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Home My WebLink About0309 LINCOLN ROAD - Health 309 Lincoln Road Hyannis A=271 080 I 0 � a e �I I . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 309 Lincoln Road �°�� "" g-o 3 Hyannis s ; Owner's Name: Sharon DeJesus -K Owner's Address: Date of Inspection: 5/6/2006 c _ Name of Inspector: (please print) Patrick T. Sullivan ' s Company Name: Ready Rooter `y 041 Mailing Address: P.O.Box 371 c-D r` v; r� Sandwich, MA 02563 Telephone Number: (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: VfT Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: Date: 52 ' 1 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving ' authority. Notes and Comments ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ZI have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pas 'section need to be replaced or repaired.The system,upon completion of the replacement or repair,as ap oved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the fol wing statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the se p c tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank ilure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as appr ved by the Board of Health. *A metal septic tank will pass inspection if it is structurally ound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availabl . ND explain: Observation of sewage backup or break out o high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or un ven distribution box. System will pass inspection if(with approval of Board of Health): bro n pipe(s)are replaced ob ction is removed di ibution box is leveled or replaced ND explain: The system required pumping re than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of th Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: I Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 C. Further Evaluation is Required by t/surface of Hea Conditions exist which require furthon y the Board of Health in order to determine if the system is failing to protect public health,safety or t ent. 1. System will pass unless Board of termines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manh will protect public health,safety and the environment: _Cesspool or privy is within 50 frface water Cesspool or privy is within 50 frdering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public ter Supplier,if any)determines that the system is functioning in a manner that protects the public he h,safety and environment: _The system has a septic tank and soil absorption s stem(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface w7SASPis py. _The system has a septic tank and SAS and within a Zone 1 of a public water supply. _The system has a septic tank and SAS an the SAS is within 50 feet of a private water supply well. _The system has a septic tank and SAS d the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method use to determine distance "This system passes if the well water alysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds i icates that the well is free from pollution from that facility and the presence of ammonia nitrogen and ni to nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of t e analysis must be attached to this form. 3. Other: r Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z 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 well. ✓ Any portion of a cesspool or privy is 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] AD OYes/No)The system fails. I have determined that one or more of the above criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facil' with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the follow- g: (The following criteria apply to large systems in addition the criteria above) yes no the system is within 400 feet of a surface inking water supply _the system is within 200 feet of a trib ary to a surface drinking water supply _the system is located in a nitrogen ensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public w/supplyell If you have answered"yes"to in Section E the system is considered a significant threat,or answered yes"in Section D above the las failed.The owner or operator of any large system considered a significant threat under Sectionder Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner shoe appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? ✓Have large volumes of water been introduced to the system recently or as part of this inspection? /11A 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 s oles 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 than 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: Yes No _ 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): j DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):s� (A.''•Zs Number of current residents: c�. Does residence have a garbage grinder(yes or no): Qcz:� Is laundry on a separate sewage system(yes or no):QL--D[if yes separate inspection required] Laundry system inspected(yes or no):1 Seasonal use: (yes or no):A� 7 ;> Water meter readings,if available(last 2 years usage(gpd)):n cna c= S'1 Sump Pump(yes or no): Last date of occupancy: Cc�r a�vt COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 31 03 gpd Basis of design flow(seats/peM5 ): Grease trap present(yes or no Industrial waste holding tank resent(yes or no):_ Non-sanitary waste dischar d to the Title 5 system(yes or no): Water meter readings,if ailable: Last date of occupancy/ se: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: " �, _� - �c�;..•,,Q� fV, ac�cU�" Was system pumped as part of the inspection(yes or n °CAS If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: �� ,o� 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 ob_tained from system owner) _Tight tank _Attach a copy of the DEP approval V Other(describe): Approximate age of all components,date installed(if known)and source of information: 39 y tx�-- SAb�ge, <nPr- �-N cl — \mot S S' Were sewage odors detected when arriving at the site(yes or no): ADO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 BUILDING SEWER(locate on site plan) Depth below grade: 3 � Materials of construction:_cast iron V40 PVC_other(explain): Distance from private water supply well or suction line:/ Comments(on condition of joints,venting,evidence of leakage,etc.): SC:.�z�.�—' �'�..� t�c o�a c +Cs-.� `�.►-r.w�. ,C-.�:�T'Z".r�� Lw� r�u�.` '1v.—F SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete_m tal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confi ed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from the top of sludge to b om of outlet tee or baffle: Scum thickness: Distance from top of scum to top outlet tee or baffle: Distance from bottom of scum to ottom of outlet tee or baffle: How were dimensions determ' d: Comments(on pumping reco endations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fibe ass_polyethylene_other (explain): / Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or b ffle: Distance from bottom of scum to bottom of outle tee or baffle: Date of last pumping: Comments(on pumping recommendations, ' et and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leaks e,etc.): i I Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 TIGHT or HOLDING TANK: (tank must be ped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_met _fiberglass_polyethylene_other(explain): Dimensions: Capacity: VgallDesign Flow: ay Alarm present(yes or no): Alarm level: Alarder(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be ened)(locate on site plan) Depth of liquid level above outlet invert: Comments(not if box is level and list ion to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump amber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 SOIL ABSORPTION SYSTEM(SAS): locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): N � 1 CESSPOOLS: cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: t Depth—top of liquid to inlet invert: j Depth of solids layer: ca Depth of scum layer: ( " Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):A_3=) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): (... •U c��Q i,G U"�.� .�•� �Y.:�,A�_ � 'Ot__)\ 1'fZ.�. \�U�S.�. .IL�@] .��ck l�� Q� -*JA . PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs/oydraulic failure,level of ponding,condition of vegetation,etc.): r Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. -b-�= 3 C Q `= 3 G Page I 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 309 Lincoln Road Hyannis Owner: Sharon DeJesus Date of Inspection: 5/6/2006 SITE EXAM Slope Surface water Check cellar✓- Shallow wells Estimated depth to ground water X-2—feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record—If checked,date of design plan reviewed: _IZObserved site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators,installers-(attach documentation) _,GAccessed USGS database-explain: You must describe how you stablished the high ground water elevation: e<- 0 �o� �•�cps . • No. aco (P L-�-OU Fee ZQV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �Diopo!gal bp.5tem Cowaruction Permit Permission is hereby granted to Construct ( ) Repair ( V Upgrade ( ) Abandon ( ) System located at Zes� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditi — Provided: Constructi�n/mu a completed within three years of the da of this pe Date �7 Approved THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (L.-IT Upgraded ( ) Abandoned( )by �. at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 5�4 Installer ��.4�-� _,�ti�� .�. Designer #bedrooms Approved design flow — gpd The issuance of this permit s ll tt�be)o�nstrued as a guarantee that the system will.funct' de igned. Date / (JY Inspector TOWN OF BARNS,ABLE LOCATION SEWAGE # VE.LAGE �,.�'. 25 ASSESSOR'S MAP & LOT II ='S NAME&PHONE .r--,�,. r . cess�C . . SE 4- K CAPACITY �S LEACHING FACM=: (type)0U 5, (size) 5- NO.OF BEDROOMS ` BUILDER OR OWNER y PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� Sl� r �� .' � _QZ w No. V v Fee /y 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for �Bi$po5al gpp5tem CCon5truchon Permit Application for a Permit to Construct( ) Repair((f Upgrade( ) Abandon( ) ❑ Complete System ®Individual Components Location Address or Lot No. `v1 G Owner's Name,Address,and Tel.No. k_` ___h ' ��.A�®ice �'L-��.�� Assessor's Map/Parcel ® 5"® S Installer's Name,Address,and Tel.No. 60S5' Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) VQ, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S'gned Date Application Approved by Date SOYV (40 _ Application Disapproved by: Date forthel following reasons Permit No. ' 00 (0 Date Issued y Ile , No. .cs�L i J d�-�6. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Mi.5posal *p.5tem Construction Permit Application for a Permit to Construct( ) Repair((♦Upgrade( ) Abandon( ) ❑ Complete System ®Individual Components Location Address or Lot No. 3CDF� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. SO P-?'Pr-6o 3�5' Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures' Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil a i Nature of Repairs or Alterations(Answer when applicable) y Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S'gned _ Date Application Approved by _ Date Application Disapproved by: Date for the following reasons Permit No. ',�)CEO (0 - � Date Issued C1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (�/j" Upgraded ( ) Abandoned( )by QXCQI'11 at 3 C-D=I , .�r.�,5� m Q - has been constructed in accordance f with the provisions of Title 5 and the for Disposal System Construction Permit No. ;:4.c-n(� -�D K- dated 5 A p Installer ��A�`g hoc" r, - Designer —" #bedrooms ""` Approved design flow -- gpd The issuance of this permit shall not be.construed as a guarantee that the system will function as designed. Date '4, r'i n Inspector_"---- nspectorf -----/—�------------------------------- No. r 1 0 (s r),-oF1" Fee 06 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migo!aY *p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( V Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructi n mus be completed within three years of the date-his per it. Date �� 'P Approved b -. .L.V 1V V1-.V "%I'mo*1 rLWL.Li_ .- .. LOCATION � � �--�� a SEWAGE # VILLAGE� ASSESSOR'S MAP & LOT 9+ 'S NAME&PHONE SERT NK CAPACITY LEACHING FACILITY: (type)C!)Ue-,X4\1--R.. (size) 'NO.OF BEDROOMS BUILDER OR OWNER• PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by�� S►. �'r ��°� 1 c tA - 3S -3c � - A a , 1