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0029 LINCOLN STREET - Health
I,inc6ln Street Centerville A= 226 - 144 ..... .. .... Commonwealth ifsachuI.Ise 1 $ubsurtace Sevrage` sposal$ysfiem Focht Not for Valun#ary Assessments <. � 29 Lincoln Street, :A 'F .:.: ... :. - :: .: .. .:: Pro ert Address. : w .......P .Y....... - :: TOBIN, :LENN&SHEILA, Owner Owner's Name tnforniatlon is : Qi �� cep regulred for euery ,Ma 0-..- 10/231201"3 page. City/Town $tate Ztp Code Date of Inspection Z2 d �l�l lnspec#i€n results mus#lie submitted.on this form Inspec#ion fsarms may not ,a altered en any. vuay.Please see domplet6ness ct,'ockIhat at.the end o,t-a f:Orm:. Important When Jul. 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I .. : use the return " r -�— key Winl of Inspector Ca -ewide Et t rises Company Name " 1,53 Commercial St Mashpee _ Ma 02649 . . ... , C.t a, wn ::: State Zip Code 608-477 8877 S! 4522: Telephone Number License Number - B ceII ICaI�f1< I certify that I have personally;rnspected thesewage disposal system at this address antl thafthe information reported befaw IS true, accurate and coinpie#e:as of the t►meof the inspection The inspection was performed.,t aced on my troinmg,'L d experlenc in tti`e proper function and;mairitenancg of on site .ser age tlispo'saI system lams ®EF':appr®ved.system rispector pursu`aiit to aeCtiori 1:5 340 a Title,5(31i3 CAR-.I'll 0).The syste rl. it ® Passes,l :: ❑ .Conditionally Passes fails : ❑. Needs FurtherEv'I afion .b the Local Approvmg fiutharity : -: -___ :• .__ 1'0/23/2013 Ins ect .. p..:.ors Si` nature ' Date 9,. The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health.or"DEP)within 3.:days of completing this inspection. If the'syster is'a shared system:or I has",a design,fEoWof 1 O,O(30 gpd c r greater,�the'inspeetor and:.the system owner,shal! submit the'. report to the appropriate reglonal';office of the DEP. Tie original should.be>:sent to the sys#ern owner and copies sent to-fhe�buyer, if applicable, and:the approving;authonty .: '.` ****This report only describes conditlans at the time of inspection;and.under the conditions of use at" hat time:This inspection does not address ho the system Wnll peorm i;rt the future under . thesame,or different conditions s , i V :` l5ins' 3lt3' Title 5,Of!cial inspection form;Su rfo Sewage 6 !$pOS81 1 ptem Qage'i of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Lincoln Street Property Address TOBIN,GLENN & SHEILA Owner Owner's Name information is p required for every West Hyannis port Ma 02672 10/23/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I 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: The dwelling located at 29 Lincoln St Hyannisport is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 4 500 gallon leaching chambers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, 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 metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is West Hyannis port Ma 02672 10/23/2013 required for every p page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ' ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): El obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further 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 public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 10/23/2013 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System 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 surface 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 from 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 fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is p required for every West Hyannis port Ma 02672 10/23/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 SAS, cesspool or privy is below high ground water elevation. El ® Any portion of 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 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. El ® 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. 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 If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name required for is every West H annis required for eve Y port Ma 02672 10/23/2013 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® 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? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as 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? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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? ® ❑ 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: ® ❑ 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 566.8 gpd provided t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 10/23/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2011 —368,000G &2012—464,000G & 1/2 of 2013—70,000G Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information isequired or every very West H annis ort Ma 02672 10/23/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Lincoln Street Property Address TOBIN, GLENN &SHEILA Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 10/23/2013 — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 12/21/2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): 811 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 6" � t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 10/23/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" 1, Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid.levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Tank is H-20 located in stone driveway. Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is P required for every y West H annis ort Ma 02672 10/23/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 10/23/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): Distribution box was in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is required for every West H Yannis 0 p rt Ma 02672 10/23/2013 page. City/Town State Zip Code Date of inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4x500 gals ❑ 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.): Vegetation was normal, no sign of past or present hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information isequired or every West H annis ort Ma 02672 10/23/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ... ... _ _ _ ...... .... _...... _ _ . ....__ _ _..... _ _ .. __ .... .......-.. . ... .... .. _...... __ ....... __ ... _. ......__ __ .......... __ __. .. .. ... ...... .._... __.. ................ .. .... ..... .. .. ,:::.!i::1.:I.:..::��.ii:..:..:.::::,��,.::,.::-d....::: l;..:,.,..:..-."...1'..:.1..:I—.......I..,iI.'...."..:...'`.;.I.—:..,...'I..I.;I!:....': .I...t..:-..:..'..-::l':....,:- �:......l.:...-'.......I�'.....11':.....,I......., ,..-,.....,:.:.�..:......--�:..:-.—,:...,.l,..�:,.1I;�...I..:'1:..':..51:..'I.'..,.:..'...'.1:.-,I:'..1.ol..-1:..l*,-...'..,.1�:.. *.::':..0..:......,.:..,�I�.:..:�':...:-,.-,i':..:.,..:...-,.1,:...;�-,...:...; :...:. iII:.1,..'I�::.�.:....'1:...:...I,.:.........7.I.i..:..I..::'::I:-:...1::'.�::..:::.1,.,:q....:.I1:.S:.::..--1::...I::.-:..:.:....:-'..:..�:.:l:I.1I...:�..W:.'..I..,,-..I'I—...-Pl:l.:...:1-:...:::1-:.II:.:.-.I,l::.:1-:...—.:.,:.:..-..e::�.1..!.—.I:.-...1....� -I:Ii�':.:1.-.:.,--I:..:—..F..':'i..:—. 1-:.-.:*-1I�:..r.q:;.��:..:::,1�...-,:::—.-..:.: .I. .. Cornrnolrwearth ®filassachuse _— m . � I Subsurface Sewage ®6spasaESystefai Porrn Not;for Va[untary Assessments;; R J:.. P'.: ... .... .. :: .. :: ':. .. 29 Lincairi Street =— — --- Property;Add,ess .. TQBIN,.GLEt<IN&SNEkLA w Qwner Owner s fvarr ... .nf.-.1.. n is W@St k-I a ims O _ required for every ' P Ma 42672' 14/23/2413 II II page :` City!Town — � — State Zip Code Dale'of lnspee66* . 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Lq . : , -�3 Z., ..... :: t5ins 3t53 c I.0 Su*_ .,_ S_ r x Sps',m s, ci; F rn:Su s?f Pajns 95of17. Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GM 29 Lincoln Street Property Address TOBIN, GLENN & SHEILA Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 10/23/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 11 + feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/31/2007 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing design plan dated 5/31/2007 on file at Town of Barnstable health dept. Plan indicates that no groundwater was encountered at 134"and system is designed to have 5' seperation between bottom of s.a.s. and adjusted groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Y Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 29 Lincoln Street Property Address TOBIN, GLENN &SHEILA Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 10/23/2013 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 .lJ j TOWN OF.BARNSTABLE LOCATION 2_y k:n chi" sr (k) V- Not-n, Sid EWAGE# ?-(X - 2- Z n _ 0LVILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NA O SEPTIC TANK CAPACITY I S70Q 5c,,\Ao,6-(-2-6) V LEACHING FACILITY:(type)�fi)SUO l, c.V%k^+ �(size) NO.OF BEDROOMS OWNER & Itnrn + 6kc-A1 rn /n PERMIT DATE: 12 S 0 7 COMPLIANCE DATE: (✓ Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 e ching facility) Feet FURNISHED r- 9`07 i 5F %9 M kV �r TOWN OF BARNSTABLE LOCATION 'Z q knc-akn Sr Wn k1 e eaw r- SEWAGE# 2.w-1—LL(Z VILLAGE If/. ASSESSOR'S MAP&PARCEL Z Zb INSTALLERS NAME&PHONE NO. bQ r-�-n Can S 9 3q SEPTIC TANK CAPACITY 1 SC30 aa,%" LEACHING FACILITY:(type) k&r Gkcw,6er5(size) 13',K L►Z ' ` NO.OF BEDROOMS 5" OWNER ( PERMIT DATE: J Z(5-1 U7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 le hing facility Feet FURNISHED BY Al: z0 A ,�2-= zs Z e 6zf �� ,� ,; 3 36 Y 5 G�� 3Z No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for Mis;pozal *p6tem Con5trurtton Permit Application for a Permit to Construct(14/Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z l/K/et�G/(J �/. Owner's Name,Addres ,and Tel.No. Assessor's Map/Parcel z X2 .r'& e ve Installer' Name,Address,and Tel.No. / ®// jp(�C/ esigner's Name,Address d Tel.No. LcJ�'C.G� � Type of uiIding: AM Dwelling No.of Bedrooms S Lot Size-5_31Jl8 sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ��� gpd Design flow provided gpd Plan Date 2 Number of sheets / Revision Date Title -%!��'^ r���+Ci --w� +►J Size of Septic Tank Type of S.A.S. JT/Y Description of Soil '�� �% �.:.�..� i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o ealt Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued 41 No. ,. Fee THE.� 6 WEA TH OF MASSACHUSE F0 Entered in computer: � M PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Dis;pogar Wpktem Construction Permit Application for a Permit to Construct e4/"Repair O Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. Z 9 C./n/�OG�,J �/. Owner's Name,Add re s,and Tel.No. 'Assessor'sMap/Parcel Z z�, .. _'.` �7 Installer's Name,Address,and Tel.No. /" ��li esigner's Name,Address and Tel.N �-�-•+� �. GtJEGGE?L if S.Soa�/-9�"�'S Type of Building: Dwelling No.of Bedrooms Lot Size.33-/,45 sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1 ' Design Flow(min.required) gpd Design flow provided 8' d Plan Date '� 3��'O gP M. ?A � IQumber of sheets / Revision Date - Title ..%!'�"-� •C.�� � e..,y Size of Septic.Tank Type of S.A.S��/Y Description of Soil 5".`-' •'Ste�i1��.-� �iZc,iy,r.J Nature of Repairs or Alterations(Answer when applicable) 4 --Date last in . t 'i -. Agreement: , ;` The undersigned agrees to ensure the construction and maintenance of the afore de§cribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ealt Signed :� Date - �. - // - f Application Approved'by ' f� f- ; — -_ / Date _. . �y Application Disapproved by: Date for the following reasons r; r Permit No: 6 / v Date Issued / o ————.--—————1 ——-- - .- -.-.- T --^ -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (L-< Repaired ( ) Upgraded ( ) BAbandoned(p )by/ f �'U/ _.G at tom. ( �'/��Q ti `. has been constructed in bcorrdance with the provi ion of(�itle 5 and the for D' posal System Construction Permit N� '7 e� `dated / Installer L(l�( Designer A #bedrooms Approved design flow ����� gpd The issuance of this permit /NG :Vkallof be con tr• ed as a guarantee that the system ill fu ction as designed': i r y Date a Inspector ,r`f 4 �/� ` ----------- — ———— No./ / 1 1 Fee v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS �Digo!gal *pgtem Construction Permit Permission is hereby granted to Construct ( t Repair (. ) Upgrade ( )�A Abandon ( �, System located at ~/?�L�/dy ,� G� /VN ' �✓, and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must he co plete—within three years of the date of this Date Approved by 03-2WE Oa: 1,3 F r o m:9CRTOLOTT I �01 GIT 1 5084289399 To:500775-10754 r 2.1 1 7 Town bf Barnstable Regulatory Services I ij� I Thomas F.Geller,Director Public Health Division `fhomas Mc.'K(ma,Director 200 Main Street,flysionts,MA 02601. Off"cr: 508-862-4644 Fox: 508490-6304 Installer&Designerjgerfification Form Date: S-e'wa' Permit# Z 00 7—Z V2ASsesior's MaPT a reel ge Desf,gnen Installer: A0, Address: Address: Can was issued a permit to install a septic system at L"Lee-..2-�!/0 7 5 based on a design dra by ark less C) dated S �31/0 z I dertify that the septiq system referenced above was installed substantially ccordifrg4to the design, which may include minor approved changes such as lateral, rel fe tion obe distribution b6x and/or septic tank. Stripout (if required) was inspPoted d the is were found satisfaotory. rn 1 'certify that the septic systern referenced above was installed with major c ges (i.0, greater than 19' lateral"relocation of the SAS or any vertical relocation of any oomporient of the septic syttem) but in ucordanot with State & Loc ations. Plan revision or certified as-built by designer to fbllow. Stripout(if r s ected and the $OiL'S were foond satisfactory. icy DANIEL E. BRAMAN CIVIL U) No. 32686C Sio IST ON L ECG Ix csigner as amp eFe) PLEASE RETIMN TO R.r4, T if DL !�A?�rl_ COMPA -NOLT BE jf�cr]L BO B T IARD IL ALCEWED Y T11-F, H 5TABLE o THANK _Y10 U Certification Fcrm Rev 03.09-06,doc . No. Fee lJ� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for 3Digpoga1 6p!5tetu Cougtructiou Permit Application for a Permit to Construct(V) Repair( ) Upgrade( ) Abandon( ) ❑.Complete System 2Individual Components Location Address or Lot No. �G'® Owner's Name,�ddress,and Tel.No. Assessor's Map/Parce( Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Siz rsq. . bage Grinder ( ) Other Type of Building No.of ersons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) c5&401 /C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental ode and not to place the system in operation until a Certificate of Compliance has been issued by this Board Hea / ne Date Application Approved Date Application Disapproved by: Date for the following reasons Permit No. [ —o Date Issued �j 1 No. ,t(J V Fee THE COMMONWEALTH OF MASSACHUSETTS' F Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes 2pprication for Wgpogal *p.5tem (fott.5truction Permit Application for a Permit to Construct 6/Repair( ) Upgrade( ) Abandon( ) ❑.Complete System 2Individual Components Location Address or Lot No. � ��+� Owner's Name,Address,and Tel.No. i Y CAssessor's Map[Parc Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �/,>`o%�" s��s Type of Building: A"T&V Lk �_,. '� Dwelling No.of Bedrooms Lot Siz sq.ft. Garbage Grinder ( ) V Other Type of Building No.of ersons Showers( ) Cafeteria( ) Other Fixtures R Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental ode and not to place the system in operation until a Certificate of Compliance has been issued by this Board Hea / I 'gned Date Application Approved Date Application Disapproved by: Date for the following reasons I � Permit No. c 6 �� Date Issued G/ F — — ————————————————————————— ————————————- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS C� (Certificate of (Compliance THIS IS TO CERTI Y,that the On- ite Sewage Disposal System Constructed (✓) Repaired ( ) Upgraded ( ) i Abandoned( )by / �s at �,� h been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ' rI if dated Installer / Designer #bedrooms_/ Approved design flow ' gpd The issuance his permi all not be construed as a guarantee that the system wi fun tion is design ' Q' O ' Date Inspector — No. ) �� V � ---------- -------- -- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS =igpogar *p --em iton5truction Permit Permission is hereby granted to Construct (✓) Repair ( ) Upgrade ( ) Abandon ( ) System located at MCP !� p� - �Q'J� l//� / and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply.with Title S and the following local provisions or special conditions. Provided: Construct on must be completed within three years of the/date of this e ii. aA^�k)oDateApproved by I , t �i Weller & Associates Bayberry Square — Suite 4C 1645 Falmouth Rd. — P.O. Box 417 Centerville, MA 02632-0417 February 29, 2008 To: Town of Barnstable Health Department From: Bill Weller ' ' Weller& Associates VA RE: 29 Lincoln St., West Hyannisport i+• Please be advised that during our final inspection of the installation of the septic system at the above referenced location, we also inspected the installation of the sewer line leading from the existing garage on the premises, to the newly installed septic tank. The pipe was laid to a point just shy of the garage, for the plumbing contractor to make his connection. All work was done in accordance with DEP 310 CMR regulations. .. If you have any questions, please do not hesitate to contact us. 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SEPTIC SYSTEM IS TO BE INSTALLED IN COMPLIANCE DISTRIBUTION BOX:N USE: - -e z•ova-- ar:- WITH 3 10 CM K 1 5.00: TITLE V. 4" SCH 40 PVC PIPE _o�s�=e. v7,o,.✓-: o Q N �, SOIL ABSORPTION SYSTEM: 3. THIS PLAN 1S NOT TO BE USED FOR PROPERTY LINE USE `5'�_5' X B,SX 2 �-- Soo DETERMINATION. - -'�" o N 4. ALL DISTURBED AREAS ARE TO BE LOAMED * SEEDED. EL. z�,25 TOP EL. /Sf/ nC • N 5. `CONTRACTOR TO PROVIDE 48 HOUR NOTICE FOR ANY ` io° i8w `/� �"no CT olzs 'G� z /'�'" � 3,�3 BOTTOM � EL. g REQUIRED INSPECTIONS - � /5!SS" �NSTALLGASBAFPLE ti CAPACITY: BASEMENT FLOOR iN OUTLET TEE SIDEWALL AREA :%/o'x 2 -w c^. 7� 1G2.8 G. THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A � EL.��zs 4 Q, BOTTOM AREA: /3' x /4/ .'� c7,) y/ _ _ .��,4/o GARBAGE DISPOSAL. 1 500 GALLON PRECAST SEPTIC TANK SEPTIC 5Y5TEM FROFILE �TZ©v-vr..a ?7•/� :.,.mil 5, .�✓.D .�'E.��� I , I L �I ( � D� P OB5EKVATION HOLE LOG5 II j I � ... 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