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HomeMy WebLinkAbout0061 REBECCA LANE - Health 61 REBECCA LANE, OSTERVILLE A= 146 059 o a u 0 INS'IN 11111-MIMI 0.1p,malip ij s3 OF :A ACommortweotth of MMSOchusetts Jtihri Grad Exeeu" office Of ENronrMi tal Affdrs - D.E.P.. Title U Septic,Inspector - Dl�epartment of _ P0:8aX210 • Teaticket MA 02536 Environmental ProtOdlon (508)564-6813 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM QS PART A - CERTIFICATION Property Address: 51 RebeccaLane,ostervllle,me.02555 Address of Owner: Date.of Inspection:>u15196 (if different) - Name of Inspector:John Grad whinnem 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: x Passes. _ Conditionally Passes . Needs FurE er E aluation By the Local Approving Authority Fails Inspector's Signature: 'Date: 8119196 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 orhas 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) 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. 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,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved bythe Board of Health. (revised11115195) One Winter Street. • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617),292-5500 ,. W Wpm- 777 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM, — PART A CERTIFICATION(continued) Property Address: 61Rebecca Lane,cistervift Ma.0265i Whinnem owner:: _ ._ Date oflnsPection:8115196 - . Sewage backup or breakout or high sfati. c water level obserJed in the distnbu oval of on box-Ithe Boat due ord of Health): settled or uneven distribution-box. The.system wIl(pass.inspection if(with approval 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. LTH NES THAT THE.SYSTE 1) SYSTEM WILL.P SIN ALMANNER WHICH WILL PROTECT nTHE PUBLIC HEALTH ANDIS NOT FUNCTIONING 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. ER, IF APPROPRIA )DET ATER SUPPLI1 2 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALR T(AND PUBLICHAT PROTECT THEPUBLIC HEALTH AND SAF TYAND HE ERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNE 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 rption system and is within a Zone 1 of a public water The system has a septic tank and soil abso supply well. _ The system has,a septic tank and soil absorption system and is within 50 feet of a private water supply well.., d is_ The system has a septic tank and sowater la absorption for system bacterea volatile o gan c compounds indicates that the wet but 50feet or more from a ell is water supply well,unless free from pollution for oc t that facility and the.presence of ammonia nitrogen and nitrate nitrogen is equal or less than ppm. 3) OTHER DI SYSTEM FAILS: ined in I have 15 303.that basis for this determination is identified tie ow. The.Board of Healt violates oe or more of thefoilowing failure criteria as h should 310 CMRsh uld 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. _ 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. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART'A. - — CERTI-FICATION (contlnued)•. Property Address: 61 Rebecca Lane,0stervllle,Ma:02655' Owner: Whingem. _ Date of inspection`.9115196. -D] SYSTEM FAILS(continued) Static liquid level in the distribution box above outletinvert.due to an overloaped.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 pnvyis 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 1 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 LARGE SYSTEM FAIL S: 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 t: public health and safety and the environment.because one or more of the following conditions exis 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 11115195) 3 57 -� ..✓ ... n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART B CHECLIST Property Address: 51 Rebecca Lane,Ostervllle,Ma 02655 - - Ovvneri Whlnnem Date of Inspection:8115190 Check if the following have been done: 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. 2LaAs 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 existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided information with inftion on the proper maintenance of Sub- �Surface Disposal System. (revised 11/15195) 4 _ SUBSURFACE SEWAGE DISPOSAL SYSTEM IN FORM — _ PART C SYSTEM INFORMATION - Property Address: 61 Rebecca Lane,0sterVIlle;.Ma o2655. Ojxner: Whlnnem _ Date of Inspection:IM96 RESIDENTIAL FLOW CONDITIONS. - Design flow: 220 gallons -... .• Number of bedrooms:- 2. Number of current residents:1 Garbage grinder(yes or no): No . - - Laundry connected to system Seasonal use (yes or no): Yes.:., (yes or no): No Water meter readings,if evadable: Na Last date of occupancy: nta COMMERCIAL/INDUSTRIAL: Type of establishment- Na. Design flow:a 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) No Water meter readings,if available: n1a Last date Of occupancy: nta OTHER: (Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information The system has not been Pumped in the last two years. System pumped as part of inspection: (yes or no)Yes If yes,volume pumped: 150o pectins Reason for pumping: Maintenance.` TYPE OF SYSTEM - 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 any) Other(explain) APPROXIMATE AGE 1976 of all components,date installed(if known)and source information: Sewage odors detected when arriving at the site,(yes or no) Yes revised 11115/95) 5 SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION"FORM PART C _ SYSTEM INFORMATION(continued) Property Address: 61 Rebecca Lane,Osterville;Ma 02655 Owner: Whinnem Date of Inspection:8115196 SEPTIC TANK: X_. . (locate on site plan) Depth below grade: 16" - Material of construction:X concreate' metal_FRP_other(explain) Dimensions: L 8'V H 5'7"W 4'10' -- Sludge depth:•0 Distance from top of sludge to bottom of outlet.tee or baffle: 0 Scum thickness:7' _ Distance from.top of scum to top of outlet tee or baffle:s' Distance form bottom of scum to bottom of outlet tee or baffle: 11• 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.Recommend pumping system everytwo years for maintenance GREASE TRAP:_ (locate on site.plan) Depth below grade: Na Material of construction: _concrete metal_FRP other(explain) Dimensions: nie Scum thickness:We Distance from top of scum to top of outlet tee or baffle:nla Distance from bottom of scum to bottom of outlet tee or baffle:nia Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural in evidence of leakage,etc.) n1a (revised t Ill5195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. -._ -' PART _ - SYSTEM INFORMATION(continued) Property Address: 61 Rebecca Lane,ostervillei Ma.02555 Owner: Whinnem Date of Inspection:8115196 _ TIGHT OR-HOLDING TANK; :(locate.on site plan). _ Depth below grade: Wa _ Material of construction:- coricrete_metal FRP_other(expiain) Dimensions: nIa. Capacity, nia gallons Design flow: nla. gallons/day Alarm level: nla Comments: (condition of inlet tee, condition of alarm.and float switches,etc.) nla DISTRIBUTION BOX:. (locate on site plan) Depth of liquid level above outlet invert: nla 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) Comments: (note condition of pump,chamber,condition of pumps and appurtenances, etc.) nla (revised 11115/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(co titinued) Property Address: 5i ke�ccaLen%osterville,Ma o2555 Owner: Whinnem -Date of Inspection:`8115198 - - - SOIL ABSORPTION SYSTEM(SAS) X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: _ n1a - .Type: leaching pits, number: 11_000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number,length:n1a _. leaching fields,number,dimensions:n/a overflow cesspool,number:n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) The leach pit is structurally sound and funcdoning properi CESSPOOLS:_ (locate on site plan) Number and configuration:' nla ; Depth-top.of liquid to inlet invert::n1a Depth of solids layer: n/a. Depth of scum layer: n1a Dimensions of cesspool: We Materials of construction: n1a Indication of groundwater: n1a 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.) n1a PRIVY: . (locate on site plan) Materials of construction: nla Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PrivyComments (revised 11115195) '. ".:'. ..•:cam �S:fk _• - - ... -.. SUBSURFACE:SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C _ SYSTEM INFORMATION(co ntfnusd) Property Address: 61 Rebecca Lane,Ostervllte,Ma.02655 m ;. . Owner: -. - Whlnne . " Date of Inspection:8H5198 SKETCH Of SEWAGE DISPOSAL SYST.EM:.. _ . include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' WJU \0>0 air �6 4 �5 DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: t1SGS Maps and Charts (revised 11115195) LOCQTIOt-11 � 5 &C-xE P RMIT UO. VILLAGE 9h1STl� LERS 1J� E ADDRESS BUILD 5 1.1 �,t�l �. . [�, DRESS - - - DATE PERMIT ISSUED D ATE COMPLI &t ACE ISSUED - - - r" i �+ �I ,. ��A ......... Fmc/ THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE 0F. .­ -----------"-Z------------�----------e-----� ----*...... Application -for Disposal Works Towitrurtion Vanift Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sys ---- ............... ---cation.---- ............... ....... .......... .. ... ....... .. ... .................................. Ad�- V ...r. ..... .. ........ .... .......... .......... .................... .............. ...... .. ............ 0 eAddress ........... .............. ............ ..................... ..... ------------------ Installer Address Type of Building Size Lot.._ feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder P4 Other—Type of Building --------_----------------- No. of persons---------------------------- Showers Cafeteria 114 Other fixtures ---- ------------------------------------------------------------------------------------------- Design Flow---- ........S7_0..................gallons per person per day. Total daily flow.................4A-4? W - -----------gallons. 9 Septic Tank—Liquid capac/e_49gallons , Length................ Width....._......._.. Diameter_........_....._ Depth----------_--- Disposal Trench "A'ig- -------------------- T_otaj!j_ength-------------------- Total Vachixarea--------------------sq. ft. ------------------sq. f t. .................. Seepage Pit No. ............ )%Vk Other Distribution box Dosing tanke'� C 4;j_, -7 Percolation Test Results �2p`ler�forme__d_---by........... ...... ....................................................... Date-----__-___--__._-_-_-.-.--._-_---_..... ,� Test Pit No. I................minutes per inch Depth of Test Pit........_........... Depth to -round water....___................. 1:14 Test Pit No. 2................minutes per inch D th off Test Pit._.--_----_--_______ Depth to ground water------------------------ . ..................... --------- --- J�� ....... -------- ------- O Description of Soil--- ------- . I ..................... .*0. t, �4 ----0--- � Y�......... tt _; ............................................................ ----/t--­----------------- U -------------------------------------------------------------------------------w.................................................................................................................... ----------------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------*---------------------------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------__........-------------- -----------------------------------...................................................................... --------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in jagn sued by the r operation until a Certificate of Compliance has b eigne(L —------------- Date Application Approved By_--- --- ------------ ........ ---------7Z Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- ............................---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo........................................................... Issued........................................................ Date -------------------------------------- w • � ff No......................... ; -Z ............................ ►f THE COMMONWEALTH OF MASSACHUSETTS - --- BOARD - F HEAL-T .---OF...r -��'' - -------------- Appliratiun -fur 4%ipoiial Works Cnunutrurtiun Vaunt Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal System at: / Location.Address' �� or.Lot No. Owner Address ---------=- ----- -•.............••-•----.....-------------•=--------------------- Installer v Address UType of Building Size Lot...... !vl�_.6�___Sq. feet .-, Dwelling—No. of Bedrooms---- ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ----Utz,��r a--�� ................ W Design Flow..............`?...O..._..........____gallons per person per day. Total daily flow................. .�1 .-..--.-_.gallons. WSeptic Tcluk—Liquid capacixw ZIlons Length................ Width................ Diameter_-.---..-------_ Depth-.__--.--.----- Disposal Trench—No...._.._.. .__. Widthi!'................. Tot Length--_-___-_--__--_--. Total chin .rea.._.._.._._...._.._.sq. ft. x r � i:� Rf Seepage Pit No.. ci�C_��Dtaineter -�°':` De th b'el� '`le{.. � iT�ta1=Y'-ac]"' trea sc ft. P --•---. g t 1• z Other Distribution box ( ) Dosing tank ( ) 4 , /JC/,7;, P -; C. - 7G a .Percolation Test Results Performed bY................---------------------------------------------------------- Date--------------------------------------- a Test Pit No. I................minutes per inch Depth of "lest Pit-------------------- Depth to ground water-----------.-_-.-_.-___. f� Test Pit No. 2----------------minutes per inch D th of Test Pit-------------------- Depth to ground water----------------------_ 01 ---si ..... It---- ------- ------- !. _ ,,tt�� / ...........................—Z -----` ".-_----`------j---- O Description of Soil-------4?-- y- ---- --a4 -----••..... ---' ------------------- --�- A----- - x W UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------- ..............................................................................................-------------------------------•-.._.......-----....---•---••---•-•••-....._....•••--•--••-------------------------------------------------------------------------------------- --------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with _the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isssued hb r ©f �eya„Iti. Date Application Approved BY-----------� ' --- -----....r------------------ ---------------- - --- F-`---`---�--------�-� Date Application Disapproved for the following reasons----------------•---•---------------------------••---•--•----------------•-•--- ................................ ..............•--•-----------•----•--•-••--••---...--.---- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �lertifirntr of ftoxnpliaurr THIS IS-TO CERTIFY, That the Individual Sewage Disposal System constructed�,.or Repaired ( ) has been installed in accordance with the provisions of Ar cue I of The State Sanitary :ode as described in the application for Disposal Works Construction Permit No�!_�_Z---_- ------- dated__.h.-_ :L_-._%__`.............. THE ISSUANCE OF THIS ICERTIRCATE SHALL. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- ----- ....--��o�-------------•-- Inspector-- THE COMMONWEALTH OF MASSACHUSETTS BOA DDOF1 HEALTH FEE- ....... Bi-rupolittl 10, k C on t �trtioit rrntit Permission hereby granted•-_.---__v ........__ _____ r- " ;f ---- ----" to Cull., cpL( or Repair ( ) an Individual Sewage Disposal System ` �» at No.-. f -......� r ....------ '." ' ... - -....... / .. I Street as shown on the application for Disposal Works Construction Permit ............ . . . e _ .�._.�_ __�---"__7 .. y_ ---- - -- DATE --------- ---- -•--------•----------------•--• Board of Healt i FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Z �, A=:moo. o�• `\ -F��� r � /l 5:cl(;� - \ Z1 O O r, �Gz. SG�iL E : /"=30 • D�gTE�: 9 20 G —/ppc�'+ C7-�IG. ..r.�,v;riG 77Uit,:s� A'-EFEe&A./CE: eE1AAE--- Lo 7- ArU✓o co u.e 7- - r Z /lEeEBY CE2T/FY THAT TiUE AAAA SHON/.V O.V 7'f//S PL�i.V IS L O G Ai TE a O.V TA/E eo u vD AS .SNO N/.�/ HE2Eo�/ 6i.vD TNgT /T tin a ro Ts,� zo.v/.vG ,S !��,�P GF , Lg4VS OF THE 72�WA./ OF A609.�tiSTiZ7l3G� ARNE o OJ4LA :26348 awn cam en ineer�n � � SC/BVE YO BS 2otJTE 6q^-� E-'iv10C/Tf-/, MgSS. 11i7FE- eEG. 1q,vD suevEYoe