HomeMy WebLinkAbout0205 LINCOLN ROAD - Health 205 Lincoln Road, Hyannis
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TOWN OF BARNSTABLE
LOCATION SEWAGE# 2OUq - 17 2
_VIL-LAGE j i ASSESSOR'S MAP&PARC/EL 2 74 ' 3lv
INSTALLER44AME&PHONE NO. SDI- �/20-c/73T c%Seoq� .0, g,�gV S
SEPTIC TANK CAPACITY /000
LEACHING FACILITY:(type) ,(� (size) X E,
NO.OF BEDROOMS
OWNER
PERMIT DATE: - / -O 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 -A'YTV'
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TOWN OF BARNSTABLE
LOCATION �O,S ��., 20 0 C/ SEWAGE #
VILLAGE_ ASSE SOR'S MAP & LOT 9 2Z QU
SEPTIC TANK CAPACITY \n�
LEACHING FACELrTY: (type) �� �_ (size)
NO.OF BEDROOMS
B_T_1UkbB13R-0RQWNER rA*
PERMITDATE: /� COMPLIANCE DATE:
Separation Distance Between 6�N
Maximum Adjusted Groundwat °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
No. r Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for �Digool Jip5tem Congtructfon permit
Application for a Permit to Construct(Repair(,C.�4pgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. 11.0.
L/�fGo/!f SC Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 70
Installer's Name,Adqress,and Tel.No.YAS^1°gG^/ 7s� Designer's Name,Address and Tel No.
� rS'taHS l�l Gri, �f" -ice/ :s�'dYs��e
Type of Building:
Dwelling No.of Bedrooms Lot Size 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 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) f�f � /!G �j�`j �'�p��Iry OPi�d��
u#!T' 4v,74 A/o
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 of Health.
Signe Date
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. r Date Issued
el
-C_ M
No. Fee
✓
� Entered in computer:
THE COMMONWE, LA,TH OF MASSACHUSETTS ' Yes
PUBLIC HEALTH DIVISION - TOWN EOF BARNSTABLE, MASSACHUSETTS
01ppYtcation for �Digpogal *r9tem Congtruction J)ermtt
Application for a Permit to ConstructV,�—Repair <Pgrade( ) •Abandon O ❑Complete System ElIndividual Components
Location Address or Lot No. 5^ G/hGOT 44/ Owner's Name,,Address,and Tel.No.
Assessor's Map/Parcel G
Installer's Name,Address,and Tel.No.Yas --2G0—77,j Designer's Name,Address and Tel.No. Soa'y '53�3
/ /�vf* =m' 5tvf�l
Type of Building:
Dwelling No.of Bedrooms Lot Size 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 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)
wl74 NU S7��,V—e
a
Date last inspected: a
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 of Health.
Signer e _ / Date
Application Approved by �� Q t� / Date
j„
r Application Disapproved by: �. Date
for the following reasons
C?(
Permit No. ..;t�'; �.'� Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( / _ Repaired Upgraded ( )
Abandoned( )by ��[�!w✓a�
at — " 4el 5 ha been constructed in accordance
with the provisions of Title 5 and the for Dispos System Construction Permit No. dated
Installer l�t�N Da s' Designer
#bedrooms Approved desi n flo gpd
The issuance of thi pe t shall not be construed as a guarantee that the system will func o n s desig ed. -
Date d Inspector
C4. —fir
No j I aI i I F >�
`� THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
3igpogal *pgtem Construction permit
Permission is hereby granted to Construct ( (,,)_Re air (U) Upgrade ( ) Abandon ( )
System located at
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: Const 'ction 'ust be completed within three years of the date of this permit.
J �
Date Y�; v Approved by j
No. t Fee
THE C,OMMrNWEALTH OF MAS,SACHUSETTS` Entered in computer:
�UBLIC HEALTH DIVISION - TOWN OF-BARNSTABLE, MASSACHUSETTS Yes
01pprication for Tigpogal *pgtem Congtruction Permit ,
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑ Complete System Individual Components
Location Address or Nod CD f r\ rn I ,^„( Owner's Name,Addr�sseand Tel.No.
)`�I!Y�t I �/� '�/j J� //`}1' 1���,1 Cull /1 ,
Assessor's Map/Parcel 1'1
In I 's Na ddres d I.No. ? g'C Des i er's ame dress and Tel.No. K -7 /
D - -
Type of Building: !� sQ ��°� e c
Dwelling No.of Bedrooms of ze sq.ft. Garbage Grinder ) 4�
Other Type of Building No.o Persons Showers( ) C feteria( )
Other Fixtures
1i Design Flow min.required) V d D i flo rovided d
g ( 9 ) gP g gP
Plan Date N ber of shee _ R vision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alt ations(A wer whe pplicable)
Date last inspected:
Agreement:
The undersigned es to ensure t construction and maintenance of the afore described on-sit sewage disposal system in
accordance with the pro ision f Title 5 o he Environmental Code and not to place the system in op ration nti a Certificate of
Compliance has been iss ed b Bo d o ealt . �
Si ate
Application Approved by ate
Application Disapproved b _ Date
for the following reasons
Permit No. 6D 1� Date Issued k. Z-
--_—-----_--- --- _—__----- --�-� __
HE COMMONWEALTH OF MASS CHUSET
BARNSTABLE,MASSAC USETTS
Certificate of C phance
THIS IS TO CE TI Y,th the On- ite S stem Constructed ( ) it d ( ) Upgra d ( )
Abandoned( )b A( o
at ha ee nstructed in/accordan
with the p vi • n of Title 5 �f�briss to Construction Pqrmit No. ted � G
Installer 7��rspirgo
ner V0#bedrooms ved design w U gpd
The issuance of this permit shall not be construed as a guarantee that the system will func 'on as desi ed.
Date Inspector
..v .. - .. + ram. i ,�.,.T.,:,;�vti ..w !'�v°W" --:. _ ••l-'
M f t
_ v=
�` Fee �
t� \� THEHE C WMMO'NWEALTH OF MAS'SACHcJSET S Entered in computer: Yes
J' ' PUBBLIC HEALTH�DIVISION -TOVI N`OF-BARN.STABLE, MASSACHUSETTS
• ',applicatioh for I�tJO$aY p$te11C A n truction Permit
Application for a Permit to Construct O Repair( );' Upgrade(�) Abandon( )(�� f omplete System Individual Components
`v Location Ad ress o_Lot Nos ( Owner's Name,Addy.ss,and el.No.
J ` G L4)(0 I r! 6P �� or)
Ch�7�e t
r` Assessor's Map/Parcel C l b r 2
Installer's ecAddres *and Tel.No. ��O�1 �� esi ner'�Name,,A-d_d�ressand Tel.No. r11 � /`t
I l tC
Type of Building: - /� 2 ��5 y r.
ISwelling No.of Bedrooms 3 oL�t S'ize sq.ft. Garbage Grinder ( )
` J Other ._Type of Building No.t Persons Showers( ) CIfeteria( )
Other Fixtures r 1
Design low(min.`required) �j V / gpdDesign flo�provided / gpd
Plan Date Number of shyyees R vision Date 1
Title / . / �s'l
Size of Septic Tank 0n V Type of S.A.S. /� A 121/ /A
Description'of Soil / ,.
%
- y / A"
Nature of Repairs or Alterations(A swer whet] pplicable) /
Date last inspected:
r
• Agreement: -
Tl a undersigned ag es to ensure the cIonstruction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisionNof Title 5 of0e Environmental Code and not to place the s stem in operation until a Certificate of
Compliance has been isled by r is Bodrd of%Healt•. i
r' Sign d- A�JI/ rrDate �9 l_ 1i
Application Approved by J t/:i�/.71 ) A ' / M�lt��j�,/Y /� � Date
Application Disapproved by - rr �� d� _ Date
for the following reasonsAl
! /r f 1
—,( v 601 C l Date Issued Permit No.
--------------------- -- -
t \THE COMMONWEALTH OF MASSA/CHUSETTS
BARNSTABLE, MASSACHUSETTS
' certificate o rrYprtar�ce
THIS IS TO CERTIFY'that the On-site Se wa`e-Dis•osa•1- stem Constructed Re aired Upgraded t
,. AbanddpnedF(._� )/by Pt9bi-F �^�f 4� 1 0.
at �/)U,� (// e 10l h bee nstructed in accordance
with the provisions of Title 5 and th'e for Di"sposal�56ter�Constru
ction Permit Npk\ o. / dated
f Installerigner e�fa�— 1-7 2P... ./ i
#bedrooms Approved design flow U ! gpd
The issuance of this permit shall not be construed as a guarantee that the system will functionon a fined.
Date Inspector
--------------------
No. ��"q�_�------ Fee (� —�
TI4E COMMONWEALTH OF MASSACHUSETTS t
PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS
Digoot i§p.5tem Con5tructiou Permit
Permission is hereby ranted`to Construct ( ( ) ' 'Upngrade'( t) AbandonSystem located at 211-6 1�( nc� h �,,Repayiy
a 0L_ 4 y-(_5
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: CoAstructi on :ust be completed within three years of the date of th�it.
Date (L/ Approved by A / / i l
t
9/16/03
Notice: This Form Is To Be Used For the Repair Of.Failed
Septic Systems. Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
I, Cpc � �; �p,•�,hereby certify that the engineered plan signed by me
dated t-n- , concerning the property located at
m all o the
following criteria:
• This failed system is.connected to esidentia wellin only,.Th are.no.comm cial or
business uses.associated with the welling.
• The soil is classified as.CLAS I d the percolation ate is les o e to 5 minutes
per inch. The applicant may se historical data to co lu e s fac y conduct deep
test holes and percolation tes .at the site without a he 1 ge present.
• There is no.increase in flow d/or change in use posed
0 There are no variances requested needed.
• The bottom of the proposed leaching facility will be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the.
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation +adjustment for high G.W. `\ = or?o1 • a
DIFFERENCE BETWEEN A and B I -4 (g p
SIGNED : DATE:
NOTICE
Based upon the above information;a repair permit will be issued for bedrooms
maximum.. No additional bedrooms are authorized in the future without engineered septic system
plans.
C
gASeptic\percexemp.doc ��
07/30/2009 09:31 5084775313 ENGINEERING WORKS PAGE 01
Town of Barnstable
Regulatory Services
Thomas F. Geiter,Director
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-8624644 Fax: 308-790-6304
Date: Sewage Permit#2609 "1?ZAssemor's Map/Parcel Z 7 `�6
-2 3 bl C q Installer&Designer Certlfotion Form
4�1-� M L.C%t-e•
r�
Designer: ff�!b Z.N-et r l'—!, C • ][astalter:`-�4e �S IC J C .
Address: M W• Cre 41 `-c k c� Address: S/
FFr4t-st�t;``e Mt4r IJZ+�`ly a•^Sl�OnS /yl s�/YI�
D2� y�
On 4o /Z 4 9 J 0� is 44c-5 vt- was issued a permit to install a
date (installer)
septic system at 20 L' 1) 4 tn, ,C based on a design drawn by
(address) ' f
a-e�-'i:M cr£►,t-e f dated. 7 13 9
(designer)
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 satisfactory.
SH OF Mgs��i
.g PETER T.
(Installer's Signature) McENTEE
CIVIL
No.35109
(Designer's Signature) (A ffiffix
PLEASE TO BARN PUBLIC TH DIVI CERTEFT
F CO C WILL N E S O T ORMAND
BUILT CARD ARE RECEIVED BARNSIABLE PUBLIC HFALTH D
YOU.
q:\ofF=formMaigmuraftwon form.doc
TOWN OF BARNSTABLE
LOCATION Ole SEWAGE# -/72
i .
XMILAGE ASSESSOR'S MAP&PARCEL z V- 34:�
INSTALLERS NAME&PHONE NO. f6E- y 2D-4-17 � vase"q � L�.�livoS
SEPTIC TANK CAPACITY 1b00`
LEACHING FACILITY:(type) /4�, 610,01 (size)
t�
NO.OF BEDROOMS
{ OWNER
PERMIT DATE: - / -el 9 COMPLIANCE DATE: 4 q
i 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 i g ty( any wetlands exist
I
within 300 feet of leaching facility)
Feet
j FURNISHED BY
F ,
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. InsP ��f
Po
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Town of Barnstable P# �a
Department of Regulatory Services
s' j Public Health Division Date O _
KASS.
�p t63q �e� 200 Main Street,Hyannis MA 02601
Date Scheduled ✓ V Time /`► Fee Pd�7 v
S it Suitability Assessment for,Sewage isposal
Performed By: Witnessed By: ✓+ W, 7
i
LOCATION& GENERAL INFORMATION
Location Address n' 'n Owner's Name
. � inn n c� (�.-/��
d)r1/1 I S s 'J0�1 Address.�J°— &4C6 f1,7 0'2al Q
Assessor's Map/Parcel: 2-7 0 —,(3 3 fo Engineer's Name Any 0
NEW CONSTRUCTION REPAIR Telephone# 50 —7✓ —V /.(O Q
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property.Line ft Other` ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands proximity to holes)
to
Lo
1 N CO t.A.l (,T-->P .J
Parent material(geologic) ��cx_c-� v Depth to Bedrock 40�
Depth to Groundwater. Standing Water in Hole: /V Weeping from Pit Face aj A
Estimated Seasonal High Groundwater 13 Z t,
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: _ in, Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adl.factor— Adj.Clroundwater level,,,,e,
PERCOLATION TEST gate -Z5 'RYme,-,�✓`
Observation
Hole# Time at 9"
Depth of Perc <3 GAA 2A SC\1\GAS Time at 6"
Start Pre-soak Time @ �`� rl p i"t . lime(911•6")
End Pre-soak
Rate Min./lnch.
Z
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be.conducted within 100' of wetland,you must first`notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:XSEPTICIPERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole°#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders:
Conslitencv. vel r
zy-3 b rL
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) f (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
> . 5 � Lams
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
_Ye
DEEP OBSERVATION HOLE LOG
Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders.
Cons. -
,r
Flood Insurance&ate Man:
Above SOp year flood boundary No— Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurrine Pervious Material
Does atleastfour feet of naturally occurring-perviolis-material exist in altar-eas observed throughout the
area proposed for the soil absorption system?
If not,:what.is the depth of naturally occurring pervious material?
Certification
I certify that on �� (date)I have passed the soil evaluator examination approved by the
Department of Envi onmental,Protection and.that the,above analysis was performed by me consistent with .
the`required training,,.expertise and experience described in 10 OM 15.0I7. '
Signature Date
Q:\S.EPTl0PBRCFORM.DOC
Town of Barnstable Barnstable
Regulatory Services Department AMmiftaCft
sn�aSWTasza�
NA� Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
03/16/09
Michelle Muriz
205 Lincoln Road O
O
Hyannis, MA 02601
. p
FINAL ORDER
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at, 205 Lincoln Road, Hyannis was last inspected on
04/28/06,by Mark Poselli, 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:
"System is in Hydraulic Failure"
The deadline for repair has past 06/04/08. We have a permit on file for installation of a
new system, but no evidence that the system was installed and no certification of
compliance. The permit remains valid only through June 5th 2009. Future enforcement
action will be necessary, if the system is not installed with an inspection for compliance
by 6/5/09 or a new permit issued.
Your prompted attention to this matter is required. You may request a hearing before
the Board of Health, a written petition requesting a hearing on the matter, within seven
(7) days after the day this order was received. .
Thomas McKean, R.S., CHO
Agent of the Board of Health
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 02 05 l r 4 co/-, g j
f,
Owner: �iro c�L
Date of Inspection:
BUILDING SEWER(locate on site plan)
Depth below grade: 7
Materials of construction:— ast iron - C_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade: 6
Material of construction._concrete_metal fiberglass_polyethylene
—other(explain)
—
If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):certificate) —(attach a copy of
Dimensions: 5 x
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: dZ 3
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outl t to or baffle:
How were dimensions determined: Oro
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as relat d to outlet invert,evidence of leakage,etc.):
GREASE TRAP:2&610cate on site plan)
;1
Depth below grade:— — 1
Material of construction: concrete metal fiberglass—polyethylene other II
explain): — —' —
I
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:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
i
7
SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 205 Lincoln Rd. . Hyannis
Owner: Vuono
Date of Inspection: 10/23/97
BUILDING SEWER: N/A
(Locate on site plan)
Depth below grade:
Material of construction: ,cast iron _40 PVC_other (explain)
Distance from private water supply well or suction Fine
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:_
orate on site plan)
Depth below grade:24 inches
marerial of con struction:x.&concrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal, list age._ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions: 1,.000 gal _
Sludge depth: 3 inches
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: n/n
Distance from top of scum to top of outlet tee or baffle:��
Distance from bottom of scum to bottom of outlet tee or baffler_
How dimensions were determined: Probe / BOH record
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.)
GREASE TRAP:_ /A
(locate on site plan)
Depth below grade:
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:
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.)
(revised 04/25/97) Page 6 of 10
FS
nn, 5
COMMONWEALTH OF MASSA
CHUSETTS
t EXECUTIVE OFFICE OF ExVIRONMENTAL AFFAIRS" '
I� DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON, MA 02108 617-292.5500 �
r
W'ILLIAM F.WELD {V V
Governor �� ro H��BgRN3 199
7 Y COXE
Ty0fPTgg� Secretary
ARGEO PAUL CELLUCCI
Lt.Governor B.STRUHS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMa\e9 Commissioner
PART A S►
CERTIFICATION Mr & mrs. Vucno
Property Address: 205 Lincoln Rd. Hyannis MA 12 i Crestdihc.
10/2 3/g 7 Address of Owner.
Date of Inspection: (If different) Danbury Conn. 06811
Name of Inspector:
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: EnvirotlMental Reclamation Inc.
Mailing Address: 446 Waouoit Hwy. Waauiot MA 02536
Telephone Number: 5 T_S n?n
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:
XXX Passe$
_ Conditionally Passes
�~ _ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date: 1 0/2 5/9 7
The System Inspector shall submit a copy of i nspection report to the Approving Authority within thirty (30) days of completing this
inspection, if the system is a shared system or has a design flow of 10.000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
AI SYSTEM PASSES:
xIXI have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS: The syst :m is in good working condition and meets the
CeQUjreMrZnts o 1P 1 1 n fl'AA& 15 000 ( Tit• 1P 5 )
BI SYSTEM CONDITIONALLY LASSES:
One or more system c01Mponents 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:ieaith, 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.
The septic tank is metal, t r,iess the owner or operator has provided the system inspector -.with a copy of a Certificate of
Compliance (41tached) indicating 'hat 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 t,rsuund, shows substantial infiltration or exfiltration, or tank .
failure is immtrnent. The system will pass htspPcnon if the existing se.r,tic tank is replaced with a conforming septic tank
as approved bN the Board of Health.
(revised 04/23/97) Paqu 1 of 10
OEP on the wona woe weo: w-lowvww magnet.state.ma.uwaeo
C.� Printed on Recycaeo Paoer
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 205 Lincoln Rd. Hyannis
Owner: Vuono
Date of Inspection: 10/2 3/9 7
81sSYSTEM CONDITIONALLY PASSES (continued) N/A
`17 —Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
,
Pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Oescribe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass
inspection if (with approval of the Board of Health)-
broken pipets) are replaced
obstruction is removed
i-URTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, Safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _
Cesspool or privv is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER. IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The systtlm has a seot)c tank and soil absorption system (SAS) and the SAS is within 100 feet to 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 absorotion system and the SAS is within 30 feet of a private water supply well.
The system has a septic tank and soil absorotton system and the SAS is less than 100 feet but 50 feet or more from a
private water suppiy weil, 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 tr.determine distance (approximation not valid).
3) OTHER
(swlmed 04/23/97) Page 2 of 10
i - I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 205 Lincoln Rd. Hyannis
Owner. V u o no
Date of Inspection: 10/2 3/9 7
01 SYSTEM FAILS: N/A
You must indicate er-.er "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
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 1/2 day flow.
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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Anv portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privv is less than 100 feet but greater than 30 feet from a private water suppiv well with no
acceptable water qualitv anaivsis. If the well has been anaivzed to be acceptable, attach copy of well water analysis for
cohiorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS: N/A
You must indicate either "Yes" or -No- as 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
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 it of a
public water supply well)
The owner or operator of anv such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 3.00 and 6.00. Please consult the focal regional office of the Department for further information.
(rwlsed 04/25/97) Page 3 of 10
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 305 Lincoln Rd. Hyannis
Date of Inspection: 10/2 3/9 7
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
XJX. Pumping information was provided by the owner, occupant, or Board of Health.
XX _ 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.
XX — As built plans have been obtained and examined. Note if they are not available with N/A. .
XUX _ The facility or swelling was inspected for signs of sewage bads-up.
The system does not receive non-sanitary or industrial waste flow.
XX _ The site was msoeaed for signs of breakout.
XX _ All system Components, excluding the Soil Absorption System, have been located on the site.
_ The septic tAn,c 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. C,
The size and location of the Soil Absorption System on the site has been determined based on:
XX The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
X.M _ Existing information. Ex. Plan at B.O.H.
XJIL Determinred in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) (15.302(3)(b)]
s
(revised 041/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 205 Lincoln Rd. Hyannis
Owner: Vuono
Date of Inspection:10/23/97
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 440 p.d./bedroom for S.A.S.
Number of bedrooms:_
Number of current residents:
Garbage grinder (yes or no): no
Laundry connected to system (yes or no): ?
Seasonal use (yes or no):,Vgs
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or no): no
Last date of occupancy:
P ry:
COMMERCIAL/INDUSTRIAL: N/A
Type of establishment:
Design flow:_gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title S system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
C
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)_
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
xxx 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)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: Thp aWGt pm wa G i n ai-a 1 1 a�
in October 1986(BOH records )
( Sewage odors detected when arriving at the site: (yes or no)___NO
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 205 Lincoln Rd. Hyannis
Owner: Vuono
Date of Inspection: 10/23/97
BUILDING SEWER: N/A
(Locate on site plan)
Depth below grade:
Material of construction: 1 cast iron _40 PVC_other (explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:
',locate on site Dian)
Depth below grade:24 inches
Material of con struction:xconcrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age , is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions: 11.000
Sludge depth: 3 inches
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: n L_
Distance from top of scum to top of outlet tee or baffle: n /A
Distance from bottom of scum to bottom of outlet tee or baffle_
How dimensions were determined: Probe / BOH record
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.)
GREASE TRAP:M/A
(locate on site plan)
Depth below grade:
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:
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.)
(revised 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
( SYSTEM INFORMATION (continued)
Property Address: 205 Lincoln Rd. Hyannis
Owner: vuono
Date of I nspection10/2 3/9 7
TIGHT OR HOLDING TANK: NIA(Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level: Alarm in working order _Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal. evidence of solids carryover, evidence of leakage into or out of box, etc.)
The box is level and shows no signs of solid carryover.
PUMP CHAMBER-N/A
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
x.
1'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 205 Lincoln Rd. Hyannis
Owner: Vuono
Date of Inspection: 10/23/97
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits. number: 1
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, sighs of hydraulic failure, level of ponding, condition of vegetation, etc.)
1 , 000 gal nit ahows no sign of hydraulic failure
CESSPOOLS: N/A
(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 (cesspool must t:,e pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level,of ponding, condition of vegetation, etc.)
PRIVY: N/A
(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.)
(iwsxed 04/25/97) Paqu 8 of 10
C.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:205 Lincoln Rd. Hyannis
Owner: Vuono
Date of Inspection:10/23/97
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent.references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
Ile
I
1 } )
(reviaad 04/25/97)-- Page 9 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 205 Lincoln Rd. Hyannis
Owner: Vuono
Date of Inspection: 10/2 3/9 7
Depth to Groundwatea.2+ Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
x_ Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local oral conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
The drain pit was dry at the time of inspectim
The bottom of the pit is 12 feet below grade.
s
(revised 04/25/97) Paqe 10 of 10
�� •�t�dy» SIC '.
W =
f
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
Frederick Kiely
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
December 12 ,1995 Acting Director of the ' ion of Water Pollution Control
I
Town of Barnstable
OF IME 1p�
P� o Regulatory Services
saxNsrnBr.E Thomas F. Geiler, Director
9 MASS. g
16g9. Public Health Division
AIFD MA'S A
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
June 12, 2006
Mr Charles Crocker
205 Lincoln Road
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5
The septic system owned by you located 205 Lincoln Road, Hyannis, MA,was last
inspected on April 28th, 2006 by, Mark Poselli, certified septic inspector for the State of
Massachusetts.
The inspection of your septic system showed that your system has "Failed"under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
System is in Hydraulic Failure
You have 2 years from the date of the system failure to bring the system into compliance.
If there are any questions about this reminder, please feel free to contact the Barnstable
Health Department.
BARNSTABLE HEAL H DEPARTMENT
Thoma A. McKean, R.S., C.H.O.
Agent of the Board of Health
? a COMMONWEALTH OF lvlASSACHUSETTS
4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM '
PART A.
CERTIFICATION
Property Address: S L o Colvt
Owner's Name: J�
Owner's Address: 4d",p ro�,,i �`/ Mo
Date of Inspection: !`^
Name of Inspector:(please print)_m0►✓y %,mil/� �
Company Name:
Mailing Address: o /gyp rrs
G 6 cd�
Telephone Number:(
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 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 15340 of Title 5(310 CNM 15.000). The system:
Passes
Conditionally Passes
Nellll�er Evaluation by the Local Approving Authority
I-
L-., ails
Inspector's Signature:
Date.-- ot8 --0-0
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 10,00o
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments / 7� �✓/�� ��eC `J-�
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
L
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
"� /CERTIFICATION (continued)
Property Address: C;�Cs L(✓1(f0(V7 /qGf
Cr✓Ir1l oL6 0/
Owner: Cro
Date of Inspection: ag 0
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
Ate(System
yste Passes:
" e not found any information
15.303 or in 310 CMR 15.30 xst.Any failure criteria note valuated ary of the e indicated below.ilure criteria
in 310 CMR
I
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"se
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,edor win pass.
Answer yes,no or not determined(Y,N,ND)in the 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.
ND explain:
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
obstruction is removed
distribution box is leveled or replaced
ND explain:
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
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMS
PART A
CERTIFICATION(continued)
Property Address: Z/'n o cam) lqj
Owner:
Date of Inspection:
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.
L 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
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 and volatile organic compounds indicates that the weIf is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form
3. Other:
?;tio C lncncrrinn Fnrm 4/1 VInnn 3
Page 4 of 11 .
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: c;2 OS G-[h r0 4?
Owner: 6-0 c
Date of Inspection: $ �,
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes �d�6
_�_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
c�ged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to.an overloaded or clogged SAS or
sspool
I,* id depth in cesspool is less than 6"below invert or available volume is less than day flow ,
--'-Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
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
+ater supply.
5A- portion of a cesspool or privy is within a Zone 1 of a public well.
_ Ayportion 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 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 pprn,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)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-
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)
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 CIMR
15.304. The system owner should contact the appropriate regional office of the Department.
T;0. c r.,�,.o .�.,., ���.,,sir ci�nnn 4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: D Z—!✓c of 7
a vti (Ua,6 D /
Owner: C/-o G
Date of Inspection: Q.(�
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes o
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?
J 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 roper
maintenance of subsurface sewage disposal systems? P ro P
The size and location of the Soil Absorption System(SAS)on the site has been determined based on--
Yes no
vExisting information.For example,a plan at the Board of Health.
_7 Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)]
TStlo G fncnantinn T7nrm �i�Si�nnn 5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: � 0 'e l i p/', � y
�.,�n,s /f� O� fo
Owner: /V lkv r
Date of Inspection: o� 0
FLOW CONDITIONS .
RESIDENTIAL
Number of bedrooms(design):-,L— Number of bedrooms(actual): �—
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): ;Z o1�
Number of current residents: c�- -
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no)/7F [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no): 1 .
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump(yes or no): /f/0
Last date of occupancy: ��,��
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
Pumping Records GENERAL INFORMATION
�[ p
Source of information: �/l 2 T /1 w 91z P�5
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: gallons--How was quantity pumped determined?
Reason for pumpm
TYP 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)
—Tight tank _.__Attach a copy of the DEP approval
—Other(describe):
Approximate age of all components,date install d f knownn)and source of ormation:
f0 e s
Were sewage odors detected when arriving at the site(yes or no): X10
Title C (nennrtinn Anrm�,i s,lnnn 6
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 02 05 'Irvrco -? /Z'
/ poZ b O/
Owner: `i,'o c�.G
Date of Inspection: 02$ t7
BUILDING SEWER(locate on site plan)
Depth below.grade: / 7
Materials of construction: a�-cyst iron �C_other(explain):
Distance from private water—supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(ocate on site plan)
Depth below grade: �
Material of construction:other(explain) .co./ncrete metal fiberglass_polyethylene
_
If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):certificate) —(attach a copy of
Dimensions: S
Sludge depth: r
Distance from top osludge to bottom of outlet tee or baffle: dZ
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlgt to or baffle:
How were dimensions determined: Quo Z'j
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as relat d to outlet invert,evidence of leakage,etc.):
4--,-k- o,-j- f r v�e o-•� mew S, S.
h
GREASE TRAP: /!(locate on site plan)
Depth below grade:_
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: C9-os L!�► o/� Q�
Owner:
Date of Inspection: 02 0
TIGHT or HOLDING TANK:��tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
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 or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
T;t-ia All;ilnnn 8
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: �J 'e/—t V7 C o
! C roe
Owner: tr—
Date of Inspection: o?$ D,b
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
l2 — C� s7
leaching pits,number: h,(✓
leaching chambers,number: OZ O
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.):
p vt /o lam(
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 or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY:Az(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.):
T;H. s r.,�„o *c,., r �.,��r�nnnn 9
e Pag 10 of j 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) .
Property Address: :2 t7S �to co(,, �'j
hG✓141'C /l/J/¢ rc/
Owner: G�9 c
Date-of Inspection: alto V9 fa
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building.
is
/JL-7- 3
S
/63 3�
10
Page 11 of 11
�► OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 17 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Obs 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 u established the high ground water elevation:� 1 Lea, �17
de
T�tlo Q fncr�o�tinn Rnrm�ii ti�nnn 11
TOWN OF BARNSTABLE
LOCATION/j!EyZd,,rA&- 4,,jQ1 SEWAGE # Rt1,-1g0:&
-VILLAGE ASSESSOR'S MAP & LOT.7,,f.dam,(
i
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY AAM
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS pZ PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER �G�l� i�4llsd
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No J�
a �l
7
I
ti
No.................:.C----� � Fes$..........................._
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® 9F HEAL.T
0 ......._.OF..........:4W,01 ............................
Aptiration for Uhipaii al Workii Tomi rurtinrt 11trutit
Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal
System at:
......1..w ., l�l .. d� ---- --------------------------------------------
Location-Address or Lot No.
--------------------------- ----- ------ - ----------------------------------------------
---•----`I Owey .............................................
Address
� Installer Address
d Type of Building / Size Lot............................Sq. feet
V Dwelling 1 o. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type of Building No. of persons............................ Showers — Cafeteria
04 Other fixtures -____•-_______•__________________
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
L=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a
ODescription of Soil............. . --•••-----•-•-•-•-------•------•-•-•-•-----••-•---•--••------•-•-••--•--------••--•...............................................
x •--•-•••--••-------------- ..............................................................................................................
U Nature of Repairs or Alterations—Answer when applicable.....
,/L/��1 .._/—/
------------------------------------------------------------------------------------------------------------------ ! '- '........---------------------------------------------....---.........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i i=... 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued b the rd alth.
�at
Application Approved By........ --•••........ ----------I --------------------------------------- -•--•------ �__ 7-t
Date
Application Disapproved for the following reasons:...............
------•----• -•••-----•------•••••---••--.....---•-••----•---•••--••-••----•--•-••......-••-••-•-•••......--
.........••••---•---•••-•-•••---••-----•--•--•-----•--•----••---•-•-•---------------------•--------•.....---------------•-----•---•---•-•---•--•--•-••-•••-•••----•--•-•••----•-•---•-••-----------•----
Date
PermitNo.......................................................... Issued_.......................................................
Date
i
No......................... Fps G..................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
I''
Ic Od i3O - --......OF......-..���.Wet✓7 - 1 ...............................
ApplirFaiion for �hipvsFal Works Tonstrnrtiun Frrmit
Application is hereby made for a Permit to Construct ( ) or Repair V�- an Individual Sewage Disposal
System at• r
-•---t---2 - ----- °may -'•• - .............
J Location-Address C or Lot No.
1
............... / °
O Address-------------------------
----•- Jao .
- -
% .............. ---•----•-•----..__..._..-------•-•--•---
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling - No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( .)
P4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
QI Other fixtures __________________________________
-'-------------------------------------------•----------------••------••-------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity____.__.___.gallons Length................ Width................ Diameter________________ Depth................
Disposal Trench—No_ ____________________ Width___.___.____._____._ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area............._....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by__________________________________________________________________________ Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water___________________.___.
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Descriptionof Soil------------ .!. -------------------------------------•--._...--------------------------------------•-•----...-------------------------...__....-•----
x
U ---••-
W ----------------------------•-------•...---------------------•--•--•-----------------------------•----•--------•--------••-•-•--------
V Nature of Repairs or Alterations—Answer when applicable____; /1 _�__.,__., : ^_______________________________________________
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iT ' of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the�bpard f iealth._
`✓
Date
Application Approved By........................................................
Date
Application Disapproved for the following reasons_______________________
•-•-•--••-•---------•--------•--------------•-----...---------------------...---•----._...-•---......-•-------------------------------------------------------------------------------------------------
Date
PermitNo.......................................................- Issued...................-....................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... ...........OF.... � . ........................
wrrtgfirFa#r of Toutpliatta
Tl�us IS TO CERTIFY Th t he Individual/Sewap Disposal System constructed ( ) or Repaired
cd:� Y'
at................�- /e1 ��/ f.. ° "----- �St.1= 7
I
has been installed in accordance with the provisions of T i 1E 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No5 6"!Q_.rb_6_______________ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE
SYSTEM WILL FUN9TI0.N. SATISFACTORY.
DATE.............. ---------- Inspector....................................................................................
IW�l-7
U G THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. S6 —10 8k ..........................................OF.................. --------------•--s--------•-----------.....................
IV ..
o......................... FEE.........................
Disposal Workii C�nntrurtinn rrntii
Permission is hereby granted...............................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No
Street
as shown on the application for Disposal Works Construction Permit Nos_:'a_6 6__ Dated..... ...........
--------------- ------------------------------------------------I..... - -----------
r Board of Health
-0./ _w�)
DATE............... 1 �. ....
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
LEGEND Route 2a "
�� 0 4 N Htit Rd � •
_— 98——. EXISTING CONTOUR Btuebet 'S
X 100.98 EXISTING SPOT GRADE r a
W EXISTING WATER SERVICE
, —
¢ h --G EXISTING GAS SERVICE
BH.jM.-- EXISTING OVERHEAD WIRES a west Mop S a SCHOOL LOCUST �o
® TEST PIT freer o' V�
BENCHMARK
LOCUS MAP
' NOT TO SCALE `
x 95.33 !
¢ q6 6 N 26'58'18" E .
0 _
1?8 stockade ence Ben ch m ark Set t • . r
60.01' �T
96,35 ;�� o wire fern MAGNETIC NAIL SET GENERAL' NOTES:' '.
1 EL.=95.89 (Assumed)
�-32' _ _i, ._ 1. ALL CHANGES- TO THIS PLAN MUST BE APPROVED-BY THE LOCAL
----- -- l . BOARD OF HEALTH AND THE DESIGN ENGINEER.
00 �-- ------ ----- - SHED x 94.05
_P OPOED___A__S. 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
v'. - OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ,
a) 95.55 EXISTING LEACH PIT LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW:
POLYLINER 5 OFF S.A.S. TO BE REMOVED OR PUMPED & FILLED —310 CMR 15.405(1)(b):
TOP,OF LINER, EL.=94.0 97.0400 96,15 \\ 95 8 WISAND DEPENDING ON PROXIMITY TO 1) A 12' variance, S.A.S. to cellar wall; for an 8' setback. `
BOTTOM OF LINER, EL.=92.0 + EN PROPOSED S.A.S.(SEE NOTE 11) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
U EXISTING SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
(To REMAIN) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
w Z--96----TOP OF TANK, 'EL.=95.30f FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN'
rn JNV.(lN)=93.97f ENGINEER BEFORE CONSTRUCTION CONTINUES.
EXISTING can } 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
1 :n ri HOUSE(#2OJr) p I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
I� T.O.F.=9Z691 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
N 1 9 6,5 6 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION..
PATIO 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
96.56
8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
9.11 97,43 96,6 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
\ 3 i AGREED UPON• BY OWNER AND CONTRACTOR OR AS OTHERWISE"
l LOT 95x 96.8 0 �� ' x 98.54 DIRECTED BY THE APPROVING AUTHORITIES.
X 98,44 ,260± S.F. C9 Q; .� �+ e 1'0. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
ap 270 4 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNIN
v p CONSTRUCTION.
X_97, 2P rce/ 36 11. WHERE�REQUIRED CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
xC9 66 IN THE AREA BENEATH AND FOR 1 ON ALL SIDES OF THE S.A.S. AND
3 —'--' C7 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR.255(3), THE
� 60.00' x 99,36 ' i PROPOSED S.A.S. IS A BOTTOM AREA ONLY SYSTEM. PROPOSED*STRIPOUT
_ BOUNDARY IS SUBJECT TO THE APPROVAL OF THE BOARD OF HEALTH.,-
-- _•_ _ _
N_2��53� 2�, E sidewalk r 12.• AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
sidewalk INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
1 edge of pavement 9g 98 13. THIS PLAN IS,TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
001 IS NOT TO BE CONSIDERED A PROPERTY LINE'SURVEY:
8 ' 14. THIS ENGINEER IS NOT RESPONSIBLE FOR ANY STRUCTURAL DAMAGE
i • `� OF MqS ASSOCOATED WITH THE CONSTRUCTION OF THE SAS.-THE CONTRACTOR,SHALL
LINCOLN
ROAD '
TAKE MEASURES TO PROTECT ADJACENT' STRUCTURES.a PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN '
� McENTEE _', '
o No�I35,o9 205 LINCOLN ROAD, HYANNIS, MA
' Prepared for: Michelle Crocker, 205 Lincoln Rd, Hyannis, MA 02601
• , •. ,op RFGISZE.� _ P Y � •
Engineering by: SCALE DRAWN f JOB.NO.
Engineering Works, Inc. ,"=20' P.T.M.' 54-09
J3 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED _ SHEET NO. fi
7�3�09
(508) 477-5313 P.T.M. j ,Of 2
NOTE: TO PREVENT BREAKOUT, A 40 MIL POLY LINER -
SHALL BE PLACED 1' OUTSIDE THE S.A.S. AS
EL�94. (NOP)EANDAELA 92.0(BOTTOM)SET LINER BETWEEN (3) 5" DIA.OUTLETS
s u 15.5" t 6�Ii
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. - _� 2
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT. INSTALL INSPECTION PORT OVER END UNIT
OUTLET AND SET TO 6" OF FINISH GRADE r
T.O.F. COVER SET TO 6" OF GRADE
EXISTING F.G. EL.=96.2!-!h F.G. EL: 96:0t F.G. EL: 96.3(MAX.) 112'
f f MAINTAIN 2% GRADE (MIN.) OVER S.A.S. 6" 11
`
INSPECTION 2„
L e 2' L 10'(MAx) PORT H-10 LOADING -
® S=1% (MIN.) ®. S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC d ,
TOP LOAD UNITS;,.
10.1 D-BOX
EXISTING 48 LIQUID is 19" TO INVERT DESIGN
LEVEL
o ADAS D BAFFLE INV.=93.87 PROPOSED INV.=93.70INV.=93.58
INV.=93.97f D-BOX (3 ROWS OF 5 UNITS AT 6.25'/UNIT) + 0.7' WEDGE = 32.0'
EXISTING SEPTIC TANK EXISTING j
-SOIL ABSORPTION SYSTEM (PROFILE)
ESTABLISH VEGETATIVE COVER 75"
BACKFILL WITH"'DEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
INV. ELEV.=93.58 r
BREAKOUT=TOP
TOP ELEV.=93.33 FILTER FABRIC
NOTES: OVER UNITS
slim
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV.=92.00 (RECOMMENDED)
INVERTS, PRIOR TO INSTALLATION.
2) D-BOX SHALL BE SET LEVEL AND TRUE TO t-2-83' �� 76" _
GRADE ON A MECHANICALLY COMPACTED SIX EFFECTIVE WIDTH=8.5' EXISTI PROFILE
INCH CRUSHED STONE BASE, AS SPECIFIED IN NG SUITABLE
INS CL I LET &(OU NO G.W., EL=85.0 T MATERIAL
3) INSTALL INLET & OUTLET TEES AS REQUIRED.
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE USE SEPTIC SYSTEM PROFILE WITH NOS SEPARATIOWS OF N BETWEEN EACH ROW &ADS SNO STONE
AS MANUFACTURED BY TUF-TITE, ZABEL OR EER UNITS
QUAL. -
' N.T.S. TYPICAL SECTION 11.2." 16'
DESIGN CRITERIA I-----3 ,_ ___
- - SOIL LOG !-. 34" -I
NUMBER OF BEDROOMS: 3. BEDROOMS - a' i PROPOSED S.A.S. SECTION END CAP
SOIL TEXTURAL CLASS: CLASS I I -------------- DATE: JUNE, 2009 (REF# 12,601)
11j SOIL EVALUATOR: PETER McENTEE (SE#1542) 16 HIGH CAPACITY (H-20) BIODIFFUSER UNIT
DESIGN PERCOLATION RATE: <2 MIN/IN NT �/ WITNESS: DAVID STANTON-HEALTH AGENT
DAILY -FLOW: 330 G.P.D. `L o Elev. TP Depth Elev. TP-2 Depth MODEL 16 HICAP
DESIGN FLOW: 330 G.P.D. 96.1, • 0„
FILL 96'0 A SANDY LOAM O LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
GARBAGE GRINDER: NO 94.6 ' 181, 10YR 3/3 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
r A SANDY LOAM 95.3 12' DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LEACHING AREA REQUIRED: (330) - 445.9 S.F. 94.1 10YR 4/2 24„ B SANDY LOAM SIDE WALL HEIGHT 11.2"
93.1 10YR 5/6
- , 10.YR LOAM OVERALL HEIGHT 16" •
EXISTING B SANDY'
.74 HOUSE(#205) 5/8 93 0 C1 36 OVERALL WIDTH 34" 4640 TRUEMAN BLVD
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 36
T.O.F.-97.69/ C1 HILL'IARD, OHIO 43026
PROPOSED D-BOX:: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED PERC 13:6 CF or 3 , .
M-C SAND
M-C SAND
48� CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
-' , .
USE 3 ROWS OF 5-16" (H-20) ADS BIODIFUSER UNITS 2.5Y 6/4 2.5Y 6/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
W/NO STONE AND EXTENED 0.7' W/ CONTOURED WEDGE 205 LINCOLN ROAD, HYANNIS, MA
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF UNIT).- S.A.S.LAYOUT Prepared for: Michelle Crocker, 205 Lincoln Rd, Hyannis, MA 02601
(BIODIFFUSERS) ' 15 UNITS x 6.25 LF x 4.70 SF/LF = 440.6 SF ,
(CONTOURED WEDGE) 3 ROWS x 0.7' x 4.70 SF/LF = 9.9 SF Engineering by: SCALE DRAWN JOB. NO. „
TOTAL AREA = 450.5 SF 85.1 132" 85.0 132" Engineering Works, Inc. NTS P.T.M. 154-09
PERC RATE <2 MIN/IN. ("Cl" HORIZON) 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74(450.5 S.F.) = 333.4 G.P.D. NO GROUNDWATER OBSERVED (508) 477-5313 7/3/09 P.T.M. 2 Of 2
. I
exe:t,eu �
SECTION A -A ALL CUTLET PIPES FROM THE ,,1e,,e
10' min. from =NOTE ALL PIPES ARE TO BE 4" SCHEDULE 40 P.v.c. PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET I-EvE>.FOtSTRIBUTION OR AT LEAST SHALL B2 FT- 12- CONCRETE COVER Sch°el 3
Existing Foundation ""'use to septic tank O-BOX cover must be
,� tonic covers must be 6 9'ods y_ r OUTLET
T.O.F. ebv. - 100.00 � 5 In. of finished be 3" of 1/5' - 1/2' Washed Peoston KNMOUTS
• Orods over septic Tank- 97.50 Grode over D-Box- 97.00 over SAS- 9&50 3/4- to 1 1/2 - Washed Crushed Stone ` ss- 1Y estT r�
OUTLET ��( � °r• f
/ 4-PVC iCAPPEO)INSPECTION Parr TO BE ' e' 1 2K klrseMr tl 1e
S 0.02 3 HOLE Tap OF System- Elev. -4175 NSTALLID AND TO BE TRIHIN r OF GRADE
3' Mw&nu" Caw
Q JJ
,n 1s' S-0.01 or 9reoter, (H-10) DtST. BOX 0"Effective Depth1.T3' J'`,ee r7 wO PM.r
EXIIST. PIPEFROM � = EXIST. TANGA
20 s= o.mo- foot PLAN SECTION CROSS-SECTION
m ,o m 25' o
H-10 a-soft a o 0 0.83' (10 inches) 5 Unit E 6.25' = 30 '>�� p; Aat,,,
e rri wS o X t r ch t
_� 3 HOLE H-10 DISTRIBUTIONBO
CONCRETE np-L F011A7A ,>; rn rn 3 3
o M rn N 31.25 1Z : 1 r oe
SYSTEM PROFILE o10
3.5' f" 3.5' R 37.25' NOT To SCALE ezeeelawreacenwrel0elNAJlEQ7' l l f t�
Not to Scab o t`3' Effective Length
0 10' _o TOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES
Q Effective Vk tl+ o
s haf 3/4'-1 1/2 0 o INFILTATROR HIGH -CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN 1. Contractor is responsible for Digsafe notification, Verification of Utilities
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE Compacted sta,e o m and protection of all underground utilities and pipes.
w Bottom of Test Hole 1 Elev.-8B.00 (OR EQLIVRLENT) Not to Scale P 9 P Pe
Ground.ater Observed _ NONE OBSERVED 2. The septic"tank and distribution box shall be set
NOTE: OVERALL Htl-%T OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10" level on 6 of 3/4"-1 1/2" stone.
3. Backfill should be clean sand or gravel with no
stones over 3" in size.
PERCOLATION TEST 4. This system is subject to inspection during installation
b Carmen E. Shay - Environmental Services, Inc.
5. The contractor shall install this system in accordance
Date of Percolation Test DUNE 1, 2006 with Title V of the Massachusetts state code, the approved plan
Test Performed By. CARMEN E. SHAY, R.S., C.S.E. and Local Regulations.
Results Witnessed By. WAIVER (Per Barnstable B.O.H.)
EXCAVATOR: Shay Env. Svcs. � 6. if, during installation the contractor encounters any
Percolation Rate: Less Than 2 MPI ® 36" � � soil conditions or site conditions 9 that are different
from those shown on the soil to or in our design
W 1 installation must halt do immediate notification be
Test Hole Test Hole I O.CIO' made to Carmen E. Shay - Environmental Services, Inc.
No. 1 No 2 I TEST HOL€ #2 7. No vehicle or heavy machinery shall drive over the
DEPTH SOILS ELEV. DEPTH S Eby I Leach Pit ELEV 97i 00 Failed septic system unless noted as H-20 septic components.
0 97.00 I 8. Install Tuf-rite gas baffles or equals on all outlet tee ends.
o s7�
Sandy Loom Sandy
Loom 9. All Distribution Lines shall be 4' diameter Schedule 40 NSF PVC pipes.
1 •';r; : "`r>l� :-f;, �s i D-Box 10. All solid piping, tees do fittings shall be 4" diameter
10 YR 3/2 10 YR 3/2
0--6' A, 96.50 e e e e _e t• Schedule 40 NSF PVC pipes with water tight joints.
o'-s- As 50 ; t•' v `* - `�::'; +<t=�ci, ` �_--_ -96 11. Municipal Water is Connected to ALL OF The Residence and Abutting
Loamy ddy � 7.25' •-11.5' Properties Within 150 Feet.
10 YR 5/6 10 YR 5/1 TEST IDLE #1 THE PROPERTY LINES ARE APPROXIMATE AND
6-- 36' Be 94.00 6-_ M. Be s4.00 ELEV.=\�97.00
Medium Coarse Medium Coaree COMPILED FROM THE SURVEY PLAN GENERATED BY
/ / 2 EXIST. 1,000 GAL. NELSON BEARSE of CENTERVILLE, MA
sand sand �� SEPTIC TANK _ ENTITLED "PLAN OF LOTS IN HYANNIS, MA
2-5 Y 7/4 25 Y 7/4 �� 10 01 DATEDJULY 30, 1934, PLAN BOOK 58 ,PAGE 99
132 C, 38"- 132 G
--J AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
36-- -- .
\ O IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
LOT #95 \�� O THE SEPTIC SYSTEM INSTALLATION.
ADO DECK w EXISTING LEACH PIT TO BE PUMPED OUT AND REMOVED
NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
#205 LOT #93 FROM THE EXISTING LEACH PIT TO BE DISPOSED
Con 1�rT EtEN(rH
OF AS PER BOARD OF HEALTH SPECIFICATIONS.
_.�•_ MARK \� EXISTING
TOP OF FOUNDATION s BEDROUA - ,
Perc #1 ELEV. = 100.00 (Assumed) 1 HOUSE -- - IITLRG ARE NO �:�+��,,:cc "-r: ^^ccr-t,TT �!R!-+!�I ?ne' or THE PROPERTY
DeDepth to Perc: 36 to 54 - 98
P i� ASSESSORS MAP 270 PARCEL 36
' "
Perc Rattle= 2 MPI 1
Groundwater Not Observed i LEGEND
No Observed ESHWT
ADJUSTED H2O Elev. = None
I D4AJ LOT #94 3 104X1 DENOTES PROPOSED
2-te-qAM. ACCESS MANHOLES
1 6,500 Square Feet
+/- �•
SPOT GRADE
5, DENOTES EXISTING
46
SPOT GRADE
-� ---- ----------f00 PL PROPERTY LINE
- r- -
"IT - al -1 PROPOSED CONTOUR
� THE ACCESS COVERS FOR THE SEPT1O TAM - - - -- -97 EXISTING CONTOUR
' .--.� • - �- r.- r--�` BOX AND LEACHING` "T ER THAN INCHES L IN C O L N A OA D
--� .:_�'.•----'-...:►• �-"` �-� --�::',.. GRADE SHALL BE RAISED To w1T1fiN s-of ®
STEEL REINFORCED PRECAST CONCRETE nNiSfim GIRADE
PLAN VIEW INSTALL TUF-T1TE GAS BAFn.ES OR EQUALS (40 FOOT RIGHT OF WAY) DEEP TEST HOLE &
PERCOLATION TEST LOCATION
�-3-24- REMOVABLE coats .--. 6 FOOT STOCKADE FENCE
�.. 4- T:
Z.
3 min. clearance tY sarT
INLET8- ml� min.- 2' mYt Inlet to outNt s.
OUTLET
FT P LOT P LAN
bso..... UwId depth
�o PROPOSED SEPTIC SYSTEM UPGRADE
� . �- :f PREPARED FOR
- - 4' -1; MICHELLE A MURZIC
CROSS SECTION END-SECTION
` AT
TYPICAL 1000 GALLON SEPTIC TANK #205 LINCOLN ROAD
NOT TO SCALE Kitchen H YA N N I S, MA
/Dining Bath Bedroom
Design Calculations of
Number Hof Bedrooms: 3 Bedroom EXISTING q PREPARED BY:
Garbage Grinder. No Room CA N cy CARNEW E. ,SHA Y
Leaching Capacity Required: 330 Gal./Day (MIN. PER TITLE V) -`
0
Septic Tank : - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. Bedroom Bedroom " ENVIRONMENTAL SERVICES, INC.
SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch O• 8
Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons P O P.O. BOX 627
Sidewall Area: 0.74 gal./sq. ft. x 78 sq. ft. = 58 gollons 0 20 40 50
EAST FALMOUTH, MA 02536
Providing: = 331.80 gallons gHi7AR P�
TEL/FAX : 508-539-7966
Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH,
T 3 BR HOUSE FLOOR SCHEMATIC SCALE: 1"=20' DRAWN BY: CES DATE: DUNE 5, 2006
O BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE
ON THE ENDS. NO STONE UNDER. SCALE: 1"=20' PROJECT#SD928 FILENAME: SD928PP.DWG SHEET 1 OF 1