The URL can be used to link to this page

Home My WebLink About0186 BUCKWOOD DRIVE - Health 18&Buckwood Drive Hyannis P .° 271 036 1 n I 1 f U G TOWN OF BARNSTABLE LOCATION /9L 3YC�'GJ 00 of SEWAGE # VILLAGE 14y Qh n t .S ASSESSOR'S MAP & LOT a7/— a34 INSTALLER'S NAME&PHONE NO._ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS B' eROWNER K`ennedU �G�ia rd PERMITDATE: COMPLIANCE DATE: Separation Distance Between the. Maximum Adjusted Groundwater Table to the 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 i COMMONWEALTH OF MMSACHUSE17S ' ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . O� DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED AUG 0 3 Z004 fftwMPT. DEPT. OFFICIAL INSPECTION FORM-N ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 186 Buckwood Drive MAP Hyannis PARCEL Owner's Name: Richard Kennedy Owner's Address: LOT 1 Date of Inspection: Name of inspector.(please print) William E_ • Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (5081 775-8776 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 15.000). The system: —IZPasses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ��1 m� Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatihvr 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 approxing 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 1 Page 2 of 11 w OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART CERTIFICATION(continued) Property Address: 186 Buckwood Drive Hyannis , Owner: Richard Kennedy Date of Inspection; L/ Inspection Summary: Check A,B,C,D or E�/ALWAYS complete all of Section D A. �tXeasses: 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 System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or rep ' ed.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Ans er yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please expl tn. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally uns d,ekhibits substantial infiltration or exftltration or tank failure is imminent.System will pass inspection if the exis ing tank is replaced with a complying septic tank as approved by the Board of Health. *A etal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance ind eating that the tank is less than 20 years old is available. N explain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or o strutted pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with a proval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced explain: The system required pumping more than 4 times a year due.to broken or obswuctcd p'tpe(s).The system will p inspection if(with approval of the Board of Health): broken pipes)are replaced ob struction is removed 4 ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 186 Buckwood Drive Hyannis Owner: Richard Kennedy Dale of Inspection: C. Further Evaluation is Required by the Board of Health: onditions exist which require further evaluation by the Board of Health in order to determine if the system is failin to protect public health,safety or the environment. 1. S stem will pass unless Board of Health determines in accordance with 310 CMR 15.303(i)(b)that the s tem is not functioning in a manner which will protect public health,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. S stem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syste 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 rface 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 50 feet or more frortl 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. then: 3 Page 4ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 8 6 Buckwood Drive Hyannis Owner: Richard Kennedy Date of Inspection: 7-52 D. yslem Failure Criteria applicable to all systems: You ust 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 AS 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%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 I00,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 f et from a private water supply well with no acceptable water quality analysis. (This system passes if tare well water analysis, performed at a DEI 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 m provided that no other failure criteria g g q PP � are triggered.A copy of the analysis must be attached to this form.] (YeslNo)The system fails.I 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. E. Large Systems: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (nic following criteria apply to large systems in addition to the criteria above) es no _ the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a smface 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 1 you have answered"yes"to any question in Section E the system is crmsidered a significant threat,at answered " es"in Section D above the large system has failed.The cmmer or operator of wry large system considered a s nificant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 1 .304.The system owner should contact the appropriate regional office of the Department. A/ 4 Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 186 Buckwood Drive Hyannis Owner: Ric-hard KPnned. Date of Inspection:, 1 —P�y Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No/ _ ✓.Pumping information was provided by the owner,occupant,or Board of Health CI Wcre any of the system components pumped out in the previous two weeks? 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? c-/ 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)J I 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 186 Buckwood Drive Hyannis Owner: Richard Kenned Date of Inspection: — � —G FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. 3 Number of bedrooms(actual):_ DESIGN flow based on 310 Cfa 15.203(for example: 110 gpd x#of bedrooms):.3 G Number of current residents: Does residence have a garbage grinder(yes or no): � Is laundry on a separate sewage system(yes or no):& o [if yes separate inspection required) Laundry system inspected(yes or no)-,I,0 Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): 7/0 3 7/0 4 81 ,7510 Sump pump(yes or no): t7 - 63,750 Last date of occupancy: % COMMERC L/INDUSTRIAL Type of establ hment: Design flow( ased on 310 CMR 15.203): gpd Basis of desi flow(seats/persons/sgft,etc.): Grease trap pr sent(yes or no):_ Industrial wa a holding tank present(yes or no):_ Non-sanitary aste discharged to the Title 5 system(yes or no): Water meter ea dings,if available: Last date of ccupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records p /� Source of information: // gl a X-is Was system pumped as part of the inspection(yes or no):,4--6 If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE SYSTEM eptic 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): -6) 6 ]'age 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 186 Buckwood Drive Hyannis Owner: Richard Kennedy Date or Inspection: — -t BUILDING/condition (locate on site plan) Depth belowMaterials ofion:_cast iron 40 PVC other(explain). Distance Gowater supply well orsuction line:Comments( of joints,venting,evidence of leakage,etc.): SEPTIC TANK: locate _( on site plan) Depth below grade: Material of construction: ✓concrete metal - fiberglass _polyethylene _othcr(explain) _ —" If tank is metal list age:— Is age confirmed-by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: a T� Sludge depth: Distance Gom top of sludge to bottom of outlet tee or baffle: d�y Scum thickness:�[______ G r Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baQl 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.): GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:—concrete—metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance Gom 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 reconunendations,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 FOIIAI PART C SYSTEM INFORMATION(continued) Property Address: 186 Buckwood Drive Hyannis Owner: Richard Kennedy Date of Inspection: -� o TIGHT or HOLDING ANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain)- Dimensions: Capacity allons Design Flow: VAlin allons/day Alarm present(yes or Alarm level: rking order(yes or no): Date of last pumping: Comments(condition float switches,etc.): DISTRIBUTION BOX: if present be opened)(locate on site plan) Depth of liquid level above outlet inv Comments(note if box is Ievel an distrib lion ou qual,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: loc eon he ) Pumps in working or r(yes r ): / Alarms in workin rdcr(yc r no): Comments(not ondition of pum cha er,condition of pumps and appurtenances,etc.): 8 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 186 Buckwood Drive Hyannis Owner: Richard Kenn -dy Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):zoocate on site plan,excavation not required) If SAS not located explain why: Type leaching 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.): , L CESSPOOLS: (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 o): Comments(note condition of soil,signs f hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of oil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 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: 186 Buckwood Drive Hyannis Owner Ri h r K dy Date of Inspection: —6=6 L 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. Y" I t � I , f r 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:186 Buckwood Drive Hyannis Owner. Richard Kennedy Date,of Inspection: 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 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 ith local Board of Health-explain: Ch ed with local excavators,installers-(attach documentation) ccessed USGS database-explain: You must describe how you established the high ground water elevation: 11