The URL can be used to link to this page

Home My WebLink About0008 EASTWOOD LANE - Health 8 Eastw Lane Cotuit F' ' � A - 025 035 �I - Commonwealth of Massachusetts : a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r� 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name - y information is CotUit ; g' required for M q o every A 02635 12/5/2017 page. City/Town State Zip Code' Date of Inspection ND Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms ��t /a"�-38 on the computer; use only the tab 1. Inspector: key to move your cursor-do not Paul Martin use the return key. Name of Inspector Cape Cod Septic Services f� Company Name 350 Main St Company Address W.Yarmouth MA 02673 City/Town State Zip Code 508-775-2825 315016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes Fails ❑ ❑ Needs Further Evaluation by the Local Approving Authority �-� 12/11/2017 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 �a � vs f Commonwealth of Massachusetts . Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is COtUIt required for every MA 02635 12/5/2017 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 310 CMR 15.304.exist. Any failure criteria not evaluated are indicated below. Comments: System in working condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. if"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is COtUIt required for every MA 02635 12/5/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below) ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ GND(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): C) Further Evaluation is Required by the Board of Health: ❑. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts AmmW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yv y 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every CotUlt MA 02635 12/5/2017 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of-Health-(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate4"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 YZ day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below-high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone.1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.) The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ ® 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ - ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of17 Commonwealth of Massachusetts u q Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 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. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)j D. System Information Residential Flow Conditions: . Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x3= 330gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official - Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °r 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 page. City/Town State Zip Code ' Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No . 2015=614 d Water meter r 9p readings, if available (last 2 years usage (gpd)). 2016=510gpd Detail: Sump pump. ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑° Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6Ver 8 Eastwood Ln. Property Address Karen Maker ` Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 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: No Records Was system pumped as part of the inspection? r ® Yes ❑ No « If yes, volume pumped: gallons 1000 00 How was quantity pumped determined? Truck Glass Reason for pumping: Maintenance 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): i t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts G v Title 5 Official , Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every Cotuit MA 02635 12/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2005 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10, feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line was checked and appears to be flowing properly. Septic Tank (locate on site plan): Depth below grade: 18feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000Gal Sludge depth: 6-811 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form` . m Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every Cotuit - MA 02635 12/5/2017 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 Scum thickness 2-3" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments(on pumping recommendations;inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert evidence of a leaka etc.): :) 1000Gal tank in good structural condition. PVC tees in place and clean. Tank at normal operating level. Inlet cover is under deck but was viewed with mirror to verify tee. Grease Trap (locate on site plan): Depth below grade: feet Material of construction. ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is " required for every CotUlt MA 02635 12/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass '❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑.No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "~ 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Oil Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 DB-3 with 1 line in and lines out in good condition. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 18" below grade. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 ' Commonwealth of Massachusetts _ Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 8 Eastwood Ln. Property Address, Karen Maker Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: leaching chambers number: 2-500gal ❑ 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.): 2-500Ga1 chambers with stone. 13'x25'x2'. No standing effluent in chambers at time of inspection. No staining or signs of hydraulic failure.. 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s•''y 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts F v Title 5 Official Inspection Form, Subsurface Sewage Disposal System_Form -Not for Voluntary Assessments •r 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every Cotuit MA 02635 12/5/2017 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 w • III t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts u r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Eastwood Ln. Property Address Karen Maker ; Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 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: +15' 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: Date ® Observed site (abutting,property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand auger to 15'with no water encountered. Max bottom of leaching is 7' 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 Commonwealth of Massachusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ••'` 8 Eastwood Ln. Property Address Karen Maker Owner Owner's Name information is required for every COtUIt MA 02635 12/5/2017 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 n03V6b1IIg rib-DUIIL UUMS Page 1 of 2 TOWN OF BAMSTABLE LOCATION EAsT hhHe SEWAGE# D/ —/$a VILLAGE O%erv.kI ASSESSOR'S MAP&PARCEL A3 ^o �� 9 INSTALLER'S NAME&PRONE NO. ./`ltilR/�s%� sz,B-yag-ss,Z 9 SEPTIC TANK CAPACITY J.100 6&1 f!-lo) LEACHING FACILITY:(type)Sao CKArhJ�CAI (size) /d/o*X 33 " NO.OF BEDROOMS OWNER- -PERMIT DATE:zt u6 S,aOla COMPLIANCE DATE; Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ------------------ /a' ` I http://www.t.ownofbarnstable.us/Assessing/HMdisplay.asp?mappar=025035&seq=2 12/1/2017 r TOWN OF BARNSTABLE LOCATION /�0a12 a �',9WC SEWAGE# VILLAGE C-0To/ 1 ASSESSOR'S MAP&PARCEL 0-9%-5 0;3 INSTALLERS NAME&PHONE NO.V CF U/al SEPTIC TANK CAPACITY �—:X i S V l K d Igo 0 ,1 `C µ* 0( LEACHING FACILITY:(type) o�_ j Ott J Fjow si e) C3 , NO.OF BEDROOMS OWNER EAl tE PERMIT DATE: S- 4 _6 S COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �C3' P 1.L� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) /oW,1 f& P,t Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fa ility)L A 0)4 9 Feet FURNISHED BY G Jv 9I0 ' z n ,4e 45 Vrv� Lod -14 1 ' LOCATION SEWAGE PERMIT NO. VILLAGE q-0,YX J a l UQ Q CQJ Y, INSTA LLER'S NAME & ADDRESS pc Q . G v ,r Cc T y c a u, , BUILDER OR OWNER e DATE PERMIT ISSUED lk DAT E COMPLIANCE ISSUED E ) aU '31 a , 7 �� ., f ��N� h �= � $ �`' ox �i J No.A20 Fee / r THE COMMONWEALTH OF MASSACH SETTS Entered in computer: Yes PUBLIC HEALTW DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for 30iopozar *pgtem Cougtruction 3permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) O Complete System individual Components Location Address or Lot No.-tt f3 &s—wow LA,31E Owner's Name,Address and Tel.No. Assessor's Map/Parcel Co'v 7 I T 1 M R 25 C)3� S�M l✓ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 15YV__% 1 -5`i Prya t( SO IB-5 9 go Type of Building: Dwelling No.of Bedrooms Lot Size a?)ISIDDsq.ft. Garbage Grinder(/00f Other Type of Building ow= No. of Persons a Showers( I-')-Cafeteria('/) Other Fixtures LAir*—T .Y . 1Gr�c �S SiaJ4ct LRU;- `W-"Y Design.Flow ? ® gallons per day. Calculated daily flow 33 -gallons. Plan:Date c3 101 o5 Number of sheets I Revision Date Title �c52d2iC $M ly4® cult Size of Septic Tank Type of S.A.S. "S Description of Soil AD p\C o Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: D The undersigned agrees to ensure the construction and maintenance of the afore described on-site se v age displ%al sysl'em in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in oLorration unt�Pa Cew-01- cate of Compliance has been issued by t ' Board o ealt C N Si 07 Application Approved by 13% Application Disapprove or the following reasons X1_ D W r- Permit No. Date Issued _, ----------- ---- ——————————— --- , No: �� P Fee THE COMMONWEALTH OF MASSACHU1�-�----SETTS� Entered in computer; ' Yes r PUBLIC HEA1T ,-VVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for 33ig9oar *pgtem Conotruction-Permit Application for a Pernut to Construct(" )Repair)Upgrade( ):Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. C C.AS�I�JCC7o ��e Y Owner's Name,Address and Tel.No. r- '�� COTU Assessor's Ma /Parcel 1 p 25 d3S: Installer's Name,Address,and Tel.No. ' Designer's Name,Address and Tel.No. ErVV1�Z�NMENTAl_ SvCS Type of Building: y 1 Dwelling No.of_B.edrooms 3 Lot Size a i �c,a sq.ft. Garbage Grinder(4A Other Type of Building ICI nk E No. of Persons Showers(P1 Cafeteria(1/) OtherFixturis - - LA-jA ° c S e k L unt Design Flow !^ �'�,O / gallons per day. Calculated daily flow 3 S O gallons. a: Plan Daie l 31 i o 1 os Numberfof sheets,l tti Revision Date Title ___-- j i v C n Size of Septic Tank V t: J < Type of S.A.S. Q- sco Cart r6nrr y OIL5• Description of Soil � o } Nature of Repairs or Alterations(Answer when applicable) k�c,Ct` An tox" T� Date last inspected: a' 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 Certifi- cate of Compliance has been issued by Heal .this Board e Si 1 - Date Application Approve 'by--- Date Application Disapprove or the following reasons 1 c:- Permit No.�'� .� Date Issued ✓5��2 3 T —_- -------CO ------------- - ----- ---` THE MMONWEALTH OF MASSACHUSETTS- BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-siteage Disposal System Constructed ( )Repaired ( )Upgraded( ) Abandoned( )by at V .) v► has been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No�7 cQ a'�dated �- Installer S' �^��-'" Designer S The issuance of this permit hall not be construed as a guarantee thathe'y to Mw'li• n as designed. Date �� Inspeagr ' r�I:L.J � ��J� ----------------- . . _. . .. No. � Fee . ..: r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -•BARNSTABLE" MASSACHUSc rTS -m m5pozar *pgtem Cowaruction Permit , Permission is hereby gra ed to Construct( )Rep ( Upgrade( )Aba on ) System located at C � 'u� Lt�� T',)/ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to.- comply with Title 5 and the following local provisions or special conditions. Provided:Constructihhn/m/ust be completed within three years of the date of this •e i . Date: d 7 d� Approved 09/02/2016 20:24 FAX 5 4- I.9�1eS Town of Barnstable .► Regulatory Services Thomas F. Geiler,Director t Kam ' Public Health Division 1639' `� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Fax: 508-790-6304 Office: 5o8-862-4644 Installer&Desi er Certification Form Date: Q Designer: Sha Environmental Services Inc. Installer: t na Address: Address: P.O. Box 627 � East Falmouth MA 02536 was issued a permit to install a On ICES cc> \\ 4( a�te (in staller) a �['� �04Ct k-r based on a desigI417 by septic system at e =�s . (address) Sha Environmental Services Inc. dated--- (designer) I to certify that the septic system referenced approved above barges such as lled lateral�relocation acc f the the design, which may include minor pp distribution box and/or septic tank. I certify that the septic system referenced above was installed with major change orient greater than 10 stemlate)al relocation of but in accordancee SAS or with State & Local Regulations. Pvertical relocation of lan revision or of the septic system) certified as-built by designer to follow. Tµ OF MAs. Cp,RMEN ✓lift„ E. ( ler's Signature) SHAY No. 1181 a S ( esigner's Signature) (Affix De t p Here) TE PLEASE RETURN TO BpRNSTABLC HE TH ESSUEDI UuL NTIL BOTIi TINS FORM ANDAAS- O OMPLIANCE WR•L NOT BE I BUILT CARD ARE RECEIVED BY TI BARNSTABLE PUBLIC_W— _ DT�YSION. THANK YOU. Q:Noalth/Saptic/Desigaef Certification Form i 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated 05 concerning the property located at w� � xt p T L e T meets. all of the following criteria: • This failed system is connected to a residential dwelling only. There.are no commercial or business.uses.associated with the.dwelling. • The.soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests,at the site without a health agent present. • There is no.increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information). B) G.W.Elevation +adjustment for high G.W. DIFFERENCE BETWEEN A and B �- SIGNED : `Z"rr�Qpr� : ' DATE: NOTICE Based upon the above information-,a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. qA.Septic\percexemp.doc Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: 0 Ui , C07'k) d'T Lot No, Owner:.- i i(IQ tA )oc-Ee.. Address: `jqM C Contractor: 1'10. `QC->• Address:__ ?Q, X (ra y V-ztraxJ�ttil 1l�ly Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OA Appropriate index well.............................. O :Water level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well Cif t month/year STEP 4 Using Table of Water level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and'water•level zone (STEP 28) determine water-level adjustment .............. ��j STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............................................................................................................. 1. Figure 13.--Reproducible computation form, 15 9116/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated 105 ,concerning the property located at Cp TO ►T meets. all of the following criteria: • This failed system is connected to a residential dwelling only. There.are.no.commercial or business.uses.associated with the:dwelling. • The.soil is.classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) -� B) G.W. Elevation a5 +adjustment for high G.W. = c q DIFFERENCE BETWEEN A and B �- SIGNFD : DATE: C�5 NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. I gASeptic%percexemp.doc Alo �- iz CFI Stock No. ' pEA1 ®RK SHEET Source Salesman VOLKSWAGEN a AUDI 'Date Bus.Phone Purchaser ' Res.,Phone Address City Zip PLEASE ENTER BUYERS ORDER FOR THE VEHICLE DESCRIBED BELOW A;,CORDING TO CONDITIONS BELOW AND ON REVERSE SIDE. y COLOR. TRIM Approx.Del.Date R.O.S.No. Year New or Used Cyl.. Make Model Body Style I.D.No.� Odometer license No. MOTOR VEHICLE PRICE DOWN PAYMENT 30% FACTORY,,EQU I P: t - � 9 r DEALER ADDED ACCESSORIES: APPRAISAL PAYMENT � t TR Yr. Make Model Mileage p V.I.N Lic.No. E LIEN HOLDER A.C.V. NAddress i. �FtME tp� DATE: F * BARNSfABLE, 9 MASS. g 1639• A REC. BY Town of Barnstable SCHED. D _ vy Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION G _ — i Property Address: O EG;__4 voocl_l �OVIQ Z C14 Assessor's Map and Parcel Number: 2 Size of Lot: rj R CtCr e Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: pyl( ma)<)e r— Name: Address: Address: Phone: Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) �i v cm� l�,o� �tisst� �•,/� r—nsc�c-fit>1 �n 195� b4 �,., �' I —roy ,d e tiGve,�k -Jeri�. NATURE OF WORK: House Addition O❑❑❑❑❑ House renovation ❑ Repair of Faile3Septic System ❑ q9g an ZMo-S'• Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. - Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only). _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A.Miller,M.D.Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Susan G.Rask,R.S. Q:\HEALTH\Application Forms\VARIREQ.DOC I� r 62 LOCATION. d ` SEWAGE PERMIT 0. yI u r P Vt11G�_e i L L A G E qca y Clot I LQ o o Dr. .. INSTA LLER'S NAME S ADDRESS B U I'l D E R OR OWN ER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED AIr 11 1 f i h Rex �� A r t '' .. Town of Barnstable MAM Board of Health '° arA 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. October 25, 2004 Mr. Phil Maker 8 Eastwood Lane Cotuit, MA 02635 Dear Mr. Maker, You are granted an extension,until April 30, 2005,to replace your failed onsite sewage disposal system component(s) located at 8 Eastwood Lane, Cotuit. The septic system originally failed during an inspection conducted by John Graci on November 9, 1998. The liquid level was over all of the pipes and the soil absorption system was in hydraulic failure according to Mr. Graci's report. Also according to recent written correspondence from Carmen Shay of Shay Environmental Services, Inc. the septic system is "failed." The Board is of the opinion that the only resolution to this problem is to replace the failed septic component. An extension is granted until April 30, 2005 to complete the work. Financial assistance is available through the Town's homeowner septic loan program, administ red by Mr. Kendall Ayers. His telephone number is (508) 375-6610. Sinc Oy yours ayne dle , D., Chairman Board f Health Q:WP/Maker 01I09/2015 03: 38 FAX 2 001/004 CARIVMEN.g, SHAY (508)-548-0796 ENVIRONMENTAL SERVICES, INC. P.O. Box 627, East Falmouth,MA 02536 Facsimile Transmittal Cover Sheet Please deliver the following as soon as possible to the person(s) listed. Please remember that all or some of this information may be confidential. r DATE; T O: �-6 l`- MC kQ0V+1 FAX NUMBER.---.!— t4e�l)6 S 0 —C4 Zycf FROM: NUMBER OF PAGES INCLUDING COVER SHEET: ADDITIONAL CO�IMENTS: l COV'1 A (2 l E 1Q. �� SAS - i If there are any problems with this transmittal, please call (508) 548-0796, i 01/09/2015 03:38 FAX 16002/004 CARMEN E. SHAY (508) 548-0796 ENVIRONMENTAL SERVICES,INC. P.O. Box 627, East Falmouth, MA 02536 November 12, 2004 Mr. Phillip Maker 8 Eastwood Lane Cotuit, MA RE: 8 Eastwood Lane, Cotuit, MA - 310 CMR 15.00 Title 5 Design Proposal Dear Mr. Maker: Pursuant to your request, the following is a proposal to design an upgrade to the on-site subsurface sewage disposal system located at the above referenced address. All work performed shall be at a minimum in accordance with the requirements set forth in the Massachusetts Environmental Code Title 5: Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, Regulation 310 CMR 15.000. As mandated by Title 5, observation and recording of Deep Observation Hole Tests, Percolation Tests and Soil Evaluation will be performed with the approving Board of Health. The soil evaluation and engineering time for a percolation test cost will be included in the design cost unless existing conditions result in time spent over three hours. Time over three hours will be billed at an hourly rate of$65.00/hr. If this additional time is required this cost will be billed over and above the actual system design cost and will be billed separately. The test holes will require the use of a subcontracted backhoe for excavation. The cost of a backhoe is included in this proposal. The plans and specifications shall be prepared by a Registered Professional Engineer or Registered Sanitarian as mandated in 310 CMR 15.220. Upon completion of the site-specific subsurface disposal design plan, you will be furnished with three (3) copies of the plan. Additional copies of the plan can be provided for additional cost. Upon completion of system installation, you as the property owner will be responsible for having a certified as-built plan prepared and submitted. before the approving authority will issue a certificate of compliance. We can on behalf of the property owner perform the as-built survey and plan and obtain a certificate of compliance from the approving authority pursuant to the requirements set forth in 310 CMR 15.021 (2) through (6). The cost of the as-built plan preparation is included in this design cost contract. 01/09/2015 03:39 FAX 003/004 Prior to the issuance of the Certificate of Compliance, the local approving authority is also required by the regulations to make a sufficient inspection of the system to determine that all work has been completed in compliance with the applicable requirements set forth in the design plan and Title V Code. Soil Evaluation& percolation Test included Design &Plan Preparation $1400.00 Backhoe for Perc Test Included Total: $1,100.00 Less Deposit of $550.00 Note 1: If minimum setback distances from the proposed septic system to the property lines are needed it may be necessary to set stakes on the lot corners. If important property monumentation in the area is missing or destroyed, a property line survey may be required to accomplish this. A full property line survey is not included in this design contract. If necessary we could perform the property line survey under a separate contract. Note 2: If a passing percolation test is not obtained on the day of the soil examination due to poor soil conditions, the time associated with obtaining the necessary variances from the local and state approving authorities for the system design will be billed over and above this contract. If this situation occurs we will notify you and obtain your authorization before proceeding with any additional work. Note 3: Our proposal is based on the design of a conventional on-site sewage disposal system. If an innovative/altemative system is required due to existing site conditions, the design fee will be adjusted according to our standard fee schedule over and above the price shown on this contract. If this situation occurs we will notify you and obtain your authorization before proceeding with any additional work. Note 4: Client is responsible for all State and Local filinz fees. Note 5: If the determination of a Resource Area, filing of a Notice of Intent or Request for Determination of Applicability form with the Local Conservation Commission and the State D.E.P. are necessary your property must meet criteria of the Massachusetts Wetlands Protection Act. Typical criteria include being within 100' of a wetland or a resource area, Costs associated with complying with the Wetlands Protection Act are charged over and above this contract. Note 6: If attendance of Board of Health or Conservation Commission meetings is required due to existing site conditions an additional fee of $150.00 will be charged for each meeting, if you or the Town of Barnstable request the presence of the design engineer/registered sanitarian. A Board of Health and/or 01/09/2015 03:39 FAX 1a004/004 Conservation Commission Meeting is not anticipated but not guaranteed. Note 7; If State and/or local variances must be applied for due to existing site conditions, the time associated with these applications will be billed over and above this contract. The contract does not include the cost of filing a property setback variance due to the size of the property if applicable. If you have any questions regarding this proposal, please do not hesitate to call me at (508)-548- 0796. Sincerely, Carmen E. Shay, R.S., C.S.E President FOR Responsible Party Please sign for"Responsible Party" and return original. If possible please include a copy of the deed for your property and a copy of the mortgage plot plan and any other plans of the property with this contract. (For lot size, reference and dimension data) Prior to doing any work on the property, we reserve the right to post a notice of contract. The parties to this contract specifically agree that Carmen E. Shay has no obligation to release drawings or other documents until the final bill for services has been paid. A copy of the executed contract will be forwarded to you for your records. oFIHE Tq Town of Barnstable Regulatory Services r + 9ELARNSTABLE,g+ Thomas F. Geiler,Director tED MA'S A Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 28, 2004 Mr. Phil Maker 8 Eastwood Lane Cotuit,MA 02635 " Dear Mr.Maker, Thank you for your letter(undated)received on June 25,2004. Your failed septic system inspection report dated 11/15/98 specifically indicated that the"liquid level is overall (of the)pipes" and the"pit is in hydraulic failure." 310 CMR 15.305 of the State Environmental Code allows homeowners up to two years to repair or replace failed septic systems. Recent Schedule of Events During a public meeting of the Board of Health held on April 20,2004,the Board of Health instructed the Director of Public Health to order all persons in violation of this provision of the State Code to comply within six months. Hence an order letter was mailed to you on April 28, 2004 in this regard. You may request a hearing or variance before the Board if you believe that your septic system is "fully operational"as you stated. It appears that you haven't sold your property since the date of that inspection report. Therefore,if you decide to request a hearing or variance,it may be beneficial for you to inform the Board that the 1998 inspection was not part of a real estate transfer requirement. Also,you should provide the Board some written documentation pertaining to the functionality of your system at this time. If you should have any additional questions,please feel free to telephone me at(508) 862-4644. Sincerely yours, Kean Thomas A.McKean,R.S. CHO Director of Public Health cc: Thomas Geiler John Klimm Board of Health f r� i 8 Eastwood Lane Cotuit, Massachusetts, MA 02635 Dear Director and Members of the Board, Thank you for your nice note. While at one time this alleged septic issue might have appeared to be urgent, we now have some questions. We would respectfully ask that you provide us with a time table or schedule of events that lead you to contact us over one thousand—nine hundred- ninety days or over five and a half years after the inspection. Our record shows that the system has been fully operational both before Mr. Graci's inspections and for the full duration of time since his inspections. Please note that no additional bedrooms have been added. And also note that the current year round residents number two people. We find all this troubling and ask that you might shed some light on it. Sincerely, L ~C E r t J U N 2 5 2004 Phil ma er TOWN OF BARNSTABLE CAIN1&M/LICENSE/PARK/ORD-VIOL cc Board of Heath Town Manager Director of Regulatory Services. f r ' ot�ZME row Town of Barnstable Regulatory Services * BARNSTABLE, * Thomas F. Ge.iler, Director MASS. 1639. bit Public Health Division rFA MA't Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Philip J. & Karen T. Maker' Date: April 28, 2004 8 Eastwood Lane Cotuit, Ma. 02635 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 8 Eastwood Lane, Cotuit was inspected on, 11/15/1998 by John Graci, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: SAS was in hydraulic failure. Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or registered sanitarian to prepare a plan of proposed replacement septic system component(s). This plan is to be submitted to the Town of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street, Hyannis), within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title V. You are also ordered to upgrade or replace the Septic system within six months (180) days of your receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 1.5.422 Failure to comply with this order will automatically it .slalt in a public hearing scheduled before the Board of Health. ORDE HE OARD OF HEALTH s . McKean, R.S., C.H.O. Agent of the Board of Health CC: Board of Health J:/faileJ septie_letter., r, 8 Eastwood Lane Cotuit, Massachusetts, MA 02635 Dear Director and Members of the Board, Thank you for your nice note. While at one time this alleged septic issue might have appeared to be urgent, we now have some questions. We would respectfully ask that you provide us with a time table or schedule of events that lead you to contact us over one thousand—nine hundred- ninety days or over five and a half years after the inspection. Our record shows that the system has been fully operational both before Mr. Graci's inspections and for the full duration of time since his inspections. Please note that no additional bedrooms have been added. And also note that the current year round residents number two people. We find all this troubling and ask that you might shed some light on it. Sincerely, Phil mak cc Board o eath �+ Town Manager Director of Regulatory Services. C { o -v Fv > w r U1 �'� s � ZHE t Town of Barnstable °* Regulatory Services BARNSTABLE, Thomas F. Geiler, Director MASS. A 9� ib39. `0m Public Health Division ArFD MA'S�`� Thomas McKean, Director 200 Main Street, A-j,.!annis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Philip J. &Karen T. Maker Date: April 28, 2004 8 Eastwood Lane Cotuit, Ma. 02635 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 8 Eastwood Lane, Cotuit was inspected on, 11/15/1998 by John Graci, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: SAS was in hydraulic failure. Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or registered sanitarian to prepare a plan of proposed replacement septic system component(s). This plan is to be submitted to the Town of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street, Hyannis), within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title V. You are also ordered to upgrade or replace the septic system within six months (I80) days of your receipt of this letter. -- Any person aggrieved by any order issued by the lcc?.l approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CNIP. 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. ORDE HE OARD OF HEALTH s McKean, R.S., C.H.O. Agent of the Board of Health CC: Board of Health 31failed_septic_let tem u !.t oFt" Tgrtti Town of Barnstable Regulatory Services BARNSTABLE, * Thomas F. Geiler,Director v 61 .0 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Philip J. &Karen T. Maker Date: April 28, 2004 8 Eastwood Lane Cotuit,Ma. 02635 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 8 Eastwood Lane, Cotuit was inspected on, 11/15/1998 by John Graci, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: SAS was in hydraulic failure. Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or registered sanitarian to prepare.a plan of proposed replacement septic system component(s). This plan is to be submitted to the Town of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street,Hyannis), within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00,The State Environmental Code, Title V. You are also ordered to upgrade or replace the septic system within six months (180) days of your receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. ORDE OARD OF HEALTH s .McKean,R.S., C.H.O. Agent of the Board of Health CC: Board of Health JAmled_septic_letters Septic Inspection Information 11/15/1998 ...::.: ::::::::::1 :::::::::::: ...............::.::.::;<P.; 2a# ... 035 '>`# a ' ' ?s 8 >> $ < tastwood Lane cotuit » t............ <` John Graci >< rs 11/9/1998 F ........................ ........................ > Aiier SAS was hydraulic failure ........................ ; R t . I CQTu I N _JfV••r' '�N 7003 3110 0000 9677 4840 Tc) �jjv 0 FB,4)�JVS T4 8 ems•;�� LE blEOWT D GW N 17/ . .r..•_t_�stevF•i.. . .�1�!E!!1�i1i1�1fIltlEttf� tii! '��#ffllitt111:E1��ti!1�Ii1iIllA-� I i ss �1 i�� i I i I' I_ _._�_ ___�_. _.. _-�._____ _ - ___� .i..�� 1 ` 1 I I �� t _ Jf ./!:'AISr:.,.r'�`�C�-+tom _ ="`a. Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection Jolty One winter Street Boston,Ma. 02108 D.E.P. pti D. .P. Title V Septic Inspector kip P.O. Box2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor FAILED INSPECT 1C ARGEO PAUL CELLUCCI Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 8 EASTWOOD LANE COTUIT 025-035 L13 Address of Owner: Date of Inspection: 11/9198 (If different) Name of Inspector: JOHN GRACI KAREN AND PHILLIP MAKER I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes This Inspection Is based on criteria defined In Title V _ ) P855C5 code 319CMR76.303.My findings are of how the system is Conditional performing at the time of the inspection.My inspection does Needs Fur 'er Evaluation By the Local Approving Authority not Imply any warranty or guarantee ofthelongevltyofthe x Falls {�I septic system and any of Its components useful life. Inspector's Signature: 'Date: 1w5r98 The System Inspector shalltbmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: _I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N, or ND). 'Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whetherlor not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection rf the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127H7) ' One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 e SUBSURFACE SEWAGE_ DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 EASTWOOD LANE COTUIT 025-035 L13 Owner: KAREN AND PHILLIPMAKER Date of Inspection:1119198 _ Sewage backup or.breakout or hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: X I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _X_ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. x_ Discharge or ponding of effluent to the surface of the groundlor surface waters due to an overloaded or rlogged --- cesspool. x_ _ SAS is in hydraulic failure. (reyleed 0427)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 EASTWOOD LANE COTUIT 025-035 L13 Owner: KAREN AND PHILLIP MAKER Date of Inspection:1119199 D]SYSTEM FAILS(continued) Yes No x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. x Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped x Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. —x- Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. x Any portion of a cesspool or privy is within a Zone 1 of a public well. _x_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No x the system is within 400 feet of a surface drinking water supply x the system is within 200 feet of a tributary to a surface drinking water supply _ x the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 8 EASTWOOD LANE COTUIT 02"35 L13 Owner: KAREN AND PHILLIP MAKER Date of Inspection:1119199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ _ Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _t_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)(15.302(3)(b)) Irevlaed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 8 EASTWOOD LANE COTUIT 025-035 L13 Owner: KAREN AND PHILLIP MAKER Date of Inspection:1119199 FLOW CONDITIONS RESIDENTIAL: d/bedroom for S.A.S. Design flow: g'p' ' Number of bedrooms: 3 Number of current residents: 3 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Ye: Seasonal use(yes or no): No last two 2 year usage d Water meter readings,if available:(as O y g (gp )' Sump Pump(yes or no): No Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment:_n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nfa Last date of occupancy: n1a OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM HAS NOT BEEN PUMPED WITHIN THE LAST TWO YEARS. System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: We TYPE OF SYSTEM x Septic tank/distribution.box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no).( if yes,attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(If known)and source Information: SYSTEM IS 20 YEARS OLD,INFORMATION IS FROM HOMEOWNER Sewage odors detected when arriving at the site:(yes or no) No (revised 04127)97) • ,. it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S EASTWOOD LANE COTUIT 025.035 L13 Owner: KAREN AND PHILLIP MAKER Date of Inspection:11r9r9s SEPTIC TANK: x (locate on site plan) Depth below grade: V Material of construction:x concreate_m eta l_FRP_Polyethylene—other(explain) If tank is metal, list age nla . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L9'8"H5'7"W4'10" Sludge depth:14• Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness: Distance from top of scum to top of outlet tee or baffle:OVER Distance form bottom of scum to bottom of outlet tee or baffle: rda How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND THEN MAINTAINED EVERY Two YEARS. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete_metal_FRP_Polyethylene_other(explain} Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rJa Distance from bottom of scum to bottom of outlet tee or baffle: rda Date of last pumping,,la Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rVa BUILDING SEWER: (Locate on site plan) Depth below grade: vv, Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction line•OWN Diameter: nla_ Qe1mments: (conditions of joints,venting,evidence of leakage, etc.) (reylaed 04117)97) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 EASTWOOD LANE COTUIT 025-035 L113' Owner: KAREN AND PHILLIP MAKER Date of Inspection:1119198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nfe Capacity: nla gallons Design flow: rda gallons/day Alarm level:_nra Alarm In working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rYa DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nIa Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (reyleed 04117)97) 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 EASTWOOD LANE COTUIT 025-035 L13 Owner: KAREN AND PHILLIP MAKER Date of Inspection:111I9f98 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits,number: ONE leaching chambers,number:Na leaching galleries,number: Na leaching trenches, number,length: rda leaching fields, number,dimensions:Na overflow cesspool,number:nia Alternate system: Na Name of Technology:_Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH Prr IS PASTTHE EFFECTIVE DEPTH OF LEACHING,LIQUID LEVEL IS OVERALL PIPES,PIT IS IN HYDRAULIC FAILURE. CESSPOOLS:_ (locate on site plan) Number and configuration: Na. Depth-top of liquid to inlet invert: Na Depth of solids layer: Na Depth of scum layer: Na Dimensions of cesspool: Na Materials of construction: Na Indication of groundwater: Nz inflow(cesspool must be pumped as part of inspection) Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: Ne Dimensions: We Depth of solids: Na Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 8 EASTWOOD LANE COTUIT 025.035 L13 KAREN AND PHILLIP MAKER 1119198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 66 0 O Page ! of 10 (revised 04n7197) r r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 8 EASTWOOD LANE COTUIT 025-035 L13 KAREN AND PHILLIP MAKER 11119198 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X— Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revised04127197) 'rye 10 of 10 �7 7(o 0......................... Fps............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,, OF..................................... - h3 Appliration -fur Uiipuuttl 10orkii Tatuitrurtion Veruiit rr ` r a Permit to Construct (P<Or Repair ( ) an Individual Sewage Disposal System at: ........._407.#-----n------- 1�--�1`&QJA�ljoc:�-��.�..-,0f4--- -------- -�®7�U,c---------------- -- TP� /� Lo ti ddress or Lot No. O er 1 I Address ----------•--- ' 'I�'�'......-C�--s1(...... ------------- ------------------------7 b91.G��2,s.S&--------------------------------- Installer Address d Type of Building ^^�� Size Lot............................Sq. fee U Dwelling—No. of Bedrooms... J.................................Expansion Attic 0/� Garbage Grinder aOther—Type of Building ---------------------------- No. of persons....11 T------------------ Showers ( ) — Cafeteria ( ) Otherfixtures --------------- ------------------------------------I---------------------------------------------------------------------------------------------- W Design Flow...... .........................gallons per person per day. Total daily flow....3.®.0--------------------------gallons. WSeptic Tank—Liquid capacit/ �_gallons Length________________ Width................ Diameter---------....... Depth.____..- x Disposal Trench—No_____________________ Width.................... Total Length------------------.. Total leaching area....................sq. ft. Seepage Pit No....../---.--__-'_/Diameter..6/.X46----- Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box (V) Dosing tank ( ) , Percolation Test Results Performed by-------- ---------------•---•-----••••••---•••---•....-----------•-----_.. Date---•-•-••-•-•----------•----•-------._.. a a Test Pit No. I................minutes per inch Depth of Test Pit----:............... Depth to ground water_---------------------- ri-4 Test Pit No. 2----------------minutes per inch Depth of Test Pit....................: Depth to ground water----- __----.-------- - ------------------------------------------------------•-•-•----•-•-------•------------ -•-•---•-•-•------•---•-------------- O Description of Soil-. ----�----•- --tl�� _ LC--�---!A-•--•----------•-------------------- ---------•--•-----•---------------------------------•---•--•-------- x rr -�----•-------SU5�f1— W ---------- --------------------------�-----�'-i2--------- MIM—t-�OP��----��Ml------------------------------------------ - .......................... U Nature of Repairs or Alterations—Answer when applicable................-------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System iti accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. C or / r - Dat Application Approved By------- 4A,C_ . ` --- -- --------- ------ - D --- Application Disapproved for the f ollowi g reasons----------------------------------------------------------------------------------------------------------------- Date Permit No......................................................... Issued....r ---��:�'Z7................... Date _—— —. —-------------------------------- t, Fsnc............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .. ..... .. .......... -- .O F................................---.. .............. ------ ........-...:........ App irtttiou -fur Dispoiial Workii TonMrurtion Vrruiit Application is hereby made for a Permit to Construct (le<or Repair ( ) an Individual Sewage Disposal System at Y */ / 4,12 / f� < Lo rio Addrs or Lot No. 0•er = �C= Address ..... C------ =------------ --_------------------/-A9Z,.,�'rt .-------_____--------------------------- Installer Address �. '�r� Type of Building Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms________ __________________________________Expansion Attic Garbage Grinder V/40 p, Other—Type of Building ___-___-_-___________-____ No. of p - Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- -- W Design Flow......... _________________________gallons per person per day. Total daily flow_..._-9_....................................gallons. WSeptic Tank—Liquid capacity XQgallons Len-th---------------- Width-- Diameter________________ Depth-_.-______---_- x Disposal Trench—No. ____________________ Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage-Pit No._____ _ Diameter__ ff ` __. � �.______,_ _ �z__� __-__ Depth below inlet____________________ Total leaching area.._______-_______sq. it. z Other Distribution box (f') Dosing tank ( ) ~' Percolation Test Results Performed by-------------------------------------------------------------------------- Date.--::------------------------------_---.. ,a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water----________-__-____. tz Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water________________________ ! --------- ------•--------------------•--•------•---------------------------------•--•-----••----••--------------------------------------- x Description of Soil----Qtit ------�-�------ ---��t�-------------------------------.........................- ------ ---- -- --- --- -------- - """ �---- ---- W ''""k UNature of Repairs or Alterations—Answer when applicable________ _____________________________...................................................... Agreement The undersigned agrees to, install, the aforedesc ibe'd Individual Sewage Disposal System in accordance with the provisions of Article.:\I of the State:Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance .has been issued by the board-of health. t' ------------ +.� a. Application Approved By------- - -- - -- --- q� " ------------ --------- ..Z__ --. --J__J. Application Disapproved for the following reasons:------------------------------------------------------------------------------------------------------------------ --------------------------•--.= -------------------------------------------------------------------------------------------=----------------- Date l PermitNo-----------------------------.........-=................. Issued...... ----------•-----..... Date a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .o.:�.AJ..............OF..:....... ? #. /C/..:5 �. ........-...........-.. Cnrrtifirate of fuoutpliaurr THIS IS TO CFRTIFY, That the dividual Sewage Disposal System constructed ( or Repaired ( ) by............. /--- ---- J,+r O r in§Xqller has been installed in accordance with the provisions of : c I of.The State Sanitary Code as described in the application for Disposal Works Construction Permit N _- >_ _ _ ____________ dated-,............................................. THE ISSUANCE OF THIS CERTIFICATE SHAL OT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... _® ? ------------------------------------------• Inspector........•--• -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' LUIt/... .. .. ..OF..._........ ................ No......................... FEE........................ Rnpwittl urk,i Cnowitrurtiou Vamit Permission is hereby granted -----)—1......._._, f�/� ----------------------------------------------------------- to Construct ) or Repair ( ) ,an Individual Sewage Disposal S stem at No............,..;-) -d-...... Street / as shown on the application for Disposal Works Construction mit N Dated__, -••---------- -=------- -- ------- -------. -.. - --_ Board of Health DATE................... ....................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS F i a; '• � � ��° '` "` :• TES LoTi rJ '� o. asr ,_elf. i ` CS 3 ,5 / �s j 8. 2 72,j 7"-. 11 /Vt6 W r"? 7�,+A:.. '7 `t,c�• r3 u/LD//vG S ETl3AC� .��QU/,��MF�/7� 30 ' F20/VT TZF�Ta. �i20 PO SEZ7 3 BED1zooMS SE P T I C S y5 T6M GOn/S T?UG T/ON SHA L.-1- GONFO/ZM TO MASS • DOES I O AJ FLOW 3 3 O GALII7A Y ENV/,eONMEn/TAL CODE TITLE L L- A C,L-/ 2.4 TE .G 2 M/N. // /C//e6vtSEA' 7- /- 77 - 5f3/i/�� 9CE G �J/ w6D /3Z Dr o TOP OF / EALT'N OL/LA 7-/0nS /020�OS E D L E-4C.�/ .4,QE4 2 C7D Fo T/ON4�2-7 �NI pE.Q✓/o v5 G'o✓6R MANHOLE �Co✓E,i2 TO �X TE�lD 7.O A TO A2E VeA.17- C--S Wi TN/N /" OF G/n//5H�c7 6T�.4 DE �20M / IC-/LT2A77AA , D/sr Qh4T SOX . I �s I�� cZo/"✓w��D E— � . rL— M/n// 6..nr�wJ 4' D/A. T2E,a Q� ~ tilun./ -�.- _. � 3..,,.►.,v iGar 4` oI,A. ` /D L Eq cN r P/72-- FLOW LINE —� t ` MIN AiTCH —�— P/T r/2 D1A. �4" FOOT /O"MIN /Q*/fool 2" Mini �i rc fi ��'¢�'/� /4 14 "/Foor t ° �WASHEI7 -Y- /O DC) Mint /7.00 N, !� GOD /7•S-ji -r - /nivF-Z r !6 •SO ( � S r0 n/E GALLON/ /NVE.er /NVE.2T CA PAG/ Ty gR0UA/O SE�T/G TA N� Mo.67 _ E-EV. /6, O 807,rom of /NVE2T C P/r*/ /N vE zr NO GA�BA6E G•e/NDE.2 ��•Oq --- — ------- 20' M/A//A4 UA4 y< 6 S / TE ILL AA/ L O C,A 7a/0AJ Co T-0 IT �EpTic TAN.�� 0/S7-r2/BUT/ON 80X --- - CS OUTL_ET.S) AND LE.4CA11N0 A='/T TO BE OF <=0AJCT�ETE _ _ CO/VC2ETE ST,eEA/GT� 3000 PS•/ M/n/. f L L L C EIJ - 1=fEI l<fOPi S 1, 1, 20000 ,. /-/- /O LOA DIn/6 r3Y C. ,e. SA-/OAT /NC. �A�t►�OF# /4 TO�y LAA/E o CRAIG y ,0,&/VEWAY h/OT TO BE LOG4T ED RAyf OND G t; OVE2 SYSTEM UA/LE 55 20 17E Nam//S , 1-7 Ll SS. o SlioFT DES/GA/ LOAD/A/G /S USED. No 27483is fm G DA TE tiE.4 L 77 4 7- A PP,eO✓Al L- A eH i VENT PIPE (0 Least 24 inches tall) SECTION A -A 10' min, from *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule 40 PVC w/Chan oai Odor Filter ' ALL OUTLET PIPES FROM THE DISTRIBUTION BOX SHALL BE Existing Foundation house to septic tank PROFILE VIEW OF LEACHING SYSTEM SET LEVEL For: AT LEAST 2 FT. t2' jcoNCReT> coven D-BOX cover must be Septic tank covers must be - ;� ••., within 6 In. of finished grads Within 6 in. of finished grade _ 3 - 5" OUTLET t Tawn 4f Grade over Septic Tank - 100.00 �rade over SAS - ELEV- 96.00 to .99.00 - -�`v KNOCKOUTS - '' 1,r..d� .x.., y Grade over D-Box - 98.00 .'I /'� ova«`R€ /a•a r r�2 " Irn.A.a cw.A+a 8ten+ 'N r/s^- +/r• IreeA.a r...m,.. : /� {' INSPECTION cover must be -Z'. - 5.5' ; ' i2" INLET within 6 in. of finished grade r'N OUTLET 6• i• 0 L'adwood La 5 - 0,02 3 HOLE H-20 i tirrttit^mlzia DIST. BOX 3' Maximum Cover Top of SAS-Etev,-94.50 •�,r } 2 S 25' EXIST. s-0.0/ or Greater S• 0.010" per foot jy J/ f EXIST, PIPE ~ 0 1,000 GAL. 1 C C3 C7 0 C C.� co 15.5 4" - SICK 40 Te 1.75" < •5r+,s`r j FROM EXIST. FOUNDATION i aNj � SEPTIC TANK Ian 36 o o n a C o o cr Effective Depth p O H-zo o 20' z units e es I7 FLAN SECTION CROSS-SECTION 9 I CONCRETE FULL FOUNOATION� i rn rn O 4' 18 4' �} H u 3.5' 5' ---3.5' - v d 3 HOLE H-20 DISTRIBUTION BOX 6 In.of 3/4`-1 1/2' a i > i tv SYSTEM PROFILE ; Compacted atone ' 2 - Effective Length NOT TO SCALE R , I Not to Scale c Effective Width > emuNa+d 44 N: raagm b2 4MA.Tw "fr c c SOIL ABSORPTION SYSTEM (SAS) 6 in.of 3/4"-1 1/2" 5' PROV!DED o 500 C H-20 LEACHING UNITS / WIGGINS PRECAST GENERAL NOTES compacted atone m ` NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE Bottom of Test Hole I Elev.- 86.00 Not to Scale 1. Contractor is responsible for Digsofe notification --------------------------_---------- P p " distributiongies and pipes. and protection of all underground utilities Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED 2. The septic tank and box shall be set level on 6 of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation j by Carmen E. Shay - Environmental Services, Inc. PERCOLATION TEST 5. The contractor shall install this system, in accordance I with Title V of the Massachusetts state code, the approved plan I Date of Percolation Test: JULY 6, 2005 and Local Regulations. Test Performed By. CARMEN E. SHAY, R.S. g 6. If, during installation the contractor encounters any Results Witnessed By. WAIVER (per BARNSTABLE B.O.H.) \ l i soil conditions or site conditions that ore different EXCAVATOR: SMOLLER EXCAVATION I from those shown on the soil log or in our design Percolation Rate: Less Than 2 MPI 0 48" \� 14$ 1 1' N, \ installation must halt & immediate notification be \ i made to Carmen E. Shay - Environmental Services, Inc. T - 19� \\ TEST HOLE #1 i f i 7. No vehicle or heavy machinery shall drive over the lest Hole Test Hole \ ELEV.= 98.00 N0. 1 No. 2 � I septic system unless noted as H-20 septic components. _ \ 8, Install Tuf-Tite gas baffles or equals on all outlet tee ends. DEPTH SOILS ELEV, DEPTH SOILS ELEV, - `� �^ VENT PI RE 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. v - _ J SCH 40 VC I',: 10. All solid piping, tees & fittings shall be 4" diameter Lsandy LScrocmyd I ��'� \\�� \\ \�t \\\ AREA ;;�12' Schedule 40 NSF PVC pipes with water tight joints. ' 'L l 11. Municipal Water is Connected to The Residence and Abutting I I ,0 Y 3/2 10 v 3/2 I � � �� i-� � \ Q __� _� �:,�_. 0"-6" A 97.50 0'_6" A. 97.50 �i 9 ' `,\ / I`2i �eoo+de 7' Properties Within 150 Feet, Loamy Loamy ?t Scnd Sand ��'~ `� i I THE PROPERTY LINES ARE APPROXIMATE AND to YR 5/6 to YR s s { `9� i j COMPILED FROM THE SURVEY PLAN GENERATED BY By Be/ GEARGE LOW, LAND SURVEYOR, ENTITLED 6"- 36" ndy95.00 g`- 40' !94.75 i \ I I "PLOT PLAN FOR LOT #13 EASTWOOD DRIVE, COTUIT, MA, Sa Loam anyoom I i '� 0 II DATED NOV. 16, 1973 and (PLAN BOOK 284, PAGE 42) ,o YTt 6/s tO 3/6 ,i' Q \� `\\ �\ ! �� TEST HOLE #1 & THE DEED DESCRIPTION ( BOOK 1346 PAGE 1056) 36"-48" c, 94.00 40"-48" C, 194.GO \\ \ I ELEV.= 98.00 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Med. Med. �! Lo THE 'SEPTIC SYSTEM INSTALLATION. Sand Sand I ® 1 1 \ 1 �� I- I I \ \ - i Foiled 2.5 Y 7/4 2.5 Y 7/4 7- I I \ ' I LOT #14 EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE OR 48"-144" C, 86.00 ��44* st.o0 (� t \\ r92� Q Leach pit REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE O i �, �' PROJECT BENCH MARK FROM THE' EXISTING LEACH PIT TO BE DISPOSED Ll ,'' DECk' TOP CF FOUNDATION OF AS PERBOARD OF HEALTH SPECIFICATIONS. i\ CO i ' �' ELEV. = 100.00 (Assumed) NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY � I ASSESSORS MAP 25, C LOT 035 i NN\ i EXISTING LEGEND 3 BEDROOM I ,! HOUSE 104X1 DENOTES PROPOSED Perc #1 ~y Depth to Perc: 48 to 66" (�{ �' #8 i SPOT GRADE Perc Rote= Less Than 2 MPI _ Groundwater Not Observed / ��' O X 104.46 DENOTES EXISTING No Observed ESHWT - - ' I O SPOT GRADE j "1 / ' ADJUSTED H2O Elev. = None PL PROPERTY LINE 96r PROPOSED CONTOUR I \�\\ LOT #13 i\ CL, % SEA SHELL - - - - - -97 EXISTING CONTOUR 23,560 Square Feet t/�� DRIVEWAY I DEEP TEST HOLE & PERCOLATION TEST LOCATION j 2-18' DIAM. ACCESS MANHOLES � � � U \\\� �/ �� 90 � 6 i \ 1 6 FOOT STOCKADE FENCE + \\ \ / --------- - ,,, ,,:,• ..,�; , �, ��____�__ REV.. 7f06/05 Revised Soil Logs and Stripout per BOH. (' �� ;1 % REV.: 5/23/05 Added Vent Pipe/Made SAS H-20 INLET OUT ET I ' 96 P LOT P LA THE ACCESS COVERS FOR THE SEPTIC TANK. _ T` t ' DISIRIBU?lON BOX AND LEACHING COMPONENT ' �'+hc.�-+y,;r-;si'•f„-'^•'T�-.,,r,;�-•',M'•• 5'cT DEEPER THAN 6 INCHES BELOW FINISHED PROPOSED SEPTIC SYSTEM UPGRADE GRADEWI NISHED 1 � { SHALL BE RAISED TO THIN 6' OF STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. I `-- --' ---' ------ -`--- --`f ---"-------------------- PREPARED FOR PLAN A N VIEW EW INSTALL TUF-TITE GAS BAFFLES OR EQUALS 3-24• REMOVABLE COVERS � - 7 0 0 -D_n_T V-A .7 ' MR . P H 1 �L I P MAKER 1 AT (40 FOOT RIGHT OF WAY) 8 EASTWOOD LAN E _ �S" mint'"clearance ' 4• r.�� r• � ! i3•fLIET �I 118" rnin. l2" m n. inlet to outlet 6 min. INLET � C O T U I T min ,' MA ! 1. 10 t }- Ltqul level OUTLET I 5' -7" --- I L i' s' -r Desicin Calculations E L�' 4'_D• min. PREPARED BY: y Liquid depth fog �.. Number of Bedrooms: 3 Equivalent to 330 GQL/Day (330 Gal./Dap Min. per Title V) q�, HEY V L e T� Garbage Grinder. No moo ti l/1/ Leaching Capacity Proposed: 330 Gal./Day Minimum (Mina Per Title o -- •'' •'�''' ;' 'y'"•"'�'''j'-•`�•�^' " "' ' ` "' ' SY Septic flank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. 0 20 40 50 0 HA '.,, VIRONMENTAL SERVICES, INC. 9'-0" ` 4 -10• CROSS SECTION ENS-SECTION SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch o. 1 Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. - 222.00 ga!lor: a P.O. BOX 627 Sidewall Area: 0,74 gal./sq. ft. x 148 sq. ft. = 109.50 gallon. IST0' EAST FAL.MOUTH, MA 02536 Providing: = 331.50 gallon; SgNIFARIPN TYPICAL 1000 GALLON SEPTIC TANK SCALE: 1 =20 TEL FAX 508-539-7966 NOT TO SCALE Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND SCALE: 1 "=20� DRAWN BY: CES DATE: MARCH 1 O, ZOOS 4' OF WASHED STONE ON THE ENDS. PROJECT#SD702 FILENAME: SD702PP.DWG SHEET 1 OF 1