HomeMy WebLinkAbout0034 FRESH HOLES ROAD - Health (2) 34 Fresh Holes Rd
' aka 34-36 Fresh Holes Rd
292-179 Hyannis
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COMMONWEALTH OF MASACHUSETTS e TO0,PB�Nsr 2�0�
EXECUTIVE OFFICE OF ENVIRONMENTAI AFF RSA, n�o�T sacF
DEPARTMENT OF ENVIRONMENTAL PROTECTION 'S . '
ONE WINTER STREET BOSTON MA 02108(617)292-3500 /,,
TTRUDY CCO
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Address of Owner: BOX 611 HYANNISPORT MA.02647
Date of Inspection: 6/23/00
Name of Inspector: JOHN C7RACI
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536
Telephone Number: 608-664-6813 FAX 608-664-7270
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 inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.The system:
X Passes
_ Conditionally Passes
_ Needs Further Evaluation y the Local Approving Authority
_ Fails
Inspector's Signature: Date:7/3/00
The System Inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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.
NOTES AND COMMENTS
"The inspection is based on criteria defined.in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My
inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life."
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.
revised 9/2/98 Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6/23/00
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated
are indicated below.
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the
replacement or repair,as approved by the Board of Health,will pass.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not.
nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance
attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,
whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The
system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health.
Wa Sewage backup 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).
_broken pipe(s)are replaced
_obstruction is removed
_distribution box is levelled or replaced
nta 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
revised 9/2198 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6/23/00
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 IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 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 SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
_ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm,Method used to determine distance nla(approximation not valid).
3) OTHER
n/a
revised 9/2198 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6/23/00
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
1 have determined that one or more of the following failure conditions exist as described 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.
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
- X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
- X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
- X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow,
u o clogged or obstructed i e s.Number of times um ed f2.
_ X Required pumping more than 4 times in the last year NOT due t gg p p ( ) P P
q P P 9
X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
- X Any portion of a 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 I of a public well.
- X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
- X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality
analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,
ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and
safety and the environment because one or more of the following conditions exist:
Yes No
- X the system is within 400 feet of a surface drinking water supply
- X the system is within 200 feet of a tributary to a surface drinking water supply
- X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the
Department for further information.
revised 9/2198 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner: JEFF LYONS
Date of Inspection: 6123/00
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health.
X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.
Large volumes of water have not been introduced into the system recently or as part of this inspection.
X _ As built plans have been obtained and examined.Note if they are not available with N/A.
X - The facility or dwelling was inspected for signs of sewage back-up.
X _ The system does not receive non-sanitary or industrial waste flow.
X - The site was inspected for signs of breakout.
X _ All system components,excluding the Soil Absorption System,have been located on the site.
X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of
construction,dimensions,depth,of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been
determined based on:
X _ Existing information,For example,Plan at B4O,H,
X - Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)]
X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal
Systems.
l;t
revised 9/2/98 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6/23/00
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 4 Number of bedrooms(actual):
Total DESIGN flow: "0 gpd
Number of current residents:7
Garbage grinder(yes or no):NO
Laundry(separate system)(yes or no): NO if yes,separate inspection required
Laundry system inspected(yes or no): NO
Seasonal use(yes or no): NO
Water meter readings,if available(last two year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: n/a
COM MERCIAL4N DUSTRIAL
Type of establishment: n/a
Design flow: n/a gpd(Based on 15.203)
Basis of design flow:n/a
Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.if available: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/a
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a
TYPE OF SYSTEM
X 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)
_ I/A Technology etc.Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:nla
APPROXIMATE AGE of all components,date installed(if known)and source of information:
1996 PERMIT 96-485
Sewage odors detected when arriving at the site:(yes or no). NO
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6/23/00
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 18"
Material of construction: _ cast iron X 40 Pvc _ other(explain)
Distance from private water supply well or suction line: n/a
Diameter: 4"
Comments: (condition of joints,venting,evidence of leakage,etc.)
THERE IS TOWN WATER
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 12"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: 1600G L 10'6"H 6'6"W 6'8
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 32"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 14"
How dimensions were determined: MEASURED
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.)
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFULL LIFE.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
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.)
n/a
revised 9/2198 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6/23/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: nla
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm present: NO
Alarm level:N/A Alarm in working order:NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:X
(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
THE DISTRIBUTION BOX IS STRUCTURALLY SOUND.
PUMP CHAMBER: _
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n/a
revised 9/2/98 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6123/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type:
leaching pits,number:(n/a)n/a
leaching chambers,number: (4)CULTEC CHAMBERS
leaching galleries,number: (n/a)n/a
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (n/a)n/a
Alternative system: n/a
Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE SAS APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE.
CESSPOOLS: _
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer. n/a ;,r
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
revised 9/2198 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6/23/00
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
C�e� Qo Goa e
revised 9/2/98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 34& 36 FRESH HOLES RD HYANNIS, MA 02601 M292 P179
Name of Owner JEFF LYONS
Date of Inspection: 6/23/00
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: n/a
USGS Date website visited: n/a
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
_ Shallow wells
Estimated Depth to Groundwater 10 Feet+
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
_ Checked FEMA Maps
Checked pumping records
_ Checked local excavators,installers
X Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
USGS MAPS AND CHARTS-10+FEET
revised 9/2/98 Page 11 of 11
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Commonwea th Of. MOSSOchusetts
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Executtvt� .omIce Of.ErmrOrtreCftoi Affdrs D.E.P. Title V Septic Inspector =-
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Teaticket,MA 02536
Env�ranrneatal Protest
(508) 564-6813`
SUBSURFACE SEWAGE„DISPOSAL SYSTEM INSPECTION FORM; - �X -
PART A
-_- - CERTIFICATION'
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Property Address: 34-36 Freshholes Rd.Hyannis• Address of Owner:. P
S
Date of Inspection: - (If different), I—
Name of Inspector:John DavidJaroR
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Company Name,Address and Tele hone Number
CERTIFICATION STATEMENT
I certify that I.have personally inspected the sewage disposal system at this address and that the information reported below is e; accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system;
AM
Passes
CELft
Conditionally Passes
Needs Furt er valuation By the.Local Approving Authority
x Fails
Inspector's'Signature: Date: 915196
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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: .
Check A. B,C, or 0:
A].SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria.nofevaluated are indicated below.
Bj SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all'instances. If"not determined",explain why•not.)
_ The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved `I
by the Board of Health:
(revised 11115195)
One Winter Street • Boston,Massachusetts 02108 a FAX(617)556-1049 '•Telephone(617)292-5500
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (contlnued) __.
i
Property Address: 34-35 Freshholes Rd.Hyannis
Owner: DavidJaroA'
Date of Inspection:915196
'Sewage-backup or breakout or high static.water level observed in the distribution box is due to a broken
settled or uneven'distribution box. The system will pass inspection if(with approval of the Board of Health)
broken pipe(s)'are replaced
obstruction is removed -
distribution_box is leveled 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 FUNCTIONING 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 10.0 feet to a
surface of water supply:or tributary to a surface water-supply. ;
The system has aseptic tank and soil absorption system and is within a Zone 1 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 volatile organic compounds indicates that the.,well is.
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm:
3) OTHER
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-in facility or system component due to an overloaded or clogged SAS or
cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
X SAS is in hydraulic failure.
(revised 11115195)
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION;(continued)
- — -
property Address: 34-35 Freshholes Rd.Hyannis
Owner: DavidJarolT - -
Date of Inspection:94196
D] SYSTEM FAILS(contlnued) -
Static liquid level in the distribution box above outlet invert due to-an overloaded or,clogged SAS.or cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. -
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped.
_ 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 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.,If the well has been analyzed.to be acceptable, attach copy of well water analysis for
coliform bacteria,.volatile organic.compounds, ammonia nitrogen and nitrate nitrogen. .
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,0o0 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 ll of a
public water supply well):
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11115195)
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SUBSURFACE S•EWAiaE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 34-36 Freshholes Rd.Hyannis _
Owner: DavidJaroft
Date of Inspection:915196
- Check if the following have been done: _
X Pumping information was requested of the owner, occupant, and Board of Health.
X None of the system components have been pumped.for_at least two weeks and the 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. -
n1aAs built plans have been obtained and examined. Note if they are not available with N/A- _
X .The facility or dwelling was inspected for signs of sewage back-up:.
x The system does not receive non-sanitary or industrial waste flow.
x The site was inspected for signs of breakout.. .
—.
x All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered;opened, and the interior of the septic tank was inspected
for condition of baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge, depth of scum:
X The size and'locati.on of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants, if different from owner)were provided with information.on the proper maintenance of Sub
Surface Disposal System. .
(revised 1 111 519 5)
4.
.. ems--
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.,
:PART C'
SYSTEM INFORMATION
Property Address: 34.36 Freshholes Rd..Hyannts
Owner DavidJ40ff
Date of-Inspection'.915196
_FL0INCONDITIONS �
RESIDENTIAL:
Design flow: 0 gallons
Number of bedrooms: 4 —
Number of current.-residents: 4 -
Garbage grinder(yes or no): Na
Laundry connected to system(yes or no): Yes -
Seasonal use(yes or no): No
'Water meter readings,if available: nNa
Last date of occupancy: n1a
COMM ERCIALA N DUSTR IAL:
Type of establishment;►t(a
Design flow:0 gallons/day
Grease trap present:(yes or no No
Industrial Waste Holding Tank present: (yes or.no) Na',":
Non-sanitary waste discharged to the Title 5 system: (yes or no) No
Water meter readings,if available: n1a
Last date of occupancy n1a
OTHER::(Describe).Na
'Last date.of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:"
System was pumped 6 Months ago bV Bortolotti "
System pumped as part of inspection: (yes or no)No
If yes,volume pumped: ailons
Reason for pumping: nta
TYPE OF SYSTEM
Septic tank/distribution box/soil absorptions system
x Single cesspool
x Overflow cesspool
Privy
Shared system(yes or no).( if yes, attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of ail components,date installed{if known)and source information:
1950
Sewage odors detected when arriving at the site:(yes or no) No.
(revised 11115195)
5 - -
r
�,� ., c: _.a.�.-,'ter•-�"aw.�3ew, .�,mm4s-� .., - r�,. ��'�'yfr_.,�r»;r c �x M'r��t�x;_ �
SUBSURFACE SEWAGE DISPOSALS INSPECTION FORM
- PART C: -
SYSTEM INFORMATION (continued)
-
_ .. -
Property Address: 34.36_Freshholes Rd:Hyannis
Owner: DavidJarort -
Date of Inspection:915196
SEPTIC TANK;_
(locate.on site plan) _- - Depth below-grade Na.
Material of construction: concreate_metal_FRP_other(explain)
Dimensions: nta -
Sludge depth:Na _
Distance from top of sludge to bottom of outlet tee or baffle: nja'
Scum thickness'.rua
Distance.from top.of scum to top of outlet tee or baffle:nia
Distance form bottom of scum to-bottom of outlet tee or baffle:n!a
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.)
n1a
GREASE TRAP:
(locate on site plan)
Depth below grade: n1a
Material of construction. _concrete_metal_FRP other(explain)
Dimensions: nia
Scum thickness:n1a
Distance from top of.scum to top of outlet tee or baffle:n1a
Distance from bottom of scum to bottom of outlet tee or,baffle: nia
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.)
n1a
(revised 11115195)
6
45W44'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM-q
PART C.
SYSTEM INFORMATION.-(contlnued)
Property-Address:-..34-313 Freshholes Rd:Hyannis
Owner: - David Jaroff
,..-Date of inspection:915196
TIGHT OR HOLDING TANK:
(locate-on-site.plan)-
Depth below grade: Na
Material of conitruction:—c6ncrete_metal_FRP—other(explain)
Dimensions: n/a
Capacity: n1a _gallons
Design flow- n1a gallons/day . ......
Alarm level: n1a
Corhments:
(condition of inlet tee;condition of alarm and float switches, etc.)
n/a
DISTRIBUTION BOX: ,
(locate on site plan)
Depth of liquid level above outletinvert: rVa
Comments.
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
n1a
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes,or,no)
Comments:
(note condition of pump chamber., condition of pumps,and appurtenances, etc.
Na
(revised 11115195)
7
n
sa & as s + cY 1 vr�47: ' r'
g { s� _M1-.ttw.z �s .'sc
s:.,. S- +si-t`+ sNs, 4lr'x' rYc.« . 3 gc2T".•� A �,�,ey +,�id.`nwuT$SX .t+Y W' Tta-.
SUBSURFACE SEWAGE..DISPOSAL SYSTEM INSPECTION FORM'
PART C -
` SYSTEM INFORMATION(continued):
Property Address: '34.36 Frest►holes Rd.liyannis
Owner: DavidJarofL
Date of Inspection:915196
SOIL ABSORPTION SYSTEM (SAS):X ti
(locate on site plan,if possible; excavation not required'but may.be approximated'by non-intrusive methods')'
If not'determined to be present,_explain:
n1a
Type:
Teaching pits, number: n1a-
leaching chambers;number:n1a
leaching galleries;number: n1a
leaching trenches,number, length: nla
leaching fields,number, dimensions:n1a
overflow cesspool, number:5x5 block
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Overflow is in hydraulic failure.
CESSPOOLS:x
4.
(locate on site plan)
Number and configuration: one
Depth-top of liquid to inlet invert: over
Depth of solids layer: 4"
Depth of scum.layer: o
Dimensions of cesspool: 4x5
Materials of construction: block
Indication of'groundwater: none
inflow(cesspool must be pumped as part of inspection)
nla
Comments:(note,condition of soil, signs of hydraulic failure,level of ponding;condition of vegetation; etc.)
System is in hydraulic failure.
PRIVY:
(locate on site plan)
Materials of construction: n1a Dimensions: n1a
Depth of solids: nta
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PrivyComments
(revised 11/15/95)
`� p��C�`.��y j 'IV"�t� @�� .. �'� �•� � „{ ..'J'.,��iv���'.�"���� �;L"l�` 4'La4�:t .2�i.;,:•:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
: PART C.
SYSTEM INFORMATION.(continued) .
Property Address. 34.36 Freshholes Rd.Hyannis
Owner:- DavidJaroft .'
-Date of Inspection.:915196 -
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at(east two permanent references landmarks or.benchmarks
Iodate all wells.within.160': -
- 3
4tk
01rCR i (fie
DEPTH TO GROUNDWATER
Depth to groundwater;12 feet
'method of determination or approximation:
USGS Maps and Charts
(revised 11/15195)
9
No. i Fee $4 0 .0 0
THE COMMONWEALTH OF MASSACHUSETTS �Z/
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pp[ication for 30iopoe;ar *pgtem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No. 7 7 1 —2 0 0 8
34-36 Fresh Holes Rd. , Hyannis, MA Jeff Lyons
Assessor's Map/Parcel }
724 Main St. , Hyannis, .MA 02601
Installer's Name,Address,and Tel.No. 7 7 —8 7 77 6 Designer's Name,Address and Tel.No.
Wm.E.Robinson Sr. Sep is Srv.
P.O.Box 1089 , Centerville, MA 02 132
Type of Building: Duplex
Dwelling No.of Bedrooms 2�rr Garbage Grinder(no
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil grAVEL
Nature of Repairs or Alterations(Answer when applicable) FILL in old cesspool . Install
Title 5 system 1500 gal , .tank, D-Box and 4 heavy duty, high capacity,
stonepacked Cultex 0330 infiltrators .
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Bo// of Health.
Signed / t L�� ..cg� Date 2:72 I-)—<? I/
Application Approved by Date
Application Disapproved for the Ho lowQ reasons
Permit No. ���� Date Issued
.� Vie..:..
No. Fee
- �-� �? `7� ` 4 4$ 0 0 0
+i �
> THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for ;Migogal bpgtetn Congtruction Permit
Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's N e,Address and Tel.No. 7 71 —2 0 0 8
34-3'6- Fresh Holes Rd. , Hyannis,,. MA Je Lyons
Assessor'sMap/Parcel 724 Main St. , Hyannis-,::hMA 02601
Installer's Name,Address,and Tel.No. 7 7p`� 8 7 Z ¢ Designer's Name,Address and Tel.No.
S
Wm.E.Robinson Sr. e c .
P.O.Box 1089, Centerville, MA 02 32
Type of Building: Duplex `
Dwelling .r�` No.of Bedrooms 2Je a nh Garbage Grinder(no
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
` Plan Date Number of sheets Revision Date
Title
Description of Soil grAVEL
Nature of Repairs or Alterations(Answer when applicable) FILL in .old cesspool. Install
Title 5 system 1500 gal, .tank, D-Box and 4 heavy duty, high capacity,
stonepacked Cultex #330 infiltrators.
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•Bo of Health.
Signed �/ tl� �.� Date �l—4
Application Approved by Date �1•
Application Disapproved for the o lowiW reasons
s
Permit No. 91-6 - V 1 -5— Date Issued
———————————---- —————————=—-——————— ——
THE COMMONWEALTH OF.MASSACHUSETTS
Lyons BARNSTABLE, MASSACHUSETTS
Certif irate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( x)on
by Installer Wm.E.Robinson Septic Sr.v. j
at 34-36 Fresh Holes Road Hyannis has been constructed in accordance i
with the provisions of Title 5 and the for Disposal System Constructioermit No dated
Date �` / Inspecto Apo, `
t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS-
TEM WILL FUNCTION SATISFACTORY.
--�—�$s----------------
No. Fee $40.00
THE COMMONWEALTH OF MASSACHUSETTS
---._� PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Ly6ns lwigogar *pgtem Congtruction Permit
Permission is hereby granted to Wm.E.Robisson Sr. , Septic Srv. 'f
to construct( )repair(x )an On-site Sewage System located at No.# 34-36 Fresh Holes Rd. , Hyannis
Street
and as described in the above Application for Disposal System Construction Permit. W ` !Vey-.
• No. Date
The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.
j All construction must be completed within three years of the date below.
Date: Approved by ,
Board of Health
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
1, Wm.E.Robinson, S r. ,hereby certify that the application for disposal works
construction permit signed by me dated' 9-2 4-9 6 , concerning the
property located at 34-36 Fresh Holes RoaD, Hyannis,MA Meets all ofthe
following criteria:
• There are no wetlands within 300 feet of the proposed.septic system
• There are no private wells within 150 feet of the proposed septic system
• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
• There is no increase in flow and/or change in use proposed
F '
• There are no variances requested or needed.
SIGNED c/ DATE:
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
S
� �
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No..s _.12 Fss. .fi ...
THE COMMONWEALTH.OF MASSACHUSETTS
' BOARD PF HEALTH
........../00,0lJ-.-.......OF.-.-...A.
Appliration for Bi-spnoal Works Tonstrnrtinn rrrnti#
Application is hereby made for a Permit to Construct ( ) or Repair (/) an Individual Sewage Disposal
System at:
.... - ....... .... -- .:._ ... ---- -------------------------------- ___-. --_---
I,lpca ddress or Lot No.
.... I .. .....: ............•••-•••-------------------- --•.......------........_................--•-----..
Owner Address
L -- :...
a ....-----•---
Installer Address
Typ of Building/ Size_Lot_____________ -------------
Sq. feet
Dwellings No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
44
d Other fixtures .............................................................
W Design Flow.............................................gallons per person per day. Total daily flow..................,.........................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__-_____________ Depth................
x Disposal Trench—No_ ____________________ Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a . Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to-ground water_______________._______.
44 Test Pit No. 2................minutes per inch Depth P Test Pit..... __...______.. Depth to ground water........................
----------- •- - --------------------- ---------•••---• •----•------------••.........................................................
0 Description of Soil........ C�� _... _.......
x ---•-•--• •••-----
U --•••--•--••-•-.._..---••.._....:••-•-•---•-•-•--••-•-•••-•-•----••-••••------••...............•--------...----------•••-•-•----•-•-------------•-•-...................................................
W ----------------------------------------•-------•---------------------------...------•-•-•--•--•---•-------- -- -- - - -----------------------
V Nature of Repairs or Alterations—Answer when applicable.___ .._.__- '_. .s.�����' _,0�____-______-
•-•--•-•••----------••------•--••---••---•••--•----••--••-•-----•--•---•-----•--•--.......-•------•---••------------------•---------•-•-----•-••- ......................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLi4 5 of the State Sanitary Code—The undersig ed further agrees not p ce the system in
operation until a Certificate of Compliance has b n issuWbtboar of li
Signe .-- -••-•• ••.......•. ..... . . :.............•
at
Application Approved By- - ......... - -•-••• ...... --- ........ 10 / -�.�`
Date
Application Disapproved for the following reasons--------------------------------------------------------•---•----------------•---------------------•-•-•••-•-•---
-•-----•--•---------------------------••-•---•-....•-•-•-•--•----._._.-_.....--------•----••--------...--'•-•---------------------•-•------•------•-•-••--------•-•-----------•----'- ----------•---
Date
Permit No---fT Z•�-------•-------------- Issued.......................................................
Date
may.
No---- ....1.... t : Fxs..., ... .....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® PF HEALTH
.........OF.....:. ..eo..-
ApplirFatiun for Disposal Works Tonstrurtiun runfit
Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal
System at:
"'- W_. ,ij�e............................
catio PJA dress or Lot No.
Own W Address
a
` - Installer Address
dType of Building'" Size Lot...........................Sq. feet
U Dwelling=No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ............... No. of persons...._................__.__.. Showers — Cafeteria
Otherfixtures ---------- - ---------------------------------------•-----------------•------------- ---------------
WDesign Flow...............................:........•-_-gallons per person per day. Total daily flow..............._....................__....__gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length_................. Total leaching area............,.......sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by---:...................................................................... Date........................................
Test Pit No. 1....._e!.......minutes.per inch Depth:of Test Pit.................... Depth to ground water--_-_--____-_-.._______. y
4q Test Pit No. 2__.s:: minutes per inch .Depth of. Test Pit ^ ........ Depth to ground water:__________________-.
k.. -
Description of Soil........ ! _.: ... ^. '`._
- -------••------•--••--•--------•---•---•-••. ...........................
-----------•--- -----------_-----------------•-•-------------•---------•-•-----------••-••............--• ----- ----•.----..-
' ---
U Nature of Repairs or Alterations—Answer when applicable----'�� ± -.��� __
-•-•---•....•--•----••--••..._........•------••--••-•-----•--•.......---•---•---•-•••-•.......................•-•••--•-•••-•----•---•---•••--•-•------•--•--••---•-•-•••-•-••-......--•-...........-----
Agreement:
. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of IT:
p S of the State Sanitary Code—The undersig ed further agrees not ,o p)ace the system in
operation until a Certificate of Compliance.has be"n issued b " e boar of h It .
Signe .•:' : '.•• r _. _ .....•..... _� "���r...�.. t" ................................°
Application Approved'B '' . --.... --. _.17 .. ��r �a��----
A .:t;<.,
Date
Application Disapproved for the following reasons----------------•-•---------••----•-----------------------------------------------------==
..
.......
—` 'Date
PermitNo.-�r----s--•/-�---•.--•---------••--•--•--••••-- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALJH........... J
f .-�'`..�'t�.�.b....0.F....e�'; '. :;rr3t"',ice' ✓'�?"� ......................
...
Trrfifiratt of ToutpliFanrr
T, ,S ISO C TIFY That "e Individual-Se age DisposaL.,� stem constructed ( . ) or Repaired
r
Installer
' x .fir ..a
t - y
... .....
has been installed in accordance with the provisions of TI T LE j of The State 4, anitary Cpde� �s descrxbgdh in the
application for Disposal Works Construction Permit No........................................_. dated =:
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUE® AS A GUARANTEE TEAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. n.'.?i..). 'r --------------•---•---•-----....... Inspector....---•---- --•--•----- -- --- --- -•------- .:_.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF: HEALTH
f E �.!f/ R Y"
�i' OF
..<
No.40
.7✓ I FEE ....t_.._......
Disposal, Works %'Donstrurtion prruti#
Permission is hereby granted..`.':_ r � �' f' . .. .Z r .. --- ----- -{...- ...............................................
to Construct ( ) or Repair ( ') ari Individual Sewage Disposal System �r r „
at No...... pp _- ----•-•. --•••-. -
Street p�
as shown on the application for Disposal Works Construction Permit Nok,�'1_7,K D ted... � . �........
- -. .z. --•••--•. .
DATE.`d/ ..... Board of Health
i
FORM 1255 HOBBS & WARREN.�1NC., PUBLISHERS -