HomeMy WebLinkAbout0552 MAIN STREET (COTUIT) - Health 552 Main Street
Cotuit a
A= 037-015
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5 M E A
No. 10339
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No. o�?O/;7 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitation for MisposaY *pstem Construction permit
Application for aPermit to Construct( ) Repair( Upgrade(' ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. CCU/r Owner's Name Add ssand Tel.No.
Assessor's Map/Parcel 91-7 411
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
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)
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 Boaro,f Heal h. ;�
Si a "�" G(1 P-�-—'�_ 31 � (— Date
Sn
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. �T�C Date Issued
I , .,- -+- .. .r .4..�''•YY'. i"',-�. ..;'\..' d'».'....y «e "'K`f�.'1.:.« t,:-n:..�M�.. ...«s. .+n Yr,.t M 5r ^'�,�4�}r..1.yY.�!f...• .�Q. ... ., •P..�fi.
No. Fee "
THE COMMONWEALTH OF MASSACHUSETTS Entered in compute!.
Yes -
PUBLIC HEALTH DIVISION,- TOWN OF BARNSTABLE, MASSACHUSETTS
9pplicatloii for jB18tlosal 6psteitt Construction Permit � ~f
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 6;5:1 7"lw�� 'f 4G�417- Owner's N ss,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and
Tel.No. Designer's Name,Address,and Tel.No.
-�;+ �D�'�'j�l�i��Ti 7 C�Dd✓�l'�..1.�c!Pj*t1,J y , - ,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Gunder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( ) a
t - r
Other Fixtures .tM t
Design Flow(min.required) gpd Design flow provided gpd E
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)
v
Date last inspected:
.,Agreement:
'
The undersigned agrees to ensure the construction d 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 Heal -� n
Signed .. G ,g. .0 ` ) .(_. Date
Application Approved by /� 1 """".. ..`�` Date
Application Disapproved by 'Date '
for the following reasons
Permit No:• l.� *-' Date Issued
j � THE COMMONWEALTH OF MASSACHUSETTS
l/ l\ BARNSTABLE,MASSACHUSETTS
U�
C Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired W) Upgraded( )
". Abandoned( )byl )
-at= - , &L U t. _ ...has been-constructed,in.accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No"/7 dated
Installer Designer `
#bedrooms Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system.will fun`ctibns designed.
Date r�� ;� Inspectors,_
. . ��---f-+---._-------------- __._. r -
No. / 7 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstein Construction Permit
Permission is hereby granted to Construct( ) Repair ) Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
h
Title 5 and the following local provisions or special conditions.
f.
Provided:Construction m/ust<be coin leted within three years of the date of this pe i
Date 0 �� Approved by
y
d
■
ti■ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information is
required for every Cotud MA 02635 10-12-13.
page. City[Town state Zip Code Date of Inspection
results must be submitted on this form.Inspection forms may Inspection res P Y not be attered in any
r xfi ' way. Please see completeness checklist at the end of the forth.
' �6;-'As
tfoni� A. General Information
filling oit \``�ttNumrlrgppi�,'
on the Computer, OF IggSS
use only the tab 1• Inspector:
key to move your \1 o
cursor-do not James D.Sears y —=—: JAMES �'
use the return
' key. Name of Inspector *:�-EKKS
CapewideEnterprises,LLC , �'•. c' �a Q_?
Company Name —'''�i,T(�'-FNT iFT'•G ��
153 Commercial St. ��iii�,5ri►.NiiSpE``,``��
Company Address
Mashpee MA 02649
CityrTotw State Zip Code
508-471-8877 S1623
Telephone Number License Number
R. Certification
I cert4 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 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes [] Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
10-12-13
ectors Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable,and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
[Sirs•3113 Title 5 Ofiidel Forth:Subaudaca age Dl 11 System•Pape 1 or 17
i
1
i
Commonwealth of Massachusetts
ESPSRMM�-W Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
.552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information Cotuit MA 02635 10-12-13
is
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cunt.)
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:
13) 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•3113 TO 5 Offidat Inspection F=w.Sutisurtace Senmage Disposal System Pape 2 of 17
Oct 14 13 11:13p p.3
4 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments.
552 Main St.
Property Address
Theresa Egan
Owner owner's Name
information is required for every Cotuit MA 02635 10A2-13
page, City/Town State Zip Code Date of Inspedion
B. Certification (cont.)
❑ Pump Chamber pumps/alarms riot operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(coat:);
❑ 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 rernoved ❑ Y '❑ N ❑ ND (Explain below)
❑ distribution box is leveled or replaced. ❑ Y.`` ❑ N ❑ ND (E*.lain 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 pipes)are replaced ❑ Y ❑ N ❑ 'ND(Explain below):
❑ obstruction is removed [:],Y ❑ N ❑ ND(Explain below): L
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:
D 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
t5in5.3113 Title 5 Official lrq;, ion Form:Subsurface Sewage Disposal System•Page 3 or 17
Oct 1413 11:13p p.4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
552 Main St
Property Address
Theresa Egan
Owner Owner's Name
information is Cotult MA 02635 10-12-13
required for every
page. Citylrown State Zip,Cade 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.
Q 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 Ail 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
El ® Discharge or ponding of effluent to the surface of the ground`orsurface.waters
due to an overloaded or clogged SAS or cesspool
o Static liquid level'in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in ermantis less than 6" below invert or available volume is less.
❑ ® than%day flow e� tlt�'/fINC
f5ins 3113 Titb 5 O(fidW hspecrion Form:Sdm rfae Sewage,Disposal System-Page 4 of 17
Oct 14 13 11:14p p.5
Commonwealth of Massachusetts .,
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information is cotuit MA -02635 10-12=13,
required for every
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS,cesspool or privy is below high ground waterelevation,
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is'within a Zone 1 of a public well.
® Any portion of a cesspool or privy is within 50 feet of a private water.supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000g pd.
❑ ® The system falls. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fai(s. 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 101000 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 feel of a surface drinking water supply
❑ El 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 11 of a public water supply well
If you have answered °yes"to any question in Section E the system is considered a.significant threat,
or answered"yes"in Section D above the large system has failed.The owneror 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•3H3 - ; Title 5 Olridal Inspection Form:Subsurface Sewage Dispoeel System-Pape 5 or 17
Oct 1413 11:14p p.6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
~' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information
required for every Cotuit MA 02635 10-12-13
page. cityfrown 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, occupa .t,'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 NA),
❑ 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?
E ❑ 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?
® El information
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)1
D. System Information,
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440
151ns•3113 TiUs 5 Mdal Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17
Oct 1413 11:14p p.7,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owners Name
information is required for every Cotuit MA 02635 10-12-13
page. City/Town State Tap Code Date of Inspection
D. System Information
Description:
The system is a 1000 Gal.tank. A 1560 Gal.tank D Box and three 500 Gal. Chambers.
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 ® No
information in this report.) `
Laundry system inspected? ' ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readin s;if available last 2 ears usage d 2011-85,00OGaIs
9 ( Y 9 (gP )) 2012�0,000Gal's
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: NA_
Dale
CommerciaUlndustrial,Flow Conditions:
Type of,Establishment:
Design flow(base&on 310 CMR 15.203): Ganons per day(gpd)
Basis of design flow(seatslpersons/sq.1, etc.): -
Grease trap present? . ❑ Yes ❑ No
Industrial Waste'holdin tank resent?
9, p ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ '.Yes ❑ No
Water meter readings, if available:.
t5ins*3113, t Title 5 Official Inapealon Form;Subs wfaae Sewage Disposal System•Page 7 of 17
Oct 14 13 11:15p p.8
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
552 Main St
Property Address
Theresa Egan
Owner Owner's Name
information is required for every Cotuit MA 02635 10-12-13
page. city/rown State Mp Code Date of Inspection
D. System Information (cost.)
Last date of occupancy/use: Dale
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)
❑ I nnovative/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.UA system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
Other(describe):
t5fns•3f13 Title 5 Official Inspection Foam:Subsurface Sewage OisposW System-Page 8 or 17
Oct 1413 11:15p p.9
Commonwealth of Massachusetts
Title 5 Official l.nspection Form l
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information is required for every Cotuit MA 02635 10-12-13
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:
1000 Gal. tank 1988 Permit#88-36911500 Gal tank and leaching. 1999 Permit#99-689.
Were sewage odors detected when arriving at the site? ❑ Yes No
Building Sewer(locate on site plan):
.18"
Depth below grade; feet r
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 is 4"PVC SCH 40
Septic Tank(locate on site plan):
8" 101,
Depth below grade: feet
Material of construction
® concrete O'metal fiberglass' ❑polyethylene ❑other(explain)
tr
If tank is metal;list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ 'Yes, [] No
Dimensions: 1000Gal. 1500Gal.
V
il
Sludge depth:
t5h3.31i3 71ft 5 Olfiaal Mspection Form:Subsurfaoe Sewage Disposal System-Page 9 oft7
Oct 1413 11:15p p.10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information is required for every Cotuit MA 02635 10-12-13'
page. CitylTown State Zip Code' Date of Inspection
D. System Information-(cunt.)..
Septic Tank(cunt.)
Distance from top of sludge to bottom of outlet tee or baffle
29' 30'
Scum thickness
8" 8"
Distance from top of scum to top of outletttee or baffle
Distance from bottom`of scum:to bottom of outlet tee or baffle
17"
How were dimensions determined?. Asbuilt'-Tape
Sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition,,structural integrity,
liquid levels as related to outlet invert, evidence of leakage,etc.):
1000 Gal. Precast tank and cover's at 8"below' 'rade. Inlet baffle,outlet tee. Note:inlet cover
under deck need to be able to open cover No sign of leakage or over loading. 1500 Gal. Precast
tank and covers at 19' below grade. In and out let tees. No sign of leakage or over loading.
Grease Trap(locate on site.plan):
Depth below grade:
Material of construction:
❑ concrete [] metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
!Distance from bottom of scum to bottom of outlet tee orbaffle
Date of last pumping: Dace
i5ins 3113 Tito 5 Official Inspeclon Form:SubwdA Sewage Disposal Sys[em-Page 10 of 17
Oct 1413 11:16p p.11
Commonwealth of Massachusetts.
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments
562 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information is Cotuit MA D2635 10A2-13
required for every
page. Cityfrown state Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage,etc.):
Tight.or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
E] concrete E] metal fiberglass El polyethylene ❑other(explain):
Dimensions:
Capacity: gallons; i
Design flow: gallons per day
Alarm present: ❑ Yes 0 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
t5in3•W 3 Tile 5 Official Inspection Faun:Subsurface Sewage Disposal System•Pege 11 of 171
Oct 14 13 11:16p p.12
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y
552 Main St.
Property Address
Theresa Egan
Owner Owners Name
information is
required for every COtult MA . 02635 10-12-13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan)`.
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.);
D Box is 16"x16"-40" Below grade w/cover at 22". Box is clean and solid w/three lines out. No
sign of over loading or solid carry cover.
Pump Chamber(locate on site plan):
Pumps in working order. ❑ Yes 0 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:
Title 5 OI[del Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
r —
Oct 14 13 11:16p p.13
Commonwealth of Massachusetts
Title 5 Official Inspection Form ,
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information is Cotuit MA 02635 10-12-13
required for every
page. Citylrown state Zip Code Date of Inspection
D. System Information (cunt:)
Type: x
❑ leaching pits number:
(� leaching chambers number: 3
❑ 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.):
Leaching is three 500 Gal.dry well chambers. Chamber's are 40"below grade
w/cover at 2' Chambers are clean and dry'. No sign of over.loading or solid carry over.
Cesspools(cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration.
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of constructlon_
Indication of groundwater inflow ❑ Yes ❑ No . .
t5ins-3113 rite 5 ofidel hspeetion Form.Sub:saeece Sewage Disposal System•Page 13 of 17
Oct 14 13 11:17p p.14
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form v Not for Voluntary Assessments
552 Main St.
PropertyAddress
Theresa Egan
Owner Owner's Name
information is Cotuit MA 02635 10-12-13
required for every .,
page, City/rown 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 r an 3 Idle 5 Official Inspechcn Form:Subsurface Sewage Disposal Syslem•Page 14 of 1-r
Oct 1413 11:17p p.15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -
v 552 Main St:
Property Address
Theresa E n
Owner Owner's Name
information is Cotuit MA 02635 10-12-13
required for every State Zip Code Date of Inspection
page CityfTown
Q. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system. including ties to
at least two permanent reference iandmarks or benchmarks_ Locate all wells within I W feet Locate
where public water supply enters the building. Check one of the boxes below.
91 hand-sketch it the area oetow
Se" raW
53 ,
3C: i 7 cam«
o_ o
F3
x M Title 5 OrticW inapacbm Fomc,Su APidws Sevsge Disposal system'Pace 15 at 17
t5irM-:Y13
Oct 14 13 11:17p p.16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary•Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information is required for every Cotuit MA 02635 10-12-13
page. CitylTown State Zip Coder Date of Inspection
D. System Information (cant.) _
Site Exam:
® Check'Slope
® Surface water.;
® Check cellar
❑ Shallow wells .Nv
121
Estimated depth tofigh 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 propertylobservation hole within 150 feet of SAS)
❑ Checked with local Board of Health-,explain:
t -
Checked with local excavators installers- attach documentation
❑ Accessed USGS database•-explain:
You must describe howyou established the high ground water elevation: ;
Auger Hole at 12'No G.W.. Bottom of dry well's at 6' below,grade. Bottom of dry well's 6' above
Auger Hole
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5 ns-3F13 Title 5 Offdd Inspection Form:Subsurface Sewage Disposal System•,Page 16 of'17
Oct 1413 11:18p p.17
Commonwealth of Massachusetts R
f
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Fonm-Not for Voluntary Assessments
552 Main St.
Property Address
Theresa Egan
Owner Owner's Name
information is required for every Cotuit MA 02635 10-12-13
page. C4frown State Zip Code Date of Inspection
E. Report Completeness Checklist
Z Inspection Summary:A, 8, 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
r
ESirc:r 3113 TMe 5 OfBdal h an Fomr.SLLstrfaw Sewage Oisposal System-Page 17 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC.
Company Name
P.O.Box 763
Company Address
Centerville Ma. 02632
rencn City/Town State Zip Code
(508)428-4028 S14454
Telephone Number License Number
B. Certification
I certify that l have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system: nn
® Passes ❑ Conditionally Passes EAUG
s❑ Needs Further Evaluation by the Local Approving Authority E/ 8/17/2010
lntfelitors Sign re Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth.of Massachusetts
v - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M •�'' 552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments.-
The septic system is in proper working order at the present time.
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
-„
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�„ •�''� 552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every 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:
I
❑ 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
�M •''r 552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
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 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 Jess than 6" below invert or available volume is less
than '/z day flow
t5ins-09/08 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
552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large_
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-09/08 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
552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
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): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
N Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,•�''� 552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
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 ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
d
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every 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:
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):
t51ns•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
G Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
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: 1
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10'+
feet
Comments (on condition of joints,venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the leaching.
Septic Tank(locate on site plan):
'
Depth below grade: 6" 1
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1000 gl. 1500 gl.
Sludge depth: 3" 211
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every 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
29" 30"
Scum thickness
1" 0"
Distance from top of scum to top of outlet tee or baffle
7" 8"
Distance from bottom of scum to bottom of outlet tee or baffle
13" 14"
How were dimensions determined? measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump tanks every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tanks appear
structurally sound.
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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
I
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
f '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert No
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Box is Ievel.Box has three outlet Iaterals.No evidence of solids carryover.No evidence of leakage.
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:
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 3
❑ 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.):
Sandy dry soil.no signs of hydraulic failure.Leaching was dry at time of inspection.No stain lines
visible.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
f -
Map Pagel of 2
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Commonwealth of Massachusetts
Olig Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
•�'' 552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every page. Cityrrown 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: Bottom of LC 22'
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:
As-Built
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation Well Data.USE D:Technical Bulletin 92-0001 plate#2 annual ranges of
groundwater elevations.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
N Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 552 Main St.
Property Address
Joanne Massaro
Owner Owner's Name
information is required for Cotuit Ma. 02632 8/17/2010
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
f
May 20,2010
To Whom it May Concern,
We, Jeantand Harold Jackson, lived at 552 Main Street, Cotuit from 1970 to 1999, and
confirm that it has always been a four bedroom home.
Sincerely,
Harold Jackson
Jeargackson
rF
• 2 i
No. Fee
✓
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
21ppricatiou for Migool *pgtem Cou5truction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. S 4 #.j ej f Q. Owner's Name,Address and Tel.No...
Assessor's Map/Parcel 40,3>s7 615 [T o w 6( r et j";4-G tt e, o a,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
G I�-VA-R
Type of Building:
Dwelling No.of Bedrooms - Lot Size 409 o 00 sq.ft. Garbage Grinder( )
Other Type of Building R r s No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 4Z P, gallons per day. Calculated daily flow O gallons.
Plan Date F hp- Number of sheets I Revision Date
Title
Size of Septic Tank A r4. Z�`o® Type of S.A.S. X
Description of Soil fo S J- a
Nature of Repairs or Alterations(Answer when applicable) S,o (cal M 6 n t-e
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu Board of
Signed Date `7 LV[4 2a
Application Approved by Date
Application Disapproved for the following reasons
Permit No. C1 Date Issued
-- --------------- -
,. No. `f�7'T�f.7 Fee --J `��
ka THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:.
�. _.� "� - Yes
*n PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pprication for �Digozar *pgtem Construction Permit
y Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No. fof I h 151 `p b Owner's Name,rAddress and Tel.No.
Assessor's Map!Pazcel Q 3 b! No w A ( d
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
G 4P—y 7_�tv1.AR
Type of Building:
Dwelling No.of Bedrooms f t# Lot{Size q'di c o��sq.ft. Garbage Grinder( )
Other Type of Building 1 12, s' , No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons.per day. Calculated,daily flow 3 3 o gallons.
Plan Date e G 4 Number of sheets /'` Revision Date
Title
Size of Septic Tank h ro. 4S-co r. Type of S.A.S. y 00 r,,a
Description of Soil /o A G//i /f'u c� /� /�i�v %a i u c%_
Nature of Repairs or Alterations(Answer when applicable) n h 6 o t-e
Date last inspected: tv E
Agreement: Yf # t
r'�
„ The undersigned agrees to en ure thecnstruction and maintenance of the afore described on-site sewage disposal system
"in accordancewith the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu Board of
Signed Date 9 G f V Z
Application Approved by Date �Z-
Application Disapproved for the following reasons
Permit No. 5!2'- �S�' Q�j Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certiftcate of (Compliance
THIS IS TO CERTIFY, that the On 't�Sewage Disposal System Constructed( )Repaired ( )Upgraded(y)
Abandoned( )by i`IV L
at has been constructed in accordance
with the provision's of Title and the Vor Disposal System Construction Permit No. - dated
Installer I Designer
The issuance of this s al t/ e nstrued as a guarantee that the s�te ;willfunctio as designe Date / Inspector � 1 if f I
VL
---------------------------------------
No. D — Fee
S I I THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
OiOpogar *p5tem Con5truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade(,><-)Abandon( )
System located at g-
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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, Approved by
1/6199
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. -
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, , itA,&k�c,t,_ hereby certify that the application for disposal works
construction permit signed by me dated lee i, concerning the
property located at &&r y c'f 60 ro 4� meets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will not be located less than five feet above the
rnadmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
method when applicable].
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) Sd• 3 cr
B) G.W. Elevation D — +the MAX. High G.W. Adjustment. 0
DIFFERENCE BETWEEN A and B y�. 0-
SIGNED. - DATE:
[Sketch proposed an of system on back].
q:health folder.cert
c Y
� I
ti
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v
Ael
� q
A
11
O
TOWN OF BARNSTABLE
LOCATION f4,1 A ivy - SEWAGE #19 ' S- 7
VILLAGE ASSESSOR'S MAP LO 'D
INSTALLER'S NAME & PHONE NO. (, A
SEPTIC TANK CAPACITY la o
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
5
DATE PERMIT ISSUED: 1 '`
DATE COMPLIANCE ISSUED: i > � `?' ts: '
VARIANCE GRANTED: Yes No
NNo...C........�.`�.... Y Fzs. .-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
a
to.W..j....................OF......&,#Av4).�vr.�e4: Lr......................................... l��-
Appl ration for Disposal Works Tottlitrurtiun Frrntit �
Application is hereby a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal
System at* 9 Sz
.... .....- .....................................................--
Location_Address . or Lot No.
X9.G C Trr.J .........•... r� 9 3�.,a?..5. .:......:G.Q_.t.vt. ---•.............
e Owner Address
.............. -C . ............... ..... !'Z........?a. 44CaX....--.094..............................
Installer Address
Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
aOther fixtures ..---------•...............:.........•..........:..........------------------•----=---------...............-•-•-=------•••.........._.............-•--
Q ,
W Design Flow............................................gallons per person per day. Total daily flow..............•-----------------------------gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter----------...... Depth...........
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..........._......._Sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by......................................................................... Date.........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0 Description of Soil-......................................................................................................... .......:
W ....-•.. ...... ........•..--------•---•--------------------------------- -------------••----•--••-•----••-- -----
. ------ ....
0- 6 ...........••-•••--------•------
UNature of Repairs or Alterations—Answer when applicable......./0.0, .... .41..... ;E�Gh fQ[r..................................
•------------------------------------------------------•-------...----•--•-••••-•-•-••....._•-••••-•-•••-•-•-••----•••--••••••-•-----•-•--•••••-•••-•...-•••--......•••••••••-------••••....------......
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIli LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in'
operation until a Certificate of Compliance has been issued by the board of bealth.
_=�5 D
ltw
Application Approved BY .....-•--•---•--••----------------• ..�
Date
Application Disapproved for the following reasons:-------•...................•-•-•----•---------•--------•--:......-----------.................................._
............
....•-`-------•--- ..•---•---•........ --....-•------.......--•---...............-•--•--•---.........---•--------..........-•-•••---•-•••�....---•----
-7 / Date
Permit No..--- ...... Issued. zf ¢
a� ..........
• i
'�G•.-"ti-•-'�..-Y+---.�--�-.....•-- j "'-•..w- - "`�- � ..r-.r._........,�;,.✓s:-.,ram-___.a-y�...... ,.�.-.
Y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH Q ,
�?ZAa.J-.....................OF
Appl ration for Disposal Works Tonstrurtion f rrmit
Application is hereby made for-a Permit to Construct ( .- ) .or Repair ( V an Individual Sewage Disposal
System at-
4, Locatiorn�-Address J� or Lot No.
/i.ri :y`......_l-/�-� ..........l�-s(.J..1._...._..-•--------------- ---=-0.. ----Ln.l ./-i� ,1 .5.: ._...�:.�?_ .1.!_l.:r
..�_._.._ ._ ....._ ...... _.,r.. ..... ..... .................
Owner Address
............... .C. � ......... ....1.)........ �. ��.----.. ��� �I
v .... --
M Installer Address
wa Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aN Other—T e of Building No. of ersons____________________________ Showers
YP g -•.......................... P ( ) — Cafeteria ( )
Otherfixtures .----••-----------------•-----.._._..------...._--•---.-----......_---•--••--------•------•--•-•-......._..._......_----• --.....----
W Design Flow.._'..~._____�:......................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'ca.pacity..___._.____gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'" Percolation Test Results Performed by__________________________________________________________________________ Date........................................
1.4
Test Pit No. I................minutes per inch Depth of Test Pit..............-..... Depth to ground water........................
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Q+' ----------------------------------
------------•--
0 Description of Soil........................................................................................................................................................................
V ---------------------------
••-----------
---------
•--------
-_----------
•--------------------------------------
••-•-•-------
•-------------------
•-----------
•---------------------------------
..
x -------•-•••----...-•••••------•--••••••-••-•-•••••••-•-•-••-•-•-•---••-•• ••••••-•••-•---•-•------•---•-•-•-- -•-••-••••----••••-•-••.................-.............................................
U Nature of Repairs or Alterations—Answer when applicable..____�!r_C!!2__._(:,4----- Fn��l��-,T.-------•.........................
•-----....-•-------------------------------------------•---•-•--•--•----------------.....-----•--••-•---.._..------------------------------------------• '... •-••-•---•••-----•.......----•...------
Agreement: r
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL is w 5.of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of Limh'.
a A-f
I/ Date
Application Approved,By.......... ...... �... ...... v ................ -
Date
Application Disapproved for the following reasons_____________________________________ ...........•.................. -----------._
.....................•----------•---..._....-•------••-•-•------------------------------•------------•--.•----------•---•----•••------------•-•-...•--------------•---•---••----•-•--...---•--..........
--�—� Date
Permit No.......... .......� Issued.............. ------------
Date
d
THE COMMONWEALTH OF MASSACHUSETTS
BOARD/O _� LTH
:...../...?1// ...............o F............. ---- �. .) i9. G..............
Tatif irate of Tomptiatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
� Installer C{
at.................. -•-----/��......... .......................... _ :.�--�r--------------------------------------------------------•----•----._....---...._
has been installed In accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.... ��-�___ �!?c1......4 dated__..-��7� �71 ____________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. —
1 1
DATE............... ............................... Inspector.................. ?,-- ........................................................
----______ _- -- __ - -=—_------------------------------------------,-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� k�/.J.......OF...................., . �_r 2w
No _ ... FEE........................
Disposal WorksTonlitrurtion firrmit
Permission is hereby granted -•--- `[ SL/ ..... ...........................................................
to Construct ( ) or Repair ( )an_Indivirjua Sewage Disposal System
at No.-.........7�z� �If7/t --, -
Street
as shown on the application for Disposal Works Construction Permit
�No/� .....�..............
� Board of Health
DATE---------••-----' ------------------------------------
TOWN(`OF BARNSTABLE
LOCATION SEWAGE# —%-e 17-
VILLAGE ( c 2_t.� ASSESSOR'S MAP&PARCEL 03`7—�jt.S
INSTALLER'S NAME&PHONE NO. - �/-°7R! -e23q!J !
SEPTIC TANK CAPACITY 3- Ink►('fit e4G .4,r44-- --retwiKS,1 i
LEACHING FACILITY: (type)
NO.OF BEDROOMS tw( Li�tcz races -
OWNER i q&G
PERMIT DATE: P i-a 1-17 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) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
l ,9
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O
a` I all
1
TOWN OF BARNSTABLE
LOCATION A* SEWAGE 079 - .S"ts 8
VILLAGE eA �1,+ ASSESSOR'S MAP & LOT `19
6
INSTALLER'S NAME & PHONE NO. (' A R V MA. � �"w�•��et
SEPTIC TANK CAPACITY logo I- A'c W 0 isoto S T
LEACHING FACILITY:(type) - .r VO 4 (size) /9 k t/6
9
NO. OF BEDROOMS E PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER �,46� ,So
DATE PERMIT ISSUED: 1�1 Iet leggy.
DATE COMPLIANCE ISSUED: lei
VARIANCE GRANTED: Yes No
4® w
Yl, TOWN OF BARN TABLE
LOCATION 550 _rA A SEWAGE #�.���--
VILLAGE C6 ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.jAt&-LC�. c S 1 rI7� 0'
SEPTIC TANK CAPACITY-1 O 'O G s-r.
LEACHING FACJLITY:(type)__pkLC sue (Size). L__
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER_ �rAckS
DATE PERMIT ISSUED: 9113 81E __
DATE COLiPLIANCE ISSUED-
VARIANCE GRANTED: -�—
Z
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645 sE1-tc6
1
TOWN OF BARNSTABLE
L•OC,NITION SEWAGE #
VILLAGE O TWt IT- ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY 1600, 441S,
LEACHING FACILITY:(type) God, Tl4,- (size) 1606 974k3
NO. OF,BEDROOMS 3 PRIVATE WELL OR UBLIC WATER
BUILDER OR OWNER ALA
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED Yes No
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- RO.BOX 2056.COTUIT,MA 02635
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LOCUS MAP NOT TO SCALE CB/DH S47 2"E CB/DH
°00'2 FOUND
FOUND 1 0 28' �/
APPROXIMATE LOCATION U) GENERAL NOTES
OF EXISTING SEPTIC SYSTEM a. _
BASED ON TITLE 5 INSPECTION co
REPORT AS-BUILT DATED 10/12/13 a w LOCATIONS ARE BASED ON AN"ON THE GROUND"INSTRUMENT
SURVEY AND ELEVATIONS BASED ON THE NAVD 1988 DATUM.
04 COORDINATE SYSTEM USED IS THE MA-MAINLAND COORDINATE
O 3X10" M SYSTEM,DATUM: NAD 83.
EXISTING TANK 5.0'
STONE WALL UNITS: U.S.SURVEY FEET.
NOT IN SERVICE °'
w CA)
PROPOSED GUEST HOUSE(416 S.F.) ZONING DISTRICT: RF
O 9.5' IF.FL.EL.=56.5
STONE WALLS PROPERTY IS LOCATED WITHIN THE RESOURCE PROTECTION
OVERLAY DISTRICT.
� FIREPLACE o o
O `54.4 EXISTIN
� BARN TO BE
G PROPERTY IS LOCATED WITHIN THE WELLHEAD PROTECTION
R
RAZED OVERLAY DISTRICT.
16.0' 24.8 PROPOSED
55.4 PROPERTY IS LOCATED WITHIN AN AREA HAVING A ZONE
Q 26.5'(EXIST) DESIGNATION OF X BY THE FEDERAL EMERGENCY MANAGEMENT
54.6 x
CONCRETE
Q x .7 AGENCY(FEMA),ON FLOOD INSURANCE RATE MAP NO.
PATIO
Z 55.3 Q 25001C0539J,WITH A MAP EFFECTIVE DATE OF JULY 16,2014.
PROPOSED SEPTIC OUTLET
i cc-n wli 0f TO BE CONNECTED TO DEED REFERENCE: DB 29174 PG 148
EXISTING TANK.
STONE SCREENED zo to MIN.2%SLOPE PLAN REFERENCE:PB 235 PG 77
PARCEL A m WALK DECK PORCH o a? I MIN. 1'OF COVER OVER PIPE
CD CD � + ELEVATIONS OF EXISTING TANK
LOT 1 cn AND LOCATION OF UTILITIES
` SHALL BE CONFIRMED PRIOR TO
20,054 S.F. CONSTRUCTION
NOTICE
THIS PLAN MAY NOT BE ADDED TO,DELETED FROM,OR ALTERED IN ANY WAY BY ANYONE OTHER THAN CAPE&
N/F HELEN M. RENNIE ISLANDS ENGINEERING,INC.
56.1 _.I UNLESS AND UNTIL SUCH TIME AS AN ORIGINAL(RED)STAMP APPEARS ON THIS PLAN NO PERSON OR PERSONS,
_ MUNICIPAL OR PUBLIC OFFICIAL MAY RELY UPON THE INFORMATION CONTAINED HEREIN;AND THIS PLAN
U \ I REMAINS THE PROPERTY OF CAPE AND ISLANDS ENGINEERING,INC.
36.8' EXISTING 0 O \
DWELLING a 38.9' \ DATE
#552 DESCRIPTION I BY JAPPR
OWNER OF RECORD:
JEFFREY DINARDO&
CHIMNEY MARIA APSE
55.1 552 MAIN STREET
COTUIT,MA 02635
STONE APPLICANT: JEFFREY DINARDO&
DRIVEWAY MARIA APSE
55.2 COBBLESTONE EDGE 1
552 MAIN STREET
COTUIT,MA 02635
54.9 PROJECT:
ai
CB/DH N RAZE BARN & CONSTRUCT GUEST HOUSE
FOUND / 120.83' __ FOUND CB/DH 552 MAIN STREET
55.4 N47001'17"W FOUND IN
55.4 COTUIT MA 02635
MAIN STREET
PUBLIC ^� 40 FT. WIDE �tOF'�gSsq�, SHEET NO.: 1 OF 1 DATE: NOVEMBER 17,2017
?� yG
DRAWING FILE NAME: MAIN-552—DINARDO—SS
MAME'N C.
c COCA y DRAWN BY: JB CHECKED BY:MC
No. 52282 PREPARED BY:
44 URVV4 CAPE & ISLANDS ENGINEERING
CIVIL ENGINEERING- LAND SURVEYING-ENVIRONMENTAL PERMITTING
INCORPORATED
SUMMERFIELD PARK
800 FALMOUTH ROAD SUITE 301C 508.477.7272 PHONE info@CapeEng.com
MASHPEE,MA 02649 508.477.9072 FAX www.CapeEng.com
0 20 50 100 DRAWING TITLE:
SCALE: 1" = 20' CERTIFIED PLOT PLAN
ASSESSORS INFORMATION: 037/015