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0520 COTUIT BAY DRIVE - Health
;20}Cotu tl'B ysDrive A 055 ,038,' %r a s TOWN OF BARNSTABLE LOCATION _saO e u ri ZC U p r SEWAGE# Z O 1 L • ZSS VILLAGE GE ASSESSOR'S MAP&PARCEL SS-O3 INSTALLER'S NAME&PHONE NO. R-LQ EXGo.Vo A►o✓N SEPTIC TANK CAPACITY /SOO oc� lyCt.J?ArJ - �QO�c On14 > LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER -T c l.. O PERMIT DATE: -Z 9- J L 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 Al — e Az- a©` f3z- 2a %5 .. A3 - W 3 O M w 4w/c d,ka / 3 No. Fee /�• THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppl tation for Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Xindividual Components, Location 4Adre sor Lot No. 620 60T0/7_6�YD C Owne 's Name,Add ess,and Tel.No. Assessor sCap/Parcel c S v 0'3� ��r1'l ®n 5 60 9`77 6 -33 tsallergar Address,and Tel.No. Designer's Name,A fA d ess,and Tel.No. xCq von ton 5ok-4-77-06 /4 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date � A Number of sheets Revision Dat Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) to - 20 ID 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 oFRp,,ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board --7 Signed Date Application Approved by Date l �Q Application Disapproved by Date for the following reasons Permit No. ow( a--, ) Date Issued 1U- / D�Oy� `� No. __ Fee—-w(J' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN.OF BARNSTABLE, MASSACHUSETTS es 01pplication for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System X Individual Components t - '�: Location Address or Lot No. 52,0 �DTU17 (� C Owne 's Name,Add ess,and Tel.No. Assessor's Map/Parcel C j�j — 03 ' t't (J` I S 50 9 _-17 6 -33 Y, Installer' Address,and Tel.No. Designer's Name,A ress,and Tel.No. IA Type of Building: /k Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided U gpd Plan Date� Number of sheets Revision D4 Title Size of Septic Tank Type of S.A.S. i Description of Soil d Nature of Repairs or Alterations(Answer when applicable) , co nal ff i U I © D Q 3 1 k '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 ental Code and not to place the system in operation until a)Eertificate of !, Compliance has been issued by this Board f Healt . r Signed ( I I I Date _7_ L(� Application Approved by Date L �Q Application Disapproved by Date 4 for the following reasons i Permit No. z( la� A5> Date Issued -------------------------------------- ------------------ - --- ---------------------------------------- k D�� HE COMMONWEALTH OF MASSACHUSETTS �e fP c BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CER IFl;tha the On- ' Sewage Disp sal system Constructed( ) Repaired( L� Upgraded( ) Abandoned( )by at :*_ d has been cons cted in acc danc di� g with th4rovisions of Title 5 and the for ispos Syste Construction Permit No. did Installer Designer #bedrdoms Approved design flow�Ul/ and The issuance of thi permit shall not be construed as a guarantee that the system wil f nct o as de�gned. Date (+ Inspectors _ = = = - Y2. j Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposat 6pstely'Construction Vermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at e--C j:A/j1' -ftj c� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date �7 /<2 Approved by U` t k AsBuilt n Page 1 of 2 TOWN OF BARNSTABLE 1 /) LOCATION �'�Q6 C:2;�?VV'- •l 02, SEWAGE # 9/—�3io2 " u VILLAGE ASSESSOR'S MAP & LOTlS3=�3� INSTALLER'S NAME & PHONE NO; ,e�40)Pr SEPTIC TANK CAPACITY �4ch_ d LEACHING FACILITY:(type) e,6-4t4 f',5 (size) yt� NO.OF BEDROOMS y PRIVATE WELL O UBLIC WATER f BUILDER OR OWNER . l�XeA)-3 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No N Ci http://issgl2/intraiiet/Propdata/prebuilt.aspx?mappar=055038&seq=1 6/17/2016 . L s� �`n . • m . I4r OFFICIAL USE cEl Certified Mail Fee Er $ `N,S Al Extra Services&Fees(check box,add tee as appropriate) ❑Return Receipt(hardcopy) $ 3 ❑Return Receipt(electronic) $ Postmark p C ❑Certified Mail Restricted Delivery $ JUL 2I2e2016 Q ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ O Postage r- $ USP5 rq Total Postage and Fees rq Sent To � Street and - ii4�RD--.I- Ifi I?!l City,State,ZIP 4� Certified Mail service provides the following benefits: e A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail n A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attt mpted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service'" Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ^ ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavallable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a i certain Priority Mail items. USPS postmark.If you would like a postmark on u For.an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion. of delivery(including the recipient's signature). of this label,afrw it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT.Save this reoelpt for your records. Ps Form 3800,Apol 2015(Reverse)PSN 7530-02-000.9047 MCI[.1011 a].1 COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A t ature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. ceived by(Printed a ) C. Date of livery ■ Attach.this card to the back of the mailpiece, ' or on the front if space permits. D. Is delivery address rfferent from item 1? ❑Yes 1. Artle Addressed to: If YES,enter delivery address below: ❑No jj�%yJ�S llQRHG' S . .tu ,9 �aap.6afUl Bey pn N „ ir, rn p- V O la 3s-� 3. Service Type gCertified Mail® ❑Priority Mail Express- Registered Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery N 4. Restricted Delivery?(Extra Fee) ❑Yes 4989 0335 V Sq PS Form 3811,July 2013 Domestic Return Receipt f i UNITEQ STATEifl <.= First-Class Mail Postage A Fees Paid USPS Permit No.G-10 :_ • Sender: Please print your name, address, and ZIP+41 in this box* Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 ( J h � J Ill'Ili''ils�llsl1i�11�s1l,ssl�aslasl��lilsi'Ilte�Ijiils�sii;s=sl�� I I y Town of Barnstable Barnstable ��t�tOwti Regulatory Services Department ,, edcaC 1 • snRxsrnsM MAW ,0r Public Health Division a 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean CHO CERTIFIED MAIL#7015 1730 0001 4989 0335 July 20, 2016 James F Lyons &Marguerite C TRS 520 Cotuit Bay Drive a Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 520 Cotuit Bay Drive, Cotuit, MA was last inspected on 07/08/2016, by Matthew Gilfoy, a certified septic inspector for the,State of Massachusetts. , The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic tank is leaking, distribution box is rotted, and garbage grinder to be removed. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic System within the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\520 Cotuit Bay Drive Cotuit.doc r;f Town of Barnstable anRtvsr,►ei.e, IMAM ,.� Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 f DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000y An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4•times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution.box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA- ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert.pipe (per Town Code §360-20 h) OTHER I 10i ICf� &2 �'C +AAT?k coed d-- D �, Gff�4 (','vide r�✓-f -7e f-e►�nover�. Repair deadline: aZ Vecir 5 Q:\SEPTIC\DEADLINES TO REPAIRFAILED SYSTEMS.doc 4� y Commonwealth of Massachusetts 066-0,39 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 520 Cotuit Bay Drive F Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635. 7-8-16 page. City/Town State Zip Code Date of Inspection , Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation ,Q Company Name 374 Route 130 Company Address Sandwich Ma 02563 CityjTown State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification 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: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-8-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health•or DEP)within 30 days of completing this inspection. If the system 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is Cotuit Ma 02635 7-8-16 required for every , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: - ® One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If 'not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will,pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): Septic tank is leaking and will need to be replaced along with d-box that is also in poor condition. Dwelling also has garbage grinder that will need to be removed. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 c Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635, 7-8-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y. ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): D-box is in poor condition and needs to be repaced. ❑ 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);' ❑ P broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑, Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health; safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water 0 . Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well ** Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided_ that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 E Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is Cotuit Ma 02635 . 7-8-16 required for every ' page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a'surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ E-1 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 520 Cotuit Bay Drive Property Address James Lyons µ ' Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system_ .obtained and examined? (If they were not ® El- available note as N/A) ❑ ®' Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the Site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the'septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Z ❑ Existing information. For example,°a plan at the Board of Health. 1 ® 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): a 4 Number of bedrooms(Actual) .4 DESIGN flow based on 310 CMR 15.203 (for example: 11`0 gpd x#of.bedrooms): 440 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents:. 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection. ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No i Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail 2014- 101,000gallo6s 2015-64,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: 1 month agoDate Commercial/industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpo) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner-last pump unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑' Single cesspool ' ❑ Overflow cesspool' ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank, d-box, pit installed 1980 with galleys installed 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2 Depth below grade: 6 . • feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: -1 6 feet Material of construction: ® concrete. ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑. No Dimensions: 1500gallons Sludge depth: 6 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M0 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) r Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" 0 Scum thickness Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle NS How were dimensions determined? Measured 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 was in poor condition and was leaking at time of inspection. Tank must be replaced. Grease Trap (locate on site plan).- Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 520 Cotuit Bay Drive M Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: 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 ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 'i Commonwealth of Massachusetts t W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 520 Cotuit Bay Drive Property Address ' James Lyons Owner Owner's Name information is Cotuit Ma 02635 7-8-16 required for every _ - . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present.must be opened) (locate on site plan): ; 0„ Depth of liquid level above outlet invert Comments.(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was in poor condition and will need to be replaced. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 6'x6' ❑ leaching chambers number: ® leaching galleries number: (4) 8'x40' ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection. New leaching was added to pit after pit had failed. Pit and new SAS were dry when inspected. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth.—top of,liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, L etc.): Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): f t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 520 Cotuit Bay Drive - Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below:. ® hand-sketch in the area below El drawing attached separately FRONT GARAGE POURC Al.�66: 82 3T C2-36W' - t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Vol untary,Assessments 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. City/Town State Zip Code Date of Inspection D. System Info rmation (cont) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW 144"feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 6-16-80 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑. Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 520 Cotuit Bay Drive Property Address James Lyons Owner Owner's Name information is required for every Cotuit Ma 02635 7-8-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION `6 <fO➢VVr- *3:�/ *02. SEWAGE # VILLAGE CaC�il, ASSESSOR'S MAP & LOT e:!X�d3Y- INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)-49-- j � (size) Tf.4e.Ad NO. OF BEDROOMS y PRIVATE WELL O UBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: a DATE COMPLIANCE ISSUED: 7 VARIANCE GRANTED: Yes No � f i Yf &ALLE6 `7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE A P P R 0 V E D Barnstable Conservation Commission Appilration for Dinpwial Worka TvmAr "'^ Application is hereby made for a Permit to Construct ( ) or Repair,: ) an I§AM8}al Sewage Disposafte System at: _.......... .... .. -•--•-••----------------••--.........•-----••----....--------------•--------------....------------ Location-Address or Lot N ..............�G'_.......................... — ............ ....!. d�----•-•---- 0 11 ......................... Owner ddress a ... r.�.... Lf -•-•••--- .........................................cS? "---!/✓l ',�L�l !�1d ........... ........... ... -- Installer Address Pq Type of Building Size Lot............................Sq. feet U a Dwelling—No. of Bedrooms.................. .....---------.__..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------........................... ...----------------- W Design Flow.................. ................gallons per person per day. Total daily flow..........._!._ 140..................gallons. WSeptic Tank—Liquid cap acit) .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ........../..... Width............... Total Length...___._... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.._..�5r.... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rz, Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ 9 ..........•------------- -----•--••-•---•-•--•----•-------•-•-•-•-•--......•--•---•--••......•-••-......................................................... O Description of Soil Q"sue....... x W x ••-•-•-- ----------------------------------•---------------------- ---------------------•--------•---•-•--•--------------•----•---•----------•-•-• •---•- --• -- •-• ...... U Nature of Repairs or Alterations—Answer when applicable._'4610----------, ....`�. -----------✓ V .�.. . ._.__. 1 --•--------------•----•---------------------------------------•---------------•-•-•----------------•-•--•-------•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc as een iss d by-the board of health. . Signed ---... .. .. -- ------ ---- . .., .. . . Date ApplicationApproved By .. - - - ---� --- .............................------------------------------------------- -------7..r./5-.Date Application Disapproved for the ollowing reasons- ...................... ---------------------------------------------------------------------------------------------------------- --------- --------------------------------.........-------------------------...................... ............................. ...................................-- -------------- ---- -- ---------------------- ----------------- /� Date PermitNo. --:'..... -.�.."��-_------_------.--- Issued ---------------------------------------- Date > • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for %gvviial Modal Toustrukhw# FO mff\ .---� Application is hereby made for a Permit to Construct ( l)� or Repair (X) an Individual Sewage Disposal System at: Location-Address or Lot N��D ...................ti. ---.-------C_!'07 /�. . ....�2 �� ..------------...... Owner ddress W %dc'G3'1�7 Q1�J�S? 71:511 (J✓ �'��, ...........:.......l illl .............. Installer W •. .......•• •------- Installer Address UType of Building - Size Lot............................Sq. feet c`'N Dwelling—No. of Bedrooms..................0'*....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------------•------------------...._...-----------•--••-•-•-•-•------••••••-•---•---••----------•-•----••-•---•-•••.....-•--•••.............•--• W Design Flow................._ -------•..__gallons per person per day. Total daily flow............ .................gallons. WSeptic Tank—Liquid capacity/f-SM_gallons Length................ Width................ Diameter............:... Depth................ r x Disposal Trench—No. .........., .._.. Width.......R.._...... Total Length..t:�2........ Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet..... :5_.._.. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------_---- ..................................................... Date........................................ W �4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------- O Description of Soil....................0-`-` -------- ... r S- Ji x W ' VNature of Repairs or Alterations—Answer when applicable.----4.�Q-----------.._&�!� .I--- ✓YJ-----------------------------------------------------------------•--......-------•--•------•---------................ Agreement, r. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian%Vas een issu d by the board of health. Signed ...... .- - ._ ........ .............. ..... ._ /.. ApplicationApproved By ---------- - - --- ---------------------------------------------------------------------- ........ Date Application Disapproved for the ollowing reasons: ............................................................ ----------------------.................................... ------------..........................-----------------------.............................-------.............................................................................................................. ......... --------. y Permit No. 1 --;"-...- ../....; Issued -- ----------------------------- f.----..... Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gerttftrate of C omplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......:........................------------- ........ --------------G'OA------ low--. --....--------...-------- -- . --.................................. , Installer at has been installed in accordance with the provisions of TITLE 5 of,The State Environmental Code as described in the application for Disposal Works Construction"-P!rmit No. ...... .. -..3./..-)...... dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHAIk NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. `2 DATE............ � ...............'9 - ...... Insp�ector .... - .... f ....................�-- ---_-_- _------ THE COMMONWEALTH OF MASSAC4U.SETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE. 222 �- Disposal Workii T-141mitr ion thrmit Permission is hereby granted.................)06, TUe-0771 0 --•---------------------------------------------------------------------•-••--••••...•......•-•............. to Construct ( ) or Repair (Ne) an Individual Sewage Disposal System_ at No..... t Street as shown on the application for Disposal Works Construction Permit Dated.......................................... l( " ............................. _. .....................................-.............. _ DATE. 7 J �j Board of Health •----------------------------------------------- VjJI FORM 36508 HOBBS&WARREN.INC..PUBLISHERS . 1 ' AsBuilt Page 1 of 2 TOWN OF BARNSTABLE LOCATION, 6 (�07V1Vr- 3 `l 012, SEWAGE # VILLAGE C1077,'112--' ASSESSOR'S MAP & LOT61S3=d3X- INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /OGbFAQ LEACHING FACILITY:(type) e-kZX-f',5 �� (size) }1� NO. OF BEDROOMS y PRIVATE WELL O UBLIC WATER BUILDER OR OWNER G-X010--S DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ''% 4-_ VARIANCE GRANTED: Yes No N cam' a 6,�6ri ,y C ALLE5 http://is.sgl2/intranet/propdata/prebuilt.aspx?mappar=055038&seq=1 6/17/2016 LOl.ATlON Sao SEWAGE PERMIT N0.• VI RAGE ,. I N S T A LLER'S NAME i ADDRESS A s- 7— BUILDER OR , OWNER Coo T 6 r DATE PERMIT ISSUED DATE COMPLIANCE . -LSSUED S '710 ,a d-Y/ 2 Fps v THE COMMONWEALTH -OF MAtSACHUSETTS BOAR® OF HEALTH d' 7- o,W1,l..............OF......3 P N,FT .134�.._............._... Appliration for UWVoii ai 10orkfi Tomtrnrttun ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal ,�Syst at: ..... ..C% _1.l T....... /.�?.Y........./�/...11...�...........•...-•-- �� �.Cr .. Locat' Address Lot No. ------.... Cd 7- -•--— �t..� � sa.l_ P.. �-•r •--- - w er Address w 9 Win. Installer Address dType of Building Size -----Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (} Other—Type of Building No. of persons............................ Showers — Cafeteria p' Other W fixtures ----------------------------------. Design Flow.............11a......................gallons per3�TssDe/}z aprear da y. Total daily flow..............�.��__�..............gallons. WSeptic Tank—Liquid capacity/_4FQ®gallons Length.&7.a..__ Width_G_-__O___ Diameter________________ Depth.5? '- x Disposal Trench--No..................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft. Seepage Pit No-------l........... Diameter..-lam F2__ Depth below inlet...C.FT... Total leaching area.....Z..<5.7sq. ft. z Other Distribution box (.Y) Dosing tank ( ) Percolation Test Results PerformedM_ - G•--•-- by.-�_,l1_i/.- _________________--•-•-..... Date----- -- Test Pit No. 1--- .Z...minutes per inch Depth of Test Pit..... Depth to ground water........................ rT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___________--•---_------ 9 ..................................•....................... ........ ............. ---- O O . // Description of Soil--l1 - �� ------ PSUf�....... -•-•sdi3SUr� .�- 1� �� W --------------------------------------------------------------------------------------•---•--•------------•------•-----------------••-•----••-•---•---•-•-•--••----•-----------•-•••......••------_...-- UNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------_.................................. Agreement: A The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT LEE y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeA issued y the oard of health. �d C 0 Igne .................................................................................... ..............a•te.............. Application Da Application Approved By................ •. ----••--•------------••-----------•--- ....4V i._ ... Date Application Disapproved for the following reasons-------------•-•--•--••-•-----------•--------------------------•---------------------------------•••..........._ ------...-•----------------••------------•--•-----------------------------------------------------------------•---••-•--•-•-----•--------•--•-•••••--•------------------•--------------•--•---••-•..... Date PermitNo......................................................... Issued....................................................... Date No. •-- ••• FF$ l'................ THE COMMONWEALTH'bF MAtSACHUSETTS BOARD OF HEALTH v/ti........-..OF.-....-�J.-/��'�.�7��T�'L/........................ Appliratinn for ami# Application is hereby made for a Permit to Construct, ( or Repair ( ) an Individual Sewage Disposal Syst at: .......................... T..._.z �` Lt No L.cat' n/-Address /�Pet rf Z— ?:j- ... ...... .......�l.•• -------------- Address -.. - i" 1rJ i -• - / .................................. ...... - -2 /�/il/�G Installer Address Type of Building Size Lot�� 7-�3 S feet V YP g xa: - ---............ q Dwelling—No. of Bedrooms.......... _____________________________Expansion Attic ( ) Garbage Grinder ( ) `k Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other d fixtures ..........................................J 1do- ----------•--•--•---•--------•----•-- •-----___-•----••-------------•---•-•--------•-•-------- W Design Flow........../f_d........................gallons pe de�r day. Total daily flow..................... ..............gallons. G :' Length - W Septic Tank—Liquid capacity/5- _gall_.___ ons ; engthl�_'U:_._ Width_ _.___Cj_. �Diameter________________ Depth _-,Z.._. x Disposal Trench—No_____________________ Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....1------------- Diameter../0__F__T_ Depth below inlet___<_... . Total leaching area....Z!6_7_sq. ft. Z Other Distribution box (� Dosing tank `� Percolation Test Results Performed by ff____._.f/.____,�_ ____________....... Date.....AX18_G___._._. �-4a Test Pit No. 1 25;; Z___minutes per inch Depth of Test Pit_____ Depth to ground water......—__.__- 44 Test Pit No. 2................minutes per inch Depth of Test Pit ................. Depth to ground water........................ -----------•-•- ••-----------------------........................................................ Description of Soil: ----......�oPSGi......... ......Svl3SJJ Q------------------ - ..... J- _1�..--------------- x i_ ? k: ��I14 hS .e9 N_D........---------=-- (� -• W UNature of Repairs,or Alterations—Answer,when applicable............................................................................................... Agreement: The undersigned agrees to install the afgredescribed Individual Sewage Disposal System in accordance with the provisions of mrn•^ 5 of the State Sanitary,.,Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued y the oard of health. Signed' •-- -• .......... .......................... Date Application Approved By................ -------•-•-••.............•----•-- "` s .^"a > _ Date Application Disapproved for the following reasons-................................................................................................................ ••-•-------------------------••--•-•--------•---------------•---•---------------------....-.-.•-_....-•--...................---......................................................................... Date Permit No--------------------------------- " --••-_. Issued---•••-••--•-...._ --- -- -- _._ _............... ............ . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y 'b. C�Crr�ifirtt#le of f�unt�li�nrr .�,, THiSli&TO YERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) f z Installer . t.c ---------ins; __{______ ______________ ___F _ 1 has been installed in accordance with e provisions of 'T 5 of The State Sanitary Code as descri e n the application for Disposal Works Construction Permit No. __Z d-`,4............. dated------ ............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION_SATISFACTORY..','; DATE................................ / ........................... Inspector .._--•---920 .... THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF EALTH 2 c...®F. c. .....................:.................. No._:..._. .. FEE. .----- 0hipaiia1 Work g Tnntr ion rrmi# Permission is herebyranted- --=------- ... ----------•--to Cons' (" . or Repair ( ) an,kdividu ewage Disposal S stem �.4e.......................................... Street / �++ as shown on the application for Disposal 71orks Construction Permi Dated.._ `.r. A' ...... Board of Ilealth��� DATE....................................... -- - .... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ` .,..��....,... �� ......��...... ��_ ..—.. ..�..,.�.5:.�s..�..o -- --tee I � I \ 3¢ 2 2 t 1 \z iZs -7- .2 9 OW o0.Q I ro I 'RTN� \ z¢ n �9 AV0T,- = S T/Al 0 .9/u17 .�/n/A�._Ga2 9 0 F 5 �9L.L 2EMA/N F"S SE/VT/, Z_&\/ jN OF MASSq�yG� RICHARD JAMES ONoE694N to `� �QNP2�06 4u t fp. �o No• Q-�O LEGEND , SA EXISTING EXISTING SPOT ELEVATIONS O,O EXISTING CONTOUR- - - 0 - - - - FINISHED SPOT ELEVATIONS 0.0 FINISHED CONTOUR 0 PROPOSED PLOT PLAN APPROVED: BOARD OF HEALTH i92NST�r3LF_, MASS. DATE AGENT LaT 24 -- OTU/T '�a�\/ S�o2�S I CERTIFY THAT THE PROPOSED R . J O�HEARN, INC, RLS, RS BUILDING SHOWN ON THIS PLAN 1348 ROUTE 134 CONFORMS TO THE ZONING LAWS EAST DENNIS , MASS. OF !3/-J2/,/sTg1j(-z MASS. DATE /G�a S CALF: _ /•� �O I BD JOB NO. Bo - 7ZG CLIENT / oH���vG�✓ DAT : REGISTERED LAND SURVEYOR '13HEE1- _J 0F Z _ SOIL TEST INVERT ELEVATIONS NOTES: DATE OF SOIL TEST E o INVERT AT BUILDING 3 /• 5 FT. ALL WORKMANSHIP AND MATERIALS WITNESSED BY IZ� INLET SEPTIC TANK 3/• 0 F.T. SHALL CONFORM TO D.E.Q.E. TITL- t�; PERCOLATION RATE « MIN./INCH OUTLET SEPTIC TANK 3019 FT AND THE TOWN OF 30.E AND REGULATIONS FOR SUBSURFACE. rrOBSERVATION HOLE I OBSERVATION HOLE 2 INLET DISTRIBUTION BOX FT. DISPOSAL OF SANITARY SEWAGE ELEVATION = 31.0 ELEVATION- OUTLET DISTRIBUTION BOX 30 -3 FT _ O - INLET LEACHING PIT 30.0 FT. BOTTOM LEACHING PIT ?4, o FT. I DESIGN CALCULATIONS - NUMBER OF BEDROOMS .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 I., 0LE:9n/ -iM� "To GARBAGE DISPOSAL UNIT... . YE s TOTAL ESTIMATED FLOW ()La aGAL./BR./DAY - 3 BR.).,, 33 -0 GAL./DAY REQUIRED SEPTIC TANK CAPACITY. . .. . . . . . . . . . GAL. ACTUAL SIZE OF SEPTIC TANK TO BE INSTALLED... . /Stf GAL. LEACHING AREA REQUiREMENTS - /4¢" 0 SIDE WALL AREA 2E GAL./S.F BOTTOM AREA /'0 GAL./S.F. 7-0— LEACHING 1TET E /�oUN`_T_ 2E� LEACHING CAPACITY ( BOTTOM +SIDEWALL ).. .... . . . .. . S�9' 7 GAL. — 3./5tX gx S,< /•6 -i- -/4 x 6'y/D x Z.6: _ I RESERVE LEACHING CAPACITY. . . GAL. TOP OF I f%O U N D., ELEV.=43,0 /� �T �''"�� CONCRETE 410 SCH. 40 CLEAN SAND COVERS PVC PIPE ' CONCRETE T— MIN, PITCH COVER 1/8 PER. FT. - - 2% MIN. PITCH + 1?- ` MAX. - t �P`SH OF Mgs�q�y _ = RICHARD. G z 211 LAYER OF 1/81j 1/?- 7-77 FLOW LINE WASHED STONE JHEAR ++ O'HEARN IVa.694 N 411 CAST IRON 1 z /9' o c 3/4" 1 1/21° (i8 ra.�✓ �. �F�^ PIPE - MIN. PITCH o w WASHED STONE ysT 1/411 PER FT. DIST. � >_ PRECAST LEACHING Any � t- BOX b b a v BASIN OR EQUIV. u- b COo w Q o Zo7-2a� C� TU,l T�/9V �/,yz,= ' J GAL SEPTIC Fr ()` HEd�RIU INC. RLS F TANK /a �r Dim ��itii R. . : : , • i 1 ,91 MAIN ST (RTE 26 ) WEST DENNIS , MASS . PROFILE OF GROUND WATER TABLE CLIENT. SEWAGE DISPOSAL SYSTEMJOB NO. 7Z0 QI r NOT TO SCALE DATE 6 1G 80 SHEET Z OF �- k