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Home My WebLink About0023 BRANDYWYNE COURT - Health j TOWN OF BARNSTABLE LOCATION 3 �� j y�"'�� COv�-� SEWAGE #®7 a2 g VILLAGE D /v7 ASSESSOR'S MAP & LOVA, "J6®yO INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY e ®® L LEACHING FACILITY: (type) (size) ;--7 X NO. OF BEDROOMS .3 BUILDER OR OWNER , PERMTr DATE: y—®� 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 l,J P A 6 ._ . �� P �� . -C � s .o s. 1 No. V� �yl��(' Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01pplicatiou jFor well Cougtructiou Verrrtit , Application is hereby made for a permit to Construct(✓S, Alter( ), or Repair( ) an individual well at: : .w� a3 yti� � �- Location-Address Assessors Map and Parcel p4� Owner Address 9 4jQce x44 b.)G Y7 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons /r Type of Well Capacity Purpose of Well If.A e Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Comp anceo been issued by the Board of Health. C� .t Signed fi. •% ��r �6` ! 7 Date Application Approved By /Date Application Disapproved for the following reasons: Date Permit No. � ""! �� Issued I ' Z� Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate of (Compliance THIS IS TO CERTIFY,that the individual well Constructed(r� Altered( ), or Repaired( ) by Installer at a 3 , �U a{�y.�v.�r► C T Coro T has been installed in ccordance with the provisions of the Town of Barnstable Board of Health Private Well Prote tion Regulation as described in the application for Well Construction Permit No.Q ALP�' Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. � V Fee BOARD OF HEALTH - .5 OF* BwA R N S TA;B L.E r.., a ,t3•. � Yicatiori orerr.�o' gtructio ernYt r� Application is hereby made for a permit to Construct(✓' , Alter.( ), or Repair O an individual well at +ti " c 7'" .+ Location-Address Assessors Map and Parcel Owner r Address Y�ew �rS �CCII ��r��ss - 4$Gy)cr �G t)JGY� `w Installer-Driller Addres;'s""� �;'^.,---�*--n�.'Type�of Bui•Iiiing ��.;�:� �.�•;,..�-±�.�- ��.�.� �,, �.. ��.� -- � �.. :;�� T;= --�' - .>..�:✓�� -5 � w.�----- Dwelling Other-Type of Building No. of Persons Type of Well - - Capacity Purpose of Well Agreement: The undersigned agrees to install the afore descnbed individual well in accordanc e with the provisions of the 2 Town.of Barnstable Board of Health'Private Well Protection Regulation-The`undersigned further agrees not yto.'place the F R well in operation until'`Certifi``caate of Compliance has been^issued by the Board of Health: r • Signed z--, . .. J Date Application Approved By Date Application,Disapproved for the-following reasons:. 4 +� .. (J,.f,/, ate Permit No. � '/'�� ' CiZP ' Issued Date -------------ee___ooeo------_- >o------,----------e--- ----. - --------------_ee__ ----___. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(v)� Altered( ), or Repaired ..rby J. J � r Installer. at J 3n (?i�a C7"- C� u ,• has been installed in'accordance with the provisions of the Town of-Barnstable Board of Health.Private We}1 Prote/etion Regulation as described in the application for Well Construction Permit No. Z Dated j 1 2! ZJ i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector . ------ ---,----_ _-- _------- - ------------ ----------- BOARD OF HEALTH TOWN OF BARNSTABLE 39ell Con!5truction Permit No. Uli "u' Fee Permission is hereby granted to 0 e N1 u 1 S Sr Gw we l Installer,' .to_ ,. :. �Construct.O .,Alter.('.-,), ,or. Re air.(-, an individual well at No Y _Z) 3. ' did Xf 4}s t C i" C l a r 7y E j Street f as shown'on the application for a Well Construction Permit No. Dated i r Date �L Z'{ Approved By /`� / Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. Cityfrown 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 q�l o tj �• tr o.J 3 �y p ) Z y3 Ll59 � r13 . 0. V k-3 . 15irxsp.doc•rev.7/28/21N8 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System Pager16 of 113 ' c Commonwealth of Massachusetts b5(o-b5b Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owners Na information is Cot Ma 02635 4/21l2021 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms p 51# 153 Slv on the computer, use only the tab Chad Hathaway key to move your Name of Inspector cursor-do not Hathaway Septic Inspections use the return Company Name key. & Company Address Forestdale Ma 02644 City/Town . State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 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 i 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 4/21/2021 Inspector's 76re Date The system inspector shall s mit a c py of this inspection report to the Approving Authority(Board of Health or DEP)within 3 days of mpleting this inspection. If the system has a design flow of 10,000 gpd or greater, the' or 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 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. Cityrrown 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: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems . Information on care and do's and don'ts can be found at town health dept or mass.gov 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): I l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . � 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. City/Town 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 obstructedpipe(s). The q P P 9 Y 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.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 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 '/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. ❑ Z 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 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for a//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 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. CityrTown State Zip Code Date of Inspection D. System Information 1. 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 Description: 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 Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 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: recommend pumping tank for maint. Was system pumped as part of the inspection? . ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Ih E t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ 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: 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.75'feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 30+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): no signs of poor venting or leaks good flow to tank t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts jm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) 1500 gal H10 precast If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6"x5'6" 8 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? tape and sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tees in place. heavy solids on inlet side. reccomended pumping tank. no visable decay or leaks t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. Cityfrown 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 Commonwealth of Massachusetts Title 5 Official Inspection Form I� a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 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 present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): in good condition. at working level . Dbox is poly plastic with riser and concrete cover t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,• 23 Brandywyne Court Property Address Stoner Owner Owners Name information is required for every Cotuit Ma 02635 4/21/2021 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: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. Citylrown 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.): camera inspected through Dbox. 6" of water in bottom clean sidewalls over current level 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 Title 5 Official Inspection Form �n Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • �� 23 Brandywyne Court Property Address Stoner Owner Owners Name information is required for every Cotuit Ma 02635 4/21/2021 page. Citylrown 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 Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is required for every Cotuit Ma 02635 4/21/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately k :p l -3 °y 0 V O .0 U y3 / I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owner's Name information is .required for every Cotuit Ma 02635 4/21/2021 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: 35' 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: per GIS mapping lot el. 48 in area of septic low at far end of property el. 1 1.5'wetlands bottom of SAS 42'el I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 II '~ Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Brandywyne Court Property Address Stoner Owner Owners Name information is required for every Cotuit Ma 02635 4/21/2021 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 I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 :c No. 9-ov-7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS ZIpphration for ;Digpogar *pgtem Congtruction 3permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ') ❑Complete System ❑Individual Components Location Address or Lot No.2 3 S aA I o-Uj 3 jjG C✓,l Owner's Name,Address and Tel.No.- Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Pj%7-C)fZZ �lE CVO Designer's Name,Address and Tel.No.&J4 C-> 0 NVZ M rA_ oa '-i77 -5313 Type of Building: ` s� Dwelling No.of Bedrooms _ Lot Size /. 1 sq.ft. Garbage Grinder( ) Other Type of Building5M)6xZ; FPM. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3,3/ 6 gallons per day. Calculated daily flow .�Y0 gallons. Plan Date /c7� - G�` Number of sheets '2— Revision Date "— Title Size of Septic Tank FX I STZA'&, 1JF 0 Type of S.A.S. :2 ,o0b 9( C'_f nki Description of Soil S736 paps Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee 'ss t s d of Health. Signed s Date I -L) f Application Approved by —Date-6 -t`/-0 7 Application Disapproved for the followin reasons Permit No. 00-7_ 'L Date Issued 6 w t`�_ 77 No. _ Fee computer: V THE COMMONWEALTH OF MASSACHUSETTS Entered in com p Yes > y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 3pprication for �N.5pooar *p5tem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.2.3 D aA ND"w i NG GI RC ' Owner's Name,Address and Tel.No. -Z T:r Assessor's Map/Parcel Installer's Name,Address,and Tel.No.PAS-)OJZ:G IC-'Se C&V,. Designer's Name,Address and Tel.No.&jz 1 NMR W fjmk P, � Qt9� IZ�q lz W. G�LGSTI=�6LO j_caiZ�SS��P►,i�j M �-�R�Srr�t�, >�b _ Soo L177 - 5313 Type of Building: Dwelling No.of Bedrooms, - Lot Size sq.ft. .• Garbage Grinder( ) Other Type of Building S%N6LZ 'RA4 i No.of Persons' /x% 5 1 Showers( ) Cafeteria( ) Other Fixtures r" t�,� � Design Flow I -``. r"'1C,� 4,.: gallons per day. Calculated daily flow �, gallons. Plan Date" /o1 - 6,7 tNumber of sheets 7— Revision Date 'o, Title Size of Septic Tank["-/' %1*6 4500 Type of S.A.S. 9, 506 41 CH14 1�I7 Description of Soil ill-APJS Nature of Repairs or Alterations Answer when applicable) I2b?P 19- F A 1 L£O SAS P ( PP ) Date last inspected: Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore:escribed 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 bee ss ed- taSB d of Health. Signed p b't _ �C CaA ate!1 Date (o - 0 4 -07 Application-Approved by Date 6 -ty 7 Application Disapproved for,the followinV reasons r F;1 t i Permit No. 00�77_ Date Issued �1 `) v -------.----- --------------- THE COMMONWEALTH OF MASSACH.U'SETTS BARNSTABLE, MASSACH�USETTSf . Certificate of Comp - `CC.rK ' �` e ria�ln l THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed'(; )Repaired'OxUpgraded ( ) Abandoned( )by at 2.3 Rim1aDy w t ij G Cox.)Qn C cs-r-(.) -)-has been nstructed in accordance �g 5c with the provisions of Title 5 and the for Disposal System Construction Permit No. � dated 6 Installer.PAS 0'R-� •EX CA V l�'�1 MJ Designer 0,3- l 1J � ' � The issuance of this permit sl�Prhl noXbostyued as a guarantee that the s� stem wi do as designed. Date / yO / Inspector No. �dy l �- S6 -----_=--- —;---- —.— - ---.---Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1i$po5a1 *pgtem Con.5truction Permit Permission is hereby granted to Construct( )Repair(1J )Upgrade( )Abandon( ) System located at 2_3 mA tarh, 4a.$) Cjput► r 1r4>T0_(T_ 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�rmit. Date:_ Approved b PP Y g�214 l'teaaranoa of Yians.anaoectncan �.= r7o , •, 1"� r f - - The plans and specifications for every on-site system shall be prepared.as follows: (1) Every system shall be designed by a Massachusetts Registered Professional Engineer k or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not-design a. system designed co discharge more than 2,000 gallons pee day pursuant to 310 CMR 15.203. Any other agent of the ors nee.tra discharge y prepare'plans for the repair of a system.designed to not more.than than 2,000 gallons per day pursuant to 310 CMR 15.203 provided they are reviewed by:a Massachusetts Registered Sanitarian and.appro4ed by the.apprbving ' authority; •. •. �(2). .Every,plan submitted for approval must be dated and bear the stamp and signature of the designer, (3) Every plan'for a new system or plan for the upgrade or expansion of an eisring:systera' which requires a variance to a property line setback distance, must:also reference"a plan which bears the stamp and signature of'a Massachusetts; Licensed Land Surveyor in accordance with Ma;.L. c: 112, § 9ID; 4) shall be of suitable scat: (one inch=40 feet ar fewer for plot Every plan for a system fans and one inch,=20 feat or fewer for derails of system componenis). f6d.shall include. tcaon of: (a) the legal boundaries of the facility to be served; (b) the hdlder and location of any easements appurtenant to or which could impact the stem, - e t the fac ility ' s or build n,als existing andproposed on Y (c) the locarsorrdf rlte all dwelling(s) o• ) g .... and identification of those to be served by the system; ahe''iacation of existing of proposed irtipertious,areas; includng:driveways and g areas; - - - (e} location and dimensions f th e c system (including reserve area);-. Veqi' stem design calculations, including design daily sewage flow, septic tank capacity -) d and provided); soil absorption system capacity (required and provided); and w_hm-ther system is designed for garba;c grinder; North arrow and existing and proposed contours; (h dot anon'and'Iog of deep observation Bole tests including the date of test, existing ado elevations marked on each tcst, and the names of the represcntave of the ap .oving authority and soil evaluator, s(' location and results of percolation tests including the are elf test and tho-names of the z.presentative of the approving authority anti soil evaluator, . dame and certification number of the Soil Evaluator of record: (k) location of every."water supply,public and private, 1. within 400 feet of the proposed system location in the case of surface water supplies-and gravel packed public water supply wells, 2. within ZSO feet of the proposed system location in the case;of tubular public water supply wells, and �- osed system Iocation iri the. case of.private water 3. within 150 feet.of the,prop - supply wells; ve elated 1) location of-any surface waters of the Commenwealth�rivers, bordering g oastal banks, regulatory floodway, velocity zoaq, wetlands, salt marshal, inland or c surface water supplies, tributaries to surface water supplies,certified vernal pools,private ' water supplies or-suction lines, gravel packed or tubular public water -Supply wells, subsnzfacz drains. leaching catch basins, or dry wells; and the location of any nitrogen sensitive area identified'its 310 CIvLR 15.2I5 withi't which portions of the Proposed 1" stern are located. I of water lines and-other subsurface utilities on the faciIi ty; (n) c�scrvcd and adjusted ground-warcr elevaaan in the vicinity of the system; o) a cemplete profile of the system; (p) •a note on the plan listing all variances to the provisions of 310 CIMR 15.000 sought 'n conjunction with the plan: (q) . the location and•elevation of one knchmark.within 50 to 75 feet of the facility which is not subject to dislocation or loss.d�°�g cansavcaois'on the fine"ilify; (r) when dosing is'proposed, 'complete desigz'•ana•�F�e * icati;oiz of the.dosing system proposed including.but not limited to er .6f �chae sing beel spand dacity e h per c C equired and provided),' // imp curves and specifications, number af`dvcnt alternative technology is required or s) when a Recirculating Sand Filter or eq ' J✓ posed, a complete plan and specification for the system,including a hydraulic profile; t a locus pIan,to show the location of the faof*the fility-, and. cility including the nearest existing strecr, the select nu ribecandlictioii a if any, dZthe specifi a ons of the system. v) the materials ofo a+ f Town of Barnstable ' Regulatory Services ` ► • Thomas F. Geiler,Director Public Health Division 1 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office::508=,862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: _Zy.�? Sewa e.Permit# `oo7,Z S ( ^ �- 0 g Assessor Ma Des>gner tiG��eenn� G .Cts Installer: A.!�-,C� x cc;c ,q ' Address: (Ld Address: X !ZF •ems a Le MA OZ4 y y ��ct& M4 4Z&Y on u ��✓�iha� was issued a permit to install a (nstal�er) sephc.,system at 2 /3�q nc4 n C�¢ �d><i,)-based on a design drawn b (address) y AACI�. 1 t ; /Vl L dated 2- 07 (designer) I certify that.the septic system referenced above was installed substantially according to the des><gn, which may include min or approved changes such as lateral relocation of the list :"on box and/or septic tank. I certify that;the septic system referenced above was installed with major changes greaterthan 10' lateral relocation df the SAS or any vertical relocation of any component of these. c.system)but in accordance with State & Local Regulations. Plan revision or ceztfied as built by designer to follow. Mgssq�y PETER T. u (jll3taller'S Slgnature) U M c E N TEE CIVIL 0 9 No.35109 Q /STO" tip' e96'IO N R L aF" (Designer's Signature) (Affix Designer'sStamp Here) PLEASE RETr1RN TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFICATE OF OMPLIANCE WILL;NOT.BE ISSUED UNTIL BOTH THIS FORM AND AS-BUIIT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, Q:Health/SepticMcsigner Certification Form 3-26-04.doc , TOWN OF BARNSTABLE yw '4 C, �T YJ� 2 dog — �. LOCATION, 3 ,rid ,Q) SEWAGE # NULAGE y e 'o T tvr T ASSESSOR'S MAP &LOT b SL Os"O 'INSTALLER'S NAME&PHONE NO. 1y C D ro 8. 9,2 s -a 00 SEPTIC TANK CAPACITY PLP C F -B ax o 071 r: yt t VW ,7 ./3 0? LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(L°any wetlands exist within 300 feet of leaching facility) Feet Furnished by - � � �w 0 0 -c , . ` , ? �� _ a •o �, ,, t f� _1 �- .' ., i i J- TOWN OF BARNSTABLE LOCATION 3 �+,��`�" yNr' SEWAGE YII,LAGE C Div? ASSESSOR'S MAP & LOTA&L h 6'S U INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY '� 2 y LEACHING FACILITY: (type) (size) �3 x 1-3, NO.OF BEDROOMS -3 BUILDER OR OWNER PERMIT DATE: y� y— O7 COMPLIANCE DATE: 7 Separation Distance Between the: I Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility,(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 4-1 9 l q3. V 8-3 7®<q a f, f YOU WISH TO OPEN A BUSINESS? For,Your, Inforn ratinn. Business siness 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 sloes not give you permission to operate.) You must first obtain the necessary sign<3tLffe.ti on this form at 200 Main St., Hyannis. Take [lie ccn ipleted 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 Liw. l r DATE:' 1 z- Fill in please: APPLICANT'S YOUR NAME/S: 00 n I L� S BUSINESS YOUR HOME ADDRESS: _QKU TELEPHONE # Home Telephone Number NAME OF CORPORATION: Q G Z Opp, 6 S NAME OF NEW BUSINESS L TYPE OF BUSINESS e-ee 5 i IS THIS A HOME OCCUPAT O ? X YES. NO' // ADDRESS OF BUSINESS Yc�iL - a O T )7� AP/PARCEL NUMBER O�lL s USG (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 Main 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 COMMISSIONER'S OFFICE This individual has been informed of any per requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has bee r prr�e0 of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS,(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signatu.re** COMMENTS: No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS f 1 ZippYtcatfon for �Digpogal *pgtem Congtruction Vertu Application for a Permit to Construct( )Repair( Lj_U`pgrade( )Abandon( ) ❑Complete System 1410vidual Components Location Address or Lot No. 0 i�'''/��v7 WI&f C 1— Owner's ,Address and Tel.No Name . cO_'T_I I- Alb g RT•GA- F��l�! Assessor's Map/Parcel S.� �D 93 66 ey iv, (IV 141 C C 7- Installer's Name,Address,and Tel.No. _ -0 $- 7 S Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil G M Nature of Repairs or Alterations(Answer when applicable) 3 e d/X —av T,L r? Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is d by this Board of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. _. ,. FeWX THE COMMONWEALTH OF MASSACHUSETTS Entered in Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for �Digoga[ *Pgtem Congtruction_Permit Application for a Permit to Construct( )Repair(, Upgrade Abandon( ) El Complete System 14-Mvidual Components Location Address or Lot No.1 - B P4A,,:D &V C`I- Owner's Name,Address and Tel.No. Assessor's Map/Parcel 2>' 3 (vy 141 C � J- 0S�, COS p 6Q/�� C0Ty ,-r- Installer's Name,Address,and Tel.No. J'0 $ . 7 j%ds Designer's Name,Address and Tel.No. h i g rAA/C O ); 350 A-� �5„Z��a 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 a gallons per day. Calculated daily flow gallons. Plan Date ;- Number of sheets / Revision Date 4, Title _ w r ' Size of Septic Tank _ p Type of S.A.S. Description of Soil g ^�, L� G l H �F-1 O/ „f� nl.t Nature of Repairs or Alterations(Answer when applicable) d®x -• ®ri 7',L r 7 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is d by this Board of Health. Signed P '' ' Date 6 -Application Approved by Date Vo� Application Disapproved for the following reasons ` r Permit No. ''~ ' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (41 )Upgraded( ) Abandoned( )by �' X.,r p '31,p oV,,,v1jA., S r 6w ' `1,py< } at 43 dd ed A,10 C d7;/7- has been constructed 'n accordance with the provisions of Title 5 and the for D' osal System Construction Permit No. Z40/—SCE s dated 1 /7 U/ y t InstallerV=ngz�mDesigner i J The issuance of this permit sha 1 t be c nstrued as a guarantee that the syst 11 func ' n ay Ysigned_ Date 7 nt Inspector -----_-._-___ No. ✓� Ll J / / G"..) —_--———==--_=————__.=——c• Fee THE COMMONWEALTH OF MASSACHUSETTS 00 PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS wisooml *P.5tem Construction Permit Permission is hereby granted to Construct( )Repair( �)Upgrade( )Abandon( ) System located at a� &P,4 3J 77, 1 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 mmust ee comp bed w' hin three years of the date of tli/) rtiait! J'f Date: i s / Approved by ,r I J Town of Barnstable P# Department of Regulatory Services Public Health Division Date 9 MASS. 200 Main Street,Hyannis MA 02601 Date Scheduled Z Time 10 Fee Pd. Soil Suitability Assessment for Sewage Disposal 9 Performed By: ��' `t Witnessed By: a YI Y14 �'Okla r LOCATION& GENERAL INFORMATION Location Address 7 2 )3 r_C4 Vt tA y LV y rje /' Owner's Name j O ►1�: Address Z3 dZ ro y)y Wl.*V Cyr Assessor's Map/Parcel: 4 Engineer's Name fCJ1 j NEW CONSTRUCTION REPAIR Telephone# ( ,>�C � Y 77'��l 3 Land Use '` �"�� 1 Slopes(%)-?1 Surface Stones / Distances.from: Open Water Body 7 ICU ft Possible Wet Area Uw ft Drinking Water Well ft Drainage Way.- Uu ft Property Line 56 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to holes) t ' CD Parent material(geologic) C_r+Q6 1 C9J s� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: A j A Weeping from Pit Face r Estimated Seasonal High Groundwater - i 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. Oroutatlwater Adjustment • Index Well# Reading Date: Index Well level.-- Adj.factor...,,__ Adj.Groundwater Level PERCOLATION TESL' bate � Tim �6 AYl— , Observation Hole# -, Time at 4" .....��. Depth of Perc q�1,401 Time at 6" Start Pre-soak Time It 6,1 5— _ Time(9"-6") End Pre-soak Rate Min./Inch �n Z4 �� 1d riS Site Suitability Assessment: Site Passed x 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:ISEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# -1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on istenc %Gra,vel -Z7 A 27-42 5L �nYR .l� DEEP OBSERVATION HOLE LOG Hole# Z, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten %Gravel) =Zs Es E 10�'(2_�- 25, —.`P Z S Z o (LS 6 y V Z`13k c P -c Sghd Z,s Y 4/. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsiste c O vel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color, Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, CD d C) Flood Insurance Rate Man: 0 Above 500 year flood boundary No_ Yes „ Within 500 year boundary No Yes Within 100 year flood boundary No Yes =Depth of Naturally Occurring Pervious Material Does at least four feet of naturallyoccurring pervious material exist in all v g P areas observed throughout the n . - g .area for the soil absorptionsystem?s s � Ye.S 1 proposed -If not,what is the depth of naturally occurring pervious material? Certification I certifythat on 1 l �1 (date)( t I have passed the soil evaluator examination xamination approved b the Pr Y Department of Environmental Protection and that the above analysis was performed by me consistent with . the required�tra*5:mg,expertise and experience described in 310 CMR 15.017. i Signature Date QASBPT10PERCFORM.DOC I f - COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 23 BRANDYWINE COURT c COTUTT,MA 02635 RECEIVED Owner's Name: ANDERTON,HERBERT O,�Nmer's Address: 23 BRANDYWINE COURT COTUTT,MA 02635 Luc 2 9 200, Date of Inspection AUGUST 17.2001 7pw N OF BAkN . Name of Inspector:(please print) JAMES D.SEARS HEATH pEp�ABCE Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17.2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer_yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound; exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed MND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 C. Further Evaluation is Required by the Board of Health: N/A _ 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(i)(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 salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of 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 colifform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to 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 pit is less than 6"below invert or available volume is less than 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) 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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes" or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 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 is 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. Title 5 Inspection Form 6/15/2000 4 r Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 Check if the following have been done. You must indicate"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 Were any of the system components pumped out in the previous two weeks? X 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 this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as 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? X Were all system components,excluding the SAS,located on site? X 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 X 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)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X 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(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): YES Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 1999 120,000/2000 74,000 Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: SYSTEM 1980 PERMIT 79-655. NEW DISTRIBUTION BOX 8-17-01 PERMIT#2001-565 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 12" Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,500 GALLONS Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 34" Scum thickness: F, Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: ASBUILT AND TAPE Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL. TANK AND COVERS 12"BELOW GRADE. OUTLET TEE.NO SIGN OF OVERLOADING SEEN IN TANK. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Conunents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Commments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS NEW AUGUST 17,2001. BOX IS 9:X15", 16"133LOW GRADE. ONE LINE IN, ONE LINE OUT. CLEAN AND LEVEL. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Continents(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X 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: Continents(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) ONE 1,000 GALLON PRE CAST PIT. PIT AND COVER 2'BELOW GRADE. 28"WATER IN PIT..STAIN LINE AT 3'.NO HIGHER STAIN LINE.WALLS CLEAN,NO SIGN OF OVERLOADING SEEN. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionX locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Conunents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Construction: Dimensions: Depth of solids: Continents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells witlun 100 feet. Locate where public water supply enters the building. /?£BR 0 6 ° Title 5 Inspection Form 6/15/2000 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: 23 BRANDYWINE COURT COTUIT,MA 02635 Owner: ANDERTON,HERBERT Date of Inspection: AUGUST 17,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 25 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: X Observation 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: LOT HIGH, ABUTTING PROPERTY DROPS OFF. NO GROUND WATER PROBLEM AT+25'. 4 Title 5 Inspection Form 6/15/2000 11 I� E N V 1 R 0 S A F E C O R P O R A T 1 - O N To: Mr. Anderton Project Location: 23 Brandywyne Court Underground Storage Tank Removal Cotuit, MA 02635 23 Brandywyne Court Cotuit, MA SALESPERSON INVOICE#' INVOICE DATE JOB DATE F.O.B. POINT TERMS NC BCHD28 9/4/98 9/3/98 same 30 days DATE DESCRIPTION UNIT PRICE AMOUNT 9/3/98 Excavation, removal &disposal of(1) 2000 gallon UST $ 1,295.00 $ 1,295.00 Removal and disposal of 196 gallons oil @ $0.60/gal (50 inc. in price) $0.60 . $87.60 SUBTOTAL $ 1,382.60. TOTAL DUE $ 1,382.60 Make all checks payable to: Enviro-Safe Corporation If you have any questions concerning this invoice, call: Heather(508)888-5478 THANK YOU FOR YOUR BUSINESS[ BCHD28/dc/nv10 At C z.%Q. ZE�� cam . P.O. BOX 8.10 EAST SANDWICH, MA 02537 (508) 888-5478 FAX (508) 888-9093 Cotuit Fire Department OT Uj ' Fire, Rescue & Emergency Services G �' c0= l 64 High St. - P.O. Box 1632 �1926 '�� Cotuit, MA 02635 Paul A. Frazier Phone (508) 428-2210 Chief of Department FAX (508) 428-0202 TO: Tom McKean, Director of Public Health Town of Barnstable, Board of Health P.O. Box 534 Hyannis, MA. 02601 FROM: Chief Frazier, Cotuit Fire Department SUBJECT: Tank Removals, et al DATE: September 15, 1998 The following tanks have been removed/abandoned since my letter dated March 25, 1998. If you should have any questions or need additional information, please feel free to call. Thank you. NAME ADDRESS DATE NOTES Andelton 23 Brandywine Ct. 09/03/98 2000 gal. tank removed, Cotuit, MA. 02635 no contamination or odor present. White 31 White's Ln. 09/15/98 300 gal. tank removed, Cotuit, MA. 02635 no contamination or odor present. Enclosing Valve Tag#186 for 31 White's Ln., Cotuit (Refer to attached copy of letter, should read Valve Tag #186 and not#183). I i l �•c� S E W A'GrE PERMIT NO. Z� �� ,`ram Ceut• VILLAGE ' e , K4STALLE. NAME 'i ADDRESS ��A. AALTO;BACKHOE SERVICE` I§G,Wafmttt-gip . 'West Barnstable, Mass. .02668 BUILDER OR OWNER DATE PERMIT ISSUED - DATE COMPLIANCE ISSUED �_ 7— w, 'r s� r Ri - , n 7y �,..s, ., a N _a w THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --------------------OF.....�3.................-..-..-..................................................... Appliration for Dhipmtai Workfitonstxurthin thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....... . ...--7 f-•--.t �....c --�'t.. -e......• ..--- ...------. .............................................. Location- ddress or No. ..... - _. �... ..... ?°•- Qom.: .....�..�....a .. -----! Owner Address ... j Installer Address Type of Building Size Lot___-&. L_ 4.Sq. feet U Dwelling—No. of Bedrooms........................•-_--_--__ Expansion Attic ( ) Garbage Grinder (V ) PL4 Other—Type of Building /�.9.�e No. of persons......Z.......... ....... Showers (Z) — Cafeteria ( ) 04 ------------ ---- ..------..........---- Other fixtures .1_---------------------3....�°.�........ � W Design Flow............................................gallons per person per day. Total daily flow.........Y.jP.........................gallons. WSeptic Tank—Liquid capacityff®a..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.Z.._!040_441 Diameter.................... Depth below inlet.................... Total leaching area..................sq, ft. Z Other Distribution box (/ ) Dosing tank ( ) aPercolation Test Results Performed by...T -sue..... ....... _4-__--- Date__- .. ,4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------............. Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .................................................d • •---••. �...._4.......... - •----- ------------- --•-- ------ ------j----------- Description of Soil ...... `_r10.csW_z� ..3 . ---fI------ -__gala ---..........-.......................................................................................................... W .................................................:.................................................................._................................................................................... UNature of Repairs or Alterations—Answer when applicable................................................................................................ -------------------------------------------------------------------------------------------•--....-----•--....----------------------------------------------------------------........................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITALE 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 th b and of health. S• e ••••-• • -- .... ..... 0 •�•••-�9 n Date Application Approved By..... f-- •- ------------ ----- - --G' ----� ----------------- L---l�� 7� Date Application Disapproved for the following reasons---------------•••••• -• ••••---------------•----•-••••--•---••••••••••••-•-•---•••••-----.........._ -----------------------------------•----......_...-----------------------------------•--•-••-••-••-\••--•--•-•-•--••••••-•-••-••••------•-----•--••---•-•••••---••••••-------------•---••-•-•--------- Date PermitNo......................................................... Issued.....1..=.7..... ............... ...... Date 7 N .._.......C,�.�....... FIZse...�.7.....-_.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 . .� r lirtt ion for Disposal Works Tonstrurtion ramit Application,is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage;,:Disposal System at: ........f::......... ...... .... �� ....:Z22�- ...... 1- .............................................................. Location--Address/ 2 / or Lq No. j y vA. �F ....� l..:i�/'b.X 4-S�: E .rs i_... J�. .....��..J....�,.d..:J: ? 1... ._io�..........._..._/..IJ4 •a:'!:.�.. T __.._._. ..... .S ...._ ... _._. __.._ `- - ..... Owner ........—Address Installer Address d Type of Building Size Lot.... feet Dwelling—No. of Bedrooms___...-.&______________________________Expansion Attic ( ) Garbage Grinder (N ) a<. Other—Type of Building 16A. � ... No. of persons___..?__________________ Showers (z) — Cafeteria ( ) dOther fixtures '� =`�`.'= =- ............. = .n a.................`-h---....... ---------- ------. wDesign Flow............................................gallons per person per day. Total daily flow........-T. .v.........................gallons. WSeptic Tank—Liquid capacity./o.Q...gallons Length----_---------- Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit em Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (/ ) Dosing tank ( ) Percolation Test Results Performed by--- )L/, ..._..8.4...... Date__ __ .._./-y_7%.... aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --•----•--•------•------------•-- ----•--• -------------------••---•-----------•---------------------------------------------------------------- O Description of Soil.... .0 n L /t - j .. <.- �c r = 6:...... u ' ' V _.. iZ t.c-==•�'------.�,�C._...L ::2:�eir"+.F�':!.;- r 9},..' ------•-•-•-•--------••--•---•------------------•-----••-•.--••---•-------•-•---..........------------......••.... W .......................................................................................m.......................................................... ..................................................... icable_______________________________________________________________________________________________ U Nature of Repairs or Alterations—Answer when appl ;r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 A&hbrd of health. S ne ...g.... Date Application Approved By..... ---- •-•--•............. " •--------------------- Date Application Disapproved for the following reasons:.. .z-=... ---•••• ------••-----------•--•----•-----•----•-------------•--•--•-----._...--•----------••--•. .......................:.....................---......._--•------------------•----------------------•-•--••-•----•----•---------------- i;. • Date PermitNo............................................ -.. Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OFALTH /.............................OF............ /............................ (Intif' tttr of (tont:rlitt"r T IS 1 TO CERTI ,. hat t I ivi ual Sewage -Disposal System constructed ( or Repaired ( ) . .. ,qal has been • a ed in accordance with the provisions of T 5 of Tne�State Sanitary Code as described in the application for Disposal Works.Construction Permit No...... .. .. .. .........• dated..... _.'".�_...._�..,. .___._. THE ISSUANCE OF THIS CERTIFICATE SHAL OT BE CONSTRUED:AS A C ARANTEE THAT THE ' SYSTEM.WILL F�NCTIQN�TISFACTORY.-•---- Ins ect ........ •-•------�_�._-�- ,. I� DATE.:: ......... ...........................•-----..._...--- P THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ACTH ......c ... ......IOF................:. .. '' ` -••---............._...,: ...: N �to�roott �k,� o I anti# FEE.; 7 0......................... 7d Perrmssi n eby,granted •- ---- --- ...................................... ---------.....---- _ eyi to Con c or Re '-� o st 1 at No4—bO Street // r as shown on the application for Disposal Works Construction Permi No. -._- ted__f- _.....�..... .. ....... Board of ealth /a �a 7-9 DATE----= -----------••--------•---•---------•-•----........-------_......•----• r. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS — — — 1L f �O J K tj ..•iC, �'a7ui7' CFATI FI ED PLOT PLAN L0f1T1014 . .�'oTc1!T. .�7f� s•. . . .. 8C�1`�...�. DATE "o-7 3 149714 PLAN REFERENCE �� . . ?T . .. . Sf/ow�u oiv A f'L.q� aF / , . . q. . PG z.�. . . . i CERTIFY THAT THE e�R! ??N G, ,, uyD )q!✓ t%WN ON THIS PLAN IS LOCATED ON THE GROUND ` T � �� SHOWN HEREON AND THAT IT CONFORMS TO THE (BACK REQUIREMENTS OF THE TOWN OF . . . . . . WHEN CONSTRUCTED. DATE 44-77,:3,.!c1�� . ,,� ER ,yy ,��.s f`7lss' REGISTERED SURV OR r N59345 r Sf�&�T aF Z. S,yeo d � Vo' 43 2 � � a All, 0 V°ti1 ti . N . GpJ � `/ � A I N � / -41 � ev 9 vp � � N, 4`r EDWARD E. KELLEY - ��• CUMMAOUiD, MASS. 02637 F DWARD d KELL£Y WsYla� iN SWAr�p o.o0 916174 �"`'1 °T�'r a �� E�33 Dom• CERTIFIED PLOT PLAN LOCATION SCALE . /��=.Go. . . . DATE s��°�;��•i97� PLAN REFERENCE Ste•w�v •o�v /-� . �l.A. �. . a!� . . . I CERTIFY THAT THE ... .....�"ETOWN ❑NIROUND SHOWN ON THIS PLAN IS LO AS SHOWN HEREON AI�� RMS TO THE SETBACK REOU� OF Vb SIG V/i9 E/S/GG U/,�- Z:;✓C • • • WHEN CONSTRUCTED. DATE . . . . . .. . . . . .. . PETITIONER'. L. i REGISTERED LAND SURVEYOR N59345 S --j- LjA� 1 TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS e o 4.,CAST IRON 12"MAX �»lT 12"MAX. " •�" • PIPE (OR 4"ORANGEBURG(OR EQUIV.) EQUIV.)— MIN. PIPE- MIN. LEACH PITCH I/4"PER. PITCH i/4�PER.FT PIT o ° PRECAST o' INVERT o Q LEACHING EL,,,••,% INVERT INVERT PIT OR EQUIV. SEPTIC TANK DI ST. w INVERT EL..,�s63. BOX EL�37 >_ ��Q.O. .. .. GAL. INVERT w 0' o; EL. QO.. INVERT U 6' : 3/4"TO I I& EL3S� ww p: EL3Soo ;� U. �. WASHED w STONE PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE pa�aa�o�QQ� SOI Lq LOG WITNESSED BY : DATE TIME. .°b. 1 P�h!G Mu2�Ay BOARD OF HEALTH TEST HOLE I TEST HOLE 2 T1 o!?i15 • • AK;Z- PE- ENGINEER ELEV. . .3,B,oS . . ELEV. .. . . . . . . . . » e. w . . . .., .t.�y W"4f,10 DESIGN DATA spa-so.� NUMBER OF BEDROOMS . . . . . has SAn+D TOTAL ESTIMATED FLOW . . 330 GALLONS/DAY BOTTOM LEACH I NG AREA .78.4P . SO.FT. /PIT SIDE LEACHING AREA . . .1BB-Jv . . SQ.FT./ PIT hE>7JvJy GARBAGE DISPOSAL . .y4"4 . .(50% AREA INCREASE) �oTtii T Sshvb TOTAL LEACHING AREA SQ.FT PERCOLATION RATE 4 S ?94"--! 7�YQ MIN/INCH No,WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE �APP. . . SQ.FT. 2 AiT.s_bVr�/ 7Lvo NUMBER OF LEACHING PITS APPROVED . . . . . . . . . BOARD OF HEALTH ar srM�� •. AST•KELLEY CO.• . . . DATE . . . . . . . ENPINEERS—SURVEYORS AGENT OR INSPECTOR 346];ONG POND DRIVE �A-dTH YA.RMOUTH,MAS , �T 74 OZ664 ��. ° 's �o7t�i7— S m OF tr,?� t THO .•� ECW QISTEM .�.� AL., PETITIONER -�'' LEGEND °'a°' 85.2 -o P8 292-PG 26� V J� -�*�, 7g PROPOSED CONTOUR e 28 O 7g PROPOSED SPOT GRADE R EXISTING CONTOUR C !/ TEST PIT W EXISTING WATER SERVICE o z CD Go ✓.x � qj,�'}} °�� /J/A UGW EXISTING OVERHEAD WIRES oQ ✓ V EXISTING TREE'/� QAf ` Brandywyne Ct boy O„ ^s Neck Rd !'"11 1 V 5�G7"�0 o I ii 1 .21 iACRE5 {I. x BENCHMARK 1 eye�q J Focus LOCUS MAP N.T.S. sg GENERAL NOTES: 00 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL " r--__ BOARD OF HEALTH AND THE DESIGN ENGINEER. BENCHMARK: 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS CORNER of LOWER STEP �.,v t� OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ELEVATION = I D0.00' N0 LOCAL RULES AND REGULATIONS. - s� ,,,. �/ . �, •�-. ,r ,.4 r (A99UMf:D DATUM) , ��x /U�,,��1/c�' „ � -, ,' 'sx 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR !'llb - `S gy f1V > >0�3 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE t, '0/? o" µ 92 A 3 DESIGN ENGINEER. / µ ^•�� / 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING / co ° / f FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN J d?s � -•-�, „�� ~ �~ ~, �^• ENGINEER BEFORE CONSTRUCTION CONTINUES. EXISTING SEPTIC TANK TOP OF TANK EL,=97.12t 1 €�.%s/ + �' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.. " I /` 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF INV.(OUT)=96.79t li �� i� .,,••... `"--N, � � !� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF Ar HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. "- - - �- 7. WATER SUPPLY PROVIDED BY TOWN WATER. "44OZ5 8. THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S. -6 V 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 4 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 1m 1 � !A 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY # � ^ O f THE LOCATION OF ALL UNDERGROUND UTILITIES; PRIOR TO BEGINNING W !n• Ft // / k CONSTRUCTION. TP-2 11, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 1 O O IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE .S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). a 5` xjjp 12. CONTRACTOR SHALL EVALUATE STUCTURAL INTEGRITY OF EXISTING 9 r 9,9� TEOXIBSTIPUMPED 8c �P�� OF Mass9cy 13. THIS SEPTIC PLANTANK IS TOIOgETOSED CONSTRUCTION. SEPTIC SYSTEM PURPOSES ONLY G FILLED WITH SAND o PETER T. ✓� AND IS NOT 7U BE CONSIDERED A PROPERTY LINE SURVEY. \ 1 MCENTEE �ti,�3 NVIL oCVIL 135109 v PROPOSED SEPTIC SYSTEM UPGRADE 23 BRANDYWYNE COURT, COTUIT, MA Prepared for: Jeffrey Stoner, 23 Brandywyne Court, Cotuit, MA 02635 Engineering by: Surveying by: SCALE DRAWN JOB. NO. EnglneedngWorks HOOD SURVEY GROUP 1"=30' P.T.M. 144-07 12 West Crossfield Road 18 Route 6A * 83 x Forestdale, MA 02844 Sandwich, MA 02563 DATE CHECKED SHEET NO. y6 9462 (508) 477-5313 (508) 888-1090 6/12/07 P.T.M. 1 of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED F O.F F.G. EL: 99.0t FINISH GRADE SHALL NOT BE < EL:96.0 G. EL: 98.4%P(EXISTING) FOR A DISTANCE OF 15' AROUND THE STING) EXISTING F.G. EL: 98.8t PERIMETER OF THE S.A.S. F. 1 MAINTAIN 2% MIN SLOPE OVER S.A.S. 4 SCH 40 PVC PERFORATED PIPE WITH SCREW CAP SET TO WITHIN 3" OF FINISH INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D—BOX TO 2-500 GALLON LEACHING CHAMBER. GRADE TO SERVE AS INSPECTION PORT. TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE IN SERIES WITH STONE ALL SIDE. INSTALL RISER OVER CHAMBER L=40' L=4' SHOWIWITHIN 6'N PLAN F FINISH GRADE COVER 4" SCH 40 PVC ----2" LAYER OF 1/8° TO 1/2" " 4" SCH 40 PVC WASHEDSam DOUBLE To ia" TONE ® S= 1% (MIN.) 6" ® S= 1% (MIN.) Sm93 603 � (OR A PROVED FILTER FABRIC) EXISTING a&" uOuiD 2' EFF. DEPTH 1118 Mi d INV.=96.17 INV.=96.00 ..... LEVEL 3/4"-1 1/2" EXISTING ADD GAS D—BOX 4' 5.2 4' DOUBLE WASHED BAFFLE INV.=96.79t EFFECTIVE WIDTH = 13.2' STONE EXISTING 1500 GALLON SEPTIC TANK (SEE NOTE 12—SHEET 1) INV.=95.50 TOP CONC. ELEV.=96.3 —BREAKOUT ELEV.=96,0 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING I INV. ELEV.=95.50 ®®®m® PIPE INVERTS PRIOR TO CONSTRUCTION. ®�®��I ®e�� 2) D—BOX SHALL BE SET LEVEL AND TRUE TO 4 BOTTOM ELEV.=93.50 GRADE ON A MECHANICALLY COMPACTED SIX 3' 2 x 8.5' =_17.0' 3' INCH CRUSHED STONE BASE, AS SPECIFIED IN 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 23.'0' 310 CMR 15.221(2). T.P. EXCAVATION OR G.W. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM, SECTION 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE. NO G.W. ENCOUNTERED 4 BOTTOM OF TP EL: 86.5 (TP-1) SEPTIC SYSTEM PROFILE N.T.S. (3) 5" DIA.OUTLETS I 16" DESIGN CRITERIA i - -. NUMBER OF BEDROOMS: 3 BEDROOMS 15.5" 12" �- SOIL TYPE: CLASS I a , DESIGN PERCOLATION RATE: 5 MIN./IN. T SOIL LOG DAILY FLOW: 330 G.P.D. H-10 LOADING 2" %�� 23 DESIGN FLOW: 330 G.P.D D—BOX 2S ` GARBAGE GRINDER: NO T �' -µ DATE: MAY 31, 2007 (P-11,770) N,ra " �R „ SOIL EVALUATOR: PETER McENTEE P.E., C.S.E.. LEACHING AREA REQUIRED: (330) = 445.9 S.F. 0 �d " . =,••'w WITNESS: DONNA ,MIORANDI — HEALTH AGENT .74 EXISTING SEPTIC TANK: 1500 GALLON CAPACITY (ESTIMATED) ®®®® 0 ®®®® ry.•• ITP— � Depth Elev. TP-2 Depth ®®®®®®®®�®® 33" Elev. —� �_ a ®®®®®®®®®®® 98.0 0" USE 2-500 GALLON LEACHING CHAMBERS IN SERIES la IR10®®®®®® �a FILL 98.5 0" CR, cam, FILL SIDEWALL AREA: 2(13.2' + 23,0 ) X 2 = 144.8 S.F. 96.7 A SANDY LOAM 16 97.2 1$" BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. 102" ' a,, 10YR 4/2 A SANDY LOAM 95.7 27" 10YR 4/2 TOTAL AREA: 448.4 S.F. B SANDY LOAM 96.4 B 25" 4" KNOCKOUT �� 1UYR 5/6 'lOYR 5/6M DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. 95.5 48" 96.0 C 42" 20' OIA. COVER �� ip C 48" _ L " KNOCKOUT0 4° KNOCKOUT b2" PROPOSED SEPTIC SYSTEM UPGRADE 60"N 1 — 4" KNOCKOUT k P OP. S. si 2.—C SAND 5Y 6/4 M-C SAND 23 BRAN DYWYN E COURT, COTU IT, MA 2.5Y 6/4 � Prepared for: Jeffrey Stoner, 23 Brandywyne Court, Cotuit, :MA 02635 Engineering by: Surveying by: SCALE DRAWN JOB. NO. 500 GALLON CAPACITY, H-10 LOADING 86.5 138" 570 138" EngineedngWorb HOOD SURVEY GROUP N.T.S. P.T.M. 144-07 CHAMBERS � NO GROUNDER OBSERVED 12 West Crossfield Road 18 Route 6A S.A.S.SAS LAYOUT PERG RATE WATMIN/IN. ("C" HORIZON - TP 1) Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. N.T.9 (508) 477-5313 (508) 888-1090 6 12/07 P.T.M. 2 Of 2