Loading...
HomeMy WebLinkAbout0121 LOVELL'S ROAD - Health 121 LOVELL'S ROAD COTUIT _ A= 025 -052 -_ _�_ ----- - - I Commonwealth of Massachusetts 0626 0Sc�— Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t M 121 Lovells Rd r Property Address a p Ginnetty Owner Owner's Na T information is required for Cotuit 7 MA 6-9-18 , every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 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 �`� 6-9-18 Inspecto 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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Il + Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. CityrTown 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 met all passing requirements at time of this inspection. This report is not to be used for bedroom count or design flow. This system appears to be original and is only occupied by one person at this time. The future performance under the same or especially with increased usage can not be determined from this report. This system is original and has seen little use in the past several years. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every 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 t5ins•3113 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 M 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. Cityrrown 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 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® 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-3113. 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 'r 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,. provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms (actual): 5per affidavid DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5,ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Bedroom count says 4 on permit but there is an approved affidavid from 1993 approving 5 bedrooms. the system consists of a 1250 gall tank d-box and 2 pits Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: limited water usage only one person living there for past several years. Sump pump? ❑ Yes ❑ No Last date of occupancy: currently occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts rz Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 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 �M 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1986 per permit. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1250 Sludge depth: light of moderate t5ins•3/13 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 M 121 Lovells Rd Property Address Ginnetty ' Owner Owner's Name information is required for COtuit MA 6-9-18 every page. CityrFown 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 Scum thickness clumping light amount Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was pumped a little over 2 yrs ago I recommend pumping at time of transfer and every 2-3 yrs there after for maintenance. 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-3/13 Title 5 Official Inspection Forth: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 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above.outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box looked typical for its age with some corrosion but was functioning at time of inspection. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): The pit closest to the drive way was opened and was empty at time of inspection with some staining 18 inches from pipe invert. I Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form: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 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ' 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every page. Cityrrown 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 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 w„ 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every 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: at least 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: design plan by All Cape Survey 12-9-1984 Before ding 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 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 Lovells Rd Property Address Ginnetty Owner Owner's Name information is required for Cotuit MA 6-9-18 every 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 ' .x ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file } t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Pagel of 2 LO AT I P1 4F,{ S F..W A G E PERMIT NO. V1.LL.AGt t11STALL[VS NA04E L ADDRESS b .Lw.ri A UILDEU OR O$VPER lUQQ1'-� T DATE RRMIT ISSUED DATE COMPLIANCE ISSUED i 5310 o tD http://www.townofbamstable.us/Assessing4Wdisplay.asp?ma-par=025052&seq=2 5/14/2015 May 6, 2018 From : Annette Ginnetty 121 Lovell's Road Cotuit, MA 02635 To: Town of Barnstable Health Department 200 Main Street Hyannis, MA 02601 Subject: 121 Lovells Road Cotuit, MA 02635 (Bedrooms) On a date in 1993, my husband obtained a building permit to build an addition onto our home located at 121 Lovell's Road Cotuit, MA 02635.The addition consisted of a 15t floor bedroom making the property a 5 bedroom property. It is my understanding that this was approved by the Health Department and Building Department since the Field Card reflects a 5 bedroom property. It is requested that the Town of Barnstable records be changed to reflect 121 Lovell's Road, Cotuit, MA 02635 being a 5 bedroom property. Respectfully submitted, Annette Ginnetty 121 Lovell's Road Cotuit, MA 026356 (508)420-0391 �I .ssors office(1st Floor). d as yQ So2 — EINSTALLED IN C®MPUAN T TN[T ,ssessor's map andiot number WITH'T11'LE 5 Conservation(4th F or): \°' i1-13 ENVIRONMENTAL ®®E Board of Health(3rd floor: TOWN REGULAT13® ssai�r�nta Sewage Permit'number .o ru• Engineering_D,epartment.(y3rd floor).- �o ror►� yn. -dr, House number,,.` Definitive'.Plan Approved 0y Planning Board 19 APPLICATIONS PROCESSED 6:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN7 OF BARNSTABLE BUILDING INSPECTOR APPLICATION:FOR PERMIT TO APO r f lu �iG/" � � r TYPE OF3CONSTRUCTIC 6X)0,0P - ! 19 S '3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1a1 �o vr�l� (S /z a C&7—y e Proposed Use 19)�—;/'y Zoning District Fire District CO TO I T � / F. (7- c, Name of Owner A0 � Nsf-%Ty Address I dl k° yv'c ll S /Z� Name of Builder S/9 ✓14 VE Address Name of Architect 5 V4- Address Number of Rooms Foundation Exterior W cam0 S/f i N�f�f Roofing Floors H04 fl-pf°C D Interior Heating Plumbing PP Fireplace Approximate Cost ��D Area f rLO Diagram of Lot and Building with Dimensions Fee yf 30 109 a 2 CLOSET C L05er 21MIR t vi may, a S ® X B Z� •,'m c >fc 38 Z �k LL 7/ >K 36 20 yl r Aw too rL arc,, M WYC Commonwealth of Massachusetts r10 -o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 _— every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the 11 computer, use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 508-420-4534 S14297 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 _ 5-13-15 Ins c o t 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 cond' ' ns at the time of inspection and under the conditions of use at that time. This inspection does n dress how the system will perform in the future under the same or different conditions of use. I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every 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: ® 1 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 APPEARS TO BE ORIGINAL ONE OF THE PITS WERE OPENED AND FOUND TO BE ABOUT 1/2 FULL WITH NO SIGNS OF FAILURE STAINING WAS ABOUT 28 INCHES FROM THE INLET INVERT. FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE CAN NOT BE DETERMINED B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f 1 Commonwealth of Massachusetts 4 Title 5 Official m Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �t a 121 LOVELLS RD M y+ay` Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every 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): ❑ 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 , 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA • 5-13-15 every page. Cityrrown 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 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins;3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every page. Cityfrown 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 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate ' regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page.5 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every 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): 5 Number of bedrooms(actual): 5 per assessing DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 LOVELLS RD Property Address GI NN ETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: according to as built card system consists of a tank d-box and 2 leach pits Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: n.a 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? ❑' 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 Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: MAY 2015 Date Other(describe below): General Information Pumping Records: Source of information: debarros septic Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined' ' tank size Reason for pumping: maintenance 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•3113 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 121 LOVELLS RD Property Address GINNETTY Owner Owners Name information is required for COTUIT MA 5-13-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: appear to be original Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: • years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: moderate 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 w 121 LOVELLS RD Property Address GINNETTY , Owner Owner's Name information is required for COTUIT MA 5-13-15 every page. Citylrown 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 Scum thickness moderate Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? wooden pole Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank looked typical for its age with some exposed aggregate, no leaks, 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 I Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s•'y< 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity; liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): } Dimensions: Capacity: gallons i Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 ofk17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every 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 0" Comments(note if box is level and distribution to outlets equal,'any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): the pit closest to the drive way was opened and had slight staining at about 28 inches from the inlet invert pit was about 1/2 full Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privylocate on siteplan): ( . Materials of construction: Dimensions Depth of solids 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 ' ' Commonwealth of Massachusetts Ij Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is required for COTUIT MA 5-13-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately Y . r 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 121 LOVELLS RD Property Address GINNETTY Owner Owner's Name information is COTUIT MA 5-13-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: greater than 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: property sits well above level of pond way in the rear of the property 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 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 121 LOVELLS RD Property Address GINNETTY Owner Owners Name information is required for COTUIT MA 5-13-15 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D,or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3r13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 ofri7 Official Website of The Town of Barnstable -•Property Lookup Page 2 of 4 Sketches Map/Block/Lot:025 /052/ -Use Code: 1010 AS-1F DI MT �, 13 20 D 16 34 43 16 1 16 _-24 FUS 16 2 B;T 4 BAS 1 8 GAR 2 16 24 ' 50 AS BUIIt Card s:Cllck card#to view:Card #1 1Card #2 1Card #3 1 Constructions Details-Map/Block/Lot:02S / 052/'-Use Code: 1010 Building Details Land Building value $298,800 Bedrooms 5 Bedrooms USE CODE 1010 Replacement Cost $339,521 Bathrooms 3 Full+1 H Lot Size(Acres) 1.34 Model Residential Total Rooms 11 Rooms Appraised Value $244,900 Style Colonial Heat Fuel Gas Assessed Value $244,900 Grade Average Plus Heat Type Hot Water Year Built 1986 AC Type None Effective depreciation 12 Interior Floors CarpetHardwood Stories 2 Stories Interior Walls Plastered Living Area sq/ft 3,744 Exterior Walls Wood Shingle Gross Area sq/ft 6,825 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Outbuildings&Extra Features-Map/Block/Lot:025 /052/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value BMT Basement-Unfinished 1920 $33,700 $33,700 BRR Bsmt Rec Rm- 320 $2,100 $2,100 Average FPL3 Fireplace 2 story 1 $4,400 $4,400 WDCK Wood Decking 585 $8,500 $8,500 w/railings GAR Attached Garage 576 $15,100 S 15,100 Sketch Legend Property Sketch Legend 132N Bam-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished)FUS Second Story Living Area SPE Pool Enclosure (Finished) BRN Bam GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) hftp://www.townofbamstable.us/Assessing/propertydisplayscreenl 5.asp?ap=0&searchparc... 5/14/2015 : Assessing As-Built Cards Page 1 of 2 LO A4 ION 1.?114114.Za���-r'�( S WAGE PERMIT NO. 9 .7 L0&E s ,ea. VILLAaCk Cm?'u,. 7- "It S T A L L E R'S NAME A ADDRESS _L^2 6� r1m�i9ctlCe�y� S 62.. Y1 -4UILDER OR OWNER 45. v L G/ w F T y DATE PERMIT ISSUED DATE COMPLIANCE ISSUED C��a i 3 3310" �� p 33io 4 1 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=025052&seq=2 5/14/2015 1 42-1 %,k COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION W t 1�1�� R�C� f��AP' ` O zT o� 2 0 2��4 PARCEL. � J�N 3 LOT 1oWNEP�THOEP� TLE 5 OFFICIAL IN N FORM—NOT FOR VOLUNTARY ASSESSMENTS - SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner's Name: PAUL GINNERTY Owner's Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Date of Inspection: 6/3/04 LOPY Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT 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 Tit e 5(310 CMR 15.000). The system: X Passes _ Conditionally a ses _ Needs Furtheq Ef aluation by the Local Approving Authority _ Fails i Ins ector's Si nature: Date: 6/3/04 P g I The system inspector shall submit a cop this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. Ie system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall sub it the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent tlo the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING_ EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Incnactinn Fnrm 6/15000(1 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a r Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged'SAS or cesspool X Liquid depth in cesspool is less than 6"below in or available volume is less than ''/z 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 nLa. X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.l NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or 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 appropriate regional office of the Department. ' d r f, Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal.systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] S Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available(last 2 years usage(gpd))::a�©—c' .�� Sump pump(yes or no): NO �? Last date of occupancy: n/a 0 COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 18 YEARS PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage, etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no):NO(attach a copy of certificate) Dimensions:H 10' 6" H 5' 7" W 5' 8"" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 2" 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: 16" 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 AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEMS USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 f Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) i Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) r Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a M R Page 9 of 11 • 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.DID NOT EXPOSE PIT D.PIT C WAS HALF FULL AND STAIN LINES INDICATE IT HAS NEVER BEEN MORE THAN HALF FULL.BOTTOM IS AT 10 FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Q Page 10 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM / PART C SYSTEM INFORMATION(continued) Property Address: 121 LOVELL'S ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide.a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. n1 0 a J AA ��0 ro 3 E Z iv C 3� 10 POD L�S f Page 11 of 11 L � OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 121 LOVELL'$ROAD COTUIT,MA 02635 Owner: PAUL GINNERTY Date of Inspection: 6/3/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. i kiegroOA's per —,m.1gyI '��j �c M h�,.,oy a d� °�(��Zo� `8 s Egg3, �, � �^'u"" � �('3" i-.S�G�• �� s/,Sys 01/42,lC73 40 12 J:� N�Is 8na�s� 1 1 Lom I s (Rood, LU CAI ION' 5f, WAGE If P10. � ( vILilAG A _ �6zu IftS ? A LLE3'S NAME: I ADDRESS hn .rove- Yi a U f L D E R OR OWM ER DA3 E CDM-PIAA NCE yS5UED� a 33io" 33 io f . No.__ 1�$vp Fps. .�..v�.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - rcv -----.OF............. ApplirFa#ion for Bispao al Warks Tnnitrnrtuan rantit Application is hereby made for a Permit to Construct (L< or Repair ( ) an Individual Sewage Disposal System at: .3 ..... _.. .._---..._•..................L—�­.---- O ./�?_.�..�fa.t�11. -----...--------------•---------------------------.....--•---....._....-•------- 1 Location-Address U or Lot No. __ -............................. .......... .-•----•••-••--•--------..._.._..................--- •--F A y�,, ................................Address Installer Address ¢ Type of Building Size Lot.58_;_S`_2=.Sq. feet U Dwelling—No. of Bedrooms_._......_..4................ _Expansion Attic ( ) Garbage Grinder ( ) ►-� 9L4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------------------------------•---•......••----•-••••......----••••••--••••-•-•---•----•-•-••-•--•-•-..............-•-•.-•-- d W Design Flow............ _______________________gallons per person per day. Total daily flow............".o..........__..._.___gallons. WSeptic Tank—Liquid'capacity/2so.gallons Length-�4.- _._ Width_,'- .... Diameter................ Depth_2. '7._. x Disposal Trench—No. .....�........_ Width.................... Total Length................... _ Total leaching area....................sq. ft. Seepage Pit No........2___-_-- Diameter... Depth below inlet. .f'.7...... Total leaching area.:'`9_(6._._sq. ft. Z Other Distribution box ( V) Dosing tp4k ( ) N - `" Percolation Test Results Performed by...... {?CT ! .,_. __ _yE.................... Date..427k.—.t6l............. Test Pit No. 1_.".z_____minutes per inch Depth of Test Pit--- ...... Depth to ground water____________ ________ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ;; '�-----------=-----------------I............................................................................................................................ O Description of Soil....4__.7.. f�Siiif cS OlL_••`• x v W 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 iITL LE 5 of the State Sanitary Code— The undersigned further 4grees not to place the system in operation until a Certificate of Compliance has ssued a - Signed--- -• •----- --. .__ ................................. -f----- -��-•--�-- Date Application Approved BY -- .............................. .................................. 1 Date Application Disapproved for the f oll ing reasons---------------------------------•-------------------------------------------------------- ................••--•••••----•-•-•-•---••----•-••--••----._........•-----•---•-••--....•••-•---..........._...................--------------•----•--•-•-••••......-•----. ............................... Date PermitNo......................................................... Issued-....................................................... Date LAND SURVEY AND CIVIL ENGINEERING ASSOCIATES ALL CAPE SURVEY CONSULTANT LAND SURVEY AND LAND USE DESIGNS 172 EAST FALMOUTHiHIGHWAY EAST FALMOUTH, MASSACHUSETTS 02536 PHONE 548-4255 CHRISTOPHER COSTA P.L.S. September 8 , 1986 ti .- TOWN OF BARNSTABLE Health Department P.O. Box 534 Hyannis, MA 02601 Ladies & Gentlemen: RE: Paul Ginnetty Lot 3 Lovell Rd. The area around the leaching pit for the above referenced lot is of sufficient elevation and grade to prevent run-out and conforms to the plan on file. - If you. hove 'any questions, don' �itate to call me. FIF CHRNTOPl' I fJ With kindest regards, C s g , OSTq Ch 1 to er Costa, P.L.S. ���19 of�Assa J. JAcow �. NO.814 . y ol ATE � Y �0. `���/YAL SAN��P John Jac` , p gs 4 al Sanitari � 6JI" _ . CC:ko 10 E91� CC:..-J Jacoby1 C • t No....... ............ .........5.q. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /t?ff-/a...............OF.............. 1 l� -CJ-4 A2,4 15 7�.�l AplifirFa#ion for Biipuaal Works Tomitrnrtinn Prrntit Application is hereby made for a Permit to Construct ( +-Tf or Repair ( ) an Individual Sewage Disposal System at: - - .......................�... ........ •--••------••-•••-............•---•- //'Locaattioon-Address or Lot No. ...... ...I.. .. ....------•----.------ -- --•-•-----------------•---•---•--..-------- ......--------•-------------------------...._" ...................... ..___.... O ner Address ... Yf9a r /1 Installer V, Address Type of Building Size Lot.- _, �--Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QIOther fixtures . -----------------------•---•-------------------------- W Design Flow................�................. ...gallons per person per day,. Total dailyflow...... /.0....................gallons. WSeptic Tank—Liquid capacity_ :�..'�gallons Length._&.-'��PWidth_�__'_Q.. Diameter................ Depth.�.._ x Disposal Trench—No....... ......... Width.................... Total Length....._............._ Total leaching area....................sq. ft. Seepage Pit No_________ _________ Diameter.... �_--------- Depth below inlet_ ._s...... Total leaching area...1` 1?....sq. ft. Z Other Distribution box ( /) Dosing tank ( ) '-' ,''•`-ti•Pgcolation Test Results Performed by.._..._ -!•. k ..... _ 'f�:. - � -------- Date.-----••••• --- ............ aTest Pit No. L..:' :.....minutes per inch Depth of Test Pit-__z i.�..... Depth to ground water............ ....... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------•----••-•----•-••--......---•--------.......-•--••--•--------•-----.....---•---••-•-----.......-----•---...._.:......---- Descr>prion of Soil--•--• ..•..... .•. ............................ ----...---•-•. ` x W ----••----••------....••-•-•-------•-------•--••••--•--•-----•••••••--•••••-•••••-••••......-••--•----•-•----•---...--•--••••---••••------•-••-••-•-------••--•-•••-----•---••••-•-••••-•--....----•... UNature of Repairs or Alterations—Answer when applicable............................................................................................... } 'J Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Com fiance has ssu " r h lth._ _.. __.. Signed--•• ._..._......•._---- ....._.._ .. ---------•-•--•..............:.. ApplicationApproved By.................. ----••-•----••--�•. --------------------•---------•- ........................................ f f Date Application Disapproved for the f oll ing reasons-................-----------------.-------------------------------••••-•-•-•-•......-------...............•--- ..................•--•--•---..•.....-----•--•-•----•---•-•--....-•--•---------•-------......-•---•------. ........................•••••................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH ............1......��' ' '/......OF............... 1� ..... ...... Tntif iratr ,af T antpliFatta THIS IS/0�CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) tole has been installed in accordance with the provisions of TITLE 5 of The St Sanitary Code as describ he application for Disposal Works Construction Permit No.__��__-_..__..._h?..... dated-.--------- 7.. ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION. . ATtSFACTORY. (1 DATE.................................. ........................-•----••....--- Inspector....... '` --........-•-•------------------------••......-----•-••-•-•... ��IFs2v5 TH€ COMMONWEALTH OF MASSACHUSETTS �����F�t Prop�sPA G � r BOARD OF HEALTH o Awj4y4ivvn ..........................•••••............••...... o� 6 ............................... .....OF.............. .f�.. ....... a No...............S s—........� FEE....................... Permission is hereby granted.......... .........:.:�......... ..... ' ( ) r Repair ( ) jn Individual j ewage Disposal S stem at Nonstruct-----•---•-oL. i--.......�. ....---`'O-v'a- _ 0!4_-r-) . -•�•T--it, Street 41•S—1 1 6� as shown on the application for Disposal Works Construction Permit No.... ........... _ Pated......................................... -• . ..... -••................................... oard of Health DATE---------' /1a � -------_------_--------FORM 1255 HOBARREN. INC., PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ............OF.............: S.T•�([3L C- Appliratinn for Dispugal 3Vvrkv Timotrarthin finnfit Application is hereby made for a Permit to Construct (VT or Repair ( ) an Individual Sewage Disposal System at: ......L U,— J LU V .5 G.- -•v..1 �_-.-.----•-•.•-.•-•-•-_-_.__ -_..-_--- �_ =-.. Lotion-Address or Lot No. .__.••••-• r- t C�car1uFz_�_.y__.._.._._.-•-•••--•-----• - -----•----•--_.._.._-•-•-••---•••---•---- :ner - ,.- a ...-...---�. nstaller. � ?r ;v-..... ------ ----------------------•--------___--- -Addr-•-•------------------------------------------------ p� Is ress- U Type of Building ��11 Size Lesot_5�,,?,,_? Jt-Sq. feet Dwelling—No. of Bedrooms_____________I___-__-___--_-____-_--__--..Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building -----_--__--_-_---__---- No. of persons............................ Showers - ( ) —Cafeteria ( ) Other fixtures ...............---------•..................... -----------•--------••-------•--------••---............................................ Design Flow-•-----•-••-`�'S-•------••---------_g P P P �`. W g gallons per person per day. Total daily flow-_._-_._.._1-.'�z''_�_____________________gallons. P: Septic Tank—Liquid'capacity�Z_fQ-gallons Length_Z6�_-0_. 'E '' W Width_,?..: ..--Diameter................Depthc__---7. x Disposal Trench—No-_---�--------Width___-_- -----___Total Length.............-......Total leaching area__--..............sq.ft. Seepage Pit No---------- ___ ----- Diameter. --<=----4._-__ Depth below inlet_-J_::7......Total leaching area-:-1_`1_G:z___.sq.ft, H Other Distribution box (1/) Dosing t* ( )_ ,� ff - i a Percolation Test Results Performed by--.__.t--flC_7-.C� .f�(--y _•••-•_-•_----••--. I <2 -•-_._._.... Test Pit No. 1__ _____minutes per inch Depth of Test Pit__�_l--_j-_-____ Depth to ground water--___:--...______...__. G=, Test Pit No. 2----------------minutes per inch Depth of Test Pit_____...___.._______Depth to ground water------------------------- 9 ------•••---•------•-----------•-•....................._..•--•---------•----._...-----•--.._...• o - Description of Soil.... fl�iu/K1 �`]jj�il7. W U ..........------••-----••--••-----.___..._..---.._...._.._.__...----•-•-------....-•----••--•----_....-•--•--_.__.---••••----••-----•••--...----- x •----------------•--------•-••••----••------•-...........•--------•---••-----------•-•---•-•----••------••----••------•---------•-----------•----------•-----••••-•---•••---_------------------•-- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------ ._._._..••-------•---.................................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further 4grees not to place the system in operation until a Certificate of Compliance has 'ssued Sign ed__ ...... •-__ Application PP lication Approved B y------•••--••---- a Date V ...__ .. ........................... -----••--� Application Disapproved for the f ollo ing reasons____________________ Date __.._.-•.................•-----•-.__.•--••---•-•-._-._.._.__._..__....._.------•------•---....---_..-----•----••-----••--•-----•-••---•----- Date PermitNo................................-•----................ Issued_...........................-- Date THE COMMONWEALTH OF MASSACHUSETTS �l // BOARD OF HEALTH 1...... "✓.......OF................ .......-..-........-.-..-..-.--... der Sfax � of (ComplitInrr by_THIS IS C Rb TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) .......... ---fn-� / fta er has been installed in accordance with the provisions of TITLE 5 of The Sta Sanitary Code as describe he application-for Disposal Works Construction Permit No.--_c�� -.--_ :-. jb- dated.._.-____- '•'T14E'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ATI�FACTORV. DATE.......................... -� .. ....I_.._ __:�-----------.... Inspector..... •-•- -EN6,N-CCi? vlAvS� THE J-,OMMONWEALTH OF MASSACHUSETTS r,Fy Arp/�seti Gf�4D£ £(O AwAv-Foy., p_- 1 t BOARD OF HEALTH a S- !bq ...........................................OF.....................- No.. -_.----•-----•- r Z?�-- ............. FEE._- Niappou �rkii Tang d rt Fimmit Permissionis hereby granted____-------____ __f--------------------------------------------------------------------------------------------------------------------- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. -------•-•-------- Street � S-)l(�' as shown on the application for Disposal Works Construction Permit No__ _________��ated,"_•-------_--.------------------------- ----- �� DATE_ / }l � -..-.. .. Hoard of Health -•-------------- -.-__ ,.. ,ORN 1255 HOBBS & WARREN. INC.. PUBLISHERS .:...,,..a ..zaesaWGrYb.v+�wwa�v.;wei.YYaw:.:...:.-.:iww.;.w:„_.:.;a.::Yourir.«.-�ww.;:a•::s.,...a.. ,.v.�.._s...w.ww.�.m:.aY2.,Lusa ,...;,-nt.,a+�.�.s.....:d:sw.:.,� a+.,,TM..Y s.4 e.+r�adua: ::z ,.. ,• r+an•-lr..»,w3., 1 Jow VaL 'S P 0&,�) 4 / A vR EA T PONG NON TIPA. L l t T �f oo -. - { `. 5 Lar i O IL �•� Y' � �N,A1�,'i Y .M . r£l.E. POL,F. C3 .1T LOT 2 v / q°r A x c� `' oaf __• �/_._..�.,,w �r C36 IiIIST�}L_LE'l� :�,/ -r•�r. �C} �1� � `'��� J PQ 1A/(7 CF 4 PROP. SPOT E-✓Evtom- EXIST. SPOT EL�'V = 3 7x,3 PROP. CONTOUR = y 1 EXIS r. CONTOUR -.-xawtsrsauuxi. 3�w.TC"r:}3:Y?,..v�ma+.a..w.•ay . wsec+✓!k?�akAF�a=•Fstl�;da.trcMFf :•nk�alw,ea+,::.t#.4xc+a.a:.:��Y�:'l•Sw.,..,,,+.w.�.r ?aa.. Y...x.;�.'�e nrB9a19Giata+ar"RXwxra.rw3£is.YiK�16i6+iSG�HBa'�. ...� •SArapyt'.awdKaV&f0h.+'Wr.,.,?m,<.arw.a._�:"rAwG.ik�.rdixu:�da9Ul cxnCel7�fs+dG•�'MhM1:�a'iiir..x+�4nns¢'da+E%7.vd9„u'«xaPwxk,�.,...„yYr�%Kaa; i.: . Ce7,i N)v ErT,Y IHt.ET KNOCKOUT o a d 4 10 1 � -• :� i/-� r • - OUTLET �» I �•\ ' /' _ 24^ .'• i �7 iTk i } 6 X 4 D ye` r�t... •i r .. 1 ( 50_ 'K it S+'-!� .r'LI/ +�' 1'�y, t ' •o`er `o T i � c- i i " '~ } I } 1. - �'. :._... w ' � ...� • n Q e . • J� - / Q • ' I p Op h � 00p e _ 00 o �OOOO ° O ° o� r0P �C'L� = DE' 1,45 o a a �,��..1✓ ,�'1�,�4C� SYSTEM ,�Rt� / rApr� _. o � � `V�� _ 00 Qo o � 0 p Q O -- o rev/5t-1 Gp"A r ___�_X5 �"/A-,IA l rr,04APE ;.o O o 0 o O 0 4�E /k _13x 9 C�G/F� t�"� 0 X . 9'1 x 3 U l�E_--R L SAC�/;�?'7 , '� Q op � QOQpo © O d� e;,; r 1 g 0 O O O O O O O r i < rH�r._ �i -rl ��� ;.r i. i `�� ✓� - : r� � ,��, i �. --_ _ — _. r- t Cj 000 G 0 0 �.: C- c—L E, I(J 4 MCA �`/L L_ C) O O O Q O �z 3 -A ST!Itl� d pa *pdWW so OO 4 3 ' f -- - - _. _._ .�;^�- �� ~ - I , I t � • ,III _ . .. USE 2 Sl�O�' T' P/Ts 4 1 x83 ,.�' 0 '0 4 0 0 m C� � O O C C I -- � 4 s U/�,T-. E3�x ,, Q 0 0 0 0 © 0 G� C © 0 0 4 0 ' �QUO _ rx � !� fl4 0 0 0 0 0 0 0 0 0 0 01 • ___ LEVEL 3G ;li00 0 0 0 00 0 0003; I �!x 4 BOTTOM d 00 CO © Q 0 0 0 �AS�SiEA��i 3 4 �J 0 C - 9 0 0 0 i, I 0 0 ^ w f� C, 0 0 0 0 it . GENERAL NOTES ;r .�1�G S LcaGS `r P/T / /. ,4LL. EZ.�V,471G�A15 -51-VWN �4R,5 b `� � � " :I �` 0 0 00 �'? G� 0 0 0 0 a, ?! !� � ,.4Ss c/ME'D. To P ii; ;' 0 0 0 0 0 c 0 0 0 0 J; } JI ,r 't 11 2, ALL ,�'/i�'�s �,c/ THE SY �M �"o B� 2.1 USE SHORT P1 Ts_ L-A S rl-POel/ 4R .S6-1-16 111 E -40 L't!C. Cc.E�a,v ,. - - OES/G N CR/TAR/.4 MADIUM 9,�EU2FAT,44 Ty /1t/j-E4T.ELS:VAT/DN ,5,4,vp �t/UMBEe4' ©�B�G7ROD�15 � E E S HE�"T Z .�.� ,4',aD/G'S Q `A tIZ? BA4f A;'�/L L PERSO�t/5 �'��P BE,O.�c'OD; ? .. _ CLE,�et/ C"DAk' E 6-1,?,41 UL.Ark A-1A r 'Al_ Lz4/L Y FL.O lit/PER dt t. R501111 Ss ,¢. 8,9,e AJ,5 TA 4C34A7 RG)Dc /SEAL TN 144 3Zt'8 ,vo WATE4 l-//il/G PROIy'/I..�ED G 9 00 _,vo LE.4C I3 Y X7'El2 Nye � T/DN Cam' 7-0 BA r �"AGCUL A S B4Ch',�/LL/1VG ,CDR R . G/FFORO f3OT7V," = y�>.,-j - = /�/3(4Ca z—o 5. CJNL.E55 IV0T�D ALA_ BARA/sr.48cF' 450A1?0 Ac AiZ:ALTN _SvSTEM COME'DrVE;�,�TS St1,A1 z- f3F ,1.�4TETST.�D : P . b� i���►_ CA��©tip- �� �5'y= _ W/T!� APPL/CAA,lT PAW, G 1NNET T Y �'RO SED DWEL L IA16-ZOG4 7/011 trG'h�/l�r r' MA Y BE APPL/CABL F PROG'Ca 5Ec't��icE S YSTEM�OCAT/©N . Tim/5 L aT/S NOT/1l/ TN.E / ' 000 A A1A/''-` I LOT 3 40VELL S ROAD 7 A CARSA6& G RIAIOER W11-4- N0T'F55� /A15T/aLLE0 ON TH,E 5y15TEM. BARNSTABLE tCOTuIT) , "A 55. L�G !D SCAB �^ '90 , .%?A7 � ' DES. 9, 19 al 4214?A �+ a .,. i , w,�, rJR��t%e',1 B Y:D.D. Ch��C,�l�,�' B�'': � JD,.,�3•'tfD. r Pi r IZIIZ185 P. r' ,�-y.a;; � ;�aU, ' _ '� �►' AL.L CAPS 1 '61Rkl,E Y C'O/V-5 7A N T _ rZS GAL s•7' '; /w L T� //f � SAL. A .