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0178 CAP'N SAMADRUS ROAD - Health
178 CA SAMADRUS COTUIT v 'I I� O O No. Io It Fee Qv THE COMMONWEALTH ®F P.'ASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARN.STABLE, MASSACHUSETTS Yes RPPYitation for MsPosal *pstem Construction Permit Application for a Permit to Construct( ) Repair(XI Upgrade( ) Abandon ( ) El Complete System individual Components Location Address or Lot No. j�� C rt�S R�y1 Owner's Name,Address,and Tel No. /a,.,,, NQ � Assessor's Map/Parcel j �-)S &n sag �a 9�i7 VIA,o�co"35 Installer's Name,Address,and el.No. Sc-Sq a�f-cSS9 Designer's Name,Address,and Tel.No. � tfa�f ` 4)a�h ewe ���`t>leer'1�� 434tMa,lvt . C1C$lisG�S ill- c o�7s Type of Building: k '� Dwelling No.of Bedrooms C�' �rdLot Size le p`� °- sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided Plan Date gpd --f—"—" �I� Number of sheets_ l Revision Date Title / Olt l� i a ' 4 a AdSize of Septic Tank UOp ` Type of S.A.S. �O lC 6D IQ �o Description of Soils 1 Nature of Repairs or Alterations(Answer when-applicable) AA SuAJ '!B x K `' 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 Cod nd not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . Signed - Date ��! �al-- Application Approved by _ Date L Application Disapproved by for the following reasons Date Permit No. 0 /)'( Date Issued 1 I I i No. 2 ( 0 / .J ... .a Fee (J!J THE COMMONWE�ALT JP-4 ASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 4plicat on for bisposai *pstern Construction i3ermit Application for a Permit to Construct( ) Repair V�Upgrade( ) Abandon( ) ❑Complete System ®Individual Components Location Address or Lot No. ins <2a p„r, _SLma_c1 rvS P8 Owner's Name;Address,and Tel.No. ��E jRod to ct r) / 1' .4r)s 0-4ph �rrx�c�r�s 1'cJ Cicafu�F Iviik 0�:Z.35 Assessor's Map/Parcel ` / �., 60F" 9 , . Installer's Name,Address and Tel.No. Designer's Name,Address,and Tel.No. -:50r40\01Z Q0rSfrLKJ-4,0rn ,Down (25xa erS'inererini R34rM�c.%v)Sf Type of Building f f Dwelling No.of Bedrooms n a 'Lot Size sq.ft. Garbage Grinder( ) I Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) L/ V b gpd Design flow provided y yT gpd Plan Date 4AA -ML04 :1- -Number of sheets Revision Date "���,1 Title 0�-�1 v Nllln I109 f-' 54-.M, A ri-6 0� o t� Ad Size of Septic Tank Type of S.A.S._L/4)X !D Description of Soil, I Nature of Repairs or Alterations(Answer when applicable) F im ae ., - 54)6! .lf-0 10 X Date last inspected: ,. j Agreement: `� - "'4 r ,.� 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 by this Board of Health' Signed — i Dated/ 1 a�- J , / 2 _ Application Approved by 1 (.�.,. , Date Application Disapproved by _ Date for the following reasons , i i - Permit No. o 7 I) Date Issued --------------------------------------------------- - ------- •- --. - - -------- ----------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(./f Upgraded( ) Abandoned( )by ' at '-, has been constructed in accordance i with the provisio s of Title 5 and the for Disposal System Construction Permit No..2 01.) /)7 dated Installer Designer #bedrooms y Approved design flow Yy gpd The issuance of this permit shall of be c•nstrued as a guarantee that the system wil�l'fnn'c'iv s ,esi ed. Date Q�w� Inspector 3 No.� � r�� Fee GO THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS _ - Bisposal 6pstent Construction 3erntit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at l�o 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:Construction in st be completed within three years of the date of this permit Date /( Approved by May 14, 2012 Dear Sirs, I attest that I purchased my residence at: 178 Captain Samadrus Road Coutuit, MA in 1999 as a 4 bedroom property,as indicated on the real estate listing form provided with this application. Sincerely, Nate 6cfrmr an EUZ'ABETH A.RIZIARDI Notary Public x COUMMAULTH OF MASSACHUSUE TB My Commission E,4*es `q. Merch•t8,20t6 ° Loop Up Print Page 2 of 3 . Sketches-Map/Block/Lot: 038/047/-Use Code: 1010. e 3s r;r F As Built Cards:Click card#to view: Card #1 . Constructions Details-Map/Block/Lot: 038/047/-Use Code: 1010 Building Details Land Building value $ 138,000 Bedrooms 4 Bedrooms USE CODE 101( Total Improvements Value $156,814 Bathrooms 2 Full+ 1H Lot Size(Acres) 0.51 Model Residential Total Rooms 7 Rooms Appraised Value $ 13� Style Saltbox Heat Fuel Oil Assessed Value $ 13 Grade Average Plus Heat Type Hot Water Year Built 1984 AC Type None Effective depreciation 12 Interior Floors Carpet Stories 1 1/2 Stories Interior Walls Drywall Living Area sq/ft 1,779 Exterior Walls Wood Shingle Gross Area sq/ft 4,262 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp . Outbuildings &Extra Features-Map/Block/Lot: 038/047/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value FOP Open Porch-roof.- 76 $ 3,300 $ 3,300 ceiling BMT Basement- 1119 $ 22,300 $22,300 Unfinished PAT 1 Patio-Average 192 $ 1,100 $ 1,100 FPL2 Fireplace 1.5 stories 2 $ 7,600 $ 7,600 http://www.town.bamstable.ma.us/Assessing/printl2.asp?searchparcel=038047 5/11/2012 Loop Up Print Page 3 of 3 WDCK Wood decking 216 $ 3,200 $ 3,200 w/railings GAR Attached Garage 440 $ 12,100 $ 12,100 . Sketch Legend Property Sketch Legend 1132N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished) FUS Second Story Living Area(Finished) TQS Three Quarters Story(Finish( BRN Barn GAR Garage UAT Attic Area(Unfinished) CAN Canopy GAZ Gazebo UHS Half Story(Unfinished) CLP Loading Platform GRN Greenhouse UST Utility Area(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UTQ Three Quarters Story(Unfinis FCP Carport KEN Kennel UUA Unfinished Utility Attic FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUS Full Upper 2nd Story(Unfinis) FHS Half Story(Finished) PRG Pergola WDK Wood Deck FOP Open or Screened in Porch PTO Patio http://www.town.bamstable.ma.us/Assessing/printl2.asp?searchparcel=038047 5/11/2012 Loop Up Print Page 1 of 3 . Owner Information-Map/Block/Lot: 038/047/-Use Code: 1010 Owner Map/Block/Lot 038/047/ GISII�APS RUDMAN,NATHAN T & Property Address Owner Name as of KATHRYN M 1/1/12 178 CAPN SAMADRUS ROAD 178 CAP'N SAMADRUS ROAD COTUIT, MA. 02635 Co-Owner Name Village: Cotuit Town Sewer At Address: No . Assessed Values 2012-Map/Block/Lot: 038/047/-Use Code: 1010 2012 Appraised Value 2012 Assessed Value Past Comparisons Building $ 138,000 $ 138,000 Year Total Assessed Value: Value Extra $45,300 $45,300 2011 - $ 322,900 Features: 2010 - $324,300 Outbuildings: $4,300 $4,300 2009 - $414,600 Land Value: $ 138,600 $ 138,600 2008 - $414,500 2007 - $435,900 2012 Totals $326,200 $326,200 2006 - $404,800 Residential Exemption Received=$88,785 . Tax Information 2012-Map/Block/Lot: 038/047/-Use Code: 1010 Taxes Cotuit FD Tax(Residential) $ 717.64 Community Preservation Act $ 59.97 Tax Town Tax(Residential) $ 1,999.03 Fiscal Year 2012 TAX RATES HERE 2,776.64 . Sales History-Map/Block/Lot: 038/047/-Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price RUDMAN,NATHAN T&KATHRYN M 6/1/1999 C153384 $210000 HARDING, DAVID C&EVORA, MAXINE C 10/15/1995 C138531 $165000 NEVES, DONALD R&OLINDA A 11/15/1984 C98959 $125000 BARGER,JAMES C&JANE E 3/15/1984 C95820 $22000 SAVERY, JUDITH ANN 10/27/1978 C76055 $0 http://www.town.bamstable.ma.us/Assessing/printl2.asp?searchparcel=038047 5/11/2012 Page 1 of 2 Sold Listing#9903287 178 Captain Samadrus Cotuit, MA 02635-2709 LP $2199000 ,Prop Type Single Family Subdivision Other .."'County Barnstable - Town Barnstable Zoning Re Sq. Ft./Source 1,801 / Rooms 7 Lot Size/Source 0.51 ac/ '` ::� s< 'F► = Beds 4 Style/Desc Cape/ Baths F/H 2/1 Levels 2.0 Year Built 1985/Actual Tax ID 47 See Mai Remarks: Large Cape So.Of 28. 1st Fir. Laundry&Master W/Walk-in Closet&Private Bath. Expansion Possibilities In Attic. Association Tennis&Fishing Pond Abuts Conservation. Directions: Rte. 28 To Putnam To Right On Captain Samadrus Showing Instr.:Yard Sign,Appointment Only General Information Garage/#Cars Yes/2 Gar Desc Direct Enty,Attached Parking Paved Driveway Bsmt/Bsmt Desc Yes/Interior Access, Full, Bulkhead Access Foundation 41 /31 /Concrete Wing Width/Wing Depth / Irreg Yes Sep Liv Qtrs/Desc No/None Year Round Yes Rd Frntg 125 Lot Width/Lot Depth / Lot Desc Wooded, Level, Interior, Clear Street Description Public, Paved Zoning Re Room Sizes&Levels Living 22 x 13 First Floor Fireplace,Wall to Wall Carpet Dining 11 x 11 First Floor Wall to Wall Carpet Family Kitchen 15 x 11 First Floor Built-ins, Dining Area, Sliding Door,Vinyl Floor Mstr Bedrm 17 x 12 First Floor Ceiling Fan,Closet, Private Master Bath Bdrm2 12 x 11 Second Floor Bdrm3 13 x 10 Second Floor Bdrm4 9 x 11 First Floor Laundry First Floor Foyer First Floor Interior Amenities Bsmt Baths Lev 1 Baths 2.0 Lev 2 Baths 1.0 Lev 3 Baths Interior Features Attic Storage, Dry/HU-E, HU Cable TV, HU Washer,Walk-In Closet Floors Wall to Wall Carpet,Vinyl Equipment/Appliances Dishwasher, Refrigerator, Stove Hood, Microwave, Range-Electric, Security Alarm Living/Dining Room Combo Kitchen/Dining Room Combo Fireplaces Yes #of Fireplaces Printed by Buyer Brokers of Cape Cod on 05/10/12 at 11:32am Information has not been verified, is not guaranteed,and is subject to change.Copyright 2012 Cape Cod&Islands Multiple Listing Service, Inc.All rights reserved Copyright©2012 Rapattoni Corporation.All rights reserved. U.S. Patent 6,910,045(Residential Client Detail) http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME=MLSL... 5/10/2012 Page 2 of 2 Listing#9903287 Page 2 Exterior Amenities Pool/Pool Description No/None Dock/Dock Description No/ Exterior Features Screens, Patio, Exterior Lighting, Deck Siding Shingle Roof Pitched,Asphalt Assoc Fee/Fee Year / Assoc/Membership Required Yes/Yes Amenities Landscaping,Tennis Waterfront/Waterfront Desc No/ Waterview/Waterview Desc No/ Miles to Beach 1 to 2 Water Acc Beach Own Public Beach Desc Ocean Beach/Lake/Pond Name Convenient to Shopping, School,Medical Facility,Conservation Area, House of Worship School District Neighborhood Amenities Mechanical Amenities Heating/Cooling Oil, 3+Zone Heat Water/Sewer/Util Underground,Town Water,Telephone, Private Sewerage, Electricity Hot Water Tank, Oil Legal/Tax Information Improvement Asmt $111,600 Land Asmt $37,700 ` Other Asmt 0 Total Asmt $149,300 Annual Taxes/Tax Year $2,109/1999 Annual Betterment 0 Unpaid Betterment 0 Title Ref-Book/Page/Cert LC346236// Plan To Be Assessed No Spec Assessment No Mass Use Code/Definition 101-Single Family Asbestos No Undergrnd Fuel No Flood Zone Not In Flood Zone Lead Paint No Presented By: Edward F McKenna Buyer Brokers of Cape Cod Primary: 774-994-1900 116 Route 6A,Suite 5 Secondary: Sandwich,MA 02563 Other: 508-362-5800 Fax: E-mail: emckenna@buyerbrokers:com Web Page: www.buyerbrokers.com Printed by Buyer Brokers of Cape Cod on 05/10/12 at 11:32am Information has not been verified, is not guaranteed,and is subject to change.Copyright 2012 Cape Cod&Islands Multiple Listing Service, Inc.All rights reserved Copyright©2012 Rapattoni Corporation.All rights reserved. U.S. Patent 6,910,045(Residential Client Detail) http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME=ML SL... 5/10/2012 3 Lf Al� GC` 1 J - c r J M Assessing As-Built Cards Page 1 of 1 TOWN OF BARNSTABLE LOCATION_ r,7 r.A?7 _Skg,4 alms' SEWAGE# VILLAGE' CGT i T ASSESSOR'S MAP& LOT INSTI R'S NAME & PHONE NO. A & B CAN00 775-6264 SEPTIC TANK CAPACITY /y 0 0 S 7— LEA CHING FACILITY:(type) 00 i T (size) A9O NO.OF BEDROOMS 'Y PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNEk. HAf31 Aid elIX DATE PERMIT ISSUED: g DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No R It 3r' o 44 _L O http://www.town.barnstable.ma.u.s/Assessing/HMdisplay.asp?mappar=03 8047&seq=1 5/8/2012 JUN-05-2012 12:04 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.1/1 FROM :down cape engineering ine f'AX ISM36298M Jun. 05 2012 11:56AM PI x 4a�a1k .s<feaLltth TA,461:nUn �..��GaM'y r.. "1;'1A41�rpRA•4SI��r�3:i041,�ttu�a!d.�x 7,00 molm,ql-etet,!XymLu ub,MA,II:1441 R Cffice,, 509-1362 464,, l rx' ',1 i 74U-(i'lQ4 jMjga Dcr ttl�an Lm�a f,;�rin9'la�ro o9 .l..n '„ nrm DOM: ncr: 0 f h $>mi��dE��lt; Ocr` pl0 flit dl3Ei15A: �� Y-((� ✓i F(� _� Q Address: �• '!�(,���, on L�Vt /L 4 5 /& — i.p9l:aa>i pL'tuL ttn ixLst ], ti tines ler) p,��w1c Sy r Itrm Lit j �!T °` A c O M Ltid �t'd an a des��r�datvu by "en, u X— tho1 duip, w�LGh fray 'M eludes t LLrx appmed ulwmgus 913C{1 11 !L dra rt1o:.r4tictl,of L4,,, c1i,!,trN4l=b07 ard/oT sc•:r,T�t�,n lflL r T caLLEV th;ri ffic scptia -Y.*.m TtiratrEuvd r 07c, WaS inqU°ilecl, wi+h Lnajnx u'1ux► cS (.o,e., -� pyr oeT Lll ua `U, 1atr.,ral TOUL at:ot d thr SA.S nr mi y ve>i ticnL rpkw- 'lirr of any C0J7:,PMUt crf lhu SrprG .w)bLtt ki sccnrdnnro%, ijJi.State&J.00 i ROKLlatiMS k`.la,l-Taild-ClU or. r Ikk OF pANl eL A. CHILI No.40602 ¢ ra ® hyytlP.1' R:�1�]Lf1i1L�� �s'.ifl]C 1JA91.�rrtt,r � .. �'�' 'd' >ti ')' �"�..La:�i-r ll,rl" g,,.a.�rrb , c: �L'� �'C(-`A'a`F;_. c� TV -fit A•LRe.hWSm- liu 0A=D.T.Ticiliml i`o„,J.,*04 elan TOWN OF BARNSTABLE LOCATION ("7 rC-4-P'4 . gq-d1izaf V'AEWAGE# VILLAGE C �, Lk i I ASSESSOR'S MAP&PARCEL � 7 INSTALLER'S NAME&PHONE NO. creZ� rs' SEPTIC TANK CAPACITY � t��'1 idc�j 4 4-c- y'/d LEACHING FACILITY: (type) (size) t G'*K4-e NO.OF BEDROOMS S OWNER a u� PERMIT DATE: --:7- 14 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) Pl Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) tq Feet FURNISHED BY � �r Ci�ai�r ,. � �. � � � v �- �,o� � � , a� 0 � � �� �1 Doi `Fawn of Ba ustable l° JDepartmolt ofRegulatory Servicespublic Health Division u BARNBTABL6, c , 200 Nlain street,Hyunuis MA 02601 7 Date Scheduled— � `� hj'—�;L Time �� Fee�"� Soil Suitability AssesSmerit for •Sewag-e Disposal �� n ' � Pcrfonned By: ,�'1' G—(— A OJ P�� S,.�� 1Yllnessed By. e � _ ----- ---= L,O'CATIOIN 8, GIENMRA L I[N1C'OWVDITION �l Location Address .I�/ Q /)� (�a�Q /� Owner's Name W 6 C�J0^ a'+� Address Assessor's Map/Parcel: 'cJ V �/ engineer's Namo (Q(.'V✓� e i NEW CONSTRUCTION REPAIR Telephone It �I e 2 Land Use• ' 7 ` Slopes(%) d^�7 Surface Shines Distances•from: Open Water Body Il Possible We[Ar" c` ft Drinking Water Well fl Drainage Way ft Property Line �IG� ft Other SKE'7CCH, (street came,dimensions of lot,exact locations of lest holes 8c pert tests,locnte wellanda'in proximity to Boles) 1 5'coo TVrL Rio' l2� 1� L(®,t'D 1 4 `y� 3.1 Purenl malcrlal(geologic)_ V H .ice Glir+ Depth tq Quthoelx Depth to Groundwater Standing Water ill 1-101r; r�— Weepllig hill l"it FlfiCc — ^ — [imaicd Si:asuuai ti vrou'nUwater ][SET ERIIU,,\TA'>C'][ON I I OR SEAS ONAL HI GH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to Sall alalthu; Depth to weeping Frain side of obs.hole: In. Onw lid mt(8r Ad)uslhtent.e.�m� Index Well M Reading Date; Index Well I¢Ynl AdJ•factor ,A41,drmilidwuter Level T ]P ERCO LA7CJ[OS`�1 -- 06servatio�l Hole$ j ` J t Tinto ill'9" Depth of Perc "/� "�`� r 1'lu'iG at 6" Start Pre-soak Time @ Time(9"-0") End Prc-soak I Rate Min./lncli -- site Sullabillly Asse,ssmunt: Site hassEd_ Sine,-Failed: Additional Testing Necded(YIN) Original: Public Health Division Observation Holy,Data To Be Com(,leted on Back----------- "��`It Iieacolatiola testis to be cofllcYucte�fl vvitYlilz lOG' ®g`vv�iiu�tpltc)i, yo�fl IavuYst!fiu•st up.oifa�y It➢Ie Barnstable Corlsevvatioll Division at least 0110 (1) week Prior to beg1tillid g. Q:\Sl3PTlC\PC1KCPORKd.00C Depth from Solt 1-rorizon HOLE LOG I$ole #� _ SnrFnce(in.) Soil Texture -� Soil Color Soil• , ``1 (USDA).. (Munsell) Other i Mottling (Structure,Stoncs'; Boulders. Con isle c ravel i ° l Depth from Soil HorizonTIONHOLE Z Surface Soil Texture Role # (M (USDA) Soil Color Soil unsell) Other / Mottling (Structure,Stones, Boulders. Nt/c Depth from Soil-Horizon 1-roIP,r# (USDA) Surface Soil Texhrre Soil Color. Soil (Munsell) Other Mottling (,structure,Stones,Boulders. t'•o i to cy `1`a Qnvell _ — [)EE1T" OnP��RVAT.><_�1 HOLEDepth fiom Soil Horizon LOG Hole# Surface(in.} Soil Tcxture Soil Color (USDA) 5a11 (Munsell) Mottling - (Structu�,tSe to ft se•; Boulders, Consistancy_ o�❑_�I1 Rgod l(nsurance Rgte MrIp. Abnvc 500 pear flood boundary No Ycs Within 500 year boundnry No IV %vititin 100year flood boundary No_L,_�Yes P�rttenlramly OCCIRg1V ](nelavMaus Miaterlg@ ' Does at least four feet of naturally occurring pervious a material exist in all areas observed thrpughout,the area proposed for the soil absorption system? ,C It not, iahat is the deptF, of naturally occurring pervi us mar6l'ial7 I certi-fjr that on W .t� (date)I have passed the soil evaluator examination ap Department of Environmental.Protection and that the above analysis was Performed byme�cons stem with She aegttired expertise and experienee.des 'bed in CIO CIv1R 151.017. Signature rr • Q:S,aPrICTERCPORKDOC COMMONWEALTH OF MASSACHUSE'I"1'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 350 MAIN STREET WEST YARMOUTH, MA !Sa TRUDY COXF, 508-775-2800 Secretary ARGEO PAUL CELLUCCI , Governor DAVID B. STRUIIS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION MAP 38 PAR 47 PROPERTY ADDRESS: 178 Capt. Samadrus Road, Cotuit ADDRESS OF OWNER: DATE OF INSPECTION: May 26, 1999 Harding, Maxine NAME OF INSPECTOR : James D.Sears I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A 8 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 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 CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: .S " 2' �f The system Inspector shall submit 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: SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. '1& , '10�6Fp 1999 *revised 9/2/98 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION (continued) Property Address: 178 Capt.Samadrus Road, Cotuit Owner: Harding, Maxine k Date of Inspection: May 26, 1999 INSPECTION SUMMARY: Check A, B, C, orD: A] SYSTEM PASSES: YES I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 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. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) 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 is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. 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 pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced 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 9/2/98 2 r . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 178 Capt. Samadrus Road, Cotuit Owner: Harding, Maxine Date of Inspection: May 26, 1999 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: NIA Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect fire public health,safely and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)TNT 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 a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WAFER 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 lank and soil absorption system and the SAS is within a Zone 1 of a public water Supply well. The system has a septic lank and soil absorption system and the SAS is wilhin 50 feet of a private water supply well. The systern 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 coliforrn 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 and is equal to or less than 5 ppm. Method used to determine distance not valid). 3) OTHER revised 9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 178 Capt. Samadrus Road, Cotuit Owner: Harding, Maxine Date of Inspection: May 26, 1999 D] SYSTEM FAILS: N/A 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 Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded 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 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A , You must indicate either"Yes'or"No"as 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 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 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 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 178 Capt. Samadrus Road,Cotuit Owner: Harding, Maxine Date of Inspection: May 26, 1999 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 not 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,including 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.Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 178 Capt.Samadrus Road, Cotuit Owner: Harding, Maxine Date of Inspection: May 26, 1999 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 4 Number of bedrooms(actual): 4 Total DESIGN flow Number of current residents: 0 Garbage grinder(yes or no): NO Laundry(separate 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 two(2)year usage(gpd): Sump Pump(yes or no): NO Last date of occupancy: COM MERCIAL/INDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 15.203) Basis of design flow 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: OTHER:(Describe) " Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes,volume pumped: Gallons 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known)and source of information: INSTALLED 1984 Sewage odors detected when arriving at the site:,(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 178 Capt. Samadrus Road, Cotuit Owner: Harding, Maxine Date of Inspection: May 267, 1999 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction _ cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: Yes (Locate on site plan) Depth below grade: 10" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 8" I Distance from top of sludge to bottom of outlet tee or baffle: 22" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined As built&tape 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.) Tank at working level -tank and covers 10"below grade Outlet baffle tank need pumping NOTE. Tank will be pumped May 28,1999—A&B Canco GREASE TRAP: (locate on site plan) Depth below grade: r Material of construction _ concrete — metal Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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.) i revised 9/2/98 7 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 178 Capt. Samadrus Road, Cotuit Owner: Harding, Maxine Date of Inspection: May 26, 1999 TIGHT OR HOLDING TANK:N/A (Tank must be pumped prior to,or 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 Alarm level: Alarm in working order Yes, No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: YES (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D Box is 16"x 16", 20"below grade, one line one line out, Box is clean,solid and level PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.), revised 9/2/98 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 178 Capt. Samadrus Road, Cotuit Owner: Harding, Maxine Date of Inspection: May 26, 1999 SOIL ABSORPTION SYSTEM (SAS): YES (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type: Leaching pits,number: 1 Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, Alternative system: Name of Technology: Comments: (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&cover 18"below grade Water level&high water mark 2" No sign of overloading CESSPOOLS: N/A (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(cesspool must be pumped as part of inspection) Comments:: (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: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) revised 9/2/98 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contiriued) _ Property Address: 178 Capt. Samadrus Road, Cotuit Owner: Harding, Maxine Date of Inspection: May 26, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least Iwo permanent references landmarks or benchmarks locate all wells within 1 00'(locale where public water supply comes into house) r 0 6� y 11,4 V?4 0 revised 9/2/98 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 178 Capt. Samadrus Road, Cotuit Y Owner: Harding, Maxine Date of Inspection: May 26, 1999 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar ` Shallow wells Estimated Depth to no groundwater 9 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record X Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) *NOTE: Test hole 3" below bottom of pit- no water Lot high - no sign of water problems revised 9/2/98 11 t TROY WILLIAMS � sFA �► 1 ., SEPTIC INSPECTIONS P �pee Certified by MA Department of Environmental Protection LY19' (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property % 7 5' C�:ya `H dl r%j Owner's name& A A/ Mailing address SAw+4 Date of Inspection //Y/Q s PART A CHECKLIST Check if the following have been done: V Pumping information was requested of the owner, occupant and Board of Health. _V 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. - As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. IThe site was inspected for signs of breakout. V All system components, excluding the SAS, have been located on the site. L 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 SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SSDS. Page 1 of 7, + Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 3 number of bedrooms R number of current residents /Yo garbage grinder, yes or no ES laundry connected to system, yes or no YE 5, o seasonal use,yes or no V. r d� k 4 A v "< 6„a- vs SG4r^5„ 117 . If nonresidential, calculated flow: Water meter readings, if available: Cj y - y0( 0 o o ?411 o h s 413 CDC ,o e Jl, Last date of occupancy GENERAL INFORMATION Pumping records and source of information: _\/o System pumped as part of inspection,yes or no If yes,volume pumped 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) Other(explain) Approximate age of all components. Date installed, if known. Source of information: )4- A IV') Sewage odors detected when arriving at the site, yes or no Page 2 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions: sludge depth distance from top of sludge to bottom of outlet tee or baffle //c/e scum thickness 4 distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle 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,recommendations for repairs,etc.) .iJ /e Cyr S ,/� �Q h Lc W a. S- h o -�-' DISTRIBUTION BOX: >/ (locate on site plan) JP depth of liquid level above outlet invert Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, recommendation for repairs,etc) w C& 5, A J H eA vi J C>✓ U A P_ G 4 1 PUMP CHAMBER: 9 (locate on site plan) pumps in working order,yes or no Comments: (note condition of pump chamber,condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) Page 3 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if pose.;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits and number ok L fA 02 leaching chambers and number leaching galleries and number leaching trenches,number, length leaching fields, number, dimensions overflow cesspool,number Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for //maintenance or repairs,etc.) / c 7!4 y o(--,j f. CESSPOOLS (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,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,recommendations for maintenance or repairs,etc.) Page 4 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' a8' y3� N t / DEPTH TO GROUNDWATER s<<6-- depth to groundwater — adjusted high groundwater level method of determination or approximation: -r h to w<--C� Cod �-e k C-it u i., o cA t Page 5 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) /'I Backup of sewage into facility? Al Discharge or ponding of effluent to the surface of the ground or surface waters? V Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool<6"below invert or available volume< 1/2 day flow? A Required pumping 4 times or more in the last year? Number of tunes pumped /V Septic tank is metal?cracked? structurally unsound? substantial infiltration? substantial exfiltration?tank failure imminent? Is any portion of the SAS, cesspool or privy: /V below the high groundwater elevation? A within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? IV within a Zone I of a public well? /V within 50 feet of a bordering vegetated wetland or salt marsh(cesspools and privies only, not the SAS)? within 50 feet of a private water supply well? /y 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 compounds, ammonia nitrogen and nitrate nitrogen. Page 6 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector: Troy Williams Company Name: TROY WILLIAMS SEPTIC INSPECTIONS Company Address: 40 Old Bass River Road, South Dennis, MA 02660 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. the inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: —ZI have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date _ 9' / 'y Original to system owner Copies to Ce Buyer(if applicable) Approving authority 34-- &As�6 (c PROPERTY ADDRESS: l 7 8 C h �o ' 1 7` ! G Page 7 of 7 LOCATION SEWAGE PERMIT NO. VI L L A:G E Co7""vi7� /14ff IN 'S.T<.A LLER'S NAME A ADDRESS Tose)' v Kfe 2 e U I L D E R OR OWNER �frM c S /3R�itti DA.:T. E PERMIT ISSUED DA`T .E COMPLIANCE ISSUED TOWN OF BARNSTABLE y L ATION VY SEWAGE # VILLAGE CO-Tv ASSESSOR'S MAP & LOT NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY / a S 7— LEACHING FACILITYAtype) ®/ T (size) /G®a NO. OF BEDROOMS Y ,PRIVATE WELL OR PUBLIC WATER BUILDER OR DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 4 !/ VARIANCE GRANTED: Yes No ..J v O ' O -r` F� f'V TOWN OF BARNSTABLE I .l' ,4CATION ;�!� Scla, at�v s SEWAGE # i L NILLAGE <f,-b �u e T ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY j duo LEACHING FACILITY: (type) (size) k6 � 2 NO.OF BEDROOMS .3 BUILDER OR OWNER PERMIT DATE: 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(If any wetlands exist within 300 feet of leaching facility) l I Feet Furnished by 7 -'1 s � � M � � �� � � a �'' `� � � � 3 s oM � O � 1 �� � ` i s � ea , � \ \ � � � � � � � S �. ��v y1�'°� :. No.....�� ....... . FHs.....�°.,......._ -• ........ x THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................... ........-.--.-..OF..........................................--------•---.........-----...................... ApVtirFation for Bwvnoal Works Tomitrnrtinn 1hrmit ,Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ...... .............................................................. ,j -ocation-Address fl j'Y ner 1� G,.. �I......�.s Installer Address � // d Type of Building Size Lot4 .__0�O 157--.-_Sq. feet V Dwelling—No. of Bedrooms-___- ................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons---------------_............ Showers — Cafeteria a' Other fixtures ............................ . W Design Flow............, ......o.......gallons per person per day. Total daily flow.........3.3v.........................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth............ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.._:---.�Xr--- Diameter.....__,............. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-------•----------------------•-----'---'------'---"-----.........--------.............--•---'-'--......................................................... 0 Description of Soil................................................................................. . --------------'-'•--'-"-""--•'•-••'......---'•'......-'-•"-••'-"-------"-'- x �i60,4ivcy `s�'``� ro . /a- 'At . U ....'--'-"-"-'•'--•...............""----'•---'-'........... -----•-"....'----•-••""'--"-'-"""•----•-•--•'•""'......"--'-•"-""'-'--"-•-...........--'-''.. Z .........................................................-----------------------------------------'---'--------••-••----'-•"-'-•---"--'--"••----""-"'-""'--"------'-"""-..........--•---'-- V Nature of Repairs or Alterations—Answer when applicable.-.............................................................................................. ----"-"-"----------•----•----"-•---•'-..._...-•........................••--••--•-'--"'--'-""'-•-'-'-"-'••--•••---------•-•--•-'•............................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ued by the board of health. Signe ------------------------------- Date ApplicationApproved By............. •- .........----•----'-......'--•-•-'----'--'---'•""'._.......-'--'-'-'---• Date Application Disapproved for the following reasons:......................................................................................_....................... _ ..--'-----'----'--'------'--------------------'---------•'-.........-----------"-------•----------•....-,--"-"---'--'----------------'-----•-'--------------------'----'---••'-----'-•'---•'....._.... Date PermitNo...... ...... Issued....................................................... __ Date FE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .................OF..............................-.......----------------------------------..-..._... a . ....._.. .... . ApplirFation for Disposal Works Tomtxnrtion erant��- 1 �t a try{ y r.eve. ' Appl>cation is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewiige Disposal System at: Location-Address or Lot ... a.p-fit s ---tea ' ,4elvwpss caner Addre -•--•••...................�re!� ........................................ .�' aJr ��+� .. �. '� Installer A dress Type of Building Size Lot 0.Q`4�__...Sq. feet Dwelling—No. of Bedrooms----- _____________________________---'Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures ------------------------------•• . - W Design Flow............ - '"'.,..............gallons per person per day. Total daily flow......... _. ___.______....__________.gallons. WSeptic Tank—Liqui capacity..!!OOUgallons Length................ Width................ Diameter................ Depth......._......_. x Disposal Trench—No. .................... Width.................... Total Length.................... Total,leaching area...........�........sq. ft. Seepage Pit No...__,P-.xr _. Diameter___--.__•___-__-_•_. Depth below inlet.................... Total leaching area...... I ..sq ft. Z Other Distribution box ( ) Dosing tank ( ) t:. Percolation Test Results Performed bY.......................................................................... Date........................................ Test 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.................... Depthl,f ground water........................ -----------------------------------------------------------------------------------------------------------•_-____---•----•--------••----•------------__----- D Description of V .............................. W VNature of Repairs or Alterations—Answer when applicable................................................................................................ ......................-=.......................................................;-••--..............--•-•-••....-••---•----------•••-•-•--••-•-•-----•••-•••••--•••••........-•••••-•-•-•---•--•••-•-••-- Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIThL 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate`of Complianee'has been-'issued by the:board of health. Signed..... ... :..... s,��- -- �' .............rr�' Date ApplicationApproved BY------------------ ---•---•-----...--- ----•----•-••--•------- -------------•-----------------...._.... -" Date Application Disapproved for the f oll/efwing reasons--------------------------------------------------------------------- ----------------------------------------- --•-••-••--•-•••-••••-•••...•••••-•-•....................•-•••-•--•••••••--••--•••----._.............•-----••-••••-•-•---•-•----••••-•--••-•••-••••---- •-----••-••-•-•••----••----•••-•-•............ Date PermitNo...... Y� ...... .................... Issued_.........................................x Date 3 TH,E�'OOMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .plrs....• OF.....-. ........................................ Tntif irFatr of Toanph anrr ..THIS IS TO CERTIFY That the nd;vidual Sewage Disposal System constructed ( ) or Repaired ( ) by... .. - I taller at--•--•••-•—••_._ �!f'�!' f.. lsr/` F.----' .=.. ;has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code as described in the application for Disposal Works,Constructioii"Permit No 'y`-° °_�•---._._.•..... dated_...- ___-- ' `_ ----------------------- THE ISSUANCE OF THIS CERTIFICATESHALL NOT BE CONSTRUEP AS A GUARANTEE THAT THE SYSTEM IL /FICTION SATISFACTORY. DATE.... .. .. ...4./................................................•-=----- Inspector.... ... THE COMMONWEALTH OF MASSACHUSETTS law r.�ryrfa it BOARD OF SHE"ALTH �lV. GfF ; r ............... ......._OF...Pitt<.tGe............._......... �U No.......... e..6v l FEE........ Disposal Works Tonstrnrtion pamit Permission is hereby granted----------"----------- ----------------------------•----------------- k - „ to Construct ( or%Repair ( ) an Individual Sewage Disposal Syste at No.......................1-4.t_-------- ........6-e7 '' .:...........!.' %�s t Street l/ A l :e „l0 tt el A as shown on the application for,+D'isposal Works Coristruc"tion Perm>t Dated_______ / IV ' Board of Health DATE--------.. ``_-_ld..-_. _ .._._._''.._•-� -2 o,f•---• r. FORM 1255 A. M,_jSULKIN, INC., BOSTON •..-, A�, M �` �y.,.,,;, ,u+ e: <�1uGLC FAMILY - ;3 6EOROOM I �, uo �'Ga,c '�AGE 6wupECZ ri DN%LY FLOW ; 110 x 3 = 3-3 pv. li 5EPTIG -rAQK z 6- 33ox15o% : -4956.P o Z� ' I u5 loon GAL. o15Po5AL PIT v5E too GAL. r / •G 's 1 D�h(ALL AR Cla - 1506,P I1 l� I/— p _r__ z-, 7 I ,1 15 X AREA- o S PD / Z/ BOTTOM - � 5 - vj 5p 5,F X ►, D 5,C) 'T oT A 1- O V-51 G N I' c AL. D A I I-Y FL-ov( = 330 G.Po• 1� / I `� 'r T PE�CQLAT1oN GzATEt 1''IN 2M►N o�1-655 � � / >i�,�,� 8' �iv� i' A>0 3of bf4s DAVIR y �; I� {• THULIN ±p f lcHAkDr) r 1U No. 29976A. �..� ;!!v QAXTER u, Tt I I No.2,(M �v`F " 0/STEM �' I y rT r°D SUS ' p -. TE�T�`�.3D3� �•G"• /�/. O Y�Y TOP FNU= /aZ.o Icon tNv. BuX 56Pr G /�•� � 000 INS( 9e TANK G N.L. 97.8 LEACW i P1 r INV.. INV. f i 98,0 98. z uIITu , %L '. I. S�N� • - WASKGD . 6Tv N E GE9_7IFIG0 PL.oT PLAIJ (+ I) PRUFIL� i � LoL4"t 1oN CUTv/T' - r�o %/.4T; Wo CALE �'!..d SATE S/7�y I P L.P.t14 R E F S 2E N GE +� , CERTIFY 'f N AT 'f N E t""`� P F N�5uA 1rYN i i; NER Eor l CoMFL-?5 WITN A W P 56T5Ac. 26Q�IR-EME.t4TtI , of -tNE- -YAWN oF= BpZNs M pgt--e AN_0 1S r.lcaT Locp-rE > .WjT"jQ TN'E FLooD (P�LAItJ I. BA�cTEcz,e I..l`(E INC. REGISZ626D'1�,uDSu�vEY��`� I 'T 1115 P L Q 1� 1 � N orT 4 n 5 c D O td A N 0:5 P.V I L LF' MASS• IN'STRuMENT 5V2vey � -T -1E. 01'r5V_75 6uou1,D a 1�1oT DE V5EOTc5 APPLICANT '113 CAT ION- SEWAGE PERMIT NO. -VI LLAGE • 5� ,�`s I N S T A LLER'S NAME 6 ADDRESS 0 U I L D E R OR OWNER A�c Co�a�� ./Yli9ss DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED e c� *o .o a o� h. St ►�C'A"T ION ` ►''� SEWAGE PERMIT NO. ;VILLAGE � �. CGS" S��go�ras � INSTA LLER'S NAMfE & ADDRESS 7- i9s 141 /,V/.,y a 8 U I L D E R OR OWNER rd7 i DA T E PERMIT ISSU E D � L _ 9v DATE COMPLIANCE ISSUED v✓ r = i � � cn ``� �.4 "� �t3�, �, �,,,t, b$ �0 �� ,_ ,!�� i �� ,� � � �.i ire � j 4�S�.�r =�� I � _ ' , � �� G �� �_ ® ., � -� � �. �, `t NOTES 0 SYSTESYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE 1. DATUM IS ASSUMED y gagk M MARKED WITH MAGNETIC TAPE OR POTd PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE kAEANS FOR FUTURE LOCATION. 2, MUNICIPAL WATER IS AVAILABLE ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. TOP FOUND. EL. 64.7' FILTER FABRIC OVER STONE Locu \--------M I 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQUIRrD OVER SYSTEM 62.5 W H-10 Locus PRECAST H-10 H-10 BLOCKS OR 5. PIPE JOINTS TO BE MADE WATERTIGHT. RISERS (TIP.) MORTAR ALL PRECAST RISERS 2'0 63.0' 4"OSCH40 PVC COMPONENTS H-10 INV'S EL. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH : • .;. PIPES LEVEL 1ST 2' 5'- ' MASS. ENVIRONMENTAL CODE TITLE V. .. 59.17 ENDS BET - HsDES 60.0' " EXISTING °' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO 10 14" qM0,0 a° ° ° ° ° '~ TEE SEPTIC TANK** TEE j ®®®� ®® go ��0®- -�®®� >g000000o BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. 61.6EoOo 0 6" MIN SUMP ®==ImmmmO000 ®®��®®®��®® ;°o° oo (//_y //�/�1//O O O O ®®®®®®®®® 000°� ®®®®®®®I�®®I� �0000000° " VOr N'�70000000000 ® 0 O O O O OGAS BAFFLE _o�o�q O,e_ 12" MIN. INT. DIM. ®®®� ®®®® ®®®®®®®®®®® 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC.5 59.31 .012 °°° °o°o°o° 57.17' Ba^°^°> - ° ° ° ° 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED s LH-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST BT�AINEDOUT I FROM BOARD NSPECTION YOF°HEALTT}ARD Fi,HEALTH AND PERMISSION l•' .� 3/4"-1-1/2" DOUBLE WASHED STONE (3) UNITS PEQUIRED * 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: `40' X 10' 10. CONTRACTOR SHALL. BE RESPONSIBLE FOR CALLING THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION LOCUS MAP UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS COMPACTION. (15.221 [21) OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM ( 5 X SLOPE) ( 1 X SLOPE) 'r' COMMENCEMENT OF WORK. NOT TO SCALE LEACHING 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND FOUNDATION EXIST. SEPTIC TANK 42' D' BOX 16' REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. ASSESSORS MAP 38 PARCEL- 47 FACILITY 51.5' BOTTOM TH-1 **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT NO GROUNDWATER FOUND 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE LEGEND 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE REMOVED 5' BENEATH AND AROUND THE PROPOSED WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE LEACHING FACILITY. CONDITIONS IF NOT SUITABLE �61.92 99- EXISTING CONTOUR \ -[991- PROPOSED CONTOUR •02 \ 198.4 \ PROPOSED SPOT EL. � � SYSTEM DESIGN. TH1 TEST HOLE \ A�► GARBAGE DISPOSER IS NOT ALLOWED ® CATCH BASIN \ DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD UTILITY POLE ` ` 61.44 Uy FIRE HYDRANT --------------63------\\ `\\\ \ V USE A 440 GPD DESIGN FLOW S % SEPTIC TANK: 440 GPD (2) = 880 WATER SHUTOFF `� \ G w WATER LINE LOT 27 \ tr USE EXISTING 1000 GAL. SEPTIC TANK G GAS LINE BENCH MARK - CORNER OF 151 63.49 21,960E S.F. \\ ��S \\ OHE OVERHEAD ELECTRIC CONC. BULHEAD EL. =64.4 _ � O\ \ pp, 14 �O LEACHING: W NOT ALL SYMBOLS MAY APPEAR IN owWM ° � / `� I` � `� SIDES: 2 (40 + 10�2 .74 = 148 GPD x 64.08 4 `�\ `✓ Ak60.77 BOTTOM 40 x 10 (.74) = 296 GPD TEST HOLE LOGS G \ ` �� \ TOTAL: 600 S.F. 444 GPD x 63.30 63.24 � � � \ USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) ENGINEER: DANIEL A, OJALA, PE. SE#1805 3.87 / �� �� \ WITH 2.25' STONE AT ENDS 5' BETWEEN UNITS AND 2.6' WITNESS: DON DESMARAIS, RS �� 3 97 �� \ AT SIDES , \ EXISTING DWELLING 6�.19 4-20-2012 DATE: __ , \ TOP FNDN. = 64.7' < 2 MIN INCH SHE '� \ I �'' PERC. RATE = / �63.35 \ � �i � � 59.87 CLASS I SOILS P# 13611 ��6 9 x .28 \\ GARDEN \>63.90 3 6 3.77 �' / ' 0.35 \ � MA 0 7 3.so �' APPROVED DATE BOARD OF HEALTH ' ELEV. ELEV. �o o, .7 DECK 3.96 °" 62.5' °" 62.8' x 2.85`\ x63.26 i TITLE 5 SITE PLAN i�sa \ � �j 63.71 �� �' i A A OF i 12 2.79 _ � (] 1 PATIO 63.65 i / � LS LS x 62.50 A, 10YR 3/2 10YR 3/2 �` �� � � 6372 6" 62.°' 6" 62.3'B 65 178 CAP'N SAMADRUS RD 1 � / B x . s�\ ,4" OAKS COTUIT, MA LS LS \`•, x 63i1'4 62.53 38" 10YR 6/6 59.33' 38" 10YR 6/6 59.63' j�� PREPARED FOR > 62.54 6�0 x 62.06 x 2.28 C CBORTOLOTTI/RUDMAN PERC 62.19 \ ESN�F Mq M/Cs M/Cs �Sgcyr DATE: APRIL 23, 2012 x 62.05 � DANIELA NNI L CIVILA off 508-362-4541 2.5Y 8/4 2.5Y 8/4 2` N.- fax 508-362-9880 \` x 62.24 0 d�SN�F AS � o s R\J _j;} down cape en in e erin inc. 132" 51.5' 132" 1 1 51.8' 502 �No.4o9sa Scale:.1"= 20' ° CIVIL ENGINEERS k�� SA ��� "� . NO GROUNDWATER ENCOUNTERED _, y, -1,3/ L . LAND SURVEYORS / 0 10 20 30 40 50 FEET � �� � � f � DCE #12-088 DATE DANIEL A. OJALA, P.E., P.L.S. 939 main St. yarmouthport, ma 02675