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0014 BRANDYWYNE COURT - Health
14 BRANDYWYNE COURT,COTU{T A = 056 042 ` i, s,> r ' � r . 30'-01 pgZ� 1 Y m r m i m i b X1 0 iq Of El m P + I}ny� Al p � g W , z p I N M � Np 4n 4t 4.--- A C � F U m � 1 1 M t�tm I 1 ' m I ]Qy li 3 22'-II' 14i.0u - I01-0' (1 1 24--0' °Oo DUNN RESIDENCE m Z� 14 BRANDY WINE GOURT FINE LINE DESIGN COTUIT, MA N 8 WEST BAY ROAD OSTERVILLM MA 0260 —� N RENOVATION PLANS PFONE SOS-4,20-12M TOWN OF BARNSTABLE LOCATION /AJ at-c rJc.wu n,c Covr SEWAGE# 201 - O)7- VILLAGE Co4 u►� ASSESSOR'S MAP.&PARCEL SG- 4/Z INSTALLER'S NAME&PHONE NO. a 4,B E xCay a�i o� SEPTIC TANK CAPACITY /000!jcx) r LEACHING FACILITY:(type) 1 (size) 2 x 3 x 32 NO.OF BEDROOMS 3 OWNER PERMIT DATE: - /$•J S/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on' site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet r FURNISHED BY q M V M M � N C7 � v in r.-._. Q � � bnUq V 1 No. I _V Fee �V THE COMMONWEALTH OF MASSACHUSETTS Enteredincomputer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es 01ppYication for his al *pstrm Construction 3permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ndividual Components Locat qn Address or Lot No. &fl00Y WV 7L&OZT Owner's Name,Address,and Tel.No. s r A slap/Parcel 6 � cirLe/ YZ, ") 111 am Wal5h 61?e-14w •- Jo j Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. &e EX c va on 5og-- /477-b&5,3 1)vwn ` y).e-. 6_79- 5a k 31a2- 45 4// Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) . 331) gpd Design flow provided _ gpd Plan Date I I to l Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ` Nature of Repairs or Alterations(Answer when applicable) fl t o A-bo t — Ler a)/nG a,;L4G�ac ko zx�x33 - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b is rd o ealth. Signe ®"7 Date i- f r� Application Approved by Dater/ Application Disapproved Date for the following reasons Permit No. p Date Issued f --------------------------------------------------------------------------------------------------------------------------------------- 7-2 No. � l _ V I • `� .- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS t 're f 1pliration for -Bisoosal *:pstrm Construction permit Application for a Permit to Construct( ) Repair(.�" Upgrade( ) Abandon( ) ❑Complete System ��ndividua*l Components Location Address or Lot No. f L{ 1-QfJ0 y I, Vak &Ore7 Owner's Name,Address,and Tel.No. r� �„'� � �A),Jl r crm Walsh 59k L4W Asse sor's Map/Parcel- 5 ?Cl(/e� yZ r"' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. , �x�gvcZfrvn 5U8- 4d 77 -Ulo53 howo CQpe F09. 50 k 36z- 95 ! Type of Building: ` Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( ) �• Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided % gpd KrF: Plan Date to l I q Number of sheets Revision Date ., Title Size of Septic Tank Type of S.A.S. ° Description of Soil Nature of Repairs or Alterations(Answer when applicable) b0 v /i/ ,n q U ! !�/` Z)3x33 — Date last inspected: Agreement: _ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in "f accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b this Board of Health. Signe )� _ (�"T Date 1-m-ol Application Approved b /, „ Date PP pP Y 1_. � r Application Disapproved Ify v Date for the following reasons r Permit No. p( Ll— (�� Date Issued THE COMMONWEALTH OF MASSACHUSETTS I' BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by � )u raw o I i U at 14 ( n V \1(l to ri, has been constructed'/in accordance with the psou'sions of Title 5 and the for Disposal System Construction Permit No. Q� y�0/2—dated P Installer p Designer / #bedrooms Approved design flow V Jj pd The issuance of this permiX-//, ,/ 1 not beEonst ed as a guarantee that the system wig 11,i'cti n as)designed Date /4P Ins /�j/ , �L No. G/ ��� Q I - _, � THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION - BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 'permit Permission is hereby granted to Construct( ) Repair( ) / Upgrade( )/ Abandon( ) System located at I y 1 /-Ai) I �7 I�j ( and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct io must be.completed within three years of the date of this permit. i Date ( C Approved by FROM :down cape engineering inc FAX 'NO. :150836298eo Feb. 10 2014 08:56AM P1 u em a —hoffia•3 M (xcilQ;Ti'y D1]i'4'.d"_u(Dl' IS �tnya Mamas McKean,Director 200 l��nAa�t:r�etr,.l�yrau�nais,MA.02601 Oth-m- 508-352-4544 Fm 508-'190-63Q4 Jmj41AD.PT&)I)esapper cL e rm."'I ki 2n Fob rI ,/ �eaisft;`r �7 wasi:5;�acd a.pergi t to inslell a. (date) s s-ptir, iystem at I t 2 W,f Kk. based oil.a design dium by ddT.ess) dated. . .., (desicl _ T certify t12af: the above wag insialled qubstunually arcording to t}1e Qesign, whichm`ty'i:orh.Me minnr, aPpTo-veJ. clti4npas such as L3fetal.relorafiion of. the dist*u ,au box an.d/oz su0n tarp. I cc:itfy'that the septic.. �ystet te-fem ced above, W'as i� .Rrrl wiL ma_lur dhmgcs [i..e. greater.than,10' htela).,reJou on of tli,,: SAS OT aity llartir Fti:rn-lc adm of a.oy commune t of the suptir,system)brat ba accordance with.Stsrto, ��.L.octtl,T{agulat.9. i?'lau rcvE510n,in certified a�s-b'uilt by de:;igner to tolloW r pJALA �kig :z�'�) civl� No.46502 a cr3TSF � ww 1 ✓ /�O���J SJr)NAl. N� PaiFnc�'s 5ignnt+l.e) �' ! (A.ffi:x l�es ��r'sfanr}�New) e t a jjyT7iq.FN TO .`, i tD Q: .yt; rii �D 'll.t a'1t. ¢ 4 7' ALM_ Nf� `4 liYF9T,'Y: C'AP.— A14F n-YYaaifh/RmlirJfTPsirnrrCmk fjcatioa Form 3-26-04-thjc Town of BarnstableF#j Departi neat of Regulatory Services R Public Health)Division Date 11 /2. / NAM s679� 200 Main Street,Hyannis MA 02601 Date Scheduled f3 Ti'me Fee Pd,� d0 •(/V Sot Suitabilio .Assessment for S e .Di 0 � e Performed•By: Witnessed By: 0 LOCATION&GENERAL]NFORMATION f Location Address I B ra Owner's Namo / a yW y� e� �- C0flA�( Address Assessor's Map/Parcel: 5'6/L/2_ Engineer's Name p W h (. ye NEW CONSTRUCTION REPAIR Tele hone# 65--0,'j 31 z— S Land Use: L of wt-- / Slopes(96) _ � Surface Stones Distances from: Open Water Body I�^G it Possible Wet Aren,//')® G ft Drinking Water Well Dmfnage Way >'C)y ft Property Line � �—Oft Other g SIMTCII:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands?n proximity to holes) si,Oct N � rJ v ca 0 w z .� 00 'a z s 0 n X v, �5bo ark or Parent material(geologic) 'a t i C( � Zl tL+� Depth to Bedrock OO Depth to Groundwater. Standing Water In Hole: NZ14 Weeping from Plt Fnee Bstlmated Seasonal High Groundwater A-1 • DE ERNdIlYAMON FOR BEASONAL HIGH WATER TA13LE Method Used: 7 W Depth Observed standing In obs.hole: la, Depth to soli mottles: ltt, Dodtb to weeping from side of obs,hole: In, Groundwater Adjustment Index Well# Reading Date: Index Well loVol__- _ Adj.floor,,,,'..,,_Adj.Groundwater1.aVnl,, PERCOLATION TEST Date /b/14 Time/I;CXZ Observation I' Hole# _ Tlmo at 9" Depth of Pere Time at 6" Start Pre-soak Time @ Time(9"-6") End Pro-soak Rate Mln./Iach ^ , Site Suitability Assessment: Site Passed Sitp Fallcd: Additional Testing Needed(YIN) /v Original: Public Health Division Observation Hole Data To Be Completed on Back----- ***If percolation test is to be conducted within 100' of wetland,you mu first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPTIC\PERCFO RM.D O C - 1 I)EEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Shcl Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Conalatenra.%'Gm'yell 0- 0 /+ L 5 toYR Ya - Z T& 32-1zU 065 ill DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. e � 5 i�v � 3(-1ZU G DEEP OBSERVATION HOLE LOG Depth from Sail Horizon Sall Texture Soil Color Sall Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist o DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sol Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones'.Boulders. Consliqtrn y _Flood Insurance Rate Map: ' / Above 500 year flood boundary No Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No.Z Yes. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious aterial exist in all areas observed throughout the area proposed for the soil absorption system? _ If not,what Is the depth of haturally occuning,perv(ous matarlal? Certification'• s 0 Z •` ' T certify that on (date)I have passed the soil evaluator examination approved by the Department of EnvironmentIAbteetion and that the above analysis was performed by me consistent with . the required training,expertise and experience described in�10 CUR 15.017. Signature �- � '+ Data Q:1 EPT1CTERCF0RM.D0C .01 © MA u U' ,.1• I ,>: ru EM ri Lf7 co Postage $ ru a Certffied Fee yq�i Y Postmark O Retum Reoelpt Fee #'p Here O (Endorsement Required) O Restricted Delivery Fee r3 (Endorsement Required) ,Z 0 Total Postage&Fees ru - o Phyllis F Wash Revoc. Trust % William P &.Phyllis F Walsh TRS 14 Brandywine Court —Cotuit. MA 02635 - i Certified Mail Provides: a A mailing receipt e A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 i n Complete items 1,2,and 3.Also complete A. Sign u /� item 4 if Restricted Delivery is desired. / ❑Agent XFo Print your name and address on the reverse / Addressee so that we can,return the card to you. B. Received by(Printed Name) I C. too Delivery o Attach this card to the back of the mailpiece, f or on the front if space permits. D. Is delivery address different from item 1? ❑Yes � 1. Article Addressed to: If YES,enter delivery address below: ❑No Phyllis F Wash Revoc. Trust % William"P"& Phyllis F Walsh TRS . 14 Brandywine Court 3. Service Type Cotuit, MA 02635, r ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑_Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2, Article Number 7 012 1010 0000 2851 1029 (transfer from service label) PS Form 3811.February-2004 Domestic Return Receipt, 102595-02-M-1540 j UNITED STATES POSTAL.SERVICE First-Class Mail Postage&Fees Paid USPS Permit No..G-10 ' Sender: Please print your name, address, and ZIP+4 in this box • A "Town of Barnstable Public Health Division N 200 Main Street . �. r �_ Hyannis, MA 02601 �' � sHWEr Town of Barnstable Barnstable yvP Mo, AFAmericaCily I Regulatory Services Department • UARNSfABLE, '""SS• 1639• Public Health Division �0 m Arf°"40�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1029 . November 12, 2013 Phyllis F Walsh Revoc. Trust % William P &Phyllis F Walsh TRS 14 Brandywyne Court Cotuit, MA 02635 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 14 Brandywyne Court, Cotuit, MA was inspected on 10/16/2013, by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system neede&further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • At time of inspection,water level was 2" below inlet invert. Town of Barnstable requires a minimum of 12" of available leaching. You are ordered to repair/replace the septic system within sixty (60) days.from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH • Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\14 Brandywyne Court Couit Nov2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=3652 yw tZI, 2 n Logged In As: Parcel Detail Thursday, November 7 2013 Parcel Lookup Parcel Info Parcel 056-042 ( Developer LOT 71 � ID Lot Location 114 BRANDYWYNE COURT , Pri1220 Frontage Sec COTUITBAYDRIVE Sec(219 �� �� � - Road• Frontage I Village FCOTUIT ' Fire COTUIT District Town sewer exists at this Road address.No Index169 Interactive / '� Map s 1 " Owner Info Owner jWALSH, PHYLLIS F&WILLIAM P Owner %WALSH,WILLIAM P&PHYLLIS F TRS Streetl PHYLLIS F WALSH REVOC TRUST Street2 r94 BRANDYWYNE COURT City ICOTUIT State EA Zip 02635 Country Land Info Acres 1.17 Use Single Fam MDL-01 ( Zoning RF Nghbd 0108� Topography --- -s' Road Utilities� Location Construction Info Building 1 of 1 Year Roof Ext 1983 Gable/Hip I Wood Shingle Built Struct Wall � ;,�. Living 2053 Roo lef Wood Shin AC(None P � Area Cover �g Type I uas . s Style Cape Cod Wall Drywall nt Be Rooms 3 Bedrooms abr ief ModelIntF Residential ) Floor Carpet Rooms 2 Full+ 1 H Grade Average Plus �� Type Hot Air rotal Rooms 6 Rooms �1/2 Stories Heat Oil Found- Stories Poured Conc Fuel ation-- r� Gross r htti):Hissgl2/intranet/propdata/ParcelDetail.aspx?ID=3652 11/7/2013 �l TOWN OF BARNSTABLE tOCATION 6W t -- C SEWAGE # ILLAGE . ASSESSOR'S MAP &OL,OT �! L�6 INSTALLER'S NAME&PHONE NO. �� SEPTIC TANK CAPACITY Z y LEACHING FACILITY: (type) _�` � )�" (size) NO.OF BEDROOMS BUILDER OR OWNER AS PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A VO �� dA +` �.t Commonwealth of Massachusefts TOO 5 m 1 - a Subsurface Sewage,,Disposal:System Form Not for Voluntary•Assessments. " 14Brandywyne Ct_..... .................................................... ...:. Property Address William Walsh ..... .... ............... -. _...._. Owner -.... _.... ...___ _..W. . .. .._ Owner's Name - information is Cotuit nna 02635 10/1.6/2013'required for;every _ _-- -. _._..W GifylTown.: State Zip Code `: Date of inspection - . inspection resuifis rrtust be sub"rnitted ott' ifoeth. inspector n;fizrms t my nofi be:'It' d`ird any duay. Please see comp leteness chepOkiitt At"the`end of:tl�e fot .. tmportant:lNhen Genera Inf4rE�atI:On filing:out forms . . on:the:com-puter.. use orily the tab - key:to move-your 1. inspector: cursor" do not Sean:M. Jones V `: use-thetcturn - .. _ Name of Inspector key; _ Capewide Enterprises' — _ — _ r�s Company Name _...... 153 Commercial St. : Mas ee Ma 02549 CitylTown State Zip Code. 50&4 1 8877 Sl 4522.. .. ' . - _. - Teiepione'Ntirriber license Number Bi .......::: Ce #�ficat�o I certify that I haue personally inspected the sewage disposal<system atthis address and that,fhe' i. formation"reported below is true,.accurate and complete as df the time of theFi ection Tikig inspaption was performed based'on my training and experience in the'proper function and m nte;nance pf one sewage disposal systems. I"am a DEP approved eystern inspector pursuant , ectron 15�340 ' Title-5 (310 C: R 1.5.000). The systern: . . .:: � •ice ❑ Passes ❑ Conditionally.Passes Fans ❑ Needs Further Evaluation by the Local Apprbving;Authority a CID .. 10/16/2013 ... ......................................................... . ........ w_.. spectors Signature — Date 6.system:inspectorsholl submit a cagy of this inspect* on report to theApproving Authority{Board of with or"D.EP}within 30 days;of completing this inspectiarr. If the systerri is a shared:system or has : esigri flow of 1.0,0d0 gpd or greater the:inspector and;the system owner"sfall suornit the report to the;approp:riate regional office of the DEP. The original should be sent;to the system owner and copies sent to"the buyer, if applicable; and the approving authority. ****This report only describes conditions at the time of,inspection and sander the:cond tions of use at that tirvie.This inspection does not address how the s ste a ilv peirfiirrn.in the future: nder the saute dr different donditions of use. t5ins•3l L3 Title 5 Official Inspecti Subsurface Sewage Disposal system Page::1 of t7 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts = r Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System-will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50.feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ondin of effluent to the surface of the round or surface waters 9 p 9❑ ® 9 due to an overloaded or clogged SAS or cesspool ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year-NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privyis within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking.water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 14 Brandywyne Ct .Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (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: 2012—63,000G, 2013—60,000G Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 14 Brand w ne Ct Y Y Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: original system 1983 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from rivate water supplywell or suction line: p feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? --- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of inspection the water level was 2" below the inlet invert. Town of Barnstable requires a minimum of 12" of available leaching. 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 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/1.3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commoner th of Massachusefts: icia Title Subsurface Sewage Disposal System s F g por�ae.-Not far Voluntary Assessments: 1 14 Brantiywyne Ct .................................._........................... ..... ................................................... _ . ..... ... ......... . .., PCope[ty,Address William,Walsh Owner — —..._ _.._........ --- O,wner's;Narne information is Cotult w Mrequired fa every --- a. 0263 10/1!612013'._._ page C ty/Town.: State Zip Code cafe of Inspection D. Syste.r lhf r ataon (cant.) Sketch Of Sewage:Disposal System: Provide a view cif the sewage disposal system, Including ties to. at least two permanent reference landmarks or benchrrlarks. Locate:all waifs ivithln 100 feet Locate where pudic watersupply ehters the building. Checkone of the boXesbelow: hand sketch in the area below ❑ drawing:attached separately' _. l�- 13 .. d 'l 13 a 2 R'l- 2-�a - . i l t5ins•3113 Title 5 arid Inspection Farm:;subsusiace S—w q gis?osa!System Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 14 Brandywyne Ct Property Address William Walsh Owner Owner's Name information is required for every Cotuit Ma 02635 10/16/2013 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 .r\ hen 0 DNA Y 2 51999 �-�114 COMMONWEALTH OF MASS A ETTS EXECUTIVE OFFICE OF ENVIRO John Grad DEPARTMENT OF ENVIRONMENTAL PRO_ TION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 -� P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 14 BRANDYWYNE COURT COTUIT Name of Owner PETER NESTLER Address of Owner: SAME Date of Inspection: 6/6199 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: n/a Mailing Address: n/a Telephone Number: n/a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My inspection does Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:5/6/99 The System Inspector shall iubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING TANK NOW AND THEN MAINTAINED EVERY TWO YEARS. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5/5/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: Wa 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nla The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nla Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced Wa The system required pumping more than four 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 revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5/5/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance nLa_ (approximation not valid). 3) OTHER nta revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5/5/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground 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 1/2 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 n(a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: 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: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5/5/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (1 5.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:6/6/99 FLOW CONDITIONS RESIDENTIAL Design flow:-=g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):I Total DESIGN flow: IQ Number of current residents:11 Garbage grinder(yes or no):]CEO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO Last date of occupancy: 5/1198 COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: nLa gpd(Based on 15.203) Basis of design flow: Wa Grease trap present:(yes or no):�LQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:Wa Last date of occupancy: Wa OTHER: (Describe) n(a Last date of occupancy: nLa GENERAL INFORMATION PUMPING RECORDS and source of information: nLa System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa. gallons Reason for pumping: Wit TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nLa APPROXIMATE AGE of all components,date installed(if known)and source of information: 1983 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5/5199 BUILDING SEWER: (Locate on site plan) Depth below grade: 2L Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n1a Comments: (condition of joints,venting,evidence of leakage,etc.) WA SEPTIC TANK: X (locate on site plan) Depth below grade: 2 Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n/A If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): MQ n/A Dimensions: L S'6'H 5'7"W 4'10" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: $.Q_ 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: in How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING NOW AND THEN MAINTAINED EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nLa Dimensions: Wa Scum thickness: nLa Distance from top of scum to top of outlet tee or baffle:iVa Distance from bottom of scum to bottom of outlet tee or baffle WA Date of last pumping: n/A Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nLa revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5/5/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Wa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) n& Dimensions: Wa Capacity: Wa gallons Design flow: n/a gallons/day Alarm present: NQ Alarm level:jjl& Alarm in working order:Yes—No—: NO Date of previous pumping: nta Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Wa DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:Wa Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) t]& PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5/5199 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Wa Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: 1]La leaching galleries,number: 17La leaching trenches,number,length: nla leaching fields,number,dimensions: n& overflow cesspool,number: n& Alternative system: nLa Name of Technology: -n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT WAS EMPTY AT THE TIME OF THE INSPECTION NEVER MORE THAN 1/2FUL CESSPOOLS: _ (locate on site plan) Number and configuration: n& Depth-top of liquid to inlet invert: n& Depth of solids layer: n& Depth of scum layer. nLa Dimensions of cesspool: n& Materials of construction: nla Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: _ (locate on site plan) Materials of construction:nla Dimensions:nLa Depth of solids: Wit Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa revised 9/2/98 Page 9 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5l5/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a r A Ob 4413 AQ 39 � 36' revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 BRANDYWYNE COURT COTUIT Owner: PETER NESTLER Date of Inspection:5/5/99 NRCS Report name: nla Soil Type: Wa Typical depth to groundwater: n& USGS Date website visited: n& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS AND VISUAL-12+FEET revised 9/2/98 Page 11 of 11 LEGEND SYSTEM DESIGN. SYS TEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES` MARKED WITH MAGNETIC TAPE OR o� COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE WATERTIGHT MIN. 20" DIAM. (NOT TO SCALE) } 1. DATUM IS APPROX. NGVD QJ Pie cz t 99- EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING��( I'A GARBAGE DISPOSER IS NOT ALLOWED o X 99 EXIST. SPOT ELEV. \ 6' it DESIGN FLOW: 3 BEDROOMS @ 110 GPI = 330 GPD �' '�` 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 99 PROPOSED CONTOUR _ MINIMUM .75 OF COVER OVER PRECAST _ 2% SLOPE REQUIRED OVER SYSTEM 48.5 a a w USE A 330 GPD DESIGN FLOW 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS o� Loc s 99 PROPOSED SPOT EL. ` RISERS (rrP)D ,4 PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE TO BE AASHO H-� d TH 1 ,•. 2'0 4"OSC"H40 VC O Baxfer e SEPTIC TANK: 330 GPD (2) = 660 _ ;_.;.. PIPES"`EVEL 1ST 2' " 5. PIPE JOINTS TO BE MADE WATERTIGHT. \ TEST HOLE 2 DOUBLE-WASHED PEASTON RE-USE EXISTING 1000 GAL. SEPTIC TANK ** OR GEOTEXTILE FABRIC ' 2% SLOPE OF GROUND ~ 44.2 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH . TEE EXISTING TEE '� 310 CMR 15.000 (TITLE 5.) LEACHING: SEPTIC TANK 44.4f s" 11 SUMP (RETAIN)** 0o0o0o0o0o00 12"MIN. INT. DIM. ' �000�o�o�00000�oa000�o�oo;°o�$°00°o0ogogo0o0o0Fo 000000g0000!0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO �Q� UTILITY POLE SIDES: 2[2 (32 + 3) 2 (.74)] = 207 GPD GAs BAFFLE ..: ,_o�o„o�o o_. 43.73 000000000000000000000000000000000000000 0 000oo00o : 0flz NO. BE USED FOR LOT LINE STAKING OR ANY OTHER °o000°o0°00°00°000°0°00°00°00°00°00°00°000 °00°00°00°00`0 0 000000co0o0o6oca0o0 41.57 FIRE HYDRANT BOTTOM 2[32 x 3 (.74)] = 142 GPD �' : 43.9 7f.f 4" PVC SET AT .005'/' SLOPE PURPOSE. NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING •' ON 2' DOUBLE WASHED 3 4" " / / 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. TOTAL: 472 S.F. 349 GPD - 1 12 STONE2 TRENCHES, 32' LONG X 3' WIDE X 2' DEEP 4.07' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED USE 2 32' LONG x 3' WIDE x 2' DEEP 6" CRUSHED STONE OR MECHANICAL WITHOUT INSPECTION BY BOARD OF HEALTH AND ( ) COMPACTION. (15.221 [21) 25 f PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE LEACH TRENCHES OF PERF. SCH. 40 PVC PIPE AND STONE 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND BOTTOM TEST HOLE 1 37.5' LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES LOCUS MAP ELEVATIONS PRIOR TO INSTALLING ANY PRIOR To COMMENCEMENT OF WORK. PORTION OF SEPTIC SYSTEM ( 1 % SLOPE) ( 1 % SLOPE) GROUNDWATER EXPECTED AT EL. 16t' PER MAP NOT TO SCALE MA 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE APPROVED DATE BOARD OF HEALTH FOUNDATION- EXIST. SEPTIC TANK 47' LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 56 PARCEL 42 D BOX 5 FACILITY LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF NOT SUITABLE 51.09' VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED BY THE ON AUG.HEALTH L H 2E REVISED DURING A PUBLIC HEARING HELD TEST HOLE LOGS 3) FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM ENGINEER: DANIEL E. GONSALVES, SE INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) WITNESS: DONNA MIORANDI, IRS AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS DATE: JANUARY 6, 2014 BE LOCATED MORE THAN SIX FEET BELOW GRADE. ' PERC. RATE _ < 2 MIN/INCH CLASS I SOILS P# 14230 N � ELEV. � ELEV. 0" `V' 47.5' 0" 48.0' A A • o : LS LS 6" 10YR 3/2 L 8" 1OYR 3/2 a r B B LS LS 32„ 10YR 4/6 44.8' 3690 1OYR 4/6 45.0 , BENCH MARK - GARAGE SLAB AT C C CENTER OF DOOR. ELEV. = 47.5' PERC 4 . / M/CS M/CS �0 r'o EXISTING GROUND IS p,REA 1C 10YR 6/6 10YR 6/6 DWELLING UNDER Cfl O 7.9 5 MAY BE IN TH T--,--4 53 �61, - T 6 -T--""-T 6.77 00 BRICK 0 . 7 A p 5 00 120 LOT 71 .95 WALK a �� " 37.5' 120" 38.0' 48 48. � �� 47.65 01 50,947t S.F. 47.57 7 X 37 7c"48.21 / 2 NO GROUNDWATER ENCOUNTERED 8.28 0� � X 48.41 8.33 GRAVEL DRIVE GCD� 45. 4 / O 48.81 8.59 6L � 48. / 58 48.78 '�� 48.74 k ■ 7 8 48.90 0 98 48. 1 �� 48.86TITLE 5 SITE PLAN 46. EDGE F LAWN 4 42 49 49.49.1 OF L� 48.95 PROP. VENT WITH CHARCOAL FILTER 46 CO 9.12 9s AND BUGSCREEN (FINAL PLACEMENT BY 49 - 49.03 CONTRACTOR WITH HOMEOWNER ,45.. o° 14 B R A N D Y W Y Ill E COURT CONSULTATION) ■ �j�' 14" OAK SLEEVE SEWER LINE FOR 10' C®T U I T " EITHER SIDE OF CROSSING WITH 16 OAK 48.48 4 80 WATERLINE T1 PREPARED FOR ��' X 45.6 Y TH2 Q& B&B EXCAVATION/WALSH 01 G X 46 73 47.87 JAN UARY 6, 2014 A Scale: 1"= 20' R'50 . 00 46.48 0 10 20 30 40 50 FEET A_7g . 54 ' off 508-362-4541 wOFMq's� ��H FEL, ASS fax 508-362-9880 \' DANIEL, 45.12 � DANIEL A. G `•�� r I downcope.com 4.80 D OJAL A A. 9 CIVIL OJA A down cape ell hleefing MC. No.+0980 �T R�° ��°F S�, civil engineers �, trr F s T� qt, land surveyors ( _ 9p 1 ONAL E� U�/ . 939 Main Street ( Rte 6A) 1 3-288 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675