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HomeMy WebLinkAbout0060 DEER HOLLOW ROAD - Health 60 DEER HOLLOW ROAD, M. MILLS A=. 030 043 I l 1�TOWN OF B . STABLE LOCATION J� �/7��' SEWAGE #i VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACIl.ITY: (type) o�—d (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: �'�� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet ^-Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet jt ,7e of Wetland and Leaching Facility (If any wetlands st within 300 feet o leac `n faci ty) Feet. Furnished b I Ed .JY kkL v ' ------------- DATE : 3/9/98 PROPERTY ADDRESS : 60 ae*er Hollow Road Marstbns Mills, Mass. 02648 On the above date, I Inspected the "ptic system at the above aCCress Tnls system consists of the following: 1 . 2-6 ' x8 ' block cesspools . 2 . One overflows to the other. 3 . Main cesspool acts as a septic tank. 8a8e-o on my Intkc�actlon, I cerllfy the following conditions: 4 . This is not a title five septic system. 5 . The sewage system is in proper working order at the present time. SIGNATURE : Name : J . P . Macomber Jr... ---------------------- Company: J_ P_Macomber— B— Son_Inc Cen � ervilLe Mass : 02632 � Phone : THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY SOSEPti P. MAC-0MBER & SON, INC. 7�nkHC•t�poolrL�ichllaldI . Pump d L Insullyd Town Sewor Connectloni P.O. Box 66 ' Centerville, MA 02632.0066 7 7 5-3 3 38 7 7 S-6a 12 . C COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 WILLIAS1 F WELD TRUDY C( Govcmor Sccrc ARGEO PAUL CELLUCCI DAVID B STRI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissi, PART A CERTIFICATION Property Address: 60 Deer Hollow Road M&M Address of Owner: Date of Inspection: 3 9/98 (If different) Name of Inspector: 1 am a DEP approve system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc. Mailing Address: BOX Centerville,Mass' . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurat 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 Evalu tion By the Local Approving Authority Fails Inspector's Signature: ljj r• Date: The System Inspectors all submit a copy of this inspection report to the Approving Authority within thirty (30) days of comp4eting 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 subm, the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to ttse system own and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES g I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.30: Any failure criteria not evaluated are indicated below, COMMENTS: BI SYSTEM CONDITIONALLY PASSES: _ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, up( 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; the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tan 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. (raviaad 04/25/97) Pay• 1 of 10 DEP on the World Wide Web: http:l/www.magnet state.ma usloep Printed on Recycled Paper i \J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 60 Deer Hollow Road Marstons Mills,Mass. Owner: John D. Sorcenelli Date of Inspection:3/9/98 B) SYSTEM CONDITIONALLY PASSES (continued) NCNt,, Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstrucied 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 R� 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: ,06_ 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: 11)6 Cesspool or privy is within 50 feet of a surface water ,Lb 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: 1,,?p 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. 1,24) The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well ,ff?) 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 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm. Method used to determine distance /Yv*�-- (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 .J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A :a CERTIFICATION (continued) Property Address: 60 Deer Hollow Road Marstons Mills,Mass . Owner: John D. Sorcenelli Date of Inspection:3/9/98 D) SYSTEM FAILS: You must indicate ei;-.er "Yes" or "No" as to each of the following: �Q I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303 The 'oasis 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. •t pa%/(,_ 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 _Q. _ —kl 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) 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 11 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) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 60 Deer H011ow Road Marstons Mills,Mass. Owner: John D. Sorcenelli Date of Inspection: 3/9/9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes .. No Pumping information was provided by the owneroccupant, 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. 7'4a*1141(C As 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. _ The site was inspected for signs of breakout. _ All system components;tY<Iuding 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 djfferent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. 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)) (revised 04/25/27) Aey• 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION Property Address: 60 Deer Hollow Road Marstons Mills,Mass. Owner: John D. Sorcenel l i Date of Inspection:3/9/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow:_'V ,g.p. ./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no): � Laundry connected to system (yes or no):Y+l- Seasonal use (yes or no):A 2 nn Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):.&�Q Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: .UJ4 Design flow: /))t Rallons/day Grease trap present: (yes or no)QL/¢ Industrial Waste Holding Tank present: (yes or no)A// Non-sanitary waste discharged to the Title 5 system: (yes or no),f2, Water meter readings, if available:_ U/O A>4 Last date of occupancy:x_ OTHER: (Describe) Last date of occupancy: A� - GENERAL INFORMATION PUMPING RECORDS d source of information: n Y 4 AWOL-ill '<4 l o 7;0`1 � f i�G: ter, f';G� C.Fi,✓ System pumped as pan of inspection: (yes or no)aio If yes, volume pumped: 4,/ gallons Reason for pumping: ltw TYPE OF SYSTEM ALL Septic tank/distribution box/soil absorption system / Single cesspool Overflow cesspool AJ�1 Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other rjJ� APPROXIMATE AGE of all components, date installed (if known) and source of information: y* Sewage odors detected when arriving at the site: (yes or no)&0 (revised 04/25/97) Yay• 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 60 Deer Hollow Road Marstons Mills,Mass . Owner: John D. Sorcenel l i Date of Inspection:3/9/98 BUILDING SEWER: (Locate on site plan) Depth below grader Material of constructlo cast iron qo PVC _ of per (explain) Distance from pyrivate water supply well or suction line �— Diameter Comments: (condition of joints, vend evidence of leakage, etc.) n r ,7-- d xi 71T SEPTIC TANK:&i0w (locate on site plan) Depth below grade: w,4 Material of construction concreteoQ.4metalN�FiberglasWAPolyethylene4!aother(explain) 10uh If tank is metal, list age 4.14 Is age confirmed by Certificate of Compliance .V4 (Yes/No) Dimensions: A),4 Sludge depth: Ahq Distance from top of sludge to bottom of outlet tee or baffle:Q,44 Scum thickness:— NA Distance from top of scum to top of outlet tee or baffle: N/f Distance from bottom of scum to bottom of outlet tee or baffle:—,V,4 How dimensions were determined: AA 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.) GREASE TRAP: 'L (locate on site plan) Depth below grader Material of construction- ),4 concrete /WmetaIV/)FiberglasW..4 Polyethylene,44other(explain) ,yA Dimensions: 1V4 Scum thickness:—A),4 Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bonom of outlet tee or baffle:�i� Date of last pumping: 22/L 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.) (revised 04/25/97) Pago 6 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 60 Deer Hollow Road Marstons MIlls,Mass. owner: John D. Sorcenelli Date of Inspection: 3/9/98 TIGHT OR HOLDING TANK: &,t2Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade!_,djd Material of construction A&concrete.&Nmetalt[4Fiberglass 114Polyethylenew,!6pther(explain) &d AM y� Dimensions: 4,)4 Capacity: 44 gallons Design flow: tiA gallons/day Alarm level. /(/i9 Alarm in working order4h`/ Yes;ilk Nu Date of previous pumping: U_ Comments. (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:Ak/ e— (locate on s,te plan) Depth o: hQuid 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.) !S / © .SC%lJT_ PUMP CHAMBER:d-bVC, (locate on site plan) Pumps in working order: (Yes or No)-A2e_4, Alarms in working order (Yes or No)-,IQ4 Comments: (note condition of pump chambe(, condition of pumps and appurtenances, etc.) (r.vi..d 01/25/97) P.g. 7 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: John D. Sorcenelli Owner: 60 Deer Hollow Road Marstons Mills,Mass . Date of Inspection: 3/9/98 SOIL ABSORPTION SYSTEM (SAS):z ;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:, leaching chambers, number leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number:L Alternative system: At Name of Technology: dida Comments: (note condition,,of soil, igns of hyd auli failure, level of ponding, ondition of vegetation, etc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth-cop of liquid to inlet invert: Depth of solids layer. Depth of scum layer: i� Dimensions of cesspool: Materials of construction: G 8 Indication of groundwater: inflow cesspool m st be pumped as pan of inspection) C " le c 0I Shod" Comments: (note_ condition of As il, s� of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: 444 Dimensions: Depth of solids: Comments: (note condition of soil, signs of-hydraulic failure, level of ponding, condition of vegetation, etc.) (r.v1.•d 04/25/97) D.g. 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 60 Deer Hollow Road Marstons Mills,Mass. Owner: John D. Sorcenelli Date of Inspection: 3/9/98 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) s, 0 I • m 'Q o°? (r•vis•d 04/25/97) Page 9 of 10 w SUBSURFACE SEWAGE DISPi: L SYSTEM INSPECTION FORM I . C SYSTEM INFOI:'..: IION (continued) Property Address: 60 Deer Hollow Road Marstons Mills,Mass. Owner: John D. Sorcenelli Date of Inspection:3/9/98 Depth to Groundwater &r FeetAb-gr 50A Z¢ydL Please indicate all the methods used to determine High Groundwater EIL-.-a:ion: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, baserr4r*simp 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 E levat ion. Must be completed) Used water contours map. Gahrety_ & Miller Model 12/16/94 (zevizod 04/25/97) P&g. '100! 10 y .+nr+.—nrr—�-r- rn—mrnm nr�.n rn•r.rr..�r:•.�r+ervr:�+r-cram r.e�is**rr.r<r.mz T.Te+sr,-'--m-a TOWN OF OF Rarnct-ahl r. BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION `_ �•••at'SST••.••• _r. r.^..:r+1.r.rm•rt.Ta'i Tstrel•s7r anTn:�-9r'fm*r�R1rm—'+'1rt1*R1�+f/+T•4T*.a.�TCrs . arm ntmrRn so-r'-r.rr.r.—.rrrr-1. -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 60 Deer Hollow Road Marstons Mills,Mass ASSESSORS MAP , BLOCK AND PARCEL # _ �6 (34,y John .D. Sor:cenelli OWNER' s NAME , PART D - CERTIFICATION r NAME OF' INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Ifi`c: COMPANY ADDRESSBox 66 Centerville,Mass. 02632 Street Town or City Stat• LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 _ 1 578 CERTIFICATION STATEMENT .. I certify that I have personally inspected the sewage dispos�7 system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or, the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA sectiolj of this form. System FAILED* The inspection which I have con acted has found that the system fails to Protect the public health and the environment in accordance with Title 6 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature LDte One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF ItZAL1'1I. * If the inspection FAILED, the owner or"'oparator shall u wit}�in one year of the date of the inspection , unless allowweddortrequiredm otherwise as provided in 3.10 CMR 15 . 305 . partd . doc