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Home My WebLink About0363 LINCOLN ROAD - Health 363 Lincoln Road F Hyannis-` A — 271 z, 082002 w i f Commonwealth of Massachusetts Title 5 Official Inspection Form S4 514 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is September 15, 2008 Hyannis MA 02601 Se required for H Y p every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name r� 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority September 15, 2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or f has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-3033.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sys f�m•Page 1 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is p required for y H annis MA 02601 September 15, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5-3033.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is Hyannis MA 02601 September 15 2008 required for Y p , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5-3033.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form I - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is H annis MA 02601 Se tember 15, 2008 required for Y P every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All-Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ E 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. t5-3033.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 f . r_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 363 Lincoln Road Property Address _ Arthur Archer Owner Owner's Name information is September 15, 2008 Hyannis MA 02601 Se required for H Y p every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5-3033.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 s Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is September 15, 2008 Hyannis MA 02601 Se required for Y P every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? SAS also evaluated ® ❑ 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)] t5-3033.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is September 15, 2008 Hyannis MA 02601 Se required for H y p every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 gpd Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 85 gpd 9 ( Y 9 (gpd)) Sump pump? ❑ Yes ® No Last date of occupancy: 1 year ago Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5-3033.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is Hyannis MA 02601 September 15, 2008 required for Y p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Reason for pumping: maintenance 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 3+. Certificate of Compliance issued 114105(Board of Health permit#2004-595) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-3033.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is September 15, 2008 Se Hyannis MA 02601 required for H Y _ p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leakage or backup into dwelling was observed. Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 10.5 ft x 5 ft x 5 ft(1500 gallon) Sludge depth: 4 in Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 1 in Distance from top of scum to top of outlet tee or baffle 9/n Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? As Built Card t5-3033.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is Hyannis MA 02601 September 15, 2008 required for y p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last um in P p 9 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5-3033.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is Hyannis MA 02601 September 15 2008 required for Y p , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet inverts 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.): D-box appears level with no evidence of leakage in or out. Few solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-3033.doc-08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is Hyannis MA 02601 September 15, 2008 required for Y p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching gallery appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching gallery stone and no standing effluent or effluent contact staining was observed in the stone or overlying soils. t5-3033.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is September 15, 2008 Hyannis MA 02601 Se required for H Y P every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): t5-3033.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is Hyannis MA 02601 September 15, 2008 required for Y p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. LEACHING GALLERY 0 0 LOCATIONS A B 3 o D-SOX 1 32 Ft 2 8 f t 2 38.5 FL 23 ft zo 3 42 ft 28 FL SEPTIC TANK B A EXISTING DWELLING # 363 W Z J W I H 3I L_INCOL_N ROAO NOT TO SCALE t5-3033.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 363 Lincoln Road Property Address Arthur Archer Owner Owner's Name information is September 15, 2008 Hyannis MA 02601 Se required for H y p every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 25+feet 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: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 25 feet above groundwater table. t5-3033.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 f 7Q GQT TOWN OF BARNST.ABLE ' LOCATION ke$�*3 — e� SEWAGE # t`1 LAGE_/ jl/I/ �ASSESSOR'S MAP& LOT o?7/-09-1-00,Z INSTALLER'S NAME&PHONE NO.Z9 �X CrGaid^ �✓IG ��y77 612 } SEPTIC TANK CAPACr1rY '�r� ? LEACHING FACILITY: (type) (size) I� NO. OF BEDROOMS. BUILDER OR OWNER rid ridr, Cd PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 391 ova' a3q3 'p L6 2�ser No. � THE COM94ONWEALTH OF MASSACHUSETTS FEE / BOARD OF HEALTH ,"-, EALTH ,., APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (V) Repair ( ) Upgrade ( ) Abandon ( ) - n/Complete System ❑Individual Components Lo tion Owner's Name 0a�r 0i1 L --6aZ �c —moo Map/Parcel# Address Lot# sle hone# ins ��Cca �C� p ; Installer's a e Designer' Name Addres1 � Address r Telephone# Telephone# Type of Building: Lot Size G s'53 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures ryI Design Flow(mi required) gpd Calculated design flow (/�� gpd Design flow provided3r_�gpd Plan: Date 1" Number of sheets Revision Date Title A AJkX h j,6,Cj � , e ,l ( Description of S il(s) �� I� �u� r 3� \ca t (oC� ,3U ��flr, �I 5��U,_ � Z"I�^� 50 Soil Evaluator Form No. Name of Soil valuatorJ,'SaJ 1 t Date of Evaluati n 1 n-La-o V DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install th above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe grees no plat system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspectio s FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 .•c�:.r.,-_:i"i"t• .'..-n. .,. ..^s.,, -•fir-• a` �-., Y-......,. ,w�vv.....y�+.�.�,,,..•..o^...-.,.�.:¢:�.y%.'"4._�r_,-�. ,p�;'^.v ;•-...,�..-,.-•.7,�. Y.+•j _. .4..n u .p�.,,.r• R f V No. E C:O OPIWEALTH OF.MASSATS FEE . �V ,)OARD OF HEALTH" o F APPLICATION FOR'DISPOSAL SYSTEM CONSTRUCTION PERMIT , 1 a ion foc a, erostr�uct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - Complete System []Individual Components Loc tion Owner's Name ffleO,)I� OLA oM661 -- x �T Map/Parcel# Address I �yt b e lj ins a elephone Installer's a e 1 Designer' Name Address 1 Telephone# Telephone# Type of Building: Lot Size Z0 1sl53 Sq.feet , Dwelling—No.of Bedrooms Garbage Grinder ( ) f Other—Type of Building No.of persons Showers ( ), Cafeteria O { Other fixtures 7 a Design Flow mint,,required)�5 gpd Calculated design flow ZZ U gpd Design flow provided�7��gpd Plan: Date I. D'C Number of sheets Revision Date Title �n C (Yl &0� . Description of S�il(s) U 01"(tip .b r 3a au 5./�-� Soil Evaluator Form No. Name of Soil Evaluator-_9 Sant t.'hti Date of Evaluati n (.—ti•O V" DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to'nstall th above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe grees no Iliacelsystem in operation until a Certificate of Compliance has been issued by the Board of Hea(ltf. Signed Date f* Inspect) )s jY fi FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 NO. 2OO , ' THE COMMONWEALTH OF MASSACHUSETTS FEE IS�1 S � BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ['Complete System QoCJrt�aMS 0��y The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) at (� ^C4ater A.�ni�l has been installed in accordance with fhe provisions of 31P MR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. S dated 1 O Approved Design Flow a 2.0 (gpd) �+ Installer lit r ., Designer: Inspector w ` ate '1 y The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. —52P5 THE COMMONWEALTH OF MASSACHUSETTS FEE /5o BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebY�granted to Construct (hR air ( )) ,Upgrade ( ) Abandon ( ) an individual sewage — disposal system at J b 3 L, c o ( as described in the application for Disposal System Construction Permit No. U L/ —5 9 5 dated 1 I I0 Provided: Construction shall be completed within three years of the date "77ST. i t. oc 1 conditions must be met. Date ��1- �� Board of Healt FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARRENrM PUBLISHERS- BOSTON B 0 TOWN OF ARNSTABLE LOCATION ,Q 3.63 L,t. lr,® 117`./C�- SEWAGE # -- VILLAGE &a-41I I ASSESSOR'S MAP & LOT a 2I"09-1-OU f INSTALL.FR'S NA vft&PHONE NO.,i?tl< fX L UIP ✓IG' SEPTIC TANK CAPACITY ~ LEACHING FACIL17T: (type) (size) f �' NO.OF BEDROOMS.. BUILDER OR OWNE Rill F4rriAQ U 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 r ® U 39 q3 �iS� I Town of Barnstable - °� Tti Rebulatory Services `. Thomas F. Geiler, Director Public Health Division `' Foy' T1:omas McKenn,`Director 200 Mair..Street,l lyannis, Nl?k 0 601 � D w JITI Officc: 509-862-:6-L4 Fax: 508-'90-6_04 Installer & Designer Certification Form Date: Sewage Permit, a200q—S'15' .-assessor's -IapTarcel Z--oo2. Designer: Cage & ,Islands Enaineeri.n Installer: M5 &CCLU Address: 800 Falmouth Road; Suite 301C Address: Mashpee, MA 02649 as ef, L/O on was issued a permit to install a ( at ) (install ) septic system at L4 based on a design drawn by (address) n CaDe & Islands En2ineeri nQ dated U —bLl (designer) _ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution.box and/or septic tank. I c-ertify that the septic system. referenced above was installed with major. chances (i.e. greater than 10' 1ateral.relocation of the SAS or any vemcal relocation of anv component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. AAA, H 0 F 4l-4,9. i o RICHARD G (Insiallei's`Signature) JAMES BERTRAND y —----29894-- -- - GIs �- - - - ---- -- Fss/ONAL (Desiner s Signature) `` (,fix. s Stamp Here) PLEASE RETURN TO BARNS TABLE PUBLIC REAL.TR Y314Z IA SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS =FO M-,kND AS-BUILT CARD ARE, RECEIVED BY THE BARNSTABLE PUBLIC BEALTH-DfV-ISION.---TH�kNK-YOu---- -- - n HPalth/Cr�Nr./Tl�c;onrr(.,•,7;i;cai;nn Fri,,,, Z7(LfLlrirr \ 36 1 LOCL.TIOPI 5EW&C,E PERMIT UO. INSTALLER5 IJ&ME 6 ADDRESS BUILDER 5 Q L MF- ADDRESS DNTE PERNA T ISSUED D h.TE COMPLI bJ,10E ISSUED ; fib �' � �' '�_ I w,. ,_ . Fim.. ................... No......................... THE COMMONWEALTH OF MASSACHUSETTS AR® HEALTH - ---....................OF....... ....... .. ................................................ Appliration for Diolimial Works T onstr ion. umit Application is hereby made for a Permit to Construct ( ) or Repair (,,�*� an Individual Sewage Disposal System at.: ............ . - .............. ......... ......._.... ...................... L ati -Address or.Lot No. ................ .. .. . .R......... .. .. . . . a .._ ............. r . ........f... caner t ----------•----. --.... •.. .__._ ...aInstllerAddress Y QType Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ............................ No. of persons.............---............ Showers ( ) — Cafeteria ( ) Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---.-----.-_-- Width................ Diameter.............--. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..--.--.....--...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........--.............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •--•---------------•------------------------------------------......................----•-----------......................................................... 0 Description of Soil........................................................................................................................................................................ x U ••••-----------------•--....•••-••••-•------------.......----------------..................-----•------------------•-----------------••--•-----------------------••----•-•------•----------------.-_.... W ----•-----------••-•------•----------•--------------•-•--••-------------••----••---------•---------•---•-----•------•------•---------. --------- U Nature of Re airs o Alterations—Answer when pplicable. , .. -� < �__& � ,�--- greement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by th b of health. Signe ,�. i ---• .17 t ; dliy� G% Date ApplicationApproved By..........................................-------•-----•-•--.........----------................... ---------------------------------------- Date Application Disapproved for the following reasons-----------------------•-------••--------------------•-------------------------------------......----------•----- ---------------•-----...--•.......--------------------•--------------------------------------------------I--------•-----••---•---••••---------•-----•-----------•---...---------------------------------- Date Permit No.. - Issued.. ..... ...........I--........--------- Date No... .� .: Fes$. THE COMMONWEALTH OF MASSACHUSETTS AR® Of HEALTH _ ...:.. .. ..------- -....OF...... .=.. Applirittion for Di. pedal Works Tonstrurtiott Vanfit Application is hereby made for a Permit to Construct ( ) or Repair Al an Individual Sewage. Disposal System at, X Lout n-address r or-Lot No 4 J wner / Adil' Installer Address UTyped Build ng -,' Size Lot............................Sq. feet `-, Dwelling—No. of Bedrooms.................................:.........Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ......•..................... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................... .. W Design Flow............................................gallons per person per day. Total daily flow................................. ...........gallons. W Septic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter---------------- Depth.......... x Disposal Trench—No..................... Width-_.•_-_--__-___-____ Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No------------------- Diameter-___-___._______..__ Depth below inlet.................... Total leaching area.....................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................----------------- ----- Date........................................` aTest Pit No. ................minutes per inch Depth of Test Pit, ... Depth to ground water ................. f=, Test Pit Nov 2-:..............minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -•-•-•-----•-----------------•--•-•---•--------•-•---•-•-----•----------......------•............---........................................................... O Description of Soil..................................... x U ---------------................................................................................................................................................................................... W --------------.................. ......... -•.-- -•---- •• .4.4 .... .� V Nature of Re airs o Alterations—Answer whet' pplicable__?._ x - _ :f-`- zz; sL.. ,. = "'�.. - �p 'T ...................................•._x Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by th boa.. of health. Signed .. =.� - � Date ApplicationApproved By................................_............................................. Date Application Disapproved for the following reasons------- ------ -------------------------•--•-----........................................................... .............................--•-----•-•------•-•••---•----•--•--••-•--•-•••-•---------••.....---••-••-•'---••---••--•----•-----•-•-•---------•-•-•-......-=•••-••.............•--•--•-•---...._........ Date PermitNo. .... . ......................' ............ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH 1` ...........................OF....... `... ................................. rtif iratt of Tompliattrr 1 TIFY. hat Individual Sewage Disposal System constructed ( ) or Repaired by..._gs ----- - ---- ---------•-------------------- d---------- .. .......................................... r.' .. ....y,. has been installed.in accordance with the provisions.'of X,I�°f The State anitary Code as deibed in the application,for D sposalWorks Construction PermitN _ ,? - ------------- dated.... - 1._? �r"............... THE ISSUANCE OF'THIS,CERTIFICA'TE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector........................------•-•---- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH .............OF.... ..................... ..... .-•-- ................................................. No . . FEE.. . li �t1 itstr to TI tit„ Permission is hereby grant d- - '. .............................................--- to Constr ) or Rep ' (,6 a Individual age Dis sal Sys atNo...... ---_. .... ............ ----- :+..... ......- �'---- Street as shown o the app ation for'Disposal Works Constructio e i• o ..:_ ........ ated.._, ^' 'f" -�'--...•.- �"^ '!i✓ '.... ., Board th DATE- . +�` .......... FORM 1255 HOBBS & WARREN,`-INC.. PUBLISHERS ' - - . -, .r. ' -n. ,: r L $ti. w . � � , ffi m ,. . 9 I � . I I I . I H I I, ,� ; , �il'i i 7 I. III. ., I :,* _ . !,II!IIII I � . I i;I•I I! �! fitl i i•�Iji 'iI .�i!!I ��' '� ►;� �' . j . .I � , � 1 '� ' um :,- . ; . 11. - '. I .. .�.! il�il � jj3t --- --j' i �% ;i'�;i; Ril ; I� h i 1� I ff -t 5- . ®9 �� . . .) --.A, U1� —C) 0 . .�:, .��., ,.*,',!,��I:_ I, - . H . .1 � . �., 1, I. : �I - . _. .. r _ ". ,I �;! r p- is�i l- Iiii.l�{ �,,�� i= ,{, ► �•.:Id �: , ia,,,I O. i . 1 • oa . . -�. . . . . a . . - .. • C _ 1 S -- 1 N _ - - P .. _ _ _ .- - Z . 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Y ' '' .. 41' .},.: �:j 'r'�= •oar - • '--r I. f i :,L, t 4 ,^F S' If l ^ I . :I i.', a ....::'' • ':' ,:., 1.. `(, A _ ''I . fit.. 1 J' e. . 1. . -. .. .. . .. ,,r. t. - 3 " t , .}. .vZ .. pit ,.J• }' °p • +"..' r - .. . .,. .. ,Y` .. J ' , . ...•. ' < _. ` ! , ' t' u i r ^J V t' ,N ,Y ` -,. i ..J b -m ' .. .. / I I': ?A 1.,.' 1 .- '. _ �.LR t,:-�.t• •'1 -. I.' .4.t Jv �~tl±i(!Y•F•? ?_ <' �'13J,..?hw A•'.' ff .. . .tYn' r a. ..3?'tdrlt:K< -I <�P }. -. @g® gg I - a�7.J,r•;°.3•r1r•1i6,�,.!r,,,i��:'r,E.f - i'.1 ' J,. }•' { ..4. - Y_ v - '3.S-:e�K�i�' Yra�•t�n r.,:rl(i. 1 •:.J.. fv'. _ _ Ir ti 7 •r SYSTEM PROFILE NOT TO SCALE TOP OF FOUNDATION FINISH GRADE FINISH GRADE OVER FINISH GRADE OVER EL.74.0 EL. 72:5 SEPTIC TANK 72.3 DISTRIBUTION BOX 72.2 f FINISH GRADE o° OVER TRENCHES 72.0 :,A RISERS TO 6 - ' r o_ F GRAD PRECAST CONCRETE X. 500 GALLON DRYWELLS 3"MIN. RISERS TO 6" _ice; H-10 REINFORCED LOADING ! :o MIKSLOPE % OF FINISH GRADE - OUTLET PIPE(S) LEVEL 13" . o FOR 2' MIN.1% SLOPE' 6" TRENCH MIN.SLOPE 1°� TRENCH LENGTH = 25'-0" MIN. P BEYOND VAI _ __ ry DRYWELL LENGTH = 8'-6" o 13"MIN. 1411 70.50 70.30 6"SUMP ,' Q.o a' 4' ..I o;o _I �;o:, �/. , MIN. 1wl .fix70.05 :1 1'!: y �10:1 �•".• O ,�, :1' i. q r` :1' `/,. 4 10'1 �l11 ' , + :1 �. D1 OI r' _ 'c PVC OR CAST IRON TEE y 69-73 ,. «a o ' h — /; GAS BAFFLE �6 DISTRIBUTION BOX ' �� o , . - - 68.60 ,,bs-�,,bl `�: '' -�.. ' °r'� •`'''' U W ,. /` y,. 1 1 > '- MINIMUM INSIDE DIMENSION 12" 3/4"- 1-1/2 DOUBLE EL.66.6 <=c ', 1500 GALLON �s OUTLET INVERTS 2" BELOW INLET INVERT WASHED CRUSHED 3/4"- 1-1/2" DOUBL , -� MINIMUM CONCRETE WALL THICKNESS 2" STONE 6' WASHED CRUSHED 4 PRECAST CONCRETE STONE INSTALL ON COMPACTED LEVEL BASE BSMT.FLR :o o�,; :.� H-10 REINFORCED S -� - - NOTE: EXCAVATE TO=C2= STRATUM IN ORDER TO EL.60.6 TH#2 ELEV.66.5 _ t 1 - o REMOVE ALL A=,=B= &=C1= IMPERVIOUS MATERIAL y WITHIN 5'OF THE SAS. REPLACE WITH CLEAN TRENCH SECTION ` _ � •I\ ., /..••ll ,\- ( I , . 1/ (I ,h�l �' ' ;:1 ,:_'lo,�,r 'r cr' .,•� ;>' �''../'� , ,,o� ,•i`,.o "1."r°'•r; ` : •+ I,z CLAY-FREE SAND.. SEPTIC TANK ' t INSTALL ON COMPACTED LEVEL BASE ...: " �a "MIN. "OF " " . • : ; ••d f �o- 4" DIAM. 36" MAX. DOUBLE WASHED • PEASTONE yes: • 4 ., ,. , ,; 3/4 1 1/2 DOUBLE • • .fl 4 11 51.211 11 WASHED CRUSHED STO NE TRENCH WIDTH R 13'-211 NUMBER OF TRENCHES 1 g NUMBER OF DRYWELLS 2 z 0� T M OBSERVATION PIT P 10832 a, GENERAL NOTES. PERCOLATION RATE: < 2 MINIAN 19'Og 1. ELEVATIONS SHOWN ARE BASED ON ASSUMED WITR1ESSED BY: DAVID STANTON \Ilgo��\99 , 2.ALL PIPES IN THE SYSTEM MUST BE CAST IRON BARNSTABLE BOARD OF HEALTH OR SCHEDULE 40 PVC. DATE: OCT.6,2004 3. HEALTH AGENT/CAPE & ISLANDS ENGINEERING DESIGN DATA ` MUST BE NOTIFIED WHEN CONSTRUCTION IS TEST HOLE#1 TEST HOLE#2 o i - EL 0" 011 .72.0 EL.7I.6 COMPLETE PRIOR TO BACKFILLING. =A= LOAM 4.ANY CHANGES IN THIS PLAN MUST BE APPROVED O =A= LOAM BY CAPE& ISLANDS ENGINEERING AND THE BOARD 10 YR 2�2 10 YR 2/2 NUMBER OF BEDROOMS 2 - S'E OF HEALTH. 8" =B=SANDY LOAM 8 = = GARBAGE DISPOSAL hQ_ •-NO.3 1 I 5. MATERIALS AND INSTALLATION SHALL BE IN 10YR 514 B SANDY LOAM r -•.l LOT 63 co�c.bd. COMPLIANCE WITH THE STATE SANITARY CODE „ 10YR 5/4 DAILY FLOW 220 GPD• 207QA Eh•72.2 [TITLE AND LOCAL APPLICABLE RULES AND 30 4211, SEPTIC TANK REQUIRED 1500 GAL, �853 EGULAATIONS. C1= LOAMY SAND SEPTIC TANK PROVIDED 1500 GAL, o 6. NORTH ARROW IS FROM RECORD PLANS AND IS 10YR 616 =C1= LOAMY SAND LEACHING REQUIRED 220 GPD. 26.00' Q : NOT INTENDED FOR SOLAR ENERGY PURPOSES. 10YR 6/6 g 48.0, 7. WATER SUPPLY: MUNICIPAL WATER SYSTEM. 60„ SOIL ABSORPTION SYSTEM CALCULATIONS: 0 8. FLOOD ZONE C [NON-HAZARD] 9611 0 4 ; ): 9. THIS PROJECT DOES NOT INVOLVE ANY PHYSICAL o S x =C2= FINE SAND SIDEWALL AREA = 152 F. h o - GROUND DISTURBANCE OR VEGETATION REMOVAL PERC TEST =C2= FINE SAND ° oa, WITHIN 100'OF WETLANDS,INLAND OR COASTAL 8411 10YR 7/4 10YR 7/4 152 SF. X .74 G/SF. = 112 GPD. 22, a ,1,�,�w $ O BANKS OR FLOOD HAZARD ZONES. EL.65.0 BOTTOM AREA = 329 SF. g LEGEND ` NO GROUNDWATER 329 SF. X 0.74 G/SF. = 243 GPD. 13211 EL.60.61 NO GROUNDWATER LEACHING PROVIDED = 355 GPD. 24.001 DEW 52 PROPOSED CONTOUR 132° SINGLE FAMILY RESIDENCE o #I ; 52- - EXISTING CONTOUR 144.60/ PROPOSED SEWAGE DISPOSAL SYSTEM I iuC=i,FA (� OBSERVATION PIT PREPARED FOR MCI ❑ DISTRIBUTION BOX4; NOTE: EXCAVATE TO =C2= STRATUM IN ORDER TO A. , WILLIAM FARRINGTON . LOT 70A] LINCOLN ROAD REMOVE ALL =A=,=B= &=C1= IMPERVIOUS MATERIAL o 0 0 SEPTIC TANK �'' P a china HSE.NO. 363 WITHIN 5 OF THE SAS. REPLACE WITH CLEAN IANNIS MASS. CLAY-FREE SAND ' SOIL ABSORPTION SYSTEM PLAN NO. 110804 SCALE:AS NOTED 'ya0FMq RESERVE RESERVE AREA �� FILE N0. 418BA DATE: NOV.8,2004 DAVI ti(� SEPTIC FILE NO. 75 PCS FILE: lincolnrd CHARLES 22.26 PIPE INVERT ELEVATION CDN1 0. L 5 CAPE & ISLANDS ENGINEERING O O O s, C'fS1R -002 045 145 5 ��,�,'V LA14D 800 FALMOUTH ROAD, SUITE 301C PLOT PLAN 271 082 SCALE: 1" =30' MAP SEC PCL LOT HSE \� MASHPEE,MA 02649 (508)477-7272