HomeMy WebLinkAbout0373 OAKLAND ROAD - Health 373 Oakland Road,Hyannis
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TOWN OF BARNS TABLE
LOCATION '
VILLAGE � l7i�%s' 3 ASSESSOR'S MAP & LOT o?;7/* 0/A0
is
INSTALLER'S NAME & PHONE NO.. "y2
SEPTIC TANK CAPACITY Jft Flo
x
LEACHING FACILITY:(type) (size) loft
4w
'y
tY
NO. OF BEDROOMS Z PRIVATE WELL OR PUBLIC WATER
qq .
BUILDER OR OWNER
DATE PERMIT ISSUED: -7�—Z--`
-DATE COMPLIANCE ISSUED; �
VARIANCE GRANTED: Yes NO r �'
5
s
Awi /.rn� "
93
No....g1.... Fx$.` ®
APPROVED THE COMMONWEALTH OF MASSACHUSETTS
com Dep ment BOARD OF HEALTH
�� OWN OF BARNSTABLE
signed � lirtt i�ait for Divi-pw3al Wurku Tomitrnrtiun rrruui#
Application is hereby made for a Permit to Construct ( ) or Repair ( J/) an Individual .Sewage Disposal
System at:
..........LU.............. .,94--- .....m1Dn',...... ...••••-•••••-••---••-•-••----•----••------------------------------------••----------•.........•-•
Location-Address or Lot No.
G..�aiva--•-•----•-•-••---.....---•---------------- -----------••-•-•--------•-•----•--•--.....-----....
Owner — Address
1 k1.c kfk k X------------------------------------------
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms__________________Z__________._____.._.__Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ............................... ..
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
R: Septic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter................ Depth................
W Disposal Trench— No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
x
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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
G Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
a ._...---•--...•--------------•••••••._...•••----•-•------••-•-•••-••...........--••--••-•-•--•---•_..........................................................
0 Description of Soil.........................................................................................................................................................................
x
U --•-••••••••••-•-•••...--•••---••--._...•--••-•-••••-•-----••••-••----••.•-•-••••-•-----•---•-----•-••---•----••-...••••-•-----•-•••-••--•--•-••••......-•--•.........................................
•-••••--------------- -------------------------------------------------------------------------------------------------------------------------------------- 1
UNature of Repairs or Alterations—Answer when applicable.-.__.._____________A,0.V......................0..............4:u�x
.....•-•.........--•--•...................•••-•--•-••....................._..-•••••-----•---•--.........----•-•-----------------...----•-•--•-••.._.................._...........---•••.........._...._.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Co e—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance s b e the board of health.
Signed .. . ..... /..V ----- ----------- ....
Application Approved By ----- - -------- --------- -- =- ---
7�blqt
Application Disapproved for the following yea ons: ..................................... . --...............................................
Dat
Permit No. Issued .... f _ 7 --------------- e......
i - ate/
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Graylizince
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by ---------- S----------- :IN-LA.;W-------------------------------------------------------------t-1
---------------------------------------------------------------------------------
4
at ----------------- ......... -------- - VAI I -------- -------------------------------------------------------------------------
�-� 7--- . (-&10--------'
has been installeZl-in� accordance �with the--provisions of TITI.E. o he StpxeEnykonmental Code as described in
I -- ------- dated ----------------------------------------
the application for Disposal Works Construction Permit I � q
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
------------ Inspector-'------- ------------------
------------------------------DATE..... 7---------------------- ..... --- ---- ---------- -----------
------------------------------------------------------------------ -------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No....1 .............. FEE---.. .....
Disposal WorU TomArtution V"nutit
--I-"
Permission is hereby granted V.Ajffl:- -;S.....wk (--W- ...................... ..................................................
to Construp, ,(,) or epair an Indivi�.0 Sewagp Disposal System
atNo........... V/0 . .................................................
as shown on the application for Disposal Works Construction Pofn- D.?-7-------- A-- Dated...c....................�..n..............
............... ......
t /�//
Board of Realth
DATE................. ..................................
FORM 38908 HOBBS&WARREN.INC..PUBLISHERS
.�..
93
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
15�VTOWN OF BARNSTABLE
Appliratiou for Big uiittl Wor1w Tomilriirtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( !%) an Individual Sewage Disposal
System at:
t e c h n ) .
/ Location-Address or Lot No.
...............l -!9zl_ ........... .............................................. ......•---•---------••-••.._...•••-•••---....••-------------••-......._........----.....-----•••.
Owner Address
aIrjin.r.6......._...���.r�t�----•--------------------------------------
Installer Address
---------------------------------
� '
UType of Building Size Lot__>........................Sq. feet
Dwelling— No. of Bedrooms...................z.-..--_.---_-__---_--_Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther 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 ( ) I Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
f1 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
0 Description of Soil.......................................................................................................... w_.......................
U
x .................------------------•---•--..._._.....---....---------.......-•----------••----••--------•-----•--------------------------------•-------•----•----------•------•-n-..........
V Nature of Repairs or Alterations—Answer when applicable....................OV.......................i.t--------- ..IL) .. .....
r
---••---------------••-••••••----•---.....----•-------•---.........-----•---•--•--•----•._..........------•-•------------------------••----......-----•--•--............................................
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 further agrees not to place the
system in operation until a Certificate of Compliance has been issu d by the board of health.
1 Signed ..! ' ;'-/..: .3�(//... ............ .......................................... .......
4
Application Approved BY -_ �'/ - `'�------------ ... G�
.................................. [Da[e
Application Disapproved for the following r ons- --------------------------------------------------------------------------------------------------------.............................
- n Dace
Permit No.-----/� .... ........................ Issued i/.3
__
Dare
TOWN OF BARNSTABLE
LOCATION SEWAGE
VILLAGE �� !?iffy ASSESSOR'S MAP LOT,27/1.041
INSTALLER'S NAME & PHONE NO. tV jf
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 9'✓ (size) /a��
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER-
BUILDER OR OWNER ��' C C � �a'f c
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED-
VARIANCE GRANTED: Yes No
---------------
14
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CEI�E� \
Commonwealth of Massachusetts
AL OCT 1 0 Igo, --
..
Executive Office of Environmental Affairs
Department of
Environmental Protection
Wlmne F.WW Trudy Cos•
Go"Ma - "amay
Arpao Patel Cwhied David B.Struhs '•;:'
tt cio�nor Gbmrnl�maw
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM `
PART A
CERTIFICATION
Property Address: 373 Oakland Rd. , Hyannis Address of Owner: Jeanne Harrington
Date of Inspection: 10-4-96 Of different) 17 Juniper 'Dr. , Norwood, MA 02062
Name of Inspector. �T g q 1� e,�
Company Name,Addr�and Tefephone Numbel: Walker' s, 143 Old Yarmouth Rd. , Hyannis , MA 02 601
( 508) 771-2424
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 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 -
Inspectoes Signature:. Date: 10—8—9 6
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] SYSTEM PASSkS:
XXX I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CW 15.303-
Any failure criteria not evaluated are indicated below.
B] SYSTEM.CONDITIONALLY PASSES.
a One or more system components need to be replaced or repaired. The system, upon ciompletmon of the replacement or repair,
6 P passes
indicate yes,no, or not determined (Y, N,or ND). Describe of determination in all instances. If"not determined", explain why no
_ The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is
<<:Y imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by die Board of Health.
Iravieed 11/03/95) 1
Om Winter Straat • Boston,tiAassschusetts 02108 0 FAX(617)b66-1049 • T•laphon•(617)292-WW
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued) gr
Property Address: 373 Oakland Rd. , Hyannis , MA 02 601
Owner: Jeanne Harrington
Date of Inspection: 10-4-9 6
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 brokers, 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] 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 100 feet to a surface water supply or tributary to a
surface watersupply.-
The system has a septic tank and soil absorption system and is within a Zone I of a public water supplywell.
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 coliforrn.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
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(revised.11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 373 Oakland Rd. , Hyannis , MA 02601
Owner: Jeanne Harrington
Date of.lnspeWon: 10-4-9 6
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 bans ,
"for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
_ Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or dogged 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'oesspool 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 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:
3
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-
the system is within 400 feet of a surface drinking water supply
a` Y the system is wtthin 200 feet of a tributary to a surface drinking-water supply
>.
4 y the system,i. loafed in i nitrogen sensitive area(Interim Wellheadf rotection Area QWPN or a mapped Zone n of a
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater Ineatrimernt program
v
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/03/95) 3
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PrOlPertY Oakland Rd. , Hyannis , MA 02601
Owner: Jeanne Harrington
Oabe of-Irrtpection: 10—4—9 6
Check if the following have been done:
_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 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.
_The facility or dwelling was inspected for signs of sewage back-up.
_The system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout-
4 All system components, exduding 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,*pth 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 existing information or
approximated by non4ntrusive methods.
_The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/9S) 4 l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
f PART C
f SYSTEM INFORMATION
Property Address: 373 Oakland Rd. , Hyannis , Ma 02601
Ownen Jeane Harrington
Date of Irupection: 10—4—9 6
FLOW CONDITIONS
RESIDENTIAL:
Design flow. n_gallons _ x
Number of bedrooms:_
Number of current residents:_g_
Garbage grinder(yes or no):no
Laundry connected to system(yes or no).*es
Seasonal use(yes or no): _
Water meter readings, if available:- n 3
Last date of occupancy: 11 4 9 s
COMMERCIAL A N D USTRIAL:
Type of establishment:
Design flow: pllons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to tfie Title S system: (yes or no)
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of>infomration:
System pumped as part of inspection: (yes or no)_
If yes,volume pumped: gallons
Reason for pumping
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Overflow cesspool
Privy ,
Shared system(yes or no) Gf.yes,atadt previous inspection.reoo[ds, if.arty)
r Other(expla n
ro
APPROXIfb m AGE of all components,date installed (if known)and source of information: 2 years " as bti i ht p l aiz
Sewage odors detected when arriving at the site: (yes or no)_
�,, (revised 11/03/95Y S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 373 Oakland Rd. , Hyannis , MA 02601
Owner. Jeanne Harrington
Date of Inspection: 10—4—9 6
SEPTIC TANK:_
1000 gallon
(locate on site plan)
Depth below grade: 5"
Material of construction::6Xconcrete_metal_FRP other(explain)
Dimensions _
Sludge depth.
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: -
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or ba(fies, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) clear water,no sludge, no scum
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of consauction: _concrete_metal _FRP other(explain)
Dimensions:
Sam thickness:
Distance'from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: _
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage,etc.)
,r
(revised 11/03/95) 6 \�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 373 Oakland Rd. , Hyannis , Ma 02601
Owner. Jeanne Harrington
Date of Inspection: 10-4-96
TIGHT OR HOLDING TANK:_
(locate on site plan) _
Depth below grade: _
Materiaf of construction: _concrete_metal_FRP_other(explain) .
Dimensions: ,
Capacity: gallons
Design flow: ttalions/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert: 0
Comments:
(note if level and distribution is equal,evidence f sol(ids arryo , evidence of leakage into or out of box,etc.)
ooks- goo
PUMP CHAMBER:_
(locate on site plan) .
Pumps in waking order:(yes or no)
Comments:
(note condition of pump dtiam ,' co Wit ion of pumps and appurtenances, etc.)
t
Y
' ��. (revised 11/03/95) 7
SLFBSQIRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 373 Oakland Rd. , Hyannis , MA 02601
Owner: Jeanne Harrington
Date of Inspection: 10-4-96
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) ,
If not determined to be_._ Present, explain. .. '
Type: .. .
leaching pits, number:_ L 100'0"gallon 'pit 3 ' stone-.----- _-. __........__._
leaching chambers, number._
leaching galleries,number
leaching trenc*, number,length:
leaching fields, number, dimensions:
overflow cesspool, number.
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
CESSPOOLS:_ - -
(locate on site plan). ..
Number and configuration:
Depth-top of liq6id46-inlet invert
Depth of solids Gayer
Depth of scum layer:
Dimensions of cesspool:
Materials of constrwion:
Indication of groundwater.
inflow(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:_
a
(locate on site plan) _
Materials of aonsirudion
�"#---- =-- Dep�th.of solds Oirnendrons _
I COrnftlt 5• (note CandltlOn 9(soil,Signs of hydiaulk fallen: level Of pordl tondltton'Of a y}
5
ng. vege�tton,etc)
(revised,11/03/95) B
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 373 Oakland Rd. , Hyannis , Ma 02601
Owner- Jeanne Harrington
Ddte of Inspedion: 10-4-96
SKETCH OF SEWAGE DISPOSAL SYSTEM:
r-.
include ties to at least two permanent references landmarks or benchmarks
lode all wells within_100' -
i
3 � 3
i
ll) r TO it O IDWATER :
Depth to ater�_k*t .or .more
method of determination or approximation:
(revised 11/03/95) 9