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4446 FALMOUTH ROAD/RTE 28 - Health
4446 Falmouth Road Cotuit A= 024-019 II1 ' I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name information is re Cotuit MA 02635 February 20 2015 wired for every 4 ry page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information �-" on the computer, r1`,4 rj use only the tab 1 Inspector: V _!✓-__ key to move your cursor-do not David D. Coughanowr, IRS use the return Name of Inspector key. 40---h Eco-Tech Rapid Response ICI Company Name 155 George Ryder Road South Company Address Chatham MA 02633 City/Town State Zip Code 508 364-0894 1328 Telephone Number s z t 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 tkA of M onditionally Passes ❑ Fails ElNeeds Further o ationD6AV Re L ti pproving Authority OUGHANOW(z N No. 1093 �F February 20, 2015 Inspector's Signature S'gNITAR\P� Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the 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. (A bl �l 1, 15 t5ins•3/13 Title 5 Official Inspection Form:Sfsrf Sewage Disposal System•Page 1 of 17 i- ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name information is Cotuit MA 02635 February 20, 2015 required for every ry page. Cityfrown 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: Z 'I have'not found any information which indicates that any of the fail ure,criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration o`r 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 201.years old'is available. ❑ Y ❑ N ❑ ND (Explain below)- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments µM 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name information is ry Cotuit MA 02635 February 20 2015 required for every + page. Citylrown 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): f ❑ 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. t 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•M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 r Property Address Paul and Grace Beattie Owner Owner's Name information is Cotuit MA 02635 February 20, 2015 required.for every ry page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 1 00 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 EJ ® 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 Y day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name information is Cotuit MA 02635 February 20, 2015 required for every ry page. CitylTown 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 pnvy_is below hlgh..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. i` ❑ ® 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 El ❑ 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 ❑ El Area-IWPA) or a mapped Zone II of a,public water supply well If you have ariswered"yes"to any question iri 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•3/13 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 , r Commonwealth of Massachusetts � . Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19: , ; Property Address Paul and Grace Beattie Owner Owner's Name information is required for every Cotuit MA 02635 February 20, 2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,.occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ® Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 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-no plan t5ins•3/13 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 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name 4 information is Cotuit MA 02635 February 20, 2015 required for every rY page. Cityrrown State Zip Code Date of Inspection D. System Information Description: An overflow leach pit was added by Macomber in 1985. Number of current residents: 0 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? h .- ❑ Yes ® No Water meter readings, if available last 2 ears usage 423 gpd 9 ( Y 9 (gpd)): Detail: 2013: 262,000 gallons 2014: 47,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: not determined 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.tra.p present? - ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 4446 Falmouth Road/Route 28 -Assessor's Map 24 Parcel.19 Property Address Paul and Grace Beattie Owner Owner's Name information is Cotuit MA 02635 February 20 2015 required for every rY page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): y General Information Pumping Records: Source of information: owner 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-3/13 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 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name information is required for every Cotuit MA 02635 February 20, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 29+ years. Certificate of Compliance for overflow cesspool was*issued 6/14/1985 (Permit#85-567). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) i If tank is metal,:list age years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: P t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts -RONW Title 5 Official Inspection Form �l s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4446 Falmouth Road/Route 28 -Assessor's Map 24 Parcel.19 Property Address Paul and Grace Beattie Owner Owner's Name information is required for every Cotuit MA 02635 February 20, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4446 Falmouth Road/Route 28 -Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name information is Cotuit MA 02635 February 20, 2015 required for every ry page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal - fiberglass - --❑-polyethylene- ❑ other(explain): Dimensions: - Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ° 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19, Property Address Paul and Grace Beattie Owner Owner's Name information is required for every Cotuit MA 02635 February 20, 2015 page. City/Town 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 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.): ` Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name information is ry Cotuit MA 02635 February 20 2015 required for every + page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type. ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: El leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 2 _ - ❑ 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.): Cesspool#2 was uncovered and found to be dry. It is made of concrete block. Cesspool#3 is a precast concrete pit according to permit application. A hole was dug into the stone surrounding the precast unit and no effluent contact staining was observed in the stone or overlying soils. No standing effluent was observed to a depth of 2 feet below the top of the peastone layer. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 3 total -2 overflows described above Depth —top of liquid to inlet invert 10 inches Depth of solids layer, 4 inches Depth of scum layer 4 1 inch 5 ft x 5 ft approximately Dimensions of cesspool Materials of construction concrete block Indication of groundwater inflow ❑ Yes ® No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Vol untary.Assessments . M 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 1.9 Property Address Paul and Grace Beattie Owner Owner's Name information is Cotuit MA 02635 February 20 2015 required for every rY page. Cityrrown 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.): a. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel 19 Property Address Paul and Grace Beattie Owner Owner's Name information is required for every Cotuit MA .02635 February 20, 2015 page. City/Town 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 A T§ONNS -OF. SEPTIC. COMPONENTS —DISTANCES IN DECIMAL FEET OVERFLOW A. 8 CESSPOOL 3 1 34. 45 2 42 43 3 61 67 VERFL O W O CESSPOOL PRIMARY CESSPOOL THIS 'SKETCH IS BEST VIEWED IN A B COLOR FORMAT EXISTING DWELLING 04446 DRIVEWAY .NOT _ • � • � TO n SCALE 508 364-0894 rn . . FALMOUTH 0 OAD i' t5ins•3/13 Title 5,Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4446 Falmouth Road/Route 28-Assessor's Map 24 Parcel-19 Property Address Paul and Grace Beattie Owner Owner's Name information is Cotuit MA 02635 February 20, 2015 required for every rY page. 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: 30+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Barnstable GIS.Department records. You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 30 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 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 4446 • Falmouth Road/Route 28-Assessors s Ma 24 Parcel 9 Property Address Paul and Grace Beattie Owner Owner's Name information is Cotuit MA 02635 Februa 20 2015 required for every rY page. City/Town 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 Z Sketch of Sewage.Disposal System either drawn on page 15 or attached in separate file GEOHYDROLOGICAL PROFILE - NOT.TO SCALE. PRECAST LEACH 4-0 PIT + M BOTTOM. OF LEACHING PIT LEA CH IS ABOVE HIGH GROUNDWATER r w v4 GROUNDWATER ELEVATION PER GIS MAPS f5ins•3/13 Title 5.0fficial Inspection Form:Subsurface Sewage Disposal System,Page 17 of 17 ti , f l l _«33S _ CF NSUS TRACT N CL I F_NT : % ! ccr iir :i i i i•. c;l; PAGE �+Z9 OWNER i : i i_T_ hi, -k i!—i>:i — - _ _— _P LAN BOOK ?.r1t5' PAGE $3t L 0 T AP['L [ C�NT : ASSESSORS PLAN_ PLOT M0RTCA6E INSPECTION PLAN OF LAND y R [ N N' SI A B L L 0 T r LOT 15 I LOT 201 u LOT 19 2 , 05 .ACRr-:s� 1 IM1 T OF INSPECTION / © Lo-r 2- `� SHCI) � ' 0T 1 �a - OfCK 14 2 S I 1 y ' �1 fj 's 1= A L i? 0 A '1) I CERTIFY TO ATTORNEY PAUL C , GLYNN , NEWORLD BATIK FOR SAVINGS ANT) ITS T 1 TLF IiJSJ P�fdC!= COMPANY , THAT TIICRE AR= NO VISIBLE FNCROACHMF^1T'., OR FASFMFNTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED WIDER MY IMMEDIATE SUPERVISION , THE OCATION OF THE DWELLING AS SHOWN HEREON l i IN COMPI- I ANCE WITH THE LOCAL APPLICABLE 70N I NG RYL AWS WITH RF SPF CT TO HORIZONTAL DIMENSIONAL RFOU I RFMF.NT S , Kt.rlrvt.l!t t, r THE DWE!_L I NG SHOWN HERE DOES NOT. FALL WITHIN 4 �•Niit ll�n A SPECIAL FLOOD HAZARD ZONE-. AS DEL I N►-ATE-D Mu.2t)Ita ',a� ON A MAP OF COMMIJN 1 TY #250001 DATED 10/1/83 BY TI-IF. F , I A Land Surveyors C101 Englneers o01011 2111t r tube 0., St (NeW �16)forl, �4$i,A 027,10 GI:NfRAL NOTF%- (1) The declarations made. above are (in the hasis of ray knowl edge, informal.ion, and br.licf �s I:he C rc;u11: of a mortgage plot plan gape survey inspe.cl.ion made to Hic normal st.andard of care of registered land P surveyors pea orLg ny in Massac.huse.Ctr^,. (7) !cecl.arations are made. I:o the. above named client. only as of this dale,,. (3) this plan was not: made for recur;ling purpo:rs, for arse in preparing deed desr.rrpl.infi or For r,on- sl:ruct-ions. (4) Verifical.ions of properly line dimensions, building uffsel.s, fences, nr lot. r,oniquratinn may be,. acr.omplished only by an accur;cle insPrumenl. :nrv,.y. Paul Beattie & Associates P.O. Box 540 Cotuit , Ma . 02635 Phone: 508-420-5727 Fax: 508=420-5729 January 29 , 2007 Chris & Leah: VP'lease, ,-,V,y.ou `sari notw leave; "loose trash and ',garbage open one theme deck. =,.This represents.'a possible health' hazard and` a"1 '-heighborhood eyesore . Per contract and as we discussed : "ALL REFUSE MUST BE STORED IN SEALED CONTAINERS" ' if not taken directly to dump. Thank you for your cooperation. z U - 73 7— 14-7-S- Sybcv/i✓G ffvvsE" 7z, /�/1rslEc77t-E Paul Beattie & Associates ��§��k�98�%�BRx•X �B�6B8 .. P.O. Box 540 Cotuit, Ma . 02635 Phone : 508-420-5727 Fax: 508-420-5729 April 17 , 2007 Chris & Leah: I prefer to get along with my tenants . You jeopardize this relationship when you break the' rules , and if violations are .not corrected , we will part ways . rl�.',In 'January I', sent you* a "Pol,ite .. note requesting.,, that you: . ., ,._,. f� , observe 'our lease agreement-,' "OUTSIDE TRASH ,IN:" SEALED - -F ;CONTAINERS , Since th.en.ythr•e�e -more requests. have�t', s _ ;absolutely nothing. Lt .appears-you are a_ `- on' _ly' people about;the '= on Cape, Coud, that "have, problem disposing of, the i.r_garbagel -� "I,'m busy "I•t was a- holiday" ,„ "She *can ' t lift There ate-+ ; " no` excuses . You have created. `a' health hazard,, and mature` 'adults simply do not live this way. You work,,,next .to the dump - 1 get a sticker like everyone. else Your. "Everyth'ing,,-is O..K attitude and igno,r,ing the- issue , ,compounds- the problem;- 2 . You are smoking in the apartment . We discussed in detail & you signed and agreed to the "NO SMOKING" clause. 3 . Last Month Rent: RvYou have had four months to prepare for this payment AND a bargain $600 rent to help you save, but still you have not honored your agreement . As discussed, please . include $200' with 'your May 1 'payment and submit the remainder as soon as you. arrange for loan as mentioned . Continued violations of our contract will not be allowed . If the Health Department becomes involved , or I ask you to leave., -you would be responsible (per contract ) for any costs incurred . On the other hand, if we both remain unhappy , I would consider letting you break the lease (when I find a replacement tenant) . Let me know - whatever the decision, I will do the utmost to'. *iaintain a good working relationship . THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M ^ACC DATA TOWN OF BARNSTABLE BAR-W '5913 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name am/pm, on 20_ Business Address - ' - -11 K.--L Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense Facts \ This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. -OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. r _ -", -.� . ... ,,,`n _.r.......�^-'::-",^.%- :.:-v,-;n�w+�:.,,•..,. .. ;r,.v,r'+.;w^.'*�v✓�.-.-. m..,'W +Y.+:.-,.we!.r*.'+^,•.r-.dig, ,r—,-,„., . ,<.;..-o*---".,--- ,►•-r....q.,... TOWN OF BARNSTABLE BAR-W .5913 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender _` i =' MV/MB Reg.# Village/State/Zip " Business Name '-a am/pw, ,,-on 20_" Business Address ' '•�- Signature of Enforcing Officer Village/State/Zip / r"y Location of Offense Enforcing Dept/Division Offense - Facts , This will serve only- as a warning. At this time no legal action has been taken. i ;. }}-It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are .attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-FROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. LOCATION 5E GL R 9 IT NO- zli ,..: - - VILLAGE - INST A LLER'S NAME Z ADDRESS 8 UILDER OR OWNER 7T LE- DATE PERMIT ISSUED DATE C 0 M P L I A H C E iS5UEy qL4 - 0 r � LO CATION 5 Ep A c e P RMIT NA VILLAGE o 1Vt I N S 7 A LLEF'S NAME ?. ADDP SS u I it. DIR on OWN ix Pam" L �. _ 7T M._ rti DATE PERAIT 15SuED DAT E C 0 M P L I A H C E 1SSL; ED— 6 i � �S ..� �.�� � i f � �y r� �f� . `tq3 �� i ,�� � `y. j �� �. �;� � � � m � . a � � ��� ... ( ,� .......�..�.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /�• lA w:.-ram ....--......-llfG(fi1 ......-- OF......... 4f ._........ Appliration for Uiipoottl World- Towitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ZYan Individual Sewage Disposal System at:' .........4/ 14 ......�a� ..- --- -7�%1�-----.-...o_�........_. .................................................. Location-Add or Lot No. ....._.... ... - --------�. -.--_- ----------------------------------------- ..... ...... _..... ��j�� • s /dd:!_lZS�iI Address Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling�o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aa4 Other—T e of Building No. of persons............................. Showers YP g --------------------•------• P ( )--- Cafeteria ( ) P4Other 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 ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ 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........................ a ............. - 0 Description of Soil......................... ------- x U ........-•-••------•-•-••••--••••-•--••--•...--•-•••------•----------•-•--•••......-•------••••••----•--•---•••-•------•------------•--•-•---•--••-••-•••••--•---•--...----•------•--................... x ••----•----•-----------------------•-------------•------•-------•-•--------------•--••--•-------•-•-----•---------- ------------ - V Nature of Repairs or Alterations—Answer when applicable......... _ " �&ZW------_. -----------------------------------••----•----------------------------------•---•--•--...•••..--•---•-••-•....------••----------•-----••-•-•--••-•---••--------•-------•--•••-•-•-----•-••-•----•-•••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'LU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by th boar heal Signed ... ------------•---...•••••--- Dat �� Application Approved BY : ................•--•••..-- ....................................... �4 ! Date Application Disapproved for the following reasons---------------•-------------------------...-•-------------------------------------------------------•-•---•----- ......-•••••---------•-•-•----•-•...-----•-•••-•-----••--•--•---.......•--------•---•---•-••--•----•••••.-•....-••----------•••--•••----•----•---•------•:--•---•-••--•-•-----•-•--••---•---•-•....----- Date PermitNo......................................................... Issued.............. ------•-- -----... -------- ate D ----------- ..__----- - ---=— -_-- -- — ----_----__-- - - - -ems -- - ------�,. No....................... .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ..........OF... ........................................—................................ Appliration for Uhipasal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct or Repair 4-) an Individual Sewage Disposal System at:. '4/ ✓.......... ...................................................... .......... ........................................................................................... Location-Addr9ss- or Lot No. ..............Z_ .......................... ................................................................................................. T_i OvIner— Address .............................. ................................................................................................ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling 215o. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons___..__....._...._...______. Showers Cafeteria Otherfixtures .......................................................................................... ............................................................. Design Flow.............................................gallons per person per day. Total daily flow...........................................gallons. 1:4 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. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---I.................................... Test Pit No. I................minutesperinch Depth of Test Pit........._........._ Depth to ground water----------------------- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.______.........__.. Depth to ground water._____..............____ P4 ............ -------------------------".............."----------"---------------------*---------------------"---------------- 0 Description of Soil........................�`_71 ...................................................................................................................................... U ......................................................................................................................................................................................................... ....................... .................................... ............................................................ ........`4------ --i...................;;......... --------------- Z U Nature of Repairs or Alterations—Answer when applicable__.....__ 4�11_ . .......... ........ ......................................................................................................................................................I.............................................. Agreement: The undersigned agrees to install. the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the StateSanitary 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 Signed :. ignc ...................................................... 2........Z. V...... ApplicationApproved By...............................I.............. ----------------------------------------- ............. ......................... Date Application Disapprovedjor the following redsons:...... ...................................................................................................... ......................................................................................................................................................................................................... Date PermitNo-------------------------------------------------..._._. issued....................................................... Date THE COMMONWEALTH OF'.:MASSACHUSETTS BOARD YF HEALTH A .4� %_0 r................................ .......................................... .......................................... THIS-IWTO TIFY, 3�at the Individra Se,%krage�Pisp Qsal System constructed or Repaired by...._...'!!'. ........... ......................................... ..................... ....................................................................................... Pf j -f Installer`/ at......t.......... ..................................................................................................................................................................... has been installed,in accordance .with the provisions of TITI�:.4,��of:5tb-jtate Sanitary scribed in the application for Disposal Works,Cbnstruction Permit No......... ................................ dated--- .................... ,THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUA%RRANTE,. THAT THE SYSTEM' WILL FUNCTION.SATISFACTORY. ............................ Inspector.............. ........................... ...................... DATE........................ L.�__2 ....... THE\COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH e... ..... F............... .......................................... ............................ ............. .................0. No......................... FEE. ........... janatrwfivtt irnti Permission is hereby"granted.........../............. ....................................I...................... ...... ... ............................. ..... ... .. ............. to ConstV Zr R idual .Se;�,age Disposal.System- ' atNo...................................................................................................................................................................... p Street 75-S67 as shown on the a d application for Disposal Works Construction Permit No. Dated.... ..___............................... ate .......................................... ......................................................................................................... Board of Health DATE f=I#J.25� -------------------------------------- FORM 1255 A. M-SULKIN. IN.C..,,IBOSTON >6KYX XV LLL �', ���, ;:• %�.y-_a I I I I I I I i ! I� I Iyl—I 1 \ ! \f ! I ! I ! ! I ! `� II IIIIIII II I I IIIIII I II I l IIIII ! it I ! ! 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