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Home My WebLink About0019 SUMMERSIDE LANE - Health 19 SUVIMERSIDE Y� If A = _307 069 e i Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection WIIIIam F.Weld 3 Q 7 �- �y 4!/ • Governor \ — suredtayry eoXFea C/ jg David B.Struhs � `96 Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t't PART A 1 CERTIFICATION Property Address: 11 5u V►1yV1e )0E L.K! ? �� Address of Owner: Date of Inspection: -gyp- b ( Y f S (If different) J v Name of Inspector: ' ,� Y,. ��10�✓� Company Name, Address and Telephone Number: 3 Fo/0TL/ t 2 3,v ��-2*�, y�wiwl s WA, 77 � . 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: t "of�li.•'.;L J 94; i 0kII 4 ' �.1 :5 hif l`", LW.Lk "k"f Il) 1 ••�' �sses ';• _ Conditionally Passes II E5•. h,S:n _ Needs Further Evaluation By,the Local Approving Authority ' w 1' _ Fails +-.4 twoe q tr' 4c , ' r Inspector's Si ature: Date: �< 5 ao-.9 Thy System Inspector shall s bmit 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 owne hall submit '< the report to the appropriate regional office of the Department of Environmental Protection. k a :; =( rr'}'frytf1'. a• •t;t -,¢ The original should be sent w the sykiem owner and copies sent to the buyer, ii applicable and the approving authority.,t!": C1;11'r'•";�1 INSPECTION SUMMARY: %rl r �. ' ..Check A, B, C, or D, to ViT L 1 i AJ SYSTE ASSES: S;'+ 1. ,it�t:r� li,N f)i? .. .t .. l � ,i .f.) '. ^!' ..�k�f�kh•ff rtln:i ,rffjt) •.l` `S .+''•' �"tA 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. { Wzri 241A1 �� BJ SYSTEM CONDITIONALLY PASSES: `fi • l; ^ '}rtl'r.�'; i;'9ftllt'��yt�3,q'l6fl 3 c;rWor more system components need to be replaced or repaired. The system, upon completion of the replacement ,pr,repair,,c-1 y ➢=y°� passes inspection. t Indicate yes, no, or not determined (Y,`N;or ND)�'Describe basis of determination in all instances.'If"not determined",,explain why not)i� _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is ,t,`. �{`' 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 6/35/95) 1 �` y 5 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 9 Telephone(617)292-3S00.1 .> .r h i,Printed on Recycled Paper r��,�, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: yN\Me-CS1O-C— Owner: &I M.e_ 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) 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. I 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. <f 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: !. J... i. _ The cvctem hay a sepuc tanK ana soli absorption system and is willlUi iOG icci Lo a suiiw-c Pram. iu P.y Or trlbuiai)' t0 a surface water supply. _ The system hay 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 systen-i 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 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• 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 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. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �`�''MtNI'e v vl�`e �t'• ```�y Owner: Date of Inspectioy ` D] SYSTEM FAITS (continued): 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. lea 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,above: The design flow of system is 16,000 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 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 II of a public water suppiy 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 8/15/95). 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: l� �•�'M tt't�r V�':i+�j��'w. Owner: Date of Inspection: Check i(the following have been done: lz/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. Miss built plans have been obtained and examined. Note if they are not available with N/A.. is The facility or dwelling was inspected for signs of sewage back-up. �4he system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. _All system components, excluding the Soil Absorption System, have been located on the site. 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 existing information or approximated by nun-intrusive methods. The faci;i;'� or,:,rr ;j••.;,' occupants, if d;'}e.—, from owner', were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95). 4 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:V k j�,•/y��v ��, f y, Owner: Date of Inspection: FLOW CONDITIONS , RESIDENTIAL- Design flow: Qallons Number of bedrooms: 1 Number of current residents:_ Garbage grinder(yes or no):� Laundry connected to system,(yes or no):Y— Seasonal use (yes or no): Water meter readings, if av ilable: Last date of occupancy:_�teti� 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: System pumped•as pan of ins ction: (yes or no) If yes, volume. pumped. 4-V gallons Reason for pumping: GA TYPE OF SYSTEM,, - 1eptic tank/distribution box/soil absorption system gle 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: —5 Sewage odors detected when arriving at the site: (yes or no) V (revised 8/15/95) $ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property A#4ess: Owner: ' &t 4/1�— Date of Inspection: SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: _concrete _,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 baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRANS (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: ni!tance fro!r bottom n, !r+im to hnttnm of O!I!lP! IPP O• ba111P' 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.) d i � i 4 (revised 8;1-5/95) , 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:. ��/Jviyi yher,_�V/fie Owner: Date of Inspection: 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:_ leaching chambers, number:_ leaching galleries, 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,etc.) CESSPOOLS: (locate on site plan) Number and configuration: Y�-'`'"+/'�qe� ryoey Depth-top of liquid to inlet inve� f 1 i Depth of solids layer: j Depth of scum layer: Dimensions of cesspool: 6 Materials of construction Z_ Indication of groundwater. / inflow (cesspool must be pumped as part of inspection) \/ i S A;eq ;�Zv�c'!0gD Qf� Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: .(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 8/15/.95) 8 h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) . Property Address: :1: Owner: Date of Inspection:• SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references,landmarks or benchmarks locate all wells within 100' 71 i DEPTH TO GROUNDWATER wo , Depth to groundr.�Zwatefe t method of determination or approximation: 7V=.✓,6' �yy GY ouN w14T,--V— D SUSTMT p�,s �� (Lf !�.ricl�m�C�� Cal�•P•i � il. /.�f vT� '1 1J�7�✓ A..�3 �T tA�l'�L. � 1 (revised 8/15/95) 9 Check list for unconnected parcels: Name: Anthony J. Biale Map/Parcel: 307-069 . Phone Company has no listing Prop location: 19 Summerside Lane Mailing address: 19 Summerside Lane Hyannis, MA 02601 Visually check property location check for any past pumping records (as of 11-7-2000) 7/28/95, 5/30/97, 6/4/98, 6/28/99 & 10/20/00 Since 1985 check water company for-water use 114 ccf per year check with engineering for permits and if they are within the bounds of connecting As of May 17, 2000.no record of any permit taken out Notify Board of Health to send letter to connect Date BOH notified: Nov. 5, 1999 Date BOH copy received: . ? Date BOH letter sent: Nov. 16, 1999 Date BOH letter expires: May 16, 2000 Sent to Tom McKean 11/7/2000 CHKLIST.DOC TOWN OF BARNSTABLE "LbCATION / 9 sum M ER S t b E L!?/yF SEWAGE # VJJ.LAGE /)MNN/S • ASSESSOR'S MAP&LCT_100-06 9 INSTALLER'S NAME&PHONE NO. tt : SEPTIC TANK CAPACITY f LEACHING FACILITY: (type) NO.OF BEDROOMS LWE BUILDER OR OWNER .) B I X I-F PERMTTDATE: 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 J o n1 In c GAzjj � k4iaft o _ O c ,a �. �_ � _ , �d � . �� . � 0. �� a o �; : `�. ��. � z •+� tkit ~ �. 1h. . ,� t, 1` ��; � � �y �� w�tn` r