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Home My WebLink About0071 BODICK ROAD - Health i �71 BODICK RD: HYANNIS 1 A� - 9 J TOWN OF BARNSTABLE LOCATION QI l JtL AQ� SEWAGE # 'VILLAGE S ASSESSOR'S MAP & LCOTL � 9PG�7=!,NAME&PHONE NO. �`: 6 Co SEPTIC TANK CAPACITY f Q00 ,QO/IO/) JeO4Tc_ LEACHING FACILITY: (type) �' �// (size) _/000 _01T NO.OF BEDROOMS BUILDER O OWNER PrKi)'1.4 (�CiGF C' 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 Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by _ l �� 6� ��_ 0 J� � . s TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops Kry unsatisfactory- 4.Manufacturers COMPANY J�3 /� �,t �� (see"Orders") 5.Retail Stores ,L' 6.Fuel Suppliers ADDRESS -71 do-ktd Class: 7.Miscellaneous � LTANTITIES AND STORAGE (IN=indoors;OUT-outdoors) MAJOR MA ERIALS Case lots Drum's Above Tanks Under&n-ound Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 0 Town Sewer ublic On-site 91Private 3.Indoor Floor Drains YES----NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES�NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler 1Product , YES NO 2. 9,1 Person(s) Interviewed Inspector Date I -John Davis s t- -Branch Manager", G z-T0RRICO`-Co.anc. Distdbutors'ot Heating'&Air Conditioning Equipment 71 Bodick Road Hyannis,MA,02601� s;BEVERLY MA HUDSON,NH (978)9277120 Phone (508)790-8856 (100)335HVnc y; ,FRANK LIN,MA .FaX' �rJ08) 790-7024 RANDOLPH,MA , (508)541-9014 i Y r- *_-;ti (600)727-HVAC` HYANNIS,MA " FABRICATION SHOP SHOP ESTIMATES:r WOBURN;MA (508)790-8856` (781)938-9334 (781)939-5997 r-(800)888-8359 TOWN OF BARNSTAB :rsatisfactoryPI.IANCE: ]CLASS: 1.Marine,Gas Stations,Repai BOARD OF HEALTH 3.Printers to Body Shops atisfactory- 4.Manufacturers COMPANY` ! "Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS _ Class: 7.Miscellaneous QUANTITIES AND STORAGE IN= indoors; - ( doo s,OUT-outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) es eros ,,#2(B) 141 Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: -� 07 .moo � L ;0_0 IV 444 Y. s 17 14,5 DISPOSAVRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply f" G�c �- O Town Sewer JrPublic On-site 'OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC_ ��•/ O Catch basin/Dry well y� c O On-site system 4. Outdoor Surface drains:YES LNO ORD RS: O Holding tank:MDC O Catch basin/Dry well 11 neAeovL O On-site system _ 5.Waste Transporter YES NO 2. Person (s) Interviewed Inspector Date s Y7W;ti o� :Do-rCtS'�cn(0�2 �V COMMONWEALTH OF 1V SSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENmoNMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02109 (617)292-6b00 TRUM COXE flscratary ARl.EO PAUL CELLUCCI BAVM B.1STRUNS IAiSNRFACE SEWAGE OKPOBAiI SYSTM MptPECTNM 011M Coantassiot►er PART A CONIVICATI0M Ptttp wW Ad*mw: 7/, ,,uL ICJ` NOM at Otnur, t uI1✓a`4, VnQy�,oa41 Ad dress afOrrr�.r__ Draaofrbm**rsn: (� ( 91 9 ,/ �( yarhas frt&15 Oakot. Mane►of rrt.p.ea.:Ala.a.(�-,�.�L�L�T� , l san a o6t apratred srsaste tnrtpaetar pttrwtarte m Secttau 16.U0 o'Tine 6(310 CMR I6.000) ON gowty Nana: Maihig Adtbwr: Awiftarlt*wvwownea(iai Senpeefiieviiii, Talapho s 1Wn I : ___ '7 P.0.Bore m DODUIB"I%ASEAN.ami I co". that I have personally Inspected ohs sewags disposal system at this address and that the information reported below is true, accurate and complete as of the time of Inspeetimi. The inapectlen was performed based on my training and experience In the proper function and maintenance of en-alto sewage d oossi i ystems. The system: Passes Condltlonally Pimoses _ Needs further Evaluation By the Local Approving Authority _... Fab T� t blownw'6 aflame: Dona: . The System Inspector shall submit a copy of this Inspection report to the Approving Authority 18oard of health or DEPlwhNn thirty 130I days of completing this inspeedon. "the systow,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 Depw&nom of E"Wonmemal Protection. The original should be sent to the systsim owner and copies sent to the buy or,If applicable, and the approving authority, NOTES AND CONIMENTS 3 ti 4 rr nVISNe Il loo wlaol 666T 6 l n r 03AIM14 revieed 9/2/96 Polls tefit Primed on ROCYCiM P.P., t 1: SUBSURFACE SEWAGE DUU4MI SYSTEM MPECTHM FORM PART A CERTNICATION IaenYeswdl Prwraey Aftese: ( ZOAACic 1L.� owrg.: Gore ofto of b►tPaeoan: 7 (S9 S/Somilc a N=UMaARY: Chad* A. t, C, or D: A. BYSTISIN PASM: I have not found any Irformatl,)n which Indicates thot any of the failure conditions described in 310 CMR 16.303 exist. Any foakoe criteria not evaiueted are indc:itted below. COBH189rE8: S. BYSTM CONDffN)UAUY PAWN: One or more system components as described In the "Condidonsl Page" s �nad�tobe replaced or repaired. The system,upon completion of the replacement;or repair,as approved by the Board of th,w. pa . locate yes,no,or not determined(Y.(N,or NO). Describe basis of nation in sM Instences, If"not determined", explain why not. The septic tank Is maul,unless tht ownor or ator Ms provided the system Inspector with a copy of a Certificate of Compliance(.nacM:l)h►/Ncedng that tM waa Installed within twenty(201 Vows prior to the deft of the inspection:or the septic tank,whalher or not nwtal,it aeked.structurslly unsound,shows substantial infiltration or exiftration, or took failure is Imminent. "lie system will is inspection if the existing septic tank is replaced with a complying eepde tanit as approved by the Boa/orunov*n _ Sewage backup or b+ atic water level observed In the distribution box is due to broken or obstructed pipols) or due to a broken,adistribution box. Ths system wGl pass Inspection if(with approval of the Board tf Health?. broken piPa(el are replaced obstruction N removed d(sullardon box Is levelled to replaced The sys required,xrrnping more then four dines a Vow due to broken or Obstructed pipa(s). The-sys%m will pass 1 If(with apixovel of tM Board of Health): broken plpa(s)we replaced of 11truc"On is removed revised 9/2/98 l►s�r:oftt SLWUiFACE SEWAQE OIiPOSAL SYSTEAA INSPECTION FORIAR PART A 001 VICATION iaervWnw 0 Property : 71 I -cIc CA Owner: K Deft oe b00'"t)sta 6 IaCCCS C. FtJ MIM EVALUATION i RELIED BY THE BOARD OF HEALTH: CorAltions exist which require fuller evaluation by the of Hsal�in order to d~r(Ane If the system is faling to protect ith* public heelth,safety and the aiwiroransM, 1'l SYSTEIM WILL PASS L�sQ WARD OF LTH DETERo11WES N ACCORDAR=WITH 310 CMR IL30311HN THAT THE S'MTABR w NOT FUNCTIMING W A M,►NN WILL PROTECT THE MJSLIC HEALTH AND SAFETY AND THE 9MR01&AMT: Cesspool or privy' 50 fast of surface water Cesspool or pd ttvithin SO feet of a bordering vegetated wetland or a ask marsh. 211 SYSTEM VALL FAIL UNLESS TIE BOARD OF HEALTH(AND PUBLIC WATER SUPPL>tFA.F ANY)OETERRW=THAT THE SYS1IRA E FUNCT10NM0 N A MAIIM116 WAT PROTECTS THE PUBLIC HEALUI AND SAFETY AM THE EUVMi)AMAEAIT': The system has a NIRIC tank and soil absorption Sys IS)and the SAS Is within 100 fast of s surface water sup tly or b1but"to a aurfeee water,supply, — The system has a septle tank and soil ab on system ami the SAS is within a Zone I of a public water supply well. _ The system has a se;4c tank and sorption system aent the SAS is within 60 test of a private were►supply well. 4 The system has a a" tank I absorption eYstsm an,t the SAS Is lass than 100 feet but 50 foec or more from■ private wow supply, a well water analysis foe colMnn baetaeis end voiatle organic compounds cates that the we"b free from poNu:on that faciMgr and tM pnssnas of ammwtis nMrogen and rebate nivogen is equM to or was than 5 ppm. Method u to datwmins dbtanoe �®lappoaie+adon not vetlid). 3) OTHER revised 9j2/98 PW3ofit SLIBS JRFACE MWAQE DISPOSAL SYSTEM MASPECTM FORM PART A C®i11 Aran(earafirm m PmWW Addreaa: 7r DesU of loan: N. SYSTM PARS:: You must indieata afther"Yet" or"No" to each of the following: I have determined that one or more of the following failure conditiorui exist as described In 310 CMR 16.303. The basis for this, determination is identified below. The Dowd of health should be contacted to determine what will be necessary to correct the failure. Yes• No Backup of*swap Into fact llty at system component Are to an overloaded or clopped$AS or cesspool. _ Discharge at pondln,l of effluent to the surface of this gre o� r surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level In the distribution box abo outlet Invert due to an overloaded or ck Mad SAS or cesspool. Liquid dspth in oessliaol is lass than below invert or available volume is less than 112 day flow. r _ Required pumping more then mes in the last year fW clue to clogged or obstructed pipels). Number of limes puritped Any portion of 204 Absorption Systenp,Cesspool or privy is below the high groundwater elevation. An/Anyfftm ortion ofnpool or privy is/ithim 100 feet of a sautscs water supply or tributary to a surface water supply. a cesspool of privy'is within a Zone I of a public well. ® s Cesspool or privy Is within 60 feet of a prhrete water supply well. a oearpOcl or privy is less•than 100 foot but greater than 60 feet from a private water supply well with no er quality analysts. If the well has been analysed to be acceptabls,attach copy of wall water analysis,for la,Val stile organic eompounde,ammonia nitrogen and nitrate nitrogen. r E IUUM$YSTEM PARS: You must Indicate either►"Yes" or "No" to each of th wine: The following erluide apply to lance sY s in addition to the criteria above: The system serves a facility w a design flow of 10.000 Spill or West&(Large System)and the system is a significant threat t4)publk: heahh and as"and the ronment because one or mere of the following conditions exist: Yes No the�*`*m Is within,=feet of a surface drinking water s opply is within 300 feet of a tributary to a surface dri&U"water supply the system is locatsd In a nitrogen sensitive Was(Interim Wollhas l Protection Ares-fWPA)or a mapped Zone 11 of a public wow super well!) The olamsr apa►ata►of any such syate tr ahafl upersde the system in accordaroee with 310 CMR 16.30412). Plosee eornult the local refionsl afflas Of tin Osparansrtt for WwOre►IMmti nation. revised 9/2/98 r.Ve 11 IM11116Id1VACE SEWAGE DUIVOSAL MUM MMP2CT ON FOIIIM PART s CHGCMAT 7( $odes rf Qca 6 Chock It the following have been dona.'lou must Indicate either "Yes" or"No" as to each of ttw following: Yes Me Pumping Information wes provided by the owner,occupant,or Board of Hoeft. S None of the system aampononte have boon punoppd for at Ueest two weeks and the system has boon roceivving normal,Iloow rates during that owl3d. Large volume@ of water have not bean Introduced into the system recently ot as part of this 11111400,01101111. As bunt plane have been obtained and examined. Note if they are not avoilaWe with N/A. _ The fad$ty or dweiffrq was inspected for signs of sewege back-up. _ The system does not receive non•so itery or IndustAol waste*ow. ,s The sift was Inspected for signs of breakout. _ AN system componorov,excluding the Soil Absorption System,have been located an the site. The septic tank manklAts ware uncovered, opened,and the interior of the septic tank was Inspected for condition of baffies or too*,nw*W ai of construction,dimensions,depth of$quid,depth of sludge,depth of scum. The site and location tyf the log Absorption System on the site has been doterminod booed on. — Exkrting Information. }'or example, Plan at B.O.M. _ Determined In the field fit any of the follwe oriterfa related to Port C is at issue,approximation of distooee is unaccept@blel I1 g.302(3)fb)) _ The fooMy owner(01+4 occupants,If different from ownw)were provided with information on tM proper maintenance of =ubSurtsas Dispood Il;yatam@. ., revised 9/2/98 Page 5of13 IIC SUBSURFACE SEWAGE DISPOSAL SY'STM tfISPECTIOM FORM PART C SYSTEM f1111O11MATINI : 7 .�ea Dow!of lrtspemllsn: 6( (99 FLOW CONDrM 1S INMEMAW Design flow: a.V.d.Androom. Number of 16-d m(design):_ hhnnber of bedrooms(ectuall:— Total DESIM flow Number of current rooklw s:_ Oerbepa phWo(yes or no1:_,,., Leumdry temperate system) (yes or nol:._,: M yes,separate inspection required Lanmdry system lrtspectad (yes or no) Seasonal use(yes or no):_ Wear motor readings,if overable(hat trvo yews usags(gpd): Sump Pump typo or no):_ Lost date of occupancy: T5� Type of es"Mishment: lJ�t�nJ°T+t+ce' beelt Design Saw:� Booed on �39 Beam et daeipi 4hw ( � -. Oresse trep pr000m.(yes or no) . WAus rtai Waste Folding Tank present: (Yes or no)—%& Won-sronftary waste discharged to the Title Water nwo toodOnp,if ovallWo: Lest dete of ecoupeney:,�, O'THOR:(Ooecrlbe) •.met asRe of occupancy: OERIEAAL BMORMATIM Po♦IMp11ifG RIBCOR$ d r infoviv" ' System ��,satio :(ya or nolL If"a.volume pumped: .—*.Nora Resew for pumping: TYPE OF SVISI IB1 ._ Septic tw*ldetl�oa/eoil absorplion system Slinolis,cosepo OverflOw,Osespow _ Pd" _ Shared system(yes or no) Of yes,attach previous Mspectlon reco►da,if sny) _ I/A Teclaiology etc.Attach copy of up to dote operation end maintenance contract Tight Tmnk Copy of Oil:P Approval Other APM O)ONATE AOE of erg components,elate installod(if known)end~ao of information: Se"18 odors deteatod when entAV at the Site:(yes or no)rib revised 9/2/98 Pap 6Ofit SUBSURFACE SEWAGIS DMVSAI SYSTEM WSKCTWAI FORM PART C SYSTEM ll>1rFofaaATfoffi lewnwarad) chom Data r tra4aafdata WJLDINQ SIEWEII: Kocsto on site plan) e< 00*below grmkx Met•IPlal of ooratnl0tlon:v can Iron 40 PVC other lexpfaln) D(sterm 1 pdva"water supply weN it suction Nne Diwnwtw Complerrta:tcardlgon of)Wets,venting, evidence of leakage,etc.) SHOTI C TAW _ flocale on stta plan) '` D@Wt below graft: T Mww4l of eorasruction:Aceonents_jwtal_fabarglsss _Polyethylene_othwf•xpIsin) If tank is metal,list sge_ Is age conf rmed by Cwdficat•of Comomme_ (Yesmal DNrarnlons: Sludgis depth — Disternco from top of s)ydga to bottom of outlet tee or beflle:I, Saw t(Mo Sokness:�, ° _ N Diswee from top of scum to top of outl44 tee or b•f11•:. ff rr Dbtarce from bottom of scan to bottom of outlet tia or baffle: t low dk w olons was debreMrnd: Cornri►santa: freconxnendsoon for pumping, on pf Inlet and outlet toes or befft depth oil!• in relationrelation to outlet�a rt,etruetunl' tity, SEE TttAP: (know on ske pNnl Depth below graft_ Material of comtruotion:_concrete_natal _Rbwgl 04etfny9•rns_athertexplain) ONn•nalons: Sown dOckness: Ditpsnn from top of sarm to top of tea or baM•: Dlsteno•from Bottom of scum to of outlet t®e or bafM: Do"of last pumpkv: Comments: (recomrnwndedsn for pu ng,condidan 4 Inlet and outlet tsss or baffles,depth of Ngnaid level in relation to outist invwt,structural hrtagrhr, edmence of leakage, rev ;.sed 9/2/98 PRIP7of11 I SUBSURFACE SEWAGE DISPOSAL SYSTM WSPECTWN FORD 'ART C SYSM MPOIIMAT1pN(aaoilim" P#WmiV A/iaaa: 7( 17AX(< R;S- Dads of- I -0°'a TWHT OR NOLOW T\ANK. (Taejb.must be pumped prior to, or at time �spoction) (kmm an also pion) Depth below Wado:� Masorfat of comtruetbn:,coecrete._.metal,Fibasla s olYetfiylene_otiwrlexplaMi Oklooneloros: _ Deeipn fk>Mr: Sallor s/day Akan preoent Ah m hwal: Akan In kings ordov Yes No- Daft of previous pu W11 — Consrnants: (condition of Wdet too,c of aierm and float switches,etc.) DWUMUTIM W3L (kwoo on via plenl Dopfhi of Nguid level above oulat invest: Comments: (note if level and dlsvftd dome of solids carryover,evidence of leakage Into or out of box, etc.) 101 PUM,CI�11111:— Ikoca+as on aite pion) ftaw"in workkq order:IYea or No) Alsi me in wwtft order(Yes or �. Camnonts: (note eandkion of pump o an h ,eondhion of pumps d appurtenances.aft.) revised 9/2/98 +�r» S USUMACE SEWAQE DISPOG1L SYUFr,MI MSPECT*K FOM PART C SYSTEM WFOfM ATM(ewrdnued) Owner. 7( o t�o�1cLC i Dat O-0 Pill : SDS,ASSOirT10M arsT>M I. n (iodate on aft per,If posblec axe not required,location may be approximated by non-intrusive methods) It not located.espidn: Type. badntrng plb,number:- isaohing chambers,rw nber:_. Nod"gallaNea.n m ilw trenches,numbs,IsM the leaslWng f�,number,dimsna�ons: ow flow oesspool,number:, Alternative system: �1 Name of Tschrrology: CommwKs: (nate l:ondi o4• `I,signs Ithydraupc failure,level of on nA, son,con Don of veg tat) , et .1� L\ VA s _�� O Nc� tidLQto CBgNOOLS: (locate on aft plan) Numbiw and oenliqu►edon: --lepth•top of Nquld to We invert: epth of.ones lays►: Oepth of sewn NW: Dhnamions of cesspool: MlsteAmb of construction: Indication of gronrndwata: Inffew(ampool must be pu d as pat of Inspection) Conampnts: (note c a Milan of soil, of hydraulic la lure,level of pondieg,calms an of vegetation, etc.) POW V.:_ fiocata en aft plan) IMeterkils of aonetruotlon: Depth of soNds• Dimensions Carnwnntvnes: drauN (now cimditlo n of soil,signs hye L�Iiwe,Nvel of pending,cerAtlon of vewetatlen. etc.) revised 9/2/98 �,�� f SUSSURFACE SEWAGE DISPOSAL SYSTEM MPECTWN FORM PART C SYSTEM t�011#NAT10M taaMMaredl AeastY AdlAaw: �� t7t��C`C Owner: GOV& Data ell t 0aallera sla MH OF SWAGE MPOM SYSTIA. k+dude ties to at least two permanent reference landmarks or benchmarks locate all wells wlthln 100' Mccats where public water supply comes irrtc houssl a 37 revised 9/2/96 Polls isof11 l;USSUVWACE SEWAGE OWVSAL SYSTEM M=PECTWM FOIMO PART C SYSTEM ON40 MUTM Coodba" Pre..rtlr�• 71 Ownsr. Cscf`l om"4*11 P id P NP1CS Mpol nenne _.. Sol Typo_ —_-- Typical depth to groundwater_ USOg. Dow wsbaits visksd Observation Wells chocked Oroundwow depth: Shallow_ Moderste ---DO" — SITE[EXAM Skrpo Surface water Check COW Shallow welts Estlewted Depth to Groundwater al Feat Plasss hedfeste all 00 msehods veld to drtermins High Groundwater Elevation: Obtained from Design Pirw on retard Observed Site(Abutting property,observation hole,basement sump ate.) DetanyOned from local oortditions Chocked with Wool go"of health Checked FEMA Maps Checked pumpino records !_Chocked local excavators.instalkrss. Used USGS Data Dascrilho how you estaW~the Filch Groundwater Elevation.1&0 be comphrtsdl lee*a- Ooz QjAkk revised 9/2/98 INVitoru 3 4 ca FEB 1 a 199� � NSTABEE :: TOV H�TMDEPT. BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 rl 508-771-9399 508-428-8926 FAX: 508-428-9399 Oj 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION Property Address: / - Date of Inspection: Inspector's . ame: ,lame Name and Address: d CERTIFICATION STATF ENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The System: V Passes Conditionally Passes Needs Further Ev luatio y ie Local Aproving Authority , Fails Inspector's Signature: Date: �171" The System Inspector shall sub t a copy of this inspection report to the Approving authority within thir- ty(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* A)SYS,T PASSES: I have not found an information which indicate s cs that the system violates any of the failure criteria as defined 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 comple- tion of the replacement or repair,passes inspection. Indicate yes,nor,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 exfilration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup 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): 1 - , f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r CERTIFICATION (conlinucd) Broken pipe(s)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 FUNCTION- ING 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 water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 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 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 the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 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 into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year ND-T due to clogged or obstructed pipe(s). Number of times pumped -2 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 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 wetl. 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 coliforni bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 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: 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: ✓Pumping information was requested of the owner,occupant,and.Board of Health. -None of the system components have been pumped for atleast 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. ✓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. t/All system components,excluding the Soil Absorption System, have been located on site. _/The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees,material of construction,dimensions,depth of liquid, pth of sludge,depth of scum. he size and location of the Soil Absorption System on the site has been determined based on existinginformation or approximated non-in pp b} trusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RFSIDFNTIALt/e--) Design Flow: gallons Number of Bedrooms: Numbcr of Current Residents: Garbage Grinder: Laundry Connected To System: Seasonal Use: Water Meter Readings,if available: Last Date of Occupancy: O M .RCLAL/INDUST I (� Type of Establishment: Design Flow:_,j 0 gallons/day Grease Trap Present: (yes or no) �C) Industrial Waste Holding Tank Present: ,()U Non-Sanitary Waste Discharged To The Title V System:AA) Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: G't? GENERAL INFORMATION PUMPING RECORDS and source of infonna 'on: )ez)el- �Ea? System Pumped as part of inspection:_ If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Sod Absorption System Single Cesspool Overflow Cesspool 1� Privy Ahared System(Ifyes,attach previous inspection records, if any) Other(explain) `G---/�7,7 ROXI , T AGE of all components,date installed(if known)and source of information: Sewage odors detected wh6d arriving at' ie site: X-9,(-) -4- a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: I/ Depth below grad Material of Construction: crele metal FRP Other (explain) — DimisioM: S-/ _Sludge Depth: Cn I Scum Thickness— Distance from°top of sludge to bottom of outle-tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid. level in relation to utlet invert,structural ' tegrity,evid e of.le age, etc. Q, l .GREASE TRAP: Depth Below Grade: Material of Construction: concrete metal FRP Other (explain) — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: 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.) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:_concrete_metal_FRP Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments:.(condition of inlet tee,condition of alarm and float switches,-etc.) DISTRIBUTION BOX:dU 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:( Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) - -5- j y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): to on site 1 if possible;excavation not required, m(� pan, po q , 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: Comm ts: (note condition�olsoil,�sign, f hydraulic failure lev I of pondin condition of ve etation, etc.) p CESSPOOLS: 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. 4 Ln1 39 , DEPTH TO GROUNDWATER: Depth to groundwater: 1 Feet ' 2 Me od of Determination or ApProxima 'on: ? -7- 8-10-2000 10:34AM FROM HYANN I S FIRE/RESCUE 508 778 6448 P. 3�, l ' Make application to local Fire Department. V Fire Departmersp'"Vins orlglnai applications and issues dya4;ate as Permit. h\r A�.PL��1 `f •�1V9nd PERMIT Fee: 0 _ for storage tank removal and transportation to approved tank disposal yard in accordance with the Provisions of M.G.L. Chapter 148, Section 38A, 627 CMR 9:00, application is hereby made by: r'ank Owner Name(piease print) Multi Brands x �na,'sr•;, WYiN taraewrr' Ai;f/r'e65 71 Boy jrk Ed. Wd Lannl c - MA 026()_1 Street Crry S;.xa z:� .)ripunvNGma Advanced Environmental Not _ Co or individual l' .O :Box 472t:-, Atlantic Ave. Address Signature ap der it Signature(if applying don permit) I IFCI Certified Other p lFCI Ceritied i7 LSP# Clhc+r ::o::atW 71 Bc�dick Rd. ,. ijvannis', MA --- StWrr Ads• - u131!c ad at;ty(gallons) 1 OOQ Suoslance Last Sto(ec. 42 ;fnk Dimensions(diameter x length) ^emarks� i — rJ yU r r'ircr,transportingwaste Advanced Environmental8tatgLic, # V5083656100 Haz.ardoJs'w&ste manifest# E.F.A.# _. —__; Approved tank disposal yard J-G.Grants C o. Tank yard# _ 035016 7,pe of i.)ert gas `��`� rank yard address __r3ea_dvi l l e,: MA FDID# ��,�d�-2 Peemits ita of issue Gate of expiration _ _�4 __— care approval number: 971304676 Dig Sale TollFree Tel. Number• OGO 322•4 4 j Signature/Tide of Officer granting permit " 'AKP.1IIZ FI R-EFI R- gREVU iM-=" " Alter removals)send Form FP-29OR signed by Local Fire Dept.to UST Regulatory Compliance Uni 0"N t UPWBEXT rtioom 1310, Boston,MA 021 00-1 61 8. HYANNIS,MR 026D1 8-10-2000 10:34AM FROM HYANNIS FIRE/RESCUE 508 778 6448 P. 4 RECEIPT OF DISPOSAL OF UNDERGROUND STEEL TORAGE TANK NAME AND ADDRESS APPROVED TANK YARD un A - APP 0, 'TANK YARD NO, #�$ _ Taa Yard Ledger 502 CMR 3.0344) Number; deli` eYd �psenaalty of law I have-PersonallY exaoaiaed the �d s tar pprwed tank Yard by,tija. Corporation or partnerahiP � Regulation 502 Q'R 3.00 Psw1-Sioard A fOr ac.epted saro�e of eot�ot�ie with Ma49aGhUS . F1re �eVPJft1Cn rmd of 6�desy:Qusd Steel Storage dismantling Yates this 33 y SSued �' LDCAL Head of Fire �Arit F9IDY OLCD trans Port Nome Off,, avid tank yard w4fer or OAT=$ e�uthori:ed reprP�S+PIItdtlV�e: r TI9 `0� 4�`aS-g7 � sz !! shis al receipt of q*Sai east be returned t4 the local Read of the fire depot FDVI�2 �c?—pursuant to 0 900. EA04 TANK KW WE.A II�.M Cr DISPQ&AW FORM F.P. 291. (rev, 11/95) (OVER) R15bR'rS SPATE FII�W-41AL'S FICA i Tank Data Tank Removed From: Gallons 47o tie- N �( o.. and:tSttreet ) Previous Contents�� !`► t� A yv/s � Diameter-_�[k--'-'Length j!Z� ( City or Towrl j Date Received Fire Dept. Permit #� Serial # (if available)_ Wank LD. # (Form FP-290)— Owner/Operator to ,mail revised copy of Notification 1Form(FP•290, or Fp1290R) to: UST Compliance, Office of the State Fire Marshal, 1010 Commonwealth Avenue, Boston, Ma. 02215.