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Home My WebLink About0038 WESTCHESTER WAY - Health 38 WESTCHESTER WAY,BARNSTABLE A= 349 071 s 390 PLUM STREET, W. BARNSTABLE A=196-017 i f d f a r-- TOWN OF BARNSTABLE tr LOCATION � L � �✓ w SEWAGE # S �, VILLAGE ASSESSOR'S MAP& LOT y �} INSTALLER'S NAME&PHONE NO. ` SEPTIC TANK CAPACITY /V U V I LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 fapili ) Feet Furnished by !�2' �� — a.2 �L ' �Si 211 rt RECE' V E® TROY WILLIAMS APR 5 1996HEALTH DEPT SEPTIC INSPECTIONS TOWN OF BAZSTABLE Certified by MA Department of Environmental Protection (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 CommorrnreM of MCWC& netts jL)X Executive Office of EMOr VTY-"d Affah �Op� Department of Environmental Protection %Vftm F.W*W 9orunor Dam strulva V9 0-7/ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 38 0-3 4-G� e s A-c✓ � C, --- Address of Owner, ! s c v ./c, S ti✓oo Date of Inspdciron: y/a./y 6 pf different) Name of Inspector, —,,y J f r 11, k.s,s f Company Name,Address!nd Telephone Number. /�d, tj.), . 3 o u 6' / CERTIFICATION ATEMENT 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 o"ite sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 5„�, y 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: V/ 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. B) SYSTEM CONDITIONALLY PASSES: 1%1//9 One or more system components need to be replaced or repaired. The system, upon oompletlon of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N,or ND). Describe basis of detefrmination in all Instances. If'not determined', explain why not) The septic tank is metal,Qacked, structurally unsound, shows substantial infiltration or exfihratkm, 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. 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner wn v Date of Inspedton: y Ia BI SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to bro Board of Health): ken or obstructed pipes) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the 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 _) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:,✓�/i 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The w5lem has a septic tank ano soil adsorption system and is within 100 feel to a surface water supply or tributary tG a surface water supply. — The ss,stem has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The systen, has a septic tank and soil absorption system and 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. I SYSTEM FAILS: /V 14 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. — 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 —Ised 8/IS/9Si 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 Owner. 0 o u ref Date of Inspection: U42/9 6 DI SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or dogged 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 dogged 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/q The following criteria apply to large systems in addition to the criteria above: The design flow of system is 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: 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. revised 6/15/95) 3 SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner. GJ ,v A Date of Inspection: VIC2 Check'if the following have been done: Pumping information was requested of the owner, occupant, and 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. M119 As built plans have been obtained and examined. Note if they are not available with WA. 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. ZAII 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 existing information or approximated by non-intrusive methods. The facility ow nP• tamed occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. revised 8/15/'95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner. (JoocQ Date of Inspection: y/a 6 y FLOW CONDITIONS RESIDENTIAL: Design flow:-33o gallons Number of bedrooms: 3 Number of current residents: d Garbage grinder(yes or no):[[s Laundry connected to system (yes or no): YES Seasonal use (Yes or no):no):2V o Water meter readings, if available: 9 S— _ /o/ , vo o Last date of occupancy: 12,,-. oc cKs »w) COMMERCIAUINDUSTRIAL: Fype 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 S system: (yes or no)_ Water meter readings, if available: ast date of occupancy: OTHER: (Describe) ast date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: I ovc . wl/A i I w 6 I t ts a'�- gu✓hs b (tom l moo. —k..e,r. ��ltv� System pumped as pan of inspection: (yes or no) IV6 If yes, s•olume pumped Rallons Reason for pumping: rl'PE QF SYSTEM Septic tank/ soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) 4PPROXIMATE AGE of all components, date installed (if known) and source of information: G urn oZ$��'S o`y a • Sewage odors detected when arriving at the site. (yes or no) ;revised B/IS/9Si $ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3g Owner: wovCA Date of Inspection: U/a�9 SEPTIC TANK:_✓ (locate on site plan) Depth below grade: I Material of construction: Zconcrete _metal _FRP —other(explain) Dimensions: Sludge depth: 6 �' Distance from top of sludge to bottom of outlet tee or baffle: / //o Scum thickness:_ 3„ Distance from top of scum to top of outlet tee or baffle: Distance from-bottom of scum to bottom of outlet tee or baffle: /0 Comments: ireCommendation 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.) Gee, 4- /e JL J P v TGe-. ,p— o , �0p�� .� �✓u,��- � c o,-�.( er /Va SiisHS o� I-ea � o✓ S�v-� `�rw� r�QYN0.4 [i GREASE TRAP:_6�/,g :locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: ,cum thickness: Distance from top of scum to top of outlet tee or baffle: `1I,tance from bonorn ni «,n., i- honnm of ou!to! tee or ban e Comments: recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural ,rnegrity, evidence of leakage. et(.) fv)Sfd BiIS/9S1 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: .3 GJ c s -4l,s Owner. woo 64 . Date of Inspection: y/a/96 TIGHT OR HOLDING TANK:N�f� (locate on site plan) Depth below grade: material of construction: _concrete_metal_FRP othedexplain) Dimensions: Capacity Gallons Design flow: Gallons/day -\[arm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:�//�►j locate on site plan) Depth of liquid level above outlet invert: '=omments: note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) 5h 0.{2 L!� � h L h✓i � " o .P - fJ°X 'TU✓'l�' O l� �Q/'C.��[�1 PUMP CHAMBER: %✓`/? locate on site plan) Pumps in working order:(yes or no) '=omments: � note condition of pump chamber, condition of pumps and appurtenances, etc.) revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued Property Address: 38 Owner. W o a Date of Inspection: 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. bj�Lz 61 s 5/000 L omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) P.J4. J. ..ti b K O cJ CESSPOOLS: locate on site plan) 'umber and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: -.materials of construction: ndication of groundwater: inflow (cesspool must be pumped as part of inspection) .omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) t'RIVY: locate on site plan) Aaterials of construction: Dimensions: .)epth of solids: omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) re��sed 8/15/95� $ t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C // SYSTEM INFORMATION (continued) Property Address; 30 Owner. W 00 a Date of Inspection; y/a/y SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 1 ICI a$ ' >EPTH TO GROUNDWATER )epth to groundwater: — feet _ adjusted high groundwater level Tlethod of determination or approximation:_ �7?c,,, S% �%y A4-c CA f rpm 1 cA No ? 54— revised 8/15/95) 9