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Home My WebLink About0018 LEONARD ROAD - Health 18 feonaril Road, Hyannis A= I� 1 I 1 v 2 3 o 'ti Q a, Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of JOy�oFe ° 199� Environmental Protects ' ® Fq��oFpjr�C� c>, William F.Weld y Coxe Governor V sm*afy Arl so Paul Celluccl 8 B.Struhs U.Gommor C.anrnhebr»r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: 18 Leonard Rd, W Hyannisport, MA Address of owner. Carol Wilbur Date of Inspection: ;_ -/-/ 9 7 (If different) 1817 Greenwood Ct. Name of Inspector. W.E. Robinson SR Spring Lake,MI 49456 Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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: _�Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: i Date: �.-4��g The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A,B, C,or D: A] SY8 ASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. J CONDITIONALLY PASSES: e or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes pectionno,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 by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-UN ice,Printed on Recycled Paper I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 Leonard Rd, W Hyannisport, MA Owner. Carol Wilbur Date of Inspection: B)SYSTEM CONDITIONALLY PASSES(continued) 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 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] THER 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. Z) 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 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 within 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 coliforn 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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 18 Leonard Rd, W Hyannisport, MA Owner. Carol Wilbur Data of Inspection: v G j_Gj DI SYSTEM FAIL: 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 determination is identified below. The Board of Health should be contacted to determine what will be necessary to ooz:act the Backup of sewage into 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 SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 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 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 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 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analysed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE TEM FAILS: following criteria apply to large systems in addition to the criteria above: 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 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 U of a public water supply well) The owns or operator of any such system shall bring the system and facility into Rill compliance with the groundwater treatment program b of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Rather information.. vz� (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PrepeityAddnea: 18 Leonard Rd, W Hyannisport, MA Owner. Carol Wilbur Date of Inapeodlow �!_ 17 Check if the folowing have been done: /l/umping information was requested of the owner,occupant,and Board of Health. V/ cne 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. 1/As built plans have been obtained and examined. Note if they are not available with N/A _6/•he facility or dwelling was inspected for signs of sewage back-up. system does not receive non-sanitary or industrial waste flow :11/u/ site was inspected for signs of breakout. All system components,excluding the Soil Absorption System,have been located on the site. e 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. a,'the sixe and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _Llinhe facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION propertyAddress: 18 Leonard Rd, W Hyannisport, MA Owner. Carol Wilbur Date of Inspection: �L-41_4j // FLOW CONDITIONS RFBIDENTI& Design flow 3 3�� shone Number of bedrooms: `d-,"3 Number of current residents: Garbage grinder(yes or no): A� 6 Immdry connected to system("or no):Yz? S Seasonal use(yes or no):_ 1995 — 1996 2200 cubic f t. Water meter reading.,if available: 1996 - 1997 Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Design flow: willons/day Grease trap present: (yes or no)_, Industrial Waste Holding Tank present: (yes or no)_ Non4auitary waste discharged to the Title 6 system: (yes or no)_ Water meter readings,if available: Last date of oocupancr OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) A-d If yes,volume pumped: gallons Reason for pumping: TYPE Ovin=Kmi Septic taak/distnbution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: , •ins yy Saevage odors detected when arriving at the site: (,yes or no) d (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Leonard Rd, W Hyannisport, MA Owner. Carol Wilbur Date of Inspection: ;L--=LI SEPTIC TANK L (locate on site plan) Depth below grade: � ) Material of construction:l/cncrete_metal_FRP_other(e:plain) Dimensions: �JV, ae Shulge depth: -/ '` Distance from top of sludge to bottom of outlet tee or baffle: Z r 6 Scum thickness: 3 Distance fmm top of scum to top of outlet tee or baffle:_� Distance fi-om bottom of scum to bottom of outlet tee or baffle: 1 �� 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.) 6 r3 a 99 Q/ i a tC� G cs a C./ e.b 7 A, d E TRAP:_ (locate site plan) Depth bel grade: Material of nstr�uion:_concrete_metal_F1tP_other(ezplain) Dimensions: Scum . DLtaace tE f scum to top of whet tee or hams:Distance bm of scum to bottom of outlet tee or bane: Comments ( tics for pumping,condition of inlet and outlet tees or banes,depth of liquid level in relation to outlet invert,structural integrity, evidence of ,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) property Addrew 18 Leonard Rd, � W Hyannisport, MA Owner. Carol Wilbur Date of inspsotlow TIGHT HOLDING TANK:_ (bade on plan) Depth below Material of concrete_metal_M_other(esplain) Dimensions: Capacity ons Design Qallons/day Alarm Common (condition f inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:_ (locate on site plan) 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 ER_ (locate on plan) Pumps in king order:(yes or no) Comments: (note of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) ptopej,Addrew 18 Leonard Rd, W Hyannisport, MA Owner. Carol WIlbur Date of Inspeetion: ;�--e i— -7 SOIL ABSORPTION SYSTEM(SASr (locate as sib plan,if possible;excavation not required,but may be appraximated by non-intrusive methods) If not determined to be present,ezplaia: Type: leaching pits,number:_ leachin8 chambers,number._ 3achin galleries,number: leaching trenches,number,length: Web,"g fields, number,dimensions: overflow cesspool, number: l ''-> Comments: (note condition of soil,s.' of hydraulic failure, level of ponding,condition of vegetation,etc.) d U 0 C '0 / )7, 0 ST& , L c l ae Co O oil. &:' Cpumb LS:_ (lsite plan) Nconfiguration: Depth-topliquid to inlet invert: Do layerDlayer:Ds cesspool: Mofn: I of water: (cesspool must be pumped as part of inspection) Comments: note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY— (locate on sib lam) Materials of n Dimensions Depth of 0 0 Comments: ( condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc. (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PnwertYAddeem 18 Leonard Rd, W Hyannisport, MA owner. Carol Wilbur Date of Inspection: SBSI'CH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all weld within 100' L � L i DEPTH TO GROUNDWATER Depth to groundwater J 2- '-feet method of determination or approximation 6 l c (revised 11/03/95) 9 TOWN OF BARNSTABLE LOCATION jff Led►-�u�c� l�� SEWAGE # / VILLAGE ttlf,i ASSESSOR'S MAP Cz LOT INSTALLER'S NAME & PHONE NO. �J, SEPTIC TANK CAPACITY LEACHING FACILITY:(type)T � � (size) 4aao L NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED' VARIANCE GRANTED: Yes No i \ 1 T N V 2� ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Disposal Works Tonstrurtinn ibrutit Application is hereby made for a Permit to Construct ( ) or RepairX(XX) an Individual Sewage Disposal System at: (1-2 18 Leonard Road W-Hyannisport " �� 1(9-�,, 4 ---••---••-•••.._.........••-••....._ .. ...................................... .......................... .._.... ......_....._..........------ Location-Address or Lot No. Collins ......................__........................................................................ ..........-•....................................... Owner Address W J.P.Macomber Jr. --------- ••------ Installer Address UType of Building Size Lot-----------------------------Sq. feet DwellingX-No. of Bedrooms............2.............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p" Other fixtures -------------------------------- --- W Design Flow............................................gallons per persop 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................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -•---•---•••--------------------------------••••-------•--------------------------------------------------..._.........------•----...---•................... O Description of Soii..............Sand___&...G_'avel..................-- W -------------------------------------------•-•-------- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... 1-1000-_-gallon•-•tank.-1-1000---Gallon leach pit. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned furl r agrees not to place the system in operation until a Certificate of Compli ce has been ' sue the bo d of lth. Signed .... 1/29/91* . �..... ................................'--' ' Date/�/ ApplicationApproved By -----... -... - ----- i�--_'----------.......------------------------...................... ; ._eW.......-- Application Disapproved for the following reasons: --------'---------------------'----............................................---------'---------'----------- ----- . . '-"-- ......................................................---------------------------------------------------------. --..........----"-'-------'-----'----------...----------...-------....--'---"----"--'- --------------------------------------- . q ` n Date PermitNo. -. ..1...-Ji. ......................................... Issued -- ----.:-..---------- ....................................Date r— 4W 14 1- W- —-I _ J r No...... s FEB......$...30.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrurtion Frrutit Application is`hereby made for�a Permit to Construct ( ) or Repaaiir.Y(XX), an Individual Sewage Disposal System at: 18 Leonard Road W-Hyannisport- b ................»...». ................................................Location 4�Address t ...................................................... Vie: or Lot No............................................. Cta11 i ns -- a Owner 1 1 Address W J P.Macomber Jr `�'` , . „ } ; ; -..... ---- • --•-•- -----•-•-•.........................•--••--••--•-•-------•. Installer L lAddress t. ? �r:+ UType of Building fi Size.Lpt.................... .....Sq. feet ,-, Dwelling X-No. of Bedrooms-. .Q............................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building JI ¢ i t f No. of persons. ! Showers ( ) — Cafeteria ( ) Other fixtures ----------------•---- --f ;zltrb-- '-- - W 't r�r. € = Ions. Design Flow_._.. gallons per person per day, Tota-___y�flow gal P4 ' Septic Tank—Liquid.capacity.•......_R_gallons Length'_ r^aWidth? . �D>amet'e-' ----------- Depth................ f�-" t u ..�V {. J x Disposal Tren No ..___-__..- Width Total Length .. ............... Total leaching area....................sq. ft. ch Seepage Pit No._ `= D>ameter _._. ._-....'`Depth,1;' inlet` ................ Total leaching area..................sq. ft. ` z Other Distribution box ( ) r Dosing tank (,- ) '-' Percolation Test Results Pe=formed by,` _,_.... t r'?.a= ,_. .............. ! Date__..__ Test Pit No. 1................mmutes per inch i Depth of�+Test,PitDepth to ground water _._.- f=, Test Pit No. 2................minutes per inch DeptVof Test Pit................._.. Depth to ground water---------.'.:_..........: ° ... O Description of Soil...............Sfd:O..k..r rsx.e�.................t�/ - - - - i_c i j��rtr 1( t� W -•--------- ........... .. . :.i r,}....' U Nature of Repairs or AlterationsAns er`when'applicable •� �1 `� � ..-----•------•--------i- .1— -a'P1,1on--tank. ?L`-:1:�R� _ CG............................................ Agreement: u� . . /71 The undersigned agrees to install the aforedescri6edti`Individual'Sewage DisposaItSysta_fg'ac(oydance with the provisions of TITLE 5 of the_Staie Environmental Code�t,The ndersigned�f'u !°herjag ees not°to place the system in operation until a Certificatef Compli nce la/been.iss e � h be o'a of�fi alleh" r f Signed - 'i �� .. � . f��,! Date Application-Approved=By.-..... � �t��- p 'r /Gi` ' " �'/ 'j//j.= s ` Uirra - � e Application Disapproved for the following reaeon� R /... 1I' --- ---------------------------- .`I.......-- �----....-----.............. ... .� r � f.� . `- 6� . .. ., �'"'.'..- I� } Date Permit No. �".. .:..... .............. Issued .� �.. «t ....................................... - r/.�.'�.,.._ s ._�c,. As are ..!. `y`� f l�.r r2 ✓f.? �; .',I/1"i�,. _. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Tnmlatiaxnce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by .......d.4.P__Ma.combe r...:1r.n.........-.........................................-I---nstaller----------------------------------------------------------------------------------------------------------------------------- at .......1R....Leo ....r rd....Road---WI-es....Fl-G:n-nj-e--ort.....................................-------------------.......------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. c!..-/ -;.. .......................... dated .... /. . . -/...- -----............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B� C�NSTRU.EIJ AS A GUA, SIT F I AT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ -.^'.. -.-.. ----------------------------------------------------------- Inspector -----r...... ®!�... .. �- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE....kaa:n.o.. Disposal Morkii Tonatrudion rrrutit Permission is hereby granted.............T u tr.�.,_, T" 000 to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at No.......18....R.MsIMI...Rne d... t dr`�a.rya,3_, r;rt..-••--...---• -•..................•--...............••-••-......••-•--•....._..•••...... Street as shown on the application for Disposal Works Construction Permit No. .. ..... Dated.._o /.. ................... ` ^,--........�•--.'•............................ �/ / Boardf Heaitlr j DATE -.....fir / _ .- FORM 36508 HOBBS Q WARREN,INC.,PUBLISHERS