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Home My WebLink About0428 MAIN STREET (COTUIT) - Health 4!8 Main Street A 022 -013 - Cotuit f 1 1 - i t TOWN OF BARNSTABLE LOCATION 4ag M A W Smzee—T SEWAGE# 195 VILLAGE (:�TU t-T- ASSESSOR'S MAP&PARCEL ,�a f a, INSTALLER'S NAME&PHONE NO.C4QCtye �NTQI �j� �li� "s�7 SEPTIC TANK CAPACITY I,�� C-20"Oos LEACHING FACILITY:(typeK3)3 00 4AL-CgAudgaS (size) t ai g .$ NO.OF BEDROOMS 4 OWNER h'lIC C., ko4�l �C C ke-ebo 4 PERMIT DATE: COMPLIANCE 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) N LA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within // 300 feet of leaching facility) �/� Feet FURNISHED BY /R8o A 4 o E r � y 1 •e C3:3 �p - - >i wALK CP GO 0 .i r: LA No. / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Misp9sal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(,) Abandon( ) XComplete System ❑Individual Components Location Address or Lot No. 142 S uA w 5 T _ Owner's Name,Address and Tel.No. �GEP l U tUtT �l��l- t! tC�7ef�'R1iV� Assessor's Map/Parcel a'3L 13 PA05Pac--r S i W AJ&HtAvi ,4 Installer's Name,Address,and Tel.No. S70 I-169 Designer's Name,Address,and Tel.No. GaaEl�C �D� SES (moo ac L'XiAj3clJU4ff—, r6G Type of Building: Dwelling No.of Bedrooms T Lot Size ` S 8a sq.ft. Garbage Grinder( ) Other Type of Building RE-91.Di5k L t 4 L— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(miri.required) ® gpd Design flow provided �5 j; gpd Plan Date (per a `�Ql Number of sheets Revision Date Title 4A2 HkW 5-T CICT.dt 7- Size of Septic Tank Type of S.A.S C`3) SOD ��-CX-60 C 6 Description of Soil Nature of Repairs or Alterations(Answer when applicable) :M57)ft.#__ lU&,C-) 15&0 1�- -C(-&j W til e_) W-a-U b-190C ID 63 j 5,00 a4t�Lo1J V-.10 C44iQfias w crt4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions.of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He th'� Si ed Date Application Approved by Date � ! CJ J Application Disapproved by Date for the following reasons Permit No. p�J D 1 5 Date Issued ' `,mot:......,r.,,. �^r.,*.r..fa'-r...n '`. ....+`��— .FT- �A M. 'tifr..�K�yu. y,•r' J a.. 'Iw"s _ ,_ - No. ., Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABL�E; MASSACHUSETTS Yes 01pplitation for i8 ,w p8t>Q11Y Construction Permit Application for a Permit to Construct( ) Repair( ) %Upgrade(k p X','Aliandon( ) [ Complete System ❑Individual Components IN Location Address or Lot NoA 642$MA ? Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Chl ��6 �'a,4Pa2(SES. �p -7c. ER•IG—l�V -�r�i�. GOp�itr 'T` �-1 14zS � :a� �tl �•Ga.b4R,� Ty. pe of Building:. Dwelling No.of Bedrooms 7 Lot Size S 8 sq.ft. Garbage Grinder( ) Other Type of Building � �[ Z t�j,r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4140 ..„.,.,.gpd Design"$ow provided ��5. gpd Plan Date�4V a l 'SDI Number of sheets ' Revision Date Title 4AR l`� mw i5 <2 7p I r Size of Septic Tank (�bQ Type of S.A.S.( ) sop rmk(, L) c'1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) /S7W�-(S4CLDJ)1j p'1(L Zip« - }14�6og). G-4-X0 1)--Uy, 175 (A)!!A�"5*00 A*u_w fd-01a :en4m& g S w r iTt( Date last inspected: 1 ; 5 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage;disposal system in s `. accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has beAlissued by this Board of Health. f / C Signed Date Application Approved by *. ( Date 1_� . Application Disapproved by Date . for the'following reasons Permit No. f "'' Date Issued �o13, c, 0-,d `? 1 bsk $ THE COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �)t� Upgraded,( Abandoned( )byS ' - at 4:101ru LT has-been constructed in accordance with the provisions of Title 5 and the for Disposal System C nstruction Permit Nv.°-./ — dated Installer A P62e l if _ Designer ��!U 2L1 =)U G #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system ill funs id— esig ed"'" � Date '11 f'pl Inspector No. ( Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nsposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(;K) Abandon( ) System located at VN CoTtj j' F f. and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:'Construction must be completed within three years of the date of this permit. Date 1"wy lc.� �J Approved b�y.. _ I Town of Barnstable Regulatory Services a8tie, 't Richard V. Scali,Interim Director L63 � Public H alth Division Thomas McKean,Director 200 Main Street,Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508.790-6304 Instatler& Designer Certification Form / Date: "9"�� Sewage Permit# AD1�~l�5 Assessor's MapTarcel Z Z Designer: 'SG 1 , Tric., Installer: GQ e.wfk LnF-cr rfse5 Address-, 2t5y Cxbn�otrrj 4j#wai Address: i55 Coonmcrctol Sp(ee,+ Ea3i 1Uor6".4, , Miff a25Z) e-e. 02.(4 On j�-25- ,2019 Ca ewicle ✓✓ftiu ffseS was issued a permit to install a (date) (installer) r septic system at �2 !"' aiy1 -S+Q_ ' based on a design drawn by (address) C eoninuxtn 7riG, dated / (designer) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' e with,the terms of the I1A approval letters (if applicable) ,��A° Mqg� JOHN L N� CHURCHILL Cl (In alter' Signatu ) NO 1887 o�o�Fp Is I igner's Signature) (Affix Des' er' amp Here) P SE RETURN TO AIZNSTABLE PUBLIC )H)EALT DI SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUMT CARD ARE RECEIVED BY THE BARNSTA13LE PUBLIC HEALTH DIVISION. THANK YOU, Q:\5eptic\Designer Certification Form Rcv,8-14-13.doc l d 6W 'IN W Z :6 81H '6 ��d Town of Barnstable P 1# Department of Regulatory Services 'sry a Publiq_Hea':.th Division Date S MJ" is3p �� 200 Main Street,Hyannis MA 02601 pW,S rEo rrtx+" �i • � r ,..ua Date Scheduled_ / 0 Time Fee Pd. Soil Suitability Assessment for S e Disposal Performed By: �ChCeQI _i i i'I'►M4 I -El '; (�E . Witnessed By: LOCATION&.GENERAL INFORMATION , Location Address Owner's Name t S-r c� T M C Ctau Address A3( RIDS?C G"'C. �4l Assessor's Map/Parcel ` Engineer's Name _7C C, NEW CONSTTRUCTION`� REPAIR X Telephone# J'rU�-�-13—t>37 M i tGt Lund Use Jcy�Q�Q T(�MW�L) 4J jelk,-�Sea %lo P ( ) O �M�l/0.. Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft. Property Line 0 ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands in proximity to holes) } 1 I i Parent material(geologic) 0 Depth to Bedrock 71444 . f � Depth to Groundwater. Standing Water In Hole: �j(� S Weeping from Pit Ppea ' Estimated Seasonal High Oroundwater > 7 7 " kg S DfPRCTD- `TION�OR SEASONAL•HIGH WATER TABLE Method Used: _k� Oh Depth Observed standing in obs.hole: In. Depth to still mattler Depth to weeping from side of obs.hole: > •I q—in.- Groundwater Adjustment Pt. Index Well-0 Rending Date: index Well ldvol Adj,-factor„ Adj.droundwaterLevel.,_ PERCOLATION TEST Mute T1.0 /I 4W7 Observation •- a Hole# Time at 9" cr `� �� • Depth of Pero P � Time at 6" A Start Pro-soak Time @ ��'Oa�� Time(91'41) End Pro-soak I•�. U J c21/✓� Rate Min./Inch ` s Site Suitability Assessment: Site Passed Vhis Site Palled: Additional Testing Needed(Y/N) _ Original: Public Health Division Obsetvaition Hole Data To Be Completed on Back---------- s ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soli Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) .(Munsell) Mottling (Structure,Stoneg;Boulders. tsistency.96 Uraveli 10 Y 3� W Ga- �I'' C edo-�ot;tse so A5-,( -- - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil, Other Surface(id.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color !._. Soil I t Other Surface(in.) (USDA) (Munsell) 1 MotUing (Structure,Stones,Boulders.. Conslstc=3� Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Scopes;Boulders. Flood Insurance Rate Man: / Above 500 year flood boundary No— Yes Within 500 year boundary Nov Yes Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? V19S If not,what is the depth of naturally occurring pervious material? Certification �7 Cj(y I certify that on LlL(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise an xperience described in 4 10 CMR 15.017. • Signature Datb �� Q:WEPTICVBRCPORM.DOC i Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. " 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 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 A. General Information filling the computer, �p`` �N OF o use only the tab 1. Inspector: `�� ••• • •'•c� key to move your JAMES •• cursor-do not .lames D.Sears � '`" use the return n o key. Name of Inspector Ca ewideEnter rises,LLC f••:C' ��I Company Name ��ii��5 INS? �``��`• 153 Commercial St. Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority CD CD 7-1-13 spp or's Signature Date .. Tha system inspector shall submit a copy of this inspection report to the Approving Authority(Board coca Ise of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or U- ° hash a Resign flow of 10,000 gpd or greater, the inspector and the system owner shall submit the rep,Orto the appropriate regional office of the DEP.The original should be sent to the system owner an ocaples sent to the buyer, if applicable, and the approving authority. ~ `V ****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 6 Official 1 v 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 "t 428 Main St. Property Address Margaret AGiardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. Cityfrown State Zip Code Date of Inspeaion 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: 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 exflltration 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•3113 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt.): ❑ 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's(dame information is required for every Cotuit MA 02635 7-1-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, N 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 Cl ® 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 El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow t5ins-3113 Title 5 Oftldal Inspection Forth:Subsurrace Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 . page. Cityrrown 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: l ❑ ® 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 N the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems; you must indicate either"yes"or"no"to each of the following, in addition,to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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-3/13 Title 5 Official Inspection Fomt: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 ' 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 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): NA Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Tide 5 Official Inspection Fonn: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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: The system is two c. pool,s. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate y sewage system?(Include laundry system inspection information-in this report.) El Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage 2011-0 Gal's g ( y g (gpd))' 2012-1,000 Gals Detail Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commerciallindustrial 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 y 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 Forth:Subsurface Sewage Disposal System•Page 8 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 19" P g 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.): Pipeing house to main pool cast iron. Out let pvc tee. 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: Sludge depth: t5ins-3r13 Title 5 Official inspection Forth:Subsurface Sewage Disposal System-Pop 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's(dame information is required for every Cotuit MA 02635 7-1-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 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 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.): 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-3113 Title 5 Official Inspection Form:Subsureew Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts, Title 5 Official Inspection Form )W Subsurface Sewage Disposal System Form'-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner owner's Name information is required for every Cotuit MA 02635 7-1-13 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 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 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•3113 Title 6 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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.): Leaching is one 4'old block c.pool w/cover at 20"below grade. Pool dry no sign of over loading or high stain line. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert Dry Depth of solids layer Dry Depth of scum layer Dry Dimensions of cesspool 30"Deep 26"Wide Materials of construction Red Brick. 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 �t 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. CityfTown 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.): Main pool red brick 30"deep, 26"wide. Dry w/cover at grade out inlet tee. 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 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments p� 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. cityfrown 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•313 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 15 of 17 . �, � d n lb � � — — n ,► i� �� _ � J �� , - , - `� �1 � O c�► ��, �.� '��.1.; �, r� � � � �F a Z Z Z � ` r v � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. CityfTown State Zip Code Date of inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells AJo Estimated depth to high ground water: 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: U.S.G.S. SDW 253 You must describe how you established the high ground water elevation: U.S.G.S.well SDW 253 at 48.5 ADJ 3' ADJ 45'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina 8r Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 7-1-13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file y t5ins-3113 Tice 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. ()l 3 Fee jvV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLatlon for Disposal 6pstem Const union Permit Application for a Permit to Construct( ) Repair A Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. M.4go S c corn 1 T Owner's Name,Address,and Tel.Nor Assessor's Map/Parcel O.A D O!3 16Q Installer's Name,Address,and Tel.No. JC265'-4tZl Designer's Name,Address,and Tel.No. CA,0e-V_X D 15 6N'dVJ31-<� LkC, IS Type of Building: / Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 906p 0� nc)-rL e— -Tee::: Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date (o d Q "d10 t 3 Application Approved by Date (o _/cJ _t2o�3 Application Disapproved by Date for the following reasons Permit No. -d-O r3 aIV Date Issued --No. •:.�O I - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) El Complete System X Individual Components Location Address or Lot No. � 8 MM0 5� Coro i T Owner's Name,Address,and Tel.No.- ., w1�4a4rEr�T'Cxi�43�Dt+J� c. SuSlW CA.Ic'!.S Assessor's Map/Parcel O a a 0/S L - Installer's Name,Address,and Tel.No. 5062 -471-NJ 77 Designer's Name,Address,and Tel.No. C AIO(=-�:A be ENT8EA<o&f Ckc Type of Building: Dwelling No.of Bedrooms N Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t. Date last inspected: ,Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of , Compliance has been issued by this Board of Health. Signed Date (0 " Q -;D(3 Application Approved by Date \. 1 Application Disapproved by Date Y for the following reasons Permit No. U d b Date Issued ET THE COMMONWEALTH OF MASSACHUSETTS 4 BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( � Upgraded( ) Abandoned( )by eJ�i—ut)( _i i�Q?9 j Cj�{_/Z X at Via& MIA I L) !S-r C()TjJ o -r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.P 03- tY dated V I r J Installer GAp6..w 1 n E ea Mhfl s ffS LLG Designer #bedrooms A-" Approved design flow / �,/ % gpd The issuance of is permit hall not be c strued as a guarantee that the system wil Nnctonas designed. 411) Date Inspector �•!�'// i � i, . No. 2 O I - -- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 9ppstem (construction Permit Permission is hereby granted to Construct{ ) Repair(X) Upgrade( ) Abandon( ) System located at t-�' MA I I—) S -I" OCa(_)yr" and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date r 1 ' ' Approved by ( 1 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal-System Form-Not for Voluntary Assessments ' 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 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. Img out forms When n A General Information ,,,,��i►illiff►, on l �`` the Computer, ESN.......ass use only the tab .� q c`N.Z� 1 '•• . Inspector: Z ;o: key to move your = JAMES •Ln cursor-do not Sears use the return James D. �0; S o,-_ key. Name of Inspector CapewideEnterprises,LLC Company Name O,�i,,F•5•�N gQ�G �� 153 Commercial St. �'��►mnuiuuu��u' Company Address Mashpee MA 02649 CitylTown State Zip Code 508-477-8877 S1623 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. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 16.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority GeeJ— 6-15-13 spector'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 DEN. 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•3M 3 Title 5 ninTo.rm:�Sutbxurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 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: 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): Need to replace broken outlet line. t5ins•3M3 Title 5 Official in spection Fonn:Sutisurtace Sewage Disposal System•Pie 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner owner's Name information is Cotuit MA '02635 6-11-13 required for 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 pumpstalarms are repaired. B) System Conditionally Passes(cunt.): ❑ 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name require for is Cotuit MA 02635 6-11-13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health_ (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. ° Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ to Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool N14 ❑ ❑ 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 page. Cityrrown 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: ❑ ® J 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. El 0 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 ❑ 11 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•3/13 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 page. Citylrown State Zip Code Date of Inspedion 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? ❑ Z 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? II Were as built plans of the system obtained and examined?(If they were not �/� ❑ ❑ available note as NIA) ® El Was the facility or dwelling inspected for sign s 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 manheles uncovered, opened, and the interior all Ills Nil inspected for the condition of the 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): NA Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins-3/13 Title 5 Official Inspection Forth: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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is two c. pool,s. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage 2011-0 Gal's g ( y g (gPd))' 2012-1,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 6 Official Inspection Forth: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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information required for every Cotuit MA 02635 6-11-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 19" Depth below grade: test 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.): Pipeing house to main pool cast iron. Pipeing main pool to overflow cast iron and PVC. Note: Cast iron outlet sweep broken need to replace. 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: Sludge depth: 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 page. City/Town State . Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 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.): 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 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: 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 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 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Flame information is required for every Cotuit MA 02635 6-11-13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ❑ leaching chambers number: ❑ leaching galleries number. ❑ Teaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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.): Leaching is one 4'old block c.pool w/cover at 20"below grade. Pool dry no sign of overloading or high stain line. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert Dry Depth of solids layer Dry Depth of scum layer Dry Dimensions of cesspool 30" Deep 26"Wide Materials of construction Red Brick 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner owner's Name information is required for every Cotuit MA 02635 6-11-13 page. Cityfrown 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-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I � . � � � � � � t � � � — — >> �► o► �, � a � - � - `� �� o 0 J O � (�`� ^ ,.`I 3 ��f per,i i � � � � � � _ ��, y , ". Z- Z -� �. "�' �'� f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 428 Main St. Property Address Margaret A.Giardina 8r Susan Weis Owner Owner's Flame information is required for every Cotuit MA 02635 6-11-13 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 t5ins-3M 3 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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells NO Estimated depth t�high ground water 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: U.S.G.S. SDW 253 You must describe how you established the high ground water elevation: U.S.G.S. well SDW 253 at 48.5 ADJ 3' ADJ 45'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3M 3 Title 5 Official Inspection Fond: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 428 Main St. Property Address Margaret A.Giardina&Susan Weis Owner Owner's Name information is required for every Cotuit MA 02635 6-11-13 page. Cityrrown State Zip Cade 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•3M 3 Tine 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 ES TOP OF FOUNDATION= 63.1'± FINISH GRADE OVER D-BOX= 62.3'± FINISH GRADE OVER CHAMBERS= 62.2' - 62.5' T f� PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1l2" DOUBLE WASHED WITH COVER OVER INLET& � REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS 2"OF 1/8"TO 1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = 62.On F.G. OVER TANK EL.= 6 2.2 ± 5 DIA. OUTLET(S) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE 19) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS _ } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3TYP.) 9",MIN. 11 } , PLACE RISERS ON ALL DESIGN ENGINEER. PROP. SCH. 40 36 MAX. 3.5 MAX. , I TOP OF SAS=5$.30 CHAMBERS WITH SEE NOTE 22 4.2 MAX. 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PROP. SCH. 40 57.30' SEE NOTE 22 INLET PIPES TO 6"OF PVC SEWER � BREAKOUT EL= 57.80 SYSTEM UNLESS OTHERWISE NOTED. FINISHED GRADE =- - 2" DROP MIN. „ 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN MIN.SLOPE @ 1% 6" 3" 3" DROP MAX, 3 9 L = 15± MIN.SLOPE @1% PROVIDE WATERTIGHT o ELEVATION =57.80' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4" PVG IN FROM JOINTS TYP. 000 0 00�� o0 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14° 58.05' SEPTIC TANK • 4" PVC OUT TO O o o O o o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY o ' 11 Q� o 0 0 = = = 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 58.30 ALL TEES MUST 1 12 6 0� o 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. BE CENTERED „ OUTLET TEE 57.77 MIN. 57.60' 2' o °° o o0 UNDERNEATH 48 00 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK RISERS 6" CRUSHED STONE °° o o oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS AS BAFFLE OVER MECHANICALLY o 0 001 o o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 14.T OFFSET TO FND. COMPACTED BASE AND DESIGN ENGINEER. 3 OUTLET DISTRIBUTION BOX 4.0' 8'5' (TYP) I 4 0' AU4.83' 4.0' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 60.00, 6"CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE TYP, 33.5 ( ) ESTABLISHED ON A MAG NAIL AS SHOWN ON PLAN. OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET < 50.30' COMPACTED BASE C, Q Q C, zVRV PIPES TO BE LAID LEVEL. zi 5.30' GROUND WATER ELEV.= 12 83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1 ,500 GALLON CONCRETE SEPTIC TANK 5' MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10'-6' WIDTH 5'-8" DEPTH 5'-8" (Dimensions per CROSS SECTION VIEW 3-500 GALLON H-20 CHAMBERS CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING � ACME-SHOREY) it TYPICAL CHAMBER. PROFILE TO THE DESIGN ENGINEER. EI~.EVATION PRIOR; TO ANY WORK� - � O t � FIEL r � i T�ON BOX DETAIL L H DETAILS NOTIFY ENG?NE'.�R IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NO DEEDED OR NOTES: - d ,2, St", de8�ti` � �..... ,`:.-' -_,-� � _' T P T D T 11• REGULATIONS. TOWNER/APPLICANT ION HAS BEEND ISTOO TAN SUCH DETAS TO COMPLIANCEIERMINAT ON FROM ZONING el r^ 11 /' 15684 APPROPRIATE AUTHORITY. PROPOSED INSPECTION PORT ,. + PERC NO. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH � * - ✓ : t SEPTIC SYSTEM COMPONENT. t , �` , , '�!/ r p *� -�- ( a ` ,r INSPECTOR: Donald Desmarais, IRS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED I } � �° UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT DRIVES OR PROPOSED 3-500 GALLON H-20 LEACHING ' ,' ,'� EVALUATOR: Michael Pimentel, EIT, CSE 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE CHAMBERS WITH AGGREGATE -:- ` .\ \�r v� TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. C.S.E. APPROVAL DATE: Oct. 1999 PROPOSED LEACHING SYSTEM TO ENSURE CONSISTENCY WITH TEST PIT DATA i '� 1rr '.- 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES. SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF r' i w� .. (' DATE: June 13, 2018 SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. PROPOSED H-20 DISTRIBUTION BOX w • '' .% ~- f `r ' r , ( a , TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. 3). ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2 ESTUARINE ' ' - ELEV TOP= 62.30' ZONE i REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, WATERSHEDS, AND WELLHEAD OVERLAY PROTECTION DISTRICT. .l (6) * , , �� Cran `I ELEV WATER= < 50.30' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY FOR THE PROPOSED 1,500 GALLON SEPTIC TANK 62x4' « * * !� "`�-.� � I Ott � �. ��`� PERC RATE_ <2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS IN THE FIELD 62x5' * * , ✓ -' 'd "" ` 9 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL NOTIFY ENGINEER IF • /'� DEPTH OF PERC= 48 -66 MEASUREMENTS APPEAR TO BE INCORRECT. PROPOSED 4 PVC VENT •+ ` - _k, 16. PROPOSED PROJECT IS LOCATED WITHIN: TP 1 y�EL PIPE; EXACT LOCATION a TEXTURAL CLASS: 1 f �Y� ASSESSOR'S MAP 22 LOT 13 PER OWNER _ -•, i2 - - 62x3 '' *' OWNER OF RECORD: MICHAEL C. CREEDON JR SHED 62x4 (5) • )'� \ `'A ,� " LOCUS r -; 0" 62.30' KATHERINE CREEDON tr Loamy Sand ADDRESS: 231 PROSPECT STREET J: 62 x 3' " /., ; ,« ,* ', � A 10 Yr 3/2 v 4S w HINGHAM M/� 02043 Sc P 2 li -' .�`< 'ti 6 61.80' ...�r� { FEMA FLOOD ZONE X r " • « ««+ ✓� Loamy Sand COMMUNITY PANEL# 25001 C0539J (3) _ 62x 5 t * ` �w g 62x2' 3`'' i ) / 62x4' 14 ~xt * «* � 10 Yr 5/6 17. DEED REFERENCE: BOOK27894 PAGE 80 s t 42,, • + \ 58. CON 0MAP 22 18. PLAN REFERENCES: PLAN BOOK 260 PAGE 73 80 (4) s - + 48 19. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A l LOT 13 } (1) � �,� � � ,, "ITT' �� +« « * rU ,,� 58.30' DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A M MAP 38 18,582 ±S.F. 62x2' 62x3 BUSH (TYP) ✓c \ Perc ,`` ;/°` _ ll ` ' = Q REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. r` 62 x 2' �, / 66 56.60' .: t LOT 4 ,L� \ '' i /� • ; .- 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 0 30�6 �' } f , , FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY g5� `L µkm I h *,.• * n FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. N , ° GP y - "` LT, Med.-Coarse Sand L E 2 5Y 21. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL a sj� °° REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. LOCUS PLAN \ . """"� I •�"``� �' 62� \ ,� 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE APPROVALS ARE REQUESTED FROM 310 CMR 15.221(7): SCALE. 1 - 1000 (1.) A 1.2 WAIVER (3.0-4.2) FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. r, HC-2 '�� 144" 50.30' (2.) A 0.5'WAIVER (3.0-3.5') FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. � `�� No Mottling, Standing or Weeping Observed PORCH HC-1 TOF -63.1 ± DESIGN DATA TEST PIT DATA LEGEND / PERC NO. 15684 50x0 EXISTING SPOT GRADE 428 NUMBER OF BEDROOMS 4 INSPECTOR: Donald Desmarais, IRS _ _ _ 50 - - - 6s 5s ��\ I EXISTING EVALUATOR: Michael Pimentel, EIT, CSE EXISTING CONTOUR o'A® oo, r'o, 4-BEDROOM DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 1999 FRO-1 PROPOSED SPOT GRADE `�� y \ I DWELLING TOTAL DESIGN FLOW 440 GAUDAY DATE: June 13, 2018 r5� PROPOSED CONTOUR Benchmark DESIGN FLOW x 200 % = 880 GAUDAY TEST PIT#: 2 Mag Nail I I C/H/\,/ EXISTING OVERHEAD WIRES Elev. =60.00' BH USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV TOP= 62.30' Approx. M.S.L. I I GAS \ ELEV WATER= < 50.30' GAS --- -- EXISTING GAS LINE / P� METER PERC RATE _ EXISTING CESSPOOLS TO BE W --W-- EXISTING WATER LINE PUMPED AND FILLED WITH DEPTH OF PERC= 6N� I / �� ¢S / ,20� CLEAN SAND AND ABANDONED INSTALL 3 - 500 GALLON CHAMBERS w/ STONE r: TEST PIT LOCATION �� 62' 10 2°� 00 TEXTURAL CLASS: 1 O� O� \ I � 55 N SIDEWALL CAPACITY O O O PROPOSED 1,500 GALLON SEPTIC TANK / ' (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAL/DAY O�� (33.5'+ 12.83') (2 ) (2' ) (0.74 GPD/S.F.) 137.1 GAUDAY 0" 62.30' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE A Loamy Sand BOTTOM CAPACITY 611 10 Yr 3/2 61.80' ® PROPOSED H-20 DISTRIBUTION BOX MAP 22 (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY PROPOSED 500 GALLON H-20 LEACHING CHAMBER (33.5 x 12.83) (0.74 GPD/S.F.) = 318.1 GAUDAY B Loamy Sand LOT 39 10 Yr 5/6 V 6 \ / TOTALS: 42" 58.80' REV. DATE BY APP'D. DESCRIPTION TOTAL NUMBER OF CHAMBERS 3 - I PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING AREA 615.1 SQ.FT. r TOTAL LEACHING CAPACITY 455.2 GAL./DAY PREPARED FOR: CAPEWIDE ENTERPRISES c �!a Med.-Coarse Sand LOCATED AT 428 MAIN STREET SWING-TIES COTUIT, MA 02635 DESCRIPTION HCA HC-2 Sc 144" 50.30' SCALE: 1 INCH = 10 FT. DATE: JUNE 21, 2018 TANK INLET COVER(1) 31.8' 17.5' 22.7' r�OF 0 5 10 20 40 FEET No Mottling, Standing or Weeping Observed �� TANK OUTLET COVER(2) 39.4' 23.9' 23.2' RESERVED FOR BOARD OF HEALTH USE JOHN L GN PREPARED BY: cr+uacMlu,IR. JC ENGINEERING INC. CORNER OF STONE (3) 47.2' 29.5' 28.5' U 41 2854 CRANBERRY HIGHWAY CORNER OF STONE (4) 47.1' 23.8' 38.3' R� EAST WAREHAM, MA 02538 SITE PLAN CORNER OF STONE(5) 80.4' 56.9' 63.3' 508.273.0377 SCALE: 1"= 10' CORNER OF STONE (6) 80.5' 59.5' 57.9' Drawn By: SJI 1 Designed By:SJI Checked By: MCP JOB No. 4239