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Home My WebLink About0026 LEWIS POND ROAD - Health 26 Lewis Pond Road A= 020-016 Cotuit No. 10339 sm®ad.com a Mad®in USA ICON9 4 {s C3 lo,� 0 Y,4k, lo No..- ..... --- F�$............................. f C) t THE COMMONWEALTH OF-MASSACHUSETTS OARD O HEALTH --- --.OF........ ��=� 1_ Appliratiun -fur Uiupuuttl Works Cnunutrnrtiun Prrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage /isposal System at: $ 11 atiyg:----dress- � y........ .......... .................'� ' caner .......... � -------------------------------- ------------------- .------------------------------------------ '`, Installer Address UType of Building Size Lot----------------------------Sq. feet �-, Dwelling)�No. of Bedrooms--------------- ---------------------Expansion Attic ( ) Garbage Grinder X/() Pq • Other—Type of Building ---------------------------- No. of persons..--_-_--.--_-_----_.-__---_ Showers ( ) — Cafeteria ( ) Otherfixtures ---------- ------------------------------------------- W Design Flow............. . .........................gallons per person per day. Total daily flow-------------- 0------------------gallons. WSeptic Tank•l Liquid capaci tylePIO-gallons Length---------------- Width---------------- Diameter--------- ------ Depth-.-..-_--_.----- x Disposal Trench—No. .................... Width-__---_-_--.--_-_- Total Length-------------------- Total leaching area.-_.-.-__--.-------sq. ft. Seepage Pit No...... ------- Diameter/i........... Depth below inlet.................... Total leachinz area._"✓R .sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �- 7 aPercolation Test Results Performed by-------------------------------------------------------------------------- Date-.------------------------------------ ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water....-------.---.--.-.._- r14 Test!Pit No. 2................minutesper inch Depth of Test Pit-------------------- Depth to ground water.................... O .�-----• i Description, Q d' �°- ° s � G° UNature 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 YI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is e b he b rd health. ed. ,- -- f__ _------f- ---- - ------ /Da �..-� - t Application Approved By---'-f�n...... -• ----•. Application Disapproved for the f lowing reasons:.-.----- --- -------ll_-- '___--- ........�►-_a-�r__- t �J ' Z ..... PIP, Pate � j ' Permit N ssue ........................................................ Date--- ?"_"_-_�- --- --- ------ ----—------ ------- - --- ---- No........... F R la.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH .... . . :.----OF........ ................ AVp iratinn -for,Ui-gpoiiaI orko :Totwtrurtion Vrrutil Application is hereby'made,for a Permit to Construct ( ) or Repair-'( an Individual ,Sewage Disposal System at: �., ,� � � " wj atq dress No --X.L_. L----•-+-i-•--- -C�'-""!-d__ --•---'. -'-•-�-+-•-----------------7- --------------5�:mt. t...-'-•-----•-------------------•-•-------•---- qy Installer Address U Type of Buildin Size Lot------------------------------------------------ er 1/4) Other—Type of Building .----._--_ _-- No. of persons.___________ ___________ Showers Cafeteria Other fist es :. ------- ----- ... W Design Flow............. .....................gallons per pet son per day Total daily flour______ - -.� .................gallons. 1:4 Septic Tank.••Liquid capacitvQ_gallons Length_.__: ..... Width . :........... Diameter---------- -----.Depth---------------- Disposal Trench—No........... ..... ... Width._.................... Total Length--_.._-_--.______--. Total leaching area.... ___.sq. ft. 3 Seepage Pit No..... ,________ Diameter/ _____---_ Depth below inlet------ ---------- otal 1 liit irea._ d'�sq. ft. Z Other Distribution box ( ) Dosing tank �' . Percolation Test'Results Performed:by----------------- ------------------------------------------------------ Date--------------- -----------•------ Test Pit No. 1----------------minutes per inch' Depth of Pest Pit...-.----_--__------ Depth to ground water....-----.--.--.--..-.-- f3:4 Test Pit No. 2................minutes per inch Depth of Test Pit.-_-__-----: --____ Depth to ground water..:_.._--__.---.-_---.-. a -- O Description of Soil—____ ... - _-_._ . U -----------------=--------------- -- ------------------------------------------=-----------------------•---------------------------------------------------........--------••--•... --------------------- W U Nature of Repairs or Alterations—Answer when applicable---------------- -------------------.-------------- -•--••----------------------•-----f ------------------- .--•-- - 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 further agrees not to place the system in >.-� operation until a Certificate'of Compliance has been i e b herb r hea i. Application Approved B - - ['~ ate R Date Application Disapproved for the following,reasons-----------------------------------------------------------=...................................................... --...--••------------•-•--•--...---•-•-••-•--•-------------•--•-•-------------•-------•-------------•---------••--------••-••--•-•----••••---------------...------------•••-•--------•---•----••--•-•-•. s,• Date PermitNo......................................................... Issued................................=....................... Date THE COMMONWEALTH OF MASSACHUSETTS r • BOARD OF- EALTH � . .. - Qrrtifirate of f"nut hatta T TO RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by - 41------ f VM.i 4KW ,,{ - ..�- �..s.-------- i! t at... . _. � ....._ X10 hP�application for Disposal Works Construction Permit No.... -_ The State Sanitary Code as descry�}} in the. een installed P accordance with the provisions of.Ar � I�- dated -..,V7"'A� .!-. .......... , THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE. SYSTEM WILL FUNCTION' SATISFACTORY. f DATE -....... ......................................................... Inspector............................................=....................................... .,,•J' THE COMMONWEALTH OF MASSACHUSETTS •t BOARD O HEALT ,w No.. ---•-•••-• *� FEE........................ %ripolitt lark Gott ' rurtiott Vr-r� it Permission i h reby gra 'nted_____ .._ ;" ' ` to Construct or or Repair ) an Indi al Se age is sal Sy at No.- -C � -----� ... ..--- ' -- Street � � y as shown on the application for Disposal.Works Construction Pe N/_.g..4,ited-__�--�-___---___,_............... - / .... Board of Health DATE--- .. ............... ......................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS. .,,j� a '1w `}F-xR i.Eob%C.H PIT - � CIO c o we 6' f 4 0• �� _ 'L1,4�S sty *;_:,•_ w _ 9y �' r�'t` 4 �' CEQTt�tEtD pLOT ~' tin LOGATIC)" C,oT• V IT' S L iN:40FT 2L"r 5�E t / 71 I CfztZTi Y TadAT TNi= •FovNDAT1ON5WSowtJ -A►J RI i=cZE►-jca Wr--e 6 O" COr APL%-lS WIT" THE 51 D'S_L1 Nk—i— Lol, AWL' SET$ACK WE-4v10EAAE:WTS OF TIA pow Li Ov -r 15 t,--•C- , iaA W C�oa. 7 oM FOczSW-A Tsr JLiWcm. e, 191-3 6�1.�CTEtZ. �. NYE: t�►JC_ REGtScr--zED LAWp hue-vEYatZS i I-115 V LAW IS t.1OT F3e.SETc� OW AN QSTE2�/1Lt,.E o tv(A55�. +' i-lc1MEk—JT Y THE DFFS�T4 St�owt:a •% e/1r USCt� ToDt_TCC?Mt�It= 1✓DT' t_tNi=S. r a _ . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� CONSTRUCTION ASSOC REALTY TRU ST&TARDANICO 8 WELCH&KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not JOHN GRACI use the return key. Name of Inspector GRACI SEPTIC INSPECTIONS, LLC. my Company Name PO BOX 2119 Company Address TEATICKET MA 02536 City/Town State Zip Code 508-641-6694 S1468 Telephone Number License Number B. Certification F 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further E al tion by the Local Approving Authority 12/05/2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 3 t5ins•3/13 Title 5 Official InV. ..j :Subsurface Sewage Disposal System•Page 1 of 17 ry 1 • t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH&KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityrrown 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 PASSES TITLE V INSPECTION 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): NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 4 i ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired.. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y, ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): NA ❑ 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): NA 4 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( )O y g 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•3/13 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< CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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: NA D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M CONSTRUCTION C ON ASSOC REALTY TR UST 8 TARDANICO&WELCH&KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 16,000 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 ❑ 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 regional office of the Department. l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityrrown 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): 402 SQFT t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments CONSTRUCTION ASSOC REALTY TRUST&TARDANICO &WELCH & KENDALL TRUST Property Address 26 LEWIS POND ROAD. Owner Owner's Name information is COTUIT required for every MA 02635 12/05/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 GALLON SEPTIC TANK 2-1000 GALLON LEACH PITS Number of current residents: 0 Does residence have a,garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage ' TOWN g ( Y 9 (gpd)): Detail 2012- 36000 2013-42000 Sump pump? ❑ Yes ® No Last date of occupancy: 09/2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No . Non-sanitary waste discharged to the Title 5 system? ❑ .Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachus etts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): NA General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: galions How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool . ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 08/04/1977 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ❑ cast iron ❑40 PVC 20 PVC ®other(explain): Distance from private water supply well or suction line: GREATER THAN 10+ FEET feet Comments(on condition of joints, venting, evidence of leakage, etc.): NO COMMENT Septic Tank(locate on site plan): Depth below grade: 14"feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 4" t5ins•3113 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 ,. CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH&KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Citylrown State Zip Code Date of Inspection Pe D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 Scum thickness 0 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 How were dimensions determined? MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY RECOMMED PUMPING AND EVERY TWO YEARS Grease Trap(locate on site plan): Depth below grade: NA feet Material of construction: ❑concrete ❑ metal ❑_fiberglass ❑ polyethylene ❑ other(explain): Dimensions: NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NA Date t5ins-3/13 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 CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityfrown State Zip Code 'Date of Inspection D. System Information cont. y (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.): NA Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Capacity: NA gallons Design Flow: NA gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NAAlarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments(condition of alarm and float switches, etc.): NA "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 III f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityrrown 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 NA 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.): NO DISTRIBUTION BOX Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * 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: NA t5ins•3113 Title 5 Official Inspection forth: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 CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH& KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA , 02635 12/05/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-1000 GALLON ❑ 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.): I LEACH PITS APPEAR TO BE FUNCTIONING PROPERLY AND STRUCTURALLY SOUND LEACH PIT 1 WAS FULL AT TIME OF INSPECTION LEACH PIT 2 EMPTY AT TIME OF INSPECTION NEVER MORE THAN HALF FULL BOTTOM OF FIELD 8 FEET Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH&KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. C4rrown 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.): NA Privy(locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH&KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Citylrown 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 'vV i POPck FL 0 i3A CK w AA 22! - A a 115 Q AC 45`® u t GA 2V i A ! as 15 2. o . 0C SO CA 3� chi 224 CC. 3®5 t5ins•3/13 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 5 CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: GREATER THE 10+ FEET feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: REVIEWED PRIOR ASBUILT ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: AUGER Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s CONSTRUCTION ASSOC REALTY TRUST&TARDANICO&WELCH &KENDALL TRUST Property Address 26 LEWIS POND ROAD Owner Owner's Name information is required for every COTUIT MA 02635 12/05/2013 page. Cityfrown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�J LI DATA toor: iot number v v =: -t �o� Tod (3rd•floor): �P o� ,,it number /; ;7 Z li e o�5��r��` ST E1W MU sranae m'g Department(3rd floor) Y ®1�Coqq p�� L� ' mdnoa e number, i wir� tlVl� 79 ,rinitive_Plan Approved by:Planning Board ��®�� 1�� ray APPLICATION,$P�idCFdS 1 800-9:30 A M and 1:00 2:00 P.M.only i TDy�� AL ®DE AND A I I Barns- b1�;�; nsj Tva son9, F-;�� A/RNS ASP E �tLl D t N 6 . C T OR c{STA L ignld APPILICATION FOR PER 1 IMIT TO Iw�l �C TYPE OF CONSTRUCTION (N. "!/ .: I I' ,rr I� `— �f N 1 I I 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information; Location 1-et l S Proposed Use Zoning District / I Fire District Name of Owner G.1 (( C �.. . f eYJ� . r/C Address `.�� ' �t I Name of Builder G Addresses Name of Architect Address Number of Rooms / Foundation Exterior /( Roofings Floors _ 'Y/ "i Interior Heating Plumbing _ Fireplace V�/ '� Approximate Cost Area Diagram of L t and Building with Dimensions Fee -� G / i i . i . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS . I / d I hereby agree to conform to all the Rules and Regulations of the Town of Barnpblgar�in the above constructiFJ Name Construction Supervisor's License L O-C A TJON S WAGE PERMIT NO. �y VILLAGE i INSTALLER'S NAME & ADDRESS 8UfLDER OR OWNER �f DATE PERMIT ISSUED �.. DATE COMPLIANCE ISSUED 7 IN wok LO=C A TON ® S W AGE PERMIT N0. at VILLAGE INSTA LLER'S NAME & ADDRESS B,UI'LDER OR OWNER 1. D;A.TE PERMIT ISSUED DATE COMPLIANCE ISSUED * ��t 70