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Home My WebLink About0160 MAIN STREET (COTUIT) - Health 160 MAIN STREET Cotuit A = 023 — 067 TOWN OF BARNSTABLE LOCATION &0 M A l PI 96-1 , SEWAGE# VILLAGE COTO l T ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 000 CA'L LEACHING FACILITY: (type) LICI— 10 0 0 (size) Frr— l OIJO 6A-L NO.OF BEDROOMS OWNER it ➢ �'' c P�ILTj� PERMIT DATE: COMPLI NCE DATE: 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 A, oS r 4 Z T3 3 �-o -o TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE r. i�� ASSESSOR'S MAP & LOT 6 Z!2 Qf? INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fe t1of�leaching facility) Feet Furnished by l✓ �/ V =I- Commonwealth of Massachuseft Title 5 Official Inspection Flo M Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 60 Main Stree t ---------------------------------------------------- ------------------------------------------------------------------------------------------- --------------------------------------------------------------------................ ------------------------------------------------------ ------------------------------------------------------ - Property Address Owne I r David - . McCarthy-------------------------------------------- -- -- - -------------------- ---------------------------------------------------------------------------- Owner's Name information is required for every Cotuit Ma 02635 3/31/2011 --------------—------------------------- ----------------- -------- --- ---------- page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1 Inspector: key to move your cursor-do not James Holler usethe return -—---- ----------------------------------------------------------------------- ----------------- -------------- -—---------- key. Name of Inspector 4L----N Holler& Son Construction Co. LLC -- -.-------------------- --------------------------------------------------- -------------------------------------------------- ran ---------------------------------------------------- ------------- -------------------- Company Name P.O.Box 702 ---------------- ------ Company Address Marstons Mills Ma 02648 --------------------------------------- -------------------------- City/Town State Zip Code 508-420-0280 ---------------------------------------------------------------------------------------------------------------------------- -----------------------------------------... ..................--------------------------------------------------------------- ------------------------------ Telephone Number License Number B. Certification : CD I certify that I have personally inspected the sewage disposal system at this address and.t,hat the,, I; 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-o"n site sewage disposal systems. I am a DEP approved system inspector pursuant to Sectiog,15.340 of Title 5(310 CMR 15.000). The system: M-11 Z. Passes ❑ Conditionally Passes ❑ Fails rn ❑ Needs Further Evaluation by the Local Approving Authority 4� 4!p 4/01/2011 . Ins ector' 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 DER 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-09/08 Title 5 Official Inspection Form:Subsurface 4Sege Disposal System Page 1 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form _ — - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Main Street -------------------------------------------------------------------------------------- --- --------------------_-------------- -- Property Address David McCarthy Owner's Na Owner --- - -me- ---- -----------------...- information is required for every Cotuit _ _ _ Ma 02635 3/31/2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I 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: 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I I Commonwealth of Massachusetts _ r Title 5 Official Inspection Fora _ -- -- Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 160 Main Street --- "0 -...-------------------..------------------------------------------------------------------------------------------------------------------------- ------------------------- Property Address - David McCarthy Owner --- - Owner's Name --- — — information is required for every Cotuit Ma 02635' 3/31/2011 _ - -- - --- ------------------------------------------------------ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form -- --- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments g 160 Main Street y .14y0 Property Address David McCarthy------------------------------- Owner Owner's Name information is Cotuit Ma 02635 3/31/2011 requiredfor every __.......__.......__...........:.... -- ---------------------- ---------------------- page. City/Town State Zip Code Date of Inspection B. Certification (coat.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 | | . . � Commonwealth of Massachusetts rZ ��N �� Official � D ' °=�° �� Title �� y� � ��N�� N�� ~��HrN�� ~ Subsurface Sewage Disposal System Fonn - NotfurVo|unbaryAnsessmenbs ' 180 Main 8tn39� `�. ------------------------------------ Property"""=" David McCarthy Owner information is required for every Cotuit �a 02635 � 3/31/2011 page. City/Town State, Zip Code Date of Inspection B. Certification (cont.) Yes No - Required pumping more than4UnnaainUhelaatyoor NOTdueko clogged or ^~ .~ obstructed pipe(s). Number oftimes pumped: El E Any portion of the SAS, cesspool or privy io below high ground water elevation. � Any po�ionof cesspool nrprivy iaw�hin1OO feet ofoeur�ce water supp� nr ' �� tributary toa surface water supply. El E Any portion ofa cesspool or privy is within a Zone 1of8 public well. El E Any portion ofa cesspool or privy is within 5O feet ofa private water supply well. ��l �� Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from o private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed atmDEPcertified ' laboratory,for fecal mm|ifmnm bacteria indicates absent and the presence uf ammonia,nitrogen and nitrate nitrogen is equal tmor less than 5 provided that no other failure criteria are triggered. A copy of the analysis ' and chain mf custody must be attached to this fmrnn.l Thesystemiea cesspool serving a facility with 8 des ign flow Of2OOOQpd' �� -- 10.000god. The symtammfmUm' | have determined that one or more of the above failure �� criteria exist aedescribed in 310 CW1R 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be ' necessary tu correct the failure. E) Large Systems: Tmbm considered mlarge system the system must serve a facility with m design flow of10.0DD8pdbmY5.O0Dgod' 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 ' ` [l Fl the system ks within 4OO feet of8 surface drinking water supply | ' � E] the system is within 2OU��atributary to 'a surface drinking water supply the system araoUnbahm\&e||headProteodnn �l �l ' ~ "="�"�p . �� Area—IWPA\ 0r8 mapped Zone Uof'aputdk6 water supply well |f you have answered "yeo^ hn any question in Section E the system ia considered o significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered osignificant threat under Section Eor failed under Section D shall upgrade the system in accordance with 310 CyWR 15.304. The system owner should contact the appropriate regional office.of the Department. mm 'oyo Title o Official Inspection Form:Subsurface Sewage Disposal System'Page*of,r ' Commonwealth of Massachusetts Title 5 Official Inspection Form `_-- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 160 Main Street Property Address - David McCarthy..............:...- - Owner ---.----------------------- -_............---------..------------------- Owner's Name - - ......._........... information is Cotuit Ma 02635 3/31/2011 --------------------- required for 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): 3- Number of bedrooms (actual): -3 -- - - DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 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 r y B 160 Main Street Property Address David McCarthy Owner wn-....._....------ -- --------------------------------------------------------------- Owner's Name ----------- ....... ---- ..._.._..----- .-------------------------- information is Cotuit Ma 02635 3/31/2011 required for every ------- -------- --- --........_.__ page. City/Town State Zip Code Date of Inspection D. System Information Description: -.................... ----------------------------------------------.-----------.---------------------------------------------------------------------------------- -..._...------------------------------- ---------------------------------------- __.-------------------------------------- ---------- Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes N No Is laundry on a separate sewage system? [if yes separate,inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 91.8 GPD Detail: Two year total water usage_was 67000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Cur re__- ntly _ _ Date Commercial/Industrial Flow Conditions: Type of Establishment: ---------------- -------------------------------------- Design flow(based on 310 CMR 15.203): Gallons perday-(gpa)--- ------------------------ Basis of design flow(seats/persons/sq.ft., etc.): , ---------- -- ------------------------------------------------------------------------- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: -------- ----- ---- t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts ---- F Title 5 Official Inspection Form _ -- - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments gs 160 Main Street Property Address David McCarthy - Owner -----....----------------------------- Owner's Name information is Cotuit - Ma 02635 3/31/2011 required for every . -----........_........-.... - ---- --._.......-..----- page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Last date of occupancy/use: --------------------------------------..._------:._-......------------------------------ - Date Other(describe below): -------,._._..---------- --- -------------------------- -------- ------------------------------------- ---- _... ----------------------------- -- - --- - - - -- - -- - General Information Pumping Records: Occupant -Source of information: - - Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: ------------------ ----------------------------------------------------------------------------------------------- gallons Howwas quantity pumped determined? ------------------------------------------------------------------------------__......_...........--------------------------------------- -------------------- Reasonfor 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): .No distribution box could be located between leach pit and septic tank, it appears there is no d-box,just plumbed directly to pit. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ - -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 160 Main Street Property Address DavidMcCarthy ---------------------------------------------------------- -- -- Owner -- -._......... Owner's Name information is Cotuit Ma 02635 3/31/2011 --- required for 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: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade-. , 2-- --- - ------- feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A N/ feet Comments (on condition of joints, venting, evidence of leakage, etc.): ----------- ------ ------------------ -------------------- Septic Tank (locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) -- _.......---------------------------- If tank is metal, list age: - yea rs Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon . ------------------__ Sludge depth: minimal t5ins•09/08 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 l Commonwealth of Massachusetts _- -- Title 5 Official Inspection Fora >> Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Main Street _--------......._-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - Property Address David McCarthy Owner ------------------------- ---...----_.._..---__- -- Owner's Name - — - information is Cotuit M 02635 3/31/2011 required for every - -------- - --- ---- --_.._....._...--.._..------ --Ma-----......_ page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 38 inches Scum thickness 1 inch Distance from top of scum to top of outlet tee or baffle 2 inches Distance from bottom of scum to bottom of outlet tee or baffle _14 inches Sludge Judge - ------ Comments 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 has cast in place concrete inlet and outlet Ts that are in good condition, no sign of degradation of the concrete. 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•09/08 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 160 Main Street ----------............._...............----------------------------- ........ .........- .........._..-------------------------------------------------- .-........----------- ..------------------------------------------------ __...... Property Address David McCarthy ..... - --........... .......... Owner ---------------------------------------------------_.. -.-......-- ..... . -------------------------------------------------------- -- Owner's Name - - information is required for every Cotuit Ma 02635 3/31/2011 ---- ----------- - - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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: Da t----e ----------------- - — " Comments (condition of alarm and float switches, etc.): -- - ------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------_'-...... ............---------------------------------------------------------------- *Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No t5ins•09/08 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 160 Main Street --------------------------------------- ----_-----------------------------------....._----------------------------- Property Address David McCarthy_ Owner ------------------------------------ Owner's Name information is required for every Cotuit Ma . 02635 3/31/2011 -- ------ ----------- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depthof liquid level above outlet invert -----------------------------------------...__------------------------------------- -------------------------------- - 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 not present, tank is.piped directly to the leach pit_ Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: leach pit was excavated to check condition. Pit is approximately 60%full at time of inspection, sized to be a 1000 gallon pit with approximately 3 feet of stone per probing. SAS passes with greater than one days flow available space above liquid level. -- -- — -- -------------- ------------------------------------------------------------------- ----.-_-----------------------------------.........-------------------------------------------- - t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts ---------- t itle 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Main Street ------------------------------------------------------.----------------------------------.._----------_-------------------------------------------------------------_------------------------------------------------------------- Property Address David McCarthy _ Owner -- - ...- Owner's Name information is required for every Cotuit Ma 02635 3/31/2011 page. City/Town State Zip Code , Date of Inspection D. System Information (cont.) Type: ® leaching pits number: one, 1000 gal_ - ❑ leaching chambers number: - - - ❑ } leaching galleries number: ---------------- -------------------------- ❑ leaching trenches number,length: ❑ leaching fields number, dimensions: - - ❑ overflow cesspool number: ------------------------------------ ❑ innovative/alternative system Type/name of technology: ----------.----------------------------------- Comments (note condition of soil, signs.of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ---------------------------------------------------------------.....- .............__.._..... - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_----------------------------- -Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Numberand configuration --------------------------------------------------------------------------- Depth-top of liquid to inlet invert ---------------------------------------------------------------------------------------- Depth of solids layer -- -- - Depth of scum layer --------------------------------------------------------------------------- Dimensions of cesspool ....... --------------------- ------------ ofconstruction ..........................----------------------------------------_--------------------------------- Indication of groundwater inflow ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts ---------------------- z Titles Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 160 Main Street ------------------------------------------------------------------------------------------------------------ -- ----------------------------- ------------------------------- --------------- ------------------------------------------- Property Address David McCarthy -------- ------------------------------------------- ----------------------------------------------- ---------------------------------- Owner's -------------------------------------------------------------- ----------------------------- Owner Name information is required for every Cotuit Ma 02635 3/31/2011 ------------------------------------------ --------------------------------------------- ....................... ----------------------------------- ..... .......------------------------------- ----------------- State page. City/Town 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): Materialsof construction: ----------------------------------- -------------------------------------------- ----------------------------------------------------------------------------- ----------------------------- Dimensions ------------------------- --------------------------------------------- ------------------------------------------------------------------ Depthof solids ------------------------- -------------------------------------------- Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): --------------------------------- ......... ---------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- ------------------- ------------------- ---------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ---------------- ------------------------- ------------------------------------- -- ------------------------ -----------------------------. ......- --------------------------------------------------- ------- --------------------------------------------------------------------------------------------------------------------------------------------------------- t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -- �i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Main Street ' -y'y0 _.._.. ....._.._.._.................._.._---.._----------------------_......_..-------------------------------_._-----------_------_------...._------------------------------___-....._.._-___..............-_................._---------------.---...._.._.._------_......_----------_..----- --------__---- Property Address David McCarthy _----------- Owner - - — - ---------------------------------------------------------------------------- ---- --- --------------- Owner's Name information is Cotuit Ma 02635 3/31/2011 required for 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 A ' ig► +►� 2 23 -2 3 33 —to $ T2,, v t 45--o 3 50 -o 3 Z A B t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts 0 Title 5 Official Inspection Form -- -- i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M q5 a 160 Main Street Property Address DavidMcCarthy_--........ _ ......................................-............... --------------------------------- ----------- Owner --- - Owner's Name information is Cotuit Ma 02635 3/31/2011 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: > 15 feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ------------------------------------------------------------------------------------------------------- ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database -explain: see below You must describe how you established the high ground water e.levation: I utilized the GIS groundwater elevation map provided by Barnstable, and compared with spot elevation map (GIS). Groundwater elevation was between 25 and 30 MSL, and spot elevation was 65 MSL. The pit is 24 inches below grade and is 6 feet deep. Subtracting 8 feet total depth below grade from 65 MSL equates to 57 MSL bottom of pit. Subtracting the contour of approximately 27 feet for the GW contour leaves 30 feet differential. Using MIW 28 well information an adjustment of 3 feet for high-GW elevation leaves 27 feet o---seperation.----------------------------------------------------- --------------------------------------------------- --------------------... ----- Before filing this Inspection Report; please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts — W Title 5 Official Inspection Form ISubsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Main Street 1W Property Address David McCarthv - ---------------------- -- Owner - - .... - Owner's Name - - information is required for every Cotuit Ma 02635 3/31/2011 .—— -- -----------------------------------.-- ----- 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 .��v//� `3'T//l 5 ✓ � ZOO( 2P / Gv t0 00°77 CIR sC z (F I C IyOc \2 St 2 \ / OAD <N RI �ra� 0 fWp 'L 'V • aJ0 q _��' o m a A w I/____ _ z \ T�9Y/moo f\ O— �Op— t NJ�.j1P RD MNOOD 4,s7 OJ T ( (o �. / Qa' p? l ♦3," -I j `. .' \l CF Cq CP ` — ,U D \; 0 G GCE aVE T 20y oW S EE KK 1 yR s l� o t_ WAY o ! _ r•..�--- =Y _ �@ _-- Off, -x,— \ -__ .. _— - —�.._ FM r0 \I` // ( \ ( / �' NER A �� \��I �I J/. �,� a t`�)p® - BAY971-1 ��/j�/ JjF' �' R\ / __. ) ...� �/ . N (dot A k ... 1 V • ,.L ' ° TY E SPae j�/� \} 0 1� tir¢ o ✓ �PRo�. e V �Z KENO�E zd /�l'f ) / 1 j 2 i S\�,S rF f - O POINT ISABE \\ i z5 �a y , Ili . ➢ :a F 2 9 Fo OLD _��//�(�� {y �"//�(�� l 3 qcy \J''/x11�! ---J�;�...� �1 A 1Y �/_/-�(�� 9RAR PpsT 0 � � �`� 1 �/ \.a 111111 �.__ 1 �OPO !Fi'X.�� g� '`' X.---J 4. boo J� _�— pOST l i �) l RD _ SCREE � r�, D � BAY o O '.,`�"t • Oar BU W y �O� Q4; COW �_ i m PPSV'` BRiDpE S9j `� WN Sill If BAY Y N o IS ----------- TUN" Fa v RO j WE TERR E II, / � J LEWIS POND '° LFW1 _ o //7� �:. "I1 • C, OOL / - RATSANT 1 X_J �� C Town of Barnstable Geographic Information System April 1,2011 X 65.05 X 64.2 �- X 65.28 X 93 X 63.04 0 ,.�-2 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:023 Parcel:067 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:MCCARTHY,DAVID J&NORA Total Assessed Value:$240300 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner. Acreage:0.48 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:160 MAIN STREET(COTUIT) a ji such as building locations. Buffer � . ....................... THE COMMONWEALTH OF MASSACHUSETTS SOAR® F HE OF .......................... ..... . ............. 7 Appliration for Disposal Works Toustrurtion Vrrutit �10 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at Loca Addre or Lot No. 4-4 J- . • •-- ---------J•----------------- - .........- ------ ............ j�/•��Gr�� er . let, --------•- .._... •—Address -- ------------------ ........ ..................... ...---------•--.�a ---..------. Installer Address Q Type of Building Size Lot.......j___f._______________S feet U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building a' Other fixtures _ o ------------------------------.-N ---of persons---------------------------Showers--(----)--- Cafeteria-(----) d WDesign Flow......:.....................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/ gallons . Length................ Width---------------- Diameter---------------- Depth___.______-__._. x Disposal Trench—No..................... Width ... Depth below inlet........_.._______ Total Length-___-_______-.P-_. Total leaching area--------------------sq. ft. /Seepage Pit No........ ........... Diameter...... ........... De p _._. ..... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosin t nk ( ) aPercolation Test Re�ut�ssPerformed by. _�a_�e�_.__5� �`" __._ �__._._..._ Date__ �Af__ _f ��3 Test Pit No. l___ C)..-.minutes per inch Depth of Test Pit....... _.__ Depth to ground water-------A--------- rZ, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water_____________________-__ P Description of Soil.. `` �.. S � --• • . `-a-C e x ............l ------------------------- --------------------------------------- �-------- U ------------------------------------------------------------ ------------------------------- W -- ----------------=------------------ -------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable.-______•-_--•_________________________________________________________ __________________- ------ -------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanita . de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een e by�the boar of health. Si .......... ---•-------------- - - ................................ ................................ D to Application Approved By--- -------- � ate Application Disapproved for the following re a ons---------------•-•---------------- ------------------------------------------------------------•..... Date PermitNo_...................................................... Issued......................................................... Date r\s v No....q Fes$............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD,'-OF HEA6,TZHI ... . 7 Appliration for Disposal.Works Tonstrn.tion V ermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 �,, �� •----------------------••-•-•-------•----------------------------------------------------------•-- -----••--•------------------------..._..-•----•-----------•---------------------------._...--•--_. ..s . Loca Qddres or Lot No--------- ----- --- owner Address W Installer Address =s k Type of Building Size Lot-___�-�--- .'_.............Sq. feet a Dwelling—No. of Bedrooms.........:.. ............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _____________•__------------ No. of persons---------------------------- Showers ( ) Cafeteria ( ) dOther fixtures ------------------------------------------------------'-----------------------------.-------------------------------------------------- WDesign Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. W Septic Tank—Liquid capacity. . ` gallons Length---------------- Width---------------- Diameter---------------- Depth-.--_-___------ x Disposal Trench No. .................... Width---_----__.-______- Total Length__________ ;..fi-- Total leaching area....................sq. ft. Seepage Pit No........i.......... Diameter....... ......... Depth below inlet___.___ '_4..... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tgnk '-' Percolation Test Resu�t �. Performed by_° .._ }�' ____.Date• ......... ......... Test Pit No. 1:... _ '...minutes per inch Depth of Test Pit----..`."' ._______ Depth to ground water.______ '' _ . �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_.------___--___-_._. W ..._......_. st -sms '®------- O Description of Soil t " ga - _ _ r o K xP ------ -------- . a . �-------------- -------- -------- --------- ---------------------- �., UW ----------------------------------•-----•-----------------------------------•------•--------------------•--•--------------...---•---------•---------......----•-------•----------.-=------------•------- Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------.------------------------- ----------------------------------- ---------------------•----•-------•------•--•------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has` eep�issued by the board of health. " Signed ----------------------- --- ------ - $ ..Date v, -.;.m. Application Approved By < y __ _ �_... � ��'� "3 �� 11 w ' Application Disapproved for the following reasons:..................................... --,--------------------------------------•--•--- Date--••---•------ •-•--------------------------------------•-------------------••---------------•-•----•---------------- Date PermitNo......................................................... Issued.....................-....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH • °t' -...........OF...... ..............................• (9rdif iratr of Tontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by --- --- r? at �9 b 1� taller erg-` ----•---- --• .•-•---•-- -- ,,,4`Sy--- ._C+i�«e9oe�--••---------•-- -••--•-------•--•-••-------------•-•-•-•---•---- --------------- has been installed in accordance with the provisions of Article of The State Sanitary C dyas described in the application for Disposal Works Construction Permit No'.....___.._ } . .......... dated-------- " �..__ ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......red ..... FE �i��al nrk� Cnnn��r�tr�inn rrnti� Permissionis hereby granted----------------------------- ----------------------------------------------------------------------------------••......----•----•----•------ to Construct-p( ) or Repair.(, an.Indiv�u+Sewa� Disposal4.S ste, --- ---- - Street e as shown on the application for Disposal Works Construction erriit No. e ,Dated '.,' `-__ p Board of Health. . DATE Y---------------•-----•--..._...._....------------............................. . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 - �� n �� `� � �' �� = - + �