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0114 CURLEW WAY - Health
114-CURLEW WAY, COTUIT A V ;. L5- QlS1 'I TOWN OF BARNSTABLE .LOCATION t 1 Ll Co,cl ew Wc,,( SEWAGE# a0 t"I 2�G?- 'VILLAGE ASSESSOR'S MAP&PARCEL C: s C INSTALLER'S NAME&PHONE NO.Q,,,,�,•,c Ar�u� Nc SEPTIC TANK CAPACITY e I&1 6N--`-i f LEACHING FACILITY: (type) h.�C�rx (size) 1�'ZSn2 NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: NO N3c 4 4- Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility w ,e w,rr Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 'Z�,Jt, 17ip.�c A*A 3s ID � •- 21 �Gli a� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF B,ARNSTABLE, MASSACHUSETTS Yes ZIpplication for Misposal *pstrm ConstCUCtion Hermit Application for a Permit to Construct( ) Repair(�') Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 114 Co(1C LZ LOeAly Owner's Name,Address,and Tel.No. -11 Assessor's Map/Parcel �k o� ANP✓ 1 ,el�s Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �J51c:S 1?�tt 5e3' n�c 5706 -LJCD.- Type of Building: Dwelling No.of Bedrooms 3 Lot Size `/7®2 U sq.ft. Garbage Grinder( ) Other Type of Building (t-'S\V No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �2, )3© gpd Design flow provided gpd Plan Date 8-7 -1 '► Number of sheets :Z-- Revision Date Title Size of Septic Tank Type of S.A.S. a.!SM 1 t&)JeA E}>2.0 c"bfyi Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q t'%Z 4D--1ZQY GVQ() X 1i 2 d S Gcjlc,n, C LICIIv\\66 , C-A9"if"Ll �I ' �� , �nrJP cz-,s ICwn� c-Y-,) %O1CA) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date a- Application Approved by Date Application Disapproved by Date for the following reasons 09 Permit No. Date Issued No. Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOW1J F_iB;ARNSTABLE, MASSACHUSETTS Yes 9ppYication for ]Disposal *p'stetn Construction 3permit Application for a Permit to Construct( ) Repair( Upgrade(- Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i 4 co f 1c o Wo� Owner's Name,Address,and Tel.No. f FoLk 017` t a. A� Assessor'sMap/Parcel O� ( , tipNdff�°5 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 'a Lot Size 117025 sq.ft. Garbage Grinder( ) Other Type of Building e"31C1t'P'3)_)( `{ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ','S 3 0 gpd Design flow provided 3 N B ,-7 gpd Plan Date '"� "I Number of sheets ^— Revision Date Title Size of Septic Tank E" Type of S.A.S. ? G{eX�)( ? © Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 Q S}G t G ,Oro V—�Qoy 0",3 o ;1- 0 500 C-s C� �trl C 10AA'D( (% fit! J�Alj (-I N P q S S�1 f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has-been issued by this Board of Health. Signed . .� Date '"-I"7 - - ��.- Application Approved by Date Application Disapproved by Date for the following reasons Permit No. '-0 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS k Certificate of Compliance THIS IS TO CERTIFY,that theOn-site Sewage Disposal system Constructed( ) Repaired(") Upgraded( ) Abandoned( )by / rol 61 �ot+1/� f at . '} C Gt✓.-�x''ul` i a " has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.saG dated Installer ��' ac►w� �� Designer y"n/ ,^I-e #bedrooms Approved design flow gpd The issuance of this perm/it shall not be construed as a guarantee that the system"will func o de i ed. j'•. Date / � , Inspector .-__._-__- ._.-------.-------------------- _____----------------------------.----------------------------------------.------------------------------------ No. L0! Fee I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem-fDnstruction permit 7- Permission is hereby granted to Construct( ) Repair(3r') Upgrade( ) Abandon( ) i System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. r Provided:Cons "etion ust bro 7 pleted within three years of the date of this permit. , Date "— .Approved by A' Town of Barnstable y�•°pTHE'° Regulatory Services Richard V. Scali,Interim Director + BARNSTABLE, MASS. Public Health Division Thomas McKean, Director 200 Main,Street,Hyannis, N A',02601 Office; 503 S62-4644 Fn: 508 90-6304 Installer & .Designer Certification Form Date: ' Sewage Permit#a�I7•-a� Assessor s41'Iap\P.,arcel 6 Designer: isny; nce -;e, Wor-its 1n Installer: s j ,° . O Address:: I (J�,.. C� e ( I`zC! Address: �xt T•o e S vpkci 1� �'�'('� CT'L(o. Z On was issued a permit to install a A (date) (installer) r . septic system at !l Cis- le 4J-l'o'`e!/; '�-ir'r' based on a design drawn by `�ei-e.r i, A C I+k-e ;i L (addres� Gi,i WbA/ti J w C., dated f (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as. lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils there:found satisfactory. 1 certify that the septic system referenced above was installed with major changes (i.e. greatei-than 10' lateral.relocation of the SAS or anv vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or ceutified as-built by designer to follow. Strip out (if.required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructe nce with the terms of the.11A approval letters(if applicable) -IN OF PETER T WEMTEE CIVIL nstaller's Signature) ;' NO.3510a {Designer's Signature) (Affix Designer amp Here) PLEASE :RETURN. TO .13ARNSTABLE PUBLIC HEALTH DIVISION. CERTIF1CATlU OF COMPLIANCE WILL NOT ICE ISSUED UNTIL BOTH T..HTS FORM. AND AS- BUTLT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. ' 0ASepticTesiencr Certification Form Rev$-14-13.doc Town of Barnstable - P# . ( �J Department of Regulatory Services BARNMBLB, : Public Health Division Date (,P I I �A t639 ,e� 200 Main Street,Hyannis MA 02601 - rE0 Date Scheduled _ //a L l Time /O I 0 C) c '4 Fee Pd. Ck), 0 X Soil Suitability Assessment ` or S e Dzs osal Performed By: ���� _n 115 Witnessed By: LOCATION & GENERAL INFORMATION Location Address 10 CL)-cip-0 C� Owner's Name l Mct �,1 . tzU sso 1 1 Y� Address I Iq (f-o�t cij- W&4 Assessor's Map/Parcel: Engineer's Nametl ` n NEW CONSTRUCTIONY —_REPAIR Telephone Land Use /tS`�A.tit aet. r. , % �t ►S p Slopes(%) Surface Stones lvd� Distances from: Open Water Body ,V 1A ft Possible Wet Area ft Drinking Water Well 7 ft Drainage Way N 1A_ ft Property Line ���� ft Other___ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) b t 1 Parent material(geologic) 00)—LA.),,5 r1 Depth to Bedrock /J Depth to Groundwater. Standing Water in Hole: OL/8"-A Weeping from Pit Race_A _ Estimated Seasonal High Groundwater t DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: _ Depth Observed stand'uig in ohs.hole ..__.._. _._..__.-._, _.in,_. Denth tf)still T Depth to weeping from side of obs.hole: in, Groundwater Adjustment Index Well# Reading Date: .. Index Well level AqJ,factor Adj.Grountlwater 1Avcl,:,..n, PERCOLATION TEST Date Ttn10 Observation Hole# --- �� iu� ;1.t' Time at 9" Depth of Perc _— �ip J{ Gl ) Time at 6" i Start Pre-soak Time @ _—� `L... M A A it C tITime(9"-6") - End Pre-'soak -- — NJOYt t v.� Sa9vlCA • Cv�.f i'ls.a-�.�.�l ; Rate Miii./Inch. _ /" Site Suitability Assessment: Site Passed—`, Site Failed: Additional Testing Needed(Y/N) + t Original: Public Health Division Observation Hole Data'ro 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:\SEPTiC\PERCFORM.DOC N DEEP-OBSERVATION HOLE LOG Hole#' Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones-Boulders. Consistency,° ravel C3 g A 'm Vo iQ 1.r-'�/2 _ 15 DEEP OBSERVATION HOLE LOG Hole# Z— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) io it �=S5 13 �'�ll- le�w to y,2,s/� • Akoc sue: ��s�rf6 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) t — - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten % raveI t i Flood Insurance Rate Map: _ Above 500 year flood boundary No— Yes I. Within 500 year boundary No '^t. Yes Within 100 year flood boundary NoDt _ Yes Depth of Naturally Occurring Pervious Material 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? Certification l�� I certify that on (date)I have passed the soil evaluator examination approved by the 1 sis Department of Environmental Protection and that the above ana y was performed by me consistent with the required traini expertise and experience described in 310 CMR 15.017. Signature_ Date Q:\.S.EPTICkPBRCFORM.DOC . LOCATION ci -4 U. ' VI-;SLAG E j DATE_ �- Z FEE c,") !:-) kP-PLICANT( (Non-refundable 614DRESS —TELEPHONE NO. EE'NG I N E E R ITELEPHONE . k 'DATE SCHEDULED S15 I I'vo (Applicant' s signature) S OIL •LOG SUB-DIVISION NAME DATE L", TIME EXPANSION ' XPANSION AREA: YES.i,' NO ENGINEER *N rQWN WATER -.i- PRIVATE WELL (a BOARD OF HEJkLT EXCAVATOR SKETCH: (Sti,ee.t na-me, etc. dimensions. of lot, exact location of test holes and '.'percolation s ) .1 ercolation tests , locate we p wetlands In to test hole NOTES : ............. ................ 'Zt)C J PERCOLATION RA (4 TEST HOLE NO: ELEVA TEST HOLE NO: ELEVATION: ti F 2 2 3 3 4 4 5 5 C-1.4y 114Y10- L. 6 7 9 9 10 0 11 12 12 3 13 14 14 Iva 1 15 5 16 16 BEACHING PITS SUITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD,� I............ LEACHING TREUC ES UNSUITABLE FOR SUBSURFACE SEWAGE, REASONS :-_ NOTE : ENGINEERING PLANS MUST SHOW ITURBER ASSIGNED ON 'PERC TEST APPLICATION: ' N _NLFD TO BOARD OF HEALTH ORIGINAL: COMPLETED LN ENT ENTJM31_J2�2 PVTATNED' BY APPLICANT L/ �� + THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Bi-aipoottl Work,i Tiamitrnrtion rprmit Applicatioy) eby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal Sy st at: / f`.. -•....L-./1.! . --/.. ....... ........................ ...........(. �.--••----....-------•----...----...-----------•---------... c'.con-A dd V s/�ij Q� or Lot No: ..> . -- .. ........ ............ ......•... •. ---•-•-••---...........................-- Address eg ----------- •- Installer Address cc Q Type of Building Size Lot-____/'..0.a._9-C..Sq. feet Dwelling—No. of Bedrooms-s. _..3.-M-----------------------------Expansion Attic (tl) Garbage Grinder ( ) a Other—T ype of Building No. of persons............................ Showers ( ) — Cafeteria ( ) _ ___ _. .._ Other fixtures ..................................... . W Design Flow......................160..............gallons per . per day. Total daily flow............ ........................gallons. WSeptic Tank—Liquid capacity.`W-gallons Length---------------- Width................ Diameter-............... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank �1" 7/�� '~ Percolation Test Results Performed by............. :.. •. Date---- -_--=--••�•----------- --.... a Test Pit No. l...L .....minutes per inch Depth of Test Pit.................... Depth to ground water../_/.Q� __... Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil........................................................................................................................................................................ x V .........----•------------••-----------•-••--•••--•--•--••------•----------------•--.................--•--------------------•------•--------------•------•-••-••---...................-----------._...... W UNature 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 TITLE 5 of the State Environmen C de —T e ders!'&Wd furl agrees no toblace e system in operation until a Certificate of Co lian ---_ ss th� - - Signed --- --- ----- --------- ........q=.. . '��'"'p7 ...................'-- -...--................-- ................—Dace.............---.. Application Approved By ----------- ems^^ C�'`�`"�`� ..................................................... ........ ..... : �..,..2 are Application Disapproved for the following rearons: .............................................................. . .............................._... ...................... ... .................................... ............................................... . . ........................................................................... ..... ..... ..... ... ........................................ Date PermitNo. ........ .. .......... ...................... Issued .............................................................. Dace l 4 •e. �rlo...9y:. 1 ..: Fss......../.. ... a...... + THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF•BARNSTABLE Appliration for E tipm3al lVnr1w Tomitrnrtion rrrntit ApplicatioiY reby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal System at, .... . . � .. ........................ J.&.... .--.-----.....................--.---.................... oca iota-,\ddress or Lot No. i� ........................... .. ........................................................ ),i Address 'a -t u+ ....--•-•......................7.G:».t�{�4 LC�3 ,-t .... .- Installer Address Type of Building _ Size Lot.....I!_0. ./46..Sq. feet U Dwelling—No. of Bedrooms._.._._' ................................Expansion Attic (✓) Garbage Grinder ( ) No. of persons............................ Showers — a Other—Type of Building ��1.?7���.�.'- p ( ) Cafeteria ( ) QOther fixture��.•-•----------•.....................:..•--------....._...-•--•-------------.......---.....-----•--•---.............................................. Design Flow..........:..........._...................gallons per Peron per day. Total daily flow.........73o .........................gallons. b W Septic Tank—I' W0 quid capacity.� .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trenchi No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit o..:................. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. N Percolation Test z< Other Distribution box ( ) Dosing tank ( ) ►� t Resultsi Performed by............. tit 1, f.y.. Date ��..�n f `? Test Pit No. I...sa. .....minutes per inch Depth of Test Pit.................... Depth to ground water..,&l�! -=-...._.. Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ------------------------------------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil.................=-..................................................................................................................................................... x .................... ........ ------------------.................---....................................•.............-.-----------.......-............. .................. w UNature of Repairs or Alterations—Answer when applicable.:._....:........................................................................................ 11, Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environment 1 C de—T e uridersigged furt agrees not to lace �e system in operation until a Certificate of Co liancef ase� --Iss a inyvb,f I� of- Ith. � � Signed .. . ....................... ............. ......... . Date Application Approved By ......... tr ..... .... ...{��,,� ................ ......... .....5......3-...9..� ................................................. Date Application Disapproved for the following reasons: ................................................................................................................. ..................... .................. ...............................qq..... ................................................................................................................................................ ........................................ PermitNo. ........L-... -......�..(..y....................... Issued ....................................................... Date .... Date ----------------------------------------------------------------- ----.—.�.. t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 01exlifirate of Cnomplianve THIS IS TO CERTIFY_, That the Individua-..S wage Disposal System constructed ( V ) or Repaired ( ) by �. ' ........................................ ................................................ .. .. ............. ..... `�....... 2 ` /... C f Installer+ at .................................................I.........................:...........,�......................... .............................................................................................-..-... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ............ `-�.....Q.-../. ... dated . .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- ..'" ......,: ..... 7""....... .. ........................ Inspect r L------------------- ------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �i� la ttl nrkii Tonotrudivit ruti — Permission i hereby granted._.._._;. -... -1� ......... ... to Construct ( ) or Repair ( ) an Individual, Sewage Disposal System atNo.__.rl J ... _ '1 d�v_ . .............. .................. Street as shown on the application for Disposal Works Construction it No,l . ._.... Dated........................................... R ~�...........� �7----- 7-�� ----------------- /�%�` v.. Board of—Health `Ys`DATE...... ...' '�................... ....-----....... FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS I L I- __ __ __- 11. TJI=516 511161-E FAMIL`( :. �p l�A�F3AtyE GRIIJvEtZ ,� :."PAIL'-( FLOW 3 x l to=33D Gt'v ,S I C TA N� o 0 E'Pf 3 I = 445 6�D a 3o x so%, -UsG loco e-mc e� v. . hISFMA L. PIT I-Ioaa GAc. �2' sTnN� 51DEWtILL AREA = I�$ SF �,15 � BOTTOM AZA �- 10 sF x 1,0 ,08 , TOTAL te51614 = 6f!P, TOTAL_ 'DAILY rtol'J = 330 4Pb 1:�'E2604-ATM4 ¢ATE olz LE4! N Lkor CO 3 �'(µ OF yqo_ o�� a q� a PtoP• PETER �, 0-'-A- RD SULLIVAN � I2I SAMR No. 29733 us, �so+s ` ` Fss� S7 cll,42 +oVE VOWrABL.E AMP-IAL �UQLEW WA� P 4�1.32 In' Au. kwoiwb ' /sue - Ir TIM,T✓ �ucov�tTt�2. TF cfl P V•e s�BSoiL �, �D Iooin � PKT Fisr� 7s LU✓ GALIs. t3ox � S rIC is GAL '15 T�N IC 5 uNsu rTABL E Mew• WfKF�F� ks, Aw—Srzv-ruREs sr-r SAND s'1 ONE' MOVZ T44hJ 4-' vr� Qrfio� 5�-IAt( BE 1t-2o 6ezrIr-I® ROE FLAN ` 44AV EL -P-/ELOpG 'PZOF-I Lr--- - Lor..�'Iot1 : �vi'vrl' -+3 E1,-G5 GAGA LE—'. DATrr r.UATELZ- - �$a'�a5b-7� pLA N �E RF JC,1 I CE;rO'FY I-Or T�'E lwatj, 4, l.oT' 4 59oW w HEZEON CM'PLyS WITµ I-4E 51PEUQE z� eeQ. C; `DA OF U21-1tirkt3ta pbG Foz CaL4v-&-.,F- A� er AL• 4+1V 6 40TI-oL•ATISD WIT01 J T1IE VXOv VLAIU, 'Pa-TIE 9170185 p�F `froiJdL AtJ� SuP.�/ yorzs -WK FLAW IS Nor F3A5Im) oN AN ItJSTi?tJtitE+JT' z�.�L L_ EL.IGL N EEt�S 4,v2�/c j AIJD TqF. °FF5e5 '440L)LD JUT" ae ogTT---2vtC.i is MASS . u5C1� To G%ABL-15N Ptzcpe zt'y U N>=5 APPIrtcA wT#' AAvj; loiL zoJ& '�TKIE Town of Barnstable BarrtstdL,le- Regulatory Services Department i adcaC j fAR ASM-Sk I E . ,�� Public Health Division jFc Mp�a� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6131 May 22, 2017 RUSSO, MARK& THERESA M 114 CURLEW WAY COTUIT, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 114 Curlew Way, Cotuit, MA was inspected on 05/12/2017 by Patrick T. Sullivan, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year 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 o as McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\114 Curlew Way Cotuit.doc l - ` "� Town of Barnstable + a + + IARHS[AHCE, � 6 ,�� Regulatory Services Department '°Tfb F1K{� Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-8624644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground y ❑Pumping more than 4 times during the last year not due to clogged or,obstructed pipe _ ❑Backup e into the house due to anoverloaded or clogged SAS or cesspool ONE (11 YEAR ADLINE CRITERIA evel in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of apipe, relocation of a driveway due to H-10 components, etc) ❑Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (Per r Town Code §360-20 h) OTHER Repair deadline: WSEPTICTEADLINES TO REPAIR FAILED SYSTEMS.doc . ~ ���~ � wm� w�� �, Commonwealth of Massachusetts � "���N� � ����~���N N�������N��� ������� 4�1 � N�@�� �� �^�� � ������@ �mm�����~�~�m��mm N �pmmmm Subsurface Sam/mgeDisposal SystemmFormn - Not for Vu|untoryAaseasrnan�s �~ �^ 00 114 C d VVo 10 — Property Address 10 Mark Russo Owner Owner's Name infonnuhoniu °v MA 02835 K8 12 2Ul/ C��i� � mquieU�revo� ---�-------------------- ----- Zip Date CD page. Ci�y/Town ^`"`" �1% Inspection results must bm submitted omthis form. Inspection forms may not be altered inany way. Please see completeness checklist at the end of the form. _ Important:When A. General Informationfilling out forms on the computer, use only the tab 1 Inspector key m move your cursor do not PatrickT Sullivan ---------�------------- usetho,rmm Name orInspector xey. Ready Rooter P.O. Box89_ ____________'____'_______-__�____________________-_--__-_ Company Address MA --- _O_2O_4_4 Forest-ale a�ta Zip o Q��uw — _ � 508-888'8055 S112843 Telephone Number B. Certification disposal s�mot�\aaddressand �otme \ co��v that \ have personaUyinsoeutod the sewage -'� ssythedmoofth� ino ' n The inspection information reported below isbue. accurate and complete a of p�^". ofo,site ---nnedbased onn�y�aining and expehenmain the proper funn�onand mamVunenue xu u sewage p�'udisposal systems. iamna0EP approved system inspector pursuant hm Section 15.340mf Title S (31OCK0R1G.Q80).The system: n Passes n Conditionally Passes Z Fails F1 Needs Further Evaluation by the Local Approving Authority K8o 15 2017 =------ Date -' - e � ' � The system inspector shall submit a copy of this inspection report to the Approving Authority (Board »f Health orDEP)within 3O days of completing this inspection. )f the system \sa shared system nr design Oo»v«f1OU00gpdnrgreator the inspector and the system owner shall submit the ropn�to the apprnpraDeregional offioeof 'the DEP. The original should besent to the system owner and copies sent to the buyer, if applicable, and the approving authority. � .""This report only describes conditions at the time o/ ''^srec`"o'^ and under the conditions of use � mt that tirne. This inspection does not address hom/the aymternvvN peunder rform the same or different conditions mYuse. ' itle 5 Official Inspectionp",m.xws"tfacen~°ag°o."p*" n,*"m'ppp`mv u/",-3/13 � �wr� /�m � Commonwealth of Massachusetts - -�� Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Curlew Way Property Address Mark Russo Owner Owner's Name-_--- —------ - — -— information is Cotuit MA 02635 Ma 12, 2017 required for every ----------- ----- ------- — -- -----�----- — page. City/Town State Zip Code Date of Inspection B.-Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates thakany of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. A y 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. i Check the box for"yes", "no" or"not determined" (Y, N, D) 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 (Expla,i�below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts =_ Title 5 official Inspection Form Imp —'�1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �;- 114 Curlew Way Property Address— - ------ --------- --- Mark Russo Owner Owner's Name information is Cotuit MA 02635 May 12, 2017 required for every —. -_—_--- - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): Elbroken pipe(s) are replaced ❑ Y [IN ❑ 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 C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evai�dation by the Board of Health in order to determine if the system is failing to protect public he Ith, safety or the environment. 1. System will pass unless Board of ealth determines in accordance with 310 CMR 15.303(1)(b)that the system is not�functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 3 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114_Curlew_Way Property Address Mark Russo ---- Owner Owner's Name information is MA 02635 12, 2017 required for every Cotuit _ —y.----- — page. Cityrrown 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 stem (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. / ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: — - - *' This system passes if the well water an lysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and tl�ie presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no ther 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 L Commonwealth of Massachusetts Title 5 official Inspection Form t - / Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /. 114 Curlew Way —------ ----- — ----—---- ----- y Property Address _Mark Russo — Owner Owner's Name information is Cotuit MA_ 02635 May_12, 2017 required for every — ------------------- ---- --- State Zip Code Date of Inspection page. CityrFown B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of.custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 f et of a tributary to a surface drinking water supply ❑ ❑ the system is located in 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. Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 5 of 17 t5ins•3/13 Commonwealth of Massachusetts - _-_ Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 114 Curlew Way________, — — ------------- Property Address Mark Russo Owner Owner's Name information is Cotuit MA 02635 _ Ma 2, 2 1017 required for every -.- page. City/Town 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 . ® El approximation 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): — Number of bedrooms (actual): 330 GPD DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 t5ins•3/13 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 114 Curlew Wa ---_---------- -- — Property Address Mark Russo _.-__-_-__-_--_-- Owner Owner's Name information is Cotuif MA 02635 May 12, 2017 required for every — — — page. City/Town State Zip Code Date of Inspection D. System Information Description: 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No 2015= 230 GPD Water meter readings, if available (last 2 years usage (gpd)): 2016_334 GPD Detail: High water usage duri _ summer months_due to pool and irrigation_ Sump pump? ❑ Yes ® No Current_ _ Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft. etc.): ---- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank prese t? El Yes ❑ No I Non-sanitary waste discharged o the Title 5 system? ❑ Yes ❑ No - Water meter readings, if av ilable: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 t5ins•3/13 i r Commonwealth of Mas.5achusetts ,W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r= 114 Curlew_Wa Property Address -- Mark Russo _ Owner Owner's Name -- information is required for every Cotuit _ — — MA_ 02635 _ May 12, 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date -- Other(describe below): General Information Pumping Records: Source of information: Owners records: Pumped A rp it 2017 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: — — gallons How was quantity pumped determined? -- - Reason for pumping: — -- — --- --=— Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form sl Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ��4,•'' 114 Curlew WaY.--------------------...._..----- Property Address Mark Russo Owner Owner's Name information is Cotuit MA 02635 May 12, 2017 required for every __ --- ----- ---------- —— ------- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Sstem installed 12/27/1994. Certificate of Compliance date on as-built. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3 —--- Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): --- -- — n/a _ Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 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 8.6' x 5' x 5.5' 1000 gallons _ Dimensions: - Sludge depth: — t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts T Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form Not for Voluntary Assessments 114 Curlew Wad -- - - ---- ------------- Property Address Mark Russo Owner Owner's Name information is Cotuit MA 02635 12, 2017 required for every — -- --- --- _May_ — ---- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness -- -- - - Distance from top scum of to to of outlet tee or baffle 6 - --- P Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape measure and dip tube. _— Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet(2) PVC tees and outlet concrete baffle in place. Liquid level at outlet invert. Staining and solids over outlet invert. Tank has been overfull. Risers bring covers within 6" of grade. Grease Trap (locate on site plan): Depth below grade: feet — Material of construction: ❑ concrete ❑ metal fiberglass El polyethylene ❑ other(explain): Dimensions: - Scum thickness -- Distance from top of scum to to of outlet tee or baffle -- -- -y Distance from bottom of sc to bottom of outlet tee or baffle ----— ----- Date of last pumping: ' Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts au� Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments a 114 Curlew _ -- Property Address Mark Russo _ Owner Owner's Name information is Cotuit MA 02635 Ma 12, 2017 required for every _—__— — — ---- page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 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 ❑ fj erglass El polyethylene ❑ other(explain): r — Dimensions: — — Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: — -- ---- Alarm in working order: ❑ Yes ❑ No Date of last pumping: ' Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts a= Title 5 official Inspection Form y� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 114 Curlew Way _ —_.-- —_ -- Property Address _Mark Russo Owner Owner's Name information is required for every Cotuit MA 02635 May 12, 2017 — —_ --- - - — — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): 11 Depth of liquid level above outlet invert 0 -- 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.): One inlet, one outlet. Solids and high staining visible in d-box with camera. D-box has been above operating level. —_ _ 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \ a 114 Curlew Wad Property Address Mark Russo _ ---_-- — Owner Owner's Name information is Cotuit MA 02635 May 12 2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: 6' x6'w/2' of ® leaching pits number: stone. ❑ 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 at invert at time of inspection. No availible storage. Solids and staining show system has been in draulic failure_No-visible holes in sidewall. System is in failure_Riser within 6" of grade. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Curlew Way Property Address--- --- --------- -------- ----- ----- ---- Mark Russo Owner Owner's Name information is required for every MA 02635 May 12, 2017 _ COtult------- -._ _.:-------_._.-- -- --- --- --- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: - - — Dimensions Depth of solids / --- -- - --- i Comments (note condition of soil,Signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 official Inspection Form.Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - % 1.14 Curlew Way Property Address Mark Russo Owner Owner's Name information is Cotuit MA 02635 May 12, 2017 required for every — — page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately V, A Q � -3_ 0 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Curlew Wad Property Address Mark Russo _ Owner Owner's Name information is Cotuit MA 02635 May 12, 2017 required for every ---.___ — y --- 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 high ground water: >5 — feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1994 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: mays.massgis.state.ma_us/oliver.php You must describe how you established the high ground water elevation: Test hole for install in 1994 found no ground water at 13' (elv= 65). Base of pit is 9' below grade (elv= 69) per engineered plans. Accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form ! - - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Curlew Way— ---- -- - -- - -- Property Address Mark Russo Owner Owner's Name information is required for every Cotuit MA 02635 May 12, 2017 —._ —.. -- page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information - Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 L7 e4 `� ( 0V i i t ! i �r� 1 i v { Public Health Division Town of Barnstable PO Box 534 Hyannis, Massachusetts 02601 Fax(508)775-3344 Phone(q08)790-6265 Y ` �"=�-== -�:bpi�.�..:.�• — -•+ -t- • i - - Q -OFEICr- � FIRM i ^ noecl - �;rs�...�.�.�.� 0 � + -- ' I 7 . �ubfic Health Divisions�� I Town of Barnstable �Ii- � PO Box534 0260A Hyannis;Massachusetts I �S N Fax(508>775-3344 --- - Qhone(508�790" 6265 GL q`x�J --- �-_ P4 14 LOCATION �-07 taL2 NO. 1°�4 VILLAGE ��4 DATE_ APPLICANT FEE ���5�- " ADDRESS & Mat Cc ELEPHONE NO. (NOR-refundable .ENGINEER - p TELEPHONE N0. �k- /3 " DATE SCHEDULED `7- 1 11 SS 1011vG ' (Applicants signature • SOIL .LOG SUB-DIVISION NAME DATE ULq LCo 06(n:5 TIME ko oc-) EXPANSION AREA: YESVNO ��k)_C�_ �ENGINEER TOWN WATERVPRIVATE WELL ^' hU BOARD OF HEALTH EXCAVATOR SKETCH: .(Street name, etc. ,dimensions of lot, exact location of test holes and '.`percolation tests , locate wetlands in proximity to test holes ) � NOTES : ZOO _. PERCOLATION RATE:Lem low TEST HOLE NO: ELEVATION: TEST. HOLE NO: ELEVATION: 2 .5u,8So c- 2 ti 3 N - 6 C—1 f+Y tl+YV— ,. 6 s 7 7 8 9 /4-rJ 0 9 10 10 11 11 12 �L� 12 13 13 14 fM L"A-y coz, 14 15 15 16 16 r / SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS V LEACHING TRENCHES UNSUITABLE FOR SUB--SURFACE SEWAGE. REASONS :- NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH COPY: RETAINED' BY APPLICANT Title 5'Info sheet Address: ` G u In uQj kA Town: Type of system: Dimensions of SAS: Bedrooms: 3 GPD: Test hole: Date: Depth: Elv: Base of SAS: Town water / Well: distance to SAS: TOW ' BA NSTABLE NOF R LOCATION �pJL� �G�i''� �/ kvllrl SEWAGE # yy' VILLAGE e,:9/k Z- ASSESSOR'S MAP & LOT Z5--..�L r INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITYAtype)0 XXI� 4Z. �`" LZZLsize) go, NO. OF BEDROOMS- .?2 PRIVATE WELL O UBL ATER BUILDER OR OWNER UI�✓ /©� �l DATE PERMIT ISSUED: 5 131 DATE COMPLIANCE ISSUED: 71! -Z/�/ VARIANCE GRANTED: Yes No 2-q, y� No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZippYicatiou -for Yell Cougtructiou Permit Application is hereby made for a permit to Construct(.jr, Alter( ), or Repair( ) an individual well at: //y Car[ew coc.�z cc7u17— Location-Address Assessors Map and Parcel . Sa%,J Cl( 4C"'r-. v ICur'14w wa ki Col-uc7— Owner Address Oeouovta aax;Ajel/ I dg DC 61gSS jVc1 /-ta3G19ee M0.'a�6Yq Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well Capacity Purpose of Well //'/' t E,aT-/o n+ Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compli ce been issued by the Board of Health. Signed Date Application Approved Date Application Disapproved for the following reasons: Date Permit No. , \ 7 Issued Date --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(t Altered( ), or Repaired( ) by &eNNIg S'c4^JAJC/f Installer at I I Y C «�t&-J &J c' has been installed in accordance with the pro isions of the Town of Barnstalle Board of Health Private Well P otecti n Regulation as described in the application for Well Construction Permit No: / CT&a Dated 6 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. j -- Fee:., <.. >t :. . BOARD OF HEALTH TOWN OF B A!kN•S TA LE Yic tior� f or eYY ow6tructioft' er'ntit' uk•rp$ .... •' � ; �.� . .y4�:i. �. ' # -..,..'f � .1, A CIS 'M Application'is,bereby made for`a permit to Construct(+�); . Alter( '), or Repair O a,lanindlvldual•well"at 4� ; f ", Ctar COT Location-Address / Assessors Map and Parcel, SQaj G / I� V /�/ �C11 1pe GJGI/ Owner �E'/I.�IVrIS,_ -.��Yx'�LJs++:JC�(rr.,•...+ s...+s'"""..'.".�',`.yr't--..-,4t/"��i�a,Q'"L°�L7"'�C{.J.S~ice/C" r—US(n ��MQ•��-'"� Installer-Driller Address Type of Building Dwelling l L �,.r '�N r..s...•�° rz 3F'�E'-.- rrt F ,&az-e.�+`>•''�, �. .x��. .'",, 5'� .a;'�u - � ,�'-� ,:�'•',fE�f° Jx+?w�.. � .„'„i Other Type of Building No.of Persons Type of Well Capacity Purpose of Well //'/ i co T/o a Agreement: 4 The undersigned agrees to install the afore described individual well in accordance with,the provisions of the " Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the L well m..operation until a Certificate,of'Compliance has been issued.by,the Board of Health. * i ` Signed- �e*. • 4 /r�i9�J/ �..^.-�,,y �„„�,,,,..,.M.•,..w.,,.. , Date,,..:. Application Approved Ey Date Application Disapproved for the following reasons: Date 7 . J'Permit No' ,� , Issued Date .—. —__—_e,-n-eR--------------- � <_—m-------and>v4o.. _ _� d e----------- ----- . BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO/(�jCERTIFY,that tt/h+e individual well Constructed(U)r 'Altered( ),- or Repaired( ) Y • - ^ Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.44�9/ 0 (0 a Dated / THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Yell Cott!5tructton 3permtt No. V,) 0) 7 0 Fee f Permission is hereby granted to n Jiir� ��(�7 ti� w ..r Installer to Construct( , Alter( ), or "Repair an). f an'individual well at:. , 4.' :No.,,' //ty+'.,. Q-C)`"/r"o �a'..C-i.l ,4'"(.�J(„\�' .0 � + (::a'/``" ydu:e Street I as shown on the application for a Well Construction Permit No. L ? �! "" � C > - . . PP Dated- Dated c� Approved B'y r, ,# r l 0 y 441 r N a` F LOCUS - 97--EXISTING CONTOUR ® o <" "*'oo x 100.98 EXISTING SPOT GRADE 0 os-1 a 97 PROPOSED CONTOUR oa ' w°oa W EXISTING WATER SERVICE ; v G EXISTING GAS SERVICE N Ir Ir GJt\Je �r�� 3 UJ UNDERGROUND WIRES 8 TEST PIT 00 BENCHMARK J N LEGEND �o�rm Route 28 t LOCUS MAP { NOT TO SCALE V N f i i LOT 4 1.08 ±Ac. ±SF 47,028 ±SF / ,/PARCEL ID: 025-062 x 77.9 ,/ x 76.44 W / 7h`7 77.11 CV P x 76.22 2 Co 0.00 /^ x 77.36 EXISTING SEPTIC TANK �� 77.17 TOP OF TANK, EL:=74.76 o - INV.(OUT)=73.44' - �� / 77.1e / EXISTING LEACH PIT �`� a� �� 76.65 +76.03 CONTRACTOR SHALL PUMP, PATIO j FILL W/SAND & ABANDON I F 78.58 x �' 76.21 76.38x+. (p/ O / / IVENT 7 76. �9 +\ O+O x 76.17 f/ �p 35' I ��9 7 .3 DECK / 1���� x 76.13 / rn 7 E.93 RRpP.. Y ,_1 l SHED lwl x 76.26 pt WALK /EXISTING x 76.13 76.99 / 0 HOUSE(#114) / T.O.F.=77.2f / BENCHMARK GARAGE i 76. CELLAR OUTSIDE COR./STEP /- 76.s8 SLAB C EL.=77.06 9 / r PK SET '`.-�'; �"•- x 76.69 / 76.20 / 76.093.73 f?q L S 0 ;.: GX76.59 I ; �-+�`Z5.97 `�,f 5.69 74.16 \ PETER T. 91.4 o _ `� CI 74.46 M VILEE Eeox N 1201,�� �en,ent No. 35109 CB 76.63 �ISl + tea:" ''*" 4.72 of r \`+ 76.39 E ':`".:.,. ' rl l edge 74.81 C� Engineering.by: MALE DRAWN JOB. Na. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=30' P.T.M. 212-17 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 114 CURLEW WAY COTUIT MA (508) 477-5313 8/7/17 P.T.M. 1 of 2 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 r r NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:72.3 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. INSTALL WATERTIGHT RISER & PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" COVER SET TO 6" T GRADE OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F.=77.2t CHARCOAL F.G. EL.=76.9t F.G. EL.=77.6t F.G. EL.=77.5f F.G. EL.=77.5t VENT MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 10' L = 5' ® S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 6" 1o"I lu_ " as as 14" 8 Baas lam EXISTING 48" LIQUID aaaaaBa LEVEL ADD 4' 4.8' 4' GAS BAFFLE INV.=73.17 PROPOSED INV.=73.00 INV.=73.44t D-BOX EFFECTIVE WIDTH = 12.8- (FIELD VERIFY) INV.=71.50 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED NOTES: TOP CONC. ELEV.= 72.8t 1 CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=72.30 r25.0' INV. ELEV.=71.80INVERTS, PRIOR TO INSTALLATION. owlease ease2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=69.80ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 4' 2 x 8.5'=17.0'STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 4' MIN. OF NATURALLY OCCURRING EFFECTIVE LENGTH = PERVIOUS MATERIAL 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON THE OUTLET TEE. NO GROUNDATER, EL.=63.8 - NO GROUNDWATER AT 13' (EL.=63.8t), P-4432, 4/26/85 3/4" TO 1-1/2" DOUBLE WASHED STONE 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE (OR APPROVED FILTER FABRIC) SOIL LOG DATE: JULY 18, 2015 (REF#15,415) 6' �� DECK SOIL EVALUATOR: PETER McENTEE PE(SE#1542) �1 1 oS.A.S. h A WITNESS: DAVID STANTON R.S. HEALTH AGENT --�1^-,- �' ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH ao 10' 0 76.8 A 0„ 76.8 A 0" �. SANDY LOAM SANDY LOAM .EXISTING 10YR 4/2 - 10YR 4/2 GAR,4GE HOUSE I14 96.1 8 76.1 8" SLAB" B B T.O;F.=77.2f SILT LOAM SILT LOAM CELLAR 10YR 5/8 10YR 5/8 71.8 60" 71.9 59" SEPTIC LAYOUT MED. SAND MED. SAND GENERAL NOTES: 2.5Y 6/6 2.5Y 6/6 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 65.8 132" 65.8 132" LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)(b): NO GROUNDWATER, PERC RATE: <2 MIN./IN. 1) A 10' variance, S.A.S. to cellar wall, for a 10' setback. SOILS IN "C" HORIZON ARE CONSISTENT WITH 2) A 2' variance, S.A.S. to slab (garage), for an 8' setback. REFERENCE PERC TEST, 4/26/85, (P-4432) 3) A 3' variance to depth of cover, for up to 6' of cover NO GOUNDWATER AT 156" the S.A.S. Chambers shall be H-20 and vented. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE. BOARD OF HEALTH AND THE DESIGN ENGINEER. ANY DESIGN CRITERIA 4 FROM CTTHOSEONS SHOWN ENCOUNTERED HEREON SHDALLING BECREPORT DTION TO TDHE ERING DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. NUMBER OF BEDROOMS: 3 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. SOIL TEXTURAL CLASS: CLASS 1 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF DESIGN PERCOLATION RATE: <2 MIN/IN THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF (0.74 GPD/SF LOADING RATE) HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. DAILY FLOW: 330 GPD 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. DESIGN FLOW: 330 GPD 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. GARBAGE GRINDER: NO 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS- GARBAGE AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF DIRECTED BY THE APPROVING AUTHORITIES. .74 GPD/SF 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY EXISTING SEPTIC TANK: 1000 GALLON CAPACITY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS CONSTRUCTION. USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). SIDEWALL AREA: 2 12.8' + 25.0' X 2 = 151.2 S.F. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ( ) INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. BOTTOM AREA: 12.8 x 25.0' = 320.0 S.F. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND TOTAL AREA:..............................................................471.2 S.F. NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD SYSTEM COMPONENTS NOT SHOWN ON THE PLAN Engineering by: SCALE DRAWN Jab. NO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. P.T.M. 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 114 CURLEW WAY COTUIT MA (508) 477-5313 P.T.M. 2 of 2 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632