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HomeMy WebLinkAbout0069 OAKVIEW TERRACE - Health 69 Oakview Terrace, Hyannis i 8 � e COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA R� ,lf`+E. �0 g� DEPARTMENT OF ENVIRONMENTAL PROT Oleic ? I ONE WINTER STREET. BOSTON. MA 02108 617-292-5500 � °A.�,t�l 199� WILLIAM F.WELD aE Governor ry ecretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: �69 Oakview Terr, Hyannis Address of Owner: Martha/Ken Mills b Date of Inspection: 1 —07 '1 (if different) 1 345 Sugartown Rd Name of Inspector: Wm E RObinson Sr Berwyn, PA 09312 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Service Mailing Address: po Box 1089 F Centprville., MA 02632 Telephone Number: ( 5 0 8) 7 7 5- 7 7 6 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 sewa e disposal systems. The system: Z asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: �� t 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: 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: B] SY TEM CONDITIONALLY PASSES: ne 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 ye , 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. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/twww.magnet.state.ma.us/dep j Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM La,� PART A 1 CERTIFICATION (continued) i� •1 Property.Address: • i Owner: ;*6 \,13ate•6f Inspection: s 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). 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] F RTHER 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 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 (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 69 Oakview Terr, Hyannis Owner: Martha/Ken Mills Date of Inspection: P] SYSTEM FAILS: / You ust indicate ei;!,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 he failure. Yes 0 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. E] LARGE SYS EM FAILS: You must indi to either "Yes" or "No" as to each of the following: The"f Ilowing criteria apply to large systems in addition to the criteria above: The s tem 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 o rator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 14•CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 69 Oakview Terr, Hyannis Owner: Martha/Ken Mills Date of Inspection: g'—f Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No �5 _ Pumping information was provided by the owner, occupant, or 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. S _ 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. e�S _ 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 land occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. V4 _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 69 Oakview Terr,' Hyannis Owner: Marty/Ken Mills Date of Inspection: $^1 �t -7 FLOW CONDITIONS RESIDENTIAL: Design flow: P g.p.d./bedroom for S.A.S. Number of bedrooms:2 Number of current residents: Garbage grinder (yes or no):�d Laundry connected to system (yes or no):4$ Seasonal use (yes or no): Water meter readings, if available (last two (2) year usage (gpd): 8/9 5 — 7/9 6 6800 cu f t, 51 , 0 0 0 ga 1 s Sump Pump (yes or.no):�6 8/96 - 7/97 6100 cu ft, 45, 750gals Last date of occupancy: CSMMERCIAUI N DUSTRIAL: Type of establishment: Desig flow:_gallons/day Greas trap present: (yes or no)_ Indust qal Waste Holding Tank present: (yes or no)_ Non-s nitary waste discharged to the Title 5 system: (yes or no)_ Wate meter readings, if available: LasNate of occupancy: OT R: (Describe) Lasef occupancy: GENERAL INFORMATION PUMPING RECOT an source of information: System pu ped as part of inspection: (yes or no)_,,&,d If yes, volume pumped: gallons Reason for pumping: TYPE OF STEM 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? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: .2 it] ® �� d + Sewage odors detected when arriving at the site: (yes or no& I (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 69 Oakview Terri, Hyannis Owner: Martha/Ken Mills Date of Inspection: F_j_q BL ING SEWER: (Local on site plan) Depth elow grade: Materi.I of construction: _cast iron _40 PVC _other (explain) Dista ce from private water supply well or suction line Dia eter Co ments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK✓_ (locate on site plan) Depth below grade: I e Material of construction: Tuconcrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: 3d IJ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 3 —,� - ` Distance from top of scum to top of outlet tee or baffle: , Distance from bottom of scum to bottomof outlet tee.orbaffle;-/A�— How dimensions were determined: Comments: (recommendation for pumping, condition of inlet anj outlet tees or baffles, depth of liquid level,�in�relation to outlet invert, structural integrity, evidence of leakage, etc.) C.0 1!% GREASE P: (locate on s e plan) Depth below grade: P Material of c nstruction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimension :— Scum thic ness: Distance rom top of scum to top of outlet tee or baffle: Distanc from bottom of scum to bottom of outlet tee or baffle: Date of as pumping: Comments: (recomme dation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, vidence of leakage, etc.) — (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 69 Oakview Terr, Hyannis Owner: Martha/Ken Mills Date of Inspection: =jam TIGP TOR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth be ow grade: Material o construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimen ions: Capaci gallons Design ow: gallons/day Alarm I el: Alarm in working order_ Yes; _ No Date of revious pumping: Comm nts: (cond' ion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: C✓ Comments: y� (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) F3 PUMP HAMBER:_ (locate o site plan) Pumps in working order: (Yes or No) Alarms i working order (Yes or No) Comme s: (note c dition of pump chamber, condition of pumps and appurtenances, etc.) i (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 69 Oakview Terr, Hyannis Owner: Martha Ken Mills Date of Inspection: 9--/r 4f rj / 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: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, conditi n of vvegetationh etc.) / ✓ f,- L b sue. (�! A CES`POOLS- _ (locate n site plan) Number nd configuration: Depth-top of liquid to inlet invert: Depth of olids layer: Depth of cum layer: Dimensio s of cesspool: Materials of construction: Indicati of groundwater: inflow (cesspool must be pumped as part of inspection) Comme s: (note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials f construction: Dimensions: Depth of olids- Comments: (note condi on of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 69 Oakview Terr, Hyannis Owner: Martha/Ken Mills Date of Inspection: T—Z.—(' ✓f 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) i �A 7 Y � ti 3 � r (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 69 Oakview Terr, Hyannis Owner: Marthat/Ken Mills Date of Inspection: / Depth to Groundwater 1 o2'Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record 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 Use USGS Data Describe in your o n ords how you est lished th ligh Groundwater Elevation. (Must be completed) v s (revised 04/25/97) Page 10 of 10 L0 CAT 10 (0� SEWAGE PERMIT NO. Lot 41 OAKVIEW TERRACE 80-465 VILLAGE HYANNIS INSTALLER'S NAME i ADDRESS JAMES J. DRISCOLL - 888 Old Stage RdCenterville J B U I L D E R OR OWN ER CAPRICORN HYANNIS DA T E PERMIT ISSUED 9-2-80 DATE COMPLIANCE ISSUED 11-13-80 �w. ��: �� �. o �� � s- � � o _ z No................ `...... Fim$......3. ..—. t THE COMMONWEALTH OF MASSACHUSETTS BOA R® gF�HEALTHLT H .. . /11......---OF__... .. .._.. Appliration for RopmFal Works (>znnstrn.rtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: C r e�o-n Ajr ss .. :................�.......... s 1 ..... pq ...... fia or Lot No��.� . / l . . ,. . .......... O ner nll Add ss // acy UType of Building Size Lot-1_0.-_3 ---.____.Sq. feet Dwelling—No. of Bedrooms............ ----------------------Expansion tic ( ) Garbage Grinder ( ) `4 Other—Type of Building No. of persons............................ Showers 0.� YP g -•-------------------------- P Cafeteria ( ) Q' Other fixtures .------••--•----•••-•----------. . d •----------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic 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.............. ft. Z Other Distribution,box ( ) Dosinggk ) '-' Percolation Test Results Performed b ,t' ____._� v.!�f IU,5Datew-A��..��-.... a Y 0. Test Pit No. 1 5...�,_...minutes per inch Depth of Test Pit.................... Depth to ground water.......----..........--. rXq Test Pit No. 2.._1�...�..minutes per inch Depth of Test Pit.................... Depth to ground water.--..................... 0 Descriptiono So ... /�"l / !. ....T....�.v SC�1 �"1l.Z._ _-, -.0 Al_6�..�- '.�-s��l� UW ----...----••----•------------------•--••--•----...-••--•••----------------•-----------.....-----••------•---•---•-•---------•-•--•-----------•-----------------------'-----------------•--------------- Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI M 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n is d by the board o lea Sig d +� r2f Date Application Approved BY -......�-D---`- Date Application Disapproved for the following reasons:-----••---------------------•--•----•------------------•---•-------------------•----------.........-----.------ --------------------------------------------------------••-----------------...•-•---•---...--•---•-----...-......-----•-•-•----------------------------------------------------------------------------- Date PermitNo......................................................... Issued_....................................................... Date 4., No....................... Fzz THE COMMONWEALTH OF MASSACHUSETTS B0ARD,,9F HEALTH .......OF....... ........ Appliration for Biopaoal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ZW_Z..... ........ ..................... . ...... ---------------------------- ..... , No r Is, 0............ Y 4,17' Ad Owner ."�A .................................... ------------------------------------------- .. ...i-ifer Addfes-­­­--Installer S U /0' .Sq. feet Type of Building Size Lot_ Dwelling—No. of Bedrooms.._..._..... .........................Expansion �tic Garbage Grinder ( ) PL4 Other—Type.of Building ............................ No. of persons............................ Showers Cafeteria0.1 ( ) Other fixtures ----_------- --------------------*-----------------------------------------I------------------------------------------*.............­,",--------- Design Flow............................................gallons per.person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................. Diameter-_----__--__-__- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter:_..__..:_._.__..._. Depth below inlet___..._.____________ Total leaching area............. sq. ft. z Other Distribution box Dosing VAk /J/' t Performed b- ':7A /4 Percolation Test Re .nC. t& 7.w...... ......... ...... S Test Pit No. L, ..Minutes per inch Depth of Test Pit.................... Depth to ground water.._..................... Test Pit No. 2_. .. .........minutes per inch Depth of Test Pit.................... Depth to ground water........................ . ......... ...........;?.............. ------- ----------------------------- 4!::::;e # ....... W[Ab ..........e3* 0 Description of So' .....0.--!- --- ............ ........ ... .............. co-AA-.5c.. ..................................................................................................L ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable...................................................................................*........... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT TIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be has becd by the board[ ok7a ..... ... S' d..... ... ------- .......... Date Application Approved BY------- ......... ....... .... ................... Date Application Disapproved for the following reasons:................. ............................................................................................. ............................................;................................................................................................................................. Date PermitNo......................................................... issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....../49.4!W........OF... ................... fflatifiratr of Toutpliatta T a IS TO � RTIFY Tha he d, idual Se isposal System constructed or Repaired b, I St at.44.r.. ......0*..&41.Cell"V----- AIAYS� ---- ----- ---- -- -----__--------- has been installed in accordance with the provisions of TVLIE f ?Ile State Sanitary Code as descrij;ed in the application for Disposal Works Construction Permit No.... ....... _:C.......... dated_....._. '._ ."___ ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOTIBE CONSTRtLFD AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S TISFACTORY. d.................................... ....... .................................................................... DATE........... Inspector.. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _OF...... ................ No......................... FEE.Jo��........... Disposal rk k. Permission is hereby granted----.. ......... .. .. ..................................... to Cons Repair ap,-4ndividual Sewage Di Sal System j# A).AJr- __ --- ....................................at No..V&k VIC.. ...... ex'z.......ea......1. Street as shown on the application for Disposal Works Construc Pe No 10 Dated......9......2 go / DATE....117.42.'­65:�............................................. Board of-Ifealth FORM 1255 HOBBS & WARREN, INC., PUBLISHERS •u. � ...,w.. + +... +r. wM .pi, 7 '��IA�,1�l.�.,,,,'.��.,�I�I..,1I,��,F.j.I:,,,II"",I,�%s,�,,.,�-;,��.,�;'',�,'-/��,,.,...­," -41 - '{ 5 1 1 6,1 i tE 1�; 4t,Y ',,.. t �.., ,t F } l - t - /�a• p.;, „ r .A•� �, r r a v y t' y V at 1 T1 t +-F.7 y} k ^.•� i .A y ;1 - � / `y F^5°} "__ i Rv-e„--� y_ kr 't'sjv. F '� %" fji 1 1 & p*: t 1 n S *Y 3 R a i f r i �' y d' k !; ,.v t 1 - F- ro - r. 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