HomeMy WebLinkAbout0448 COTUIT BAY DRIVE - Health 448 otuit Bay-Drive
455-032,' C&Uit t
4
k
i
TOWN OF BARNSTABLE p�
LOCATION i�!,�Q r'n j�/ T RA JV SEWAGE#
VILLAGE�'27°-6�� ASSESSOR'S MAP&PARCEL t?S S-0 3 2
INSTALLER'S NAME&PHONE NO. f e f2 T 1 C
SEPTIC TANK CAPACITY /0 0 O
LEACHING FACILITY: (type) -S.06 r 'L.chi to ba6(size)
NO.OF BEDROOMS
OWNER M AI 2 41 C
PERMIT DATE: fd COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
`•1
o
!�d 47 6.,
� 3 /33�
No. Fee
THE COMMONWEALTH_OF MASSACHUSETTS Entered in co puter:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplication for Mispo8AY 6pstrm Construction VPrmit
Application for a Permit to Construct( ) Repair(Upgrade(abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 9,W earu 43,421 p/'1 k/! Owner's Name,Ad ess,and Tel.No.
Assessor's Map/Parcel ��- 3Z
�or'�iT 5 cu41,�s--iilir�n/cCI Lr-vy
Installer's Name,Address,and Tel.No.S'D8-4,'2 a-q7-3 g Designer's Name,4ddress,and Tel.No.rO�S'-3f lJ-r.3//'
c 0_3 e 1Q%0. &Ye d^o" S /!yJ%S/f=lam'�,�d�!S LNG
AN//�6- 3�h�c�/i c
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.te hire ) 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) I&Yr
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 issupbothis Board of Health.
011
a c! \ n Date
Application Approved by DateApplication Disapproved Date
for the following reasons
Permit No. Date Issued
} y_n..� �. ., ti,�. .y.� �e�w�.{a—'",�.?.I'ei^! Y''"',.`:,+k'irr� R.S ,}'"`i,,.rTr;n'.•..i`r• v �='S.»t....'dLi"+. ,,j*,..y,yY,,,.<6.:i;+-Ilk�+r«. .r .. .. F .-.... ^.K^,s`�I
0;00001
No. / _ 1 Fee / r
_ Entered in com uter:v
�. THE COMMONWEALT1+0F MASSACHUSETTSp
PUBLIC HEEALTH''DIVISION - TOWN'OF BARNSTABLE, MASSACHUSETTS Yes
01ppfltation for Bisposaf6pstrm Construction Permit ,
Application for a Permit to Construct( ) Repair(4-)-Upgrade(4)-"Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. rT 3& C,rt1/r 0,4el 0/'/t//�'Owner's Name,Address,and Tel.No. s,
Gore i LrV
Assessor's Map/Parcel — %A
Installer's Name,Address,and Tel.No.,!rQ9 4;1'2 0, _4'-f_37 Designer's Name,Address,and Tel.No.a/"O
1�'!G��►.� -- �l H ✓mil s f�I'//s' -/_'.See�`>�/r-r/i c� ,
Type of Building:
t t,
Dwellin No.of Bedrooms �j Lot Size s .ft. garbage Grinder
g �" q g ( ,)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
` t
Other Fixtures L
Design Flow(min.required) gpd Design flow provided ® � gpd
PlanM1 d C
Plan Date 1 l., (� Number of sheets Revision:Date.
Title t
Size of Septic Tank Type of S.A.S. k �.
Description of Soil hp' ,
Nature of Repairs or-Alterations(Answer when applicable) 6dy sY�'n
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 Health. i
Signed rr�i%��'P��/y�� ,�/ ^ ' �—�-, Date ✓�/. // /� ,
Application Approved by / Date
Application Disapproved by \ / � Date f
forxthe following reasons
Permit No. ,f)�/ �p ^"' Date Issued
-k---•--•-•--- -- ---------- --- --- -------------------- -
THE COMMONWEALTH OF MASSACHUSETTS
'BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
�O THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(g�,), Upgraded' (e—)—
Abandoned( )by 1/10. 04--_4�kd, "a5 1
at �a't 1_D��//�13d4G/�/!1//� r� rG/r has been constr�►cted in acc rd ce ` t
r ,
with the provisions of Title 5 and the for Disposal System Construction Permit No. � �, ated
Installer t/0.3-Q;�4 L)1;;e l '`'i"/ Designer 1'W'
` #bedrooms Approved design flow mils If! gpd
The issuance of this permit shall not be construed as a guarantee that the system will function dd}e-si ed. J
Date 1 f / Inspector ( (�r, rT/ p \
,
- - --- --- -- ---"------------------------ - - - - - - ----------- -----•--- -----
---------1--_-- '
No �+Il/ Fee
r THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction i3Prmit
Permission is hereby granted to Construct( ) Repair(4 ;Upgrade(4-)^ Abandon•( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions _y
r
Provided:Constructio must be cgmpleted within three years of the date of this permit. ° 1
..Date (�j e Approved by
Town of Barnstable
. " .� Regulatory Services
Richard V. Scab,Interim Director
MABEL Public Health Division
1639.
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer&Designer Certification Form �^
Date: E 10 t / Sewage Permit# G� - 61 Assessor's Map\Parcel
Designer: 1 e-11'^`10 S�J Installer: LIn�a::� a S
Address: B? , &kJ" Address:
I.Md M ����.
°�-,if ) l
On �- l ., l*,dS' was issued a permit to install a
(dat installer)
septic system at �42 t ° based on a design drawn by
(address)
'`ty\ dated
r-_=(d s� igner)
-k zw i e-e-i SAS n(
X I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory. -
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State& Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in compliance with the terms
of the IAA approval letters(if applicable)
DAMEN
�staller's Signature)
t IN
�)( A
esigner's Signature. (Affix
PLEASE RETURN TO B TABLE PUBLIC HEALTH D ON. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
QASeptic\Designer Certification Form Rev 8-14-13.doc
Town of Barnstable. P#4,!53
Department of Regulatory Services ,
Public Health Division Dace _
16Jy 2l>D Main,Street.Hyannis MA 02601 V l 00'CD
i
Date Scheduled u/ ! Time - FeeyPd,b� . �O
,moil Suitability Assessment for S e Dispose
Performed B : th Witnessed By:
- i
LOCATION& GF.NF.RAL INFORMATI N
Location Address'. (a` /'.��—t J r ownet's,Watne
Address- � '�����` '•{.:� � • ��
�Tu t�
Assessor's Map/Parcel: O 6-5-I0.3 d, � I !Engineer's Name
NEW CONS?RU�'110N REPAIR k • i Telephone# � 36 3 3 I)
� - 1 `j\�- Surfaee.Siones
Lead Use Slopes(%
Distances from: Open Water Body '> 00 ft Possible Wet!Area�_ft �Drinking•Water Well� -ft,
>LS ! '
Drainage Way ft 'Property Line �1 ft Other fi
SKETCH:($Ireet name,dimensiods of lot,'exact locations of test holes&pare tests,locate wetlands in proximity to holes)
Parent material(geologic)
Depth to Bedrock' l r"
Depth to Groundwater. Standing Water in Hole:' I Weeping from Pit Pace
Estimated Seasonal high Groundwater i ,
Dt _TION FOR SEASONAL HIGH WATER TALE
Method Used: I.
Depth C14erved standing iin obs.hole:- In. Depth to 6tt11 mottles. !n.
Depth toiweeping from side of obs.hots: i - in. Orvundwnter Adjustment
Index Well#_� Reading Date: Index Well Ievel, M,_... Adj.factor..,,._�.Adj.6nndwater Level,,..
_ PERCOLATION TEST • Data. 'Clear~ '
Observation
Nola# 71ine at W,
Depth of Pere J '19me at 6"
Start Pre-soak Time.@ 'lime(9"•6")
End Pre-soak ��•'' i 4 .'
Rate MinJlnch ���
p X 1,
Site Suitability Assessment Site Passed Site Failedt. Additional Testing Needed(Y/N)-
Original:.Public 1441th Division Observation Hole Data To Be Completed on Back—
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable C40servation Division at least one(1)week prior to beginning.
DEEP OBSERVATION HOLE LOG. Hole#
Depth from m Soil Horizon Soil Texture Soil Color SMottloil Other,
Surface (USDA) (Mansell) ing (Structure,Stones,Boulders.
sis c %Gravel)
W,— 0il
DEEP_OBSERVATION HOLE LOG " Hole#'
• Depth from Soil Horizon � Soil Texture • ' Soil Color Soil
Other
Surface from
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
nsis enc % ra el
�- 132,' e� Z
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
istenc O el
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders.
st
i
.t
Flood Insurance Rate Mau:
Above 500 year flood boundary No
Within 500 year boundary No�4 Yes
Within 100 year flood boundary No v Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious terial exist,in all areas observed throughout the
area proposed for the soil absorption system?
naturally
i 'ous material?
If not,what is the depth of n y occurring Pa
Certification I certify that on 1 Q a� (date)I have passed the soil evaluator examination approved by the
Department of Enviro ental Protection and that the above analysis was performed by me consistent with
the required ing,expertise and experience described in•3:10 CMR 15:017.J"
Signature •Date
0 vSRPI ICIPERCFORM.DOC
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a 448 COTUIT BAY DR
Property Address
Owner 'JOHN FALLON
information is Owner's Name
required for every page. COTUIT MA 02635 JUNE 12,2012
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
on the computer,.
use only the tab 1. Inspector:
key to move your
cursor-do not MARK L WHITE
use the return Name of Inspector
key.
A.B. CANCO
rab Company Name
350 RT 28
Company Address --
WEST YARMOUTH MA 02673
City/Town State . r7 Zip Code
c
508-775-2820 S-13381 'f _
Telephone Number License.Number
-.f1
wow
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection .
was performed based on my training and experience in the proper function and maintenance,of on site
sewage disposal systems.I am a DEP approved'system-inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
❑x: ❑ ❑ v�auuuuiun
Passes Conditionally Passes F�.�11 ,(H OF
❑ Needs Further.Evaluation b the Local Approving Authority
MARK •••yc
y pp 9 y
v' HITE
NIoN 13381 i
JUNE 12 2012 'T FRrtF��`•'o �S
AnsASiana ure Date ���,q5f NS?eC'
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 thesystem is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate,regional office of the DEP..The original should be sent to the system owner
and copies sent to the buyer, if'applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•11/10 Title 5 Officia I s ion Form:Subsurface Sewage Disposal System•Page 1 of 20
Commonwealth of Massachusetts {
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR I
Property Address
t
Owner JOHN FALLON
information is Owner's Name
required for every COTUIT MA 02635 . JUNE 12 2012
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:
X❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in.310.CMR 15..304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
El 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•11/10 Title 5 Official Inspection Form:Subsurface e 2 of 20 Sewage Disposal System•Pa
P S 9 P Y 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
R' a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every COTUIT MA
page. 02635 DUNE 12,2012
_
City/Town State.L Zip Code Date of Inspection
B. Certification(cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or breakout 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 I ❑ ND (Explain below):
El distribution box,is leveled or replaced 0 Y ❑; N El ND (Explain below):
El 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):
- i
t5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 3 of 20
Commonwealth of Massachusetts
Y
Title 5 Official Inspection Forms
T' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR J
Property Address
Owner JOHN'FALLON
information is Owner's Name
required for every.: .
page COTUIT''• MA 02635 J.UNE 122012
City/Town —State Zip Code` Date of inspection`
C) further Evaluation is Required by the Board of.Health:
❑ Conditions.exist-which require further evaluation by the Board of Health in'order to determine
if the system is failing to protect publichealth, 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"notfunctioning-in a manner which will protect public
health, safety and the environment:
y ..
❑ Cesspool or privy.is within 50 feet of a surface water ;
Cesspool or privy is within 50 feet of a bordering vegetated.wetland or a salt marsh
- B. Certification (cont.)
System.will.fail unless the.Board.,of Health and Public Water Supplier, if 4
` ( 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 aseptic tank and SAS and`.the SAS is within a Zone 1 of a public
Water supply:`.M k
El The system has a septic tank and SAS and the SAS is within 50 feet of a private
water supply well. i
'❑ 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. a.
distance: --
**This.systempasses if the well water analysis, performed at a DEP certified laboratory, for fecal
co 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.
t5ins•11/10 Title.5 Official Inspection.Form:Subsurface Sewage Disposal System-Page 4 of 20
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c 448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every Page. COTUIT MA 02635 JUNE 12,2012
City/Town , ,� State Zip Code. Date of Inspection
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
El
0 Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El ❑x 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
El overloaded or clogged SAS or cesspool
❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/.day flow
B. Certification (cont.)
Yes No -
0 0 Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ 0 " Any portion of the.SAS, cesspool or privy,,is below high ground water elevation.
0 ❑x Any portion of cesspool or privy is within 100 feet of.a surface water supply or
tributary to a surface water supply.
❑ 0 Any portion of a cesspool or-privy is.within a Zone I of a public well. .
El
0 Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 20,
f "
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR..
Property Address _
Owner JOHN FALLON
information is Owner's Name -
required for eve ry page. COTUIT MA 02635 JUNE 12,2012
Cityrrown State Zip Code Date of Inspection
❑x 'Any portion.of a cesspool or.privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis.
[This system passes if the well water analysis, performed at a DEP
certified laboratory,for 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.]
❑x The system is a cesspool serving a facility with a design flow of 2000gpd-
° : 10,000gpd.
0 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:Jo 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
❑ El 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'll 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. y l
C. Checklist
Check if the following have.been done. You must indicate"yes" or no as to each of the following'
Yes. No f
❑ - ❑x. Pumping information was.provided b the owner, occupant,ant, or Board of Health
P 9 p Y p .
El
0 Were any of the system components pumped out in the previous two weeks?
❑x Has the system received normal flows in the previous two week period?
i
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 20
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
• 448 COTUIT BAY DR i
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every COTUIT MA 02635 JUNE 12 2012
page. City/Town State Zip Code. Date of Inspection
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)N/A
El Was the facility or dwelling inspected for signs of sewage back up?
❑x ❑ Was the site inspected for signs of break out?
Z ❑ Were all system components, excluding the SAS, located on site?
❑O l] 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?
❑X Was the facility owner(and.occupants if different frcm 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:
. 19 El Existing information. For example, a plan at the Board of Health.
❑x ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance.is unacceptable) [310 CMR 15.302(5)]
:D. System Information
Residential.Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example' 110 gpd x#of bedrooms): 330
D. System Information
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 20
Commonwealth of Massachusetts
Title 5 Official Inspection form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every .page. COTUIT - MA 02635 JUNE 12,2012
-
City/Town. State Zip Code. Date of Inspection
s
Description:
SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK AND A 1000 GALLON LEACH PIT
Number of current residents: —2
LX
Does residence have a garbage grinder? 0 Yes
No .
Is laundry on a separate sewage system? [if yes separate inspection required]Is ❑
No
El
Laundry system inspected? Yes El
No
Seasonal use? s El❑x Ye
No
Water meter readings, if available(last2 years usage (gpd)):
2010- 140,000 2011-66000
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 c`20
Commonwealth of Massachusetts
Title 5 Official Inspection Form
— e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every :page. COTUIT MA '02635 JUNE 12,2012
-
Cityrrown State Zip Code Date of Inspection
Sump pump? a .
Yes ❑x
No
Last date of occupancy: CURRENT--
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.): -
❑- Yes ElGrease trap present?
No
El Yes ❑
Industrial waste holding tank present?
No
Non-sanitary.waste discharged to the.Title 5 system? ;. El, Yes ❑
No.
Water meter reading§, if available: -
D. System Information (cont:)
Last date of occupancy/user.. Date
•
Other(describe below):
General Information
Pumping Records:
Source of information: TOWN.:.6/23/10 & 9/1111
Was system pumped as part of the inspection? ❑ Yes x❑ No
If yes, volume pumped:
gallons
t5ins•11/10 Tiitle.5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 20
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address•
Owner JOHN FALLON
information is Owner's Name
required for every page. COTUIT MA 02635 J.UNE 12,2012
Cityfrown State Zip.Code Date of Inspection
How was quantity pumped determined?
Reason for pumping:
Type of System:
❑x Septic tank, distribution box, soil absorption system
❑ Single cesspool
El Overflow cesspool
❑ Privy
El 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):
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
6/26/75 B..O.H:, C.O.C.
Were sewage'odors detected when arriving at the site? ❑ Yes M No
Building Sewer(locate on site plan):
Depth below grader 2 FEET
feet
Material of construction:
El cast iron Z 40 PVC ❑ other(explain):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System:Page 10 of 20'
i
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
-' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every page. COTUIT MA 02635 . JUNE 12,2012
-
_Cityffown State Zip Code Date of Inspection
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
RAN CAMERA UP THE MAIN LINE , LINE WAS ALL CLEAR, CONCRETE BAFFLES IN PLACE
Septic Tank(locate on site plan):
1 FOOT 61NCH
Depth below grade. feet
Material of construction:
❑x concrete El metal El fiberglass ❑:polyethylene El 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:
Sludge depth:
D. System Information (cont.)
t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System Page 1 i of 2G
Commonwealth of Massachusetts '
Title 5- Official Inspection Form
m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments`" .
>4' 448 COTUIT'BAY DR
Property Address m -
Owner JOHN FALLON
information is Owner's Name
required for every
page. COTUIT MA 02635 . JUNE 12,2012
City/Town State Zip Code Date of Inspection "
Septic Tank(cont.:)
Distance from top of sludge to.bottom of outlet tee or baffle: . 2 FEET 5 INCHES
Scum thickness I INCH '
Distance from top:of scum to top of outlet tee or baffle 6 INCHES
'Distance from bottom of scum to bottom of outlet tee or baffle - 14 INCHES _ -
How were dimensions determined? SLUDGE JUDGE
Comments(on.'pumping`recommendations,.inlet and.outleftee or baffle condition, structural-integrity,
liquid levels as related to outlet invert,'evidence of leakage, etc.)
Grease Trap(locate on site plan): n
De
pth,,below grade:, feet
Material'of construction
❑.concrete. ❑ metal '❑fiberglass ❑ polyethylene ❑other.(explain):.
Dimensions: °
t
M
Scum thickness
Distance.from top of scum to top of outlet tee,or baffle -
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 12 of 20
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR .: .
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every COTUIT MA 02635 JUNE 12,2012
page.
City/Town State Zip.Code Date of Inspection
Distance from bottom of scum to bottom of outlet tee.or baffle - -
Date of last pumping: Date
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.):
TANK IS IN GOOD SHAPE, SCUM AND SOLIDS AT GOOD THICKNESS'S
Tight or Holding Tank`(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete ❑ metal ❑fiberglass ❑ polyethylene other(explain):
Dimensions: --
Capacity:
gallons
Design Flow:
gallons per day
Alarm.present:. ❑ Yes ❑ No
Alarm level: Alarm.in working order: ❑ Yes 0 No
Date of last pumping: Date „
Comments(condition of alarm and float switches, etc.):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-?age 13 or 20
Commonwealth of Massachusetts
Title 5 Official. Inspection form
R' a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every COTUIT MA 02635 JUNE 12,2012
Page. -
City/Town State Zip Code Date of Inspection
*Attach copy of current-pumping.contract(required). Is copy attached? ❑ Yes ❑ No
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert NO DISTRIBUTION BOX PRESENT
Comments (note if box is level and distribution to outlets equal,any,evidence of solids carryover, any
evidence of leakage into or,out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in Working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 20
f
Commonwealth of Massachusetts
Title 5 Official Inspection, Form
-Y a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every page. COTUIT MA 02635 JUNE 12,2012
City/Town State Zip Code Date of Inspection
Comments (note condition of pump chamber,-condition of pumps and appurtenances,.etc.):
Soil Absorption System (SAS) (locate:on site plan, excavation not required):
If SAS not located, explain why:
D. System Information.(cont.),
Type:
❑x leaching pits number:1 6X6 -
El leaching chambers number: -
❑ leaching galleries number: --
leaching trenches, number, length:
❑ leaching fields number, dimensions: —
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 20
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Jt 448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every page. COTUIT MA 02635 . JUNE 12,2012
_
City/Town State Zip Code. Date of Inspection.
❑' . 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.)
PIT IS HOLDING 4 FEET 10 INCHES OF LIQUID, LEAVING JUST OVER 1 FOOT_ OF ROOM BEFORE
INLET. PIT APPEARS TO ONLY HAVE .1 FOOT OF STONE SURROUNDING IT:
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
D. System Information (cont,)
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage.Disposal System Page 6 o 2C
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every page. COTUIT MA 02635 JUNE 12,2012
City/Town state Zip Code Date of Inspection
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 20
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ e a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name
required for every page. COTUIT MA 02635 JUNE 12,2012
CitylTown 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
0 drawing attached separately
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 20
I •
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 COTUIT BAY DR
Property Address
Owner JOHN FALLON
information is Owner's Name_"
required for every C.OTUIT MA 02635. JUNE 12,2012
page.
City5own State Zip.Code Date of Inspection
D. System Information (cont.) '
Site Exam:
Check Slope .
❑x Surface water
Check cellar
Shallow wells
Estimated depth to.high ground water: 15 FEETfeet
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: cafe
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)
El Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
II
t5ins•11/10 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 19 of�O
P 9 P Y 6
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
e Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments
. 448 COTUIT BAY DR
Property Address
Owner JOHN FALLON "
information is Owner's Name
required for every page. COTUIT MA 02635. JUNE 12,2012
Cityrrown State Zip Code, Date of Inspection
SHOT GRADES FROM ABUTTING."PROPERT AND LEACH PIT AT 448 COTUIT BAY RD IS 9
FEET 8 INCHES HIGHER THAN ABUTTING PROPERTY'ALSO PERMIT DATED 5/6/75 REPORTS
NO.WATER-AT 12 FEET
Before filing,this Inspection Report, please see Report.Completeness Checklist on next page.
E. Report Completeness Checklist
❑x Inspectiori:Summary: A,.B, C, D, or E checked
0 Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
❑x System Information—Estimated depth to high groundwater
Sketch of Sewage Disposal,System either drawn on page 15 or attached in separate file
i
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 20 of 20.
t.
I y:
I .
1 .
b -
-� - yC° 9
L000,TION _ / _ 5EW&<4E PERMIT_1.10. .
---INSTQ LER� -1JdME-�--ADDRESS — _ _
5UIL ER - E:--4t,�_ TS-
�f��. SS -
--- - -- -- -- -- - -
D&T-E-CO MP_LI_hMCE_ISSUEQ-_fie"�-C
L
i
G
No...... . �'. .a .� Fic$... ®..................
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
OF........................................ ........ .....- .......................
AVp ira#inn -for M_gVvii al Workfi Tons#rnrttnn Vrrmit
�l Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
q System at
cation.Address or Lot No.
Cervir f�/f �it` ?� l3ex /LC�9 ah lies
-----------------------• --••-•- :.:--- ------- ---• ----------------------- -----------
Owner Address
.......YA -----
Installer Address
QType of Building Size Lot............................Sq. feet
ai'Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ("v) Garbage Grinder (+�
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ________________ _________________
W
Design Flow-------------------57-__----------------gallons per person per day. Total daily flow.........3. ...............---..gallons.
WSeptic Tank—Liquid capacitv_!PT! .gallons Length---------------- Width---------------- Diameter.......--------- Depth._-.-._-_-_---
x Disposal Trench—No.____________________ Width...._______ ,��-- Total Length........................ Total leaching area-------.------------sq. ft.
Seepage Pit No----- _________ Diameter....! A_�` �e'pth below inlet__________________ Total acI a area--------------.---ST it.
Z Other Distribution box (t J Dosing tank 74
Percolation Test Results Performed by------- ------------------------------------------------- ... Date------•-••------------------------------
a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water..._---.-.--..-._.......
(Z4 Test Pit No. 2________________minutes per inch Depth of Test it...... Depth to groun water_. ._
---
�s f--/-------------- ,� - -
Descriptionof Soil---..J�_�D-- ------------------------- -----••---------•-------------- --------------- ------------
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
V Nature of Repairs or Alterations—Answer when applicable..------------------------------------------------------------------------------------------'-.
Agreement: -
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued tithe board,of health.
gned----- ----
•Date
Application Approved By------------ -- -- ....... --- --...let � . -- � -------
e�� Date
Application Disapproved for the following reasons--------------------•---•-----•-•----•------------------•---------...-•----•-•-••--•--------••-•----•-------•--•-
-------------------------------------------------------------------------------------------------••--•-----------=----------------------------------------------•----•--- -------------------• ..........
Date
PermitNo......................................................... Issued------ —
Date
No.._�..6._ ....... '= Fug.. ......................
THE COMMONWEALTH OF MASSACHUSETTS
EOAR6 OF HEALTH
.... . ...`.. ... ... .................OF... .......ii!Y I....-'6!4r.. ........
Applirtttion -for Iiopotittl Workii Totuitrurtiott Vrrntit
v
,Application is hereby made for a Permit to Construct 5(. ) or Repair ( ) an Individual Sewage Disposal
System at:
�a� C o rv,r B A y
. : } ----- -- -----.
cation Address or Lot No.
- ------------- - ----------------
f Owner Address
N lJ� /gyp p p _
............. '�Lr� N=Sa7Y 11iC�f.'--a4. •--�A._.S
Installer Address
Type of Building Size Lot____________________________Sq. feet
H it Dwelling—No. of Bedrooms......_+3.__--------------------------------Expansion Attic Fhv) Garbage Grinder (✓j'
Other—Type of Building ............................ persons............................. Showers ( ) Cafeteria ( )—
d Other fixtures --------------------------------------- -------- 'v _r
_.__ ...................................._..__..._....__..._..__..
W Design Flow............................................gallons per person per day.' Total daily flow--------------------------------------r-.---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 es x_�.----_- Depth below inlet......_____._._.__ Total ach}i w area.-.__.._-._-___.sq. it.
s z Other Distribution box (1 -Dosing tank (M ) d ` .5Z
Percolation Test Results • "Performed„by: :.................................................. Date___l
Test Pit No. 1...............minutes per inch , Depth of Test Pit.................... Depth to ground watP_r:.---_--.----.-.---
rZq Test Pit No. 2----------------minutes per,inch. Depth of 'rest t.-____-_---.--------------- Depth totgrou Ir n water
DDescription of Soil-----SA6- .I/--------------•---------•------•---•-----------------------------------------------------------------------•------------�----------------------
U •-••-------------------------------------•--------------...----------------•-------------------------------------------------------------------------------------------•------------. ---------------
W ------------------------=------ ------ -----------------------------------------------------------•---------------------------------------------------------------------------------------------
V Nature of Repairs or Alterations—Answer_when applicable..---------------------------------------------------------------------------=L................
.
-------------------------------------------------------------------------------------------------------------------- ..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor"dance 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 issued the board,of health.
gned---- �/-- ' k - 1 `�
Application Approved By----------- ------ t
Date
Application Disapproved for the following reasons:------------...............................----------------------•---------•--••-•---------•--••-----•--••-••--
--•-•---•-------•-••-------•--------•--------------------------•------- -•----•-•---------•------------•--......--•-•---•--•----•-------•---------•---------•--•----------••-•------------.------
Date
PermitNo......................................................... Issued........................................................
Date.:...
F,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
ry
I _,
.. ........OF*...... ....... ..... ���' �/V
.tom �.• .��.: s.�.
..7-4
�rdifirttfr of f�omplittnrr ; ;
THIS IX TO CfRT That the Individual Sewage Disposal System constructed (y) or Repaired
----------------------------------------- ------------
' � • Installer
at---- --- -... ..---- d R'f'.--------•-....• . ......................................................... ill
has been installed in accordance with the rovisions of eijXI;;,of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N _.4 .0—--....__.__. dated-------J7`'1&'---_.��___..5...__ .
THE.ISSUANCE OF THIS .CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM W L FUNCTION SATISFACTORY.
DATE-
__"-- ` , ` ..k!�.---------•----------------•-- Inspector.. '--------------•---•-------•-•-----------•---
THE COMMONWEALTH OF MASSACHUSETTS
"�. BOARD OF �LT..
H
&;� �^'� ,COF'.. ....... ....... . ...... :...:.. ..
No.--• -
I FEE..... ...............
,�tt, ( ,tt�txtzrt �tt �rrmit
Permission 's reby granted.-- .- f G'- .-- ----=• _ l' ..C.144.............. ......... _.._ ......... .
to Constru ( r epa' ) n.i id ewage oral S to
* =
Isl=et }�- ...+-
as shown on the application for Disposal Works C truction r IN ... _...fa
Dated__+.:__.� �;,}'
.............
A
....--•----•-•----
/ / `� {` Health
DATE--V b ✓--------------':_ " .
FORM 1255 HOBBS & WARREN.'INC.. PUBLISHERS.
coT
0
s6.o �5r
N
Un�Afi p n ad -
0 � d
u
o
o L o f 3 �:
a
a y 2�•>3, _
v
/ certify that the foundation is located PL a T PL AN. _.
as shown on this plan' and conforms to the
33
Zoning 'By Lows of the. Town stable•
47*
OF llgssq�y N /� -p-'`/�7- o /�
GRETF G� tr ®/ iJ/ / LJ H I SHORES
ORES
/N
o to
800.26Q6" COTU/T, SARNSABLE' , MA
Dote, /9T5 d c1S7Eg oR-. Sco/® / = 40' il9oy, 15 , 19 TS.._..:-
,adGARC/A•HANACK•R/CHARD ENGINEERING CORP.
Jog•P 74-io a law Bedford, Barnstable 8 North Pembroke., Moss.
fi
Lt: 9
t� <
/o .
n Q
4v.5'
certify that the foundation is located P L'O T PL.A IV
as shown on this p/on-and conforms to the
Zoning'By Lows of the Town stable. 4.07.
OF 1`14Ssgo
GRETE.
COTUI T BAY SNORES -
e M. yR+i IN
j v ' BOHANNON H.
K
Nd.26105 o COTUl T, BA.I?NSTA BL E MA SS.
Dote, /975 Seale -/ �,._ 40' May,/5 , /975
GARCIA HANACK•RICHARD ENGINEERING CORP. s
joe 4r 14-io a �/ ��" wrVew Bedford, Bornstoble a North Pembroke, Mass.
77,
COTUIT
COTU I T
R=308.;Sp L-1 D/•` V Ro�� Z8 0
44•45 E o
Irb
t O
v% W
4 O
°°
o LOT 33 � I - • . . , . ��O �
AREA= 25,310f S.F. _ W
=__- - - - - - - _- LOCUS
- - - __ -__ - - - _ LOCUS MAP
-- - - - LOCUS INFORMATION
TOF & B.M. r. _
- EL=52.0 ? _ PLAN REF: 292/27 & LCP 3216-C
TITLE REF: CTF# 197907
PARCEL/G #44H 51.3 _ ZONING:
I RFMAP 55 PAR. 32
G a - _ - _- - �\ - - FLOOD ZONE: "X"
COMMUNITY PANEL:' 25001C0543J DATED:07/16/14
col SEPTIC SYSTEM
= EXIST. NK l POND ^^
SEPTIC TA y; REPAIR PLAN
- t LOCATED AT:
OAK PINE
448- COTUIT BAY DRIVE
COTUIT, MA.
PREPARED FOR
-
PP,-no LOT 34 SUMNER & NANCY
=-- LEVY
APRIL 5, 2019
GAR AGE _ =
UNREGISTERED LAND = = JA- - OF M,q
-------------------------- ------------------- _----------= C P
REGISTERED LAND a' RPJEL __ _ _ _ __ _ �''. ; �� DA N M y
G SANITAR�P�
j -- PINE fi
_ -
® --- --_ 49 ` MEYER Bc SONS, INC.
{� -� PINE _
'PANE P.O. BOX 981
CBAS
GRAPHIC SCALE
SH+ED EAST SANDWICH, MA. 02537
� \�� _
0 10 20 40 PH: (508)360-3311
FAX: (774)413-9468
.00 _,, ��� meyerandsonstitle5@gmoil.com
1 =209 �>25 �00` L=27.73
SHEET 1 OF 2 J 2076
_ }
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GENERAL NOTES:
SEPTIC TANK GRADE SHALL NOT BE < EL:47.50 FOR A DISTANCE
TOP OF FEND 15;R AROUND THE PERIMETER' OF THE S.A.S. '
INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX "! 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL -^
EL.=52.0f " PROPOSED S.A.S. -BOARD OF HEALTH AND THE DESIGN ENGINEER.
OUTLET AND SET TO 6 OF FINISH GRADE
INSTALL RISER & COVER '
INSTALL LOCKING COVERS IF AT FINISH GRADE .� INSTALL A RISER OVER 'NE CHAMBER (MIIN) • _'�2; ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
SET TO 6 OF GRADE AND SET TO 3" OF•F.G.r of ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE
F.G. EL.=51.30t F.G. EL: 51.0f --
F.G. EL.=51.30f LOCAL RULES AND REGULATIONS.
•
THE
AGE DISPOSAL
OT BE
KFILLED PRIOR
• f F.G. EL 50:50(MAX.) 3. DESINSPECTION
GNPE GINEEANDD APPRSYSTEM SHALL N BOARD OFCHEALTH AND THEow j.
R.
9" MIN COVER/ y E 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
��<• _ 8 36" MAX COVER L = 50' L = 25'(MAX
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
®SCH40(PVC) EL=49.30 ® S=1T5 (MIN.) ® S=1X (MIN.) 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
4"SCH40 PVC 4"SCH40 PVC
STONE OR FILTER FABRIC• DOUBLE WASHED STONE'
10" 6 , 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
INV.=47.75 14• HEALTH THE CONTRACTOR
F R PRO ER INSPECTIONS DURING IFY CONSTRUCTOON.AL OF
M'uouiD INV.=47.50 ®I®®®- 0 ®®®®
LEVFL 7. DWELLING IS SERVICED BY PRIVATE WELL.
PROPOSED �®®®®®®®®®® SHALLONSTRUCTION
GAS BE RESTORED
�0 INV.=46.75T E3 EM E3 E3 EM ER®EM ER E3 EM 6 TO ALL AREAS DITION AGREED UUPON RING CBETWE N OWNER AND CONTRACTOR.
^' INV:=46.95 DB-5 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
r > > LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK.
EXISTING 1.000 GALLON SEPTIC TANK H2O) 3.2 3 X 8.5 3.25 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5.
EXIST. SEWER OUTLET EFFECTIVE LENGTH = 32.0' 11. 46 HOUR NOTICE FOR ENGINEER CERTIFICATION
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
LNV. ELEV.- 46.50 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT 13. NO KNOWN ABUTTING PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING
PIPE INVERTS PRIOR TO CONSTRUCTION EL. 47.50
14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. )
2) D-BOX SHALL BE SET LEVEL AND TRUE TO _„• v a,`' INV. 461507'50 15. FOR TTHEIG USE OF HA GARBAGE GR NDER.T ALL
.. - 'TOP' CONC. ELEV. .• •` • ow
GRADE ON A MECHANICALLY COMPACTED SIX _ ELEV.- as
INCH CRUSHED STONE BASE, AS SPECIFIED IN - aaBaa®® 16. NO WETLANDS WITHIN 100 FT: OF PROPOSED LEACHING
310 CMR 15.221(2)
aaaaaaa
3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK BOTTOM EL. 44.50 _ 4, aB5 FT.aa 4'
WITH 1500 GALLON SEPTIC TANK IF FAILED,
DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPARATION 5.70 FT. EFFECTIVE WIDTH = 13' .,
4) INSTALL INLET & OUTLET TEES W/ - SOIL ABSORPTION SYSTEM (SECTION)
;T
GAS BAFFLE AS REQUIRED BOTTOM OF TESTHOLE EL: °38.80
{; _ (500 GALLON LEACH CHAMBER)
n SEPTIC SYSTEM PROFILE =
SOIL . LOGS:- P#: 1.5908
N.T.S. x
DATE: , FEBRUARY 26, 2019
SOIL EVALUATOR: DARREN MEYER, CSE 1614 .
' WI NA SMA S,' BARNS.OF SIP _ WITNESS:' O DE ARN HEALTH
T q 2
Elev. I P- I Depth Elev. - Depth
o D R
49.90 A 49.80
y O E A
N0. 1140 _
" LOAMY.SAND LOAMY SAND
DESIGN CRITERIA f 10YR3/2 1OYR3/2 11y
' 49 0
` NITAR0a� , LOAMY SAND4 LOAMY SAND _ ^
,� 8 B 10" 8 88
NUMBER OF BEDROOMS: 4 BEDROOM DESIGN •. . • _ 9 10YR 5/6 1OYR 5/8
SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF)
DESIGN PERCOLATION RATE- <2 MIN/IN - a 47:40 30", 47.22 si"r
C
DAILY FLOW: 110 G.P.D. X 4 BR DESIGN FLOWN 440. G.P.D. _' _ PERC TES_T Y MEDIUM
MEDIUM
•EL. 45.70 SAND SAND
GARBAGE GRINDER: NO (not designed for garbage grinder) - _ g_ 2.5Y 6/6 2.5Y 6/6
SEPTIC TANK: 440 gpd x 200% = 880 gpd RE-USE EXIST. 1,000G SEPTIC TANK, W 38.90 132"a 38.80 132"
LEACHING AREA REQUIRED: ' (440)/0.74 = 594.59 S.F. . PERC RATE <2 MIN/IN. (*Cl* HORIZON)
1k NO GROUNDWATER OBSERVED
USE THREE (3) 500 GALLON PRECAST LEACH CHAMBERS
PROPOSED SITE AND SEPTIC UPGRADE PLAN
W/ 3.25' STONE ON ENDS AND 4' ON SIDES: 32' L x 13' W x 2' D < '
e ,
a
448 COTUIT BAY DRIVE, COTUIT, MA
BOTTOM AREA: 32 x 13 = 416 SF a ^
_ Prepared for. Lev
SIDE AREA: (32 + 13) X 2 X 2 180 SF SONS,INCSystem Design. and Topography Plan,.by: SCALE DRAWN DATE
6 Darren M. Meyer, EYER B S S,l N T.S. DMM 04/05/19
TOTAL SQUARE FEET PROVIDED = 596 vs. 594.59 REQ D ' eyer, R.S.;:CSE,:hereby certify that I'am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX981
to conduct soil evaluations and that the above analysis,has been performed by me consistent with the Y� EASTSANDW/CH,MA02537 REV DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74(596 S.F.) = 441 G.P.D. vs. 440 .G.P.D. req d requirements of 310 CMR 15.017. 1-.further certify that)'I have passed the Soil Eval. Exam in October; 1999. 508-382-2922 DMM 2 Of 2
2 .
. F20'`L>f K Ca �3=QrT
i
.DH T+'�R-rRY++wiry e-c. DRAWN BY
-{1L[oIJ FFTLEhtT i'4'9_��-ENo�as � _
�� - 45gw r.arraoowS vicerT r-O rla2&-LA � �+�•`SokT�
�4 ie t __
K �as✓�lm�••1 I .�
-
- Arl-.:.
—_
Tm
vT•
{-{+{-{ ' --J-1 _Ell S'LSNb Fi�NuuR�-5 -fl rrl p 3.
IJ� 1 I —r Rt-LoctiTE � ' r r r � 1l ti
r l 1 -
--{ sNv+cabS,Entire
loP�+r I CtAR�GE. { u5t imou-5 �{ w
I — I— -- --1 --- 3 wolow. Rk a
, — l /" a N o
FRONT ELEVATION {
GARAGE ADDITIOPI
cx�z p
tTaVCTYILE4_kOU$E ULpv-,_ liri✓_bVl24GE _— C '!
(�wo0EL6lJ g.
-- (�u� 6✓csr+•k6C- EaySTNv 6Y�v GT✓tG � t 9 e
-- -- { REAR ELEVATION —— - --- - EY
141 s
S+
3
J
Q$^PR.c-GVvr-KT cCw4E2
{ {p
GnS I traPl-tics. ,°_ FD I�i " ��-8 3
r acsT•� gX�yrwsl wwE
I y r— T NHS FwH fD Prurs- jB�S
916' � I
Rs Rat H $PeiSIF/-f. ��°X6'�®` MhTG.(�i(r$10E 1-ITE °�••
ww v"f—�kt.Irw c aano Roo¢S.,Srs. TLi•rt B�1oC. I k c16utCmT - _ -- ------ - i'`�,
:G e1M+A�Ceru.W
--
G-
�ertKrk000Hv I o-Of-W.a' a^ — _ `t
h
- RF_li+u✓�N'[Jce.-y� - Z j--�. _ - _ _ �26w.ri:-R�L�u«�t'fR�CST eE
_ __ �-7b RSSC-�•nO�INfs-
It j•411-Or YC,srFt - ' �3 + — PI?IIMED+15T caAT OFfn,Kr
,•..' tTRTCII"OQp�S'CE.__-1" i i .� �dL"r"H1S4Mu.-� K - pNo -
Ft2r>EtwcE;.
2 FAAMY ROOM
* sy s
Nll ZlAefZrPwcK { m
. F+rlW'cw uS V. S'lf DFX�tF • _ -_ L
Un"M C�-ly F+ -blilSS fN$Ulhlidy _� 1 _C= .t161<k'+W�A1N6 v
I ..
la°lnvx I r� ----- � -
-- -_ ---- =- --r•}a-rcH RE.V Exl>�nb 6HbYalE -- -
k � I I ' �� _ _--.___.__-_--. --�{ i 8N0£o FOa llt lollQ.•ETE
• I
l { Y
A L4? C43c�
- l
FIRST FLOOR PLAN
r�R RIGHT ELEVATION
{
I
j
nn
i
I.
4 � ` DRA%VLJ BY
I Y 3D_R e- nffi
I -1'1 ltE+bJTo�D pr,xLUEwz.' 2
w '
Z 9zJ0 IV D.G. zf WS��y _
u R" 8'Xj3'/i"HIC2M/CK"Y KeW4�E
F — ... — •w xoR a,v....«u.. IALror`,U 6 2.teacaoa 9r��
7D BE E!K lKrcPLFL."—
3_L.•�.x It'NIcaN-Aw. S�u1D4 I n "A
— .. — NEd FLaa2 N .o �� �• -- '
•may _�--='"fir_.:--T' •
- ROOF PLAN- L
S r6.y�mr _����wwFwwc-cat Y°
SECTION DETAIL
Ills
I.I �NoTS�. i• lX s �
YERbo�Goa.�••+uS ,q b I g
`wQ] b'
I1I V �EK(e2 oN REA2 ! j E j
y F2E�fR{Oco2. � E e o
all!
( 1
IftSc16.=01iV I ---
�Wu-�?�•i W/ct?oz - ¢«�
�s-a2 4r n•cTu.
I' 4xH(SST
I �
GARAGE axs s
I'�3 0 � - rLF•✓+t�iDarr�rt�r�.+�-- +� -¢^�•wnrbwnl . . I
I.jN� � OVF�.M•hLN�NF Y✓l:.l�l':(J-GPAVEL—'- -'� I Q •�--r�_L•6ta x16'.�.VV. hL'f�.Ea.BG�vI 1 m o
16Y"— 1� 1 -�4"�_"'iG�45e�•l - ��D'BCaC1'C EACJt 61YD. .�i
X f
� � a! $t.�eDP+al)�SK�wCo•�C I Q p
_ — .—_ — _ ._ c-,usn+w - I I I _ 8•f.S —
a.� L�•_ nwww. d f _ ._ _ — BEi«ao'ITlosf �.
W ~k ttt v—P t,••
4
FOUNDATION PLAN
SECTION DETAIL,GARAGE
r