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0160 BAY ROAD - Health
007 - 017 Cotuit 6 z7f 0 i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate. omust first obtain the necessary signatures on this form at 200 Main St.,'Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required-by law. DATE:I ill in please: a yry APPLICANT'S YOUR NAME/S: i Ka� Y�c�r� n =t.0 yl V SD ` BUSINESS YOUR HOME ADDRESS: C.6�--W �( J TELEPHONE # Home Telephone Number C'In l n $'3 Gt,5 NAME OFCORPORATION:_NAME OF NEW BUSINESSTYPE OF BUSINESS YY-`e —�✓ MAP PARCEL NUMBER CCUFYES NO ADDRIE S OOF BUSINESS TION � � r7 / ER "� l (Assessing)'. When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Min St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your Business in this town. 1. BUILDING CO ISSION R'S OFFICE This individ al h infor d f n er dt r irem nts that ertain to this e of busines UST COMPLY WITH HC)ME t� �UF'ATION q 41i p type RULES AND REGULATIONS. FAILURE TO Aut or' Si nat r_e * COMPL"r` MAY RESULT 1N FINES. O MEN I,; my _---------- �. �. 2. BOARD OF��LTH This individual has h,,een ME ed,gf the permit requirements that pertain to this type of business. ; Authorized Signature** f COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Commonwealth of Massachusetts DO�� ,IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 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. A. Inspector Information 51 4r 15L4aco Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 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. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 41 &%— 4/23/21 Inspector nature 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 Commonwealth of Massachusetts �. Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t, 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. CitylTown 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 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts iip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. Cityrrown 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 or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts !: Ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. Cityrrown 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 a 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 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �n (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. Cityrrown 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 Y2 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. ❑ ® 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 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �. ►ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 160 Bay Rd. Property Address Gaiotti Owner Owner s Name information is required for every Cotuit MA 02635 4/23/21 page. CitylTown 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner information is Owner's Name required for every Cotuit MA 02635 4/23/21 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: 5 bedroom design per 2006 permit on file at BOH Number of current residents: 2 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped 2017 per owner 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 f Commonwealth of Massachusetts �. ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �a 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. CityfTown 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 ❑ 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: Unknown, no info at BOH except 2 chambers were added in 2006 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 12" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 TBIe 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts re Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 3„ Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ® polyethylene ❑ other(explain) Poly tank appears to be structurally sound, steel covers at inlet and outlet ends If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 5„ Distance from top of sludge to bottom of outlet tee or baffle '12 Scum thickness 1/2 Distance from top of scum to top of outlet tee or baffle >2„ Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. City/Town 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 top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 ❑ 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 f Commonwealth of Massachusetts �e P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owners Name information is required for every Cotuit MA 02635 4/23/21 page. Cityrrown 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 switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box if resent must be opened) locate on site plan): ( p p ) ( P ) 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.): H-10 D-box is 2' below grade, cover raised to 6", no adverse conditions t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �o 160 Bay Rd. i Property Address Gaiotti Owner information is Owner's Name required for every Cotuit MA 02635 4/23/21 page. City/Town 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 chamber, 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: Type: ❑ leaching pits number: ® leaching chambers number: 6 ❑ 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 ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. Cityrrown 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.): The infiltrators were video inspected, they are damp at this time, no indication of past hydraulic failure, bottom of chambers 4'6" below grade 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts ►ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �e 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. Cityrrown 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 3 02 A `a / C_ 09-1� t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owner's Name information is required for every Cotuit MA 02635 4/23/21 page. Cityrrown 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: >144" 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: 2005 NGW 144" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4' seperation per compliance on file at BOH ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 27'msl and nearby surface water at 2' msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Bay Rd. Property Address Gaiotti Owner Owners Name information is required for every Cotuit MA 02635 4/23/21 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 No. FOCI('` go -I Fee 40 fp THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVIS►ON -TOWN OP BARNSTABLE,MASSACHUSETTS 77 p Rpplicatton for W5pont Op5tem Con6tructton Permit Application for a Permit to Construct( . )Repair( )Upgrade(7<,)Abandon( ) E)Complete System Individual Components Location Address or Lot No. SS 1 Sa I„d R- Co-Fu,? Owner's Name,Address and Tel.No. D.C�I�Q►�c 7l s. Assessor's Map/Parcel �� ` 6 3 Zo r CH H6✓!N JZoO. *1mr2 7,'Qc_1 17 / 441ee Ci . (lfah 6,V12-/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S4-phen A. U115G» o ILL- go-KVr, !�WG 1-C �vin�g, N1�SS tl26ac2/ Type of Building: ,/ Dwelling No.of Bedrooms 1'i w- Lot Size 2'7i Upo sq.ft. Garbage Grinder(rVc� Other Type of Building No.of Persons Showers( ) Cafeteria( ) �Q Other Fixtures Design Flow 116 12J1 61.1jrcer, gallons per day. Calculated daily flow S 50 gallons. Plan Date 9- 2 2- tl S Number of sheets a ,w Revision Date 11-// O 5 Title f..cl c-4 ands (mac,. m d- 21 an --i9rbr.n&ca A",-tz"s Size of Septic Tank 15c o a e I(cns (cx�� Type of S.A.S. �[.e,.c� C hetyn bee •i Z Description of Soil 191 cQ.se rc g6Lr- +e, 56 i i c,!i 5 vn 12 to„ Nature of Repairs or Alterations(Answer when applicable) /C•ec6r i -,4—ArT S 71 Date last inspected: J'e-i2 - 13. z oa 4f 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 been issued b is B f He Signe Date_ Application Approved by 11 Date G Application Disapproved the following reasons Permit No. 00 -b�G Y Date Issued ` d No. 4 o?017�_ 5 O -/ Fee THE COMMONWEALTH OF IIAASSACHUSETTS irntered in computer: Yes / ' PUBLIC HEALTH DIVISIG*- 'OWN 0�BARNSTABLE MASSAC USETTS \� 2pplication for t4 ozal *I ztem Con5tructiott Permit 3 Application for a Permit to Construct( . )Repair( )Upgrade )Abandon( ) O Complete System `d Individual Components Location Address or Lot No. 5:5 Sq,.,�v Co}y of Owner's Name,Address and Tel.No. Assessor's Ma /Parcel S ��"S p Vha 7 ''Pcl 17 (032.0 CJrcr,ha✓rvi Roo. b 2- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S*-Phch A. (.J C3a-,clz+- 1,cJc 78 �ia�1wt S•I". c,r� s ViIQSS 026G5 Type of Building: Dwelling No.of Bedrooms b� Lot Size :Z ,g� sq.ft. Garbage Grinder(4/0) Other Type of Building No.of Persons Showers(`') Cafeteria( ) Other Fixtures Design Flow t I c5 4 ,�/�� "gallons per day'. Calculated daily flow S S0 gallons. Plan Date q_ ��_n a Number of sheets m Aw Revision Date I/- e3 S Title t.1 r 4-1Ge=5E �..� A- �I� IeN �fct! /V/• '�';fm 5Z a Size of Septic Tank !grQo 5, 4, ��#, Type of S.A.S. Ltic..ra Description of Soil 12 .c, �—FeT 4„ r Nature of Repairs or Alterations(Answer when applicable) .c � 44 1 4pp� t 3 Date last inspected:Sr_19j= 1 2 cc 6( �' f 4 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 Certify- o` --cate of Compliance has been issued by,this ark.-of He)1 _ � / Si Date Application Approved by 1 Date Application Disapproved r the following reasons �A . 4 q, -7141 Permit No. :? 00 6 - 20 V Date Issued 56 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERT Y, that the On Sewage Disposal System Constructed( ) Repaired ( )Upgraded ) Abandoned( )by at r has been constructed/in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.0Od 6 -70 V dated ?�s/� ti Installer Designer _ J The issuance of this pe shall ndt be construed as a guarantee that the ste will'function as;'esigndd/ ✓ Date " / �h�tZ Inspector ZII No. v( — O Fee 1 {, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC.HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS -Di5pool 6p5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade Abandon( ) System locaied at -<'`/ led 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: Cons' ction°must be completed within three years of the date o this permit. Date:_----1 / Approved by Transmittal Letter- To: Letter B To: oard 6f Health - ° `2�00.MV in•Streef Hyannis,_MA 02601 _ Attn: From: Stephen A. Wilson, P.E. Subject: Pc,,-..,,.k 2_06 - 3 aY ssi Date: We are sending you ®Attached ❑Under Separate Cover The following documents: ❑Prints❑Order of Conditions El Variance Approval❑Recording Slip,❑Septic System Permit ❑Notice of Intent®Other DATE QUANTITY DESCRIPTION 7-!9-07 or+a orr iad/ Cmrh. e../ar+r .w•i,., 2 -o These items are transmitted as checked below: ❑ For Your Use ❑ As Requested For Your Files ❑ For Review and Comment ❑ For Recording n As Required Other: Additional Distribution Q_j g_X Qert..L.44-; Cz.La4. File No. Z005'-02Z.Z Baxter Nye Engineering&Surveying Phone:508-771-7502,ext.13 78 North Street,3'd Floor Fax: 508-771-7622 Hyannis,Massachusetts 02601 E-Mail:swilson@baiter-nye.com TransmittalLeaff5.doc Town. of Barnstable " ' . Regulatory Services Thomas F.Geiler,Director t BAItNS•Psw a s . Public Health Division '' Thomas McKean,Director T 200 Main Street,Hyannis,MA 02601 Office: 508-862-4.644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 7- 14-6 7 Sewage Permit# 2500(v— 301f Assessor's Map\Parcel. M oft?j P41 01-1 Resigner: S .ek.N A. Wi Isaft , CAE. Installer: l3or+u 1*W C kul-rvshca. Address:. Ta Zxl-.r IJ•. Address: P.Q . �3•or- 70 y On 7 G Zao 6. 4%eya le N 40M V4. was issued a permit to install a (date) (installer) - septic system aY based on a design drawn by (address 5bw c.. A. Upson. P.0 dated 1►-11- ZcaS (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. _ ALL YN �?� (Installer's Signature) V ►�oj`SON a �Ss�OP1a►4.�E'��� • esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc ��2 0 nS-09/:Z Baxter Nye Engineering & Surveying, 78 North Street,Hyannis, Massachusetts 02601 r MEMO To: Board of Health From: Stephen A. Wilson, P.E. Date: July 24th, 2007 Re: 551 Santuit Road; Permit#2006-304 As required I am submitting the following inverts for the existing septic system: • Septic Tank—Invert In=26.6 • Septic Tank—Invert Out=26.4 • D-Box—Invert In=25.6 • D-Box—Invert Out=25..4 • S.A.S—Invert In=24.0 #2005-091:2 BMW= Phone (508) 771-7502; Fax (508) 771-7622 l a ro 1 TOWN OF ARNSTABLE i LOCATION' SEWAGE# VILLAGE + ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY �SU� LEACHING FACILITY: (type)A� A�%f1� � �� NO.OF BEDROOMS OWNER PERMIT DATE: 7 46 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) IV Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Town of, Barnstable P# � 11 Op 1HE rOk �P� ~o Department of Regulatory Services BAawa1'ABc,e, 'r Public Health Division Date MASS. w 039. ��� 200 Main Street,Hyannis MA 02601 ArFO MAC / Date Scheduled J O // `� Time Fee Pd. Soil Suitability Assessment for ewage Di sal Performed By: Witnessed By: LOCATION & GENERAL INFORMATION Location Address IT. 1 6C.,% VI (Ze9 (z4u i Owner's Name Po,iaNO J, C+r lcil6era,'T1'S' G+324 i t-w.n he-vccn AQ Address5e•If. Le+lee C, U�� tIL! r Assessor's Map/Parcel: yyk, 7� Pe ( i.7 Engineer's Name S�itc t A Gay P.E NEW CONSTRUCTION REPAIR Telephone# ;ft)VZit-- -3 Land Use eeS Slopes(%) Surface Stones Distances from: Open Water Body 160 ft Possible Wet Area i LJ;E ft Drinking Water Well it Drainage Way it Property Line it Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1 " , 1 1 �f •�'x,M�' 'y I� t '� I I,f�l�);�11;li::', "• "M•'' ,� NS 5tl 80p... — _ _ �'___ —' y i � f'('7`711'i •II,,`:,,,.>.�• � .. ��• stl ` •nv;>. xis (]'� E ( ,t It �,;��°: '�,.7' ,` ,I �u �d/ ar:,, pe r. m M6 s•. r1'?�,,i co F �..c l !ter ly" ,I \11. 'j,�i ^ "> ' /Fm..�.,I..• I.-,d^ l - '�-. aO l i 111I%',' ni ;I�•. `BA \_ x ip�s� � .(r' y,•'" 1'n�(q�a j'',��'� e . .- s 4 .+,..�' I Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole:.___•_ Weeping from Pit Face._•_•_._T.__.r_ Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date 10 1 Time Observation Hole# Time at 9" 0 Depth of Pere 6!� 4 li0�t Time at 6" Start Pre-soak Time a Uri Q bL soa Time(9"-6") End Pre-soak �( Rate Min./Inch 14&- Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) - Original: Public Health Division Observation Hole Data To Be Completed on Back----------- '--- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:HEALTH/WP/PERCFORM DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling_ (Structure,Stones,Boulders. Consistency.%Gravel) Q S u O y 'Sa 0,el 10 ?a to"— 2Z Sati`� i0 yR' 6 21"- tHy�� C� Mcolt�w� Sattol IC� YIQS�b DEEP OBSERVATION HOLE'LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.°o Gravel) Q A o G.r iC 10 - 2y" "ay �► 1'a Yt2 N�6 2y=l32d G )Medan+ SaJ laY9 5/9 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Swi'ace(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No X Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? —Y-455 , If not,what is the depth of naturally occurring pervious material? Certification I certify that on q (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, xpertise and experience described in 310 CMR 15.017, Signature Date 7 S d Q:HEA.LTH/WP/PERCFO.RM DATE_9/13/04--- PROPERTY ADDRESS: 5 L L -La-aL -iL—Adi---- 5----------- ve date the septic system at the above t� �cgjEo On the above s , � Inspected. 2004 This system consists of the following: SEP 15 1.4-1500 ga.Uon 3ept.ic tank.• -TOWN FEBAD S-T BLE 2.� �-di.3t2.i&ution 9ox.- . 3.� 4-.ink iitaat oah. conditions: Based on inspection, I certify the following 5. 7h.i4 .i,3 a tit�e dive �e�t is �,y5tem. 6. The eept.ic hyztem "3 .in p2012ea .woaking oad ea at t ion. the /22e,6ent time. 7. 7he, .9each:ing aaea wah d zy at time o� P SIGNATURE• --- --'------ Rogeat l ao.e.in.i __ Name:-------- -------- I,JAP =kRCEL, OT Address:-2_Q•aQ2 6 6------------- Cent eav i fie, Ma., 026 32 2 8 775-3338 ---- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, 6 02632-0066 775•33 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OF ICKOF E RGrNNMNTAL AFFAIRS A DEPARTMENzOF +�NV1�tON �N"� pROTCTION Y TITLE 5 ••.v OFFICIAL INSPECTION FORM_.N'T;FOR.VOLVNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART•A CERTg'ICATION Property Addres§:5 5 1 Saatdit Road Cotuct lea 02635 Owner's Name: '^h n Q V antra c „fh Sf22P-f Owner's Address: Date of Inspection: ^ " ' '0 4 Name of Inspector: (please print) i2'o e LA° 1t Company Name; 7 •l�acomae�t .S,ori L�c� Mailing.Address: t-151n8- Q, ab.e OZ6�2 Telephone Numl2er 7 7 :3 3 3 CERTIFICATION STATEMENT i that I have personally inspected the sewage disposal system.at this addresosn n thaerformed based on my reported lcertfy , below is true;accurate and complete as of the time of the inspection.Tlie inspection P training and experience in ttie proper function and maintenance40 o itle 5(31 CMR'.15••000)disposal The system: a DEF approved system inspector pursuant fo=5ection.1�53 TT XXX gasses Conditionally Passes Needs Further aluationby the Local Approving•Authority Fails DAW- Inspector's SignaWr ~ ecti�on.ie pinto the.Apptoving Authority-(Board of Health or The system inspector shall submit a copy of this insp s eR j'a,shatad system or has a design flow of 10,000 DEP)within 30 days of completing this inspection.If sy to the d or greater,the inspector and the system owner.slialP co 1iels sentt rtha buyegP f applic bl�e�and thel app oving gP. DEP.The original should be sent tathe system owner an p authority. Notes and Comments **** ort only describes conditions at the time of inspectldr�and under theunderltions of use at-that the same or different 'phis rep Y time.This inspection does not address.how the system will perform in the future conditions of use. -,��n naee l . Page 2 of 11 OFFICIAL INSPECTION;FORM—NOT:FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM.INSPECTION:FOW ' PARTA CERTIFICATION(continued) Property Address:5 5 1 San.tu.i.t Road C o.t u.i..t Ma Owner: 2o h n .,i P m n n o Date of inspection: 9/7 3/0 4 Inspection S.umma•ry: Check A B;C,D or.E/ALWAY&OmpleWall of Section;D A. System Passes: n o I have not found any information which indicates that.any of the failure criteria described in 310 CMR 15.303.or in 310 CMR 15.30.4 exist Any failure criteria not evaluated are indicated below. Comments: The 3eflt is zyztem .ins .in Pz0Re2 woak.ing o,idea. at the /22ezen time.- B. System Conditionally Passes: a o 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. n o 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 mminent:System will pass inspection ifthe existing tank is replaced with'a complvying 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- no 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 ins.Pection.if(with approval of Board of Health): broken.pipe(s).are replaced. obstruction is removed distribution box is leveled orreplaced 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 INSrPECTION FORM-NOT IOR VOLUNTARY ASSESSMENTS SUBStRFACE SEWAGE D.ISR"OSAL SYSTEM INSPECTION fORM PART:A . . 'CERTIFICAT�ON(eontinued) : Property Address: o u.� Owner:.aohn G.4 mo2e Date of Inspection: 13104 r C. Furtber Evaluation-is Required by the Board of Health: n o Conditions.exist which require further..eualuation by theBoard oPHeaithdn order.to:detetmine if-the system is failing to protect public,health,safety or the environment. 1. System will pass unless Board ofoTealth determines4ii atcordance with 310.CMR 15:303(•I)(b)that the system is not functioning in.a�manoer.-.which:will.protect public health,safety-and.the•.environment: no Cesspool or privy is within:50 feet of asurface water n o 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)determines4hat the system is functioning in a mariner,that protects the.public health,safety and environment: n_o_ The system has a septic tank and soil absorption system(SAS).:and the SAS is within 100 feet.ofa surface water supply or tributary to a.surface water-supply. noThe system has a.sepfic tank and SAS and the!SAS is:within a Zone 1 of apublic water�supply. rioThe system has a septic tank and.SAS:and•the SAS is within, fEat of a private water.supply well. n o The system has a septic tank and SAS and the-SAS is less than 100 feet..biit 50 feet ox;triore froul a private water supply well**. Method used to determine distance, mea.SuaeId "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-tl}is form. 3. Other: I Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR YOLUNTARY ASSESSMENTS SIMBURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Property Address:5 51 Saa. u.i•t Road Co.tuit Ma Owner: John giemdae Date of Inspection: 9/11/0 4* D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to.each.of.the:following,for.all-inspections.. Yes. No . x Backup of sewage ritWacility or.system component due to overloaded.or clogged SAS or cesspool y Discharge:or ponding of effluent to the surface:©1=the:ggound or.surface waters due to an overloaded or clogged SAS or cesspool x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in-cesspool is less than.6"below invert or available volume is less than'h•.day flow x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped x Any portion of the SAS;cesspool or privy is below high ground water elevation. Ariy.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface T water supply.. x Any portion ofa cesspool.-or privy is within a-Zone l of a:public well.. x Any portion of a cesspool or privy is within.50 feet of a private water supply well. x 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 niust be attached.to this forte.] No (Yes/No)The system fails.I have determined that-one or.more-of the:above.failure:<criteria exist as described in 310 CMR 15.303,therefore the system.fails.The system owner.should contact the Board of Health-to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the:systtm must.serve-a<.facility with a design flow of 1,0100.0 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 - x the-system is within 400 feet of a surface drinking water supply _ x the system is within 200 feet of a tributary,to a surface drinking water supply the:system is located'in a nitrogen sensitive area(1Tnterim Wellhead Protection Area—IWPA)or a mapped Zone Il 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. 4 Page 5 of 11 OFFICIAL INSPECTION TORM—NOT FOR VOLUNTARY ASSESSMENTS �— $itSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CIiECIULIST Property Address: r•_i.. :t lYlri Owner Date of Inspect on: 9/ 3 X'0 44 Check if the followin have been done.You must indicate` s"or"no"alto each.of the following. Yes NR AP — — Pumping information was provided-by the owneT,occupant,or Board of Health X 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? _ X Have large volumes of water been introduced to the system recently or as part of th' inspection? X_ _ Were as built plans of-he system-obtained and examined?(If they were not available-note es N/A) X Was the facility or-dwelling inspected for signs of sewage back up? X_ _ Was the site inspected for signs of break out? trl Were all system componentscludingthe SAS,, located on site? X _ Were the septic tank manholes uncovered Oopened,and the interior of the tank inspected for the condition dimensions, depth of liquid, depth of sludge of the baffles or tees,material of construction 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 lion:For example,a plan at the Board of Health. " � — Existing information; P • — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance .. is unacceptable)[310 CNM 15.302(3)(b)] S Page 6 of 11 OFFMAL INSPECTIUN:Fl1rORK—NOT FOIE,VOLUNTARY ASSESSMENT'S SUBSIP'ACE SEWAGE DISP.;OSAL.AYSTUM.%INSPEET)IOI"'�1 FORM PART.0 SYSTEM•INFORMA31ON Property Address: Cotuit Ra Owner: John q,7imo2e Date of Inspection: 9/13/0Z FLOW CONDITIONS RESIDENTIAL ' Number of bedroor is(desfgn�: ;�tumber of.bedrooms(actual): 3 DESI69flow based 6010 CN4R 15.203':(for example:-1I0 gpd z#•ofbedrootns): Number of current residents:..: 2 Does.Tesidence have a garbage Binder(yes or no)n o Is laundry on a separate sewage.system.(yes or.no)�,a_ [if yes separate insp tion required] Laundry system inspected(yes or no):_ Seasonal use! (yes orno):I/a-3 2002=26, 000gaiion s 9PD=71, 23 W ater meter readings, if available(last 2 years usage(gpd))z 0 0 3=2 2. 0 0 0 gLI %D 6 0.•2 7 Sump pum (yes or no)rz o Last date o�occupancy%v n s o n n_"Q CO.MMERCJAL'I bUSTRIAL Type of estalWV--o on 310 CMR 15.203): NA gpd Basis.of dkign'flow(seats/persons/sgft,etc.):.N,4 Grease trap present(yes or no):N A Industrial waste holding tank present•(yes or no):dA Non-sanitary waste discharged to the Title 5 system•(yes or no):,gL Water..meter readings,if available: N Last'dite of occupancy/use: . Nh OTIIER(describe):. N C 'GENERAL INFORMATION Pumping Records Source ofinformation:7/30/02 maim � �s�u2oe.6 PKil. . l. Macom&e2RSon Was system pumped as part of the inspection(yes or no): n o If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for.pumping: NA TYPE OF SYSTEM y es Septic tank,distribution box,soil absorption system n o Single cesspool n o..Overflow cesspool n o Privy n o Shared system.(yes or no)(if yes,attach previous inspection records,if any) n o Innovative/Alternative"technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) no Tight tank. _Attach a.copy of the DEP.approval n o Other('describe): Approximate age of all components,date installed(if known)and.source of information: unknown Were sewage odors detected when arriving at.the site(yes or no)n o 6 - Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 51 Sant u-it Ro ad Cotu-it N Owner: g e Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade:16" Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply vgrll or suction line: NA Comments(on condition of'omts,venting,evidence of leakagge,etc.): 4,e,e ,�o-int�s ate Tight,- Vented tha.ough houae vent No rs-ign4 o,,' .eeakage, SEPTIC TANK:_(locate on site plan) 1500 ga.e.0 o rz 1?-ea z.t i c .tank. Depth below grade: 0 Material of construction:_concrete_metal_fiberglass X polyethylene _other(explain) If ta certificate)nk is-metal list age: N R Is age confirmed by a Certificate of Compliance(yes,or no):—(attach a copy of Dimensions: 1 0' 6"L 5 ' 8"i!l 5 " 7"11 Sludge depth: t 2 a c e Distance from top of sludge to bottom of outlet tee or bafflet a a c e Scum thickness:t 2 a c e. Distance from top of scum to top of outlet tee or baffle:0 Distance from bottom of scum to bottom of outlet tee or baffle: 0 How were dimensions determined;.m e a,3 u a e d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural irate as related to outlet invert,evidence of leakage,etc.): sty,liquid levels Iri�et ou.t.Qe.t lees a/te -in ?iace. ;tank ins 3t2uctu/za—Pey .sound, L.igu.id eeve-ez aae noama e. No z ignz o� Lea age GREASE TRAP:NO (locate on site plan) Depth below grade:NR Material of construction:_concrete_metal_fiberglass(explain): N 4 ___polyethylene_other _ Dimensions: NA Scum thickness: NA Distance from top of scum to top of outlet tee or baffle: N{1 Distance from bottom of scum to bottom of outlet tee or-baflle: N,Q Date of last pumping:N 4 _ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): aea�se taa� .is not /2,c.6en.t TWA S Tnonnrfinn T7nrm 6/T thnnn 7 Page 8 of 1 I OFFICIAL INS-PECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 9,�V, SVRF ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) Property Address:5 51 Sant u it Road Owner:-John O-Umo2e Date of ldnspection: 91 9 3/•O4 TIGHT or HOLDING TANK:NO (tank must be pumped at time of inspeection)(]ocate on site plan) Depth below.grade: NA Material of construction: concrete metal fiberglass___polyethylene other(explain): NA Dimensions: ,414 Capacity: gallons Design Flow: N,4 gallons/day Alarm present(yes or no): - NA Alarm level: NA Alarm'in working order(yes of no): Date of last pumping: NA Comments(condition of alarm and float switches,etc,): Ti ghl o,7 hn PrlIn y InnkA a a a n �o a a,6nnf, DISTRIBUTION BOX: (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.): Dtzt -,igut.ion P-ox .i,s —Peve.2.'No evidence o� zo gidz ca zayove2., q e.egni o ea age .-n o2 OUT o ox. PUMP CHAMBER:NA (locate on sife.plan) Pumps in working order(yes or.no): NA Alarms in working order(yes or no): NA Comments(note condition of pump chamber,condition of pumps and appurtenances, eta,): NA - f 8 . Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I PropertyAddress:551 San-tu.i /2oarl Cotu�t Owner:.aohn gi.emo ze Date of Inspection: 9113104 h k SOIL ABSORPTION SYSTEM(SAS):_.(locate on site plan,excavation not-required) in If SA�eeloc ated a yexp10 why . Type no leaching pits,number: 0 n o leaching chambers,number:0 leaching galleries,number: leaching trenches,number, length: !1e%leaching fields,number,dimensions: 4-in ie.taa-toass 121x35 ' 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 a zea day,` no z ionz o.1 hudfiaail c eni-P1j,? 1Zo nO fni iD is noamai.• CESSPOOLS: NO(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: N,4 NA -top of liquid to inlet invert: Depth of solids layer: NA Depth of scum layer: N� Dimensions of cesspool: /V�! Materials of construction: NA Indication of groundwater inflow(yes or no):N� Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Ce.3,3 oo.eh aae no PRIVY: NO (locate on site plan) Materials of construction: NA Dimensions: NA Depth of solids: N.4 Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): p a.ivy .ih not Raezeat 9 • Page 10 of 11 OFFICIAL INSPECTjON I`ORM>�-NOT�FOR•YOLUNTARY.ASSESSMENTS Si 35i�RPA'CE SEWAGE HISP.OSAL SYSTEM.INSPECTION:FORM PAR`F C` SYSTEM INT•ORMATI.ON(4ontinued)` Property Address Owner:1o/zn GcPmo2 — Date of Inspection: SKETCH OF SEWAGE•DISPOSAL SYSTEM vvide a sketch of the sewage disposal system including ties to at Ieast two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Ir J 116✓ G9mo d C��n" R m • r 10 •Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:551 San.4_tL.i /toad Co.tuit Na Owner: loihn Gizmo Date of Inspection: 0 4 a SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 3 0 feet Please indicate(check)all methods used to determine the high ground water elevation: .no 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) La Checked with local Board of Health-explain: o Checkedwith local excavators, installers-(attach documentation) e,6Accessed USGS.database-explain:/, f 4 Y ,f n i)n P n n n A f n 0. O g, m u u,6. �— You must describe how you established the high ground water elevation: u.6ed:gahe2.tU anti mi modgJ 92196_/_92 used: 7echnicaZ PuLP-Py 92-000-9 _Plalo#7 jnn_. 1992 nnniin0 4aage6 - roun l Leaching Pit 'eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frim9lerr Method Therefore,the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. r�U�. 11 WARD OF HEALTH d 'I'OHN OF SU[)SU[IFACF SEWAGE I)TSPO,,AL 5ySTFM INSPECTION FORM - PART D . I CERT� FICATIONr,. � ...z,, ^T,;.;;1-�.i.�^.rrr+:r+rm•n.�,rnir.-,ss+em-+rn-rrnrt,rrrtrtsstrmr's-�°r�°"^�^��� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED , STREET ADDRESS 551 :Sqn;tail Rd., ASSESSORS MAP , DLQ;CK AND PARCEL # 007-017 OWNER' S NAME John f�mo2e PART D - CERTIFICATION NAME OF INSPECTOR *Ro&ez nD , .3 COMPANY NAME Joseph P. Macomber COMPANY ADDRESS B_ x 6 Cen V To,,,, ar City state LIP street COMPANY TELEPHONE ( 508 } 775 3338 FAX ( 508 •� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that t)i.e informa��oon 'rTherinsptrctionewascperfo:rmednand any omplete as of the time of �lnqpec , recommendations regarding upgrade , maintenance , and repair are consistent with my t'rainitt.g and experience in the proper function and maintenance of on- site sewage disposal systems . „ 111,„1, 'Check one: System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public Ilealtll or tl)e enviroaament as defined in 310 303 , Any CRITRIAfailure section of criteria not evaluated are as stated in the FAILURE this form . System FAILED* r The inspection which I have cod e environmentnant accordance swith fTitle to protect the ��ublie }Iealt}� and th 5 , 3i0 CMR 15 . 303 , and as specifically noted on PART -,FbILURE CRITERIA of this inspection f rm . Date Inspector Signature' One copy of this certification must -be provided 'to the OWNER, the BUYER ( where applicable ) and the I30/�RD OF HEALTH. ./ * If the inspection FAILED, the owner or operaturrsh.alless alloweddertrequi.,rehe em within o'ne year of the date of the inspection., otherwise as provided in 310 CHR 1.6 . 3.06 . partd .doc t No. Fee ✓/ �.. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Miopoml *pgtem Conztruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot o. H —��,, n Owner's Name,Address and Tel.No. / 5 1 < Assessor's ap azcel �_..q /' Installer's Name,Address,and Tel. o. (� Designer's Name,Address and Tel.No. ef p Type of Building: Dwelling No.of Bedrooms Lot Size 7i sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ss o gallons per day. Calculated daily flow .5 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 0/s / Nature of Repairs or Mterati ns Answer when applicable) kae w 14-1 f �. S 6 v Ga c) Jo Q-t„ cam 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 he Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ' su this o of Health. Signed Date Application Approved by Date l Z Application Disapproved for the following reasons Permit No. 77-0 Date Issued l C Z o� o _ r d i No.'-/ / 6 6 / - -- ' t=-^-ez Fee ��• /^ THEOMMONWEA"� OF MASSACHUSETTS -Entered in computer: ✓ 11 Yes f PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01ppfication for Con!tru-cf :or permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System 1�Individual Components._ ?` L�ation Address or Loft 1 . s „ n Owner's,Name;Address and TO,,No. Assessor's Map arcel' t ��� 9�-+� ./_ /��it/a //�/u J `r G• Installer's Name,Addres-s,and Tel. o.( i igwner's Name,Address and Tel.No. . My� a y Type of Building: i Dwelling No.of Bedrooms Lot Size 21 sq. ft. Garbage Grinder( ) Other Type of Building 1,Joo d No.ofsPersons y Showers( ) Cafeteria( ) s Other Fixtures d Design Flow 33 0 gallons per day. Calculated daily flow 3o gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of,&A.S. Description of Soil z Nature of Repairs or lterati ns(Answer when applicable) p u r �c+ S F' (,t Date last inspected: r 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 ofthe Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has.beety' u' b ,this o f Health. a Signed ADate Application Approved by Date 2 Application Disapproved for the following reasons Permit No. Date Issued l 0 l Z ———————————————————————————————— ,——————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _ Certificate of Compliance THIS IS TO CER t e On-site S g pps SIzz, onstructed( )Repaired ( ) Upgraded( ) Abandoned at has been constructed 'n ac o�dance with the provisions of Title Ud the for Disposal System Constructio Pe . No. �66"7dated Installer Designer The issuance f s e t s 1 be construed as a guarantee that the s 11 function ash esign Date Inspector l'/�% -------------------------------------�-1 — No. t% Fee y' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migogar *p! temr2� 5truction Permit Permission is hereby granted to Construct( )Repair( e( )AbandonSystem located at r 3X41 ^t7� �, dam' �r 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 of this pemut.Date:��z��9� Approved by I 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic:S:yst.ems:�Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, o7 kv hereby certify that the application for disposal works l construction permit signed by me dated concerning they.: property located at yr� <�'u meets all of the T following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. .� „� ,�• The soil is classified as CLASS I and the percolation rate;is,less thanior equal to 5 minutes per inch. J.y There are no wetlands within 1QQfeet of the,proposed'-septicrsystem ,_.., • There are no private wells within 150 feet of the proposed septic?system—,�4V" !iJ' tT:lc�� .Q istis►�G/� • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the ma..,dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the m -dmum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX. High G.W. Adjustment. _ DIFFERENCE BETWEEN d B 114 0`4- iu,44aa SIGNED : DATE: [Sketch Pr osed plan of system on back]. q:health folder ._.... .» ... �.. , � f �� �Gu�s gyp. / /�.' _1epG"� I�a�o✓'s c--,� - �� - - � L/L//1►� .�acf. � �°� _ �-- � ' �o rile �— � Po�'c� ((��� ��-ao �--,�a•. f✓SKv �ru �l p,�. � _� ,, a � � v j61 trot a /"i TOWN©F BARNStA$LP d LOCATION EVt�AGE - (,4 ` &LOT , 7 1�+IAP A(3 AS5F.5SG3R S ; V'II.li. � N bNl±i+ii0. i�s NAME � 1�h� INSTALL.E SEPTIC tANX O`APAdtY al L EA.CI•[ 4d FACU-M: (tM), � / v3 (si t) NO.Of BEDR06MS $UII.bER bR OWNElk Ad 5 , M.Mr DATE zd/r..PL& .CC'MPLL4,NCt DATE: I� SeparAtion bistance Between thi: MdXiftth Adjusted GnoundwiteiTable to the Bduoin df Leadhitfg Facility Z Priva(a Wafar SuPp1r*el1 acida6ching Facility (If aay wall$- ��st� on-site oY•within 106 feat bf km",facility l oge of Witland and LesehiAg Awilityi (if any wedaf►ds exist within 300 fit?gdachin�f' ty) ---- =-FCe Fdrlushdd by �� v���ouV� �u�vclaYJaey �a1� y0 -�=i--3` . �-�✓�vey a ��Q�S�'�-�Ns ���� - �V�+a1 Q- / !� INtt�Or ♦ //5 � /Cv,ti�. R 4• � • ' A, '` -_,��� e _ . , � t _ .. AA` � i �. '1� `,,- ' , f WATER 3 �►RT NT IQ; WAT��DEP 'DIG SAFE T ET No. 'PR VICP APPLI SEAyIGE �Z`'�ON r 4 t Y male aPWkation f9r Street �yaterse�,lcpe at Lot No. Ind�' to'Olde t y ® d A 9 cateq within t Of rules and r 9, in the Vlll�t of ice trues tee aeY cess a ulafions,of the 1Nat r 9e to Iat with cesgp�l 4epertm V" >ePhOne Tires, tp feet of min tines Or lines gnt, No"necti Plter linprov 9CWC. tei s entering AnS wiq t� Serv- eiirs e�nt Fee of�gpp. Done or gas iip s g cess"I.. No made to water Se are char ed L�m++et a , or to water se : cpnne�tians will nnce r[r�es �`;e Bill must at Labor, Materi rs mpany this aPwicati , r*6 rides which Bass made to Water Meter pepartrrient is be paid before Water is to Sales Taut, and Con i ° (unless dWeMin pd4r tamer slectrrc or �t res med on. �#ort(3har g [� 9 May 29 i lame of 4 PorrsibTe f r excav $e• y �73). Wner per Deed ation,backtillin resentAddr !!�f� 9�.orthe repairof pstchin Address 9 of fqundation rtu � pf for I an re'Pilling Addr n �, y such backtiflin . tnqture of VSr` d, l r►er or Agent r� Re and Php f se sifetch 4 C >9tagt Verson ad upon request a a"Y utrrlt)es in ludr g PeasppoI aid 1000Non Qf Whet e water is to be►nstprlecf SOMce iSQx Will be <t TOWN OF PARNSTABLE LOCATION ��/ � r��u;� SEWAGE# D VILLAGE 1"'eys le+ ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO.' CS0$) °7-? 3<11 SEPTIC TANK-CAPACITY LEACHING FACILITY:(type)- �, p / s(size) �ie ci' NO.OF BEDROOMS OWNER zclILA' . PERMIT DATE: '] D6 COMPLIANCE DATE: y Separation Distance Between the: Maximum Adjusted Groundwater Table to the"Bottom of Leaching Facility 1V 17 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 Q `� 5EW AGCE INSPECTIONS LOCATION 57SI 50Qh)1T PA&'l' - DATE VILLAGE QD'ft2l 7 ASSESSOR'S MAP & LOT �TNSFLsCTOR k ) f PaO�i ) a P S�lh is SEPTIC TANK CAPACITY lb �,Srt�IC LEACHING FACILITY: (type) , (size) NO.OF BEDROOMS 3 BUILDER OR OWNER OWNER MAILING ADDRESS .! ,%� Imo d fop� � y►' � � � 5 L nj fi Q 0 TOWN OFpBARNSTABLE LOCATION �j �� � �fi �4 SEWAGE # j `�y� VILLAGE ! ,�V r.� ASSESSOR'S MAP & LO -4/ `INSTALLER'S NAME&PHONE NO. T n► AW, a _ SEPTIC TANK CAPACITY �S d(1 �T 6 L . �` i F' , LEACHING FACILITY: (type)�r:�r �, •,, �, od•S (size) ,t NO.OF BEDROOMS BUILDER OR OWNER ZJ4 PERMITDATE: 0 & 9 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �� Y Feet Private Water Supply Well and Leaching Facility'(If any wills exist �/ on site or within 200 feet of leaching facility) rw'-" 4Ja7-e ?O b #A Feet /IYS n /lOcO Edge of Wetland and Leaching Facility If any wetlands exist within 300 feet le hing acility Feet Furnished by /Qo Q 0 /2 ` No............ �. ..... Fics.. ................ THE COMMONWEALTH.OF MASSACHUSETTS \P F-,3 v '/' a,2 BOAR® OF HEALTH SUBJECT TO APl'',7,^,1+a ..BARNSTABLE C0P1S_."T.% Appliration for Disposal Works Tonstrurtinn 0Orrm MMLS"" Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal-, System at: ................__... -_................. ................................................. ................-••---•-•---......._.............----•---••-•.... Location-Address or Lot o. .............. a Owner Address ...s0f ............ r` Q .--------•--•--------...... .... .. .._... Installer Address UType of Building Size Lot_ ....Sq. feet .-, Dwelling—No. of Bedrooms..........a...........................Expansion Attic ( • ) Garbage Grinder ( ) a`k Other—T . _ Type of Building _fLi -1W.1C.____ No. of persons......../................. Showers (z) — Cafeteria ( ) dOther fixtures ......-----•r j n P '� ==� ----------•-----------------------------------------------------•-------•--•--•------- W Design Flow.............. 'J -----------------gallons per person per day. Total daily flow...............23 A...................gallons. WSeptic Tank—Liquid capacityf0.00..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Widt _ .../.. ..._...__. Total Length..................... leaching area_...................sq. ft. Seepage Pit No....... ........... Diameter.... i... ... Depth below inlet........7........ Total leaching area..2.zP../.sq. ft. Z Other Distribution box ( ) Dosing to k ( ) / Percolation Test Results Performed by o_. 44-------------------------- Date.... ....... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f74 Test Pit No. 2................minutes per inch Depth of Test Pit._..............__.. Depth to ground water............... O, Description of Soil....r/ _ a�_ .... ------- 'L _— k a( ° x p --•-•• ..................•-••-----------------....--------.......-----------------....---•-----------------.---------------------------•----------------....---•--------.-----•--•••--- W a UNature of Repairs or Alterations—Answer when applicable.......................................................... 9 ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance,has been issued-by the board of health. K, Sig;. d --------•------•--••-----•----------• ................................ Application Approved By..../ �' .? — Date Date Application Disapproved for the following reasons:..........................................•••....•......................................... ............. /� 4ti / Date PermitNo......................................................•.. Issued- ................................................. Date F, No----------------$1 FEs ....a`"r. TH-E COMMONWEALTH OF MASSACHUSETTS BOARDi OF ;6-i'EALTH fi <i....-..OF................ i--.=---...._._.---- ,..._. .._._ Appliratio ' for Rio sal iax Cho tr coon rxmit Application is hereby made for a Permit-,to' Construct ( ) or Repair an Individual`:Swage vD> posal�M System'at: ..!� ;oda4[ol Address �A �°�'7r! '[ ... .. , i. _•— or Lot No. ..... .. _______________ / /� !� +P"— --__-------.•------ J( V -__•--7i3 � ner--••---•---^_-____--7 �4, Addre3S +IO• J p� ......••.. $ .•--•••-•-••••-••_.....•••--......•---•-••........................ /7�L.� Installer /' Address Type of Building ' Size Lot............................Sq. feet Dwelling—No. of Bedrooms___:..._...�+� _____________�__Expansion Attic ( ) �4rinder P4 Other—Type of Building .... ........ .___.... No. of persons___________________________ Showers ( ) — Cafeteria a' Other fixtures ....... -------•-••------------- W Design Flow..............J_..................gallons per person per day. Total daily flow.............._ gallons. WSeptic Tank—Liquid'capacity/00p..gallons Length_______________ Width................ Diameter___:__:_____:___ Depth................ Disposal Trench—No..................... Width................._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_________........... Diameter....../ ,__ Depth below inlet___..._:.______ Total leaching area.... . .�sq. ft. z Other Distribution box ( ) Dosing tan ( ) 7 1 `-' Percolation Test Results Performed, by........ ______________ Date....... Test Pit No. 1................minutes per inch Depth o. estr it_______.__.___:_.___ Depth to ground w ter_._____._._._____.__.__. 44 Test Pit No. 2................minutes per.inch ...Depth of Test+Pit.................... Depth to ground water__:____.....____.___.___. w .....`.3! _ .._. ... .p �..� Descrs tion of Soil........ U ----------------- •------------- ---------------------•------•------------------------------------ •------------ -' ------•--------•----•---------------------•-------•------------ W U Nature of Repairs or Alterations—Answer when applicable.------------->:.......................................... ..................................... s. Agreement: P The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �. the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,k*ssued'by the board of health. Sig ........................................... .Y :... Application Approved By ,- �4� -�- .:.. - ----•--...---•- ���� .Date g,+ Application Disapproved for the following reasons:-------•-------------------•--------------------------•-----------------------------------------------.••••.- .........................•--••-•-----•--...--------•-----•-------•-----••-•------•-----..--.....-•---------------------••---•-•-•-------------•------•-•--------•-•.................................... Date PermitNo......................................................... Issued-......................................................_ Date 14 . �► ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H ALTH ..............Y ......................OF.......... ...-..::.:: (9rrtif iratr of Toutp$iattrr T 1 0 F at t e Individual Sewage Disposal System constructed ( ) or Repaired ( ) y .. ..r �. --. ................. --------- 1.. � -- at -..�. - � T�Stal • ,� /"'� • W I/1 J has been installed in accordance with the provisions of /5 The State Sanitary odg `clas.Qribed in the ir application for Disposal Works Construction Permit No......................................... dated__---_-_----_-______----_ti__"___:........_...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A RANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. d d ,e. ' DATE....... ..............................•----••-•....---•-••--•-•..........••--• Inspector......: .............................. .::.. THE COMMONWEALTH OF MASSACHUSETTS � BOARD HEA ...........................................OF....... ............:.--.. .._./.7..._....................... No......................... -'� FEE........................ to Peris 'oyr,� hereby gr rite ..... -•----... .......... ................. --------------------•-------•------------------------------ ....................... ) P to Co ndivi g Vl Disposal atNo...................................................--------------------------- ------ .. ----..._-•---•........ 7 Street as shown on the application for Disposal'`Work's Construction 'emit D3o. _.... __.__ Dated_:_ _ - ... .-- ..�: •--- N Board of He Y_. r,. DATE..................------------•----•-••---•--------......._--------•--...__...----. _. FORM 1255 HOBBS &-WARREN• INC.. PUBLISHERS ,sC./. Pipf "r3�Y =lEEtl �.rP£ TiGt{T` JOINTS oc-7ze-7 LIE F r •. 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':a~.:r*r`c^"'ti�'t� E .�_,_ "�i' �`tXq:•': ee:. z�, •`•< � 't.�9 - "-ts"rxt'``c { •fr--• rF_' .�r•` �• ..-i.. 5 ^_r ,s`��ti,.;i''• ..y. •+=- ,zj� n �H�i'. � + 'CK. . ,v - ry- '4'�. 1. •�. �g y�y_) y LLB -_. �" /.��y�y��l�+ d• jam- _ �t"" �'"� i - e• _` '_ • ''`' 2i4 s" fif Vl`.I-[J- !�L rf fT. 11G✓ P- iVJI V/i(.- ��� rr� __`• t- -. -1 •; �( a.- _ ��]] £Y .• IC i'•w.+ _lam� ..t'� •. a'r' i Y^ r f ^i +t -'%SL , L-{.ff-'A T /�..±�� �. -•�;-` �� -s. 6z a,r r•,,- -t-.- ..i L- �' _ _ Y V r +a .I( {T a, - ,: +.. }� e; -:w q/ d DUST ilk 'L.�CV 'r am_ ` WASHCO CRt/S � t COVER. -.5TS7rN£ L AA�i�Np _irk.F ; ,ANrp dtlST Inr 7tt , I, E _ -LEACHING i SEC TIaIV�.. - Ply CONCRETE 'TO,BE- 4000 "PSr 28 DAYS 2. RE,NFCRCED'-+lFtTH . 6 x 6 N0.6 GA., W.W.M. To D 3 2'.AND 4 SECTIONS ARe AVAILABLE_ FOR GREATER .DEA.T1•# RE4UlAEJYIE.NTS r y ' C' �dP���r�((IIjjA Ssw jA1ltrlT}^4- �4;• NUMKft�OF .K S KOWREO, 964a 'A1,4hlE'7'ER ':Nf}TE: XCAVATF 70, EU•VAtink �40R LQ.WER A3 3 EQ:stREt� TC}IREMOVE QLL r~pAM CLAY _ ENEATH Pt'. REPLACE EXCAV ATES MATERIAL 'N1Tfi CLEHN }} �' fiRlaVcl TO GESIGNEO. GRADE i - 2-0 - ---1 `--?- --q-� FF o t EC"r� CIQMFT jNo t TO EXGf£Q 3FINES FF-FG'T/YE. ..�:� #JAPER ;"AB' SPEC . T 2 1.I '� ;� NO HE�;rY EQUIPMENT TO RUN OVER SYSTEM..--:-'-. ` - SEPTIC: TANK, DISTRIBUTION BOX LEACH NIG P1T$ TO 8E"STANDARC TEST BY , W/c Pt�ECA�F �t; 't Gr�Ct=l� CONCRETE Ufa T5. _. 'WFTNESSo S8Y.. f r4eL .IY1�'Ri2.�7J/_ : ,8. AD f1. AL! 5 STEM �:�1YrJhEPITS SHALL_ BE 11�fSTAL1.ED .Il�f ACCORDANCE Tp =c£VtS£C TtTL S flF THE - STATE ENYPF �INMEN'FAk CODE, 41 '� ST P DATA• 5f29�8o S _ .. riEM1titJIUTr! R£OtJ��cFETf'�S ; FOR.'THE JSSLtFgCE OfSPQS1tL OF e n r PEST NO.t- - x .{1 TEST F'IT. KD.7 SAINITARY SEWAGE EFFECTIVE !. ytULY__l97'7 ,• ANY CHANGES- 70 ri S PL.- N MUST BE •APPR'OV1 BY THE e,I" -- Tap 4ciA. 0w:- g�;i:;D OF �fE.aLYh.�A. T COMPLE'tON 0; CONSTRUCTIOR, PRIOR TO BACKFtLkIPIG, TliE IJA4E. EGA►RC . OF HEALTH SHALL. B NOTIFIES? FOR . INSPECTION, • ;_.GG EA.V MAD. �� ¢: CoTtriT �iofiJO ?tTD}i ALL SE`NSR L!NES I4 f t='T. UNLESS iMbICATEfl 'l44; 07HERWiSE. - ,eJo 4,,c vo. YV�r, _ DESIGN. DATA BECROOMS 3 gISPOSAI_ EST. T•?'SAL CA t LY EFF. �1P GAL - SEPTIC-TANt� -OD0G GAL _ `S11)b-V ,.L -AREA 2 £SAL_/SO. F _ 8�'T;GJr'. Q!3EfiGlkLSO ,FT. GE= ^ STEM ! fff. S_EACt 'NG REOUIRED So,FT - �... FOR ACTiJ LEACH, .AREAS r - V i fit Co %T 4-3�4,Q.t�.ST.4E'�L � SCALY AS MICATED DArF, - .� t rs"V M. WAPW.IC,e -9 ASSOCIATES = lx �4 ! COX 8C! l�li:�,�T�t FA TH�._ I II rtc �t m 4� Lr ILJ o Ta L m c h � 0 C pppp � 1 o ® F O dye ©, y�,D��e av3a dv3d� IfYt l9vb ID PAD OD7I - - d4'/6-.2 1. LAV a e •,j8x \ w toa-f< IIlu rpp Mur)2DOM - /� s,t y DP UJ.J r10 Sam& W Q di -�-8 F h DxFT 31010-� ,� / �H !s% /O d �� 0 r�bQ f LIOLI D 6 LOCK �!I SOLI.D .Fj L OGK - LVt_Ti u t4 7aFi TN EThR 4A,32 U5R O,!; 3KL8 u�2 I . Gu>G F'o�8 Dw _ __ ova P IT 8Ry- S/7-77/0G AR$A ul 4o D ,-47. /Dyd-2o _ . /i 30-O .v1 - c . yuu.'Y^-/ .v noveu en v/�Zo2 -mac v v /r i -6" -G � QN v yi, � t r 'a � 1 It O � -ye - '8" m 4 ILI r� CI m lu VV J L �cs:) `C n X• M = L z � - - i L 3=h. as I. � r yp•U'. - G O I 4 I i • ' I t A . j i . 11 u gll) 6W .IILJ m 4 . .. I PT P p.ecow LI ,J _ 3 3�x3�'X.r�:'..t- PAS axlofE _ P-30, !W A-,V AWO Q O GR<1tJr EXISTi G R/, 3-dX/A n h .,al-Ps�cr Ga.elf..1.,� c..c,5 foftZ7 I'm - �y yfLLvH.B" 7:-7 rfr6Fr 'r- axro�,/�.rG1 9to ` Dr. cETs c ^7 G LOtJ T. PTGs.S. Y'.v7,J. U.SE St " rj c QT• 6 y02 2oDM !� 3 cow G2An�.-. .4.'Pove r r.f- - o o n)( I! y •t/'IONL. LA/S Ld9-F/U..-�ti DLY�2 �`�Ese.o '�D y' h // PRAOi- r, ANLkOQ 5!�OLt c1L GODS- Daarn.. ODF �^'��� o 3�ba-0 ,9Az-u- Q ti � xy a/'a-K. l A RA-4 f- C•r / - /(p'tOL r [ii ��� � �// •� ._ cur - _ -Dus 1,CAP� � -47'A,i oPvoNA t N L . T. rb ,wavk LUD A) P.T S r 7vEuJ E] 3 a�L.F '&S LOLJ N _ I D D Q G2aaEG. 41x P-T. / n Pos'r5 ql I � - /LticRo OR- LOAD - r axl o OEW 3 -x / �a axro X &/A-1. r- FL v s Box 1 c_. r _ PiLOLCG AGC 2 "7 _T.tA L.46 PC � - a - .. ATOP 9x6 CAG P-T z - - F/f.L�l� A?z�E.- O'x 3 x IDk - I ATOP Po��� l0•Df x.�a°<0N/. r':i. t-to\9 b'62L - - rlflu.C CG'd O L.3 ID r!• - `� W^) I ' ._Ex IS T7.JG GRAL <_ - (ifE EN(�i/ust-�j 5//£G!>) � HOUSE 5P-LI - a'DO_ OPLO nAta) •. �� �/Ju.0�a-ri.,x) AU Ls}..fV- �iG>9-trE �/f°=i-i�" VE.R.IFy .If.6TAIAt. _ S 6 U N _ . r LEGEND /ABBREVIATIONS -0- = UTILITY POLE = ELECTRIC METER = AIR CONDITIONING UNIT F— a .+ W r WE �`'— — w —a. —�.-- ►-- = OVERHEAD WIRES TREE LINE CONCRETE BOUND " a</ e •� ,u: _'`` — �' A — WETLAND FLAG } ,'+0Corp • IRON PIPE 8 EL = ELEVATION N • — _ CB = CONCRETE BOUND z DH = DRILL HOLE . FND = FOUND 4 CB FND WF = WETLAND FLAG F.F.E. = FINISH FLOOR ELEVATION LOCUS MAP Scale: 1" 2WO' N/F KATHERINE J. LLOYD GENERAL NOTES : LOCUS AREA IS COMPRISED OF g o LOT 17 ® PLAN BOOK 19, PAGE 143 SHEET 3 N �s•4s. f) ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE $ oo" W o U WITH TITLE V OF THE STATE SANITARY CODE DATED BARNSTABLE ASSESSORS MAP 007 PARCEL 017 WF A_8 2�8't Ta IP FND MARCH 31, 1995 ANY LOCAL RULES APPLICABLE. DEED REFERENCE: DEED BOOK 19,142 PAGES 320-321 W °•��,i 2 LOT 17 ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING OWNER: SANTUIT ROAD REALTY TRUST ��� PER PLAN BOOK 19 PAGE 143 SHEET 3 o g BY DESIGNING ENGINEER ►- ox z W TOTAL AREA PER PLAN N o DONALD J. GOLDBERG, TR. I. ; 3 27,000t S.F. g � WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, 6320 WRENHAVEN ROAD „ t ' ' Io 0 ' ' NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT o.620t ACRES SALT LAKE CITY, UTAH 84121 �•1 .. / 2 FOR INSPECTION. ZONING INFORMATION f " ,o i 1 (f r ", i ~' 1 •g ' 3 ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4" PVC., SCH 40 A�-7 , t l r t i S �'48'OO" E $ 3 ,,$ ZONING DISTRICTS: RF ^� 1 too OFFSET FROM •r �' EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING • j r r ' f �'> 278'f COASTAL BANK o AP AQUIFER PROTECTION OVERLAY DISTRICT 1 ,/ �, /r', ;' N SURROUNDING THE I FACHING FIELD FOR A DISTANCE OF 5', PER RPOD RESOURCE PROTECTION OVERLAY DISTRICT `� �' / - �, y 310 CMR 15.255. 7,9 IRON PIPE DETAIL MINIMUM CURRENT ZONING REQUIREMENTS ZONE RF o�t:3 x � s ;'/ �` I, i�- `, x .,E N.T.S. '., PRIMARY BENCHMARK DATUM: NGVD 1929 �� •-5 ��: a -.,� •i EL. = 28.80 NGVD •'� GRANITE TOWN LINE MONUMENT MARKED BC & 1894 MIN. LOT AREA = 2 ACRES (RPOD) �,1 ! ,'� �'/ '� �� _ 0 �' ��0 IBM: IP FND MIN. LOT FRONTAGE = 150 � ' oP O \` \ EXISTING 1U�t.. • r;,r; �- ® MASHPEE BARNSTABLE CORP. LIMITS AND QUINAQUISSET AVE �,.y , G _..- 1 (SEE DETAIL) / / J , ;' ; , ,' ;' 'I 'r �( oy r?`.`;; /., INFILTRATORS ' — ... -� SHOWN ON FIRM MAP 250009 0007 F AS RM 3 EL. = 8.39 2 rf) -- FRONT YARD = 30 SIDE & REAR YARD = 15 /I�y' o ;� � � �, , ��'(� � � t�a.r; , � , ;�, x - ' y OD ` C _ PROJECT BENCHMARK SEE PLAN - ,c r , - — PROPOSED ADDI WO-BOX COMMUNITY PANEL NUMBER. 250001 0021 D � �' � � � ' ' �� 1 y�P, � ,� � `, ', � �-- �. �x lt:f�C`,, - THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONES [�� :;� „ ? J' f ; , tz'( ; \2 � -- '" - ` '' * - �. ;A<�-,�,,� LEACHING CHAMBERS cR - _ `_ U11LTY INFORMATION SHOWN HEREIN: WF A-5 41t1s t r �(� ,l �f ` '.(1 c'7.1 N V14C� '1 `5.21 pig DRIVE �.f3, GRA1/E� �0:0 A11 EL. (11 ) & C. ; ; : I , 4R,, I <v SEPTIC TANK v G N LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND O C ■a 't ! ! 1";I;t�l F TEST f` t° MUST BE VERIFIED IN FIELD BY THE CONTRACTOR AND T PIT 2 Rq •�OVEp ' 8 _GRAVE 3„ r U11LITY COMPANIES PRIOR TO ANY CONSTRUCTION. � APPROPRIATE m o 2TI t7 •N , I ''� '�.�) �c1, r� -� ■ °.� - ? `� �• : *-: PIT t r - WETLAND FLAGGING AND DELINEATION PERFORMED BY SAMUEL Leaching Area Requirements f�:� � ' ' I ;�`, ` '', W- I oPosED. °P`o �R,, x " a o 3 ECKiVL / HAINES OF ENSR INTERNATIONAL ON JULY 28, 2005. W ..r i t''.1 ,f' WOOD g icK ' • ' t STORY j` ` W WELLING - , ° A TITLE SEARCH HAS NOT BEEN PERFORMED FOR THIS SITE. 5 BEDROOMS AT 110 GPD/BEDROOM = 550 GPD ^mil o ,M I ` FRAMED ,, WA ; '' �,f3 o. 551 28.4 ='.l IF DETERMINED TO BE NECESSARY A TITLE SEARCH SHALL ar • - 1 t? , 1 EXIST. N g -PRW VE ADDITIONAL 50% FOR GARBAGE DISPOSAL _NANGPD cif' • �'`{ 1 WF AL4 F.F.E. 3 �' :< 1 ' �� BE PERFORMED BY OTHERS. ■ , "' } ` , t ' �. PORCH " ' `A a. ! %y + "• + ' TOBE `. i THE PROPERTY LINE INFORMATION SHOWN IS BASED ON CURRENT I ! I I > 7 �?;E, t TON PERC RATE - MIN. INCH (CLASS 1 ) I !, +,a �, IOVAT� N x (.':,3, I - y ro AVAILABLE RECORD INFORMATION CONSISTING OF PLANS AND x x' I a xt An 1�1Di �+ CERTIFICATES. THE EXISTING FEATURES SHOWN HEREON WERE ar ,, �k t ■ INC3 '. t i� q_ - , ','1 .., , SHOWER , (fi / ....1., ,. •�-�'� �w LIAR = 0.74 GPD/S.F. , '•I--:- ., t' `? 1 �� '4 IP,.FND 1 \ SURVEY OBTAINED FROM AN ON THE GROUND FIELD SU Y PERFORMED 1010 .z SEE DETAIL .r`, Y BAXTER NYE ENGINEERING & SURVEYING ON AUGUST 23, 25, & MIN. LEACHING AREA OF S.A.S. v, t i s o o _ z i; /. 100 --_._. ray �,' r' n \" w P 91.3' Q 1 a SED �p E igTiNc I �' 550 GPD/ 0.74 GPD/S.F o.�'= 744S.F. MIN. q ,4 I . i PLAN REFERENCES: • o WF A-3 ?, ` ` -f3,E, 7 r, WR uNE � j h PLAN BOOK 19 PAGE 143 W PROPOSED ADDITION -" - PLAN BOOK 159 PAGE 1 17 ■ o`> 100' OVER EXISTING BULKHEAD N 79`w N� _ ' _I �' ( PLAN BOOK 184 PAGE 3 PROPOSED SYSTEM: ADD TWO ADDITIONAL LEACHING CHAMBERS , SIDEWALL (12' + 44') x 2 x 2' = 224 S.F. 1 WF A-2 ' "�`z��o I I y NOTE: LOCUS IS THE BENEFICIARY OF EASEMENTS AND A RIGHT BOTTOM 12' x 44' = 528 S.F. N 131 OF WAY FOR INGRESS AND EGRESS SET FORTH IN 752 S.F. `IP FND - I —�... BOOK 980 PAGES 440-441 DATED: 7-30-1957. • ' (SEE DETAIL I �I '"�--�� EXISTING SEPTIC SYSTEM LOCATION IS APPROXIMATE. PER INSTALLER'S TIES, PERMIT 99-667 << ? WF A-1 :a. , la .� 'a PASSED INSPECTION ON SEPTEMBER 13, 2004 SOIL LOGS WE: 10/17105 HOUSE IS SERVICED BY COTUIT WATER DEPARTMENT P#=P- 11,126 � SOIL EVALUATOR: STEPHEN A. WILSON, P.E. 18�.53 o � IP FND BOARD OF HEALTH AGENT: DON DESMARAIS IP FND �a N �9'4s oo. W 268t, 7D to N TEST PIT 1 TEST PIT 2 $ o s9*-�� • ' G.S.E. = 28.8' G.S.E. = 2 7.9' 0 3 551 Santu�t Road cotuity Massachusetts 0" 0 1OYR 4/6 0" 0 1OYR 3/3 PREPARED FOR 5" 6� m Santuit Road Realty Trust AP SANDY LOAM AP SANDY LOAM N/F JASON STONE, 1R. Donald J. Goldberg, Tr. 10YR 3/2 10YR 3/2 ME10" 10" B SANDY LOAM B SANDY LOAM Wetlands Permit Plan - Proposed Additions 10YR 4/6 10YR 4/6 IRON PIPE DETAIL 220 24" N.T.S. BAXTER NYE ENGINEERING & SURVEYING C MEDIUM SAND C MEDIUM SAND I OYR 5/6 10YR 5/8 CS FND Registered Professional Engineers and Land Surveyors 144" 132" 78 North Street, Hyannis, Massachusetts 02601 NO WATER AT 144" (ELEV 16.8) NO WATER AT 132' (9" 16.9) PERC o 60' PERC o 60' Phone - (508) 771-7502 Fax - (508) 771-7622 � L�w RATE= 2 MIN/IN RATE- 2 MIN/IN �'ay UNABLE TO SOAK UNABLE TO SOAK N CLASS 1 SOIL CLASS 1 SOIL 20 0 20 40 No aazte' DA ■ 05081 SCALE FEET 1 c OIII � SCALE: 1" = 20' AI L sr 1. LIMIT OF WORK SHALL BE MAINTAINED IN GOOD REPAIR UNTILL COMPLETION OF PROJECT. 2. ROOF RUNNOFF TO DISCHARGE TO DRYWELLS OR DRIP TRENCHES. DATE: 9-22-05 3. PROPOSED DECK WILL HAVE SONOTUBE FOOTINGS. 1. jre 11-11-5 soil logs/tp—wl locations SP ND. BY DATE REMARKS RAWN BY,• MCL IDESI ED BY ECKED BY. DRAWING NUMBER 0: 2005 05-091 SURV wrksht 2005-091—PB.dw 2005-091