The URL can be used to link to this page

Home My WebLink About0298 OCEAN STREET - Health � IN 298A OCEAN ST Tj HYANNIS. A= 325 050C�-� y� 4 .; ASSGSSPR'S MAP N0. lJj PARCEL 'n 49 LOCATION • SEWAGE PERMIT NO. a qom ®C8a�bv S VILLAGE �\( A 0, 1 10 T LLER'S NA E A ADDRESS 1 BUILDER 0R 0w NUE R 41 '-s,o ,-- -z- \\ r UAW DATE PERMIT ISSUED flA o 1, 9 ® (o DAT E COMPLIANCE ISSUED k t aATu V i �f (S J LA �R� V ILI S 1 _I� .,-- S,S SOR'S MAP NO. -IA5 PARCEL 0'49 t LOCATION SEWAGE PERMIT NO. VILLAGE ' L. ot'9�lz IN A LLER'S NAME i ADDRESS R U R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� _ $ � O� IL a oce4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 3 a J Address of property Zr'IeSA OGtAt--1 -STeFZ i -5 owner's name C rr f-1r,:Tls ` "5Aj,,J _ Date of Inspection A - Zd-pis PART A aq CHECKLIST � �,�' /'U� 3Z5 /CC- O`f 1 Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. 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. _ As built plans have been obtained and examined. Note if they are not available with N/A. Y The facility or dwelling was inspected for signs of sewage back-up. X_ The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. I _ 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-SAS .on the site has been determined based on existing information or approximated by non-intrusive methods. - The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 3 number of bedrooms _4 number .of current residents(lit-x) i./ garbage grinder, yes or no `T laundry connected to system, yes or no 4_Pt! seasonal use, yes or no `z or= If nonresidential, calculated flow: Water metar readings, if available: N/W Last date of occupancy GENERAL INFORMATION Pumping records and source of information: `Jt.lh'7'F /dT /�ili✓r'',�1� �/.�! '. �'.r/...��At�.�t�"/vim /N �� System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: i Type of system 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information: /.y --'cc T// < Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK:_, (locate on site plan) depth below grade: Z , material of construction: concrete metal FRP other(explain) dimensions: 8 'X 5 'x 4' F� sludge depth distance from top of sludge to bottom of outlet tee or baffle lo" scum thickness 4" 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, recommendations for repairs, etc. ) S5 ' i[ /WX i a hAr To Aw1w W,— a, Sc /tJl•,e s SC:iirt Zr r 7O"iA L DISTRIBUTION BOX: X (locate on site plan) D 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, recommendation for repairs, etc. ) PUMP CHAMBER: (locate on site lan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : X (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 and number leaching chambers and number 7- leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : WAI number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool s materials of construction 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, recommendations for maintenance or repairs,etc. ) PRIVY: j (locate on site plan) / materials of construction dimensions depth of solids Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' PWOU A 4 5, %1*/1c a )To � !�-•�oX 13 gig;c. I. xc 11�1C; c • f Z il�t iTS i a DEPTH TO GROUNDWATER z depth to groundwater method of determination or approximation: 6��Y�TIDa/ D� /i22�i./.c!/�L✓�ZT�72 �'LE=✓f�/?��1 ic/ 4 � 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? I Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? ff/ Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration. subs �tantial exfiltration. tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of a surface water? DITL,l ' f/1CM f�r�ojT y Al within 100 feet of a surface water supply or tributary to a surface water supply? M within a Zone I of a public well? IV within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? .1 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. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector /% Company Name BENNETT & GREILLY, INC. / Company Address 84 Underpass Road P 0 Box 1667 Brewster, MA 02631 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Check one: I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. .f Inspector's Signatur , XZ Date Original to system owner Copies to: Buyer (if applicable) Approving authority ASSESSORS MAP NO: AldOFL 4iO., __ 49 NoFEE............._............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ft- L ----------- ---OF.....-. .�� 3f,% Appliration for Dispaiial Works Tomitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal System at• � ``�° .a JLocation-Address ® .A_. % . J - ..... = `.4n.: 4Yf/" dress .....I . .....'- N pp"" q caner c ... ___L____ x. Installer Address �__________________...�._. UType of Building ` Size Lot___________________________Sq. feet Dwelling—No. of Bedrooms.__...___._a_________________________Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water--------_-------------- 4� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ' -•-•-•-•--------•--...------•---------•-•-•-------------•--•-•----...-----------••••---•----••--••-•........................................................ 0 Description of Soil........................................................................................................................................................................ �., s V N .ure Repair r Alteratio —Answer when applicable____ S_ ___.•---•---- _1_-- ------- - C-- _---_---_-• .--------• =rQw C g Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iTT E', , p �` of the State Sanita Code—The undersigned furti er agrees not to place the system in operation until a Certificate of Compliance ha b issue by the b�o t he \ Signed...... ......... . ........................ .. ----- ----•••-= I �� Application Approved By.......... �-'t---.�`J... -�1� �pD�e Application Disapproved for the following reasons-...............................=............................................................................... Date -------------------------------------- PermitNo......-..__../--`/[----...............a�j--(-,-,-v�-'--------•--. Issued_....................................................... Date r .. 04f 9 Fes$-�__G_.,_ ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f OF_..... .. �.�_.( BLC= Appliratiun for Di-spoual lVarks Tanutrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ` ) an Individual Sewage Disposal System at: _c:�!�.�__.......L�................ .•-----------------........ _ . .` q," Ecation-Address / � ` or Lot -.. ._\�-- --- » ._'.'Ar.----•-•------------------ .�a::1?_.......W.R...:r3!� :....... . ..2-----...----.._..---......--- Aress 1 � Installer Address UType of Building Size Lot............................Sq. feet ., Dwelling No. of Bedrooms............ ...........................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................ 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------__________,__. Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. P4 -------•••-------------------•••--•---•---•----•---•-------..__.....-----•------------•••--•-.............-•----------------•---------•---------•------_----- 0 Description of Soil........................................................................................................................................................................ x V ------------------------------------------•-•--•---••--•----------------------------••----____-----________-•-----------•--•---------------•---•----------------------___•--•--------------------------- W --•---- - -- -----------------------------------------------------------•--•--------------------------------------•- x U N turef Repai s['or Alterati —Answer when a pp��lyyi��c•yyable___` ?_ _____________ Agree I nt The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanit Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h b issued by the board of health 1 ,4.. Signed.•-- ----------.........................................-94�-•----•--- � l�° . �;. . ............................ / D ApplicationApproved By------------------------------------------------ - :---._..............._.._. .__•-- t Date Application Disapproved for the following reasons:............................................................-................................................... ..-••--•--•----•---•---------•-•-----••.....-----------•••••---------------------•.......--•-•-•-----•--•---------•-----....•-•-..-------------------..------------•------------------------------_---•- / Date PermitNo.---- _!� G(------------- Issued....................................................... ------ -------- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' OF......... N� .......................................... ........................-..................._.._................_... (Infif iratr of TompliFanrr THIS ISjt' CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } by-• •--- r .t =� ,...... , � Installer has been installed in accordance with the provisions of TiT1Z j of The State Sanitary 1140-1-4& � as e-cribed in the N application for Disposal Works Construction Permit o.__._____ _______�t9_ti date.�l__.._ ___________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTIONSATISFACTORY. DATE------------------------------------ ... ......... Inspector.-•--- / ------------------------....--------•---._.....---------•---••-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s5. .......OF....... ... `.. ... ..........................................:........ Disposal Workii Tonoir ion rrmi# Permission is hereby granted......P)elf r_!.?A..�.................................... •...................... .......................................... to Constru .L-,�_ )_or Repair ) an Individual Sewage Disposal System _v.r a Street / as shown on the application for Disposal Works Construction Permit No..J� .' 'ated_____7'_y_10.�____________________ -- G tt DATE------ ! -!.��] ............................... Board of Health FOGR%J 12S HOBBS & WARREN. .INC., PUBLISHERS