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HomeMy WebLinkAbout0219 COTUIT BAY DRIVE - Health 219 COTUIT BAY DRIVE Cotuit I �l 1 I No. �/ � Fee THE COMMONWEALTH COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfiration for Disposal 6pstem Construrtion hermit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 2,19 <4_Vj U dT 0A-y ©I? Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Q a0TOd t �9 C pT U9 Q C),TV rt j Installer's Name,Address,and Tel.NA. j()Q-t f?I—n' Designer's Name,Address,and Tel.No. (jA- P&;LUt bt-5 � u2LS � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan . Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) =T� J26W t}'__A6 D A0V 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 H " g A/ / OA Application Approved by t �/ '/ Date / Application Disapproved y Date for the following reasons Permit No. Date Issued No. / 1 ' ' �r ' �A Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t 5 z Yes is PUBLIC HEALTH DIVISION - TOWN;OF BARNSTABLE,, MASSACHUSETTS �- P OWpYtcatiou for Disposal 6pstem Construction permit w . Application fora Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System VVndividual Components Location Addr ss or Lot No. A t c1 A tq U I'T t)j2 Owner's Name,Address,and Tel.No. Assessor's'Map/Parcel (� ��(� TV lT �q O VI T o Q C)�(v I T Installer's Name,Address,and Tel.No. 5e�g-t(-71-� ? Designer's Name,Address,and Tel.No. �CAPsx be CZ4,1�026ES 153 C-oc444.te-we-q l A-c - S�-r p,!' I Type,of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date w Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ;• f Nature of Repairs or Alterations(Answer when applicable) S' � I SEA, r . Date last inspected: Agreement The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance wiAe 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 Healt . Date .�.. Application Approved by `�CirA ✓ f ���� / Date Application Disapproved by e Date r for the following reasons Permit No. aL/ / / Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ') Repaired( Upgraded( ) Abandoned( )by (?Ak")(b6 ��419 :at ;Ll q Cerro t-ii" &A� b D— <ZrO T has been constructed in accordance p 1 with the rovisions of Title 5 and the for Disposal System Construction Permit No. /I/1�/_elated. A nr,,�-�y A,v Installer d ArQEW I E� GKEp Aj S Designer r #bedrooms k) IA- Approved design flow +J�� gpd The issuance of thi rmit shall not construed as a guarantee that the system wil function as designed. n \ }� Date S [pe, M Inspectord-� i s7 - ------------------------------------------------ ------------------------------- ---------------------------- No. 1 Fee " ,P THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstrm Construction permit Permission is hereby granted to Construct( ) >. Repair( Upgrade( ) Abandon( ) System located at a 19 a DTU t* C n--u I 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. f .I Provided:Constructiol must be•completed within three years of the date of this permit. fANM , Date ( ( �( ) Approved by Commonwealth of Massachusetts 05(a -D 3111 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every COtUIt MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms 61 p eae `����t►utuwgrr�/r� on the computer, �I A OF use only the tab SIF g key to move your 1. Inspector: ; cursor-do not JAMES U'- James D.Sears =�; m use the return Name of Inspector key. *: Jim The Inspector Mane. " Company Name 7` ..ITTTF�. P.O.Box 784 °% 5 I N I?"- Company Address West Yarmouth MA 02673 Cityrrown State Zip Code 508-364-4398 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails El Needs Further Evaluation by the Local Approving Authority 2-5-18 JA' pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system 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 allthority. ****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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 64 0 17 S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system.is a 1000 Gal. Tank D Bo x and three chambers. Note: Old it still tied into N system. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements, If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20.years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑.N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owners Name information is required for every COtUIt MA 02635 2-5-18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No".to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in NAMPM is less than 6" below invert or available volume is less than 1/day flow L Efi C#/PG t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis..[This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system.is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form a �o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address ' Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of breakout? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal •System Page 6 of 17 Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is Cotuit MA 02635 2-5-18 required for every - page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1000 Gal. Tank D Box and three chamber's. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.), Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2016-64,000Gals 2017-59,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date 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 Industrial waste holding tank present? ❑ Yes ❑ No No waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6h6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �- i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 219 Cotuit Bay.Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit R MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 219 Cotuit Bay Drive \V� Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2-2018 New D Box- Leaching 1997 Permit # 97 - 175. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade:. 45"feet Material of construction: ❑ cast iron ®40 PVC ® other(explain): Distance from private water supply well or suction line: feet Comments.(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40 & SCH -20. Septic Tank (locate on site plan): Depth below grade: 35"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- H10 Sludge depth: 1 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness Distance from top of scum to top of outlet tee or baffle 1211 Distance from bottom of scum to bottom of outlet tee or baffle 1711 How were dimensions determined? Asbuilt-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 and outlet cover at 35" below grade. W/inlet cover at 17". Inlet tee- outlet baffle. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.6116 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc,): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: El yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official'lnspection Form:Subsurface Sewage Disposal System•Page 11 of 17 c Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-40" below grade w/two lines out. Box is new 2-2018 w/cover at 8" below grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: -❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why:, t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Fora I' Fio Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ® leaching chambers number: 3 ❑ 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 is a old pit and three chamber's. Leaching is a old 1000 Gala pit. Newer leaching is three Cultec Recharger Chamber's. Ck D Box and camera out to pit and chamber's. No sign of over loading. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration ' Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts �9 Title 5 Official Inspection Form lf a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. City/Town State Zip.Code Date of Inspection D. System Information (cont) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form `i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every Cotuit MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 14 55, --------------- LF 13 d © e o3 s 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 b Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owners Name information is required for every COtUit MA 02635 2-5-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water . ❑ Check cellar ❑ Shallow wells Nv Estimated depth to high ground water: 10, feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,,date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Auger T.H. 10' no G.W.. Bottom of chamber's at 5' below grade. Bottom of chamber's at 5' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form .' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 219 Cotuit Bay Drive Property Address Gretchen Perry Owner Owner's Name information is required for every COtUIt MA 02635 2-5-18 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—'Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage P g Disposal System•Page 17 of 17 Y 9 TOWN OF BARNSTABLE LOCATION ,_ 'I 9 C O �A �e SEWAGE # 7 VILLAGE ASSESSOR'S MAP & LOT •O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)Mew (size) �5 NO.OF BEDROOMS BUILDER OR OWNER ae PERMPTDATE: l 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by DI ri ve 00 .0o,1 i .t No. " ' 5� Fee $ 5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS 7.Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppricatiou for ;Digozar bpetem Conmructiou Vermit Application for a Permit to Construct( )Repair( )Upgradeh(X�Abandon( ) ❑Complete System XX Individual Components Location Address or Lot No.21 9 Cotuit B a Y Drive Owner's Name,Address and Tel.No. 4 2 8—01 1 1 As9e9so is /1PNAlss . 02635 Thomas Wals�`i_ 219 Cotuit Bay Drive Cotuit Mass . Installer's Name,Address,and Tel.No. 5 0 g-7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8-7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc . Box 66 Centerville MaSS. 02632 Box 66 Centerville ,Mass . 02632 Type of Building: DwellingXXXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder NO) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 1 1 0 gallons. Plan Date 4/12/97 Number of sheets Revision Date Title Size of Septic Tank 1000 existing D-Box Type of S.A.S. 1 -1 000 gallon nit. Existing Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Adding 3-3 3 0 C u l t e c r e c h a r g e r s to the existing septic system. I LD Date last inspected: 4-0 -9 7 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this B and f Health. 4�1 2�97 Signed Date Application Approved by Date V- (-S- '7 Application Disapproved for the follo ing reasons Permit No. 7 - 7 Date Issued No ,. 5 1 Fee 50.00 z 4/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLES MASSACHUSETTS ZIppYication for nigw6ar'*p5tem Con.5truction Permit Application fora Permit to Construct( )Repair(. )Upgradei(XX Abandon( ) O Complete System XX Individual Components 1 Location Address or Lot No.21 9 C o t ui t Bay Drive Owner's Name,Address and Tel.No. 4 2 g—01 1 1 Cotult Massµ. 02635 Thomas. Wals#h, Assessor's ap/I'azce 219 Cotuit, Bay Drive COtuit.Mass. Installer's Name,Address,and Tel.No. 508-775-3338 Designer's Name,Address and Tel.No. 508-775-3338 J.P..Macomber & Son Inc. J.P.Macomber & Son .Inc. ' Box 66 Centerville MaSS. 02632 Box 66 Centerville,Mass . 02632 Type of Building: DwellingXXXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(�0) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3x1 1 0 gallons. Plan Date 4/1 2/97 Number of sheets Revision Date Title Size of Septic Tank 1000 existing D—Box Type of S.A.S.,1-1000 gallon pit.Existing Description of Soil Sand i Nature of Repairs or Alterations(Answer when applicable) M,1 i n a 3—3 3 0 C ul t e c r e c ha r g e r s to the existing septic system. Date last inspected: 4-9 -97 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's of the Environmental Code and not to place the system in operation until a Certify- t cate of Compliance has been issue by this B and. f Health. Signed Date 4/12/.9'7 f o r Application Approved by G. '1 Date" (5 - 7 j Application Disapproved for the follo mg reasons it i r r x i' Permit No. /,'7, 7 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired( )Upgraded)(XX) Abandoned( )by J.P.Macomber' & Son Inc. at 219 Cotuit Bay Drive Gotuit,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. S dated Installer J.P.Macomber & Son Inc•. Designer J.P.Macomber & Son Inc. The issuance of this permit shall not be construed as a guarantee that the systemwvill f ction as designed. /Date i ( "Iq Inspector — ! / —� 7 ('------------------------ ----Fee 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS �Dtgoal *p6tem Congtructton Permit Permission is hereby granted to Construct( )Repair( )Upgrade Z? X�Abandon( ) System located at_219 Gotuit Bay Drive Cotuit;Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: �/ 5 ' 7 Approved by i +aMp� -• �` w CERTIFICATION OI' SKETCH AND APPLICATION FORA DISPL.. WORKS CONSTRUCTION PEIZn,11'I' (W1'I'flOU'1' DESIGNED PLANS) I Joseph P.Macomber Jr.,: ,' ` ck:rtily th;tt the application for disposal works construction permit signed by ntc 4/1 2/97 , concerning the property located at 21!9 Cotu; t Ray nr; -p data}t 14A— — ►neets all of the following criteria: • There are no Nvetlands Within 300 feet of the proposed septic systelll • There are no private »•ells within 1 5U feet of the proposed septic system • The observed groundwater table is •t I'cct or greater below the bottom of the leaching facility • There is no increase in Ilo\v and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: 4/1 2/97 LICEN SEPTIC SYS'rENI INSTALLER 1N Ti-iE TO1VN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed s;stem. Also if the licensed installer posesses.a certified plot plan, this plan should be subtniticd]. 4 , Rear 219 Cotuit Bay Drive Cotuit Existing 1000 gall. S.ezz,i cLtank. C1 Existing D-Box 3-cultec 330 rechargers . � -D 3 . U - A �� tr Commornweotth of Mossochusetts Executive Office of EnWonmenfol Molts Department of Environmental Protection WUua�m F.Web Trudy Corn Arpw Poul GUuou " ow�rrwr and e.Strum SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Prop,rVAddmea; 219 Cotuit Bay Drive Cotuit,Mass Address ofOwner. Date ofInsPectiow 4/9/9 7 Qf dltferemt) Nam.ofln,p.otor. Joseph P.Macomber Jr. Company Name,Address and Telephone Number. J.P.Macomber & Son Inc. Box 66 Centerville,Mass,02632 508-775-3338. CERTIFICATION STATEMENT I cw%ib that I have Pereonal(y inspected the"wage disposal system at this address and that the information re petition. The!ace P �baler true,accurate and complete AS of the time of ice. petition was performed based on sty training and e:parisnce in the proper A+ntition and ' maiatenaaee of onaita"wage disposal systems. The system: _ Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority ZFaiL Inspector's 8lgnatus`%,75LQ ll Data: The System Inspector&ha/ submit a copy of this inspectioff report W the Approving Authority within thirty(30)days of completing this in+pectba If the system is a shared system or has a design now of 10,000 gpd or greater,the inspector and the system owaar shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be"at to the system owner:tad Copley sent to the buyer,if applicable and the approving authority. WBPECTION SUMMARY: Check A,B,C,or D: A) SYSTEM PASSES: I have act found aqy information which indicate"that the system violated any of the(&our*Criteria,as donned in 310 CUR 15.303. Any future criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: .,,j2d— Ons or more system oomperosnta used to be NPlaoed or repaired The system,upon completion of the replacement or repair,pas," Indicate yes,�np,or not determined(Y,N,or ND). Dedcribs basis of determination in all instant". It"not determined',explain why not) The septic tank is metal,cm kid,structurally unsound,shows substantial iumtration or exAltratioa,.or tank failure is lmminsat. The system will Pau inspection if the existing septic tank is replaced with a toaformiag septic teak As approved by the Board of Health. (rerl&ed 11/03/95) l One winter Street a Boston,Msa&aehusetts 02106 a FAX(617)55&1049 a Telephone(617)292•SW % retread m a.gcw ropw TOWN OF BARNSTABLE LOCATION C 07 U i T /_3,4 /Z SEWAGE # 7 V��l VILLAGE G 0 rUl T y� ASSESSOR'S MAP & LOT D 0 INSTALLER'S NAME&PHONE NO. c VA/1, el, SEPTIC TANK CAPACITY /f LEACHING FACILITY: (type) 4/Pw y,rA e . (size) NO.OF BEDROOMS_ BUILDER OR OWNER v PERMITDATE: ' l 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wel➢s exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i \\ �q1 �i 5 0 SUBSURFACE SEWAGE DISPOSAL SY8TEM INSPECTION FORM PART A CERTIFICATION(continued) P>ope,eyAdd�... 219 Cotuit Bay Drive Cotuit,Mass. Ow"11 Thomas Walsh Date of Inspwtloor 4/9/9 7 B)SYSTEM CONDITIONALLY PASSES(coatiauad) $swap backup or breAout or ho sutie water Leval obearvd in tba diatrbAlca box is date to btokan or obstrucud pips(s) or due��to a broken,settled or uasvea distrbstion boa. The system wM pass laspeetion if(with approval of the Board of Halve: A.l! rIM V1 ,41T e So' ?-(A LL) broke'pipe(s)am replaced obstructioa is removed dlauOution bos is la,v4W or replaced The system required pumping mom than four Limas a pear due to broken or obstnwwd pipe(s). Tba system will pass inspectba it(with approval of the Board of Health): broken pipe(s)are replaced obetruction is removed ClURTHER EVALUATION IS RED 8 E 1 REQUI BY BOARD OF HEALTHr —Ab_ Cocditioas eclat wbkb»qulre&Khar evaluation by the Board of Health in order to determine If the system is failing to protect the public health,safety and the eavironmant. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMom Ceaspool or privy is within 60 feet of a surface water Cesspool or privy is within 60 fast V a bordering vegetated wetland or a salt marsh. 7) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM 1S FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. The system hu a saptk tank and soil absorption system and is withlo 100 feet to a eurfics water supply or ter AM&:y to a surfam water supply• dLd I lea system has a septic tank and soil absorption system and is within a Zone I of a public water supply wall 40 The system has a septk tank and soil absorption system and is within 60 feet of a private water supply wall The system has a septic tank and soil absorption system and is Is"than 100 fart but 60 feet or man from a pnvats water supply well,unleas a well water analysis for**Urns=bacteria and volatile organic compounds lndleataa that the weU is tee. from poUutioa from that facility and the prwnce of ammonia nitrogan sad citrate nitrogen is equal to as 6u than 6 ppm 3) OTHER (revised il/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) PropertyAddrees: 219 Cotuit Bay Drive Cotuit,Mass. Owner. Thomas Walsh Date of Inspection: 4/9/9 7 D) SYSTEM FAIR: • I ban determined that the system violates one or more of the following failure criteria as deHnd in 310 CMR 16.303. 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. -7 Backup of"wage Into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of sMusat to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. s Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Ar Liquid depth Ice ees.p.4 is Is"than 6•below invert or available volume Is less than 1/2 day flow. I, I Required pumping more than{times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ I�Q Any portion of the Soil Absorption System,casspool 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. �]Q 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 60 feet of a private water supply well. AB Any portion of a cesspool or privy is Is"than 100,feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analysed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above. A)SL The eye.serve a facility with a design flow of 10,000 gpd or greater(large System)and the system is a significant threat to public b"Ith and safety and the environment because one or more of the following conditions exist: 42 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 MA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into dill compliance with the groundwater treatment program requirements of.314 CMR 6.00 and 6.00. Please consult the local regional olIloe of the Department for further information., (revised 11/03195) �^ 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST p„op.AyAdd,.. Thomas Walsh Owner. 219 Cotuit Bay Drive Cotuit,Mass. Date of Inspection: 4/9/9 7 • Check if the following have bean dons. zP—pie9 information was requested of the owner,ompant,and Board of Health. ZoN—of the system components have been pumped for at kaet two weeks and the system has be »osiviag normal flow rate dunes that period. Large volumes of water have not been introduced into the system romat)y or as part of this uwpwb,,. �k lit plans have been obtained and examined. Note if they am not available with N/A. lL 1Oe facility or dwrlliny was inspected for signs of sawage back-up. ZThe system does not receive non-sanitary or industrial waste Dow L The site was inspected for signs of breakout. .� l system compoaeab,Wwluding the Boll Absorption System,have been located on the site. /.ni L'U spptk tank manholes were WXPMed,opened,and the interior of the septic tank was inspected for Condition of baffies or use,material of construction,dirsiensions,depth of liquid,depth of sludge,depth of sarm. IThe nine and kucatioa of the Boll Absorption System on the site has been determined based oa existing information or ap ted by non•iatrusive 7if cDixffit eat from owner)were provided with information oil the proper maintenance of Sub. Surface Disposal System. (revised 11/03195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddrew: 219 Cotuit Bay Drive Cotuit,Mass. Owner. Thomas Walsh Date of Inspeotlaw4/9/97 FLOW CONDITIONS RESIDENTIAL: Desip flow 4 ns 1x+"d7s-'4 Number of bedrooms: Number of curraat raaidaate: Garbage Mader(yee or ao): L+undr7 coaaaeted to system(yes or no):�i s Ssasoaal uss(yes or no):-" r W r if a &Z � � c Last date of oavpanc7:—I-4-17 COMM ERCLAL/IND USTRIAL- Type of setabliahment: AIAI_ Design flow;�n y Gres"trap prvaant:(yes or no)A Industrial Warta Holding Tank present:(yea or no).&—A Non-aanitary waste discharged to the Title 5 system:(yea or tw)�/9 Water meter readings,if available: P Last date of ooeupancy: AM OTHER:(Describe) R//4 Last date of occupancy: Vft_ GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped u part of inspection:(yas or no) If yes.volume pumped 6D 0 n. Reason for pumping: TYPE SYSTEM _ K Septic to WdisU*Aion bos/soil absorption system X Single cesspool Overilow cesspool Privy Shared system(yes or ao) (if yes,attach previous inspection records,if aqy) Other(e:plaia) APPROXIMATE AGE of all components,data Lni alled(if known)and source of information D X! Sewage odors detected when arriving at the site:(yes or no) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 219 Cotuit Bay Drive Cotuit,Mass. Owner: Thomas Walsh Date of Inspection:4/9/9,,••7 SEPTIC TANK:10000A l oD ' e (locate on site plan) 1) Depth below grader Material of construction: concrete_metal_FRP—other(explain) Dimensions: r ' Sludge depth: - Distance from top o Judge to bottom of outlet tee or baffle:-D.- Scum thickness: Distance from top of scum to top of outlet tee or baKle:�_ Distance from bottom of scum to bottom of outlet tee or baffle. Comments: (recommendation for pumping,condition of inlet and outlet tees or baffle,.depth of liquid level in relation to outlet invert,structural rity,evidence of leakage. etc.) Pump tani ev y _2-3 ygas f-ja e&- 4-outlet tees"-Are' GREASE TRAP./ O4,Y- (locate on site plan) Depth below grade:.,' Material of consimrtionn-_:oncrete_metal_FRP_other(explain) Dimensions Scum thickness;ZLs Distance from top wt scum to top of outlet tee or baffle:ev/l Distance from bottom nl crum in honnm o)ounet tee or oahie-./ffJ� i Comments: (recommendation for pumping,condi—n of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage. etc'I Grease Iran is not Dresent. Irevlsed 6/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontlnued) PropertyAddreea: 219 Cotuit Bay Drive Cotuit,Mass. Owner. Thomas Walsh Date of Inspection: 4/9/9 7 TIGHT OR HOLDING TANX-A&E.- 00cs"on sits plan) e Depth babw p ds_ Ph Matarlal of .(j�oacr.t._metal ARP_othex-plain) - Dimension.: AIA Design Gpadty: 91aw .../dy Alarm leveL• Comments: (condition of inlet tea,condition of alarm and float switch",stc.) Tightor hoiding tanks are not present. , DISTRIBUTION BOX (locate an site plan) Depth of liquid level above outlet invert: , Commaab: (note�f level aqd distr�jutioa�i equ&'-"a& oe of solids carryover,evidence of l�akep into or out of has,etc.) Distribution box is level: There is evidence of solids carry over: o suns of ieakage into or out of the is ribution box ('ivPr must hp rniGad nn the diatrhutinn hnx rr)var ; a /inn halnor grave, PUMP CHAMBER.Z iVe, (locats on site plan) Pumps in working order:(yes or no)la Comments: (note ooadttiou of pump chamber,condition of pumps sad appu:tananow,stc.) Pump chamber is not present. (revised li/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(000tinu.d) Prop.AyAddr., 219 Cotuit Bay Drive Cotuit,Mass. Oeroera Thomas Walsh Date of t-P. tl"4/9/97 , Son,ABSORPTION SYSTEM auxlt: "Q,40) �Jrec a�7',C¢�4c.1 t�•y� /of r Oocau on dL plAA if pouible;cmvation not rsquir4 but my be approximated by non•lauuak"metboda) • If not determined to be present,explain LacMns Pit.,onmber._•j_ kwhi,j chambm.,number p1laries le"hias treoebar,nnmb.r,i.nytb _ l..chias aalde,number, vftrraaw a�wspdll�000l,uueom{)ber. p�,� Sa Yiydraulic I'a` ur8 1"S pTnesen .W'p°� P°O° P dWan of~is over h inlet P ,nvPr ep tige 19 _o.4 ng it. *All veseta-tJ-on is Pormal C,nueg+ m11at hP rni ged on CESSPOOL&4&A am, on Sue plea) Number and ccaEquntios Depth•top of iiquid to Inlet invert: Depth of eolida L>Jet Depth od==layer. Dimaarioa+of oaupooL• Maesrlala of oonatructk,. Indication of yrouadwater. bodow(aupool moat be pumped u part of iaapoodo ! CommeaL:(wo condition of&4 dyne of hyamulk(ailure,level of pondiD&oonditioa of vegetation,•te) essDoo s are not Present PRIVY,LI�Qi(1(9i (brat.OU dL plea) Hatarlala of oonatruaks N R DIa>.aaka•: N A Depth of aolid&_gg . CommanL;(aoto oondW=of&4 dyne of?Odraulk fa un,level of pondin coaditloa of vex tatkm,eta.) pj+i uj ag arP nnt. nrARAnt. (r•vitd il/03/95)• y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION •FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Cotuit Water Company 428-2687 0 DEPTH TO GROUNDWATER depth to groundwater r+pthod of determin4iop or ,approximati,o;): r DATE: _ 4/9 PROPERTY ADDRESS: Thomas Walsh FREA 219 Co.tuit Bay Drive 997Gotuit,Mass. 02635 On the above date, I Inspected the septic .system at the above address. This system consists of the following: 1% 1-1000 gallon septic tank. 2. 1-Distribution box 3 1-1000 gallon precast leaching pit. Based bn my Insr ction, I certify the following conditions: T. This is a title five septic,.:system. ( . 78 Code ) 2. The septic system is in failure. 3. Must be upgraded to a title five septic system. ( 95 Code ) 4• Covers on toe tank distribution box and existing leaching pit. 1Y7w,-r joenq I c ed. 5. Pumped system as part of inspection. Filled to capacity. SIGNATURE: L 6L4� Name: J_P_M_acomber Company:_`.P_Macomber- & Son-_Inc , Address:_fie-x-bb-----=-i------- __Centerville.Mass__0.24632 Phone:___SagJJ .333a....... t THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tank&-Cesspool&-Leachflelds Pumped i InsUlled Town Sewer Connections P.O. Box 66' Centerville, MA 02632-0066 775-3338 775-6412 •n.mr+ rn.r•�-�.wrTnnawrrnwn�.++.�.�iww�.w.n nwwy r�rw��,w+ •�' TURN OF Barnstable WARD OF HEALTH .-n SU11Saw•ns..U11FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D•- CERTIFICATION �, F.-•rn-�••.•:.-r.:a-.-++ nn+u•name•s+r+�+rnr�rn�-an.�vw-�ww�++e.+w�,w+�r�.nw+R� ten^'inn+r�ew+n•r..'r.n•.-,rr.•-•r-.�.�. -TYPE OR POINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 219 Cotuit Bay Drive Coot'uoit Mass. ASSESSORS MAP, BLOCK AND PARCEL # `�/ OWNER's NAME Thomas Walth PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Soif 'Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632. street Town or City State tip COMPANY TELEPHONE ( ) R 508 775n - 3338 FAX ( 508 1 790 1 578 CER•rIFICATION STATEMENT " I certifythat I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate, and complete as of the time of .inspection. The inspection was performed and any recommendations regarding upgrade, maintenance, and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems. Check one: System PASSED Tile 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 15. 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. :XXXXXXXXXXXSystem FAILED* The inspection which I have con aloted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 ,303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form. Inspector Signature Date 4/12/97 One copy of this cer ification must be provided to the OWNER, the BUYER (where applioable) and the BOARD OF HEALTH. * If the inspection FAILED, th'e owner or"*4erator shall u d within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 CMR 15 .305 . partd.doc �G L THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Departrnent's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. lunc 8. 1995 Acting Director of the ion of Water Pollution Control TOWN OF BARN ST B_LESE LOCATION_rr /�� WAGE # VILLAGE''- C /�/j ASSESSOR'S MAP & LOT ,--1N M h-L�'-n-�AME & PHONE NO. SEPTIC TANK CAPACITY o LEACHING FACILITY:(type) A/////.� � 7(slze) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE - ISSUED; �J0 RIANCE GRANTED: Yes No �,►a C� bow 1 / s . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF......� !��.5 �. +8 Oq liration for Uhi oottl Vorkg Tonotrnrtion Vamit Application is hereby made for a Per It to Construct ('✓) or Repair ( ) an Individual Sewage Disposal System at: Ccl)+6.1 A_:s" ®. .........6.t2.y s�©'ems J 07 b 9 Location•Address or Lot No. ✓` �- 95...... !9 .s .... ..... £?!�!.a+!.QJ r_.... ! ............................................ Owner Address / /..... a - - ? `; ti 1 G•... .................. ....... .........................(e...................................................... Installer Address dType of Building Size Lot..`—... �.....Sq. feet Dwelling—No. of Bedrooms_... 2_. __f'....................Expansion Attic Garbage Grinder VC) P4 Other—Type of Building ''9" ........... No. of persons......... ................ Showers ( a) — Cafeteria ( ) a Other fixtures ...................•--...-••-••. •'- . . •......_ . W Design Flow....._old'...............................gallons per person per day. Total daily flow......................:"...E_.........gallons. WSeptic Tank—Liquid capacity/ fL.gallons Length._5�..�,.__. Width_`e .��... Diameter................ Depthss.'.......... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......?------------ Diameter......efA......... Depth below inlet.................... Total leaching area...FR!.:?....sq. ft. Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.....ef'.J'......... .......................... Date.... _- ......... Test Pit No. 1..`...a....minutes per inch Depth of Test Pit....Z 3`Y."... Depth to ground water..................... Test Pit No. 2__3..a.....minutes per inch Depth of Test Pit.._.`'!`�...... Depth to ground water......:................ R+ -------------------------------- -....................................................................---•-.......••---•--..._------•-•--••••••..-•--- Description of Soil............... = ay......-----?� ---�---su�gso.C-•-----------•-------- ------- V ......................................................?Y i f�nrl..- 'LC'=� ... .....n7�' t__4'. .............................................................� W .....................:....................•----••--•------••--...----................-•-------•--...............-•-------••••----....----•-••----........••••-••----------•-•--...--•-----------......... VNature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of Health. gned ............... ...................................... ...... ••... ............ ApplicationApproved By.... --• •-. -• .... .................................................................... ••.. ...... . •................... Date Application Disapprove f or t following reasons-------------------------•-----.............-•-•--------•------•--•----------------------..............--••--..... ....................••--•--.'......-•--•-•---•-......--•-•--•----.............---•---------••-------.....................--•--•--•---_.............................. ----••--•-•• ............._ Date PermitNo......................................................... Issued....................................................... Date ,4 No........................ FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .c .v...................oF...... �^�. .. ....... Appliration for Dhipaiial Workii Tonitrnrtion amit Application is hereby made for a Permit to Construct ( v-) or Repair ( ) an Individual Sewage Disposal System at: .- ..... Location-Address or Lot No. ...�f i _r, !Q............ .......................................... Owner Address ai._ ._...../ !'I.................................................... ........ ....................................................... Installer Address Q Type of Building Size Lot..M e..AA Sq. feet U Dwelling—No. of Bedrooms...Zk,?..e..y0....................Expansion Attic (A Garbage Grinder Wd) '4 Other—Type of Building �'S'"' No. of ersons...._...O................ Showers P-I YP g ----------------•----------- P ( Q) —`Cafeteria ( ) P4 Other-fixtures ---•-•............•-•--.._..... . . ell W Design Flow....... l_P..............................gallons per person per day. Total daily flow..............o........:''s� ........gallons. GG Septic,Tank—Liquid capacity/ 6...gallons Length...`k..!..... Width.y�/0.:`. Diameter................ Depth''_ ':... xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area.. .:__:...........sq. ft.' . -Seepage Pit No._..- /........... Diameter....../A........ Depth below inlet.................... Total leaching area... ....sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...... ......... .......................... Date..... ._ '_. . Test Pit No. l...<.... ._..minutes per inch Depth of Test Pit....Zyv....... Depth to ground water...................... Test Pit No. 2..:�....0.....minutes per inch Depth of Test Pit...../.'y.y._j.._. Depth to ground water......`................ f� -------------------------------•---•--------------••---•-•-•--.....--------....-•-•------=-----......._........---.............._.........._•••••-•••-.....-- O Description of Soil...............-O----4 Wit '._.?..-•>�At ls'.6,4.------------•--------------•-•---••-. V _.............................................`'•.�....... ,----.. t".!7 fa._"....!!yIroZe.�fr-.":d-- �`*9=�!.<)................................................ W ........................................................ -•-•----•--•-•----................----•-•-•------.....----....---•----•----•-•-••----••----•-••-•--•-••••-_........_•-•---•••-•-... UNature of Repairs or Alterations—Answer when applicable................................................................................................ ---- --•••••-•-----••------•-••-••---•••-••••••--•••---••-•-•••--...•--•--••=-••-•----••----•....••.....---....•••••••--••-••-•••-•••-•......••-•--... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of. Compliance has been issued by the board of health. Application Approved BY - -- ---Zd..-. - ----..---------------•--......._...............-- ' Date Application Disapprove or t follo 'ng reasons:..........................................................................................:.Da.t.e•---....-•_. ...................................... ......................................................................................................................................................... Date PermitNo......................................................... Issued.................. ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... � Tntifirate of Tompliatta T . . IS' TO CERTIFY, T the Individual Sewa e Dis osal System constructed (,,.o)-br Repaired ( ) by-- � .... ------•• •-•- ...--• ........ 1 7-----------------------------------------------------------------------------------•-- �� InstB� _ '' . .. has been installed in accordance with tl e prow ions of TI.. F 5,of The State Sanitary C, scribed in the application for Disposal Works Const ucti Permit No....... _ _..�.�.................•.. dated_/. ` :__ ._ ..._............_........ THE ISSUANC,E OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A'GUARANTEE THAT THE SYSTEM WN LL FJINCTION SATISFACTORY. DATE....._�.-- --.... ....................................................... Inspector.... . _ .......------------------••---...---••------•--•-------•---•----•---•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH x `� :.........................................OF.................................._.. No . r, FEE....................... io o orko Tonotrnrtion unfit Permission is _._reby ranted_:._ .._ to Construct ( �. pairi( �j' an a1 �e gager isposal Sys at No......... ._ •.... ...........1...._....._.. = ..... = r--- = Street as shown on the application for Disposal Works nstruc 'on Permit No.............. ... ated.......................................... ................................;... -----•--- ---...-----------------------------•......•- Board of Health DATE........................................................•--.........----........ FORM 1255 A. M. SULKIN, INC., BOSTON • + yF 41 v .. jEPTcG fTPNK 33®x15D%.•A9�G•P�o . ..z } , w X• . GAL: !. .�� ' !" �,_:..1 '. „;. ..�: '; � ., : GAL.. . ''2!�' 1� �-/S►/, � ��'�..`_•� ;,.. o%5Po5AL-- P1'r' s S►DG WA�� A¢Gp• .r i 5o 5.� Lor Com.)l°r �•5375 .Po 4 .5 s si 3 G. i 'TOTAL. -raTA1- PA 1 L.Y FLov�! - 330 6.Po i s A •� IN O�L� <i t , PE2coL.taT►oN RAT6i I IN 2M 5 ��,•; t ��` i RS%)iARD G� ` ALAn OAXTER NE Na 24 �Q � Iu. 2' � 1 • u BURS TOP F N D HOLD 7 �^� � 4v6,It'� 7 1000 INS• S ' . -► #, D►ST• INS. 0 A. 13 X SspT ` 2 s �Oao INS Tt T INV INV. F e vJP tpNG D a � CE2TIFlGD P .1 PR.UFILG l.aC4-TIoNv�T ' Y Y„ &a-7 12" NO� SGAI.E SCALE �j � �c/at�.... y _ p�p,tJ RE P E2E►� GE ' C E csT►.F K '.'-t NAT 'T HIJvAT�ol.3 SNo�YN _ .,.t_.., NER.Eo►.l Lompu-?6 YJIT►A-T HE S I o�L.►N LD'}� �q .. Auk S<:T2�"GK 26QV►2EMENY� oF -CNE' a ` ( . To P I.OGp"TED °WIT I►J Tu,E G�.00D I D A-r e: C.t g p"xT E iZ e IJ Y 6 I N C•� :'' �I REG l S'T�Q6U%.AN D 5 u Sty 1 OSTEQ-VIL.L.E' � ��s' c. TuIS Pt-QtJ 15 KIO'T at-,5C-_D O►d AN IW,51-9-uM -THE o►=F,SETS Sua�►,� y No-T CAI: U5E0-T'O DETER!^INE t•�T -INE�j APPLIGA►,I'r o Idt•d. y4 i a ,�, Pl- 70 Fir . . TH ' Ur AL tq M W. RICHARD f` A. N SAXTER v �v JO?ES p Mn,21048 ho sua� t C�'!11�.�( �.o 1 t a X' 3 -33 G G•R c?' ; 3 EPT►cf:°tP K• .33G><Ig,o% •495G•Po d r&WA L ARC.ls r t r •1.3?S G,pp I t � G 1 s 1 t3o-c roM •AQ ►'� S,F,_ , . /^...i.,v �• m4"" + .f 5 s i OGPo, , ` "T oT AL p A 11-Y �F�-o v�( *- Q3 3 ,PEIZS�o1.AT►o GLA'C1r I�'IN Z/1AIN O�LES�i a" 41. � i ( v�RICHARD .ryG ¢ %o� nLniv ° A p W r }r E BAXTER. �, 3. ' NE Y i I No.24M ju. 2' GfSTS Su OL J, .. / I.000 lN�• r f x } i 015T. 56PT quo �.a > s PI•f ENV. 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