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0218 LITTLE RIVER ROAD - Health
218 LITTLE: R' RD., COTUIT -�.1 0 - o pis I, :x i a No. Fee* � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Misposal 6pstrm CoT s"ttion permit Application for a Permit to Construct( ) Repair(k� Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No..�_l;?Lj#le j&eA#Q_W Owner's Name,Address,and T� rc Tel. POI� Wg L+° ,Ai u��. Assessor's Map/Parcels' , + A Gxo:� Installer's Name Address,and Tel.No. GO S- Designer's Name,Address,and Tel.No. - '56'? y ,@ter-folu�tc: C�onsf-�Nor,,�,•K. �/s� u���^y/� ,r�ou�n ��t°�:"�'rJ,.1ac y�:�t�i� s r t va�� 5. Type of Building: � oo``'' Dwelling No.of Bedrooms 3y-x;s iYt� Lot Size l�113� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) V Y0 gpd Design flow provided gpd Plan Date j wex n (� Number of sheets / Revision Date Title l i 4]p All !4 Con �a f f�' AJOPAeA koaj eoAlu /1 Size of Septic Tank l°�f/ ' ° Type of S.A.S. 3 - f�a[)Sc11�I /�q Ja fiX5L Description of Soil ` 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 C a not to place the system in operation until a Certificate of Compliance has been issued by this_BoWd of Health. Signed 1� Date Application Approved by - - Date Application Disapprove y Date for the following reasons Permit No.� �Z Date Issued w No� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1 2pplication for r3isposal,6pstem Construction permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ElComplete System P�Individual Components Location Address or Lot No..;./ /p Owne s Name,Address,and Tel.No. ?r9V aW- -'73r1 Assessor's Ma /Parcel �/ Installer's Name Address,and Tel.No. w$ y0f4?026 Designer's Name,Address,and Tel.No. ,16a 69r,Q0tt-c; d�Y7Sfy�l'aruo>�ryl - Type of Building: ! {v / ' Dwelling No.of Bedrooms.3V-X1 Sk r,9 tt rGN� Lot Size (PO y39 t- sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures !/ Design Flow(min.required) Y YO gpd Design flow provided y�7 gpd Plan Date -e on 6,, 4„ p/(-, Number of sheets . Revision Date Title I i-de t S i k Rn i, � 41 S l 60,O) e'4,-A i Size of Septic Tank �J Type of S.A.S. 3 - k2l) n AopA iyl q Description of Soil 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 a d not to place the system in operation until a Certifl e of Compliance has been issued by this rd of Health. Sign Date Application Approved by - - Date Application Disapprove, y Date for the following reasons Permit No.7c>f o "L4( I- Date Issued / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired X), Upgraded Abandoned( )by at 'e A;bLeA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer �1rI C '`�pS�✓UG17C�,n Designer _ ,, ,, �` _ o n i is J #bedrooms Approved design flow y gpd The issuance of this permit shall not a construed as a guarantee that the syste ill fun 'o d signed. Date ,� q T/ Inspector a -----------------------------—----------------------------------------------------------------------------------------------------- No. OD/b '`� LI Z Fee-6/ 0�, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Constructio ermit Permission is hereby granted to Co struct( 1 Repair( ) Upgrade Abandon( ) System located at �( G�i 7I- 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:Construc ion must be completed within three years of the date of this permit. Date 'Q Approved by TOWN OF BARNSTABLE LOCATION L, a'LtE ULytZh.,. SEWAGE# VILLAGE o ul ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. G ( • �'1��- '?7/-�t `�`� SEPTIC TANK CAPACITY C,t i (1 ►NV6 a pep y�Q LEACHING FACILITY:(type) (size) iA-Ar x— � NO.OF BEDROOMS 3 SCE 1-c-M ) 3 t;u_-" L"V /,�•BZG OWNER Z PERMIT DATE: COMPLIANCE DATE: J (� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY c/D W4l 61r _ l � Lf a- I,y rc,,\zrt . C6 r-R nj CO F• CO Postage $ nj des Certified Fee tr p r- Q Postmark p Return Receipt Fee Hire"I, p (Endorsement Required) p Restricted Delivery Fee = Q� p (Endorsement Required) ��• r-3 60A p Total Postage&Fees ru Sant To Dou /as Pol/ard Pa- L - o;PO Box No. -- �------------------------------ p SWIW;Apt No.; ------ �/B Liffle,Piv off= ------------- City,State,ZIP+4 �%1� D�36— 1 Certified Mail Provides: o A mailing receipt a A unique identifier for your mailpiece Y e A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. n Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return'Receipt Requested".To receive a fee waiver for a dueled to return receipt,a USPS®postmark on your Certified Mail receipt is n For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on they Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 3 SECTIONSENDER: COMPLETE T14IS .MPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si na e C F item 4 if Restricted Delivery is desired. r nt ■ print your'name and address on the reverse X see so that we can return the card to you. B. Received by(P anted N C. D e f. i ry ■ Attach this card to the back.of the mailpiece, �� / or on the front if space permits. D. Is delivery ad ss di eent from ite 1 Y s 1. Article Addressed to: If YES,enter live Kaddressbelow: No I Doc has Pol%1 Pa L . o� 6ss I Oo?1�3� 3. Service Type J PCertified Mail- O Priority Mail Express- ❑Registered Wetum Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery ,j 4. Restricted Delivery?(Extra Fee) 0 Yes I ,7012 1;010, `0000 '2847°'8216 ,PS Form,3.$11,July2013 Domestic Return Receipt I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No-G-10 _ I • Sender: Please print your name, address, and ZIP+4®in this box• boo f�'Ia�n sfi �::3-�iiiE;:•1ii;;ifiliii.ii�li3Ei:EIS=:E�=:fiiei �tiE::tiei:i LF°t TWKQE Town of Barnstable Barnstable Regulatory Services Department e'caC j . BAANSfABIE, ' ;� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8216 November 8, 2016 Douglas C Pollard &Patty L 218 Little River Road Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 218 Little River Road, Cotuit, MA was inspected on 10/25/2016 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h) and distribution box is rotted. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:ISEPTIC\Letters Septic Inspection Failures or Future Evl\218 Little River Rd Cotuit.doc DEC-21-2016 03:20 From: To:15087906304 Pa9e:1/1 - I Town of Barnstable � Replatory,Services Thomas F.Geiler,Director Public$ealth Division 166�'„' Thom"McKean,Director 200 A faw Strea,NpaI,,%MA 02601 Fax: SD8-790.6304 omee: 508-W-4644 Inatalles&Des' per Ce u--Gabon Foram faUJID � sewage permit# a'014 —fQ Assessor's Map\Parcel Date: � � � ! �� Iltstalltcr: �� Desi per: Addmgs: f'6• Qa K 0 •� -f�M �� if (in ' s issued a permit to install s LI 1mmd on a design dmwn by septic syAecn at (addsess) f��� /�!-!' dated �- Cs /Lp !� a ..t e. 0 , � - - ( eslgner) '- i certify that the septic systeM.Xvferenced above was installed substantiaft according to the design, which may include minorapproved chmges such As lateral relpcatibn.of the distribution box andlor septic tank. instg]led with J. certify tb the septic syystem referenced above wvertical xeloc;atlon of or any eompane yat11 greater than.l 0' lateral zelocatinn of the SAS or auy of.*B septic syste n accordanc:e with State.&Local.Regulations- Plan revision'Or certified as- by d ner to fallow. "OFM,�� o} yD'ANIELA. OJALA stall$r'slgxi£LttltB) S CNfL '" 'pNo.46502 r Izo t Z/ f 4 �sslONAL . (lesigner's Signature) (Aix Designer's StnrrmP Hers) YLIt-. SE TUAK—ML—B—aMTABI& P>(1WC REA, H DTVMI CF CA I o C LIANC NOT RE '1FD.4UED ll, M TIM FO A14D n-w- - C A,RF C RX Tl3E BARIYS`i' BLE-PUBLIC HRAY,'II H RIV.19ION- ''�:IAI .OU. - �1►+e ram, Town of Barnstable • RARIMA U � ' ,�� Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601, Office: 508-8624644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO -Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS` (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline " 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ' ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code §360-9.1) Leaching facility with standing liquid level at or above the invert pipe(per Town Code §360-20 h) OTHER CAO fo4 j U -V Ox- Repair deadline: 1 Ve CW i Q:\SEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc i Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments K 218 Little River rd Property Address. Patty Polard p Owner Owner's Na information is required for every Cotuit Ma 02635 10/25/16 page. City/Town State Zip Code Date of Inspection930 ti.T1 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 Michael DiBuono use the return - --- ------ - ---... _ - - key. Name of Inspector DiBuono Sewer and Drain fr o - Company Name _ - 8 Johns path Company Address S Yarmouth Ma 02664 City/Town State Zip Code 508-364-9587 S103522 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: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority —� 10/27/16 _ In ector's g -Si nature 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. .. t5ins•3/13 - Title 5 Official Inspection r`orm Subsurface Sewage System•Page 1-of 17 I/ b 1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary- - y Assessments 0 /,.• 218 Little River rd -- - Property Address Patty Polard Owner Owner's Name information is required for every Cotuit___ — Ma 02635 10/25/16 page. f 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: ❑ 1 have not found any information which indicates that any fof the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a Vie 218 Little River rd Property Address Patty Polard Owner Owner's Name information is required for every Cotuit Ma 02635 _.. 10/25/16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System:Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND'(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 151ns•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal Syslem•Page 3 of 17 Commonwealth of Massachusetts = iL Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,a 218 Little R fiver rd Property Address Owner - Patty Polard - - -- ---___..------ information is Owner's Name required for every Cotuit — Ma 02635 10/25/16 page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The.system has a septic tank and soil absorption'system (SAS) and the SAS is within 100 feet of a surface water supply or 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 ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 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 ''Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Little River rd t Property Address -- - - Owner Patty Polard -- -------- ------._.._ Owner's Name -- information is required for every Cotuit Ma 02635 10/25/16 _ page. City/Town State Zip Code Date of Insp— ection B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or ® obstructed pipe(s). Nu,mber of times pumped: ❑ M,. 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 he 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 s. ;rely ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Pro; :;:tion Area— IWPA) or a mapped Zone 11 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 appropi i:l'r: regional office of the Department. t5ins•3/13 Title 5 Official inspr:ctton f orn, Suixu face Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts �L Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 218 Little River rd Property Address Pam Polard Owner Owner's Name information is required for every Cotuit Ma 02635 _ 10/25/16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as.to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑ Were any of the system components pumped out in the previous two weeks? ❑ ❑ Has the system received normal flows in the previous two week period? ❑ ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? El ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ❑ Existing information. For example, a plan at the Board of Health, ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): 330 t5ins•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 ° .., 218 Little River rd Property Address Patty Polard Owner Owner's Name information is Cotuit Ma 02635 10/25/16 required for every __ -- ----- -- — -- page. City/Town State Zip Code Date of Inspection D. System Information Description: System contains a 1500 GI septic tank as well as a concrete distribution box and a leach field pipe in stone. Leaching was viewed via sewer camera, Camera was under water inside perferated pipe. distribution box is rotted and decaying_ Number of current residents: 2 Does residence have a garbage grinder? Yes [ j No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) _l Yes fJo Laundry system inspected? Yc:s No Seasonal use? [_J Yes [: l No Water meter readings, if available last 2 ears usage d 21£3 G ,d 9 ( Y 9 (gp )) Detail: Sump pump? ❑ Yes [_ No Last date of occupancy: -- - Date Commercial/Industrial Flow Conditions: Type of Establishment: ------- --- --- Design flow (based on 310 CMR 15.203): - ---— - Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): - ---- - - Grease trap present? �_] 1'.;s (.._.[ No Industrial waste holding tank present? ❑ Y No Non-sanitary waste discharged to the Title 5 system? [] w , No Water meter readings, if available: ------ - -- t5ins•3/13 Title 5 Official Ins),xciion Form, Subsurface Sewage Disposal Sys!: 7 of 17 Commonwealth of Massachusetts �100 ifle 5 Official Inspection Form f'I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Little River rd Property Address Pat_Polard Owner U — ---- wner's Name In ormat;on is required for every Cotuit _ _ _ Ma 02635 10/25/16 page. City/Town State Zip Code Date of Inspection D. System information (cont.) Last date of occupancy/use: Date Other (describe below): General Information Pumping Records: Source of information: 5/2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? — Reason for pumping: — Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe):_ t5ins•3. - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f : Commonwealth of Massachusetts —W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments } � 218 Little River rd Property Address — —- Patty Polard Owner Owner's Name --- information is required for every Cotuit" — Ma 02635 10/25/16 Cit ----- ------_ page. Y/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Ye-s Building Sewer(.locate on site plan): Depth below grade: f eet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): -- — — - ---- Distance from,private water supply well or suction line: -- — - -- --_ feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at roof Septic Tank (locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ otter:.,: ((—.xi,lain) 1500 If tank is metal, list age: -----. __. a years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yc : )o Dimensions: Sludge depth: --_ t5ins•3113 Title 5 Officlai inspnction Form:Subsurface Sewage DispoSnl S•,: of 17 Com a:anwealth of Massachusetts l _i t l e 5 official Inspection Form t `- Subsurrace Sewage Disposal System Form - Not for Voluntary Assessments 218 Little River rd Property/address Natty I_'olard Owner Owner's Name nforma::. n Is Cotuit Ma 02635 10/25/16 required ,i "cry _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of leaking,Tees and or baffles in place at time of inspection. ---- - - — ...-------- j Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins• Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments 218 Little River rd Property Address Patty Polard Owner Owner's Name ---- information is required for every Cotuit - Ma 02635 10/25/16 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 in;ec;rity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal. 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 of eth lene ( ) 9 ❑ p Y y ❑ other ex;�� ain Dimensions: Capacity: --- _ -- gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: - — Alarm in workin order: _1, .;g ❑ Yes (- o Date of last pumping: -------- _. _ —_. Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes 1-7. :0 t5ins•3/13 1 ille 5 Officiai Inspection l orm:Subsurface Sewage Disposal Sy •i,a_:1 ',of 17 -omn;c wealth of Massachusetts �itie 5 Official Inspection Form m ' j; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Little River rd - Property Address fatty Polard Owner Owner's Name -- informatioi Is required to; �ve;v Cotuit - --- Ma 02635 10/25/16 page. City/Town State Zip Code Date of Inspection D. System information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Rotted and decaying 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.): Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why- t5ins - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Little River rd Property Address --- Patty Polard Owner Owner's Name - -- - information is required for every Cotuit _ Ma 02635 10/25/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) -- Type: ❑ leaching pits number: - -- ❑ leaching chambers number: — ❑ leaching galleries number. — ❑ leaching trenches number, length: — ® leaching fields number, dimensions: 30'x- • ❑ overflow cesspool number: -- -- ❑ innovative/alternative system Type/name of technology: -- - -------- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, cc r of vegetation, etc.): Field is saturated Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert -- Depth of solids layer Depth of scum layer Dimensions of cesspool __- Materials of construction _— Indication of groundwater inflow ❑ Yes ❑ h: t5ins•3/13 Title 5 offaal norm:Subsurface S•:wage nisposal Sys!. ;J 17 Conti-i-ionwealth of Massachusetts T , fficial Inspection Fora �,...; i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 218 tittle fiver rd Property Address Pattv Polard wne. Owner's Name infonit.,:;,,:, is Cot Ma 02635 10/25/16 i,requ ,:,. i,;re.ery _.--- —_--- page. City/"I Own 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.): No ponding no break out 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.): Sins• .. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Little River rd Property Address --- -- Patty Po lard Owner --- ----- ---- Owner's Name --- -- ---- -- information is required for every Cotuit _ Ma 02635 1-0/2_5i 16 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, inch: to at least two permanent reference landmarks or benchmarks. Locate all wells vvithin 100 f. tie where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Offic,al Insnoci1on Form:Subsurface Sewage Disposal Sysi. P+. A 17 Comi!;onwealth of Massachusetts u � TiVe 5 Official Inspection Form Subsur-lace Sewage Disposal System Form - Not for Voluntary Assessments 218 Lillie: River rd Property Address Patty I'olard Owner Owner's Name -- inform::... ;, requiick. ._; .--:ry Cotuit Ma 02635 10/25/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ftfeet Please indicate all methods used to determine the high ground water elevation: �]C Obtained from system design plans on record If checked, date of design plan reviewed. 8/1/96 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data on plan -- ------- Before filing this Inspection Report, please see Report Completeness Checklist on next page. Sins Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 y i TOWN/OE BA-RNSTABLE � LOCATIONSEWAGE 7! 9 VILLAGE �- ,r C�✓ — F ASSESSOR'S MAP & f.U' �''�_�-��-Cs_y ; INSTALLER'S.NAME&PHONE NO. SEPTIC TANK CAPAC= -00 LEACHING FACILITY: (type). ;..,144 � — --- — (size) -y NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE:_ -COMPLIANCE DA'1'Ii:_-._e?v� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility i'cct Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) F Edge of Wetland and Leaching Facility(U any wetlands exist within 300 feet of leaching facility) Furnished by F U 30 -------------- -_ E I I y1 I l Commonwealth of Massachusetts W Title 5 official Inspection Fore _ a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 218 Little River rd Property Address — Patty Polard Owner ---- ---- -.__..-- - -- Owner's Name - — information is required for every Cotuit Ma 02635 10/25/16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Ins.pection_Summary D (System Failure Criteria Applicable to All Systems) completeC' ❑ System Information — Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate t5ins•3/13 Title 5 Offiaai Insporlion Form:Subsurface Sewage Disposal S . Copy COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL.AID FAIRS DE,PAILTMENT OIL ' VIILONMENI'AL YIL&rECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-6609 TRUDY CORE Secretary ARGEO PAUL CELLUCCI Governor DAVII)B.STRUH3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner, PART A CERTIFICATION PropertyAddross: 218 Little River Rd. NarrwofOwrrer ohn BartolQQmei jr Date or ins (Cotuit) Barnstable Addressorowner: 76 a mou Rd. , suite 8A Inspection: October �9 1 99 as ee or Jane E. Rabesa r Narrra of Inspector:(Please Prim a 11 y p 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMIt 15.000) CornpanYName: Warren CesS ool Service MarTingAddress: Sandwich Rd . E. lmouth, MA 02536-5602 Telephone Number: (�R_c,a n_71 4 CERTIFlCATION STATEMENT I certify that I have personally Inspected the sowago disposal system at this address and that the Information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-silo sewage disposal systems. Tiro system: XPassos _ Conditionally Passes _ Needs Furtho valuation By the Local Approving Authority Fails Inspector's Signathrre: v Date: November 2, . 1999 The System Inspector shall bmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)with1n thirty(30)•days of • completing this Inspection. If the system is a shared system or lies a design flow of 10,0o0 gpd or greater,the Inspector and the System owner shall submit the report to the appropriate regional office of the Department ot'Envirotimental Protection. The original should•be sent to Vts system owner•and copies sent to-the buyer, if applicable,and the approving authority. NOTES AND COMMENTS This does not. certify that. the' system. is adequate for the current use nor the future use of the system. It only certifies conditions on the day of inspection. �t1e V system in good condition with no failure criteria. �rHMElTHl ai �ECEIVEO • O N0V 4 19ag ,..�) TOVV 0FB*N T.MLF �iri.�, e.' • revised 9/2/98 Page Iof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM (DF PART A CERTIFICATION(continued) Property Address: 218 Little River R d. , Co t u i t, Ma O1N1Or: John Bartolomei , Jr Date of Inspection: October 29, 1999 INSPECTION SUMMARY: Check A, B, C, or A A. SYSTEM PASSES: Y E S X I have not found any Information which indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: NO One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no, or not determined (Y, N, or NO). Describe basis of determination in all Instances. If "not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of.a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the Inspection,or the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribut)on•box. The system will pass Inspection if(with approval of the Board of Health). broken pipets)are replaced obstruction is removed distribution box Is levelled ot'replaced The system required pumping-more than•fourtfines a year due to broken or obstructed pipets). The system willpess Inspection if(with approval of the Board of Health): broken pipets)are replaced obstruction is removed 1 I Warren Cesspool%wvwe Gory and.lane Rabesa 72 Sandwich Rood East FA!moa h,MA 025YP 6= . 50SbW-7143 revised 9 2 98 Psge 2 of 11 C "NF_)y ur SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION (continued) Property address: 218 Little River Rd . ', C o t u i t, MA Owner: John Bartolomei , Jr Date of Inspection: October 29, 1999 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: NO Conditions exist which require further evaluation by the Board of Health In order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.WILL PROTECT THE PUBLIC HEALTH.AND SAFETY.AND THE ENVJBONMEN:T: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: - The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is'less than 100 feet but 60 feet or more from a private water supply well,unless a well water agalysis for coliform bacteria and volatile organic compounds Indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid).- 3) OTHER r s Watti7Bf1 Cesspod Service Gory and.lane R abesa 72 San&rich Road East FafYnoulk MA 02536-6602 509oU0-71/3 revised 9/2/98 Page 3of11 COPY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 218 Little River Rd. C o t u i t, MA Owner: John Bartolomei ; Jr Date of Inspection: October 29, 1999 D. SYSTEM FAILS: NO You must indicate either "Yes" oe "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board,of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facilityor system component-due tto an overloaded orclogged-SAS•orcesspooi. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool Is less than 6" below invert or available volume is less than 112 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. X _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply.• X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well haq been analyzed to be acceptable,attach copy of well water analysis for •►coliform bacteria, volatile organic.compounds, ammonia nitrogen-and nitrate nitrogen. E. LARGE SYSTEM FAILS: N/A You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply _ the system•is-within..200 feet of••a-tributeryAo•esurfsoe•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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional , office of the Department for further information. Warren Cesspool Service Gary and Jane Rabesa 72 Sandwich Rood East Fabrtoufh,KA 0253&5602 508-SW7143 revised 9/2/98 Page 4of11 ) y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property address: 218 Little River Rd. , Co t u i t, MA Owner: John Bartolomei , Jr Date of Inspection: October 29, 1999 Check If the following have been done: You must indicatb either "Yes" or "No" as to each of the following: Yes No _X _ Pumping information was provided•by the owner, occupant, or Board of Health. _X _ •None of the system-components hava:been pumped+forataeast two weeks and•thwirystem has*ww aceiving .flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _X _ As built plans have been obtained and examined. Note If they are not available with N/A. _X — The facility or dwelling was inspected for signs of sewage back-up. _X _ The system does not receive non-sanitary or industrial waste flow. _X _ The site was inspected for signs of breakout. _X _ All system components,excluding the Soil Absorption System,have been located on the site. _X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on•the site has been determined based on:-- X Existing information. For example, Plan at B.O:H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)) _ The facility owner..(and.occupaats,if differaut from.owned,were.provided.with Information-on,ths..prxWw n a1n•anauw of Subsurface Disposal Systems. Warren Cesspool Service Gary and Jane Rabma 72 Sandwich Road East Faknoufft.KA 02536MO 508-6W7143 revised 9/2/98 Page sof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C C (DPY SYSTEM INFORMATION Property Address: 218 Little River Rd. , C o t u i t, MA Owner: John Bartolomei , Jr Dateoilnspection: October 29, 1999 RESIDENTIAL: FLOW CONDITIONS Design flow: 110 g.p,d./bedroom. Number of bedrooms(design): 3 Number of bedrooms(actual):4 Total DESIGN flow 446sa ft (480sq ft proviTed per engineered plan) Number of current residents: Garbage grinder(yes or no):--ye8 Laundry(separate system) (yes or no):na;. If yes, separate.inspection,required Laundry system Inspected (yes or no) Seasonal use(yes or no):gyp Water meter readings,if available (last two year's usage(gpd):_1 0-1 3-99 to 1 0-08-98 avg. 183 gpd Sump Pump(yea or no): nO 10-08-98 to 10-01-97 avg. 163 gpd Last date of occupancy: oc upied COMMERCIAL/INDUSTRIAL, N/A Type of establishment: Design flow: apd ( Based on 15.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Owner: never pumped. System pumped as part of inspection:(yes or no) I10 If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM _ Septic tankldistribution box/soil absorption system Single cesspool Overflow cesspool Privy V _nr) Shared system(yes or no) (if yes, attach previous inspection records,if any) 1/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date instailed{if known)-and source•of,information: c OmA 1 i a nc e d a t e d 8/1/96. Sewage odors detected when arriving at the site:(yes or no) n0- Warm Cesspool Service Gory and Jane Rabesa 72 SandWich Road East Faknouilk KA 02S36-6602 5084MG-7113 revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM C(OPY PART C SYSTEM INFORMATION(continued) Property Address: 218 Little River Rd. C o t u i t, MA Owner: John Bartolomei , Jr Dace of Inspection: October 29, 1999 BUILDING SEWER: (Locate on site plan) Depth below grade: 1 8 Material of construction:_cast iron 40 PVC_other(explain) Distance from private water supply well or suction line over 15 r Diameter 411 Comments: (condition of joints, venting, evidence of leakage;-etc.) SEPTIC TANK:X •(locate on site plan) Depth below grade:_IA _10 Material of construction:.�f_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank Is metal,list age_ Js.age-confirmed-by Certificate of Compliance_(Yes/No) Dimensions: standard 1500 gallon tank Sludge depth: 411 Distance from top of sludge to bottom of outlet tee•or baffle:- 2 8" Scum thickness: 2 if Distance from top of scum to top of outlet tee or baffle: 11 Distance from bottom of scum to bottom of outlet tee or baffle: 15" How dimensions were determined:_plan/onsite Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, atructur"tegrity, evidence of leakage,etc.) No apparent failure criteria Town of Barnstable rPnnmmends lallm=i nq PVPry irpp_yi--ar4 nRP rec ommends veY VP.7r for C3zCfA2M-S trl f-.h 81 Cpn.Qa1 s l n nGp_ GREASE TRAP.- NO (locate on site plan) Depth below grade: Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Warren Cesspool Semice Gary and Jane Rabesa 72 Sandwich Road East Falmouth.MA 02536.6602 508-610-7143 revised 9/2/98 Page 7of11 V D SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 218 L i.t h e River Rd. , C o t u i t, MA Owner: John Bartolomei , Jr Date of Inspection: October 29, 1999 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present -Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:_X (locate on site plan) Depth of liquid level above outlet invert: none Comments: (note•if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box, etc.) Viewed by remote camera No failure criteria Cover 121, below arade. PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No) Alarms In working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Warren Cesspool Service Gary and.lane Rabesa 72 Sandwich Road East Fafknoutk NA 02S364%M 508-640-7143 revised 9/2/98 Page serii D SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM COIFY PART C SYSTEM INFORMATION(continued) Property Address: 218 Little River Rd. , C o t u i t, MA Owner: John Bartolomei , Jr Dateotinapection: October 29, 1999 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries,number: leaching trenches,number, length: two 30'x4•l x2 r leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of ve etation, etc.) No onical failure sicins No problems in d-box noted CESSPOOLS: NO (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure,-level of ponding,condition of-vegetation, etc.) PRIVY: NO (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.) Warden Cesspool Service Carr and.lane Rabesa 72 Sandwich Road .'East Falmouth KA 02SX-66M S08bW-7143 revised 9/2/98 Page 9of11 0 ® SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 218 Little River Rd. , C O t u i t, Ma Owner: John Bartolomei , Jr Date of Inspection: October 29, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) NOT TO SCALE (G.ke)r I III I (kr� a watTen.cesspool Senric'e I Gary and.lane IRabesa I(n 72 Sarmhuia,(Road East Faknoutk W1 025X-56M 508-640-7143 revised 9/2/98 Page 10or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM COPY PART C SYSTEM INFORMATION(continued) Property Address: 218 Little River Rd . , C o t u i t, MA O1Nf1er: John Bartolomei , Jr Date of Inspection: October 29, 1999 NRCS . Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater DaNfeet Please indicate all the methods used to determine High Groundwater Elevation: _X Obtained from Design Plans on record Observed.Site(Abutting property,observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Engineered plan shows no groundwater down 120" from an elevation of 27 1 . { I Warren Cesspool Service Gary and,Aare wbesa 72 Sandwich Road East Fabnowjk NA 02S36-SM 54Ea40-7143 revised 9/2/98 Page norn TOWN OF BARNSTABLE .'1/S �at fiver o ?, L t!LOCATION SEWAGE g VILLAGE �.,�Tie> r ASSESSOR'S �MAP & 05�00&'—'010 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACTTY a00 LEACHING FACILrrY: (size) NO.OF BEDROOMS / LI BUILDER OR OWNER PERMIT DATE: S'g`9 6 COMPLIANCE DATE: ef, Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet K 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 f lity) Feet Furnished by �� yy�� r � D 'j 20`2 ,3���,. No. / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migozal *pgtem CConmruction Permit Application is hereby made for a Permit to Construct(.✓)or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. j �1. �p Owner's Name,Address and Tel.No. f VI U, e1fLmm-T — 69TV Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J_ yo u cXrZ5r va LA_ G�Z 13 Type of Building: Dwelling No.of Bedrooms ' Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures a� Design Flow N gallons per day. Calculated daily flow JCS gallons. Plan Date MAA 'ZV Number of sheets I— Revision Date Title 69TV ri- WILL_ l;71.t Description of Soil mw-�,I uvv- 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 b is oard of Health.,e Signed L� 2i— Date 7 30— Application Approved by } Application Disapproved for the Vollowin reasons Permit No. ?,/ " 1 2/ Date Issued t. No. ` _ _ Fee_In � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLE, MASSACHUSETTS Application for wgpooal *Proem Conetructiori Permit :1 Application is hereby made for a Permit to Construct �_)or Repair(' ).an On-site'Sewage Disposal System at: F \Location Address or Lot No. Owners Name,Address and Tel.No. U IC D�'L--• Lirr�6 121�1 .., LU I Ufc- Installer's Name,Address,and Tel.No. _ Designer's Name,Address and Tel.No. II XTErL I�hf Ike 8tv M A fN ^ !�M,. C� �11rr ds�-�z�� - 440-QI 13 Type of Building: TM Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow N gallons per day. Calculated daily flow 3C7 gallons. Plan Date M AA *K I Number of sheets z., Revision Date Title fJ CeTUf'r MA,94, Fff6 WiLt L t 2 CT•T" Description of Soil M En!utiti S A-A l f t Nature of Repairs or Alterations(Answer when applicable) l t j 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 b( is oard of Health. t Signed l A Date d— 76 Application Approved by Application Disapproved for the Yblowinq reasons Permit No. ! G ' �/ Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance - - THIS IS TO CERTIFY,that the On-site Sewage Disposal System ins alled or re a' ed/replacedy. on .. �� by mA9 4 for l as t G ad.. 'aJ _o has been constructed i accance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated, �"" Use of this system is conditioned on compliance with the provisions set forth below: No. — Feed i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migw6ar 6pgtem Con!5truction Permit . Permission is hereby granted to to construct(�)repair( )an On-sit Sewage System located at �k and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to G' comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: — 3/ — 5 Approved by .L, Bottle Number: 00•6301 Date: 04/29/96 O� BA� BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT h. r SUPERIOR COURT HOUSE V hj BARNSTABLE, MASSACHUSETTS 02630 • • A S 5 PHONE:362-2511 LAB 337 Client: EVERITT, WILLIAM Collector: CHARLOTTE STIEFEL Mailina 1136 OLD POST RD Affiliation: COUNTY Address : COTUIT MA 02635 Tvpe of Supplv: W Telephone: Well Depth: 53 FT Sample Location: LITTLE RIVER RD Date of Collection: 04/22/96 Town: COTUIT Date of Analvsis : 04/22/96 (Lot #8) PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 mL 0 0 pH 6 .2 Conductivity (micromhos/cm) 260 500 Iron (ppm) < 0.1 0. 3 Nitrate-Nitrogen (ppm) 1 . 1 10.0 . Sodium (ppm) 22 20.0 Copper (ppm) < 0 . 1 1 .3 Ammonia (ppm) < 0 . 1 5.0 BASED ON THE ANALYSES PERFORMED, THE FOLLOWING ADVISORIES ARE GIVEN: * Based on the results of the parameters tested, the water is suitable for drinking but has high levels of sodium. Persons on a low sodium diet should consult their doctor. Thomas F. Bourne , Laboratory Director Barnstable County Health and Environmental Laboratory Superior Court House, Route 6A P.O. Box 427 Barnstable, MA 02630 (508) 362-2511 ext . 337 Volatile Organic Analysis Analytical Method: . 502 . 2 Collection Date : 04/22/96 Date Received: 04/22/96 Analysis Date : 04/24/96 Client : WILLIAM EVERITT Mailing WILLIAM EVERETT Sample Location: LOT 8 Address : 1136 OLD POST ROAD LITTLE RIVER ROAD COTUIT MA 02635 COTUIT Sample ID: 006302 Laboratory ID: 006302 Sample Description: PRIVATE WELL Compound Amount Detected (ug/L) Detection Limit (ug/L) Benzene BRL 0 . 5 Bromobenzene BRL 0 . 5 Bromochloromethane BRL 0 . 5 Bromodichloromethane BRL 0 . 5 Bromoform BRL 0 . 5 Bromomethane BRL 0 . 5 n-Butylbenzene BRL 0 . 5 sec-Butylbenzene BRL 0 . 5 tert-Butylbenzene BRL 0 . 5 Carbon tetrachloride BRL 0 . 5 Chlorobenzene BRL 0 . 5 Chloroethane BRL 0 . 5 Chloroform 0 . 7 0 . 5 Chloromethane BRL 0 . 5 2-Chlorotoluene BRL 0 .5 4-Chlorotoluene BRL 0 . 5 Dibromochloromethane BRL 0 . 5 1, 2-Dibromo-3-chloropropane BRL 0 . 5 1, 2-Dibromoethane BRL 0 . 5 Dibromomethane BRL 0 . 5 1, 2-Dichlorobenzene BRL 0 . 5 1, 3-Dichlorobenzene BRL 0 . 5 1, 4-Dichlorobenzene BRL 0 . 5 Dichlorodifluoromethane BRL 0 . 5 1, 1-Dichloroethane BRL 0 . 5 1, 2-Dichloroethane BRL 0 . 5 1, 1-Dichloroethene BRL 0 . 5 cis-1, 2-Dichloroethene BRL 0 . 5 trans-1, 2-Dichloroethene BRL 0 . 5 1, 2-Dichloropropane BRL 0 . 5 1, 3-Dichloropropane BRL 0 . 5 2 , 2-Dichloropropane BRL 0 . 5 1, 1-Dichloropropene BRL 0 . 5 cis-1, 3-Dichloropropene BRL 0 . 5 trans-1, 3-Dichloropropene BRL 0 . 5 Ethylbenzene BRL 0 . 5 Hexachlorobutadiene BRL 0 . 5 Isopropylbenzene BRL 0 . 5 4-Isopropyltoluene BRL 0 . 5 l j AV page 2 :Sample ID: 006302 Laboratory ID: 006302 1' Compound Amount Detected (ug/L) Detection Limit (ug/L) Methylene chloride BRL 0 . 5 Naphthalene BRL 0 . 5 Propylbenzene BRL 0 . 5 Styrene BRL 0 . 5 1, 1, 1, 2-Tetrachloroethane BRL 0 . 5 1, 1, 2, 2-Tetrachloroethane BRL 0 . 5 Tetrachloroethene BRL 0 . 5 Toluene BRL 0 . 5 1, 2, 3-Trichlorobenzene BRL 0 . 5 1, 2 , 4-Trichlorobenzene BRL 0 . 5 1, 1, 1.-Trichloroethane BRL 0 . 5 1, 1, 2-Trichloroethane BRL 0 . 5 Trichloroethene BRL 0 . 5 Trichlorofluoromethane ` BRL 0 . 5 1, 2 , 3-Trichloropropane BRL 0 . 5 1, 2 , 4-Trimethylbenzene BRL 0 . 5 1, 3 , 5-Trimethylbenzene BRL 0 . 5 Vinyl chloride BRL 0 . 5 Total Xylenes BRL 0 . 5 BRL: Below Reporting Limit Thomas F. Bourne, Laboratory Director �SI�►-i �aTA �' s5 i"4,Ls FAM IL`( 3 PLA 14 OW 'BAD 4&ME OF GAW,gLG W— 1vat�-y F.oW = 3 Y. IIc =l'� Gr'o LoT 0 Lrt�t-t �tj�. Qoab�Cv�rv,�r' u�& 150o GAL. Lrz Gql" 5`(5TMA MI&W -t TRt3'NiG�{�c5 ��XPArJsioN � I d d A1TUGATIoN AZEA t7E4'D. p�Z P o GPD 4 o,14- sF=44&S� d ,IppUGds.'itaN AGtsA v ,lbN �x PA N S o N 3a" '5MEWALI.- 42s,A=3o xz t 4= 24o' 1, ,, OF LRA6Al tL T>zWkEs tvoTToM At&A = 40 x A-'x Z e 2Uo SF r-.,& -rout- AM%a AE6OSF M 41 I .x. SOIL Cl H OF 4 OF Sut.LIVAN: ----- 3 QA. NO.CIVIL L ' - vo 24W �` �FA►Y1rc�� '�% AL T.9 `1 34 p i IOU 1►h� ZS o pj'!7�"$ l F�dl�4 13GN1 24 �07( Z,� g 24 lw Mao 'RAC 1 re C 6.4 b • F1�� �' PLAN LLaCATt[7N! �foTu 17- .PlvloCc 3�Zl �q<o _ ySCAL� ���-5D /t�G9Z! ZS,R4G i 1 wlry `T14T.. "rs 'Dwv-.ul, PLAN 4 aMPWS wt T14E 3I .0 A►Ja LO - jMULK. zMut OF TI{GG V u!N OF MAP' S-4 Pam- &_4 $• TMD WIT41N /� S ►->fl . LL1GA �u AL Fts�aD W� EZ.ae.�' zv �. �axTt�.. � Nye I�c Lp,gD 15MMYtsu6 • 044I"SW MqL 'r,WUP ogT evlu..f°. MA44, Pvom w I ,,ttl W5 sNocatp NPt' s ra AM11 e aM 1": �`� � , . S��T '� of •L EV ER rrT � r ,- (�L r�O 3•���1. i Wal- i watt, ' v 1 ~ OF l SUWJAMNo.29M ' OF RD 0� � ��' � LA•� 'ter I��,��v �� 1y �/q 16 3e"fj (� Town of Barnstable P# 156113 partmentof Health,SFafety'andE�nvieg} Se aces f lot �D WN P.ublic�°I4Itealth D><��is><`on Date: // 367 Mair,Sire MA'026 1 __. . � et I-Iyaams 0 s �a $ IAMMBM AfAB.4� 16 9. bate Scheduled �(� , r Time--t--=— Fee Pd. c°i�or�uda I ��1 I Soil Suitability Assess mnent f or Sewage Dasp0sal _ ; co l.?�� >q t �S Witnessed By:. Performed By: [_ _ - �. ,... N Ai :... ;... : lV ":::: t•i ':i Y<G i.. : :i, .` '."' 03:JN:`'` Location Address L R(fie Owners Name G/6 Assessor's Map/Parcel: 0,6-f jOQb w� Engineers Name p„�1^_ t4� r l Tele hone# ( 0` NEW CONSTRUCTION REPAIR P Land Use (� t° Slopes(%) Surface-Stones /V Gl'3 / Distances from: Open Water Body. (C)o ft Possible Wet Area 1/� ft Drinking Water Well Drainage Way �t/y ft Property Line ft Other ft SKETCH:(Street name,dimensions of tot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1�1 N - JM 4C .t \ �Rl• 's• oar. '= 3, �ta ,.� °��`:�r{. 't� 3S �3 • r I -was zC) Parent material(geologic) (/{� /� Depth.to Bedrock Deptli to Groundwater: Standing Water,in Hole: NIA Weeping.from Pit Face Estimated Seasonal High Groundwater_ w/ .;::;:;.;;>;;;;;:.::::;a:::rt:::i..:.:.........:..:..:.:...........:•'' ."._. ..::• 'i i : . .:;: • :"':.:. . ..; :.. ':. .. -._�• Lt1.....i:i:iE:ii:i:i�:::::'S>::;::fii 1t� �+ y�:.�r:�:. .�y'a1;::Y:1:,t'�:�'1.i�'.1?I,i.;�,��lr.::::;::<,:::;.o-:::.;•:.;>;:.,:. Method Depth Observed standing in obs.hole: in. Depth.to�soil°mottles: in. Depth to weeping from side of obs•hole: in. Groundwater Adjustment ft. Index Well# •Reading Date:_.___ Index Well level•__' Af0factor Adj:Gioundw;Ater Level_ :..:::::::..................:::::::..... " ::` ?::%>:>: Observation #' I Time.at: Holer� s y'� Depth of Perc Time at`6"` i Start Pre-soak Time End Pee-soak Rate Min./Inch L� ,• r . ._ / ": ; Site"Suitability Assessment: 'Site3Passed t/ Site F.ailei9: • - AdditkcgL1 Tesii g Needed(YtN) Origin Public Health Division ®bservtotion Hole Data To Be, �.ompleted on`Baek Copy: Applicant �. µ , ::.;:,;:;:.:;•;:»<>:,»>;<;;•:;:<:::»>s»:::;»»»>:> :<:>;»<>:>:>:•;;: res. • 4Depth from Soil Hori:<:»»zon I SoilTexturet 1 f f#tSo�l�Color,,a Soil Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones,Boulde e � - 3 L ��YR 31 1 g� 2 z 6 C. .q 14,q// V#••� �f.\ :\4/ //1.��. C J r I rl t'+£}� R»: 7 `►£R .+ '4t„�; . l+#act� 1� � ......... .......... ........... ........ ....... IMP;:��.�.��t:�?;�T.LC�N;,I�:O►.I.,E:::;:.;:.>;:;.::.;>:<.;;:::.:;;:::.;:;:..>::::::.;::.;::.::;•::......... 'Deepth from Soil Horizon Soil,Texture Sail Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. U - 3 � � 5 . IOY� 3 , o n °° r 3 - 10 'q D YK .::.::.::::.::.::::.::.:::.:::.:::.::::.::.: .::.: :.::::::::::.::::::.:.:::::.:::.:>o► :. > �r.:::.::::.:::.::.::::.::.:::.:.:::::.:::.::.::.::.::::.:::.:::::::::::.:::::................... . .... . . :::: ::::: ::.:..:....::. Depth from Soil Horizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Ivhansell) RRbttling (structure,Stones,Boulderes. o i enc %Gravel) MW Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. onsi en °° r e r i)F o'od�In�tre�ance�I3at��1�Ia`r`i •° •� ` .I:/ ,. h# Above 500 year flood?boundary,-No'_ Yes v Vdilhin500;.yearrboundary .Nov Yes witliitiIO'O year floodboundary`No V_ Yes 9,'6pth of NaturaHv Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? `/2 1f•:not,what,is the depth of haturally occurring pervious material? C?ertiiication Icertify that on �� f Z (date)I have passed the soil evaluator examination approved by the Department of-Environliiental,Pf'dtection_and.that,•the-above analysis was:performed byrme•consistent•,with tti`e required training,expertise and experience 5described in 310 CMR 15.017. Signature .___Date ,/� ---- Fee------S-6----....-- No.--- - BOARD OF HEALTH e,,11a QOL� TOWN OF BARNSTABLE Application-*rVell Conetructionpermit �( Application WKereby made for a permit to Construct ( ), Alter ( ), or Repair ( an individual Well at: u - ------------------ Location — Address Assessors Map and Parcel ---------------------------------------------------------------------------------------------- Owner Address r --�� n _�Z.i,�---�_---------- - ----- --`---`---!5_ --------- '_--- Installer — Driller Address Type of Building Dwelling------------------------------------------------------------------- Other - Type of Building ------ No. of Persons----------------------------------------------------- ----- Capacity — -Type of Well-------'�--------�-------------------------- P Y------------------------------- ---------------------------------- Purpose of Well ---------------------- - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .00f,,-Coompliance has been issued by the Board of Health. Signed c ---- /date ----------- Application.Approved By date Application Disapproved for the following reasons:------------------------------------------------------------------------=-------- ------------ -- -- -----_------------------ ---------------------- - - -- - -- ------------- ------ date Permit No. -- -------- ---------- Issued------------------------------------------------------------------------------- date BOARD OF HEALTH TOWN OF BARNSTAB LE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired / � h `� 1-� by — ! -- - --- -- - --—-- - --- --- -- Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -l___arq e Dated----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- ---- — --- —-- Inspector------------------------------------------------------------------------- �,,, �� R.�. ,,i--.- �rr:•�.�.. 'M. .....,,�;,,• .�py^.'".^..i4`t,..,;•v+_..�.-...,r,.M'7i'1""�4.,.w,.,,,�-,,, i .�y'�+t✓�. ..►' � k y .. k`wit•. , BOARD OF HEALTH - �� 00'4T.OWN OF- BARNSTABLE s ApplicationArVell Con0rucjt onPermit Application is✓hereby made for a permit to Construct ( ), Alter ( ' ), or Repair ( an individual Well at: -- - - -- - - o . Location — Address Assessors Map and Parcel R1- t- ------------------------------------- ------------------------------- ----------------------------=----------------------------- Owner Address /vl h q r_v t t c _p_�,_i_1,- - _3. r1 / �' -=----- ----------- _ - -- - - a 'p = Installer Driller Address Type of Building Dwelling----------------------------------------------------------------- Other - Type of Building ------------ No. of Persons---------------------------------------------------- Typeof Well- --- -- ------------------------------------ Capacity ----- - - ----------- ------ YP QY Yl ` Y-- Purpose of Well - —"- ` ' ` ---------------- --- Agreement: The undersigned agrees to install the afor'edescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed - /date (� Application Approved By date Application Disapproved for the following reasons:------------------------------------------------------------------------- ----------------------------------- -------------------- ------------------------------------------------------------------------------------ date PermitNo. -- r Z-- --- -- - Issued---------------------------date---------------------------------------- BOARD OF HEALTH -A TOWN OF BRNSTABLE i f � Certificate Of ComPhance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired by GL. -------------------------------------------------------- -- - - - -- --- �% -- - - Installer at ---------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -7 127-----Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- ----- — - ----- Inspector-------------------------------------------- - ------------ BOARD OF HEALTH is TOWN OF -BARNSTABLE Veit Con5truct ion Permit No. - ---------7 Fee- ----------- A,, Permission is hereby granted---L� �✓ - - -------------------------------------------------------------- to Construct (S4, Alter ( ), or Repair ( ) an Individual Well at: !. N o. --------- ------------------------------------------------------- Street as shown on the application for a Well Construction Permit ----------------------------------------- Dated --------- -------------------------------------------------------------------- -------------------- --� - Board of Health i DATE--— -- --- --- -- ----— - '51"G1_fi FAM W 3 SmR=m t;4=-E PL A" OW 'DA44 "M&OF q0 6Am3A,,;,,c a4apnr- 'PA.tt_y Flow SQ ne- TAWL'. - T-'A)x'Z0o%w&&06PD - v5a= 1500 GAL. tsAcc}t� SYsT��t vEs�N � oN � d AffU CATIoN A¢EA o4'D. — — —— d PAo Q7D 4 O 14- *-44&s(z d Stt�Y,IALL AtaEA=3o xz,c 4= 24o sF l -At 1. of LEA��FFi T—t �tG�4E5 voTToM AMA = 40 x•4)t2 e l4o SF IDT L. AWA" AeoSF ;�oiAT X4 G 5 M U/j► Z� '��-�s sates 4` SOIL C1d� � Of N N �yZN OF I rg sTbJG 9�ER j A. NO.29 vo a�as GAXrM CIVIL ,g.yga-Ppt} op -mra AL � 2 F'6 z8 TG-zq 3a p �8ir IW t�Ivc Zs.o g'! "� Lrd4t 1 �IcH R14 2 C ; M&D &Ab �y4 �OFtl.�r► PLO 1.rxkTtata CO`T U IT t L'>= r%f •Tw►T_ T+E 'Dw�t.t,tN� - otiuN Pl:A!`1 F MWW &1Pt.`K w mg 1-4E -w mw4ls AWv LOB- � 4�SAG1G xpu OF TIAG 'DD►UN of MAP 5,4- Pam- -� !X►fJS`�'14�1�5' ADD _ .. LZXATiD W 1 Tu 1 N A �PG�.14L FLtIVD ►{�►ZAt� zo E':. BAIT=— A RYE I MC oST�¢.vtt.i.� MA�fti. OWOW s ; USCD 'Ib- " om•�wIpDitjp"�t TCy9 06XnP N;or 6r: z� aUtANT; •�- W Lc. EV E�►TT /SZ.-� ZoNE 7-F t,wall ,,•` 5 ie Ile LIT. Kati; _ . : . _._ - � • � ti^ . Div i 03 �0.4 OF MAI Olm A .-OF tqPCHAFRtP49 aim BAXTER e - ti ,�, uw Barnstable County Health and Environmental Laboratory Superior Court House, Route 6A P .O. Box 427 Barnstable, MA 026,30 (508) 362-2511 ext . 337 Volatile Organic Analysis Analytical Method: 502 . 2 Collection Date : 04/22/96 Date Received: 04/22/96 Analysis Date : 04/24/96 Client : WILLIAM EVERETT Mailing WILLIAM EVERETT Sample Location: LOT 8 Address : 1136 OLD POST ROAD LITTLE RIVER ROAD COTUIT MA 02635 COTUIT Sample ID: 00.6302 Laboratory ID : 006302 Sample Description: PRIVATE WELL comoound Amount Detected (ug/L) Detection Limit (ug/L) Benzene BRL 0 . 5 Bromobenzene BRL 0 . 5 Bromochloromethane BRL 0 : 5 3romodichloromethane BRL 0 . 5 Bromoform BRL 0 . 5 Bromomethane BRL 0 . 5 n-Butylbenzene BRL 0 . 5 sec-Butylbenzene BRL 0 . 5 tert-Butylbenzene BRL 0 . 5 Carbon tetrachloride BRL 0 . 5 Chlorobenzene BRL 0 . 5 Chlorcethane BRL 0 . 5 Chloroform 0 . 7 0 . 5 Chloromethane BRL 0 . 5 2-Chlorotoluene BRL 0 . 5 4-Chlorotoluene BRL 0 . 5 Dibromochloromethane BRL 0 . 5 1, 2-Dibromo-3-chloropropane t BRL 0 . 5 1, 2-Di-bromoethane BRL 0 . 5 Di' romotriethane BRL' 0 . 5 1, 2-Dichlorobenzene BRL 0 . 5 1 , 3-Dichlorobenzene BRL 0 . 5 1, 4-Dichlorobenzene BRL 0. 5 Dichlorodifluoromethane BRL 0 . 5 1, 1-Dichloroethane BRL 0 . 5 1, 2-Dichloroethane BRL 0 . 5 1, 1-Dichloroethene BRL 0 . 5 cis-1, 2-Dichloroethene BRL 0 . 5 trans-1, 2-Dichloroethene BRL 0 . 5 1, 2-Dichloropropane BRL 0 . 5 1, 3-Dichloropropane BRL 0 . 5 2 , 2-Dichloropropane BRL 0 . 5 1, 1-Dichloropropene BRL - 0 . 5 cis-1, 3-Dichloropropene BRL 0 . 5 trans-1, 3-Dichloropropene BRL 0 . 5 Ethylbenzene BRL 0 . 5 '+ 3exachlorobutadiene BRL 0 . 5 Isopropylbenzene BRL 0 . 5 4-Isopropyltoluene BRL 0 . 5 s� - c � page 2 Sample ID: 006302 Laboratory ID: 006302 compound Amount Detected (ug/L) Detection Limit (ug/L) Methylene chloride BRL 0 . 5 Naphthalene BRL 0 . 5 Propylbenzene BRL 0 . 5 Styrene BRL 0 . 5 1, 1, 1, 2-Tetrachloroethane BRL 0 . 5 1, 1, 2 , 2-Tetrachloroethane BRL 0 . 5 Tetrachloroethene BRL 0 . 5 Toluene BRL 0 . 5 1, 2 , 3-Trichlorobenzene BRL 0 . 5 1, 2 , 4-Trichlorobenzene BRL 0 . 5 1, 1, 1-Trichloroethane BRL 0 . 5 1 , 1, 2-Trichloroethane BRL 0 . 5 Trichloroethene BRL 0 . 5 Trichlorofluoromethane BRL 0 . 5 1 , 2 , 3-Trichloropropane BRL 0 . 5 1, 2 , 4-Trimethylbenzene BRL 0 . 5 1, 3 , 5-Trimethylbenzene BRL 0 .5 Vinyl chloride BRL 0 . 5 Total Xylenes BRL 0 . 5 BRL: Below. Reporting Limit Thomas F. Bourne, Laboratory Director r �GL Cr FORM 11 - SOIL EVALUATOR a OR M g Date: No. goo�o� Commonwealth of Massachusetts Massachusetts l 'ta ' ' n r - ' e Performed By: .... � t .l ........ .�... ..�"�.•• .................. Date: '?-/'.q. .............. . . ............. Npa? ......... ......... ...... Q ....Q�......... .............................. . ........ ..� ................ Witnessed By: owmw,s rime. Ci/v �l(//l.[� ✓ wauen"aa�'�r-rz, / '/ Aaarw.eV4 LA/ 8 L/ 1/ TC:00A e P"J JT ew Construction [Repair ❑ Office Review No Yes L� Q Published Soil Survey Available: ❑ CG...G......... Year Published J �.3. Publication Scale %.ZApJ Soil Map Unit Drainage Class �XCSI..✓..g�.' Soil Limitations .a ............................................................................................ Surficial Geologic Report Available: No ❑ Yes p 24t000 Publication Scale Year Published ............................ Geologic Material (Map Unit) ; ��.a,,c/ ... ........... ................... .............. earr6.?........ Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes l 9 - Within 500 year flood boundary No u"es ❑ Within 100.year flood boundary No eyes ❑ . Wetland Area: p (map unit) ............................................................................ National Wetland Inventory Ma .... Ma ................................ Wetlands Conservancy Program Map(map unit) . . :. � �'.�:.�.... Current Wate Month Resource Conditions(USGS): ❑ Range :Above Normal ®Nonnal ❑Belc�,i Normal Other References Reviewed: DFP APPROVED pORM-12/0719S FORM 11 I . EVALUATOR e FORM 3 Location Address or Lot No. nn-site R y� iew Time:... Weather Deep Hole Number Location (identify on site plan( Q.• . Surface Stones � � Slope 1961 . LandUse :::.... :.:.:.:,.:::,:....::.:::...::.......... .. :.., Vegetation ...Q.��.a�� .:.:GU.�I�-.. .: .::...::.::.:::::: .... ....: ...::::::..:::..:.:::..... .. . ... ........:.......... . ........................ ......... Landform .::.:..:.�� :,.:.... f Position on landscape (sketch on the back) 5 Distances from: Drainage way : feet Open Water Body ��. feet feet ��? . fast Property Line ..:::•�� �� Possible-Wet Area ... . Other Drinking Water Well ..O 0 feet DEEP OBSERVATION HOLE LOGS Soil other Mottling (Structure,Stones,Boulders, Consistency, `>6 Depth from Soil Horizon Soil Texture Munsslll)' Greve() Surface(Inches) (USDA) o p f=/tI/1�Lt�� _ ��i6/1gVd7�• A4 So Sa40 vye 6/� ev-bet wYe 14Zt1*cA , .A:,►��l/A1S� • _�._. DePthtoBedr°ck: -� Parent Material(geclogio) .._r Weeping from Pit Face: groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: DEP APPROVED FORM.12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Add ress or Lot No. log" 8 �/ � d ✓ X CorWr Determination for Seasonal Hi¢h Water Tam Method Used: ❑ Depth observed standing in observation hole.................. inches ❑ Depth weeping from side of observation hole inches ❑ Depth to soil mottles ..;:...::.::: inches ❑ Ground water adjustment ................... feet Index Well Number!�!!./..w. 9 Reading Date .�G- ....4..G Index well level ... '.Z.... Adjustment factor ..... Adjusted ground water level ............................................._...._. Death of Naturally Occurring Perv1A11s Material Does at least four feet of naturally occurring perviousornate Material st em?st in all areas observed throughout the area proposed for the soil abs p Y If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) I have passed the soil evaluator examination approved by t1�a De artment of Environmental Protection training,a�expe,d that sa and experience he above i dwas escribed in 310 CMR 15.017.consistent me with the required Signature UAa8-LL ate 1K '•21. �q DEP APPROVED FORM-12/07/9S 1101, is Tr Lip a %pa fi c n r FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: . ..�l: t cam.... .'°d...ti^^, Observation Hale # I Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time t9"-6"1 c�NaBc.O Rate Min./Inch � '� IrJ ''� rci►tr1 " Minimum of 1 percolation test must be performed in both the primary area AND reserve are SitePassed- Site Failed 0 :......................................................................................................r......_......_ Performed B : � Perfo 12�Y _ Witnessed By: E`e`"'r�"" �t7 � Comments: � ./�...�.......�r..�.�.�.,..�,...�..�.�..�.�..M.�.w�..�..........�, DW APMVW FORM-UWIPS i ALL SHALL SYSTEM PROFILE MAR EDSTE WITHC MAGNETIC TTAPE OR BE a COMPARABLE MEANS FOR FUTURE LOCATION. > (NOT TO SCALE NOTES r� o LEGEND ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE --- 99 - EXISTING CONTOUR \ TOP FOUND. EL. 44.0' FILTER FABRIC OVER STONE NAVD88 1. DATUM IS ? w 42.0' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 40.0' 2. MUNICIPAL WATER IS EXISTING o � X 99.1 EXIST. SPOT ELEV. PRECAST H-10 WATERTEST D'BOX FOR LEVELNESS BLOCKS OR (TrP.) -[99]- PROPOSED CONTOUR 2'0 MIN. 2" WALL THICKNESS PRECAST RISERS 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.RISERS e 4"OSCH40 PVC MORTAR ALL 41.1 PIPES LEVEL 1ST 2' 4' COMPONENTS INVERT IN 37.0' 4 (Z 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS (98.4] PROPOSED SPOT EL. �ENDS (TYP') SIDES 38.0' TO BE AASHO H-22 EXISTING �,, TH1 14" `' °°°°°°° m6mm f �Eg®® mmmM ®®® o�oog000 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEST HOLE T E SEPTIC TANK** TEE 39.7f'* ° 6" MIN SUMP °g°o°o° mmmmmm®®mmm mm®®®mmm®®m >g000gogo °°°°°°°°°°° 12" MIN. INT. DIM. '°°°°°°°° ®®®®®®®®®®® ®®®®®®®® ® °°°°°° GAS BAFFLE ). °° N >°0°o°o08 ® ® ,000000°g ° ° ° ®®®®®m®®Enm ®m®®®®®®®®® ° ° °°° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH Locus ' 35.0' 310 CMR 15.000 (TITLE 5.) o 22; SLOPE OF GROUND . ` '. 37.57 37 4 ° ° ° ° ' ° ° ° ° s H-20 500 GAL LEACHING 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO � `< ) UTILITY POLE 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. 3) B ME PRECAST OR EQUAL UNITS REQUIRED BE USED FOR LOT LINE STAKING OR ANY OTHER �--� ALL AROUND PRECAST STRUCTURES PURPOSE. ZX FIRE HYDRANT 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.5' X 12.83' NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING COMPACTION. (15.221 [2]) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ' ( 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED 6_5% SLOPE) ( �� SLOPE) I H-20 LEACHING WITHOUT INSPECTION BY BOARD OF HEALTH AND FOUNDATION- EXIST. SEPTIC TANK 33' D' BOX 10' 28.0' BOTTOM TH-1 PERMISSION OBTAINED FROM BOARD OF HEALTH. FACILITY *THE INSTALLER SHALL VERIFY THE NO GROUNDWATER FOUND LOCUS MAP 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC ��/� DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND TANK SIZE AT 1000 GALLONS AND ITS 36 LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES NOT TO SCALE ELEVATIONS PRIOR TO INSTALLING ANY SUITABILITY FOR RE-USE. REPLACE WITH 1500 __V PRIOR TO COMMENCEMENT OF WORK. PORTION OF SEPTIC SYSTEM GALLON SEPTIC TANK APPROPRIATE TO SITE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE ASSESSORS MAP 54 PARCEL 6-4 CONDITIONS IF NOT SUITABLE � REMOVED 5' BENEATH AND AROUND THE PROPOSED 38 LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND Cp S`, DESIGN: REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. STEMN J GARBAGE DISPOSER IS NOT ALLOWED v9 EXISTING 3 BEDROOM DWELLING DESIGN FLOW: 4 BEDROOMS © 110 GPD = 440 GPD USE A 440 GPD DESIGN FLOW 3 SEPTIC TANK: 440 GPD (2) = 880 40 **RE-USE EXISTING 1400 GAL. SEPTIC TANK d LEACHING: SIDES: 2 (33.5 + 12.8) 2 (.74) = 137 GPD TEST HOLE LOGS TEST HOLE LOGS BOTTOM 33.5 x 12.8 (.74) = 317 GPD ��� k ENGINEER: PETER SULLIVAN ENGINEER: DANIEL E. GONSALVES, SE #13587 TOTAL: 614 S.F. 454 GPD ' LOT 8 WITNESS: WITNESS: DON DESMARAIS, RS USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 60,439± S.F. o DATE: 3/21/96 DATE: 11/29/16 WITH 4' STONE ALL AROUND PERC. RATE _ < 5 MIN/INCH PERC. RATE _ < 2 MIN/INCH 4' J CLASS I SOILS P# 8666 CLASS I SOILS P# 15213 �M ELEV. ELEV. ELEV. ELEV. x, 42 Ott 4 40.5' 0„ 4 40.5' 0„ `V' 39.0' 0" 4 39.0' A A 0 0 LS LS ���'R ;3/1 10YR 3/1 , �-43 3" 3 3,, 3,, �oI l r E E E E MS MS BE MARK - CENTER OF FLAG. �2� 10YR 5/2 10YR 5/2 WALE ERE. ELEVATION = 42.7 8" 10" 8" 38.3' 10" 38.2' B B 42 44 B B LS LS DIN 10YR 4/6 37 2, 24„ 10YR 4/6 37.0' - I 43 24" 24" 22" SLEEVE SEWER LINE WITHIN 1 10' OF WATER LINE G� G�\G` PERC C C PERC G C \ G%� DECK MS MS M/CS M/CS S G EXISTING 2.5Y 7/4 2.5Y 7/4 j O o DWELLING 70 / O 0 TOP OF FNDN R, �y EL. 44.o TH 1 120" 30.5' 132" 30.5' 132" 28.0' 132" 28.0' l 1 NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED 41 w \ \ \ 1 SHED TITLE 5 SITE PLAN 1 24.4' 43 O F TH2 Rm"'I V E R�. 218 LITTLE MUAD h9 ° \ TH4 COTUIT, MA TH3 J\� PREPARED FOR 0 39 BORTOLOTTI CONSTRUCTI(ION/ 39 1 O 38 `r < PAVED POLLARD 1 DRIVE DATE: DECEMBER 6, 2016 1> I Scale: 1"= 20' 38 45 I0 10 20 30 40 50 FEET mA � :.a ' off 508-362-4541 0�n1 s' � yC ASH Or M s\ , fax 508-362-9880 �N A '�� S`S \ AVc I ^� �� ' OE P SSgc S���, • ����'f� DANIEL G o� ` DANIELDANIELA o DAP�I.-L DANIEL. downcope.com G� �S N - c 4� CIVIL CIVIL - A. �1 down ca a en ine�fin inc. OJALA A. . . p 36 No.46502 ro No.400f10 No.40980 f °,sT R�"�>w q `12 ` . °�� �P civil engineers G�STE' �t� Fs�_ ��, ; _ p� , q b land surveyors ' S�/Or A / w�!0 ALE o J{V 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 DCE # > 6-389 XXXXX.DWG