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Home My WebLink About0095 TOBEY WAY - Health 95 TOBEY WAY, HYANNIS A= 247 228 fa tr - URECIEWED B`OR:TOLOTTI CONSTRUCTION INC. ED MAY 9 19951 HEALWvMOFTMB E igIIBgpRp7lCy'.:gySlJlaE•• DISPOSAL SYS.TEX INSPECTION P 1►ddr4ss ;oZ:Cp'roperty Lr/ /� r! S r _.. Owneris 'nani 4 Ae��l5 Cata' oi•zlrispaction PART A CHECKLIST Check if- the fol-lowing have been done: ✓ Pumping..information was requested of the owner, occupant , and Bcart: Health:• Nona of the system components have- been pumped for at least two e �f» . and `th .system:has: been receiving normal flow rates during that pariod.: 'LArga.:.volumes of water, have. not been introduced into the systam. racently'.or� as• part of this inspection . phans have •been obtained and examined . Note if they Are�)►s built /availabla;with •N/A. The, fa`ei'lity •or• dwelling was inspected for signs of sewage hack- _zThe site vas. inspected for signs of breakout . ,ZAll system components, excluding the SAS , have been located on /site. ✓ The septic tank manholes were uncovered, opened, and the inte'ri �- the. sapt'ic, tank was inspected . for condition of baffles or tees , i.ateriah :•ot''construction, dimensions, depth of liquid , depth o: sludgQ•; •,d.epth .:of•'•scum. The-'size •and--loCa.tion• of the SAS on .the site has been determined C,as. on exist nq.•information .or approximated by non-intrusive methods . The facility- owner. (and occupants, if different from owner) were, provided'-vith ' inlormation on the proper maintenance of SSDS . i It . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS if residential , number of bedrooms number `of: current residents ND garbage. grinder,: yes or . no' yt laundry connected. to system, yes or no yew. .seasonal :use, yes or no If nonresidential., calculated flow: . water meter readings, if available: —I�7 Last date of occupancy P Y GENERAL INFORMATION Pumping records and source of information: system. pumped .as .part of inspection, yes or no i.f.,.yes,.. volume pumped Reasom. for pumping: Typ of system Se tic tank ' p /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. Source of informations Yew Sys� .Sewage "odors detected when arriving at the site, yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT I ON FORM PART B SYSTEM INFORMATION continued ..SEPTIC TANK:22_0 ` (locate on site.,:plan) -V depth below. grade: . material of*. constructions concrete metal FRP other(explain) dimensions: sludge .depth 9 distance from top of sludge to bottom of outlet tee or baffle O scum .thickness 0 distance from top .of scum to top o.f outlet tee or baffle D 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 . o; leakage, ecommendat* ,ns for repairs, etc,,) DISTRIBUTION BOX s (locate,on :aite plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakaag out of box, recommendaOtign for repairs, etc . ) PUMP CHAMBER: (locate on. .sit plan). pumps ....in .working order, yes.-or no Commentsc . (note condition of .pump chamber, condition of pumps and appurtenances , recommendations. for. maintenance or repairs, etc. ) E `SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.. B SYSTEM: ZNY. TION continued SOhL;:ABSORPTION SYS.TEM.. .(SAS) : (locate on site. plan, >. if: possible; excavation not required, but may be approximated -'Ary :non=intrusive methods) If not determined to .be .present, explain: eac leac hing; pits .nnd number leachinq,;chambers . arid number leachinq'.'galleries. and .number _.- leaching .trenches, number, length _. leachin q ;fields, number, dimensions over:f1ow ;cesspool., number Comments:~ (note `cond t s1 signs. of hydraulic ,,failure, level of ponding, conditon of vegre tat:aion, �r- commen®ds ohsfo r� maintenance anticee or .r5e��ai , etc . ) CESSPOOLS' (.lbcate on site plan) number. :And *:configuration depth`.-top;;:Qf`.'liquid to :inlet -invert depth ot' sohds:,layer depth .of:_xcum..,f,layer -- d'iiaensions o! `cesspool '. mateiials:-of'..construction indication ,of!:groundwater -_ inflow (cesspool must re . pumped as part df: inspection) Comments (note condition of soil, signs of 'hydraulic failure, level of ponding, condition"`ot vegetation, recommendations for maintenance or repairs, etc. ) PRIVY: (I'ocate on, site plan) i4naterialz=..of construction ' dimensions. depth of_ solids Comments (no.te . condition. of soil, signs of hydraulic failure, level of ponding, condition `of vegetation, recommendations for maintenance or repairs, etc . ) 8IIH8IIRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B . SYSTEM -INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' r zf Ys" p DEPTH TO GROUNDWATER / depth to groundwater ` method of determination or approximation: Zv p owe v qoW Aelo h, ' 8ussURFACE .SEWAGE DISPOSAL SYSTEIi INBPECTZON FORM PART C FAILURE' CRITERIA Indicate yes, no, or. not determined (Y, N.. or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) �Backu.p :of. sewage into facility? !� Discharge or ponding of effluent to the . surface of the ground or surface waters? /—/Static. liquid _level in the distribution box above outlet invert? Liquid depth in- cesspool <6" below invert or available volume< 112 da;. flow? .t Required. pumping 4 times or more in the last year? number of times pumped Septic. tank is metal? cracked?structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is .any -portion of` the. SAS,. cesspool or privy: below the high groundwater elevation? within O' . feet-of a. surface water? within..100 feet .of .a surface water supply or tributary to a surface water.% supply? within a.,Zohe I of. a public well? ate" within 50. feet of .a bordering vegetated wetland or salt marsh ' (cesspools and privies only, n= the SAS) ? Within:50. feet of a private water supply well? "y 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 analys for 'coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.• SUBSURFACE SEWAGE DISPOSAL. SYSTEX INSPECTION FORM PART D CERTIFICATION Name of �I sp ctor kDdel-r r/ �jD✓�� 1 .Company Name. �D/'�LO��f'�CDylv7�r�G�®yl L�NC� Company Address <= Certification Statement I .certifythat..I have personally inspected the sewage disposal system at this .address:,'and :that the information reported is true, accurate and complete .'as .of. 'the time of inspection.. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent':.-with 'my., training and experience in the proper function and maiitenancd of -on-site sewage disposal systems. Che one: ✓ I have ..not found : any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 .CMR'.i5.'303. , Any. .failure criteria not evaluated are as stated in the-`FAILURE CRITERIA section of this form. I: have`'determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination-�is provided in the FAILURE. CRITERIA section of this form. Inspector' s/ Signature . .Date yl/S`Q� Original to system owner Copies to: Buyer (if applicable) Approving authority 8 , C 6