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HomeMy WebLinkAbout0181 OLD CRAIGVILLE ROAD - Health 181 Old Craigville Road, Hyannis A= i r r =.•t " � ` ` TOWN OF BARNSTABLE LOCATION SEWAGE # S�CL► n^ 311LLAGE-Jjt�J.l-k%o ,+w1& 1' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)�1 k&k&s (size) i4JL!� NO.OF BEDROOMS BUILDER OR OWNER a1�1 DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ✓ e �j •�. �t 1 �l' N � ..�-� � � � 1 .Nr N W N � �, t � � � � � w � . .. C''_ c ,.,�. A,(ZE S R'S MAP N0. PARCEL r7-3 LOCATION 444 `Zu SWAGE PERMIT NO. T 3 01-� PILLAGE � I N S T A LLER'S NA.,ME JZ ADDRESS �u-15 CST. 8 U I L D E R) OR OWNER i & DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i a � I 0 elf, COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Uq DEPARTMENT OF ENVIRONMENTAL PROTEC ONE WINTER STREET, BOSTON MA 02108 (617)292-5� 1 WII,LIAM F.WELD 40 2'RUDY CORE Governor `��`/,(` Secretary ryp ARGEO PAUL CELLUCCI R 3 [ DAVM B. STRUHS Lt. Governor a 1 OF 199? Commissioner /�j��ti`4*1 k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO ;Q PART A nn '� /CERTIFICATION Property Address:- 61r 6'wSi,""6 Jam(. fly``' Address of Owner: [��G7 al,�: Date of Inspection: C4L/«/,7,— ` (If different) Name of Inspector: M,�_\ Company Name, Address and Telephone Number: R�'LA•�1L �,t,;J�¢.c�M�.��ncl... �t•(��ox dl'��y 1 i'"lnsrix•�-t tyra. oZLti`� C5�°G,� �177-1V7� 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: Qa- _% Date: 4 t`ck) 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: AJ SYSTEM PASSES: 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. B] 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 by the Board of Health. (revised 11/03/95) A i� Printed on Renrled Paper s ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property,Addre s---7/PW4� ��rct�✓ Glf� /��" ���"`"'`" Owner. Date of Inspectio: ..'p B] SYSTEM CONDITIONALLY PASSES`(continued) rt Sewageiba`&8p orbreakout or high static water level observed in the distribution ox is due to broken or obstructed pipe(s),or`due to aZ`broken, settled or uneven distribution box. The system will s 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 br en 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 Boar 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 DET MIKES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND AFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a s ace water Cesspool or privy is within 50 feet of a ordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD O HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MA ER THAT PROTECTs THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tan nd 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 nk and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septi tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a se p c tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollutio 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:'11f/ Mai(/ �cc u � . Owner: �c-.# Date of Inspection: �� "` D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as fined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to d ermine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface aters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to n overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available olume is less than 1/2 day flow. Required pumping more than 4 times in the last y7ofa to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspo below the high groundwater elevation. Any portion of a cesspool or privy is within 100 fe water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zonc well. Any portion of a cesspool or privy is within 50 f t of a private water supply well. Any portion of a cesspool or privy is less than 00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the wel has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compou s, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems addition to the criteria above: The system serves a facility with a design ow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environ ent because one or more of the following conditions exist:. the system is within 400 f of a surface drinking water supply the system is within 200 eet of a tributary to a surface drinking water supply the system is located i a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply ell) 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 annA.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 / I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 'l(�c� Cv'cc�Sv• l/� /c� /a.o�-tu Owner: / l Date of Inspection: ©41 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. f-'4ks 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. t//The system does not receive non-sanitary or industrial waste flow. t/T//he site was inspected for signs of breakout. vAll system components, excluding the Soil Absorption System, have been located on the site. v 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. I/The size and location of the Soil Absorption System 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 Sub- Surface Disposal System. (revised 11/03/95) 4 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,�Q Q SYSTEM INFORMATION Property Address: 111 Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:S30 Gallons Number of bedrooms: e3 Number of current residents: Garbage grinder (yes or no): 73 Laundry connected to system (yes or no):—VS Seasonal use (yes or no):r-'o Water meter readings, if available: Wk.p UnMta�f Last date of occupancy: ?Qyz— COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 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 information: c�4.vr W c—\\ r.9 System pumped as part of inspection: (yes or no)__CtEp If yes, volume pumped: eallons Reason for pumping: 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) and source of information: (UytR—C Sewage odors detected when arriving at the site: (yes or no) Q 0 (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION (continued) Property Address: `, S �, C� , c�cc 4.u.� Owner: Date of Inspection: SEPTIC TANK: tS (locate on site pl n) Depth below grade: 11"� Material of construction: concrete _metal _FRP —other(explain) Dimensions: ihflC�Qwwl•1 Sludge depth _ Distance from top of sludge to bottom of outlet tee or baffler" Scum thickness: t �t 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 aAd outlet tees or baffles, depth of liquid level in relation to outlet invert, structural inte��,n����yy,�evidence of leakage,etc.) 0 1VY10Ir11GI T�.sic ln�Tt��T L_c. 1A ram-, tThJr Jr 22f n, a�n W T t GREASE TRAP:N() (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: 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 baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: VzP-7-, � �f�„�v� `( ✓��(- A,�c�fig� A Owner: / 6w_� . / Date of Inspection: TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:4-es (locate on site plan) ti Depth of liquid level above outlet invert: qc Comments: (lot, if level and distribution is equa, evidence of solids carryover, evidence of leakage into or out of box, a c.) —Qo v PUMP CHAMBER:—O—O (locate on site plan) Pumps in working order:(yes or no)4L10 Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:� v,Owner: Date Date of Inspection: D' SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excava on not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number. 41� leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool,.number: Co ments• (note condition of oil, signs of hydraulic failure, level of p di condition of vegetation,etc.) o,1 S`*R.x'1 Iy°�'`��_T`� �, CESSPOOLS: IJ() (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of pording, condition of vegetation, etc.) PRIVY: 49-0 (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, etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add ess: � (�(Ga' ��,+ � : /20/ 71� Owner: �� Date of 4 p"e'ction: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 1Z DEPTH TO GROUNDWATER Depth to groundwater: fi 1() feet ((�� c method of determination or approximation: U S . tt_o�V tin v� (revised 11/03/95) 9 i n ° Y s° \\\ 9?OO L n [ •L J • 1 it Family gym. \\ '----..___—'_ �8 ! _2 It- Z Now L - lp .-.I� - 11 V Ir n.E E as 1 @@ gy £ � I�EN��Ii.L.-.NOTEh a�y2 CONTRACTOR SHALL FIELD VERIFY ALL EXISTING CONDITION5 .PRIOR TO GOMMENCING r.04, 'jRUCTION AND NOTIFY DESIGNER G p u 9 hEh 0 0 OF ANY D15REPANGIE5 ANp�OR OMMISSION5 THAT MAY BE - ®n,.9 ✓i G Z 0\ FOUND DURING THE COUR5E OFGON5TRUCTION. m�`�m•m R y O F THE CONTRACTOR MAY NOT ALTER THE DESIGN IN ANY WAYS WITHOUT FIRST CONTACTING THE DE5IGNER ZONING 1W PF—"AT"ION DRAWING TYPE: -- r.�r/dIto• yit'e LayouF Plan . �A>e�U I f L-AN SHEET NUMBER: A000 I t� �ofiiac+�•aEuaAyiPawooa Xmmm.wo I Cg�+jlpge�-7—' ' ]Ypnu y �—�W„'7u615>p¢9 T�fi Sd 5 ��=r-swg+=.vu=-+=�>'9=n�=e=n-ro 5�.�:asnr�<jNssl��„�`alllnaa�-ua7 1—LL66'ObL'90$•109Lo VW'sryugfiH•btll xop'p.i�. 71 - lep.iawwm zcwmo+ Yrn+y.woij zoi I a.s ua say• I a=c O 4imEulpaa>wd vole>vi]u ado uiPll - s�w,we+a Rminwlla+d zo/%t/s N>w>.�>wwu>a4]=]+=�e+zsRaa>w i _- uBis�p Bnq}oualssaja� _ .i.�,m>.o,�+,.�,Wla-d a•oio�s uamro>]]¢>41 o]Nbn=+9>Q fiHS p azy]=gyp FNo=zEvlmc+p K s volsln3a O +�.Cu>'s'oFua psaiw ayi ul I :NOI1tlJ01 sa{nroossy��lf"'Gi N-Fauua wen+Wo,oip,ef+w+a zar-V¢e>+aeF lwv I Q o a ana �j aj„ ublsad s47/o uc{sslWA s] Y G m I 4 01 Ei l¢uelssaJc+d ua]71+*ssaxlxa 7yilm pa]19Mo+d 69�a+ [ no �+a6 sa bul In uel7¢^I/IpoW veld sly]6ulsn awcy auo 7 -� ,10 SLLOI I 7SU01 7nouaJ # �® pug auo]on+]w000]Gaa+cy]n¢s,u¢Id Z >lon*r a Maaol �. h.l'I' F L--, 9� z_ o sly7/o.osay^+'d lgul6l+o ayy smg"I7461+fidc7 3 L H •AB NMVNO W¢43NJI53a �jJ d I®+gF>d+apun pa7oa]o+d>+g q,gld azayy "' 'sa]¢Ix-�tl+>IW547auua>I fi9LOoLd•]ybl+fido7 \ Nw Odm � �F= < _ zO Y z z i�Q 00 p��ggL W< pg 1 �wai o O J F S N OJa <g /. <�OO 0is s s O 6 s d`0 �E - .. �� - �:' ^♦1 /�' � - c+f.�.x� •boy , - e9 a // `\ ♦1P. /�/' �♦♦`PVPx c n oa � j� •o v�, ' W li a O � M1 bp All +t ° so61 w , s - r } l . f 1 , rayy' 1 k t c! t r 1 aq:Y .__.�__ .__-._ __:__.__�_�.�.___�_.�=—a_.�,Le`.��''.t`b kv tk..uii„K.k^i?��•4Y r_..L�'u^__4s�-___.e.__.�__._.JI_____ I ' oeuy�ee 6uRno 0. wajo RaBnnuoeev aw avooaq pmwzae w4nlaYFa�wu6aaauWlpr,a,o�s a.nav9a ameava,alNe e.aeai ae,uwoela oVonoe�a uYnag+u�+�a6pmaneoa a iaae saluaa 5�.�p.absO(��LI�JaNlSlinSbtni��oa'S7aIfI 1I/0\'�a�•LLQa�) LL�bEu'ObL'GOG-L09m.LmO.woou6w1sa7N v•s yb4�allnpx9yB .1 d lBl 2 Is2Ji.I6;7Jl3WW07 -I'— Od s6u.•cvur!n�,d.�uaa.ry�nl!4�.:ti l�no;�7!d rsoo//o16!//6 1�Q I ouCSS�j6J8ls�p 6ulPI. . e O w�IM.,a�a wwfv�d z o/ois O ��eueyv apaw�aaufine�aaopma, _ .5� - uav paucaueaeWynvup I � �o c'a�o�suawR•�aw wail .NOI1dJ01 sa{tii7os.sy-'all"'Gi N-I'auua� } o a,onewe.e�wpa,e..p•wpusda.a�p Auv v auola.�lJ„�.ana-hG> •aj-,l uaaal�*z�a,�'°ubva4.vo���vlpaiau �o uopvoillWwv.Id sml 6ulvn auoy auo —61sad 6u1Rl^0lvuolssvJeud -jaj suo�{ippn suoi�nnOuaa 1 enowa auc�o��aa+o,e�va'il�vmp a,�ple iL z I�?nVcd'M aClo1 � 9� l # �®�d eery/o asvy�rdlpul6l vVl'smp'17461+fid�7 tr as Mtladp'e03 �Isao 1J3 01ld a ana�npvn%roa;o ea p pleasavl 'saavloossV jalRas4avw 6q LOOL®aA'fido7 p y NW o�m z �Of Y JLL< Z N O d ' JZ4)F Id O ' u400 �i0 S1 /r , 00 0 . z JZ�O < V Q �izw iz � J �O�z dm �yy~''ZO 00 �17 (I I r_—--------- __---___--------_-- ----------1 ; 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