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Home My WebLink About0127 LINCOLN ROAD - Health 1,27:UNCOLN RD., HYANNIS A. i TOWN OF BARNSTABLE d ti LOCATION g 7 l 14yc 0 Z,4,R,4 • SEWAGE# r VILLAGE LhA4 dz I C ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. a SEPTIC TANK CAPACITY � A LEACHING FACILITY:(type) -S-a 6&j L ehAnfl&ers (size) 13 X 2 5 NO. OF BEDROOMS OWNER PERMIT DATE: /Ohk 3 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 leaching facility) Feet FURNISHED BY ^ �� -1 — C-4 M q O ch a� p O r M (`') cal M 7' TOWN OF BAFLNSTABLB LOCATION �� )► _—cad SEWAGE # VILLAGE �� _ASSESSOR'S MAP & LOT��®ZZJ INSTALLER'S NAME&P NE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) N .OF BEDROOMS _ R OWNER --�orsr) In PERMIT DATE: C `► 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 facility) Feet Furnished by �� _ i __ T_ oC` .._G �- r re �I ,� No. a'D13 - �03 t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / 1 Owner's Name,Address,and Tel.No. hw , (� _ Assessor's Map/Parcel 4 70-- ;� ( o p Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Buil g: IZ-1117— - Dwelling No.of Bedrooms I x Lot Size sq.ft. Garbage Grinder( ) Other Type of Building n tlp No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3•S•� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank I YV0 Type of S.A.S. J o9 64-L 6 yiyo_14 Description of Soil Nature of r35 rs or Alterations(Answer when applicable) K IVOA ow ij_VA(S 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 Environme tat Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 0(�c Application Approved by Date (C) Application Disapproved by Date for the following reasons Permit No. Q[21 3✓7?J D 3 Date Issued t�Q�1. No. c;L ID 1 3 — L1 V f' Fee�2 THE COMMONWEALTH OF,MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ptJfication for Disposal 6pstem Construction 3permit °I Application for a Permit to Construct( ) Repair grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I� ^ IZV Owner's Name,Address,and Tel.No. ti Assessor'sMap7Parcel a 70— 02 ��(�C{SCv b 2C6O Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Buil g: Dwelling No.of Bedrooms yl(� Lot Size iz sq.ft. Garbage Grinder( ) Other Type of Building Hn(&e No.of Persons Showers( ) Cafeteria( ) Other Fixtures r' 4 2 Design Flow(min.required) gpd Design flow provided 35 oZ gpd tier Plan Date Number of sheets Revision Date .Title Size of Septic Tank 15"17o Type of S.A.S. Op Description of Soil f c 9 1 v' Nature of epairs or Alterations(Answer when applicable) 10 S4-OA( y} /�00 6--tte. -rn k )).g 3 Date last inspected: a f f i'•, Agreement: a. Art, —The undersigned agrees to ensure the construction and maintenance of:the afore described on-site sewage disposal system in r � f accordance with the provisions of Title 5 of the Environratll ode grid not to place the system in operation until a Certificate of Compliance has�been issued by this Board of Health. C ��,,Signed �, � // J��'t.:� �-_ ` Date Application Approved by z_5 .)Date to Ira Application Disapproved by Date for the following reasons Permit No.,.Q u 1 3— 74 t/3 Date Issued 10 I i(/'' `. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �f `\THIS IS TO CERTIIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by Rim I t--)ke 0- at I) j Lt rtc-0 l7 - has been con to in a Ice with the provisions of Title 5 and the for Disposal System Construction Permit N� d ed InstallerA�_ /Shy Designer #bedrooms Approved desi flow gpd The issuance of this permit shall not b construed as a guarantee that the system will ncti n as esi Date Inspector No. Fee 0 V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-B RNSTABLE,MASSACHUSETTS Nsposal *pste Construction permit Permission is hereby granted to Construct( ) Repair(n ) Upgrade( ) Abandon( ) System located at i-�r7 L t'�C p f rl (2r) H U r}'w""'J and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: onstruction must be completed within three years of the date of this permit. Date ' i Approved by l �C� Town of Barnstable �IK .E , Regulatory Services ti Thomas F. Geiler,Director BABNWABLE, Public Health Division MAM 1639. 6 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Nw lio lso t3 Sewage Permit# X Assessor's Map/Parcel z-L Installer & Designer Certification Form Designer: �- 5 �J �y �� J Installer: ��-- Address: Address: AA-0 fA jLln1 �7'r M 0, t Gl4/tNt N oz64� On f(,/- /& 120 V/JL=`f FU5 t4L_gwas issued a permit to install a (date) (installer) septic system at 27 tt rJ c o-a F—yd-9 based on a design drawn by (address) -P/k t/L V D, F_L As t-1 t_f T dated (designer) kA TL. I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found sati actory. �g��N of l��ss�' oo� DAVI D �`c' D X (Install s Signature) FLAHERTY, JR. ti No. 1211 ��G/STERN° /$ Sq �> /J 11 (Designer's Signa r (Affix Design - p Herb) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercectification forn.doc Town.of Barnstable r as mania:rt�°� Department of Regulatory Services MASS. Public Health Divi 51®ri Date 8-'T t 3 r6j9. ,d1; 0 Main Street,Hyannii MA 0260 rFD AIIAV�' - I .. Date Scheduled_ Time Fee Pd. Soil Suitability Assessment-for S e ° p® Performed By: [! Wittiessed By: LOCATION& GE1 NEIIAL EVORMATION Location Address , Owner's Name l Z 9 Lt``t�l CO t_rS T20ay �CtscvTLEVa a tV ti1 l S r 'til/T� Cl ZC.n Address 12 ,uVi.`i � �_.i Assessor's Map/Parcel: Z'7 Q to ZZ Engineer's Name CL�.S �J� �Y�`► ?d�R.gc� NEW CONS 1 t2liCT10TV REPAIR Telephone#&wee tSdrj,-j'Lq -'3&0O v 'a'tz` -e-%_5 , S.J1/V¢� � 00_,ce1`1 Land Use d Slopes(%)' Surface Stones Distances from: Open Water Body_1 ' —ft Possible'Wet Area ft Drinking Water Drainage Way_fft Property Line +_ft Other ft SICETCTI:(Street name,dimensions of lot,exact locations of test holes&,perc tests,locate wetlands fa proxinuty to holes) O 1,f 1 1I ll- 9 -- l �iZo t 4 4-471..)&17 A,,[c 1 X_ L--..C ' V ��` � alb~`�•V , � \ �C�/'7 .. Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Raec � Estimated Seasonal High Groundwater > DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: l In. Depth to soil mottles: Depth�toWeeping from side of ob�,hole: _(i/-yL in, Groundwater Adjustment ft. Index Well#�LLe Reading Date: y Index Well level Adj.t'aCtor 1C//A- Ac�,(Jrnundwater Level Z' �_`��•�- PEI RCOLA.TION TESL' `,D"aatte 917 4rhip Observation % Hole S Tinie at V' ,j s Depth of Pere Time at 6" I Start Pre-soak Time @ ' Time(9'-6") End Pre-soak 3 Rate Min./Tech ZM Site Suitability Assessment: Site Passed LL Site Palled: Additional Testing Needed(Y/N) Original: Public Health Division (( Observation Hole Data To Be Completed on Back---------- **4:lf percolation test is to be conducted within 100' of wetland,you midst first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\S Er rtc\PERCPO RM.DOC ,l DEEP-OBSERVATION HOLE LOG Hole# �Ar� Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,Boulders. ansistency,`%Oravel) O /D" _ vaS��[ /d Y/2¢13 f iyr qz% /r R G /!moo ra -/.re' C Z' ,dam a s s Ale AeawZ,illd DEEP OBSERVATION HOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil - Other Surface(in.) (USDA) (Munsell) ' Mottling. (Structure,Stones,Boulders. onsisten % ravel Ap y� ¢ �aa�, 7,s s/6 d . /a .d D �rd✓e CZ fie. S�J 2.5 74 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling, (Stricture,Stones,Boulders. — Consistency,%Gravel) I Nil— f Y DEEP®PSERVATI®IV H®LE L®G Bole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, # Consistency, b a _ll_ ; f Flood Insurance Rate Map: -Above 500 year flood boundary No— Yes Witidn 500 year boundary No_. `.Yes Within 100 year flood boundary No_ Yes Dentli of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviot material exist in all areas observed throughout the area proposed for the soil absorption system? pay If not,what is the depth of naturally occurring pe ious material'?' f Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai in ex p rose and exper' ce described in 10 CMR 15.017. Signatu " Date Q:WHPTlC\PJ RCFORM.DOC I,� 6f �oF zHe r� Town of Barnstable Barnstable Regulatory Services Department AMmedcaC-j BARN STABLE, p MASS. $i639' Public Health Division �� m ATE0 MA�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.GeilerLeach pit is only3f wndwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7006 0810 0000 3525 5286 May 19, 2011 Darrell J. Pavao %US Bank,NA 209 S. Lasalle St., STE300 Chicago, IL 60604-1450 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system 127 Lincoln Road, Hyannis, MA was last inspected on 4/27/2011 by Patrick M. O'Connell a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool • Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass. You are ordered to repair or replace the septic system within sixty(60) days from the ' date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action EOF TtC .. OF HEALTH R. - Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\I-I SAMPLE 60 Day Deadline.doc Map Page 1 oN Town of Barnstable Geographic Information System New Search Home Help Parcel Viewer Custom Map Abutters Map size ® ®❑ Zoom Out J J J J J J MIn _.,N__ )PG Map: 270 Parcel: 022 Full Property Location: 127 LINCOLN ROAD Info 270262 k 120 270138 Owner: PAVAO,DARRELL) O a tat "�., Location Information 270054, 014D Map&Parcel 270022 _ Location 127 LINCOLN ROAD Acreage 0.17 acres Current Owner 138 AVAO,DAR i 27008 ( Mailing Address WAY } 270263 % �j %US BANK,NA W Milo 270D22 '.. 209 S LASALLE ST.,STE 300—' 1121 E /CHICAGO,IL 60604-145 Appraised Value(FY 2011) Extra Features $0 Out Buildings $2,500 �D N 2 1 Land $63,200 120 _x Buildings $68,200 Total Appraised $133,900 27 a 121 Assessed Value(FY 2011) 270264 270028 270067 Extra Features $0 %112 42-.Fea- 1J,1. �' `" %12D Out Buildings $2,500 fr "� Land $63,200 Buildings $68,200 Set Scale 1" = 42 I Aerial Photos I MAP DISCLAIMER Total Assessed $133.900 Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS - Barnstal leMA v1.2.41.13[Production] http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=270022 5/19/2011 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .' `127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27, 2011 required for State Zip Code Date of Inspection every page. CitylTown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information (� When filling out forms on the IlY/1 computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name -Q 189 Cammett Road Company Address Marstons Mills MA 02648 State Zip Code CitylTown S1128508.428.1779 Licennsese Number Telephone Number License B. Certification 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 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: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 4 April 27 , 2011 Job# 11-62 Ins ctor's Signature Date 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. ****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. [1)6� �/j 1 Title 5 Official Inspection Form:Subsurface Sewage Dispos System-Page 1 of 17 l5ins•09/08 Commonwealth of Massachusetts IM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °y 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27, 2011 required for State Zip Code Date of Inspection every page. City/Town 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: 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): 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27, 2011 required for State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) 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): ❑ 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 3 of 17 t5ins-09108 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27 2011 required for State Zip Code Date of Inspection every page. Cityrrown 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 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 ® El clogged 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 El ® 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_day flow Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 15ins•09108 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27, 2011 required for y every 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. ❑ ® 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. ❑ ® 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. l5ins•09/08 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 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27, 2011 required for y every page. City/rown 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): Unknown Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A t5ins•09108 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 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis H MA 02601 April 27, 2011 required for y every page. Citylrown State Zip Code Date of Inspection D. System Information Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Unknown Last date of occupancy: 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27 2011 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: .4 None 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-09/08 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 "( 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27, 2011 required for y every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: 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.): Septic Tank(locate on site plan): 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: Sludge depth: t5ins-09108 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 "< 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is MA 02601 Aril 27, 2011 required for Hyannis P every 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 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is required for Hyannis MA 02601 April 27, 2011 every page. CitylTown 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 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27, 2011 required for y every page. Cityrrown 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 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 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Leaching system not identified due to signs of failure in primary cesspool. l5ins•09/08 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 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is required for Hyannis MA 02601 April 27, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ 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.): Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): One with overflow. Number and configuration 2' Depth—top of liquid to inlet invert 5" Depth of solids layer 4" Depth of scum layer 6x6 Dimensions of cesspool Block Materials of construction Indication of groundwater inflow ❑ Yes ® No l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 • 9 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is required for Hyannis MA 02601 April 27, 2011 every 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.): Observed solids on top of outlet tees indicating hydraulic failure. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ' Commonwealth of Massachusetts - .'� Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °y 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 _ April 27 2011 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 48 Back of House 46 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is required for Hyannis MA 02601 April 27, 2011 every page. Cityrrown 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: N/Afeet 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: 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: I Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 127 Lincoln Road Property Address One West Bank Owner Owner's Name information is Hyannis MA 02601 April 27, 2011 required for State Zip Code Date of Inspection every page. City/Town 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 l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 127 LINCOLN RD. HYANNIS C) - C�2- Name of Owner JOHN MCGAGH Address of Owner: 64 TAFTS AV.WINTHROP MA.02162 NO�I/ , Date of Inspection: 10/21/99 d-,t TO OF 1999 Name of Inspector:(Please Print)JOHN GRACI a 1 am a DEP approved system inspector pursuant to Secfion 15.340 of Title 5(310 CMR 15.000) �OEA�' E Company Name: nla 49 Mailing Address: nla z . Telephone Number: nla CERTIFICATION STATEMENT 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 on-site sewage disposal systems.The system: X Passes The Inpection Is based on criteria defined In Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is _ Needs Further Evafuallon By the Local Approving Authority performing at the time of the Inspection.My Inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:10/22/99 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY ONE YEAR TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2198 Page 1 of 11 ' f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: ' Iva 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or 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 complying septic tank as approved by the Board of Health. WA Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced _ obstruction is removed distribution box Is levelled or replaced Wa 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 revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 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 ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS 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,Method used to determine distance n/a-(approximation not valid). 3) OTHER Iva revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described 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. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.' X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n . X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a,facility with a design flow of 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: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X 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. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X 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: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 1.1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 FLOW CONDITIONS RESIDENTIAL: Design flow:110.g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):2 Total DESIGN flow: 221 Number of current residents:It Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no)M Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NQ Last date of occupancy: 1011/99 COM MERCIAIJINDUSTRIAL Type of establishment: n/a Design flow: nla gpd(Based on 15.203) Basis of design flow: n1a Grease trap present:(yes or no):DLO Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) nla Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: nLa System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa_ gallons Reason for pumping: nLa TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nLd APPROXIMATE AGE of all components,date installed(if known)and source of information: THE IS 50 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no): NO e . revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 BUILDING SEWER: (Locate on site plan) Depth below grade: I Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: WA Comments: (condition of joints,venting,evidence of leakage,etc.) n/a SEPTIC TANK: X (locate on site plan) Depth below grade: 2 Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): XG DIA Dimensions: 6'X6'BLOCK CESSPOOL-EMPTY Sludge depth: n& Distance from top of sludge to bottom of outlet tee or baffle: n(A Scum thickness:jiLa Distance from top of scum to top of outlet tee or baffle:jVa Distance from bottom of scum to bottom of outlet tee or baffle: Wa How dimensions were determined: n& Comments: (recommendation 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.) MAIN CESSPOOL AND ALL COMPONENT ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY ONE TO TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n(a Dimensions: n& Scum thickness: nla Distance from top of scum to top of outlet tee or baffle:-iLa Distance from bottom of scum to bottom of outlet tee or baffle n& Date of last pumping: Wa Comments: (recommendation 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.) . nLa• revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10121/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,Inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nLa Capacity: Wa gallons Design flow: nla gallons/day Alarm present: NQ Alarm level:jiL& Alarm in working order:Yes_No_ NO Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nta DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:n& Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.) nLa PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa 40 revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: n& leaching chambers,number: _n1a leaching galleries,number: .iLa leaching trenches,number,length: 2 TRENCHES/ONE 15'/ONE 10' leaching fields,number,dimensions: nta overflow cesspool,number: n& Alternative system: WA Name of Technology: ji& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH TRENCHES APPEAR TO BE FUNCTIONING PROPERLY-SYSTEM WAS NOT INSPECTED UNDER NORMAL USE CESSPOOLS: _ (locate on site plan) Number and configuration: n& Depth-top of liquid to inlet invert: n& Depth of solids layer: n1a Depth of scum layer. nLa Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: n1a Inflow(cesspool must be pumped as part of inspection)n& _1 Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:nta Depth of solids: n1a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& revised 9098 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a t �I b revised 9/2J98 Page 10 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 127 LINCOLN RD.HYANNIS Owner: JOHN MCGAGH Date of Inspection:10/21/99 NRCS Report name: n/a Soil Type: nIa Typical depth to groundwater: n/a USGS Date website visited: n& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET 1 revised 9/2198 Page 11 of 11 AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION Lk 42 SEWAGE# VILLAGE r ��S _ASSESSOR'S MAP & LOT—:) Z� INSTALLER'S NAME&P NE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (size) N .OF BEDROOMS R OWNER l f. y PERMIT DATE: CbI h !u 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 facility) Feet Furnished by 1f http://issgl2/intranet/propdata/prebuilt.aspx?mappar=270022&seq=1 5/25/2011 TOWN OF BARNSTABLE LOCATION /Z 7 114 CzV6 a_SEWAGE# VILLAGE ASSESSOR'S MAP.&PARCEL INSTALLER'S N &PHONE NO. Z9&1 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) jj�7(0 6� 42QVZg+/4size) ZL NO.OF BEDROOMS OWNER r/Q&z7C--66D �L z° DO PERMIT DATE: 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 leaching facility) Feet FURNISHED BY r. C4 cc) O .. C d d7 <cz- . - HYANNIS / ROB 2S n LOCUS o S/yFo TBM: ? / PUMP, CRUSH, FILL CORNER OF BULKHEAD Mq�N & ABANDON LEACHPIT ELEVATION: 48.00 S PER TITLE FIVE N PARCEL ID: / PARCEL ID: 270/263 �/ 022 /AREA 7�624t S.F. / \ LOCUS MAP �N / // CESSPOOL �3 // \ OTC p LOCUS INFORMATION 00 �� O / HOLLY 2� / \ �STR�/ TPLAN REF:ITLE REF: 25 59 / :; CT ::::::: ::::::: :: 19 f` Fp,D• / PARCEL ID: MAP 270 PAR. 22. ZONING: "RB" 'WP' ZONE II `'`: FLOOD ZONE: "C" COMMUNITY PANEL: 250001-0005-C DATED:08/19/85 / / SEPTIC SYSTEM / s TP2 i REPAIR PLAN LOCATED AT: / r R o�'�-� 127 LINCOLN ROAD /l �, ��/ °tip HYANNIS, MA. / S`p qlk 2-BEDROOM /ya PREPARED FOR #127 /�� FRANCISCO TOLEDO TCF=48.72 722 W /� SEPTEMBER 16, 2013 O H OF Mgss - OF MASS9 EDWARD cs A, PARCEL ID: E R ® y N 270/029 S4NITA �P i E. A. S. GRAPHIC SCALE SURVEY, INC. 141 ROUTE 6A 20 0 10 20 40 so SALT POND BUILDING P.O. BOX 1729 SANDWICH, MA. 02563 ( IN FEET ) 1 inch = 20 ft. BUS:(508)888-3619 CELL:(508)527-3600 SHEET 1 OF 2 J 1578 n { TOP OF FOUNDATION ELEV.= 48.72' 2" LAYER OF 4" SCHEDULE 40 P.V.C. PROFILE Orc 1 MIN. PITCH 1/8" PER FOOT R SEWAGE DISPOSAL SYSTEM DOUBLE WASHED STONE 10' MINIMUM-� (NOT TO SCALE) OR FILTER FABRIC EL= 48.0' EL= 48.0' I, MAX:` ::� ...................... EL= 48.0 EL= 47.7 6" MAX.' .., :,..,;;::,....,, .. ;}:;:;:a�.., s" MAX. Z attr;::::::::::::: :::::::::..... ,... ` .,...... ADD RISER ASER & INVERT CLEAN SAND FILL 4" SCHEDULE 40 P.V.C. COVER COVER CONC. ®RL2 + 31" '� MIN. PITCH 1/4" PER FOOT EL= 46.56 RISER & EL= 44.7 �Q` 27" 22' ® 0.23 11, - COVERti �� PER 310 CMR 15.255 ® S= 0.03 . { =01 EL= 45.45 EXIST. FLOW LINE INVERT INVERT 110" 14" INVERT INVERT i ° ° ° ° 0 0 ° 0 0 0 0� ° °° „ EL=46.06' EL=45.56' MIN. ADD EL= 45.31 EL= 44.98' „ 0 00 00 4' GAS 6" SUMP 24 00 0 � 0 0 0 0 0 0 �o°- 33 BAFFLE 6" BASE OF,MECHANICALLY ° 0 0° oco o W COMPACTED SAND EL= 42.7 PROP. DB3 DISTRIBUTION 4.0' 8.5' 4.0' 6" BASE OF MECHANICALLY BOX W/"T" (TYP.) COMPACTED SAND 3/4" TO 1=1/2" 25 C PROPOSED DOUBLE WASHED STONE 2-500 GAL. (H-10) DRY WELLS (5' X 8'-6" X 2'-9") 1 ,500 GALLON TANK SOIL ABSORBTION (TRENCH FORMATION) o SYSTEM (S.A.S.) 13' X 25' GENERAL NOTES I CERTIFY THAT I AM CURRENTLY APPROVED BY THE {DEPARTMENT OF BOTTOM OF TEST HOLE #2 ELEV.= 35.5' ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT NO GROUND WATER 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE FOR SUBSURFACE DISPOSAL OF SEWERAGE. DESCRIBED IN 310 CMR 15.017. 1 FURTHER CERTIFY THAT THE RESULTS OF MY DESIGN DATA 2. ALL ACCESS PORTS OVER TANK TEES SHALL BE SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING ARE ACCURATE AND JJW AfCOR ANCE WITH 310 CMR '15.100 THROUGH 15.107. ACCESS PORTS BROUGHT TO WITHIN 3" OF FINISH GRADE. 1 2 DESIGN FOR 3 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE - � NUMBER OF BEDROOMS.........-__-___ CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE GARBAGE DISPOSAL.................-- NO -- UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY EDW RD A. STONE, CERTI IED SOIL EVALUATOR TOTAL ESTIMATED FLOW MUST WITHSTAND H-20 LOADING. _ 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION I (110 GAL./BR./DAY X 2 BR.) _220 220 OF ALL UTILITIES PRIOR TO ANY EXCAVATION. TEST PIT R E S U L TS. 220GPD X 200% = 440 GAL 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE INSTALL NEW 1500 GAL. SEPTIC TANK OR WITHIN 6' OF GRADE SHALL BE MORTARED IN PLACE. 6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE SOIL TEST DATE: AUGUST 27, 12013 INSTALL: 2-500 GAL. DRY WELLS (W/4' CRUSHED STONE OVER THE S.A.S. AND DISTRIBUTION BOX. B.O.H. AGENT: DONNA MIORANDI 7. SEPTIC TANK SANITARY TEE SHALL ON THE SIDES, 4 ON THE ENDS AND BACKFILL S ALL BE CONSTRUCTED OF ) SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE SOIL EVALUATOR: EDWARD A. STONE WITH CLEAN SAND FILL PER 310 CMR 15.255 THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND BACKHOE: RODNEY FISHER LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. SOIL CLASSIFICATION................ 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN DESIGN PERCOLATION RATE..... <� �,/LN. 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT TP 1 EL.= 47.2 ELEVATION OF THE OUTLET PIPE. # 1 - EFFLUENT LOADING RATE.........___74 - 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER REQUIRED LEACHING CAPACITY.....220 GAIDAY 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS LEACHING CAPACITY PROVIDED.....352 GAL DAY BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. 46.4 0"-10" A LOAMY SAND 10YR4/3 N/A 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND 45.4 10"-22" B LOAMY SAND 7; FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL :5YR5/6 N/A SIDEWALL: (13' + 25')x2x(2 SIDES)(.74)= 112 GAL/DAY BE LEVEL. 43.2 22"-48" Cl COARSE SAND 10YR6/6 N/A 1'0%GRAV BOTTOM: (13' x 25')(.74)= 240 GAL/DAY 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION 35.7 48"-138" C2 MEDIUM SAND 2.5Y7 6 N A TO EAS SURVEY, INC. FOR B.O.H. AND DESIGN / / TOTAL= 352 GAL/DAY - ENGINEERS REVIEW AND APPROVAL. NO GROUNDWATER ENCOUNTERED 13. LOT WITHIN ZONE II 352 GPD PROVIDED - GPD REQUIRED 132 GPD RESERVE TP#2 EL.= 47.5 (PERC @ 50"<2MPI) .��'`t"D� Ss�� `�"�F ssq�ti CONSTRUCTION NOTES: o`' DAVID a� EDWARD �� SEPTIC SYSTEM DETAIL PAGE 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER �� g A. ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 47.0 0"-6" A LOAMY SAND 10YR4/3 N/A H TY J STONE #127 LINCOLN ROAD WORK ON THE SITE. 45.5 6"-24" B LOAMY SAND 7.5YR5/6 N/A N 21 �No. 28980 HYANNIS, MA. 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE " p o F I 0 OBTAIN OR SUCH ZONING REGULATIONS. FROM APPROPRIATE OP RIATAPPLICANT CA .NTHORITY 43.0 24 -54 Cl COARSE SAND 10YR6/6 N/A 107GRAV SQrSTER� F o ST o SEPTEMBER 16, 2013 35.5 54"-144' C2 MEDIUM SAND ]2.5Y7/6 N/A A TARXP A 3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING TAPE OR A COMPARABLE MEANS. NO GROUNDWATER ENCOUNERED Gt (� �3 �.fG'i3 SHEET 2 OF 2 J# 1578