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HomeMy WebLinkAbout0092 COTUIT COVE ROAD - Health 92 Cotuit Cove Road Cotuit —- - - ---- - — — --- A=006-066 Town of Barnstable P /603,�; Department of Regulatory Services uAartarAnt$ Public Health Division Date MARL � t61fl �� 200 Main Street,Hyannis MA 02601 plEt7 Ml►'1� • Date Scheduled Time j I ftf'1 Fee Pd.— Soil Suitability Assessment for Sewage Disposal Performed By:- IChQt°I P/M2nft?I bit. S E, Witnessed : �:�+B 'd w Y 4 LOCATION&.GENERAL INFORMATION Location Address Gja Owner's Name F'KA9,K 5u C:L(VAk) / L' OZvt 1 Address �,'Z �C�!!U 1 i gvl\(.bk Q46-TurT' Assessor's Map/Parcel: ` 05(a/0 tL3 Engineer's Name -T C GIVGWEIS�lV&--JIJC- 73—037 7 NEW CONSTRUCTION REPAIR _ Telephone# ��-' 7 Land Use- 5//7,9/2 .Panrl/y Ajell149, Slopes(%) — _ --- — Surface Stones /V A Distances from: Open Water Body 7/SO ft Possible Wet-Area I'6 0 ft Drinking Water Weli 7I OA ft Drainage Way �P ft Property Line 7/_Oft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands 1`n proximity to holes) See Aff6iched Parent material(geologic) t/t w-,5rh . g ) � Depth to Sedroek' -- — - Depth to Groundwater. Standing Water in Hole:.' r.. Weeping from Pit Rpee Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: DrrCCf- ObSer✓af�A �,rh �7 126 S' Depth Observed standing in obs.hole: __�, :.- , . _ -in. Depth to Boll mottles: In. Depth to weeping from side of obs,hole: — In. Groundwater Adjustment tt. Index Well-4 Reading Date: Index Well level �?_.. Adj,factor Adj.Oroundwnter Level v PERCOLATION TEST Date_____, Time._, Observation; I _ Hole# Time at 9" Depth of Pere J 6 —5y Time at 6" Start Pre-soak Time® W.4 7 Time(91141) End Pre-soak _ � Rate Min./Inch Z Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- , ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICIPERCFORM.DOC 1 (� DEEP.OBSERVATION HOLE LOG Hole# I Z Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsistency %Gravel) 0-6 1yt ► E S vy2 3 , 6- lz6 C MS 2 5 6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil'Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No Yes 'N Within 500 year boundary No Yes Within 100 year flood boundary No.T Yes _ Depth of Naturally Occurring Pervious Materlal Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Vej If not,what is the depth of naturally occurring pervious material? Certification I certify that on ��'Z 7- 9 9 (date)I have passed the soil evaluator examination approved by the Department of En vironmental Protection and that the above analysis was performed by me consistent with . the required training,ex erti and rience described in�10 CNM 15.017. Signature e` 5�-- Date Q:ISEPTIC\PERCFORM.DOC Commonwealth of Massachusett` r - r Title 5 Official Inspecti01n Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 92 Cotuit Cove:Road< Property Address Estate of Karl and Edith Stritter Owner Owner's Name information is required for every Cotuit MA 02635 September tember 19,2010 — page. City/Town State Zip Code Date of Inspection Inspection results must be;submitted on this.fo.rm. Inspection forms may not be,altered irr any way. Please see completeness checklist at th'e end of'theform. Important;When A. General Information. filling out forms on the computer, use only the tab key to move your 1. Inspector: cursor do not David D. Coughanowr' use the return. Name:of Inspector key. Eco-Tech Environmental r� Company Name 43 Triangle Circle Company Address Sandwich MA 0.2563 Cityrrown 'State Zip Code 508 364 0894 1328 ' Telephone Number License Number B. Certification certify:thatl 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. t.am a DEP approved;system.inspector pursuant to Section 15.340.of Title 5(310 CMR 15.000):The.system w M CV Passes,, Conditionally Passes- [] Failsca - h E 0 Beds;=urther Evaluation by the Local Approving Authority �SVU September 19; 2010 1--= Inspector's Signature Date Z ca 0 o The system inspector shall submit a copy of,.this inspection report to the Approving Authority (Board �-- o of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or `" has'a design-flow.of 1.01000,gpd or greater, the inspector and the system owner shall submit the report to the appropriate,regional office of the DER The original should be sent to the system owner and copies sentl1b the buyer, if applicable,and the approving authority. ****This report-only describes conditions.;at the time of inspection-and under the Conditions Of use at that.time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins''69168 Title S Official Inspea on form:SubsuAace Sewage Disps I ysle )of)- I Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w .92 Cotuit Cove Road Property Address Estate of Karl.and Edith Stritter Owner Owner's Name. information is Cotuit MA 02635 _ September 19, required for every 2010 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes- 1 have not found any information which indicates'that any.of the failure criteria described in 310 CMR 15.303 or,in 31.0 CMR 15.304 exist. Any foilure,criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed:below. Tha septic system has been evaluated according to the conditions observed on thee day it was inspected: No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as.described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the.box for"yes", "no" or"not determined"(Y, N, ND)for the.following statements: If"not determined," please explain. The septic tank is metal and over 20 years old*;or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass 'inspection if the existing tank:is replaced with a coftlying 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): l5ins•09108 Title 5 Q(ficial Inspection Forth;Subsurface Sewage Disposal System•Page of 17 fi Commonwealth of Massachusetts Title 5 official Inspection Form _ Subsurface;Sewage tposal.System Form;-NotfbfVoluntary-Assessments 92 Cotuit Cove Road Property Address Estate.of Karl and Edith Stritter Owner owner's Narne urahon.is reqi Cotuit: MA 02635 September 19,.2010 'requred for every —P . page: Clty/rown ' State Zip Code Date of Inspection B. Certification (cont:) n B) System Gond_itiona:ly Passes (cost.) ❑ Observation•of sewage backup•or break out or high static'°water;Ievel°in the distribution box due to broken orobstructed pipe(s)or;due to.a'broken, settled or uneven distribution box:System will pass inspection If(with approval of Board of Health): _ ❑ broken;plpe(s}are,replaced ❑ Y ❑ .N ❑ ND(Explain below): ,❑ obstrueton;is removed L "❑ 'N ❑ ND (Explain bei`ow): distnbution box Is leveled or replaced, ❑ Y ❑ N '❑ N:D (Expialn below); ❑ The system required`pumping more than,4 times a.year due to broken or obstructed,pipe(s). The; systeenwill_pass inspection,if,(withapprovalofthe:Board;of Health ❑ broken plpe(s):are.replaced ❑ Y ❑ N_ ❑ ND.(Explain below)- ❑ obstruction sremoved ❑ Y ❑ N ' ❑ ND(Explain below).; C) Further Evaluation is Required by-the„Board of-Health: El 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_unles,s.Board of Health determines imaccordance with 310'CMR 15:303(f)(b)that the system is notfunctioning in-a manner which~will protect public health, safety,and:the environmert: ❑ CCesspool or privy is`within-50 feet of a surfatea water ❑• Cesspool or privy is:within 50 feetof a bordering vegetated wetland>or salt marsh i5ins c09108 -N1e5 official Inspection Form:'SUbsurface'Sewage disposal System•Page 3 of.t7 Commonwealth of Massachusetts,' Title 5 Official Inspection Form Subsurface-Sewage Disposal System Form-Not forVoluntary Assessments ti 92 Cotuit Cove Road. Property Address Estate of Karl and Edith Stritter Owner Owner's Name information on is MA 02635 September 19, required for every Cotuit em2010 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health.(and Public:Water Supplier,.if any) determines that the system is functioning in,a manner that protects the public health,, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of.a.surface water supply or tributary to a surface water supply. ° - ❑ -The system has.a septic tank and SAS and the SAS is within a Zona 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 5.0 feet of a private water supply well. ❑ The system has aseptic tank and SAS and the SAS is less than 1 00 feet but 50 feet or more from-a private water>supplywell"*. 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 distributiorr box above outlet invert due to an overloaded. or clogged SAS or cesspool Liquid depth in cesspool is less than 6-" belovinvert or available volume is less than day flow 15ins•09M Title 5 official inspection Form:Subsurface Sewage;Disposal System page 4'of 97 I` f Commonwealth of Massachusetts _L- Tithe- 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 92 Cotuit Cove Road Property Address Estate of Karl and Edith Stritter Owner- Owner's Name. information is required for every Cotuit MA, 026.35 September 19. 2010 page: CitylTown stave zip Code Date of Inspection B. C;ertification Yes No Required pumping more than 4 times in the,last year:NOTdue to.clogged or obstructed pipe(s). Number of times pumped,* ❑ 0 Any portion'df the SAS., cesspool or privy is`below;h gh ground water'elevation. s:•<O , An _,pp rtionof•cesspoo or privy;is within 100,feet of G=surface water°supply or tributary to.a.surface water stapply: Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ED Any portion,of a cesspool or privy is within 50 feet of a.private watersupplywell., I 0 Any portion of a cesspool or privy is less than 1.00 feet but greater than 50 feet from a private water supply.,well with no acceptable Water quality analysis. (This system passes ifahe 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 ppmi. provided that no other failure critera_are;triggered. A copy of the analysi a"n;tl chain of custody must be attached to this form j ElThe system is a cesspool serving a facility-,with a design flow of 2000gpd= 1Q1000gpd 0 ® The.,system fails:I have.determined-that one or more of the:above failure, criteria exist-as described In,310 CMR 15.303, therefore the system fails. The system owner should contact'.the:'Board-of'Health to determine,what:will.be, necessary to correct the failure, E) Large Systems::•.To"be considered a large system the system must serve-a facility with a design flow of 10,000'god to 1-5,000 gpd. For I'arge systems; you must indicate either"yes or"no" to each of the following; in addition-{othe questions in Section.D. Yes No 11 El the.system'is within 400'feet of`a surface drinking°,water supply r ❑ the system'is within 200.feet-of a tributary to:a surface drinking water supply 0 the system is located in a nitrogen sensitive.area(Interim•Wellhead Protection Area, IWPA) bra mapped Zone ll of a public watersupplywell 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 systern considered.ia significant threat under Section E,-or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department., t5ins•69108 Title 5:01ficial Inspection Form:Subsurface Sewage Disposal System•Page5.of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection 'Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 92 Cotuit Cove Road Property Address Estate of Karl and Edith Stritter ' Owner Owner's Name information is Cotuit MA 02(i35 September 19, 2010 required for every p page. Citylrown 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? ❑ M Has the system received normal flows in the.previous two week period? ❑ Z Have large volumes of water been introduced to the system recently or as part of this inspection? Z. ❑ 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? Z ❑ Was the site inspected for signs ofbreak out? �C] ❑ 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? L 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. © ElDetermined in the field(if any of.the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN.flow based on 310 CMR 15.203 (forexample: 1.10 gpd x#.of bedrooms): 330 gpd tsins•09108 Title 5 0166el lnspection•Eorm:Subsurface Sewage Disposal System•Page 6.of 17 777 Commonwealth of Massachusetts' r Title 5 aff icial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 92 Cotuit Cove Roatl, Property Address. Estate of Karl and Edith,,Stritter Owner Owner's Name ' information is _ required for every Cotuit MA 02635 September 119,201 0 page. cltyrrown state Zip Code Date of Inspection D. System lnfo.rmation Description: Number of current residents: p Does residence have a garbage grinder?' ❑ Yes 2 No Is laundyn separate,sewage [f yes separate inspection required] ❑ Yes No Lau ndry:system,ins.pected? ❑ Yes. El No Seasonal use? ❑ -Yes 0 No Water meter°readings, if available(last 2.years usage,(gpd)): 107 9pd Detail; r 200a-2'009 Sump pump? , ❑ Yes No: Last date ofmccupancy_; - -.. _: not determined Date Commercial/Industrial Flow Coriditions:. Type of Establishment' Design flow(based on 210 CMR 15 203) Gauons per day(gpd) ' Basis,of design-flow(seaWpersons/sqA, etc..): Grease trap:':present? ❑ Yes. ❑ No: Industrial waste holding'rtank present? : . ❑ Yes ❑ ;No Non-sanitary waste discharged tolhe Title 5 system?' [I Yes ❑ No Water meter readings, if available° t5ins•09/08 Title 5'Offidbi Inspection Form::Subsu fate SeWags Disposal System'•Page 7 of 17 Commonwealth of Massachusetts Title -5 Official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 92 Cotuit"Cove Road Property..Address Estate of Karl and Edith Stritter, Owner Owner's Name information fo ie Cotuit MA 02835 September 19, 2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records:. Source-_ohnformation: 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 z Septic tank, distribution box;_soil absorption system 0 Single cesspool ❑ Overflow cesspool Q 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 UA system by system operator under contract ❑ Tight tank. Attach a copy of the"DEP approval. Q Other,(describe): t5ins o9%08 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Forrri _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments �v 92 Cotuit-Cove'Road Property,Address Estate of Karl and Edith Stricter Owner -- :w Owner's(Name information is required for every Cotuit MA 02635. ;September 19,2010 page. Gityrrown state Zip Code Date of•Ins"gtion D. System Information (cone.) Approximate age of all components, date installed (if'knOWn) and source of.inforniatlom. Age 29+ years. Certificate of Compliance issued 8/20/81,(Board of Health files). Were.sewage o..dors detected when arriving:at the site?` ❑ Yes No B.Uildin4 Seever,(l;ocate.on site plan): 2 Depth below grade; feel Material of;c'hStruction':' cast iron ®,40 PVC. Z other(explain);: r Distance from private water supply well or suction lime; fear .CommentS.(on condition of joints, venting, evidenceof•leakage, etc.): Sewer line appears structurally sound with no evidence-of leakage or backup into dwelling. Septic Tank (iocate•on site plan'); ' 1 Depth below grade: feeE i Material Of Construction: � concrete ❑'metal ❑.fiberglass ;❑ polyethylene ❑ other(explain) If tank is metal, list age: yearn Is age confirmed by a Certificate of Compliance? (attach a copy of.'certificate;) El Yes ❑ ;No Dimensions: B.5 ft x:6 ft x 5 ft.(1000 gat),. - 14 in Sludge depth:. t5ins•091.08. Title 5 Official Inspedion Form:Subsurface Sewage Disposal System-.Page 9 of 17 Commonwealth &Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 92 Cotuit Cove Road Property Address Estate of Karl and Edith Stritter - Owner Owner's Name information i required for every. Gotuit MA 02635 September 19, 2010 e _ page. City[Town State Zip Code Dateof Inspection D. System Information (cont.). Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20 in Scum thickness 0 Distance from top of scum to top of outlet tee or baffle - 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc:)- Pumping is recommeneded at this time and maintenance,pumpin g is recommended eve rytwo years. Tank appears structurally sound rand functioning as intended. No evidence of leakage in or out was observed. Grease Trap locate on site Ian Depth below grade: - feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scurn 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:. bate 15ins 09108 Title 5 Official Inspection Form-Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth,of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage:Disposal System Form-Not for Voluntary Assessments 92 C.otuit Cove.Road Property Address Estate of Karl and Edith Stritter Owner - Owner's Name - -- information is required for every, Cotuit MA 026:3:5 Septemb.er'19, 2010` page. Citylrown State Zip Code Date of Inspection D. System Jnformation (cont ) Comments,.(' pumping,recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid.levels'as related to.outlefi avert, a idence of'leakage,.etc)I Tight or'Holding Tank(tank must be pumped at time of inspection) (locate on site plan):: Depth below grade.; Material ofconstructiIo ❑"concrete ❑;metal El fiberglass. ❑ polyethylene ❑other(explain): Dimensions, Capacity; gallons Design Flow: - gallons.per,day' Alarm present: ❑ Yes ❑ No Alarm level . Alarm`in working oKder [� Yes ❑ No Date of last pumping: Date C.or'nments'-(eondition.of;ala(m and floatswitches etc.) *Attach copy of current pumping contract(required). (s Copy attached? ❑ Yes ❑ .No t5ins.'09108 Title 5 Official Inspection Form:Subwrfaco Sewage Disposal<System-Page 11 of 17 I C;ommonweafth of Massachusetts L -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -:Not for Voluntary Assessments w 92 Cotuit Cove Road Property Address Estate of Karl and.Edith Stritter Owner Owner's Name information is required for every Cotuit MA 02635 September 19, 2010 page. City/town State Zip Code Date of Inspection D. System Information (cont.) Distribution B6k:(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): Distribution box appears structurally sound. A bucket'of water was.poured in and was observed to _ pass through in a rapid and unobstructed manner. az. 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.): Soil,Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•09108 Title.5'.Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official In Form Subsurface Sewage Disposal Sy.stem.Form -Not,for Voluntary Assessments 92 Cotuit Cove-Road Property Address Estate ofKarl.and Edith Stritter Owner Owner's Name information is Cotut: MA 02635' September 1:9,; 2010 required forevery page. Citylrown State Zip Code Date of Inspection; D. System Information (cont.) Type. 1 leaching pits number: ❑. leaching chambers number: leaching;gallenes. number; r leaching trenches number;length: leaching fields number, dimensions;. :.overflow-:cesspool .number innovativelalternative system TypefiarrSe of'technology Comments(note condition of soil, signs,of hydraulic.failure, level of;pon:ding; damp soil, condition of vegetation, etc.): Soils.above.leaching field appear unsaturated, No,evidence-of surface ponding;-breakout; lush vegetation, or other evidence of hydraulic failure was observed.'Leaching pit was.uncovered.and found to contain 3'feet of'effluent. Staininq level at 4 feet. Cesspools'(cesspool must,be pumpetl as.part`of inspectlon) (locate on site plan); Number and configuration Depth , top of.l'iquid to Inlet invert "Depth of solids layer Depth'of scum layer, Dimensions of cesspool Materials of:construction Indication of groundwater inflow El Yes ❑ No 15 ns,,09/08 Til165 Official lnspedion:Form::Subsurfaca Sewage Disposal System,-Page 13 ari7 Commonwealth of Massachusetts _ 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 92 Cotuit Cove Road Property Address Estate of Karl and Edith Stritter Owner Owner's Name. information is required for every Cotuit MA 02635 September 19, 2010 page. Cdy/Tdwn State Zip Code Date of Inspection D. System Information (cont.) Comments,(note`condition of soil., signs of hydraulic.failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Y5ins-09108 title'5'Offiicial Inspection Form:_Subsurface Sewage;Disposal System-Pago 14 of 17 Commonwealth,of Massachusetts; , Title 5 Official Inspection Form Subsurface-Se-wage DisPosall System Form -Not for Voluntary,Assessments.,. -- 92 Cotuii Cove`Road` Property Address Estate of Karl and Edith Stritter Owner Owner's Name _ information is required for every Cotuit MA. 02635' September 19, 20`10' page. City/Town, state Zip Code Date of Inspection D. System Information (cont`.) Sketch Of Sewage Disposal System Provide a view:okhe sewage:disposal system, inelutling':ties to at.least two permanent reference'.landtnp ks'or benchmarks:.LocateallMetls within 100 feet. Locate where public water supply enters the building. Check one,of the boxes below: ® hand=sketch in'the..area below ❑ drawing.attachetl separately i V 43 � 72' Z, SANK JBIA qz 15 ns•09l08 Title 5 Official nspection Form:Subsurface Sewage.Disposal System•Page 15 of 17 Commonwealth of Massachusetts ITM Title 5 Official Inspection Form -_ - Subsurface Sewage Disposal System Form-Not for Voluntary,Assessments '92 Cotuit Cove Road Property Address Estate of Karl.,and Edith Stritter Owner Owner's Name information is Cotuit MA 02635 September 19,2010 required for every Q page.e. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water r ❑, Check cellar"t Shallow wells Estimated depth to high ground water' 35+ft feet Please indicate all methods used to determine the7 high ground water elevation: ❑X Obtained from system design plans on record. If checked, date of design plan reviewed 8/18181 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: GIS maps ❑ Checked with local excavators; installers-(attach documentation) ❑ Accessed,USGS database-explain: You must describe.how you established.the high ground water elevation:. Approved design plan on file with Board of Health shows bottom of soil absorption system to be 4 feet above the bottom of a witnessed test pit in which no groundwater was encountered. Barnstable GIS maps indicate property is over 35 feet above Shoestring Bay. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•09108 Titlo 5 official Inspection Form,Subsurface Sewage Disposal System•Page'1.6 of'17 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface.Sewage Disposal System Form-Not forVoluntary Assessments 92 Cotuit Cove":Road Property Address _ Estate of Karl and Edith Stritter Owner. .Owner's Name information is required for every, Cotuit MA, 02635 Septembei '1'9, 20.10 page. Cityrrown State, Zip Code Date of Inspection E. .Report Completeness Checklist Z Inspection Summary- A, B,.C, D, or E:checked: Inspection S.ui'nmary.D(:System FaiflurO.'Criberiae Applicable to AII.;Systems} completed' C System Information -Estimated°d6101th to high groundwater SketChkk pf Sewage Disposal.Syste%either drawn on page 15 or.a tt ac �pld in separate file. ` t5iris:•.09100 Title.5 Official Inspection Form,Subs urface'S"age Disposal System•.Pa'ge,17 of17 _ yy j 1k F l 0 C Al ION vV71 -�3� ;' t ' INST•A LLER'S NAME: 'All- A_D Wit ES„S ;f c k oLe—1 Q`L.oc 1.1 W C. r.. r r, e.a klk �C!�.�C i•�NI cµc M t • ,,,rram� t R V, •-A to a %► 1 :D A T E P E R M'I T 1'S4 Y-E D y 1 D"ATE C.O MPII ,A NtlE �;1SSUED#" " ,� Q+ �f �q�y i 4.. a� �� � ; ,` J 'lam c ` B d ..:� ` _ Fic . .. .............. THE COMMONWEALTH.OF MA�SACHUSETTS BOAR® OF .,HEALTH Tod✓a1...............OF....... ..•....e.v i T ........ -- .- i�� Z pliratioll for Dispas al Marks T.nstrnxtinn Prrutit A acation is hereby made for a Permit to Construct (,1C) or Repair ( ) an Individual Sewage Disposal System at: /J`. .+ p� ...... vTV�.r....... .7C:.-.../. IPA..----G�......................... ------------•• .............................. ......................................... Location-Address or Lot No. ......................_.............................-............................................ ..................•.......................................•••••-•-•--------•-•----.............--- Owner Address W ® `L.................................... • .....................•--•-•----. O.-NH..� ..ss? f��,CA)J«fP..���"--•--......... a Installer l Address Type of Building Size Lot.!/_j...P 9.6.._..Sq. feet U Dwelling—No. of Bedrooms................. ......................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria PaOther fixtures -----•-------------------------•-•-•---------- -------------------------------------------------------•------..._..------- W Design Flow............... �...........I..._..gallons per person per day. Total daily flow____._....._3 ..0.........._......gallons. WSeptic Tank—Liquid capacity«aPO..gallons Length....?!....... Width.... !_..__. Diameter______________ Depth.....`..... x Disposal Trench-No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.......I........... Diameter........4. Depth below inlet......fo--......... Total leaching area.. ®....sq. ft. Z Other Distribution box (,K) Dosing tank ( ) Percolation Test Results Performed by_LVc ___. EL�G-c G:. -----•- .-•- --�-----.1�.... Date_� ............. Test Pit No. 1. .Z.-_-_minutes per inch Depth of Test Pit--- Depth to ground water.V- .V.?........... Test Pit No. 2.-C..L...minutes per inch Depth of Test Pit.. _!V.1�.`_.. Depth to-ground water.e�?v�v QED R t Description of Soil.#/....A`- c " . " ASsBSdG /Z4 . L . s t3�. �� 1.. ....A2. !2.. /.vG...2l�Nl ............................................... _ U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. ...................................-..................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIli U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issue by the bo r f h 1 Signed---- d �� .......... Date Application Approved By... , .. -----------------------------•-- D Date Application Disapproved for the following reasons:-----•--------••------------•---•------------------------------------------------------•---•----•----••--....... ............................................................................................................................ ..... -- --------•....................._..•----..............._.......... Date PermitNo......................................................... Issued------------------------------......._....... ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N Appliration for RapaiiFal Worku Tondrnrtion ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: CU/? U L � 77.... .T........ ..............••-••-......-• . -- ....-- .....---•---••-•..............•-•........ Location-Address or Lot No. ......................--........................................................................ ................................................................................................. Ow/D-C Address a 2 /�A 2u� sT, ........... Installer Address Type of Building Size .....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafetria ( " ) Other fixtu`e's ................................-................................................................................... ................ ..... ...: ....... Design Flow..............5 .....::.:...._.__...gallons per person per day. Total daily flow............:33..0-................gallons. w y WSeptic Tank—Liquid"capacity&'DU...gallons Length............... Width.......I...._. Diameter................ Depth... '...... x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No......./.._._._...... Diameter.......8. Depth below inlet.....k........... Total leaching area.Z. ....sq. ft. Z Other Distribution box (X) Dosing tank ( ) ' ' Percolation Test Results Performed by.L.0.!^j..._.�.Y......_wE. L....... Date.3.--./ ............. a Test Pit No. 1.c..Z.....minutes per inch Depth of Test Pit._/-`i-?...... Depth to ground water UT.•C' - fi, Test Pit No. 2. ..Z._..minutesper inch Depth of Test Pit_/..�5�` Depth to ground waterCuvA/7_15Fi2ED ----------------------------------•-----•-----•--•-----..._----......---.........•... ,-----:-r..........-•--�.--------......---............... O Description of Soil#�..-6�. -..-Z::.`.::S.��InY_.S�a_so.. /Z �'-•�iu�' M�.�..•ev!....r•..'`z.._..5A!v0-J-•----- W 00" McO. "/Cl1UE SfIN0 G!) ' / 44 `MEO r.J/G/,)4 5r7NO . " _, T V . .... I............ ............ --•�----...••----......•........................ W 7.....���.. /8 GoM SvSo/Lr /8' s� '' /L/.cD...CGT. SAND 6 �'' -/f4`/7E0. '�-/N� 1 GuT. SA.IJ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•------•-••----------------•-..............----------......-------------------•-------••----...--•--...----•-------------------•----•------•--.........-•----------------...--•------------••-....•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 'the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been'issugd by the bparb of health. �..----------- Signed L p Application Approved By .... .z - .1�. Date.............. Date Application Disapproved for the following reasons:.............................................................................................................. --••---•.....................•---•-----------•--•------•-•-•-----.........................................- '•-------...._•-�-.. L..._.___..._........._......__....._...._......_....._.........--•..__-- �! I/iG. �Ssu Gi •• �P O� Date .— PermitNo..................... .. .................................................. Date THE COMMONWEALTH OF MASSACHUSETTS Z _ BOARD OF HEALTH / OF. 1 �nati ..................................... ....d`;.e�..... ......... 01rdifirtt#r of fananph anrr IS IS TO CERTIFY T t the ndividual Sewage Disposal System constructed 'r) or Repaired ( ) .---....� -...------------------------------------•-----•--.................------....---•-------------•-•-•----........--•--------- by r Installer has been installed in accordance with the provisions of ` of The State Sanitary Code as described in the application for Disposal Works Construction Permit NoWBi''`. _.JJ............... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �. DATE................................................................................ inspector.................................................................................... 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