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Home My WebLink About0110 CLAMSHELL COVE ROAD - Health 110 Clamshell Cove Road, Cotuit I No. = ®v Fee VYes THE COMMONWEALTH OF MASSACHUSETTS Entered in computerPUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitatlon for 3Bisposal-Opstem Construction 3pCrmit Application for a Permit to Construct l") Repair( ) Upgrade( ) bandon( ) �mplete System El Individual Components 06 e s or Lot No. lQ ��ls �� Owner;s� e,Address,and Tel.No.0 - 06j Assessor's Map/Parcel Installer's Name,Address,and Tel.No. '7 7�. /��/� Designer's Name,Address,and Tel.No.hr/10/6>05V 7 Z Type of Building: f2 Dwelling No.of Bedrooms J1 Lot Size Z /i °� ��sq.ft. Garbage Grinder(/�d Other Type of Building J� Cle No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow(min.required) 3j gpd Design flow provided �' ,j� gpd Plan . Date // Number of sheets Revision Date Size of Septic Tank 6 ®� Type of S.A.S. Description of Soil �Q Q Nature of Repairs or Alterations(Answer when applicable) Lp 6 djoq, xfD/1 Q SU a v`��` r O W cSz�ee Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of th Date Application Approve Date Application Disapproved by Date for the following reasons �-Z�Permit No. , J ��d Date Issued j w .r._, ti W 4r �...,r.....-� •...IyYp.rr�'"i!•�'.,r, ..+.r..*.a.,.r....—.....•.. ^�+...» .'ow i,�.+e.:.-.--i'.r+;- +.r^� �� q. 4d Fee ISO f THE COMMONWEALTH,OFMASSACHUSETT,4 Entered incomputer: a ' .PUBLIC,HEALTH DIVISION -TOWN T F BARNSTABLE, MASSACHUSETTS' Ye ♦ Olp"plitation for MisposaL*#stem Constfuction i9ermit Application for a Permit to Construct Repair( ) Upgrade( ) bandon( ) /complete System ❑Individual Components Location Address or Lot No.��Q G^/� �cy�j�C��O. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 40'7V 7- Installer's Name,Address,and Tel.No. 7.7 � ''�3.�j3 Designer's Name,Address,and Tel.No. �. Coe-5/'> 41 �00 ��"�i°� sow-3,!5z -17/57y/ Type of Building: >/ Dwelling No.of Bedrooms �/ Lot Size 1- 3, J t�9 sq.ft. Garbage Grinder(� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .3 ,_05/ gpd Design flow provided �/s' gpd Plan Date / y 1-14 Number of she Revision Date Title .J� .s l / Size of Septic Tank Type of S.A.S. � �©D 9'Q/ C Description of Soil ». i Nature of Repairs orAlterrations(Answer when applicable) L�'GG' G•t/`J�%`/' ''�j©/I Q'gL j`' J Date last inspected: Agreement: i 1 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 H alth. Signed Date Application Approved Date Application Disapproved by Date for the following reasons Permit No. _ Olto /00` Date Issued L) THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compfiance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(t/ Repaired( ) Upgraded( ) Abandoned( )by 1401-lele at /^ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No)914 400 dated Installer p`' n�j��J`/� Designer #bedrooms S' Approved design flow end- The issuance of this pe it shall not be construed as a guarantee that the system will nc oVas design d. Date /o Inspector �r --_ -- _ --- No. �d1 � /� ----------------•----------- -- ------ •----------------- - ------__..�----•----- _=----Fee 1,5 C) THE:COMMONWEALTH OF MASSACHUSETTS -- PUBLIC HEALTH DIVISIONt=BARNSTABLE,-MASSACHUSETTS_T. ispo at 44pstem Construrtion jermit Permission is hereby granted to Construct'( 7l Repair( ) Upgrade( ) Abandon( ) System located at 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. t Provided:Construction must be completed within three years of the date of this permit. Date C//CJ�EJ,/�t� Approved y....�-.._ FROM :down cape engineering inc ' rAX NO. :15083629880 Jul. 22 2010 08:46AM P1 1 ' 11vuaEm�v F. a>Cacr., 1!�vu m.fc?Pa r xr�a!vsrn�sr_r,.,11Jjj� , � ab;�/y�,J� 1-tut.]��.li.� ..E[a^.s�l3�flT il�,7t�•v,9it�.bu "I'VD M,iuct ,adr�a:rr, Tt><ytn>suo;ir�, ,of?m�QUll Off�c: 508-862-1644 508 790-i3b4 Iry .11.Jfen. r. �� cel f0 �Al"01,1.Form s" _ S,rw a$;4" Fei orntitt# ��!%°"l�<�ygc�S��lC' lf�esii n�:r: 0 t✓J } ! � IUSTA)Eler: !�.Q�xtu"ess: 'Ln jy- 7 A.cDal.0 a a s: d• / ya,�MOUV4 PO-JNk //J� issu od a pi.rruit Lo inotalf.a (date) (i astallcr) s..ptic.5ysti:Aai <LL / d a a kll . C Vt.. !s-el 1, ..�;ed osx rt design drawn I->y (address) --_. I ccrtily that the s-optic system reforc;riced ,above was installed subsiantial-ly ace T ing to the design, which may Include rni-n.o.T approved uliaT:iges such as la.tcral relocation of the distri.btitl(ril box rind/m,.Septic tank. 1. certify tb.a1 the septic. systen.c refereTicr.d above was installed with. a.u9jor c:llita►gcs (1.0- )reatcr than lU' lateral rc;location of tho SAS in any vertical relocati.o.tt Of arsy ourripcTner.it of the 5apl.i,c ;�y�;E:etn} biat in a.ccordan.ec with ISI:a-tea Local I�cgttlttiiartti. 1T1<.ta .l'eVIS1G11 Gr c m f'tod as-built by cksigtter to !"oll aw. OF aisLa.rr' ,'ignatutel �� OANIEL etc A. OJALA v+ to _ © _ (T�esi�nzer':; �yi nfi:tii:�e) — (Affix,lac � n � 'rip i3�re} 0;/ E*:t. T�1�,7C17.1 TO Ri1I�T;�T��1BL:IH' u�u.111rAs1�' 1[1:�.�OR't'Yclt 1D9NR.t�I(Q�1V. G'IE. "A.'9F➢r::A,R OF_....__.........._...-- _........,.....- -------- _.-., . . a�c:�lilit'.l.;L� L°i '.;&�. .va�u,..L Jqd 9:;;a1yaBD T.TN11L V,,() FT ')F'MS' T'B:bltIM .hLND AS-BUILT CARD ARE RIA.'XI<N>t�D B 7 E BAtaNSTART R KflRr.1t!i UL,IL'➢H➢)TR5,'I[o�, 7CY1 t�11r w2n�r• i�: llca(tu/ c tic/t)r,�i ncaCcitifucntioa Fomi3-2h--,14Am; 'FROM :d6wn cape engineering inc ' SAX NO. :15083629880 Jul. 22 2010 08:46AM P2 I 70 ll.. EXIST. SAS v � EXIST. ' 1500 V GAL. ST 61 S' EX5f, CONC. LOT 15 FOUNDATION 19,935 5F+ DCE #10-043 SEPTIC AS-BUILT PREPARED EXCLUSIVELY FOR THE HEALTH DEPT. LOCATION 110 CLAMSHELL COVE ROAD PREPARED FOR: �cOTT;Mai JOSEPH A. THIBEAULT .SCALE : .1 " 30' DATE JULY 7, 2010 REFERENCE ASSESS.MAP 6 PCL 61 r LOT 15 PB 134 PG 41 OF MAs I HEREBY CERTIFY THAT THE STRUCTURE o DANI6L T� SHOWN ON THIS PLAN IS LOCATED ON THE Aso GROUND AS SHOWN HEEON. A. �1 t.� OJAI-A m i, stir-M-4Sa, __ No.40980 fax]Utf SG'1—B1nn QA- down cape) engineeriny, ll7t L 1 ��^/ In ... V i ND SUHVE-YOR-^, 938 Maln street• - YARMOUTWPOR7. MA.S.S. DATE REG, LAND SURVEYOR t TPUNS. NO.: CITY/TOWN: APPLICANT: (tea. ,a eLN— '--- la ADDRESS: 1 c o oQ; pe". DESIGN FLOW: 33a gpd REVIEWED BY: DATE: �N/A OBE£ NO 6 Legal boundaries denoted [310 CMR 15.220(4)(a)] ✓ Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for / upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours 1310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(11)] Address Sheet 1 of 7 N/A OK NO F ation of every water supply, public andprivate, [310 CMR 20(4)(k)l wit 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case I--E- within 150 feet of the proposed system location in the case J of private water supply wells Location of all surface waters and wetlands located up to 100 ft. / beyond setbacks listed in 310 CMR 15.211 and any catch basins ✓ located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve V unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep(unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Sheet 2 of 7 Address I lei/iA OK NO Size OK? [310 CMR 15.223(1)] VA Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minunum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] "n"Pry` fiYn'r. '�sM atitidcv23lr•P.' MIS,W , y �iE.:ilr*. tib"+•]�'k''a n �r5,111+^�1-�d'�� I i`7.,fi.;.`. Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CNM 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO �YP1 Gy � } - Located at least ten feet from any water line? [310 CMR / 15.222(2)] Y Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMM 15.211(1)[1]) Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mauls? 310 CND 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/f.) 0.02 preferable [310 CMM 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches V and beds) [310 CMM 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachficld below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMM 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR. 15.251(5) specifies various pipe types allowed) ��:.��,�� a �?�Y►.� �,��. z`: Stable comp acted base [310 CMM 15.221(2) and 310 CMM 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 Ma 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] 1111i uF:4.k7N1 i;. Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMM 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Al.a m floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating ilz lead-lag mode- [310 Cl\vM 15.231(6) and(e)] Stable Compacted Base [310 CN1R 15.221(2)] 011/ Buoyancy calculations needed ? Provided? [310 CMR 15.22118)] Address Sheet 4 of 7 N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR I / 15.240(1)] V Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] Svstem Venting required/provided? (system under driveway or / >36" deep) [310 CMR 15.241] ✓ Inspection parts specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] v Aggregate I'minimum- 4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] im Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM RI5.252(2)(d)] Maximum separation between lilies and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A OIL NO Pressure Dosed System ? Provided pump and piping calculations as required [310 MIR 15-220(4)(1)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CNR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CNEZ 15.254(2)(d)] Coiistructi©n in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(Z) and Guidance Document] At least 5 ft_ from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] `Cr�t el �S'lfP rca;� less ste.rta Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface C ' SrY :FSx''14dY h' �F�iiN3t7�FF3� �) a ltercafeS�y .reP�a jI/AP �iDyal ] Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance C!,1M,Y CB Are the variances listed on the plan ? [310 CIV R 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Sheet 6 of 7 a - N/A ox NO Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15,216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR / 15.216(1)] C w (; tt s } - sLSCLLZILLY2®!£LSD:Iliy i F iv eJ,�"f: a �, nkn71 � 1r � � F {{ i kd +�H Pumping to septic tank ? [ 310 CMR 15.229] Shared System[310 CMR 15.290] Address Sheet 7 of 7 TOWN OFBA��RNSTABLE LOCATION i t® C L�-K f Ceti tZSEWAGE# Ad 10 'too VILLAGE i,trt_ ASSESSOR'S MAP&PARCEL �o L INSTALLER'S NAME&PHONE NO. __ -�• ��-� SEPTIC TANK CAPACITY � e LEACHING FACILITY:(type} (size) 10,� r NO.OF BEDROOMSe — OWNER .q-t L�/L-�•C L! PERMIT DATE: - 10 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 36 -5- A. Ig- i �' 34 � Commonwealth of Massachusetts a W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M. '< 110 Clamshell Cove Rd M SVOy Property Address Jay Thibeault ""a Owner Owner's Na information is 1""1 required for every Cotuit MA 02635 8-9-15 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 a way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority , 8-9-15 I pector'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 to the buyer, if applicable, and the approving authority. ****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. �0 �S (/ � t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts W Title 5 Official. Ins-pection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,,as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a'complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. t ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 - page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is.within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M °p 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: I. ❑ 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 Itank and SAS and the SAS,is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or ® clogged SAS or cesspool ❑ ® Discharge or ponding'of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 s Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is Cotuit MA 02635 8-9-15 required for every ` page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No , ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or El ® tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. "❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 B-9-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® '❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example:,110 gpd x#of bedrooms): 330 t5ins•3/1 i 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: 1 Design flow(based on 310 CMR.15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holdingtank resent. Yes No P ❑ ❑ Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--not pumped since new in 2011 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins-3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 'r 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. . Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M "r 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): I Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):. Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town• State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Good condition with water at working level and no sign of back-up from chambers. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach chambers in good condition and empty at inspection with stain line at 3"off bottom of chamber. 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 N, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °f o 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 GG � Af ; I r 3(o -d - 302r * *J� A 3-) I r s 3 ! ~ 6—F ' 1 sf t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M °p 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. Cityfrown State Zip Code Date of Inspection D. System Information cont. Y (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,••''� 110 Clamshell Cove Rd Property Address Jay Thibeault Owner Owner's Name information is required for every Cotuit MA 02635 8-9-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 /o Town of Tlif P Departineaat of Regulatory Services19 4a' Public Health Division Date 200 Main Street,Hyanuis MA 02601 9 L' ApFO FAX < Date Scheduled b J Time�U _ Fee Pd. nln `oil Suitability Assessmentfior SeMa e isposal 1'crYonned By: 1 �r /� / Witnessed By.: 1 LOCATION & GEA NE RAL INS+O IVIATION Location Address /!0 C�a r> �� /� �1„✓� Owner's Name Co`f7el�w ' l Address Assessor's Map/Parcel: '(p Cugineer's Namc d w NEW CONSTRUCTION REPAIR Teleepph)one It C`�0(f' Land Use- `� 1 � / Slopes(1o) I 1 Surface Shines Distances from: Open Water Body �W�11010 Ft Possible Wel Areu ?7040 fl Drinking Water Well //eft Drainage Way ft Property Llne t� _Ft Other It F S]IMTC]H : (Street name,dimensions of lot,exact locations of lest holes Bc pert tests,locate wetlands In proxindly to Boles) "lei 3 00 Parent material(geologic) Depth to Bvl rock Depth to Groundwater: Standing Water in Ilole: Weeping from fit t�flt e _ _ t Estimated Seasonal High Groundwater ]D�IE'JC'ERAUNA7CJ[ON FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: 111, Deptla 10 S911 N]010:-_ Depth to weeping from side of obs.hole: _ In. Owulidwater Adjustment a I't. Index Well Ik Reading Datc: Index Well IeVVI — Add,f:.1L'toP •�_ At��.CJYtiUll[lwuleY 1xVel PJERCOLATION TEST - - Atatr 'A'luttt Observation 1 Holt ff ` Time lit 9" Depth of Pere _ Time at G" Start Pre-soak Time @ _ Time(9"-6") End Prc-soak Rate Min./Inch Silc Sullabili(y Assessment; Site Passed_ Sikr'Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted avatliiii 100' of Wetland, you must first Uotify tile. Barnstable Conservation T)ivisioii at least oiie (A) Week prior to begiaiiau><.rlg. Q;\S EPTIC\PERCFORN9.DOC TION HOLE, LOG Depth from Soil Horizon HoleSurface(in.) Seel Texture Soil Color (USDA).. ' ' ' Soif. Other uo-A (Munsell) Mottling (Structure,5toncs;Boulders, �5 Con istenc , ravel �__ 13(Z{ b DEEP OBSERVATION HOLE LOGDepth from Soil Horizon �]i-I®le Surface(in,) Soil Texture Soil Color (USDA) Soil Other Moulin 61 (Munsell) g (Structure,Stones,Boulders. CbrisiSrenc %C avel ------------- 1� L„ ®C P O B SERVATIT �C Depth from* Surface(in.). Soil Horizon Soil Texture Sail Color, �# (USDA) (Munsell) soil '--_O t— her Motll g (Structure,Stones,Boulders, — L Co si tc c a ve --- C, DE EP Depth from Soil Horizon OBSERVATION ®�']E �,®�a Hole' Surface(in.) Soil Texture Soil Color Soil " (USDA) (Munsell) Mottling Other 1 �1e g (Structure,Stones;Boulders, i � Cons' ten o I a I Flood I nsurance IRate Ma Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No� ye5 ]nth m_._ f Nil ttau'ally�flng Pe�waous ME,terial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system IG not, what is the depth of naturally occurring perviou material? I certify that on NOV (date)I have passed the soil evaluator examination approved by the Department of Environmental.PI-Otection'and that the above analysis,was performed by me consistent with the regoi n expertise and experience described in.CIO CMR 15.017. ,Signature .- Datb Q:\SF-PTlC\PERCFO r Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection .titl One winter Street' D.L.P. Titlee V Septic Boston Ma. 02108 epti c Inspector kv P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508 Governor ®� i ARGEO PAUL CELLUCCI klyl Lt.Governor SUBSURFACE SEWAGE DISPOSAL ASYSTEM INSPECTION FORMCERTIFICATION 199TDto of Inspection: 11�SProperty Address: liO I97 Shell Cove Rd.Cotuit AddifTerentdress of Owner: C1H0 pT7�[f Name of Inspector: John Graci Joel Macquire Cc I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) 49 Company Name,Address and Telephone Number: >�► 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 This Inspection Is based on criteria donned In Title V Conditional) Passes code 310 CMR 16.303.My findings are of how the system is y performing atthe time of the Inspection.My inspection does _ Needs F rth Evaluation By the Local Approving Authority not impyany warranty or guarantee ofthelongevhyofthe Fells septic system and any of Its components useful life. - r Inspector's Signature: . Date: 11114197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. 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 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. (revisedM7)97) ' One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 110 Clam shell Cove Rd.Cotult Owner: Joel Macquire Date of Inspection:11►1sr97 _ Sewage backup or.breakout or hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health), Describe observations: 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D) SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined 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 in 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 overloaded or clogged cesspool. — SAS is in hydraulic failure. (revised 0427)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 110 clam shell Cove Rd.Cotult Owner: Joel Macquire Date of Inspection:11115197 D]SYSTEM FAILS(continued) 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers 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 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 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: 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: 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 pub is 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 a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 11e Clam Shell Cove Rd.Colult Owner: Joel Macquire Date of Inspection:11ri5197 Check if the following have been done:You rrust indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with NIA. x — The facility or dwelling was inspected for signs of sewage back-up. x _ The system does not receive non-sanitary or industrial waste flow. —x_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x — Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)J (revlsed O4127197) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 110 Clam shell Cove Rd.Cotuit Owner: Joel Macquire Date of Inspection:11l1SI97 FLOW CONDITIONS RESIDENTIAL: d./bedroom for S.A.S. Design flow: 220 U.p Number of bedrooms: 2 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No last two 2 year usage d Water meter readings, if available:( ( )y g (gp ),. rda Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:g gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nra I Last date of occupancy: We OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped 3 years ago by Hickey. System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: '1992 Sewage odors detected when arriving at the site:(yes or no) No (revised 04127197) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 110 Clam Shell Cove Rd.Cotuit Owner: Joel Macqulre Date of Inspection:11115197 SEPTIC TANK: x (locate on site plan) Depth below grade: 4'4" Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L6'6"H6'1•w4'10^ Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 25" Scum thickness:"' Distance from top of scum to top of outlet tee or raffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: Meausured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound.Recommend pimpinp system every two years for maintenance. GREASE TRAP:_ (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: rda Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:nfa Distance from bottom of scum to bottom of outlet tee or baffle: We Date of last pumpingril, 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.) nfa BUILDING SEWER: (Locate on site plan) Depth below grade: 5- Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction Vinetown Diameter: 4" Qmments: (conditions of joints,venting,evidence of leakage, etc.) (revlsed 04rl7)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 110 Clam Shell Cove Rd.Cotult Owner: Joel Macquire Date of Inspection:11r15197 TIGHT OR HOLDING TANK: (locate on site iplan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: rde Capacity: rda gallons Design flow: rva gallons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nla Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) We PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)—Yes Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rda (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 110 Clam Shell hove Rd.Cotult Owner: Joel Macquire Date of Inspection:111115197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: n1a Type: leaching pits,number: 600 gallon leach plt leaching chambers,number:We leaching galleries, number: nta leaching trenches, number,length: rda leaching fields,number, dimensions:R'a overflow cesspool,number:nla Alternate system: rda Name of Technology._nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The leach pit le structurally sound and functioning properly.Pit has not been more than 112 full. CESSPOOLS: (locate on site plan) Number and configuration: rya Depth-top of liquid to inlet invert: rda Depth of solids layer: We Depth of scum layer: Na Dimensions of cesspool: nia Materials of construction: nta Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) nfa Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) nta PRIVY:_ (locate on site plan) Materials of construction: Na Dimensions: We Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.) rda (revised 04127)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 110 Clam Shell Cove Rd.Cotult Joel Macquire 11115197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 9A I S \ l 41 •� (revisedo427197) Pal• ! of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 110 Clam Shell Cove Rd.Cotult Joel Macquire 11115197 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. 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 x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revlsed04r2TI97) sage 10 of 10 Fxs... d............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /t ...............OF......... , ppliratioo for Di,4pooal Works Too i rur#ion thrutit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at: ...----••---...._--------------•---•----....----------------------------- ..................... G Q-=------ ...................•.................. Loc ioon-Address or 11 No. ... '/l 1"1!` ��. -•------------------ 1 vE. D .--- Owner Address . - --------- ..........Cl> i.U/T--- ----------------------------------------------------- Installer Address r Type of Building Size Lot--- 2 .J 5._Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (Nb) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures __--_•--••_____________________ __ W Design Flow----------- 'S---------------------gallons per person per day. Total daily flow............. ;17—..0................gallons. WSeptic Tank—Liquid capacity/a4?0.gallons Length...._`_---- Width____> _ -_- Diameter_.............. Depth....4.°.._.. x ,Disposal Trench—No. ................... Width.................... Total Length--------------_--- Total leaching area--_____---_------sq. ft. Seepage Pit No---------I.......... Diameter...../O--____- Depth below inlet--- Total leaching area...188...sq. ft. Other Distribution box ( ) Dosing tank '-' Percolation Test Results Performed by.-- EO, ? ......... GSJ` ------ -__•_- Date..... 8. ... _ as Test Pit No. 1. __Z----minutes per inch Depth of Test Pit----- Depth to ground water.�lJP__Z-..��t�' fT, Test Pit No. 2.4 Z__minutes per inch Depth of Test Pit----- Depth to ground water.d0l0N7-.&—)�_-,E-D 9 ..................................... ......-_--.............--..........................................................4.......................... O Description of Soil---7C.H......... .. ��.._.._..._ `— - r. ........................--------_. W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of R airs or Alterations—Answer when applicable.____________ _ ....... ......•.........�...... --L � � Agreement: /$® ., • " .�i _� G..+.r.� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f'1TTI^ the provisions of J.- �.,,.. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be sued by t rd of 1 lth. Sinecll---- -- •• .-----� -- --------- ----- ---•-•.------------ ................................ g C� 2 Date Application Approved B _.. t�' �----� .-- ••------ -------•-- --------•-Z � PP PP Y �`' -----•.......................................................Date Application Disapproved for the following reasons________________________________ .--.....-..._ .............................................................-................................................................... ---------------------•-------------•----------------------------------- Date ................................................ Issued-....................................................... Date C s T � J Fxs..:?-.e................ THE COMMONWEALTH OF MASSACHUSETTS BOARD /OF HEALTH 7; Appliration for Uhipaii al Works Tonitrurtion ramit Application is hereby made for a Permit to Construct (X or Repair ( } an Individual Sewage Disposal System at: ................_--.............................................................................. ............................ .......•- Location-Address or Lot No. ..........-•----------. ............ Owner Address 1.4 Installer Address C d Type of Building Size Lot-__�_.L;..S-`7�..Sq. feet Dwelling—No. of Bedrooms............... ............ .. .Expansion Attic ( ) Garbage Grinder. („p) Other—Type of Building .............. No. of persons....._....._.__..._.._..._.. Showers — Cafeteria Pa Other fixtures -------------------------------• . W Design Flow............. .....................gallons per person per day. Total daily flow..........._•s�-_-Z.Q................gallons. WSeptic Tank—Liquid capacity/0.UJ_gallons Length.__..._.__._ � Idth____� .____ D>ameter________________ Depth..__*__....... x Disposal Trench—No. ....................Width.................... Total Length.................... Total leaching area....,----------------sq. ft. 3 Seepage Pit No.......... Diameter.....4-2........ Depth below inlet.- ,_ ._.___. g q.' � ' Total leachin area___�P�._s ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by._.G U�':.G E=. .... e0-_.... Date..../C..- Test Pit No. I.�..Z____minutespper inch Depth of Test Pit..../44..`.. Deppth to ground ound water.A.)ZC..77- _�N = (z, Test Pit No. 2_��_....r?.__.._minutes per,inch Depth of Test Pit..__!:-}..._` Depth to round water.d!�1��J:l�_E 1� k. s' �_ hl -- Q ii r. OFl•a- .# tJ!` Description or Soil.... '--- ........... - :..__... - ti - '/. v W ---------------------------------------------------------- ------------------------ -----------------------------------------------------:--------------------......................................... U Nature oY fe ins whplicable o-VZ �" ^ . ...... �..................................................... ..••. -------------•------- -A Agreement: I i i The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �. �^ the provisions of TIT 5 of the State Sanitary Cgde—The un s gned fu tl:er agree not to place the system in operation until a Certificate of Compliance has b en's . jb ,tia 1 a igned. -------------------------- C,/. Ye Application Approved By...... - --'----------------- -------------.....---•---------•---•- Date Application Disapproved for the following reasons:................................................................................................................. ...., Date o PermitNo................................................=........ Issued------------------------------•---•--..._............-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..,�.. ^` ..........OF......... ........................................... Tledifiratle of TontpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repairedby ( ) ...... .-•--•------------------•-----•---•••-------•--••--•••-- . ......... -•-------•--•----•-------•-•----......----.............................. �7 Installerff� at.......... / ------- ,�� ---- ^+ l�s --- --- = �' -------------------------------------------------------- C�---been installed in accordance with the provisions of TIT.I.;;- j of The State Sanitary Code as described in the f J. . - ............ da.ted-----------------------------_..--------..._... application for Disposal Works Construction Permit No.._l�,, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION /SATISFACTORY. DATE..................................... ................... Inspector....._:,.-- I?d.................................................... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH '�.. �' OF....................... 10..E-�' .......................................... ..................................... FEE..... ................ Disposal Workv ONano#ra ion rrntit Permission is hereby granted............. s 4- ............................... •-••----------------------------•---------------•-------------.----- to Construct ( o 1�epair ( ) a Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... i• - -- ------•.................................- / �/---iL---------------- Boayd Health DATE-------------------------------------(�-7- /,1--Q.- FORK 1255 HOBBS & WARREN. INC.. PUBLISHERS LOCATION SEWAGE PERMIT NO. Ila V;1'LLAGI t ,7' .INSTA LLER'S NAME_ i ADDRESS~ e UILDER OR OWNER r GS 1 /71 ` � ?/��E Z� )-�?®,3®x 0 7U iT DATE PERMIT ISSUED DATE COMPLIANCE ISSUED o4,Z2ZZL r +� � o?� , � r K� �/ ,�J�. "k �.L.:. .. . _. '� � . a G �.�, c a __. 1 1 F t r u -� I I. ` t l • f � I I \. E Fm dw L 0 ZI ZI ° in 77, In ILL { EEE9 � I n 1 I rl L I z F G . . N o L n i O � I I •� � -srsunsr� w — qQ 4 I I I j l � v 3 1 I"fig i - - - J 3•• 6.1o'q" T:o'. �.o' G-t61/q�� 3" � � - IA ""-:LTtK FTG..:[jSh.C6WM;AB^I.N�I.iDEIiI�Y..liLLl ISH�FiIt+�'fJE_._... � - _ 7 I dD - - /E61.1T�fE'nTJ�FU51JfA5 - 12 WtL ^m'rViw RC%.TS.- s A./u.Fucnx..6o5.ifw/ .'T..RJF^.-Tva;ru�ccs.3b^s..c.t• 1 _ r Q _ __ Sl �._t ESOS?S F•SD`Z kI -Oo — 1 ,: bECK.b6CTIUNiiI��'.r_o')- _ _ 1 p e�Y {._ , �' I�.O' � 3.}O" 6�q' St0" 1.�3` -1.9' 3Q.. �q• _____ . WVnnTtON PLAN C'•g• o'.J__^ / 1 ecnu�5txxrn - °""""" .i rtik,�..nu-S�1+l'-n�."9^Tru.kl;4v'JFT4:40"M.u'.hE Wlv Gv_�InE �I Bruce Devlin en s'IRriu.'r.Jro �o •. •wro e nvuy ryIRdERU��f4 stns �. .. - � esi n® t04T m oolws UW xv.✓'i(Q-4 E0.U'JES .` 77423"773 I I I ; - - � � ISTS,Geq ► � I m IT 1 ri i (r FICK57ER,SIiIIr— ciREnT1200ti(.._..a) N N 1 _—) _. _.__.�"ti.____ --._—_..._.`___►r___.... _�� _-._v i0;_8�0` � l2:fo° �,•SIi .: - jl �., . 2 I .f0. - _ ___ __._._.--___—. _ V SIU•C,G6U SlaEfrRCY1C;�� O' _ I' ,? M I CihRtiCE QQ r j .yirC _ !. 50.1i) IYfX_K�4 Ae,•�,�.ink CU P R5T RCOR ' QRCn KE,c,sr I RZlv.'cru j .........._... ..:'._ _. hel.JC LST5^r ALL R.a,E.U�ME FU..f^RYCRo1J.5 G b ; � _NSE JOl51 Fk VS eCS'�6 - of - • y.9" S 3' 9:0 �2.M1` 11"� 2:R' 2•v� 3.3" ` Bruce Devlin r•::__ __.�,'_ .o�. �..,�, DesignA 9i+� ` 774-23"773 I _ ..S�st1a.P.ilQC.eHAt��i`t F,crw.l II I N I — ._c, x O t _ m 1 I I m �E=CUN s Rr � itM��l•� Ir Wo r�7 - - - Sc JUt ST'.y is slRt As RE61U pi,r)/,.11 t[l' .. B';O.• �{.O" 20• SL. .5. V/. IdNS 1 O . —I l P3RWl c t ar'T �Rmn/ 3 — v $ ,• 0. ilRtc OJ 2G 'Lc . - _— so 24 >c g O 3c'r26• --- - __ t9 U UAIFiMISI4r-,D I N i a � I i - . 9 wnvPOKn ev Bruce Devlin r' r Design® ��ortJ;.alo -- 774238d1773 a L N N !• Hw' R.s m 6r:r i L c a - � r Ny (I '^ rl low I jsj: kX t V �m cj r I o i o - I , z n - : r' D6 if e a r :p p A - I 6 N � i r o i I i �a r. L � t'D il F7I • 1 j, i 0 n - 17 /Jo ° Li 4 1 • T 1 t T I n ` I I I I I 1. I T p �11 I I I G > W..,- i s WNr I o a rti r pmr - ,ae5 r Z _ r • z bss-len-I w-1 a . . ° s ws;� _ gym tA3$$$ 5$�osea� 8 .z8 "onQ Rnnr. E ,D, 8r $ ZAP � o �a Er ail � ��" t: g �.3��> c ��" � R a Fa Fs � g��> 8� > s � 9 � a3 g�•'� L�, 9 qg 9 88 A immi D V ,.nT w r nm i; zr i Fotiti�;.y a� Ti>-I w � Qa0 $3u58g $a w§p wo�EggA 6 �s gg€ P �gngaw3 nR aA' '�,''e�' CSIn� ��6 g°`3' 8n $ A� .� �� 7 �s=Stt�•go s' �� ® �• �� $ �$ N �095• i $N€ AABg a'aa g Wgsg= 9 � g� S :L Q "g R= a A _ aa5•=WS - $aaF3 s d�g 4�a aP- 09 S g �Er Ir ��a � gp�y o9e gg ati '38 Ss � g ' y g_ lit a e p•'+K •^• n"a, BS 'g3g Sd�'z ., ii F _e ST Yg `dam 6 n sa ^s aett g� It 8, I $ E;m� 11 wcltI R 6Vq. Id'O' - - A rl•L 4 . 0 A LTTFU Iti . . _- - � !!�O•• 'I.O" 20` � RI.-JOIs�7.5/�T.KIL R.C+5.tp11AE0..All P/�KT16N5 .. 117rtC73M Z� W io'. — � L35trr v -— --" L .C Oso ..2°: m tp 2-4IG:'.w '2+Rc�aT f /-YI517 IV/i G�� o • Ox uNFiNiS146,o t • i e • t i • Bruce Devlin '�'•''^` I �'' °^�"� Designa `'� 77+238-0773 #2 /dot � L .S 4 � t /ate �.� /4 4.DO' - I-.�,v:L, /? .SOT" PRO v U 9 CRa. TE S r A cO L E R E S U L 7'•,, PER TohrN �?Eeo,eD D fA TE T o W A/ WA7-EE R /�.5 /�/'o A VA f L. A 13 L E / S�? e, M /All /y U,Aj 8U1L D 1^J6- © VE ,� SE t✓ 12f��' SY5TE1l7 UJVLESS DE'516W =,LokV 220 GrA4.1D,-qv 14- Z)E:S /GN L0AD/AJG 16 USE1) : P;e0 PO5,�5D .1-4'1'9C'H /9;;->4E:1'9 /88 SEP7-lo s14,g1_L PEP_Co4_,A7T/0A/ 77ES7- C 0NFO .e Nf T"©- /-% r1�7 S S. EA✓ V f,P_ 0 A1111 E/V 7'A 4.. _ -SILL ELEV rO BE > — Fr. lg23OVE yen TOP of f�2o oSEl� /` L G'/eFaU,E 230VE FcO UNDATJon/= le 8.o Al O SO A L E �-A //"/F'E�V/0115 CQVtt� N9ANHo� CovEQ 7"o ExTrA1.D 'TO TO P,?F_V'EA/T F'/n/ES F'I/tl J S,�Ea G•�'Az�'E ----- sr0Al E of f rQ ,.4_. /p' Z4 CovEe ZQ 7>I5*7- / i -�-'`� co A.S'NE7Q s7ON Box /"tr/vim AL,t ?9R6 vN2:) "M!N• M lnJ• r ZS/f�. R7�£,t c3r8 i ^ .2`Q R�• !''1/,v JJy� _.. �iC,.... ..._ ..s ac: „?"MIN• t+�'N7' �¢ 3>J1'4. /t] 3°'I TCII �.I r4 �- '� J�Foor 14 Foor j , , ee,12 r/,4"f ocrr �' aft IL L O ,t {S'fl€Z r4�L L.C►Al !nJ v ;e-�- p J-r � v .5' rg,�atJNl^s SEAT/G� TANtC aZL t.t . a0,Z9 ('h/f3rE,er'/G �', fnJ► e e-r /rvV AlIAJ 4$" ~,p x� - -17 f'') ''�"' J� 9�l 7 mac,. PjL�/ / r� A ! V C�r�'.t�lJ�tt Z7 1 h9TL p rLt`_'!r'. ce LOCAT / onf: IV 9 rj j' tv ta�tn •'93 j i 'i.� /'- RE /~�R E N C E: E/N 0 ,C. 0 7- /.� 9 S 5'/-0 AIAf 8 �.:T � .S�Yv%�/'f' f,� Ort1 ,A P4- ,'I IV ,e.JE7 C C?;e Z7 E Z> 11'V 7W F_ 23/7;eA!- / E �C� U JTyG I.STJ Y o, -1� EIS .��s3 ��„ Xof .Sc�/LO.+x/1✓'/ ,�� , /c e .. _• yr vices c r • I 5 P7-/ T,-?A.J k Y'p 'g_15:� C) -71 AJ- -rlGIN 7A/.7a ' L. EF e14 Q 42c r C ; co 4 Sf9CH/NG ' P/7 S 74 8e: A !"T/A/- . F ,sae' 40 'A P C 1= RTy g C 1r2 T/ y 7-u 7-•. T! -r" A A:::� Sl�t.7L✓N UN T 1.5 ,.J�"LJ n! !S c�,ac� e✓ ,t �9A D Old 0 U" 77f-7'T"/�7r�J 7 f/E Q R UA l A : 5 S/-/C� L✓N f� /C' QA� ,�� , `.r T t ✓Ic7 77 / 77 �f,��"� C 0141 rr= C7.�1�-"f �� G£�St� �1� D A ..._ T'C7 7"J E 11lt,4.b 5!E7` J9ACe .C%V:�C.l _ ._.L, SltF3' / _ 7-fir Oft k' Z> t F <-I 'r-!!7/L7W .C. -d`,z� S / t� C7 R, f pP ' a j57 7 ALL SHALL TEM SYSTEM PROFILE MARKEDS WITHC MAGNETIC TTAPE OR BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) o ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS AVAILABLE Ob \ TOP FOUND. EL. 43.5' FILTER FABRIC OVER STONE 36.0' MINIMUM .75' OF COVER OVER PRECAST 1 2% SLOPE REQUIRED OVER SYSTEM 33.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MIN. 8" DIAM. COVER 4. DESIGN LOADING FOR ALL PROPOSED PRECAST c Locus PRECAST H-10 BLOCKS OR RISERS (TYP.) PROP. TEE UNITS TO BE AASHO H-� a 2'0 4"4SCH40 PVC PRECAST RISERS PIPES LEVEL 1ST 2' 4, COMPONENTS H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. o'�a (rYP.) INV'S EL. 29.17' SIDES 30.0' ° " ENDS 6. CONSTRUCTION DETAILS T 10" 1500 GAL H-10 14 IN ACCORDANCE �o , 32.98 TEE SEPTIC TANK TEE ° ° ° ° o o o o a o o°o$o 00000°o° WITH 310 CMR 15.000 (TITLE ) 2.73 0000 0 ooi_�o_ 0000 ° o�o�_ _ o moo_a_a >°°°°°°°° TI 5. BASE. SLAB ® o 0 o o 0 0 >°o°o°o°o O O O G] O O O _f 0000°° O O D O O O O O '000 oo 000 ° o ° 0 0 0 6" MIN. SUMP 0000°°° ooa�ao�o�� °° ° ° ��oaoaoao o ° ° o o o O > ° ° o ° ° ° GAS BAFFLE o 0 0 0 0 ° 12" MIN. INT. DIM. ° �D�oaa��;�� 00�0��0�0 ELEV. 35.5't 00000 0 0_ N 00000°0000 000000 000000°0 >°o°°°°°° 0�0�1�1��0�� 0000°° oaa000000aa :°00000°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND ' °°°°°°°O , ° °° NOT TO BE USED FOR LOT LINE STAKING OR ANY 0000 ° ° ° . 0000 29.41 29.24 ° ° ° ° 27.17 OTHER PURPOSE. Q Poponesset 4' LIQ. LEVEL (ACME OR EQUAL) ° ° ° ° ° ° ° JOO O O O O O•O O•O O O O O•v0 0,0O O O O Oil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° LH-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. VII, Bay 0 0 0 0 ono 0 0 0 0 0 0 0 0,,000no„ono 0 0 o. ono„o_0_ _no_n o 0 0 0 o _ �n.o 0 3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED V*33.�± 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.83' 9. COMPONENTS NOT TO BE BACKFILLED OR d //__ CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [2]) rN�K�• �I�2 coo HEALTH AND PERMISSION OBTAINED FROM BOARD ( 2 % SLOPE) (22 % SLOPE) ( 1 % SLOPE) G, 0�k� `i `O OF HEALTH. 26' LEACHING r�J 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP FOUNDATION SEPTIC TANK 15 D' BOX 9' FACILITY 20.5' BOTTOM TH-3 CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL No GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS (14-IV --�hvX � WORK. ASSESSORS MAP 6 PARCEL 61 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM �� S� 11. ANY UNSUITABLE MATERIAL ENCOUNTERED LOCUS IS WITHIN FEMA FLOOD ZONE "C" PROPOSED LEACHING FACILITY.SHALL BE REMOVED 5' BENEATH AND AROUND THE ZONING SUMMARY BENCHMARK: CONC. BOUND ` TEST HOLE LOGS AT EL. 26.1' 12. EXISTING LEACHING FACILITY SHALL BE PUMPED ZONING DISTRICT: RF AND REMOVED OR PUMPED AND FILLED WITH CLEAN 24.53 SAND. MIN. LOT SIZE 43,560 S.F. ENGINEER: DANIEL A. OJALA, PE, SEA 6.13 NOTE: RE-GRADING REQUIRED MIN. LOT FRONTAGE 150' S WITNESS: DAVID STANTON, RS TO MAKE BREAK-OUT MIN. FRONT SETBACK 30' / 5' REMOVAL OF UNSUITABLE SOIL REQUIRED MIN. SIDE SETBACK 15' DATE: 3/8/10 �/� AROUND PORTION OF PERIMETER OF LEACHING MIN. REAR SETBACK 15' FACILITY, DOWN TO SUITABLE SOIL LAYER. PERC. RATE REPLACE WITH CLEAN MED. SAND, TO MEET SITE IS LOCATED WITHIN RESOURCE _ < 2 MIN/INCH 2j tiQ29 x 29.33 ��•C0 SPECIFICATIONS OF 310 CMR 15.255(3) PROTECTION OVERLAY DISTRICT, AP AND CLASS I SOILS P#12856 Q 2 . I •6 o x 30.27 ESTUARINE PROTECTION DISTRICTS x 30.72 31 - " 4 ELEV. " ELEV. �0 26.96 32 -_ SYSTEM DESIGN: 0 34.0' O `V 34.5' t '28 4 3 x 33.75 1 4 \'oDgR, � GARBAGE DISPOSER IS NOT ALLOWED 1 x 35. R� 5 FILL FILL r\ _ 3� TH rj DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 18" 12" x 31.24 ^ 3 ° �h CARPO 1 USE A 330 GPD DESIGN FLOW RT/�TOKAG B B of 33 2 4.58(REMOVE) 6.07 LS LS 34 5.17 'SEPTIC TANK: 330 GPD (2) = 660 t'V TH 84 2 5.89 3S USE H-10 1500 GAL. SEPTIC TANK 48" 10YR 6/8 �N0, 5. 0 36 10YR 6/8 40" 1.16 x 88 x 35� �66" AK x 5.38 x 35 74 3� / x 37 ( 38 LEACHING: - 3 ` , SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD x 41.1 PERC C C vr`f �S / /1 95 39 x8 7� BOTTOM 30 x 9.83 (.74) = 218 GPD x x 81 M/CS M/CS 1 .04 / // BENCH MARK - TOP OF TOTAL: 454 S.F. 336 GPD �g 1 LP 41 / CONCRETE BND. EL. = 42.7 5 6, / 7 O _ / USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 2.5Y 8/6 2.5Y 8/6 / WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' I 42. fl x 37.37 14" OAK 39.65 \ EXIST. SE IIC\SYSTEM (RE VE) BETWEEN UNITS / \ \ 36.0 \\ x 41.57 132" 23.0' 132" 23.5' ° \\ .o�oQ 1.99 MA H�vSF \ o \ x 1 APPROVED DATE BOARD OF HEALTH NO GROUNDWATER ENCOUNTERED x/70 x 41.55 \\ \� \ ELEV. " 4 ELEV. I x -79 3 4�,3 � DECK PROPOSED DWELLING `� �9� 4, 50 86 TITLE 5 SITE PLAN p 32.0' 0 `V 34.8' / �41.10 \ TOP FNDN. = 43.5' 42.15 � 4 � OF 3 .87 N 12" OAK 4 \\ 42.09 41.89 �y A�O 2 \\- -�41.20 FILL 1 x 39.81 / �x 0.60 23 41.59 44,.2 ` \� �\ i 110 CLAMSHELL COVE ROAD FILL \ 41.5ft, 41.92 COTUIT 12" 12" i 26 40.34 �1Y 1. 1452 \ $4� i / 'Q / A g. 4 41 60 11268 x 42. B � 14" OAK � * 1 5 DIRT DRIVE / x 41.26 LS x 8 o i ' �41 � x 41.76 � � A PREPARED FOR LS X 3�66 ' 14" OAK po 10YR 6/8 x 1. 5 'Sti +, 40" 28.6' 10YR 6/8 9. 7 x 41.09 14' 38 9 �� \3� 41.41 i' LOT 15 \ / F' -aSN OF MgS 5%��`� r�ssq�ti'': BORTOLOTTI CONSTRUCTION/ x39. 4 .3 �' 8 8" OAK >141.73 19,935E S.F. ,/` S'P�r f. S' 17/1NItiL Gm ', 1.10 8. / ® o,1rlI ALA.. �� j" 2 _ THIBEAULT \ x C B 80 1.54 4-2 4 .291.42 G GJF tiA r LS 6D x 42.35 / '/to :IV, r 0 v No A 39. 5NE 0 a02 MARCH 31, 2010 10YR 6/8 40 31.4 \ 41 ,, M/CS 9.93 1 \ / G�� Fp`� �F MAssq�ti. o��jH oFMgssgoy off 508-362-4541 C \ x 41.92 - .1 1 �o`� DANIELA. �N DANIEL �6 fax 508-362-9880 / � OJALA o A `-+ I downcape.com PERC \x 49 42 �40.40 40.90 0o CIVIL OJALA u 2.5Y 8/6 V73 M/CS o.46502 0 No.40980• down cape engineering, inc. N P°�Fsst�sT'~��G .� ` tio Rv��oe. civil engineers 2.5Y 8/6 Scale: 1"= 20 �31` 1 Cc) NAl �\/� .�` land surveyors 939 Main Street ( Rte 6A) 138 20.5' 138" 23.3' DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 0 10 20 30 40 50 FEET O-O43 NO GROUNDWATER ENCOUNTERED 10-043.DWG(SBO)