HomeMy WebLinkAbout0034 SECOND AVENUE (HYANNIS) - Health 34 Second Avenue,Hyannis
A=
�\ COMMON VEALTH OF NSASSACHUSETTS
^] EXECUTIVE OFFICE OF EwIRONMENTAL AF 1 12
;. DEPARTMENT OF ENVIRONN1E\TAL P �'O�TECTIO.N 1
!;
ONE WINTER STREET. BOSTON. '•lA 02I06 bl'-_ ®�
1' CFO
TRUDY COX
VaILLIAN'F VELD
Govemc- !T g9ti 1 9� Sere a
��FOTT99
i
ARGEO PAUL CELLUCCI �4�'ID B STRUF
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM', Commission
PART A 19
CERTIFICATION
Property Address: 5te- #QCk �v�l w' �`1"'6)N1S000'T_ Address of Owner:
Date of Inspection: /0(G�97 (1f different) ?-S, S��QtP'-`a-'s
Name of Inspector: H, a o +' 11 E��Cn or'� �h 1w1• C2LtAS
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 3 (310 CMR 15.000)
P
Company Name:A:/l/a 4,14.•e En /^r•r+cj H #" P AA n-aw,_/
Mailing Address: Pin Ac x e 37?51 H H Ig-p a.C4—C/
Telephone Number: rs'G 7J !!:j= /L+c ZO
CERTIFICATION STATEMENT
I germ that I have personallN inspected the sewage disposal systen at this address and tha: the iniormaticn reported below is true. accurate
and complete as of the time of rnspec:-o-. The inspection was performed based on mN training and exDenence to the proper function and
maintenance of on-state sewage disposa systems The system:
X Pas es
"TC Conc,00nai:% Passes
Neecs Furthe• Evaluator+ 9,, the Local Approving Author^
_ F . s
Inspector's Signatu 1. Date:
The Svs:e^ Insoeco- shall submr, a cop\ of this inspection report to the Approving Authorm within them- (30, days of completing this
tnspec or.. It the ststem is a share_ system o- has a design flow. of 10,000 gDd or greater, the inspecor and the system owner shah submit
the report to the aaorooriate regional office of the Department of Environmental Prote^.for. The orig:na snould be sent to the system ow•ne-
and copes sent to the buve,, ii applicable. and the approving authority
INSPECTION SUMMARY: Check A, B, C, or D:
AI 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 Wow.
COMMENTS: SgSX%w% %a 'FJNt�T�ew�w�S ins-\� V%.-r 'llmar, o. 5.+.,K �G�a►�aL y^&0JT 'llrw 9- •S
t.`MT Cow»A_cr k a S..9T c.... 4,j%STc..-% L'a.r.., wamT VA.&. A.a s.a,W,& l j
s S �w�a.n. Co«cvtiT-� ��10•'
eI SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The system, upor
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate ,yes, no, or not determined (Y, N. or NO:. 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 inspect or with a copy of a Certificate of
Compliance tartachedt indicating that the tank was installed within twenty (20) years prior to the date of the inspection; o
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
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO% FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner.
Date of Inspection:
BJ SYSTEM`CONDIT(ONALLY PASSES tcontin j-d
_ Sev.age backup or breakout or high static water level observed in th distribution box is due to broken or obstructed
pipes) or due to a broken, settled or unever. distribution box. The ystem 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 ue to broken or obstructed pipe(si. The system will pass
inspection if twith approval of the Board of Health)7
broken pipets) are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF H LTH:
Conditions exist which reouire further evaluation by the oard of Health in order to drsrmine if the system is failing to protect the
public health, safe'\•and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH ETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH A SAFETY AND THE ENVIRONMENT:
Cesspool or pri%-� ,s within 50 feet of a urface water
Cesspoo' or pn., ,s Hithin 50 feet of bo•denng vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLE5S THE BOARD O HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT
THE SYSTEM 15 FUNCTIONING IN A MA ER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The systerr has a septic tank a soil abscrption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water su ply.
The systerr. has a septic tank nd soil absorption system and the SAS is within a Zone 1 of a public water supn'v well.
The system+ has a septic tan and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic ta. and soil absorption system and the SAS is less hoar: 100 feet but 50 feet or more from a
private water supply well uniess a well water analysis for coliform bacteria and voiatile organic compounds indicates thz:
the well is free from pol Lion from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 porn. Meth used to determine distance (apprmdaration not valid).
3) OTHER
ts.va..a o4-zsie-) sage 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION' (continued)
Properh Address:
Owner:
Date of Inspection:
DI SYSTEM FAILS:
You must indicate either "Yes" or "No' as to each of the following
I have determined that the s%,stem violates one or more of the following failure crit na as defined in 310 CMR 15.303 The basis
for this determination is identified below. The Board of Health should be contact to determine what will be necessary to correct
the failure.
Yes No
Backup of selvage into facility or system component due to an overl ded or clogged SAS or cesspool.
_ Discharge or ponding of effluent to the surface of the ground or s ace waters due to an overloaded or clogged SAS or
cesspool
Sta:ic !lc_,d level in the distnb iron boa above outlet invert d to an overloaded or clogged SAS or cesspoo!
Licuid depth rr cesspoo! is less than 6" belo" invert• or avail ble volume is iess than 112 day floe.
Recu,rec pumping more than, 4 times in the last year NOT due to clogged or obstructec pipe s .
Nurnoer o-*times pumper' _
Any pon.o- o' the So:! Adsorption System, cesspool or nvy is below the high ground%ate, eievation
Am, pc,•:or. o-,a cesspoo' or privy is within 100 feet f a surface water supply or tributal to a surface Nate, supply.
Ant po-:,or. of a cesspoo' or prnl is N rthir a Zon I of a public we!].
Any pc-:c- c-a cesspoo' o• pr;%, is wi;hir 50 f ' t of a private water supple we!!
An, po^,c of a cesspoo' or pm- is less than DO feet but greater than 50 feet from a private water supoh• well with no
accectab a Nate• qua!ir. anaivs s li the well as been analyzed to be acceptabie. artacn cope of well water analysis for
cohiorr.. ba-er,a vo!a.ile organic compound ,_ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate e;:he- "Yes' o, "No' as to each of the fol wing.
The io!ioN:r,g c,,te,,a a-)r,\, to large systems in ' 'rtion to the criteria above:
The system sen•es a iacilir% with a design fioN f 10,000 gpd or greater (Large System; and the system is a significant threat to
public hea!th n ' i p a a safer) and the environment cause one or more of the following conditions exist
Yes No
the systerr, is within 4D0 feet of surface drinking water supply
the system is within 200 feet o a tributary to a surface drinking water supply
the system is located in a ni ogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a
public water supply well)
The owner or operator of and such system s r all bring the system and facility into full compliance with the groundwater treatment program
Tequrrements of 314 CMR 5.00 and 6.00. lease consult the local regional office of the Department for further information.
(revised 04/25/97) page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PARI B
CHECKLIST
Propert. Address: SM�P '4
Owner: Tixwr%4,
Date of Inspection: 10
Check if the following have been done: You must indicate either "Yes" or 'No" as to each of the following:
Yes No
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 pan of this inspection
As bull: plans have been oo:a:ned and examined. Note if they are not available with N/A
_ The facair or dwelimg %%as rnspeaed for signs o-*sewage back-up.
_ The sstern does not rece, a non-sanitary or industrial waste flow.
The site ,as inspected for signs of breakout
_ Ail s%ste r co ripone-.ts. eacludir.e the So-! Aosorption System, have been located on the site
•, _ The sep:,c tank rnanho;es were uncovered. opened. and the interior of the septic tank was mspeaed for condition of
baffles or tees. mater.a o• cor^structiorn, dimensions, deptn of liquid,.depth of sludge, depth of scum.
—The size and loca:,on o'the Soy' P.bsorption Svstern on the site has been determined based or
The iacd,t, ovine, anc occupants. if difteren: from owners were provided with information on the proper maintenance of
Sub-Surface Disposal Svsterr.
R Existing information Ea Ptan at B.O.H
_ Determined in the fielc .i;an, of the failure criteria related to Part C is at issue, approximation of distance is
unacce:):ab�e (>5 302 3;b?
(revised 04/25/57i Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.St
PART C
SYSTEM INFORMATION
Property Address: �j� Secoad
Owner: Fqsxln
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design floes 330 a p.d.lbedroorr: for S.A.S
Number of bedrooms 4o2
Number o:current residents
Garbage g•. der (yes or no, -1�J
Laundry co-•^ected to system (yes or no! /Jc7
Seasonal use ryes or no-. DLO
Water meter readings, if available (last two i2 vear usage tgpd): Pa Lc.,--, c�3nt
Sump Pump (ves or no) Wp
Las dare o`occupanC" "%04. *v %NkpA.A*%(3
COMMERCIAL'INDUSTRIAL•
Type of eszabltshmen:
Design fro%% _ga!ionsrda\
Grease trap present Ives or no_
Industr,a! 1�aste Holding Tani; presen; •ves or no
Non-sanita-� waste d,scnargec to the T,;,e 5 syszerr ;,es or no
eater meter readings if a.ailabie
Las:Faze o: o
OTHER: .:)e:cr,be
Last care o,I occuc;a,)c.
GENERAL INFORMATION
PUMPING RECORDS and source of,mforma:ior
IJI4.
System pumped as par, of inspection. ;ves or no.IJ—CD
If ves, volume pumped gallons
Reason for pumping
TYPE OF SYSTEM
--V Septic tankldistnbut,on boxrsoil absorption system
Single cesspool
Overflow cesspool
Prn�•
Shared system (yes or no! (if yes, attach previous inspection records, if any)
VA Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site. (yes or no) A3
(revised 04/25/91) lag• 5 of 10
SLBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 5V 54to"A
Owner: PnJuc�
Date of Inspection: go(`N
BUILDING SEWER: "1
(locate on site plan) 1v V
Depth below grade.
Material of construction. _cast iron _40 PVC _other (explain:
Distance from private water supply well or suction li-t
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:445
(locate on site plan
Depth below grade
Material of construction -kconcrete _me:a _F'oe,g:,ast _Polyethylene _othenexplam
if tank is meta". Iis: age _ Is age cor.f;rmec o, Ce^.fica:e of Conpiiance _(Les."No
Dimensions (000 4 *1
Sludge depth Ate tl
Distance from top o: s?udee to bonorn o` ou!;e: tee o• ba;-;.e _
Scum thickness 0 _
Distance from top o; scurn to top o` outlet tee or bake VZ ((
Distance from bonom o; scum• to bo-e'-. o; outlet tee e' bane —
How, dimensions Here dete•minec IK,,tAAs.t►An
Comments
trecommendation for pumping condition p, mie: -cc outlet tees or baffles. depth of liquid level in relation to outletickt invert, uL al
integrity, evidence of leakage. etc "A'o u
w\eGREASE TRAP:
(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:
trecommendation for pumping, condition of islet and outlet tees or baffles. depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.;
(rep•:v•d 04/25.17) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR-M
PART C
c,, e SYSTEM INFORMATION (continued')
Property Address: sq dccD
O%ner: ��,(ti1C
Date of Inspection:
TIGHT OR HOLDING TANK: W0 '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.
Capacrn• gallons
Deng^ floN galions-da.
Alarm level A;arm ,n „orking order_ Yes. _ No
Date of previous pump-ng
Comments
(condition of inlet tee. condition o• a'a,n-. and float switches. etc.)
DISTRIBUTION BOX:-1
tiocaie on site p a-
De;:h of hcu!d le e' zoo:e oune: m�e- dv � -out
Comments
incite r leve' and d:sr-ib_:,cr is ecua ev, enCE o n•
solids carover, evidence of leakage into or out of box, etc
y�
PUMP CHAMBER: ITV
(locate on site plan
Pumps in working order: (Yes or No'
Alarms in working order (tes or No
Comments.
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: sewo-id
Owner: TIXwk�\
Date of Inspection: l0lb I9 /
SOIL ABSORPTION SYSTEM (SAS): ��
(locate on stte.plan, if possible, exca�anon not required, but may be approximated by non-intrusive methods,
If not determined to be present, explain:
Type:
leaching pits. number. 11
leaching chambers, number:_
leaching galleries, number.
leaching trenches, numbe,Jength.
leaching fields, number, d,-nensiors
ovei4iow cesspool, numbe-
Alternative system
Name or Tecnr,oiog�
Comments.
to to cond un of 01i. s!grs of hgdraul�c failure, leve': of on pond g ic uon f vegetation, etc
��• 3 t' e,
CESSPOOLS:
(locate on site plar
Number and config;;rat,or%
Depth-top of liquid to inlet m�,er,
Depth of solids laye-
Depth of scum layer
Dimensions of cesspoo:
Materials of construction
Indication of groundwate-
inflow tcesspooi must oe pumpec as part of inspection:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
it
PRIVY: �J
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, s,grs of hydraulic failure, level of ponding, condition of vegetation, etc 1
(revaaed 04/25/97) Page I of 10
•I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properri Address:
Owner: T�n,ph
Date of Inspection: 10 L(97
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)
6-
2eani
2
a3
�t
�Z- 32,
3m"
30 IN '-13
Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO% FORM
PART C
SYSTEM INFORMATION (continued)
Propertv Address: rj� &tor-,J0( ,
Owner: r�Qr�h
Date of Inspection: �GIL�47
Depth to Ground%ater k)5 Fee;
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained irom Design Plans on record
Observation of Site (Abutting property. observation hole, basement sump etc.)
Determine it from local conditions
Cnech %%ith local Board o• newt-
Chec"K FE.NAA maps
Check pumping.records
Check loca! e�.cavato•s ins:alle•s
t.se ' SCS Da-.c
r
Desc be in vou, o% %%o•onnro•.N %o- esaohs^)ec the6-tig�'• Croun6%ater Elevation. (Must be completed
(J.g. �o fog r cam( �jp a✓E.Y� ��o��c �h/vcs!r���T?o`�/s (-�. A. !a_7 Z e-'�"� 3 I
tzev%fed 04.25'9-. Page 10 of 10