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HomeMy WebLinkAbout4380 FALMOUTH ROAD/RTE 28 - Health 4:380-Falmouth/Rte 28_. Cotiiit A = 024,- 024, t — i �I No. l �. Fee TH COMMONWEALTH OF IV SACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppliLation for 0sposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(D Abandon( ) [:]Complete System '[ Individual Components Location Address or Lot No. yjsb Q M6 Owner's Name,Address and Tel.No.:.5o?-7 V3_ .26 Assessor's Map/Parcel V aZ S/ , �cc� /K2r�cxnn� �rCiu(�.i eY '7 3 Ctocz rl k1 flog Insta is Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 15 or u'6' 1 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date A/j l� Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) — l �hao) Iso0q,'a U—J/C,2,. J, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date — 4114'.2911AV Application Approved by Date Application Disapproved by Date for the following reasons Permit No. `ZQ J Date Issued �l v Fee No. I ! / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for Misposal *pstem Construction VPrmit Application for a Permit to Construct( ) Repair( ) Upgrade(W�Abandon( ) ❑Complete System W Individual Components Location Address or Lot No. l'3� MGu Owner's Name,Address,and Tel.No. .50 6-7 4/3-. 9,402(0 Nar Assessor'sMap/Pazcel 0e15/ 0.2 l t. ,uao &14 Instal er's Nam e,Address,and Tel.No. Designer's Name,Address,and Tel.No. Or- 1 Ul ` Type of Building: f Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided I gpd Plan Date A A- Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1ka , ,,, cD >�- 14 s���t {��� " ���� Dom.__ ,-,' A Date last inspected: 4 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 Environrnentale-and t o place the system in operation until a Certificate of Compliance has been issued by this Board ofHealth. Sign 3� / _ ( -- Date Application Approved by t., . , f Date Application Disapproved by v Date (V for the following reasons Permit No. Date Issued •, tl THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(P/� Abandoned( )by A,0r 4:,tn at � � �6 �'� you.r_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No d/y`(; dated I)1 i dj Installer yONArL f`�: l_��►T�a�-�r, �� n..� �.C_ Designer 1V1raCIn { c #bedrooms `I�, Approved design flow gpd The issuance of this -ermit shall not be construed as a guarantee that the system wil�c io as desi net _ g Y `` g Date ° (`1 Inspector 1\ 4 1 --------------------------------------------------------------------------------------------------------------------------------------- No. U r C, z Fee / &61 ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS jBiepoBal *pstem Construction permit Permission is hereby granted to Construct( ) ' n Repair( ) /y Upgrade(Jk/) Abandon( ) System located at y �> �-��ll � �/ J and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc ion must be completed within three years of the date of this permit. f , 1 C Date Approved by /�/, C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owners Name is required for every page. Cotuit MA 02635 3/12/19 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 =C) �---� t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of V Town of Barnstable Barnstable Inspectional ServicesCC 1 BARNSTABLFE bs Public Health Division . m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL47015 1730 0001 4987 7695 March 22, 2019 GAUTHIER, MARY-ANNE 73 COUNTY ROAD BOURNE, MA 02532 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 4380 Falmouth Road, Cotuit REAR SYSTEM was inspected on 03/12/2019 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Need to relocate driveway or upgrade to an H2O septic tank. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean, R.�, CH`O�� Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\4380 Falmouth Road Rear System Cotuit.doc oF� Town of Barnstable • w + 1ARNSfAB[E, • Regulatory Services Department `-----Public Health Division _ . ......._ _ 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6,2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool Any"conditionally passed systems" (broken cover-,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER ' J Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) ' Q,M Svey`� Property Address Fd Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 City town State Zip Code Date of Inspection �i -«3 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. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City town State Zip Code 508.272.6433 13010 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 3/12/19 Insp rs ig to Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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 I the same or different conditions of use. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owners Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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): The septic tank is of H-10 construction and is in the driveway t5ins.doc•rev.6/16 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 M 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown 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 ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M a 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a 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 indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 M 380 Falmouth Rd. There are 2 homes at this eo a this is the one at the rear ( P P rtY ) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 City/Town 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.suriace 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M °'< 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for Cotuit every page. MA 02635 3/12/19 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: Pumped post inspection 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): No indication of a d-box t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 30 yrs ago per owner Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2'6" Depth below grade: 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.): Septic Tank(locate on site plan): 2, Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 compartment style tank is in the driveway If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 6" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owners Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown 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 >12 Scum thickness 6" Distance from top of scum to top of outlet tee or baffle >211 >2° Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3112/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No D-box 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.): Probing gives no indication of a d-box 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Octagonal style precast pit is in the driveway, in my best professional judgement it is of H-20 construction however this is not verified with documentation at the BOH, it is 3'6" below grade, effluent level is 2' below the invert at this time, no indication of past 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.doc•rev.6116 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 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 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.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title In n F te5Inspection Form 0 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityfrown 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 ---- , l o t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown 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: >132"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: front house plan 2014 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: TOPO mapping puts the sit at 70'msl and nearby surface water is at 38'msl You must describe how you established the high ground water elevation: see above I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes at this peoperty this is the one at the rear) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 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 t5ins.doc•rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts oa7 - 00-? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �s..1 4M , 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) ;�3 Property Address Gauthier Owner information Owner's Name tN' is required for every page. Cotuit ✓ MA 02635 3/12/19 - City/Town State Zip Code Date of Inspection ram? i; 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. A. General Information �1 13�SCP 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 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 a IAor' 3/12/19 Inspect6es tignaW Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate ` regional office of the DEP. The original 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Citylrown 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: 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): t5ins.doc•rev.6/16 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 M 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown 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 ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 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 indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 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)] 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 t5ins.doc•rev.6/16 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection D. System Information. Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ❑ No Last date of occupancy: Occupied Date Commerciallindustrial 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped post inspection 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): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original septic tank and new D-box and Chambers 2014 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): 18" Depth below grade: 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.): Septic Tank(locate on site plan): 'Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 2" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown 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 >12 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >21# >2 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ' 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-20 D-box is 5' below grade, cover raised to 30"of 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): H-20 chambers (per BOH record)are damp at this time, no indication of past 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 Lt&n. c•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 Citylrown 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.): i l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 TOWN OF BARNSTABLE LOCATION n%J- 96 kL+��i Y SEWAGE/f JOIN} -?7!r VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. Lt,7:�K.�Ti 1 �r✓� �. G�7 f•� � SEPTIC TANK CAPACITY jtVo-.l+t l LEACHING FACILITY:(type) _�'j �.�-f!Gam- (size) �S',e •�31C NO.OF BEDROOMS /� r1�o OWNER fu4v: LS, PERMIT DATE: 1 B-&-11 COMPLIANCE DATE: 111VO Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) 1`I Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) eet FURNISHED BY 4 w-J f t R,6, ol� uw YY y I Rr e �� Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GM ,•�'°- 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for Cotuit MA 02635 3/12/19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high round water: >132" p g g 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: 2914 NGW 132" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4' seperation per 2014 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Site is at 70'msl and nearby surface water is at 38'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 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 4380 Falmouth Rd. (There are 2 homes on this property this is the front house) Property Address Gauthier Owner information Owner's Name is required for every page. Cotuit MA 02635 3/12/19 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 l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION FJ9'b .4Ly�(G�+L"i SEWAGE# a01,q ,VILLAGE Ca.lr ASSESSOR'S MAP&PARCELtf INSTALLER'S NAME&PHONE NO. d '��L�}� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) <'- tZe-Vf Gyim— (size) NO.OF BEDROOMS - — t /1 OWNER L44cL �' LS PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _4--_N/G Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) " -4. Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ft Feet FURNISHED BY Qgw4 �/Jr Leh 1 i�yr►-.�.�r 2 7' ve.t 1 1 � 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes �,!t ftplitation for Misposal *pstrm ConstTUttion Vermit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System ['Individual Components Location Address or Lot No. q3$® � Owner's Name,Address,Fd Tel.No.sd_$-7 N3" 99 aL 4, Assessor's Map/Parcel a ®a-S/ 0.4-Ui -D�4 Installer's Name,Address,and Tel.No.S08-71/- 9399 Designer's Name,Address,and Tel.No. 8or-i-olc*, C'onskt�c-�ior�,Ir�c. CISJrJus+ryM, .Jva,A-N 6n9,ne603 g0?Main Sf• i Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3,30 gpd Design flow provided 37`(/ 9 gpd Plan Date. / -y—.24,�O(� n -Number of sheets e Q I' /�_ Revision Date Title I;IL �S S;� , Oar Y310 �^IYYIc.1Vg A . C-c4u T f Size of Septic Tank e11 �_I�� Type of S.A.S.ja,$3 L,�C ��(, f--; o� 11.2U,�cr Q G�I421.o' Description of Soil6g,e , ( o c Nature of Repairs or Alterations(Answer when applicable)` w 14ao as w tC Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co n to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ign d Date At ky Application Approved by Date Application Disapproved by Date for the following reasons i Permit No. Date Issued �J No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for MispoBal *pste'm ConStrUttion permit Application for a Permit to Cohstruct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. q3$Q jC;JVYMW+jn 1f j Owner's Name,Address,and Tel.No.,y o&-'1 a 3- 93 a MaryAtv,e �s4c�t-��eC l2cf, Assessor's Map/Parcel a cl3�ci kJMauf-�o�� C.OT«- C, �� , Installer's Name,Address,and Tel.No.SO&•77/- 9399 Designer's Name,Address,and Tel.No. O:R--3(.a-yi'V MIA Qoc�+olo'tt� A1. c. yS Ir�us�F�, ,rJv<..rn C� C:.25 y r�Q-�'i v�5 ,T�c�,S�,S�Mc��� Sf• Type of Building: DwellingNo.of Bedrooms_ � Lot Size sq.ft. Garbage Grinder( ) 'Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3V 9 gpd Plan Date, ,O" r-,2 t{_a Ul Number of sheets / Revision Date Title ri4le 5- 5,i� Aa n U SO Qr»ov4 A. Caut+- Size of Septic Tank e c r ,Type of S.A.S. �� 112U SCL' e C ' Descripfro\of Soil's , Nature of Repairs or Alterations(Answer when applicable)`{}R_ o 14 du Ro1r/a At lahLfftly7 A)LA 1. X r%�f 'A 17gle4 Suh_4ty _,, s�rna { -�; �U li��. verb-, r�sirs t- r-��;��St��t� Qu�.�; c��„ lA p . C'e�,t,���-• ����`� ����,,�/� -' Date last inspected: �•' / Agreement: e ..., _ •w r_ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r accordance with the provisions of Title 5 of the Environmental Code.and no17to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i ign d Date 46. (C ' - Application Approved by Date �- Application Disapproved by _ Date for the following reasons Permit No. Date Issued 101141 --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS w Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(W Upgraded{__,) Abandoned( )by r�\a i 01n:56 KILT'n ;;�..01 at y3 S i;aA noe,K Ak ki. - C04-11 t - has been construct d' accogd ce with the provisions of Title 5 and the for Disposal System Construction Permit No " O ed Installer�pr �, ..yyt� �� ��q�,�i,� Designer( G #bedrooms J / Approved design ow g /� gpd The issuance of this permit s 11 o b o strued as a guarantee that the system wil ction as des' /e C a Date Inspector / V/l_ (J ---------------------------------------------------------------------------------------------------- - 4 No. 1.�� ✓ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS f Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(IN ) Upgrade( +) Abandon( ) System located at T 3 $0 Q(mn u 4L iR J- 'U4-u l't— and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio sticort ed within three years of the date of this permit. Date /� Approved by )Q<f11_j l ell `,�'. �1`w. 4, .`.7F� YM,�. � �'�n e` �; _ P e>' 2��--... 1\ 73;+tZr.•.. _ will IIIIIIM yyiLy a f ti. - z - ! .•.- y e - �4 A _ _s erne •.`� .a i� � � �'�`. �.. \ 9 ` .`K, •'� �sy� `� • � __ ;��w asp. -:•�•'f; =mac' �`• � . . •�, 1 t . .r dAV 6"M� .!I�Mw .rtsPr. }�,: 'fir �• , r,irk �^ �� � � € � _t'y¢c, �,+ �� i•�, � �i�F��� � rQ �t"� fit' .III����a'�`a� �`��.c' ., { a. �P ��L.� •. `t NOU-ie-2014 23:50 From: To:15087906304 Paee:1.11 FROM :down cape engineering inc FAX NO, '15063629880 Nov. 18 2014 10:28RM P1 -r n of RarnstOT_P 1 �rfl�. +L4 'b e9el'vL�'�v.`, b 'S h�rl�nas . Geller,Director ub 213Qi IYYJ(�iam 54reCR,V:PmTua,AU(1,601 1+jx: Sob-790-804 Of,w. 508-967-464.4 ��'.vc 4emi rs �'cxte a�rtau�D+`aax 0 37.E L _z ate• 1� �$ f�t�m�a�e pint#! � r �a ®r'9Il�a�l�'aT�e� 5 J aA v. . ( 'D VJ Q ; Installer, C. o Iy ^ , !' '.lr�.waa inmcd.a P remitto stfltl a date) tUst s�pt;x:Qysf�m at FaIM 0 A . 'oa�.ed cc,a dcSipn drawn I'Y yes z Y ,x_ i c stiry f it the Yt.p1%G yystsm r4ThmnGed above�s mse NA sub ttaily accardiu to the Qesi '��. .1 angy Lncludc manor RPPT(sac.d crimes 31zn as Kral relocs�i oaf she disgriblAion box nwWOT,,WjG tiu k. I ctlnfy tb'_ i�te septic sy iefei� eed ht�ow, WU'iz�Jjod with riltjoz cb gE:a grater tblm lit' leter�I elura#r.+�n of t,,o SAS ar any ve:riical rcloraliUn of sny aoLn�n.ei of the svOr' ir.as a:�nrdaur� wi.Lh gee,A--'Local Re�daticn�. :k'1fw tevjSmn 07 eerti era�s�im7t d•P er-to follnw. N MOP"144 OJALA ,, (�nst, 1F ° Yp�att�.Te) CIVIL V' No.46502 x 10�`�pRGI 8 T�p�♦'��� �SSlpNAt eN4 — Y__— '� �F3e3tsyn8r4t��]i1pl'e}�. esier's Sip�Tco) q. }2 JAL vr;�}7RrT 'ice t9A� aa. , . 4;r CTbx.l CAR13 —A-BA ' TOWN OF BA��RNSTABLE .LOCATION �s � acscarrr 6�lTzc�� SEWAGE VILLAGE ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. gzzvUsr, SEPTIC TANIX CAPACITY LEACHING FACILITY:(type) ADDD S"�C+[� u%G( (size) NO. OF BEDROOMS _ PRIVATE WELL ORCtVi WATE BUILDER.OR. OWNER .DATE PERMIT ISSUED: DATE COLIPL.IANCE ISSUED: I J- VARIANCE GRANTED; Yes , y THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �(�C�"- IL DATA ;i TOWN OF BARNSTABLE i.00ATICNs� cw�Ze SEWAGE,# I VILLAGE .�. ASSESSOR'S MAP Cz LOT $i INSTALLER'S NAME & PHONE NO. ;� Fac37 SEPTIC TANK CAPACITY / EIS v �s LEACHING FACILITY:(type) . � Scu! '7- (size) NO. OF BEDROOMS _ PRIVATE WELL O�UBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: / . -DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No~ 9 i� j i TOWN OF BARNSTABLE TOCATICN SEWAGE # ;L VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO, SEPTIC TANK CAPACITY fJ - LEACHING FACILITY:(type)_ l �T (size) NO. OF BEDROOMS _D T -`' RIVA E WELL O UBLIC WATER_ BUILDER OR OWNER17 DATE PERMIT ISSUED: I DATE COLIPLIANCE ISSUED:. VARIANCE GRANTED: Yes No I - � 4 1 r, r. _ _ � - .� -,,.V i �. -� _ ,- _- - � _�_ 11lf • �i 3 ' f �i A -. n'�• •ram . POW , ' ol " n a=' rs� 1— ��F � c L � D '�t uw�vrl y� � � u� � CF' I.A �Pr�t x;r��`�" a ,� �- I - �— tv , ^ Al .4'A"/ ^�yn..r je b+ � ram_ _ ._ i• •� '' ` Y rI^ Y - t �,�y 1`w1iV� •`y�1-_ •�. 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Soil Suitability .Assessment for Se e Dis ' os � Performed-By:_ 0(n. e ( 600 Sa Witnessed By: I' LOC; UION& G NERAL Ilifl+�ORM[ATION Location Address //nj "0�� � Owner's Name t�U ' Address Assessor's Map/Parcel: tJ� Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use: l V e u of !/, Slopes(%) �' Surface Stones !V do e Distances from: Open Water Body /" c #t Possible Wet Aren�l y�/fk Drinking Water Well ft Drainage Way �/ ft Property Line ft Other ft SIMI TCH:(Street name,dimensions of lot,exact locations of test holes& ere tests locate wetlands P w t ands•1`n proximity, to holes) A- �%!zz a 2 xa. � L:3 3 Q 5 z. . a N _ y v o • a° act Parent material Ux a f o (geologic) Depth to Bedrock Depth to Grou`ndwatei: S[anding Wa[or in. /Hfrom' ae _ o- I Z Weeping PIt Fg Estimated Seasonal High Groundwater NSA__ i TE4NUNAUOIY FOR SEASONAL)EGG WATER TABLE, Method Used: G lA/r. Depth Observed standing in obs.hole: In, Depth to loll mottles; ln, Depth to weeping from side of obs,hole: In, ©roundwater AdJustment ix• Index Well# Reading Date: Index Well]oval Adj,thctor,.,,,.��..Adj,GroundwaterLevol— PEB.C',OLA.TZON'.rES ' Observation I Hole# Thne at 9" Depth of Pere �t/ Tlme at 6" Start Pre-soak Time @ Time(P-0) Bud Pre-soak h RatoMin.11uch L� n&hC' Site Sultability Assessment: Site Passed Sitr Failed: Additional Testing Needed(X/N) Original: Public Health Dlvlsioa Observation Hole Data To Be Completed on Back---- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Consgvation Division at least one(1)week prior to begin g. Q:\SRPTICIPL'RCF0'RM.DO C DEEP.OBSER'VATION HOLE]LOG Hole# Depth from Soil Horizon Soil Texture .Shcl Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders, o i ton,Y.%'Gravel) 35- 132 DEEP OBSERVA.TION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Bouldrrs. onsis en %Grave 0-� y- ?9 B . 3�432- C NI/CS 2. (e DEEP OBSERVATION HOLE LOG Hole 9. Depth from Soil Horizon Soil Texture Soil Color Sail Other' Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. Colialutrnry,%G e ]DEEP OBSER,VATIORHOI.,E LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Cositn 6 Flood Insnrance Rate Map: Above 500 year flood boundary No Yes "Within 500 year boundary No Yes Within 100 year flood boundary No. .__ Yes. _. Depth of 1Vaturally Occurring Pervious Material Does at least four feet of naturally occurring pervlou tnaterlal exist in all areas observed thrpughout the area proposed for the soil absorptibn system) Y-e If not, what is the depth of naturally occurring pervious matarial? Certification � I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,experdse and experience described in�10 CUR 15.017.Signature L-/ �— Datb 9 b `// Q:15.LPTl aPE1tCPORM.DO C f V P CA AJ� SENDER: COMPLETE THIS SECTION • • • DELIVERY 4 ■ Complete items 1,2,and 3.Also complete A Si item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse to ❑Addressee so that we can return the card to you. B.,Re ived by(Printed Name) C. %te elivery ! ,■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 11 ❑ ' 1. Article Addressed to: If YES,enter delivery address below: ❑No 3 3. Service Type C b v l b ®certified Mail ❑Express Mail ❑Registered 0 Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extre Fee) 2..Article Number r ., (rmnster from service iabeq t i 7 0'0 6#t 0 8 j;d' 0 0 0 0 3 5 2 4 9 5 8 2 t PS Form 3811;February 2004 Domestic Return Receipt F ss-o2-M-1540 i UNITED STATE P,%I L,S V 1' M ' Sender: Please print your name, address, and ZIP+4 in this box• r q Town of Barnstable �M e Health Division, \ I 200 Main Street Hyannis,MA 02601 iii44E]?fEfll 4y��i4:414�i1�441Ff4441E444!41!1114141144'.A All Certified Mail#7006 0810 0000 3524 9582 i OFIKE rows Town of Barnstable y�P o Regulatory Services tA.ELYS-TABLE, 9 MASS. Thomas F. Geiler, Director �p i639. �m �fDMA�t` Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 19, 2007 Maryanne Gauthier 4380 Falmouth Road Cotuit, MA 02635 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 4380 Falmouth Road Cotuit, was inspected on April 10, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.482 —Smoke Detectors. Inoperable smoke detector on second floor. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by repairing or replacing smoke detector. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Q:\Order letters\Housing violations\Rental ordinance\4380 Falmouth Road.doc Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER-ORDER OF THE BOARD OF HEALTH Thom s A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector Q:\Order letters\Housing violations\Rental ordinance\4380 Falmouth Road.doc H&W HoBBs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 � BOARD OF H TH CITY/TOWN � a a � D PA{i.MENT „ A�c ADDRESS Solo GSM 50"� TETE EPH� p � V,4_A P4 Address � 5 8 � Occupant—j� Floor—Apartment�lo. No. of Occupan l_� No.of Habitable Rooms �� o.Sleeping Rooms No. dwelling or rooming units_.✓ No.Stories Name and address of owner mm _ D6TA044,*� Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches.- Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains.- Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : J !Ile STRUCTURE INT. Hall,Stairway: - w Q Obst'n.: Hall, Floor,Wall,Ceilin Hall Lighting: Hall Windows: b HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box.- Gen. Basement Wiring: DWELLING UNIT Ventil. Latna. . Outlets Walls C ind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room Bedroom 1 . Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: SAa4s, FILAeA Ven ties: Kitchen Facilities in ve Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECT .(See Over) "THIS INSPECTION R 0 T IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTI�S OF Y.' INSPECTOR TITLE A. DATE `� d TIME �j A.M. THE NEXT SCHEDULED REINSPECTION �� / P.M. J. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(8)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements,of.105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth'or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint'on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. _ (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. es PnT dy' _ yr i 1 OCCv •ek C e 1 �p 6 M � D Parcel Detail Page 1 of 3 iq _r>ctced I'As: Fn iyt Mia Pa rce I Detail '<a,ce Parcellnfo _ _..._ ...... _ ..... .... per Parcel ID 024-024 DeveloLoot€LOTS 24 7 24A Location 4380 FALMOUTH ROAD/RTE 28 Pri Frontage 100 Sec Road Sec,..... Frontage Village COTUIT Fire District i COTU IT _-_ ._.,-__ -.--__._.___ _._..--.,.__--....__,_..__.. _-.-_- _-__-_.__- Sewer Acct Road Index 0522 IRK", Interactive i ,. ` Owner Info _ ._ OwnerGAUTHIER, MARY-ANNE Co-owner ... .. __. ... ........... ...._ ..... .. .. ......... ......... . ......... ......... Street. 14380 FALMOUTH RD Street2 ;...... _ ... _ ................... ......... .............. ........ ..... City;COTUIT State MA zip 02635 Country? Land Info .......... ........... __..__... ............. .......... ............. ... . ..._..... ........ .......... ........_ __-__.. _., _._ ____ _�.._ Acres!0.47 Use'Sngle Fam MDL 94 zoning RF Nghbd I0104 .... __.�..... Topography Road . Utilities Location Construction Info Building I of 2 - ....---_-- _.--------_.__-. Year I1950-__-� --._.� Roof`-"�-- Ext.WOOD FRAME Built 1 Struct -- .. Wall Effect 12568 Roof ' _. _ '. "� AC NONE Area l._ ._ Cover Type _ _ __...._.._ ......... Int Bed Style Stores/Apt Wall _ Rooms Int ...,. .,. .. Bath Model :Commercial Floor Pine/Soft Woad Rooms 2 Full + 1 H Heat!----"' _. _ Total Grade?Average Type _ I Rooms http://Issgl/lntranet/propdata/ParcelDetail.aspx?ID=1315 3/2/2007 Parcel Detail Page 2 of 3 IF t5JN, r ___.. M Stories Heat; � Found- ;Poured Con c. s � Fuel toil ation I I n. 2�5 ,Building 2 of 2 Year .... _. ._.. Roof _... Ext 1988 Gable/Hip Wood Shingle Built: Struct Wall Effect Roof ....... .._ _.__ AG _..._.... ....___ ._._. �� 1697 p As h/F GIs/Cm None x , Area cover, p Type .. Int:.__._ _ ...,_� Bed Style:Cape Cod Wall .Drywall Rooms 3 Bedrooms �3 _---______.-____ Int __... Bath m _.-. .. _• �Nr ,,x` ���+,�... ; ;odel:Residential 2 Full i Floor _ Rooms Heat Total ,...:. _.. . _.... Grade!Average Type Hot Water Rooms 5 Rooms --m w« macs 1 Heat _ Fuel G F ation stories 1/2 Stones as Poure d Conc. Permit History, _ Issue Date Purpose Permit# Amount Insp Date Comments 3/6/1998 Remodel &Addn 29287 $10,000 1/1/2000 12:00:00 2ND FL ADD/ AM WINDOWS 4/1/1995 B37669 $2,000 11/15/1996 12:00:00 CO ALTER AM 7/1/1994 B36881 $2,000 11/15/1996 12:00:00 CO ADUN AM 4/1/1990 B33655 $1,000 11/15/1992 12:00:00 CO ADUN AM 4/1/1988 B31778 $8,000 CO DORMER 4/1/1988 B31793 $28,000 CO REBUIL 2/1/1988 B31644 $0 CO DWELL. 6/1/1974 B17174 $0 CO REMOU Visit History ......... ...... ........ ......... Date Who Purpose 3/4/2000 12:00:00 AM Martin Flynn Mea./List Bldg Permit Only 5/18/1999 12:00:00 AM Gary Brennan Meas/Listed 7/15/1989 12:00:00 AM ML http://issgl/intranet/propdata/ParcelDetail.aspx?ID=1315 3/2/2007 C Parcel Detail Page 3 of 3 Sales History ............ ................... ..................- ........... Line Sa.le.Date Owner gold age Sale p 1 6/19/2002 GAUTHIER, MARY-ANNE 15278/209 2 2/15/1988 GAUTHIER, MARY-ANNE 6138/232 3 8/15/1983 MACPHEARSON & HOWELL INC 3829/294 Assessment History ...................... ..................... ................ ........... Save# Year Building Value XF Value OB Value Land Value Total Para 1 2007 $318,000 $0 $8,700 $117,400 2 2006 $280,200 $0 $8,900 $114,800 3 2005 $251,400 $0 $9,100 $107,700 4 2004 $216,900 $0 $6,200 $71,800 5 2003 $180,100 $0 $6,400 $67,500 6 2002 $180,100 $0 $6,400 $67,500 7 2001 $180,100 $0 $6,400 $67,500 8 2000 $149,200 $0 $6,700 $44,400 9 1999 $148,400 $0 $5,300 $44,400 10 1998 $148,400 $0 $5,300 $44,400 11 1997 $132,700 $0 $0 $30,000 12 1996 $130,500 $0 $0 $30,000 13 1995 $166,000 $0 $0 $32,600 14 1994 $130,300 $0 $0 $32,900 15 1993 $130,300 $0 $0 $32,900 16 1992 $97,700 $0 $0 $36,600 17 1991 $127,900 $0 $0 $48,800 18 1990 $127,900 $0 $0 $93,800 19 1989 $49,000 $0 $0 $93,800 20 1988 $30,000 $0 $0 $53,300 21 1987 $30,000 $0 $0 $53,300 22 1986 $30,000 $0 $0 $53,300 Photos ............ ................... .................... ..................................... ............. http://issql/intranet/propdata/ParcelDetail.aspx?ID=l 315 3/2/2007 TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 4�Y UZ& INSTALLER'S NAME PHONE NO.,,-3 Co7YP �_n/t � — k9a SEPTIC TANIK CAPACITY /046 LEACHING FACILITYAtype) /�®D S (size) NO. OF BEDROOMS -3 PRIVATE WELL ORCP ILUB C WATER BUILDER.OR OWNER DATE PERMIT ISSUED- DATE COEIPLIANCE ISSUED: VARIANCE GRANTED: Yes No f . P 12 �. � TOWN OF BARNSTABLE ,. I ,JCATICN SEWAGE # VILLAGE ASSESSOR'S MAP & LOT Q3/ INSTALLER'S NAME G PHONE NO SEPTIC TANK CAPACITY /ayo LEACHING FACILITY:(type) - �laD 7 (size) NO. OF BEDROOMS _PRIVATE WELL O UBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COZI?LIANCE ISSUED: I G V,:RIANCE GRANTED: Yes No �-�- , s ���;t��'� -t �i S t'i I�1C�-j .r �' _ �. •�#'�� C'� �i41��. Y 1•�.. } �, d �L + :'` f ��'-, 1 _.__.._____ 4 � . i r _ _ No.... -..�.a Fx$. ----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -: ..-..O F...... -- °----•------ ...................... Appliration for Dispaii al Works Tomitrurtiura Famit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: / - - -- - _ -- Locatio ddress.- or Lot No.. . ...... ---- •----------------- -•-....... -----------•----------- --------------------------------------------- wner ress Installer Address �.� d Type of Building Size Lot_ -t —_Sq. feet U Dwelling—No. of Bedrooms.............. .__..Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons...................: a YP g --------•--...-•-----------• P -------- Showers ( ) — Cafeteria ( ) Otherfixtures ..............................................................................................................................•....................... W Design Flow............................................gallons per person per day. Total daily flow......................................_.....gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..............-.....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by----------------- ........................................................ Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-._-______--_-_•___-_ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ------------••------------ --- - -- ---- ---------------------------•--------------------- O Description of Soil................................ ...__ --------------------------------- .. ..... x W ---------------------------•--•••••--------------------------••-••••-•-----•-----•-----------------------------�--a-----------------••.... ----•--------• --- U Nature of Repairs or Alterations Ans er when app 'cable- `' ?l -,..Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TT r1T•-� ,T t IS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' d by the b ardof health. Signed - - --------•--------• ...- Dave .._ ... Application Approved By................. � ).. ................................ ........4, Date Application Disapproved for the following reasons:-------•------------------------------------------------------•----------------•---------------------........._ ---------•-------------------•-----•-•--••---•---•----------....---••-•--...--------.......--------...-- Date PermitNo.......... � .-... -.�/ ----•------------ Issued....................................................... D it.. ......... � FRs.-- �.-.---.-.-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---------.0F...... ...... --------------------------------•------- ApplirFaffou for Dhip sal Works Tunotruriion rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( '�� an Individual Sewage Disposal System at: ......T. , .5�...`.�C.........f(....C. Y� G ..------�------------------- -------------------------------------"•. -=----' ----------------------------- Location.ZAddress _ __- --------------------•-.--..--•--•---.-.•.-or Lot No. —, Owner ress W ....................::..... = _F^�.--... ........... Installer Address UType of Building Size Lot_.,—,---2_Sq. feet Dwelling—No. of Bedrooms...........:.........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-____-_______-_____-___. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ------------•----... ..... •. ------------------------------------------------------------------- O Description of Soil.............................. .............. .ti✓ R x w -------------------------------------------------•----•-------------••------•--•----------•------•------•--•--------------------....-------------------........ . _ UNature of Repairs or Alterations . 'Ans er when app cable. = l - � -- . . O - •- Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of '�.TTr1:^ :.LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been�issu d by the b ard health. Signed--- .... _ , . '--------- Date Application Approved BY................� .� � •----------------•- -•--•-. Date Application Disapproved for the following reasons_____________________________________________________________________________________________________________•_ ------•----------------------•-•---------••-•---•-•-•-------------------....--•--•------------.....-----•-•-•--•-----•--------•-----•---•------------------•------•--••-----••-------•-•---•---•-•-••--- Date C �' Permit No..........-`�k----7 .................. Issued--•--------•----------------------......-----------•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OR HEALTH �. ...............OF......... 1� � .....R........................................ Trrtifiratr of Tompliaurr THIS d I That- the IS-T'0 CE IFY, ae nwidl age e Disposal S-stem constructed or Repaired c �.. _g P �' ( ) P (�} i' staller . J at.-------- - `S ------------- :l?rl�i, ..... r'=`........... ._ -----------------------....--••------------ has been installed in accordance with the provisions of TI T IE 5 of T_1te State Sanitary Code as described in the application for Disposal Works Construction Permit No.......... 4__ ........_a. __. dated.......................___.______......:....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Cr DATE.....................1_c�'- - _ .1?- ............................... Inspector---.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH NO....!?.i!.. _� ...............OF..... r .O,_........................._............ FEE.... i................ _ Disposal irk T onotr Wit rrmit Permission is hereby granted.......... ...........•.. -- -- .......... .......................................................... to Construct ( ) or Repair ( . an Individual Sever -e Disposal Syyst at No........... -_..._...c�_.4 . �{ --......... ......--,.:fir-f----- .......` --=----------------•----•---.............. ss as shown on the application for Disposal Works Construction Permit Dated.......................................... ...................................... --------------------.....-----•-••---.......---_..... Board of Health DATE....-------- ......................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS i r LTH THE BOARD AOF FHEALTH TS ...---....--------OF............J.A.A.t"V. J.l.L'—8.4-4 - .......--..._ Appliration fox Uhipoii l Workg Tomitrurtion Vrrnift Application is hereby made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at: 1SSa-------------•------ -----49-,s€A.'Ir...M ...... Locatio -Address �t No. ...A.NK_.._ �L N F Bdt--&�f��1D--- /1r._:'. s�fi__f1t9i41vJiVtF O¢rb$r Address st� Address d Type of Building Size Lot_.__ 2f_L�M___Sq. feet U Dwelling—No. of Bedroom __________________ _________________________Expansion Attic ( ) Garbage Grinder (No�✓� Other—Type of Buildinf"u�Y a yp g .._die•:.__ �s°P_ No. of peraons___________________________ hoovers (ynp� — Cafeteria (4'oq,� S QOther fixtures --•-------------•------------------------------------------------------------ -----------------------------,------- ----•-------------•-------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow......--------------------------------------gallons. G; Septic Tank—Liquid capacity------------gallons Length---------------- Width........-------- Diameter---------------- Depth.............. . W Disposal Trench—No-____________________ Width-------------------- Total Length-__--__-_--_--..--__ Total leaching area--------------------sq. ft. x Seepage Pit No--------------------- Diameter..............._.... Depth below i et_...... _._._._�Total lea iii are: --- .sq. It. Z Other Distribution box ( ) Dosing tank ( ) ����� ~' Percolation Test Results Performed by---------------------------------------•---_---___-_ a ---------------------- Date----•�/--Z-Y ---''�-- -------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------..-..--.___-. 44 Test Pit No. 2................minutes per 'inch Depth of Test Pit-------------------- Depth to ground water_------------.-------- - ------------------------------------- Description�of Soil '1 d... (�' --•----------------- ------ ---------------- 1 - - ----- -- -- --- ------- ---- ---- x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 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 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. Signe . . f!I.�� ^'�_.....-----•---•-------- ..__ . Date Application Approved BY 1te �D Application Disapproved for the following reasons----------------------------------------- --------------------- -------------------------------------------- ----------- = .._.... nn at ' Permit No......3..r?.......................................... Issued---�---1 -- -----�---• --_------ Dat No.....PLY_ J,?.. Id............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _�..ow.QC.. .... . .......OF........... .f1.n..N..S-%.19_l3_t. ..._._..............---------- 'Appliration for Di_qpviial Works Tomitrurtion Prrmit Application is hereby made for a Permit to Construct Q<) or Repair ( ) an Individual Sewage Disposal System at: ----------- ----- -- p Locati A ress or Lot No. l\:..1_! EUDD!Ct NNCN ST ,NH�4.Q�c ��i! [3a1cu�raa1_.._L�2.__-_ tr l�s�rr�.lr��sec' Oy4r �j Address W f•V� �( j /C— - I�eF.__ R_TI.tA!i! *6Y.----.!`' &4e[F.>!?�l�y_��SIjJ . a ff nstar Address d Type of Building Size Lot...2-2/.Z.�...Sq. feet U Dwelling—No. of .Bedroom __________________ _________________________Expansion Attic ( ) Garbage Grinder (Nowt- 6,n&LCO b � p.I Other—Type of Building .-_, �,.=.r.._S'tiar__ No. of persons___________________________ Showers ('Vo*� — Cafeteria (*o4,)- Q' Other fixtures ----------------------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. R: Septic Tank—Liquid capacity------------gallons Length---------------- Width---------------. Diameter___.-_..-_-_-_ Depth_-_-._-_.-_--- W x Disposal_ Trench—No.____________________ Width____.___._._________ Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No---------_--------- Diameter-------------------- Depth below i et..._... _._..__ Total lea lii <tre. `__ __sq. it. z Other Distribution box ( ) Dosing tank ( ) e�- �C /L IIX '~ Percolation Test Results Performed by.......................................................................... Date.....ei11_y/?�____-... Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-..---_----_--_._..----- �, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--.-.-•--_-----.--_.__.. --'--'---•-----'-'--'-----..._--y' - --------------------------- - _----r/-------- -it-- ---- t------------i D Description,of Soil D lO = = ? " ' r - -2 ... . . -------- U -�--------•-------- -`-•-•-- - ... � - - - W ----------------------------------------------------••------------------:-----------•------------------•--•----------------------•-------------- ..................................................... UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------- ------------------------------ --------------------------------------------------•-------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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. - ................................................ � �Signe � =. •------------------------ /mayt .. --. . /7 Application Approved BY ._._.. D; - Application Disapproved for the following reasons------------------------------------- -----------------------------------------:-•---•------ ......................................................................................................................................................................................................... n Date PermitNo.....1?--17.......................................... Issued........................................................ `- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .70W.Al................O F..........�1�I)K..4..J..74.40.44 ........................... Owrrtif irate of Tomplianrr T IS IS TO CERTIFY, a e In ividual Sewage Disposal System constructed X) or Repaired (. ) by....... �-� ------------ ------ Installer at---- ! Z T of T f '1 v'I S !' �1,�sEssvK_I...I?!1A -z - Z-0 -------------- has been installed in accordance with the provisions of Article XI of The State Sanitary C de descr'bed, in he application for Disposal Works Construction Permit No---__-._�............................. dated.... .._ .-------- _..7.... . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THA . THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................•--•----...-----------------------....---•--.........._..... Inspector-------------------------------------------------------------=-=-----------------... THE COMMONWEALTH OF MASSACHUSETTS �•� BOARD OF HEALTH > ......./...D...!W.N................OF...., ?/9 11/..I...T...I`7.41 .F...................---.... �j................ No.......�-.� .. FEE/j....-- Di volia / a� /eisposal r ion rrrutit Permission is hereby granted... ____ ____ __ ..._____.____ . to Construct ) or Repair ( ) an I ividual S Sys mat No. -: f!.v viT-- p1.1-�_.... _71--- ----AP•- `... LUG , Street as shown on the application for Disposal Works Construction Pe- ii No _ .______._. Dated.......................................... ..........., --- Board of Health DATE------------------------- ------------------------------------------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �b Cc L O CQT_I ON SEW_ _o,G�hP E.RMIT 1.1 O. �Dvim" - — —ac_ QAT_E—C.O M.P -?- _ — k � ..-. .. .. .. :.. .. .. .....- ...d c.. .ns. ..,.1: .. '`. .:._. _ _ ..,.. ,.. _ . , , _ i . , ALL SYTE SHALL SYSTEM PROFILE MAR ED WITHCMAGNETICTTAPE OR BE NOTES PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO GRADE 2. MUNICIPAL WATER IS EXISTING FILTER FABRIC OVER STONE \ 2% SLOPE REQUIRED OVER SYSTEM 72.3 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST c PRECAST H-10 THICKNESS REQUIRED BLOCKS OR UNITS TO BE AASHO H-2Q o RISERS (TYP.) PRECAST RISERS 3 2'0 *t69.6 4"OSCH40 PVC MOFTAR ALL H-20 PIPES LEVEL 1ST 2' �E4COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. NDS (TYP.) �73' [-4' SIDES 67.7' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE c 8 ens EXISTING 14" p00000ao ,o 0 o a° t �d 10" "� " TEE SEPTIC TANK** TEE ° ° ° 00�m 0M071 DOOM- -mm00 1��00000o WITH 310 CMR 15.000 (TITLE 5.) 00 e 68.2 6" MIN. SUMP oaoaoa000ao ' R� R 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 0 0 0 0 0 12" MIN. INT. DIM o 0 0 0 �a�aoa0000� O�O�O�D�DO(� 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND o fin' GAS BAFFLE : ° ° ° o ° o ° o � o � 00000000 00000000000 0 0 0 0 0_o�o�o�o,�o_ N ,c°o°o°o° 000°o°o° ° o 0 ���0��0�0�] NOT TO BE USED FOR LOT LINE STAKING OR ANY $ gob L °°°°°o�°o�, 4' LIQ. LEVEL (ACME OR EQUAL) 67.0 66.83 °° 64.7' OTHER PURPOSE. o L 8. PIPE FOR SEPTIC SYSTEM TO SCH, 40-4" PVC. H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. ? 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' CONCEALED WITHOUT INSPECTION BY BOARD OF ***3.4' HEALTH AND PERMISSION OBTAINED FROM BOARD COMPACTION. (15.221 [2]) OF HEALTH. SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LEACHING CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP FOUNDATION- EXIST SEPTIC TANK 112' D' BOX 12' 61.3' BOTTOM TH-1&2 VERIFYING THE LOCATION OF ALL UNDERGROUND & FACILITY NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT NOTE: LOVELLS POND ELEV. 38) WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 24 PARCEL 024 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. ***INSTALLER SHALL CONFIRM SHALL BE REMOVED 5' BENEATH AND AROUND THE SUITABLE SOILS AND NO G-W PROPOSED LEACHING FACILITY. FOR 5' BELOW SAS AT TIME OF INSTALLATION 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 42 VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE z - 4 IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR 73.52 SHED PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED \ BY THE BOARD OF HEALTH REVISED DURING A PUBLIC 73.', HEARING HELD ON AUG. 4, 2009 ��\3_29 .36 �_-��,Q 2) FAILED SYSTEMS ONLY SEPTIC SYSTEM COMPONENT TO 3.00 GARAGE �d 55 \\ SYSTEM DESIGN. FOUNDATION SETBACK, IF AN IMPERVIOUS LINER IS DESIGNED BENCHMARK: CONC. BND. AND INSTALLED (10' OR GREATER ALLOWED). �,' �\ 24" OAK AT ELEV. 73.1' j GARBAGE DISPOSER IS NOT ALLOWED 3) FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW '� \` � DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) 2 83 3A`7 GRAVEL _x 2 - AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS X73.22 DRIVE '�. �� USE A 330 GPD DESIGN FLOW BE LOCATED MORE THAN SIX FEET BELOW GRADE. �� \ PROVIDE 38' Or 40 1 R�DoOOM \ c r r r n �r nn.ld. z?n ran CL\ {�_ \� MIL LINER AT 5' OFF `� \ COTTAGE SAS IN AREA SHOWN. 20" OAK TOP AT EL. 67.7; �� `� **RE-USE EXISTING 1000 GAL. SEPTIC TANK Q2 � BOTTOM AT EL. 63.7 cas LEACHING: ��N x �.TEST HOLE LOGS NOWN LOC.) \7. a METER SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD \\D O EXIST. Sr BOTTOM 25 x 12.83 (.74) = 237 GPD ANIEL E. GONSALVES `�\ o ry PROP. VENT WITH CHARCOAL FILTER - ENGINEER: ' SE #13587 \ AND BUGSCREEN (FINAL PLACEMENT BY TOTAL: 472 S.F. 349 GPD WITNESS: DONNA MIORANDI, RS x'73 ks 2'29 �\d \ CONTRACTOR WITH HOMEOWNER DATE: 6/20 14 �� CONSULTATION) USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) / < 2 MIN INCH WITH 4' STONE ALL AROUND PERC. RATE = C x 72.21 CLASS I SOILS P# 114479 \ �� 4 ELEV. ELEV. p" 72.3' " w 72.3' �4 \ �a �� LF MA " x 72.05 \ , N APPROVED DATE BOARD OF HEALTH FILL FILL TITLE 5 SITE PLAN 4„ 4„ � � '�� � � 1.83 OF B B LS LS EXISTING BUILDING \\\�r \GASLINE' 1��, 4380 FALMOUTH ROAD 35" 10YR 7/6 69 4, 34„ 10YR 7/6 69 5, �� �\ 1�, COTUIT N 9.9 � G `� Scale: 1"= 20' PREPARED FOR LG. RUC . \� �-�71.75 81 BORTOLOTTI CONSTRUCTION/ PERC C C 0 93 08 �� 71 44 0 10 20 30 40 '_-10 FEET x69.68 �1.>��1. 6 1.48 GAUTHIER x 71.11 x 71.03 � �'� M/CS M/CSa .83 2 11496 o OPQ SEPTEMBER 24, 2014 Z 2.5Y 6/6 2.5Y 6/6 �20� 71.68 I LP -' off 508-362-4541 0 0 fax 508-362-9880 71 �1�- sq� �� DANIEL A. y� DANIEI downcape.com ` o OJP.A � A. , 132" 61 .3 132" 61 .;' c,vlL.46502 .N No N°�� �; down cape e/18'%Ilee�%/18, %I1C. �� 1 0 o, �, ° ti. °FE y .;o�P i civil engineers SLEEVE SEWER LINE FOR 10' EITHER TE NO GROUNDWATER ENCOUNTERED O� SIDE OF CROSSING WITH WATERLINE 6)-2�-��� S ��,. a, FN� �= land surveyors 88 � � 939 Main Street ( Rte 6A) > 4-220 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675