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0010 CONTENT LANE - Health
Content Lane;.',, - - - - -- - — - �, Cc'tuft, A =.040 - 036 I' i No.O?o Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for -Misposal Opstent Construction 3permit C& I b31 , �f Application for a Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ( 6 COOT&LIT L,A&)E Owner's Name,Ad ess,and Tel.No. �QC" j: eaTv tT' Do15veRT FC-D 14a'tC G L A Assessor's Map/Parcel Lto Z9Gv 1 6&)ES 'D� r(,e LIMO VA �n Installer's Name,Address,and Tel.�No. �j p�_eL?Z -g g-i7 Designer's Name,Address,and Tel.No. �8 Cw t�� A1bi�S 1(�LL^ N l� Type of Building: Dwelling No.of Bedrooms 1 ! Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided Ak gpd Plan Date Number of sheets Revision 6ate Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (ZC� Lit a&4 ?0 -To S0 5 T44L_ l L U-T- TEZE 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 Hea . Si end A Date Application Approved by Date L Application Disapproved by Date for the following reasons Permit No. D-0 Date Issued i No.rZ — 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,Ji .- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ltlfiLati01l for bi8flD8AY 6pstem CDnstrULtion Permit Cuff Ib3�j Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System K Individual Components r 3: Location Address or Lot No. r,t-y Owner's Name,Address,and Tel.No. � I Assessor's Map/Parcel `'f'v d�ta ("t' 13o�5�lt R-T FAD L-� l.oA� ' Installer's Name,Address,and Tel.No.50_t471 _8 8'7 Designer's Name,Address,and Tel.No: G40 C(DE R(6a t,� Q • MA Type of Building: ° i Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) I d gpd Design flow provided gpd) P � , Plan Date - ;r Number of sheets Revision ate Title r s Ir Size of Septic Tank 'Type of S.A.S. Description of Soil ✓r: j t f i Nature of Repairs or Alterations(Answer when applicable) (Z& L Lil iQ6 Fik &1 ' WaoC6 ZO *l� -TtJ s-cam t rJ t.&T- T E�c 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 VHeaI Si ed/ ` Date Application Approved by / Date w v Application Disapproved by "�' � Date for the following reasons Permit No. p Date Issued / ' THE COMMONWEALTH OF MASSACHUSETTS � cvJ �,z� BARNSTABLE,MASSACHUSETTS P IA Certificate of Compliance n . THIS IS TO CERTIFY,that the On site Sewage Disposal system Constructed( ) Repaired(�) Upgraded( ) Abandoned( )by U, t 06 Aou Z at VD 0_oAjT &"C� has been constructed in accordance a� l / with the provisions of Title 5 and the for Disposal System Construction Permit No. _-f Gated / / Installer 0.A` 8Q_.)4 j I A2 066aa LSC>e�. Designer #bedrooms Approved design flow 4 J1 and �{ P The issuance of this p rmi shall not be construed as a guarantee that the system wi func Pas design Date I D� Inspector () ---- ----- - -- --------------------------------------------------------------------------------------------------------------- No. 2 Fee d 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair O 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.. Provided:Constructio- must Yle completed within three years of the date of this permit. Datet711 Approved by _ G I 6/13/2019 AsBuilt TOWN OF!IARNSTABLE LOCATION /D !eH r6el Av1iG' SEWAGE s_?DO) VILLAGE_ .r ASSESSOR'S MAP&LOT o Z LG INSTALLER'S NAME&PHONE NO.,-la.S SEPTIC TANK CAPACITY /000 / LEACHING FACILITY:(type) 9^J00 _ ��i/-�S (size) NO.OF BEDROOMS 3 / BUILDER OR OWNER OsJtr i/re9 �r i rTFn SFh PERMITDATE: q—2 3'0_f COMPLIANCE DATE: 9" 2 3'0 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�� / Ho,o6urF// ,l?o/ I e� ZS' N $q. � c„,�,o a �Z Irk b / IIII issgl2/intranet/propdata/prebuilt.aspx?mappar=040036&seq=1 1/1 Commonwealth of Massachusetts 6Y0,0(3(0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 r., a � 10 Content Lane 7 v� Property Address ,; Federal Home Loan Mortgage Owner Owner's Nam 1% information is r; required for every Cotuit MA 02635 6-20-19 ell page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. ``,`N�H11 UrI rr►I/II�j/ Important:When A. Inspector Information ��//�� ° filling out forms 3_:• y on the computer, S;0 JA M E S N use only the tab James D.Sears ;�, ;m key to move your Name of Inspector =v cursor-do not use the return Ca ewide Enter rises * Company Name !'.. R T I F key. 153 Commercial Street 5'I N'Sp"G1 °�` r� Company Address Mash pee MA 02649 City/Town State Zip Code 8� 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 6-20-19 Spector'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: The system is a 1000 Gal. Tank D Box and two chamber's. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out r g p o 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in 6501p=is less than 6" below invert or available volume is less than day flow ,C FIJCNIvG ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts �y Title 5 Official Inspection Form Io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Content Lane U� Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No I ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal. Tank D Box and two Chamber's. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2017-52,000Gals g ( y g (gpd))' 2018-39,000GaI s Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. � 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is Cotuit MA 02635 6-20-19 required for every — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form �; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and mainteroance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2005 Permit #2005-472. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 30" feet Material of constrLction: ® 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.): Pipeing is cast iron and PVC SCH -40. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is Cotuit MA 02635 6-20-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 19" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 19" below grade w/inlet cover at grade and outlet cover at 8". Inlet tee w/outlet tee. No sign of leakage or overloading. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i cam, Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: ' Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 I Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form ll� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-32" below grade w/cover at 10". Box is clean and solid w/one line out. No sign of over loading or solid carry over. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �. Subsurface Sewage Disposal System Form Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 500 Gal. Dry well chamber's w/4'stone. Chamber's at 33" below grade. Chamber's are dry w/clean like new wall's 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �PR 6' L0_V, --b-Z-C A 7_191v i,./C ZT 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 11'-6" 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: 8-18-05 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: T.H. on Design plan 8-18-05 1 V-6" no G.W.. Bottom of chamber's at 5' below grade. Bottom of chamber's at 6'-6"above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 ` A Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form P _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Content Lane Property Address Federal Home Loan Mortgage Owner Owner's Name information is required for every Cotuit MA 02635 6-20-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 03 o o m I f CNAMBERs. �0 G..W, t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 L/ No.�5 7 / Fee THE COMMONWEALTH OF MASSACHUSETTS 4 Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mi!5poga1 *pgtem Construction Permit Application for a Permit to Construct(ea-Repair(. 4,ijpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.!b GDII^,T4`r_ 44101, Owner's Name,Address and Tel.No. 6a�,�P Porrjcr� Chrisr Assessor's Map/Parcel e G Sag g O;ate D �o Installer's Name,Address,and Tel.No.f',9S'1/f'0- Designer',s Name,Address and Tel.No. 4/77 5,1/3 jv ,of -� �1/ his,-54: :'5 Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Na,%5p of Re airs orAlte;ations(Answer when applicable) ZrJ5'1149 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be b tkoad V eat . Sign d Date Application Approved by Date Application Disapproved for the following reasons Permit No. DCr5 5 �1 �'- Date Issued 13 ——————————————————————————————————————— No. "`— 5 7 U Fee / JIHEit MMONWEALTH OF�MASSACHUSETTS.a "� ` �� Entered in computer: !} " Yes PUBLIC HEALTH DIVISION -TOWN OF MARNSTABLES MASSACHUSETTSir Yicat on for loi ool Stem e6n5truchori Permit Application for a Permit to Construct( 'Repair( rade( )Abandon( ) El Complete System 1:1 Individual Components Location Address or Lot No. �o �� f'�r ' �` OY ner's Na Addre s and Tel.No. mecis C�hr�s Assessor's Mdp/Parcel Y ' D T7-S3/3 Inst�er's N e, dress' and Tel.No.S� y2 1� De gner's Name,Address��eo� j9�i��� �hgiti�= / G�/2�1 �r��^5�o�"S i��S /2 Gv�ST �rosS��r�.�� /2�f SWVo141IC4 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. / Description of Soil Nature of Repairs or Alterati ns(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has beeni—sslqeO y t d f ealt Sign Date_ Application Approved by Date Application Disapproved for the following reasons Permit No. 5 Date Issued 5 { THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance ' THIS IS TO CERTIFY,that toe On-sit Seyv ge%�posal System Constructed (� ) Repaired ( )Upgraded r L ( ) Abandoned(,; )by DS ,E7Yvo S at /d GyI r/_."-1T Zweli, ��� _ h s been constructed iri accor•a ce with the pro�isions o Ti , 5 the for Disposal System Construction Permit No dated f Installer �/03ep v6e, 'wy�f Designer The issuance of this permit shall n-t e ca str d as`,guar-antee that the sy ftem wil fu�nctr n as esigned. - - Date Inspector No. �co � L` �T ------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpool *pgtem Construction Permit Permission is hereby granted to Construct(� )Re air(�Up ,rad ( )Abandon( ) { System located at �a ��N�t N7 O 74117 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction 'ust b completed within three years of the date of this per it. Date:_ Approved by --'"�----ti TOWN OF BARNSTABLE LOCATION M _a�T l�l T Ls�y/' SEWAGE # 260.E^ `/72 VILLAGE ASSESSOR'S MAP & LOT D INSTALLER'S NAME&PHONE NO. 12.5z ,ee4 z2e SEPTIC TANK CAPACITY 10d / LEACHING FACILITY: (type) f-- SDO � /�%!�S (size) /3 NO. OF BEDROOMS BUILDER OR OWNER P'49 -"r/� 164 ��iv i 1?�hSFl9 PERMITDATE: 9'—2 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 , t r N off $q, j Grvuap r 5/25/0i NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. _ PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, ' `�'� `L +u' , hereby certify that the engineered plan signed by me dated ��3) �� , concerning the property located at �a►.�c��- lit �-tv�r ._, � meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fart or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. A,, �d � 5 . ) • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation (using GIS information) U B) G.W. Elevation I k— + adjustment for high G.W.5'• 1 = -3 ( 'j DIF RENCE BETWEEN A and B SIGNED DATE: NOTICE Based upon the above information, a repair permit will be issued for _ ,bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. �� q:health folder:percexmp Town of Barnstable Regulatory Services s Thomas F.Ceder,Director YA�t11tTA�. k t Public Healtb Division Thomas McKean,Director -~ 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: �) Z3 ©� Sewage Perneit# �' - Y 7°L Assessor's IVIaplParcej `f 0-63 6 Designer: � /� +K-L—J-- Installer: _ 1Y?l ors. Address: L2__ja)t J-C C Rl- _�4 Address: Ccn✓n/V1Z4_ lZ-1 r � cr��t NE14 F?n vZ�g�t4 - - d ze, y8 On 21 f a�� eU°s 41C (0?oo was issued a permit to install a (date) (installer)! septic system at /U C,?1-fA4 Lr), based on a design drawn by (address) ✓��na (AlYiv-(A,t dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. flan revision or certified as-built by designer to follow. o���plT H OF tijgsS � 9 PETER T. (Installer's Signature) McENTEE m CIVIL 9 9 No.35109 y o/sTYk �Q (Designer's Signature) (Affix Designer s1_f Ir ere) PLEASE RETURN TO BARNSSIABLE PUBLIC FIEALIH DIVISION. CERTIFICATE OF +C 2MiPLIANCE WILL NOT BE ISSUED UNTIL, BOTH THIS_FORM AND AS- ARU ARE CEIVED BY TIME§AMSTAIILF,PUBLIC HEALTH.DIVISION. lflat%YQL - - - Q:tiealth/Septic/Designer Certification Form 3-26-04.doc 'tEN D. . COMPLETE SECTION ■ Complete items 1,2,and 3.Also complete APgna item 4 if Restricted Delivery is desired. X �Laalw'�u Agent ■ Print your name and address on the reverse ,GOv Addressee so that we can return the card to you. eived by(P' ted Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, � ' Al c� or on the front if space permits. m n'ple1,4 f `4lSr `� / '��1 D. Is delivery address different from Rem 1? n Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Ms Patricia Christensem. 302 Porter Road Bath,NH 03740 3. service Type ' ❑Certified Mail ®Express Mai ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service iabeq PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 ' I • Sender: Please print your name, address,and ZIP+4 in this box • I I I PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE 200 MAIN STREET HYANIVTIS, MASSACHUSET l"S 020501. i I A I t'jfj o m lc3 0 F F i C I A L. U S E71 MPostage $ Ln Certified Fee `Tj' O c13 98 o /p Postmar ) k � Return Receipt Fee uC� Here M (Endorsement Required) a/�3 I I ) 1 2 2005 rl ✓ M Restricted Delivery Fee 0 (Endorsement Required) /► p Total Postage&Fees Is .0.. —0 Sfn�t T T= a Street,Ajot ;or PO Box NQ, , 3 °�-�---7-`JO�P-----Kcx --------------------------------------------- O Cityftate,ZIP+4 r a t N Q3'7 0 '�) Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece n A signature upon delivery o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. n Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquixy.' PS Form 3800,May 2000(Reverse) 102595-99-M-2087 COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION � y\ 1 SV• TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ' 1 CERTIFICATION r Property Address: 10 Content Lane Cotuit MA 02635 ` Owner's Name: Patricia Christensem i = Owner's Address: 302 Porter Road s'�43t trSr`Tf rri \� Bath NH 03740 Date of Inspection: August 3,2005 Job#05-238 �"I Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD f1� MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 D111111111t/ approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ���� '(N OF Passes P TRI ••'ycGn' Conditionally Passes .m— Needs Further Evaluation by the Local Approving Authority M' '�__ _X Fails L ' co Inspector's Signature( / --. ..- V J,ld Date: August 3, 2005 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: Tank full to top from saturated leaching pit. ****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 r Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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: T41P S I"Cnant;^. 17-4/1 snnnn 2 Page 3 of l 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 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: T41a C lncnantinn 17nrm 411 VIOA 1 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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 forma _Yes_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: 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. Titles G lnonartinn Rnrm All ;/)nnn 4 f Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 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 _X_ 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? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? 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 _X_ Existing information. For example,a plan at the Board of Health. _X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title C Ine—,tine {:nrm 5 i Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMF 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required) Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2003—88,000 gal.2004—94,000 gal.=249 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped 12-18 months ago. Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 1970+/- Were sewage odors detected when arriving at the site(yes or no): No Titles G Inenantinn 17-411�;Mnnn 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia C'hristensem Date of Inspection: August 3,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' under slab Materials of construction:_cast iron _X_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: XX (locate on site plan) Depth below grade: 16" Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions:8.5' long x 5.2' wide—1000 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Outlet baffle is broken off,liquid level over top of outlet pipe with solids buildup to top of tank. GREASE TRAP: No (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 cf 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.): TitlA S Incnortinn r:nrm 411 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 TIGHT or HOLDING TANK: No (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: No (if present 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,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (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.): Titla G Inenartinn Fnrm All siInnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. 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.): Leaching pit in hydraulic failure and causing backup into tank. CESSPOOLS: No (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: No (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.): Titlo C lncnantinn Gnrm A/1';nnnn 9 f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 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. Front # 10 Garage Title G lncnurtinn Fnrm ail ci�nnn 10 Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water 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: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: A pere test will be performed prior to repair to determine groundwater elevation. Title C Inmartinn Rnrm(/l v1nnn 11 TOWN OF BARNSTABLE LOCATI�IN ��C.o�' r � — SEWAGE # �5' VILAGE� A//SSESSOR/'S�MAP & LOT INSTALLER'S NAME&PHONE NO. a •GL �l• D L r / SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Ze i NO.OF BEDROOMS_ .3 B1;3$$ER-6R OWNER r U�lQ� id s PERMITDATE: •i(D LIANCE 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 t- /41- l0 of l l - i OFFICIAI.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL CSYSTEM INSPECTION FORM P I SYSTEM INFORMATION(continued) Property Address: t0 Content Lane Cotuit MA 02635 Owner: Patricia Christensem Date of Inspection: August 3,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM benchmarsk t h Locate allswellgwahinosal system including ties o public weete upplyy t two ent m the buildinrt reference lgndmarks or Front #10 Garage I THE COMMONWEALTH OF MASSACHUSETTS BOAR..D,?F HEALT --- OF _'.-................................ Application is hereby made for a Permit to Construct (1-51-or Repair an Individual Sewage Disposal System at.* ... Address-_�V------ Owner A�14,E Installer Address Seepage Pit No....../------------ Diametery RD Zer�t Z Other Distribution box ( ) Dosing tank ( ) /----------- ---------------------------------------------*-------------------------------------------*------------------- --------------- ---------__ -4---------------------------------------------------------------------------------------------------------------- ------------------------------------- ---------_.---------_.-_-_-_-_-__.--'_'_------'-_--'--_—'---''--'-'--._ ug,ccozeoc: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with N .... ................. WFq .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 't.........0 F......k4l.�.... .1............................. Appliration -for BWVoiial Worko Tomitrurtion Vamit Application is hereby made for a Permit to Construct ( or Repair an Individual Sewage Disposal Systemat, 2 .................. ............................--------a....................... ................... ... r>1,0No_A ocation•A dreig _Ine _...fir ....... /W-------------- ....... . Address .......... ......... Installer Address 11 Type of Buildip& 3 Size Lot----------------------------Sq. feet U Dwelling NO. of Bedrooms------------------------------------------Expansion Attic Garbage Grinder ( ) Other—Type of Building ...................... ..... No. of persons---._._...__..____.....__... Showers Cafeteria ( ) Otherfixtures ____________________________------------------- _;-----Desi n Flow',...................... .......gallons per person per day. Total daily flow----------3 9. ...gallons. P4 Septic Tank-r-Liquid capacity/1"4- allons Length________________ Width..... ---------- Diameter__-___-__-____ Depth-----____--. Disposal Trench—No- -------------------- Wi(411----------- otal Lervil- otal leaching area--------------------sq. f t. oto ----ii�4 T)tph�,Seepage Pit No------/------------ Diarneter//1 DeVp el(pv ........ ... Total leaching area------------------sq. f t. Z Other Distribution box ( ) Dosing tank ( ). aPercolation Test Results Performed by-------------------------------------------------------------------------- Date-----------------------•--------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit_-________________- Depth to ground water-------3a---------- f� Test Pit No. 2................minutes per inch Depth of Test Pit.___.____.__._.:.__.. Depth to ground water------------------------ ------------------------ ...... e.27......................�n....................Z------------ ................. 7-------------------- 0 Description of il_ -- So _ n --------- -----------------------------------------------------------------------A U -------------------------- -------- ..... x --- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.------------------------;--�--,--------------------------------------------------------------- - - U Nature of Repairs or Alterations—Answer when applicable--------------- ........................------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------...............................----------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The under)5(ed further Agrees.not to place the system in operation until a Certificate of Compliance has�beehiolsJued by the e boattd otjhjSLtl1 J!✓� -- ------ -------------D tApplication Approved By----- - -- -- - -------- ----- Date Application Disapproved for the following reasons:................................................................................................................ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued.............. ......................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD/`OF HEALTH ......... .....0 F.. . . .. "U.1rdifirate of Tlimphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (il)-lor Repaired b ........ e.!) .... . ..-A----.------.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.- ..............................................Z - Inst 4 T at.... i ------- J. 61-- --------------------------------------------- has been installed in accordance with the provision of Article I of The State Sanitary- -oyle' as d/esc ibled in the application for Disposal Works Construction Permit No...__.__._ '`___ _____________. .. .... .. ....... -------- -0 dated ��,_____._.__.__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector--------------_-_---............................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALT ell 11Z) .... ... ...........OF..-' .......:.......... ..................... No_________________________ FEE..9;:�t... Bi.nVviial Morkii ClIontitrurtion Prrmit Permission is hereby granted-.-fn-'---------------------------/--e -........................................................................................................ to Constrt1 orRepaiq( )-an Indi jDisposal-$�j atNo.-Y'!........ ......L.....lot....&—%. ........ --------------------------------------- ...................................... Street as shown on the application for Disposal Works Construction Permit No t. Dated...7/!?_r,.// ... ............................ DATE................................................................................ Board of Health FORM 1255 H0813S & WARREN. INC.. PUBLISHERS a 0 CS 30, 4 l � � D LOCUS , LEGEND 7g PROPOSED CONTOUR 79 PROPOSED SPOT GRADE ss ti 00__r. EXISTING CONTOUR FALMOUTH (STATE HIGHWAY - ROUTE 28) ROAD ® TEST PIT ca,TGr! €w ?raa ........ ............ L'>! _.._.. EXISTING WATER MAIN e..... ... (J _ __ _ "'w BENCHMARK N62°48 0T ^ 1 � pd 150.00 )COPNLRd LOCUS MAP N.T.S. EXt5TING TANKAPN 04 - 3G TOP OF TANK EL.=97.9131 ,742±5F � \ BENCHMARK.INV.(OUT) EL.=96.57t `� `� �, TOP OP R.R.TIE AT i ELEVATION - 100.,� \ (AWUMED DATUMI GENERAL NOTES: EX15TING 5.A.5. , (approximate location) 1 CONTRACTOR TO LOCATE, "� �'-" `-"� .- ~ � 1, ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL PUMP AND FILL WITH SAND. f Csr \ t BOARD OF HEALTH AND THE: DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE O LOCAL RULES AND REGULATIONS. 1 r 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR w N TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN No. 10'...' ..' ;''..f 4� ENGINEER BEFORE CONSTRUCTION CONTINUES. I'STY.: ` f 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. rn TP—i! W !` —.� /t7ECPC `... 1M),:FRAA..,`., f,. �" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 50, _ THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. yt5 I I O 21' rABOVr r' I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. GROUND 8, THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. I p � 9. ALL AREAS DISTURBED OURING CONSTRUCTION SHALL BE RESTORED 1 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. f� 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE Q THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY , <xOr rj AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. ___ _� ... 69 ICY �' �' � 13. CONTRACTOR SHALL EVALUATE STUCTURAL INTEGRITY OF EXISTING SEPTIC TANK PRIOR TO CONSTRUCTION. 562°4&20NW 1 np Or. l. ----- ----• - - - ._.— - . PETER T W..... .. y l \\(VNENT . ✓ McENTEE CIVIL - PROPOSED SEPTIC SYSTEM UPGRADE CONTENT LANE No, 35109 10 CONTENT LANE, COTUIT, MA �'EGISZ��� �� Prepared for: Patricia Christensen, 302 Porter Road, Bath, NHASHEETNO. i FFSSI NA N f Engineering by: Surveying by: SCALE DRAWN o EngineeringWorks HOOD SURVEY GROUP 1"=30' P.T.M. 12 West Crossfield Road 18 Route 6A DATE CHECKED Forestdole, MA 02644 Sandwich, MA 02563(508) 477-5313 (508) 888-1090 S/31/05 P.T.M. ( I r NOTE: TO PREVENT BREAKOUT, THE PROPOSED F.G. EL: 98. DISTANCE 5t FINISH,, GRADE, SHALL NOT BE < EL:96.0 ' TOP OF FOUNDATION ^ FOR A (EXISTING) F.G. EL: 99.7t F.G, EL: 98.7t (EXISTING) PEERIMETEROFTHEE,,FS.A.S. AROUND THE (EXISTING) (EXISTING) (EXISTING) r MAINTAIN 2% MIN,SLOPE OVER S.A.S. ' INSTALL RISER OVER D-BOX TO INSTALL RISER OVER CHAMBER/S CHAMBERS INSTALL RISERS OVER INLET & OUTLET 2-500 GALLON LEACHING SHOWN ON PLAN AND SET COVER/S TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE IN SERIES WITH STONE ALL SIDE C WITHIN 6" OF FINISH GRADE L =64 L =5 4" SCH 40 PVC 4" SCH 40 PVC 2" LAYER OF 1/8" TO 1/2" 10" EXISTING 14^ ® S= 1% (MIN.) s ® S= 1% (MIN.) ��®�+�®® DOUBLE WASHED STONE ►' 1000 'GALLON 2' EFF. DEPTHT 8air�a ° EXISTING SEPTIC TANK 3/4"-1 1/2" ` (SEE NOTE 13 -SHEET 1) INV. ELEV.=95.87 D-BOX INV. ELEV.=95.70 4' S•2' 4' DOUBLE WASHED A D GA STONE D 5 FFECTIVE WIDTH = 13.2' BAFFLE _ E ! INV, ELEV.-96,57t I (EXISTING) INV. ELEV.=95.50 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP CONC. ELEV.=96.3 —BREAKOUT ELEV.=96.0 PIPE INVERTS PRIOR TO CONSTRUCTION. mom ®aa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE INV. ELEV.=95.50 a�63 ON A MECHANICALLY COMPACTED SIX INCH CRUSHED i ���a s��a�i BOTTOM ELEV=93 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). . .50 3.5' 2 x 8.5' = 17,0' 3.5' 3) INSTALL INLET & OUTLET TEES AS NEEDED. OF M 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OOR G.W.TTOM EFFECTIVE LENGTH 23.0' AS MANUFACTURED BY TUF-T1TE, ZABEL OR EQUAL. TP-1 LEACHING SYSTEM SECTION Q PETER BOTTOM OF TP EL.=87.3 T. ( ) McENTEE v CIVIL SEPTIC SYSTEM PROFILE No, 35109 (3) 5" DIA.OUTLETS N.T.S. 16.5^ 60 16" 2^ DESIGN CRITERIA 8� 7 --� SOIL LOG i1 ^ NUMBER OF BEDROOMS: 3 BEDROOMS 6" ? 8" ...., DATE: AUGUST 18, 2005 SOIL TYPE: CLASS I ' ' ' ' , ; SOIL EVALUATOR: PETER McENTEE P.E., C.S.E. DESIGN PERCOLATION RATE: 2 MIN./IN. 2° i i i I I , i , i i H-10 LOADING ; Ho. 10 INSPECTOR: NOT REQ'D - REPAIR W/ GLASS 1 SOILS DAILY FLOW: 330 G.P.D. 13TY. ; ;t I; ; DESIGN FLOW: 330 G.P.D D—BOX , ; WD.RWI' '! 1 it I i ! < <..1'...,i,_..!....A'.....1.,....�..... GARBAGE GRINDER: N Elev. Depth Elw. Depth RED 445.9 S.F. LEACHING AREA REQUIRED: (330) = 14 98.8 A 98.5 A 74 A( SANDY LOAM SANDY LOAM " tIND , 98 3 10YR 3 3 6„ 98 0 10YR 3/3 6„ EXISTING SEPTIC TANK: 1000 GALLON (ESTIMATED) rE ® ® ®®®® � �{ INVERT ®®®®Ea®®® 33 B SANDY LOAM SANDY LOAM 24" ®®®6R®®®® `�!�, 10YR 5/8 10YR 5/8 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 93 95.3 C 36" 95.5 C 36 SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. 102" � g 48" U 42" BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. 71F �� 5 448.4 S.F. ti^KNOCKOUT Q' � a 54" TOTAL AREA: ao^ ow. coven 60" 4" KNOCKOUT �4" KNOCKOUT 6y" / MED. SAND MED. SAND DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.Q. � 'f 10YR 6/6 10YR 6/6 4" KNOCKOUT ' �'�: a1A� PROPOSED SEPTIC SYSTEM UPGRADE °� 10 CONTENT LANE, COTUIT, MA ' 87.3 138" 88.5 120 Prepared for: Patricia Christensen, 302 Porter Road, Bath, NHdf2 500 GALLON CAPACITY, H--10 LOADING PERC RATE <2 MIN/IN. (MED. SAND) Engineering by: Surveying by: SCALE DRAWN CHAMBERS S.A.S. LAYOUT EnginemingWorkr HOOD SURVEY GROUP N.T.S. P.T.M. N.T.& N.T.$. NO G.W. ENCOUNTERED 12 West Crossfield Road 18 Route 6A Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED (508) 477-5313 (508) 888-1090 8/31/05 P.T.M. S YS TEM PROFILE NOT TO' SCALE TOP FNON. FINISH GRADE OVER FINISH GRADE t 0 VER TRENCHES r, A i EL . -T l -o FINISH GRADE 7C�• 3 FINISH GRADE OVER DIST. BOX .5 .?'0.0 4 SEPTIC TANK G 8. a p` I, .o o..a tp 0 oaf. ii " 12 MAX. :o:.d,-"n ?s::Q.gyap :oaoP.b'+dp�4�,•. .A'titi. i0 •,a..r•, TOTAL LENGTH OF TRENCH_ zS' - o 3„ o' OUTLET PIPE LEVEL _ IN i _ r FOR 2 FT. M e•.00 0 :'D, �f o i' . '.w: o.• Q, -o t0 .P •o.. :Od• •-b, ,, ..v ,.• b 6.0 0p" P�:O• 'D' 4 l0 'i' O s O P' eeepU s " o q CO�1,rj4 4� p . a,� e, oo P o , ' , P; 4 i s:'•°•V Co<o."I!D 0C t 'v e:. ;b:::.o.r o a *' CAP END ° �05.91 C. I. OR PVC TEES ro a.71 Cv5. �1- ra 3.00 g •oo:eo• � �� � ham'+{ ro : 1500 GA L L ON DISTRIBUTION BOX 8SMT FL . p':o.o ;t p► 'EL .5�,.S INSTALL ON LEVEL BASE v 9� PRECAST CONCRETE ob H- /0_ _REINFORCED 50:41bd,:,,o.bp•e n 'b::b�;.:Q p nRYQ' v�:c'apc.e..•e.a; . SEPTIC . TANK TRENCH SECTION INSTALL ON LEVEL BASE NOTE.' EXCA'VA TE TO EL EV N/A OR L OWER TO REMO VE AL L IMPERVIOUS • MA TERIA L BENEA TH THE L EA CHING AREA ` 12" MIN. 4" DIAM. REPLACE EXCA VA TED MATERIAL WITH o: .4 qq 3" OF 1/B"-!/2". CLEAN. CLA Y FREE SANG e. o MASHED PEA STONE 0?G U I N 3/4" - 1-1/2" NA SHED �„ N ROUTE 28 G, CRUSHED STONE S, Z N 62•Qe'20"E GENERAL NOTES TRENCH WIDTH 120.00 i ,9 0 0 1. ALL EL EVA TION5 SHOWN ARE BASED ON ASSUMED NUMBER OF TRENCHES 1 2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON NUMBER OF DRYWELLS 2 OR SCHEDULE �' PVC.. �' ''MEAL TH MUST BE NOTIFIED f C�f�.�� R VA 'ION PIT 3. THE BOARD OF�TION IS COMPLETE PRIOR WHEN CONS RU r-- - PERCOL A TION RATE.' ' �1 , 600 t SF 2 TO BA CKFIL L ING > I _ 4. ANY CHANGES Ill THIS PLAN MUST BE APPROVED <5 MIN./IN. BY THE BOARD OF.. HEALTH AND CAPE 6 ISLANDS WITNESSED BY.• SURVEYING CO. INC. AN ' INSTALLATION SHALL BE IN DONNA MIORANDI _ 5. MA TERIAL S Y BARNS. BRO. OF HEAL TH DESIGN N DA TA a W Z COMPL IANCE WITH THE STATE SANITARY Q DA TE.' MAR. 4 1999 - o CODE - TI T1,E V AND LOCAL APPLICABLE — — s- — — ULA TIONS - F'' 9 3 G� I 3 RULES AND REG NUMBER OF BEDROOMS NORTH OW I FROM RECORD PLANS AND __._a~L...::__ _O_..._ E L . 0-•rD a pIT#1 N 6• IS NOT RC BE SED FOR SOLAR PURPOSES LC�i"l_ L Ot�r'l GARBAGE DISPOSAL NO b / 12' O 7A 7. .FLOOD HAZARD ZONE NO�V-HAZARD 12" \oY __ . 2 _ coYR� 330 GAL . z 2 DAILY FLOW 1 V B. WA TER SUf�PL Y I TOWN WA TER � L.oL1MY �' l_Ot.�MY - SEPTIC TANK REO D. .2500 GAL . d SEPTIC TANK PROVIDED 1500 GAL . i OICZr'�6 IDYtZ_��6- 330 GPD. ' LEACHING REQUIRED N .._ FUL L �t'1T i �Z SIDEWALL AREA = 152 S.F. - C"tED1 U M C'1�D tUt1 152S. F. X 0. 74G/S. F. _ 112 GPO. BOTTOM AREA =y329 S. F. �o y___.. 3 ►� AA LEGEND 329 S. F. X 0 G/S. F. = 243 L EACHING PRO VIDED = 355 GPD NO o p E NOouNaW�Tt:tZ O _.__ _ S 69"!4s'2o w 7o PROPOSED EL EVA TION J — _ "• - - ---- --_To - EXISTING CONTOUR CONTENT LA E SINGLE FAMIL Y RESIDENCE. & I OBSERVATION PIT O DISTRIBUTION Box OSA L SYSTEM PROPOSED SEWA GE DISP �O 6 1 C=7- 3 li E 2 PREPARED FOR o o SEPTIC TANK DESIGN TECH LOT 18 (HSE. 96) CONTENT LANE =.=I RESERVE AREA CO TUI T BA RNS TA BL E — MA SS. �oG-00 PIPE INVERT EL EVA TIONt � .�,�r���,��i :> DA_TE.�_("Ihl2 . �4,l9 9� __ k. 2ANK CAPE 6 ISLANDS ENGINEERING PLOT PLAN - 3I 1 �� _. 9�s �e`�°, ,<° , SCALE AS NOTED 133 FALMOUTH ROAD — SUITE 2E MASHPEE. MASS. _ MAP SEC PCL LOT HSE ;�'. PLAN NO:G 03ZW`�9 G I -.