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HomeMy WebLinkAbout0010 HOPEWELL LANE - Health 10 HOPEWELL LANE, COTUIT A= O L4 O 31 i I i r _ rAlp © cfc — -37 1, , - Commonwealth of Massachusetts � � f Title 5 Official Inspection Form pet3��� �N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hopewell Ln 'r Property Address Bank Owned (Contact David Holt @-Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit ,/ "� MA 02635 12-22-16 page. City/Town- State Zip Code Date of Inspection , C.e1 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 4k- 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services • , Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that I have personally inspected the,sewage disposal system at this address and that the information reported below,is.true,,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000):The'System: ` - N1,Passes,, , ,;F ,, Conditionally,Passes, -;❑ Fails. El Needs Further Evaluation b the Local Approving Authority 12-22-16 f, Inspector's Signature Date " The system inspector shall submifdcopy of this'inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts ' Title 5 Official Inspection Fora "A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit MA 02635 12-22-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts :+ Title 5 Official Inspection F®rm �. •.-� Subsurface Sewage Disposal System Form.-Not for.Voluntary'Assessments .• 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit r. MA 02635 12-22-16 page. City/Town .+ State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with.Board of Health approval if ` pumps/alarms are repaired. B) System Conditionally Passes (cont): •,, ,•r , ❑ 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 Boardof Health):' ❑ broken pipe(i) are replaced ❑ Y- ❑ N ❑ ND (Explain below): ` ❑ 'obstruction is removed'` '` ` '"❑ Y ❑ N ❑ ND (Explain below): ',t . r I � t ❑ distribution box is leveled or replaced ❑ 'Y ❑ 14 ❑ 'ND (Explain below): f. ❑ The system.required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed - ❑ Y ❑ N ❑ ND (Explain below): I C)j,Further Evaluation is Required by the Board of Health:- El 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. ' 11."Sy4em will pass unless Board of-Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning'm a manner which will protect public health, safety and the'environment: ❑ Cesspool or privy is within 50 feet of a surface water 'F ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-.rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form �'i�--i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit MA 02635 12-22-16 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 tributay to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface'of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection -dorm ` ul Subsurface Sewage Disposal System Form, Not for,Voluntary Assessments a� 10 Hopewell Ln Property Address r Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)- Owner Owner's Name information is + + required for every Cotuit MA 02635 12-22-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) _-tYes 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. 1 '1 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 S a - 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.] j❑ I,® E The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ' The system fails: l 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 r ; f !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 pdblic water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 , Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form �III,., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @ Today Real,Estate 1-800-966-2448) Owner Owner's Name informEtion is fo required for every Cotuit MA 02635 12-22-16 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 t5im.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts , f Title 5 Official Inspection' ,Form l hI Subsurface Sewage Disposal System Form:=Not for Voluntary Assessments 10 Hopewell Ln " Property Address Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448) Owner Owner's Name information is Cotuit ' ' MA 02635 12-22-16 . required for every " page. City/Town . State Zip Code Date of Inspection D. System Information :. Description: ar Number of current residents: 0 Does residence have a garbage grinder?. ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection t El Yes ® No information in this report.) Laundry system inspected? : :}, r '= ❑ Yes ® No Seasonal use? r _ - ❑ Yes ® No Water meter readings, if available.(last 2 years usage (gpd)):'' ; Detail: 1 r Y t T Sump pump? ,, { .; ❑ Yes ® No ! Last date of occupancy: - +' 2016Date Commercial/Industrial Flow Conditions: Type of Establishment: Design.flow,(based,on 310 CMR'15.203):, Gallons per day(gpd) f Basis of,design flow,(seats/persons/sq.ft.,,etc.):r 4.1 �'. Grease trap present?,., t _ ❑ Yes ❑ No Industrial waste holding tank present? " :, + r, ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts f' Title 5 Official Inspection Form 21 �"A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit MA 02635 12-22-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) a Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts a�l 0 Title 5 Official Inspection Form IN Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @-Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit > �+ MA 02635 12-22-16 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: 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): ., - 24" Depth below'grade: ; " . t, - feet' Material of'construction: ❑ cast iron ® 40 PVC' ❑ other(explain): Distance from private water supply wellf61r'suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: !' - r' 18"feet- Material of construction: z ® concrete ❑ metal [I fiberglass E] 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 gal ryn Sludge depth:, 1211 _ t5ins.doc-rev.6/16- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts f+ Title 5 Official Inspection Fora �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hopewell Ln l J Property Address Bank Owned (Contact David Halt @ Today Real Estate 1-800-966-2448). Owner Owner's Name information is required for every Cotuit MA 02635 12-22-16 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 20" Scum thickness 4" 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 12" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle ' Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: -- Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts '+ f Title 5 Official Inspection Form �N Subsurface Sewage Disposal System Form -Not.for•Voluntary'Assessments 10 Hopewell Ln t J Property Address Bank Owned (Contact David Holt @ Today Real:Estate 1-800-966-2448), . Owner Owner's Name information is required for every Cotuit "i MA 02635 12-22-16 page. City/Town :it 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:).'' ' •1.3 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' o f r j Design Flow: 41n gallons per day Alarm present: ❑ Yes 0 No Alarm level: Alarm in-working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts a=1 Title 5 official Inspection Form r' ' lf;�I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit MA 02635 12-22-16 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from pit. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �� Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments. 10 Hopewell Ln - t J" Property Address Bank Owned (Contact David Holt @ Today Real,Estate 1-800-966-2448) r Owner Owner's Name information is required for every Cotuit MA 02635 _ 12-22-16 ` page. City/Town State Zip Code Date of Inspection D. System Information (cont.) .Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields ..number, dimensions: ❑ overflow cesspool number: , ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding damp soil, condition of vegetation, etc.): Leach pit in good condition and empty at inspection with stain line at 30" below inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts L asI f Title 5 Official Inspection Form ,. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit MA 02635 12-22-16 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts =1 f� Title 5 Official Inspection, Form' �lf;�, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a<; 10 Hopewell Ln r- Property Address Bank Owned (Contact.David Holt @ Today_Real'Estate 1-8007966-2448) " Owner Owner's Name information is Cotuit r'"' "+ required for every a "r MA 02635 12-22-16- page. City/Town , _> e° State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 9 j r i r� f ",• t5ins.doc•.rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I� Commonwealth of Massachusetts Title 5 official Inspection Form �1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Hopewell Ln t J' Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit MA 02635 12-22-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ; ❑ Check cellar ry ❑ Shallow wells Estimated depth to high ground water: 20' 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: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 d Commonwealth of Massachusetts :a Title 5 Official inspection Form f Subsurface Sewage Disposal System.Form Not.for Voluntary Assessments 10 Hopewell Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Cotuit MA 02635 12-22-16 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a d DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner's Name: Gia Huang Owner's Address: Same Date of Inspection: August 11,2005 Job#05-241 ? Name of Inspector: PATRICK M. O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD `' MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779I -; U CERTIFICATION STATEMENT woo t:a I certify that I have personally inspected the sewage disposal system at this address and that the inform tion reported below is true,accurate and complete as of the time of the inspection. The inspection was performed ba ed on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DW 0111111111���� approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: � '(t1,OF.tij 9 Passes TRI • Conditionally Passes m Needs Further Evaluation by the Local Approving Authority v Fails ELL ;c� Inspector's Signature jinn \`,; �, �l�.t � Date: August 11,2005 '��i,�Fs INS?EG�o\`��. �411111liltttt��� 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. Notes and Comments: Observed one foot standing water in leaching pit, recommend pumping tank. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times alryear 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: Titiv G Incnartinn Fnrm 411 VInnn 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Titles f 1"o—tinn Rnrm Oil 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than %i day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped . _ _X Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a,DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma _No_(Yes/No)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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead_ Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a 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. Titlo G Tncn—tine P—m 411 V1000 4 Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks'? _X_ _ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X _ 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? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Title C 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2003—50,000 gal.2004—18,000 gal.=93 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM —X_Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1986 Were sewage odors detected when arriving at the site e r g s o no : No g (Y ) T41.G ►ncnArfinn Fnrm 411 VIAAA 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: 30' Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX ' (locate on site plan) Depth below grade: 16" Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5' long x 5.2'wide—1000 gal. Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 8" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,.structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles intact and clear,recommend aumaing tank. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle_ condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Titles G lnc...tinn Rnr—All si,)nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Trace of solids carryover, no high stains. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Titla C Incnartinn Rnrm 4/1 r,1100n 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits, number: One 6x6 pit. leaching chambers,number: leaching galleries,number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Observed 1 t standing water with no staining above current level CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan)j Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Titles i lncnantinn Fnrm 411 vXnnn 9 Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Hopewell Lane Water service Driveway #10 27 52 57 35 57 43 a Titles C Ine—tinn Rnrm A/1;i,)n1)0 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Hopewell Lane Cotuit MA 02635 Owner: Gia Huang Date of Inspection: August 11,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.35 and topo map shows property at el.70. T;r1A C incn.nt;n V�r 4/1;n1)0n 1 1 COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION n Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Address of Owner: 10 HOPEWELL LANE COTUIT,MA 02636 Date of Inspection: 612/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 CERTIFICATION STATEMENT eft 1 certify that I have personally inspected the sewage disposal system at this address and that the information reporte?1'elowisyo, acc`�te and complete as of the time of inspection.The inspection was performed based on my training and experience in the_proper functlrS and tY%G maintenance of on-site sewage disposal systems.The system: P F ¢9{ 0- Q Q X Passes a `& _ Conditionally Passes �o't lea, _ Needs Further Evalu 'o By the Local Approving Authority ►. Fails Inspector's Signature: Date:6/6/00 The System Inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If th 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. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its components useful life." THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.RECOMMEND RAISING COVER TO LEACH PIT-THE COVER IS 6'DEEP. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: s s�'h X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. Wa The septic tank is metal, ,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiitration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Wa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n/A The s stem req uired y q fired pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES TH AT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n&(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No " X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 0. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, - X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: i You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply X the system Is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please.consult the local regional office of the Department for further information. ` t revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B 3!.a CHECKLIST ;Al Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner: GIA HUANG Date of Inspection: 6/2/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and.location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. i revised 9/2198 Page 5 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO', Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a lw;, TYPE OF SYSTEM r X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system.(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1986 Sewage odors detected when arriving at the site:(yes or no). NO revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2100 BUILDING SEWER:X (Locate on site plan) Depth below grade: 30" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 24" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10"" Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 29". Scum thickness: 8" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of:Inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 111 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) f n/a revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: w n/a Type: leaching pits,number:(1)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a +; Dimensions of cesspool: nla Materials of construction: nla Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: locate on site Ian ( plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a �a I �t� I revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) NAO peck F-200 g 1 AA a a� � 3� +D `(3 BA 41 � 57 c �C revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 HOPEWELL LANE COTUIT, MA 02635 Name of Owner GIA HUANG Date of Inspection: 6/2/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers , X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET j revised 9/2198 Page 11 of 11 TOWN t}7-_,BARNSTABI.E Lt�ca�i�arr �Q stwAGE# �.� u;f; ✓ AssEssot�s�► LoT IMSTA3.LER'�t'dAiv1£c4 P�iOtdE N4 S9P'T1G TAAIK C.4I?ACT!'X n �-� NO.<3F$Fd3k�QOMS �tJSI CttrR OR 6W,M PERMF£f>ATB.. ' ` CC}IIPTfAIdt DATE: Separation Atalanta Between the tviaxu um.* Uuste�l Groundwater Table to the Bottom of I.eact tng Facility lFeet Pnva#e Wit f Suppli-W. , t aAd S tracility �€aay-W exu€ nn�.sits nr wtetun?.IZD feet afleaclnngfaciryy met Edgy of wand and Leaehtng faa'lity`(if ariy wetlands extsi withtst 3ti0 het leacfun$f J feet 1.,��rtushed 7� AL Oa CIS P o I 1 1 A � �-3 33 56 TOWN OF BARNSTABLE L��CATION SEWAGE # �``✓ILLAGE- 6 ASSESSOR'S MAP & LOT NAME&PHONE NO. SEPTIC TANK CAPACITY VOV AA, LEACHING FACIL=: ( pe) 1 l (size) lk-Sj .o NO.OF BEDROOMS y $ba:BeR OR OWNER A i PERMIT DATE: EflMPh-hkNtT-t* : Separation Distance.Between the: ! 7 L U I,nSPe ldA Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 113 Z'7 5z 35' r TO OF BARNSTABLE LOCATIO40 L�ZwellSEWAGE # Y``t`,TI .LAGS , ASSESSOR'S MAP &�0'fU V 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: 2,9-0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply-Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by II f Deck F L°Ig • 1 Bp ''� ASSESSOR'S MAP NO. 0 �V4>- PARCEL CZ51 LOCATION SEWAGE PERMIT NO. I N S T A LLER'S NAM1E i ADDRESS I LL.u. Vie s R U I L D E R OR OWNER DATE PERMIT ISSUED L DATE COMPLIANCE ISSUED �y��� ' O` �8� No.... FE$... b THE COMMONWEALTH OF MASSACHUSETTS P"Q BOAR® ; E HEALTH P" �'� 1 OF.... ......-............... ............ App iratiou for Disposal Works Tottotrurtiun ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Dis posal Syst at• �,,,. ...• ....�� hL.... .�r,�c���.�..,.. � - ;----•-----•------- ----------------------------------------- _ oca n- ddr ss t 1rr - - ---. ..... i, � w a --•--••• - Z � Installer Typ yry Lot_ o,��J` 6/ Address ' Q e of Building ``G°C/ q Size _ ._� ....Sq. feet U Dwelling—No. of Bedrooms-----2...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building f9.AAA*47!.... No. of persons............................ Showers p., yp g -- - --- p ( ) — Cafeteria ( ) a4Other fixtures ..... &46_e,.............................................................................................................................. W Design Flow.... ...=_.�.__...........gallons per persojn err day. Total daily flow............7S. .................gallons. WSeptic Tank—Liquid capacityA.-tv. lons Length.Cf./aa...... Width�f< 4.... Diameter_' �_--- Depth.___-iy. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area------..............sq. ft. Seepage Pit No.___--�....._...... Diameter........AP...... Depth below inlet.....(........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to ( ) ,. n '-' Percolation Test Results Performed by..� l1SC�* ----- !v`�� ----------------------- Date_...., a Test Pit No. (................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------- ---... ••••-•......-- O Description of Soil Q G•..�?.---'�i✓lJ------. r'`x •--•.•--•••••--••----•-•-•-----•.-•••.-••-••--•---•-•-•- ._- ...z ------. .................................................................................. w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITILj 5 of the State Sanitary Code— The undersigned further agrees pt to place the system in operatio it a Ce,t sate f Compliance een is by the board o�Ihea th. igned -------_----•- ° to Application Approved B ................. •--• •-••-•--•- 1 DaTe Application Disapproved for the following reasons---------------------------------••----------------------------------------------•-----------------............-- ----•----------------••----•----------------•------------•--------------....---------------.•...-----------•-•-•-•-•-••••---••••••-••••-•---•--••---•----•••••-••----•---•--------••---••--•••-•-----_.. Date PermitNo......................................................... Issued....................................................... Date L- ------ - r THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH . f .............. ..._........-----------.OF.......................................- ... Appliration for Biinnsal Works Tonstrurtion amit x. Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .... ... -••- ...... ���." - 1 lam..: ;✓ .%'� :.:,..- ............................................................... Location Address + i of`Lot o. J . .r .. . ! ... ..tr /..... . h r �..!` '�] ��"O1 lOJ -f. Jf, J.�f: ((( r I - .. ............... Ow9er s A 9 A�lress...e.. ................... s • Installer Address Type of Building Size Lot P:�' !_�:?....Sq. feet Dwelling—No. of Bedrooms-_--- '':...................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons............................ Showers Other—Type g ---•----•------------•--•-----•------•----•P � ) — Cafeteria ( ) � Other fixtures ....' i „,r,!r%...... ...•-•--•-••-••-•-•-----•---•---•••--•-••...••-••••••----•-••••---------••-•...................... . W Design Flow....= ._._'=.°? ............gallons per person„per,day. Total daily flow..........._2_2��.....................gallons. W Septic Tank—Liquid capacity��'^K i..gallons Length"'.K_..__. Width-55-.�«..__. Diameter'"�"'{-4?..... Depth._^.—/)._. x Disposal Trench—No. .................... Width.................... Total Length.................... Total.leaching area--------------------sq. ft. Seepage Pit No...../------------- Diameter........:f!l------- Depth below inlet................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed c.�r..:...................... Date....!-?.....:`'5n.-n--- y`. W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fLl Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ R+' -•-•-•--•--•......... ------•-•-•---•---•--...••-•....................................... D Description of Soil....... =" ' :! .,"' ''�..� ... G'a P• . '.... .... ......-----•-•--.----............................................................... ............................................................. W -------------- --------------------------------•----- -------------------------•------...----------------------------------------------------......................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----•-----------------------•------------------...---------•---•----•-•--------•----•-•----•-----•---•---•--•-------------------------------•--•--------............................................... Agreement: The undersigned agrees to install the aforedescrib�ed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Coder. The undersigned further agrees°riot,to place the system in operatio til C cate Compliance has-been issue ,by the board of health. �-- Si ne ...... r 1-�.� r-- /' / .�t r ..._ _ •/Date Application Approved B ..._.:::.. jj• f > t Application Disapproved for the following reasons: .............................................. .... ..........•--------------•----....---••-•---••••-••-----------•---•---••-----•-•--------.........._......••------•------•----•••••---•-••-•--••--•-•----•--•--••-............................... r Date PermitNo.......................................................- Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF HEALTH r1�•iie.............0F.............!�l o` i/ 1i'.�r7.�:�[ r�.r....................... upwrtifiratr of Toutnliana THIS TOCERTIFY, T the Itid.v dual e age Disposa ystem constructed ( ) or Repaired ( ) by.................. '"......._. ....... . .-•------------•........................................•--...........--•-- Inst ler at.........._� °i...--- -----•- .�..?.�.....� c- ,at f .. ---------------------------- -•--•- h`as been installed in accordance with the provisions of TIT of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..___._ ,�?...._.(0.1...... dated_iUA4RANTEE �.(�j_t.l��.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A THAT THE SYSTEM WILL. FUNCTION SATISFACTORY. DATE.....----•.--.... z �� ...................... Inspector.........I..z.% --------------------------.........------.........----------•----- THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF HEALTH � f - !. N . .................... FEiZ.................. IN11110p5a Works TOaaat Uan per it Permission is hereby granted........---------••• _--- . ---• - ' _._.. to Construct ( ) or Repair„-( ) an Individual Sewage Disposal System atN ------------------- --•••--...... ------.--------•----- -------- ---------------------------•-------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No.. _ _. Dated•. _ _:_...� 9. f....... -------- DATE. // Board of Health FORM 1255 A. M. SULKIN, INC.. BOSTON - .- O v-7`�: `�Ts1 T //I c: f I ✓t/ ;�A ^o c�• R q5• cc O t,o. 19�1� zo ' � —� ,G , a v �b 1110� L d 7 z�l Z 7 r 7 7 .SF`. 9� � � _ M f N IV �. 1� N It V r, J o W 4`X Lv -T z s C.A.0 N 5 � / (�) __�� !!! /O - /.` gait ZoOVE 2,F� t o ti,s o NhJ r : A SS u M n OFNITN, 017 �l ALBE13T, JORSE v; _ � r O pro.109514O F LEGEND `EXISTING SPOT ELEVATION OAO y1 -EXISTING 'CONTOUR --- ® — CERTIFIED PLOT PLAN . . : -_FINISH ED.. B:NOT ELEVATION 4 0 7- 2- 1- POUTS 2 ` !1011SHED CONTOUR 0 ;..:No -. `The location of any existing unders�.ound sewerage, Ott 'or. other utilities. shown on this plan is .approx- IN �;• mate`only as determined from records .and/or verbalSA norR iation. The contractor is responsible for the .SA' k, r49 LA,# ASS* Yl Yor; cation of the existing locations in the field. SCALE, "= 40 DATE 7�c ��s /. ,3A 14WST .03 c DREDGE ENO/NEER/NOca r-2, ....�CLIENT. E 1 CERTIFY THAT . THE PROPOSED"',,' ' 18 �r� E01STE11E REGISTERED J06 N0. /° BUILDING SHOWN ON THIS PLAN t Plii ' ; CIVIL LAND CONFORMS TO THE ZONING LAWS OF BARNSTABLE MAS:< '�y/A :T12 MAIN STREET. CH. BY, :_....:. 7 g :� /// N YA N N I S M A S S. - ' SHEET OF Z. ATE REG. LAND SURVEYOR ` I �O FT. M//V- NOTF /F E/TNGR.Ti- NE SEPT/C TAN AC OR 5 �_-,4c.a 1ma P/r A/rE 11ORE TNA v /2"QELow 1R.4OE, 24'O1AAfETER COiVCRFTE COVE.r ''✓ /O M/� _ SJ+1.4 L L.gF B QO u6 N T To 4,TA o 0.6oA N FX TRA CCNGPETE �' g PVC P/PE i �4Zr.4Yy C^ ST /All O/Y GO NER SHA L L BE USED M/N. P/TCN I /F/IV OR/VIE j•VAY, T -•-r �L, /!J Z.O COYERS '' 'PFR FT. leM1N. �� CO.IVCR4F77E CGl }iER CL E,4,V .SA,%,.O 3 A� s i :._ BACXF/LL � r 'VIA. - - _ „2`,,� �- 2 LAYER ov- .: V. P/TL/+l. 0AL s ST ioi�G 1 ii • • ♦ • • • • •�� %s PdK Jrr SEP 41 T/C TANK BOX :•;, fEl EL :. • • • • • DEPr1W • • • . : WASXE•7 STOA'E i O • I • • • .• • I ) • O PREG45 T SEZA;)76E .. 1 /3 /• O /73 i •. . • • • • . • i • I ,•r P/7 OR EQU/V- ` IA(VCAT rLEY 77,0NS P/TCA-jPAc,-ry 4,90 c5�y.1pA-y � ` EJL �0-0 ' . E G� Dl�ll•I. ''-' 'NYERT AT 01/1LDI)V6 q1=.p FT. 3 Z C(SEE 7;--, /LA7 0� /15/L E7 .SEPTIC YANK 6 S FT -� FT O/�4 M. _ OUTLET SEOT/C Ti4/VK 9 3-FT• r 9•S,8 FT. G,QOLJNO I�4TEI< TAQLE /INLET OJSTRIA4T/ON BOX SECT/ON 4F' .1V7ZFr,&/3TRlAWrION BOX 9-s.6 4F7. /NLET L&ACNJJyG oJT. . SEWAGE O/S~A L SY.S7EM IrAXIL.�IT/D/V L EACH/IVCw O/T 3 FT ' DJJyENJ/ON �/► DES/G/V CR/TER1A1 ?c,�LE 0IAfAW51dN Al FT• D/MEWS/ON G FT./Ni'v• N!/AlDER OF EED�ROOMS 3 2A,q&A6,-o/5P05A,4 ufv/T 50/L L.OG ®iZ TEST o / ST � / SOIL TFST**2 T 3 3 ,4 ,a Y SO L TE . O .4 FLOW G L. D T L E3T/JTED � ¢ O T / O Jo/ TES 9 E AT F L .4CAllNr. P I ELEY. �'. LFY. Q E vu/ti� o� t,E /rs v � S/OIF/e.♦+CH/!VG PER.P/T /S/ S�, r;r r -' AESUlTS !�/JTNESSFD dY e a-4 L �'SLS tNCN ,r /O IIAT M l ! � PER L AT N E / JO TTOM L.E�C/•1/NG PER P/T 3 $q. F�• v` CO Lv EJtGOLAr/ON R T f2Zvi_ MIN. /JV OTAL 1EA,.H/1?'47 AREA _f 5�. fT. F ? 54. TESE,IYE�.EACN/N6 ARE�► , P.- 3976 .4 � LOT Z" � t;F .�a.L =`'?e /�►E.t��U . -4'• SA/vim CwTc>[ T :.. ALBERT �•�� ' iP { { G7 sd fr'rZ3 j r6 -0 A rni J .. .0 NO 19 f y J�� o MORSE ELOi;€DGE EIMGIIVE�R Ul. OWEAr , 4�v� o- A Now%Sl w� r ' G 6 72 7iP .M.4JM. ST•. iV.N/3,.MA S. L L00 '<°S.; / (�. IYDGRIJND:YY.4TZ`R ENGO(INTER �? 1>/i✓ 3. .� 4 709 Z-QI/e I ✓oe► awes' _ -.... i c xxk... F a...«'. d �-Y:'�"✓ ,,{ y.. , ' � >y rip. R'; .c. < u >.•r.'` tom,:•" `.^ -..er•n....* ..�q:.-.� ,.�..gr., .ti :'..r.. '"�rt�' rr. - -.1 ....• �..,.r :., (� �..._j:t �.r_ .a.:r..o.,:"r-r -rw,.,.Rt:i.. -n '^v-.r6+* ,.rt ..,",�-'`" Yam^� %;•x..-,wW: .7....-. ..+::e. 1-� -k�.... ': �_.., �':� rrW.. t .,.,-ny+y1.. s ... ..s, •... •'aM1L.:.:: � ��.yyn.K!r•.i.n?+�e:. Mk. ..F-.�. .-di. +r +�:.e+a-%..Li-.w+T. wwwMrliiJF'V•ti•wn-�•ift'"i�.:. f a .Mr. �aiv r. '••� ,..-.•ato ...�..a1;C:br..r„ M . :r:;.-:tr..