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Home My WebLink About0160 HIGHLAND AVENUE - Health (2) L160 ghland AveN1 106 1 _--- — - - - - - --- - --- -- - - I1 I I �1 BIKE Town of Barnstable Inspectional Services snxrisrnsLE. 39 0 . Public Health Division i679 �0 ArED""�A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7985 September 17, 2020 COHEN, THOMAS S & DOREEN E TRS 50 PLUM STREET WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 160 Highland Avenue, Cotuit, MA was inspected on 08/19/2020 by Michael T Bisienere, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: 0 The distribution box is rotted and needs to be replaced. You are ordered to replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\160 Highland Ave Cotuit.doc Town of Barnstable + BARNSI'ABLE, Inspectional Services Department �ptfD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) we QjffER G.,rJ S � �n ��c bok Repair deadline: f a Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc f , Commonwealth of Massachusetts /06O �n Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c 160 Highland Ave u Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Na"� information is required for every Cotuit 1/ MA 02635 08/19/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Co � Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 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 j ? l 2. ❑ Conditionally Passes Cl �l 3. ® Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 08/25/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 l f Commonwealth of Massachusetts �n Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments * /- ��./w 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 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 Title 5 Official Inspection Form III; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 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 ❑ ND (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 i Commonwealth of Massachusetts ,�,A Title 5 Official Inspection Form IR Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Highland Ave V� Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 page. Cityfrown 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: This three bedroom home has an H-10 1000 gallon septic tank with an H-10 D-Box feeding a leaching pit with stone. At the time of inspection the liquid level was aprox 10" below the invert. The H-10 D-Box had root infestation and decay. I recommend a new D-Box be installed. 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 li Commonwealth of Massachusetts �n Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Highland Ave -� Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 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 'h 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 page. Cityfrown 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. Commonwealth of Massachusetts Title 5 Official Inspection Form .{ p �4 I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 2 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage town water 9 ( Y 9 (gpd))� Detail Jan-Jun 2020- 19,000 gallons were used and in 2019 155,000 gallons were 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 I .' Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Highland Ave u Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 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) .Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If ,es discharges to: Y 9 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 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 page. City/Town 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 co of latest ( Y ) copy 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: 1977 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 21"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet ro� Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flowing freely at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Fig Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 160 Highland Ave u� Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: ears Y I Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1000 gallon Sludge depth: 2° .... Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the baffle was in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 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 ❑ 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 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): Depth of liquid level above outlet invert OilM- �- --�,•_ �.�� Comments (note if box is level and distributionto,outlets equal, any evidence of solids carry-d-ve any evidence of leakage into or out of box, etc.): At the time of the inspection the D-Box has roots and decay. The D-Box needs to be re laced. 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 .III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is Cotuit MA 02635 08/19/2020 required for every page. Cityrrown 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: One ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is Cotuit MA 02635 08/19/2020 required for every page. Cityrrown 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.): At the time of the inspection there was ponding apx 10" below the invert. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w !% 160 Highland Ave u- Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is o required for every Cotuit MA 02635 08/19/2020 page. Cityrrown 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts 190 Title 5 Official Inspection Form U'v Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owners Name information is required for every Cotuit MA 02635 08/19/2020 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 **As-Built from the installer attache `don next page** t5insp:doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 r Assessing As-Built Cards https://townofbamstable.us/Departments/Assessing/Pro'perty_Valu.. _ 7J yX9, LOCLI.TION 5EWAGE PERMIT VJO. - -1LO- ��- - - - - - - - - - VILLAGE WSTQLLER'S UwE ADDRESS — WILDER 5 U ACME +r A.DDRESS DATE PERMIT 15SUED DATE COMPLI&MCE ISSUED: -Lt-77 /3��k of /7�owF .14w.rA =y,jr,— alb �Y, 1 of 1 R/25/2O?.O-9-41,A1v Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �G !% 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is required for every Cotuit MA 02635 08/19/2020 page. City/Town 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: 13 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 160 Highland Ave Property Address Thomas and Doreen Cohen, TTEEs Owner Owner's Name information is Cotuit MA 02635 08/19/2020 required for every 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 a � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the computer, r,use 1. Inspector: L only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capeiwde Enterprises, LLC. Company Name r1 P.O.Box 763 Company Address Centerville Ma. 02632t � City/Town State j Zip Code 's (508)428-4028 S11454 Telephone Number License Number ' •a F B. Certification I certify that I have personally inspected the sewage disposal system at this address d that the information reported below is true, accurate and complete as of the time of the inspect on. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes El Conditionally Passes El Fails ❑ Needs Further Evaluation by the Local Approving Authority r 11/17/2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. LAt 1 -7 1A t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 w State Zip Code Date of Inspection Ci /To n every page. City/Town P B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will ass inspection if with approval of the Board of Health): Y P P ( PP ) ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 iL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence, of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic sysem consists of a 1000 gallon septic tank,Distribution box and a 1000 gallon leaching pit. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007:39,000 g ( y g (gpd)): 2008:21,000 Detail: 2007:58 gpd. 2008:107 gpd Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 160 Highland Ave. _ Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 20'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 2" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 0 81, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" 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.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °w 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is Cotuit Ma. 02635 11/17/2008 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert no 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gl. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system T e/name of technology: 9Y: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.Leaching pit was dry at time of inspection.Stain line is 13" below invert pipe. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M ,. 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® ® Zoom Out J J J Jfi jIn r FK E N _ cto 5 5 r � i � ! 5t 4 15k �y 1 5 y.J ti 1 1 •4 y �t J' S•'y�5� 55 5 55 J . 0 20 Feet Set scale 1" = 20 I I Aerial Photos I MAP DISCLAIMER (`nnvrinhf )MF_9MR Tnum of P—nefnhln KAA All rinhfc rnen— http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=021106&map... 12/1/2008 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit G Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 40' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Highland Ave. Property Address Doreen Cohen Owner Owner's Name information is required for Cotuit Ma. 02635 11/17/2008 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ol -ibuCi I A/v _ C Z) 5 el 3 C 17 ASsEssoRsMAPNa�Al Commonwealth of Massachusetts PARCELNo: ,v Executive Office of Environmental Affairs Department of Environmental; Protection CEpV ® William F.Weld OCT G"Mor V 1 18 1996 Trudy Coxe s.�r.wy,eon► HEALTH DEPT. David B. oner Commi�aioner TOWN OF BARNSTABLE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A •'k.x+p� CERTIFICATION Property Address: /60 Hif4 �a.j 1ji e) Address of Owner: Date of Inspection: la—/6--44 (If different) Name of Inspector: -jP4, !� l� (7ky�✓f T h, Goy�,i Company Name, Address and Telephone Number: '75- �/t-ac�Yar�u �.�tie C.-4 re,fill e 4,fo, CERTIFICATION STATEMENT �L I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate 0 and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: L l,"Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Sislur /�G%'�✓�'- Date: C/r The Syste nspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: .Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 6] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Wlnter Stet a Boston,Massachusetts 02108 a FAX(617)SWI049 a Telephone(617)292-UW Printed on wcydad ftW r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A l CERTIFICATION (continued) Property r Ownerii `7a'r(`�G!/l„�i�;y.v�co.r��++>ss�vyri- Rlpo�f �g � Date of Inspection: B'. SYSTEM CONDITIONALLY PASSES (continued) ed Sewage backup or,breakout or high static water level observed in the distribution box is due to broken or obstruct inspection if(with provaI of the - distribution box. The system will pass spe aP pipe(s) or due to a broken, settled or uneven disc Y Board of Health): 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 bstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed i C) FURTHER EVALUATION IS REQUIRED BY THE �OARD OF HEALTH: which require further evaluati n by the Board of Heal h in order to determine if the system is failing to protect the Conditions exist q public health, safety and the environment. %\ 1) SYSTEM WILL PASS UNLESS BOARD OF HEALT DETERMINES HAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH A D SAFETY ND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surf a water Cesspool or privy is within 50 feet of a borde in vegetated wetland or a salt marsh. D OF HEALT ( ND PUBLIC WATER SU PPLIER, IF APPROPRIATE) DETERMINES THAT 2) SYSTEM WILL FAIL UNLESS THE BOAR HEALTH AND SAFETY AND THE THE SYSTEM 15 FUNCTIONING IN A MANNER TH P TECT THE PUBLIC ENVIRONMENT: _ The cvstem has a septic tank and soil a sorption sysie and is within i00 feet to a wifaLe water supply or tributary to a surface water supply. _ The system has a septic tank and so' absorption system nd is within a Zone I of a public water supply well. _ The system has a septic tank and s•it absorption system a d is within 50 feet of a private water supply well. _ The system has a septic tank and oil absorption system an is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform batten and volatile organic compounds indicates that the well is free from pollution from that f cility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• DJ SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or dogged 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. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: 7 /P of �s • Date of Inspection: /•d—A_q G D) SYSTEM FAILS (continued): Static liquid•level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in ce pool is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping mo than 4 times in the last year NOT due to cloggeo/or obstructed pipe(s). Number of times pumpe Any portion of the Soil Absor ion System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or pri is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is ithin a Zone I of,a,public well. Any portion of a cesspool or privy is wit 'n 50 feet;of'a private water supply well. _ Any portion of a cesspool or privy is less tha 106 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well/.. been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, a onia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: .41 The following criteria apply to large systems:in addition to the criteria bove: The design flow of system is 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 ynpre of the following conditions exist: 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 supp fy well) i . The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program 6.00. Please consult the local regional office of the Department for further information. requirements of 314 CMR 5.00and: i (revised 8/15/95) 3 r , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 1 Property Address: /60 ri1V l4' Owner: Date of Inspection: j�J ld 9 Check if the following have been done: uPumping 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. f/s 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. -L"The system does not receive non-sanitary or industrial waste flow V'T"he site was inspected for signs of breakout. AI system components, excluding the Soil Absorption System, have been located on the site. ZThe 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 existing information or approximated by non-intrusive methods. _The facility owner (dnd occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal Svstem. (revised 8/15/95) 4 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -�-SYSTEM INFORMATION Property Address: N' Date of Inspection: YY'� ,4 -f Owner: ,7Kn �,>/"�7i�, Co.+.syr�ssid�lr /P�, oi �s/a� /G_//�� FLOW CONDITIONS RESIDENTIAL: Design flow: 3 o gallons Number of bedrooms: 7 Number of current residents: NOW Garbage grinder(yes or no): Np Laundry connected to system (yes or no):'�e_ Seasonal use (yes or no):y. Water meter readings, if available: Last date of occupancy: L&-;:r COMMERCIAUINDUSTRIAL: Type'of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)—No o If yes, volume pumped: eallons Reason for pumping: TYPE OF SYSTEM f/ 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) and source of information: 1 r74�'s q'��/' 77 Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Y i•, 7�%6 N�iSt�O H Owner: Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: concrete _metal _FRP—other(explain) Dimensions: 711-et!r x y"'r w X Sludge depth: /z" Distance from top of sludge to bottom of outlet tee or baffle: /`" Scum thickness: /I" Distance from top of scum to top of outlet tee or baffle: /D Distance from bottom of scum to bottom of outlet tee or baffler_ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle , depth of liquid lev I in relation to outlet invert, structural integrity, evidence of leakage, etc.) strll, Tay k s4e.1 be • vs+ ar :�� °/�' "�� GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _ etal _FRP_other(explain) j Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baff . Distance from bottom of scum tr bottom of outlet tee or le: Comments: (recommendation for pumping, condition inlet and outlet tees or affles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) �/ ----��--- A Property Address: I(p �� ✓�/ �Y� CD!"i f Owner: Kati �� Cv"'syrisfio�s/r �P�, Old Gflq/$ Date of Inspection: TIGHT OR HOLDIN TANK:-- (locate on site plan) Depth below grade: Material of construction: —conc ete_metal _FRP_other(explain) Dimensions: Capacity: >;allons n flow: Design o w: A allons/da y Alarm level: Comments: (condition of inlet tee, condition of alarm anXswitches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: 6/0 Comments: (note if level and distribution, is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) /Il0 frcq<y O' SO�ri/ CN✓I'bn <!r ' PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps an purtenances, e . (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 0 SYSTE-M-INFORMATION (continued) Property Address: 16o I/leti L, �vt Coluif Owner: jery 1dG.r7i Date of Inspection: 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: leaching trenches, number,length: - leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, ;igns 9f hydraulic failure, level of ponding, condition of vegetation,etc.) �try c !1/ -ell P14" i ors. 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 construction: Indication of groundwater: inflow (cesspool must be pumped as of inspection) Comments: (note condition of soil, signs of hydraulic failure, level o onding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydrau' failure, leve of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 r 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: f GO �}�y4 A! Owner: Tuh Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within'100' N 1 37, N LI �i'fo Wo f c S v DEPTH TO GROUNDWATER Depth to groundwater. L/f feet method of determination or approximation: 7"I,,All l��ovc�s w�•+•, �,It11 a •h /9 77 (revised 9/1S/95) 9 r LOC&TIOP1 ' SEWD,C,E PERMIT UO. IWSTQLLER�S// ► &ME � ADDRESS — — —/no w,AILys 6✓.�— — — — BUILDER 5 IJ &MIF- ADDRESS —. — Cow, DATE PERMI-T ISSUED D ATE COMPLI &MCE ISSUED : . .... ....... . f NoufP sew p y' s y?�--- ' � 3 - 72 - LOCATION S.EW&GE PERMIT UO. NALLAGE - - - - - - G'o�f IWSTALLER 5 W&ME ADDRESS Wahl BUILDER 5 Q &MF- ADDRESS DATE PER"VT 155UED DATE COMPLI &I ACE ISSUED : 3��k of S y, 3 I . No.............2s. Fug..... t7............ THE COMMONWEALTH OF MASSACHUSETTS .. BOARD __.. ._/ ..... .... ....F TH 4.........OF.. ...... .. .... ...... ...... ........... Apphratinn -fur 43WVviittl Works Tottmtrurtinn Vrrmtit Application is her m e for a ermit t IConstruct ( ) or Repair ( ) an Individual Sewage Disposal System at*... 110 . . 1 o-------------- . ::. . .........¢ _.:.. ocatio ress ... •..__-or Lot No.-•- •-•-_-••---••--•-----_--• ner / - Address W Installer Address Q Type of Building Size Lot............................S . feet U Dwelling ..__.Expansion Attic ( ) Garbage Grinder) �No. of Bedrooms------------------------•----------.... — aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) Cafeteria ( ) a' Other fixtures ____.--______________________ __ W Design Flow--------- ________________________gallons per person per day. Total daily flow....-_._._D._D------------------------gallons. Septic Tank L Liquid capacity/oq _gallons Length________________ Width................ Diameter----- ---------- Depth_..._-_-.----- xDisposal Trench—No..................... Width ....... Total Length-------------------. Total leaching area_-_._.--__-_..._-___sq. ft. Seepage Pit No.--/--------------- Diameter.__f 4.o.,c�..-��epth below}}-nlet_...._.. _______. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) c�P_/ i— rS 7 r Percolation Test Results Performed by------- -----------------------•-------•---•----•-•-----------------.----- Date........------------------------------- W Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.--------------..-.----- f� Test Pit No. 2................minutes per inch De th of Test Pit.................... Depth to ground water------1--__--_-----_.... R' . r Description of Soil l `2 ` jzV /� V -------------------------------------------------�1 ••------•••--•--------- --------•-•----•-•----••----------------------•--------•--•-•-----•-----------•--- W Zr -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the afor esci'ibed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sa y — The undersigned further agrees not to place the system in operation until a Certificate of Compliance h be b the and of/ ZvI-xd) - 5 -3/ 7igne _ __ - Date Application Approved By------ -- - ----- -------- - -•-------- ------- ..... -------- --- —.7/ 7 7------- Date Application,Disapproved for the following reasons:.................................... --....----•-------•-•••-•-----------...---.._......----------------- - h ..................................................................................................................................................................................................._...... p Date PermitNo.---=------•--------•---•--•--------•-----•--------................................................... Issued------.(..'= 3 7 ..................... Date No......................... FhR...... �+G... ...... THE COMMONWEALTH OF MASSACHUSETTS �HEOF...... . ... ...... .. ,_....... . ................ 40ration fear M_gvvr al i3porkii TM6trurtivn Mani t Application is her m�le,.for a ermit for Construct ( ) or Repair ( ) an Individual Sewage Disposal System at �--67-----`. �.-x . .. te, . ocation- ress or Lot No. -- ... ^ .... /��..� . t r---t...•...................................................... er Address a ----- Installer Address Uype of Buildin y Size Lot............................S . feet Dwelling o. of Bedrooms----_ --_-.__•-----------------------Expansion Attic ( ) Garbage Grinder�g) a, Other—Type of Building ---------------------------- No. of persons_.----_.--_-_____-_._-_-._- Showers ( ) — Cafeteria ( ) a Other xtttres ------------------------------ - - WDesign Flow....::... �c�...................:.gallons per person per day. Total daily.flow........ ... `..____________.........gallons. WSeptic Tank—Liquid capacity/4'10 V gallons Length................ Width................ Diameter-----........... Depth.-.------- x Disposal Trench—No. ....:............... Width----------- ------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No _./-------------- Diameter l°. * _.9epth below 'nlet. __ Total leaching area.___..___._.____.sq. tt. Z Other Distribution box:( ) Dosing tank ( ) E `" '" '"" ° WPercolation,Test Results Performed by -----------------------••=-.-•-•--......:----- •-- ••---•..... Date_-----------------•--------------_----- a Test Pit No. .1,............._minutes per inch Depth of Tesf Pit.................... Depth to ground water...---.----.-.---.-...-. �14 Test Pit No. 2________________minutes per inch�De th of Test Pit-------------------- Depth to ground water--.-...__-___-----_-. Description of Soil " 1 _� -------- ------------- ►S 1s� U --•---•----•----------------------------------- '1a-4"' ................................................. ---•-----•---------------------------•----•-------------•--•----------•---- W U Nature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------- . . Agreement: The undersigned agrees fo"install the afor es cribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sa y Co —The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha bee the b ard`of-he gne Date Application Ap roved By = '" !G -- f.. '. Date Application Disapproved for the following reasons: !!•-----•-•------------------------------------------• •---- -------------------------- - --------------------------------- -- •--.....--•--••---••-•-------------•---------•-•--------... �. Date PermitNo--------------------------------------------------------- Issued--------------------------- =`= ............... Date THE COMMONWEALTH OF MASSACHUSETTS "I BOARD OF EALTH / .................. )... ....OF.............. . ./...................................... 101pprtifiratr of T,aritPaurr T S I TO C . " IFY hat the Individual Sewage Disposal System constructed oe-�Ior Repaired ( ) by ial has been installed in accordance with the provisions of <' tic XI of The State Sanitary Code as described in the application.for Disposal Works Construction Permit N _�._-__A-_________________ dated ._.. i ":.�,E.r�!'.7�____---_--_. TF9E.'ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .. Inspector--- ----------------............. ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARDO HEALTH No -•----•-- -••--•. FEE ...................... Permission yS reby granted--- - ----- ---------- ----:. ... --------- .... -------•---• to Constr t or Repair ,( ) n.In vidualWg -]..System. ?f .� Street _ as shown on the application for Disposal Vborks Construction. it N -------- ---. Dated--.. '_------------------------------ _7. ( r/ 3 — 77 Board of IIealth - + DATE l ° - ------- FORM 1255 HOBBs & wARREN.';INe. PUBLI�SHERS. +±•�w'..- , Jt " K 20 FT MIN: h '. 5 FT. MIN. - - CONCRETE 4 • PVCy PIPE w CLEAN SAND ' Elti /oo,D COVERS MIN#• PITCH 1/6 PEP f 7 CONCRETE `o: .. COVER 11 A t 10 LIQUID LEVEL , A 4•• CAST ,�� 2" LAYER RONPIPE . 'f oa o G� ° 1/8'- 3/8• . PITCH- ,. ,:�. �- . "o : . . • . ° W SHED STONE PER SE ?TIC TANK ° ' 1/4 FT OF . ° e_ a.•d • ••• • ° ° , BOX - . s• IVE1 L .°4L 3/4T 1 1/2• 0 0 . . • . •; VIED STONE . • . • : 4: . .. . . -PRECAST SEEPAGE . . a .; .` � . • �: . . . . • .-._ , PIT OR EQUIV. INVERT ELEVATIONS' 6 FT 04A._-___ i7j " IO FT 01A. {SEE TABULATM) INVERT AT BUILDING . FT. . . . , INLET SEPTIC TANK 'AFT. _ OUTLET SEPTIC TANK 9G.(OFT. GROUND WATER TABLE IN_L_E_T�-;DISRiBUT1{}N—gOX ' b. FT SECTION OF SEWAGE DISPOSAL �YSf�'A4 `76 OUTLET DISTRIBUTION BOX ,3FT. E ► . SCAL I/4 = / -®. INLET SEEPAGE PIT � 9n F.T. TAS .�LATIO w' DIMENSION A FT DESIGN CRITERIA 'rr DIMENSION B 6 FT. NUMBER OF BEDROOMS 3 DIMENSION C FT rn n GARBAGE DISPOSAL UNIT TOTAL ESTtMAi'fD -"`FLOW _!! GAL./DAY.: SOIL LOG SOIL TEST NUMBER OF SEEPAGE PITS f' / ELEVATION ✓ SIDE LEACHING PER PITY SQ. FT DATE OF SOIL TEST '' r BOTTOM LEACHING PER- PIT ' 79 SQ. FTp/ i.=.� �.- ��r�F� RESULTS WITNESSED BY mot. rr r PERCOL AT ION, RATE MIN/-4NCH TOTAL LEACHING AREA =��SQ. FT. 3i1�r'�(,.5'%��._� RESERVE LEACHING AREA :2. I-L SQ., FT. A,/CA , - 1 UBE1;T G� J/ �r. , J( .. /GN. LAn'DS' R[[�.e®rX�. C07fl f. � ,.gib • 4u.40 ELDkF.C- E - •� ELDGE EN( MERiiG. CC: ''�� 'i -,' e�,� �'Fc,ByF��Q i;f a t'• _` 33 NO. MAIN ST. 712 MAIN ST 4ao Sid O YA RIU 1'HAff AAIR9. 111�4NNt$ IbAS [+I�'1• '/7 0 3 SHEET Z OF Z 1 AV r 29';30of h o (� /00'l0 �2 ` FXptNsrON •t3 TG�T s, SL'i"T/C-mmk " 30, b /000 GAL. LrAcµfnr4..pi7 97. /¢ 5 3/o -15' C. 5 3a_ 53 /D �L Z 0 YS TAR D a CERTIFIED° PLOT PLAN LO T N NLAIV05 W, aerxT, CoTV/T NEW CONSTRUCTION ONLY , TOP OF FOUNDATION IS_5 3 FEET IN ABOVE LOW POINT OF ADJACENT Jai Jl,i l-fAjlJj44VAS-S# ROAD. S ALE: 1tY--40 5r4)ATEtMAY27,1977 LD EDGE ENG/NEERING CO.iN CLIENT q"tJ0,yo CERTIFY THAT THE LENG,INEE; GISTER REGISTERED S WN ON THIS PLAN 18 LOCATED CIVIL . LAND JOB N0. �7.._ 03* 0 THE GROUND AS INDICATED AND SURVEYOR DR.BY, ,-� C OFORMS TO THE ZONING LAWS 0 BARNSTABLE, MASS, 33 NO. MAIN ST 712 MAIN ST. CH"BYto-- 'P_: _ S ' 7 7 n SO. YARMOUTH, MASS. HYANNIS, MASS. u EY 8HEET.LOF 2_.._, D TE RE4. LAND SURVEYOR