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0522 COTUIT BAY DRIVE - Health
522 Cotuit Bay give ; -- -- - - Cotuit 055-037 -- - --_ --- — — --� OF I I • o �- Commonwealth of Massachusetts Title 5 -Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c, l; 522 Cotuit Bay Drive r . Property Address Bernard&Jennifer Conway Owner Owner's am N information is Cotuit Ma 02635 10-29-2020 ' required for every 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. Inspector Information �'/ ��p� • on the computer, , use only the tab Daniel Hawkins key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 y Company Address Sandwich Ma� 02563 City/Town 'State Zip Code rt3t (508)477-0653 S114324 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); I have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting,this inspection I have determined that the system: 1. 0 Passes 2. ❑ Conditionally Passes - 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Dan Hawkins Digitally signed by Dan Hawkins : Date:2020.11.02 07:47:40-05'00' 10-29-2020 c 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 has a design flow of 10,000 gpd or greater;the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority: Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 522 Cotuit Bay Drive Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes:. I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 t c � Commonwealth of Massachusetts �T Title 5 Official Inspection Form + -1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 522 Cotuit Bay Drive u Property Address Bernard&Jennifer Conway Owner Owner's Name " information is Cotuit Ma 0263' 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board'of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will + pass"inspection if(with approval of Board of Health): ❑ . broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): - ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑- Y " ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑.Y ❑' N ❑ ND(Explain below): i 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: s P t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �v ,,p Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive V� Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water Cesspool r riv i o s within 50 feet of a bordering vegetated wetland or a salt marsh � ❑ privy 9 9 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply I well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance.- This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ O Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts " �v Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ 522 Cotuit Bay Drive u Property Address Bernard&Jennifer Conway ` Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont) - • 4) System Failure Criteria Applicable to All Systems: (cont.) i Yes No , Static liquid level in the distribution box above outlet invert due to an overloaded ❑ ❑ or clogged SAS or cesspool ' ❑ 0' Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Q 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 tributarysurface to a su ace water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ - Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence ` of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] • ❑ The system is a cesspool serving a facility with a design flow of 2000 gpd- El10,000 gpd: ❑ El 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either,"yes" or"no"to.each of the following, in addition to the - A questions in Section CA. Yes No ❑ ❑ ' the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page S'of 18- W Commonwealth of Massachusetts �m Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El 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? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? El ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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? ❑ O 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: 0 ❑ Existing information. For example, a plan at the Board of Health. ❑ a Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive ' V Property Address Bernard&Jennifer Conway r Owner Owner's Name information is required for every Cotuit Ma 02635 10-29-2020 St page. City/Town ate Zip Code Date of Inspection D. System,Information . 1. Residential Flow Conditions: Number of bedrooms (design 3): Number'of bedrooms (actual): 3 330/GPD' DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes R1 No r Does residence have a water treatment unit? r ❑ 'Yes Q No If yes, discharges to:' Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonaluse? ❑ Yes 0 No See below Water meter readings, if available(last 2 years usage (gpd)): 4 Detail: 2019- 126/GPD r Only 1 year,provided by Water Department., Sump pump? ❑ Yes X .No k . - current Last date of occupancy: h ' Date r r - t5insp.doc`-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 522 Cotuit Bay Drive Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- pumped spring 2020 Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts - �� ,,p Title 5 Official Inspection Forma r, , 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive R V� Property Address , Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: EJ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ , Overflow cesspool ❑ y 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): Approximate age of all components, date installed (if known)-and source of information: New SAS added to existing tank in 2009 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 31 Depth below grade: ` feet Material of construction: ❑ cast iron '❑■ 40PVC ❑ other(explain): Town water. Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.):." I ,,,. _.-t5insp.doc.•..rev.7/26/2018. / Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 .,. Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive V� Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 000gallons 211 Sludge depth: 3411 Distance from top of sludge to bottom of outlet tee or baffle 3„ Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 1411 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 4. Commonwealth of Massachusetts Title 5 Official Inspection Form "` w �= ,. Subsurface Sewage Disposal System Form_-Not for Voluntary Assessments el { 522 Cotuit Bay Drive t V - Property Address Bernard&Jennifer Conway „ s' Owner Owner's Name information is required for every Cotuit Ma 02635 . ,': 1.0-29-2020 V page. City/Town State= Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): - .. r NA Depth below grade: feet Material of construction".'N: ` a concrete ❑metal ❑fiberglass t ❑ polyethylene ❑other(explain): Dimensions. Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date .. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): y 8. 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: q. Capacity: gallons - Design Flow: gallons per day - f5insp.doc-rev.7/2 612 0 18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 .a , .. Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive V� Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): offDepth 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.): The d-box was in working order at the time of inspection. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form, r R Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 522 Cotuit Bay Drive Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information` (cont.) = r w M 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes'- ❑ No" Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA If pumps or alarms are not in working`order, system is a conditional pass. .. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries - number: a_` . _�. ❑ leaching trenches number, length: 4 infiltrators E leaching fields number, dimensions:- - ❑ overflow cesspool number: , r, ❑ innovative/alternative system Type/name of technology: 1566sp.66 rev:7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts ,,p Title 5 Official Inspection" Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 M 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Leaching had 2" of standing water when viewed. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 14 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection, Form �= w Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 522 Cotuit Bay Drive - u Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) T 13. Privy(locate on site plan): ' r NA Materials of construction:. Dimensions , Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):' , r f. ' t5nsp.00c•rev..7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18' w. Commonwealth of Massachusetts Title 5 Official Inspection Form I1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I v— 522 Cotuit Bay Drive Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below ❑■ hand-sketch in the area below ❑ drawing attached separately 4 Garage i B i O Al-12' B1-52' A2.23,6'. 0 132.53'6rr A3.33'9" B3.64' 2 3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurace Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts '? r �M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive V Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 '10-29-2020 . required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ' 15. Site Exam: ❑■ Check Slope ❑■ Surface water ❑E Check cellar ,- ■❑ Shallow wells No GW @ 126" Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: F Obtained from system design plans on record 7-13-2009 If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: " . ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. t Before filing this Inspection Report, please see Report Completeness Checklist on next page. �t5insp.doc-,rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 17 of 18 III' c Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface _ Subsu ace Sewage Disposal System Form Not for Voluntary Assessments I I� F 522 Cotuit Bay Drive Property Address Bernard&Jennifer Conway Owner Owner's Name information is Cotuit Ma 02635 10-29-2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑■ A. Inspector Information: Complete all fields in this section. ❑■ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ■❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ❑■ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION , ZZ C4�GGInr �a Y ��� SEWAGE# D VILLtGE ASSESSOR'S MAP&PARCELS y INSTALLER'S NAME&PHONE NO. Of/O�O l r/IJ/ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER e, PERMIT DATE: 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 lea acility). feet FURNISHED BY 9 i No. l,l/ r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 11 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mfigpo l 6p5tem Cow6tructiun Permit Application for a Permit to Construct( ) Repair klJ Upgrade( ) Abandon( ) ❑Complete System LJ Individual Components Location Address orLot No. 5772 Co All ��� for Owner's Name,Address,and Tel.No. �ess - re Map/Parcel a Fl v Yae-r CO 1 Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size .//l! sq. ft. Garbage Grinder ( P< Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures z Design Flow(min.require ) 3�® gpd Design flow provided c�t�� gpd Plan Date Number of sheets Revision Date Title $� ,,,,-- //Ti Z c-{/�(.lA> Size of Septic Tank �CLL / 7 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by ABoar &Hlelth. 7+. ;j Signe Date ( v Application Approved by Date Application Disapproved by: Date for the following reasons Date Permit No. Lj � :. �q\ i 'Fee FA Entered in computer: E,COMMONWEALTH'OF MASSACHUSETTS P S PUBLIC HEA TTI DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for &.5potar *p,5tem Con!gtructiorl Permit r Al Application fora Permit to Construct O Repair Upgrade(_) Abandon O ❑ Complete System I I Individual Components Location Address or Lot No.�7 z C®f U�^ C f y/ ��� Owner's Name,Address,and Tel.No. 56 - �7 / cle&,4er Assessor's Map/Parcel C 0 /�1 Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. 7'd/e)�4i Cl W1 5 771).NY two 6 t4,- , 34 Type of Building: Dwelling No.of Bedrooms Lot Size ?l1 sq.ft. Garbage Grinder ( P< Other Type of Building ,���l � GP No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.require ) ® gpd Design flow provided X5_0 gpd Plan Date r Number of sheets Revision Date Title V ✓f (�� lJ�' Z Cd�!./�.7` ! ,./. Size of Septic Tank ��'JCy f , ij'/5 s Type of S A`.S y © 50 y X, Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He lth. `� � Signeo-- Date `/ /f ®� Application Approved by Date Application Disapproved by: Date for the following reasons- . �y f Permit No. v oC ( Date Issued Q ` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( //) Upgraded ( ) Abandoned( )by at 577 7 L ® n,/ Ce/U/ has been constructed in accordance with the provisions o Title 5 and the for Disposal System Construction Permit No. Pf - „dated Installer �C� ? 1 Designer #bedrooms Approved design flow `{ 'Z gpd The issuance of this permit shgi'1 , be con rue as a guarantee that the syste``m�w 1 ft� ttc on as esigned. Date J Inspector No..;�'--�� -/ � � - Fee All'!� s THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligoal *pztem Cougtruction Permit Permission is hereby granted to Construct ( ) Repair e< Upgrade ( ) Abandon ) r System located at .5 7 2- C6,"A j� jCi(/ Jot' , �� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction us be c mpleted within three years of the date rhis ermit Date / !/ jG Approved by,, ory- dam` 'F FROM :d.oUh cape engineering' inc FAX NO. :15083629880 Jul. 29 2009. 01:34PM Pi Town of Barnstable all Regulatory Services g Thomas F. G.eiler,Director "'HAM. l Public Health Division Thomas McKean,:Director . 200 Main Stirect,14yannis,MA 02601 V Office: 508-862-4644 Tax: 508-790-6304 installer& DeManer Certification Form - Date: Sewage Yerm.i.t# �� �� °ZIJ Assessor's MapfWarcel 0,7�,� ��7 _. _ Designer: � r installer; o -mil Address. Ila, i 61: Apr"�YUn 69/16e).1-"was,ssued a permit to Install a Otte) (installer) septic system at L vQ. based on a design drawn by (a- 6'. ddress) dated - i certify that the septic system referenced above tivas installed substantially according to the design., which may include minor approved changes such as lateral relocation of the di stribution box and/or septic tank. i certify that.the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. 05 OANIEL A. ci OJALA (Instal s Signature) MIL No.45502 MAL STD \p4+ (Designer's Signature) (Affix Designer's Stamp here) - PLEASE TC1RN' It)` L3ARNSTAR)<1?_ PUBLIC 11EALTH DWSTQI�i.__ CELtMllCATE OF CQRIrl.IANCE WILT., NOT HE ISSUED UNTII, AQTH T1115 :FORM ANT) .AS.-RIJILT CARD ARE RECEIVED BY TRF AARNSTAI3LE PUBLIC HEALTH DIVISION. THANK YOU ( :I lealth/Sc tic Desi ;rr Certification Form 3-264U.doe R � S . O 9 - low qel We P#_�� �TRE Department of Regulatory Se>rviees "R "STAII + Public Health Division _ ](Date 200 Main Street,Hy;muis MA 02601 7 Date Scheduled Tithe J m Fee Pd'. Foil Suitability Assessrizent for Seepage DID sposal Perfonned By: Wlhtessed By: LOCATION ORIVIAi['i ON- Location Address sptoZ C Q `) �- i Owner's Name co Address Assessor's Map/Parcel 6� j � Engineer's Name �d tN ^ CAf e NEW CONSTRUCTION REPAIR Telephone 11 � s • i Land Use' s t�� Slopes(%) -" Surface Stones------ Distances from: Open Water Body'ate ft Possible Wet Area ft' Drinking Water Well ft Drainage Way ` ft Property Unc 0; l ft Other It SKETCH., (Street name,dimensions of lot,exact locations of test holes&pert tests,locnte wetlands'IT]proxintily to holes) lf�.: r t P -to "A Parenl,titaterial(geologic) '"""" -- ' --Depth-lU Bedroelt_ Depth to Groundwater: Standing Water in flole: Weeping i'Io111 hit f itce Estimated Seasonal High Groundwater 11.111J��3®l�/lAl V A 1L A'lJ�l�t t FOR SEASONAL 111011 WATPER TABIA Method Used: Depth Observed standing in obs.hole: ___ In, Depth to sell t (Atls; _ram Im Depth to weeping from side of obs.hole: -__ a lit, Groundwuter Adjustment _fr. Index Well# Reading Date: Index Well level m Adj,fttetor AQj,Groundwater Levul z Observation `r Holt# Tine Ill 4" Depth of Perc �`�� Tlme at 6" Start Pre-soak Time @ c� 1Nv V Time(9'-6„I End Pre-soak_ ' Rate Min,/Incli Site Suitability Assessment: Site Passed— Sit.G-Failed: Additional Testing Needed(YIN) Original; Public Health Division Observation Hole Data To Be Coinpleted on Back----------- ***It percolation test is to be conducted witilill< 100' of wetland, you niust first notify tlie. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\S EPT10PER CPORM.DOC l D EEROBSIERVATIOZ�T HOLE.LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) (USDA) Soil Color Soil• Other • (Munsell) Mottling'. (Structure,Stones;Boulders, Con istenc % ravel C- 11�E EP O-BSERVATION HOLE LOG Depth from Soil Horizon Soil Texture le#_ Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottlin --_ g. (Structure,Stones, Boarders„ Consistency r1 CA• C %Gravel r�V 01 Depth from D EET ®BS]ERV TION H®LE LOG Soil Horizon # Surface(in.) Soil Texture Soil Color. —'-- Soil (USDA) (Munsell) MottlingOther ' (Structure,Stones,Boulders. Co siste cY,4' Gravel — — DREv, OBSERVATION HOLE' Depth from LOGSoil Horizon Soil Tcx[ure Hole Surface(in.) Soil Color Soil Other r (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consi ten ','6 amypa- Flood rnsurance Rate IVlarr• Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No� Yes . Depth of Nultura19LV Occurring]Lervious Mato; j Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? r CeHi 1cation I certify that on 9 4 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and illat the above analysis was performed by me consistent with the required training, expertise an"d experience described in 310 CMR 15.017. Signature_. f� Date ():15BBTICU'BRCFORM.DOC t `� �O Barnstable y0,* wn of Barnstable Regulatory Y Services Department �'"`�iCa�' s�vseAHL.E. * >AS& A Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508 84 Thomas F.Geiler,Director FAX: 508-79090-6306304 Thomas A.McKean,CHO t CERTIFIED MAIL# 70081830000205008871 6/01/2009 Susan Fletcher 522 Cotuit Bay Drive Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 522 Cotuit Bay Drive, Cotuit MA was last inspected on May 20, 2009 by Patrick O'Connell, a certified septic inspector for the State of. Massachusetts. The inspection of the septic system showed that the system"Failed"under the.guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS, You are ordered to repair or replace the septic system within Sixty (60) days 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 THE OARD OF HEALTH a c ean, S., CHO Agent of the Board of Health i . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is Cotuit MA 02635 May 20 2009 required for every 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. Important: A. General Information When filling out forms on the 154 computer,use 1. Inspector: only the tab key to move you: Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name 189 Cammett Road _ Company Address 4 Marstons Mills Mr,...� 02648 �rvm City/Town State Zip Code 508-428-1779 SI 12855 Telephone Number License Number . B. Certification I certify that I have personally inspected the sewage disposal-system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 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 May 20 2009 Vlec=tore's—Sign lure 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. 09-83 Fletcher.doe•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal SysteAge 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2009 every page. Cityrrown 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: U I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 09-83 Fletcher.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r( 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2009 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 publicfiealth; safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 09-83 Fletcher.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is Cotuit MA 02635 May 20, 2009 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): El The system has a septic tank and SAS and the SAS Is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool . ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 09.83 Fletcher.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 f, " ,<LN� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is Cotuit MA 02635 May 20, 2009 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ 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 El 1:1 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. 09-83 Fletcher.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 i. Commonwealth of Massachusetts PEI Mai . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is Cotuit MA 02635 May 20, 2009 required for Y every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® , ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue _ J approximation of distance is unacceptable) [310 CMR 15.302(5)] 09.83 Fletcher.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ y 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is Cotuit MA 02635 May 20 2009 required for Y every page. Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN"flow based on 31U CMR 1.5.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 09.83 Flelcher.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2009 every page. Cityfrown . State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped last year. 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) 0 Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance Date: 7/24/79 Were sewage odors detected when arriving at the site? - ❑ Yes ® No 09-83 Fletcher.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is Cotuit MA 02635 May 20 2009 required for Y every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2' Depth below grade: 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): 1' Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ----------------------------------------------- --------------------------------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. 21, Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness Trace 6,1 Distance from top of scum to top of outlet tee or baffle - Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 09-83 Fletcher.doc•08f05 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r(0 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is COtUIt required for MA 02635 May 20, 2009 every page. Cltylrown 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.): Liquid level was found at bottom of outlet invert tees are intact and clear. Tank is structurally sound Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee<or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): 09-83 Fletcher.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 . a `.� Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2009 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No IAlarms in working order: ❑ Yes ❑ No 09-83 Fletcher.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 f ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is Cotuit MA 02635 May 20, 2009 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Liquid level in pit was found 6" below top row of holes with a high stain line over top holes. Pit has no effective leaching and is in hydraulic failure. 09-83 Fletcher.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 +� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) . Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert. — Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 09413 Fletcher.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ` 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is Cotuit MA 02635 May 20, 2009 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r , r r r r . . r , r , r „ . r rrrrrrr , r r%r%r r , r%r r%,%r r r „ r „ % % %r%r % % % % % % % % % r% % % % %r%, . rr , . r rr , , „ , r ,r,r,r♦r, rr , rrrr % % % % r , 48rrrrrrrrrrrrr , rrrrrrrr 2 r rrrr r r%r r re%r%r% %r%r%r%r% „ rrr % r%r%r%r r%r%r r%r%r r r%r%r%r%r%r%r%r , ,%,% r r r r . . .%r%r%rr , r . rrrrrrrrrrr , rrrr , rrrrrrrr ♦r♦r♦r♦r♦r♦r♦r,r♦ ♦ ♦ „ ♦ ♦ ♦ ♦ , 34 I Commonwealth of Massachusetts J W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 522 Cotuit Bay Drive Property Address Susan Fletcher Owner Owner's Name information is required for y Cotuit MA 02635 May 20, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground waterN/A feet Please indicate all methods used to determine the high groundwater elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I 09-83 Fletcher.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable P# l Department of Regnwwy Services 11 1 • Public Health Division Date C noNda7pStte4 NAO.d I Q D Fee Pd._ C 0 .� eyed Dam sit ._._,. , SOO,&I itabMity Assessment for Sewage OLW©sal • �a w'dnessadBp: o Deg M�.r�i,� �� • Paced sy: T ,�►�l o�`S.,, ��C_._.__ f e A �✓� T.OcA QN& VMRMA►, N y Loudon Address. S �et Ce'f u f-tTZ � OwndsNmna Adm 2 CO-fU � AssessoesMaplPe NBW t�ONS1RUCliON IMAM TbteOOM s (Eels) Land Use Slovas(°X) — �— Suc h Stance ej DMN=ftmw Opal WawBod►-t20Gg rmMk wctam_--- A z wawwdt --� a DrainvOwar S �'TGH:(strcda ,d'unao � � tta�oftestlroles�n� • toe�nwgiands in pcoximi4►ou Gobs? V4 .•, t I • /�l_ �f�c I /�U�'w�s h�' �Dr�tG.to Bdkock /U ern e e n�vc1,�,��C/��( Patent mate w(geotogte) Depth to Groff Stiomlig water in HOia: {#going from Pit r Estimated Seasonal> amundwaflar L' DE17lAiVII UTION FOR SEASONAL OGH WATtR TABLE h e w f Mehod� tg in ohs hokc- in: Depth to soiltias: 1a- no eV i deh ce to flam s'�ofobs.hIL ole in. Doh _____—Ad Qom�dwdwLpd-,_- o G, �✓� lndex wen — Re$dmE D� LWec wen lava /►d1•: PERCQLAZTOlY.'IT ` '„ a Tirna:ffiti — ti Dep6lOfPeiC �,." stutPre-soakTiou;® ' 0- /✓1 - Z"un '( "-� End used a 5 �(. )A d rreBoak lest �,a✓i /S/`'')A• , w0 V vto �l Rate WmAnch M. S'itaStiitabitiq►A tt rdePassed =- SitCFapA&-.-. Addis wdTw6ngWev&d(Y1M Original: Pnbik item&Dbision Observation Hojqp. aft To Be Compleoed on Back +n I%^r„nr u&M within 100'of wedpnd,.Yuu ntnst first notify the DT H ..- e f n e- ,,4ul� qL1 —Fe Ct S� C9 r Y lVo f e-JO Mo(' kip ��� fU K' S / „ o Nee rr� �� j Sal r N rn � TH _ � to r —� . r No U Commonwealth of Mossochwetfs Executive Office of Enviromentol Affolrs Department of 8 Environmental Prot Wtulant F.Weld Trudy Cos. A r Paul GAvoc! y ✓(/y 4c �p avW � o wn+a , 1�6LV Q SUBSURFACE SEWAGE DISPOSAL SYS INSP 4l i qu ~+ PART A r �` CERTIFICATION ti PropertyAddr•esar522 Cotuit Bay Drive Cotuit,Mass . Ad ref 7 Hearths Date of Iaspeotlon. 5/2 7/97 (u different) Sunapee N. H Name or Taspeotor. Joseph P.Macomber Jr. 03782 Company Name,Address and Telephone Number. J.P.Macomber & Son Inc. Box 66 Centerville,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I cwibr that I have parsons.11y inspected the"wage disposal system at this address and that the information reported below is true,ao=rau and complete as of the tins of inspection The inspection was performed based on my training and experience is the proper Nachos and maintenance of on-site sewage disposal systems. The cysts=: 6adttwnal1i Passes Needs Furthar Evaluation By the Local Approving Authority _ Fafle Inspector's 8lgaat 6 0/k"�W, . Date: 0_ '�cJ7 The System Inspector shall submit a copy of this iaspectidh report to the Approving Authority within thirty(30)days of completing this insp.akm If the system is a shared systam or has a design flow of 10,000 gpd or greater,the inspector and the system owner&hall suhmit the report to the appropriate regional oMce of the Department of EnAroameatal Protection. Ths original should be sat to the system owner:tad copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A B. C,or D: A) PASSES: I hAve not found information which indicates that the m violates of the failure 'te Lay caste any tst ru u defined is 310 Cb!$ 15.303. Any Z%Dure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES; , VQ, One or more system componaats used to be replaced or repaired. The system,upon completion of the replacement or repair, pa&see iaspeaiaa. Indicate yes, ,or not determined(Y,N.or ND). Describe basis of determination in all instances. if*not dstermiaed',explain why act) The septic teak is metal, era:ked,structurally unsound,shows substantial infiltration or wailtratioa,.or tank failurs is imminent. The system will pass inspection if the existing septic tank is replaced with a ponformiag septic teak as approved :by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02106 a FAX(617)SWI049 a Telephone(617)292-5500 �'3 rMIW an ROCWIW r.ry f 1 SUBSURFACE SEWAGE DISPOaAL SYSTEM INSPECTION FORM PART A CERTIFICATION (ooatlnued) b Prop.MAddrvi522 Cotuit Bay Drive Cotuit,Mass . O '"n D. Petvasko Des.of LwP"tioas 5/27/97 B)9YBTEM CONDITIONALLY PASSES,(continued) 1 10 S*w gs backup or breakout or ho static water level observed in the disuOAdion boa is duo to brow or obstructed pips(s) or dw to a broken.&sided or uarvsa distribution b=. The system win pass inspection if(with approval of the Board of Health): broken pipe(&)are repLad obstruatioo Is removed distribution box Is levelled or replaced 4W The system required pumping more than four times a year dw to brWwn or obstructed pipe(s). The system will pea. Inspection if(with approval of the Board of Haakh): brolua pipe(s)are replaced obetructloa is removed CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTHs _ Coaditlow exist which require!lather evaluation by the Board of Health in order to determias If the system is inning to pra.aa the public hsahb,selety and the aavironmsnt. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DZTERMINE13 THAT THE 8Y8TEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND BAFET'Y AND THE ENVIRONMENT Cesspool or privy is within 60 feet of a surface water Cesspool or privy is within 60("th!a bordering vegetated wetland or a salt marsh i) 8Y8TEM WILL PAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERhUNES THAT THE MTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALT8 AND SAFETY AND THE ENVIRONMENT The system bar a septic tank Lad soil absorption system and is within 100 feet to a surface water supply or u%NoAry to a surface water supply. The system has a septic tank and cog absorption system and is within a Zons I of a public water supply wa Ald The system has a septic tank Lad soil fbeorption system Lad Is within 60 feet of a private water supply well. The system has a septic tank Lad&oil absorption system and Is lea's than 100 feet but 60 feet or two bv=a private wasar supply well,unless a well water analysis for conform bacteria and volatile orpnk compounds indkat"that the wall is bw Imm pollution bom that Udllty and the pressace of ammonia aitrogen and nitrate aitroQen is equal to or 1es. than 6 ppm 3) OTHER d ('revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION(oonUnued) PropestyAddresa: 522 Cotuit Bay Drive Cotuit,Mass . Owner. D. -Petvasko Date of Inspection:5/2 7/9 7 D) SYSTEM FAILS: N iD I have dstermined that the system violates oae or more of the following faihtre criteria as defined is 310 CMR 16.303. The basis for this determination is identified below. The Board of Health ahoald be contacted to determine what will be necessary to Correa the !Ahura. �Q Backup of"wage into facility or system oomponant due to an overloaded or clogged SAS or cesspool. Discharge or ponding of aMusat to the surface of the pound or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet!avert due to an overloaded or clogged SAS or ceespool. kax-x►A�- I Liquid depth is eseepcol-12 less than 6-below invert or available volume is Is"than 0 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high poundwatar elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or trOutary to a surface water supply. ,dZd Any portion of a cesspool or privy is within a Zone I of a public wall. OVO Aqy portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is leas than 100 fart but greater than 60 feet from a private water supply wall with no aomptable water quality analysis. If the well has been analysed to be acceptable,attach copy of well water analyw for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to large Ohms in addition to the criteria above: ND The systam serves a facility with a design now of 10,000 gpd or greater(Large System)and the system is a&igaid"Ut threat to publ baslth and&slaty and the environment because one or more of the following conditions scist: the sysum is within 400 feet of a surface drialdng water supply /III the system is within 200 feet of a tributary to a surface drinking avatar supply the system is located in a aitrogan sansWve area(Interim Wellhaad Protection Am-(IWPA)or a mapped Zone 11 of a pubt WSW supply well) The owner or operator of any such system&hall bring the system and facility Jaw tall compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please Consult the local regional 901ce of the Department for!lather information., (revised 11/03/95) '" 3 f 4 •• _ I l SUBSURFACE 8ZWAOE DISPOSAL SYSTEM INSPECTION FORM PART B CHECXLIST Prop.rtyAd&..a 522 Cotuit Bay Drive Cotuit,Mass . Own.at D Petvasko Date of insp.O loos 5/2 7/9 7 • Check it the have been done: ' `�information way of the or ooat r.quertd pant,and Board of Health. zNOae of the system oompons4ts have been pumped for at Last two weeks and the ring that period. Large volumes of water have not been introduced into the been normal now rat.. du system recently or as part of this ,ZAs built plane be"been obtained and asamiaed. Now if they are not available with N/A 27U UcMq or dwrlliag was inspected for signs of sewage back-up. The system does not receive nonsanitary or industrial waste now sits was inspected for signs of breakout. 2A.Il system componeat+,.raidudi the Soil Absorption System,have been located on the site. X1T1e septic tank manhols were uncovered,opsaed,and the interior of the septic tank was iasp.cted for eonditioa of bafn or teas,material Of construction,dimensions,depth of liquid,depth of sbdg%depth of scum. . The sise and location of the Sou Absorption System on the site has been determined based on existing information or approximated by noa•iatrualve methods. .Z he facility owner(and oaupaats,if diftwvut from owner)were provided with infosmadon on the proper maintenance of Sub- (revised Disposal System (revised 11/03/95) r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address- 522 Cotuit Bay Drive Cotuit Mass . Owner: D. Petvasko Date of Inspections/2 7/97 FLOW CONDITIONS RESIDENTIAL: Design flow: ' 1 .p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: 6 Garbage grinder (yes or no):-WE Laundry connected to system (yes or no):/—r- -P' Seasonal use (yes or no): Water meter readings, if available (last two (2) year usage (gpd): am mozwci' Sump Pump (yes or no): N46 9 K- ,dda 494&J'4 S ' b L0 J O'ev Last date of occupancy:._____ COMMERCIAUIN DUSTRIAL: Type of establishment: ,*- Design flow: V,4 Qallons/day Grease trap present: (yes or no)'&:�q Industrial Waste Holding Tank present: (yes or no)IV Non-sanitary waste discharged to the Title 5 system: (yes or no)" Water meter readings, if available:�ll� Last date of occupancy:y OTHER: (Describe) A)/9 Last date of'occupancy: J GENERAL INFORMATION PUMPING RECORDS and source of information: stem pumped as part of inspe ion: (yes or no),:!D If yes, volume pumped: allons Reason for pumping: TY� SYSTEM Septic tank/distribution box/soil absorption system Single cesspool 407 Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) IFUE VA Technology etc. Copy of up to date contracts' Other APPROXIMATE AGE of all components, date installed (if known) and source of information: / 7W�1(r1LJ Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) Pay 5 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C- . SYSTEM INFORMATION (continued) Property Address. 522 Cotuit Bay Road Cotuit,Mass. Owner: D. Petvasko Date of Inspection: 5/2 7/9 7 SEPTIC TANK:J00C,4&0v 7i%4/e (locate on site plan Depth below grade:f material of construction: .,_concrete _metal _FRP_other(explain) Dimensions: ' ' Sludge depth: Distance from top of ludge to bottom of outlet tee or baffle:�IV�- Scum thickness:_/,(�g� Distance from top of scum to top of outlet tee or baffle:.2�� Distance from bottom of scum to bottom of outlet tee or baffle.,-7- Comments: (recommendation for pumping, conditigg of inlet and outlet tees or baffler. depth of liquid 1Pvgl in relation to ou et invert, structural rity, evidence of IeakagP, etc.) '► - 1 4 AJ 1 /r t GREASE TRAP.41kWE (locate on site plan) Depth below grade:, material of consininion*A cincrete _metal _FRP_other(explain) Dimensions• Scum thickness: Distance from top vi scum to top of outlet tee or baffle:./ Distance from bottom ni arum to honnm of outlet tee or baltle:. Comments: (recommendation for pumping, condil-nn of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, struaural integrity, evidence of leakage, etc.1— rease trap is noz present (zevlsed 1/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) p=•ops,,tYAdde.,: 522 Cotuit Bay Drive Cotuit,Mass . Owner. D. Petvasko Date of Inspection: 5/2 7/9 7 TIGHT OR HOLDING TAN& (]ocou on site pt.a) • Depth bolo.►Vwlc-_&4- Notarial ooast:vctlon:y�ooacsea•_metal_YR?_otha:(espLW - D4maasions: Alit Dwesip ao.► �� Alarm level: Commaat+ orr ho i�ng tan cl s are nod present DISTRIBUTION BOX: , Uocats on site plan) Depth of liquid level above outlet invert: Ccazmanis: isri aution��ox�is�e`ve • 'asr one'` aero ev9i"ceoce o)! sollas carry ovFr o evidence or leakage in or out of the distribution box. PUMP CHAMBER:,O•tle (locate on axle plan) Pumps in working o:dar.(yw or no) Comments: (note coadid=of pump chamber,condition of pumps and appurtenances,etc.) Pump c am er is not present. (revised 11/03/95) SUBSURFACE BEWAOB DIBPOSAL 8YRTEM INSPECTION FORM PART C MTEM INFORMATION(oontlauwd) 522 Cotuit Bay Drive Cotuit,Mass. O„"n D. Petvasko Dasa of Lwp.otiow 5/2 7/9 7 SOIL AMRFTION OYSM(B U9 / Oomu oa disa plan,if pawaL;azcavatioa m4 roqub*4 but my be appraaimatad by wo4atruaiw motbc d�) • If aot drtarmlad to be pru at,crpUL%: I—hN cj&Abejj,Aumbat:s ^�PZ ^, i..chlaj a.acb.., yaehia W4 aumb.r,dimaAalpni arartow oo�rltpoal, number. L.// Loamy sand do ac1a n�san'ycfr-*Io Slgnso' X' ot4.)failure or Uon In a. kil -ft is Rwpifi-1 CESSPOOLS& (local.oa&U4 pL►a) Mamba aad aoddru:.sloa:_ D.pth.top of liquid to lalat immu Depth ot.olid+Unr._ A) - Depth of so=Cigar. Dim�d orspooi:— MLtaial.of ooastrudiOa Indiatioa of pound.at.r in-flow(ft-pool mu+t be pumpd u part of(aip�etkn) Cesspools are not present _ Ccmm.ata:(w"ooaditiaa of 64 sIPA of kvdmuBc UQ^Irvrl of pondia&ooaditloa of vrgqtatto4 ate.) PRIVY:-A&We- Oocasa an Site Plaa) lLatariaL of ooasrrv�iaa_ ilJ� Dimu lo". jz Depth d solid&.,&_ Cam""*(note=ditiaa ad 84&IPA of}ldraulk UDU:*,bvel of pondia&ooaditloa of vegetation,ite.) Pri iry is not. present (revlsed 11/03/95)• 8 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM PART B SYSTEM INFORMATION continued . SKETCH OF SEWAGE L:SPOSAL SYSTEM: include ties to at least two permanent references landmarks. or benchmarks locate• all wells within 100' Cotuit Water Company 428-2687 C 0� of � PTH TO GROUNDWATER depth to groundwater PsRtAod of eterminA-ttio or proximation: = I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / LI DATA a 44 , l FUV►.,Ld,-I(DN -' �• �f'tt�� '_ -fit.` � ::�`',`. e-aGN SAP .. 1 1 1 � �� • , I M G,Ai<B►CJ� 141 ISO G.PRD- �' -�-A,u4c • 22 o rt t5 � S ,G �bOO u1;E v�sPasAl- P'T��a = t5o SF PL.4 Q 00 SOT-TOM A ZCA e v- I l NZ,E.or 'rOTA%- P E�Lp'i'l Or..l ,111 Z hf11J OQ 46 oj tg TV Fr-w Te 1 I-lei r Fc"'7T�fi � 4 y,/t tuu • CrI;v ••Pip• I000 lwv 4 •'% Los ,. p tY�t �,GPf IG TILUV- wv. �5 .L• ItJ�I. �/.g t000 ;v Ge.l.• 4G•I ` Pae.G �Cv ► wl�u, Tv I-�wmolgD =o R-o•"r 616 � 1 �"• G C�TtFr,�a p¢oFI 5G- Fy sm 14 SGo� per,A.tr.l Jt t` U u/AT6L- .'..l..►A.T ;���I � COMPL-'� s v/tfH �.1TS OF -rwe Q���e�.nn 6. -8� 2QS PG 2'1 oF��;�l��lY�" �� J e�.XTor AWV v✓�-t Q�1� ¢� t� Tb , G vl L J- A�tl►.SrS -r �asEv oLI 'hu WwTCOMA 'T CVaa1��A T"IS ?L s&" kIr uo v� uort ISL uSao oFFserrp ol" uuF•�G. _ .E' 1 tot .a �0 a•.n,qn,.-n.r�a�„�\.t►raw•I.s.wrs-nn/�r•RrnRn1P►.�,'►r�..'w11T.RA'V 1�w��11�T .. v TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- •CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY I NSPEC7'ED STREET ADDRESS 522 Cotuit Bay Drive Cotuit.Mass . ASSESSORS MAP, BLOCK AND PARCEL # 55-37 OWNER' s NAME D Petvasko• PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J. P.Macomber & SaTf 'Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632. Street Town or City Stat• LIP COMPANY TELEPHONE ( 508 775 3338 FAX (508 790 - 1578 CERTIFICATION STATEMENT I certifythat I have personally inspected the sewage disposal system a this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and exPerieace in the proper function and maintenance -of on• site. sewage disposal systems . Check one: :XXXXXXXXXXXXXsysteai PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILEll* The inspection which I have con\"'4Vcted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 5/27/97 One copy of this certification must be provided to the OWNER� the BUYER ( whore applicable ) and the BOARD OF HEALTH. e If the inspection FAILED, thb owner or"'operator ehall upgrade ' syste within one year of the date of the inspection, unless allowed orthe requiredm otherwise as provided in 3.10 CMR 15 . 305 . partd .doc f _ Sd'jy �71 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF E ONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June s, 1995 Acting Director of the ' ' ton of Water PoUution Control LOCATION SEWAGE PERMIT NO. �o-r iT Paste On VILLAGE 6l I INSTA LLER'S NAME & ADDRESS BUILDER OR OWNER DATE . PERMIT ISSUED � � DAT E COMPLIANCE ISSUED --.2y_7g Y eel rL No.- --- :. Fps..... ................. .. ..... _..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �. I'�✓ ---...OF..............��.. .................................................. Appliration for Disposal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• / L.... _ LoAddrre>ss -o rr oLot rN o. !ce � �.... a� •. Owner Addres ......................... --••----•--L......Uo ` .............. -•---------------- Installer ddress Type of Buildin ` Size Lot._... 5��_�_l ...S feet U yp g, q Dwelling-,"No. of Bedrooms__________________'L-________________.__Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons____________________________ Showers — Cafeteria P4 Other fixtures ___ W Design Flow.._._____. _ .___gal�l99ns Rer person per day. Total daily flow______________ _.._...............gallons. WSeptic Tank TLiquid capacity ga114nss°v Length................ Width................ Diameter................ Depth................ x Disposal Trench—No _______________ ,C�---Width_._.__. _____.. Total Length._____._.... Total leaching area_. ___ - _�..sq. ft. Seepage Pit No______ ____________ Di ate Depth below inlet___..__ ,,r.... Total leaching area_. __sq. ft.Zal Z Other Distribution box ( ) Dosin to ~' Percolation Test Results Performed by.__ � _.._--_/ :_ d'{ %4__________________ .Date__s3: �-_7. �._____.______.. ,-a Test Pit No. 1....2__:_.._._minutes per inch Depth of Test Pit...... Depth to ground water___ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R' ................. ----------- O Description of Soil--2...__.. ...... ---------------------------------•----- "� W -----------------------------------------------------------------------•------••-----•-------•--•--- ............... ---••--•---------------•--•---................... .................. e. U Nature of Repairs or Alterations—Answer when applicabl _______________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the T provisions of TTLL p 5 of the State Sanitary Code—The undersigned further agrees not to place the system-in.,.. operation until a Certificate of Compliance has ed by the boar Si ed. ... .2t6t2n�. health. ....... 7 ate e� Application Approved By..--•- / • •----- ---- � �1.. •7 /:_...._.. `� Date , Application Disapproved for the following reasons:.............................................=................................................................. ......----•----------------------•---.._.............-------•----._.........:-----------•---•---=---•-----•••-•----------------------•-•----•...................... ................................... Date PermitNo......................................................... Issued._.... .. Date 1 e No.........../Oc....... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ........OF............. ....... Applirationtor Disposal Works Tongtrurtion Prrmit Application is hereby made for a Permit to Construct,.,. or Repair an Individual Sewage Disposal System at: 041-rwr -24........................................................................... LoS",ID-Address t No. *� , '141.1 i - ----------- . ............ Owner W Addr ......................... ...........0ext-ml.kuvilks ... . ...j4,................................... 14 Installer Address Type of Building Size Lot.....Zr5A q...Sq. feet U It.�-4 Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Ort)A14 Other of Building ............................. No. of persons............................ Showers Cafeteria Other fixtures ................................................................................................................. ---------------------- Design Flow. ..._..._...' 0*.2=....gallorisyer person per day. Total daily flow.......... e........._....._gallons.S. 9 Septic Tank Liquid,capacity:ilgl$'.gallgs 'Length......I.......... Width.............. ' Diameter..............-- Depth.............._. Disposal Trench'—No-----------S"_A,_W'dth1 Total Length.. Total leaching area-AV.011M...sq. ft. tjl� Depth below Seepage Pit No....../............ I I inlet Total leaching area... Z Other Distribution box Dosin t Percolation Test Results Performed by... . .................. Date." Y e.-------------!----------------------- Test Pit No. L-2-ov.Almlinutes per inch, , Depth of Test Pit...... ...... Depth to ground water... ........ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..___...:...........___. ------------------- .................................................................................................................................... 0 Description of Soil...,...... d IV ..................... U ......................................................................................................................................................................................................... ................................................... .........:.......................................................................................................................................... U Nature of Repairs or Alterations=Answer when applicable................ .. ......................................................................... .........................................................................A.............................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with .h the provisions of T'L TLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ed.by the boar health. 000( Date Application Approved By.. -Z ��, . �.. .. I .... ...... -- -- ------ ..... ..................... .... ... Date Application Disapproved for the following reasons:................................................................................................................ ........................................................ .............................................. ............................... ........... Date Permit No......................................................... IssuedL.-.._; �i-•-•••••-•....._............_....../a.................................... Date THE COMMONWEALTH OF MASSACHUSETTS .BOARD OE HEALTH .......... .....OF..... 0 ....I.......................................... tertifiratr of Tontpliattrr T� S I6S,,TO fiRTIFY, at the Individual Sewage Disposal System constructed (/--r—or Repaired by_...... ....... ....... . ............................. .................. .... . ...... .............. 7.1....................... ...... -----I'n's't'----- f a f f al d.... 5 of b� �e a-cc �cZewith the pr has een install d in ord ovisions of TI/State Sa i Code.as chescribed in the application for Disposal Works Construction Permit No. .......lk-to............. dateaKr.. --------------------- THE ISSUANCE OF THIS CERTIFICATE: SHALL NOT SE CONSTRUE® AS'A GUARANT&THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... �--------- Inspector.............. ...... .............. .. ................................ ---------------------- THE COMMONWEALTH OFiAMASSACHUSETTS BOARD OF HEALTH ' ......;7.4740� -_44........OF.......... '4 ............V.................................... .. Ne)z FEE...'I'I............... 'DillpV154 , IV rks nstruction rani#. Permission hereby rantd...... ............g ....I.. ....... .......................................................... ............. a Individual Sew ge isposal to Constpuct Repair Sq e, ............. 4, a Z Street as shown on the application for Disposal Works Construction Per it No _,:Dated_._J�;?.-.7.�t............... ............................. ,Q 2- a Fflo f He a I DATE.._. .............. .............................................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS- ttt) S�Pt"tG TAt ftC 220 u�E IGOC� CA-� vt S PoSAt_ t? T V;sE l.t 5a' Ni 31 t At1. AZEA - l 5j S ,F tSp 5t= 4 2,5'1 Sl5G,� 50TToAn AREA t ca Gr- 50,x 1,a ; 5o G-P> P J o�J TOTA►` L?EStGtJ 4ss dv.pb peZc=o t&-r t C>Q 2A2 l t u 2 AW Oe LE:r S. i .�. `Z.s MCHARD If A.th in S �� * 'rop FWD too' TWIST �21�'1q F G .�, a hvi u //lW/ ELZ 91 T �,q ,��•-,rTnc wv 9 a .4 LDAwt ¢''APEwv. t1h/. Box. �GS1� TIiG 2 Uk 1000 351 tuv. mot_.Poet, Pi T ~. NeD 11t WtTLJ •': �4ixv t I. CSZ T t F t rr-a PL•-o'T' PL-A ti.J P:12o F1 L-F-- L.q-A T'%O 1 �TL)I-T 14 WO scoter scp�� �; � 1�7 {� WATER- o �''' pt_.a t�1 Q t CmCmFY T"AT -r H- r-1oVjjDA "lt)Q t-kE¢.ewc>"4 Go�,cP�-`f S w t T�t TFE:. ` rit�E�.t�►� AND SEC'$AGtC Q�QU�tZE.ME►-1T� of TWe 7a tsTQ rZt v >r n evtr{o�� T"14 P &Q Vr 140'r BA5ED OU AU tt.WTWMElAT OST �t��-6 M�� t. 5ut'.1ml 4 TOrm oFF5ET; 'S1•aOoLtb •uoT $E UiW> APPt-tGAaJT .� �V�11J1kJC� AWE To 7�t_T'EfU,ti1.�E 44T t_tJJF..;• 17 J Le L r ,. 30#� k � w1-4GM j 0 A t r , la r _ rlta t�� G'L.C>w z t tc, i Z .o SEPTIC. TAt•.ttL = 2.2c )e�rvo% - 33raC�P ofSPa5AL ptT ygE (= /I 310e.WALL Ae&ta = t 5o sF 15o Sr' 4 Z, -4 S7 S 4p►p SOTTOAA AREA t 15a Gj- 50 ,< p - o f 'SER5 PL-40 off) ToTa..- L?�atGN �Z�j G�rP P zCO"T tow ZATC- t, r u T Atjw o(Z LEAS. TV A- AX ER • �il�fy=i{�y :h ST ToP FWD = bo' uot� n r f� LoAK1 A rI ¢••/iPE 1��r„+ INv IUvI ,� JJf'aOfC. 4 //Pi DtST == (uv C*A L. 2' I4h/ al Box. QL,S SrIG 1000 GAL. LEACu y PIT ttP W1T1.1 +y. wE Wi►Kw9 Lor A.' 104o 1 i.Jo 5c-b L.C=* Cis 3cl-1 r->AT RE S51 `1 Igo KJAJ-r=►Z h t Cu6vLTIFY T"AT T"f v `{t7� 5uowu jcAa:o'7 j31'1 1-kE2EO1.I Gom?L--f S W t TN T(4fi. AWD, 5,kE% ACK OF TWIL TOV-J" oF` ,p(�.f�I�T�A I'll. `$ .• 4'L Pt,. PA-rr✓ C L I'J T— S2 t5TE Q� 'LAWn SL)P-V&{Oer, TWev PLAW ldr UOT $A5ED OL! AU lQ4TCOMEuT Oe,Tf--Zviu••� TNr oFrrSQ.r; 5u0ULb uoT $E USES APPUCAw r To -Pe.TF—V-mft.IE. %..OT Wwsx. oBdzS �v�al A� II r a-� a. 4-1 �vt.��,4'T"►c�IJ � � ( vr-A414 77 i i TT - i i r � 9�0-rO �-r / �t5 t ^1/t- )'71 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WI1H MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS ASSUMED (GIS SPOT E.L.) Route F' ACCESS COVERS TO WITHIN 6" OF FIN. GRADE TOP FOUND. EL. 41.2' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING o� a \ MINIMUM .75'1OF COVER OVER PRECAST 2% SLOPE REQUIRED VER SYSTEM 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS TO BE AASHO H-M 39.2' 4"OSCH40 PVC 2" DOUBLE WASHED PEASTONE o PIPES LEVEL 1ST 2' I I 5. PIPE JOINTS TO BE MADE WATERTIGHT. 0- OR GEOTEXTIL FABRIC a EXISTING _ 37.8 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE rt 10" 1000 GAL H-10 14" NTH � Baxter Neck Rd SEPTIC TANK TEE Ow 0 TEE (RE-USE**) 37.8 f* o00 o 000 310 CMR 15.000 (TITLE V.) a 000000000000 6" MIN. SUMP o 37.3' o GAS BAFFLE.::: °o°o° 12" MIN INT. DIAM. 37.47' 37.3' 0 2 8 NO7. T IS PLAN IS TOBE USEDFO RPROPOSED LOT LINE STAKING NG OR ANY �' o0 00 35.3 OTHER PURPOSE. H-20 3050 INFILTRATORS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2" DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR Locus COMPACTION. (15.221 (2]) CONCEALED WITHOUT INSPECTION BY BOARD OF OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4' X 10.25' HEALTH AND PERMISSION OBTAINED FROM BOARD 5,8 OF HEALTH. ( 2 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LEACHING CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION EXIST. SEPTIC TANK 23' D' BOX 2' FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS BOTTOM DWA R FOUND 29 5' PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE NO GROUNDWATER FOUND 11. ANY UNSUITABLE MATERIAL ENCOUNTERED WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 55 PARCEL 37 PROPOSED LEACHING FACILITY. LOCUS IS WITHIN ESTUARINE PROTECTION DISTRICT 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND AP DISRICT LEGEND AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. SEPTIC UPGRADE ONLY - NO CONSTRUCTION PROP 99 - EXISTING CONTOUR "GARDEN" X 99.1 EXIST. SPOT ELEV. 9. SYSTEM DESIGN: 315 99 PROPOSED CONTOUR 1�� 39.19 [9840. CHAIN LINK FENCE •1 0 GARBAGE DISPOSER IS NOT ALLOWED ] PROPOSED SPOT EL. TH1 TEST HOLE BENCH MARK - TOP OF FOUNDATION 2 91a-TH 1 2 4 39 UR . 339.53 DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD AT CHIMNEY ELEVATION = 41.2 USE A 330 GPD DESIGN FLOW 40.0 / STOCKADE FENCE 21% SLOPE OF GROUND X 42.1 UTILITY POLE _ 42.59 x .31 x 39.72 SEPTIC TANK: 330 GPD (2) = 660 X 40. 0 X 39. 40.1 2 RE-USE EXISTING 1000 GAL. SEPTIC TANK**: . > FIRE HYDRANTS t3j tiy0 x 40.48 0 40.1 LEACHING: NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 4 o O p`L 40.90 x 40.07 EXIST. $T �' SIDES: 2 (30.4 +101,25) 2 (.74) = 120 GPD 1.2 40.39 BOTTOM 30.4 x 10.25 (.74) = 230 GPD TEST HOLE LOGS TOTAL: 473 S.F. 350 GPD ENGINEER: ARNE H. OJALA, PE, SE ` EXISTING GAS��NE USE (4) H-10 3050 INFILTRATORS, / WITNESS: DAVID W. STANTON, IRS S WITH 1' STONE AT ENDS AND 3' AT SIDES DATE: JULY 10, 2009 TOE FND12'- PERC. RATE _ < 2 MIN/INCH CLASS I SOILS P# 12618 ` GARAGE SHELL DRIVE MA ELEV. z ELEV. ` v j ����3' APPROVED DATE BOARD OF HEALTH off A A . LS LS 10YR 2/1 10YR 2/1 � 4" 6$9 B B � TITLE 5 SITE PLAN oA � MS MS L Af OF 10YR 6/4 10YR 6/4 1 24 38.2 24 38.0 � oR 522 COTUIT BAY DRIVE �`� NOTE. POOL AND DRIVEWAY ARE �o coN�c eP COTUIT APPROXIMATE ONLY FROM TOWN G.I.S. C C PREPARED FOR PERC LOT 25 BORTOLOTTI CONSTRUCTION/FLETCHER MCS MCS ` 35.719f SF JULY 13, 2009 2.5Y 6/4 2.5Y 6/4 IN of MAs tGp�jKOF4fq off 508-362-4541 DANIELA. yes o�'� DANIEL gcyG fax 508-362-9880 OJALA a� A I downcape.com CIVIL �o �No.465020 � �Noo..40 80 N down cape engineering, inc. 126 29.7 126 29.5 �Fss�isre�NG� �9aF� S+ o� civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' -7_l - "A` N° uRv land surveyors 939 Main Street ( Rte 6A) 0 10 zo 30 4o So FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 0 (]f1- ' 42 09-142.DWG(SBO)