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0141 HIGHLAND AVENUE - Health
r; 41 Highland A nue Cotuit A = 021 - 0.14--002I SMEAErl Y j v No. 153L UPC 10330 HASTINGS,MN Y spa, 07 I �r- tp i I i I i I i I Stanton, David From: McKean, Thomas Sent: Monday, November 09, 2020 12:23 PM To: Frank Nunes III Cc: Stanton, David Subject: RE: 141 Highland Ave Hello Mr. Nunes, I received a voice mail message that you called this morning. I attempted to call you back but there was no answer. As David indicated in his email to you,you may apply for 4 bedrooms to repair the system.This property is greater than an acre in size and is located in the Saltwater Estuary Protection Zone; it is not located within a WP,GP, nor a Zone 11. Therefore,four bedrooms maximum are allowed at this property. If you need to call me back, my office telephone number is 508 862 4640. From: Stanton, David Sent: Friday, November 06, 2020 3:24 PM To: Frank Nunes III Cc: McKean, Thomas Subject: RE: 141 Highland Ave Thanks for the update, I have cc d Tom on this to see if he is ok with it From: Frank Nunes III [mailto:titlefive@comcast.net] Sent: Friday, November 06, 2020 3:22 PM To: Stanton, David Subject: RE: 141 Highland Ave Yes the old pit has a high stain line but the leach chambers are still functioning I do not believe this constitutes a Failure On 11/06/2020 3:11 PM Stanton, David<david.stanton(?town.barnstable.ma.us>wrote: Thank you Frank. I just gave Tom the update. He said based on your e-mail dated November 2"d which said "however there is a stain line above the invert which suggests that it was in hydraulic failure at one time" then the system needs to be repaired. PS You may apply for 4 bedrooms on the repair as the system is only located in the estuary protection and allows 4 bedrooms based on the size of the lot. 1 Thanks, David .... From: Frank Nunes III [mailto:titlefiveCcbcomcast.net] Sent: Friday, November 06, 2020 1:51 PM To: Stanton, David Subject: RE: 141 Highland Ave It is for a property transfer On 11/06/2020 1:19 PM Stanton, David<david.stanton cktown.barnstable.ma.us> wrote: Hi Frank, I just resent the previous e-mail again, about Toms question if this is for a property transfer or a voluntary inspection From: Stanton, David Sent: Friday, November 06, 2020 1:09 PM To: 'Frank Nunes III' Subject: RE: 141 Highland Ave Hi Frank, Did you get my previous e-mail? The question Tom has asked is this for a property transfer or just a voluntary inspection? Once he knows, he can answer the question and whether the system passes or fails. Thanks, David 2 i f From: Frank Nunes III [mailto:titlefiveCa)comcast.net] Sent: Friday, November 06, 2020 12:24 PM To: Stanton, David Subject: RE: 141 Highland Ave David As you know I'm trying to resolve this because my client is waiting for a response. I realize that you deferred it to Tom, but I am wondering as there was "no objection to 4 bedrooms at this property" per the 2005 amnesty agreement why would that change . Thank you, Frank On 11/02/2020 2:58 PM Stanton, David <david.stantongtown.barnstable.ma.us> wrote: Frank, I did not say it was approved for 4 bedrooms,that confirmation would need to come from Tom, I said that this may change the status as to the number of bedrooms. Thanks, David From: Frank Nunes III [ma i Ito:titlefive@comcast.net] Sent: Monday, November 02, 2020 2:46 PM To: Stanton, David Subject, RE: 141 Highland Ave 3 Ok I will write it up as approved for the 4 bedrooms Thank you On 11/02/2020 1:28 PM Stanton, David <david.stantongtown.barnstable.ma.us> wrote: Hi Frank, Thank you for the update. I looked in our file today and found a more recent (dated 5/29/2005) amnesty application (attached)that was signed and approved by Tom for 4 bedrooms. I don't recall seeing this one in your attachments, so I apologize if I missed it, I only saw the one for 3 bedrooms. This may change the status as to the number of bedrooms approved at this location as the previous document said 3 bedrooms. Thanks, David From: Frank Nunes III [ma i Ito:titlefive@comcast.net] Sent: Monday, November 02, 2020 12:42 PM To: Stanton, David Subject: RE: 141 Highland Ave David, FYI I did the inspection this morning. The pit was dry, however there is a stain line above the invert which suggests that it was in hydraulic failure at one time. The leach chambers are under a paved driveway with no access. I video inspected them and the effluent is about 12" below the invert. 4 I CAUTION:This email originated from outside of the Town of. Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 5 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •�; 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 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. A. Inspector Information 6011 Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 11/2/20 Inspectors ignatur 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 i Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �e u 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Ip Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 FIND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 j . Commonwealth of Massachusetts �n (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •.� 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Highland Ave. u 9 Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �n (0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 lip", Commonwealth of Massachusetts Ip Title 5 Official Inspection Form I° Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Per conversation with Health Agent Thomas Mckean the home is approved as a 3 bedr000m. The leach pit is considered to be failed and the system installed in 1998 is functioning. The 1998 system is a 3 bedroom design Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 289 GPD Detail 2018 108,000 gallons used and 2019 103,000 gallons used Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts ,�_p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) i Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I Commonwealth of Massachusetts ,F Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every COtuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1998 new D-box and chambers, leach pit per age of home Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): � Depth below grade: 3'6"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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, inlet and outlet covers raised to 12" of grade 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" 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 >2„ Distance from bottom of scum to bottom of outlet tee or baffle >2" 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 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �r ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass El polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ,z� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owners Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): 0,1 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.): There are 2 D-boxes, they were video inspected, no adverse conditions observed, no indication of raised covers t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ® 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leach chambers are under a paved driveway with no access cover, per engineered plan they are of H-20 construction, the chambers were video inspected and effluent level is approximately 12" below the invert, no indication of past hydraulic failure, the leach pit was excavated, it is 5'6' below grade , cover raised to 12", it is dry at this time, stain line above the invert is indicative of hydraulic failure in the past 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� u 141 Highland Ave. Property Address Tosti Owner Owner s Name information is required for every Cotuit MA 02635 11/2/20 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Cornm0 riie9 06 of Massachusetts Tit 5official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 GC- I� D 39 a1 3 c �kD 30 l6 3 6 `to � C a C_ a`` t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ►ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >12'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: n/a Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 1998 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Site is at 48'msl and nearby surface water is at 6'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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �s ro Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �e 141 Highland Ave. Property Address Tosti Owner Owner's Name information is required for every Cotuit MA 02635 11/2/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 I McKean, Thomas From: Stanton, David Sent: Friday, November 06, 2020 9:33 AM To: McKean,Thomas Subject: FW: 141 Highland Ave Tom, is this ok to allow them 4 bedrooms now? This is the one that he sent me stuff that said you restricted them to 3 bedrooms and you e-mailed the engineer to see if they were including the failed leach pit in their capacity count back in the day without an answer. Then when I pulled the file in the office,there was an amnesty application approved for 4 bedrooms. I'm assuming 4 bedrooms would be ok now with the amnesty sign off for 4 bedrooms, but we need confirmation from you that this is ok. He called again this morning because he hadn't heard from you yet. You can e- mail him or his phone is (508) 272-6433. Thanks, Dave From: Stanton, David Sent: Monday, November 02, 2020 3:47 PM To: McKean,Thomas Subject: FW: 141 Highland Ave FYI From: Frank Nunes III [mailto:titlefive@comcast.net] Sent: Monday, November 02, 2020 3:07 PM To: Stanton, David Subject: RE: 141 Highland Ave OK....I will wait to hear from Tom On 11/02/2020 2:58 PM Stanton, David <david.stantongtown.barnstable.ma.us> wrote: Frank, I did not say it was approved for 4 bedrooms, that confirmation would need to come from Tom, I said that this may change the status as to the number of bedrooms. Thanks, David From: Frank Nunes III [ma i Ito:titlefive@comcast.net] Sent: Monday, November 02, 2020 2:46 PM 1 0 ' �- 3t May 1, 2018 Mr.Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable 200 Main St. Barnstable, MA'02601 Dear Mr. McKean: This response is in regards to a letter that I received on Friday,April 27, 2018 for Msgr. Ronald A.Tosti of 141 Highland Ave. Cotuit, MA, regarding his amnesty apartment and means of egress. Msgr.Tosti is at the JML, Falmouth Rehab and Nursing trying to get back on his feet. He has been wheel chair bound and extremely ill since December 19, 2017. He is unable to request or attend a hearing regarding this matter. We would like to request that you set up a meeting with the contractor, Dwight Giddings, 617-365-5165 to go over the apartment. He is more than willing to meet you and to try and settle this matter. I would also like to point out that the tenant's daughter does not sleep in that room. She sleeps with her mother. I can be reached at 508-420-7864 if you would like to speak with me. I have power of attorney for his affairs. Thank you for your consideration regarding this matter. Sincerely yours, Carol A. Daniels I TOWN OF BARNSTABLE----— - — - — ---- LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT ! INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type), 1 > } (size) ✓ G' NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and ea 'ng Facility (If an wetlands exist within 300 feet 1 ty) Feet Furnished y ' 1 l _d 4 (aw Ave , C'o4-v a, t qll Ire 6 \ i 26� iS ry e r Town of Barnstable Health Inspector .1 oFz�tp� Office Hours P� Regulatory Services 8:30-9:30 Thomas F. Geiler,Director 1:00—2:00 * anaxsrMLF4 9� 16,59. ,�� Public Health Division ATE p �s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: /•1 AeXEr Address: l7� � 4 TU/7- Map LM Parcel 0/ -600 Name: 011/A'L8 Phone #: ZO- /'7?Z 2a. How many bedrooms exist at your property Ynow? 2b. Are you planning to add any bedrooms? /yO If yes,how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or ND If tli'e dwelling rs�connected topublic�sewer,skip questions#4`through#9 below; 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? �1 r 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATE ? f= -ti s _ 6. Is a disposal works construction permit on.file? YES xn-or NO 6a. If yes,how many bedrooms were approved according to this permit? drobWis.e c' 7. Were any building permits obtained for construction of additional bedrooms? YES or NO w Y 8. Is there an engineered septic system plan on file at the Health Division? YES .c zr 90 �-o rm 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE /ONLY The Public Health Division has no objection to `7 bedrooms at this property. Special Conditions: Signed: :. - Date: �I 0;/health/wpfiles/amnestyapp SULLIVAN ENGINEERING, INC . March 8,2005 Thomas A. McKean,Health Director Barnstable Health Department 200 Main Street Hyannis,MA 02601 ti SUBJECT: 141 Highland Ave.,Cotuit Septic System Expansion Dear Tom: For your consideration, we are forwarding you information regarding a proposed expansion at 141 Highland Ave., Cotuit, MA. The property has been inspected by Joseph P. Macomber,Jr.,a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). His findings indicate that the system passes and according to our analysis of the system design, there is present capacity in the 1,000 gallon septic tank and one (1) 1,000 gallon leach pit as well as a leach field with two (2) 500 gallon leach chambers to allow an expansion in the number of bedrooms from four(4)to six (6) per Section 15.301(5) System Inspection. The analysis also identified that no garbage grinder was proposed in the past, nor for the future at this property. Our client wishes to make this expansion. Sincerely, Peter Sullivan,P.E. CC.: Ronald Tosti Eric-: Analysis Worksheet Official Title 5 Inspection Form FILE COPY 7 PARKER ROAD, P. O. BOX 659, OSTERVILLE, MA 02655 TEL: (508) 428-3344 PSu1)PErao1.co-w FAX: (508) 428-3115 Sullivan Engineering, Inc. 7 Parker Road -P.O. Box 659 Osterville, MA 02655 Project: Ronald Tosti Mailing: Same 141 Highland Ave. Cotuit, MA 02635 1978 Title 5.Code Plans Dated: Original Septic Design Analysis: Residential Flow: Bedrooms 110 x 4 = 440 gal Septic Tank Requiements: 440 x 150% = 660 gal Used 1,000 gal Tank minimum Installed 15 years ago per owner. D-Box: Leach Pits Provided: Quantity Size Leach Pits 1 1,000 Stone: 0' Leach Chambers 2 500 Stone: 2' LP-Sidewall Area 188 SF x 2.50 471 gpd LP-Bottom Area 79 SF x 1.00 79 gpd LC- Sidewall Area 130 SF x 0.74 96 gpd LC-Bottom Area 103 SF x 0.74 76 gpd Total Provided: 722 gpd Daily Flow: 440 gal Garbage Grinder: This analysis identified no garbage grinder was proposed in the past, nor proposed for future use. Per Title 5, Section 15.301(5) upgrade of the system is not required if the system was designed to accept design flows resulting from the change in use or expansion of use. New Capacity 6 Bedrooms x 110 gal 660 gal 3/8/2005 I . � r '� r; CVM•"O�NW—EALTH OF M-ASSACITLTSETTS EXFCliTIE -)FF?CE Or' ` EN 11ROT\'M NTpL �F FAIRS DEPARTMENFT OF ENVIRONMENTAL PROTECTION OFFICIAL INSPECTION FORM TN T FOR VOLUNTARY ASSESSINTENTS SU13SLIR ACE SEWAGE-DISPOSAL SYSTEM pORtii PART A CERTIFICATION n.Prcpert} Address: _1 1 Hi 7 ---..... d v e Owner's Name: 0wner's Address: e Road Date of Inspection: 4 7 !Vamc of Inspector: (please print)_Jo 3ei,h p Company Name: J nr M2comber Jr. Mailing Address: Mo�� & SOri _Br^sr r,F r Inc. TelephoncNumbersg_775_��� U2632-0o66 CERTIFICATION STATEMENT I certify that I have persona;lv inspected the sewage disposal Vs:ern at this address and that the informat;on;epot:ed below is and e accurate and complete e; of the time of the inspection.. The inspe.ltion�was performed based on rn� nosing and expo.*fence " :he proper finc:ion and maintenance of on site sew°age disposfll systems. 1 am a on approved system inspector pursuzat to Section 15.340 of Title s(310 CMR a disposal l sy erns. ,, stc i�Passes Concitionall'v Passes Needs Further Evaluation by the _, Fails (cal Approving Authority t Inspector's Signature: r Date: s ��� ���• The system Lns cctor p ha11 su m;t a copy of this inspection report to the Approving Authority DEP) wi hin 30 days (;`tortpleting this i,ttpection. If system is a shared system or has a design tlok of IjLh r 4'(Boar(+of kealtts or DE . greater, the inspector and tie s)stctt, owner shall submit the report to the appropriate regional offrce of he DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the spprohe authority Notes and COn1ments 'This report only describes conditions at the t tune. This inspection does not address how the system me f inspection a�dh under the conditions of use at that conditions of use. will p - future under the same or different Title 5 inspection Form 6/15/2000 page 1 F0 39rd NOS a 63 WO0VW'd'r Q CT_Mc ,_n�� -- .-- Page ? of I I OFFICIAJ— 1,'�SP1=C7ION FnR,� _NUT FOR VOLUNTARY SUBSLRF.4CE SEWAGE DISPOSAL.,SYSTEM INSPECTION � E.FORUM PART A CI✓ItTIP'I CATION (coniinued) Property Address: 1 nad Avenue Ownrr: Qczn 35 Date cf Inspcctioo: a Melner Inspection Summary: Cbeck A,B,C,D or E/AL_,_WgyS ;omp)ete all of Section p A. ystetn Passer. is ! hav�-1110-01C-1� o hich indicates that anv of the failure cnteria described in 3.4n fai.ttre crj!eria not of eva!va:ed are indicated below. Comments: TI e Q2 �tiC_ gpsten is in proper working order : -_ g. ent tine . B. System Conditionally Passes: A''O O•*•e or more system compor•enu d e -Con repaired.The system. upon cornpie::on of theerep?acemenbed Ln hor epairsiar, appr,ved by,On need to be the Board.of Heals h,wjl)r ' pass. Answer yes, no or not deters ned(Y,\ ; ;n the for the feI)owing statements• If-not Qctermir,:d°'please ezpiaen. r rr:e septic tank is c:tal and over 2C. ears Old* �r crnsound, exhibits scbstantiai inf)nation or Y i ' the sep;jc tarts (whether meta; or not) is strucru-ally existing tank js re !se, P y g xpfi nation or Lank failure is imminent. System will pass inspectior if tht p jl w"h a com 1Y L') sc tic=k a ppro�ed by the Board of Heaah. •A than! thatseptic tank will pass inspection if it is Mcraral)y sound,not leaking and if a Ceni;icate of Ccr;cp!iance lndiCat!rg that the tank is less than 20 Years old is available. N�D�e!,\pia;r,: Servati0n Lf SeK'8 a backt, ' -AObstn t.d i e s t g p or break out or high static water !eve! in the distrtburon ox7du: co brok:r, or ] P O or due o a broken, serried or uneven distribution box. System wil!pass inspection if(with appro�s! Of Board of Nea!rh) broken pjpe(s)are.replaced z Obstruction is removed disVibutior box is leveled or replaced ND e,Pla)n: The system required pimping n`10% than 4 times a ,Year due to broken or Pass :.'tspectior, if(with approval of!be Board of Health) , obstr c:td pipe(;). The System will — broken pipe(;)are replaced — obstruction is removed `:D expla;n 2 t^© 3 Vd NOS T ;d321WODVW'd'f' S yl-E+•�-F�fiS 313 :OT b5=:T'ST./TG1 Paa' of11 OFFICIAL INSPECTION FOPNl • NOT F V S' BSLRL'ACE SEWA;E DISPOSAL SYSTEM INSPEC IONA$S F IR.Nj PART A INSPECTION FORM. CERTIFICATION(conrinued) Pr^perT} Address: 1 ari ems= i • `elr•er Drte cf lnsptMoo: C Further J:yaluatico is Required Cy tae Board of Heath: " a 8 COrid'110115 exist h p v public heathr quLre Pr sa ec!.trher evaluation by the Board of Health ui order to determine if the Y or the cneitowneet S,YS;e^ 1 System Mill pass unless guard of Health determines in a�eordance with 310 CMR 15.303 system rs not functioning in a maztjer wbich will protect public Ecattb safer {1�(ht that thr ,/4 y and the enytroament v� Cesspool or privy is µithin SG feet cf s surfact water ' 41 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh S%slcm Mil; fail urless the Board of Health (and Puafic water S ) s�stetr .s Iunctior.iOg ;r. a manner that protects the public htalth,sa upplier, if anfety and enviyl dt enmines that the �G�The sys!ern has a septic (A ;}; and Sail 8b5arption sy5ttm I,SAS)and the SAS is'wttri,� surface water supply or rr;butaw to a s"r race water supply,Y, tGU feet cfa system has a e_ept;c tank and SAS and the SAS is within.a Zone I of a pubii; water sopph, The sy stew" "as a septic Ur1k ar.d SAS ar,d the SAS is within 50 feet of a private water supply well XT)The system has a septic '41K and SAS and the SAS is I!ss lhar tGvlcct but $ feet or more fro,,t a ;r sate %%atcr st110:, "111'• Method used to determ,ne distance / 'This $,slern passes if the weir water analysis.performed at a DE certified laboratory, for coliforr-; bacrena and volatile organic compotutds inCicates that the wcit ;s Free (turn a!luti the presence of arnmonia ;;rrogen nnc -titrate nitrogen is equal to or less than 5 or �o` that faetl,t) ena ratlu,c criteria arc rTtggercd. A COPY Oft—le analysis must be anached vo this formpm'provided Ihat rto oi�e; 3. Other i 3 S0 3nt7.d NCS S �132W,30CVt'd'C' pj.ST—aF1—An:; 7Gn:1717 hC.ZT iQT ITn Pzgt o! I . CFFICIAi— INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURF.aC�. SEW^CE DISPOSAL SYSTEM INSPECTION FORM PART A CCRTIFI CAT]ON (COWirsued) Prepem Accress: 141 Highland gZve Cot.uit .Mass: Ow.ccr _P_risCil19 Mejnar Dale of lolpretion: 7/17/n]� D $v:iem Failure Crittr'a appiicaDic to all systerns: Y:. rrvi: tndleaie - ycs•• or ''r.o••to ea;h or the following for a_I Vtspeelions: �r s �4// �//�ac vp Of sewage L^te fa; l rr or systsm comp onent Out to overloadeG or clogged 5A$ or ersspoo: �/ Ctschw&( or poncur.g Orefflutnt to Int surface of the g70vno or surface waters due 10 an dverioadee 0 clogged SAS or cesspool S.AItc liaulo I(,-(I V1 rrse oisenOvuon ttiox bore ou;let inven due to an overloaded or cloggeo $AS or c e 4 t.p o01 2rtl'D iti+� qu!d depth v,_.;_e=Ql ;s less than 6"below invert or Available volume is less than . Rtquved Pumping more than a timer Us the last yea✓ lY T due so e1p c try flc. — �of times pw►tpto —Q-- BSeC or obstructed ptP<(s) vur^ c port oa ;f:hc SAS cesspool or privy I-, below high g ound water eleva:iori. y pon!On of ersspoo; or privy is withtt 100 feel or stu-race water supply or tributr„'. 10 IS s=act at<( supply ��y pcnlo,) ore cesspool or Privy is within a Zone I ore public &ell. > ponton of a ctsspool or pri,ry;I within 50 fees ors private water supply well A.^> ponton Of a ctsspool or privy Is Its% than 100 rcr[ but greaser than $0 raat•(yorri II priralt +attr sJpp11 welt ,.n.t no acceptaote water quastry analysis. 1Tbis sysscm passes Irthe well water analysis prrl,:rmto at a D£P ctrliftcd labors:ory, for coliform bacteria and rola(Ile organic eompounos Indict tes lnat the tell is fret from pollution from trial raclli;y Ina the presence of ammonia ni:rpgen and n!:rolt o,lrogen is equal 10 or less than 5 pprn, Provided thll no other ratlurr criteria art Irigocred. A cop)' of the aaa!ysis olust be 21;aehe0 to t!sis (0rm.� o)Thr system ra j, I have detcrrn,nee+ that one or more of the above (ailure erilcna exist as ,7<scr rive 5 )0) tnerrrorc the system falls, The system ov-ner should eontaet ,,t 3�,•; Healt'• :o deiermtne whal will Oe necessary to correct inc. ral!ure F Large Systems: To oc eonstoered a iargc syllrm the syslem must serve a facitily with a acslgn-now or ID,D00 eP•O 10 15.00C, gpd Y06 MusI nalrat< tilhcs 'yes"or "no" to each or the rollowing- '?e fallowing cnterts aPPly to la,ge lysltms to addition (0 Inc criteria above) n0/ !� Iif system is with.ln 400 feel Of a swfaee drinking water supply he syslem.• is —1hV 400 (cc; of a oTWlairy;o a surface dArlking water supply _ the syslem is spcased vs a nitrogen scnsilive area (Inlcrim Wellhead Protection Alen - IWPA)or a mappc; Zone it or a pu011e water supply well f>., have anywerea •.yc:"to arty gveslion In Section G the system is eonsiCcred a sivifieanl threat,O! answcrcc es :n Scc1 On D above the !3tge system has famed. The owner Or Operator cr any large system cpnstoereo a s e^ :cant tNeat under Seeltcn « Cr failed uiaer SeCIion D shad upgrade the system to aeeordanec with 3 10 Cry R. i�sterr;p-rr shoLld epntact the appropriale regional Crrt:c of the D:pienTrsent. a 90 3DVd NOS � �133WODtiW'd'r 8LST-06L-809 Z0:01T b66T/8T/T0 f '• 1 . ?age cf I I OFFICIA- INSPECTION FORM — NOT FOR VOLUNTA.'RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART $ CHECKLIST PropernV Address: 141 Hi hland Avenue Cotuit, Ma. 02635 Owner:_ P Scilla Melner Dale of lospectioo: 1 7 ChccK if the following have been done You must indicate' is"or"no"as to each of the Following-. Yes \0 Y ump=ng nfomia;ion was provided by the owner, occupant, or Board of Health IA ere an.%of,hc s;stem components pumped out in the previous two weeks Has Oc system received normal flows in the previous two week period � ave is ge volumes of water been inroduced to the system recently or as part of this inspection ? ��— VYe,.e as built plans of the system obtained and examined?(If they were not available We as N/A) 'A/as the facility or dwelling inspected for signs of sewage back up ? — Was the site inspected for signs ofbreak out � 4— W re all system Components,p iA'cluding he SAS, located on site? �— were the septic ;ar3 manholes uncovered. opened, and the interior of the tank inspected Of the baffles or tees, material of construct;on,dimensions,depth of liquid,depth of sludge andscum, depth of r°11)VR was the facility ewncr(and occupants ifdifferent frern owner rnamn:e:iance of subsurface sewage disposal systems° )provided with information on the proper The size one location of the Soil Absorption System (SAS)on the site nas been determined based on: Yes j no ExistLng information. For example,a plan at the Board of Health. /,7'_ Determined in the field(if any of the faila a criteria related to Part C is a; issue n rox' is unacceptable)(.10 CMR 15.3%(3)(b)j pp t r*nalton of distance I _ S ` L0 3.r)ad NOS 3 633WO0VW'd'f BLST-0EL-839 0 0T. r66T/ET;T,_i Page 6 or I I OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ProperlyAddresr. 141 Highland Ave otult , ass , Owner: Prised!a l e ner Date of Inspection: I 1 , i QZ FLOW eON'Dtr?GNS RESIDENTIAL Number of bedrooms(desi�i111 Nurnber of bedrooms(acrua;): DESIGN f1Cw bated on 310 5.20 ,for cxarnp)c: 110 gpd z N of be : x) � � �!'umber of current residents: ) �— Docs residence have a garbage grinder (yes or no):AD Is ta+;nd y on a separate sewage system cs or no): (jf Laund yes separate inspection required) Laundry system inspec!ed (yy e w�s or no): Seasonal use:(yes or no): Water mrrr readings, if a,,11Zilabic (last 2 years usa e 2Q0.0-91 iJ00 5urnp PUMP(Yes orno):Ve fi (gPd)1 gallons-249. 32 GPD Las! date ofoccupancy:y 2 �gallons-435. 62 GPIs COMM ERCLAULYSUSTR.IAL TYpe of establishment Des,gn now(based on 310 CMFZ 15 2Q)). Bas's of design flow(seata:persons!sgft,etc,); 1::Pd Grease crap present (Yes or no): . In6usrr1a; waste holdingtank resent ',� Nornsenitary waste discharged to tnc Title 5 sy tc es or no,: Water meter readings, if avai;a_bJe: , Last date of occupancy use; OTHER (describe): GENEFAL INFORMATION Pumping Records Source of information. J. P.MaLorcber & Son Inc, Was system pumped as pan of the inspection (yes or no): If yes, volume pumped IOQCball3r.s •- How was quantity pumped determined? Measured Reason forpuratng: Heavy Scum & Solids la ers were resent . T]Y S OF SYSTEM / eptic tank, soil absorption system i� Kngle cesspool ,L42 Overflow cesspool Privy ti Shared system(Yes or no)(jf yes, amen previous inspection records, if any) lnnovauvelAlternauve technology. Attach a copy or the current operation and maintenanee Contract(ro be Zdined born system owner) Tjghi unk t)lb Aruch a copy of the-DEP approval Chher(describe): .414 Approximate age of all components, date installed (if known)and source of informali 15 ears old , er owner on: Were sewage odors detected when arriving at the site(yes or no): , 6 80 3E)Vd NOS T t13aWOGHW'd'f R qT—P.P,i=r.Rr 'C1 CiT t-FFT PT/TPI P"e 7 of 1 1 OFFICIA-L INSPECTION FORM-- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOPUMATION (continued', Property Address: Avenue * M �_C, Owner, 2635i113 Melner Date of Inspection: BUILDING SEWER(locate on site plan) Depth below )Fade: Materials of cor.sm,,c+,ion: cas: iron a Disurce frorn private water su wel,��PVC °thcr 1, No" Comments(on rendition pf' pp y or ,u-lion line: _ -- —� joints, venting, evidence of leakage, etc.?Joints Anne., ht . !r'-o eviderice ka leaks e, S through the house vents, stern is vented SEPTIC TANK: (locate on site plan) Depth below grade e 'vlaterial of construction: A ,other(ezplain) e �me ziti�/1(;berglass olyemyiene !f tank is metal list a g is age confurted by a Certific,t�cf Cor-tpl~ tar cert:ficate (yes or no ar f Dimensions. �/ n � I/ 1 ( zch a copy o. Sjudgc depih: Distance from top of sludge to bosom cf outlet tee or baffle: ' Scum thickness: )istance from top of scum ro top of ocrlet tee or basic: _�_ Distance from bottom of scorn to bottom of ou�ar�,d r baltl: How wire dimensions determined: Ccrnmer.ts (on pumping recommendations, inleutlet tee or baffle condition, structUral integrity,liquid 1 v as related to outlet invert,evidence o;[eakage, etc,): 9 e ets —�-�D` n every 2 vears��nlet & utlet tee re , n of leakage. 1 J'�9u ho s ro v ence , GREASE TRAVZA40ocate on site plan) Depth below grade:.1,Z Material of construction:/✓A concreted fibergl,ss iene of cth other (expiainj. y y ' Dimensions: - Scum thickness: ; Distance from top oT scum :o top of ouCet tee or baff)e: Distance tom bosom of scum to bottom of outlet tee or Date of.last pumping: Comments (on pumping recon-r.endations, trlet and outlet r bafTe condition, as related to outlet invert,evidence of leakage, etc.}; structural integrity, liquid ieveLr Grease t t . a 4 not resen . 60 39Vd NOS T d33W00VW'd'I 7-0:0,T 17661,/6T/T0 t E OFF1,-1AL IrtSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS S U9SJRF.4!'=SEWAGE DISPOSAI,SY'STE!.7 IRSPF.CT10h'FORM PART C . SYSTEM i1FOk11,T10."r Kmun•ledr P.ope.*l,,dd•ns,l�'- Y. gn'-ar..d Avenoe t Jlt O.nv-Friacilla Mei r.er i^7:.+35GRPT7p,SYSI EM!S,Si' Uoare Dn;ur puo.r•ca-r.:Pn nm ngmrca) T,py — ,li;l,, d ' �kaeh::g feie:.aurae•J'm ns.ons: - I .:6V -.'r'•t't'1'.ItT.a:ivr ly;;er:. T f;:nl.T.:>!IrrlyylOgY:// �{�G C,^f� ICjJ•j) enO;port coDai4nn>!SDP,s:gnf Ji ny9raV!c faLure,Irvrl D(pa:a:ng.armD soil.:c'G:cPn O!.eg!'It.or -=r--P,,,,e4++i ci.i_ s nr�dr v.t'e�g ra-;ten iB, �7_ ure -E SSo00:Stile i;esspwl of a of pumped r/Pam of inenx::orj!ioeue rn site p:arl •,,De•arc ccaL;we:ior. 0 - Gk:�:-op o!:�5o�d�o slu n-•:n:�t2 i,r�.e.>f tcl ds laver iyy'�le :�.rr.rt.om ci unywl .rc:ass of coTtcuc:an. - :,.d,ee::nnorgror.,d,a:e: - '_':,nvn:n:c;n Ir rnnll:ion of:>�:,s:=::s o!nr'dnuin(>�:ure.;evfl o(^cnC:ny,cord;lair,of•tge!nr�pn:X) Ceeso _- - ?,,;tYl' �(locaee on sae plan) - D:merunnr. .f� _ DeplF.cf schd:. .i _,_ Peg,YM OFFICIAL iNSFECT!ON FORM-NOT FOR VOLUNTARY ASSESSA4EVT5 S*L�HSL'RTACE SEWAGE DiSPOSA!,SYSTEM!.N;PECTIC+tY FORM PART C SYSTEM 1NFORNATION lcrnrnvco; Pro,-,,oa•rss:141 -t1ald :,ve - otuit,Fla_ Gase�1jjrl lnsprr1conpp);i-l;�'rf.J a �+ y� `` �! 1,uA'h.I�Jl l�,'Clr j,ilI:bf (i��)I PJ II,E�j�,)i,f ,i�jlDlLtl ' psr;, :•sl:trn:e!con;m.eu;��i cone:ele.j;�mesal(��(;Derglall///�o!yrayienr.j�oJ:aTrrplail7 ./w gallons:dry _4A A'Vr:n Ws,".g ordf r(vB Cuc o(:w,w.'np,g Cornmee:l kon6�u>n ct.1—and(Iou I .nr,tu.) =& tT� ! n pool din Lansc5 al" no DtFTP�8tJT10"A�:%dGt��(.f pre sere nvs:tr.opened'.;w It rn f::e p:,n; •."Cn cf I�ou iJ�!rrl aD>ve e•.irlel!oven .(ab - ^r.merl:inD�r r!Don 1;:r 1 Ie oul!eu-qV - , riderrf of eolldf eaTYovrl L'j`r�ier:r.�Distrfbtt_c_n n_ Cx i9 n"t pre.cws;C, -- I Fi.,+?P CH NIBF.'ZrAu_p>cas on r:e poor - oroer;yes or n> AdE ' Ce T..T.rnlr`:;n0ir_14m>n,f pu;nF<n4 mDe!.Go.tOilion of PUmDI an0 ipe:ynr;:nets:el<'• I iF'ucin cheTOnr is f1:resent, _, --- f TOWN OF BARNSTABLE LOCATION I 6 A L,4,/� !ate SEWAGE # /l(2 VILLAGE- C d w lr ASSESSOR'S MAP& LOT t . 6 4 6 � j INSTALLER'S NAME&PHONE NO. T p M A n .0 X ex f S a/J SEPTIC TANK:CAPACITY 0 p LEACHING FACILITY: (type),&ay- l- Los C NA.e9 f'if size) S-0 G a 61 L. NO.OF BEDROOMS_ a_ • BUILDER OR O" I ------------------- i PERMITDATE: COMPLIANCE DATE: p �� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility ,(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Furnished by Feet CA a 37 I I pr;t 10Pil! !a_ . i)�SPrCT10N FORM , NOT POP, ` CLV?VTARY As.szssv.Fr,- Sl SURFACE SEWAQZ GISPOSAJ. SYSTEM INSPE':'T(OI"� FORS PA RT C SYSTEM FNFoR Yj,ATjojN (cCntinucti) �•op,� mac-tl, 141 Highland Avenue O�cat Fr,;s�cilla �M ner �I't t IA1p1(11.t o: 7! 1 /!Ci2 S��rcK o� sewt.c� �Isco��: sYs•rer�s P G. O< tich ci inl Ilvl(t disp0l tl tyUtr} intIVCVr IIt; tp Ai Ir4$ twp PCM41) MI 'tftttP,tt it^t:,^;.s, Ot tryst it :o:s;r Iu ..Ills •11 •^ i00 ftcl. LOCI,, ..hilt Pvblit wAlcc IvPPIr tr.tsrl Lac CvllCtnp _ f�f 3rt t a vt A-ve , Co I •\, s t / 0 19 i Y T� 73E"*-'..I f.IrIC tp 1--1QtAtrt•l4•!InI r• 0i r..T_rc _0mr: -n•r.T Mc T IC 'T;:, � t C Page OFFICLAL INSPECTION FORMM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR 4ATION(continued) Property Address: 141 Hi' hland Avenue Cotuit. Ma. 02635 Owner: Priscilla Melner Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Esumatcd depth to ground water `7_feet Please indicate(check)all methods used to determine the high ground water elevation: Y E S Obtained from system dcsign plans on record , If checked,date of design plan reviewed; 7/17/0 Z _ Observed site(abuuing property/observation hole w•itiain 150 feel of SAS, NO Checked with local Board of Health-explain-, N A YES Checked with local excavators, installers-(anach documentation) YES Accessed US;;Sdatabase-cxplatbsttn : 11t own . birag able . ma . us. You must descrbe how you estabUshed the high ground water elevation: Used : Gahrety & Miller Nodel 12 16 94 Ground water elevations above sea level . Used ; USGS Observation well data Junp. 1992 Used . USES Technic water efe 'tions. Leaching , Pit ect • Groundwater Feet Be1DW Bottom of Pit High Groundwater Adjustment 1.8 ft per Ftimpter'Method Thcr-fore.the vertical separation distance between the bottom I of the IeachihS pit and the adjusted groundwater table is 'flip feet, r.. It 7T -AC",4 una :9 ?PQWn11"1-U A r Q/CT_Ma)-QPC 7M!nT tGGTIPTiTCA • ��-. n,n-.� ,�. ,m r•T nr-..w t••,•.rtr-.w�•"w..+ram-,•,..w�Rtii,w,�r+v�Ye �(j� TJWN OF Barnstable ilUARU Qp �IgALTI� Sl11iSl1RFnOF BF.Hh(;E f?!9f'f)SAL SY3TF;M ]NSf'FCTION FORM - PART a .- CEKTIFIC�T►�,,>r i -TYPL Op PRINT CI,EAALY- PROPERTY INSPECTED STREET ADDIIrS$ i41 Highland Avenue Cotuit ,Mass . ASSESSORS MAP , BLOCK ANU PARCEL 0 021-014-002 OwtiCR ' s NAME Priscilla 1°elner PA177' U - CERTIF.ICAT,(ON I NAME Or INSPECTOR Joseph P.Macomber Jr . CO,HPANy NAME J. P.Macomber & Son Inch G -:r'ANY .ADDRESS Box 66 Centerville Mass . 0.2632 Stffft CCMPAf,'Y TELCPIioNC { 508 ) 775 _ 3338 Town or City Stitt •r FAX ( 508 ) 740 - 1578 CERTIFICATION STATEMENT I certify that I hRve personally inspected the sewage die osa'1 s *o ;>rLeC0jmr,,e;)da,1- icIjs his ndJress And thaL thph inforination reported is true accurate , Ys . m nr. omplete Rs of the tine o: • inspect;on . The ins A ► and re Ard:►I u POCtion was Performed and any 3 g Ngrade , maintenance , and repair are my LrR: nI,g and experience in the Gfl`1819tenC sire sewage disposal systems . Proper func ,.lon and maintet,nnce of Ch/ec one ; System PASSED , Tl;e inspection which I have conducted has not found any information which indicates tliat the system fails to adequately pr , An} eRi tII or i l;c envi ronmerit as defined in 310 CMR 15. 303Otect fabl f r criteria not evaluated Rre As stated in the FAILURE CRITERIA section of this form. — Systea FAILED; \ Tne inspection which I have co.nauct Protect the Ezubiis )�enl.th and the environment found that the system 5 , 310 CMR 15 , 303 , and as 'specirically noted on ART C `ails t.c onment in Accordance with Title CU 'TERIA of this inspectio form , P - FAILURE r Inspector Sigr,stur Date ne copy of this rt.ification must be( "here applicable and the ao^RD or to to the OWNER, the BUYER It the inspection FAILED, t:hb owner ' Other' one dear of .tlie ;ante of the inspection, unless2sllaueddor a uY6tem othe;uzse as provideu in 310 C"IR 15 , 305 , . 9 i red PArtd .doc G I. ��ib,-I 4.h1c J v771dn^'.a,.,•J n �. r.� �' --- -- -- SULLIVAN ENGINEERING, INC . March 8,2005 Thomas A.McKean,Health Director Barnstable Health Department 200 Main Street Hyannis,MA 02601 SUBJECT: 141 Highland Ave.,Cotuit Septic System Expansion Dear Tom: For your consideration, we are forwarding you information regarding a proposed expansion at 141 Highland Ave.,Cotuit,'MA. The property has been inspected by Joseph P. Macomber,Jr,a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). His findings indicate that the system passes and according to our analysis of the system design,there is present capacity in the 1,000 gallon septic tank and one (1) 1,000 gallon leach pit as well as a leach field with two (2) 500 gallon leach chambers to allow an expansion in the number of bedrooms from four(4) to six(6) per Section 15.301(5) System Inspection. The analysis also identified that no garbage grinder was proposed in the past, nor for the future at this property. Our client wishes to make this expansion. Sincerely, Peter Sullivan,P.E. CC.: Ronald Tosti Enc.: Analysis Worksheet Official Title 5 Inspection Form 7 PARKER ROAD, P_ O_ BOX 659, OSTERVILLE, MA 02655 TEL: (508) 428-3344 PSu11PE@ao1.com FAX: (508) 428-3115 Sullivan Engineering, Inc. 7 Parker Road-P.O. Box 659 Osterville, MA 02655 Project: Ronald Tosti Mailing: Same 141 Highland Ave. Cotuit, MA 02635 1978 Title 5 Code Plans Dated: Original Septic Design Analysis: Residential Flow: Bedrooms 110 I x 4 1 440 gal Septic Tank Requiements: 440 1 x 1 150% 1 1 660 gal Used 1,000 gal Tank minimum Installed 15 years ago per owner. D-Box: Leach Pits Provided: Quantity Size Leach Pits 1 1,000 Stone: 0' Leach Chambers 2 500 Stone: 2' LP-Sidewall Area 188 SF x 2.50 471 gpd LP-Bottom Area 79 SF x 1.00 79 gpd LC-Sidewall Area 130 SF x 0.74 96 gpd LC-Bottom Area 103 SF x 0.74 76 gpd Total Provided: 722 gld Daily Flow: 440 gal Garbage Grinder: This analysis identified no garbage grinder was proposed in the past, nor proposed for future use. Per Title 5, Section 15.301(5) upgrade of the system is not required if the system was designed to accept design flows resulting from the change in use or expansion of use. New Capacity 6 Bedrooms x 110 gal 660 gal OF PETER SULLJIPAZI NO.297s3 TONAL 3/8/2005 slalom COMMONWEALTH OF MASSACHUSE7TS EXECLIUVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF E+ NVIRONMENTAL PROTECTION TITLE S OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUEStRFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Prcperty Address: �41g g d, p,venue n?_F� Owner's Name: Owner's Address: e RoaC, Date br inspection; 4 7 Name of inspector: (please print) Joseph,�'Macomber Jr. Company Name: _,j p L p .Mach ho. & Son, Inc, Mailing Address; Telephone NumberS 77S_333 0263.2-0666 CERTIFICATION STATEMENT 1 certify that 1 have personsify inspected the sewage disposer system at this address and that the information repoRed Wow is Me,accurate and complete as of the time of the inspection.The inspection was performed based on my rras,ing and experience in the proper Finction and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspcctor pursuant to/Section 15,340 of Title 5(310 CMR 15,000), The system• it Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails r ' Inspector's Signature; % Date: The system inspector shall su mite 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 shard system or has a design flow of 10,000 gpd or greater, the inspector and tie system owner shall submit the report to the appropriate regional office ofthe DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, end the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the some or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 60 30Wd NOS �R 63SWO0VW'd'f 8LSi—OK-805 Z0t0Z t66T/eZ/L0 i page ? of I 1 OFFICIAL ItiSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (cominued) Property Address: 141 T4 i ry h1 ri Avenue Owner: 35 Date cf lospeCOO o; a Melner• Inspection Sutnmar).! Cbeck A,B,C',D or E/ALWAYS Complete all of Section D A.el y`steto patiee 1 have not found any infg�r, hich indicates that any of i .313 or in 310 CM' I 4 ex . y failure criteria not evaluated hare aindic indicated b'eloW described in 31t7 Comments: The e�tir system is in proper working order at- Lile Ant kirn�, B, System Conditionally Passes: &C One or more system components as described in the"Conditional placed or onal Pass"section need to be re repaired.The system, upon compleTion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not dererrnEned(.Y,iti,1�1D);n The e.xpiai.n. for the following statements. If"not determintd"please Tl:e septic tank is metal and over 20 years old*or the septic tans (whether metal or not) is strucruraliv unsound,exhibits substantial infiltration or exfilmation or tank failure is irnmtnent. System will pass inspectiot; if tha exisl4fg tank is.replaced with a complying septic tank as approved by the Board of S.Yste •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Cenificace of Compliance indicating that the tank is less than 20 years old is available. `.D cxpla n: ,bservation of sewage backup o° break out or high static water level in the distribution ox ue to brok:r or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System wilt pass inspection if(with approval Of Board of Health): — t>roken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced N'D explain: The system um in m re aired r+ p 6 4 P ore than 4 times a year due to broken Or obstntcttd pipe($). The system will Pass inspection if(with approval of the guard of Health): — broken pipe($)are replaced —.,,_ obstruction is removed *JD explain: 2 t70 39Vd NOS T �138WOOVW'd'f KgT-06L-809 Z0 .0T b66T/ST/10 Page 3ofII OFFICIAL INSPECTION FORA4 . NOT FOR VOLUNTARY ASSESSMENTS SL.BSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Properr} Address; � ) h rid Avenue O++oer: psiSciiLLa l ner Gate of Inspection: C Further Evaluation k Required by the Board of health: V3 Conditions exist which rtquire fw'her evaluation by the Board of Htalth in order to determine if the system Is failing to protect public health, safety or the enyironnent. 1, S>step, Hitt pass unless Board ar Health determines in accordance with 310 CMR 15,303(1) system is not functioning in a magAer which will protect public health,safety and th (bl that the e enviroament: Jet Cesspool or privy is within 50 feet Ora surface water Itom? Cesspool or privy is within 50 feet Of a bordering vegetated wetland or a salt marsh '.. System wilt fail unless the Board of Health (and Public Water Supplier, irony)determines that the s�steOn .s functioning :n a manner that protects the public health,safety and environment; The sys+ern has a septic tank and soil absorption System(SAS)and the $AS is,within 100 feet are surface water supply or rnbutary to a surface water supply, "fie system has aseptic tank and SAS and the SAS is within a Zone I of a public water suppiN 'I The system has a septic tank arc, SAS and the SAS is within 50 feet of a private water supply well The system has a septic tan:.and SAS and the SAS is less Ihan 1 GG eel bat S feet or more fro-n a pn ate eater supp') �%ell Method used to determine distance °This SNslem passes if the well water analysis,performed at a OEP Certified laboratory, for coliform bacteria and volatile organic comppunds indicates that the well is free from pollution from that ratiht)•and r the presence of ammonia rorrogen and nitrate nictogert is equal to or less than 5 ppm,provided that no o6ner ("lute critera arc m&Stred. A copy of t,)e analysis must be artachcd to this roan. 3. Other: 3 S0 39V8 hJOS S 832W0.0aW'd'C 8LST-06L-80S z0c0T P66T/'81/10 pqf (DFF1CIA-L INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUSSURF.ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propere} AdOrrss: 141 Highland Ave Cotuit Mas Owocr: -Priscilla MeInAr Datt of loipcc6on: 7/1 7 jn9 ,.- 0 Svstrrn Failure Criftr:a applicaole to all systems: YO4 mv: tnoiraIt "yes" Or "r.G" to each of the following for !Ll Lnspettions: L/AYe4 �.G D.(scup of sewage u,ie ratiitrr or systtm component due 10 ovr1`1090ed or clogged SAS or ccsspool lschargr or ponevg of a rflucnl to the surrace:of the Votind or suuface waters ave to an Overioa0t0 or clogged SAS or cesspool S'At'C IiQuio ic"rl 0' tAr)t dliMl:Iuuon box bovc outicl inven due to&A oyer1090ed or clogged $AS or cesspool Q quid depth o tras¢nal is less than 6" bclow invcn or available volume is less than 'A day (low Requved pumping more than o times ;n the last yea/ NQT due to clogged or obsrsveted pI;Kl. Nunn /of times pumpcd -,L 901`110.) Of the SAS, ccsspool or privy i; below high ground water elevaliOn. Yy pon!on of cesspool or privy.is withlt 100 let[ Ora surface water supply or 17lovtwj to a stvfact vascr supply _ �y 90r110n of a ccsspool or privy is within a Zone I of a public wtll. YXO> ponton of a ccsspool or privy is within Sp feet of a private water supply well ,-n> Pon'" Ora cesspool Or envy is less than 100 rcet but greater snan S0 feet.00m is privoir water luppl> "" w,tn no ac"P"lc water qualtry analystl. (Tbil system passes if the well water analytn. pert,rmra at a DFp eerlIrtr0 laboratory, (or coliform baeleria and volaille organic eompounas Ino,rales that the "ell is (rte from pollution from Inal racllily and the presence of ammonia nurogtn and miratr ailrogtn is equal to or less than $ ppm, provided that no other failure criteria are Irlggtrtd. A copy of the aaalysis trust be atsa(heo to This forma Thr syliem fails I have a<Icrmtned that one or more ortht above failure criteria exist as 0tse ted .n ;ID C,AR i S )O) lhcrcr0rc the system fails. The systtm owner should contact lnt 3�e Heath ;o deitn7tine what will be necessary 10 correct the failure E Large 5yslrms; To De considtrtd a large iystrm the system must ltrve I facility with a design now of lo,Doo gpo to 15 000 4pd Yd, must Jndtcate tilhcr "yel" or "no" to each of the (ollowi lg- '1 r following cr,terta apply to large lylttms t.n addition to Inc criteria above) _ t/ Inc systcrr. is wish,r, 400 feet of a surface drinking wolcr supply t system is withtl, 700 (ceI of a Q7 bvta y ;o a surface drjrjking wafer supply Tine system is located N a ninogen sensitive ergs(IL nlerim Wellhead Protection A I - IWPA)or a mappeQ Zone 11 Of a puolsc water supply well f yo have aAlwered "ye:"tO My 4NCsllon in Section E the sysiem is considered a significant threat, or aAsweree: es" A Section 0 above the large syslem has failed. The owner of operator or any large syslem consjOerco e s 2 r:canl INN under Section E or (ailc0 under Section D shall upgrade the system In accor0anee with ] ID Coo.R Tr.c system pwmcr shot.10 contact the appropriate regional orTtce or the Deparrment. A r. 90 39Vd NOS 'S 639WO0dW'd'f 8LST-06L-809 Z0:0T b66T/eT/T0 Page v of i I y OFFICIAL INSPECTION FORM — NOT FOR VASSESSMENTS 4 L,UNTA.R Y S,UBSUR.FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORJv1 PART $ CHECKLIST Property Address: 141 Highland Avenue Cotult Ma—0�35 Owner: P cilla Reiner Dale of lospectico: -7117/02 Check if the following have been done You must indicate s"or"no"as to each of the following: Yes v Pumputig information was provided by the owner,occupant,or Board of Health �U'ere any of the system components pumped out in the previous two weeks Has 0c 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?(Ifthey were not available note as N/A) +� ^� Was the facility or dwelling inspected for signs of sewage back up? the Site inspected for signs of break out ? _ Were all system components,itluding the SAS, located on site? Were the septic tank manholes uncovered opened,and the interior of the lank inspected for the condr,ton Of the baffles or tees, material of construccon,dimensions,depth of liquid,depth of sludge and depth of scum Was the facility owner(and occupants if different from owner)provided with inform maintenance of subsurface Scµ age disposal systems? auon on the proper The size and location of the Soil Absorption System (SAS) on the site nag been determined hated on: Ycs no t/ Existing information. For example, a plan at the Board of Health. Determined Ln the field(if any of the failure criteria related to Part C is at issue approximation' is unacceptable)[310 CMR 15.3a2(3)(b)j of distance a. S L0 39Vd NOS 2 d39WO0VW'd'f 3LGT-06L-805 z0:0T b66T/eT/Z0 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SU13SUR-FACE SEWAGE DISPOSAL SYSTEM INSPECTION FO." PART C SYSTEM INFORMATION Property Address; 141 Highland Ave otu>.t , ass, Owner: Prise a e ner Date of Inspection: 2 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms (acrual) � current flew based si )It)C 1 -20) (for cxarnplc: ) 10 gpd x a of bcdroorns):Number of curre residents: Does ras:dence have a garbage grinder(yes or no): AD Is laundry on a separate sewage system Laundry system inspected{yyew�s or no}; es or no) (tf Yes separate inspection required) Seasonal use: (yes or no): /Ll� Water meter readings, if a,vyailable (last 2 years usage (gpd)):2 0 0.0—9 1 , 000 gal l ons=249, 32 GPD Sump pump(yes or no):Alle 2 Ldbi date ofoccupancy:A gallons@435. 62 GP COMM E RCLAULNno USTRIA L, Type of establishment: des gn now(based on ?l0 CMR 15 20)). d Basis of design flow(sea ts,person+Jsgft,etc.): Grease trap present (yts or no) .ate Industrial waste holding tank present(yes or no): Non sanitary waste discharged to the Title 5 system es or no): Water meter readings, if avttilablc: Last date of occupancyruse, OTHER (describe): Pumping Records GENERAL INFORMATION Source ofinfonrimion: J. P.Mac_omber & Son Inc . Was system pumped as part of the inspection(yes or no): If yes, volume pumped 1004allons •• How was quentiry pumped determined' Measured Reason for pumping: Hesav Scum & Solids la ers were resent . TYpE OF SYSTEM ./ Septic tank,visa;b $ soil absorption system Single cesspool Overflow cesspool Privy Sh&td system(yes or no)(iryes,attach previous inspection records, ifany) Innovative/APemative techPOlogy. Attach a copy of the current operation and maintenance contract (to be Zob ained bom system owner) Tight tank a Aruch a copy of the DEP approval Other(describe): Approximate ate of all components,date installed (if known)and source of information: 15 yggrq old , er owner Were sewage odors detecttd when arriving at the site(yes or no):_ 6 - 80 39Vd NOS T N3HWOOVW'd't' 8L9T-06L-809 Z0:0T b66T/8T/T0 P�;e i oC 1 I OFFICIA-L INSPECTION FORM �-NOT FOR VOLUNTARY ASSESSMENTSSUBSURFACE SE"A AGiE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION (continued} Propert} Address: q 4 Z Aih 7 m nd Avenue Owner, 2635 Date of[n lla Melner spection BUILDING SEWER(locate on site plan) Depth below grade: � ���1� / Materials of con snuctio�n: cast iron Zp PVC 4:&Lothrr(uxpiain); Distance from private water supply well or suction line: Comments(on condition of joir.r�, venting, evidence of leakage, etc.^ Joints a ear ti ht . No ev.id ence o 1 eaks e . S scam xs vented through the house vents. SEPTIC TANK: 200cate on site plan) ./i�0d Depth below grade: !e' !Material of construction: concretemet21 fiberglassrt/1�polyethylene its other(explain) If Lank is metal list age: Is aoe cunfur-tad b� a Certic,tr of Con liartce cert:ficate) i� ^ p (yes or no)/�(attach a copy of Dimensions. - l /C 1�/%. � Siudge depth: 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 scorn to bosom of out! t tee or bat 1 — Mow µere dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert, evicence of leakage, etc.): �eva.r , 2-3. v�ars��nlet & utlet tee re in r tur 1 v of ,leakage, � `��u _ �h s noo avid@nee GREASE TRABI�t(locate on site plan) Depth below grade:.d2i Material of construetion:AM concrete�metaV?%A fiberglass pplye�ylene other (explain). Dimensions: SS7 v Scum thickness: Distance from top of scum :o top of outlet tee or baf'ne: Distance From bottom of scum to bosom of Outlet tee or bL:ilv: Date of last ptunping:-_Ak Comments(on pumping recommendations, inlet and outlet r bafT]e condition,structural integrity,liquid seven as related to outlet invert, evidence of leakage, etc,); Grease t a is not present . a. 60 39vd NOS a d38WO0VW'd'f 8L5T-06L-805 ZO t0T b66T/8T/T0 r A OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUES'JUACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(c uv,ued) Property Aderes,:141. Y,:. hlan Avenue , �OtpiLl'Ia95. tr.'ner Friaeilla Melner Date 0; SCEi.5BS0)iPTIO�SYSTEM(SAS):_(lonte ao slu yta o,ezenvatlon nm reyulned) -I000 align yr l,. nhe.. ' rwilad ales eeewe-&,01' If SAS..c..r aced eaplarn why, Tr!D,e aching yi:s.n,mhc:.d ch'rg cha.'rbcr,,nv.n6c:C lcac^mg gaileHcs,nwn:ee Q_ ' - itachIg Film;,nur.Der,dime1n�s,ons: (J v:e-11cw cesspoa;.numar `' /J vus;vuive!aitemr.ive syuem Typeiname oftechno1ogy;.�R6„fide � C4y+ri, Cernmrms Inure candiocn of sail,signs of hydraulic Nil..,level otponding,damp soil,conen:on of vof ageut.oc. y.a�ooC icsB oils nre dr 5r `� pure C ESSPOU LSL /�+rcesspccl mu.e be pumped as pNl Of WDttt;nn){IOCatt do site pianl ;mbe!and cenfglut ion-Q CA—-cop ofhi,id io mini m,en: — Oep•hofsol.;l l yer:-..-_�.r Oe of Scam Is � _ '.r r,ans e(cesspwl _ Y rc::ais of consm[run:an. :nd"at;"of grov,daa+ec inflow(yes a no). C>mm:ns(note rondkion of soil,sign.,of hyd!aulic f3ilur[,11,11 uf;mnding,condirim of v<g<urion,acj PAISI',lrjL4 0Ocate on sift plan) V,al mis Ctenn,Pai!iCn' 9:mecs;om: 7agc gof;; OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISP(pSA).,SYSTEM INSPECTION FORT! PART C SYSTEM INFORMATION tcom;nucd) Fropar:y Address;141 Highland Ave S,3Luit.atas_ ' Owner: P-;:rg rla Melne Data rs Iu'pwia 211;;fl7 T1cK'!KJ!'K A Y*j�'��!i����faJl�Ml�d��l�!fb��"lp�c?iool�Iorat�asdlpllarl naps Delnw Qad.:� !.sal<r,a;of consm;cu-+.�conerere�mesal�FD<a Iaas.e�4 I !A g ._pC yethYlcn<�osheKcr.ptaln7 C Caca< �gallonl Ces,gn F:.,- ,G/7 gauens%daY . PJarm ore,rnt(yrs or no):`('� A.—le.eI_4A A'artr:n w 4u g order(Yes Dam vt:wp,rnp.ng-Allf- Co.+uner;a(condillon Of l lsrn and 00,,-4che,,etc.): i$ t nt_-o DICTR;BIJTIC''BOad4e_}(;f pretent must be opened)(Ivcare an sire p",,) DIP"Cf Iiatrid 11-1 lb-c cutlet Coruner.ts(pore;(bos Is trs':I a,ne 441itulion to outlets equal,anY eriderc:of solids camyvre,.any evidence v( rak,ge.mo ur am cf bvz,rtc.): Distribution h_ az is not Dreeent: "rt,sIP CRAM BF.BRA(Ioca:e on site pion? :mps�n wnrr.ing order bzs or nny-.r�fAr, Alartr,in v:Ork,ng Crdrr(yes O:n01.2N Camr.enss(note coran,on of pump chnniner,condition of pumps and,opurtenanees,etc.;: Yurno c'h em der is nyjt_p`resent. '- -^�------ R •. 01 39lid NOS 8 839W37"1W'd'C 9LST-06L-605 ZB:61 06611ST/T0 r TOWN OF BARNSTABLE LOCATION 141 /t; ,4,t/� h PC SEWAGE ._ E # . VILLAGE C O f u IT ASSESSOR'S MAP& I:OTA2 1-0i�-bb i INSTALLER'S NAME&PHONE NO. /I/1 L ®at �K t SS OW SEPTIC TANK.CAPACITY / O o o— LEACHING FACILITY: (type)WGUI- 2 r2',6,W C yam,y fl c 'size) _ .f Q 0 (a AZ. 1 NO.OF BEDROOMS\__ • BUILDER OR OWNER PERMITDATE: ?, - I Iff COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching.Facility Feet Private Water Supply Well and Leaching Facility ,(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by CA9, 3/ o � T � O d Pigs 100i 11 OPF 4 H'�SPZCTION FORK! NOT POR VOLUNTARY SU85t FeLE SEWAGE DISPOSA_[ SYSTEM INSPEC71ON FORM PART C SYSTEM TNFQRlvLA"r(ON (eontfnue0l Proprrty �oarr , 141 Highland Avenue 0"arr: Frjggi1j M iner lnIpIcuca: 2 SKFTCN OF $EWACE DISPOKAL SYSTEM �+o• ac , xmh or,rr I(` ItI di,poIII Iymn inelvdtllg Ilr, toil It4$l nvo rc perm{nenl rcrente ILA".i,s, �. o1�v�nvx ��;,,r ,li wrllt .r,n,n 1001rri. Lotrr= what pvt3lic wltcr tvpplr Cnitrl {At Ovilcin( Arve Y I Q q+ IT 3DVd NOS ? H39WODVW'd'f 8LST-06L-805 Z@ :0T b661118T TO Page i I of 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 Highland Avenue Ctatuit, Ma. 02635 Owner; Priscilla Melner Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Y E S Obtained from system design plans on record • If checked,date of design plan reviewed 7�17�0 2 M Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health•explain7 N A YES Checked with local excavators, installers,(anach documentation) YES Accessed USGSdaubase-explaih.ttp : IIt own . h rns able ,ma.us . You must describe how you estabUshed the high ground water elevation; Used : Gahrety & Miller Model 12 16 94 Ground water el v ons v sea level Used ; USGS Obserygition well eta June -�992 Used . USA water e1e ations. Leaching ) Pit 'eet Groundwatex Feet Below Bottom of Pit Nigh Groundwater Adjustment 1.8 ft per Flim ter P p Method Thertfore,the vertical separation distance between the bo t rn f of the leaching pit and the adjusted groundwater table is feet, ar• 11 Zt 39dd NOS 83EWO0VW'd'f BLST-06Z-805 Z0 :0Z t:661/8Z/10 y• ��r.r- r..+�...wv.,..nr r m rvr...�r..rr..:.:w�s.�r:�s►^r!,ww e,�wtiy Fr�r.y,is,yrt .TOWN OF Barnstable WARD 'OP HEALTH 91111SUNFA'K 9FWA(;F DISR)SAL SYSTF'M INSVFCTION FORM - PART D CEf{Tf FICATIc?N -T'tpl ON PAINT CLEARLP® ne„etiq,,.,,r,R,a� F110PERTY INSPECTED STREET ADDRCSS 141 Highland Avenue Cotuit ,Mass. ASSESSORS MAP , BLOCK AND PARCEL 0 021-014-002 ' OWNER ' s NAME Priscilla Melner PAI?T D CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr , COMPANY NAME J. P.Macomber & Son Incrf ' CObFANY ADDRESS Box 66 Centerville Mass , 02632 str•at Tgwn or Citr COMPANY TELCPl4ONC ( 508 J 775 - 3338 st.ts ;rp FAX ( 508 ) 790 - 1578 CCRTIFICATION STATEMENT I certify that I have personally inspected the sewage d1sposa`1 system nr. ;)r1ecommendatioris- his Address And 01eLL the information reported is true , accurate , and omplete ns of the time of . inspection , The inspection was performed and any regarding upgrade , maintenance , and repair are aonaistent -;iLh my training and experience in the proper function and maintenance of on- sire sewage disposal systems , Chee one; +' System PASSED T1,E inspection which I have conducted has not found any information which indicates that the system fails tv adequately protect public heRIL)r or Lhe environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as ststed in the FAILURE CRITERIA section of this form . System FAILIED \ Toe inspection which I have conducted has found that .the system fails tc protecL the Ezublic health and the environment In accordance with Title 5 , 310 CMR 154303 , and as specifically noted on PART C - FAILURE Ch 'TERIA *9jf hio form , Inspector SignDateD necopy of th must be provided to the OWNED,. the BUYER uhery aNpl ica1R9 OA t,H.. 1• • I r the Snapect lon TAILED, th'a owner or ='oporator eha.l,l u wil,hin one year of the date of the inspection, Unless alr°de ' brha ayetem otherwise as provided in 310 cFIR 15 . 305 , lowed or required partd .doc ET 39Vd NOS T 83E1NO0tiW'd'I' 8tST-06L-809 ZO:OT b66T/8T/TO I Town of Barnstable Health Inspector oFtNe r Office Hours ti Regulatory Services 8:30-9:30 Thomas F. Geiler,Director 1:00—2:00 • BMWSPABLE, MASS.9� Public Health Division ArFp �a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT- SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: �• A � Address: X/ � TU/7 Map AU Parcel t7/ Name: j�011 kt d A. /0 S T/ Phone #: 2a. How many bedrooms exist at your property now? '- 2b. Are you planning to add any bedrooms? IY Q If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 7 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If the'dwelling .s connected ro public sewer'skip..1 uestions.#4'through#9 below. .:> 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wellsLAP 5. Is the dwelling connected to an ONSITE WELL or.to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed:.. Date: Q;/health/wpftles/amnes app � i., 95 �/ �1�c 1 �S�l'" ?a G jam,( 2, C`kW4,es,, 40/ l c�..7 !i '�� K !�✓1 _ �/ l�e i 1 XIN L 71 1 � y l 01*04 AV 'CO . 4Tdrr FI�r � RodlL — 1 lqt /�16,�c�r vD Avg Co7d�7 fECoND 12Ao'' — tZOLIA bjvtO �e�t 1'1 � �ht►�rtA�n pit,, 01017 .— A�ttoRY ArAK7ME� — rf 5� fv 2dvVA f tz x A4 COD I t3 RP r(v Lai i2vv,M µ4asr� L i S r r L,0 0 e- RONALD A. TOS T i RO. BOX 814 1 �'q y S� • �` COTUIT, MA 02635 Lo co (Y) 0 N I— CC) 0 _ . QX < < ® � 0 �. r - �� nn � r r 'r 0 AKD CA) St aR 5 r� / f v 9 • RONALD A. TOB T i PO. BOX 814 C®TUIT MA 02635 TOWN OF BARNSTABLE ;;;'L OCATION Al/6,i L,4wa( R V SEWAGE# 110 wII:LAGE G d T(/17 ASSESSOR'S MAP &LOT 6 7 J Al y bo� ;;INSTALLER'S NAME&PHONE NO. J"/.' wt A c O A X r X f :SEPTIC TANK CAPACITY l D D D•- '•LEACHING FACILITY: (type)WCO- .24 64&C 14A.eefR size) S�O<O :-:NO:OF BEDROOMS 3 `E:CJII.DER OR OWNERa9�y.� .PERMIT DATE: -_,J b Y g COMPLIANCE DATE: ;?Separation Distance Between the: ,:,Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet ..:Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet :;::Edge of Wetland and Leaching Facility-(If any wetlands exist `within 300 feet of leaching facility) Feet �fE i0 shed by Y 2 . AY", McKean, Thomas From: McKean, Thomas Sent: Tuesday, May 17, 2005 4:52 PM To: Dillen, Elizabeth Subject: 141 Highland Ave Our septic system records indicate that the septic system was approved for three bedrooms. Two 500 gallon chambers were added due to an apparent failure in regards to the existing leaching facility. Is the engineer including the original leaching facility (which failed) with his calculations, concluding that it can now handle 6 bedrooms? 1 r P DATE: 7/17/02 PROPERTY ADDRESS: 141 Highland Ave Cotuit , MassOV __ 1 /____________ '6 � 02635 cal ------------------------ On the above date, I inspected the septic system at the a This system consists of the following: RECEIVE) 1 . 2-1000 gallon precast leaching pits . ( 6 ' X10 ' ) 1-1000 gallon septic tank_. JUL 2 5f2��2 3 , No distribution box. TOWN OFBARNSTABLE HEALTH DEPT. Based on my inspection, I certify the following conditions.- 4 . This is a title five septic system. ( 78 Code ) -5 . The septic system is in proper working order - at the present time . i 6 . Pumped septic tank at time of inspection . T/ ` j 7 . Waste water for #1 pit is 19" below the invert pipe . �? 1 Waste water for #2 pit is 54" below the invert pipe . SIGNATUR Name: J.- P. -Macomber-Jr. Company:JoseR1 P ._ Macomber & Son, Inc. Address: Box 66 Cen-tgrv_i11 Q ) ��_Q2632-0066 Phone: 508-775-3338 . THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH P. MACOMBER & SON, INC: Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 141 Highland Avenue Cotui , Ma- 02635 Owner's Name: Pri sci 1 l a mt- nc-r Owner's Address: 42 01-d PnWrjimr Notice Road Takefi eld. Ma. 02347. :Date of Inspection -, i 2 Name of Inspector: (please print) Joseph P. Macomber Jr. Company Name: Joseph P_ MacomhPr & Son, Inc. Mailing Address: gc)x 5F rent--prvil 1 a� Ma 02632-0066 Telephone Number508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my raining and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP ,6pproved system inspector pursuant j P to Section 15.1340 of Title 5(310 CMR 15.000). The system: asses r "Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails T Inspector's Signature: Date: `� - The system inspector shall su VMita 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 b_e sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I I i OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 41 Highland Avenue C`ntni t Ma 02635 Owner: Pri sci L a Melner Date of Inspection: Inspection Summary: Cbeck A,B,C,D or E/ALWAYS complete all.of Section D A. ystem Passes shave not found any information: hich indicates that any of the failure criteria described in 310 CMR 15.303 or m 310 CMR 1 4 exi�failure criteria not evaluated are indicated below. Comments: - The septic system is in proper working order ! at the present time . B. System Conditionally Passes: ` Afh One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N„ND) in the for the following statements. If"not determined" please explain. — The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurall unsound, exhibits substantial infiltration or exfiltranon or tank failure is imminent. System will pass'inspection if the existip'g tank is replaced with a complying septic tank as approved by the Board of Health. `A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: observation of sewage backup or break out or high static water level in the distribution boxldue to broken or w -obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health) broken pipe(s) are replaced obstruction`is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 f Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propem Address: 141 Highland Avenue rotuit , MA_ 02635 Owner: Pri Sri i i A Melner Date of Inspection: 7.11 7.102 C. Further Evaluation is Required by the Board of Health: old 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. I. System µill pass unless Board of Health determines in accordance with 310 CMR 15,303(I)(b) that the system is not functioning in a manner which will protect public beal.tb, safety and the environment: Ild Cesspool or privy is within 50 feet of a surface water IJZ� Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh 2. S.stem will fail unless the Board of Health (and Public Water Supplier, if any) determines that the $,stem is functioning in a manner that protects the public health, safety and environment: ti�OThe system has a septic tank and soil absorption system (SAS) and the SAS is:within 100 feet of surface water supply or rributary to a surface water supply. it)l) The system has a septic tank and SAS and the SAS is within a Zone I ofa 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.eet but 5 feet or more from a private \pater supply well". Method used to determine distance 'This system passes if the well water analysis, performed at a DEP certified laboratory, for'coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that faciliry and the presence of ammonia nirrogen 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 anached to this form. 3. Other, I 3 Page a of I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIF]CATION (continued) Proptrty Address: 141 Highland Aare Cotuit ,Mass . 0wocr: Priscilla Melner Date of lospeetion: 1 7/f12 D. System Failure Criteria applicable to all systems: You must indicate `ycs" or -no- to each of the following for all inspections: _ _ ackvp of sewage into (aciliry or systcm component due to overloaded or clogged SAS or cesspool Discharge or pondusg of effluent to the surface of the ground or surface waters due to an overloadeo or clogged SAS or cesspool O Static liquid level u, the dtsmbuuon box bovc outlet invcn due to an overloaded or clogged SAS or cesspool /L j �iq Dl uid depth`in&cii is less than 6" below invcn or available volume is less than 'A day now cquvcd pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number �of times pumped `,ny ponton of the SAS,cesspool or privy is below high ground water elevation. rysy ponton of cesspool or privy is within 100 feet of a surface water supply or rributary to a surface walet supply y ponton of a cesspool or privy is within a Zone I of a public well. _ y ponion of a cesspool or privy is within 50"feet of a private water supply well. Any ponion of a cesspool or privy is less than too feet but greater than 50 (eet.from a private water svppl.y well with no acceptable watcr.qualiry analysis. IThis system passes Irlhe well water analysis. perlormcd at a DEP cenified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria art triggered. A cop) of the analysis trust be attached to this forma The system fails. I have determined that one or more of the above failure criteria exist as lcscnocd in ;10 CMR 1 S )0). therefore the system (ails. The system owner should contact the 9oa c Health to determine what will be necessary to correct the failure E Large Systems: To of considered a large system the system must serve a facility with a design now of 10,000 gpd to 15.000 9Pa. You must indicate either 'ycs" or "no" to each of the following: ;T1tc following criteria apply to large systems in addition to the criteria above) es now ! 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 11/ _ the system is located in a nirrogen sensitive area (Interim Wellhead Protection Area I WPA) or a mappcc Zone 11 of a public water supply well yoc nave answered "yes" to any question in Section E the system is considered a significant threat, or answeree Nes" to Section D above the large system has failed. The owner or operator of any large system considered a s gn:f.canl threat under Section E or failed under Section D shall upgrade the system in accordance with ) 10 CMR :�- The system gwncr should contact the appropriate regional oMce of the Department.. 4 Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 141 Highland Avenue Cotuit, •Ma. 02635 Owner: Priscilla Melner. Date of Inspection: 7/1 7/02 Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes No 4/ Pumping information was provided.by the owner, occupant; or Board of Health / 'ere any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period ? YHave 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 44Fc1uding the SAS, located on site ? Were the septic- arik 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 faciliry.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: Ye/no Existing information. For example,a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)J 5 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 141 Highland Ave otuit, ass . Owner: Priscilla Me ner Date of Inspection: 7 17 02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): : DD DESIGN flow based on 310 C 15.203 (for example: 110 gpd x N of bedrooms): �Xw—J �fO Number of current residents: Does residence have a garbage grinder(yes or no): zo Is laundry on a separate sewage system(yes or no): (if yes separate inspection required) Laundry system inspected (Yjs or no): $ Seasonal use: (yes or no): IUD Water meter readings, if a�`j ailable (last 2 years usage (gpd)):2 0 00—9 1 , 000 gallons=249 .32 GPD Sump pump(yes orno)-IU4 200 — .gallons=435 .62 GPD Last date of occupancy:'Auat COMMERCIALYLNDUSTRIAL Type of establishment. AA Design now(based on 310 CMR 15.203): gpd Basis of design now(seats/persons/sgft,etc.): Grease trap present (yes or no): A Industrial waste holding tank present (yes or no):a Non-sanitary waste discharged to the Title 5 system es or no):Ao Water meter readings, if available: Last date of occupancy/use: OTHER (describe): N/T GENERAL INFORMATION Pumping Records Source of information: J. P .Macomber & Son Inc . Was system pumped'as pan of the inspection (yes or no): YES- If yes, volume pumped: 100(�allons -- How was quantity pumped determined? Measured Reason for pumping: Heavy Scum & Solids layers were resent . TY➢E OF SYSTEM J/ Septic tank,d+s `x, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank �hb—Attach a copy of the DEP approval Xb Other(describe): A14 Approximate aoe of all components, date installed (if known) and source of information: ` 15 years old . per owner Were sewage odors detected when arriving at the site (yes or no): _ 6 1 Page 7ofII OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 Highland Avenue Cnt-11i t , Ma n2635 Owner: Pr•; srilla Melner Date of Inspection: 7.117.1 n2 BUILDING SEWER(locate on site plan) Depth below grade: --�� Materials of construction: cast 'von 40 PVC AJLother(explain): _ Distance from private water supply well or suction line: 'f Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight No evidence of leakage S stem is vented through the house vents . SEPTIC TANK: (locate on site plan) Depth below grade: !d'� Material of construction: concrete metal!fiberglass//cj polyethylene Nbother(explain) t If tan].,. is metal list age: 1 is age confirmed by a Certificate of Compliance (yes or no)/W_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to borom 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 outl t 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.): ' Pump septic tank every 2-3 years Inlet & outlet tees are in �lace . The tank is structurally sound and shows no evidence of leakage . GREASE TRAk�L(locate on site plan) Depth below grade: 114 Material of construction:/✓concrete41metal/1/4 fiberglas54 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 b;:(ae: 4r` Date of last pumping: Comments(on pumping recommendations, inlet and outlet or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): � , Grease trap is not present Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 Highland Ave Cotuit ,Mass , Owner: Priscilla Melner Date of lospectioo: 7/1 7/02 TICHT or HOLDING TANYA&& (tank must be pumped at.time of inspection)(locate on site plan) Depth below grade: Material of construction: Aaconcrete .02 metal CA_fibergIass !/ polyethylene other(explain): w1�4 Dimensions: Capacity: gallons Desien Flow: �(, gallons/day Alarm present (yes or no): 4 Alarm level:- A Alarm in working order(yes or ): 40 Date of last pumping: Comments (condition of alarm and float switches, etc.): Tight or hoiaing tanks are no L present . DISTRIBUTION BOX/4t,(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.): Distribution box is not present . PUMP CHAMBER4& (locate on site plan) Pumps in working order(yes or no): 40 Alarms in working order(yes or no):—;R Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): _Pump chamber is not present . I 8 $ Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress:141 Highland Avenue Cotuit.,Mass , Owner:Priscilla Melner Date of Inspection: 7/1 7/02 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) 2-1000 gallon If SAS not located explain why: L0 CRted QPP naoa 1 (1 Typ leaching pits. number: leaching chambers, number: 0 leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions overflow cesspool, number: innovative/alternative system Type/name of technology: 1jJ //dt✓ � G�?'w, Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,il, condition of vegetation, Loamy Sand to aanrt� 1 nam r� fine a �r or P6_ndjPCz Soils are drv . VeQetatio normal e�hydraul}E failure CESSPOOLS,7�c)t; (cesspool must be pumped as pan of inspection)(locate on site plan) Number and configuration: 0 Depth — top of liquid to inlet invert: fJ Depth of solids layer: Depth of scum laver Dimensions of cesspool: sQ Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools a P not nrPCPnr PRIVY(locate on site plan) Materials of construction: 9 Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Sri Iry ; � .vim p-Ie- - 9 pig( 10 0( 11 OFF!C!A! fNSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM TNFORjMATlON (conlinvcd) P,cperty A00f(11: 141 Highland Avenue Cot uit 'Mass . OHocr: Priscilla Melner Om of Inlpcclioo: 2 SKETCH OF SFWnCF DISPOSAL SYSTEM Ao.ioc 1 Iknch of the )(wit( (Ji'Pol l) lymm inclvd(ng ilc$ IQ 111 Imt rw0 permtncm rcfcrcncc lV.C/n11K1 Ocn;r�nuki Loctic ill wclli -iihin 100 (ccl. Loccic whcrc public wilcr supply cnlcn the bviloin6. it 1 / z 10 Page 1 I of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION (continued) Property Address: 141 Highland Avenue Cotuit, Ma. 02635, Owner: Priscilla Melner Date of inspection: 7/1 7/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells 1 Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: 7/17/02 Y E S Obtained from system design plans on record - If checked, date of design plan reviewed: YE7 Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: NA YES Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explatihttp ; 11 town , barns table .ma , us . You must describe how you established the high ground water elevation: Used : Gahrety & Miller Model 12/16/94sGround water elevations above sea level . Used ; USGS Observation well data June 1992 Used . USGS Technicapj — water ele at1ons . Leaching ) Pit ;eel Groundwater 'Feet Below Bottom of Pit High Groundwater Adjustment. 1.8 ft per Ftimpter Method Therefore, the vertical separation distance between the bottom 1 Of the leaching pit and the adjusted groundwater table is J 1 feet. 11 r i •nrne^r.—nra+—.•rrrn—frrr•nts+rm+n'tn.mr.:•.•T+•�:tarr:•nr+•e+•m•n rer�v t•m•srrv.rr•+ MOWN OF Barnstable BOARD OF 11EALT11 _-SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTJFICATION I -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 141 Highland Avenue Cotuit ,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # 021-014-002 ' OWNER' s NAME Priscilla Ilelner PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J.P.Macomber & Son Inc- ` COMPANY ADDRESS Box 66 Centerville Mass .02632 Street Town or City State LIP COMPANY TELEPHONC ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Cheec one : y System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have c Ucted has found that the system fails to Protect the E)ublic health and the environment in accordance with Title 5 , 3.10 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspectiorl form . Inspector Signatur Date copy of this crt.ification must be provided to the OWNER, the BUYERarnei where aPplicable and the I30ARD OF }{EAL1'1l. * If the inspection FAILED, the owner or"'operator shall upgrade • the system within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CFJR 15 , 305 , partd .doc TOWN OF BARNSTABLE LOCA-11ON '//4` 91 G,6 L 4AM( R 1/e SEWAGE# VILLAGE C ®w rr ASSESSOR'S MAP & LOT d`3 J 01if-&a I INSTALLER'S NAME&PHONE NO. .'J0, /VI A C 01M X eJC t S O.0 SEPTIC TANK CAPACITY / 0 0 0 LEACHING FACILITY: (type)�l/Gfi� .Z �L D/.y C HAW size) .f O 0 6 AZ. NO.OF BEDROOMS BUILDER OR OWNER Ila PERMIT DATE: COMPLIANCE DATE: O Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 TOWN OF BARNSTABLE /- LOCATION �' �'�� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) A IUD 1,r- (size) NO. OF BEDROOMS BUILDER OR OWNER e� /l�La J PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility, any wetlands exist within 300 feet o aching f li Feet Furnished by r 9 � t w I NrG1,Iand ": " do TOWN OF BARNSTABLE LOCATION 4 g�G�G-�qN� / .SEWAGE # VILLAGE a,2ra_/,T ASSESSOR'S MAP 6a LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO® OF BEDROOMS®PRIVATE WELL OR PUBLIC WATER BUILDER OR O"ER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUE GNP No. �S �(� Fee $ 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatiou for Migpogar *p.�tem Comaructiou Permit Application for a Permit to Construct( )RepaiNX)o Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. 141 Highland Avetf Owner's Name,Address and Tel.No. CotL44� laae. 02635 Michael Crossen Assessors a / 0d ( 141 Highland Ave Cotuit Mass 0263 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1 000 & box Type of S.A.S. 1 -4 ' pit Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Adding 2-H 2 0 5 0 0 gallon chambers packed in four feet of stone Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this o of ealth. Signed r Date 3/1 h/9 R Application Approved by Date Application Disapproved for the fol7owing reasons Pe t No. 7 $ — 1 `70 Date Issued Je • - C�' �' t .r.s-... l No. I ��7 Fee $ 50.00 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS? 2ppfication for Miopaal *vstem Construction 3permit Application for a termit to Construct( )RepairXX)1 Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No: 141 Highland Road Owner's Name,Address and Tel.No. Cotuit Mags., 02635 Michael Crossen Assessor's Ma}�/Pazcel 0 -,� / 0 . Q O • 141 Highland Ave Cotuit Mass 02635 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8-7 7 5-3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Iac. HRx 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1 000 & box Type of S.A.S. 1 -4 ' pit Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) _ .-' chambgrs packed in four feet of stone. , Date las inspected: Agreempt r The u tfersigned agrees to ensure the construction and maintenance of the afore described`on-site sewage disposal system in accor� ce with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this froll of ealth. Signed Date 3/16/9 8 Application Approved by t Date -21ni f -�_ --a-- II--�---Application-Disappr-owed for the fo _owing reasons Permit No. 7 $ l -7 0 Date Issued n_r..--------------—�-- --------------- ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance 4 THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (XXXUpgraded( ) Abandoned( )by J.P.Macomber & Son Inc, at 141 Highland Ave Cotuit Mass. has been constructed in accordance-4- with the provisions of Title 5 and the for Disposal System Construction Permit No. - 174 dated Installer J-P.Macomber & Son Inc. Designer J.P.Macomber & Son Inc. The issuance of this ermit shall not be.construed as a guarantee that the system will,unction as designed. Date ' �-� 7 Inspector ,..L y No. �� ^I7y ----------------------------Fee $ 50.00.E-: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwi5po5al *pgtem Construction permit Permission is hereby granted to Construct( )Repair(XX)Upgrade( )Abandon( ) System located at 141 Highland Ave Cotuit,Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: - O / Approved by . TLD v d 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I,Joseph P Macomber Jr , hereby certify that the application for disposal works construction permit signed by me dated 3/16/9 8 , concerning the property located at 141 Highland Ave rr)t-11; t, Mass - meets all of the following criteria: V'There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. /ifthe proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete-the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) " B)Observed Groundwater Table Elevation(according to Health Division well map) 25 ' l � SIGNED : • / DATE: V-1�- T LICENS SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 7- 1 [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert i Fron .,_ . Existin 1000 gallon septic tank. 2-50OH2O Chambers Existing Distribution box Exising 600 Leachin pit. ,r 0ATE :k3 1. 2/98 PROPERTY ADDRESS: 141 -.Ric�hlanrltr�E°a+. Cotuit Mass ® ro yy�Fe I Q 02635 �`rtic9✓r `9� 8 On the above date, I Inspected the s-eptic system at the above This system consists of the following: 1 . 1 -1000 .gallon septic tank. 2 . 1 -Distribution box. 3 . 1 -600 gallon precast leaching pit. Based on my InPc�actlon, I certify the following coridltlons: 4 . This is a title five septic system. ( 78 Code ) 5 . The septic system is in failure and must be upgraded to' the new 95 code. 6 . Waste water is witin 6-" of the invert pipe to the leaching pit. Name : J . P . Macomber Jr•. ---------------------- _ Company: J • P . Macoc)ber & Son 'Inc _- ----------------- 9 __Cencervi11e `Ma99:_02632 Phone :---SAS-�338------- I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY (;)OSEP-H P. MACOMBER & SON, INC. Tanks-Cvupoolr-L4 bchfleld► . Pump+d L Inttall►d Town S-owor Con noctloni P.O. Box 66 ' Centerville, MA 02632.0066 7 7 t,-3 3 3-8 7 12 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS z DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 WILL1.4N1 F WELD TR', D1 C- Go,cmor �c,"` ARGEO PAUL CELLUCCI D.A\ID B STR Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commiss PART A CERTIFICATION Property Address: 1 41 Highland `, Ot COtuit MA Address of Owner: Date of Inspection: 3/1 2/98 (If different) Name of Inspector, ,Tospoh P.Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Centerville,Mass . 02b32 Telephone Number: 5DR_77ri—33-18 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accura and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function anc maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes eeds Further Evaluation By the local Approving Authority Fails G Inspector's Signature: Date: �,107�/g— The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing (h,s 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 subm the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to tt, srsiem owr and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.30 Any failure criteria not evaluated are indicated below. COMMENTS: el SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, up completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes,no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined-, expla,n wh� not The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Cen,f,cate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection. the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tar failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (rrrvia*d 04/25/97) ?ago 1 of 10 DEP on Use World W4de Web: nttp:Nwww.magnet.state rna usroep Printed on Recycied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Properly Address: 141 Highland Cat Cotuit,Mass. Owner: Michael Crossen Date of Inspection: 3/1 2/9 8 B) SYSTEM CONDITIONALLY PASSES (continued) BJP Sewage backup or breakout or high static water level observed in the distribution box is due to 'broken or obstr ced pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of :he Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pays inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: �0 Conditions exist which require funher evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: &0 Cesspool or privy is within 50 feet of a surface water 4D Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water suppi) or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water suppl; wel! The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply "ell The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indica es that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance iUVIL (approximation not valid). 3) OTHER (rovisod 04/25/)1) ➢&go 3 of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 141 Highland ,y*t Cotuit,Mass . Owner: Michael Crossen Date of Inspection: 3/1 2/9 8 D) SYSTEM FAILS: You must indicate ei; .er "Yes" or "No" as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The bans for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backupof sewage into facility or system component due to an 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. �r Liquid depth in rvupmeF is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets) Number of times pumped W, Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. 41 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply &4 the system is within 200 feet of a tributary to a surface drinking water supply N4 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area • IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (rov1sed 04/25/97) Pa9. 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 141 Highland ,' :`,Cotuit,Mass . Owner: Michael Crossen Date of Inspection:3/1 2/98 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No, Pumping information was provided by the owner, occupant, or Board of Health. ZNone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components,:6kcluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) Pegs 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:141 Highland aft Cotuit,Mass. Owner: Michael Crossen Date of Inspection: 3/1 2/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: tt.../bedroom for S.A.S. Number of bedrooms '`✓ Number of current residents:�R.II Garbage grinder (yes or no):Vi7 Laundry connected to system (yes or no): 5 Seasonal use (yes or no).� l Water meter readings, if available (last two (2) year usage (gpd): /g9d k`✓y 7�� kv -r Sump Pump (yes or no):till] / Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: AA Design flow: AM allons/day Grease trap present: (yes or no).AL/-14 Industrial Waste Holding Tank present: (yes or no)A& Non sanitary waste discharged to the Title 5 system: (yes or no).dZ,3' Water meter readings, if available: N Last date of occupancy: AA OTHER: (Describe) /J14 Last date of occupancy:_ GENERAL INFORMATION PUMPING RECORDS and source of information: r System pumped as part of inspection: (yes or no) If yes, volume pumped: gallons Reason for pumping: ,IP:N �1� /��irlrjjV /�' $ � �Ily TYPE OF STEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool /—Ft') Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contractt Other kk APPROXIMATE AGE of all components, date installed (if known) and source of information: 1152e f -ey O.4-4- Sewage odors detected when arriving at the site: (yes or no)f � (revised 04/25/97) Page 5 of 10 � I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 Highland &t Cotuit,Mass. Owner: Michael Crossen Date of Inspection:3/12/98 BUILDING SEWER: (locate on site plan) ff Depth below grade ./ Material of construction: cast iron 4 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints ventin , evidence of leakage, etc.) — 3 SEPTIC TANK:L&7.3 (locate on site plan) Depth below grader Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age AZIs age confirmed by Certificate of Compliance &A(Yes/No) Dimensions: 7 6''. 4')4 Sludge depth: Distance from top of sludge to bosom of outlet tee or baffle: Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Distance from borom of scum to bonoT of outlet ee or baffle:_ How dimensions were determined: Comments: (recommendation for pumping, conditio of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) kf` ° ',e .i•r / .3 e s V> 1k; GREASE TRAP:-t4�*e_ (locate on site plan) Depth below grade:4/ Material of con struction:NA con creteN•�metaWilFiberglassUsq Polyethylene,,tlother(explain) /✓ Dimensions: AM Scum thickness:_W Distance from top of scum to top of outlet tee or baffle: w141 Distance from bosom of scum to bottom of outlet tee or baffle: A411 Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inven, structural integrity, evidence of leakage, etc.) r'ce 2S te r' L lr.vl..d 0�/ZS/97) P.y• 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 Highland ve-&t. Cotuit,Mass. Owner: Michael Crossen Date of Inspection:3/1 2/98 TIGHT OR HOLDING TANK: kit (Tank must be pumped pr,ur to, or at time, of inspection) (locate on site plan) Depth below grade JAM Mater.ai of construaion:/26concrete4,!&metal,LJgFiberglassAWPolyelhylene4Aother(explain) A/) AJQ Dimensions: A14 Capacir gallons Design flo"' gallons/day Alarm level. Alarm in working o(derA{// Yes, AONu Date of orevrous pumping: 42& Comments (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:Z1 ioocate :)n site plan) Depin c: hc,�d level above outlet invert: W1 Commen.:s (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) Ah r PUMP CHAh1BER-Alhf� (locate on site plan) Pumps r. working order: (Yes or No)'t" Alarms n working order (Yes or No) Comments (note condition of pump chamber, condition of pumps and appurtenances. etc.) (r.v1..e O4/25/97) P.g. 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION (continued) Properly Address: 141 Highland Cotuit,Mass . Owner: Michael Crossen Date of Inspection: 3/1 2/9 8 SKETCH 0i SEWAGE DISPOSAL SYSTEM: oe ties to at least two permanent references landmarks or benchmarks fccale all wells within 100' (Locate where public water supply comes into house) /2 1 137 i ti ► N�_41,Ignd r� Co t-u17' (revised 04/15/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 Highland 4VG Cotuit,mass . Owner: Michael Crossen Date of Inspection:3/12/9 8 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) if not determined to be present, explain: Type. leaching pits, number: leaching chambers, number: leaching galleries, number: 5 leaching trenches, number,length: io leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: i 7 �• Comments: (n to condition of soil, signs of h draulic failure, I el of ponding, cond tion of vege ation, etc.) _ ti '� ! / 7a 5�.�y9 I"off S �✓ CESSPOOLS: -ihwe— (locate on site plan) Number and configuration: AI/P Depth-top of liquid to inlet invert: i1lA Depth of solids layer: 4,111 Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Aloy inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: 'Orly (locate on site plan) Materials of construction: "9/9 Dimensions: Depth of solids: A))9 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) l"•t Il e (revised 04/25/97) Pag• 8 of 10 r SUBSURFACE SEWAGE DISP(: 1 SYSTEM INSPECTION FORM I'. . . C SYSTEM INFOI:'., LION (continued) Property Address: 141 Highland Aj/& Cotuit,Mass. Owner: Michael Crossen Date of Inspection:3/12 9 8 n r Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater EIr:aion: Obtained from Design Plans on record observation of Site (Abutting property, observation hole, basemtnt'simp etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps _ZCheck pumping records _zCheck local excavators, installers Use USGS Data Describe in your own words how you established the High Grounctwater-Elevation. Must be completed) Used water contours map. Gahrety & Miller Model 12/16/94 (revisod 04/25/97) Pa9, '160f 10 n'-.•-n+rr—rrrnrnr.•i.m'a-e.r.rerr.rrn:-.�.••'rurr:+rr•s*mn m-rnv*rar.n.+.rasp *s�-oT..s-e*rrs.re*r:T- r—r-.--_ tT Barnstable '1'UNN OF IlUARU OF HEALTH FUR -I SUIISURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .-M PART D CEItT I F l CAT 1 UN �_ �'•••r•-s-r•..-•. e--.sir.^..:-+�.rr+n-rfrst rt�sstrrrrn�•n.-.+rT�annvr-r+nrnswrnrsmnstw�ers rm+n�.srrm-.so^rrr.�.•.r.•.:rr� r-„ ._..� -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 141 Highland Cotuit,Mass . ASSESSORS MAP , BLOCK AND PARCEL OWNER' s NAME Michael Cmssen PART D - CERTIFICATION J NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Sorl1 'Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or Clay S tat• LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this nddress and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : Sys teui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 15 - 30.3 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA sectioll of this form . System FAILED* \ The inspection which I have con 'acted has found that the system fails to Protect the i-)ublic health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . 4 Inspector Signature Date J � One copy of tilis c tification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HrALTII. * If the inspection FAILED, the owner or""oporator shall u pgrado ' tho ayotem within one year of the date of the inspection , unless allowed or required otherwise .as provided in 3.10 ChJR 15 . 305 , partd . doc L 7J 7 P7 y THE CONMONWEALTH OF MASSACHUSETTS DEPARTMMNT OF ENYIZONNENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualificatigns as required and is hereby authorized to use the title CERT + + D TITLES SYSTEM INSPECTOR as provided in 310 CMR 1 S-340 and Section 13 of Chapter 21 A of the General Laws . Issued by The Department of Environmental Protection. Cootr(�I Acting [)irccior of the ��4s l<�n c�( \U11cr ('olluiinn 101 /`;� C �' t� (/ 17 s 199�. . D ATE: 6 • PROPERTY ADDRESS: 1 a_1 Highland Cotuit,Mass.' ------=----------------- '• J 02635 On the above date, I inspected the septic system at the above address. • This system consists of the following: A. 1 -1000 gallon septic tank. \ i B. 1 -d-`stfi-bution box. I C. 1 -1000 - gallon leaching pit. I Based on my inspection, l certify the following conditions: A;, .TThis is a title five septic system. ( 78 Code ) B. The system is structurally sound. I SIGNATURE: Name: J.P-Macomber jr. ' Company: J.P.Macomber & Son Inc. ------------------- .. Address:— Box 66. ---- — --- Centerville_,Mas 2 --�s-L-UK.EIb.Y� t Phone:---50- 8-775-3338 ----------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY J. JOSEPH P. MACOMBER MQ4ZLnm, INC. Tan ks-Cesspools-LeachfIelds Pumped & Installed Town Sewer Connectlons P.O. Box.66 Centerville, MA 02632-0066 775.3338 775.6412 I 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , Address of property 14t t 16HL Arvo Yzoyo"0 Owner ' s name RoWo-07- ltfrwe Date of Inspection �uksa PART A CHECKLIST Check if the following have been done: ✓ Pumping information was requested of the owner, occupant, and Board of Health. -None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility .or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior pf the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. J The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. f 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 3 number of bedrooms number of current residents o garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no r If nonresidential , calculated flow: Water meter readings, if ,available: �j�, - 140 djm ?rzE5�MTL Last date of occupancy OGC- U eP,C,7 GENERAL INFORMATION Pumpin,g5-.,records and source of information: 't�E2 0 E 2 µAs&1 o'T- aF—F U IF0�Lk System pumped as part of inspection, yes or no if yes, volume pumped 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) Other (explain) Approximate age of all components. Date installed, if known. Source of informs ion: QP2pY, ►`�o Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: 100 (locate on site plan) depth below grade: MLGT 1 ` ill avZ" L ET 5(. C A)o QLSlf"e) material of construction: K concrete metal FRP other(explain) dimensions: lb~ sludge depth '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 the or baffle. Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) Loos o e- DISTRIBUTION BOX: (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) l 6" o►� PUMP CHAMBER: a0 r0 L5 (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : ✓ (locate on site plan, if 'possible; excavation not re approximated by non-intrusive methods) gaited, but may be If not determined to be present, explain: EeO roT YA 2.0 Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of pondin condition q; vegetation, recommendations for maintenance or repairs,etc. C V 02 P d CESSPOOLS (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 .constructionI indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure., level 'of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition -of soil, signs of hydraulic failure, - level of.pondin , condition of vegetation, recommendations for maintenance or repairs,etc. 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y PART B SYSTEM INFORMATION continued SKETCH OF SEWAGt DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' M.p J1 �.A(V V—L t-n-A I Aj LC)C'r • � r 17 W DEPTH TO GROUNDWATER it �A depth to groundwater f 2-eo*A (�r2d;c�(UDSU2F{�C.� method of determination or approximation: S &S (. 40 i _ 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA I Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) Backup of sewage into facility? Discharge or pond`ing of effluent to the surface of the ground or surface waters? Static li id level in the qu distribution box above outlet invert. Liquid depth in cesspool <6" below invert or available volume< 1 2 day Y Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? `ry Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of a surface water? within. 100 feet of a surface water supply or tributary to a surface water supply? I� within a Zone I of a public well? �1 within 50 feet of a• bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a, private water supply well? less than 100 feet but greater than 50 feet t from a private water — supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of. well water analysis for coliform bacteria, volatile Qrganic compounds, ammonia nitrogen and nitrate nitrogen. TOWN OF BOARD OF HEALTH SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART D - CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS l� �, 16MLkCOQ CoA p LCi7U (T ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME PART D - CERTIFICATION NAME OF INSPECTOR �E-T-E-Z 4SU LL-% U 40,L rt COMPANY NAME (20"u L-M"T TO ��rGpl�(3 � 'So xi t"C_ . COMPANY ADDRESS. CLR� ( \lQ, fr)GS-5 C0 3Q Street Town or City State ZIP COMPANY TELEPHONE (5 ) �� S - 3336 FAX CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and complete as of the time of inspection . The inspection was .performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems. Check one: System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have conducted has found that the system fails to protect the public "health and the environment in accordance with Title 5 , 310 CMR 15 .303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form. Q _ -99 Inspector Signature Date One copy of this certification must be provided to the OWNER, the BUYER (where applicable) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc MAR 22 '95.18:01 U.S.P.508-668-9802 TOWN OIL]BARNSTABLE P.1 LOGdTIONIi�h Crr�, c��./_sEWAGE # G► - !U G 2 VILLAGE G'o AssBSSpR's MAP LOT .7 -4 INSTALLER'S NAME, 4 PHONE NO. f�A tiCrS! ,�SE -:M- C TANK CAPACITY 6 a -, LF-ACHING FACILITY:(tgpe) QU a rQ No-,.OF moltOOMS PRIYATB WELL OR PUBLIC W ATER _.. BUILDER OR OWNER ~ DATE PERMIT ISSU EID eQ U rp - DATE C01IPLIANCE ISSUED: RIANCE GRANTED �^ VA : Yes Now j .0 4 r SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART D CERTIFICATION Inspector : Peter Sullivan PE Location : 141 Highland Road Cotiut Date : June 8,1995 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. Please note the summary of recommendations as presented in this form. Lastly please note 310CMR:15:302 Criteria for Inspection(1) "The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it by the new owner. " ruly your d ter Sullivan PE Of Distribution: f''c.TER Original to system owner y SULLIVAN F3o Buyer . 29733 fi Board of Heath ,����,s,r ? <� 'If I #ICIIL,,4ND AlIr TOWN OF BARNSTABLE LOCATION 40t �o? '¢°�t�AL&4S do SEWAGE # k& VILLAGE ASSESSOR'S MAP & LOT 21 m 2. INSTALLER'S NAME & PHONE NO. !Vl1rof# �SEPTIC TANK CAPACITY Alt t LEACHING FACILITY:(type) /'k t'f (size) I (,� (�, NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER M C-5t4 1P.. Ys E DATE PERMIT ISSUED: ®o " S o DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No /'� r f . 36 �2 17' (.�+ 2 M,.�k t,, j F $ _ r-. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH µ ....�Q.�""/`I...------..OF...... 1�-. ..1.""/'��.. -. .............. Appliratiun for R-4pootal Works Tomitraartiun rumi# Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal System at: C C NA A e— �j��A�..� /��� �a�• t A/ ....... or Lot No. Owner Address ----rr.....----•.................................................... ..--•-•----------...----•---.......-----•----.........---•-•--.....-•------.........c...... Installer Address nn U Type of Building Size Lot......... 1_i Dwelling—No. of Bedrooms............... ........................Expansion Attic (NO) Garbage Grinder (NO) aOther—Type of Building ............................ No. of persons......... Showers ( ) — Cafeteria ( ) Other fixtures_ Design Flow................��. � .._•.....---._gallons per person per da Total daily flow g g P P P -----33. -----•-•----. g�llons. W / ry / y er ------ WSeptic Tank—Liquid capacity.]OAOgallons Length_$..-..(P_. Width�-7-�0 Diameter---------------- Depth.�8___. x Disposal Trench—No. .................... Width.................... Total Length...__...._..___..� Total leaching area....................sq. ft. Seepage Pit No....__..�.._._...... Diameter.__,/:y_.__..... Depth below inlet.-!� .:._ Total leaching area.a�-�_._..sq. ft. Z Other Distribution box (X) Dosin tank ( ) gg Percolation Test Results Performed by �E__=¢ .5+�i��EY--Cd�S��A�Date._.._.�Ite!,__ .-------------------- Test3 • a , Pit No. I......<�-.....Minutes per inch Depth of Test Pit -!�......... Depth to ground f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..-' j* _ ---•---------------------------------------------••----------••-------...------•--........_................._..............•-----..._.. 0 .. O- £3 OL6G SO 'Description of Soil �..d....... P� �^'. �L __ROGER $ c, �......42. Y,6 L f1 w .svBs�l = L ------ -•-•-:•-----• tr_ �}_.fir "_.... S/41YDS PAU j f1�PCN1�EWICZ 1 G�7 u� INo.3i4R2a �+ fiK1�S CIVIL U Nature of Repairs or Alterations—Answer when applicable.________________ .......__._______. ....... .___-__- ' v, ----------------------------•-----------•--•---------------•---•--•-----------••------......------•--.....--------------------------•----------------------------•---- ..... Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i a rdanc v 7t the provisions of TITL U 5 of the State Sanitary C09 — The un tgned further agrees not to the system operation until a Certificate of Compliancekhl � ssued by the b a of health. / . --- . ... - ------ ------------ •---•-•-------...-•-----•-------- o _�� � D�a�j Application Approved BY - :....•--------•--•.................................. �� = ........ Application Disapproved for the following reasons:-------•------•-------------•--------------------------------. ................................................ -------•--•......................•-•-...----•----••-----•-•••----•---••••-------•••----••••••-----••------•-----------••••••---•------•---•-•-----•-•------•----•-------•--•-•----------•---••------_... Permit No .•--•..�. -�------•--- Issued....----•-------.. Date ......-•--•-•-•-•-•----•---•-•. Date t — N6.... ...... FEB.. 3 THE COMMONWEALTH OF MASSACHUSETTS }' , AABOARD OF `HEALTH 60 ! L'�1.- .....OF.... r',, . j!u .-Ma-Z - ...................... Appliratinn for Di_gpvii al Workii Tnnitrnrtiun thrutit Application is hereby made for a Permit to Construct O<) or Repair ( ) an Individual Sewage Disposal System at: o. l� ! 1 ._»!c i - ^"!6..►.f. ._ `•t �......... .. Lot............................................... Owner Address W Installer Address U Type of Building Size Lot....._t_.:-0•- -•-- Dwelling—No. of Bedrooms.............•.3........................Expansion ttic (lea) Garbage Grinder (1,110) e� Other—T yp of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------•-••--••••--- • -----•-•---.-•••••---••••••••-----•-----------••--••••............•-- -- - ------- Desi n Flow...........1". _�_►. .............gallons per person per da Total Il fig �'� W g g P P P� ,X � Y, �)I' , ...ions. WSeptic Tank—Liquid capacity.r. QO.gallons Length.a...... . Width"' '_."/P Diameter---------------- Depth. x Disposal Trench—No. .................... Width....i........_...... Total Length.._... .. _.... Total leaching area....................sq. ft. Seepage Pit No........`4.......... Diameter....1."�......._.. Depth below inlet__� Total leaching area..;. .....sq. ft. z Other Distribution box (<) Dosing tank ( ) q S '-' Percolation Test Results Performed by END. 3M0 ...C-Q8504rA ..... Date. I r . ......./-, ........ -..------ a Test Pit No. 1...... .....minutes per inch Depth of Test Pit...._. _......_. Depth to ground 4L Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground Ovate tN OFy � p O Description of Soil '__.-A-` R . I'�_ :5.01 „................................------------------------- o Ei� -'FfOG � ., x " * '�' �3 ..fit/ SS I ... x ,W ................................................... AN �r a , --- 5 ••••---- U Nature of Repairs or Alterations—Answer when applicable........ ..................... ....... ..__.............. .. l ...---•-----•--------------------------------------------------------------•---- -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System ccordance ith�'_�j_QL the provisions of TI'I'M 5 of the State Sanitary Cpde— The un z;; ecTfurther agrees not to ace the syst m in operation until'a Certificate of Compliance ha een,issued by the boar of health. } __. Sig._ ' ':......._.._{ / 4_146 -- •... ._ �I gDaate -= Application Approved BY •------: ..r,� � �, -_-•=------------------------------------ c�i Y3ate !! Application Disapproved for the following reasons:-------•-------•---------------•------------•--------------------------------------------------•--•---•----•••-- ---•-••-••••.....------•.................................•-----•-••••---•--•---.......---.....---•-•...•--•••-••--•--•-••-•--•--••-•--•---•-•--•-•••••---------•••••-••--------•-•-----......---•---•-- Date Permit N(2:=-•-'-��--' f.- .(*:a.-._ -----------_ Issued_............................. .......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................U. .r4.......OF.....:- 3.1�. ��is�.� ................................................ Trrtifiratr of Tlimplianrr THIS�IS-TO CERTIFY, That the Individual Sewage Disposal System constructed ( . ) or Repaired ( ) by ` Installer (... has been installed in accordance with the provisions of TI T IE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._`_`:..�-;v._-f:L, -,',=......... dated-..... :; '�_!`_ ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .... Z.L. --•................. DATE — — Inspector ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .- FEE...... gifipwi al luorb Tnnptrndirrn truth Permission is hereby granted---- �1 -►s� ..... " ?`r--•--------------------------------------•----------.--..--_------ to Construct ( ) or Repair S ) an lIndividual1e;-ge Dis osal System at No.... • :f----.....Z-.•.....-t 1.re,�n. ...•..._ '. - • - Street-,— t as shown on the application for Disposal Works Construction Permit No�2... 'Dated.___......LD. DATE.. .. 1 O Board of Healtli ••--- -- .•... ... v FORM 1255 HOBBS & WARREN, INC., PUBLISHERS .- - _ , qwmqm�mpw4W ` r ,� �� Stiff REVISIONS: TEST PIT DATA DATE OIL TEST/NG: - �- _ PERC. TEST DATA : SEPTI C TANK DETAIL : sze, >oo l. DIST. BOX DETAIL : LEACHING FACILITY DETAIL: NO DATE TEST BY c,� s�r, DATE OF TEST/NGr 9'8 -E43 TO CONFORM TO T[rLE5REOU/REMENTS: T P WITNESSED BY: �T"oi/r/ -T..lc".n., , — TANK TO CONFORM TO TITLE 5 REOU/REMENTS. TEST BY. c,,� �� ��, NO. OF OUTLETS f S �• _ c . -17 --- - — WITNESSED BY J"ac./i✓ _7,.�e�,t3,' k a. REMOVEABLE COVER 4iANtil,� BROUGHT TO 2"PrASTONE -DLO NaF/LL /2"AAX. � :...• ..;,....,..,.• StI GRADE. , . .. .. ,. YEZG ti '. 3 CLEAR 3 CLEAR �- ': - T... . ....... ds -- 6"M/N. 2"M/N r �1 AS REQUIRED OUTLET S �; r- -� DEPTH OF TEST 6"MIN II INLET ' I I t d, _. RATE .�,.,. / .�•r' I DISr. " /O"MIN. ����1 �� \ i I INLET TEE II BOX i J i-G , TEE e - \ \ / I - i i/ I b Y .i: I L F - 'fc DEPTH SEPTIC TANK I I. :. INLET AND ourLEr 4 O" MINIMUM v _- 2„ 6„ ! O 3B TEES TO BE CAST L IOU/D DEPTH a' JU/D D,.PTN OF 4' PRECAST OR BLOCK 'M/l1!' � a 5' o f ` . CONCRETE W i SEEPAGE P/T i IRON, SCHED.QO ' r --- DEPTH OF TEST: 4 B' b o . . CONSTRUCT/ON /o r , , . .e.. E- P.V.C. OR CAST/N , , �f `y RATE PLACE CONCRErE CONCRETE T B' BOTTOM ON LEVEL STABLE BASE MIN D - -- -- -- CONSTRUCT/Dlv (WATERTIGHT) INLET TEE PROVIDED WHERE SLOPE i _ ' ABLE TO WITHSTAND ----— I -- • a A „,",.- IN A PUMPED SYSTEM. 20 M/N. I \\\/� WASHED STONE ✓G� BOTTOM TANK ON LEVEL ST : OF INLET PIPE EXCEEDS D.OB % OR -- --- -- -- -- -- -- kC+ [ SC UNDER --- - --- —� / cN' F.H-20 3�. / MENTOR NOTES f INVERT ELEVATIONS PLAN VIEW : /. THIS PLAN/S FOR THE DESIGN AND CONSTRUCT/ON OF THE SEWAGE - ---- DISPOSAL FACILITY ONLY. SCALE INV. AT BUILDING 44.9 Q /NV. AT SEPT/C TANK(IN) -4- 0 =' 2. ALL CONSTRUCT/ON METHODS AND MATERIALS SHALL CONFORM TO -- — y „ MASS. D.E.Q.E. TITLE 5 AND THE�.4�2�.��>.����E BOARD OF - , HEALTH REGUL AT/ONS. -- /NV AT SEPTIC TANK(OU7-) _�4.- ,•. K 1 f . ,. lNV AT D/ST BOX(/Nl 4�4."�,� l-�`- ,,�'� �� _ ^ �, • , s _/NV. AT D/ST. BOVOUT) 44.94__ f .. M � .� a'� { r'z •.,,,� " " A T L EACHING FACIL I Ty.. BOSTQN, MASS. WORCESTER,`,. _ HALIFAX, MASS. NORWELL, <IT $0TTOM OF PrT: �• 1 BEDFORD, MASS. LEXINGTON, ~ HYANNIS, MASS. MANSFIIrLO, CRANSTON, R.I. DERR`". f c rl y PROFILE: SCALE: , I _ s _Vie,.. i.:\�\ • y \ •DES � N D TA • r % t _ o- ; . DESIGN FLOW r - , \ a ! \ FtEQU/RED SEPTIC TANK N 3 a GAL �► „ � �,/ per;: `, ` �'' SEPTIC TANK PROVIDED = 1 Q 0_— GAL. CAPE COD S�� �` 1 • C�.JlV�V��A REQUIRED SIZE LEACHING FACIL ITY NTS 3261 MAIN ST. ROUTE 6A �` ""' - .. ` `, ----- - -- - ---- ---- - --- -- -- BARNSTABLE VILLAGE, MA 02630 617 362-8133 / A 4..— ! t 1 -- --- --- -- --- -- -- --- --- -- DIVISION OF BOSTON SURVEY CONSULTANTS INC. :. SIZE OF LEACHING FACILITY PROVIDED: ENGINEERING SURVEYING PLANNih'�x ♦ .. �. °�� fir..-/ e�C ' ------------ - ---- .--._ ._ --•� TYPE OF-SYSTEM: �_ .�� �,� � J /, - -- TITLE: SECTION• SCALE • I - ,�, f - - .� � `� � `' � ® I , � . �'rt �'_����-sue�_�-r�►�� - -- --- • � SEWAGE DISPOSAL. SYSTEM ----- - -- ,`� �, �, 1JT•TC� = 1-�' tx .© 1 _� 3SaF's?. DESIGN-- , -- - --- — ----- -- -- - 1 -- - --— - --- --- --- --- 7. �; l/V LOCOS PLAN: � r FOR. r 1 SCALE: AS SHOWN r w SceuoL e "'oe oy METERS FEET 0 11 ` ,! ,�.i • , r , DATE: COMP./DESIGN: ?� CHECK: DRAWN. -` k DA TUM FIELD: ' FILE NO: — - - — DWG. NO: F" 70 JOB NO: �--/�"'`,/J i SHEET: # OF- i r __ .. .L"�_. a .?s1_ -t-..$. ;.Y ..J: ., i, , �. ,. C` V.. . ' , ,.. : P. .., .. C. ..y. - i Y ... �, ]'• .X,h.- Ye K...._a. _' .�.. $-.,.Y>. 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