Loading...
HomeMy WebLinkAbout0025 HULL LANE - Health 25 Hull Lane Cotuit go No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4pliCation for Vsposal 6pstrm Construction 'Permit Application for a Permit to Construct(k<Repair(') Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `L S �f��r �t� Owner's Name,Address,and Tel.No. 6© 0 r - Assessor's Map/Parcel D 19 GLAC Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: r Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow providedit gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4(C)(VI eX ustTN S St'30d7C �L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date 3 -21 Application Disapproved by Date for the following reasons Permit No. — 6 Date Issued J s �'� No. O Fee ' THE COMMONWEALTH DF MASSACHUSETTS Enteredincomputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal *pstrm Constrktion,VPrthtt ' Application for a Permit to Construct(<Repair(' ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.,2 11oll fir/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel C>( Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. i S!L Type of Building: Dwelling No.of Bedrooms ( / Lot Size sq.ft. Garbage Grinder( ) Other'• Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ?' ?. { , ,• ,. - Design Flow(min.required) L f; l ., gpol Designow provided ` gpd - A •. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature.of Repairs or Alterations(Answer when applicable) ` � I n E' •t- (C)M coo(G c,P t t0'0 Date last inspected: Agreement: The undersigned agreesa Y g P to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 112 �- Application Approved by not P. r LL S Date - -7 Application Disapproved by , Date' for the following reasons PermitiNo. 9G - t — 1�Jb. Date Issued 3 ` � � N THE COMMONWEALTH OF MASSACHUSETTS V1C \ BARNSTABLE, MASSACHUSETTS Certificate of CompliariLP THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(� Repaired( ) Upgraded( ) Abandoned( at yj\ tV r9� � has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 U�i"� dated Installer �1 A Designer G�ou #bedrooms Approved design flow gpd The issuance of this permit shall not be constr ied as a guarantee that the system will function as e igned. J J ( t { Date / J } '; Inspector \ �C� ------------------------------------------------------------------------------------------------------------------------ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Ne PUBLIC HEALTHDIVISION-BARNSTABLE,MASSACHUSETTS Diop0 t 6pstem Construction Vermit Permission is hereby granted to Construct( _ Repair( ) Upgrade( ) Abandon( ) System located at 2 S- 00 tr r0 r 4 o i, }^ Fyya. f 4 and as described in the above Application for;Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date - - Approved by r LOCUS INFORMATION g gg <uMntlr oIBER: lu B RWEN � F nitF RESFgpt': 0®BOOR NIM PA(2 124 } PLNI R6t]IpK'E: RAN BOOK Tb,PA¢w LOCUS Q'f LOCUS MAP a �J0 io 11E Brs oP N, sm[ ! :.:svaiu Iwoame[.nra+wiiael 1EM 1! .. OEUEr 1lMi ilE lDi CORNEAS, Lm s¢: n,laat s.r. .w-VsoRs um sclB.sxs ro ila R:crvRE As I>Ettaw.m T>r ` ObiMO lAYA1m LOi RAfw HI,O113f SE. . i.RUP1.WE ME CORRECT.AS SNOAN 011 MRtSfA SE.6RM �-Ibl IONL A ZONE tl x p1E COTALR I urzn i-B-ml. b\ O.ilawr Olsimct. MVO \ 0091111G BURDINO CRE E: 215Bx Sf. (tO.a) \ \ PRCPOSm BINn1O CUp1NE: 27].S SP. 01 m LOT2 � ca are Ba Ro h eaNcane tar B.Y1 BdA1D iO1RID S BTlYn'W 11�33' � � � �� J/ ` \ PLAN OF IAND /^ \ol mom``,"� l�ro• \ 0 25 HULL LANE by LOT3 / ( % COTIAT N I �� " — �\ —__ MASSACHUSETTS — � (eRer+srneLE couNm PROPOSED I a / GARAGE LOCATION JI NOVEMBER 3.M. I / cahlAPclaR ro coormMRiE wrtN r P511,111 51_ n a sAtE INE lnutroN a NL o.� \ oMium:s�cNalsLrov i.Rr 1,11 1kW DMhl 1v i Bun Pott sfr � I� \ 6 h 7j�Ib^B. \ / `b� IIrO i AT b`Mrt 0 \ PROPOSED AF N � � DRYB111 eat Am + ( \ LOT 4 LEGEN C.&♦ GTCN 815R1 \� � 1 , , \ nBM1MP rve 51810 aoRwLWk'wi` �\ \' 1 1 \ E`er KAREN JACOBSEN am� E POtE!ET f 1 1 ✓ )( 1176 WALNUT TERRACE J` ZT tlRlrc P4E/Uafi 1 ` � B RATON UYT UtUIY POIE/llptT!IANIliDMEA HOB L H.h\ \ \ ' JACOBSENI1WMY O.COM UPi —POIf/lAP1Nf1I1BHP �m MJABMM WHL C M\ SPA_ GROUP Otl£MIE.D f1ERMC 111E -BMSDf a0 (OTT Odd \ n� \ \\\ BSC e Ow EtFt1MC NuptltE \ •G1Ei YfIEN m' \ \��\\O W.Y�349 T uth.28,UnkMawDdluuns O S GR B;lfVIC SYSIFL OEPW.'tEO 1 TI IS BM1S©CN AN \ Q NL vIR1EA GTE NEAIM lq Nl9L EAOEMLE K 111E SETIC M1E4 AS \ \ S — WTET NNE 1ossuNIM 1EaBOMILMWI wq AT�A R5�t1Er�R0t�.uL lbw+.': \ � \ � S�,t 506 7788919 11E4 11MS YAtf[1N11GL SENSE \ E T \ II�.IL�SEAT b��V f S �vm 4 o.w r b_ 9y99YYY NOTE: �•(B. SULE: 10' 111TOQY.1 PU11P BY PL111B]t YODEL. PRO BlO�'JBlB. �qyb Yy{ a DLO PM1E_I1rylOByVlI}SMJB ONG Iq b C JO&MJ 9-M1101 �i 1 OP 1 3 j y i ` U1 R51 EiL , OVEN n-THORAL. . j f i > 1 Fir-sr rtcoFL _. _:�� I ..- I. e'PxoAM IVaCFI Ln,I _ it ,.'y� � J Uv:u E, UK4�'ho171•h � _ Is, i I k Rn�ove �o>Z A*�o o uwNo coon FoR E-KMNT /ttoMlc&nDkI - +9 CBc^RS ryonneofFICCl-CX-, NEIL $ ap0.eN ZAcoD5E�-1 I 25 HULL. IMF . - F:R9T E S11.W111 FlAO'w 4L-M•IS i . I Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is required for every Cotuit Ma 02635 5-3-12 page. Cityrrown 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 A. General Information - filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not David J Burnie use the return Name of Inspector key. David J Burnie Mgmt, Inc �I Company Name 307 A Commerce Park North Company Address S Chatham Ma. 02659 City/Town State Zip Code 1-866-980-1440 SI 386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and th8t4he information reported below is true, accurate and complete as of the time of the inspection Th_e inspection was performed based on my training and experience in the proper function and maintenance of on sRe sewage disposal systems. I am a DEP approved'system inspector pursuant to Section Ii340:of Title 5(310 CMR 15.060).The system: ;3 ® Passes ❑ Conditionally Passes ❑ Falls. ❑ Needs Further Evaluation by the Local Approving Authority t 5-3-12 InseWor's-SignaturV 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. LW orm: .JII t5ins•11/10 Titl.,5�aVlnspedion FSubsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name ' information is required for every Cotuit Ma - '02635 5-3-12 ' _ page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/a/ways 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: - 1500 gallon Septic tank;distribution box and 3, 330 leaching chambers. 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•11/10 M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f .. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M < 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is required for every Cotuit Ma• 02635 5-3-12 page. Cityrrown 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): y ❑ 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): 1 ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name t information is required for every Cotuit Ma 02635 5-3-12 page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ - The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water-analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections:. Yes No Ej Z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool T. ❑. ® 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 El. ® than'/2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts R uTitle 5 Official Inspection"'Forni Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is required for every Cotuit Ma 02635- 5-3-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) J Yes No E] ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply,or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure' E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. y 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 . ❑ El _ 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 A regional office of the Department. t5ins•11/10 r Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is Cotuit *` Ma 02635 5-3-12 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes or i'no" as to each of the following: Yes No M :- ,❑ 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? v ® ❑ 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): 330gpd t5ins-11/10 r Tittle 5 official Inspection Form:Subsurface Sewage Disposal System°Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 25 Hull In - Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is Cotuit Ma 02635 5-3-12 required for every - page. City/Town State Zip Code Date of Inspection D. System Information ' . 4 Description: 1500 Septic tank,distribution box and 3 leaching chambers seasonal Number of current residents: Does residence have a 9 arba9 a grinder? ❑ Yes No Is laundry on a separate sewage system? ['if yes separate inspection required] ❑ Yes ® No Laundry system inspected? r ® Yes ❑ No Seasonal use? ®.Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): yes Detail: 2011=214gpd..........2010=217gpd k .. Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of:design flow(seats/persons/sq.ft., etc.): Grease trap present? L ❑ 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma:.02459 Owner Owner's Name - information is required for every Cotuit Ma 02635 5-3-12 page. Cityrrown ,, State Zip Code . Date of Inspection D. System Information (cont.) �- Last date of occupancy/use: Seasonal r. Date Other(describe below): seasonal A , General Information Pumping Records: Source of information: 2011 per owner ; Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: , gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool - ❑ Overflow cesspool - ❑ -Privy - ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and, r 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): t t t5ins•.11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is required for every Cotuit Ma 02635 5-3-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known)and source of information: Plan on file dated 11-18-97 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): ` • 25" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1 feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: 3 ® concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) Some minor decay, normal for age. If tank is,metal, list age:' years -Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 ' Owner Owner's Name information is required for every Cotuit Ma 02635 5-3-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) :A Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness Distance from top of scum to top of outlet tee or baffle • 22" . 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 should be serviced every 2 years. Grease Trap(locate on site plan): ' Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: Scum thickness Distance fro'm 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.•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 25 Hull In ' Property Address _ Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owners Name information is Cotuit Ma 02635 5-3-12 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) { Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day x 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•11/10' - Title 5 Official Ins ection Form:Subsurface Sewa a Dis sal S stem•Pa`a 11 of 17 P 9 Po Y g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is Cotuit Ma - 02635 5-3-12 required for every ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) r Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Normal working level 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.): None. 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: located and viewed using a sewer camera, found dry. t5ins•11110 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 25 Hull In k Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma.•02459 Owner Owner's Name information is required for every Cotuit Ma 02635 5-3-12 page. Cityrrown State. Zip Code Date of Inspection D. System Information (cont) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ teaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system 4 Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): None, dry , 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 7 ❑ Yes - ❑ No t5ins-11110 Tifla 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form NW- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y` 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is required for every Cotuit Ma 02635 5-3-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): None,dry 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Hull In Property Address , Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is required for every Cotuit Ma 02635 5-3-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below y ® drawing attached separately 4 . tSins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Hun j air e- Property Address Owner Owner's Name _ information is J required for every C���tA-4- • h 1 = page_ City/rows State Zip Code Date of Inspection. . D. System Information (coat.) , 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 separatelyilk , Hu\ Lone C C E . i t i11t0 rdta 5 ofrrW hopecom FGM subwrlew Sump obi&IMm•papa 18 of 17 L f w + I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 25 Hull In Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is Cotuit Ma 02635 5-3-12 required for every I page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope , ® Surface water ® Check cellar Z Shallow wells Estimated depth to high ground water: 10' plus 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: 11-18-12, . Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Plan on file 11-18-12 T ' ❑ Checked with local excavators, 'installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file test hole, no water to 10' Bottom of leaching is 515' below grade dry test hole to 10' leaves a 4.5' seperation to bottom of dry test hole. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 25 Hull In M Property Address Jeremy Pozen 61 Montvale Ave Newton Center Ma. 02459 Owner Owner's Name information is required for every Cotuit Ma 02635 5-3-12 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ` ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page,15 or attached in separate file • t5ins-11/10 ,Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title .5 Official Inspection Form p _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ' 25 Hull Lane `'1 J y Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not use the return Name of Inspector key. Capewide Enterprises,LLC , Company Name r� P.O.Box 763 ;Company Address r r Centerville Ma. eJ02632 City/Town State --;1!Zip Code—~ Y (508)428-4028 S14454 dt 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: J ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further aluation by the Local Approving Authority 8/16/2007 Inspector's gnature 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. 25 hull lane•09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments" ,M ,•'v 25 Hull Lane Property Address John Naughton Owner Owner's Name information is Cotuit Ma. 02635 8/16/2007 required for every 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: 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. 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 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25 Hull Lane Property Address John Naughton. Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 every page. City/Town State Zip Code Date of-Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is levelled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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. 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 ' every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 El ® 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 ❑ ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 25 hull lane•08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis, [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 25 hull lane•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 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: l 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 ins ected for signs of sewage back u ? � ❑ Y 9 P 9 9 P ® `❑ 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)] 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 every page. City/Town State Zip,Code Date of Inspection 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 Number of current residents: 2 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? N Yes ❑ No Water meter readings, if available last 2 ears usage d 2005:17,000 9 ( Y 9 (gpd)): 2006:28,000 Sump pump? ❑ Yes ® No , Last date of occupancy: Date Date 007 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: Last date of occupancy/use: Date Other(describe): 25 hull lane•68/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth,& Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 every page. City/Town State Zip Code Date of Inspection D. System' Information (cont.) 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: J 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other.(describe): Approximate age of all components, date installed (if known)and source of information: 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of'Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): - Distance from private water supply well or suction line. 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of I'eakage.System vented throught the house vents. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ®concrete El 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: 1 0'6"x5'1 0"x5'7" Sludge depth: 3„ Distance from top of sludge to bottom of outlet tee or baffle 28" 2 Scum thickness / Distance from top of scum to top of outlet tee or baffle 8„ Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 J Commonwealth of Massachusetts Title 5 Official-Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 °M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 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.): Pump tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness J 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: 1 Material of construction: ❑concrete El metal ❑fiberglass ❑ polyethylene ❑ other(explain): 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 ' every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 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 25 hull lane-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal'System•Page 11 of 15 \ Commonwealth of Massachusetts W Title 5 Official -Inspection Forma Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . ^M 25 Hull Lane Property Address John Naughton. Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc,), i Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ' ® leaching chambers number: 3-330 rechargers El 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.): 0 Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil. 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 i ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is re uired for Cotuit - Ma. 02635 8/16/2007 9 every page. City/Town State Zip Code Date of Inspection D. System-information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert 1 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.): { Privy(locate on site plan): Materials of construction: Dimensions r Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635 8/16/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. Prot 01� t1 l r I AM Bolof 25 hull lane>08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System>Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments, ,M 25 Hull Lane Property Address John Naughton Owner Owner's Name information is required for Cotuit Ma. 02635' 8/16/2007 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 ground water: Bottom of leaching 14' feet I 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: 1997 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:Gaherty& Miller model 12/16/94 ground water elevations. Used: USGS Observation well data June 1992. Used:Technical Bulletin 92-000-01 Plate#2 Annual ranges of ground water elevations. 25 hull lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Y Town of Barnstable OF I 1p� Regulatory Services BARNSrABM Thomas F. Geiler, Director MARS A,F039. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not i automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. G , TOWN OF BARNSTABLE D 11 1/-3 LOCATION /Ua LG;,Lp SEWAGE # 9 /s 6` o VILLAGE C O( l Ul ASSESSOR'S MAP & 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACM=-. (type) 0,el CA Gea•cti d4d,,2r (size) NO.OF BEDROOMS UII,DE R OWNER PERMITDATE: COMPLIANCE DATE: Separation.Distance Between the: s Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility), f Feet Furnished byAr , ®AID `� t pf g3 � ,cT �Y 1 No. � z�?7 Fee Entered in computer: H F MASSACHUSETTS THE COMMONWEALTH OYes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Migogar *p5tem Con.5truction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Ler 3 uLL �XNM. Owner's Name,Address and Tel.No. 644 IJALVQ 7VQ Assessor's Map/Parcel �oT�IT e_1p Stl—VIA } ei iLVtA 1� ,A44r 1� IZ GtZ �l fo t°t j1E141 4 6 P" Gt=rJTEe VI CJ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1 L A C A Go,�S�-. pA,xj� �. IJq r trJc. t' t✓•�O b�.� BIZ MA �1� S"T r 1 wo(f, nqy"IW,,& A4 A, � gt31 Type of Building: Dwelling No.of Bedrooms Lot Size 20,0&2sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3"3D gallons per day. Calculated daily flow 33 U gallons. Plan Date f,6� 3 latch Nu'j Aber of sheets I Revision Date I�ot/ 16 1gq-1 Title 'S tt-r F.A,4 aF lor'3 7.5 Xyae 4— L4 l V Coyv r1^ �A UG t+MJ Size of Septic Tank 1SOU 64z— Type of S.A.S. LEI—IE JIJG e gAmA IB E�Z4 Description of Soil XA GD I u vv-, S A 02 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this BoaW of Health. a Signed Date Application Approved by �` Date '° Application Disapproved for the following reasons Permit No. ^�Cp �., Date Issued No. f 'sue r. t � / _ Feed THE COMMONWEALTH„OF,-MASSACHUSETTS Entered in computer: �.•/''� Yes PUBLIC HEALTH DIVISION°-TOWN OF BARNSTABLE, MASSACHUSETTS Rpprication for Mi!5po4ar{*pgfim Cougtructiou Vermit , Application for a Permit to Construct( -)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Au Lt- LA N*a Owner's Name,Address and Tel.No. - GoTV IT o11N 0auGt1T111l Assessor's Map/Parcel G�0 SIL.V,IA SIt,y1A �. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. max . I�c.MVIL-A A GojSr � B) ro-'Bo.y ba$ a zn *�� 13�oab 33 � Ils Type of Building: 3 Dwelling No.of Bedrooms A Lot Size 20,062-sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3'�Q gallons per day. Calculated daily flow 33 v gallons. Plan Date Ian✓ 3 1 cl q'1 Nu ber of sheets Revision Date 1I of 11"✓i 19 cl"7 Title SIT' 1�N DF ttJt"3 �5 Xy,we La. Ill Goryit ro,/_ Jnif,J 1jAQ6I+TVQ Size of SepticTank i500 64L_ Type of S.A.S. L'EA,.-d iA16 G•uAwt 156Zf Description oUSoil XA 601 y%-^ IS A Wz> J Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued.by this Bo d of Health. Signed Date. Application Approved by Date A Application Disapproved-for the following reasons F .m� Permit No. �' �: Date Issued --------------- ,--------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance ,f THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ✓ )Repaired ( )Upgraded( ) Abandoned( )by at �gr 3 T-, VW. LA.- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated�/ Installer Designer Or The issuance of this permit shall not be construed as a guarantee that the syste function as designed. Date Inspector -------------------------------------�J—q--�. or No. ' / FeeE/f�F —`� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5po5al *pztem (Cou!5tructiou Permit Permission is hereby granted to Construct( ✓)Repair( )Upgrade( )Aba.don System located at 4 qVt,_ L,4-' and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio mus a co pleted within three years of the date-of t Date: - rZ Approved by � r I � h oAI� � 3 -316 c -a w t, TOWN OF BARNSTABLE 0 l `l.��jlr�J LOCATION ") 1�— SEWAGE # VILLAGE- C`Ci(/V U/ ASSESSOR'S MAP & 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /-rC-,-Ca �1�f LEACHING FACILITY: ' (type) e CL,cyc�C' -C NacL, cZ �.r (size) 18,'C 2-50� ,1(,2 ` NO. OF BEDROOMS U DE R OWNER PERMITDATE:_ I/ - �--COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or.within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet LOC 10 5ENNW:�E PERMIT O. �_ 0/ 1 � �3 VILLAGE -- = - - - - - i1uS T L R ADDRESS -� � - - - - - 5U1 DE 5 1 i M--E ADDRESS i DATE PERWT 155UED = ���•5=� - - DATE COKAPLI W-ICE ISSUED : x ��e �A J�s��� �� No.. 'f '` F>ta... . ... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD t-9EA T ®oo t I ��..._.". ...... OF.......... ........................ Applira#iun -for Bi,i giitt1 Barks (�owitrurtion rrtti$ Application is hereby made for a Permit to Construct (y) or Repair ( ) an Individual Sewage Disposal System at okk 4kN----- . r o`er Lo n-Addres or Lot o �? k ._. A P$o.O.... eO�K......--•----------•....................... ------ ------------------- -------------- -------- ---------------------------------------- ---------- Installer t� / M iag Address Q Type of Building / 1 N Size Lot----------------------------Sq. feet Building Garbage dligooBms � EUpansion Attic �O Other—Typeot Bilding ..___.__._ ____.____ No. of persons • Showers Cafe:eria a' Other fixtUes ------------------------------ W Design Flow------------ ----&----------------gallons per person per day. Total daily flow---------.2%. ---------------.-gallons. WSeptic Tarik—Liquid capacitv)Q®(_gallons Length---------------- Width_.............. Diameter---------------- Depth.--__-------_ x Disposal Trench—No. .................... Width--__•-_--.-__--_-_ Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No.../00A__�81Diameter-------------------- Depth below inlet-------------------- Total leaching area.-----------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------- -----------------------•---...-••----•------------••••---•-..._._ Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..---__-----------.----- (� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--.------_-.-_--------_ ---------------v----,---)- - - - - -------------- Description of Soil D.:'--z.._._Lt! �`a '? ' ... L6 `-- ---- - ---------------- •• --------------- ----------------- x J x � W -------------------------------- -----` -- -------1 g- - U Nature of Repairs or Alterations—Answer when applicable.-.--------------------------------------------------------------------------------------------- -----------------•-----••---------•--------------•-•-------•---------------------------- ----•---------•------------------------••------------------------------- ------------------------------------ Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned furthe lgrees not to place the system in operation until a Certificate of Compliance has been issued the oar of ealth o � y- ied-- - - - ----- ---------- ----------------••••-•-----•- Date L Application Approved By.... ---- -- ��� ---- •--•---•--•-•--- --l�aS> ate Application Disapproved for the following reasons-------------- ---------------------------------------------------------------------------------------- .......•---•••---•-••••••••••-••••-•••••-•••••----••••---•--------------••--•••--•-•••-•••---••--••----•••--•-••••-••---•-----------•-••-•-•--••••-•----••----------------••-••-•---•-------•--•--•-- Date Permit No.......................................................... Issued...... < ....7-r--•------• Date No.....--................. - Fincl .................. t THE COMMONWEALTH,OF MASSACHUSETTS BOARD :. F HE4. i j Vi • Applirtttiun -fur ihtipuiittl ' ifrkii Tomitrudion Vamit Application is hereby made for a Permit to Construct (JV) or Repair ( ) an Individual Sewage Disposal I System at: + k4------ -AAtk------------------------------------- �" -------------------------------•--- ------ - ---------------- Location-Addres ' - ----------•---•-----••-----_.. W caner r ver y✓�a Y�EiC.►+ss �� Installer j40sTod ILk� Address d Type of Building 1�` Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms_-._=__,_7------------------------------Expansion Attic 40) Garbage Grinder ( ) aOther=Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a4 Other fi_ e�, --------------------•--•-------------------------------------------------- - Desi n Flo ........................................... allons er erson er da Total dail flow............................................" W g g� P P P Y• Ygallons. WSeptic Tank—Liquid capacitvipQO__gallons Length----------------'Width------.:_ ...... Diameter................ Depth..-___._--_.._. x Disposal Trench—No.--------------------- Width-------------------- Total Length..................... Total leaching area--------------------sq. ft. Seep,ge Pit No---l0p4L_�,�Diameter.................... Depth below inlet.................... Total leaching area-..-__.-____-_____sq. It. Z Othel Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........ ---------=------------------------------------------=-- ------ Date--------------------------------------- a ;Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.....-______..--._-__-_- (� Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water,..-____._____________-- 1 ....... ---- - .----- -- D ......--------- r Descript' niof S � ., "" t -- l W ----.__�:'..................•--•--- Y - - -----•------------------- ---------------------•---------------•••---•-•-•--•• ------------------ E y VNature of Repairs or Alterations—Answer when applicable-----_________________`ti.................... - Agreement: f The unflersigned agrees to .install the aforedescribed Individual Sewage Dis-Q al System in accordance with the provisions of Article NI of the,State Sanitary Code— T nd igl��f d f ther ees not to place the system in operatioUuntil a Certificate of. Compliance'has40 �'1'i'"`""��s " ar(�'�/ * 4 ,. --------_ ........--................ Application Approved BY - ------- -- Date '":•; Application Disapproved for the following reasons:.::.................................... ` ...........................Yr" Datf ;. . Permit No......................................................... Issued--=............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA TH ~...............O F..... ... : ................. ................................ (9rdifirtttr of Tomplittnrr , T ,S T C 1 hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) 0 by-- •-- ...... --------' ............ ller./---------------------------------------------------------------- has been installed in accordance with the provisions of Articleo�The State Sanitary ode s described-in the application for-Disposal Works Construction Permit No.......................................... dated._''_ 5........�Y,. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. x • DATE--------- ..............•••...------•---•-----••.......•••---..._..._-•-... Inspector----------------------------- = = r. THE COMMONWEALTH OF MASSACHUSETTS BOARD "HEAL.#T � IeZ ..............OF `� No......................... FEE._!...... .......... �i��u�ttl r ,� un� r ' �rrmit �• >r Permissio Y),rR hereby granted-�- - = to Con t r Iv al l System t --------- •-----.. --.• . f--------------------- -- > . w:. Stree - as shown on the application for Disposal Works Constructio er Dated_. j � y s -- ----- ------ -- .............................................. ax Board ealth DATE-----------------------------------------------............................ FORM 1255 HOBBS & WARREN. INd. PUBLISHERS 1 1 ; «' �� ��._�` � T^`• �.�-.•ice--•— r�_W-_ � — `� 4 i '. r �r e -r' , r } ;(o�PaA 1 I i i- ...-t ,� -.ate—._.,�__'_.__�-+"—C--.--_•. '. ,, ._. � • �,-_...'_..._,.�._..—.�—r—:+Y-_.—.-._ _ - S ?,.. I 1 SL►�r�, mol I i, 4 ( r l i• - r v* ' PIP STAIRC_Ms'ELL„// �'( 'uI r r 2 NEW FrN2MEF� Rood' ` f \ i ICI I I Rill' Ex 1ST. K 1TCN CA I _ �ticrED Po.cr NFw suu Rc M ' 1 nil � I 22' !! B Rrrl LI B L^ Krc1r[M � BAM , it L R I 50N Rosh 1 j j � D ✓mI 22 - 64' - —=I Z' N&N1 SVn+J.gdv1 EkIsrIn1a 15r FLoo& 4—wr_ x Py,NJ E�cISc. 2nl0 RLuDiC 4141 M It Srb'C .I a/rTTq $1 m+,I A . bDRM Yan Cn al NEIL t K✓rReu 7kcobso-4 j QYLIJ CEILING G Lo 5-e I I I i su�i: Yo I hor w►►woveo sr: owwwr.er i f DAW: I 25 rL r�cw 1 2S 1.11ALL LANE - CoT 00 VNA. owAW066 mum+ FLoo R. �LIRN� A_3 QF 3 ]lE/% f�tlN RvoM F7R5FRa* jm,-- 'PL4 ) h5 NJrnae?-LD ,'A15TIN6 DECV- FRAME wr**t M0P)F1O-tn ^/.S I FOOT ' r-- 2/2x 10 FT 6RhJ'E BE'n MS w/ 4x(n 1��� _ Ex15P71J 4. ON l0' x '4' $ONp T'v9ES SW6C.0 2- I'O L V60?- L �fT i T. (�oOREo conlcriEtE) 2x>3 p• u.. A.CfESC� O NGJ aEPI-m 3/2XlO New Io" 50ne N8E Ny Q /lEtJ 12" 56-0 tudE cN 24" 'B Ib FVO�` hNCnu C• AL Dow"_ 1 a 72 � �•� II � NL`rl� IL`` SVNa 'Yv3E orJ Zy" i DIN IN G d - ® wc-�j Io° Soso woe '---......._... ...._... till all! A 1 IZu .56NJ 7U3E N Ek1 li So uJ tvbc du Zy„ l � I I t I i I I 1 R�6M"r 9.DE E�Y+►Tlo1.l - tcx�9T. � NEIL J/4Co6stlxJ SCALE. Yq"- I F6.T A'►RoveD A: DRAWN BY jl zs H U LL- L-.r"e y Ca7vir, ^A A. i DRAWING NYMD[R ,' Exl�r• cau�ITivNs � . �i :r SCH00 STREET \ GRAND COTUIT ISLAND B3IGN 1c) QVAM COMPACTED Flu. DESIGN DATA GRAPHIC SCALE BAY OST. CULTIC IJACMG CMumm D 3' MAXIA�iUfd � �� 33OR PEASTONE SINGLE FAMILY— 3 BEDROOMS p 20 40 •••••••••O•T ••••••••••• LOCUS •.v•vo.v. v•.vv..••• NO GARBAGE GRINDER ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED v•v o v v v•v ••v••••• 3 j4•'TO 1 1 J2 " WITH CAPPED ENDS vv.vvvv• vvvvvv•v DAILY FLOW = 110 X 3 = 330 G.P.D. BLUFF PT. O N s .•...•.. ••..... USE 1 — 4" DISTRIBUTION LINE IN 3 RECHARGER UNITS •vvv•v• •vvv•vv _ •v...vv v*•*•v SEPTIC TANK = 330 X 200% = 660 G.P.D. •••••• v••vv• WASHED STONE � COTUIT BAY IN A 12'X 25' WASHED STONE FIELD AS SHOWN 52" USE 1500 GAL. SEPTIC TANK z LEACHING AREA REQUIRED w 330 G.P.D.f.74 = 446 S.F. END SECTION COTUIT O SAMPSONS 2(25 + 12) X 2 = 148 S.F. SIDEWALL AREA NO SCALE ✓ HIGHLAN S NANTUCKET (12 X 25) = 300 S.F. BOTTOM AREA SOUND 448 S.F. TOTAL PROVIDED PERCOLATION RATE < 5 MIN./INCH SOIL CLASS I S69 46'0 „ LOCUS MAP 9 C8 FND e SCALE I : 25,000 ASSESSORS CB FND MAP 19 PARCEL 3 zor t� OFF - ZONES �~o A.P. o RESIDENCE F ctr �' s MINIMUMS NOTE : � catch basins' AREA- . �„ ; �'�.z = 43,560 S.F. ABANDON,PUM ', & FILL "�' '" CB FND N FRONTAGE = 150 EXISTING SEPTIC\SYSTEM. 569. FRONT SETBACK = 30' N87°57281E x \`yS�e Of 09,E 46, ' � SIDE SETBACKS = 15' 114,52' x c •� .�er�ent 4800, REAR SETBACK = 15' 77 pine D4 \„ BUILDING HEIGHT — 30' x D. BOX-- ° treed ak K . .^•\k CB FND x° x sto v`. 569,4t� 09� ' lv •• ... ,1 existing d1-ike M o 20,062 S.F. v septic sprue X .7 ry � wQ _ _ \ rn 34 rn 0,46 Ac _._ __... X rrw--BENCHMARK ELEV. — 34.9 m 2' x 3pg�, �yo�� �s / CO3ND Z « �' L1 ni re ' PROPOSD i 201.4g 12,pa. ADDITION o& DECK _N '$ � NCI•�6 t x N\ 1t EXISTING DWELLING 3 F.F. EL.= 36.82' a x 35.1 GARAGE F.F. EL. = 26.85 M °° ( LOT 4 0 i NOTE: ALL SEPTIC COMPONENTS SUBJECT TO VEHICLE LOADS 00 SHALL BE H20. "696 SITE PLAN OF LOT 3 COVERS LOCATED TO WITHIN 49„W F.F. ELEV. _ 12" OF F.G. 36.82 AT 25 HULL LANE T F.G.- 35 IN ELEV.-35.8 ' FFWNDATI 1 a (C O TUB I T) INV. 33.0 INV _ 1500 GAIT ¢,. DIA"M ER T LEACHING CHAMBE2S i m i 32.8 s LANK INV. - DIST. SCHEDULE 40 P.v C. #- I BARNSTABLE MASS . 32.6 INV. =32.2 BOx .... . •• INV. 32.0 INV = 3,.8 0 o o a o 0 o o o; o 0 0 FAR . ... a o 0 o C 10.00 � ' .. ....... ..-•:s-a� MIN. o 0 0 0 0 0 o a 0 0 0 M�BOTTOM ELEV. EL — 29.8 ! 5�.�.i J HN NAUGHTON eta - SCALE: 1 "= 20' DATE: NOV.3,1997 EPHEN J ALLYN 1 Q: �, n `' REV.: N O V.18,19 9 7 .� . WILS0�1E10.1{TEA hip Wf 1 n. �W16 '40 24M BAXTER & NYE INC, PROFILE REGISTERED LAND SURVEYORS NO SCALE Lai CIVIL ENGINEERS ❑STERVILLE, MASS. DEED REFERENCE.: BOOK 8444 PAGE 105. #97116