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Home My WebLink About0048 SPICE LANE - Health -47 Spice Lane,Osterville s y TROY WILLIAMS SEPTIC INSPECTIONS ��V�'Q �) �B Certified by MA Department of Environmental Protection ® oyNOFe 9ypD-08 385_1300 19 Hummel Drive ��rHo PtTge(F '� South Denn* MA 02660 Cf COMMONWEALTH OF MASSACHUSETTS 8 ti r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r (COPY ONE WINT ER STREET. BO i.t STON, MA 02108 617 29_ .500 WILLIAM F.WELD Govcmor TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION Property Address: q7 Sp'c_ L&A. 65 4r✓,.It,;, Address of Owner: oltbP�l C0 Date of Inspection:cC 13 /` 9 Of different) / Name of Inspector: Troy W i 11 i a m s t3 d I am a DEP approved system inspector pursuant to Section 1S.340 of Title S(310 CMR 1S.000) / S �07 Company P p r Name: Troy Wtlltams Septic Insaections ��.�;"Aso�t Mailing Address: I9 H rmtnpl nrivp , South ftpnnis , MA 02660 ' Telephone Number: ( 5_r08)_385-1300 ?8 636 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 Signatur l lt/ xcp�yr, e Date: 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] SYSTEM PASSES: V 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. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: A I119. r One or more system components as described in the "Conditional Pass' section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (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 metal, is 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 by the Board of Health I r.vi..d 04/2S/91) Paq. 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 47 Spice Lane,OsteMlle,MA Owner: Joan Spencer&Debra Copy Date of Inspection: February 3, 1998 B) SYSTEM CONDITIONALLY PASSES (continued) 1\1119 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). Describe observations: 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 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 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS 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 thari 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. Method used to determine distance (approximation not valid). 3) OTHER (rwiud 04/25/97) ➢ao• 2 �f 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 47 Spice Lane,Osterville,MA Owner:Date of Inspection: Joan Spencer&Debra Copy February 3, 1998 D] SYSTEM FAILS: A/119 You must indicate ei;,.er "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. 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. Yes No 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 So 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 FAILS: You must indicate either "Yes" or "No" as to each of the following: 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: Yes No 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 04/25/97) ry Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 47 Spice Lane,Osterville,MA Property Address:Owner: roan Spencer&Debra Copy ' Date of Inspection: February 3, 1998 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No �L Pumping information was provided by the owner, occupant, or 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. As built plans have been obtained and examined. Note if they are not available with N/A. Y _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. —I — The site was inspected for signs of breakout. ]L _ All system components;excluding the Soil Absorption System, have been located on the site. 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: _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. NJ'9 Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)j (rwised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 47 Spice Lane,Osterville,MA Owner: Joan Spencer&Debra Copy Date of Inspection: February 3, 1998 RESIDENTIAL: FLOW CONDITIONS , Design flow:33d Q.p•d./bedroom for S.A.S. Number of bedrooms: J - Number of current residents: c;l Garbage grinder (yes or no): '1ES Laundry connected to system (yes or no): Y6-S Seasonal use (yes or no): No Water meter readings, if available (last two (2)year usage (gpd): 7 = 10 Owv o a /lo,`f q C = 61, Sump Pump (yes or no): Nb Last date of occupancy: COMMERCIAUINDUSTRIAL• A114 Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sanitary 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�o//f information: �� H'I a r+'r+�S .or=U r'l'?7 r h Sl�c c.Aj o <-v' hz,,E �+. h a c+� Ot,--r-�¢✓, System pumped as part of inspection: (yes or no)Ala If yes, volume pumped: gallons Reason for pumping: TYPE 9'F SYSTEM Septic tan k/4ist ion- soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy.of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)_,�141 (rwis•d 04/25/97) o Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) , Property Address: 47 Spice Lane,Osterville,MA Owner: Joan Spencer&Debra Copy Date of Inspection: February 3, 1998 BUILDING SEWER: A/ (Locate on site plan) Depth below grade: Material of construction: _cast iron_40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: 3•S �-��s r, s�r Material of construction: �oncrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions:_ OOd Sludge depth: J, Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 1V01V Distance from top of scum to top of outlet tee or baffle:/VO S c-- U Distance from bottom of scum to bottom of outlet tee or baffle: it/6 S u How dimensions were determined: >�Yo 6e• 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.) � �` u. �✓ a✓ iL 1�-I w s h ,,,o y� 's h. U J� C�0. L, o v- 5 / �. .� K ✓ [i✓4 r hp O L STD ✓ L�I �o Wi ✓tic b T 1 - 4-G.-O i-LS c.:-.)L Off-. Ll t '� / !�✓l H O T GREASE TRAP:_.A//�� . (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain), Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: w Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet i nven,'structural integrity, evidence of leakage, etc.) (revised o4/2s/91) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 47 Spice Lane,Osterville,MA Owner: Joan Spencer&Debra Copy Date of Inspection:February 3, 1998 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _,metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:.S//"9 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence.of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_N/^7 (locate on site plan) Pumps in working order: (Yes or No) Alamo in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (r*vimad 04/25/97) a Page 7 of 10 _ r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: 47 Spice Lane,Osterville,MA Date of Inspection.Joan Spencer&Debra Copy February 3, 1998 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: , leaching pits, number. 6 h S �, . leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, siigos of hydraulic failure, level of ponding, condition of vegetation, etc.) '� Q Tom,✓!1 r� -�- S Gl.L1 J G c._ c.r f� 7'� (itJ cam S ✓h. (i.J T F� �- ✓ Yh. v.. C'� e r J S /-�• b o r-a., A/O S O C�y cam./ �` v�� d r r✓rd � �tv..S / ti � � CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: r Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: IV14 (locate on site plan) Materials of construction: _ Depth of solids: Dimensions: � Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) _ page ! of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:Owner: 47 Spice Lane,Osterville,MA Date of Inspection: Joan Spencer&Debra Copy February 3, 1998 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) 6 a' 91 93 yy /aao � SGp�` wKk wry (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 47 Spice Lane,Osterville,MA Owner: Joan Spencer&Debra Copy Date of Inspection: February 3, 1998 Depth to Groundwater — Feet adjusted high groundwater level 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 Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) -7-$ (ravtaad 04/25/97) Page 10 of 10