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Home My WebLink About0001 WAGON LANE - Health 1 Wagon Lane,, A =370-.219 Hyannis f �� rur-t� i3Go'caa--t°1' Jo env x�� ar'► (1-0 -a1.u,Aj^av, Barnstabie IKE r, Town of Barnstable , °* Regulatory Services Department` �;Ca « SARNSTATSIM Public Health Division s Qj 1639 �� m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO, October 13, 2010 Nanci Thurston 1 Wagon Lane Hyannis, MA 02901 f ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1 Wagon Lane,Hyannis MA was last inspected on September 28, 2010,by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Further evaluation is required by a DEP certified inspector to determine the nature of the second SAS._ The evaluation report shall be submitted to the Health Division office within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OFT BOARD OF HEALTH as cKean R.S. CHO ll:J D Agent of the Board of Health CERTIFIED MAIL#70081830000205008.963 1 A ACE CESSPOOL SERVICE INC �775-1056` OR • Septic, Residential Cesspool ACE & & Commercial Grease 1 - Scheduled Tanks Maintenance Pumped Available JOHN B.MONIZ PROP. Family Owned&Operated P.O.BOX 534 CENTERVILLE,MA (508) 775-1056 (508) 362-3400 JOHN B. MONIZ OWNER/OPERATOR ACE CESSPOOL SERVICE,INC. P.O. BOX 534 CENTERVILLE,MASSACHUSETTS 02632 Ac— TVIe GU Wl VVV �Q �►5C y �f U Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® ® Zoom Out ,In FSRI•, ` T R K y ` k } is �i• 3 M �7 a ' A PN I r l� T� ��yy,�+ �•3 4°f�c yz51 m ' 20 Feet ypa Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER i (`nrnirinhf 9MF_OfMO Tr... of P.-O.H. MA All rinhfc rocnnn j �a \� o 4 1 ACE CESSPOOL SIFIRVICE 1"' C. P.O. BOX 534 )r OENTIERVILLE; MA 02632 G!t/ v � (508) 7 5-1056- (5€ 3) 362-3400 SOLD BY DATE ' NAME I_ i— ADDRESS " s CITY k.. �4TvA s xw A �a W, ' MERC�HANDISE9RETURNED Sol, PkID OUT ' PAID ONAUNT P xrx�'t k, dtlw.ta.W,u � ., < QTY. DESCRIPTION AMOUNT R� I U I I I � 1 4 1 1 I ' RECEIVED BY ke TOTAL C' I THANK YOU QF YNf Tpy, kzftd Town of Barnstable Barnstable Regulatory Services Department 1 erica j BARNiSfABM Public Health Division i639• ♦� e �fa �A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO October 13, 2010 Nanci Thurston 1 Wagon Lane - Hyannis, MA 02301 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system.located at 1 Wagon Lane, Hyannis MA was last inspected on September 28, 2010, by Robert Paolini, a certified septic inspector for the State of . Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: . Further evaluation is required by a DEP certified inspector to determine the nature of the second SAS. The evaluation report shall be submitted to the Health Division office within two (2) years from the date you receive this notification Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OFT BOARD OF HEALTH as cKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL#70081830000205008963 Pd ok P l e s-.�-P „at Commonwealth of Massachusetts C��• W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is required for H annis Ma. 02601 9/28/2010 y 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. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number _l 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: o 0 ❑ Passes ❑ Conditionally Passes ❑ Fails cm z ® Needs Further Evaluation by the Local Approving Authority -n 9/28/2010 3 u' :Inspecgnature Date N D W The system inspector shall submit a copy of this inspection report to the Approving AMoriF(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. ****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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dis al System•Pa•e 1 17 .•. .._. ,ice.*. r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town 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: ❑ I 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 Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 1 Wagon lane M Property Address Nanci Thurston Owner Owner's Name information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): e ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 1 wagon lane Property Address Nanci Thurston Owner Owner's Name information is Hyannis Ma. 02601 9/28/2010 required for y every page. City[Town State Zip Code Date of Inspection B. Certification (cont.) 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. ❑ 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: Not able to determine what type of SAS for second pipe leaving tank.No permit ,plan or as-built on file with town. 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is Hyannis Ma. 02601 9/28/2010 required for y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. El ® 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is required for Hyannis Ma, 02601 9/28/2010 every page. City/Town 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) E ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ E 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form -Not for Voluntary Assessments �M 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 d NA 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 9/28/2010 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: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface'Sewage Disposal System Form - Not for Voluntary Assessments 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is Hyannis Ma. 02601 9/28/2010 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 ' Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints,venting, evidence of leakage, etc.): Joints appear tight.no evidence of leakage.System vented through the house vents. Septic Tank (locate on site plan): 2' Depth below grade: 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: 1000 gallon Sludge depth: 3" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Wagon lane GSM Syey`e. Property Address Nanci Thurston Owner Owner's Name information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" 2„ Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.no evidence of Ieakage.Tank appears structurally sound. 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 pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is Ma. 02601 9/28/2010 required for Hyannis 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.): 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): 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name _ information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of.liquid level above outlet invert No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town State Zip Code Date of Inspection D. System Information. (cont.) 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.): Sandy dry soil.Leaching pit was dry at time of inspection.Speed leveler was observed in tank diverting flow away from Pit.Pipe observed leaving side of tank.Unable to determine type of SAS pipe 5' below grade observed with camera.Appears to be no D-Box.No plans or permit filed with town. 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 Wagon lane Property Address' Nanci Thurston Owner Owner's Name information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size . Zoom Out g I,In . 1 e 'wo".�,�,•w,.n,._ 5{ ; ..""�; y Y•:... H"9 a"4 �Fu1..�3� �n 54, N 4g14 { f� s F r. � ::•.•� --k w iv V i 31 A 1 urn , a IT r - i- 1 S = r) ♦ t t t F 20 Feet ,t Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER r`nrnrrinht 9MR_9Ml1 T--of P.—fohle AALN All rinhfc ro<ent� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is required for Hyannis Ma. 02601 9/28/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check-Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 30' 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: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1 Wagon lane Property Address Nanci Thurston Owner Owner's Name information is Hyannis Ma. 02601 9/28/2010 required for y every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary:A, B, C, D, or E checked E inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file ti t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ;v `Y CCry No. L .(1��' Fee �J r THE COMMONWEALTH OF MASSACHUSETTS entered in computer: . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplitatlon for Bisposal *pstrm ConstrUttion permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. qy®-q /`:,- Ow�`err'sNName Address nd Tell.No. 6�7_ �a� Assessor's Map/Parcel /J�i�✓h< /W'g �'Z�� ///CC cte g, a %T Installer's Name,Address,and Tel.No. 7R ^ Designer's Name,Address,and Tel.No. �i7 CS-4?3 2�b7� e 61��i�(atcLL'e S-i tc�. f env 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) 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) �� / ® crI/e-� Z`as e i �o/% n sn/ /e i/ ��.�'t_� ii�rg L i.sd X2 e eyioo-'c2ae tnf Bf� gg��` Qi7c� i�iS�CY�/ G�e�`r rPLrirP �orscrf� 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 T tle 5 of the Environm tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this B'o d of Health. S Date 1/11A1�0 Application Approved by 1 Date o Application Disapproved by Date for the following reasons Permit No. )L y/d — V l r Date Issued ( U � -_--------------------- -------------------------- - - - - — — !r No. THE COMMONWEALTH OF MASSACHUSETTS entered in computer: PUBLIC:HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es ftpficAtion for 33isposal Opstem Construction i3ermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon/ ❑Complete System ❑Individual Components Location Address or Lot No. / �¢yo / Ow.er's Name Address,and Tel.No. �7- Assessor's Map/Parcel /`�Gsrr�i t /�YS� G.26o f c 170�7 L"'6Q01i�/ Y r wQ4,o / a ", r T Installer's Name,Address,and Tel.No. -&-c" i />S Designer's Name,Address,and Tel.No. '976-HZ3.2%716 7, tit sf tv- Grw�o� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) r - 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) / "".'.,,� 06. >IX-71- L "'1e '3�i l✓c� >�Ys'�oJtY� r OJT �la fib �^_ 1.��r" R'r7i� �h S�� /�i'l<<i ri!✓ �/ /ia ry r.� _ 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 Environme tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this�ard of Health. "= Siga d Date Application Approved by Date Application Disapproved by Date for the following reasons I t ' Permit No. 6 / — y� Date Issued / l AV r ----------------------------- - - - - THE COMMONWEALTH OF MASSACHUSETTS uyl f m e u�.f I fir. k, BARNSTABLE,MASSACHUSETTS 4C-0 k, '10 p r o"44 Certificate of (Compliance THIS IS TO CERTIFY,that the On-site'Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned at .a,,ro/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System,Construction Permit No. o- ��1/�j dated Installer <-ra.� /j��,,.,s �/ 5,, ,C�•� Designer #bedrooms hIJA Approved design flow I kA# gpd The issuance of thi permit shall not be construed as a guarantee that the system will fun%iionlJ sdes Date ? Inspector No. d l0 Fee Y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Misposal 6pstent Construction Vermit f r Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(vr' System located at / ,�, /� ,S✓s-oirrr�p �� O?gyp/ r 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:Constructio must be completed within three years of the date of this permit. Date i /0 Approved by f d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Wagon Lane M Property Address Charles Coleman Owner Owner's Name information is 1 required for Hyannis MA 02601 9/12/08 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: A. General Information When filling out forms on the 'P computer, use 1. Inspector: u ly the tab key to move your Carmen, E Shay cursor-do not Name of Inspector c� use the return «� key. Shay Environmental Services, Inc. (7D Company Name 4:1 ON M 185 Ashumet Road Company Address Mashpee MA 02649 reran City/Town State. , Zip Code vri 508-539-7966 3080 _ Telephone Number License Number P r� 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 Gy CAW ��.I<i A E. 9/12/08 " v SHAY k° Inspector's Signature Date 4� � Tt`\�� The system inspector shall submit a copy of this inspection report to the A � r Yrity (Board of Health or DEP)within 30 days of completing this inspection. If the system is re 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. ****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. A V Wagon Lane,Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 f, Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town 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: ® I 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: leach pit has No liquid- 1.5' effective depth available per stain line 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 Wagon Lane,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 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. Wagon Lane,Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 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 Y 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. Wagon Lane,Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town 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. Wagon Lane,Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !1 Wagon Lane Property Address P Y Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 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? ® ❑ 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)] Wagon Lane,Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: None 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 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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): Wagon Lane,Hyannis•03/08 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 !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe).- Approximate age of all components, date installed (if known) and source of information: 1987 - BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Wagon Lane,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 3.5 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 leaks, plumbing properly vented Septic Tank(locate on site plan): 2' Depth below grade: 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: 6' x 8' - 1000 gallon Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Wagon Lane,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 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.): Tank in good condition,lnlet tee in good condition, outlet tee in good condition 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 pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 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): Wagon Lane,Hyannis-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town 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 D-Box Present 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.): One outlet to pit. D-box in fair condition -3' below grade Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Wagon Lane,Hyannis•03108 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 ° 11 Wagon Lane,M a e 9 Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 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: 1-6'diam x 6' D ❑ 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.): SAS fuctioning properly, No Riser present . No liquid in leach pit, Top of pit is 3 feet below grade, 1.5' effective depth remaining per stain line Wagon Lane,Hyannis-03/08 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town 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.): Wagon Lane,Hyannis•03/08 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 11 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town State Zip Code Date of Inspection D. Information System y o mation (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. -- 3b,s �oT Ui Wagon Lane,Hyannis•03/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !1 Wagon Lane Property Address Charles Coleman Owner Owner's Name information is required for Hyannis MA 02601 9/12/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 11.5 feet 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: Performed frimpter calculations per BOH ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: refer to plans on file and groundwater Adjustment data Wagon Lane,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: V��C1�^— ��3L j �c� Lot No, Owner: CtiR2 v 'r Address: Contractor: Address: C. < Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. .............................................................................. .Date O c S month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site:and determine: OAAppropriate index well................•...•..•............................ OWater-level range zone ..................................................... STEP 3. Using monthly report "Current Water Resources Conditions" determine current depth to Q water level for index well ........................... mont /year STEP 4 Using Table of Water level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and'water•level zone (STEP 2B) determine water-level adjustment ......................•.......................:..............•..•.•......,,....•.......... 4r STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water _ level at site (STEP 1) ..................................................c........ .......,.......•... C3LZUC1 lc �CiL\ _ �. � Ca�� "T6a)_ Figure 13,--Reproducible computation form. �� " f TOWN OF BARNSTABLE V LOCATION)g i",!� W SEWAGE # � VILLAGE -I Ya � i,< ASSESSOR'S MAP & LOT ``INSTALLER'S NAME & PHONE NO.p-k,-uy c- cSEPTIC TANK CAPACITY .,_,LEACHING FACILITY:(type) � ��s-, (size) k 0 NO. OF BEDROOMS PRIVATE WELL.OR PUBLIC WATER Plk3flL B4I,Wd•OR OWNER Cl, pA--�-eS CoLL<Zvy,,0cN i DATE PERMIT ISSUED: i DATE COMPLIANCE ISSUED: ►- i � g. I VARIANCE GRANTED: Yes No i op— � �) t ( I . I R J TOWN OF BARNSTABLE V/ LOCATION i i"*I �QCC_Xl Lane --> SEWAGE# VILLAGE t��n,�(,�S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 0t)o 's LEACHING FACILITY:(type) L.e CcA- ?tT (size) 1 1 i NO.OF BEDROOMS (d to,CAS OWNER 0-6-i g2LC-S \ernr� PERMIT DATE: 4— 66 — ES—+ 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 Leachi Facility(If an wetlands exist within 300 feet of leach' g acility) Feet FURNISHED BY x e U o) z u�� NOF BARNSTABLE LOCATION A WE SEWAGE # j?& PC- Z VILLAGE._]H yAWT&< ASSESSOR'S MAP & LOT 1W?4�b ak6 ',INSTALLER'S NAME—& PHONE NO, dSEPTIC TANK CAPACITY ) Od0 e6LEACHING FACILITY:(type) (size) G 'x Q NO. OF BEDROOMS PRIVATE WELL .OR PUBLIC WATER N3L.1 ._ B�OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 'I VARIANCE GRANTED: Yes No � Z 6 � 1 i r a p _ e f �i rr'her f` /f Z 7(!5 VAe- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . 1 �.�N4_10...............OF - ,�� fir�a#ila Disposal� � fur Works Toaastru.cttuta Frrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: :�P.. !.�-�&".E....... , ,�x�5.................... ........................ ............................................................ -------- /-i Locatio -A dress or Lot No. /.' /� -...---�'----------------------------------- -•-- .1�Q!/.,..w� Z... /eR .......�:?...._..... a W . tiLk4fje Xe h Owner r ................................ •1Ad c .t Installer Address Type of Building Size LotA1%_1).,,3_11)......Sq. eet U Dwelling—No. of Bedrooms........... .............................Expansion Attic �0> Garbage Grinder r) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures -------------------------------------------•----•------------•-•-------.-•.. d W Design Flow............5.5 .._.._......•.....•--gallons per person per day. Total daily flow..........��10.............•......g allons. WSeptic Tank—Liquid capacity.MCC@.gallons Lengthe-L..._.. Width.14 Diameter--.----- ..... Depth.5.'ca...`.' x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... Diameter.......61........ Depth below inlet...... g . . __...sq. __........ Total leaching area._ ft. Other Distribution box qer,-> Dosin�jtank ( 0 aPercolation Test Results Performed by....V.."Ie ...9,1.c..1-h _�................ Date... Test Pit No. 1.4 z........minutes per inch Depth of Test Pit--- ........ Depth to ground water.0.GrQNr_DUU Test Pit No. 2_G Z......minutes per inch Depth of Test Pit----\k............ Depth to ground water.l41XS.A WD LA �3 ...�.� ........ ..� . Descr ptnfS � �:��......4.=1A..... - --•--•----•-------------------------------------------------------------•-------•---.....---•-•--......._....-----•-------••-•-.0 W x - ESIGNING ENGINEER MUST SUPERVISL U Nature of Repairs or Alterations—Answer when applicable......................... ...................--.. ;STALLATiON AND CERTIFY IN WRITIN" -------------------------------------- -------------- •--•----------- •................. .------------------------ ......... ��:"�irl:.�7"Sr�li V1lAS INSTALLED IN STRIG Agreement: `r.,L ),1 Yr": T<1 PL�iN The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 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 and of h alth. Signed.,ti . ....... � ..._... ............... __..---------------------------- ................................ Date Application Approved By........�< - ----------------•-----••----•----•--•-- Applieation Disapproved for the following reasons:............................................. .......................................................... ------------------•-------------------••----•-----....---------•-•--------------......-----•---......•---..................------•-------.........--------------••----------.......-•-•-•----•-•••------- Date Permit No �-7-`-•-34,61...---•-•--••-•----------.. Issued....................................................... Date No......................... I� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r.Q.W-! .........OF.......d( rn.�S: a b. )c.................................. AVVIiration for BWVviial Work.5 Tiatutrnrtinn ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: La 17 't? L7 n�.l.S /` �• ............�a : ...... ...._ .... .... ............................... ---- . � .Location- re s o Lot cRs.._.. ... .. ;�. pry_TipNti .... . v............... w �1.�:k)Cktt�so� oW �..� r �rso��l, 1 o2G� ...................... .... tc.................................... l�... 1-�-1K:........:f---. ....... 3 Installer Address /� �� O U Type of Building Size Lot___--}....................Sq. feet Dwelling—No. of Bedrooms........ .................................Expansion Attic ( ) Garbage Grinder Other—T e of Building ........... No. of persons............................ Showers - Cafeteria Otherfixtures ------------------------•----------------------.......---------•------------••--------------•-•---•------•-----••---•••--•...............---•-------- d W Design Flow....._f -- �.............................gallons per person per day. Total daily flow--- v� ...........................gallons.// WSeptic Tank—Liquid capacity./V .gallons Length 1--�-.-6_.' Width x�--_/0" Diameter................ Depthj!-:.-.0.. x Disposal Trench—No. .................... Width_................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../........... Diameter..---r_�___._...... Depth below inlet................. Total leaching area.,;Wd......sq. ft. Other Distribution box V�q Dosing tank 4) q/ Percolation Test Result Performed by... pX.fVJ"_`f�U- __........ . Date-a.-,21 17..?..6...... aTest Pit No. 1_L_a...._.minutes per inch Depth of Test Pit..�Q c_c�__...._.. Depth to ground water../.ZD .L'_1)L'941!7 YC'� f= Test Pit No. 2.L._ ..... per inch Depth of Test Pit....ZZ........... Depth to ground water607�.21IL041..1-)-IPt ec Ri7 s 6m.' .................... ----------------------------- •-----• ............ O Description of Soil °LS•....__ _`_ .. Pd Sind �'Das ...__s�g�1d_ ...L� r�el x V •-•-------••-••-••--••---•-•----••-------•-----------•-•------------•-•--•••-•-------•---•-----•---•---...--•-•-----------------------•--------•-------•------........................................ W -•---•--••-•---------•--•---------••-•-••-------•--.._....-•--......--••-•---------------•--.......--=.........---------------•------•------------------ ....................................... UNature of Repairs or Alterations—Answer when applicable...._.................... sr. INC --.................................................................................................................................................[ C i I�. FiTIFY I[J__WI�IT..... Agreement: -I+r YSTEM WAS INSTALLED IN-STRIC The undersigned agrees to install the aforedescribed Individual Sewage'DisposaP?y' eril in accordance with the provisions of T I TLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliancge ha een ' sued t ealth. r-1 ---- �``' -----•---------- -------------------•---------------------- ----------------•------------•-- Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons----------------------------•--------------------------------------------.----------------------------••-------- { Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF M�ASSSACCHUSETTS �c B0ARD�AW HK- W4& .................................I........OF........................................................................ ............. CIrr#if iratr aaf Tompffitnrr THIS IS TO CEPTIF, That the,gidividualSewage Disposal System constructed ( ) or Repaired ( ) by..........�- ................................ ....:... nstaller at--------------------------------------------------------------------------------------------------- �.9 --------------------------...-----------------------.............---•-- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......................................... dated_._._--__...___.._...........___.._._._._.._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 4. n QQ j r -------•----_.... Inspector ----- ��___J A DATE.....................Cl...........- ---•...... ............ THE COMMONWEALTH OF MASSACHUSETTS ................................I.........OF...................................................................................... No......................... FEE......................... Permissin fs.' reb g me -c yr c,; ._... ------------------------•-------------......._.....--------•---------.....--•---•--- to Construct c) or Repair ( � I4ividual Sewage Disposal Syst atNo.•--••••....-----•••------------•-•-•---•-•---------------•-•-•-•-----------••--...-•--------•-.--•-•------------••• -.--7........ ---------•--------------------------••----........... Street as shown on the application for Disposal Works Construction Permit No....................... Dated.......................................... ..........-----------------------•--------------------------------------------------------- Board of Health DATE.................................... ...................... -................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ' 4 r BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville, Massachusetts 02655/Tel. (617)428-9131 WII.LIAM C.NYE,A.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering August 11, 1987 Board of Health Town of Barnstable P .O. Box 534 Hyannis, MA 02601 RE: Lot 26 - Wagon Lane Gentlemen: Per the conditions set forth in your Disposal Works Construction Permit , I have inspected the septic system for Lot 26 Wagon Lane . The system has been installed as per the approved plan. Very truly yours, Peter Sullivan, P . E . Baxter & Nye, Inc. PS/fmj % OF MSS PETER SJLLltfAN i3V 2;t P4o. 29733 ;, MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGIVEERS 1 �P�oFTHETO�I TOWN OF BARNSTABLE 1 d OFFICE OF BAHt639 L : BOARD OF HEALTH vo,e� e39. `e� �E0 MAY A 367 MAIN STREET HYANNIS, MASS. 02601 January 7, 1987 Leon Jodice 76 Hope Lane Dennis, Ma 02638 Dear Mr. Jodice: You are granted a variance from the Intrim Ground Water Protection Regulation to install an on-site sewage disposal system on Lot 26, Wagon Lane, Hyannis, with the following conditions: (1) The dwelling cannot have more than three (3) bedrooms. f Ai (2) The dwelling must connect to Town sewer when the Board determines it's availability. 'i (3) The designing engineer must supervise construction of the on-site sewage disposal system and certify in writing that his design has been strictly adhered to. (4) The septic system must be pumped every three (3) years and written certification submitted by a licensed septage hauler. (5) Variance expires February 1, 1988. This variance is granted :because the Lot is 19,939 Sq. Ft. The area is almost fully developed and is in fairly close proximity to the Town Sewer Plant. It is the opinion of the Board that the addition of another septic system in the area will not have a significant effect on the already poor quality of the groundwater. Very truly yours, Ann Jane Pshbau h - g Acting Chairman BOARD OF HEALTH TOWN OF BARNSTABLE JMK/bs ` I �P LOTT 2Co 19��39� .5 �1�aoosbD WYl .`� 5 io' S LL! o '3,t o 20'KIM. p3cc d - 99 �oogo�xr. P-G2Ag q/ NA ICC6 � Q OF M%P P"T R SULUVAN No. 2y7s3 i�-..'� � �.i � �.:._ Vim../ �=."!•'�.1.E,,�;. 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