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HomeMy WebLinkAbout0075 BAY ROAD - Health 75 BAY-ROAD COTUIT i i I i I I * '� TOWhI OF BARNSTABLE LOCATION _ .�� ¢�'� SEWAGE # 9'5 :5) VILLAGE CO `fit/l ASSESSOR'S MAP & LOT- a INSTALLER'S NAME&PHONE NO. C t/re GC• `-1 d Sso SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 3.S� NO.OF BEDROOMS BUILDER OR OWNER e!D�AJ N`e PERMIT DATE: A �' `� .i 0ACOMPLIANCE DATE: 7-- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 19-c 3y a_ c 3� Commonwealth of Massachusetts D0� Oo'2 Title 5 Official Inspection Form 'OPSubsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 75 Bay Road Property Address -, Pennell Family Irrev Trust r _,r Owner Owner's Nam r information is required for every Cotuit J MA 02635 August 28, 2020 page. Cityrrown 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 A. Inspector Information filling out forms on the computer, use only the tab Patrick T. Sullivan key to move your Name of Inspector cursor-do not Ready Rooter Excavating use the return Company Name key. ' PO Box 89 Company Address Forestdale MA 02644 Cityfrown State Zip Code 508-888-6055 S112843 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function ` and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined: that the system: 1. Passes 2. 0 Conditionally Passes 3. 8 Needs Further Evaluation by the Local Approving Authority 4. Fails August 28, 2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the,buyer, if applicable, and the approving authority. Please note: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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 i f ' c� Commonwealth of Massachusetts �w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is 9 required for every Cotuit MA 02635 August 28, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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 /is ars Id* or the septic tank (whether metal or not) is structurally unsound, exhibits substantialo exfiltration or tank failure is imminent. System will pass inspection if the existing tankwith a complying septic tank as approved by the Board of Health. *A metal septic tank will pasn if it is structurally sound, not leaking and if a Certificate of Compliance indicating that thss than 20 years old is available.❑ Y ❑ N- plain below): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is required for every Cotuit MA 02635 August 28, 2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup orb ak out or high static water level in the distribution box due to broken or obstructed pipe(s)or ue to a broken, settled or uneven distribution box. System will pass inspection if(with approval )f Board of Health): ❑ broken pipe(s) are re aced ❑ Y ❑ N ❑ ND (Explain below): Elobstruction is remo ed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box i leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a ye due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Bd of Health): i ❑ broken pipe(s) are replaced ❑ Y '❑ N ❑ ND (Explain below): ❑ obstruction is removed j' ❑ Y ❑ N ❑ ND (Explain below): - A 3) Further Evaluation is Required/bthe Board of Health: ❑ Conditions exist which requii further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I a. 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: t5insp.doc•rev.7/26/2018 m Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts lip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Bay Road F Property Address Pennell Family Irrev Trust Owner Owner's Name information is Cotuit MA 02635 August 28, 2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of fa bordering vegetated wetland or a salt marsh b. 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 spil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or trAbutary to a surface water supply. ❑ The system has a septic tank an SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank nd SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tan and SAS and the SAS is less than 100 feet but 50 feet or more from a private water sup y well**. Method used to determine dis ance: **This system passes if the wkii water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates ap` ent 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. i c. Other: t 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool surface of th e round or surface waters . ndin of effluent to the g ❑ � Discharge or po g due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts 1- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is 9 required for every Cotuit MA 02635 August 28, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. 0 ® 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. 5) 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 CA.- Yes No ❑ ❑ the system is within 400 eet of a surface drinking water supply, ' ❑ ❑ the system is within 00 feet of a tributary to a surface drinking water supply El ❑ the system is loc ed in a nitrogen sensitive area (Interim Wellhead Protection. Area—IWPA) pr a mapped Zone II of a public water supply well l5insp.doc-rev.7/26/2018> 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is required for every Cotuit MA 02635 August 28, 2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ` 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is Cotuit MA 02635- August 28, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 4 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+GPD Description: 4' x 6' leach pit w/2' stone. - - 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ 'Yes ® No If yes, discharges to: 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 2018= 191 GPD Water meter readings, if available(last 2 years usage (gpd)): • 2019= 167 GPD Detail Sump pump? ❑ Yes ® No July 1, 2020 Last date of occupancy. Date t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts i- Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owners Name information is Cotuit MA 02635 August 28 2020 required for every g , page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 2. 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 Water treatment unit present? El Yes ❑ No If yes, discharges t. . Industrial waste holding tank pw ❑ Yes ❑ No Non-sanitary waste discharged Yes ❑ No Water meter readings, if availaLast date of occupancy/use: Date i Other(describe below): 3. Pumping Records: Source of information: No previous recods found or known Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? ' Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is Cotuit MA 02635 August 28 2020 required for every g page. Cityrrown State Zip Code Date of Inspection D. System Information (Cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy t ❑ 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: System installed 07/18/1995. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site?- ❑ Yes ® No 5. Building Sewer(locate on.site plan): Depth below grade: 5 feet Material of construction: ❑ cast iron 0 40 PVC ❑ other(explain): — Distance from private water supply well or suction line: n/a feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 f c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is g required for every Cotuit MA 02635 August 28, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' x 5.5' x 5' 1500 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 29" - Scum thickness 10" at inlet, 1"at outlet 6„ Distance from top of scum to top of outlet tee or baffle Distance from bottom ofscum to bottom of outlet tee or baffle 14" How were dimensions determined? Dip tube and tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees in place. Liquid level at outlet invert. Risers installed to bring covers within 6" of grade. Recommend tank pumping before winter months due to heavy solids on inlet side of tank. Recommend maintenance pumping every two years with full time use. t5iriF.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts r- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is required for every Cotuit MA 02635 August 28, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 p of outlet tee or baffle Distance from bottom of um 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal O'fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I� '- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is g required for every Cotuit MA 02635 August 28 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: . Date Comments (condition of alarm and float switc es, etc.): *Attach copy of current pumping contract(required)..Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): 011 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.): One inlet, one outlet. No high water staining over outlet invert. H-10 D13-3 4' below ground. Installed riser and 18"concrete cover to bring access within 6"of grade. t5insp.doc•rev.7t26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is required for every Cotuit MA 02635 August 28, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes. ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump ch ber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: A Type: - t. ® leaching pits number: 1-4' x 6'w/2' stone. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 ' Commonwealth of Massachusetts` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is required for every Cotuit MA 02635 August 28, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1' liquid in unit at time of inspection. High water staining 1' above current level, 2' below invert. Clean stone visible in sidewall w/mirror. No sign of past hydraulic failure. Leach pit is H-10, 5' below grade. Riser added to bring cover within 6" of grade. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet i/ve I Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inf ❑" Yes ❑ No Comments(note condition oaulic failure, level of ponding, condition of vegetation, etc.): f _ t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments- 75 Bay Road Property Address _ Pennell Family Irrev Trust Owner Owner's Name information is required for every Cotuit MA 02635 August 28, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (coat.) 13. Privy(locate on site plan): Materials of construction: Dimensions i Depth of solids Comments (note condition of soil, sig/fhydraulic failure, level of ponding, condition of vegetation, etc.): ' i• t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is 'Y required for every Cotuit MA 02635• August 28, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 � . LU o - i Tom • ra , , 3 3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts _ Title 5 Official Inspection Form 6) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Bay Road - Property Address Pennell Family Irrev Trust Owner Owner's Name information is Cotuit MA 02635 August 28, 2020 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >3 feet , Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 1995 If checked, date of design plan reviewed. Date Date , ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed•USGS database-explain: maps.massg is.state.ma.us/oliver.ph p You must describe how you established the high ground water elevation: Test hole in 1995 found no ground water at 12'. Base of leach pit 9' below grade. Accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-.rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Bay Road Property Address Pennell Family Irrev Trust Owner Owner's Name information is Cotuit MA 02635 August 28 2020 required for every g page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 �j__., Kr ASSESSORS NEAP NO: (5 !NO. - THE COM A1'V'WA E1'TS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratiou for Diinpwi al ]Unr1w Tnnitrnrttnn ramit Application is hereby made for a Permit to Construct (-,,/) or Repair ( ) an Individual Sewage Disposal System at: •----•----�'r-= ��''-� �Tv/ --------•---------- --------'""T-�-------3•--•�--�s -----•-------------•----.....-----•------. le ... Location-Address or Lot No. 1:7Z g � Cg'Zo�l v - �- P�7�NEZG 1149 il/,. z./�� I" -_--- ------------- •------• ------------------------•----------------- ----------------- W \ � �Owncr Address V ner IustatIer Address d Type of Building Size Lot----G�`,_�vv___.Sq. feet Dwelling—No. of Bedrooms_______________ __________________-_.__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.......--.--..--_-_--------_ Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------- - - W Design Flow...............5'_._._.__.________._gallons per person per day. Total daily flow......._.��........_..................gallons. WSeptic Tank—Liquid capacity_A,!�-gallons Length/taw-"_.. Width_✓jPt"/--. Diameter................ Depth.: 790. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------/.......... Diameter-----/a.1.._... Depth below inlet___ ,G_....__.. Total leaching area.. 8:`�sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.--.- L .__ ..�!CCelT1V______________ Date__!`?'`�~J Test Pit No. 1..4.4....minutes per inch Depth of Test Pit_/ _ -__-___ Depth to ground water........................ GX4 Test Pit No. 2...<-.Z--_minutes per inch Depth of Test Pit--- _...... Depth to ground water........................ P+ --------------------------------- ---••-•--------•-----•-••---•----••••-•---•--••••.........-••-•----•••••-••---••--.....-•••---•------•--......_...--•-••-- 0 Description of Soil.... •• 404-�% i !_..�5"v Sci�. uL•r � �� �4=� =4-2_,0 -•••••. • -----•--•---•................... x W ---------------------------------------------------------------------- -------------------------------------------- -----------------------•--•--------------•-----•-•----•------•----......-------• VNature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------------------------------•--•-•----------•.....---•-••-••.........----••------•--•-----------_...-----•-------------••--------------•---••--•-----•--................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ........... ....... ..................... ............... . . ........ ---------------------------------------- Da Application.Approved /c -- ff�7 Dare Application Disapproved for the following reasons- ---- ----------------------------------- -------------------------------------------------------------------------- -------- --------------------------------------------------------- ------------- ----------------------------------- --------------- --- ........................................ Da Permit No. ... :.----- ....... . -------- - Issued .......... �j -- Dace THE COMMONWEALTH OF M SS-'ACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allp iration fury Diipnial Works Tomitrnrtinn ramit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at: w ......7-6- eXh f -----------•-•------...--•--•-------•--••------..... Location-Address or Lot No. ......T,�h✓ 1�. PE-7t/r�tZG --------- --=---------------------------------•-----••-•----- Owner Address - � ---------- ems-�-------�.'---'-------------------------------------------- Installer Address Type of Building 3 Size Lot....Gg.. a�?....Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------- ---------------------------------------------------------•------------ ----------....-----------------.----------------------------- ^ ....................gallons per person per day. Total daily flow.........330 w ,Design Flow..................._ .._.-._-_-._....-_._._..gallons. WSeptic Tank—Liquid capacity.4S�.galIons Length/a'S?'.'.... Width.�' ''_ Diameter................ Depth_.-_'1�7p... x Disposal Trench—No. .................... Width........--.......... Total Length................ Total leaching area....................sq. ft. Seepage Pit No--------.../-------- Diameter-----/Q.'------ Depth below inlet---- -'G-....... Total leaching area... ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.....�C-!�C's..Ve..1`?cGe'A�.............. Date.. 'g'���. �y�6 - ----------------- Test Pit No. 1...4.Z._..minutes per inch �Depth of Test Pit..! ..'...... Depth to ground water./-.""............. (T4 Test Pit No. 2...L.Z-_minutes per inch Depth of Test Pit---Z!�#------- Depth to ground water......-............... D Description of Soil---v = ` ,� �.oA�r�. .. Sum-SvC� � ��_� �� McZ� /�-v x w UNature of Repairs or Alterations—Answer when applicable....`._..l'`..----------............ .........._--:........................................... ` ". Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------------ ------------------------------------------------------------------------------------------- Application.Approved Byr ............` I.......... .......... '-... . .... .4%�.-------�.-- ----- � Dale Application Disapproved for the following reasons- -------------------------------------------- ------------------------------------------------------------------- ----------------- ...................................................i� .........------......----'-----..--------....`....`---_........-------...................................... ----------. Dare -----�---- Permit No. ~.. ........= �,'�.'. � ..._. Issued ------ ------ ��... Dare THE COMMONWEALTH OF MASSACHUSE77S BOARD OF HEALTH TOWN OF BARNSTABLE Qwrtifirnte of V orayliance THIS IS TCERTIFY, That the-Individual Sewage Disposal System constructed ( �) or Repaired ( ) b .............. --- ----------- ... ---------- --------------------'-------------------------------------------'-------------------- ------- -- .... has been installed7ilaccordance'with the provisions of TITLE State - vi-conmental Code as described inthe application for Disposal Works Construction Permit No. �of�'The ....... - datedTHE ISSUANCE OF THIS CERTIFICATE SHALL NO BNSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... / �`'�: .. ------................................ Inspect.---- '"�'- -- ------'".q _�;-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �'� TOWN OF BARNSTABLE No.....:..........• FEE. .................... �i��n�tt1 urk���un,�tr n �rrntit Permission is hereby granted------- j+...... to Construct (,� or Repair ( ) an Indivcidduua-1 Sew a e Disposal System o -----.. .•-• -••-------•- strei 7 y as shown on the application for Disposal Works Construction '; ................ Dated..:.f.. ..G.."......... DATE........... ................. Board of Health f..-`�'.. FORM 36508 HOBBS h WARREN.INC..PUBLISHERS y RX> r t� TOP OF FOUNDATION Q(�'1 CONCRETE COVER CONCRETE COVERS P� 4 CAST IRON 2r M �mr�rr ' •• At ' 12"MAX. . OR SCHEDULE 48 ,1 . sf1�, Grp✓ P.V.C. PIPE 4 SCHEDULE 40 PVC.(ONLY) • PITCH 1/4"PER. PIPE - MIN. LEACH R' L PITCH 1/4 ptE sy o}e PIT PRECAST /p� Ra .�Ftrt o -�" LEACHING NV RT a ... _ EE .. o EL..3 ,rS'/, . . { PIT. OR 7 INVER INVERT fwSEPTIC TANK DIST. EOUIV. a INVERT BOX —s {,. GAL. INV RT .+ 501 o EL....�...... INVER r�. 3/4 TO11/2 ELF... . w w 4 _ n eq ° � EL�I""r,..,. •. {,,, •; WASHED: w .r• STONE ZoeG/J 3Z. 'cigLE / .. 2 c►cs Cl �/ Qo PROR LE OF GROUND WATER TABLE �� �f 9� SEWAGE DISPOSAL SYSTEM ` K• ,TEE.S r -� NO SCALE n . Y ,�,�,�.-, �f ► d2 SOIL LOG WITNESSED BY DATE !`f'a'/�. ./z./%�L TIME. . .. . . . . ... .. ai'a'i7,5• C!G'�Ri'✓ . . BOARD OF HEALTH &/N/./14i•'" Ae z 'sf3 •57r� - r V TEST HOLE I TEST HOLE 2 ! rl � •#'�/r"lGa/i'/ ENGINEER ELEV.49? `LC'. . . ELEV. '¢/../Q• , DESIGN DATA ' NUMBER OF BEDROOMS Z,.,$r � � o �� TOTAL ESTIMATED FLOW ' '�n . GALLONS/DAY BOTTOM LEACHING AREA ?B•.'"' ' SQ.FT. /PITS P�' \ � SNGI SIDE LEACHING AREA '�® > , / ,� { `\1 r S0.FT./ PIT, '. R SL Jr" T (�ZG 1 / ,! ' 1\` GARBAGE DISPOSAL :NO'lE` (`�% AREA INCREASE) •� � � � r \ / \ r / f TOTAL LEACHING AREA SO.FT LC.-S Ate/7-kv !r 4 N N e^ hoe tz,Zs,l7c, n PERCOLATION RATE . . . , . ! MIN/INCH GpVr s , 0 �o-y1[ 5 '"7 ,,,•w LEACHING AREA PER PERCOLATION RA7E.. `"'.r'.-T. SO.FT WATER ENCOUNTERED �y � -- -. _- awe �, bV,� y { NUMBER OF LEACHING Pi75: . . . r � . . . . 61a ___ ✓ APPROVEDAR A'��' ..._ , . . . . . , . . . . . BOARD OF HEALTH �. , T�. , (�.'t • 1�G�. ✓�`. � \ --' 1 : }, Q DATE . 9' r L .- AGENT C # OR INSP CT.. ........ . E O R r .� /•.. / al A, S eee ., y ` IQ 1 _ .. . S / J Ag t"�y. n.,. r t aE ` +t r ; 1 r O STETSON Z � 8T � r 1 r Y � r . LL tt ; t O 3 q..... tt , t .r fY' 1 r EPA '. .- g ., (y` r 1' c L f. ,i M1 a . r r urn yvb�' ! . PETITIONER 163 r f .tot' 5 , 1 -A- -7 - e j • � / r5,r f � i fit, Tv Ole -. �6A C✓�h/�$'!, ."r` s.*-°,r ,. `•Y. , ..- .:� \.-. w * \ .- � ,, � —YC.!.... '-�"',^rl�ka�,,,,, �}�r.r,e,,r..,. : svz 03 s { .�.. / 4 6 ,`+► J (�# r v 2 '"�„��,� ,��,�••.�,,,,. ��h//'c./� cn .�'���, ', r�'�,��; w✓z� ...�'�...�'��'' �+ ` 7- LC—iVGCic/r� P � . _. 1