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Home My WebLink About1503 HYANNIS-BARNSTABLE ROAD - Health a 1503yannis 4arnstable Road Barnstable P - I _T f T r a� 4 •r y, •• 298 9r 8A - 023002 23002�„• M, 1.l.♦..�,: ; tM. .. -i'y , „:. •.�+ n ,a ,rr ]. « , r•.�.•.. is J k . 4 1, ♦ -G .. l i e, x u , ' ' { rt a, r c + n • • ' �' � .. ". ' ° t ,A � - ' ' " Y `�' ;• cai•1 f" :.ram i "- � ,r{.. �� ,. .. - � r•� 4 r:'� r �; A j�S,;� 'fib 4 � , ii y � o c r ♦ c p COMMONWEALTH OF MMSACHUSE17S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROT CEIVED OCT 2 7 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1506 Hyannis—Barnstable Rd MAR Rarnct-ahl Owner's Name: PARCEL ' Owner's Address: 8 Chestnut St Pittsfield NH SOT e Date of Inspection: ;-'/ zi 'G Name of Inspector:(please print) Wi 1 1 i am _ .Robinson Sr. Company Name: William. E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT. 1 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 1/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ; g Inspector's Signature: �.. ..._`,� Dotes The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health-or . . DEP)within 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 DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title-5 Inspection Form 6/15/2000 page 1 N . ' a Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1506 Hyannis Barnstable Rd Barnstable Owner: Stephen Ra zi Date of Inspection: —/zr —eat Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syst Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. ystem Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or reps' d.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answe yes,no or not determined(Y,N,ND)in the for the following statements.if"not determined"please explain e septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsoun exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A McU I septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicati ig that the tank is less than 20 years old is available. ND ex ain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obs cted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with appr val of Board of Health). broken pipe(s)are replaced obstruction is removed distribution lox is leveled or replaced explain: The system required pumping more than 4 tines a year due to broken or obsmxicd pipe(s).The system will p s inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rtmotrod e Pa►n.' ' 1 i _1 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1506 Hyannis Barnstable Rd arns a e Owner-, Stephen Radzik Date of inspection:. C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation bythe Board of Health in order to determine if the system is fail' to protect public health,safety or the environment. 1. stem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the s stem is not functioning in a manner which will protect public health,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. Sy tem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a sur face water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more fronl a private water supply well" Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 r Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1506 Hyannis Barnstable Rd Rarnctable Owner: RtaPhcn Rad7ik Date of Inspection: Jfl 9-4,3 D. System Failure Criteria applicable to all systems: You must indicate"Yes"or"no"to each of the following for all inspections: Yes o Backup of sewage into facility or system component due to 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 esspool iquid depth in cesspool is less than 6"below invert or available volume is less than''/,day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number f times pumped y portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100,feet of a surface water supply or tributary to a surface ter supply. A iy portion of.a cesspool or privy is within a Zone 1 of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply well. y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private%atcr s pply well with no acceptable water quality analysis.(This system passes if the well water analysis, p rformed at a DEP certified laboratory.,for coliform bacteria and volatile organic compounds i dicates that the well is free.from pollution from that facility and the presence of ammonia itrogen and nitrate nitrogen is equal to or less than 5 ppm,.provided that no other failure criteria re triggered.A copy of the analysis must be attached to this form.] (Ye o)The system fails.1 have determined that one or more ofthe above failure criteria exist as _scribed in 310 CMR 15.303,therefore the system fails.The system owner should contact tlic Board of Health to determine what will be necessary to correct the failure. E. Lar a Systems: To be c nsid_red a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd• Yo ust indicate either"yes"or"no"to each of the following: to following criteria apply to large systems in addition to the criteria above) y 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 Projection Area—IWPA)or a mapped Zone II of a public water supply well If ou have answered"yes"to any question in Section E the system is considered a significant threat,ar answered "y s"in Section D above the large system has fated.The owner or operator of wry large system considered a s' nificant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 1 .304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1506 Hyannis Barnstable-,Rd Owner: Stephen Radzik Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No/ t/ �//Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? V Has the system received normal flows in the previous two week period ✓ Have large volumes of water been introduced to the system recently oras part of this inspection?,, Were as built plans of the system obtained and examined?(if they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? , V/_ Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site 7 ~ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ _L/Was the facility owner(and occupants if different from owner)provided with information on the proper ' maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: . Yes ..no 11 Z- EXisting information.For example,a plan at the Board of Health. • . _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) 5 Page 6 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1 506 Hyannis Barnstable Rd _ Barnstable Owner: Stephen Radzik f' Date of Inspection: —0 r 0 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):X 3 Number of bedrooms(actual):; ✓ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents:`-,`=— Does residence have a garbage grtnder(yes or no): Is laundry on a separate sewage system(yes or no)ji,,,o [if yes separate inspection required] Laundry system inspected(yes o no �✓ Seasonal use:(yes or no): v A, Water meter readings, if avai able(last 2 years usage(gpd)): 2002 42, 000 gals Sump pump(yes or no): /✓0 2003 41 ,000 gals Last date of occupancy: .r CO MME CIAIANDUSTRIAL Type of es blishment: Design flo (based on 310 CMR 15.203): gpd Basis of d ign flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial ste holding tank present(yes or no):_ Non-sani waste discharged to the Title 5 system(yes or no):_ Water met readings,if available: Last date o occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: fi/ fe Was system pumped as part�f the inspection(yes or no): cJ If yes,volume pumped:_gallons-=How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _VV OF tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known).and source of information: �C'.. moray � .� � (y..c✓c� � 71•> Were sewage odors detected when arriving at the site(yes or no))/� 6 ]'age 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUN TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properly Address: 1506 Hyannis Barnstable Rd Barnstable Owner: St phen Radzik Date of Inspection: BUILDING NER(locate on site plan) Depth below ade: Materials of onstruction:_cast iron _40 PVC other(explain): - Distance fro private water supply well or suction line: Comments n condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:Z- (Iocatc on site _ plan) Depth below grade:_ Material of construction:_j,,t<oncrete metal fiberglass_polyethylene —other(explain) - If tank is metal list age:_ Is age confumed•by a Certificate of � Compliance(Yes or no) certificate) (attach PY of Dimensions: � P t/.= Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: (� e Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions d r determined: .n 3_ u Comments(on pumping recommendations, inlet and outlet tee or baffle conditicn,structural integrity,liquid levels as related to outlet invert evidence of lca�kue, -etc/ dr . •: / � GREASE TRAP: locate on site( Ian . P ) Depth below grade: Material of eonstructio :_concrete metal fiberglass polyethylene other (explain): —' _ Dimensions: Scum thickness: _ Distance from top of s um.to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: -" Date of last pumping: Comments(on pumpin recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet inv rt,evidence of leakage,etc.): Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1506 Hyannis Barnstable Rd Barnstable Owner:��te hen RRadzik Date of Inspection: 49-y a.—0-3 TIGHT or HOLDING TANK: (tank must be pumped 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 Ala, »present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Corunents(condition of alarm and float switches,etc.): DISTRI13UTION BOX: t (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): — ) PUMP CHAMDER: (locate o site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump cl amber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1506 Hyannis Barnstable Rd Barnsta e Owner: Stephen Radzik Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required), If SAS not located explain why: Type king pits,number: leaching chambers,number: -;t— ` leaching galleries,number: " leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CE OOLS: (cesspool must be pumped as part of inspect ion)(locate on site plan) Number d configuration: Depth—t of liquid to inlet invert: Depth of s ids layer: Depth of sc layer. Dimensions cesspool: ' Materials of c nstruction: Indication of oundwater inflow(yes or no): Comments(not condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): I PRIVY: (lo ate on site plan) Materials of cons ction: Dimensions: Depth of solids: Comments(note c ition of soil,signs of hydraulic failure,level of ponding,conditIion of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1506 Hyannis Barnstable Rd t5arnstal3le Owner: en Radzik Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Pat- ,sa 40 3 A i 10 • 'Page l l of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE_SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: .1506 Hyannis Barnstable Rd RarnGtahlP Owner. Step1jen Radzik Date"of Inspection: 4-1 SITE EXAM '. Slope Surface water Check cellar Shallow wells Estimated depth to ground water 0- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) � cked with local Board of Health-explain: C t 5 Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: O 11 S