HomeMy WebLinkAbout0082 FRAZIER WAY - Health 0'2 .Frazier Wdy
Marstons Mills
A= 057.006 007
i
DATE 10/28/06
PROPERTY ADDRESS 82 Frazier way
Marstons Mills
MA 02648
On the above date, the septic system at the address above was
Inspected.
This system consists of the following:
Based on inspection, I certify the following conditions:
SIGNATURE �-
Name: Robert A. Paolini
_ f
Company: Joseph P. Macomber & Son Inc .
er.
Address:4 P. 0. Box 66
Centerville, Mass 02632
CD
Phone: 508-775-3338 or 508-775-6412 _ _$
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N)
P i 'm�
JOSEPH P. ,MACOMBER & SON, INC.
Tan ks-Cesspools-Leachfields
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA.02632-0066
775-3338 . 775-6412
�•\ COMMONWEALTH OF MASSACHUSETTS
EXECU'i7VE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
d
TITLE 5
OFFICIAL INSPECTION FORM—.NOT:FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: .82 Frazier Way
Marstons Mills MA 02648
Owner's Name: George Wilson
Owner's Address: 647 Main Street
Hanover MA 023--19
Date of Inspection: 1 0/2 8/0 h
Name of Inspector: (please print) Robert, A Pao_l'ini
Company Name: �_ P. 11accomlelt .S:o.n Inc.
Mailing Address:
Cen e.¢vi e, a z. 02632
Telephone Number: 5 0 8-7 7 5=3 3 3 8
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 the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section.15 340 of Title 5(310 CMR I.&600). The system:
Passes =
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
F ' s
Inspector's Signature: Date: 10 /0, ®�
The system inspector shall submit a copy of this inspection report to the.Approving Authority(Board of Health or
DEP)within 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
DEP.The original should be sent to-the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
-�. time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of-II
OFFICIAL INSPECTION:FORM—NOT FORVOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION YORM
PART A
CERTIFICATION(continued)
Property Address: 82 Frazier Way
Marstons Mills MA 02648
Owner: George Wilson
Date of Inspection: 1 0/2 8/0 F
Inspection Summary: Check :A,B,C,D or.E/ALWAYS eomplete all of Section:D
A. System Passes: y�f5
I have not found any information which indi6atesliffi0any of the failure criteria described-•in 310 CMR
15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Commen :
e-
S-1>U6ifM
P P,.- In 1 YY1 C
B. System Conditionally Passes:
Y�Q One or more system components.as described in the"ConditionalTass"section.need tote replaced:or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not.determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
The septic tank is metal.and,over 20 years old*or the septic tank(whethei metal or:not)is:structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank;as approved.by.the.Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is.available.
ND explain:
YVQ Observation of sewage backup'or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection,if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levele"a br replaced
ND explain:
The system required pumping more than 4 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
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 82 Frazier Way
Marstons Mills MA 02648
Owner: George Wilson
Date of Inspection: 10.128.106
C. Further Evaluation is Required by the Board of Health:
{]2� Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
y� Cesspool or privy is within 50 feet of a surface water
Q 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 any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS).and the SAS is within 100 feet.of a
surface water supply or tributary to a surface water supply.
)VQ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more frotfi a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, 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,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
li
3
Page 4 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART A
CERTIFICATION(continued)
Property Address: 82 Frazier Way
Marstons Mills- MA 02648
Owner: George Wilson
Date of Inspection: 10 2£i 10 6
D. System Failure Criteria applicable to all systems:.
You must indicate"yes"or"no".to.each of the.following_for all inspections: .
Yes No ^
. Backup of sewage into facility or.system component due;to 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'h.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 SAS,cesspool or privy is below high ground water elevation.
_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ X 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..[This system.passes if the well water analysis,
performed at a DEP certified laboratory,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,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails.I have determined that,one or more�;ofthe above failure.criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner.shoulsl contact the Board of
Health to determine what will,be necessary to correct the failure.
E. Large Systems:
To be considered a large:system the.system must serve a facility.with a design flow of 1.0,000 gpd to 15,000.
gpd•
You must indicate either"yes"or"no"to.each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
Q the system is within 400 feet of a surface drinking water supply
_ the system is within 206 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 71.
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
Page 5-of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST.
Property Address: 82 Frazier Way
Marstons Mills MA 02648
Owner: George Wilson
Date of Inspection: 1 0/2 8/0 6
Check if the followinghave been done.You must indicate s or no as to each the following:
� g
Yes No ^
Pumping information was provided by the owner,occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
_ Have large volumes of water been introduced to the system recently or as part of this inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage.back up
_ Was the site inspected for signs of break out
Were all system components,excluding the SAS,located on site?
Were the septic tank manholes uncovered,,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems? _
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
Existing information.For example,a plan at the Board of.Health.
_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)]
5
Page 6 of i l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 82 Frazier Way
Marstons Miiis MA 02648
Owner: George Wilson
Date of.Inspection: 1 0/2 8/0 6
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of,bedrooms(actual):
DESIGN.flow based on 310 CMR 15.203(for example:.110 gpd x#of bedrooms):�Q_ .r•
Number of current residents:
Does residence have a garbage grinder(yes or no):jQ
Is laundry on a separate sewage system(yes or no): r [if.yes separate inspection required]
Laundry system inspected(yes or no):12Q
Seasonal use:(yes or no): �D�� 3L1,DDD( GQiSpY15 �,1�= �3,
Water meter readings,if available(last 2 years usage(gpd)): �(�f 7 h�=a�][T(�'j CrO 1(0n 5 (j-�• l�=tl3,
Sump pump(yes or no): �
Last date of occupancy: ca t
COMMERCIAL/INDUSTRIAL -
Type of estabJislin ent: 42 (l
Design flow(based on 310 CMR 15.203): a gpd
Basis ofdesign'flow(seats/persons/sgft,etc.) XJ)f a,
Grease trap present(yes or no):4CL
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: j(
Last date of occupancy/use: . ,,,)j Ct
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: 51p, mGfCOb f-_�''S't4-C'4'n,n
Was system pumped as part of the inspection(yes or no):Ip
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
Single cesspool
_Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):—
h
6
Page 7 pf 11
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 82 Frazier Way
Marstons Mills MA -02648
Owner: George Wilsorl
Date of Inspection: 10 j1 9 10 h
BUILDING SEWER(locate on site plan)
Depth below grade: �4 i
Materials of construction: 'cast iron _40 PVC X other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,'evidence of leakage,etc.):
SEPTIC TANK: /6(locate on site plan)
Depth below grader
Material of construction: concrete_metal fiberglass _polyethylene
—other(explain)
If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):-(attach a copy of
certificate)
Dimensions:�,�r �nf't t> gi 1�1 O L)i`AQ°
Sludge depth: `'
Distance from top of sludge to bottom of outlet tee.or baffle: 1 II��
Scum thickness: I "
Distance from top of scum to top of outlet tee or baffle: -7
Distance from bottom of scum to bottom of outlet tee or baffle: 11
How were dimensions determined:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of.leakage,etc.): -�+ RC
GREASE TRAP: (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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 8+2 Frazier Way
. Marstons Mills MA 02648
Owner: George Wilson
Date of Inspection: 1 o/2 81 o f
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass .polyethylene othef(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes.or no):
Date of last pumping:
Comments condition of alarm and float switches,etc.):
�' VOL* fb
DISTRIBUTION BOX:
(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence.of solids carryover,any evidence of
leakage into or out of box;etc.):
5 `f e
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
`Fum0 clluxr)�ek— 1 E mo+-- Oizesex�
8
Page.9 of I 1
OFFICIAL.INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C —
SYSTEM INFORMATION(continued)
Property Address: 82 Frazier Way
Marstons Mi s MA 02648
Owner: George Wilson:
Date of Inspection: 1 0/2 8/0 6
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
--X leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
S ;
S
CESSPOOLS:JVL(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
C'et�riS_ rake. y)(2e�� t1
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
F_az y Is no - kE"5 - mom
9
I
Page l0 of 11
OFFICIAL INSPECTION FORM . NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE-DISPOSAL: SYSTEM INSPECTION FORM i
_., PART C
SYSTEM INFORMATION(continued)
Property Address: 82, Frazier Way
ars ons Mills MA 02648
Owner: George Wilson
Date of Inspection: 1 0/2 8/0 6
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building:
1
47-
10
Page 1 Lof 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION.(continued)
Property Address: 82 Frazier Way
Marstons Mills MA .02648
Owner: George Wilson
Date of Inspection: 10128.106
SITE EXAM
Slope
Surface water
Check cellar _
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high groundwater elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed:
y e.s Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:a c .u j P_ - n.,?d
no Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explainA•-�/2.t own.i &a2n,6.t agie.,ma.-ua
You must describe how you established the high ground water elevation:
11-6ed Cape Cod Comm.iz.ion !da.tea 7agie Con.tounz And %uUeic ldatea Supl2.2y
Ne ,e head pao.tec.t.ion a/teaz map., Sent 1995
Gla.te2 ae,6ou2ce,3 o4—P-ice cage cod eomm.i'3.ion.'
Top of Ground
Leaching
Pit feet
Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore,the vertical separation distance between the bottom
of the leaching pit and the adjusted groundwater table is
feet.
11
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TOWN OF BAR1�iSTABLE :. Bow QF ULPA-mi �%���•�
.49UASURP'ACR SEWAGE DISPOSAL AYSUM INSPECTON FORM - PART D. CEItTIF1CATION
w•'7'Mt�T•SMtf�T1111'1tT1'gR11A'MA'IT�1l1/�/i�/'f11�MT.�•A•1 �* y .
-TYpt OA PAINT.01,E�ALY� •*'�•—•
PnQPERTY rNSPECTRD
STREET ADDkES$ 82 Frazier a Marstons Mills 02648
A-83•ESSORS MAP, BLOCK: AND 'PARCE'L � U�
OWNER's NAME George :--W son
PART:D -• CxRTIFICATION -
NAME 'OF INSPECTOR 'Rob,.ert. A-:-pa03iai
COMPANY NAME
COMPANY AADWS f: :-Bo*`66:..Cor .will& A 'b-,H;3.2-0068
Str• k' Town'. ty..
COMPANY TEUPHONE (
508. ) 7.5 3338 FAX 508 ,,i790 f 578
C]3RTITICATFON. STATEMENT
I certify that I -have persorial,17Jns•peoted ..the elewage digpo9a`i• system at
this nddress and that ;tt1e information reported .is true
omplete as of the time .af � ns eatiop., '' aavara•te., and
i P Tl�e insPept:lOn was per-tarmed and any.
recommendations regarding .upgrade•, .ma•inte.nitnoe 1'. abd xeps.ir are• eon is'tent
with my trainiklg and exp,orience in th@ proper furroti-on• and rttaintenanoe of on-
s i to sewage disposal, systems
Check one;
Systeul PAS92D _
The inspection whic•h. .I. mation
'have .•oondugted has •,n•er't' found any infor .
which Sndicateg• that• .the system' ,falls to ade,j.uate,ly,p�oteGt publi•o
health or the envi•ropment as defined in. .310 CMR. 1��s03,
criteria riot ••evaluafed' are as stated in the FAILVIZ CR Ry f$blur
this form. ' seat i
System FAILED ~
The inspec•tioh wfiicir T have 10o6cm6ted 'has found that 'the*
protect the public health Rnd tho enV4ronM' en•t ' in aogoxdanc�esctriChfT t�etQ
61 310 CMR 16 , 308j and as • speeiflcallY noted -on .PA'RT- C .•w. FAILURE
CR•.ITERIA of this inspec'ti,on .form, ,
Inspector' Signature*
Pne copy of this cert.i, f ioat•i'ah must •be rrovided -to the ,gWMR•1 t. g BUY$R'
where appli'.oable) and thlp DPARD OP' HEA T!{.
* rf the inep.eet$on FAx'L'Eb•,
ox tion, to •e.he►1,� . uPgxar�e'.the eYetem.
wlthin one year of the da`t•e of the inspeotion� unless• a1;'ldwsd 'Qr. ree�i,red •
n t.harw{se. av Provided in �110 CMR 16 , 306 ,.
LO CATION S T A G E PERMIT N0.
7 (//
VILLAGE _
//�v-a r
INSTALLER'S NAME i ADDRESS
►4
BUILDER OR OWNER �s
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED 1„��
ry
f
1�
ci c k
LOCATION e-Y Acr SEWAGE PERMIT NO.
V;iLLAGE
INSTALLER'S / NAME b ADDRESS
R U I L D It R OR OWNER
fle y
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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�-� !0 ��
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