The URL can be used to link to this page

Home My WebLink About0100 LINDEN LANE - Health 100`Unden Lane _ osterville F/R e R TOWN OF BARNSTABLE LOCATION fo 0 &ivbe e/ Z-e/ SEWAGE # c�G[�S VILLAGE G ef'�®�f G ASSESSOR'S MAP & LOT ly Z- Z c5 INSTALLER'S NAME&PHONE NO. OaOrU . 4- mil/Zyl- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 350o Gofctc� Cyi � '/3X3�s S NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE; 3 LlYCOMPLIANCE DATE: 3Z14Zd S 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 Weiland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Al ;9 ti7-s p �5 d ca= 3 ' r � Jul 02 2017 16:01 HP Fax page 19 � a ac— Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t•� 100 Linden Lane Property Address r.• Carol Lyall Owner Owner's Name information is required tor every osterville MA 02655 6-27-17 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:When filling out formsA. General Information ut �I on the computer, 1 lJ e�+��ZN OFr44�r��i�, use only the tab 1. Inspector: aa�4 '""•• •'•s`r9�''% key to move your ��,: •.�'�,% cursor-do not JamesD.Sears � JAMES '•G use key.the return Name of Inspector SEAR y _�• S Capewide Enterprises *:•, „ '*? e/rlaa i i Company Name y�l�••„RT�l1FF O 153 Commercial Streets Company Address imHm� » Mashpee MA 02649 Ckyrrown state Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-30-17 n�spectoes 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 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 underthe 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.doc•rev.6116 Title 5 official Irspeaion Form.Subsuiace Sewage Disposal System•Page 1 of 17 _ �o VS e Jul 02 2017 16:01 HP Fax page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "t 100 Linden Lane Property Address Carol Lyall Owner Owner's Name information is required for every Osterville MA 02655 6-27-17 page. Cityrrown state Zip Code Date of Inspectlon 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: Note :Tank should be pumped,The system is a 1500 Gal. Tank D Box and three chambers. 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): 15ins.00c•rev,6116 rtle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Jul 02 2017 16:02 HP Fax page 21 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Linden Lane Property Address Carol L all Owner Owner's Name information is MA 02655 6-27-17 required for every OSterville page Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpsialarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(Explain below): The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The ❑ Y q P 9 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 l5ins.doo•rev.6116 Title 5 Official Inspection Form'Subsirfece Sewage Disposal System•Pepe 3 of 17 Jul 02 2017 16:02 HP Fax page 22 Commonwealth of Massachusetts Title 5 official Inspection Form A a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Linden Lane Property Address Carol Lvall Owner Owners Name information is Osterville MA 02655 6-27-17 required for every . page Clty>'rown 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspectlons: 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 is less than 6" below invert or available volume is less than 1/2 day flow F/Ie1{(NC- t6lns.doe-rev.6118 Title 5 Official Inspect Ion Form:Subsurface Sewage Disposal System•Pape 4 of 17 Jul 02 2017 16,02 HP Fax page 23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Linden Lane Property Address Carol Lyall Owner Owner's Name information is required for every Osteryille MA 02655 6-27-17 pap. 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. ❑ ® 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 6 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 falls.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 16,000 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 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 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. 15ins.dcc•rev.VG Title 5 Official Inspection form:SubsLeace Sewage Disposal System•Page 5 at 17 Jul 02 2017 16:03 HP Fax page 24 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments F .r 100 Linden Lane Property Address Carol Lyall Owner Owner's Name information is required for every Osterville MA 02655 6-27-17 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 ❑ N 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? ® El available as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ 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. 1:1 ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms), 440 l5ins.doc•ref.WIG Title 5 Official Inspection Form'Subsuilace Sewage Disposal System•Page 6 of 17 Jul 02 2017 16:03 HP Fax page 25 Commonwealth of Massachusetts Title 5 Official p fi ial Inspection Form tilp - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Linden Lane Property Address Carol Lyall Owner Owner's Name information is required for every Osterville MA 02655 6-27-17 page Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal Tank D Box and three chambes. 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2015-45,000GaIs2015-86,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Dateesent Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203); Gallons per day(gpd) Basis of design flow(seatslpersonslsq.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: l5insAX-rev.6/16 Title 5 Official inspection Form:Subsrrface Sewage Disposal System.Pepe 7 of 17 Jul 02 2017 16:04 HP Fax page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Linden Lane Properly Address Carol Lyall Owner Owner's Name information is Osterville MA 02655 6-27-17 required for every page. Citylrown State Zip code Date of Inspection D. System Information (cant.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA 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). ❑ Inncvative/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 IJA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6116 Tifle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 17 Jul 02 2017 16:04 HP Fax page 27 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Linden Lane Property Address Carol Lyall - Owner Owner's Name information is required for every Ostefville MA 02655 6-27-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 30" Depth below grade: 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.): Pipeing is 4" PVC SCH 40 - Septic Tank(locate on site plan): 18" 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: 1500 Gal. Precast H- 10 411 Sludge depth: I, 4 15ins.doc•rev.6116 ?hle 5 Official.nspecbon Form Subsur'ace Sewage Disposal System-Page 9 of 17 Jul 02 2017 16:04 HP Fax page 28 i Commonwealth of Massachusetts Title 5 Official Inspection Form NNW Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Linden Lane Property Address Carol Lyail Owner Owner's Name information is Osterville MA 02655 6-27-17 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cant.) Distance from top of sludge to bottom of outlet tee or baffle 26" 61, Scum thickness Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 12' How were dimensions determined? Asbuilt- Plan -Tape Sludge Judge 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 at working level. Tank at 18" below grade w/both cover's at 6". In and outlet tee's. No sign of leakage Note: Tank need to be pumped 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 15ins.doc•rev.6r16 Title s ofriial Ir"cilon Form Subsufece Sewage Disposal System-Page 10 of 17 Jul 02 2017 16:05 HP Fax page 29 Commonwealth of Massachusetts Title 5 official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Linden Lane Property Address Carol Lyall Owner Owner's Name information is Osterville MA 02655 6-27-17 required for 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.doc•rev.6116 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 17 Jul 02 2017 16:05 HP Fax page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Linden Lane Property Address _Carol Lyall Owner Owners Name requinforma retion is osterville MA 02655 6-27-17 required for 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 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.): D Box is 16'x16"-38" below grade. w/cover at 18". Box is clean and solid w/three lines out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.dcc-rev.6116 Title 60fficisl Inspection Form Subsurface Sewage Disposal System-Page 12 017 Jul 02 2017 16:05 HP Fax page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Linden Lane Property Address Carol Lyall Owner Owner's Name information is Osterville MA 02655 6-27-17 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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 three 500 Gal. dry well chambers w/4' stone. Chamber's at 3' below grade w/cover at 10" 6"water in chambers. No sign of over loading or solid carry over. 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 tbins.doc-rev.6t16 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Pegs 13 of 17 Jul 02 2017 16:06 HP Fax page 32 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 100 Linden Lane Property Address Carol L all Owner Owner's Name information is Osterville MA 02655 6-27-17 required for 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.doc-rev.6116 Tille 5 Official Inspection form:Subsurface Sewage Disposal System•Page 14 of 17 Jul 02 2017 16:06 HP Fax page 33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments C " 100 Linden Lane Property Address Carol Lyall Owner Owner's Name information is required for every Osterville MA 02655 6-27-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately R { c a o e s A � A h ! ' --� 18 , ,e `! �-6 C-3 = /! -/o 3 Pa-G � t5ins.doc•rev.W6 Title 5 Official Inspection Form:Subsur'eoe Sewage Disposal System•Pape 15 of 17 Jul 02 2017 16:06 HP Fax page 34 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 10D Linden Lane Property Address Carol Lyall Owner Owner's Name information is required for every Ostervllle MA 02655 6-27-17 page, City(Town State Zip Code Date of Inspection D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N� 12' Estimated depth t high ground water: 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: 9-7-02Date ❑ Observed site(abutting property/observation hole within 150 Feet of SAS) ❑ Checked with local Board of-Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain.: You must describe how you established the high ground water elevation: T.H.on Design plan 9-7-02 12' no G.W.. Bottom of chamber's at 5' below grade. Bottom of chamber's at T above T H Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.We Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 16 of 17 Jul 02 2017 16:07 HP Fax page 35 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Linden Lane Property Address Carol L all Owner Owners Name information is Osterville MA 02655 6-27-17 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I 15ins.doc-rev.8116 Title 5 Official Irspection Form:Subsurface Sewage Disposal System•Page 17 of 17 P' No. a UD,S��(/0 Fee ! U THE COMMONWEALTH OF MASSACKUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Miopooal 6potem Conotruction Permit Application for a Permit to Construct( . )Repair(v<pgrade( )Abandon( ) CJ Complete System ❑Individual Components Location Address or Lot No./6V 4.4 A t4L Low Owner's Name,Address and Tel.No. 11\ C, / Z-VssG Assessor's Map/Parcel 2�5 s Uv-yaf- 41/Z v Installer's Name,Address,and Tel.No. J*,5'41 4- Scci Z c- Designer's Name,Address and Tel.No. Av!(o t.SlJ/tea y Z-7 C4;, ry /tells �nu�!- —c , ?K,, S*)�l��f �° =ne�✓��/� Type of Building: Dwelling No.of Bedrooms Lot Size i'll sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L/Ll o gallons per day. Calculated daily flow `� --gallons. Plan Date k7 Zug 2—Number of sheets Revision Date Title Size of Septic Tank >:500 Type of S.A.S. V,, C i r Description of Soil 11 gmd,1,m Nature of Repairs or Alterations(Answer when applicable) A-lew A 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 Certifi- cate of Compliance has b%e,,n issued by this Board of Health. Signe Date q d Application Approved by � Date Application Disapproved fort following reasons Permit No. �Lvo, -497 Date Issued �� No: •� UOS �()t� ( �- �, x. Fee l o d— .�' THE COMMONWEALTH OF MASSACHU$ES Entered in computer: Yes % / _— PUBLIC HEALTH DIVISION,-' TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for 30 gpogal *pgtem Congtructio'n Permit Application for a Permit to Construct( , )Repair( pgrade( )Abandon( ) '®'Complete System ❑Individual Components Location Address or Lot No./,M L n,/ �,`„ Owner's Name,Address and Tel.No. �r�lc 11�Q ../o/ L Assessor's Map/Parcel �- YAW 2nm /yL - o zC Installer's Name,Address,and Tel.No. J<}Svyr 4 , Scv Z c Designer's Name,Address and Tel.No. y�,/U t Svw Z cam,^* �- "7�.c�sl-�o-�c , 02,4 Le �j y2 ° �.wSY 1y !Aa. � ' - 3 a Type of Building. Dwelling No.of Bedrooms _ Lot Size /Z !!2/Fsq.ft. -- Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) } x. Other Fixtures It Design Flow L/C1 y. gallons per day. Calculated daily flow Z/7 F gallons. Plan Date i, . z,,, , Number of sheets 7— Revision Date yr/L I Title Size of Septic Tank /5 oo-- Type of S.A.S. �. Description of Soil Nature of Repairs or Alterations(Answer when applicable) .l✓e.� Date last inspected: N Agreement: 1 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 Certifi- cate of Compliance has lieen issued by this Board of Health. _ d � Signe /1 Date " Application Approved by `_ S Date .l Application Disapproved for&efoll6wing reasons i , E Permit No. 2 uu —0f-7 Date Issued /40 I ------------ ----------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(/1)Upgraded( ) Abandoned( )by 1 _ 6 :�Z C /" at <<tu . L. rPn„ of�„_,i/� has been constructed in accordance with the rovisions of Title 5 and the for Disposal System Construction Permit No.?G S-� 7 dated V Installer Designer The issuance of this ermit shall not be construed as a guarantee that t syste �ilr�cas�deign�ed. , Date 3 / f, Inspecto --------------------------------------- No. --i ni,F /1,P7 Fee /Dr) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5pogar *pgtem Congtrurtion Permit Permission is hereby granted to Construct( )Repair(K)Upgrade( )Abandon( ) System located at /ln L s and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date o,tf f s`pe1rmjt. Date:_ Sf !/rAI S Approved by I l,Ct /,�n . I"E TO Town of Barnstable Regulatory Services * BARNS'PABLE, Thomas F. Geiler,Director 9 MAss. �► 1639• �� Public Health Division t a Ep '� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8Q-4644 Fax: 508-790-6304 Carol Lyall Date: March 1, 2005 24 Poponessett Road Cotuit,Ma. 02635 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 100 Linden Lane Osterville, Ma. was inspected on, 12/12/2001 by James M.Ford a Massachusetts licensed septic inspector. The. inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to an overloaded SAS or cesspool. Our records show that the system has been in a failed state for more than two years. You :are ordered to hire a professional engineer or registered sanitarian to prepare a plan of proposed replacement septic system component(s). This plan is to be submitted to the-Town of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street, Hyannis), within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title V. You are a lso o rdered t o u pgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f y our receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal..to any c ourt o f competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. Z ?A. R OF 9n,R. tC. OF HEALTH McKe Agent of the Board of Health CC: Board of Health I/Wled_septic_letters Barnstable Assessing Search Results Page 1 of 2 — t ✓ f Home: Departments:Assessors Division: Property Assessment Search Results 100 L E N LAME Owner: LYALL, CAROL Property Sketch Legend Map/Parcel/Parcel Extension 142 /025/ Mailing Address LYALL CAROL 24 POPONESSETT RD P COTUIT, MA.02635 2005 Assessed Values: Appraised Value Assessed Value -s Building Value: $ 131,500 $ 131,500 Extra Features: $3,500 $3,500 Outbuildings: $6,700 $6,700 ' Land Value: $236,400 $236,400 Interactive Property Map: Ma .requires Plug in:, Totals:$378,100 $378,100 1 have visited the maps before ' Show Me The Man k April 2001 photos available ; Sales History: Owner: Sale Date Book/Page: Sale Price: LYONS, HAROLD T 4/15/1995 9639/245 $ 1 LYONS, HAROLD T& EDITH 1 6/15/1983 3772/001 $0 LYALL,CAROL 12/6/2001 14538/291 $0 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $68.63 Town Fire District Rates Other 1 $6.05 Barnstable-Residential $2.12 Land B. Barnstable-Commercial $2.80 C.O.M.M. FD Tax(Residential) $381.88 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $2,287.51 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 W Barnstable-Residential $1.44 W Barnstable-Commercial $2.10 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005 Barnstable Assessing Search Results Page 2 of 2 r- Total: $2,738.02 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.34 Year Built 1957 Appraised Value $236,400 Living Area _1512 Assessed Value $236,400 Replacement Cost$ 164,400 Depreciation 20 Building Value 131,500 Construction Details Style Cape Cod Interior Floors Hardwood Model Residential Interior Walls Drywall Grade Average Plus Heat Fuel Oil Stories 1 1/2 Stories Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 4 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 7 Rooms Extra Building Features Code Description .Units/SQ ft t. Appraised Value Assessed Value BRR Bsmt•Rec.Room 264 . ,$ 1,100 $ 1,100 FPL2 Fireplace 1 $2,400 $2,400 FGR2 Garage-Avg 432 =' $.6,700 $6,700 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http:Hwww.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005 Septic Inspection Information Data E ry Dated 1/7/2002 Sept�c�tnspect No: 217 iAssessors Maps 142 °Parcel: 025 (�Busmess;� u er 100 ��d`d'ress: Linden Lane Vivage Osterville inspector James M. Ford lnspectd to 2/12/2001 System`Status F Comment: Backup of sewage into facility or ststem component due to overloaded SAS. ,f%Nt�,e rm�t,_Y#�,. .,w RepaEDate° ' Notification,FD �aEng/instal Repair Deadl ne�Dat a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 100 Linden Lane. Osterville, MA 02655 CTIOpo Owner's Name: Estate of Harold Lyons FAILED p1, �° �V Owner's Address: Same Date of Inspection: December 7, 2001 SPEC'rION I Name of Inspector: (Please Print)James M. Ford ' AILED I� R ECEIVE Company Name: James M. Ford MaMailing Address: P.O. Box 49 PaOsterville,MA 02655-0049 Telephone Number: (508) 862-9400 ABLE I ^_��•_ 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: Pas es Con itionally Passes Nee urther Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: December 12, 2001 The system inspector shall subm` a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 Linden Lane Osterville, AM Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 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. 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 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 Linden Lane Osterville, AM Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 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 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 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: 3 Page 4 of 11 OFFICIAL'INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 Linden Lane Osterville, MA Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ ✓ Any portion of a cesspool or privy is 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 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.] Yes (YesfNo)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 System: To be considered a large system the system must serve 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 406 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 N 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 100 Linden Lane Osterville, AM Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 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? n/a 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 5 e ✓ 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 r Page 6 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 100 Linden Lane Osterville, MA Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4-per town assessment DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]' Laundry system inspected(yes or no): No Seasonal use(yes or no): No ` Water meter readings, if available(last 2 years usage(gpd)): 2000-38,000 Qals.; 1999-39,000 Qals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCLUJINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): apd Basis of design flow(seats/persons/sgft,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/user OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None on file-per treatment plant - Was system pumped as part of the inspection (yes or no): . 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) Tight Tank. Attach a copy of the DEP approval Other(describe): j Approximate ageeof all components, date installed(if known)'and source of information: I Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Linden Lane Osterville, AM Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 BUILDING SEWER(locate on site plan). Depth below grade: - 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 on site plan) Cesspool acting as,a septic tank Depth below grade: 12" Material of construction: _concrete _metal fiberglass _polyethylene ✓ other(explain) Cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 6'W x 8'T x 9'6"bottom to,grade Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: 12" Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: -- How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or,baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The cesspool had Y of water on the bottom. The scum line wds up to the inlet pipe. No outlet tee was present. The cover was 12"below grade. GREASE TRAP:, None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 100 Linden Lane Osterville, AM Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 TIGHT or HOLDING TANK: None (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 Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on.site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence.of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (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.): 4 7 r 8 Page 9 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Linden Lane Osterville, AM Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches, number, length: leaching fields,number, dimensions: ✓ overflow cesspool,number: 1 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.): The overflow cesspool was 6'W x 6'T x 9'bottom to grade, and had 4'of sludge on the bottom. The liquid has been up to the inlet pipe. The overflow cesspool was in hydraulic failure. The cover was 2'below grade. CESSPOOLS: None (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: None (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.): 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: 100 Linden Lane . Osterville, AM Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 Map: 142 ' Parcel: 025 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. oQ(o t 3i - co / - 33 ,� Q v 10 Page I 1 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION (continued) Property Address: 100 Linden Lane Osterville, M4 Owner: Estate of Harold Lyons Date of Inspection: December 7, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water. 50'+/- feet (Adjusted High Ground Water Level is 44.9) Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain:_ topographic and water contours.maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the cesspool to grade was approximately 9. Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 50'+/-to groundwater at this site Using the Cape Cod Commission Technical Bulletin, the high ground water adjustment for this site (Ml W 29 Zone C 10/01) was 5.1' This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. I 11 , i _ 6rA . k - 41`I.9 Groa- ,��SvsTr,,,e��" M►w aq c .I TOWN OF BARNSTABLE LOCATION !0 0 �lfwoe U � s o t — SEWAGE # o��S r VILLAGE 6 Cf�vB�fa ASSESSOR'S MAP &LOT /`/2,- 7 INSTALLER'S NAME&PHONE NO. 'T `/Z_+ SEPTIC TANK CAPACITY v"fJ.O LEACHING FACILITY: (type) 3 NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE; 3 /y�t�,� - COMPLIANCE DATE: -� iG�Os 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) .. Furnished by � � •S�ve�- - a I �t 44 (� rt � J \y I Town of Barnstable Regulat6ry Services yP w o� Thomas F.Geiler,Director Mom• Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax- .508-790-6304 Installer& Designer Certirication Form Date: Designer: yea,A-kce Sv �� Installer: Address: .'. 1/6 Address: 2_ 1 C ouyx+4 Zd 5 On / 4/0 S"' sCLU Z ck-� was issued a permit to install a # `a � o 2; (date) (installer) septic system at `0 U Li Av d W OP based on a design drawn by (address) 3✓uc� dated 3 l C. 0 / (design r) �/ I certify that-the septic•system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I 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 I egutations. Plan revision or certified as-built by designer to follow. of s BRUCE + G. MURPHY �taHer'sSigbature) fao.749 • Gt;tE�0 . A rA��P ✓ (Designer's S' e) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HkALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM' AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE P ' LIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form 'i3Own OI isGarnstaute A. RegiWatary Services . Thom as F.Geiler,Director snKri$r�sr a. = . Public Health Division 3�B Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: AS Designer: VAIN Installer: Address: •. arco4os-f�, (� . Address: 7 eovl- V On '• �5 + �-' Sey��--was issued a permit to install.a (date) (installer) septic system at / !9® Z-in 0(-e-A based on a design drawn by (address) /Lem -rug' dated (designer I certify that-the septic'system referenced above was installed substantially according to the design, which may include minor approved changes such as-lateral relocation of the distribution box and/or septic tank. I 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. a 4 BRACE ,' '. G. �F1 : er afore �,, MURPHY eis t' No.749 CISTf,11 a vim- �/7'A�a� ' (Designer's Signa e) (Affix Desiguer'sSamp Here) , . PLEASE.RETURN TO BARNS PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPL ANCE WILL NOT BE ISSUED UNTIL BOT THIS FORM' AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE P - TIC HEALTH DIVISION. THANK YOU. - - Q:Health/SepticMesigner Certification Form 3 1 L t2 30 .-I (i-e..p 'S 110 A.M. 142/36 )VOTE: EXIST SEPTIC SY.�TEM � .� a / ;' - ,. _ -s�. ._. ,. �STE�R VILLE� ; SHO WN PER TITLE V INSPECTION REPORT BY JAMES M. FORD f A.M. 142/24 / 1 TOWN -WATER / -« 3d�. ��•� �. 4 � f � 9g LOT9c / P ' e 0.�1� LOCUS 41 — -- �o A.M. 142/35 I . t �POLE _2=__ — -- b TOWN 'WATER T.O.F. �- a ao ELEV.=58.0- c.I S cEssPooLs ,�� a b x o C-1 " HOUSE .�. ° r MAIN STREET ., � \ - Ll(4-BEDROOM)-_ -'; LOCUS MAPTP _ CK �2 C� ` BCE PLAN~ REF1151.125, 14117 & 1841141 W - - - DE c4 Mi1RPNY J ZONING. »RC, No. 749 I `i)GE CAIRA 1 P E PL d _ _ ;SE' TIC_ UPGRAD AN 12 � LOCATED AT. '' . OSTE'R VILLE' MA. 142/34 - Y O 1. T WN WATER - --- PREPARED FOR REs CAROL' • L YALL•.1 112 ;S'EPTEMBER 16,. 2002 LOT 8. °• YANK EE SURVEY CONSULTANTS <, UNIT 1, .40 INDUSTRY ROAD AM 142125 \ AREA=14,918t SF P. 0. BOX ,265 7g 1 MARSTONS MILLS, MASS. 02648 g9 TEL: 428-0055 FAX 420-5553 Sff A.M` 142/28 TOWN WATER NOTE.• PUMP AND FILL CESSPOOLS SCALE •1 = 20 FEET. J# 53105 GM dr J EL - 5_8.0 719P OF FOUNDATION 20' MIN. 10' MIN. CONCRETE COVERS ` 4" SCHEDULE 40 P. VC. MIN. PI7rH 1/8 PER FT EL= 2"LA YER OF CONCRETE COVER 1/B"—1/2" EL=55.0 EL =54.5 6" MAX . / � • • �, i i / � 'WASHED S717NE - 4" CAST IRON PIPE B NAX / . . B"MAX (OR EQUAQ MINIMUM PI7CH 114 PER FT �i . / F/RST 5' h , FLOW LINE PH 1 4 PER FT CLEAN SAND EXISTING 1 10" EL=51.5 INVERT MIN. 14" coo 00000000000 o°�y -56.1 °° o000000000`0 ° EL.---- cAs INVERT LEVEL o0 o 6 SUM eo 0 00000000000 BAFFLE . o 0 0000000000o u8 _ INVERT EL.=55.35 IN INVERT.' EL=48. �' EL.=55.6 _ EL.=_52.25 EL:=52.0__ 4. _f , - __ (3J 500 GAL LEACHING 'CHAMBERS 4 (70 BE PLACED ON FI" BASE) DISTRIBUTION EL. MECHANICALLY COMPACTED OR 6" OF S7VNF as » BOX W� T 12.8' X 35.5' TRENCH FORMATION __15Q0__GALLONS 719 BE W4 TER TESTED �' cv ,SEPTIC. TANK IF MORE THAN ONE OUTLET SOIL ABSORPTION t PLACE ON 6 S719NE N 3i4" 7t7 1-1iz" SYSTEM (SASS PROFILE O F DOUBLE WASHED SMNE E . SEWAGE, DISPOSAL, SYSTEM NO OBSERVED WATER TABLE (9/07/02) ELEV.= 42.5 _ NOT TO , SCALE 5.5 ADJUSTMENT (MIW 29, ZONE C) USCS PROBABLE WATER TABLE ELEY. C.I.S. WATER TABLE (JOSHUAS POND) ELEV. =_9.5 _ OBSERVATION HOLE 1 _ .. ELEV. 55.0 PERCOLATION RATE S2=_ MIN./ INCH AT _3E— INCHES DEPTH HORIZ -TEXTURE . ` COLOR OTT. OTHER = 0"-7" A SANDY LOAM 10YR 5/2 B LOAMY SAND - 10IR 5/8 x 3-12.5' Cl MEDIUM SAND IOYR 6/6 _ PERC GENERAL NOTES 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO REP NO WATER ENCOUNTERED '- TITLE 5 AND THE TOWN OF _BARNBT 9BLE____ RULES AND - - REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO OIL TES T 91071W SOIL TEST DONE' BY BY WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE OF :SOIL TEST BRUCE C. MURPHY, R.S. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE DESIGN CALCULA TIONS.' USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . . . . . . . . 4 4) ANY MASONARY UNITS USED TO BRING COVERS• TO CRADE SHALL CABBAGE DISPOSAL . . . . . . . . : NO z BE MORTERED IN PLACE. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH - LVSTALL• TOTAL ESTIMATED FLOW DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO (3) 500 GAL LEACHING CHAMBERS ( 110__GAL/BR/DAY x ___4 BR.) 440 CAL/DAY — -- x OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. SPACED 1' APART - _' 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR CONNECTED BY PIPESOIL CLASSIFICA TION . . . . . . . . 1 • '� WITH 4' STONE ALL AROUND �.J�- r IS TO CALL DIG— SAFE AT 1-800-322-4844 AT LEAST 72 HOURS r Q DESIGN PERCOLATION RATE < P MIN./IN. 12 8' X 35.5' PRIOR TO COMMENCING WORK ON SITE. ?� �1L EFFLUENT LOADING RATE . . . . . . •74 GALIDAY/S.F. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL .A$ tl ,I, %`�` r EACHINC CAPACITY (AREA X RATE) 478 GAL/DAY 478 n �,- � RESERVE LEACHING CAPACITY . . CAL DA Y SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. � tt „5 / Y ```3 "C" �l t' 35.5XI2.8X.74 f 35.5f 35.5+12.8+12.8)X2X 74 8) PARCEL IS IN FLOOD ZONE___ _. ( ) ( ) 9) LOT IS SHOWN ON ASSESSORS MAP AS PARCEL 25____ PACE 2 OF 2 JOB 53748 .� . � , -., .r .... ;�. �1 :\ �� .�t 2, r. . � a � � �, I ..�� . :..�� .. { �� .� A . . ��. . .� `, _ � - _ ,_ �.