The URL can be used to link to this page

Home My WebLink About0208 LINCOLN ROAD - Health 208 LINCOLN ROAD HYANNIS A= 270 - 047 TOWN OF BARNSTABLE I<.,OCr1TION �� (. J SEWAGE# ,�0`(p "" U VILLAGE ��[ ^\� ASSESSOR'S MAP&PARCEL` 0^ Q 47 7�4INSTALLER'S NAME&PHONE NO. ',(� SEPTIC TANK CAPACITY tooO C2(1( LEACHING FACILITY:(type) p��) 1A a O 1D )( NO.OF BEDROOMS 3- V 1� s kcoG OWNER `�M C..�b Cd to PERMIT DATE: 1® C Ito 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 9-1 - Q1 J. 77 V 6 ( —, c Q- v' - vv Communweaft of Massachuse Mille 5 Official! Inspection Subsurface Sewage'Disposal hem Form-Not for Voluntary A,—.,,�sn nts ElizaWh .01 Omerr, e�PN / __._.._._._._.�.._..,._.... �....,�_...a_.._._.. ...�.-- Hyanm7is ,/ _ 601 3d� 1 t ired for wry _ _., _.� _ �._.__._._ � _ ._— -- ® state r iPC e D 9f Wa page. WT .._ . r Cfspe€:t lmn a m�1ust be submitted on tKjs form.Insp time forms array not beaftered in any f. please completeness checkiist aitthe end of the ffdrrn- 'to rmwe your Name of PMWWOI wr-do r&t &MJ0M7ilWV op Ins it rerGr Pi key. 14 Beldart Lane i ;'� Cca�ny arc gym. Caynawrl D. zip"M 77 48.4850 -.5mjo titles grnail.c0M, St 452 1 rR Litattee Mirnber Cerfification I oe tli}P thatI M 21'DEP app� d syr insp o'in full Comp�I:tsmmce tr Section d She of Tide 5 �(310 CUt1� °IS.00 )., I have po sorkully inspected the Sewage-disposal sVsrtern at the property erir ss. listed Clae jrp rr lic7d r par ct I t is true,accur4le aiid Complete es Of the timlr Of rV1Y ins trr�na and the inspe Fe = d ors m Iraining anti, erg -in the pna function a� rmeintertan of -silf-7 serge d . : s , Aft r cx idi tin this inspection ! 3�re d .� fined that the sysieM- 1. 0 Pusses 2. n CondiMmally Passes 3. n Needs Further W;06 ft by the Loci�Approvirmg Avlhc* 4. dFeiisID �4 The systeern inspector shall su'tTrtit a copy of ffil is ire-p t n r-Fc7rt 10 the Approving Authoft (lord of Health or DEP)Wifthin 30 days of completing this inspentiora. If tha s"}s rn leas.a r -n#fir of. 10,000 gpd W greaWdie im,specr r rrd s stcl u e r r shall srabMiz the reP rt to the epprt�pri2P:C to regiorml e the TIER The original form.show be sent to the system wee and copf sent the buyer,if applicable,and the approving autl1oft. Fgeat mom=This mport only,deGeriibeS conditions at the tinm of inspection and+loam the conditions of use,at that tnrne.This inspeaton dbioz not.addratas hcrw the sysUM will perfOrm in the fixture sander the were or dilfEe►ent condiOns of use. `;fiM a r— tAW*Ictm k 1xlL s:dOiAa�A`,Z�c. •.sea s-L)' !kbfk 1v A.t-P 1 comet. ` :Mill cis+us Title 5. Offidal inspection r �F Subsufface Sewago Mspissal SY9WmFoTm-Not lbr Vdluntary Assessment 26B Lincoln Road Pre .Adl il� Bizaboth Wordell oomw*Name i► roi�lits�r� rdl?� �2�C�1 �' ��N1 uR'eaC far r lE ll5_ __ _._ w .�_ 5 T_ e-- d :W in- Pap- CVTOW Inspection Summary: riplete 1, 2;.3, or 5 ark aQ of 4 and g- 1) system Passes: is hie not.lbund any iriforirnatiort which iridi lbr.t=any of i1he Hilaire criteria deacribedi in 310 QMR 15.30a cir'in 31 a CMR 15i 304 exist- Any failure criteria not evaluated are indioatAdbOlOW. ornmerulsp The property I t 1 ,ir qln Ftd tii ;nni is y r aed ' a Tim v septic s tern nsisting.of 8 � 40 71an pfic tank, distrib4�tior box and 2 "dDIX1,gallon precast;leach pits. Alth q Me s t n a found;t be in'P a r` rich t�tsnd' ' at to tiene of inspeCtian this report does net gue n future Wormanva under simiLar ar increased us Q- One cT n. a systeM CUTT100110illts as de5chbed in the"Conditional P='section.need t be ireplaced or&Vairadi.The!5ystem. upon'Comp4etion of the Qep . . , erHt OF Tep6Mrq as.2PPMved by the 80 d of Health_.will pass. N, N for the ilaffl, slater[ tS.. if u Clie € e t fib[`yes",`ru��or'not :,.- rned' r �{ ''� d�:tf'6�irli�dan .asp., c;xpi�at- The septic lank is rnete:9 and over 20 yeas olir or the sep1it iank(wrhethec metal or not) is structuia19Y unsourrdf, exhMS,sutStilnEi2l iri tiar w'eAltt'atior or tank%ilure rs srr miinem System will Pass illpea tiara if the existing lank is:repcac w ith a c mplyin� sgpric tar* efipr� d by the aercii of Heal , li pllia ink milt past ins n if its i structural sound, not ink;and if 2 Ce ' - of Corr roan indk .-ng Oqd the tank is less than 20 years oW Ks available. Y N El ND(Expla-i bal ): 'Chc S Gf low IW440 f tmv.aawfionqRw3r n=;CSeASFtWit-P.YP 2 C41 I" I Title f dal Inspection, Form - ? face �rr �Sabsur a Disposal Sys FormN for Volurdtary.Asse � t 20$ Lincoln Road Pr i try AWr vrsWs ittedamshom is rtr�i M �2��1 W2023 o r r� es o -_for Fj .d...... _...... ._n.. _. - M 2) System Conditionally Passes ( MY Pump Chamber purnpskalarms not opera, _atw SlMm will Ids w im Board of Health approval W puftVgMkmrs am Tepaired.. observation of sewacle backup cT break out or high static water level it the distribution box due to b or obsructed pipe() due to a b, n,'Settled unea►e��istr�l�u box, System win pass inspeclion if,(with approval Of Board of".HealthY Y , broken pe�;sl�are,� 0 � ,f� N[� (.,Explain iri,�r�l��r): obstu,otbn is rerncved rJ., Y 0 N F_11 ND(Explain taw): distribution t ox leveled or replaced 12 Y C IN 0, ND(Explain belOWY The system required pumping mWe.Man 4 times a Year due 110 broken or abs tructed Pipe(s)-The g,ystem gill as ®r► if(wj.t Ara l cf the Bt rt f { h}; I - brokers arc re ed 0 N [ : D(Explain balliowy obstructbn is removed Y Ni ND(Explain below): 3) Further Eeraluatton its Regpirad'by the Board of Health- CAmditions exist w hiO require further evaluation by the armid of Nealth in.order to deteirtfirLe if the ys rn,is fbeJling to pgoted public healfte, afffely or the environment a. system will pass Unfese Lard of Health d rmi in 80wrdance wi h 3f0 CMR 9; ,3 1�i;h�that thesystem not tunctiriarr rr in a,rnanner wh th p c�t;pubffc hea61h,,, safM and th,e envifariru Commonwealth of Ma5�ac usetts u uet Sewage Di spotall -Not for Voluntary ra ts. ' 288 Unoln Road r ?�a : W 1 rogL&ea Faremy -Y _ . ., d _.m ��fl. �m Slate ziv of� . Inspection Summzry (Oonl.) Ceggml or pr y' is within 50 feet of a suff2ce water J Cesspool or privy is wilhin 50 Jimf of a bordering ted wetland or a t Tharsh .;b,, System wul fn anless the Boat 14 t>hi (end Pulairc.Waftr Supplier;.if any) determines the system- is functioning in a,manner that the public health, safetyand envir me ; E] The,system has a sew tank and soil absorpbon system(SAS)anti SAS S is within 1011 fact of a surfacer r alpr supply,or tributes to a surface WAUtef suPpl?• The system has aseptic,tarok and SAS and the SAS is within a Zicaru.- 1 a public,wail. upply_ `G"he system hasa septic tank and SAS and:the SAS u3 wathin 50 f6el,of a price watehr supply.well. The system has a 5�-,ptir,larak:and SAS an€i the SAS is less.than.100 foot but 58 fit,or =re from a private walar supply+Well". used to determine istan e EP r fa l laboratory, for f l This system passes it the well� =, r s�I�r I pc rfr�rrrne�et e[�_. ry� coliform bactefia.indicates absent ar l:the presen h of ornmonia nrtra!gPn;and nitres�n- +mot is equal to or Ress thoin 15 Ppm, provided that r other Maikire cTitena am.tHgqmd. A copy oE the aralysis rrwsk to a=hed to this fora,. o. Other, 4), System Failure Of fteria Appihiea6lle W All Systemat You,rttiog lindi to°"ire'°.or'No" to each;of the fol.lowing fbir 2M%sep tic '. Yes o ® Satkup of sew into iatili or sygtPrn OOrmpomenc.due to&Oesloaded or �1 9od SAS,or cesspool Discharge oT lending of affluent to ttae su& of the ground ofsurface waters 0 due to an o4derloa led ouctoggei SAS or cc.sspooll :seuy.( -iWv.+l f;?I� Y;JaaSork4,7 hsmo P'�aM°i saaros_vu 7+.'C d�l�;ypx!col:$, s:�aY -5 1$ Title Official Inspection 'dorm Subsudwe Smage Disposal st�:� Form-Not for Volur-eery ks srne nts `_. 0B Uncoln load' Elizabeth VVE)rdelt � rr�i is�r Hyannis Pa1'a. d 9 2 . I regwmd for - ..__r___ tCttyfl roil Dift 40 IN, im 4) Symern Failure Crr eia Appleoal-ls to All MS: (ooWN Yes N li level in t� diistr�t iitia�ru aloe Pu invert.due to an cwr4ftoadod or clogged SAS or cell Liquids depth in,cesspad is loss tharr Gr below invert or availabLe,volume is less than ' day fbw Required pumping nrat than 4 tiara,in fine last.year NOTdue to clogged.—or obstrUCIMd 5), N u.mber of ti pump;. Any Pwtion of the SAS,c*-sspoot orpflivy is high ground war e52 Any porgy of cesspucd Of ptWy is.within 100 Eft of a sure Wat ier supple or tnbutaryr to a surf . terr super. Any pore n:of;a ces,-,,pod aa privy is w.ithirr�,one I of a pubic wader supply well. .Any portion of a cess{iavol yr p+'®vy is wirirr 50 foot Of,a priMM rrrr'jupplY well... Any pixtio=irn-ofa,cesspool or Privy Privyis less the I QD feet but greater than,50 flit: from,a private water supply well with no acce.pWble wad quality analysis (This systm passes Iif the well air analysis, performed at a DEP cerfirsed lab rattiDr►y,.for fecal Collfform ria lAdicates abseiiA and the presence of ammmnia rni ard nitrato ru en its equal to or lem than 5 p1rna pmvi.ded Chat no teirfait`ure cnitwh are B aid-A.copy of the analysis and chain.of custody must he allached to this fronn The system is a•ces&paol serving a facility with.4 design'flow of 2000 qPd- 1Qo:17 gpd The system fail I have dettrTnined Inac one or snore of the ate failli.re Grit is exit as-described in 31 0MrR 115.3O3,therefore the system fails.'tl system owner shou .=tact the Soard of Health to,deterritirm ghat will be, necewary to correct the failure., ,) star : To considered a large sysfoernn the system,must yea a f . ty with a design flog of 10.000 gpd to 15,000 glad- Four lama systems,you rrrust En :'to di dither yam° or'rld'to each of a l�llr ing, in addition to CIS questions in Section C AS, yes ' o C1 , the system is within 400 fact Of a surfar-e- drinkiq,water sup* 0 D the Sys rrn is vifthin,200 lit of a gibutary to a surface drinking.water sup t)esystern is Ipr~ated' In a inn ern sarrsil3: area(Interi'.m:'I kllboadl Protecton Ma—0 A)* or a rapped?tine 00 of a public Veate>3 sixpply scroll mop%oind ift4mwitm F :SA;af—; ,00064A EV,10ry Commonwealthof Massachuseft Title 5 Official Inspection Form Sut rfaoe'Semgi;Disposal System F -flit:for voluritary Asseswents 206 Lincoln Read Property Aftess li a#h WgrdeO ul�dxra� Y Fi I�Is Ma 02601 2i required der �... .w w. _.... __._ rta -state of Impee C. ]rasp _ r`t uMa (saint.) 1f you,have an54r a "la any quesil on in r-tiore C,5 the,s s ounsidered a s�rii� at drat;of any -yes- to any question in Sechon CA above the large system has failed,The own&ot operator of any Isrg system onsideMd a nifii rit fir alh uur�l r - _ ,5 or failed un&v Section C.4 sta 91 u the�-yeslrn in a rdan with�10 15,3 , The gs-Wrn O"Or should r t i `, ua n t r��im- ofthel0eimrt nerut. fir. You m us n-dic- ��-"gar� "for a�b o�tCe�fa!llu�nr®nab.fir a�iiu a� Q e Yes No Pumping information waS provide by the.crvnpr,.c�ccu n9;or BdArd cf HeaItFv 011 °urifi.re;any(if tl" stern sinponents pLEmped but in thr� rev ous two wuOPks [] tiss the s si msi receivLid riprtnA in:Me previcas hun, week period! Raw,-Large voluTnes of waster been i!ntradLXed to the sy5lem mcenflyar pipit of this rripiori? Were,. .built plans of the systern owain and:mmmineV(If they,#we not available rrote as NA) 'tha-Facility or dwi ling lo pWted for signs of sego batk up? `'the,site,inspatiodidt Sigma of tsr �c out, Were all,system imponents" Iudi the SAS, 10=ted on Site? !, " re the.sePtic tangy rr thiolC� un r i., apei ed,and the iffbefiorof tha tank in dixt for the condiGorr of the lbaffics,or bam, nmEarial of construction, dimensions, depth fJ4'Ujd', depth of sludge and depth of scum? the facgity rimer(end oCMpants if'different trorri Own)pwiridied with inibmiiation,on the prqmr main,tenance of Subsurface seve digposal sywemV The sibe and Gabon of the Soils Abisarptioni System(SAS)on the site has bew determ4ned teased ow Existing'information. For example, a plan at the Board of Healthi Determined in the field if any of the fallure criteffia related to part C is at issue appmxiffnationoof distance is,u na- ep able)E310 CMR, 15, 9 (5)j };yR�p •rgrrr a ,3pl y 1'iA:5 t}Ff s!tis5{K*tliiR7 F:k7YB Suia u.n alma is bi°wosai Sf.ix-m-Pap 5 cf A � '"'tie � I I p� !I ' c Su rfipce,Sewage Disposal Systm F Not k r Voluntxy ASsessrneotS 208 Uncdn Road Roperty A r>e Eli both VYbrdell i"rhmasw is Ma 02601 202 mquiredfwem3r p�� -„,�... � —1---, _. _. . w _n___ � . . �...�_..� . - .. MCI D. System InfoTmabon 1,: Resideftfiall flow ndiiti oos- Number of bedr ins,(de ion), .� _. , Number of bedroom (actual): _ Dr:SgGN flow bad an 310 CMR 1 R2o,3(fay example, 110 gipd ei k i t < Description: 2 NucrnW of CurreMt.residQntS_ - - Ljws midence have a garbage grimdeO !des No Does resider -e have a water fwea " unit? � yes �' No I i discharges tv. . _.,. is laundry on a Separate SOW-29e,W terti? (1nr9ude lau.radq system in ion Yes No Information in thi Tep t.) Laundry system'ir p t i?. O .Yes No Seasonal use? E) Y es NO 'i ter abater readings,if available(last 2 years usage Igo )': Detail: Sump;punvi 0 Yes No cur nt Last4 to of u mc,Y; tip: Tak5ue m4iwknrc,+-,omma»=:Ek G, ,,1SYK)MM iA ?as CammonweaM of Massachusetts Q.. Titleail InspectionForm Subsurface Sewage Disdt Systern Farm -Not fqT vownury Assessments 208 Lincoln Road €k beth Wordell s M1lara�t; Inmsuom isiyis 012601 Salle 2:0-Coft of Icy# i0i . System IM r ataon (Cant.) 2, IommemiaMrdust F .00nd-if n5 Type of E : . sh . 9 ► rr (based on 3�0 CMR 1 a:203)° 10,a day 8asis of wign flow(sea Rer n ,�, ;�: Cam Bra Present? Yes F No ter tlreatrmwt unit osent) Yes ] No, LP yes, dise"es to. Ind,ustnal waSlo h0di Unk present? EJ Yn D 'ito Nori-salift-ary waslw discharged to the Tie s.ystern! ��v [� No ter meter r Mdin ,if.available daile Of o u ancyl user Other(d i baelb '): 3. Pumpfag Records: tank�� u[ce of kntcamr anon; Vas system 1purnped as part of 11ie iris tion'? Yes No If Yes, volunw-P.wiz sizurx�rx of tangy _ .. . . . _.. . mv wasqul�r�tit r urn P l dat ralin di? _. �... rra�rtt�a�n; R 4 ;for pining 3 Commmwealthof MassachuffOft fidal Inspection Forr in Title 5 Off I �. -_ Sut�wrface o Disposal We.M. Al Form- t for Voluntari Asses m, ^ots 4W. .� Properly Addmi& Umbeth rowners M, Wormarfion.is Ei anni 02601 2 1 mq far_V" �_:.� - D. SYSUMU InforMatiOn (cont) Ty"of syme I Seproc tank distribution box: !soil,abaofpbion systern Single ces5podl 0 O l PEA n Shared system (yam car no)(if yes, attach previous inspection records, if any) I';n tQwati l r t%chr pg . Anach.a mpy of mo cu p.e nt wrand mwinte nance contract fAp be obtained from!;pmerri awno;and a,copy of latest in!ipedion, of: a IAA system by 'systerrt opera°under c uftact Q Tight tank. Mach a copy of the DF-P approval. �] Other( rii ): AppToximate age of ali mrnponanis, date,installed(if )and w ur infbn : unknown VVem wwage odors detected wFne t arriving at Vie.site? � yes 5. Building (late on site pl3n:): 2.:b Dept burr r ,mat+N[al'of,com -ruction: ml i 40 PVC aiher( patiri)'. _ .w Distance t omr prWate s ete;-supply vuell or suction line'. Comments(on condifion of joints®veruting, evidence of kage, O )d it ire good condition:, no leakage,ventf.44 itrra ugh mf,. 'I"ili:.$Ot •a29 r,:�I'�m :.'.^ {i aG4.:iW''D ."mTps8�4n-Pap 9 0' Commonwealth of Mlassacbusetts Title 5 ,Off cial Inspection Form Subsurface S a' is orsal Systarn Form-Not for Voluntary nients. 208 Unc lrn Road Propeq.Address I=Iiii of 'i��t AJ10.11 ram_ €auP€erOwnwNs Name teng4a4n is Hyarnms Ma OWA 1 2 2=0211 page. C 1 awn stew zip C r,of IrAjeewoti . Sege Tank,(Iccz,to on site plan); Depth below grade; f Material of construction; concrete E) rnetal 0:" h lene ❑other(explain) ff tank is metal, Pst:age. _Yr��_ Is age co.n rm—ed by a CL-,rtrfiratr mpkance? (aaach a copy of cer1 ) [I Yes NO S. Sludgedepth: �.....�,�_.�.�..............�.,_.�.�.._e.. ..�...�..... Distance from top ofslu doe 10 (jm cif outlet tee or :T ScurnAhickness Dist2rice from top of scum to top of qutlet 10e Or baft .._...._ Vistance fret bottom of scam,to butbo-m- of outlet tee or b2ft Opel sae and Wk Htw,were dimensions fined? rn inert lip rir rit n.�uiti el r irnr nd ions,inlet and Outlet lee L�condition, I rk iw0eg t ,: fiquid levells as slated W Dully invert evidenoe of leakage,atc.Y Tank,was as mped rfor ins; > i ant should to dome again wry 21 yeam for proper maintenance.. meter level °a�j even vmith::outlet,, tank waz not leaking and was struClunally round.Inlet and outW covers are on n mama doc-fev'7rXkM$ Ticti scerKw€awoow <:--i us&—it—x+ +tis ,a *so,Pap id or CommonweaM of Massachusetts Title 50ffidfal Inspection Fonn Subsufiaca image Disposal Systm Fomm-Not,!or Voluntary Assessrrw is ti 208 LinwIn Road PKK... .,. Elizabeth.Wbrdell Owrx Ownc es Marne infornuhm is F annis Fula 7 2-t23d"021 mired every ._. _ _ _ g. rgbM7"vim UL .Irp fir° babe aY IrAeiion D. System Information (cont.), 7_ Gresse Trap (kcate on,site p[ ): Depth;tee gee MaReriai of con5ituction.. Ej Cmixote, ED rnmle fi"'Iass [D pc4yethylene E]Mer(explain)-, 80urd thickness DWancm frrom;Wp of scum to top ot wtlet tm or ba Me Onstance fmm;boftern of scumi Ro Mlorn df autlot tee or ha Date of fast purnping: Cornm s(on pumping recommendations, inlet and ocuffet tee or bale�cvruditiord9 stfur Aral imi1000y, liquid Iao-I5 ar�related to outlet invert, eviderice of kaakage, etc,): 8„ 'tight or Holding Tank(lank,mast bepurnped at time of inspc tion) (. to on file ;Darr); �- � - r0a.teraa-I of construction, s concrete 0 McIal ®fibeTlass L-1 polye ftlerw []rather(explain) Cap fty= Dep,ign Rdrrd; Jauorm Per di G $p.dmc P1d(9 7 016 Title 5 Official Inspection Firm ubsu Sewage �3�sposali Sy IFa€afm - ot f or' un ry�s3's-l'.s�9TIPn. 208 Lincoln Road, /�,,� 11=ti�akr' !r'dell Ow net dLL Or.trra irdomatbon is p nrt Ida 02601 f2, Cityffown ZpPcwa DzW of Iftapeefieft. D.System linformation (owq. 8. right or Heddl—mg Tank(cowQ Mann ptesent, Yes INN Outs of lost pUO= Cornmonls(condition of aljtrm!and.feat switches,.etc.):. ":attach copy" current purriping tontract Is copy attachedr? 01 Yes; too 9: Distiibufibn Box(d print must be open on site plan): D fat li Midi above n 'fit inert .� prtt'i; - � u.. Comments(note it box is levet ar$d distritwfian to cutlets equal, any evidence of saWs r "any evidence of leakage into air out of box,tft.):. Distribution box ww level and in good Canditan with no ram.'U4at 'L-wel was even with outlet inve tswith no signs of past baaug. Covev en a YtAor r;tralac.-.�;i.TrA'� � 'i9� r :im��,�• � IGt��aam-Rs�t«;�ar;� Commonwealth, of Massachusetis Title 5 Official Inspection Form Subsurface She Disposal System For -Not fbr Votuntary we ts: 108 Unnlrr Road tpie�y�I�tlr.E�3 OWW SrrMes WMO Waromption is g Oqu, ired W Ove,ry ItRqruk p C T ar9 tow zip co f� � i ,; ! n�_ M SySteM InfDr ation ,(cola,) 10- [P9rMp Chathiltr(I is On Site 0211): Pomps in workirig order Yes 'Noh Alafrm in v.mrkinq Ci :. Yes fro' Co_, ends,(no di6on of pump ch mbeir;cond tion,of pumps and,appuftnanoe%, etc -, It purrrps at ajafmare not in wwking order, system is a cond'itior l pass, i1_. Soil Absorption item(SAS) (Irate on:s#e plan,ex avxflon nak regviv ); If SAS notkcated,explain may: T leaching; - number WOOD leachirl chambem number -- leaching gafflIenes number le hinge t neh nuumber, length: 0 Ieaic;hring field number, dimensions: Oveir!5�w number- inmovatielaltiemative System � trrls,-fir Frfdl�9 Y * 47 ,rmt,* rt7ss� m-r� a�• �d Commonwealth of Massichuseft Title i l Inspection For, Sultosurface Sege Disposal System Form Not for Votuntary Assa smea;as. Pr . Etaza 1h Vftdoll ewer intomarom rcqu' forevoy :! T_LPS tom, 02601 =312�1 P090- CWOVM ftw Zip Code Die tff L► ifM . System Information; (cont) I1_ Soil Aboorptibon System��) Cori eats(not e di, of soil,signs of hydraulic failu , levol of ponding damp soil,cvndet—P of vegelation,OtC4 Both le=h pfts were Vomled and-axCaYWOd.Pft wem taund with less,than standing V06wr and no signs:of past overloading- _ are on risers, 12. sp is{cesspwl must be pumped as,part of inspection) (l=L-on, site plan)- Number rand C aritirguration Depth top of liqurid to inW invert Depth of soles.lees Depth of scum layer Dimeasionsoaf'ems: . _ Materials of Constuclion: Inds f a trndaer r irrfl0W- Yes `hl Comments (note condffibn of soil',signs of hydraulic'f;@O , level of pandingi, condi of vege Its biorn, C-®tio adt ILV-7t 1t-le; TWO�5�'L`�IG•'9e�s�rc1F4k4%,S,q�S�F+ '4*mAWa}a&P49 fa IN~ .:'0(s..:t-(P.@P 14 OCA Form- ea Title 5 Official # n Subsurface age Disposal System F -Not fbr Voluntary Arse sswriurats coin 208 Lin - Road Elizabeth Wordell bfcm9upin d is. }� PmnuS 026011 2=021 Peae. GityjTwm zip Coae uste of Ii iiorta D. stamu� Inform,ation (Pont 13, P ft(locaw an site plan):- Mlatermfls Of nsw=tir5ry: Dimensions Dcoh solidi Commer mate condilion of soil, oigm of h?ya r`duli f4du , Iwel of pomfing wndifion ofi ge Cion, I r :eas aaa.�/ R� 'n a a at» r, suers 5s s9i ae OW-41€y1we-;;4wIsoi as -Comamnwealth of Massachusetts Title Official Inspection Subsurface Sewage Disposal hem Form i, !finr Voluntary Assess wts w 208 Unqdn.Road EI"izd ill Owner c, iroln3G�nI. nis Ftr �2 �1 - 2021 rt fiar czar r. i "I of Inspection D. System Information (cont) 14_ Skefth Of SewageD4posel-Est: Pmvi a fir of the sewage disp=l syStem, ,irmiu,ding at lit two pecmanerd wai Ran dmairks or benchmarks- Late all walls wilhin 1 limit, Late where public water supply eri . e a ildi". Chi one of the bcxds Defies; ® hand-sketch,h in the arm below d`aMnq shed separately pg6 g 1 � Al Ii I.LI p; 4 a '. 4.1 � -4 r 3Y a Title 5 Official inspection Fort Subwftce Sewage Dlsposa1l tewr Four Not fbrVduntary Assessments 208 Lincoln Road JhvoeFLy.AWfftS Ovmr ��i�stati t'andelli s Mars Mramation in requite far every qrrnis page, Ift", Zip Code OaW of ampec-hoot D. System III ati n ( nt): 15, Sit*IlExiarnx Check:Slope D -Since water D Ch%kr Cell ' D :5ha1w wefis E,-5tinmated ftth to high ground 2 r*de- ind6Mk all methods iused`o determine the high gvDund water eb rt- OtjUined from system dest-n plans on rwofd If checked, date of dtsign p1W revie-wed, E) Observed:site Obutbng:propertylobservMn hole wilhin 160 fact El Checked withlocal'Soard of Heal - explain, Chrtked with I aP excavators, installers-(amach d r nation) Accessed USGS d2tabase-&plai '' You must desraibe hove your establish the Hqh glow d water L- _ , Gmun&wallerwas estabr%hed by am-cessing tow of BarzMbie gFounawaler contour maps- Embre fiIiiivgl this InspecKon Report,pI ,e see Report Cowpl!Oenm Checklist an neW. page. rnl omwee of Massachuseft Subsurface,Smage Disposal Slystem,Fwm-N !or y olu FIi Beth 1 vrdell OwWslltarae ffMire hl auror ae Ma 02601 2d 1 1 SWIM ..R, Zp cod'o [Dole of 1mqmrrftn E-Report Completeness Checklist COMPIM all appricabiesections off thJs form Inclusive : ►k Irupoctor Inlathwiftm. Complete an f It in thir,sed'ran. B Cenificatiom Slqrwed& Dated and t,2. 3,or 4 cht ckk- C.<Irrwxtian Summary: i 1,Z 3,;or 5 completed as appropriate 4(Failure Criteria)and 6( h €list)comptoled D. System information,. For 8,Ti<ghCt olding Tank—Purr►pi,ng contract attached For h of Sewage'ObTp sal System drawn on ptg_ 16 or aUached For 15- Expfwation cat P-slimated,depth to high,groundwater cnduded ` l t "fiv.3..MwA &L* CD l"M I-ARM ul of;H a TOWN OF BARNSTABLE L&CATION -26-6f- L--jNCCW .gam SEWAGE # l VILLA._ E us ASSESSOR'S MAP & LOT /11'- INSTALLER'S NAME & PHONE NO. -0�� SEPTIC TANK CAPACITY [00C G 1N-L j otV LEACHING FACILITY:(type) l k� ip(T. (size) �MO NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER C,.G Q�k ik S fl(L � DATE PERMIT ISSUED: ° DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No j J 26 az a 1600 r Sic TrVJ tC D�X 1000 6A� P��c�,.s► 1��T � A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..-� ..........OF......... , . Appliratinn for Uispnstt1 Morks Tonstxnrtiun rumit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage. Disposal System at Location-Address -•or No. ............ ---—----.�.�' .....S.J. Q. SQ�i �--^----.................... ...................�� `Q.� .................. IWiress Installer Address Type of Building' - Size Lot................ Sq. feet • U Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ...... No. of persons............................ Showers - Cafeteria pr Other fixtures ..........................................................:............ WW Design Flow...........6.......................gallons per person per day. Total dail� flow......... 3_. ................. W Septic Tank-Liquid capacity .....gallons Length.... ....... Width... .!_..._..... Diameter--,............... Depth..:............. x Disposal Trench—No:.................... Width.................... Total Length.................... Total leaching area..................-sq. ft. 3 Seepage Pit No....._.I._..__..._.. Diameter_....2 `._.... Depth below inlet.__ _.:....... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch - Depth of Test Pit.................... Depth to ground water.._..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......:.......:........ a ................. .............................................•-----------•----- ...... ----------- 0 Description of Soil.................-----------------------------------•------.......---------------....----------------------=---------------------------------...-•-----------••._...._.. V -------------------------------------------------- W •-----------------------------•----------.........----------------...-------------------------------------•-------------------------.. -- • ....... U Nature of Repairs or AI ration -Answer when applicable...-,—ws�"�.........�..�L...... ........I� -- -- •-------1-rT ....�? w a .. �!Y../o vv._�................ ..........:.......:....•........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'A U 5 of the State Sanitary Code—The undersi ned further agrees not to place the system in operation until a Certificate of Complia sued by the b r hea t Signed............ - -----...------ ...... .... ---•----.--- ..... ...... .......... � .. Date - Application Approved By_______________f��___- ---G----,--�� ..... n _�.1.._r:17 --- Date Application Disapproved for the following reasons:..........................................................................:...........................•--_-- Date PermitNo........CE.Z..- wE73.................. Issued-............................................_......... Date •-'-rn_�.-..�»....,."..r-�� ..r..�.r-r- -•--` .,' �;,,.r-.^..,as-----_•--...��n.�:�...�..-..,.,.�...,._--�...�..%•--«r ;s--�.^-rr•� -w ..,.�.,..�s�._....-..«... � .�-. -. ... _.__-.---....�._i.�......- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s VC �c�V. ..........0F........�G ust. ....... .��.. Applirttfiun for Disposal Works Tonsfrurftnn 111trutif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ............�,� �,n i-�t.c ...�_1 K�'.4:�_._ ................. -�\ ..!.................................................. ......-........ Owner-, Address ►Wa ._.....,,_,.1 ,�;c5/; r � ,Ee.Nam: i._�................ .. �ti L 1.�.�-_......--•--........................._....... ......................• Instaaler Address Type of Building Size Lot....•....._..... Sq. feet t-� Dwelling—No. of Bedrooms......:...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers Cafeteria lit YP g ..........................•- P ( ) — ( ) a ....................gallons per person per day. Total dail---flow........._.. 7._ .gall s. Other fixtures ...................... . ... ...... WW Design Flow.......... - � P P� ---- •-------- Y �-•---cD................. WSeptic Tank-Liquid ca.pacity�! _gallons Length Width.... ....... Diameter................ Depth................ x Disposal Trench—No:--•------------ ---- Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No.......I............^Diameter...... Q.`...__ Depth below inlet.... .......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...............•--............................-••••---•-••----•-....•-_... Date........................................ 1.4 ,.� Test Pit No. 1_--t...........minutes�er inch Depth of Test Pit.................... Depth to ground water....................,... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ....-.............•...................................................................................................................................... ODescription of Soil.................................•-•--•------.....-------------•-------•----•--------------------------------------•--------...---.........-••--•-•--...._....-•--•-••-- "� W ----•-•--•---•---•----------••••••--••--•------•--••••---•••-•---••-••••-•••••--•-•-......••-------•---•--------•------------•••----•--••------•-••-.........-••.....---••.............•-•-•••••••••.... U Nature of Repairs or Alterations—Answer when applicable...,? ?..Sq ..........-7✓TGl : G 1'`' . ...... ..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 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 board-of health' , Si ed_ �j..P A .n '-�= -�y -�-- 7 >m / J Date APPlication Approved BY :_ ._._; ......• - ��---.-•-- ---•---9 =•-� i S? Date Application Disapproved for the following reasons:;..............:..........•..................................__._______._:___............_...__...........--- --•---------•-•-•------.._...•-••••••-••••-•-•-•-•••-......••••--•---•...-•-••-----...•--•••-•-•-.....••-'•----••----•--••---•...•--------•••••---••----•-j-• ... ............Daft................... Permit No.---•--.8. .7 t.............. -.. Issued...........................................-.......... Date -------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ! ,, ............................. (UrfifiXMtr of Tomplinurr THIS IS ,T-O--CERTIFY_,That the Individual Sewage Disposal System constructed ( ) or Repaired ( �� by...................... :.... - .:.... :�: ....-• --•• ---...---------------•-•----...............•........--••-------.....-••.....•-••--..------••- -7•- ..Y. J Installer _ .......- -- .................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ ...&7-. ..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ 7................ Inspector................................................................................... ------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �^- �--' ,]_ Sr- .....OF......... ��..C�>. ._'!-c? t _�..-��......................... No..............:...,L�1 FsE.-..,,., .......... Disposal Works C oustrnrfinn rrruttf Permission is hereby granted..................K.............. �/----------------------------------------------- to Construct ( ) or Repair (L_)_an Individual Sewage Disposal System atNo.r?-T Sc __1_...._ti..�1.. n...l_!-t._:.•......12 ........................15��'� =^=`'�............................................................. shown on the Street he application for Disposal Works Construction Permit NJT .1`..,7,3. Dated.......................................... �' — ...........................•••... l J Board of Health DATE...... V _..._�� . OC,&.T1 -N ' _ 5EW&C.4E PERMIT MO. _--B U.I L DE R-S_ z r - -O_D.TE _COMPLI-[�t�I.CE _-1SSUEQ _ _ -� -- a J s � , " r Y .• .1 .,y , j� { J50 .................... THE COMMONWEALTH OF MASSACHUSETTS BOARDQF HEALTH OF..... 4-- -------------------------------------------- Application -for 11itipanal Works Towitrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair ( 4-an-mividual Sewage Disposal Sys at ------------------------------------------------------------- V-------------- ------ 1/1----Z� jkbi9vtion-Address or Lot No. ..................................................................... ... . ........................ ............................. Owner Address - --------- ------ ------ --------instal-l-er---------------------------------------- ---------------------------------------------Address U ------------------------------------------- Type of Building Size Lot____------------------------Sq. feet Dwelling—No. of Bedrooms----------------------------------- --------Expansion Attic Garbage Grinder ( ) -4 PL4 Other—Type of Building ---------------------------- No. of persons...__..._..._..........._.__ Showers Cafeteria ( ) PL4Other fixtures ------ ----------------------------------------------------------------------- ----------------------------------------------------------------------- Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------_------------------ ........gallons. P4 SeQtic Tank—Liquid capacity----------_gallons Length_ ______________ Width_.----.___-_.--_ Diameter_--.-_..._.---__ Depth._..-----_------ Disposal Trench—No. .................... Width-----___-____---_-__ Total Length_-______________-_.- Total leaching area--------------------sq. f t. Seepage Pit No_____________________ Diameter........._.......... Depth below inlet____-_-________-_._. Total leaching area------- ----------s(. f t. 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.-.._---._._--.._-.-___. ;L1 Test Pit No. 2................minutes per inch Depth of Test Pit-_-_____-_--_______- Depth to ground water------------------------ 9 ----------------------------- -----------------------..................................................................................................... 0 Description of Soil---------------.................................................................................................. ......----------------------------------------------- U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- ------------ ------- --------------------------- --- ------- ----------- - - --- ----------- U VINat f Repairs or-Aitera *6ns—Answer when applicable..- -- -- -----1,___.A^147_1Y------ W't u 0' p ...... . .......................1�� __ - - '�_/�------- ------------------- reeme, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b7A'N1,sued by the board of health. ------------ Sign ... .... .. .. ...... 25--2 Date Application Approved By---------- - --- - _... •. . .2- -— -Z ---------------- .....�7.ff:.......&........- Date Application Disapproved for the following reasons:............................../-------------------------------------------------------------------------- ...............................................................................................................................................--------------------------------------------------------- 'Pate Permit No. Issued. 7 -9- 7 6. . ....... ................................ Date ---- --- ------------------------------------------------- t1 J No.•--` FE$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH _/_. `"' -F/�•i .0F.....1�.__1..(�P/(,�z .� ------------------------------ -------- Appliration -for Biipu.'ial Works Cnowitrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( n n ividual Sewage Disposal Syst at --• = ..... ..... r-•---• ------------•. -•-----•-•- --- - t -- L- tion-Address or Lot No. r C� 1 ;3.......................... _ I Owner ----------------•------------•-•---•--------Address W7s' U/ Installer Address UType of Building Size Lot-_------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QI Other fixtures ---------------------------_ ------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width....___...... Diameter----------------- Depth................ x Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area......-.-..-.-__-.sq. It. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ------------ --•--•--•---•--•------------------------••------•--- Date---------------------------------------- a Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-.-.--..---.---------- G% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.............--.--_----- ------------------- ------------------------------------------------------------•--•------•-----......................................................... 0 Description of Soil..........................................................................................................................-------------------------------------•-.------ x U --•----------------------•---------------------•---------...•-------------------•-•----•-•----•-----...........------•-----•----•---•---•----------------------•---••----------••----------------------- W ------------------------------------------------------------------------------------------------------ - -- --•------------------- jae of Repairs or 1 era ons Answer when a licable... -_'!_ti UP" PP .. Gr. r..•. I+. fi1- 1 ----------•--..+' /7?� --••---•------- •------ --- -------- -------- ment: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has 7beni sued by the board of head - �Signed...... ii /.r.�� ........ ----� ..--�5 -----• :• s Date Application Approved By---...` / ci.— ( f. i / Date Application Disapproved for the following reasons-------------------------- ••---........------......---.............---------...-----•--------••- --•-•........................................................•••-----•--•----•----•--••------•-----•---•------ - --- --------- - - - ---------•---•--••-•- Date PermitNo......................................................... Issued....................... ................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L f n :. ......% . r�.(..........OF...........:.. - Z....................................... � Trrtif iratr of 0.1.11mphaurr THII IS TO,ER-DIRY, That the I dividual Sewage Disposal System constructed ( ) or Repaired ( ) by....•--••�' �'; 5------4�G-� ......%.�` ........................ ! at.• -------• e--- -!i-` y .ems"`•.:_.. ------•------------------•-----•----- has been installed in accordance with the provisions of i�e XI of�The State Sanitary Code as described in the application for Disposal Works Construction Permit No4� ----��..� -...-..... dated---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector------------------------------. .................................................... 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ....G 'Z..OF.......... ! G G-' ..........---------..............--------... No......................... FEE........................ Permission is hereby ranted—z ....... ........... .A_.J.�.-...11/----------------.•-----.................................................. to Constr� ct ( ) or Re ai ( an Individual Sewage Di p"osal System f .r •• Street as shown bn the a � application for Disposal Works Construction mit N0.........�-.-__--=ated_...: t........................... r� ��L%J Board of Health �. DATE..... ............................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS