HomeMy WebLinkAbout0140 CLAMSHELL COVE ROAD - Health 140 Clamshell.'Cove Road I
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 140 Clmnshell Cove Road
Cotuit, MA 02635 c Ll
Owner's Name: Patricia Kotchen
Owner's Address:
Date of Inspection: September 15, 2006 /
pt
Name of Inspector: (Please Print) James M. Ford
Company Name: James M.Ford
Mailing Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone Number: (508)862-9400
CERTIFICATION STATEMENT
Cl
I certify that I have personally inspected the sewage disposal system at this address and that the info ation resorted
below is true, accurate and complete as of the time of the inspection. The inspection was performEl9based oc�y r
training and experience in the proper function and maintenance of on site sewage disposal systemV I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sysiA
✓ Passes
Conditionally Passes o
N s Further Evaluation by the Local Approving Aut rity c
F ils
Inspector's Signature: Date: September 20. 2006
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.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection-does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
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. Page 2 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 140 Clanishell Cove Road
Cotuit, MA
Owner: Patricia Kotchen
Date of Inspection: September 15, 2006
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:
i
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.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with 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.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
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Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 140 Clamshell Cove Road
Cotuit, MA
Owner: Patricia Kotchen
Date of Inspection: September 15, 2006
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
I
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for colifonn
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
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. Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 140 Clams hell Cove Road
Cotuit MA
Owner: Patricia Kotchen
Date of Inspection: _ September 15, 2006
D. System Failure Criteria applicable to all systems:
You must indicate either"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 '/2 day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped—
_ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
yes in Section D above the large system 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.
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Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FO
R VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPO
SAL SY
STEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 140 Clamshell Cove Road
_ Cotuit. MA
Owner: Patricia Kotchen
Date of Inspection: September 15 2006
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 wa
ter
— — g 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:
Yes No
✓ _ 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(3)(b)].
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Page 6 of I I
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OFFICIAL INSPECTION FORM-NO; FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 140 Clamshell Cove Road j
Cotuit. MA
Owner: Patricia Kotchen j
Date of Inspection: September 15, 2006
FLOW CONDITIONS
RESIDENTIAL I
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 2
Does residence have a garbage grinder(yes or no): n/a
is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No I
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
I
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.): j
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: _ Tank was pumped after the inspection for maintenance
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank, distribution box,soil absorption system j
Single cesspool
Overflow cesspool j
Privy
Shared system(yes or no) (if yes,attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
I
Approximate age of all components, date installed(if known)and(source of information:
Installed on 10110197-per as built
Were sewage odors detected when arriving at the site(yes or no): No
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Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 140 Clamshell Cove Road
Cot dt MA
Owner: Patricia Kotchen
Date of Inspection: September 15, 2006
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC other(explain):
Distance from private water supply well or suction line:
Comments (on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 12"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no
certificate) ) (attach a copy of
Dimensions: 1000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 5"
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: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.).
Cement tees were present. The li uid level was even with the outlet invert. There did not appear to be an si ns o leaka e.
The tank was pumped for maintenance after the inspection
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Cominents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
7
Page 8 of 11
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OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 140 Clamshell Cove Road
Cot fit, MA
Owner: Patricia Kotchen
Date of Inspection: September IS 2006
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: allons
Design Flow: allons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level. No solids were present.
PUMP CHAMBER: None (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.):
8
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Page 9 of l l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 140 Clanzshell Cove Road
Cotuit MA
Owner: Patricia Kotchen
Date of Inspection: September IS 2006
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Y
Type
✓ leaching pits,number: 2-6'x 6'(1000 aL_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
The newer pit had 2'of liquid on the bottom. The scum line was at the same level. The cover was to rade. There did not appear to be an si ns of failure. The older pit was not due un
CESSPOOLS: None (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 or no):
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
9
Page 10 of 11
d
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFO
RMATION(continued)
Property Address: 140 Clams hell Cove Road
- Cotuit MA
Owner: Patricia Kotchen
Date of Inspection: September 15 2006
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the.building.
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37� 37
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• Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: :40 Clamshell Cove Road
Cot fit, MA
Owner: Patricia Kotchen
Date of Inspection: September 15 2006
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 25 +/- feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain:_ Topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using Barnstable topogryRhic and water contours snaps the maps were showin"pproxirnately 25'+/ to ground water at this
site.
This report has been propared only for the septic system and components described herein. This septic system has been
inspected and passed a,of the date of inspection. This report is not a warranty or guarantee that the system will
function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,
relating to the septic system, the inspection, this report and/or any components of the septic system which have not
been located and inspected.
11
CAM
OF BARNSTABLE
LOCATION NOCAM Shy L SEWAGE#
VILLAGE C d(^U ASSESSOR'S MAP&PARCEL O�� 0/.0
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY 16% n/'�
LEACHING FACILITY:(type) e�' G'+ /.S GX(a (size) / UW
NO,OF BEDROOMS / f
OWNER
PERMIT DATE: 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) _ I Feet
FURNISHED BY�/)S/SGf<<dl J F0 C
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all
b 3a-
3 a�
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a S
e COMMONWEALTH OF MASSY CHUSETfS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTIO`l��
MAR 0 4 2003
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION P o�
MAR
Property Address: �7 0 /�Ole S 4 /e�( edu e (�Ck ® �
PARCEL
Owner's Name: we a T— LOT `
Owner's Address: /f-/O -1" f A e.G C a uvc Ac
T; T-k-•�cr
Date of Inspection: & -g y a d 3 /J
Name of Inspector. (p ease print) I/V�� r� �[ h 4,j e,(
Company Name: W;t f4m ti- e L/
Mailing Address: n
:: _ r, "t-1 S C�a 13b
Telephone Number. cDa'
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage.disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP .
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
yPasses
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
F '
Inspector's Signature: Date: A DoZ a3
The system inspector shall submit a copy of this inspection report to the Approving uthority(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
DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
�z
Notes and Comments
****This report.only describes conditions at the time of inspection and under the conditions of use at that.
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 14 6 /� �57X6 1 (fVc�L2. Q
Owner:
Date of Inspection: � j'j
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 CUR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments: �—
�t2efr/ T, Slaw--�
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.
Answer yes,no or not determined(Y,N,ND)in the. for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old' or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
existing tank is replaced with 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.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
f
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner. CJ
Date of Inspection: $
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(l)(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
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water'supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**.Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Page 4 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: »14 `C ��
f � �
Owner: J S e.
Date of Inspection: U3
D. System Failure Criteria appli able 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 day flow
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
— Any portion of the SAS,cesspool or privy is below high ground water elevation.
_,,,,Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ Any portion of a cesspool or privy is within a Zone 1 of a public 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CUR 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.
You must indicate either`yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
- -the system is within 400 feet of a surface drinking water supply
✓e system is within 200 feet of a tributary to a surface drinking water supply
Vthe 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 CUR
15.304..The system owner should contact;hg appropriate regional office of the Department s:.
I
Page 5 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
/ C,H/ECKLIST
Property Address:
Owner: J 0
Date of Inspection:
Check if the following have been done.You must indicate`yes"or"no"as to each of the following:
Yes No
1Z'_ 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 taffies 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:
Yes rya
_✓/_ 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(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
l SYSTEM INFORMATION
Property Address: / 6 f/" 4e (�
lam'OR e
FD (s
Owner: ' W e
Date of Inspection: D
FLOW CONDITIONS
RESIDENTIAL 1
Number of bedrooms(design): Number of bedrooms(actual): v
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Number of current residents:_� J
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no):/D [if yes separate inspection required]
Laundry system inspected(yes or no):)2_'e-5
Seasonal use: (yes or no): p��a o3
Water meter readings, if available(last 2 years usage(gpd)): o
Sump pump(yes or no): /00 -
Last date of occupancy:
,Type
TRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): wd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFO TION
Pumping Records Source of information: I o-2 JQ lo
7
Was system pumped as part of the 4spection(yes or no). N
If yes,volume pumped: g--�la Ions—How was quantity pumped determined?
Reason for pumping: --
TYPE OF SYSTEM
is tank,distribution box, soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age 1M, n ed ' o ) / of Qort!
z Were sewage odors etected wlken arrivingat the site(yes or no): _T
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
TA,,Property Address• S Aa( c.e-2A
ellJ , n S
Owner:
Date of Inspection: -142
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction:_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting, evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade:
Material of construction �ncrete_metal_fiberglass polyethylene
_other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate) �Q �
Dimensions: (o L
Sludge depth: p
Distance from top of sludge to bottom of outlet tee or baffle:
m ✓�K
Scum thickness: N
Distance from top o scum to top of outlet tee or baffle: /!J�✓`�
Distance from bottom of scum to bottom off gullet tee or baffle: '
How were dimensions determined: /r A t�L -C OAL J S G�k-P �U ,�j�� e �v ` r
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels .
as rePal to outlet invert,evide7e of leakage,etc.):
W. f VL"' >C—Jv►✓i z C"
GREASE TRAP:�( cate on site plan)
Depth below grade:
Material of construction:_concrete_metal fiberglass polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: /J G S CR-R-
Owner•
Date of Inspection: 6,
TIGHT or HOLDING TANK: y(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no): .
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: � resent must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of.,solids carryover evidence of
leakagTin o or out of bo , etc.): 2 :; _ `) /� -�c
PUMP CHAMBER:AL4ate 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.):
Page 9 of 1 l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INF TION(continued)
Property Address: W 2 S Lt-f
Owner•
Date of Inspection: 0
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
eaching pits,number!Z_
leaching chambers,number:
leaching galleries, number:
leaching trenches,number,length.-
leaching fields,number,dimensions:
overflow cesspool, number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure,lev of nding,damp soil,condition of vegetation,
etc. .
02 Cr79-e� c� '
CE SPOOLS: 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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY` i(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.):
Page 10 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: �`�� � S�� "�
P
-7
Owner.
Date of Inspection: /�3
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet.Locate where public water supply enters a building.
UCH60 � 1 � �� T07
1-3
C 01
� 7
13 C,� 0't
G �
1
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(c ntinued)
Property Address:=
CS
Owner:
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water .0?/ feet
Please indicate(check)all methods used to determine the high ground water elevation:
wined from system design plans on record-If checked,date of design plan reviewed:
s,0bserved site(abutting property/observation hole within 150 feet of SAS)
!/Checked with local Board of Health-explain:
decked with local excavators,installers-(attach documentation)
/Kccessed USGS database-explain:
You must describe how you established the high ground water elevation:
4P---> v
i
\06
1
DATE: 4/�.$/.9 9
PROPERTY ADDRESS: ,• 140.-Clam Smell AA Ad
Cotuit ,Mass . .
0263.5
ECEivEO
On the above dale, I Inspected the "ptic systom a(,.;thq,$ ova addreau
Thls' aystem conslsts of the following; 1999 .�
1 . 1-1000 gallon septic tank. TOWNQFgARNSTgg�E
2 . 1—Distribution box, iri d16or
3 . 2-1000 gallon precast leaching pits
packed in stone . f
Based bn my Inrc�actlon, 1 certify the following condltlons; '
4 . This is a "title •five' septic system. (,7,8rCode )
5 . "The septic system 2s in pToper •wotking order
at the present time .
6 . Pit .#1 is 30111 below grade.. Pit # 2 is 54" below grade .
7 . It is recomme ec:.that these covers Ve raised to within
6" of grade . '
81GNATUR 71;
Name . J F. 8'a c om b e r
Jr�` • i
Company,-'J. P_Hacoigber� & �Son- 'Inc
,, •; , ,
Address ' "
en q rvA 11e j(,u-j;_Q253*2
Phone: 1SQ8� g38------- --
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P, MAWMBER '& SON; INC,
T+nkt C�upool�-LiachftoIdI
Pump+d L In;L.illyd '
Town Siwir Connictiont
P.O. Box 46' Cenlervllie, MA 02632.0066
77.5.33M M-4412
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500
TRUDYCOXE
Secretary
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
PropertyAddress:140 Clam Shell Cove Road Name of owner Donald Dennis
Cotuit ,Mass . 02635 Addressofownar: 140 Clam ell Cove Road
Data ofinspaction: 4/28/99 Cotuit ,Mass . 02635
Name of Inspector:(Please Print)Jose ph P.M a C O in b e r Jr .
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
cornpany Name: J.P.Macomber & Son T n c .
Mailing Address: B o x 66 C P n t e r v i 1.1_e_'Mass_- C12 6 3 2
Telephone Number: 5()8 7 7:5 o
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:
es
!/ Passes
_ .Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date: ?
The System Inspector all 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 oftEnvironmental Protection. The original should'be sent to-'Mm
system owner and copies sent to the buyer,if applicable, and the approving authority.
NOTES AND COMMENTS
revised 9/2/98 Page IofII
�, Printed on Recycled Paper
r
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 140 Clam Shell Cove Road Cotuit ,Mass .
Owner: Donald Dennis
Date of Inspecoon: 4/2 8/9 9
INSPECTION SUMMARY: Check A, B, C, Or D:
A. SYSTEM PASSES:
1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
V 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.
,10 The septic tank Is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
/�i5 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumphtg•more than four-dmes a yeardue to broken or obstructed pipe(s). The system MtImss--
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
revised 9/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (contirwed)
i
PtopemAddraas:140 Calamshell Cove Road Cotuit ,Mass .
owr*: Donald Dennis
D.0 of kup.ctioru 4/2 8/9 9
C. FURTHER EVALUATION tS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health In order to deterine If the system Is falling to protect tit
m
public health, safety and the environment.
1) SYSTEM WILLPASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE ACCORDANCE WH 310 CMR 16.303 (1)(b)THAT THE SY
IS NOT FUNCTIONING INA MANNER WWCK W"-PROTECT THE PUBUC HEALT"ND SAFETY CHID THE EM\a80NMENT:
'4D Cesspool or privy Is within 60 fastvf surface water
Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETVWLNES THAT THE SYSTT
FUNCTIONING W A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
IVO The system has a septic tank and soil absorption system(SAS) and the SAS Is within 100 feet of a surface water supp�
tributary to a surface water supply.
AIP The system has a septic tank and toll absorption system and the SAS Is wlthln a Zone I of a public water supply well.
Im The system has a septic tank and soll absorption system and the SAS Is wlthln 60 feet of a prlvate water supply wall.
The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 feet or more from a
private water supply well,unless a well water anaJysls for coUform bacteria and volatile organic compounds indlcstss V
well is'free from pollution from that facility and the presence of immoNa nitrogen and nitrata nitrogen Is KuaJ to or Is:
than 6 ppm. Method used to determine distance (approximation not valid).•
3) OTHER
N�
revised 9/2/98 Pasc3oru
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Impaction:
D. SYSTEM FAILS:
You must indicate either"Yes" or "No" to each of the following:
I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this
determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of.**wage imofacility-or•-eTetem component-due tto an overloaded orclegged-SASor•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 di nbu box above outlet invert due to an overloaded or.clogged SAS or cesspool.
-� s
Liquid depth in eegepeal is less than 6" below Invert or available volume is less than 1/2 day flow.
_ Y Required pumping more than 4 tiryes1p the last year NOT due to clogged or obstructed pipe(s)..
Number of times pumped-•. 7" &A)Y. 10,4
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 I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
zAny 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" to each of the following:
The following criteria apply to large systems In addition to the criteria above:
_Aj 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 Np
the system is within 400 feet of a surface drinking water supply
the system.is-within 200 feet of-a-uilwtery-toa a urfeo"r4A4A9•watar•supply •• - —
othe system is located In a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further inforpation.
revised 9/2/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PropertyAdcire43: 140 Clamshell Cove Road Cotuit Mass .
Owner: Donald Dennis
Date of Ir'spection:4/2 8/9 9
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
✓ Pumping information was provided by the owner, occupant, or Board of Health.
None of the system compoaants.haua-b an pua►pod4oFatJeast two aweWw an&tbe-rystem hasbaeol4acaiaiwg wsmal 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.
Y The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for
signs of breakout.
_ All system cornponents,Zluding the Soil Absorption System,,have been located on the site.
_ 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 to--ation of the Soil Absorption System on•the site has been determined based on:-
ZExisting information. For example, Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
I15.302(3)(b)1
The facility owner.(and.occupaats.if diffarant frnm.oxcner),wetaprnyided.with infnrmatiori,on.th&;uzparlaain*anaQca^f
SubSurface Disposal Systems.
i
revised 9/2/98 Page 5of11
l
i
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
PropertyAddraas: 140 Clamshell Cove Road Cotuit ,Mass .
Owner: Donald Dennis
Date of ktspactiort:4/2 8/9 9
FLOW CONDITIONS
RES IDENTIAL: j'
Design flow:_1149 g•p.d./bedroom.
Number of bedrooms(design): Number of bedrooms(actual): t
Total DESIGN flow 'lwcl)
Number of current residents:
Garbage grinder(yes or no):
Laundry(separate system) ( as or If yes, separate Jnspectl on.required
Laundry system inspected Qe�or noo
Seasonal use (yes or no):
Water meter readings,if available
able (last two year's usage(gpd): f�``��7i[ 9 �i441 i
Sump Pump(yes or no): /; / yV tiv� .0= 3
X4
Last date of occupancy: '�7
COMMERCtAUINDUSTRIAL:
Type of establishment
Design flow: ij gpd ( Based on 16.203)
Basis of design flow
Grease trap present: (yes or no)
industrial Waste Holding Tank present:(yes or no)A-214
Non sanitary waste discharged to the Title 6 system: (yes or no)"
Water meter readings,if avail Ie: I
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS an ource f informal ow
System pumped as part of nspection: (yes or no)Z.6
If yes, volume pumped: gallons
Reason for pumping: 141
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
_�i1 Single cesspool
Overflow cesspool
—��- Privy
4 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 d, Copy of DEP Approval
Other4FPR 4 xy
OXIMATE AGE of all components, date Installed{if known)-and source of4aformation: -• i� 7� �/ /�
ILI AW44--
Sewage odors detected when•arriving at the site:(yes or no)
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
ProportyAddress:140 Clamshell Cove Road Cotuit ,Mass .
Owner: Donald Dennis
Date of Inspection: 4/2 8/9 9
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 /O
17'-
Diameter tI/
Comments:(condition of joints,venting, evidence of leakage,-etc.) -
.Joints appear tight No Pvit(PnrP of laakaoa
S C TANK: S
(locate on site plan)
�t
Depth below grader
Material of construction:Zoncrete metal_Fiberglass _Polyethylene_other(explain)
AM
If tank is Instal,list age Js.age.confumad by Certificate ofCompliance_4/4(Yes/No)
• Dimensions:
Sludge depth:
Distance from top of �pge to bottom of outlet tee or baffler -'
Scum thickness:_ 1 1/
Distance from top of Scum to top of outlet tee or baffle: ��
Distance from bottom of scum to botto of outlet tea r baffle: Af
How dimensions were determined:
Comments:
(recommendation for pumpin , condition of inlet and outlet toes or-baffles, depth of liquid level in relation to outlet invert, structuroHntegrky,
evidence of leakage,etc.) ump tank annually . Garbage disposal is present _
Inlet Cat outlet tees are in -111 arP T i =tti d 1 PVP1 at nni-1 et
n
evi ence of lea a
GREASE TRAP: (-
(locate on site plan)
Depth below grade:W�
Material of con3tructionIv-dconcrete4-etaL4 fFiberglass.f/�Polyethylane�/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 tea or baffle:A)W
Date of last pumping:_M
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.)
Grease trap is not present -
revised 9/2/98 Page 7ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 140 Clamshell Cove Road Cotuit ,Mass .
owner: Donald Dennis
Data of Inspection:4/2 8/9 9
TIGHT OR HOLDING TANK:yav�. (Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
Depth below grade: NA
Material of construction.4,4concreteV,4meta[4aFiberglassk&PolyethyleneVAother(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes42,1 No/4
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:z
(locate on site plan)
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, etc.) — —
Distribution box has two laterals No evidence of solids rarry
over , No evidence of leakage intn nr Out of the r)ictrih„t; nn hnv -
PUMP CHAMBER:'t_&/4
(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.)
umD chamber is not present -
revised 9/2/98 Pages orii
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddress: 140 Clamshell Cove Road Cotuit ,Mass .
Owner: Donald Dennis
Data of 1"spe`So": 4/2 8/9 9
SOIL ABSORPTION SYSTEM(SAS) �0D0/lrs &-Al 1;a.9'ioNft.
(locate on site plan,if possible:excavation not required,location may be approximated by non-intrusive methods)
If not located, explain:
A
Type:
leaching pits, number:
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.)
Loamy sand to coarse sand-,
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: 44
Indication of groundwater: VIg
inflow (cesspool must be pumped as part of inspection)
o I'�
Cesspools are not prPqPnt ,
Comments:
(note condition of soil, signs of hydraulic failure,.level of ponding,condition of,vegetation, etc.)
Cesspools are not presant _
PRIVY:,db04
(locate on site plan)
Materjals of constr ction: ,(�/9 Dimensions:
Depth of solids: 441V
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.)
Privy is not :scant
revised 9/2/98 . Page 9of11
a.t
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM
PART C
SYSTEM INFORMATION (Q"Tdnued)
Prop-tyAd&—: 140 . Claglshell Cove Road Cotuit ,Mass .
own4r: Donald Dennis .
DZU of trne�: 4/2 8/9 9
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent reference landmarks or benchmark&
locate all wells within 100' (Locate where public water supply comes Into house)
r ,�.t n9,w� �, •3,n0•� h� �' 0 hi,
i
I
I
•�� ��`
revised 9/2/98 Page 10of11
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 140 Clamshell Cove Road Cotuit ,Mass .
Owrw: Donald Dennis
Date of Inspection: 4/2 8/9 9
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep _
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
i
Estimated Depth to Groundwaterk Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed.Site(Abutting propert bservation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
I//Checked
Checked pumping records
local excavators, installers
Used USGS Data
Describe how you established the,High Groundwater Elevation. (Must be completed)
Used Water contours Map .
Gahrety & Miller MDdel
12/16/94
revised 9/2/98 Page 11of11
nrnrn.—n+rs+-- — r*rmr•nsmnr�n+a+rrrrrmr:r-r�r�rnrn'n esrrn:u rra�rnLrt ras+ .. 1
SO
TOWN OF Barnstable BOARD OF HEALTH l
SUBSURFACE SEWAGE DISPOSAL SYSTEM I NSi'F.CTION FORM - PART D •- CERTIFICATION
�•••T••t^T••.••.:f—P.it/.^.VTR IS TRI'tI.'TJI TT�IITIT.ITT'1'1�!.'1 r'{VTR'>iIR101—TRfRRS01'RITRIR'iRw'IiTS arm n'•mr+r�sm�r'+rr+r.•.r.�rr•r-ter•—..�
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 140 Clamshell Cove Road Cotuit ,Mass . '
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Donald Dennis
PART D - CERTIFICATION f
NAME OF INSPECTOR Joseph P.Macomber JR.
COMPANY NAME J. P.Macomber. & Sogir Inc .
COMPANY ADDRESS BOX 66 Centerville Mass . 02632
Street Town or City State LIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578
A
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj 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 net
011 System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 16 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have con Lrcted has found that the system fails to
Protect the public health and the environment in accordance with Title
6 , 310 CMR 16 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
"r cc
Inspector Signature Date
One copy of this c tification must be provided to the OWNER, the BUYER
( where appI i c a b 1 e ) and the BOARD OF 112AL1'il.
* If the inspection FAILED, the owner or.11,operator shall u d
within one year of the date of the inspection, unless allowed ortrequired,
otherwise as provided in 3.10 CMR 16 . 306 .
partd .doc
i TOWN OF BARNSTABLE
LOCA. ti. enx SEWAGE # l b�
VILLAGE , ASSESSOR'S MAP& LOT 6o�s:.O
INSTAL I;ER'S NAME&PHONE NO.
SEPTIC:-TANK CAPACITY
LEACHING:FACILITY: (type)c� a`F' (size),_l?�U a
NO.OF:.'$EEDROOMS L
BUILDER OR OWNER
PERMTTDATE: 1 13 fTS� COMPLIANCE DATE:
Separation-Dis.tance 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) Feet
Furnished.bZZ
o - O -P r
cr o
Fzs.. .1.ac?.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirativtt for Dijpuuttl Works Tonutrurtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair (�) an Individual Sewage Disposal
Systtenj at: p // ,,p/, ,p ARCO..
n
Location-Address r Lot N
owner Add es
w -.� tom- Mv.U.Ex
Installer Address
ype of Building Size Lot..._Ij 4000. ..Sq. feet
Dwelling— No. of Bedrooms-----________/--_-.__--_-_-_--_-_--._---Expansion Attic ( , ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) .
at Oth r fixtures ------------------------------------------------------
W Design Flow......_`/.0...........................gallons per person�per day. Total daily ow........5Y�40......................gallons.
WSeptic Tank—Liquid capacity 0. gallons Length_�S•_S___ Width-y..�- Diameter... ............ Depth.. 0
x Disposal Trench—No. .................... Width.... ....... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---------Z------- Diameter------I.Q------- Depth below inlet_._.S,.S... Total leaching area.—W-1.6.sq. ft.
Z Other Distribution box N)
a Dosin nk ( )
Q ...�..............Peercolation Test Resul s Performed b ... )
Date... �Q/ _....�.._..
„a '( �i est Pit No. 1.._._._Z..minutes per inch Depth of Test Prt._____. Q..... Depth to ground water.--.., ..........
C
G%, 0 est Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
� W�� ------------------------------- - --•----•---------..._...--------------•---.......--•---•-•----
�ODescri tion of Soil... L._ Q 0 r JW�-.-----3 ------400:�--` A�.. .
x
x --------------------------------------------------------------------•------•--------•---....---------------- •-----•----•--...-----•------•......----------- .....
- ----------------- /�
U Nature of Re airs or Alterations—Answer when a plicable._.. .. V. _
......3.......R8l� ...
Agreement: `�� lgG(,L1 ,94w E A � AmA* ysr� ��"� � �
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Comp�lia`nE
issue y the board of health.
Signed . I(.... .................................................................................
Dace
Application Approved By ............. -�.... ... .............................................--- ....... '....Date`'"
Application Disapproved for the ollowing reasons: ..................................... .. .........................................................................................
...................................................................................... ... ..... ............................................................................... . ........................................
yDace
Permit No. ------.�..��:......F 1 _.............. Issued .................:c --...�...�,.�...--:: _
Dace
O
No...5.. Fizz......i.4.C ........
THE COMMONWEALTH OF MASSACHUSETT S
83 �a
BOARD
O D OF HEALTH
TOWN OF BARNSTABLE
Aliphration for Diripniiul Worlai Towitrnr#iun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: J,
..�` G�� ns � Gov r�v ss s.. -- -:S ,_. 4 /d
+bra. ----------- /` A --- . ..
ocat�on Address --or Lot N .. M...
v
Oa ner Address
An-)>!`S 90CL E/"� /�__L'��!�� �l, S�AiD la1/Crt/ /YI� p25�3
•--•---------------• --••-----------•---•-•----•-•--------•----.-..------ -----------------.-.----•---•---•-------•--•--
Installer Address
VType of Building Size Lot.__ / J_'200 ___.Sq. feet
,.a Dwelling— No. of Bedrooms............. ...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons___...__-___-__-_-__-__.____ Showers ( ) — Cafeteria ( )
a' Other fixtures ............................... ...
W Design Flow......_//.0..........................gallons per person per day. Total daily flow--------c/�_......................gallons.
04 WSeptic Tank—Liquid ca acity/�O0- alIons Len th_�-- Depth'---- Width_�. �- Diameter---------------- - �-�-.--
Disposal Trench—No. .................... Width.._.._..___.__..__.. Total Length......._......... Total leaching area....................sq. ft.
x _
Seepage Pit No.........7....... Diameter------.�Q__----- Depth below inlet..... :.. ..... Total leaching area 03 -6.sq. ft.
Z Other Distribution box Do
sin /I /
aPercolation Test Results/ v Performed by. A4AA..._?,A.Xi__s.._................... Date_._/ ?......__.
,,.a est Pit No. I.......7.__minutes per inch Depth of Test Pit__ _... Depth to ground water....... .........
GZ4 est Pit No. 2....:..........minutes per inch Depth of Test Pit.................... Depth to ground water........................
I� -•------•---------•------•---•---•......................•••--...-•----.....•••.............--•-•-- -•••-
Description of Soil_.� F-r= oe�._..2U..:. �1t1 SQT4,-----..IEk-•----=. C? �
�!�. ��t!v► �" 1 -- .......................
x ••• ........................... ................................................. ---------------- -- ............................................................
U Nature of Repairs or Alterations—Answer when applicable__. ._.._� 1 �?__._._ -------- 8 ,ruYl.>_. -
S1�PJ.u�...S 5 ?S �To....AO.....up6ajol_%_ .....I/V/� ...?,,W---------A,86_'C it AL-.....C-k:�Ao�f a�T
Agreement: TD Ao-_6#i nAT2�
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance,has been,issued by the board of health.
SignedX......................Rr............... .............................................. ...........-............................
D a[e Application Approved B .... •.......... ......... .....-a...
Dace
Application Disapproved for the following reasons: ... . ............................................................................................................
....... ................................. ............ . . ..................... ........ ..... -- . ................................ .-- -- ...... ......................................
•�
Permit No. ...... .5"�....-~-----l l G' ................... Issued .................. -..-....1.. ...-.
u Dace
TOWN OF BARNSTABLE
LC�A'I'l�:V f� f� Po_&� (anm- QQ SEWAGE #
VILLAGE . CAV ASSESSOR'S MAP & LOT 60S- ® 10
INSTALLER'S NAME&PHONE NO. .u�e_ ,�
SEPTIC TANK CAPACITY 1000 eLA_ 2S
LEACHING FACILITY: (type) (size) to O o
NO.OF BEDROOMS_
BUILDER OR OWNER p' A S 1d.e.,�19i
PERMITDATE: COMPLIANCE DATE: .10
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) Feet
Furnished by
4 �
e �
0 a �
v� CD
10
n �
C-i � �,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cleztificttte of Comylianve
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (��)
..-- ............ .. .................. .. -------------------------------------
at ... ..y.. ...... ... _.......- �02 .....P. ... .... . ....... ....
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .._.C�..�..------�-.577..._... dated ..................
.............................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE - ..`.."..... �'.........! 7 ...... .... Inspector E . ....� _...........................------
._-------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No...l..-`.?------..!_�.J FEE.....l zl--�J-----•
Permission is hereby granted ..(�I 1 F �-1 r=................................................................
to Construct ( ) or Repair '(>C) an Individual Sewage Disposal System
at No. - n - � .......
Street
as shown on the application for Disposal Works Constructio�Per a.�No./.S_;_.11s..-- Dated..... �►�1--.--.- _....._.._......
_.
/� � � (� - --- Board of Health
DATE----••-----•-------------(-1-•-•,--•------•----------•----------------••-• >
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS - �'
i v
C415
Gel 14
- >L ,
�. w
• f�J ,„ate.
y
. q
No.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
V" - ... ...�.f .. ' ---------OF........ E..�u A-/-.....................
�gO Appliration -fox Ui,i niia1 Worms Towstrurtion rruiit
Iq� Application is hereby made for a Permit to Construct ( ) or Repair ( ) an- Individual Sewage Disposal
pSystem at:
5 � tG7l 1--•••- •---------•-•-•-----------••--•-•-----------•------- _ --------------------------
�----•--._...Loc 'on-Address ---------------••-•--•---•••-••-•--••----•.. Lot No.
etc.�---------------------------------- --------------------------------------------_..
O ner Address
j Installer Address
d Type of Buildin Size Lot....��/.� ----Sq. feet
Dwelling No. of Bedrooms-----------------3__-_____-______---__---_-Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons- _____--.________-.-_-. - Showers ( ) — Cafeteria ( )
P4 Other fixtures --------------- --------------- -
W Design Flow.............�T___-..__..__.__.____.____,.gallons per person per day. Total daily flow____-__-___-3_-�_6---------.---------gallons.
WSeptic Tank—Liquid capacity//.-OMgallons Length---------------- Width---------------- Diameter---------------- Depth----_._----_.
x Disposal Trench—Ng_____________________ Wid h_____---__--__-----_ Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No......../__......... Diameter_h.o_B_6_--_ Depth below inlet-_ tdN�__.Total leachin�tr t.
z Other Distribution box ( ) Dosing tank �f�7'��
a Percolation Test Results Performed by-------------------------------------------------------------------------- Date.............._.-c--- .�
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...hole �.fJ_/�
f14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------.._----.-.--.
9 ------------- •-•- _-
Description of Soil "--- F - !�/ _`'i a P� .._
U Nature of R airs or Alterations—Answer when a ------------- ------------------------------------------------ _-.--.-_-._----.-._.--.-_.-....
PPlicable-
----------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- -------------------- -----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Cod en Th unders• n d further agrees not to place the system in
operation until a Certificate of Compliance has been •ssu b t boa f health.
-
Si e�d ----- -•••--•------_. . ._----- --- - ------ -- ----- ---..
Date
Application Approved BY--------../ -- ------ -•---•-- Da-�7
Application Disapproved for the following reasons: •---• •---•-----...... --------- ------- ..........................................................
�d I2 --- - -•--------••-------•----------
L Date
--------------
.-.--�1 •� .••. zt Issued-•--.--�_-�at ----7__/________________
Date
NO.___;R_�3' T_--- Fizic Zo................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
> i--------OF......... /-e.....
AV;dira ion -for 4:1_qpotti Works Tonotrnrtion Prrulit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
....................................................
Loc n-A dres or Lot No.
.............................. ...................................................................................................
O r Address
q Installer Addresit
U Type of Buildingy� Size I1ot.....
34-4-ft._._Sq. feet
Dwelling No. of Bedrooms_..............
-------------------------Expansion Attic ( ) Garbage Grinder ( )
p`l-, Other—Type of Building ____________________________ No. of persons___________________________ Showers ( ) — Cafeteria ( )
0.' Other fl.Itures .......................... .
W Design Flow________________Q__________.__.______ Mons per person per day. Total daily flow___._______�_f��________ -..____
g -- g P P P Y y gallons.
WSeptic "I`ank—Liquid capacity._f0_0 allons Length---------------- Width................ Diameter----------.----- Depth................
x Disposal Trench-N}_____________________ Wid li_ "=___.__.___-__.. Total Length----------------- Total leaching area--------------------sq. ft.
Seepage Pit No........!.___:_____ Diameter_&AdA___ Depth below_ let_. otal leaching<ir a.__._- ________sq. it.
z Other Distribution box .( ) Dosing tank ( ) (� !!�Cr - / 7AI
aPercolation Test Results"""' Performed by----------------------------- .......................................... Date..................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_._._________-_-__-__---
(� Test Pit No. 2................minutes per-inch Depth of Test Pit.................... Depth to ground water__-____________-______--
OWx - C -
. ' "
i----------
Description of Soil-----. -- ` '" - -..... -
---------------------------------------------------------- _.._____-•-- ___ .......
..............................................- -----------------------------------------------------------
W
U Nature of Repairs or Alterations—Answer when applicable---------
___ -
•-•----•-------------------••-••_..••---------•-------------------- .
Agreement:
The undersigned agrees to install the aforedescribed Individual S wage Disposal System in accordance witli
the provisions of Article XI of the State Sanitary Cod — h under-s' n d further agrees n to place the system in
operation until a Certificate of Compliance has been 'ss b t boa d health.
Date
Application Application Approved By------ -- - ------ ------..... --frle!' 1. .......
Da
Application Disapproved for the following reasons-------------------•--------------------------------------...------------•---------------------------------------
.....................................................-•.__-•-•-•-------•---•-__._.___________•--••_____..-
---------------------------------------------------------------------------- --------------
Date
PermitNo......................................................... Issued.........................................................
Date
t
THE COMMONWEALTH OF MASSACHUSETTS
v
BOARD OFJHEA TH
1.. ...........OF......15*44A4, ....................
101.1rrtifirat a of Tomphaurr
THI IS 7-0 ERTIF at the In -v•dual Sewage Disposal System constructed ( ' or Repaired ( )
..«.
by __ ___________'_..-- / `� teT /
w1ns
s
at-`----- - ./�``- -- ___1..�% m!�--- _ .... ........:"_d t�' "-` 'lei l
has been installed in accordance with the provisions of Article XI of The State Sanitary Co e.ps described in the
application for Disposal Works Construction Permit No._____-—-_ _'�__............... dated.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................--•-••-----_.... Inspector....................................................................................
�J
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Of HEALTH
....
OF.-........ .�-: 1... .r ,/!r_-�........ ,-zt
No
�i��>��ttl ork,� � �tr�tr�ion �rrmit
Permission 's hereby granted--....�'� � I =
to Cons t ( �rr Repair ( 14an ndividual a age-Dispo. I S em -
________________
Street
as shown on the application for Disposal Works Construction it ___ ____ ________ Dated_ / �z/7� -•••..••
{
...... ................................
ba ealth y
DATE__ ---7 -•__________ _____
6/FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
"
TOWN OF BARNSTABLE
yoFteeT�w
®4ie % �O� OFFICE OF
s s
saaasTs>iz BOARD OF HEALTH
.
9pp 1639 `�+ 397 MAIN STREET
�f01IpY�" HYANNIS, MASS. 02601 May 31 1974
Mr. Elmer J:: Roka
Clamshell Cove Lane
Cotuit,�'Massachusetts
Dear Mr. Roka :
Your request for a variance to relocate the
leaching field 120 feet from the well on Lot 14,
Clamshel•1 Cove Lane, Cotuit, has been approved by
the' Boa-rd of Health.
,This system must conform to the other require-
ments of Article XI of th t to San'tar Cod .
R bert L. Childs, Cha—l'rban
E�
Ann Jane E hbaugh
Gerald W. Hazard, M. D.
TOWN OF BARNSTABLE BOARD OF HEALTH
mm
• �4
•
' ¢•, .�-. .. r�'', � .. ,�L ' a r `,�ra i r l- r.. -•' # 4 Y= C' a
May 3l
f F tY 4
ole
41
r_ ;. it r'• E"{<. ' a L i J i �' 4 r`• _ .r s - •'4y�, Y I+ 9 �' ` � •y� y � '
•.•rrilIIler¢ J• .�Roka:t' �'4r,,� t *C.a _� * *'•i T*
CiamaheIl. .Cove• Lane
Cotuit Massachusetts
Dear` Mr*', Roka i
+/� s`E 1'�.\ } .fv,.a ` r r J:' �. '• �`,. �'A ! , i tJ .
Your recjuest fog a .variance to reiocate the
"" �; t • . 6 ',.leaching f1d' d €'iset' fro they; re1�.+ o» Lct 14, f
m,�hell Cove i4ne• Cotuit►,'has been:;approved ,by,
r ' the Board Of`Healih r ,Y
h
4 4 Y J� � rR A a - }{ f• • '. .'L, r5 �. ` {t 1 i Y
Ths'system mubt .conform to the .other``requixre -
of article<,Xt.of the,'State' Sanitary Code
�i 'a• a r '•v + � fF ,€r - T �-0F ° s 4 '��', - ,P •.-.^ �.V s �t ,r.4..s` P _
'_ •°,� , • Robert
f '
L: Ghilds Cha rman 3y
D , - ,�-.'., Jr .} 7� ,.
r r
-Ann Jan Bshbaugh
r,4 y ,-. ^y , t,� r R t�..� `} ` > - .fYYiS.•• :nor a • r y !
x�' } v •r, r r. ,.•.E a`,$. a C ,E f ��� Varr a.LL:ir, a Haza v M.* Drc-.. -y., i.} o- s• :y;;r'L v -v,, a+. ',d, ,. �# a t T a t
�• a TOWN OF BARNSTABLE BOARD, 4F HEALTH
5 ', .. - r _ +':y.`� �� S�'� a� ry�:%,:+ �}, 7.Q 3' .�.•y '�,t y a 'v [� s .:rd n t
r T i .. J a�:� t 4 4� .a � - y '� ¢ r_ r- 1 t .: rgt}#.E f .• • c
<� S `�` w. fJ r` b� .yr.'� .� �Y -• ..r _ e + E } y < t �• � F t4• e �
f 'Z.j.�• _ r � i �l ^. aa,' ,1 ) � 't .�'- ,,Y � 4 t y � � `' f .,"..� ,t.,3 a .i�,, i,
'x rr .�-. � , �.. T ar. � t � ,t i` " � �' r 'f J 't'� Y•� ♦ s
i _ ry. .Y ��s. t `t z a n• �`'•� r:"rs, h s,rr,a•ar L
[ •�.': � r:Y ;4, J"�^.; .r 'r T.,"'..� �'". x �!;^ � � . t, ,'a �.I 1 C� 4 , r i.
1y � i ., ,^ - '+ t� .�,• `'y � �`+_• t it �Y,..:c r r
- a� �• 'r . .. � ., x'`t. L +y A a i :!; .. 't.l t '�>� .n� ` -:� �¢, ,
Memo from F-LMP-R
KA
1-7
'70 Z�
All
'7 44�
Memo From ELMER ROKA
J'
' Y `TOWN OF BARNSTABLE
LOCATION 1L EWAGE #
VILLAGE�r9 1 u� ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY 16ts-0 C4ALLeti f
LEACHING FACILITY:(type)^4: -fl A& i>I'�lsize)�Y(a/
NO. OF BEDROOMS PRIVATE WELL PUBLIC W TER
BUILDER OR OWNER �(�
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
I v +a �
6�
i
�.
I
3�
����
�, � _
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UhNtKAL NOTES
' 1.REFER TO NOTES ON PRIOR PAGES. O ;
DOOR SCHEDULE R NOTES
TAG I W. JK IMAFQ MODEL IaEUARIts �/ v l.i�(�J`^
Ot P-P 6d AIAERSDN FNt19pSS mm WNITE I
G! 2'd. 6d NUNTrNGTON 2PANEL SNAIQR '
O➢ I 7d I 6•d NUNTMGTDN 2PANEL SNAKE
1/ 7- lrC NUNTWGTON 2PANEL SNAKER
tJ 7d — KWMGTDN 2PMEL SNANER
// 7d Cd TBO TBD
t5 Sd 6-C TSD TSD N
1.ALL NEW INTERIOR DOORSTOBE PANTED.
oIf
WINDOW SCHEDULE 8 NOTES
�`(If0 f
TAO W. N. 1 MARS. Imme. REIAARKS '`•
E -. ./ ANDERSON JAWZ - -
BREEZEWAY _ -
�2
NEW WO.STEPS
EKTNG.P.T.DECKTJL PRESSURE 2
OB WASNED 6 SEALED.INSTALL NEW P.T.
NAHDRAILTO MATCH NEW
THROUGHOUT.SEE All FOR SPEC.
NEw Sm CH NEW ROUGIL
.-. EXTH BENCH D SHOWER 7WERED
ACCOMOG. VAC D--NCKUCT LOWERED
TO
ACLONODATE BENC1l
t• .+:
CENTRALVAOVUMTONAVENWE J,O9 i•^ 1 f
CONNECTION IN GARAGE J ON 2ND CNiRL
FLOOR
STEPS TO NAVE NEW CMPET.TsD.M
OWNER
x GUEST ROOM - BATFIROOM -
- 13 1 '
T.B.R"-LOCATED
PROSE 1N WµRFOR RA�tTHSTAiR AC GRILL
PRONOE DOOR FOA ACCESS
GARAGrTm-
E
`• 1
I I `
!, LOCATgaI OF ATTC ACCESS NATCN,
NFILL NEWWA{L 15
i
F-11FIRST FLOOR BREEZE WAY PLAN
' SCALE. va =1-0• F-.,-1 SECOND FLOOR GUEST ROOM PLAN
' SCALE:1/4•=1'-0'
KOTCI•IEN RESIDENCE _ e. lnfoCworkshopapd.com
555 8TH AVENUE SUITE 1509 t. 212.273.9712
140 Clamshell Cove NEW YORK,NY 10018 f.212.273.9713 BREEZWAY/GUEST ROOM PLANS
Cotuit,MA 02635-3419 OWNER CONTRACTOR ARCHITECT OF RECORD CONSULTANTS 1 04/11/03 OWNER REVIEW
Patricia Kotchen UCI Corporation 2 06/18/03 REVISIONS CONSTRUCTION Al
15Gilbert Hill Road Walter Unis 3 0720/03 FOR CONSTRUCTION DOCUMENTS
Chester,CT 06412 218 West Main Street DRAWN ADK Hyannis,MA 02601 BY:
CHECKED BY ADK A n
CONSTRUCTION SYMBOLS&NOTES
1.ALL EXMM WALLS AND CLGS.TO BEPAICNED.SIGY COATED.AND
ED,PAINT
2.ALL E%T/NG.BASEBOARD.DOORAND YIN00W
CASING TO BE REMOVED.REPMCE VTH NEW AS INDICATED
ON ELEVATKNS.
2.A LICENSED PLUMBER WILL PERFORMALPLUMSNG WORK
.. INCLUDING OCTENDING GAS LINE TO NEW RANGE LOCATION.
4.A LICENSED ELECTRICIAN WILL PERFORM ALL ELECTRICAL WORK
CONSTRUCTION SYMBOLS&NOTES
1
®EASTING CONSTRUCTION
f 2
i N+
I ®NEW CONSTRUCTION
I cG WINDOWTAG
E]GNC.P.T.DECK T.B.PRESSURE
WASHED&SEALED.NSTALLNEW P.T. ;
HANDRAIL TO MATCH NEW OA DOORTAG
THROUGHOUT.SEE AT.I FOR SPED I \
.t' - - '? -„�; _---'u.:'-... <»•+`- - z - 2.DO HOT SCALE DRAWINGS.
2 I MNGANY D6CREPANOFSTOARpOIECTSATTEMION
MMEOU7ELY.
].MATCH M(TNG.WALLTH1CIOIESSEsVIF.
1 II DOOR SCHEDULE&NOTES
TAG W. H. MAFO. MODEL REMARKZ
18 Vd I HUNTINGTON 2PANELSHN(ER
NEW CAM+ET III 17 S-I HUNTINGTON 2PANELSKWJM
15 Vd HUNTINGTON 2PANELSHAKER
MASTER BEDROOM _ 18 E-C HUNTINGTON 2PANELSHAKER
d ® BEDROOM 'A BEDROOM 20 Vd HUNTINGTON 2PANEISHAKER
t ® 21 V-r HUNTINGTON 2PANELS"MR
22 S-r HUNTINGTON 2PANEL SHAKER
2S S-Ir HUNTINGTON 2PANRLSNAKER
21 V- HUNTINGTON 2PANELSHM(ER
fL`"�""•=•+: NEWOAKFLOORTW _ 25 V- NUNTWGTON 2PANELSKAKER
17 III ?e Vd HUMWGTON 2PIAl0.SHAKER
? _ 27 Sd HUNTNGTON 2PANEL SHAKER ,.
25 1 1 Sd I HUNTINGTON 2PAN0.SHAKER
I I I 29 VC I HUNTINGTON 12PANEL SHAKER I I .
-- - 1.ALL NEW INTERIOR DOCRSTO BE PADnED.
HALLWAY
FKTNG.POST TOREM.AK ' 24 ® NEWWKFLOORTHROUGH /, r(TNG.OPENING TO HAVENEW CASING
TO MATCH NEW THROUGHOUT.NO DOCK WINDOW SCHEDULE&NOTES
TAG I W. IN. MAFG. M000. 1 RE MLS
22 D l' A:1?AHOERSON —51 1,NAHSw
LINEN CL
26ON _ - - _
•- •. NEW HANDRAIL■BAULESTRAT ES.OCTAIL - -
TOFOLLOM.n1, - -
• ..TAIL NEW CHROMETRK ON TUB. .
E1(TNG.TUB TO REMAIN.NEW IOICIER BATHROOM'. -
VES9.ESNG(IL WALL fD(TURESONNEW Ar
_ - CLOSET
I NEW CARPET - .ROUGH.SEE PLUG SCNED FOR SPECS.
E]RNG.CENTER LNE OF S W TO RELMK - - -
MASTER BATH WALK-IN-CLD,SET — _ 1
2
I lie,
Lj
III 1 � 1
CLOSET BY OWNER -
8
F TI SECOND FLOOR PLAN
SCALE 1/4•=1'-0'
e. info CaVmfthopapd.com
KOTCHEN RESIDENCE 555 NEWY RK,AVENUE.10018E 1509 1. 212.273.9713 SECOND FLOOR PLAN
NEW YORK,NY.10018 f. 212.273.9713
140 Clamshell Cove 1 04/11/03 OWNER REVIEW
Cotuit,MA 02635-3419 OWNER CONTRACTOR ARCHITECT OF RECORD CONSULTANTS 2 06/18/03 REVISIONS CONSTRUCTION
Patricia Kotchen UCI Corporation 3 0720/03 FOR CONSTRUCTION DOCUMENTS
1S Gilbert Hill Road Waller Unis DRAWN B K
Chester,CT 06412 218 West Main Street Hyannis,MA 02601 ZREC-TTD5 8Y ADK w ^
CONSTRUCTION SYMBOLS&NOTES
1.ALL 8(TNG.WALLS AND OLDS.TO BE PATCHED.SKIM COATED.AND
2 PANIm.
w1 Z ALL EXTNG IN.BASEBOARD.DOORAND WINDOW
CASING TO BE REMOVED.REPLACE WITH NEW AS IDVATED
ON ELEVATKMNS.
A A LICENSED PLUMBER WILL PERFORM ALLPLUMBINC WORK
INCLUDING EXTENDING GAS INETO NEW RANGELOCATDN.
..A LICENSED ELECTRICIAN WILL PFRFORMALL ELECTRICAL MORN-
CONSTRUCTION SYMBOLS&NOTES
EXISTING CONSTRUCTION
EXTNC P.T.DEOKTA.PRESSURE
WASHED a SEALED. NSTALL NEW P.T.HANDRAIL TO MATCH
NEW TNRWOHOUT.SEE NU FOR SPEC.
®NEW CONSTRUCTION
O WINDOWTAG
ODOORTAG
1.DO NOT SCALE DRAWNOS. ..
�-.�:`�': :•^=v'= b _ .. 2.BRNGANYDEiCREPANCIESTOMPIILECTSATTENTION
bIMLI-DITELY.„ P J.IMTCXEXTNC.WALLTIOCIONESSEB.VIF. -
aF.
NEWCABINETS&MANDTOKAYE rQ DOOR SCHEDULE&NOTES
SHAKER STYLE OVERLAY DOORS a '� NEWDISHLVASHERa SNKOHNEWROUGM. TAG W. K MAF4 .MODEL REMARKS
FitONTS.FNISM TAD.BYOW„ERt_•�= Z.P , 0. �/L��1 N E COW/. NCE
SO 6-C AHOERSON FWQBB
DONND W
RAFrON�YROVGIL
8-T JQ vWGSCHEDSSEEAPR-a 11 - WHf7E
STEEL BE7ONSWNGRT PRIMED
10
I1 T-C Bd HUNTIN(TPV 2PANELSINKER
• ` h x DINNG ROOM 12r T•P 68 NIINi1HGTON 2PANELSHAKER
NEW t` LIVING ROOM I,� a ® 29 rd S-a' 76p TED DIVIDED UG
SURRUNDACERA6NTI.EED . ® S i1r 1.ALL NEW INTERIOR DOORSTOBEPANTEO.
SURROUND 8 NEW NAANNTIE AL
Au KNEEWALLTO HAVE STONE CAP, .
TO MATCH COUNTER
' = -- NEW OAK FLOOR WINDOW SCHEDULE&NOTES ..
RAISED KNEE WALLA RAISED DOUNTER. KITCHEN TAG I W. 1 H. I"AFC - MODEL RENNARKS
--_•� 4�2 = A 4'Q P-0S AINDERSpI CW24 PR IN EXTNGOVENNG
1O J ) NEW FRIDGE a DOUBLE OVEN T.R.FLUSH
tat
b'-P---}•7•,Z �1'�'�Z•T = IN WALL NEw%-B.D.B DESMH RL .
1 1 '` NAEFEW PULLO TPANTRNER
DOUBLE 29 _ ,F T.6 NEW DOOR NEEDS TO BE ORDERED.DOOR -
FRIDLL �� - TO HAVE ONDED UGHTWICLFARGLASS.
2
• PAHEFNY r vANTRY PANTRY <�, .
NEW 12X 12 TILE THROUGHOUT
EMRY.
WD.a76EFLOORSTA.LEVELSEE
STONE LE SCHED.FOR SPEC _ I -
NEW OAK FLOORTINOU NEW FBER CUSS
SHOAML
.L_ SITTING - — _ DRY
1 I.
WASNEA a VENTED
W _ JFM
BATHROOM® 1T I M® 'I NEW ER ON NEW ROL" -
T.B.INSTALLED
/ .. .. .i _.I - TO NMTCX TXRWGNOUT SEE -
NEW DECK a RAIL DETAILS a MATERIALS
AL1FdN SPEC
.. HEW WASHER a DRYER ON NEW ROUGH.
DRYER T.S.VENTED TOOUTSDE -
0 0
VANT'XEKMTE.36IL NEON
BREE2EWA _ NEWROU ROUIX ..
- - +:-_"s.,.r..;• - A MUDROOM.IND.a TEX FLOORS T.S.IEVEL
I f / SEE STONERLE SCHED.FOR SPEC
NEW FUL HEIGHT BOOKSHELVES.PHED.
FINISH
.1 TFIRST FLOOR PLAN
� sca�E:va•=r-0-
mnrksbc
s^.j a. infoQWorkshopapd.com
1
KO'TCHEN RESIDE14CE 5558THAVENUE SUITE1509 t. 212.273.9712
NEW YORK,NY.10018 f. 212.273.9713 FIRST FLOOR PLAN
140 Clamshell Cove OWNER CONTRACTOR 1 04/11/03 OWNER REVIEW
Cotuit,MA 02635-3419 ARCHITECT OF RECORD CONSULTANTS 2 O6/16/03 REVISIONS CONSTRUCTION p
Patricia Kotchen UCI Corporation 3 0720/03 FOR CONSTRUCTION DOCUMENTS
15 Gilbert Hill Road Walter Unis DRAWN BY: ADK
Chester,CT 06412 218 West Main Street CHECKED Y ADK
Hyannis,MA 02601 DATE: 10 APR 2003
Sc o! Street
C TUIT
FOUNDATION (Existing)
/ esset
E1.=28.4' EL=26.8' t<,</AQ pp°c, o0
E1.=26.8' E1.=29.9' Concrete Riser (H-10)
t Finished Grade
Finished Grade •- • � P
..
4" SCH. 40 PVC w
El.=25.9' 4" SCH. 40 PVC y
.~ Shoestring co
r SLOPE .02 (1/4 PER FT.)
Fill Fl1I washed s�one/2� EL=25.5' / Ba �v
Y 50
0
'' ,•; SLOPE .02 (1/4";-PER FT.)
, LINE �° E1.=25.6' .. .
10 0 O
i4a °p 0 0 0 0 800 o0
.' EL-25.5' MIN. 4' �1.=25.2' 6' _ moo' w/shed 1-1/2"
T EL-24.6' o 0 0 0 0 0 Na s�one EI-=24.5 °
:.:. ..•.
.' 1: _ 00
E1.=24.8' 001a, 0 0 O Ob
0 0 °o�' 0 0 O l LOCUS
8.5 El.-25.0' g� o /
_.. Distribution o` 0 0 0 0 0 ° ° off° 0 O
SEPTIC TANK (Existing) Box (H-10) g 0 0 0 0 °° g°
0 0 °Ao l 0 0
1,000 GALLONS (Proposed) 2�`- s' 2• EI.=19.1' o0 o
(H-10)
0,
LOCATION MAP
(1 200o'f) '
Leach Pit #1 (Existing)
(1000 gal H-16) Leach Pit �112 REFERENCES:
(1000 gal U__• vT ff,
PROFILE OF (Proposed) Zone RF
SEWAGE DISPOSAL SYSTEM
- - �i Assessors. -Map 5 Parcel 10
NOT TO SCALE FEMA Zone C (see plan)
Pon el # 250001 00021 D
Revised July 2, 1992
"I82 N/F AP Aquifer Protection District
Mean Low Water El.= 0 / ' John D. & Katharine k. &
• P "Revised�,
Mark C. Beyer �
as per
Revised Groundwater Protection
Overlay Districts" plan Dated April 1993
I I I
+32-46
Deed 5558 129
ry
o {--o.ez +41.26
o� / / ,.ee �� .• / // / / //A/•
Design Calculations. �,
Perc Test. ./
11 10 94 10:00 AM / / ✓ // ( / '
TestDate. 1 -¢" .+3
6 • , / > / / 1
.: Health Agent.t. Edward Berry �
g Septic Tank. / �'' o // ♦ / c� I I V\ 3szo 1 o,
Town Reference: No. P-8310
P vJ
/ PR OSED I �
- Desi n Flow (no arbage disposal). / / ... ••• G P,. .T 5/ i / / / HAY AILS / \ \ O
Engineer, Norman Hayes 9 9 /� _ .A A' / /�/ // / �� i ,y \
_ 660 GPO J O ♦/ / / l / / I lY
r Environmental Services 4-Bedrooms X 10 GPD X 1.5 -
Representing. Forest Enwro nt (1 ) / .� A / G� ,• /D �/ // /// //// I I / V I \
Use 1,000 Gal Septic Tank / // / // 71E
Desmond Well Drflling, ino. 9
Excavator.
p \ .�/ •. / pEz�G� / // // / / , ' _ REW / ('RO + �se /��
„ Test Hale TB #1
\ / 0 F,P �P // // -_I A S�D I \
Elevation" `round : 31.3 MLW A V l 0 // /// aUONC I / / Gq�'A j A I A \
-0.7 MLW
� �
.I
(water).- Leeching Facilities: Z .• � ..
h . MEAN HIGH WATER
I
Percolation `Rafe:: <2min inch
- � ,.4z \ / �� / // /!/ /�/// / \ ` Sad 3zso )
O
Design Flow For Leaching: =2.5 \ .. . oh •� I / I O
9 EL 'k / /
o ,� \ / O
- 440 _GPD � \ •, \ /�O pS� !/�//j � //� \c�
0 4 Bedrooms X (110 GPO) - � \ F, /
Test :B ring <v
Use 2 6 X6 1,000 Gal Leach I / r
Depth Soils Elevotion / 11/ G //f �+ f
--�- Pits H-1o : Per Barnstable BOH `� ` // // A� e \ ea
0 31.3 ( ) - \ I \--�. / / �// 'A�`� P vi �.�/ •j gin ' / \ / 1 1 �.k +3s.w \ I �\ / I O•
Topsoit --•Loom . . . \ / / / \�`/ �� '/' cv oI,",-
. . . . \ 1 \ t
1 Sidewall Area 2mh 2.5 Gal SF �s / i li /A �/ / .� r• / U r -39.64
= 2TK5)(5.5)(2.5) = 432 Gal I : I / //// /�j�� % / -/
Tan :Brown' = 2 / z zs .%'// / /• • / �o
Bottom Area lyr 1.0 Gal SF = / o /
M,edlym #o F►ne, =rr 1.0 / )= 79 Gal. l �-} / // / / Ric. -_� /
Soil Log ..,.Sand. . . . . . . . . . \ / / /. / I / /
Total = Gar. /
511 \ \ /
. . . . . . . . . . . . . . . . . . . . .
> 44o cal. / / / ii // i//
. . . . . . . . . . . . . . . . . . . . . l l I •1 (( ( � �/
Total Area For Leaching a / / /// /, .f I °Q Qy / / '� _ / / O / / / / / l / / /
/ I 60( ./ Q / / / /, O V
32 _ -0.7 / I 1 1 / / /
.. .Groundwater. ._. _ (2)X(251.8 SF/Pit) - _ � / ✓ � I 11 /1
. . . / -f�.7, Q
. . . . . . . . . . . . . . . . . . . . . .
40.0 -8.7' �/ I I 1 j " I• / + Q �. ' z/ / / / / �`r' / / / -40.
/ / EXiiS71NG �• / /
e / T K / / / / �40,3 O / O
/,.30 / / / / �✓ // 1 I . PROPOSED
PROPO,$ED
�-o I f .J• / �� 13
ExisnNQ -
1 + sa L,PIT / /
I / / �'39. `T
• 1
0.44
l ( L / I/ 1 l l / / / / / /
// 20/'�IN CO
�-?93 TOWN WAY
1-
TO WATER -
7
(12' WIDE)
BM EL=41.36' MLW
SPIKE IN 36 PINE
N/F
NOTES. TBM EL=28.47 MLW /
John F. & Hertha G. McConville ✓
N.W. COR OF FIRST STEP
1,) PLAN REFERENCE PLAN BOOK 134 P. 41. Deed 6964/208 }3898
2.) THE PROPERTY LINE INFORMATION WAS COMPILED FROM"AVAILABLE
RECORD `INFORMATION: '
3.) THE TOPOGRAPHY SHOWN WAS OBTAINED FROM AN ON THE GROUND
SURVEY PERFORMED BY A&M LAND SERVICES, INC, OCT/NOV/1993.
THE DATUM SHOWN ON THIS PLAN IS MEAN LOW WATER (MLW).
Prepared For:
4.) THIS PLAN IS FOR THE INSTALLATION/ REPAIR OF AN EXISTING SEPTIC SYSTEM
AND NOT IS TO BE USED FOR SURVEYING OR ZONING PURPOSES.
Donald A. & Sherri Deinis SITE PLAN
5.) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO 310 CMR 15.00 140 Clamshell Cove R(�ad FOR
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS Cotuit, MA V
FOR THE SUBSURFACE DISPOSAL. OF SEWAGE. 1 4O CLAM SH ELL COVE ROAD
6.) ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN
12" OF FINISHED GRADE. "� - "
$
7. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME, ��' sq� Q° I N
UNLESS NOTED BY FINAL CONTOURS. $' <.i 7 J7�, PleSC� Engineering & A��®�1�t�5
{ _ R. g BARNSTABLE
8.) ALL LEACHING PITS FOR THE SANITARY SYSTEM SHALL BE CAPABLE OF 8 LHELJREtix i_
�i :,,: 3 Leona Lane
WITHSTANDING H--10 LOADING. - +si 2 v I{t r�s w i L �n
CNrN L � >>~ Zoe ,, M A S S A C H U S E TTS
. � ass
Osterville, MA U2655 ;
9. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE � 7`U.Ld�-W n �n oQ �, _
�4N c'1 n� `�� 508 428-3730
MORTERED IN PLACE. a �� , u,� I�t ( ) February 7, � 995 Scale: �"=20'
' 07 �E� 9S' fo � '
Field: [)ate:
10.) ALL PIPE TO BE 4" SCH. 40 PVC PIPE. 'Re istered Land Surveyor Date Professional Engineer Date
9 Y g Calc./Design: RLH SRL Draft: RLH 20 0 10 20 40 80
11.) THIS DESIGN DOES NOT ' REQUIRE APPROVAL OF VARIANCES BY THE
Review: ERP
File: s132s 1.dw
BARNSTABLE BOARD OF HEALTH. SHEET ' OF ,