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HomeMy WebLinkAbout0025 WESTON CIRCLE - Health 25 WESTON CIRCLE, HYANNIS A= 083 005 t { JCx oMMONWEA1171H OF SSAC �S 'TS Cun OFFICE 4F'EwiRO�IIEi� AL AFFAIRS t DF pAitTArENT of `i NvrRO 4 CTTO i T E-S. t�ITs ICIAL IW CnoN-Fo -NOT It VOLUNTARY SU$SURFACF SEWAGF DISPOSAL SySTM FORM PARS'A CER CATION Property Address:ti S �ix7'Ur Owner's Name". �t "� A owner's Address: Rate oflnspection: Name of Inspector(please print)��A`i"�� � �'r.�/►'sr"!.►� company Name: NiaWMg Address- /�N,vt O J Telephone Number: �-U T- CERT MCATTOIT STATEMENT I cep*that I have personally k specmd The sem*age disposal system at this address and thar the information repari ed below is true,aCCmMe affid complete as of The time of the inspection-Tlae won was pied based on m-r training and experience in the proper A m+cdon uance pf on site sewage dual -I tan a DEP approved system i ectos pursuant to "on 15.340 of"Fitle 5(310 CMR L 5.000)- The system: Passes Conditionally Passes Ade✓ds Further gvaluation by the Local Approving A'31h0rity Fails �/' �' r I3afee S r/ O O ro the g Authority(Board ofxealZ: 0t or The system insgectar a -ofthis iuspecdoaz report A�pp DEP)within 30 days of completing this you-If'the system is a shared system or has a design flow of 10',_r: 00 gpd or greater,the inspector and the system owner shall subatit the most to the appropriate regional office of tine DEP.The original should be seat to the system Owner and copies sent to the buyer,if applicable,and the auproving authority. Notes and Comments report only descr:rabes conditFons at the t'attre of boa and under the conditions of use at that time.This inspection_dogs xwt address how the system waif perfarate in the.f�re under the same or differrat conditions of use. Page 2 of 1 I ` 0 MCM.@.rIMSPEMITO Y JC'ra.3*�2S"a --AFT FOR r�:�3�14J1'2?;3i��t`9.3a?F17iYlB'.L.F:alt�� SUBSURFACE QEWAD- ;_.._. '' 7a?FFf. PART A CEP_7—UTCA ON(corrtirme I 1'resPet ty Address: J —S 7 U cL c Bats of Ius bra_ /�_ d 61 Insg---tiou Summary. check A. Sgstern _ 1 have not found any Iafoamamon YAAch indicates that any of the Favae criteria described in 310 Ova 13303 or in 310 CMR 15-304 exist.A-qtr fadm­e,criteria not evaluated are indicated below- Comments: B: System Conditionally Passes. One ormore system componems as "Canditional Pass"section ueed to be replaced or repaired.The system,upon completion oftbe .:nt-oraepair,as approved by the Board of Health,will pass. Answer yes,no or not determine ,N, )in the for-the following staternenn If"not determined"please explain The septic lank" metal an vet 20 years old'*or the septic tank fvi&eth=xaaaI.ornot)is st ruciara ly - unsound,exhibits - 'on orb artwk fmftm wxawam=jL 5ystemwffl passMz.,e=aat - --- existing tank is with septic vmk is approved bar the Board of Heafth. =A metal septi will inspection Wit is shucturAy smmzt not-leaking and if a Certificate of C Mhawe indicating a tank" ess than 20 years old ss.av2flable_ ND exo O'asen tm of sewage bacbM or break aunt cr nn hm.due tobmk=or obs'uucted pipe(s)or due to a broken,settled or3mexqmM pass.ias on if(With 2pprovaI of Board of Health)_ broken - b i ID explain- The system 4tames a year due to-broken or obstructed pipe(s)-The system will pass inspection if(with ap the B of Health)_ broken pipe(s)are replaced obstruction is removed ND e:plain Page 3 of l l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE ON F 8?'a17C PART A CE-P—�@'`�CA'}[ T-IN(con-tiprred) Property 4ddress-,2,5 40'S Z Owner: ,,,, 7- Date of inspection: r 3: -then'—Evabration is Required by the Board of'Re-alth: Conditions emst which require further evaluation by the Board of i-lealth m order to determine if the system is faring to protect public health,safety -the enviro ent �. System will pass unless Boar€l A determines in accordance with 310 C R VL3t )(b)that the system is not£tmetioning in a er which vniiff protest public health,s2fety and the envii Mutest — Cesspool-or within feet of a surface walm _ Cesspool or is within 5 fe~t of a bordering vegetated wetland or a salt marsh 2. System zyr`II fail renters the Board of'Health,(aatel lf'ablie a Supplier,if any)determines that the system is functioning o's in 2 manager that pr tine p:tbb gal ,safery and env ame¢t: _ The system has a septic rank and soil absorption (SAS)and the SAS is w itlam 100 feet of a surface crater supply or tributary to a surface water y. The system has a septic tank and SAS and SAS is within a Zone 1 of a public wearer supply_ _ The system has a septic rank and SAS the SAS is within 50 feet of a pmrare water supply well. _ The system has a septic tank and and the SAS is less than 100 feet but 50 feat or more from a private water supply well::;:---Metho to determine distance *nbs system passes ifthe w analysis,performed at a DEP certified laboratory:far colifarm bacteria and volatile organic napo indicates that the well is free from pollution from that r and the presence of aratmauia geu d nitrate nitrogen is equal to or less than 5 ppm,provided thatno otber failure criteria are ori°a A y of the analysis must be attached to this form_ 3. Other- Pa=e 4 of 1 l SPA . _-K�FOR VO +- ` t � � DISPOSAL �SURF*CE SE -� ` VTI 7-- propel Adder: y q It�I J 47e r S Date of Iaaspe�iana �. System Eaflure Criteria a applicable fro aH systems_ for�I vou must indictee`Yeg'of-ne to eadt of the followMg Ala or component due to Qv.J.Jaded or c2o—�.SAS or�ooi yes Of she iW �e ofthe oiffid on ce waters due to an overloaded or DiscbmZe— 3�� or goading of efflux�2he siniace oaa SAS o-c"..sspool m overloaded or clogged SAS 0-1— static liquid level lYl the box aksDve outleet �� oIbelow carava�isZe les§than�day flow -- — � �is less than yes ye2ri ft'f dune to cio or olssaruc�I PISS)-fit ber Pump _ of times puinped cesspool or prny is below bi& selevax to a sm-face Any prom of Lime SAS,cessp as within 100 f, • ny lam of cesspool or privy / Anyater supply-Pfl�°a of a o I isms Zu=i ofa public wed- well 3 or AtnY portion of a c�spooi or ptIVy is witltD�5� of a private� fmm a privaae water Any pordms of a cesspool or privy isle BUQ fit b�_ �is ff.the wafer analysis, amply well with no acceptable waterq��y' -� rsa.:uBd�'��e�TZanlc cumponUUS perjor- ted at a IIDEP ceeitfxed la r 9'�®r eol ®t m e ce of'atm�enia Ira boss fx f and S p indicates#hat the Alas free�ffi 4gA ICY p .w.atd gt0 p]t$eZ �''' aitragen and nitrate nitrogen4sc�s #t+tl ore•trsggeted- offlte - ors�xhe ahns�e - - - east as Yhet me a Board of esJAio)'I'be system I-l�re ..�'_ per shred contact the desca�.ied in 31t1 CY�Fit 1.`s363,flief • flee - Flealth to deterniMe�be•ae Y E. Latge Sy-stems' s v of 1"99 gna to'I5,01DD To be considered a Barge sysCewtbe - YouEst iadic 'or"ao" each of fo - ghe falloering applym in t�s above} yes no -Water sonply —— the sy�is" 400 f(_ of a drWdn. the system is wi 200 feet o xn-tR=ry to a g water sup y —— WdH=dprm=onAM—j7,Pfa}ora?�-MPA the systextrislocated ia-a- o s area� � — — Zone II ofa public ply well IFyou have answered"yew to gtsesfion in Section Elbe system is considered a sigiii5cant threat.or answered "yes"su gecYioarY3 above the leaa�system l fax�Eed:Thc des or ap�'dtttz of affi3'Iarge m considered a sa_ffiificaat t3reat zmder Section E or wed xMder Sea,(M l� 1 upgrade the Systemffi accordance with 3 I©CnrtlZ i5304.l sys tem stem owner should co=cf the apprapra M regiotaal office of the Lenasgmcat -Page 5 of I 1 (A CC INSPE=01V FORM—is OT FOR VOLUNTARY ASSESSMENTS _ P -13 PANT !7, Property Addresss: J ��✓GV�S Owner:J" '-) Date of Inspection: Check if the following have been done-You mast indicate es or-no-as to each of the following: Yes o - Pumping information v.-as provided by the owner,occupant,or Board of Health _ _Zwere any of the system compone pumped out in the previous two weeks HH2s the system received normal flows in the previous two week period? / Have large volumes of water been introduced m the system recently or as part of this inspection? Were as built plans ofthe system obtained and examined?(If they were not available note as N/A) Was the facliry or dv ell"aug ir-tspected for signs of sewage back up Was the site inspected for sums of break out? Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the inteeior of the tank inspected for the condition oT a baffles or tees,material of con_statction,dimensions,deptIf-of liquid,depth of sludge and depth of scum Was the facility owner(and occupants if different from owner)provided with informatiop on the proper maintenance of subsurface sewage disposal systems`' The size and loeatien of the Sag Abstsm ion System(SAS)on the site has been determined based on: Y �no 1 _ _ Existing information.For example, at the Board of Health. DeMmined in the field(if any of the fails-e criteria related ao Part C is at issue approximation of distmce is unacceptable)1310 CMR I5.302(3)(b)J f Page 6 of 11 t OMCIAL INSPEMON FORM-NOT FOR VOLUNTA-RY.�A-SSESSIIENT-S SUBSURFACE SEWAIGKDISPO�I,-SYS FL":IiT3ifi FORM- . TLART--C S YS TEM RMATTOT%T Property Address:-2 r 4.5 i s a/ C i 42c_ ,/,—/Y Owner: c 2=�/ Date of Inspection- J O _ FLOW CONDI' O-NS RESEDEi1TTUL Number of bedrooms(design): Nwaber of bedrooms(actual):2 DESIGN flow based on 310 C MR IS.203(for exaxnple:110 gpdx Il ofbedmarns): 3 Number of current residents: Does residence haws a garbage grinder(yes or no)�I � Is laundry on a separate sewage system{yes or no):! jf yes separate-inspection required) Laundry system inspected(yes or no):_ Seasonal use:(yes or no): Water meter readings,if availaple(last 2 years atsage Sump pump(Yes or no)•_ Last date of occupancy_ S l e CORMIEItCYA. JIMUSTRYAI. Type of establishment Design flow(based on 310 C1VIlZ 5 03): epd Basis of design flo (sea2s/pers0 sgfi etc.): Grease nap present, or nod Industrial waste ho Q resent(yes or no):_ Non-sanitary waste a to the Title 5 system(yes or no):— Water meter readings, 'able: Last date of oc fuse OTHER(describe): GENERAL IN R ATIM Pumping Records Source of information: VTas system pmnpedas part ofthe kgxx:fioa(yes or-no): Ifyes,volume pumpok' palons—How-was amaMy pumped;deMrariMd?- Reason Rw pumping: t eptic tank,distribution box;soft absorption system-Singh--cesspool _Overflow-cesspool- Privy _Shared or no)(If yes,wta if any)- _Inno"MetAlternative tec hff010U Attarhm-copy ofthe current operation and mamtenance contract(to be obtained*oru system owner) - _.__Tight Yank' -Attach a copy of the DEP aptnuvaI _Other(describe): Approximate age of all comps date installed(if own)and source of informaiion, 'Were sewage odors detected when arriving at the site(yes or no): i PiLge7of11 ]N"E oTq FORM—NOT FOR VOLUNTARY ASSESS YT5 ST.3R. ACE d A D 'OSAL-SYSTEMI SPE C Property Address.-oZ S �� To, i✓Cf .2 C .� i .01_1/v1-5 €3wner_ ✓ ^^ � f?� Date®f�Hisgee�6a' . BtlMDING Sl*WM(locate On sate PIM) Depth below garde: a F ii�i3te�7a15 of camnnctinx c2st irun ,�.Pvc Ei�2 le �FL) Distance from p wei'suPPfy 2 or sucaou lime Comments(on ctmdizeon of joaas,Ves?mg,eAd of leakagg-.etc.): S '' IC TANK:�o�te on satc Plan.) Depth below wade: / 3 Matnial of won � is metal_fibarglass_lsolyethyleM otb::(e�lain) - if�is meud list age:_ Is age coaf=ed by a Ce*ufrcam of Compliance(yes or no)=_(a s ct r,►c_ cWtifiDimensia ns: /X S_/ ly Siudaae deptb.: �' iistance tmm mF of sivd�_ to btto m o€outiet teeor baffle:3 Scan ihiclmess: y i Distance flora tap of scum TO top of oBtli:ter or baffle_- Distance from bottom of scum to botxoM of whet a!e o=baffle: a -?ow were dimes on dzaTri bw&- �/�;C� COuaneuts(an pume� inlet and o e4 tee or baffle condidoii,sun k may,higaid ie:'�ls a.related to outlet invt,evidw*iee oa_leaka��etr-): GRE, SF TPUP: (lotane on Site PIM) c Depth below grade:_ iviaterral of om *++-�+an: _�oiyet7ilene a*Iser (e�laia): Dimension S:-irm thickness: �- Distance Rom tars of sc• to tap of et tee or baffle: Distance from burtom of am to of outlet tee or b-z�e: en inlet and outliet ,,or belle condtfim�''fII-��-��a limed Eev:.S it Page 8 o;I i -FDEMON FORM--NOT. FOP,VOLUNTARY ASS S A M. S P. RT C Ao, S3 er. J try, 9,1;s Date o€ fly 0 6 STGEST Or HOLDING TA1T—K (tmz'--]MULL'be mm- ou sim plha) Deorb bra grade Nfatenal of cmmr=1fow me'2, Dimensin� CaFaciqr- Design F m EoIIo Ajalm preset(yes or no): Alum Juvei: Maim in (yzs ar no}: Dare af�pumpins . CoatmeM(boa of'ai f?ost sVito ew-): MSTRIM M DOM present mrts2 be openedXIomme on site p1m) DapYh ofliquid JcvrJ above outletaneez-E; e� Comme=(pre ifbox is level and disniLmnion to and-Is€-qua#_-my--vide of soli& arvevid��z 3:akaz6e mm or out of box,mr): PDMP CAMIR r: ocate siiz place) punms in vmicmg odder an): AIM=in wow order or no} CenimenLs(note pump cicambe - cm�f P2gC 9 Of I I G'V-nCIALINSPEC-ryO-NFn-RM-T*TOD'rP-O'-R VOLM14TAURYABST-SEAMN-F S V- property-Addr.ew. 7--0 le Date Of SOM ABSORT77MT SYS TIEW(SAS): not If SAS not located,-%plain-tty: 7 pits,number- leaching clramben-z number_ lea cbbiggalleries,number leaching trenches,number,length: leachbig fieldsmumber;dimerssaotss crner9ow-c I en —h3n --Vwalitatsdtivt:sYSUMT-Tyrr-Jnameofmr-bnology-- Conmaenis(noti--conditiond- level ofpondin&damp sail,condition Ufv&R=adoF1, -31 0 ge CESSPOOLS__(cesspool must be pumped as part ofinsper-tion)(locale on site plan) Number and configuration: Depth-top of liquid w inver-L: Depth of solids layer Depth of scum layer Dimensions of cesspool: Materials of consunction: Indication of groundwater. ow es or no). Comments(note ca€id iau of soli,simns of-hydrai'll.c PRIVY: (locate an site plan) Dimensions: Comments.(note condli on a iL sa ns of vdr Hc.faU-; f Page 14 of 11 �_jR pe ys1O✓svos Date of inspection: SSE i CH OF SEW AGE 12F S L—SYS'-EA% Provide a sketch of the sewage-disposal system inchidingtses ai leasriv ems?r'`==oc?z d - banchmm-ks_Locate a vIeffs 'i Qil feet Locale-whew-VubUc wan—asuuDb-enters!he-bu"�ag. L3j 1 Ilk � _ - 35 FJjq ® CIAL o104 FORM-190TFOR vul"VINki SUBS-DACE SAGE D SAL SYSIM `I PA3rr C Omer- Date at - Si,s EXAM Sm.b= Ale a/ t [hwk G=BW 0&)/ SbaIIaw wells /K,/o� C d�zv�adwata �� lea please iB&W=(dtedr)aft media&vmd us dctmvo imetheb�&gmmd via= elovatim Obi fmma leol v i�159 fea of SAS) Obmvadsft(WmtbPgPGPM t TROY WILLIAMS IN, SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection r$ 19 (5 385-1300 19 Hummel Drive 98 South Dennis,MA 02660 Q N� COMMONWEALTH OF MASSACHUSETTS ` EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE HINTER STREET. BOSTON, MA 02108 6I7-292.5500 WILLIAM F.WELD TRUDY CORE Govcmor Secretan• ARGEO PAUL CELLUCCI DAVID B.sTRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION � Wti�aH Gi✓. AhH i s Property Address: 5 l � Address of Owner: to �Nrr r y�h Date of Inspection: /0/ f' (If different) H Name of Inspector: Troy Williams ("30 L J 54: I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) AA AN S 7c; t 11/ A4 Q Company Name: Troy Williams Septic Inspections Mailing Address: 19 HummPl Drive Snuth Dpnnis , MA 02660 Telephone Number: (5 0 8) 3 8 5-13 0 0 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: ,_11/Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature:JJi Date: 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 PASSES: y 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. COMMENTS: 61 SYSTEM CONDITIONALLY PASSES: /V�,4 One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is 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 (rwL.d 04/25/17) P•q• 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 25 Weston Circle,Hyannis,MA CERTIFICATION (continued) Property Address: John Harrington Owner: October 7, 1998 Date of Inspection: BI 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). Describe observations: 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: 11114 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance (approximation not valid). 3) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 25 Weston Circle,Hyannis,MA Owner: John Harrington Date of Inspection: October 7, 1998 D) SYSTEM FAILS: IVII9 You must indicate e(;,.er "Yes" or "No" as to each of the following: 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. Yes No 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 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. El LARGE SYSTEM FAILS: n/1s; You must indicate either "Yes" or "No" as to each of the following: .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: Yes No 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 supply 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. (—i""d 04/25/97) Pip" 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 25 Weston Circle,Hyannis,MA Property Address: John Harrington Owner: October 7, 1998 Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Ye; No Pumping information was provided by the owner, occupant, or Board of Health. IL _ 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. Y _ 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. _ 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of / Sub-Surface Disposal System. �L Existing information. Ex. Plan at B.O.H. JL _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 25 Weston Circle,Hyannis,MA Owner: John Harrington Date of Inspection: October 7, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow:.2.2 6 g.p,d./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):_LVb Laundry connected to system (yes or no):—�_9S Seasonal use (yes or no):_,&/Q Water meter readings, if available (last two (2)year usage (gpd): / 7= .27 0U0 �, //vim s �G = o� d 00 Sump Pump (yes or no): A!y Last date of occupancy: ac- 'Jyo c�.. COMMERCIAUINDUSTRIAL• /1/114 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 part of inspection: (yes or no) /Vd If yes, volume pumped: gallons . Reason for pumping: TYPE QF 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) I/A Technology etc. Copy of up to date contract? CRher APPROXIMATE AGE of all components, date installed (if known) and source of information: 57�y Sewage odors detected when arriving at the site: (yes or no) /Vb �•� ..c 04!1S/911 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 25 Weston Circle,Hyannis,MA Owner: John Harrington Date of Inspection: October 7, 1998 BUILDING SEWER:IV14 (Locate on site plan) Depth below grade: Material of construction: _ cast iron _ 40 PVC _ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Material of construction: oncrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions:_ `�(y �X6 /60G g..//�h Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:o? Scum thickness: N,)Nd Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: IVY S K, How dimensions were determined: 0,w I.< , Comments: (recommendation for pumping, condition of inlet and outlet tee or baffles, depth of liquid level in relation to outlet invert, structural integr( evidence of leakage, etc.) �` g wcr� GREASE TRAP: /t(li9 (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _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: Date of last pumping: 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 04/25/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 25 Weston Circle,Hyannis,MA Owner: John Harrington Date of Inspection:October 7, 1998 TIGHT OR HOLDING TANK:(Tank.must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order Yes; No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: t� (locate on site plan) Depth of liquid level above outlet invert: G Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)__ S i ti ! ci �' Lo✓r o�/c✓" Ida t "a PUMP CHAMBER:d//9 (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (r—is.d 04/25/97) a __ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 25 Weston Circle,Hyannis,MA Owner: John Harrington Date of Inspection:October 7, 1998 SOIL ABSORPTION SYSTEM (SAS):Z (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: 6 XG �. •�.. �;a- w': YL, .Z S�.,-., leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil,'si s of hydra failure level of ponding, condition of vegetation, etc.) • ✓1 '�t..� os�ff11 H O CESSPOOLS: (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 ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (z.v1m.d 04/2S/97) P.q• ! of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION (continued) Property Address: 25 Weston Circle,Hyannis,MA Owner: John Harrington Date of Inspection: October 7, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Vic...►-cam 1,.. t .ay %h �y 3y ' 95 � (raviaad 04/25/97) Page f or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 25 Weston Circle,Hyannis,MA Owner: John Harrington Date of Inspection: October 7, 1998 Depth to Groundwater- Feet adjusted high groundwttcr lcvcl Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record t/ Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers IL Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) /46' k a� 1 S f.A a t ! v L "` �, C) ,A c.,c�- 4- (—v1..d 04/25/97) a P.q. 10 or 10 �/�/�/ TOWN OF BARNSTABLE LOCATION,? rLe /�STo.r/ VILLAGE �yAGYrt//S ASSESSOR'S MAP&PARCEL oMV INSTALLERS NAME&PHONE NOINAYa6 A e,0 4 .ft Avl7- SEPTIC TANK CAPACITY Se, s T" /p D 0 LEACHING FACILITY: (type) Ze,9 c.t/ /`/ 7— (size) X NO. OF BEDROOMS OWNER A 3,4%6 S' /ass/x er,,o.� DATE: S / d G COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 x J�