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HomeMy WebLinkAbout0089 EISENHOWER DRIVE - Health w 89 EISENHOWER DRttic A F f l i °I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 89 Eisenhower Drive Property Address Jarred & Haley McMurray _ Owner - ----- ----..._------------ Owner's Name ---- - ----- --- - ----- — information is required for every Cotuit __ _ MA_ 02649 9/23/10 — _ _ page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:when filling out forms A General Information ' on the computer, I , use only the tab 1.. Inspector: key to move your j cursor-do not Carmen E Shay__ use the return Name of Inspector key. Shay Environmental Services, Inc. ? de Company Name 185 Ashumet Road Company Address — eJw� Mashpee ---- — -- MA _ 02649 City/Town State Zip Code 508-539-7966 _ _ _ 3080 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 ❑ Nee Fp ' er vAya by the Local Approving Authority c ; C= _ 9/23/10 o ` r°-- ---- - -n —--- Ins ctors Si nartur Date The system inspector shall submit a copy of this inspection report to the Approving Atdhori (Board:; of Health or DEP) within 30 days of completing this inspection. If the system is a shams stem or has a design flow of 10,000 gpd or greater, the inspector and the system owner sha Sub4 the report to the appropriate regional office of the DEP. The original should be sent to the syst� owner and copies sent to the buyer, if applicable, and the approving authority. to Co m ****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. l� 89 Eisenhower Drive,cotuit•03J08 Title 5 Official Inspection Form:Subsu�ace Sewage Disposal System•Page of 15 L Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive _ Property Address Jarred & Haley_McMurray _ Owner Owner's Name information is required for every Cotuit MA 02649 9/23/10 __ _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E /always complete all of Section D A). System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 1 Leach Pit present. 4.5' liquid in leach pit, 5' Stain line. No evidence of backup B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive Property Address -- Jarred & Haley McMurray r Name —_------------ -- - — —e Owner's information is required for every Cotuit _ _MA 02649 _ 9/23/10 _ _ _ _page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect 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 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. 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner -----------_—-- --- ------- ---—-----.. Owner's Name information is required for every Cotuit MA 02649 9/23/10 _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or ,more from a private water supply.well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool O ® 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 ❑ ® 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. 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner Owner's Name information is Cotuit _ MA _ 02649 9/23/10 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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. 89 Eisenhower Drive,coluit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner Owner's Name - - information is required for every Cotuit MA 02649 9/23/10_ 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)] 89 Eisenhower Drive,coluit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner ---------_ -------—--—---- -- ---- Owner's Name information is Cotuit MA_ 02649 9/23/10 required for every page. City/Town State Zip Code Date of Inspection 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): 330 Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): - Sump pump? ❑ Yes ® No Last date of occupancy: 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: — Last date of occupancy/use: Date Other(describe): --- 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner Owner's Name _-- information is required for every Cotuit MA 02649 9/23/10 ___._ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping.Records: Source of information: None available 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): Approximate age of all components, date installed (if known) and source of information: 1980 Were sewage odors detected when arriving at the site? ❑ Yes ® No 89 Eisenhower Drive,cotuit-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts —W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments As••' 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner Owner's Name -- information is required for every Cotuit MA 02649 9/23/10_ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18 inches feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leaks, plumbing ro erly vented 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 -------------------------------------------------------------------------------------------------------------------------- Dimensions: 5x 5' x 8' - 1000 gallon Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 1 _ Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a � 89 Eisenhower Drive Property Address Jarred & Haley McMurray__ _ Owner Owner's Name --------- — -- — information is Cotuit MA 02649 9/23/10 required for every __._—.___ _ 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.),- Tank in good condition, inlet tee in good condition, outlet Baffle in food condition. Grease Trap (locate on site plan): Depth below grade: feet -- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: - Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive _ Property Address Jarred & Haley McMurray Owner Owner's Name ---- — information is Cotuit MA 02649 9/23/10 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: --- - - - -- Capacity: — gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert D-Box Present 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.): 1 Outlet to leach pit. D-Box in fair condition. No significant evidence of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 89 Eisenhower Drive,coluit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner Owner's Name information is Cotuit _ MA 02649 9/23/10 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-6'diam x 6' D ❑ 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.): 1 Leach Pit present. 4.5' liquid in leach pit, 5' Stain line. No evidence of backup 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e •'`r 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner Owner's Name information is Cotuit MA 02649 9/23/10 required for every _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and.configuration Depth —top of liquid to inlet invert Depth of solids layer — Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids -- - Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive Property Address — -- --- — ---- -- -- Jarred & Haley McMurray Owner Owner's Name - -- information is Cotuit MA 02649 9/23/10 _required for every _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide.a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 89 Eisenhower Drive.cotuit•03/08 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 14 0l 15 New Page 1 Page 1 of 1 p TOWN OF BARNSTABLE LOCATION O9 59G1\k0WCr gtJ SEWAGE VILLAGE C U-Fu T ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. _ SEPTIC TANK CAPACITY I M"D c LEACHING FACILITY:(type) (size) I C'n _ NO.OF BEDROOMS 3 ^ OWNER 2-S.SAC5 PERMIT DATE:_ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) I Feet FURNISHED BY!r-A T_ 4n -:57 FOr� �0 f lr(07 1 A a ,3 3 / Ya a� y a Y3 a� 3 S3 �v y s� So http://www.town.barnstable.ma.us/assessing/2010/HMd1splay.asp?mappar=039092&seq=1 9/25/2010 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Eisenhower Drive Property Address Jarred & Haley McMurray Owner Owner's Name information is required for every Cotuit _ MA 02649 9/23/10 page. City/Town State Zip Code Date of Inspec_tion ___ D. System Information (cont.) Site Exam: ® Check Slope ® Surface water- Check cellar ❑ Shallow wells Estimated depth to high ground water: 14 + feet. 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.- refer to Topo Maps and plans on file i 89 Eisenhower Drive,cotuit•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 � GJ � . t� COMMONWEALTH OF MASSACHUSETTS �� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF.ENVIRONMENTAL PROTECTION " ;TITLES OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ,CERTIFICATION'. Property Address: 89 Eisenhower Drive Cotzrit. MA 02635 Owner's Name: Margaret Isaacs. Owner's Address: t -. Date of Inspection; October 25: 2007 ra -T5 Name of Inspector: (Please Print) James M. Ford -.:: Company Name::. James M.Ford 'T n,,3 Mailing Address: P.O:Box 49: Z' Osterville,MA 02655-0049 Telephone Number: (508)862-9400 ' co 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 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 N ds Further Evaluation by the Local Approving Authority F it Inspector's Signature: Date: November 2. 2067 The system inspector shall subs. t a.copy of this inspection report to the Approving Authority(Board of Health or DEP).within 30 days of completing.this inspection. If the system is a:shared system.or.has.a design.flow of.10,000 gpd or'greater,'the inspector and the system owner shall submit the report to.the appropriate regional office of the DEP. The original should be sent to the.system:owner and copies sent to.the buyer;if applicable,and the.approving .authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page'1. Page 2 of 11 OFFICIAL INSPECTION FORM-,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 89 Eisenhower Drive _ Cotuit,MA Owner's Name:. Margaret Isaacs Date of Inspection: - October 25, 2007 Inspection.Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. ' Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or . repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)i,n the for the following statements. If"not determined",please explain. The septic tank is metal and over.20 years old* or the septic tank(whether.,metal or not)is structurally unsound,exhibits substantial infiltration'or exfiltration or tank failure'is imminent. System will pass inspection if the existing tank is replaced with a complying septic.tank as approved by the Board of Health. *A metal septic tank will:pass inspection if it,is structurally sound,not leaking and if a Certificate.of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or,break out or high static water level in the distribution box due.to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: Tfie system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION '(continued) Property Address: 89 Eisenhower Drive Cotuit, MA Owner's Name: MarQaretIsaacs Date of Inspection: October 25, 2007 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:r; Cesspool or privy is within 50 feet of a surface water Cesspool or privy is. within.50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of.Health(and Public Water Supplier,if any).determines that the system is functioning in a manner that protects the public health,safety and environment: The system has aseptic tank and soil absorption system(SAS)and the SAS.is within 100 feet of a surface water,supply or tributary to a surface pater,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 aseptic tank and SAS and the SAS is less.than 100 feet but 5.0 feet or more from'a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 , Page 4 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued)' r Property Address: 89 Eisenhower Drive Cotuit:MA Owner's Name: Margaret Isaacs Date of Inspection: October 25. 2007 D. System Failure Criteria applicable:to all systems: You must indicate either"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 ''/z day flow Required pumping more than:4.;times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any-portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is,within 100 feet of a surface water supply or tributary to.a surface water supply. _ ✓ Any portion of a cesspool or privy,is within a Zone 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 10.0 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 coliform.bacteria and volatile organic compounds indicates that the well.is free from pollution from that facility 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.] No :(Yes/No)The system fails. Lhave 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 whatwill be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow.of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply,to large systems in addition to the criteria above) 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 E 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 89 Eisenhower Drive' Cotuit:MA Owner's Name: _ Marzaretlsaacs Date of Inspection: October 25 2007 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: Yes No 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(3)(b)]. 5 , Page 6.of l l : OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C 'SYSTEM INFORMATION Property Address: 89 Eisenhower Drive Cotuit, MA Owner's Name: MarzaretIsaacs Date of Inspection: October 25, 2007 FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design): '3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203.(for example: l 10 gpd x#of bedrooms): 330 . Number of current residents: 0 Does.residence have.a garbage grinder(yes or no) n/a Is laundry on a separate sewage.system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no):., No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump.(yes onno): No : Last date of occupancy: Unknown COMMERCIALANDUSTRIAL Type of establishment: - Design flow(based on 310_CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water.meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe):. Approximate age of all components,date installed(if known)and source of information: Date of installation unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION,(continued Property Address: 89 Eisenhower Drive Cotuit. MA Owner's Name: Margaret Isaacs Date of Inspection: October 25 .2007 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: -cast iron _40 PVC . other(explain):. Distance from private water supply well or suction line Comments(on condition of joints,venting,evidence of leakage,etc.): SE I PTIC TANK: ✓ .(locate on site plan) Depth below grade: 12 Material of construction: ✓ concrete _metal fiberglass _polyethylene: _other(explain) If tank is metal list age; Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) . Dimensions:. _ 1060 gal Sludge depth: 211 Distance from top of sludge to bottom of outlet tee or.baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10 How were dimensions determined: _Measuring stick Comments(on pumping recommendations,.inlet and outlet tee or baffle condition,structural'integrity,liquid levels as related to outlet invert;evidence of leakage,etc:): Cement tees were 1yesent. The li uid level was even with the outlet invert. There did not aZpear to be anv si ns of age. GREASE TRAP:* No (locate on site,plan) Depth below grade: . Material of construction: _concrete _metal `_fiberglass _polyethylene`_other (explain): Dimensions: . Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments-(on pumping.recommendations,inlet and outlef tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): ` 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 Eisenhower Drive Cotuit MA Owner's Name: Margaret Isaacs Date of Inspection: October 25 2007 TIGHT or HOLDING TANK: None (tank must bepumped 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: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc:): DISTRIBUTION BOX: ✓ ` (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _Even Comments(note if box'is level and distribution to outlets equal,any evidence of solids carryover,any evidence of'. leakage into or out of box, etc.): , The D-box was in normal condition. No solids were 12resent.. PUMP CHAMBER: None (locate on site plan) Pumps in'working order(yes or no): .,. Alarms in workin&order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,.etc.): . 8 -.. Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 Eisenhower Drive Cotuit MA Owner's Name: - MarQaretlsdacr Date.of Inspection: October 25 2007' SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: . Type leaching pits,number: I-6'x 6'(1000 jza1) 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, The nit had 4'of liquid on the bottom. The scuin line was anproxirnately 5'up from the bottom The cover was 14"below--grade,There did not a ear to be an signs o ailur e. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic,failure,level of ponding,,condition of vegetation;etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued). Property Address: 89 Eisenhower`Drive Gotuit MA`, Owner's Name:. Mr a aret Isaac s . Date of Inspection: October.25'2007 ' SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at'least two permanent reference landmarks or benchmarks. Locate all wells.within 100 feet. Locate.where publicwater supply enters the building: G r y a y3 a 3 53v y ESo A 10 Page 11 of 11 y OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address: 89 Eisenhower Drive Cotuit, MA Owner's Name: Margaret Isaacs Date of Inspection: October 25, 200T SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water. 30+/. feet Please indicate(check)all methods used id determine the high ground water.elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,.installers-(attach documentation) Accessed USGS database-explain- You must describe.how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 30'+/ to groundwater at this site: This report has been prepared only for the septic,system and components described herein: This septic system has been inspected and.passed as of the date of inspection. This report is not a warranty.or guarantee that the system will - function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected; Town of Barnstable ` ypF THE Tp� hP ti� Regulatory Services snxrrsrnare Thomas F. Geiler,Director MAM Public Health .Division TEa rw'�" Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. /' ".. Ll --• c��/ cam', ?,�'., •.,--,-• �1)(� (�)�� i� 1 �7 3 Cam } ` l' •i� /-���l�i/�7:,- t •-,.•may �� .C..�Y._. ._ jo 10 1111 `--F rc r S -T d .B(//G'r' T� G�/i J-'h'/•�,� COMPLETE •N COMPLETE THIS SECTIONDELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature �� �• item 4 if Restricted Delivery is desired. XfA� Cpd,,� t� ■ Print your name and address on the reverse L�VAdd sse& I Aft so that we can return the card to you. B. Received by(Printed NarnXW ate of Tivery ■ Attach this card to the back of the mailpiece, / or on the front if space permits. r ZS i C D. Is deli address different from:item % 1. Article Addressed to: r If YES,enter delivery address below: =No 0 6�655 3. Service Type :Certified Mail ❑Express Mail ❑Registered jT Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7006 0810 0000 3525 2711 (rmsfer from service laben P$Form 3811,February'2004" ' ' Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail P USPS Permit No.G-10ostage&Fees Paid • Sender.Please print your name, address, and ZIP+4 in this box• Public Health Division Town of Bamstabie - 200 Main St Hyannis,Massachusetts 02601 j I I I I I j I III„I„I,I,III I II,,i,,,1!,I„Ill,,,fi,,,,,i,lii,,,ii,,,,i,i,i E _ �� F C"itizen Web kequesi Page 1 of 3 41 l� W MASS T �t ,f �,. 'a •"._.w »ate'fir' �/C'* Ma: ,:rw t. .= "•,...... Logged In As: Citizen Request Management Tuesday, AP TOWfV�oconnelt 1'� r Route to Users Search Requests Create Requests Request Information Request ID: 20842 Created: 4/10/2007 2:34:21 PM Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard T Estimated 4/12/2007 Change Estimated Mar April 2007 Completion Completion Date: iw Date: Sun Mon Tue Wed Thu Fri Sat 25 26 27 28 29 30 31 1 2 3 4 5 6 7 ' 8 9 10 11 12 13,14 129 30 1 1 2 3 4 5 Created By: Crocker, Sharon Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel Number Ma Someone has P 039_. ._.,' Block: 092 :Lot: 000 vandalized elec. meter to house. The Elec Co. has shut elec off at street. Parcel Look She does not expect to be able to fix the electricity any time soon due to finances. Does this make it http://issgl/IntemalWRS/WRequest.aspx?ID=20842 4/10/2007 I Citizen Web Request Page 2 of 3 uninhabitable? Her son and daughter- in-law are living there. (See internal notes) Email: Edit Re uestor Information Track Request Progress Request Work History: Internal Note History: Entered on 4/10/2007 2:33:49 PM by Crocker, Sharon It sounds as though she is trying to get them (and possibly a child)out of house. (They do not pay any money to her and are not bein, responsible) System entry on 4/10/2007 2:33:49 PM: Assigned to O'Connell,Timothy Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) J, Spell Check` '" a ySpell Check Add document or image link: ' Browse I' * You can also type in a folder name to see everything in the folder Current Links: I Time worked on request: 0 Response time: *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 http://issgl/lntemalVvRS/WRequest.aspx?ID=20842 4/10/2007 Citizen Web kequest Page 3 of 3 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. G Save changes Check to notify town employee below t Save changes and notify o review this request. citizen* Health Office f= r Close request and notify citizen* Agostinelli, Joan Brief message to reviewer: *notify works if email address was given SpeIL C Public Use: Printer Friendly Version Internal Use: Printer Friendly Version M http://issgl/IntemalWRSPNRequest.aspx?ID=20842 4/10/2007 Parcel Detail Pagel of 3 T HE �a -- ; � -3.j ey p13SthDL r _ ry Logged In As: Parcel Detail Thursday, Ap Parcel Lookup Parcellnfo Parcel ID 1039-092 Developer LOT 23 Lot { Location EISENHOWER DRIVE Pri Frontage j125 Sec Road Sec -_ Frontage Village iCOTUIT Fire District COTUIT Sewer Acct 1 Road Index 0483 r� InteracMapT, f Owner Info Owner KOC, MARGARET&ALLEN, CAROL TRS Co-owner streetl;PO BOX 836 � streetz City IOSTERVILLE Q State jMA zip j02655 Country g Land Info Acres 10.60 Use Single Fam MDL-01 zoning RF Nghbd 0106 Topography E Road _-.._....._ .................. ......_..... ..._.. _ ..._......... Utilities i Location j Construction Info Building 1 of 1 Year Roof _.__. Ext Built 1980 struct!Gable/Hip Wall;Wood Shingle Effect 2140 Roof Asph/F GIs/Cmp"- AC None Area Covert Type F r __-„__ . _ Be Style Cape Cod Wail Drywall Rooms{3 Bedrooms - - - � Model iResidential Int Bath Floor j2 Full ll Grade Average Heat Hot Water Total 15 Rooms Type Rooms http://lssgl/intranet/propdata/ParcelDetail.aspx?ID=2539 4/19/2007 Pazcel Detail Page 2 of 3 _ s 1:. Stories 1 1/2 Stories HeatiGasTW4 W _..a__ Found- PouredYConc. ° [ Fuel 6 ation i h -- - _.. _-- .... ........_.... Permit History Issue Date Purpose Permit# Amount Insp Date Comrr 10/1/1979 B21743 $0 1/15/1981 12:00:OOj AM CO 11. - Visit History Date Who Purpose 6/27/2005 12:00:00 AM Paul Talbot Meas/Est 11/14/2000 12:00:00 AM John Greene Data Mailer Sales History Line Sale Date Owner Book/Page Sale P 1 6/11/1999 KOC, MARGARET&ALLEN, CAROL TRS C153510 ; 2 CROSBY, JOHN R&JOHANNA C77225 Assessment History _. Save# Year Building Value XF Value OB Value Land Value Total Parcf 1 2007 $187,500 $0 $0 $178,800 2 2006 $164,600 $0 $0 $189,500 3 2005 $152,800 $0 $0 $189,500 4 2004 $122,100 $0 $0 $113,700 5 2003 $108,400 $0 $0 $56,000 6 2002 $108,400 $0 $0 $56,000 7 2001 $108,400 $0 $0 $56,000 8 2000 $81,800 $0 $0 $47,900 9 1999 $81,800 $0 $0 $47,900 10 1998 $81,800 $0 $0 $47,900 11 1997 $89,500 $0 $0 $35,900 12 1996 $89,500 $0 j $0 $35,900 13 1995 $89,500 $0 $0 $35,900 14 1994 $88,500 $0 $0 $39,500 15 1993 $88,500 $0 $0 $39,500 http://issgl/intranet/propdata/ParcelDetail.aspx?ID=2539 4/19/2007 Parcel Detail Page 3 of 3 16 1992 $101,000 $0 $0 $43,900 17 1991 $98,000 $0 $0 $63,800 18 1990 $98,000 $0 $0 $63,800 ; 19 1989 $98,000 $0 $0 $63,800 20 1988 $70,000 $0 $0 $25,000 21 1987 $70,000 $0 $0 $25,000 22 1986 $70,000 $0 $0 $25,000 Photos http://issgl/intranet/propdata/ParcelDetail.aspx?ID=2539 4/19/2007 Town of Barnstable ti Regulatory Services * snxxseABM 9 MAS& $ Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail: 7006 0810 0000 3525 2711 April 19, 2007 Maggie Isaacs PO Box 836 Osterville,MA 02655 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter H: Minimum Standards of Fitness for Human Habitation, Timothy B. O'Connell,Health Inspector for the Town of Barnstable, on April 14, 2007, conducted an inspection of the dwelling located at 89 Eisenhower Drive Cotuit, Massachusetts.. The owner's name in this dwelling is Maggie Isaacs. Based on the results of that inspection, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D),the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (C) Shut off and/or failure to restore electricity or gas. Observed electrical meter missing from home. Therefore no electrical power within home. QAOrder Letters\Condemnations\89 eisenhower.doc Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health(Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Note: This is an important legal document. It may affect your rights. Signed Cc: Maggie Isaacs, Owner Paul Curtis, Occupant Mr. Tom Perry,Building Commissioner Chief Harold Brunelle Robert Smith, Town Attorney Chief Macdonald,Barnstable Police Chief f QAOrder Letters\Condemnations\89 eisenhower.doc Citizen Web Request Page 1 of 4 L� .l �C,„ ln• � y3° y -fit S Etta r� 41 fa� ' Citizen Request >Management Route to Usc,'s Sear, £Y.,.. . ilii:s�ts 4..re;4.4tc keq `.Sr.`..i t Request Information Request ID: 20842 Created: 4/10/2007 2:34:21 PM Status: Closed Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard Estimated 5/4/2007 Change Estimated Completion Completion Date: 1� t}� Date: Sun Mon W Ue Wed Thu Fri Sat 29 30 1. 4 S 7 8 9 10 i1 1.2 13 1.4 1S 16 17 1 19 20 21 222 23 24 25 26 tffi4 2Q 3 31 5 1 6 1 73 } Created By: Crocker, Sharon Priority: Medium Health Office .....__............_____......... Citation Numbers: Requestor Information Requestor Request Parcel Number Someone has Map: 039_ Block �92 Lot: 000 vandalized elec. meter to house. The Elec Co. has shut elec off at street. Parcel_Lookup She does not expect to be able to fix the electricity any time soon due to I finances. Does this make it uninhabitable? Her son and daughter- http://issgl2/intemalwrs/VvRequest.aspx?ID=20842 11/28/2007 Citizen Web Request Page 2 of 4 in-law are living there. (See internal notes) Email: Track Request Progress Request Work History: Internal Note History: Entered on 4/10/2007 3:40:33 PM Entered on 4/10/2007 2:33:49 PM by O'Connell,Timothy by Crocker, Sharon On 4-10-07 talked with owner of home who It sounds as though she is trying to get actually made complaint. I told her "yes, the them (and possibly a child)out of house. (The) house is uninhabitable due to lack electrical do not pay any money to her and are not beirn supply." I obtained her son's phone number responsible) and left a message of not to sleep at home and to call me back. f System entry on 4/10/2007 2:33:49 PM: Entered on 4/11/2007 8:05:58 AM Assigned to O'Connell,Timothy by O'Connell,Timothy System entry on 4/12/2007 2:58:50 PM: On 4-10-07 talked with owners son who 3 indeed told me that the electrical service had Estimated completion changed from 3 been shut off at this location. Although he said 4/12/2007 to 5/4/2007 it was due to lack of payment. I told him this is a uninhabitable home according to state code j System entry on 5/8/2007 3:04:45 PM: 410.750 (C) (D). I told him not to sleep there and he said he will stay with friends. 9 -Please Review- email sent to O'Connell, Furthermore I told him I will post an orange Timothy i sign deeming it uninhabitable. Will update as -- -°- -- info comes in. i. System entry on 11/27/2007 11:28:55 AM: M... �, .0 .._. Entered on 4/12/2007 9:35:08 AM Request Closed by oconnelt by O'Connell,Timothy i i On 4-11-07 went to said property and knocked on door. No answer. Posted orange j uninhabitable sticker on front door. Entered on 4/12/2007 2:58:48 PM by O'Connell,Timothy On 4-12-07 talked with RM from building and he also went to said property and posted a uninhabitable sticker on the door due to building issues. Will continue to monitor as info comes in. Entered on 4/20/2007 8:09:13 AM by O'Connell,Timothy On 4-19-07 sent out condemnation letter. II http://issgl2/intemalwrs/WRequest.aspx?ID=20842 11/28/2007 Citizen Web Request Page 3 of 4 This was sent out after the fact do to I neighbors of said property coming into office E and telling me that people are still living there. Entered on 5/8/2007 3 04:45 PM by Wadlington, Ellen Hyannis Police Department had a call from neighbor who stated someone was living in house even with the sticker from BoH and 3 Building. { Entered on 11/27/2007 11:28:17 AM by O'Connell, Timothy On 11-27-07 went by said property and did see that the electrical meter had been restored which means power has been restored. Will close. ; Enter work progress: Enter internal note: (Viewed by everybody) I (Viewed internally only) e I 4 ' P i , I s; ' �d SpeIl�Che`ck�� ! I SpeIICYheck s 1 1 Add document or image link: You can also type in a folder narne to see everything in the folder Current Liars: L"H lth Jin i O' n€ell i139 a is n€ &Ater # ' ' { I Time worked on request: 4.00 Response time: 1 00 F- Time entries are in hours, Examples of r-,r,e entries: 1..25, 0. , .7 ? 1., 3. , 0,25, 0A0 Response tirne, Measured from the creation date to your first actions or, 11he request, Do not include nigi t s, weekends, and l`Iolidas in response time for most dde jai t�'° e Ls, .........________.___= -_.......................................... ............... .......- _.. .... ....-. -.._. .........___ { http://issgl2/intemalwrs/WRequest.asp x?ID=20842 11/28/2007 Citizen Web Request Page 4 of 4 C° Reopen Reopen and notify citizen 3 RZ s (� 1 i i P....ubl_i_c..._U_s..e_;__P..,.rinter_FriendlyVersi_on Internal Use: Printer_Friendly_Version. http://issgl2/intemalwrs/WRequest.aspx?ID=20842 11/28/2007 TOWN OF BARNSTABLE 'a LOCATION- SEWAGE # VILLAGE CI ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Q14— (size) I ICJ NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: _. DATE: Separation Distance Between the: �Z Z 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 B Am �a Ob AD �3 m a� _ 31 TOWN OF BARNSTABLE ` LOCATION T p�1 . 51rW1k OWt.r Re SEWAGE# VILLAGE C UT-u T ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) P,T (size) UW NO.OF BEDROOMS 3 OWNER zSS��S PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / Feet FURNISHED BY Z-n S c, ?' T eord to }5,10-) i � Q 3 y� a ys ag 3 S3 yv y sv so 999 ��-`"'� COMMONWEALTH OF MASSACHUSETTS �~ EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS Joh r ` DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Ti pector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 89 EISENHOWER DR. COTUIT LOT 23A Name of Owner JOHN CROSBY Address of Owner: BOX 26 HYANNISPORT MA.02647-0026 Date of Inspection: 312/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 Telephone Number: (608)664-6813 CFR IFICATION 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: X Passes The inpection is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:3/9/99 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design now 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. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:3/2/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: _ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. NO 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,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is Imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. NO Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced ND 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:312/99 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)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 surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nla_(approximation not valid). 3) OTHER n/a revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:312199 D. SYSTEM FAILS: You must Indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described 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 into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. 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). Number of times pumped n&. 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 I 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: _ 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:312/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks 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. X 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.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)[ X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:3/2/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-Q g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):1 Total DESIGN flow: IV Number of current residents:) Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):JMQ Seasonal use(yes or no):JMQ Water meter readings,if available(last two year's usage(gpd): n1a Sump Pump(yes or no): NQ Last date of occupancy: n(a COM M ERCIAL/INDUSTRIAL Type of establishment: n!a Design flow: n/A gpd(Based on 15.203) Basis of design flow: n[a Grease trap present:(yes or no): �IQ Industrial Waste Holding Tank present:(yes or no): Na Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:xi& Last date of occupancy: WA OTHER: (Describe) n/a Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: !v System pumped as part of inspection:(yes or no):MQ If yes,volume pumped nla_ gallons Reason for pumping: Wit TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n(a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1980 COMPLIANCE ISSUED ON 3-13-80 Sewage odors detected when arriving at the site:(yes or no) NQ revised 9/2198 Page 6 of 11 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:3/2/99 BUILDING SEWER: (Locate on site plan) Depth below grade: L'f:" Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: niA Comments: (condition of joints,venting,evidence of leakage,etc.) nla SEPTIC TANK: X (locate on site plan) Depth below grade: V Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) D& If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No n& Dimensions: L 8'6"H 6'7"W b'10" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: ME 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: 11 How dimensions were determined: MEASURE13 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 SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n(a Dimensions: n(a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle:j3/a Distance from bottom of scum to bottom of outlet tee or baffle n(a Date of last pumping: D& 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.) n/a revised 9/2198 Page 7 of 11 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:3/2199 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: ilia Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) ilia Dimensions: n(a Capacity: n1a gallons Design flow: n& gallonstday Alarm present: NO Alarm level:jib-L Alarm in working order:Yes—No—: NQ Date of previous pumping: nia Comments: (condition of inlet tee,condition of alarm and float switches,etc.) ilia DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Wa revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:312/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nla Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: ja(a leaching galleries,number: -(a leaching trenches,number,length: nla leaching fields,number,dimensions: n(a overflow cesspool,number: n(a Alternative system: nla Name of Technology: -n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT WAS EMPTY AT THE TIME OF THE INSPECTION LIQUID LEVEL HAS BEEN CESSPOOLS: _ (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert: n& Depth of solids layer: nla Depth of scum layer. n(a Dimensions,of cesspool: n& Materials of construction: n(a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:Wa Depth of solids: nla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla I revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:3/2/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a Io A b � PC 0� �A�a U� Ac s3 Ao � as 6� 40 revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 EISENHOWER DR.COTUIT LOT 23A Owner: JOHN CROSBY Date of Inspection:312/99 NRCS Report name: WA Soil Type: n/a Typical depth to groundwater: Wa USGS Date website visited: i& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers XUsed USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USSGS MAPS AND CHARTS revised 9/2198 Page 11 of 11 -00 No...................... Fps.. _ ...... ©� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Applirati an for Disposal Works Tonstrurtiun runtit Application is hereby made for a Permit to Construct (6-Y'or Repair ( ) an Individual Sewage Disposal System at: s6 ?r e.. - Cam. f..._ ................................... -o tion-Address or Lo No. W Bd ddress --•- Installer Address I/ Type of Building Size Lot.................... .....Sq. feet �-, Dwelling—No. of Bedrooms................3.......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixt es -------------------- -----------------•----------....----------•-----------------------------•-----------•----••----------...----•.........------ Design Flow...... ........................gallons per person �r day. Total daily ow..._.... ...................gall 0 WSePtic Tank—Liquid capacity/KM. allons Length Diameter................ Depth 5. )W* x Disposal Trench—No. ............... Width...........F...... Total Length...........o.................... Total leaching area....................sq. ft. Seepage Pit No...... ........... Dj meter/�_ .O.. Depth below inlet-.X!; ."���.... Total leaching area. :� Z Other Distribution box ( Dosing tank `-' Percolation Test Results Performed by. _ �! p 5'--•---_... Date------ .---- a Test Pit No. 1... Zninutes per inch Depth of Test Pit. t� Depth to ground water..ti/ :-....-.. fro Test Pit No. 2._� minutes per inch Depth of Test Pit.; . ._��_.. Depth to ground water.-y ..�... R+' w ............................................................................... O Description of . -• --- ---- ---•-- ... -- W V Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------------------------------•----------------------------------•-•--•-•-----•--••----•----------------------------••• I Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI i 1Z 5 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. Sied....... -----------------------•----•----------------------------•--------•----•- Date Application Approved By.... .. —� �-=Z 7 . �� Date Application Disapproved for the following reasons:................................................. --••.....................................................•-------•---......-----•-------•-•-•-------•-••-..-------••-----•-----------------•-------------------------------------------------------_...-- Date PermitNo.......................................................... Issued-.- = Date No Fimic ............... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................... Appliration for Dhiposal Works Tonstrartion Prrmit Application is hereby made for a Permit to Construct (6)"*�r Repair an Individual Sewage Disposal System at: .............. ............................ ........... ........................................... d s 4OW r No .......... ---------------------------------- ------------------- . . .... Owner d4ress 5' . ......................... .... ..... ......... .. .. PQ Installer Address' j U 14 Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms.................:3...........................Expansion Attic Garbage Grinder '4 P4 Other—Type of Building ............................ No. of persons........................... Showers Cafeteria P4Other fixtures ...................................................................................................................................................... Design Flow____._., .......................gallons per.personper y. Total daily flow.__.....--33.o..................gallops. Septic Tank—Liquid capacity, - gallons ...Qallons Length.c;1. . ... W 4L Width.._' .—.. Diameter................ Depth.>-S.` 9 N h l Tr ench— o............... h...... Widt ...�011*11------I'll Total Length_......_...;........Total leaching' area. Z 'e. --------_--------sq. ft. Seepage Pit NO------/*--------- >meter/0_7:�"Depth below inlet...6*�� ... Total leaching area..���­qrftr Z Other Distribution box 6r Dosing tank Percolation Test Results Performed by.2,_'!f�- ... Date.......... ................. 14 P 14 Test Pit No. inutes per inch Depth of Test Pit--- Depth to ground water.... Test Pit No. 2...i<:Zn;minutes per inch Depth of Test Depth to ground water.._'' ./...........Chi .. ........................................ ........ -------------­­*......... 0 Deesjript�ion of. oil-;:z�z­ .......... ...... ...... --------------- --- ........... ------------ ............. .......................... ....................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TILT-11 5 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. S, ' ed... D t --------------- --------I------1-1-1­1-- ------------- Application Approved BY-----;.46W/.. z............................ Application Disapproved for the following reasons:......... ....... Date ................................... .......................................................... ......................................................................................................................................................................................................... Date Permit No........................................................ Issued....\7-._ _A�....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r. OF..... . . ........ ....... .. ........ Tntifirate of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed 4� or Repaired Repaired by....... ......... .......<::.p....................................................................................................... Installer at----- ............ ................................................................................ - r , has been installed in accordance with the provisions of T 1 5.of The State Sanitary Code as described in the applicat;pn for Disposal Works Construction Permit No....... .... . ...JK�a............ PIV I ...�.. ....Z-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRYED AS A GUARANTEE T AT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. / ................................................... inspector...................................................... .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 .............. .............................................................. NOID FE&. . . ................. —Permission is h ,xV e! b t d.....119 ......................... �g y gran e ........................... ........................................... to Coiistr ct� I-) R-6r i ( ) an Individual Sewage Dispgsal System Re at No---- .......Z........e:n._Z.. 4_1 C_�: Street as shown on the application for Disposal Works Construction Permit_)No.___. e. .. ..... . ted.../A .......... . ....... ­'17------------------ oar of ealth DATE......../:7i2 .............................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS y Z OrZ3 � N I� 3G lot. 3�q tt Ion'/�'o �' .s "� hr IQa ED r,4 0 r /w .B ,6?v/G7~' rov�OAT'/O A-/ �; � A-/. a o G gsrLeo v ,y• 1A_ AD 619LCOA/ /N� v /uv ° O p�. /s� -Ile a/� /A✓UE� Q-�- oXV fT '' O';© Gt/ `?S N E O SAD✓E ���-e8 G� 1 '� r 4'�- ---n?. LcGEI/ �3aTT0 4� F .,0/ 7J l2/n/O G� p � b PROFILE OF SANITARY DI SPOSAL SYSTEM DESIGN DATA NOT TO SCALE ; BEDROOMS CONSTRUCTION OF SANITARY DISPOSAL DESIGN FLOW 3 GA LID AY SYSTEM SHALL CONFORM TO MASS . LEACH RATE '" - MINJINCH ENVIRONMEt<1TAL CODEnTITLE -M PROPOSED LEACH CAPACITY : AN. D THE TOWN OF HEALTH REGULATIONS. GAL./DAY r' 1p , SITE PLAN SHOWING PROPOSED CONSTRUCTION LOCATION FOR ..-a APPROVED 19 E � �d DATE BOARD OF HEALTH S C A L R E F E R E N C E / T - ` � 1`f` DATE A G E N T Isi Of r45fPH M � 3660 J . M. M O N A H A N, J R . 8► ASSOCIATES o �a REGISTERED LAND SURVEYORS & ENGINEERS 651 MAIN STREET DENNISPORT, MASS. 02639 � '- '50 . _