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0306 COTUIT BAY DRIVE - Health
" 306 CotuitSay'Drive -Cotuit P A 056 052 E I� �4 I r DATE R 1 7 2003 PROPERTY ADDRESS306_ Cotuit Bay_Drive—_-- TOWN UFBARNSTABLE Cotuit,Mass.^ c _THDEPT. ------------------------ �5 L - ------------------------ 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. ( 6 'X10 ' ) 4 . 2-500 E%jedonnlmachi ghambers. ( 25 'X13 'X2 'o )) 9 y p%c ion I certifythe followin conditions 5. This is a title five septic system, ( 95 Code ) 6 . Pumped the septic tank at time of inspection. 7. The leaching pit and the two 500 gallon leaching chambers are presently dry. 8. The septic system is in proper working order at the present time. SIGNATUR Name : - J__ P . _Macomber Jr . Corripany :�qagPh _p�- M��Qmt,2e,r _b ton, Inc . AddresS : __5Qx -.6--------- - __Q-e-nS2rYLUP,—Na--Q-U32-0066 Pnone :__508- 775_ 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY IOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools•Leachf lelds Pumped & Installed Town Sewer Connections P.0 `Box 66 Centerville, MA 02632 0066 775.3338 775.6412 COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 306 Cotuit BaV Drive Cotuit,Mass. Owner's Name:Bob Sawyer t Owner's Address: _Same Date of Inspection: 2/2 6/0 3 Name of Inspector: (please print) Joseph P.Macomber Jr Company Name: J.P.Macomber & Son inc. Mailing Address:Box 66 C`antarvi l l cam{Mass_ 02632 Telephone Number: _S08-775— 38 CERTIFICATION STATEMENT 1 cenify 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 traiping and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursua�ZRasses t ction 15.340 of Title 5(310 CMR 15.000). The system: — Conditionally Passes Needs Further Evaluation by the Local Approving Authority _ Fails Inspector's Signature: Date: 'd� The system inspector shall mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments •**'This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different _conditions of use. Title 5 Inspection Form 6/15/2000 page 1 _ Page 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 3-06 Cotuit Say Drive �'otult,Mass. Owner:�� ' Date of laspection: 03 Inspection Summary: Check A,B,C,D or E/ALWAY complete all of Section D A. S stem Passes: .� 1 have not found any information which indicates that any of the failure criteria described in 310 CM15. 003 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the me 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. ,t)d The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurall unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existiAg tank is replaced with a complying septic tank as approved by the Board of Health.4A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of C ompliance indicating that the tank is less than 20 years old is available. ND explain: : d Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)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: ±rd The system required ptunping more than 4 times a year due to broken or obstructed i e(s .The s ste pass inspection if(with approval of the Board of Health): p p ) Y m will broken pipe(s)are replaced obstruction is removed ND explain: 2 I Page 3 of I I Ur Y OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 306 Cotuit Bay Drive Cotuit,Mass - Owoer: Bob Sawyer Date of Inspection: _2 26/nI C. Further Evaluation is Required by the Board of Health: Conditions exist which require funher evaluation by the Board of Health In order to determine if the system IS failing to protect public health, safety or-the environment. I. S)stem Hill 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 bealtb,safety and the environment: 46 Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin SO feet of a bordering vegetated wetland or a salt marsh 2. SN stem 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: &r The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. "A The system has a septic tank and SAS and the SAS is within a Zone vof a public water supple /a The system has a septic tank and SAS and the SAS is within SO feet of a private water supply well. • ,W The system has a septic tank and SAS and the SAS is less than 100 feet b 150 feet or more from a private eater supple well, Method used to determine distance This s,,stem passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is tree from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm,provided that no other failure criteria are triggered. A copy of the analysis must be anaehed to this form. 3. Other: 3 'Page 4 of 11 < OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:306 Cotuit Bay Drive Cotuit,Mass . Owner:Bob Sawyer Date of Inspection: 2/2 6/0 3 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ackup 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 A-I squid depth-in eesspMl is less than 6"below invert or available volume is less than 'h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ! . Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface /water supply. portion of a cesspool or privy is within a Zone I of a public well. ��A:nyy portion of a cesspool or privy is within 50 feet of a private water supply well. y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Alp(Yes/No)The system fails. 1 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. l 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 Xthe system is within 400 feet of a surface drinking water supply /the system is within200 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. 4 'f 'Page 5 of 1 1 r' OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 306Cotuit Bay Drive Cotuit,Mass. Owner:Bob Sawyer Date of Inspection: 212 6 l o-3 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? ZHas 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 ? d _ luding the SAS, located on site? Were all system components;!Ac 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: Yet no Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) t 5 Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:306 Cotuit Bay Drive Cotuit,Mass . Owner: Bob Sawyer Date of Inspection: 2/2 6/0 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): r DESIGN flow based on 310 CAI 5.203 (for example: 110 gpd x#of bedrooms): Number of current residents:D Does residence have a garbage grinder(yes or no): S Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)):2 0 01 —5 3, 0 0 0 ga 11 on s=1 4 5 . 21 GP D sump pump(yes or no): V6 2002-134, 000 gallons=367 . 13 GPD Last date of occupancy:d "Inw,I C O M M E R C IA L/IND U S TRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): /y Grease trap present(yes or no): 40 Industrial waste holding tank present(yes or no):A44 Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: A49 OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 4e f}I Was system pumped as part of the inspection(yes or no): If yes, volume pumped: /00 gallons--How was quantity pumped determined? X8/><,LC+�I C Reason for pumping: Heavy scum & solids layers were present TY,Py OF SYSTEM V Septic tank,distribution box,soil absorption system /lam Single cesspool / Overflow cesspool iez Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) /_�j_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank 0 Attach a copy of the DEP approval .oUd Other(describe): 1)3 A Foximate aee of all comporlents,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): /Lb 6 r Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 306 Cotuit Bay Drive Cotuit,Mass. Owner:Bob Sawyer Date of Inspection: 2/2 6/0 3 BUILDING SEWER(locate on site plan) Depth below grade: .05'" Materials of construction:,?cast iron Z40 PVCAlet other(explain): W11 Distance from private water supply well or suction line:ld t Comments(on condition of joints, venting,evidence of leakage,etc.): Joints appear tight No evidence of leakaa The system is vented through the house vents. SEPTIC TANK: Zlocate on site plan) /6vOp'r'J�4S �a Depth below grade: Material of construction: y concretedmetal,40 fiberglass,t, polyethylene >Jct other(explain) tV If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 5'1 Sludge depth— Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: 0 Distance from bottom of scum to botto of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendation , inlet and outlet tee or baffle condition, structural integrity, liquid levels f as.related to outlet invert,evidence of.leakage,etc:): - ( Pump the septic tank every 2-3 years Inlet & outlet tees are in place.—The—tank—is stucturally` sound and shows no evidence of leakage.Liquid level at the outlet invert is 51 GREASE TRA134"locate on site plan) Depth below grade:,L Material ofconstruction4f Lconcretee metaWfiberglass�polyethylenaa other (explain): ems) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: -10 Distance from bottom of scum to bottom of outlet tee or baffle: ;1�' 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.): rrpAge tran i4 not nrPGPnt 7 x Page 8 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 306 Cotuit Bay Drive Cntuit1,Mass _ Owner:Bob Sawyer Date of Inspection: 2_/2 6/0 3 TIGHT or HOLDING TANKf&94tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete A-* metal WX fiberglass,e/A polyethylene t4P other(explain): Dimensions: 'Zo Capacity: .t/r9 gallons Design Flow: ,q gallons/day Alarm present(yes or no): Alarm level:, A14 Alarm in working order(yes or no): oe64 Date of last pumping: AJA Comments(condition of alarm and float switches,etc.): Tight or holding tanks are not present. DISTRIBUTION BOX: Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 46 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.): T)4f-rihution hnx has two laterals.No evidence of solids carry oy9r.Nn cvi denoa of l aaknge into c)r c)ut of the box PUMP CHAMBERf1bOC;(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.): piimi nhamhp-r is not present . t - 8 ""Page 9 of 1 I t OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Add ress:306 Cotuit Bay Drive Cotuit,Mass. Owner: 2/26/03 Date of Inspection: Bob Sawyer SOIL ABSORPTION SYSTEM (SAS):Z(locate on site plan,exca vation not required) 1 —inoo gallon orecast leachin it. ( 6 X10 ) 2— 500 gallon leaching chambers. ( 25 X13 X If SAS not located explain why: Iocated- See page 10 peT �pleaching pits, number:leaching chambers,number:leaching galleries,number: �— leaching trenches,number, length: leaching fields,number,dimensions: Z1 overflow cesspool,number: 0 _ ��-- _ innovative/alternative system Type/name of technology: /��y TJYG Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): o fine sand.No signs of hydraulic failure or leaching it and the wo gallon leaching chambers are presently dry.Vegetation is norma . CESSPOOLW416(cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: Q Depth—top of liquid to inlet invert: llt Depth of solids layer: ItI .J Depth of scum layer: A Dimensions of cesspool: Materials of construction: ,4J/7 Indication of groundwater inflow(yes or no): Al Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): C'esspor)ls are not present PRIVW/,*& (locate on site plan) Materials of construction: Dimensions: ,q Depth of solids: 144 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not prP9pnt 9 Page 10 of I I • OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:306 Cotuit Bay Drive Cotuit,Mass . Owner: Bob Sawyer Date of Inspection: 2/2 6/0 3 , SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. �P7 0 10 1 1 G G b o Copy of as built from the Town Of Barnstable Board Of Health Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 306 Cotuit Ray Drive Cotuit Mass . Owner: Date of Inspection: 3 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�feet Please indicate(check)all methods used to determine the high ground water elevation: YFS Obtained from system design plans on record-If checked,date of design plan reviewed: 2/2 6/0 3 YES Observed site(abutting property/observation hole within 150 feet of SAS) Yes Checked with local Board of Health-explain: Obtained As Bui It Card YES Checked with local excavators, installers-(attach documentation) YRS Accessed USGS database-explain: http: //town ,barnstable.ma.us. You must describe how you established the high ground water elevation: 3ed: Gahrety & Miller Model. 12/16/94 Water table elevations above sea level . 3ed: US n well data.June 1992 3ed: USrS-TPrhntcnl hullet-tn 2-000-1 Plate #2 January 1992 Annual ranges , of around water elevations. to run Leaching Pit �� ,/ -eet Groundwater: Peet Below Bottom of Pit _ High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. 11 RrRT+I —n.•rT.'rT {rn. arR nTfRTleR ilR.rRsrr.9+lrserlT,RRn.n Avr+11ft1R•�s►at'eT TOWN OF Barnstable BOARD OF HEALTH •-•T.,-�• : .-T.,,,•-.,r„)iSU[ZFACF SEWAGE DISPOSAL SYSTEM IN�9P.FCTION FORM - PART D •- CERTIFICATION I -TYPE OR PRINT CI.EARLY- PROPERTY IN.SPECT'ED STREET ADDRESS 306 Cotuit Bay Drive Cotuit,Mass. ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Bob Sawyer. PART D - CERTIFICATION Y NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Sop Inc-'.` COMPANY ADDRESSBox 66 Centerville,Mass . 02632 Street To►m or City State LIP COMPANY TELEPHONE ( 508 1 775 - 3338 FAX (508 . ) 790 _ 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at ID his address, and that the information reported is true , accurate ) and omplete as of the time of -inspection . The inspection was performed and any ecoinmendations 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 ne: r` System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh 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 . System FAILED* The inspection which I have con trcted has found that the system fails to Protect the Eiublic health and the environment in accordance with Title 6 , 310 CMR 15., 303 , and as specifically noted on PART C - FAILURE CRITERIA of, this inspection for . Inspector Signatur Date d copy ort.ification must be provided to the OWNER, the BUYER Orne where applicable ) and the I30ARD OF' HEAL'I'll. * If the inspection FAILED, the owner or"*operator shall u pgrade ' the aystem ,within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . partd .doc DATE; 10/11 /00___ PROPERTY ADDRESSt��-___,..________ 306 Cotuit Bay Drive _ Cotuit, Ma 02635 ------------------------ On the above date, I inspected the septlo ,system at the above address. 'rhls system conslsts of the following; 1 . 1 -1000 gallon septic tank 2. - 1-1 000 gallon leaching pit 3 . 2-500 gallon chambers 4 . 1 -Distribution Box 6'a3ed on my Inapectlon, I certify the following condltlonv 5 . This is,.a title five septic-system. (_ 78 Code ) 6 ._'The septic system is in .proper working order S-46 O at the present time. 7 . 'Systeem was upgraded 11 /5/97 8. Permit# 97-636 S I G N AT U R E t Name :_ i,_P. 2t9ssto>t.tr__Jj Company: Jo2!yh_P _ Nacomber_6 Son , Inc , Address,_ box_66-- __Centerville Har_02632-0066 Phone :___ THIS CERTIFICATION ODES NOT CONSTITVTe A aVARANTY OR WARRANTY J6SEPH P. MACOMBER & SON, INC, TanksvCssspools-Le achflsIds Pumped 4 Installed Town stwor Connsotlons P.O. Box 66 Csnlervlllo, MA 02632.0066 7753338 776,6412 41,E n ?00 VN I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTEMON ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 t TRUDY COKE $ecr+t.ary ARGEO PAUL CELLUCCI DAVID B. STRU`IS Commiuiooer Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERnFICAnON Property Addrsss: 306 Cotuit Bay Drive Name of owner Scott Jordon c/o William Beard Cotuit AddrossofOwnar:73 Flemmenway St. Apt. 506 Data of hspecton: Boston, MA. 02115 Nama of r%poct>x; cQ�bseph P. Macomber Jr. I am a DIE➢ syiusm Inspector pursuant to Section 16.W of T1tSe 6(310 CUR 15.000) C ,,,p,n,y Nam»; Jose h P. Macomber & Son Inc. f.laiv+gAd6rsu: E x en ervl e M 632-0066 Teiaprwrw liursber _7 7 5_ CEtTIF r_AMN STATEMENT i cervey that I have personally inspected the sewage disposal system at this address and that the Information reported below Is lave, accurate and compleu as of the time of impaction: The Inspection was performed based on my training and experience In the proper function and ms,ntenancs of on-sits sewage disposal systems. The system; r' P,sssas. _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Falls �^ v�speczo+'s Slgrutur�: Darts: 1 The System inspect, hall submit a copy of this Inspection report to the Approving Authority (Board of Heahh or DEP)wttNn thirty (30) days of completing this InsAct)on. It the system Is a shared system or has a design flow of 10,000 gpd or greater, the Inspector and the system owner $'hall submit the report to the appropriate regional office of the Department oK-nvVonmen:W f'tatectlon. The original should be sent tovv system owner and copies sent to the buyer, If applicable, and the approving authority, NOTES AND COMMENTS re'viSed 9/2/98 f page Iof11 y - tt, anted on Rec W4►ape, f SU&SURYACi SEWAGE DL3P03AL SYSTEW MPIECTtON FORA MAT A CV"ViCA=W foontl+wQI PTopw y Ad*.": 306 Cotuit Bay. Drive, Cotuit oWnw-. Scott Jordon Cvo or tup.ct— 1 0/1 1 /0 0 1K3/'£CTI0N SVs,tMAAYI Cpwa A, B. C, a D* A.% SYSTF}1IA33ES: I have not found my Informadon wNch Irtd)cates that any of the faAure condtdorta described In 310 CMR 14,303 •xlst. Any fy uttsr(a not ev•lusted Ne Ind)csted below, CCl uxDM: i, SYSTE7d CONDMONA.LIY PASSES: One w mole system sompononu as do•orfbod In tho 'Con47do" Issas seodon need to be repiaood Or repaired, rew syt.&M. compledon of the replacement w fopair, as approve4 by-the Sowd of Health, will pays, dcato yes. at , or not determined (Y. N, a NO). Deabe b"a of detwrnlnad tan on In aL Inao•a. It 'not dotarmLned', •z�+lal�+ wnr rwj. Lr �[!! The sepdc tank la metal, unless the owner w opwatw has paovlded tho system Lnapeotor wtth a oopY of a Col Aule Compuonce (onschod)Ind)codnp that the tank was M•taUod wlWn twontY (20) Yews prtw to the d4w of tt.e trup.rC90 the eepdc tank, whether or not metal, Is erooked, strvewraUy unsound, ahowe evbstandal InfVVadw+ a erftrveoon. w failure it ImrrJnent. The system wW psss Inapscoon If the oxJsdnp sepde tank Is replaced whh a somprYtnp septic t+^ approved by the tJoard of Health, IVO Sewape backvp or breakout or Nph stado water level observed In the dJatrlbudon box Is Out to Orokan a oarwct.d P or due to • broken,.eetded or uneven dlstrlbu don box. The oyetom Will pass ktapeotJon If (wro approval of tho Ooua c H9&Jth). broken plpo(s) we replaced obswcdon Is removed dJavibudon box 1s levelled w replaced The system raQuked pumpLet7"NWV ttt+n "�+^ss�ry+ardue to brol(enw obtrWoted PJpef•). The TY.. . w+ry�car InapecUon.lf (with approval of the Sowd of Health)t broken plpe(s) we ropiac•ed obewcdon Is removed k hte 2 of It ,revised 9/2/-98 SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPEC'nON FORM � PART A t;,gftT1F1CAT10N (condnLAJ) prop.rty Addr.aat 306 Cotuit Bay Drive, Cotuit O.rrw: Scott Jordon D.w of VAp.ctscn: 1 0/1 1 /0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: i.^ondtions exist which require further ovaluadon by the Board of Health In order to determine If the system Is hZng to protect tf+e lwbllc health, safety and the environment, 11 :SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETOWINES W ACCORDANCE WITH 310 CUR 15,303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONWO W A 1"NNEA WH1CKyALL.PR0.IEV THE PUBLJC bfALTVLA.ND SAFETY A D THE Ei80NlrBCL• Cesspool or privy U within 60 feet of surfaoe water ; Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh, 2) S"STEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, 6F A r DETERUDa3 THAT THE SYSTEU tS RINCT)ONWO W A mANNEA THAT PROTECTS THE PUBLIC HEALTH AND BAFETY AND THE EWVtRONI.tFXT: A)Q The system has a septic tank and soli absorption system(SAM and the SAS Is within 100 feet of a wrfacs water wppry or trlbutary to a surfece water wpplY- �� The system hoe a septJc tank and ►oil absorption system and the SAS is wltNn a Zone I of a public water wpplY wvu The system hoe a septic tank and aoll •bwrptJon system and the 3A3 Is within 60 feet of a private water wppry weu 7,0 The system has a septic tank and atoll absorption system and the SAS Is less than 100 toot but 60 feet or more hom e private water supply well, unless a well water analysis for collform bacteria and volatile org&Nc compounds Indicates T+I tr4 well Is Tree horn pollution from that facility and the prey nce of smmoNs Ntrogen and Ntrete nJvogen Is oquaJ to or lots than 6 ppm. Method vied to determine distance (app(oximrtion not valid). 71 OTHER • 1 revised 9/2)98 Pste)of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERT1FiCATION (corrdnU`gd) propw'YAOdes": 306 Cotuit Bay Drive, Cotuit Owns: Scott Jordon Dote of vwp-C,6—: 1 0/1 1 /0 0 D. SYSTEM FAILS: You vat Indicate either 'Yes' or 'No' to each h the following: ti&L I have determined that fi'ndeti fowcr ThetBoardloWH althing l should ure nbeticontacted to dsteons exist as r(ml oIwhatt will be necessary tote c°rtw Vw too diterminstlon Is Identl Yes No / oornponMC do*town over4o.dod vrvW99�d SorcNsl�• '";"" L{/ Backup c4.+w+9e IRW 4e`clW1-V or•+T*1 austere due to an overloaded a Clogged SAS of Discharge or ponding of effluent to the surface of the ground or surface cesspool, rloaded or clogged SAS Static liquid level In the distribution box above outlet Invert due to on ove . cesapoor. _� Liquid depth In cesspool Is lose than 6' below Invert or available volume Is less than 112 day flow. Required pumping more the 4 times In the lost Year K).due to clogged or obstructed pips(O. Number of times pumped. privy Is below the high groundwater slev+don. Any portion of the Soil Absorption System. cesspool or p Y / Any portlon of a cesspool or privy Is within 100 feet of a surface wolf r supply or tributary to a surface water wDWy _ Any portion of a cesspool or privy le-within a Zone I of a public well. f a cesspool or privy Is within 60 feet of + private water supply well. Any D�l onlon o / onion of a cesspool or privy Is lees•than 100 feet but greater then 60 het from a private water &u we11 wi6 Any D acceptable ptab avatar quality analysis. II the well has been analysed to be acceptable. attsch copy of wall water an ys -conform bacteria, voistllo organic-compounds, ammonia nitrogen-and nitrete nitrogen. E. I_ARGE SYSTEM FAILS: You must Indicate either 'Yes' or 'No' large of the lfollowing: ditlon to the criteria above: The following criteria aDD Y 9ad I r�Aoant tweet I J� The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system le s fag err health and safety and the environment because one or more of the following condldons ezNt: Yes N he system Is within 400 lent of a surface drinking water wDplY er ie�wrle.o��r�r+Ww9'r,'eaM'w►}lY.... he 6y61em•I�wIM:A 200 teal of ►t Y Z-4 11 of e ,—the system Is located In a nitrogen sensitive area (Interim Wellhasd Protection Area•IWPAI or + mapDe4 water supply well) The pwnor or operator of any such system shall upgrade the system In accordance with 310 CMR 16.704(2)• Please con+u►t t7+e lour oMcs of the Department for further information. I sgf 4 of It reNiised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART i ' CHECKII3T Prc4wy Ad*"4: 306 Cotuit Bay Drive, Cotuit own«: Scott Jordon °"" of tn`poc`s'ol: 1 0/1 1 /00 Check If the following have been done. You must Indlc*te either 'Yes' or 'No' as to each of the following: Yes NO J _ �/ Pumping Information was provided by the owner, occupant, or Board of Health. •Norw of the system con4ww+nt* ma..oi f rates during that period. Large volumes of water have not been InVoduoed Into tho system recently or as part of vvs Inspection, As built plans have been obtained and examined. Note If they are not available with N/A. The facility or dwelling was Inspected for signs of sewage backup, _J 41 The system does not receive non•eanJtary or Industrial waste How. The she was Inspected for signs of breekovi. — / All system componenu:iecludinp the Soll Absorption+Sytitem, have been located on the site. _ The septic tank manholes were uncovered, opened, and the Interior of the *optic tank was Inspected for condition of oa or ise►, material of construction, dlmen►Ions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soll Absorption System onthe site has been dete►mJned based on: _ Existing Information. For example. Plan at B.O.H. _ Determined In the Held (If any of the failure crlterls rented to Part C Is at Issue, approximation of distance Is unecceptat 115.302(3)(b)) L� . _ The faclUty owrur ditfw&W froati--ar),wat, p; f—' ell wUh Iri+^ alloson th,pr_;. i— SubSurlece DI►posaJ Systems. revised 9/2/918 Page lofII f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION P+w«-tYAdd,*": 306 Cotuit Bay Drive, Cotuit' Ownw; Scott Jordon Data of louPect 0n: 1 0/1 1 /0 0 ROW CONDITIONS RES*E TUI: Design Aoxr:. aig _g•p•d•/bedro m. Number of bedrooms (d 'I /n Number of bedrooms(actual):—f Total DESIGN Aow �,-r Number of current rssidents;� Garbage grinder(yes or no):LAW _ orno 0l^+P�ctlon•r�qulr�d Laundry (separate system) a _ Laundry system Inspected ye or no) Seasonal use IYe+ or nol: < t Water meter readings, If av able (last two Year's usage I9Pd1:��1,,,„��c Sump Pump(yes or no): 'Aae— 4�� Lost data of occupancy: .qq MERCtAtrN TR_lAl: Type of establishment: Ali' Design flows ,(>d ood ( Based on 16.203) Bawls of design flow 01e8se trap present: (yes or no) Industrial West@ Molding Tank present: (yes or no)J2 Non•sanitsrY waste discharged to the Tide 6 system: as or nol'�)V _ Water meter readings,It available:_ Lost date of occupancy: A21d OTHIER:(Describe) last Oslo of occupancy: GENERAL INFORMATION PUMPING R CORDS�nd source f Infor at14II:, System pumped as part of Inspection; (Yes or no)_Q If Yes, volume pumped: 9►lions Reason tot pumping: TYPE OF YSTEM TYPE tank/distribution box/loll absorption system Single cesspool Overflow cesspool Privy Shared system (Yss or not (If Yes, attach previous Inspection records,If any) I/A Technology si5. Attsch copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other A OX17dI, A E of all c ponenp, date InetalledNf kno n-and souse o(•sseforrt++don: � ^(:/ �� � Sewage odars detected when arriving at the $lta: (Yes or no) Pees 6 of II revised 9/2/98 i SUBSURFACE SEWAGE DIBPOSAL•SYSTEM INSPECTION FORM :v PART C SYSTEM INFORMATION llcon*sued) Property Addrw6s: 302 Cotuit Bay Drive, Cotuit owner: Scott Jordon D"'of k%P*c`fa" 1 0/1 1 /0 0 SUILDWO SEWER: tLocate on site plan) Depth below grade:'l Material of conswctJon;a cast Iron Z40 PVC�4 other ( xplaln) Distance tronj privat0 weer supply well or suction line Diameter '-ALL .. • Comments: (condition of Jolnu, ventlng, evidence of Nakft C-stc,) Joints annear en— of 1pakicip - SpSItZ i s ven SEY1'IC T"ANK: C3[ (locate on site plan) Depth botow grade'/ Material of cons trucdon4r concreteAQmetalbr Flb erg lass/fa_Polyethylene.(3'other(explaln) 11 IF tf tank Is fnetal, list age Js.age.conArmed by Cgrditcate of Compllance/,.P,_ (Yes/No) Dimtnsiohs: Sludge depth: Distance :'Tom 1OP_qjj4udqa to bottom of outlet tee ortratflr/z Ci Scum Wakness: /� Distance hom top of scum to top of outlet tee or Distance i'rom bottom of scum to bolt of outlet to or atf o f How dimensions were determined: Comments: �n utcommendation for pumping, itlon o} Inlet grid o let t es or•batfles;depth of.11quld Iev�I II{le{atleot to invert, structvrsJ .�t•grrtr. $uMtl septic- an�C ever 2- 1 1 o£avid• a of leakage, s , 1 cal de th let tees are i e ank an s ow is F i_ Tv13nce OR TiAP:�MfL (locate on slit plan) Depth below grade: Material of constructlon;/8concrett*m•t&WAFlberglassA��Polyethylen✓1��other(explaln) Dimenslons: Scum thickness: Distance tTom top of scum to top of outlet its or bstfle:�i . Distance from bottom of scum to bottom of outlet tie or baMt:iY Data of last pumping: L; Comments: ror'� (recommendation for pumping, condition of Inlet and outlet tee$ or baffles, depth of Uquld level In relation to outlet Invert, etrumral int evidence of leakage, etc.) Grease rap J 2 Paee 7 of 11 revised 9/ 9 8/ 31.193URfAC9 3EWACE DUPOM 3Y$TtW 1,143rf MON fxOPWU ,J FAAT C 3YSTDA WFOR"'now It-y&-od) PToq.rTy Ada..+: 306 Cotuit Bay Drive, Cotuit 0%~: Scott Jordon °" W1 `up d— 1 0/1 1 /0 0 n01fT OR HOLDING TANK: (T+nk must be pumped prior to, or +t Um• of, Inapecdon) (Igc+te on Nu pl+n) 019%h below gr►de:�lh MeterleJ of con,wcUon afAconcr+►+a'/m+t� fib+rpl+++.d,/1oly+chyl+noth+r(+xpl�ln) plmen+Ion+: Cipaclry:��[ 9+I1orts Disign flow: g►lion+/0+Y Al+rm pre►enl ���q, Aurm I+v+l: Al+tm I �orking order:Yq1' Nw(ST Del# el predovs pvmpingl �� Comments: )) Uo �`f2��n gOretheOldln el arm of ut0 flo+t +wltcMh gw.l NST-nis JTION IOX:.Z I19461e on We plan) Oeptn of liquid level above oudlt Invert:�. CommeMS: t�l' to ��lLe�r011 o DOX V haSOenw of +o%Id+ carryover, wvNo a evI+oko9+Into or out •1►vs; •tc.l S wa ° O pump Cr�AueEA:� 1104410 On III+ pl►nl ►umpe In working order.(Yes or No) Alarms In working order IYII or N010 Comments: Ingle condloon of pump ch+mber, condlUon of pump+ end eppurtenenoe+ ate, Pump am fe{e l of ll ;revised 9/2/98 i SUBSURFACE SEWAGE DtSPOSAI SYSTEM INSPECTION FORM PART C SYSTEM WFORMAT10N (COfi*Kjod) p„pe,ty„d&"6: 306 Cotuit Bay Drive, Cotuit Own«: Scott Jordon Darts of Inspection: 1 0/1w 0 SOIL ASSORYTION SYSTEM(SAS): (locate on site plan, If possible; excavadon not required,location may be approximated by nonantrusive methods) If not located, explain: Type: IoachIng plts, number: loaching-chambers, numb; :e,,% loathing galleries, number: isaching trenches, number, length:---ICJ--- leaching fields, number, dime dons: L% overflow cesspool, number: Alternadve system; Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, demp soil, condltJon of vegetadon, etc.) Loamy .sapdNo si ns of hydr e or on M. 8fH System isdry- is norms . CF_S S POO U; (locate on 0t plan) Number and configuration: Depth-top of liquid to Inlet Invert: Depth of solids Layer: Depth of scum layer: Dimenslons of cesspool: Metsrfals of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of Inspection) C SSpnnlG ArP not proms At Commenu: (note condition of soil, signs of hydraulic failure, level of ponding,condltlon of.vegetatlon, etc.) Cesspools,_ are not z rpcPnf- - PRJVY: kk� (locate on site plan) Materials of constru ld 2� Dirttenalorta: Depth of solids: Commenu: incte condidon of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) Privy is not orPSpnt a revised 9/2/98 Pa¢e9orll SVOWACt:S[WA01 DtS CiYWTVA WirLGTON FORM PA.ASyiTDA WFOPJJ.AT)ON (oon*wodl Ate,«,; 306 Cotuit Bay. Drive, Cotuit- QWTW.; Scott Jordon Dqu °'v% ..-rd—I 1 0/1 1 /0 0 SKVC.H Of SEWAGE DtSPOSAI. SYSTEM: Inciudo of# to it Imt two pfrm+n#nt relfroncl I+ndmukl or bonchrmuntc'hou+,, locr,tu NI willr wlthln 100' Ilocoio whore publlo water supply Comso O O fl i l �Cis 3 . nc� to or tt revised 9/2/98 SU93URFACE SEWAGE O13P9SA1 SY3mii wsrecT10N FORM PART C 3YSTF7d PMRlrlJ MN (c0f*W*4) ' hopKty Adds++: 306 Cotuit Bay Drive, Cotuit Owr,.: Scott Jordon 0ou of InapeclSon: 1 0/1 1 /00 NRCS Rsport name Sou Type_ TTpIcN depth to proundwoler USG$ Oslo wobslte Ashod Obsorrotlon WIAs checked Orovndwotsr depth: ShallowModenle Deep — SITE EXAM Slope Suffice waist Check Calls( Shallow wells i E,urnaled Depth to Oroundwotsr Gas-Fct't Ilee,s Indicate NI the methods vied to deNrnJne High Groundwater VvvatJon: Obtained hom Design Plano on record Observe0 Site IAbvNvtdnp propart�observsdon hole, bssemeot Bump *to-) E�Delerrnlned Irom local condltlons Checked with local Ioard of health Ch}cked FEMA Maps k- CChh@cked pumpinp records 4*'�Checke0local eicavalon. Installers Used USOS Oslo Oe,crioe how Yov established the High Groundwater ElevolJon. (hjW be completod) Installed upgrade 11 /5/97 No water encountered ar 14" Used; Water contours Map, Gahrety & Miller .Model 12/16/94 revised 9/2/98 hpllofll . .war..�nir�•-r-,*w�w�•rr�rrn�'r.w�.wnw•.wvni�w.+.w.•n�tirww�n�v+ .rw-R+-�-.-- .. .- TOWN OF BARNSTA$LE WARD OF HEALTH � SUM9Vf?FACF 8FNAUF 013F`Q3AL 8YSTFM 183PFCTION FORM PART D •- CERTIFI CAT 10N .n-. ..,-•liR-.�rnT n�.,w,n►�ww�..wr.r,1.�T..�w�w-r�'�I�wI w��R+w� .ww v..r..- •---,. _. 1 -TYPO OA PAINT CI.CAIILY- PROPERTY INSPECTED STREET ADDRESS 306 Cotuit Bay Drive, Cotuit ASSESSORS HAP , BLOCK AND PARCEL # OWNER' s NAHE Scott Jbrdon PAI7T D - CDiRTIFICATIOH NAHE OF INSPECTOR Joseph P. Macomber Jr, COHPANY NAME Joseph P . Macomber & '`Son, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 strggt Tovn or C ty 8tat• 1IP COMPANY TELEPHONC ( 508 ) 775 - 3338 FAX ( ) CER'rIFICATION STATEHCNT I certify that I have personally inspected the sewage dieposa`1 system nt this nddress and that the information reported is true , accurate , and omplete ns of the time of - inspection . The inspection was performed and any recommel loll io►ls 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 ; : A� System PASSED , The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public heallll or the environment as defined in 310 CHR 16 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED= The inspection which I have con doted has found that the system fails to protect the j)ublic health and the environment in accordance with Title 5 , 3IQ CHR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this Inspection form . •Inspector Signature Date anocopy of this certification must be provided to the OWNER , the BUYER h• r• app). loabl• ) and the AOARD OP' FIEAL'I'll , • If the Inspection FAILED , thb owner or operator shall upgrade ' the eye tem within one ,year of the dote of the inspection , unless allowed or required otnerw13e as provided in 3.10 CHR 16 . 306 , partd . doc TO,W..N OF BARNSTABLE LOCATION L-EI 1 SEWAGE # VILLAGE �7 (��' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /60 'A 'A� 1 LEACHING FACILITY: (type) 8 (size) NO.OF BEDROOMS BUILDER OR OWNERc �,�1.�,�� PERMIT DATE: COMPLIANCE DATE: /O///`D 9 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any weUs exist on site or within 200 feet of leaching facility) Feet Edge of Wetland an Ching Facili (If any wetlands exist within 300 feet f acili Feet Furnished by i. V O 0 , TOWN OF BARNSTABLE LOC—ATION 3 Q to G OTU/ f 13A y /,?2 SEWAGE # VILLAGE` C 0-7'0 l.T ASSESSOR'S MAP & LOT C)S�"(o ®.S L INSTALLER'S NAME&.PHONE NO.-- 44 Al C ®A4 Reg f S ON SEPTIC TANK CAPAC="A Q(20 LEACHING FACIL=—:'(type) fltld-PG C1,W Cl A,4&,f(size) SO O G NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE~ �/ —v�/— q COMPLIANCE DATE: /1'©S 97 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 r� r/� � � \ �� ��` / �� % / . \ � d_ f ` r ,. I � � �� C� No. �7 _ 6 3 Fee $ 5 0 .0 0 /. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppricatiou for Mi5pozar *pgtem Cougtruction permit Application for a Permit to Construct( )Repair kX)Upgrade( )Abandon( ) ❑Complete System 0 Individual Components Location Address or Lot No. 306 Cotuit Bay Drive Owner's Name,Address and Tel.No. Scott Jordon [�otuls MMa 306 Cotuit Bay Drive Assessor sJI ip7Parels• Cotuit,Mass. 02635 Installer's Name,Address,and Tel.No. 5 0 8—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.PM.acomber & Son Inc. J.P.M.acomber & Son Inc. Sox 66 Centerville,Mass. 02632 BOx 66 Centerville, Mass. 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building RES No. of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3X 1 1 n gallons. Plan Date ' 1 1 /3/9 7 Number of sheets 2 Revision Date Title Size of Septic Tank 1 000 existing. Type of S.A.S. 1 000 gallon pit- exist Description of Soil Loamy sand to dead sand Nature of Repairs or Alterations(Answer when applicable)�.!.daing twee 0 O q-9 , It - ate; nrr t-wo five hundred chambers hacked in 4fl` of stone. 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 been issued by this B d o Health. Signed ZI Date 1 1 /3/9 7 Application Approved by e Date // yP 27 r Application Disapproved for the following reasons Permit:No. 7 Date Issued '14 No. - ;..' C9 F ee $ 50.00 «THE COMMONWEALTH OF MASSACHUSETTS . Entered in coinputei " Yes r PUBLIC HEALTH°DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 3pprtcation for Migooar *potent Con5tructton.30ermit Application for a Permit to Construct( )Repair kX)Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. 306 Cotuit Bay Drive Owner's Name,Address and Tel.No. Scott Jordon =qrs� � Ma s 306 Cotuit Bay Drive, AssessorslVla�i/Farce� Cotuit,Mass. 02635 Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5.—3 3 3 8 J.PM.acomber & Son Inc. J.P.M.acomber & Son Inc. 'Box 66 Centerville,Mass. 02632 BOx 66 Centerville, Mass. 02622 Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building RES No. of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 3350 gallons per day. Calculated daily flow 3Xa 10 gallons. Plan Date 1 1 /3/9 7 Number of sheets 2 Revision Date Title Size of Septic Tank 1 000 existing. Type of S.A.S. 1000 gal lnn Pit , exist Description of Soil Loamy sand to dead Gann. Nature of Repairs or Alterations(Answer when applicable)_ Adding two '590 chambers lk j h j hgvy Adding two five hundred chambers packed in '` of:�stone. 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 been is d by th' B/ard o Health. 11, Signed f� Date 1 1 /3/9 7 Application Approved by Date Application Disapproved for the following reasons t x Permit No. 9 7 3 A16 Date Issued r ---------------------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS j 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 306 Cotuit Bay Drive Cotuit,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 97-(o.li0 dated 11—1-1 9 7 Installer J.P.Macomber & Son Inc. Designer J.P.Macom er & Son Inc The issuance of thispe t shall not be construed as a guarantee that the syste 1 fun�on-"s esigni'd. �> Date /� � Inspector 00, — 9 7-(v � Fee--------------------------- 7-- 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Dizpooal bpotem Conotruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(XX)VAbandon( ) Systemlocatedat 306 Cotuit 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 focal provisions or special conditions. Provided: Construction must be completed within three years of the date of this Revrnit. Date: �/ '�/� 7 Approved by A�nle � t l0/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I S Y /L?G , hereb certify that the application for disposal works, 0 construction permit signed by me dated �l �/— 9 7 , concerning the P g �dcfv� �. property located at 36 G l� i3 l)r'�µ-°. meets all of the following criteria: (y' There are no wetlands located within 100 feet of the proposed leaching facility 4-//There are no private wells within 150 feet of the proposed septic system c! There is no increase in flow and/or change in use proposed V/ There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will nQt be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) i B)Observed Groundwater Table Elevation(according to Health Division well map) / SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cen � � 1 1 CERTWICA'110N Or SKE'ral AND APPLICATION FOR A DISK,- WORKS CONSTRUCTION pc, lt�,ll'I' (1Vi'I'II0UT DESIGNED PLANS) I Joseph P. Macomber Jr.. :. c:rtily that tltc application for disposal works construction permit signed by nt: d::tQd _ 1 1 /4/97 , concerning the praperty located at 306 Cat J t gay Dr..i v® Co—t—t—j-t _ meets all of the following criteria: There are no wetlands within 300 fc:t of the proposed septic system el Thcre arc no private wells within 151 tLct of the proposed septic system `�-- The observed roundwater 1,bl: :s ft:t or gieater below the bottom of the leaching facility There is no increase in flow and/or clianbc in use proposed �1 There are no variances requested or needed. SIGNED : /�se�G � DATE: �I �7 LICEN SEPTIC SYSTE,'Y1 !NSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the propos:d s) Also if the licensed installer posesses a certified plot plan, this plan should be s&nittcdj. O �, • o v� �� . � o 75_ 0-6 No...... .... . ......... �t Fizic... ®.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ApV irtt#iatt -for Uiipu,iat Workii Tutuitrurtion Vernift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ----..rvii----.--A. ....�ieit' ----------- afiv`I..-------------- -------------L0-r---- No......-9 -------------------------------------------- . Co ocation_Addres or Lott oo.. Corn, i3 c2,1.. . •3 sYl G =, ® k .aeaS ..J /�/NiSIC S S 0?�fJ/ w � s • Installer ----------------------------------------- Address QType of Building Size Lot----------------------------Sq. feet . vr.aGarba e: Dwelling—No. of Bedrooms___________________________________ ________tx pansion Attic �( ) ,Garbage Grinder ( �}' PA Other—Type of'Building ____________________________ No. of persons.:-------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------- W Design Flow............................................gallons per person per day::Total daily-flow--------- ----•-•---.---- y;'- ---------.---gallons. WSeptic Tank—Liquid capacity-/ -gallons Length................ Width............... Diameter................ Depth----.--____.-_. x Disposal Trench—No. .................... Width.....................Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No....''............... Diameter..._.6_X.B..._ Depth below inlet.................... Total leaching area.-___________- _.sq. It. Z Other-Distribution box C ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date------------------------------------.... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_..---.___.__.__-___.__- �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------ Description of Soil ---- ------------------------------------------ x 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue the board of health. QQll ig 12t / ' ' --------------- -------:-- -. Date Application Approved By-- Cj "l-�d ----------- ��....... J - Date Application Disapproved for the following reasons:.......................... .. .. ...... . ............................................................... Da t at Permit No......................................................... Issued.... a.. — t�._..... Date - - ------------ ------------------------------t-------------------- No...... .. . ........ ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rlll:10,441; ...............OF.......4.44"�t 4414.......................... Appliration -for Bbpoiial Workii Ton/arurtion Prruift A I' tion is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal ............................. ................................................................ ................................................................................................. Locati or Lot.No. , ff ff V;j..�21M 0 f.,0,20,ol wor R ?0�Afx...j. ....I / ........ .................................. ............................ .......&... . ...... . 4n r ddross . ... . .................................. .. .....7�;Vke el, ........ ------------------------------------ Installer Address U Type of Building Size Lot............................Sq. feet W Dwelling—No. of Bedrooms--------------------------------`.:;;___-;- - --Expansion Attic *P) Garbage Grinder Other—Type of Building ..............z............. No. of persons---------------- Showers Cafeteria QAkier, fixtures .....I------------------------------------------------------------------------------------------------------------------------------------------------ Design Flow.. ...........................--gallons per person per day: -Total daily flow----------------------.-_______-__---.--.__..gallons. 04 Septic Tank—Liquid capacitv./ -gallons Length................ Width..___........_:. Diameter___............_ Depth-__.-----_..._.. x Disposal Trench—No. ............ Width............____.... Total Length_-_-_____-__-_--_-.- Total leaching area--------------------sq. f t. Seepage Pit No...,.v---------------Diameter....G.X.8.._._ Depth below inlet........_....._..... Total leaching area-. -..-_--_.-____s(l. ft. Other Distribution box Dosing tank Percolation Test Results PerformeCby----------------------I------- ............. ............. Date-. - ----------------------------- �est Pit------*.........:i--�--- Depth to ground',R my Test Pit -No. I...............m-linutes per inch Depth of ------ L14 Test Pit No. 2................niinut6*Ver inch Depth, of cI est Pit...... .............Depth to,g.Vound water________________________- -----------------------------------------------------------------------*-------*------*-------------------------- --------:------------------ 0 Description of Soil----- .................................... -------------------------------------------------------I------------------------------------ Is xU -------------------------:--------------------I...................................................................................................................................................... ------------------------------------- --------------------------------------------------------------------------------- ....- --------------------------------------------------- -------------------------- U �4 Nature of Repairs or Alterations—Answer when applicable--------------- ............................................................................ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees,,t'o install the aforedescribed.,Ilndividual Sewage Disposal System in accordance with the provisions of Article XI of tl e State Sanitary Code— The'tfndersigned*t�urther agrees not to place the system in operation until a Certificate of Compliance has been issue, the board of health. KA ----------- dAk.4w---- 12t 0,000�� ---------------- ................. Application Approved By-';;,eda-4/ ............................ Date Date Application Disapproved for the following reasons-......................................................................................... ---------------------- ....................................................................................................................................................... ................................................. Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD)6F -HEALTH .............. .OF.... a.42o.t... .............. ................ Tatifirate of TOmplia-urr TH I T CERTIF, at thyjIndii ual S, ewag sposal System constructed )�®r Repaired 4( 7 by.... ... ------- .................................................................................... *Ins!�Ie ........... ------ X------------------------- ------------------ -------------------------------------------------------------------------------------------- has been installed in accordance with the provisions o XI ofle State Sanitary as d scribed * th 4- ------- As_ e application for Disposal Works Construction Permit 0-----/-V ......... dated....__(.7--------- -------------------------- 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 ALTK" f�E . . .......... .......OF........ o.. ........................................... N ....... FEE-_ ------------ Permission is y granted A------ -------SewIr----------- --------------- ------------------------------------------- -----------*------- to Co ir isposal Syst atNo.. . 6- ..... . - - .. `..... ....it------------------------------------------------------- tr ..... st,r,eetA� street, as shown on the application for Disposal Work's Construction er o-------- --- ----- Dated----- J. ..—Z7. U000.. . . .. ..................... Board of Health DATE......---------------------------------------------------------------------------- FORM 1255 HOE313S & WARREN. INC.. PUBLISHERS ........................Approximate Cost ....................... C Fireplace ........................................................... .... ... ................ Definitive Plan Approved !qy,Planni6g Board --!-------------19 Area ............. .......... Diog'ram of Lot and' Building with Dimensions Fee....................T(V........... ............. SUBJECT TO APPROVAL OF BOARD OF HEALTH C3 f 7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r rding the above construction. �f, ,j u ,IF MIL44 - ikklal— Name ........................................ ........................................ Approximate Cost �^ OCCt o Fireplace .........................................x.........,........................... PP .................................:.......................... Definitive Plan Approved by"Plonning Board _._ __ �-____ f__________19_ 5 Area Diogram of Lot and" Building with Dimensions _� Fee ...................I............... SUBJECT TO APPROVAL OF BOARD OF HEALTH i r• i - f M ' r / t hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r rding the above construction. Name .........................................I.,................... `..";``:'..... �o OP - R L0CAT10N.�eTU'I • -�.,SEINACE PERMIT N0• 1 J VII: LAG � fNSTA LLER'S . NAME V- 104IdESS . t UILDER 0�1 OWNER ti w:. : DAT E PERMIT ISSN^ED DATE C'O,MPLIANCE ISSUED f� 3 ' a ter. ��1