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Home My WebLink About0065 BRIARWOOD AVENUE - Health Z ,B iarWood Avaen e - Hyannis P A = 289 085 r 0 0 I I I e 0 TOWN OF BARNSTABLE LOCATION '/65-ta W001A JQOC- SEWAGE # �L VILLAGE I PUAIAJ�T A�A°7" ASSESSOR'S MAP & LOT E -ORR5- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /S®® 6s77 LEACHING FACILITY: (type) PgF—r-.4S7" e) YO `X 3o X l--�— NO.OF BEDROOMS -rW O 3 47wc ArPvv.Ja BUILDER OR OWNER auaL PERMITDATE: / _COMPLIANCE DATE:_rl�/��d' 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) UJ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o -2 � oZ C454J 0Or 9Er - 2 b 4 6RiAR wvv of hoc J -\ COMMONWEALTH OF MASSACHUSE17S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF..ENVIRONMENTAL PR VED JUN 0 2 2004 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION rty Pro a Address: 6 5 'Br i ood Ay n rw MAP p a e ue Hyanni sport., MA PARCEL, O . Owner's Name: T)Pnni c; Ki 1cj�iff Owner's Address: `CT ' 1 Date of Inspection: Name of Inspector.(please print) W i 11 i am E_ .Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (508) 775-0776_ CERTIFICATION STATEMENT 1 certify that 1 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 15.000). The system: &.04es Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails fl Inspector's Signature: w L i( ,.� Date. 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 now 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 -- l Page 2 of 11 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPO SAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: 65 Briarwood Avenue Hyannisport, MA Owner. Denis Kilduff _. Date of inspection: Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A. System Passes: 1 have not found any information which indicates that any 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. Comments: B. stem Conditionally Passes: One or more system components as described in the"Conditional Pass."section need to be replaced or repaire .The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.• Answer es,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. Th septic tank is metal and over.20 years old*or the septic"(whether metal or not)is structurally unsound, xhibits substantial infiltration or cAltration or tank failure is imminent_System will pass inspection if the existing is replaced with a complying septic tank as approved by the Board of Health. •A metal eptic tank will ass inspection if it is P P structurally sound,not leaking and if a Certificate of Compliance indicatin that the tank is less than 20 years old is available. - ND expl in: bservation of sewage g backup or break out or high static water level in the distribution box due to-broken or obstru ed pipe(s)or due to a broken,settled or uneven distribution box.,System will pass inspection if(with appro al of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND expl in: Th system required pumping more than 4 fumes a year due.to broken or obsut.�cted pipe(s).The system will pass inspe ion if(with approval of the Board of Health): broken pipes)are replaced . obstruction is Itsmoved ND explain: 1 Page 3 of I 1 OFFICIAL INSPECTION FORM-'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 Br i a rwnn Avenue Hyannisport, MA Owner.• _ Date of Inspection: CJ L 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 fai' g 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.environi ent; Cesspool or privy is within SO 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 any)determines that the . Sys em is functioning in a manner h .Y g that protects the ublic heap p p h,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. _ The system has a septic tank and SAS and the SAS is within a Zone.i 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 SO feet or more from 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: 3 Page 4 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 Briarwood Avenue Hyannisport, MA Owner: Dennis Kilduff Date of Inspection:. D. stem Failure Criteria applicable to all systems: You ust indwate'Yes"or"no"to each of the following for all inspections: Yes o 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 town overloaded"or clogged' AS or cesspool Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or 4 cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number 4 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 I00.fe.et of a surface water supply or tributary to a surface water supply. Any portion of.a cesspool or.privy is within a Zone 1 of a.public well. .Any portion of a cesspool or privy is within 56 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 f^_et from a private Kaim 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 S 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.1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. & L rge Systems:To be onsidered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You in ast indicate either"yes"or"no"to each of the following: (The f illowing criteria apply to large systems in addition to the criteria above) yes 0 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tribunary 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 If yoqha,a answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in ection D above the large system has failed.The owns ar operator of any large system considered a significa t threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304, system owner should contact the appropriate.regional office of the Department. 4 L Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.B CHECKLIST Property Address: 65 Briarwood Avenue Hyannisport, MA Owner. Dennis Kilduff Date of Inspection: t-� Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes f4o Pumping information was provided by the owner,occupant,or Board ofHealth _ Were any system of the s t em components pumped outin the previous two weeks _✓ _ Has the system received normal flows in the previous two week period? ZHave 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 baffl r es otees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? v/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 ny 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)13 10 CMR 15.302(3)(b)J 5 Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 65 Briarwood Avenue Hyannisport, -MA Owner: Dennis Kilduff Date of inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#ofZed—rooms): 3 G y Number of current residents: Does residence have a garbage grinder(yes or no): b Is laundry on a separate sewage system(yes or no): a (if yes separate inspection required] Laundry system inspected(yes or no): �A,6 ` Seasonal use:(yes or no): �! 3 Water meter readings,if available(last 2 years usage(gpd)): 2003 - 19 5 0 0 Sump pump(yes or no): ti J 2002 - 21 ,750 Last date of occupancy. S-I—o COMME IA11 USTRIAL Type of esta list ent: Design flow based on 310 CMR 15.203): gpd Basis of desi flow(seats/persons/sgft,etc.): Grease trap resent(yes or no):_ Industrial w ste holding tank present(yes or no):_ Non-sari waste discharged to the Title 5 system(yes or no):_ Water met readings,if available: Last date occupancy/use. OTHER describe): GENERAL INFORMATION Pumping Records Source of information: � A Was system pumped as part Of the inspection(yes or no): ti If yes,volume pumped:_gallons-=How was quantity pumped determined? Reason for.pumping: Tyr F SYSTEM _ optic 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 thc 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 at installed(if kW k)and source of information: Were sewage odors detected when arriving at the site(yes or no):,O 6 I'agc 7 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Briarwood Avenue Hyannisport, MA Owner: Dennis Kilduf Date of Inspection: S BUILD G SEWER(locate on site plan) Dcpthbel w grade. Materials f construction:_cast iron _40 PVC_other(explain): Distance om private water supply well or suction line: Comment (on condition of joints,venting,evidence of leakage,etc.): SEPT IC TANK._(locate on site plan) Depth below grade: L! Material of construction:. ✓concrete metal_fiberglass_polyethylene _other(explain) _ If tank is metal list age:_ is age confirmed-by med•by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 6,°' 1 v Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: X q � Scum thickness: 0t Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: 8 Pt,-d-- )"A n /L Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE RAP: (locate on site plan) Depth below ade:_ Material of a struction:_concrete_metal fiberglass_polyethylene_other (explain): _ Dimensions: Scum thickness: Distance from top f scum to top of outlet tee or baffle: Distance from boat m of scum to bottom of outlet tee or baffle: Date of last pumpin Comments(on punt ing recommendations,inlet and outlet ice or baffle conditions,structural integrity,liquid levels as related to outlet in rt,evidence of leakage,etc.): 7 Pagc 8 of i l OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Briarwood Avenue yannisport. A Owner: Dennis Kilduff Date of inspection: S/—G1-1 TIGHT or LDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below gra e: Material of const tion: concrete metal fiberglass_polyethylene other(explain):: Dimensions: Capacity. gallons Design Flow: allons/day Alarm present(yes r no): Alarm level: Alarm in working order(yes or no): Date of last pump' Comments(conditi n of alarm and float switches,.etc.): IL DISTRIBUTION BOX: (if present must be o ened locate on site plan) P )( P ) Depth of liquid level above outlet invert: O 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.): lL. PUMP CHAMBER (locate on site plan) Pumps in working o er(yes or no): Alarms in working der(yes or no; Comments(note c dition of pump chamber,condition of pumps ana appurtenances,etc.): �� 8 Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Briarwood Avenue Hyannisport, MA Owner: Dennis Kilduff Date of Inspection: 67--/`0-/ SOIL ABSORPTION SYSTEM(SAS): 1/ (locate on site plan,excavation not required) If SAS not located explain why: T e yP aching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow,cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOO (cesspool must be pumped as part of inspection)(locate on site plan) Number and co figuration: Depth—top of li uid to inlet invert: Depth of solids ayer: Depth of scum ayer: Dimensions of esspool: Materials of c nstruction: Indication of oundwater inflow(yes or no): Comments( to condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of c nstruction: Dimensions: Depth of soli s: Comments(n to condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): vu Page 10 of 1 l ` { OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Briarwood Avenue Hyannisport, MA Owner: Dennis Ki 1 dL_f f Date of Inspection: 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. r i 10 :Pagel I of 1 I Y OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Briarwood Avenue Hyannispor , MA Owner. Dennis Kilduff Date.of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water I h feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: /Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must des be h w you established the high ground water elevation: CC�7 d� k 2-082 11 I:Y rI No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplitation for Migogar *potent Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 7 go_ 3 1 P6 Installer's Name,Add5ess,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No. of Bedrooms '0 O Garbage Grinder AJO) Other Type of Building W y 0 4 No. of Persons G Wd Showers( ) Cafeteria( ) Other Fixtures Design Flow /In gallons per day. Calculated daily flow /SO gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alt rations(Answer when applicable) E_J _ l ® C-.ST d&X Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health., / Signed Date �" b Application Approved by Application Disapproved for the following reasons � I Permit No. V& Date Issued THE COMMONWEALTH OF MASSACHUSETTS i PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS r ` Certificate of Compliance a f THIS IS TO C R th t th n-site Sewa a Disposal Systerri instal d )WNW! dlaced( )o i� by for (5 as h ee constru n accordangee with the provisions of Title 5 and the fo Disposal System Construction Permit No. dated z Use of this system is conditioned on compliance with the provisio forth below: — ----� - No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTA'BLE, MASSACHUSETTS io o ar )P5 ent Congtruction Permit �I1oIl /ems /UCH { Permission is hereby granted to 4 to construct( )r r n-site Sewage System located at (� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction u be ompleted within two years of the date below. p Q Date: Approved by g ;^ M;fi 095 /F- THE —COMMONWEALTH OF MASSACHUSETTS- 4 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Miopooat *pgtem Con5truttion Vermtt 3 Application is hereby made for a Permit to Construct( )or Repair"( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. /?70 kit 4O Installer's Name,Add ess,and Tel.No. Designer's Name,Address and Tel.No. t Type of Building: ' Dwelling No.of Bedrooms _rtk)a Garbage Grinder(Lkj) Other .Type of Building W o 8 4 No. of Persons t�rJd Showers( ) Cafeteria( ) �' f Other Fixtures Design Flow. !%r gallons per day. Calculated daily flow d 5'0 gallons. it I, Plan Date Number of sheets Revision Date Title , I -Description of S_oil Nature of Repairs or Alt rations(Answer when a plicable) E.iJ 9 /, O Gs"/ '6 ax sv &-j� Date last inspected: Agreement: '' / The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date S- Application Approved by o i Application Disapproved for the following reasons Permit No. ' z�Date Issued' ! _ �'` X -- r _ L0 � _ f 00 C3 _ u F7 O z4.3IZ }}i - 00 a o ti o ; ems.. l J r ,