HomeMy WebLinkAbout0026 SUDBURY LANE - Health 26 Sudbury Lane
Hyannis P
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TOWN OF BARNSTABLE
L1--'--AVON S(�� 06 Ut SEWAGE #
VIL"'AGE ASSESSOR'S MAP & LOTS7/-
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IIER'S NAME&PHONE NO. d (-/l�✓r , a. :"'_
SF,PTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
�).OF BEDROOMS t
BUILDER OR OWNER I`�� A Ae v L L
PERMITDATE: 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
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LOCATION PAP LA NC SEWAGE#
VILLAGE nV AM QV� ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO. Cove C oA S L'
SEPTIC TANK CAPACITY 6 6 u
LEACHING FACILITY.(type) MIU-1—AS (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: COMPLIANCE DATE: / Z Co-
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility .4�94/-X7 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
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppfitation for disposal *pstem Construction permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Pfndiidual Components
Location Address or Lot No...X �u- 117, Owner's Name,Address,and Tel.No.3 mod'
Assessor's Map/Parcel ..57
Ins ler's Name,Address,and Tel.No.-g°d'' 'a �s Designer's Name,Address and Tel No.-5241^
u/.�'t'tlz'rr� G'°is%� Coa✓Sv�fiG Se's''veG�S �!/ G�G� ..pef'i�r�_&a-- ,$c�t/'G-F�/
Type of Building:
Dwelling No.of Bedrooms _3! Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3® gpd Design flow provided gpd
Plan Date � y/�� Number of sheets Revision Date
Title
Size of Septic Tank /O O& Type of S.A.S. ��,.-�
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �ri
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.
Signed Date 92(h
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. 2,0-z,I —31; Date Issued of 3 1 Z
1 M4 ry�� Ma,n .^� '�FS�r. �('. 6. w°\ f..0 *'r. a,� � R'Tyu .. 1 }7 'kb n ., a 1.. 1fl j,1.•C��a _ ,n7-11.4 t''1=��IK Y H�'•.+Y°� ..Irr. ,Y.y
9c. $' ` %
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No. C Z t Fee �y
THE COMMONWEALTH OF MASSACHUSETTS Enteerredincomputer:
11 Yes
} PUBLIC HEALTH DIVISION,- TOWN OF BARN STAB LE,;,MASSACHUSETTS
Rpplication for Disposal ConBtrUciion -ermit
Application for a Permit to Construct Repair /U rade Abandon Com lete S stem ndividual Components
PP ( ) P (�) Pg ( ) (: ) ❑ fp I rtiY4k� , r � p
Location Address or Lot No--G il, U� , Owner's Name,Address,and Tel:No.J��'— 7�d—9✓ �`'
Assessor's Map/Parcel �T/��/ 3 S^;�+�e� 1; 1Am✓i 1J ''(,,rl jA } t 6A
Insta ler's Name,Address,and Tel.No�3°�' fir" �`�X3� Designer's Name,Address`?and Tel.No.jdO— --�"71 47';0
44�/fir®Ofjlpf LG� C—f3�✓.!L-'✓�f/C S'Pi+.'!//C�.S ��� G'�C/6'iG .SG'J�nT G � ,,�'.a.F/"G.C��•
zzex
Type of Building:
Dwelling No.of Bedrooms Lot Size —sq.ft" fGarba a Gnhder 4M
Other Type of Building No.of Persons f ,c t Showe s( t ) Cafeteria( )
Other Fixtures'' °� 1 iti• -:•._
Design Flow(min.required) gpd . Design flow,proAded•, gpd
Plan Date a4 z1 Number of sheets Revision'<"--`� Date
Title - "
Size of Septic Tank /QOd �.., Type of S.A.S.
Description of Soil
Natured Repairs`or Alterations(Answer when applicable)
Tom%
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.
Signed/r Date ?'
Application Approved by Date /
Application Disapproved by ^'""' Date
for the following reasons
Permit No. 7,i(J� I 31:L Date Issued 3 Z
_------------- -- -----° -- - - - ---- ---------•-
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY that the On-site Sewage Disposal system Constructed Repaired Upgraded
. g P Y ( ) P � ( )
Abandoned( )by 5!_X Aekn /.y �/'o mod S SP��iI rs
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal Syst Construction Permit No. 37,Ldated
Installer / -- Designer
#bedrooms r 3 Approved design flow "' 3 Q gpd
The issuance of this permit shall not
be construed as a guarantee that the system will a_on as desi ed.Date Inspector
fJ Inspector
No. IN %Z Z Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction 3permit
Permission is hereby granted to Construct( ) Repair� Upgrade( ) Abandon( )
System located at 2cS SU� ��� l cl, /,/s•i� ,�r�is
i
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.
Provided:Const tion Plust be completed within three years of the date of this permit. ^�
Date 312 ( .d Approved by �.�_.
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Town of Barnstable
.°``"E'O' .o Inspectional Services
Public Health Division
BAMSTABM
v� MAC Thomas McKean, Director
t61Q. �0
°rFCMa+a 20.0 Main Street,Hyannis,MA 62.601
Office: 508-862.4644 Fax: 508-790-6304
Installer & Designer Certification Form r
Date: I �l" Z� Sewage Permit# 3 Assessor's Map\Parccl 2_ 7 I 2
Designer: P-N V 1 12 7�-�/ Installer:
Address: L"G' !-'� 3 Address: o
QQ I
14'r-11AA G i 0( r�"
On i was issued,a permit to install a
(date) ('nstaller)
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septic system at (� Olu based on a design"drawn by
(addressh
10 ����"t dated
(designer)
I certify that the septic system referenced above was installed substantially according to
l
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 f
were found satisfactory.
3
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 certify that the system referenced above was constructed in compliance with the terms of
the IW approval letters (if applicable) zm
(� ol:M c `
t:) t
�((Installer's Signature)
N NO. xLE 1€ r s
Designer's Signature) (Affix Designer't`Stamp Here) i
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PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE i
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- i
BUILT CART) ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU, j
\\toa\depts\HEALTMSEWER connect\SEPTIC\Designer CeniGcation Form Rev&14-13.DOC 1
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COMMONWEALTH OF MASSACHUSETTS LOPIT
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
m + d DEPARTMENT OF ENVIRONMENTAL PROTECTION
�qM Sve
350 MAIN STREET RECEIVED
WEST YARMOUTH,MA
& 508-775-2800
Cc"�'1C0 MAY 13 2004
TITLE 5 TOV0,OF BAmNS1ABLE
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENIS HEALTH DEPT.
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
MAP 271 PAR 209
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner's Name: FORD,MANUEL
Owner's Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Date of Inspection APRIL 7,2004
Name of Inspector:(please print) JAMES D.SEARS
Company Name: A&B Canco
Mailing Address: 350 Main Street
West Yannouth,MA 02673
t Telephone Number: 508-775-2800
CERTIFICATION STATEMENT
I certify that 1 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
Needs Further Evaluation by the Local Approving Authority
Fails
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 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 tot he 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.
Title 5 Inspection Form 6/15/2000 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes: ✓
I have not found any infonnation 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: 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.
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 complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval
of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health)'
broken pipe(s)are replaced
obstruction is removed
ND explain:
Title 5 Inspection Form 6/15/2000 2
5
Page 3 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
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 detennine 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(I)(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 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 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 detennine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the 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.
3. Other:
Title 5 Inspection Form 6/15/2000 3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
D. System Failure Criteria applicable to all systems: N/A
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 pit 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
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation
N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply
N/A Any portion of a cesspool or privy is within a Zone I of a public well
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well
N/A 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 or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.)
NO (Yes/No)The system fails. I have detennined 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 detennine what will be necessary to correct the failure.
E. Large Systems: N/A
To be considered a large system the system must service a facility with a design flow of 10,000 gpd to
15,000 gpd.
You must indicate either"yes"or"no to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a
mapped Zone 11 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 is 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.
Title 5 Inspection Form 6/15/2000 4
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Page 5 of 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
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
J Were any of the system components pumped out in the previous two weeks?
✓ Has the system received nonmal flows in the previous two week period?
J 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?
I� J 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)has been determined based on:
Yes No
✓ Existing infonmation. For example,a plan at the Board of Health.
J Detenmined 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)]
Title 5 Inspection Form 6/15/2000 5
I
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
FLOW CONDITIONS
RESIDENTIAL
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
Number of current residents: 2
1 Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage 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 2 years usage(gpd)): N/A
Sump pump(yes or no) NO
Last date of occupancy: PRESENT
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CM 15.203):
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of infonmation: N/A—TO BE PUMPED AFTER INSPECTION FOR MAINTENANCE
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: gallons—How was quantity pumped deterrnined?
Reason for pumping:
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 copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
1982 PERMIT#82-681
Were sewage odors detected when arriving at the site(yes or no): NO
Title 5 Inspection Form 6/15/2000 6
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
BUILDING SEWER(locate on site plan): ✓
Depth below grade: 12"
Materials of construction: Cast iron _ 40 PVC _ other(explain)
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK(locate onsite plan): ✓
Depth below grade: 21"
Material of construction: J concrete metal fiberglass polyethylene
other(explain)
If tank is metal list age: is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1,000 GALLON PRE CAST
Sludge depth: 2"
Distance from top of sludge to the bottom of outlet tee or baffle: 28"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 12"
Distance from bottom of scum to bottom of outlet tee or baffle: 17"
How were dimensions detenmined: ASBUILT AND TAPE
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
MAIN TANK AT WORKING LEVEL.OUTLET BAFFLE.NO SIGN OF OVERLOADING OR LEAKAGE.
GREASE TRAP(located on site plan) N/A
Depth below grade:
Material of construction: concrete metal fiberglass _ polyethylene other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
Title 5 Inspection Form 6/15/2000 7
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Page 8 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain)
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alann present(yes or no)
Alann level: Alarm in working order(yes or no):
Date of last pumping
Comments(condition of alann and float switches,etc.):
DISTRIBUTION BOX: ./ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 0
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.,):
DISTRIBUTION BOX IS 16"x2l",34"BELOW GRADE.ONE LINE IN,ONE LINEOUT. BOX IS CLEAN
AND SOLID.NO SIGN OF OVERLOADING OR SOLID CARRYOVER.
PUMP CHAMBER: N/A (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Title 5 Inspection Form 6/15/2000 8
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Page 9 of i 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
SOIL ABSORPTION SYSTEM(SAS): ./ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 1
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.)
LEACHING IS ONE 1,000 GALLON PRE CAST PIT.PIT AND COVER 30"BELOW GRADE. 30"WATER IN
PIT.NO HIGH STAIN LINE.NO SIGN OF OVERLOADING OR SOLID CARRYOVER.
CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.):
PRIVY: 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.)
Title 5 Inspection Form 6/15/2000 9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 SUDBURY LANE
HYANNIS,MA 02601
Owner: FORD,MANUEL
Date of Inspection: APRIL 7,2004
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.
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Title 5 Inspection Form 6/15/2000 10
R P
Page 1 I of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 SUDBURY LANE
FORD,MANUEL
Owner: APRIL 7,2004
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to no groundwater 12 feet
Please indicate(check)all methods used to detennine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
/ Observation 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:
TEST HOLE 12'NO WATER.TEST HOLE Y BELOW BOTTOM OF PIT.
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Title 5 Inspection Form 6i t5/2000 l l
►?DU52���
A T 10N SEWAGE PERMIT NO.
t5oD too r�( 1911e
VILLAGE �—
`INSTA L//LER'S NAM 6 ADDRESS
e \Tr.
el
5UILDER OR OWNER
C ov RC t
DATE. PERMIT ISSUED
DATE -C-OM,P.LIAN.CE ISSUED
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0... ............... icic...33........................... ---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town..................OF.. Barnstable
.................. ...... ...................!....................................................................
Appit-ration for Uispaoal lVerkg Toustrurtion "amit
Application is hereby made for a Permit to Construct (X ) or Repair, an Individual Sewage Disposal
System at:
....... ....5 ... ................... .HYAMiaj MA
.................................i...................
L ' A
Capricorn ReatV,V'rSust
.................................................................................................. .....Z�5- Falmouth fiouata�. Hyannis
................................. .............................................
Owner �W�ress
Steve Lebel
.................................................................................................. ..................................................................................................
Installer Address
Type of Building Size Lot........................... e
U
Dwelling—No. of Bedrooms.........3..............................Expansion Attic Garbage Grin
Other—Type of Building X��ITPh............. No. of persons............................ Showers (2 Cafeter
Otherfixtures ............................................................................................................................................
Design Flow.............5.5............ .Wgallons per persopgr,day.. Tota4qaj%,flow............33,0........................
5,agon s.
1:4 Septic Tank—Liquid capaci� :_..._..___.gallons Length________________ Width.____________.__ Diameter................ Depth I......... ..
Disposal Trench I—No..................... Width..______._.__.._.___ Total Length_.____.__.__________ Total leaching area....................sq. f t.
- I
Seepage Pit No_____________________ Diameter_._6!-------------- Depth below inlet.-6............... Total leaching area_._266.....sq. f t.
Z Other Distribution box Dosing,tank
Percolation Test Results Performed by.....E.--1....dr....e...d90.....E.D9111Q.RrIng........... Date.11—Z5m$1................
14 Test Pit No.,< 2,,0 1;2.!......... Depth to ground waternone encounte
�-4 minutes per inch Depth of Test Pit -------- ------------
Test Pit N NA__'_.minutes per inch Depth of Test Pit.'VA.... n eg
....... Depth to ground water.. ---------------
.............................................................................................................................................................
0 �Description •of Soil............... .........loqL M...A.;....toppoll
........... -----
medium vellow sand
... ............................................. .....................
................................................ ..................................................................
U
10' - 12' med. white sand7traced,- ...."---------o...f-----*.................Z---------------i----------
------....................................................................................................................................... ..nQAMJAr t 12'
........ ...
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of '5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
L
Sied.... ............. ... ----- .. ...
ApplicationApproved By__.'.____-------------------------------------------------------------- -------- __-----
Date
... .........
Date
10
Application Disapprove o the following reasons:..............
0 --- ---- ..................... .
............................................................................................................................................ ...........................................................
Date
PermitNo......................................................... Issued .......................................................
Date
7-4 f
- V0......................... Fizz...........................
�. THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable t
..........................................OF....................-...-------...._..................._......----............_......._.__
r
ApVftrafton for R,4pooal Worko Tontrttrtion rrmi#
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at
.: . '
Lot - -- =..7... ' ='f-! ,-- ... ]ya2i8', M,Q....
Loca Ad ss or Lot No.
Capricorn Rea �y `gust Z65 Falmouth Road,- Hyannis_•--••--•--.
-- -
_...- • --
Steve Lebel owner Address
a -• --•-•........................••-•----•-----•------•-...... .---•--- ------............ .................................................................................
Installer Address
Type of Building Size Lot__________________________'
U Dwelling—No. of Bedrooms.........3._ _Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ranch -- No. of persons____________________________ Showers 2 Cafeteria
Q' Other fixtures .......................••---•--•-----...._....._._..-•.--••--------•-----------•-------- -----------------•--------•--------..........._..,...........
d `
Design Flow...........3.3..........................gallons per person ��day. Totaldaily�flow.._.._......33D_...__... _____...__._gallons.
WSeptic Tank—Liquidcapacit�000 gallons Length8: �__..._:_ Width ___�: _-.. Diameter________________ Depth58.......
Disposal Trench—No._____............... Width...' Total Total Length.____._.._._.__.... Total leaching area...................,sq. ft.
Seepage Pit No..................... Diameter.__6__.:_..._..__. Depth below inlet__6.__.._____.___. Total leaching area___26.6_.....sq. ft.
z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by....___lCox'Mfg_e...Engineex' ........... Datellm?_',5=.81................ r
1.4
inutes per inch Depth of Test Pit....12!......... Depth to ground
Oxp
Test Pit No. 2 NIAo__minutes per inch Depth of Test Pit. ........... Depth to ground water�2 $___e�.... "'
R+ •••................................................................................................ ......................................................... .
O Description of Soil................ 2.....----•�.QIm__�---t12�21�oll.................................................................................. y
...............•------ .. -------10...----•medium_ e11Qw-•sand ---------------------•-----------------.......------•--------
10' -- 12-' med.•••white_•sand/traeed-_Q•-•_travel ho___water....at 12'
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
• ••------•---------•---•---------•-••••--•----•----•-••-•••--•.............................•-•-------•-•---•......-----•--••--•.._._.._._.._....._._........_...._..-•----•-•-•----
Agreement: t
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLap. y g g p y
5 of the State Sanitary Code—The undersigned further agrees not to lace the system in
operation until a Certificate of Co lance has been issued by the board of health
' ate
Application'Approved $ .
_:_..
F Date
Application'.Disapproved for the following reasons__________________ _____ :_ . .....................................................................
..........................................................................................................................................................................................................
Date
• k
PermitNo......................................................... Issued-..................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
F
BOARD OF. HEALTH
...............TAwn..............OF...........BR=table.......................................... .
(Inrtifiratr of Tontplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( )
by........ .................................................
Installer
at Q t ...... /�' 's�,.k�' r, --••-_Hyann3 •----•---...--••-....
L�,4...a < x t r
has been installed in accordance with the provisions of T " 0 The State Sanitary e cribed in the
application for Disposal Works Construction Permit No......................................... dated.........................._.....................
3
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST A GUARANTEE THAT THE
SYSTEM WIL , .'FUNCTION SATISFACTORY.
DATE__,L/Z—X� ...._ Inspector.-- •- ---•----•............................................•----•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.... ........................
Town OF..........�.a..x^n;�_tabl-e.............•------•--
: .............
No.......:................ FEE.........................
Permission is hereby granted......... -teve...Le.be1..............-....................................................................................... a
to Construct)( ) or Repair ( f ) an Individual Sewage Disposal System
at No __ o.t.-4_... Sr -'- Y3T S�,r ' .._.._....
----. --
Street Y
as shown on the application for Disposal Works Construction Perrl�it r'' _.: Dated..........................................
.. _
Y
1.i Board of Health
DATE¢--••---•--------•--------•----------------•--•-------------- -•-------•-•----
FORiN 1255 HOBBS & WARREN, INC., PUBLISHERS
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L.DREDGE ENGINEERING Cat IN CLIENT-`F��-n/Gc,
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EGISTERE REGISTERED J08, h10, $ / BUILDJNO SHOWN ON THIS PLAN.
R CIVIL LaIND ^,r�. CONFORMS TO THE ZONING hAWSF�" `,
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RAISE MIN. 20" DIAMETER COVER RAISE. MIN. 20" DIAMETER COVER Vent
TO WITHIN 6" OF FINISH GRADE TO WITHIN 6" OF FINISH GRADE
CONSTRUCTION NOTES EL=58.7t
58.Ot EL=58.2t
1.) ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, TITLE 5 (310 CMR 15.000):
STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, AND \
EXPANSION ON SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT /\/
AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS.
2.). ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR
VEHICLES OR HEAVY EOUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 it
LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE.
3.) TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS AND D-BOX SHALL BE INSTALLED ON A STABLE 56.2t GEOTEXT{LE
MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. 54.8 FABRIC
4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK, THE DISTRIBUTION BOX, AND
THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN 6" OF FINAL GRADE. LEACHING 56.7t r�1
FIELDS, TRENCHES, AND OTHER SOIL ABSORPT
ION SYSTEMS WITHOUT ACCESS MANHOLES SHALL
HAVE AT.LEAST ONE (1) INSPECTION PORT CONSISTING OF PERFORATED 4" PVC PIPE PLACED Existing
VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP, TIED WITH MAGNETIC a 54.8t
MARKING TAPE ACCESSIBLE TO WITHIN 3" OF FINAL GRADE. 3/4' to
Existing 54 7 54,5
5.) PIPING SHALL CONSIST OF 4" SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A 54.3 N! 1-1/2" STONE
MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2%FROM THE BUILDING TO THE SEPTIC TANK, Exissting (Double wosh)
AND NOT LESS THAN 1% OTHERWISE. GAS BAFFLE DB-3 H-20
6.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4' DIAMETER SCHEDULE 40 D-BOX THREE (3) 500. GALLON H2O PRECAST
PVC (OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPPED
AT END OR AS NOTED. 52.3 CONCRETE LEACH CHAMBERS WITH 3' OF
7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO (2) FEET BEFORE STONE .ON ENDS AND 2.5 ON SIDES
PITCHING TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO EXISTING
ASSURE EVEN DISTRIBUTION. I 000 GALLON r- 2't {--12"f -- S.p'
8.) GROUT TO.BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES }--12'f �,
IN ORDER. TO PROVIDE A.WATERTIGHT SEAL. SEPTIC TANK LEACH CHAMBERS
9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE (To Remoin) (END VIEW)
DISPOSAL FIELD.DURING THE COURSE OF.CONSTRUCTION OF THE SYSTEM. FLOW PROFILE
10.) IN ACCORDANCE WITH 310 CMR 15.221, ALL SYSTEM COMPONENTS SHALL BE MARKED WITH NOT TO SCALE EL-47.3 Bottom Test Hole
MAGNETIC MARKING TAPE.
11.) THERE ARE NO KNOWN WELLS OR WETLANDS WITHIN 150' OF THE PROPOSED SOIL ABSORPTION SYSTEM. T HOLE LOGS
UNTIL RECEIPT OF 7 7t
TES
T SYSTEM u L 1 EL 5 .
12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION Test Hole ( )
THE CERTIFICATE OF COMPLIANCE, THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT
USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. SYSTEM DESIGN CALCULATIONS
Depth Elev. Layer Soil Class Soil Color
13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS P
CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE ENGINEER,
56.8 Fill SEWAGE DESIGN FLOW: THREE BEDROOM DWELLING 0110 GPD/BEDROOM = 330 GPD
14.) THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE (MINIMUM DESIGN REQUIRED 330 GPD)
BOARD.OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE 11 t0YR3/2
SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT -15" 56.4 A Sandy Loam SEWAGE DESIGN FLOW PROVIDED: THREE (3) 500 GALLON CHAMBERS
R ADVANCE NOTICE IS REOUESTED. TONE ON THE SIDES
AND THE
PLANS 48 HOURS AND 2.5 S
15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR-SHALL BE RESPONSIBLE FOR B Loamy Sand 1OYR4/4 WITH 3' STONE ON THE N
DETERMINING THE LOCATION ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO 15"-27" 55.4 Vt [(31.5 x 9:83) + 2(31,5 + 9.83) (2) x .74 = 354 GPD PROVIDED
ANYMPRI ATE UTILITY COMPARNIES, AND THEDLOCAL WATER DEPARTMENT IS NOT LIMITED T' REQUESTS TO DIGSAFE,
16.) CONTRACTOR SHALL VERIFY THAT ALL WASTELINES ARE CONNECTED BY WATER TESTING
27"_127" 47.1 C Medium Sand 10YR5/6 354 GPD PROVIDED > 330 GPD REQUIRED BSI K l� �+1�'R
WITHIN THE DWELLING PRIOR To INSTALLATION OF ANY SEPTIC COMPONENTS. I SEPTIC TANK CAPACITY .REQUIRED: 330 GPD X 200 = 660 (MINIMUM)
17.) CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS`PRIOR TO INSTALLATION OF ANY
SEPTIC SYSTEM COMPONENTS. DATE OF TESTING: 06/24/20 SEPTIC TANK CAPACITY PROVIDED: 1.000 GALLON SEPTIC TANK (EXISTING)
18.) TEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE, TITLE 5. SOILS CAN BE SOIL EVALUATOR: MARK POSELLI A GARBAGE DISPOSAL IS NOT PERMITTED WITH THIS DESIGN FLOW
VARIABLE AND T LE DATA IS NO GUARANTEE SOIL CONDITIONS IN OTHER AREAS IF WITNESS: DAVID STANTON, BARNSTABLE HEALTH AGENT
SOILS DIFFER FROMOM THOSE SHOWN IN THE SOILS LOGSS,, DESIGN ENGINEER IS 70 INSPECT THE
SOILS PRIOR TO PROCEEDING WITH INSTALLATION OF ANY SEPTIC COMPONENTS. PERCOLATION RATE: LESS THAN < 2 MIN/INCH
19. EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND pERC p 44" (C Layer) sal I System
ABANDONED IN PLACE OR REMOVED AS REOUIRED. AREA TO BE COMPACTED TO MINIMIZE SETTLING. Proposed S e w a Cg e. D I s p 0
NO GROU
NDWATER ENCOUNTERED
NO MOTTLING ENCOUNTERED 26 Sudbury Lane Hyannis, MA
1
Prepared for:
Test Hole 2 (EL=57.7t) �ZNOF.N,S
.. Lisa Platanitis
Depth Elev. Layer Soil Class Soil Color Vi �` 26 Sudbury Lane
a
I R J
0"-9" 57.0 Fill 1 i Hyannis MA
10YR3/2 0
9"-13" 56.6 A Sandy Loam �o/sTE�L`` Prepared by:
1 10YR4/4 SgNITAR P
13"-29" 55.3 B Laamy Sand _ ` All Cape Septic and Survey
I 10YR5/6 `(� 618 Route 28
2 C Medium Sand
9"-125" 47 3
West Yarmouth, MA 02673
(508) 771-4200
allcapeseptic@gmail.com
Date: 06/29/20 Sheet 2 of 2
Revised: August 9, 2021 Project No. AC-348