due to broken or obstructed a4pe(s'}:- system wilfpass inspection if(with approval of the.Board of Health) „ broken pipe(s)are'replaced, ° = obstruction'is removed Y t y C] FURTHER EVALUATION IS.REQUIRED BY THE BOARD OF HEALTH Conditions exist which require.further evaluation by the Board.of'Health inorder,to determine if the "system is failing to protect the public health,.safety and the environment. 1) SYSTEM WILL PASS UNLE55.BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN`A MANNER WHICH WILL-PROTECT:THE PUBLIC,HEALTH'AN,D 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.sup ply . The system has aseptic tank and`soil absorption system and is withinia Zone 1 of a pufilic water;, supply well. _ The system has a septic tank and soil absorption system and is wrthin'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 oY more from a private water supply well, unless a well water analysis for coliform bacteria volatile organic compounds'indicates that the well is -- free from pollution:for that facility and the,presence of ammonia nitrogen and nitrate nitrogen is.,equal or less than 5 ppm. 3) OTHER. 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 in facility or system component due to an overloaded or clogged SAS or cesspool: r ' Discharge orponding of effluent to the surface of the ground or surface waters due town overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11115195)... 2 - �- 'y-,-��-�•� ��-: �-�-.�,--sc��sc�'sl=wac��ia�����sa�rsr?E�T�o "c�ar�'� -a. �.. - _�� .tom-'.-"- _ - T 17 _. F[bpeaAofee' s• f03MuneRd asterWf T =— _ ry iw _ 6rgu�cl=depth�n cesspaal i's"le"ss ttia C�beloviKwerf or=auariabte_volume is�ess tsttar�112dasrfCotir — _ Required pumping more than 4 times in thef last Year NOT due to clogged or obstructed pipe(s).` Numbers-of times-pumped Any portion of, Soil Absorption System,-cesspool or privy is below:the,high groundwater elevation: , k" Any portion of a cesspool or privy-is'within 100.feet of a surface water supply or-tributary to a,surf ace"water supply Any portion ofa cesspool or privy is within a Zone 1 of a public well s Any portion of.a cesspool or privy is within 50 feet of a private water supply well:; Any portion of a cesspool or pnvy.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: The following criteria apply to largesystems in addition-to the critera 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 t. 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 surf ace drinking,water"supply _ the system is-located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA).or a mapped Zone 11 of a public water upply well) The owner or operator of any such system shall,bnng the system andjacility.into full•cgmpliance with the'groundwatertreatment program requirements of"314 CMR 5.00.and 6.00.. Please consult the local regional office of the Department for further information... 71 (revised 11115195) 3 �ra"�+�" aF'L=-:.ter u-=='A..wc.s`�.^.-K^-.r Y'..-_-k"'_'�c.•�`��.e�-�72i�.'��a�;?�� ��.__..�.-...,��-'x-a.: __..:.� �`a-.e.�`.�.�'�H%�;��_�rv�w,r". �.;....- '"G- _. a SUBSURFACE SEWAGE DISPOSAL`SYSTEM'INSPECTIAR- ON FORM r _ tr8� - - _. `Property Address 1D3MIIne Rd`Ostervllte` . =' .-;.< -x - - �-- - Qv� 1TWInsor 7 Watertowk Mar - i 1:1t0419B _ r _ s N - =� -;_.-,y, -'.,�• . - J _ x `Pumpmg:nformatron�was requested'of the owner, occupant,-and Board of WBalth �, - ---- 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:recentlyoras part of.this Y inspection. . nfaAs built plans have been obtained and examined' Note.If:they i re not available with N/A v , x The facility or dwelling was inspected for signs of sewage.flack 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 wasjnspected. !,• for condition of baffles or-tees,,material of construction,dimensions, depth of liquid,depth of sludge, depth of scuni. X The size and location of the Soil Absorption System'on the•site has been.determined based on existing.mformation or: approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided with'.information on the proper maintenance of Sub Surface Disposal System..' (revised 11115/95) - 4 �w pip- -__ -='L�_.. `ate"-_ .....'��--�----�� i—•-�`� _ _ ��"•- �'f.� ��'� �_�. _.._,r, �_U$SUREACE SEWA DIS.POSAL�SYSTEM INSPECTION FORM -- . _ ProparEyAddrass 103-MllneR&Osterville - - Vincent By 17_NIIn4ocAv Wetertown.;Ma • . .. :_ - gallons.. _ -_•— - - - - — .— _ __ flow --Nturnt e'oV-tyetlrooms Number of current residents: 0 Garbag grinder(yes-orno): Yes- - Laundry co'nnectedto,system-{Yes-or:no) _Yes ,w ; Seasonal use(yes or no): Yes Water.meter readings,,if available, nla4. - Last date of occupancy: summer -t GOMMERCIAUINDUSTRIAL: Type of establishment; Na o• allons/day Design flow: 9 Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no), Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: Na Last date of occupancy: Na— OTHER: (Describe] nla Last date of occupancy: GENERAL INFORMATION _PUMPING RECORDS and source of information System was last pumped 34 years ago. System pumped as part of inspection: (yes or no)No If yes,volume pumped:o ,, gallons - ; Reason for pumping: nla - TYPE OF SYSTEM X Septic tank/distribution boxLsoil absorptions system Single cesspool , Overflow cesspool Privy - - , Shared system(yes or no): if yes,.attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components date installed(if.known)and source information. 1975 Sewage odors detected when arriving at the site:(yes or no) No (revised 11I15195) ti _....._:..." .--�-,�:°'�'.s. . _ -�"�$--.1.:_ .__.�..`�`-�`z.,�-�- •�-<.�_ - .. :.. -` -. .. _ .... ..ate..... .. ..,'�..._ _,K._-,�.:�:�^fi�"�•.,a:���x�.r.:�`:; .... Off ,! - ».« SItBS1�REACE...S><WAG�DLSP.SkSAI.-S_YS'fE1N'IISFSPE+✓TIOht FARM �- _, �- �,.,� _ s _ z� t P[opert�Address t0lMiine•R�Qstervilte � '-� '� �.u. ,OWneG WncentByrsie_17Wfttso�AKWatertnvrrM - (Joca a on si an _ _ _ T - - - — = `Deptfibelow''grde 3' _- _ — _ - _Material:of_consiructiM,.X concreate_metal_FRP 'other(explain) Dimensions: L 8'B H-5'79 W'T 10' Sludge depth:Z' Distance from top of sludge to,bottom of outlet tee or baffle z5' Scum thickness 0- 4j Distance from top of scum to to of outlet tee or baffle:B" p r Distance form bottom of scum to bottom of outlet tee or'baffle u Comments:, t (recommendation for pumping,.condition of inlet,and outlet tees or bafflesc depth of liquid level in relation to outlet invert structural integrity evidence of leakage, etc.) ` Septic tank and all com onents are structurally sound.Recommend pumping system every two years faCmaintenance: z � GREASE TRAP: (locate on site plan) Depth below grade: nia F Material of construction. concrete_metal_FRP_other(explain) Dimensions: n(a - Scum.thickness n!a n!a tee or baffle. o of out let , of , cum t , Distance from top o fs P Distance from bottom of'scum to bottom of outlet.tee or baffle: nia c Comments: (recommendation for pumping, condition of inlet and outlet tees baffles aepth of liquid level in[elation to outlet invert,structural`integrity ` evidence of leakage;etc.) nla c (revised t 1l15195) a ' 6 ---���,� � _ SFJ�f_!CF-SEIIY'AGE-QtuP-�.�LATS�'�S.'C.•Efl�1D1����1f3�}...�.�.lt�ly�� �.� - =_= -._-.—.'"_ - P rtyAdtl[ess 103MICneRdrOstervilf� - � � � �� "OAvttef _ �Ancent8yare=17WlrrsoeAv Watertawo,-Ma - - �- __�—�-------s---._ -_ __ ._ - _ `.__ �:ate •- � �� �'' �.� '.�'-_ . TCG�L'�=�3Ct�i��-DfNG�ARII�-_• _ r— t Depth bielow grade Na Material of construction:_concrete_metal -FRP other(explain) - 77 _ `Dimensions: Na17, Capacity: n{a gallons. Jt ;! r Design flow: Na gallons/day_; Alarm level: Na comments: ;condition of inlet tee; condition of alarm and float switches etc.) i DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (Na note if level and distribution is equal, evidence of solids carryover: evidence of leakage into or out of box etc.) PUMP CHAMBER: ;locate on site plan) f Pumps in working order(yes or no) Comments: (note condition of pump chamber, condition of pum ps Na P . P and appurtenances 'etc.)- Al (revised 11/15/95) - 7 Y 2 — p a , _ SUB&UFdFACESEA6AGE DISPOSAE SYS7 EM INSFE.G�IOI�PORM x PropertT-Ad -W I Mtlne Rd Ostervllle - 4Wyt r Vincent-Syme 1-MlnsorAv,Watertovm=Ma f — - -Qate of Ins"aGtlnn04196 - T _�-,�.... --,_� -. -'... ..tea---6�---._ "`-�" �.�i,��- -��—:�`x._.�.,..�:.-:_ ..-.._. _ .b.�...` - - •c"--% z�'-��^„„ -_ - y �;=(locate ortstte,plan �f possib =excavatorrnot regwreds but m"aq be ap:pr."oximated by-non-intrusive.methods) uetermtned t YIM press p i ln: -Na. Type leaching.pits,number' 1,000 gallon leach.plt leaching chambers, number:nia leaching,galleries, number:nia." leaching.1l enches,number;length Na• 'r ' leaching fields: number, dimensions:nia x overflow cesspool, number:nia Comments: (note condition of soil signs of hydraulic failure level of ponding �ondrtion of.VegetatiJon etc ) x The leach pit is structurally sound and functioning Properly. f.. CESSPOOLS: (locate onsite plan) Number and configuration: nia ` Depth-top of liquid to inlet invert: nia.! 'Depth of solids layer: nia Depth of scum layer: nia r Dimensions of cesspool: nia Materials of construction: nia , Indication of groundwater: . nia inflow(cesspool must be pumped as part of inspection) nia Comments:(note condition of.soil, signs of hydraulic failure,'level of ponding condition of vegetation, etc.)' nia -77 PRIVY:_ r (locate on site'plan) Materials of construction: nia Depth of solids: nia tDimenslons: nia Comments: (note condition of soil, signs of.hydraulic failure. level of ponding, condition of vegetation etc:)'' PrivyComments t I (revised 11/15/95) - �SYSTEMI'INFORMATION(continua- _ --- SKETCH OF'SE-WAGE DISPOSAL SYSTEM - - ex tick URZLft ws... oGate.atkYYe!!s uw.ttun,1 QD _. _." � ' .t`•.s5$3' ' ' sue: a-• ,;t .,���r, _x v'^!5qa v�^.:tl; .sr.��r�;L,l'�•, '�iu� N�:b�.,air.^-«tr' :SiS'° .c��ii' �:[" � r. �-.s-+r a q^yv n_e; we r us• -'� ,. e�'�"_ - c a , Q v xq gc , DEPTH TO GROUNDWATER , Depth to groundwater:.12 feet _ method of determination or approximation. USGS Maps and Charts (revised 11115195) 9 - - I THE COMMONWEALTH OF MASSACHUSETTS BOAR® h-BEAL _......� 1.......OF...... s_................... , ppliratintt -for Di_gpwial Worko Tonstrurtiou ' rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual ,Sewage Disposal System at: ----------------------------------------- Location-Address of ----- ..... ....... .�.. .tv - ---- ----- -- ......:5-.iR�N : r Own Address Instal J�t � Address / U Type of Building Size Lot.... Sq. feet Dwelling 4 No. of Bedrooms_----- ---------------------------------- Attic ( ) Garbage Grinder ( ) aq Other—Type of Building ----------------------------- No. of persons_.__._--.-----__-_--.-_..... Showers ( ) — Cafeteria ( ) Q' Other fixtures ---- -----------•------•-------- W Design Flow__________ �_________________________gallons per person per day. Total daily flow__-__---__-_---_�OP---..-.-.--__--_gallons. WSeptic Tank-L Liquid capacity-_I DPOgallons Length-_------------- Width-.-_-.-__-_-.. Diameter---------------- Depth---------------- x Disposal Trench—No--------------------- Width-------------------- Total Length--------____..Total leaching area.._...--__--___._---sq. ft. Seepage Pit No----- -------------- Diameter-_--_I_�QC:?. Depth below inlet��?� I lea ping a ea--.---.-----_-__--sq. ft. z Other Distribution box ( ) Dosing tank ( ) ® f e �CI �2 �,/F7 y . aPercolation Test Results Performed bY------------------------------------------------------------ ------ Date.......................---------------- Test Pit No. 1...............minutes per inch Depth of "lest Pit--------------------- Depth to ground water..._--_-__-_.--.__.-_... LT, Test Pit No. 2......_---------minutes per inch Depth of Test Pit-------------------- Depth to ground water....-.-.-_-.--.-.__-__._ -------------- ..........I....... `-'•-••..------� ---- --------- _ ------- (' Description of Soil---------- tl' >1,_..." - �� x W VNature of Repairs or Alterations—Answer when applicable-----------------------------------------______________________________________________________. --------------------------------------- ----------- -- •-•-•--------•------------------•------------------------------------•-------------------------•-------------------------------------- --------- Agreement: The undersign rees to install the aforedescribed Individual Sewage Disposal System in accordance with 2 -• the provisions of Article I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by-ihe boardof health. R Sign ate Application A roved B 2. PP PP Y �117.�---------- 4 - - •- - ------------------•---------•-•----- Date .----------- Application Disapproved for the following reasons:.............................. .. -----------'---------------------'--'...-----'-------'---'------------------------•-----•............................ --------------------------------------------------- .............................. Date Permit No......................................................... ` . Issued..-. •.--� Date f No.•••.`� 1 ... i Fizz..... .. THE COMMONWEALTH OF MASSACHUSETTS BARD F HEAL. ---OF....... .... . ..... . { Apphrtttion fur Digp.tttittl Works C ontitrurtion Vrrui t y Application is hereby made for a Permit to Construct ( )+'or Repair ( ) an Individual Sewage Disposal System at j�� .................................. ------- 1:` ' ;` a ........................................YLo—I °IVL Address ------ ._ . ~"/V -•-- c �`+ °t - ) AP Own Address Instal r Address j Q Type of Buildin { Size Lot....1 '�_ln_ Sq. feet DwellinNO. of Bedrooms':__ .______ Expansion, Ga ba e Grinder g P ( ) "1 ' g ( ) aOther-:Type of Building _______________________ No. of persons.............._ :_. Showers ( ) — Cafeteria ( ) Q Otlterturesr ----- - 13 --- ------- ------------------------------- ------ ,jW Design Flow_ __. ______4 .___._.__ _.gallons per person per day. Total daily flow ___________g0QC1 ----gallons. W P g W Septic Tank Liquid capacity_._ . �allons Length____ __ Width___ Diameter_____-___-_____ Depth--------- ----- Disposal Trench—No. Widt i____________ ___ Total Length-- Total leachingarea_-_______,._..__. .sq,. ft. x . Seepage Pit No------______'_______ Diameter___.__. ' Depth below inletZ�i 1 lea hing ajjea_________________sq- it. Z Other Distribution box ( ) Dosing tank ( ) , Q,&.. PC 9��C �P 7 y �' Percolation Test Results Performed by------ -=-------- ....................................................... ijale--------------------------------------- Test Pit No. L___________.__minutes per inch Depth of Test Pit____________________ Depth to ground water-:.... __.-___-___.._ fXq Test Pit No. 2.................minutes per inch -Depth of Test Pit____________________ Depth to ground ' � water_..- -:____________- -------------- ••. ..............r - ---------� ---------------/ - �0ADe'scription of-Soil__ — — � (lfr/U fi W -- --•-------------------•--•-----------------------•--------___--------_______-•------•----•-•------•-___-•-------------------•---------------------•-------•--___-__-••-----------•---------------- .� U Nature of Repairs or,-Alterations—Answer when applicable----------------------------------------------_______________________---__-_----_ g �x Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli x `"the provisions o_f Article XI of the`State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep.-issued by e boardAf health. Sign =' .......................... - Approved B �a y x -x pate Application Disapproved for the following reasons:........................__ ___ ______ __________________________________________________Dat_____________ 5 Date t PermitNo..................................... ------------------ Issued........................................................ r, " Date ti? THE COMMONWEALTH OF MASSACHUSETTS BOARD F` HEALTH{ a ..............O F.... . ..... ......'....'............ ... .... . ................. �rrtiftrtttr f�lattt�littnrr T I 0 TIF h t t di 'd I age Disposal System,constructed ( or Repaired ( ) by�• 7- --- ----- yy --- -------------­--------........ ----------------------------------------------- st- ....aller >.,'g ................. ................................. ...... . .. ........................ ae­ bas been installed in"accordance with the provisions of :Article XI of The State Sanitary C d as des: ibed i the a,`pplication for Disposal Works Construction Permit No-____.V dated_-____ ____," :_ ... .. '' .____._. ., THE•ISSUANCE OF THIS CERTIFICATE SFIALL NOT BE CONSTRUED AS A GUARAY E THAT THE SYSTEM WILL FUNCTION ATISFACTORY '� -- nsDATE- t j pector------ -----•-THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH c ` .............OF........... .. .....-.. No. r �'L FEE .-•�-^-'- 31 Permtssto is eby granted 1 - ----- ................. ..................._ to Co'�`u t ).-o pan ) an Individual:Sew D' sal yste at�No.l.__ '~-= ... '-------- f r r° r ras shown on the application for Disposal Works Constiuctio e StittN Dated 6r+ DATE--- (/ ----/ +--- --.../- --•--=---=---------•----.._.:___... - - - - -- a f ea th . --•------...__ ..._ FORM 1255 OBBS;•& WARREN. INC.. PUBLISHERS � Q-t- i-o-r A)p ort p- - IYl - 119 -- Lcsr i a V) Mi`0C' j Togwx dJa�� qo NN CA r c+1 V �. C� n <y -1 i N IQD QN r ! j J 5 q ] d it 7 i ;I 1 1 r d I �-r z fo N L 1 O , z � w I I ; ! I f o i E I I t I 1 1 t t i I / ' ( L7 1� I I t �7! i� REVLVN\IONS 1DE 17:ETA iPl'�'(�Ii�LJO'i} / �No �L. Gt��'�_� `Jti�WS 10 '(�'�� L��? mac , �� -��c.�,t k�t,= 8- 0-C>� BUILDING &RENOVATIONS (508)428-9929 f� i 4 C G ri Cli At t5 '� � I : I o a U1 I` C � r . H z o � 00 (fie 2 N r C OG !. 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