HomeMy WebLinkAbout0295 LINCOLN ROAD - Health 295 LINCOLN-ROAD HYANNIS
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TOWN OF BARNSTABLE
LOCATION o2�s /Ai Ca l41 RD SEWAGE #
VILLAGE /� ASSESSOR'S MAP & LOT A
INSTALLER'S NAME & PHONE NO. A-&-B-CA:1CO 7�5-6�C4
SEPTIC TANK CAPACITY /D o o SAL
LEACHING FACILITY:(type) y /T (size)
NO. OF BEDROOMS- PRIVATE WELL OR UBLIC WATER
BUILDER ORIOWNER 4rATi51-1
DATE PERMIT ISSUED: /.2,,2 r-.7 r -3£P7lc 1ti T arc%/c A-
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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TOWN OF BARNSTABLE
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LOCATION 2 9�L/dJ /���� SEWAGE#
VILLAGE .S ASSESSOR'S MAP&PA/RCELZ:7 13.Z
INSTALLER' NAME&PHONE NO���
SEPTIC TANK CAPACITY &S'V
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS 3
OWNER / y rqR _ S
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) - Feet
FURNISHED BYG�/
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A 3 5/
is
B-1 13 3
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- Ch1
No.��(�/�� ' � � Fee_
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pphtation for 30ispoBaf *pBreffi ConstCUttion i3Ermit
Application for a Permit to Construct( ) Repair/ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ZQS Z/.vcoL.v 4P&,4D Owner's Name,Address,and Tel.No.
r
Assessor's Map/Parcel ?/ 7y�aN� V « L/�
In taller's N ,A�c�ress, d Tel.No..3 �Q � Designer's Name,Address,and Tel.No.
oS�� /ZL. / )6?33 6Z a
u o
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size a z9 sq.ft. Garbage Grinder( )
Other Type of Building ;5;WZL No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided gpd
Plan Date ;V4Z!�?- Number of sheets 3 Revision Date
Title
Size of Septic Tank /_$(>O Type of S.A.S.
Description of Soil ASe S dAef%'/✓ chi(/ ;G�� &.4AI
Nature of Repairs or Alterations(Answer when applicable)
;51mes,,� Tir
Date last inspected: CZ
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.
Signed % fe
a/Gte /8�tirrJ
Application Approved by / Date
Application Disapproved by Date
for the following reasons
Permit No. 2_p z,o 0,99 Date Issued 3_ Z ;� z o
. .'^i.... .., ._.i,. .... ,y,w.e`�.E>�. .�;�y�' .•:.n1. ._m ..(v.•'hi;'('�hti.:}+-r.n n. -."5_i'"'.. .. ,T-:+r:r +.. ._ `_ ..., ..,.r . �
. r: f�(�
No. 7-0?�L l fly Fee l( o
THE COMMONWEALTH,OF MASSACHUSETTS Entered in computer,
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PUBLIC HEALTH DIVISION -TOWN%OF.BARNSTABLE, MASSACHUSETTS,'
Y''✓
Application for Disposal 6 Construction permit
Application for a Permit to Construct( ) Repair/ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Zz °: / LA/ .f)df D Owner's Name,Address,and Tel.No.
t �-�',��ry v � L/ J �" cam ' .s
Assessor's Map/Parcel '°
Installer's Name,Address,,and Tel.No.S /1, a 7 Designer's Name,Address,and Tel.No.
:s
Type of Building: }
r
Dwelling No.of Bedrooms -3 e Lot Size G;% f sq.ft. Garbage Grinder( )
4 Other Type of Building -51mn551 A /7y>y�OL V No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow.(min.required) 530 gpd Design flow provided gpd - v
Plan Date 5//7�.�0 Z- Number of sheets Revision Date c�
r
.. Title <.,
Size of Septic Tank A! ,OCJ Type of S.A.S.
Description of Soil .-:5-1 V 41 ir/,— o>Z.4 A/
Nature of Repairs or Alterations(Answer when applicable) -
Date last inspected:
Agreement: f
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 r`
Compliance has been issued by this Board of Health. �J�` �.
Signed ff "`�f •/� � �2J�ate �/;el;;tJ2w
Application Approved by Date
Application Disapproved by d° Date
for the following reasons
Permit No. 2070— Q Date Issued )
THE COMMONWEALTH OF MASSACHUSETTS
qw. BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired,(VI) Upgraded( )
Abandoned( )by /"
at 7CIC i wftol-N i2b I4,4Mu!i has been constructed in accordance/
with the provisions of Title 5 and the for Disposal System Construction Permit No.2070_ QP9 dated ?.7 Zu7 !1
Installer Designer
#bedrooms Approved design flow gpd
The issuance of this per lit shall not be construed as a guarantee that the system will functionjls designed.
Date t'? ►.�d Inspector �d �1t" r-
No. 2-o 20 — 089 Fee Ay au
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction i3ermit
Permission is hereby granted to Construct( ) Repair QN,16) Upgrade( ) Abandon( )
System located at 7 9 1� /,f 111 Ct r,3 P '� j!LJA A,VM 1 S
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions. '
f
Provided:Construction must be completed within three years of the date of this permit
Date �175'I 7ir��_t� Approved by
Town of Barnstable
Inspectional Services
• Public Health Division
&AWWaer.&
'AM Thomas McKean,Director
039. .E
ot ° 200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 10/19/20 Sewage permit# 2020-084 Assessor's Map\Parcel 271/132
Designer: Horsley Witten Group,Inc. Installer: Joseph DeBarros
Address: 90 Route 6A,Unit 1 Address: 81 Cammett Road
Sandwich,MA 02563 Marstons Mill,MA 02648
On 3/23/20 Joseph DeBarros was issued a permit to install a
(date) (installer)
septic system at 295 Lincoln Road based on a design drawn by
(address)
Horsley Witten Group,Inc. dated 3/17/20
(designer)
X* 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. Strip out (if required) was inspected and the soils
were found satisfactory.
*Magnetic warning tape was not placed over pipes -water line is 11+/-feet from pipe
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. Strip out(if required) was inspected and the soils
were found satisfactory. i
I certify that the system referenced above was constructed n ° :i ce with the to rms of
%µ OF
the I1A approval letters(if applicable) ,
1 O JOSEPH E.
HEHDERS `
C1
t(Desigfejr'sSignature)
ure)
�r
x ,
(Affikx Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
WoAdeptAHEALTHISEWER connecASEPTICOesiper Certification Form Rev 8.14-13.DOC
H
Cy
THE CO TH OF M
BOARD OF HEALTH
1!OWN. OF.....»BARNSTABLE »....».........»..............................
Jr 5 Applutt#inn for Disposal Works CIonotrurtion remit
4 Application is hereby made-for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
Lincoln Road Lot #):301=8:..,., ;� " ; � ) Assessor s Map,271,Lot 132
Kathleen M. En M....n.Add`e" 103-A Saran Lake Rd�.,�Vo' Yarmouth MA 02673
_. _ _ 1 -........_... ..........._...._._ _._.._...t__�....
�1/ Owner AddressI
....... ... ...... ..........................3......................».. .................................»........... .....................................».....---
Iostailer Addreu
Type of Building. Size Lot...12,.63.7...........Sq.feet
a Dwelling—No. of Bedrooms.. ........ .............................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons............................ Showers ( ) —Cafeteria ( )
Otherfixtures ....................................'.................................................................................................................
Design Flow.......330........................
l0i}0 gallons pretxpa�tWmcpIr dal Total dailyOfllow............330 gallons.
Septic Tank—Li Liquid ca acit tons Len ff -6..Width..4...'1.....Diameter................De thA'.=A.....
P 9 P Y............gal gth............ p »
Disposal Trench—No.....................Width..................Total Length..................Total leaching area................_.sq.ft.
3 Seepage Pit No....... ........... Diameter....lo...... Depth below inlet....:.k..........Total leaching area.2Q4..........sq.ft.
M Other Distribution box(1) Dosing tank ( )
Percolation Test Results Performed by....Mr...,I...DQl.1()Van:...................................... Date.....1/11/89.................
Test Pit No. I
inutes per inch
Get Test Pit No.2.... ........n Depth minutes per inch Depth of Test Pit......14........Depth to ground water....NIA............
....................................................................
o Description of Soil....TP_1Q-2�. top.and..subsoil1„2�,-6lysancl with gravel„and cobbles,.,6-12'.
coarse sand
. r ........*" ..... 1 r t f .......... .._..
• - top an subsoilt 2 S »sancl.wth gravel ant cobblesr..5...-14_ coarse sand.
.........................
Nature of Repairs or Alterations—Answer when applicable........ ......... ......... ......... ......... ..........._...
....................»....................._.............................................._..........................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accorlan a with
the provisions of TITIS 5 of the State Sanitary Cod —The wmlervgned further agrees not to placceeiv syFs gt in
operation until a Certificate of Compliance has b e th 01*1 / /7
Signed.. »: �lY .�r
Application Approved By... . �.:.t .. . .......... ....:..... _ .....�..{......
"
Application Disapproved for the following reasa ....................................................................................................._.._
a
Due ----
Permit No..... Issued_..............................
Dsee
THE COMMONWEALTH OF MASSACHUSETTS
/�) /� BOARD OF HE LTH ,./C L,C
' � farrtifirttte .af tlrmnplittnr�
T I E TlFY,That the Individual Sewage Disposal System constructed ( or Repaired ( )
by. .. .........I. ........... ..... ....... �,....... __ .._
el— //�� �� ./�j�, /Q��mtailu i—
at_... •P�!✓..c.. ....7K X .. ......................
........................_..__..
has been installed in accordance with the provisions of TI of h State Sanitary Code as described in the
application for Disposal Works Construction Permit No..... .gr �. .......... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE�CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. ...._...................................................... ... _ Inspector......_.........�..�:....................... _ _.....
THE COMMONWEALTH OF MASSACHUSETTS
�, OARD F HEA TH
No.. OF OF..... . . ,6'.lr�..............
FELL Z
Disposal nrAs Tnnntrurtion jrrmit
Permission is hereby granted........ ti
. ..-.........................................................................____�_»
to Construct or Re 'r ( ) an Inndiividual Sae/ge i sal Syst
at No..... -� I.. . �.Il CE>+Fu- ft [.i...r:............ ...... _....
as shown on the application for Disposal Works ConstrucliotL � ated....
. : :� �-......... . ._..._ ._... 7.
'yc; tlosrd of Health
DATE — ........ .. _. ...,_......1............................._.._
i
FORM 1255 HOODS 8 WARREN. INC.. PUBLISHERS
ti° ray TOWN OF BARNSTABLE
OFFICE OF
} XAUSTAUZBOARD OF HEALTH
f b AY k� 1 987 MAIN STA,EET
HYANNIS, MASS. OzBat
February 22, 1989
Y
Ms. Kathleen M.; Enbom
103-A Swan Lake Road
West Yarmouth, Ma 02673
Dear Ms. Enbom:
You are granted a variance from the Board of Health Interim Groundwater
Protection Regulation limiting sewage flows to 330 gallons per acre in certain
zones of contribution to public water supply wells.
This variance will allow you to install an onsite sewage disposal system at
Lot 301-B Lincoln Road, Hyannis, Ma., with the following conditions: '
'(1) The septic system must be installed in strict accordance to the submitted '
plan.
(2) The dwelling cannot contain more than three (3) bedrooms. Sewing rooms,
dens, lofts, mudrooms, enclosed parches, finished cellars, and similar
type rooms are considered bedrooms according to the Department of
Environmental Quality Engineering.
(3) The septic system shall be pumped every, three (3) years and written
certification submitted to the Board by a licensed septage hauler.
(4) The dwelling must be connected to public water.
(5) The dwelling must be connected to Town sewer when the- Department
of Public Works determines its availability.
This variance is granted because. it-is one of the few remaining vacant lots
in a developed area. It is the opinion of the Board that the installation of
another septic system in the area 'will not significantly alter the. poor quality
of the groundwater in the area. '
Sincerely yours,
Ann Jane Es baugh t
Acting C hairpercon
BOARD OF HEALTH
TOWN OF BARNSTABLE
AJE/bs
copy: Joseph Polcaro
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TOWN OF BARNSTABLE
LOCATION L' '�
4.4r SEWAGE
VILLAGE,, '. .S ASSESSOR'S MAP&PARCEL�7i—13 Z
INSTALLR' NAE&PHONE NO,f D2f'—y7U_ y� 5 Li 0
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type),'�—5 .�; ��� r, (size)
/d S _
NO.OF BEDROOMS
OWNER_/ Yl'DI�JF (j�iyl/"S
i
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility(If any wells exist on Feet
site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist within Feet
300 feet of leaching facility)
L FURNISHED BY , Feet
. GI
13
)31 147
11 ,E 131 LY
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7745213547 MW TRIBE HOUSING OFFICE Mashpee Wampanoag Housing 10:02:57 a.m. 08-07-2019 2/2
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3 DEPARTMENT OF HEALTH& HUMAN SERVICES
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Public Health Service COPY
Indian Health Service
Mashpee Service Unit
483B Great Neck Road
Mashpee, MA 02649
August 6,2019
Cecelia Gomes
295 Lincoln Road
Hyannis,MA 02601
Re:Approved Application,295 Lincoln Rd,Hyannis,MA,Service Request Number 76,
Project No. NS-18-HO4
Dear Ms.Gomes:
This letter is to notify you that your application has been approved for sanitation
facilities service as of July 24,2019.
The specific system to be install has yet to be determined;however,it will comply with all
State of Massachusetts Title 5 specifications and regulations for residential onsite
wastewater treatment systems.
Please remember that the time needed to plan and construct sanitation facilities is
variable. Our office attempts to provide these services in a timely manner,however
these projects often require planning and coordination with other agencies and/or
contractors that may cause delays.
Should you have any further questions,please contact me at 508-745-7120 or by email
at charles.th0MDSon(@,ihs.gov.
Sincerely
.�.•C�v��LG�ad�Lehr�aa.�ri .
LCDR Charles D. Thompson
Senior Field Engineer,TUC
cc: Project File
Homeowner File
Housing Department
7745213547 MW TRIBE HOUSING OFFICE Mashpee Wampanoag Housing 10:02:45 a.m. 08-07-2019 112
Q�E WAlajp
Nlashpee Wampanoag Housing Department
3� ^ 483 Great Neck Rd. South
Mashpee, MA 02649
Phone(50S)477-0 08 Fax 774-521-3547
r�ls�
Fax Cover
sheet
T0: FROM:
FAX. U�j (P3Cj v PAGES:
PHONE DATE: (Pick the datel
clt�J /Altt-I CC:
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Comments:
Our Mission is to Encourage Self-determination and Economic Independence for all Tribal Members
yoFt r a Town of Barnstable Bari b'e
` P
Inspectional Services Department All�fteiicaC
ffy
BARN67ABL€;
9. ,�� Public Health Division s
ArFO �e 200 Main Street, Hyannis MA 02601 2007
OPtice: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7012 1730 0001 4987 9682
June 26, 2019
GOMES, TYRONE V & CECELIA C
295 LINCOLN RD
HYANNIS, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 295 Lincoln Road, Hyannis, MA was inspected on
06/12/2019 by Chad Hathaway, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310,CMR 15.00) due to the following:
• Backup of sewage into the house due to an overloaded or clogged SAS or
cesspool.
You are ordered to repair or replace the septic system within sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
c an, O
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mading\Failed or Needs Further Evaluation Letters\295 Lincoln Road Hyannis.doc
♦
Town of Barnstable
♦
• BAMSfABMMAM
•'
�A 6 9 0. Inspectional Services Department
rED MA'f
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An"x" marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑ Leaching facility with standing liquid level at or above the invert pipe (per Town
Code.§360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is
required for every Hyannis Ma 02601 6/12/19
page. Citylrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
on the l computer, 13
use on the tab Chad hathawa
key to move your Name of Inspector
cursor-do not HPS
use the return key. Company Name
Company Address
Forestdale Ma 02644
Cityrrown State Zip Code
774 274 2581 12866
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ® Fails
6/12/19
Inspector's Sig ure Date
The system inspector sh submit opy of this inspection report to the Approving Authority(Board
of Health or DEP)within of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
5/6/2019 (8,788 unread)-hps1 oncape@yahoo.com-Yahoo Mail
Commonwealth of Massachusetts
t Titl(1 �
F1ffd rrlL�ssa Jn eetio n Form Home
Subsurface Sew
age age Disposal System Form-Not for Voluntary Assessments
295 Lin of d — e Delete Spam ompose property Address
Tyrone a,ng C Celia m
Yahooinbox I
64iSW" 9990wnees NarALF
information is Department ! PermitEyes-Mashpee Q
re for every H an Is _Ma-.- _.026
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CC f� istratio � A r�va 11:12 ANr P�,-
Drafts 43-' ' c d8t Mary
Sent Archive —
In pec+ti6fi�!9bMf'P&y: Complete 1, 2, 3, or 5 and all of 4 and 6.
Fee for your application has been calculated.You can now login to your
Spam 1) S steWPIA691y the fee. —
Trash Application T p ame Site Address Date Amount
Less I Nve not f u?icFan i 7ormati n w ' o the failure criteria described
in 310 CMR UbMce in 310 IM;2 15.30 exist. Any failurecriteria not evaluated are
Views Hide in y lie TnspItle 5 Chad Hathaway RUDMMERSEA 04/24/19 $25.00
ctio® Photos Comments- Report '?
Documents URL:http
L.//ptrmiteyes.us/mashpee/login sser.phP"
T is inspection is not a guaranteeand applies no warrantyof the described septic components in this
3< Deals re ort tg4WI not limited to piping structual intergrity of co ponents and life exspectancy of
Purchases le chiming a escr b_1�4ed I -—,n s ThlsTlnspectlon isYton gsc be conditions witnessed at time of
i& Groceries in p6etionlonly Regular tan�'malnCenance and water conseiva on can prolong life of septic systems
Information on care and o's rid n' can be found at town health de t or mass. ov
�i Travel
® Tutorials
Folders Show
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
I
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System form-Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is Hyannis Ma 02601 6/12/19
required for every y
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
11
❑ Observation of sewage backup or break out or,high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
3) 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.
a. 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is
required for every Hyannis Ma 62601 6/12/19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
r
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
�
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner information is Owners Name
required for every Hyannis Ma 02601 6/12/19
page. Cltyrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
® ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less
than %day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® 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.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
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
t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
i�
Commonwealth of Massachusetts
!� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owners Name
information is required for every Hyannis Ma 02601 6/12/19
page. Citylrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5))
t5insp.doc•rev.7/26/2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�� 295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owners Name
information is
required for every Hyannis Ma 02601 6/12/19
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Description:
no design on file
Number of current residents: 4
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No.
If yes, discharges to:
Is laundry on a separate sewage system?(Include laundry system inspection
information in this report.) ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use?
❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd)):
Detail:
Sump pump?
❑ Yes ® No
Last date of occupancy: current
Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owners Name
information is
required for every Hyannis Ma 02601 6/12/19
page. Cltyfrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present?
❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use:
Date
Other(describe below):
3. Pumping Records:
Source of information: owner pumped 1 month ago
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyr and Cecelia Gomes
Owner information is Owner's Name
required for every Hyannis Ma 02601 6/12/19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
1989
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 3.75'
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line:
5'
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
no signs of poor venting or leakage
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
1p Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owners Name
information is
required for every Hyannis Ma 02601 6/12/19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 3.5'
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene
❑ other(explain)
H10 1000 gallon tank tank riser on outlet tank overfull into riser
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 8'x5'
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
level in tank was over tees and into riser
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner information is Owner's Name
required for every Hyannis Ma 02601 6/12/19
page. CltylTown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade:
feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene
El other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. 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
El other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
- Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is
required for every Hyannis Ma 02601 6/12/19
page. Cltyfrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping:
Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. 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.):
full
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is required for every Hyannis Ma 02601 6/12/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No"
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
probed out saturated soil
Type:
® leaching pits number:
6'x4' precast
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:.
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is Hyannis Ma 02601 6/12/19
required for every
State Zip Code Date of Inspection
page. Cityrrown
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
saturated soil in leakching area probed
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
O. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is required for every Hyannis Ma 02601 6/12/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.� 295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is required for every Hyannis Ma 02601 6/12/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
a 55 i
3 - '? (0
i II
�3
d I - s 3
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
�^ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner Owner's Name
information is required for every Hyannis Ma 02601 6/12/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
6'
Estimated depth to high ground water: fe t
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
lot el. 56' low wet lands in area el. 30'
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
�d ,9 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
L
295 Lincoln Rd
Property Address
Tyrone and Cecelia Gomes
Owner . Owner's Name
information is
required for every Hyannis Ma 02601 6/12/19
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist)completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
ITI - CIUMMON WEAL I'I i OF MASSACI IUSETTS
EXFCIJTIVF OFFICE OF ENVIRONMENTAL AFFAIRS
_ llEPARTMLNT OF ENVIRONMENTAL PROTECTION JAB► 6 1999
ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500
TRUDY CO`i;F
350 MAIN STREET Secretary
ARGEO PAUL CELLUCCI WEST YARMOUTH,MA DAVID B. STRUHS
Governor 508-775-2800 Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
MAP 271 PAR 132
PROPERTY ADDRESS: 295 LINCOLN ROAD,HYANNIS ADDRESS OF OWNER:
DATE OF INSPECTION: DECEMBER 21, 1998 KATHLEE3N LEBLANC
NAME OF INSPECTOR: JAMES D.SEARS
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000)
COMPANY NAME: A&B Canco
MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673
TELEPHONE NUMBER: (508)775-2800
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,
accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper
function and maintenance of on-site sewage disposal systems. The system:
X PASSES
CONDITIONALLY PASSES
NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
FAILS
INSPECTORS SIGNATURE: DATE: DECEMBER 28, 1998
The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(30)
days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and
the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original
should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
NOTES AND COMMENTS:
revised 9/2/98 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIVICATION(continued)
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC, KATHLEEN
Date of Inspection: DECEMBER 21, 1998
INSPECTION SUMMARY: Check A,B, C,or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR
15.303. Any failure criteria not evaluated are indicated below.
COMMENTS: SITE OVERALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME
OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM.
B SYSTEM CONDITIONALLY PASSES:
N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The
system,upon completion of the replacement or repair,as approved by the Board of Health will pass.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate
of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the
inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or
exfiltration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a
conforming septic tank as approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s)or due to a broken,settled or uneven distribution box. The system will pa
pass inspection if(with approval of the Board of Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed
pipe(s). The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
revised 9/2/98 2
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC, KATHLEEN
Date of Inspection: DECEMBER 21,1998
C]FURTHER 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 IN ACCORDANCE WITH 310 CMR 15.303
(1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY
AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone
1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet
of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100
feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility
and the presence of ammonia nitrogen and nitrate nitrogen and is equal to or less than 5 ppm.
Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC, KATHLEEN
Date of Inspection: DECEMBER 21, 1998
D]SYSTEM FAILS:
You must indicate either"Yes"or"No" to each of the following:
N/A I have determined that one or more of the following failure conditions exist as described in 310 CMR
15.303. The basis for this determination is identified below. The Board of Health should be contacted to
Determine what will be necessary to correct the failure.
Yes No
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 over-
loaded or clogged SAS or cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged
SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than''Y2 day flow
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 surface water supply or tributary to a
surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,
attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and
nitrate nitrogen.
E)LARGE SYSTEM FAILS:
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:
N/A 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
mapped Zone II of a public water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local
regional office of the Department for further information.
revised 9/2/98 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC,KATHLEENQ
Date of Inspection: DECEMBER 21, 1998
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health.
X None of the system components have been pumped for at least two weeks and the system
has been receiving normal flow rates during that period. Large volumes of water have not been introduced into
the system recently or as part of this inspection.
N/A As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,including the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the interior of the septic tank was
inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid
depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site
Has been determined based on:
N/A Existing information.Ex.Plan at B.O.H.
X Determined 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)]
X The facility owner(and occupants,if different from owner)were provided with information on
the proper maintenance of Sub-Surface Disposal System.
revised 9/2/98 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC,KATHLEEN
Date of Inspection: DECEMBER 21,1998
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 220 g.p.d./bedroom for S.A.S.
Number of bedrooms(design) 2 Number of bedrooms(actual):
Total DESIGN flow
Number of current residents: 4
Garbage grinder(yes or no): NO
Laundry(separate system) (yes or no): NO If yes,separate inspection required
Laundry system inspected(yes or no): YES
Seasonal use(yes or no) NO
Water meter readings,if available(last two(2)year usage(gpd): 1997 74,100 CU.FT./1998 82,200 CU.FT.
Sump Pump(yes or no): NO
Last date of occupancy: PRESET
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: Gpd(Based on 15.203)
Basis of design flow
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:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
N/A
System pumped as part of inspection:(yes or no) NO
If yes,volume pumped: Gallons
Reason for pumping
TYPE OF SYSTEM
X 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.Attach copy of up to date operation and maintenance contract.
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information:
AGE OF SYSTEM 1989
Sewage odors detected when arriving at the site:(yes or no) NO
revised 9/2/98 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC, KATHLEEN
Date of Inspection: DECEMBER 21,1998
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 line
Diameter
Comments:(condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK:_X
(Locate on site plan)
Depth below grade: 42"
Material of construction 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 GALLON PRE CAST
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 25"
Scum thickness: 4"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 16"
How dimensions were determined TAPE AND PLAN
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.)
TANK AT WORKING LEVEL,OUTLET TEE,OUTLET COVER 42"BELOW GRADE,INLET COVER 18"BELOW GRADE,TANK
NEEDS TO BE PUMPED.
GREASE TRAP: N/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 9/2/98 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC, KATHLEEN
Date of Inspection: DECEMBER 21,1998
TIGHT OR HOLDING TANK: N/A (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 present
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:X
(locate on site plan)
Depth of liquid level above outlet invert: 0
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,)
D-BOX IS 16"X16"ONE IN,ONE OUT.BOX IS 50"BELOW GRADE,BOX IS CLEAN.
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 9/2/98 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC,KATHLEEN
Date of Inspection: DECEMBER 21, 1998
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not located,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,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
ONE(1)4'PRE CAST PIT,PIT IS 80"BELOW GRADE,PIT COVER IS 2'BELOW GRADE. VIWATER INPIT.NO HIGH WATER
MARK.PIT IS LEACHING.
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 be 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.)
revised 9/2/98 9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC,KATHLEEN
Date of Inspection: DECEMBER 21, 1998
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)
-"�ia� T
3-
,V ;
ss , �Ll�`� L
revised 9/2/98 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 LINCOLN ROAD,HYANNIS
Owner: LEBLANC, KATHLEEN
Date of Inspection: DECEMBER 21, 1998
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Ground water depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to no groundwater 12 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
X Obtained from Design Plans on record
Observation of Site(Abutting property,observation hole,basement sump etc.)
Determine it from local 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)
DEPTH TO NO GROUND WATER TAKEN OFF DESIGN PLAN.TEST HOLE 12', NO WATER.
revised 9/2/98 11
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOW[�1.. ................OF......BARIVSTABLE_....
j Appliration for Di-spuiiFal Worku Tomitrurtiun pamit
ags
Application is hereby made for a Permit to Construct (X) or Repair ( ). an Individual Sewage Disposal
System at:
-___Lincoln Road___ Lot #301-B �W1 1) Assessor's Map 27--_Lot 132
_... Location-•------••-----.--- -•............... ----...-----------------••----•.
Location-Address or Lot tio.
Kathleen M. Enbom 103-A Swan aR ;__W: Yarmouth, MA 02673
........................................... ...............................................
W Owner Address
Installer Address
Type of Building Size Lot__12.637-__-_____._Sq• feet
Dwelling—No. of Bedrooms........3.................................Expansion Attic ( ) Garbage Grinder ( )
44 44 Other—Type of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ..................................
W Design Flow.......330.............................gallons Mtxpmwttc er day. Total daily flow.._..........330_________ ___________.Vlons.
P: Septic Tank—Liquid capacity1O...0. lions Length---- Width-4'.30fl, Diameter................ Depth_S_-_-4'.--.
Disposal Trench—No..................... Width.................... Total Length............ Total leaching area....................sq. ft.
Seepage Pit No-------1------------ Diameter.._.10---------- Depth below inlet......4........... Total leaching area.204..........sq. ft.
Z Other Distribution box ( X) Dosing tank ( )
0-4 Percolation Test Results Performed by....M ._.J,..)QJaQVaU...............�...................._. Date------./11/89.................
Test Pit No. I________________minutes per inch Depth of Test Pit......12......... Depth to ground water....NIA------------
44 Test Pit No. 2.....2__......minutesper inch Depth of Test Pit------ Depth to ground water____N/.A....._.____.
�'..1-:0-2 ..`
0 Description of Soil.... top and subsoils 2'-6" sand with gravel and_cobbles,_
x coarse sand _
W TP__2_:0-2r___top__and__subsoil, 2' Sr sand with gravel and cobbles_z___5' 14' coarse sand
x
U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------._.____.____............_..
Agreement: i
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor an a with
TT/�14^
the provisions of 11.!,*• .5 of the State Sanitary Cod —The to 4erpgned further agrees not to placed s s�e� in
operation until a Certificate of Compliance has be e th
Signed• ` ... ...........----•---•• .4 --a•`3••6
Application Approved By... -• :.......... . . . ............ . ---- �•••.
ate
lication Disapproved for the following reaso ---------------------------------------------------------------------------------------------•----....••-•--
-----•----....----•-----------------------•----------------------------•----••----....-•----•--•--------•-----.._..--------------••------------------------------------------------------
Date
No. _.. / ------------------------ Issued.......................................................
Datz
L
Nam••,[..-....L.. Fs$.....7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN. - _..:.O F......I3 ........................................
--------------------
, pphrFation for Dispaii ai Mjarkfi Tonstraastiun pamit
Application is hereby made for a Permit to Construct (X) or Repair { } an Individual Sewage Disposal
System at:
..Lincoln Road Lot #301-s.................... a:Assesso s Map 271 iotr 32
_ - ....
Location-:Address or Lot No.
Kathlee . - - .............................................. ........._...........--•---•-----....---•---•-••....------------....................-----•---•---
v / Owner Address
Installer Address
Type of Building Size Lot-.12.1637...........Sq. feet
Dwelling—No. of Bedrooms----
._..3............................ 'Exp'a iP ion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ...................................
W Design Flow 334 gallons giktRp�9fX=p�r da�y. Total d�ily ���' 330------------------------ allons.
R: Septic Tank—Liquid capacityl ..gallons Length-_--0.."..... Width.4..:-�.0-_ Diameter---------------- Depth 5.."4.:__.
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter----10-.......... Depth below inlet:.....A.......... Total leaching area.204..........sq. ft.
Z Other Distribution box (X) Dosing tank ( )
1.4 Percolation Test Results Performed by....d....J....Dollaviw........................................ Date......
Test Pit No. 1----------------minutes per inch Depth of Test Pit------12�,....._. Depth to ground water----NA............
G=, Test Pit No. 2..... per inch Depth of Test Pit------ ......... Depth to ground water....NIA.__-.-_-----
x ------------------------ ------------...._.........----------------=------------.
Description of Soil....MAJ O-2°___top and subsoil. 2�-611__sand•with_gravel and co�bles,�
x coarse sand
w ----------------------------------------•- --
---------- --- ------------------------------------- -------
x TP 2:0-2 top and subsoil_p_,�§ m5 sand_with_gravel and cobbles. 5'_-147__coarse sand
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
-------•--•• - ..................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor an a with
provisions of i
the p ^T"'r' 5 of the State Sanitary Cod — The gned further agrees not to place s s em in
y::.;".
T operation until a Certificate of Compliance has b th �y
7 -
/ Signed. ,. ... _ . .............••••.... e� . .. .
at
Application Approved By..... , 'tl :......... ... .r.._._. ...... _. ... ......
ate
Application Disapproved for the following reason ..................................................................................................:.............
--------------•-•.........---••••....•-•••••-••-•--••----•--•------------....----`------.......------------..-...--.---------.......----------------------------------------------------------..-------
Date
Permit No----- /.Q� ---------------- Issued.....................................................
-
Da-_-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE LTH
�C/utJ�•-V.•-......OF... ... . ......Q .. }�.J3�-?5 :.................
Ilea of iratr of TuntpliFanrr
T V '. /EER,TJFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby...... S. .;i. a....... ........---•----•••....--•--..._•••-- •--•--------------•---. . --•---••-•----•--...... ....
at �o�^ nstaller [� �(� h
! - 1 I�•-a T! -f-I ----< II—S-------------------------------------•--------•-----•--
has been installed in accordance with the provisions of TI _ of Th State Sanitary Code as described in the
application for Disposal Works Construction Permit No.. --_ ��e'...... dated_.............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT WCONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....................................---------------•-------•----------•........ Inspector................... • ..........................................
THE COMMONWEALTH OF MASSACHUSETTS
QARD JOF HEA TH
NO.. � �. ......... 7.0101.. OF.. .. '66C FEE....7'`�.... ....
Disposal nr s �onstrn�tuan amit
• 1
Permission is hereby granted..........•-,-- , _....
to Construct or Repair ( ) an Individual Sew ge i sal Sys
1/�/� A 3
at No.•-• �� 1' �-�/}�LjE�.� �'.� h � �/ J w
}} -- -• ....... .........
�Screet
as shown on the application for Disposal Works Constructi� on- � �� ated.... --.. --G._�._......
------
.......................................... --.. -----.............-
G� Boardf of Health
DATE--- � •.I--•--••-•-----•-•-•--•••-
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ,
r
r
p�c Toffy TOWN OF BARNSTABLE
OFFICE OF
"'X"
rAas BOARD OF HEALTH
16.19• STREET
� 367 MAIN
6 MAY k'
HYANNIS, MASS. 02601
February 22, 1989
Ms. Kathleen M. Enbom
103-A Swan Lake Road
West Yarmouth, Ma 02673
Dear Ms. Enbom:
You are granted a variance from the Board of Health Interim Groundwater
Protection Regulation limiting sewage flows to 330 gallons per acre in certain .
zones of contribution to public water supply wells.
This variance will allow you to install an onsite sewage disposal system at
Lot 301-B Lincoln Road, Hyannis, Ma., with the following conditions:
(1) The septic system must be installed in strict accordance to the submitted .
plan. _
(2) The dwelling cannot contain more than three (3) bedrooms. Sewing rooms,
dens, lofts, mudrooms, enclosed porches, finished cellars, and similar
type rooms are considered bedrooms according to the Department of
Environmental Quality Engineering.
(3) The septic system shall be pumped every. three (3) years and written
certification submitted to the Board by a licensed septage hauler.
(4) The dwelling must be connected to public water.
(5) The dwelling must be connected to Town sewer when the. Department
of Public Works determines its availability.
This variance is granted because• it is one of the few remaining vacant lots
In a developed area. It is the opinion of the Board that the installation of
another septic system in the area will not significantly alter the poor quality
of the groundwater in the area.
Sincerely yours,
cu""
Ann Jane Es baugh
Act' C"ha �pe�w....
..�llb' V1141♦rv.uv.• ,
BOARD OF HEALTH
TOWN OF BARNSTABLE
AJE/bs
copy: Joseph Polcaro
<11
�6FTHB TOWN OF 0ARNSTABLE
OFFICE OF
ISAUSTAIM � BOARD -OF HEALTH
_ rasaM
s� 1639• �� 367 MAIN .STREET.
D MAY M'
HYANNIS, MASS. 02601
February 22, 1989
Ms. Kathleen M. Enbom
103-A Swan Lake Road
West Yarmouth, Ma 02673
Dear Ms. Enbom:
You are granted a variance from the . Board of. Health Interim Groundwater
Protection Regulation limiting sewage flows to-330 gallons per acre in certain
zones of contribution to• public water supply, wells.
This variance will allow you to install. an onsite sewage disposal• system at
Lot 301-B Lincoln Road, Hyannis, Ma., with the following conditions:
(1) The septic system must .be installed in strict accordance to the submitted
plan.
(2) The dwelling cannot contain more than three (3) bedrooms. Sewing rooms,_...
dens, lofts, mudrooms, enclosed porches, finished cellars, and similar
type rooms are considered bedrooms according to 'the Department of
Environmental Quality Engineering.
(3) The septic system shall.. be pumped. every, three. (3) years and written
certification submitted to the Board, by a licensed septage,hauler.
(4) The dwelling must be connected to public water.
(5) The dwelling must be connected to Town.sewer when,.the. Department
of Public Works determines its availability.
This variance is granted because it is one of the few remaining" vacant lots
in a developed area. It is the opinion of the Board' that the installation of
another septic system in the;area will not significantly alter the, poor quality
of the groundwater in the area. V `
Sincerely yours,
CUt4,A._
Ann Jane Es baugh
a.aug ♦..atnaap on
BOARD OF HEALTH �.
TOWN OF BARNSTABLE
AJE/bs
copy: Joseph Polcaro
I
Permi,_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF',�Hj!E�LTH
(trr#ifiratr of (g.umplintwr
T !I FY That the Ind'svidual Seveage Disposal System constructed ( ) or Repaired ( )
by.
[�i-
has been installed in accordance with the provisions of TI of Th State Sanitary Code as described in the
application for Disposal Works Construction Permit ti'o.�_ qf-.» � dated....._...............................THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.._._................_»._.. .�..��. .. ».�. Inspector _._
'-�• §ter tt``r ,5^�-^
A.M. Wilson
Associates
Inc.
June 7, 198g.
Thomas McKeon, Agent
Barnstable Board of Health
Town Hall
P.O. Box 534
367 Main Street
Hyannis , MA 02601
Re: 89-124, Snbom Property
Lot 301-a Lincoln Road, Hyannis
(our file 2. 0408 .0)
Dear Mr . McKeon:
To the best Of our knowledge and belief , the septic system
installed at the. above captioned site conforms to the
requirements .0f Title 5 and the Town of Barnstable Board of
Health requirements as set forth in its Variance of February 22 ,
1989 and is in substantial conformance with project plans
submitted with the Disposal Works installation Permit
Application.
Yours,
A. M. WILSON ASSOCIATES, INC.
Michael J. Donovan, P. E.
689MD6 :eko
Attachments : Variance, Board of health Inspection Certificate
and Installers Card
cc: Joseph PoIcaro
01ilmd)t i MA it?f,55
428 1450
6
i
TOWN OF BARNSTABLE
LOCATION_ �.�� � �rn (�,y,,�,�. SEWAGE #
VILLAGE /7c�ot ._ ASSESSOR'S MAP & LOT-77/-- ,10c2_
INSTALLER'S NAME & PHONE NO. C-,&rtg hU,4tt61S S'Y--acid{
SEPTIC TANK CAPACITY 1600
LEACHING FACILITY:(type) ego ! 4d C.. (size)
NO. OF BEDROOMS PRIVATE WELL O UBLIC WATER .
BUILDER OR OWNER
DATE PERMIT ISSUED: _ J
DATE . COI.IPLIANCE ISSUED:
k
VARIANCE GRANTED: Yes No
i
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to
X X X [(x�� Xfj
{{ a_
'�/ �T2 v J + ./� �r 7l �t �tlMl'D Pond ,� p.�-Y� � y '4l� �'.l +~".:^!�'R -=p�7 �•,( J ~ j r
T.P. 4hi/ I, \c.(/.� r j � � 137 4+ ,� l/ �� 1.1/•`G f V
1 w � -� V ;r� U f7 C�l).`T�»�y� rl 1,�•v f� � ����_
SITE LOCUS ;5
x NOT TO SCALE z z N pQ iF W.�W Q6N
SOIL TEST PIT DATA
.�
W>Z WoLi
TP-1 TP-2 w W ~z
0+ A --- 66.5 0" A 6.4 tz Q m z
� 10YR3/3 10YR3/3 zcWiQ z �
PROPOSED 4"DIA
LOAMY SAND LOAMY SAND w o
/ 10' 5.7 10' 5.6 �x r=
SCH 40 PVC PIPE S 12°00'07" W 25.00' o
1 �a LENGTH=14.0' ! B Bza
_ �_ i
SLOPE=2.00% I Y 10 YR 4/6 10 YR 4/4 N
r /
sl� j - LOAMY SAND LOAMY SAND
PUMP AND REMOVE REPAIR
DRIVEWAY AND by 22' 4.7 24' 54.4 C
EXISTING TANK
1 i WALKWAY i PROPOSED 4';DIA
(n l
SCH 40 PVC PIPE C C
LENGTH=44.0' 2.5 Y 4/4 2.5 Y 4/4
11
SLOPE=2.00% MED SAND MED SAND
PERC @ 38"
SLEEVE WITHIN
10'OF WATER <2 MIN/INS,_(
I PROPOSED 3 a N LINE
iVl I,Q�t OUTLET D-BOX N
w'�f CAA �^ / 132' 45.5 132 45.4
l.� J�o �h NO GW OBSERVED NO GW OBSERVED
JN OFFS PERFORMED BY: ELIZABETH KITTILA, HORSLEY WITTEN GROUP, INC
PERFORM TEST PIT AT
TIME OF CONSTRUCTION /O� REMOVE AND RESET WITNESSED BY: DAVID STANTON, HEALTH DEPARTMENT
TO VERIFY SOILS ` O o JOSEPH E. a
zs.00 EXISTING LIGHT POLE m DATE: JANUARY 17, 2020 Li- In
a � 19ri:NDERSO n+ w
c i+� DkL I certify that I am currently approved by the Department of Environmental Protection pursuant to 310
PROPOSED SOIL CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me ~ o
ABSORPTION SYSTEM ��, O PROPOSED 1,500 { consistent with the required training,expertise and experience described in 310 CMR 15.017. 1 further Z^ W
2-500 GAL, PRECAST I'' 129i GALLON SEPTIC TANK n �� certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are OoN z
CONCRETE CHAMBERS _Z —""-15.ss COVER TO �/11, j2� accurate and in accordance with 310 CMR 15.100 through 15.107. � m S &
GRADE I / / C) =:5
ss '_PUMP AND ABANDON
s 92°00'0 od' EXISTING LEACH PIT GENERAL SITE INFORMATION � aa
c IN PLACE
1. PARCEL ID 271 132. OWNER OF RECORD: TYRONE V& CECELIA C o N
I GOMES L'- N
O
BENCHMARK: ! , ADDRESS: 295 LINCOLN ROAD, HYANNIS MA Z M M
CB/DH EL.55.47, 2. LOT SIZE: 0.29 ACRES
Y 2
3. EXISTING DWELLING SEPTIC IS FAILED. PROPOSED UPGRADE TO a_ W �
TITLE 5 STANDARDS. m
4. NO KNOWN POTABLE WATER WELLS WITHIN 100 FEET OF THE m W
PROPOSED SANITARY ABSORPTION FIELD (SAS).
$ m 5. SITE IS LOCATED WITHIN THE GROUNDWATER PROTECTION "
+ 20' I -
o ,40' DISTRICT. SHEET
6. EXISTING VARIANCE FOR 3 BEDROOMS (2-22-89). 1 of 3
RISER TO WITHIN 9"OF FINISH GRADE OVER
FINISHED GRADE DISTRIBUTION BOXES=56.5 FT
PROVIDE COVER AND PROVIDE COVER FINISH GRADE
RISER TO WITHIN 6"OF AND RISER TO OVER TANK = _ _ :LOAM AND SEED I 1--j -
:r FINISHED GRADE GRADE EL.56.0 _ _ _ _ _ _ _ _ _
- - - CLEAN
- - - - - - -
,
PAVED DRIVEWAY - - _
BACKFILL _ _
Q''M1 1 'yW--' _
.• :BACKFILL _
JJ.•-- - - - - - - O =
FLOW , FLOW
'• - - - - - _ - - - --
( i
•i - 6110 F 3/4"
14
RESIDENCE :.r:: I I I-• •MIN '' I ( I -_-_ - - - - - - D PHE.
- - -
COMPACTED O JOSE
.. :• :,•Y � � i-• ... •••. _ - CRUSHED o ENDERSO n+
MINIMUM 48' STONE BASE v GV
a• -. >. ,
3"DROP GAS
- •IY : '+ BAFFLE
III •.:�•.. . .. ... . .. ... . .. .. .. .: . . .. : • �:.:: I^I -� � � �- • ,�,�
� r
I I III I _ -III NOTES. W
6"OF 3/4"COMPACTED 1. PROVIDE 3'OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL STABLE
CRUSHED STONE -� I I I UNDISTURBED EARTH -I I I I I I I- BASE.
2. BLOCK ONE OUTLET. w yz w rn
H-20 1500 GALLON MONOLITHIC SEPTIC TANK 3. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. w``'
SPEED LEVELERS(OR EQUAL)ON OUTLET PIPES.
NOT TO SCALE
4. INSTALL SP1 z ww r
PROPOSED 1500 GALLON MONOLITHIC CONCRETE PROPOSED H-10 DISTRIBUTION BOX DETAIL
�w O
SEPTIC TANK ACME PRECAST OR EQUIVALENT
LENGTH: 10'-2" WIDTH:6'-1"DEPTH:5'-7" NOT TO SCALE Zq- ..
3/4"TO 1-1/2"'DOUBLE WASHED RISER AND COVER TO
4"SCHEDULE 40 PVC STONE TO CROWN OF PIPE GRADE AT LOCATIONS
MIN SLOPE 1% SHOWN IN PLAN VIEW
TOP OF SYSTEM EXISTING GRADE 56± ►(aS
9"MIN.
BREAKOUT FILTER FABRIC
36rr M ` ,
":u.. •1-0a:. {:•�blvr�• ,ti .. .,... ._,,y;,,.,�,u„,';• 6+%+::V•rZ' .'•;��=y'L w%'•. It e
rr - �:a, ems• r �• Mid
rr, -
`'S
'�u::r.2crbs'��.i _ �iti;��.•.'�"'�'"��Y2..Ct'2 ����:x�„' .''a: y.�s'Y... +i; .�r!1.. ;�': e' ;tc�.a!�,,.�„��.:r.r� •.'k. •r tX
SCHEDULE OF EL EVA TONS
t''�'!:�-.."`.:aR 'k' .r. ti4 %j'.''rT'ice: •eta. �,Rad �}•°N: wt%K. � '-�p'.`: � wa i �•�' *. k�� Y�w ?4i' � I.a.)
�'. J:,yd.
2' ' s 'S s h EL, RUN SLOPE D
.. BUILDING FOUNDATION 59.30 N o o
31•' ... .� „! ".�'. $< � rx�, ,Y;Mrve' -��, .�fL'•- ='3=� •'I�'':•''•��.31�`.` +b• �A .J•
yi• ::• �� BUILDING INVERT OUT(EXISTING) 55.00 44.00 2.00% W
,. I SEPTIC TANK- INLET 54.12
4.0' �-- 8=5'(TYP) I 4.0' 4.9'(T c 4.0' c=i a
25.0 SEPTIC TANK- OUTLET 53.87
r I sP� 14.00 2.00% � psg S a
5'MIN. 12.9' „D"BOX- INLET 53.59
„l BOX- OUTLET 53.42 g �
i 14.00 1.00% °-
CHAMBER END VIEW o
PROPOSED H-10 500 GALLON CHAMBERS LEACH CHAMBER- INLET 53.30 o N
CHAMBER BOTTOM TO INVERT 2.00 O h
NOT TO SCALE LEACH CHAMBER- BOTTOM 51.30 Z M M
WIGGINS PRECAST OR APPROVED EQUAL BREAK OUT(TOP SYSTEM) 54.38
LOWEST FINISH GRADE 56.00 CL W
f MINIMUM COVER 1.62 > m o
HIGHEST FINISH GRADE 56.25 = x a
MAXIMUM COVER 1.87 0
G.W.ELEVATION 45.40 SHEET
0
ESHGW BELOW SEPTIC BOTTOM., 5.90 2 of 3
SURVEY NOTES WASTEWATER NOTES
1. THE TOPOGRAPHY AND EXISTING SITE CONDITIONS DEPICTED HEREON ARE THE RESULT.OF.AN,ON'THE GROUND
FIELD SURVEY CONDUCTED BY THE HORSLEY WITTEN GROUP, INC ON JANUARY 61 2020. 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS SHALL BE IN
ACCORDANCE WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF THE y
2. HORIZONTAL DATUM IS MASS STATE PLANE COORDINATE SYSTEM. DATUM ESTABLISHED BY SCALING ORTHOMETRIC LOCAL BOARD OF HEALTH.
PHOTOS PROVIDED BY GPS RTK.
2. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO LAYOUT AND
3. THE ELEVATIONS DEPICTED HEREON WERE BASED ON THE NORTH AMERICAN VERTICAL DATUM;(NAVD) OF 1988. � CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON IT.
4. THE PROPERTY LINES AND RIGHTS OF WAYS DEPICTED HAVE BEEN ESTABLISHED BY FIELD SURVEY AND DEEDS AND 3. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOCAL BOARD OF
PLANS OF RECORD. HEALTH (BOH) STAFF.
5. THE ACCURACY OF MEASURED PIPE INVERTS AND PIPE SIZES IS SUBJECT TO FIELD CONDITIONS, THE ABILITY TO _ 4. PRIOR TO CONSTRUCTION,THE CONTRACTOR SHALL COORDINATE WITH THE PROPERTY OWNER AND a
MAKE VISUAL OBSERVATIONS, DIRECT ACCESS TO THE VARIOUS ELEMENTS AND OTHER CONDITIONS. ` ENGINEER ON THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE AREAS.
z
0
6. THE LOCATION AND/OR ELEVATION OF EXISTING UTILITIES AND STRUCTURES AS SHOWN ON THESE PLANS ARE BASED 5. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY LOCAL AND/OR
ON RECORDS OF VARIOUS UTILITY COMPANIES,AND WHEREVER POSSIBLE, MEASUREMENTS TAKEN IN THE FIELD. + STATE PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE REQUIRED TO TAKE PLACE cz ix
THIS INFORMATION IS NOT TO BE RELIED UPON AS BEING EXACT OR COMPLETE. THE LOCATION OF ALL OUTSIDE OF NORMAL HOURS OF OPERATION FOR THE FACILITY. THE CONTRACTOR SHALL PLAN ,?� z E
UNDERGROUND UTILITIES AND STRUCTURES SHALL BE VERIFIED IN THE FIELD PRIOR TO THE START OF ANY ACCORDINGLY. zw v o=
CONSTRUCTION. THE CONTRACTOR MUST CONTACT THE APPROPRIATE UTILITY COMPANY,ANY GOVERNING r
``'7'z w
PERMITTING AUTHORITY IN THE TOWN OF BARNSTABLE,AND "DIGSAFE" (1-888-344-7233)AT LEAST 72 HOURS PRIOR TO 6. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE
ANY EXCAVATION WORK IN PREVIOUSLY UNALTERED AREAS TO REQUEST EXACT FIELD LOCATION OF UTILITIES. SHOWN ON THE PLAN TO THE DESIGN ENGINEER.
4 �N
7. THE PROPERTY IS LOCATED WITHIN F.I.R.M ZONE X AS SHOWN ON COMMUNITY PANEL NO, 25001C0566J DATED JULY 7• FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM OR CHANGES TO zW o
16, 2014. ,
EFFLUENT FLOW, GRADING, OR LANDSCAPING, EITHER ON-SITE OR ADJACENT TO THE SITE, MAY RESULT ,. s
o a
N IMPROPER FUNCTIONING OF THE SEPTIC AND LEACHING SYSTEM _I (S .)
z
8. REFERENCE PLANS: BARNSTABLE COUNTY REGISTRY OF DEED PLAN BOOK 271 PAGE 82. N
8. CALL"DIGSAFE"AT LEAST 72 HOURS PRIOR TO COMMENCING'CONSTRUCTION AT 1-888-DIG-SAFE AND
TREATMENT SYSTEM DESIGN CRITERIA ANY OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF EXISTING UTILITIES.
9. , THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE j
USE: SINGLE FAMILY GRINDER.
NUMBER OF BEDROOMS (DESIGN) 3 y `
TITLE 5 DESIGN FLOW 110 GPD/BEDROOM 10. ' THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY YEAR.
G
TOTAL DAILY DESIGN FLOW 330 GPD
11. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE PIPES ENTER OR
GARBAGE DISPOSAL: NO LEAVE ANY CONCRETE STRUCTURES.
SEPTIC TANK 12. ' USE SCHEDULE 40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. ALL
200% OF DESIGN FLOW. 660 GALLON 1 PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE.
a �
It
13. ` THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE INFORMATION FOR
USE NEW 1,500 GALLON SEPTIC TANK w 8
THE SEPTIC SYSTEM TO THE ENGINEER, IF NECESSARY. u
LEACHING SYSTEM DESIGN CRITERIA 14. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR 15255(3). ANY
ADDITIONAL AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL SHALL BE REPORTED TO THE O '"
ENGINEER. W
SOIL ABSORPTION SYSTEM !
mSET 5
15. / ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. w`°`co$
LEACHING SYSTEM USED: CONCRETE CHAMBERS 1 p 9B
g8
DESIGN PERCOLATION RATE: 2 MIN./IN. 16. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION AFTER ci g
SOIL CLASS: / CONSTRUCTION IS COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL BE LEFT NATURAL. mad
LONG TERM ACCEPTANCE RATE(LTAR): 0.74 GPD/S.F. THE CONTRACTOR SHALL TAKE CARE TO PREVENT DAMAGE TO SHRUBS, TREES, OTHER LANDSCAPING 3
TOTAL AREA REQUIRED-LOCAL CODE: 446 S.F. AND/OR NATURAL FEATURES. WHEREAS THE PLANS DO NOT SHOW ALL LANDSCAPE FEATURES, Q
' EXISTING CONDITIONS MUST BE VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE WORK. r
TOTAL AREA REQUIRED- TITLE 5: 446 S.F. p
17. + EXISTING SEPTIC TO BE ABANDONED PER TITLE 5 REQUIREMENTS. (310 CMR 15.354 .T
TOTAL AREA PROPOSED: IH OF 4 S. m = x
I �o JOSEPH E. m r
A(sidewall): (2 x 25.0'+2 x 12.9)x 2'x 2: 151 S.F. o HENDERSO r m
A(bottom): 25.0'x 12.9: 323 S.F. " CIv = W
Y
d
TOTAL AREA: 474 S.F. o� o
TOTAL ALLOWABLE FLOW. 350 GPD '
�OAIA SHEET
USE 2 500 GALLON CHAMBERS SURROUNDED IN 4-FT OF STONE 3�117 2a 3 OF 3
SOIL TEST PIT DATA: UANHOLE COVER TO VINISH GRADE I.� " „-�) NO )F OUTLETS: 3 �►is,o�:
I I NOTES: DATE OESCRIPT0N
24" DIA. COVER
" 12aMIN. 4'' 1. DIMIJIG TON BOX TO WITHSTAND H-10 6" 2" LAYER OF
INDICATES INDICATES OBSERVED 8 COVER ---.1 LOADING UNLESS UNDER PAVEMENT. DRIVES PEASTONE
I OR TRAVELED NAYS WHEREBY H-20 LOADING
PtBC ,r GJROUNDIATdJt � . - ., �. :�_ . •- . � - � I SHALL AtPI'1'. •• .
'i. ..
�� r J"-� - -- - - -- - - -- ---- - - - ,9 4 INLET M ZTEE i 151 i 22. PROVIDE INLET TEE AS SHOWN WHERE o y INLET N
TP No. I 2 1 i 13 Mat Mvrtq I ORINE OF thST PIPE A PUk°ED SYSTEM.
ODd FT/FT av °0o0 r
TP No. 1000 GAL. , L___ J 1
GRD EL 10 0.I GRDJrL 9 9.8 - - I 3 19 V 1
A MttCAlT�STEEL �- 4'-l0" i J. FIRST T1IG FEET OF PIPE OUT OF THE 3/4"-I I/2"
N A N.A. RlINfORCEO DISTRIBUTION BOX TO BE LAID LEVEL
' 4- �� PLAN VIEW
GW.EL GW.EL -'� s[/T1C TANK - r 4-4 i INLET OUTLET %� WASHED
0 0- H-IO 4 -6 TEE LIOUID N. TEE 5 4 ROTC DO 01,APP DEDMANUFACTURER
EQUAL. - STONE
' ' *. 4 4 Locus
1 TOP a SUBSOIL 1 TOP a SUBSOIL I •� s/I4•To H/t`sTONE
REMOVABLE COVER
2_ '' 13/4�
IL = - - - - - - -- - •- - - - - - - - � !S•DIA.OUTLET(S)
SAND BOTTOM ON LEVEL STABLE `ASE �• r�� 3' �- pfpa o
o p
3 SAND . . e: 0 • �WAT Rlf °o.o °o° d�' e
WITHJOIN7v
3 WITH Z4 DIA.MANHOLE COVER --.-�
4 4 GRAVEL 8� 4 INLEMT .]
4�OUTLEt I I 2' - x t-
GRAVEL a CROSS SECTION VIEW -�I if- - 6 D I A. -n �4-- 2 f r 4 References: '
COBBLES �� VIEW 14
5- COBBLES 5 - 94.8 NOTES: 7 1/2" -10 - 'DIA.
I I 'S�DUI
COARSE
!. SEPTIC TANK TO WrrHSTAND H-10 LOADING J. INLET AND OUTLET TEES TO BE CAST IRON, BOTTOM G INLET
PLAN OF LAND IN BARNSTABLE
---- ---- - 94:' SAND 93.8 UNLESS UNDER PAVEMENT. DRIVES OR TRAVELED SCHEDULE 40 PYC OR CAST-IN-PLACE CONCRETE.
6 6 oy►• q„ .WAYS. WHERE BY H-20 LOADING SHALL APPLY. TEES TO BE CENTERED UNDER MANHOLE COVER. 2 J • • LLEV 91t
FOR PHYLLIS M. TYRONE BY
COARSE SAND
7 T 2. ALL PIPE CONNECTIONS AND CONCRETE CON- 4. RECOMMENDED MANUFACTURER - ROTONDO OR CROSS SECTION VIEW 6"MI K 3A•TO ASSESSORS MAP 271 L 0 T 132 C H A R L E S N. S A V E R Y, DATED
STRUCTION TO BE WATERTIGHTAPPROYaD EQUAL I K_10 F-V2•STONE
8 NO WATER 8 NO WATER LEACHING PIT DETAIL MAY 4, 1973.
s ENCOUNTERED ENCOUNTERED SEPTIC TANK DETAIL NO. OF GALLONS: 1000 DISTRIBUTION B31X DETAIL LOCUS MAP Q.
NOT TO SCALE NOT TO SCALE NOT TO SCALE SCALE V-2083- N
10 10
DESIGN ANALYSIS
11. 11
BOTTOM OF BOTTOM OF
12 HOLE 88.1 14 HOLE 85.8
DESIGN .
DAM. DATIL 3 BEDROOM X' 110 GPD/BEDROOM = 330 GPD
- II-89 I-II-89
7F.ST BY.M.DONOVAN TEST ST'M.DONOVAN
Project Title
WITNESSED Br. WITNESSED sr. _SYSTEM PROFILE '
G. DUNNING G. DUNNING � NOT TO SCALE SEPTIC TANK REQUIREMEJYTS:
330 GPD X 150% = 495
PERC. RATE.- PERC.TRAM DWELLI NG MANHOLE AND COVER FINISH GRADE TO HAVE
Y7ll►,/IMC1 �2 dflN,/tNCR
BROUGHT TO FINISHED GRADE jTYP) MIN. 20/c SLOPE OVER USE 1000 GAL. TANK
FINISH GRADE
LEACHING FACILITY
100.5
TOP OF TP IVa. Tr No. FOUNDATION
LOT B
GRD.EL GRD.EL = 102.00 FIRST VIVO FEET TO BE
�n.,,
G�1'.EL GW.EL 1/4"/ FT - ( TYP)
0 0 LAID LEVEL _ 2 LAYER OF PEAS TONE
LEACHING FACILITY REQUIREMENTS: = 330 GPD LINCOLN
1 1 98 0 \97 55 97 47 9730 �Q T �C o 6 DIA. 4 DEEP PIT W, 2 STONE 97 80 H-10 97. i6 3/4"- 1 1/2" WASHED STONE SIDE AREA = 125.6 SF ( 2.5 GPD/SF) = 314 GPD ROAD
1000 GALLON DISTRIBUTION
REINFORCED CONC. BOX 4
2 2 ' BOTTOM AREA =i 8.5 SF (1 0 GPD/SF) = 78.5 GPD
a'.
HYANNIS
SEPTIC TANK o° �v 0 392.5 GPD
S 3 TO BE INSTALLED ON A ®� os, op �U� `
MA.4 4 LEVEL, STABLE BASE BOTTOM EL.- 93. 16
S S LEACHING PIT
6 6
7 ' LEACHING FACILITY PROVIDED:
1-6' DIA., 4' DEEP PIT W/2' STONE
8 8
CAPACITY PROVIDED 392. 5 GPD
8 B
CAPACITY 'RE-QUIRED 330 GPD
10- 10 -
11 11
12- 12
NOTES
DATA DATA - _ 9-fi- / 1 UNLESS OTHERWISE NOTED, ALL CONSTRUC-
- A'rr
-aX-X TION METHODS AND MATERIALS SHALL CON- PREPARED FOR:
TEST Br TEST BY: _gg
FORM TO TITLE V OF THE STATE ENV/RON-
MENTAL CODE AND ANY APPLICABLE LOCAL
wrrNFSSED ST.- IIITNESSED ST. RULES AND REGULATIONS.
7 4� WIRE FEN I 6� STOCKADE FENCE- N 0 T E S 2 GROUT TO BE USED AT ALL POINTS WHERE
rERc.RATS rERc. RATE t PIPES ENTER OR LEAVE ALL CONCRETE
KIN,/INCH TIGHT
SEEALAL MIN,/1NCH 1 I)PROIDERTY LINE SHOWN HEREON WERE COMPILEC T /N ORDER TO PROVIDE A WATER-
FROM A PLAN RECORDED AT THE BARNSTABLE TIGHT
x REGISTRY OF DEEDS IN PLAN BOOK 271 PAGE 82 3 ALL SHIPLAP JOINTS IN SEPTIC TANK SHALL
AND DO NOT REPRESENT AN ACTUAL SURVEY BE SEALED WITH NEOPRENE GASKETS OR
ON THE GROUND. ASPHALT CEMENT TO PROVIDE A WATERTIGHT
INVERT ELEVATIONS ` x SEAL
PWF
4 PRECAST CONCRETE SEPTIC TANK. DISTRIBU-
Iao I T/ON-BOX. AND LEACHING FACILITY TO WITH-
INVERT AT BUILDING 98.00 x 2)ELEVATIONS ARE BASED ON AN ASSUMED DATUM. STAND H-10 LOADING UNLESS UNDER PAVE-
MENT,
� �� TRAVELLED WAYS WHEREIN A.M.
4- INVERT AT SEPTIC TANK (in) �, - aI
tes
97.80 H 20 LOADING SHALL APPLY.
4'INVERT AT SEPTIC TANK (out) 97.55 LOT B Inc sociates
12, 637 SF x S ALL PIPES IN THE SYSTEM SHALL BE SCNED-
0.29 AC. 3)LOT IS LOCATED IN A TOWN OF BARNSTABLE ULE 40 OR EQUAL
4' INVERT AT DIST. BOX (in) 97.47 GROUNDWATER PROTECTION OVERLAY DISTRICT.
E FREE OF
. x
I' INVERT AT DIST. BOX (out) 6 WASHED CRUSHED STONE SHALL B
9730 ALL DIRT. DUST AND FINES.
PROPOSED I 911 Main Street
I STORY 7 AT ALL POINTS OF INTERSECTION OF WATER Osterville/MA 02655
INVERTS AT LEACHING FACILITY: 3 BEDROOM x 4)ALL UNSUITABLE MATERIALS WITHIN 10' OF THE LINES AND SEWER LINES, BOTH PIPES SHALL 617-428-1450
WOOD FRAME LEACHING FACILITY SHALL BE REMOVED AND BE CONSTRUCTED OF CLASS ISO PRESSURE
4' INVERT AT.BEGINNING OF I STORY �p�~ #301 PIPE AND ARE TO BE PRESSURE TESTED TO
LEACHING FACILITY 97. 16 p �p REPLACED WITH CLEAN SAND HAVING A PERCOLATIC ASSURE WATERTIGHTNESS. Drawing Title:
WOOD FRAME p HEDGES RATE OF LESS THAN 2 MINUTES PER INCH.
DWELLING '
4' INVERT AT END OF _ T.O,F = 102.0 8 SEPTIC TANK DISTRIBUTION BOX. ETC.
LEACHING FACILITY SHALL BE MANUFACTURED BY ROTUNDO OR
10 AN EQUIVALENT MANUFACTURER.
ELEVATION AT BOTTOM OF MIN. PROPOSED
93.16 w 9 EXCAVATE ALL UNSUITABLE MATERIAL IN SUBSURFACE
LEACHING FACILITY 1000 G� . > WATER SERVICE
LEACHING AREA AND BACKF/LL WITH CLEAN
� 0 0 SEPTIC 4NK o GRAVEL OR COARSE SAND.
OBSERVED GROUND WATER NOT 100 I SEWAGE
ELEVATION ENCOUNTERED {D.BOX o Q
10 HEAVE' EQUIPMENT SHALL NOT B ALLOWED
-6 CHIt DEEP w TO OPERATE OVER THE LIMITS OG THE DISPOSAL DESIGN
LEACHI� G PIT 0 ,_ SEWAGE DISPOSAL SYSTEMS DURING THE
I CrO .� o COURSE OF CONSTRUCT/ON OF THE SYSTEMS.
99 8 0` 11 NO FIELD MODIFICATIONS TO THE SEWAGE by o!
B.IV1. EL =I00. - I DISPOSAL SYSTEM SHALL BE MADE WITHOUT 4
10' MIN 2# PRIOR WRITTEN APPROVAL OF-THE ENGINEER mot MIr,HAEf� ,
CB/DH AND THE LOCAL BOARD OF HEALTH. 3 v
�. 12 THIS SYSTEM SHALL BE INSPECTED- AS RE- s ! 1230 1
QUIRED BY SECT/ON 2.10 OF.TITLE V.
BITUMINOUS WALK
- ---- 13 A CERTIFICATE OF COMPL NCE AS RE-
PAVE QUIR1iD BY SECTION 2.8 OF LE V MUST BE
�EDGE>i OF OBTAINED BY THE CONTRACTOR UPON COM-
E / PLETION OF THE ABOVE WORK. IF AN 'AS
98 I*-GAS LI E 99 BUILT' PLAN IS REQUIRED DUE TO CONTRAC- '
L I N C 0 L N ' (50' TOW 4 WAY) _ ROAD TOR DEVIATING FROM THESE PLANS. WORK fib: 1-s 20
\ FOR SUCH 'AS BUILT' PLANS SHALL BE
\ I COMPENSATED BY THE CONTRACTOR
;---- 2.0 40 6OFEET
EDGE I OF PAVE =
U. _ , 0 P. 14 THIS SYSTEM IS NOT DESIGNED FOR , A
u P- - �� p H w .^__�_ 1 _ -- _ GARBAGE DISPOSAL. UNIT, Date: 1 - 12 -89 D" No
i 15 ALL ELEVATIONS ARE BASED ON A SS U M E i DoWni M J D
DATUM.
Crack
Drawn: J V B
Job No - 2 -,,40 r3 0 Sheet I Of I