HomeMy WebLinkAbout0804 MAIN STREET (COTUIT) - Health 304 Main Street(Cotuit)
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SY ft
PART A
CERTIFICATION MAY 14 2002
Property Address: 804 Main Street TOWN OF BARNSTABLE
Cotuit, MA 02635 HEALTH DEPT.
Owner's Name: Leslie&Nanette Lewis
Owner's Address: q
Date of Inspection: May 8, 2002
Name of Inspector:(Please Print) James M. F6rd
Company Name: James M. Ford Map: 035
Mailing Address: P.O. Box 49 Parcel: 069
Osterville,MA 02655-0049
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000), The system:
✓ Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fi
Inspector's Signature: Date: May 8, 2002
The system inspector shall sub 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.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 804 Main Street
Cotuit, AM
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
Inspection Summary: Check A,B,C,D or E L 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.
Answer yes,no or not determined(Y,N,ND)in the 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.
ND explain: .
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s), The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
` ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 804 Main Street
Cotuit, MA.
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
I
3
Page 4 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 804 Main Street
Cotuit, MA
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow
✓ 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 cesspool or privy is within a Zone I 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd-
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
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 CNIR
r 15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 804 Main Street,
Cotuit. MA
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
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:
Yes No
✓ 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(3)(b)].
I
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Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 804 Main Street
Cotuit, 1M
Owner: Leslie&Nanette Lewis
Date of Inspection; May 8, 2002
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 5 Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550
Number of current residents: 0
Does residence have a garbage grinder(yes or no): Yes
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): Yes
Water meter readings,if available(last 2 years usage(gpd)): 2001 -210,000 gals.;2000- 144,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: None on file-per treatment plant
Was system pumped as part of the inspection(yes or no): No
If yes, volume pumped: Qallons--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)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components, date installed(if known)and source of information:
Dec. 2199-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 804 Main Street
Cotuit, MA
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
BUILDING SEWER(locate on site plan)
Depth below grade: Approx. 24"
Materials of construction: _cast iron ✓ 40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 12"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 2000 gal.
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 39"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 9"
Distance from bottom of scum to bottom of outlet tee or baffle: 20"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present The liquid level was even with the outlet invert. There were no signs of leakage. Scum/sludge were
minimal The tank was under a driveway. Recommend bringing covers to grade.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:,
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 804 Main Street
Cotuit, MA
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
TIGHT or HOLDING TANK: None (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/day .
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level No solids were present The D-box was clean. There were no signs of backup or failure from the leach
field The cover was 24"below grade The D-box was in a driveway. Recommend bringing cover to grade.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY-ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 804 Main Street
Cotuit, AM
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
✓ leaching-trenches,number, length: 5 infiltrators 12'x 44'x 2'per as built card
leaching fields,number, dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,
etc.):
The leach veld was located but not dug up There were no signs of failure in the D-box.
CESSPOOLS: None (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 or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 804 Main Street
Cotuit, AM
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
Map: 035
Parcel: 069
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
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Page l l of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART'C
SYSTEM INFORMATION (continued)
Property Address: 804 Main Street
Cotuit, AM
Owner: Leslie&Nanette Lewis
Date of Inspection: May 8, 2002
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 30' +/ feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately
30'+/-to ground water at this site
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
11
,^ s
TOWN OF BARNSTABLE
.LOCA`I10N �O �/1'1QIn Sr SEWAGE # �1�I' S3�
;VILLAGE CQ+U ASSESSOR'S MAP & LOT
INSTALLER'S NAME& PHONE NO.
SEPTIC TANK CAPACITY a-�U
LEACHING FACILITY: (type) (size) 4a X q41 X a
NO. OF BEDROOMS S
BUII_DER OR OWNER �GS I�� l Cf�✓�s
PERMITDATE: COMPLIANCE DATE: �1 Z
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 leac 'ng.facility) Feet
Furnished by TGnS�e.0 �Or�
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TOWN OF BARNSTABLE
c LOCATION
SEWAGE SEWAGE #
VIL AGE L ASSESSOR'S MAP & LOT .
INSTALLER'S N:e ME&PHONE NO. ! _&2
SEPTIC TANK CAPACITY OL7 !B-
LEACHING FACILITY: (type) (size) -,2�7—
NO.OF BEDROOMS
BUILDER OR OWNER i e. tit
PERMITDATE: 0 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or.within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching.Facility(If any wetlands exist
within 300 feet of leaching facili ) Feet
Furnished by � G° iC
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.No. Q� Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes/�
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS �Y/
Zipprication for Miopogaf *pgtem Cottgtruction Permit
Application for a Permit to Construct( )Repair( )Upgrade(�(,)Abandon( ) 1I Complete System ❑Individual Components
Location Address or Lot No. 1904 11')ath st P ce f ut t Owner's Name,Address and Tel.No.
L, A?, Aowfs
Assessor's Map/Parcel
fi9i7R 490+ A77e0? --514- Gee/'voGr
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -4 ZS—f/J/
Ql�X7�'72�tall YG� /.✓G�
Type of Building:
Dwelling No.of Bedrooms f ivr_ (cy4shwJ j Lot Size Z , )/G sq.ft. Garbage Grinder(/pl
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow Acc g ]Ions-gec.day. Calculated daily flow 3 SO gallons.
Plan Date ! Number of sheets Orw Revision Date,8//-t l
Title ' lc- 9� Sr s� U�J�iraa¢�
Size of Septic k a7imcse9 ;d&&2zd Type of S.A.S. Xew&y 1 .+/! iZ x•�9 K2����G
Description of Soil /J�
• DESIGNING ENGINEER MUST SUPERVbSE
INSTALLATION AND CERTIFY IN WRITING
s Nature of Repairs or Alterations(Answer when applicable) THE SYSTEM WAS INSTALLED IN STRICT
ACCORDANCE TO PLAN.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by thi Bo o lth. 41
Signed Date e q-
Application Approved by Date -�
Application Disapproved for the following reasons
Permit No. Date Issued "
r N f l Fee /4 f!—410
j y Entered in computers
THE COMMONWEALTH OF MASSACHUSETTS 1e
F'4y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS
a .
Zlpprication for Migpogar 6pgtem Congtruction Permit
Application for a Permit td�tlonstruct( )Repair( )Upgrade(X Abandon( ) X Complete System ❑Individual Components
*p` Loc4pon Address or Lo BOA Inam Sf� Co 1-V L Owner's Name,Address and Tel.No.
4
Assessor's Map/Parcel
!a Installer's Name,Address and Tel.No. % Designer's Name,Address and Tel.No. 4 Z$—j/_?/
SAX7LM#WY � /NG,
Type of Building: - ° t
Dwelling No.b€'Bedrooms fiuc , Lot Size Z'7r'7/6 sq.ft. Garbage Grinder(�
-' Other Type•of Building No.of Persons Showers( ) Cafeteria(
_ )
tkOtherFixtures\,. w�+
Design Flow day. Calculated daily flow SSO gallons.
Plan Date 9 Number of sheets Drt,df Revision Date 8//g l
.Title /�-� �'�;�r3c �.silc,. Uwe #
s Size'of Sept r Type of S.A.S. lewe6e-f /Z X44 xI'L,✓!�
Description of Soil op/� eco. 'en 424 h
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,Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
i _
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system_ in operation until a Certifi-
cate of Compliance has been issued b thi Bo Mth.
nn
Date �i 7
Application Approved liy Date -�
Application Disapproved for the following reasons
Permit No. Date Issued l ,
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CER134Y,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by
at Q ` h s been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. - +0 7,.17dated Af A?e3 4P 9.
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the syslefii will function as de 'gn
Date--- -' Inspector
i
--- —_.----_--
No. 9 `r 47 Fee �Y r✓J'f1�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
ligpogal *pgtem (Construction Permit
Permission is hereby granted to Construct( )Repair( U grade( bandon )�
System located'at S! /S �� �M
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: Approved by
TOWN OF BARNSTABLE
LOCATION ���E%^ 'G>w SEWAGE # �
VILLAGE C' 'li� ASSESSOR'S MAP & LOT(..� .� L��r g.
INSTALLER'S NAME&PHONE NO. ��. �cz�l e1+1 C?n
SEPTIC TANK CAPACITY OU L
f LEACHING FACILITY: (type) ,L/4�` ra r� (size)
NO,OF BEDROOMS
i
BUILDER OR OWNER L���^!.� V� !fit-9 f � �' <) .� 1
PERMIT DATE: COMPLIANCE DATE: f ✓ . f _
Separation Distance Between the:
j Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
# Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
?. ? Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 fees of Teaching facili ) Feet
Furnished byel' �
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BAXT ER & NYE, INC.
Professional Land Surveyors and Civil Engineers
812 Main Street•Osterville, MA 02655 Tel. (508) 428-9131
Fax. (508) 428-3750
WILLIAM C. NYE, R.P.L.S., President STEPHEN A.WILSON, P.E.,Vice President- Engineering
RICHARD A. BAXTER, R.P.L.S.,Vice President JOHN R. ELLIS, R.P.L.S.
December 6, 1999
Board of Health
Town Hall
367 Main Street
Hyannis, Ma. 02601
Re: Permit#99-535
804 Main Street, Cotuit
Members of the Board:
This letter is to inform you that I inspected the above noted system, prior to backfilling,
on December 2"d 1999.
The system was completed in substantial compliance with the approved plans.
If you have any questions or comments please call me.
Very truly yours,
Baxter,Nye & Holmgren Inc.
St en A. Wilson, P.E.
V.P. Engineering
cc: M. LeBlanc
#98092
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS
N GRAPHIC SCALE 40 V `�P� OLD POST RD
.39' 0 20
IN ST. PATRICIA MOORE I
M.B. 0qp�F,p LOWSFND. S87°49'00'E 0 IDGE ST.
45.5 45.6 45.2 M.B.
S.B. o0 181-29' ball hoop ° 44.9 FND.
�-°<<ff,nce 42.4
light posts 44.9 ® 7- co °--a° 40.9 SCHOOL � COTUIT BAY
FND. r- 45.4
45.1 44.3. -"°° ° �p 39.4
x 45.3 2 5 dam-- + 37.0 S T.
43.8 � °
4�1 Q X 44.�aved 1 39.4 °-.-° ° 34. Z
45.5 Stone \ parking area 24" aple r- _ - 3 .8 °
45.5 �x �7 drive 44.5 4.1 i I
45.7 x 44.5 44.3 39.8
elec. meter 44.8 4�('� 44.3 4. ' PROPOSED ADDITION LOCUS MAP
44.3 - �� �'
145.6 45. .. _ 1 # 3 1
z sprinkler 44.5 41.3 36.0 SCALE 1 25,000
I �4 0 41.1
' I w
/ 1 II lawn ° w ASSESSORS
45.2 I a �� 16.4
MAP 35 PARCEL 691 o' 44.8 stone drive j I 38. ZONE
I
24" pine 44.2 I RF & GP
12.9' DIST. MAN a) 8.3 Q,. j 4 7 I RESIDENCE F
BOX .z 00 41.5 ° 35.3 w MINIMUMS
2000 GAL �, 1.6
4 �0 TANK 7J t 41.7 37.7 Q AREA = 43,560 S.F.
c
I 41.5 ° FRONTAGE = 150'
light post ` °i } I 3 z
' Qj co M FRONT SETBACK = 30'
o 8 �-44.OL c�
x 44.Oj 43.g '; -- -- " SIDE SETBACKS = 15'
44.4 > Q 44.3 `� alck 37.0 �� ° In
REAR SETBACK = 15'
44.5 44\2 / % j t �f 41.0 a BUILDING HEIGHT = 30'
I 44.3�\� Q 20' l / x 41 I I
44.8 w _ I
a I > 43.8 37.1
43.6 r
Q rrc .5
_ 41 °
L<J -�c x
o co 43.3
43.8 f' I 35.7
a� 14-.2 lawn 37.7
a, shrubs 42.4
44.5 Z077 .1#80 144.3 43.9 43.4 C� t� 36.7 I
44.3
fountain ',r,
44.2 27,716 S.F. 00 ®40.1 °
�.-- lawn
4 4 --- y
x 40.8 I
.-- I ! °
x � 9.2 � I
44.1 i
C.B. f% 43.7 0.0 3 3�.5 ° C.B.
FND. 43.5 43.2 424_ 19: 52' 40.8 40. I FND.
° -f°-° 2 �37.9
'44.2 ° ° -° °-,-° _° -ape
143.00'
BENCHMARK N88 32'09'W C.H.
BENCHMARK 48.52' 34.8
#M28SA FND. TOP OF C.B.
ELEV. = 44.21 NGVD ELEV. = 40.24'
NOMs CHARLES 0. RADDEN STEVEN C. GOULD TR.
1. ALL COMPONENTS ARE TO BE H2O LOADING.
2. THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. 12'
3. THERE ARE NO WETLANDS LOCATED WITHIN 100' OF THIS LOCUS. FINISHED GRADE
4. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL \\/\\/\\/\\/\\/\\/\\/\\/\\/\\/\\/\\/\\/\\/ COMPACTED FILL
WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT 36"MAX.- 12"+IN. //\\//\\//\\//\\//\\//\\//\\//\\//\\//\\//\\//\\//\\/�\//
MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED 2" -!- PEASTONE
ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. 4
100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE SOII__ TO RF APPRn\/Fn I a 3/4" TO 1 1/2
B'1 ENGiNEEN FUR COMPLIANCE PRIOR TO PLACING ON SITE. 30 5" < °
5. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS I 4, 0 a a DOUBLE
PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE 1 'a WASHED STONE
THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE
1
WATER DISTRICT TO DETERMINE UTILITY LOCATIONS.
6. SOIL SUITABILITY TO BE VERIFIED AT THE TIME OF INSTALLATION OF LEACHING FACILITY.
7. INVERTS TO BE FIELD ADJUSTED AS NEEDED TO ACCOMODATE EXISTING PLUMBING. SECTION
NO SCALE
COVERS LOCATED TO WITHIN
6" OF F.G.
F.G.= 44't T T
F.G.= 44t
INV. 41.8 D !EL
X �. .
2000 GAL. 2' I Q
INV. = 41.6 4" DIAMETER
SEPTIC TANK INV. = 41.3 -L-1 SCHEDULE 4n LEACHING CHAMBERS
DIST. P.V•C. 1
INV. = 41.1 BOX
10.00' -.--__-6" STONE BASE _
........... '1V = 40.9 INV. = 40.7
..... ------------
MIN. ::::::::::
BOTTOM ELEV. = 38.7
PROM u
NO SCAT
PLAN OF SEPTIC SYSTEM UPGRADE
AT #804 MAIN STREET
:av ^dG ENGINEER WST SU'
IN37iALLATION AND CERTIFY IN Ml';T; .'� I N
THE SYSTEM WAS INSTALLED IN STR:G+"
D83 N DATA A CCORDANCE TO PLAN. (C 0 T U I T)
EXISTING SINGLE FAMILY HOUSE WITH 5 BEDROOMS BARNSTABLE MASS,
NO GARBAGE GRINDER
DAILY FLOW = 110 X 5 = 550 G.P.D. FOR
SEPTIC TANK 550 X 200% = 1100
5 TOTAL UNITS 1 STARTER,1 EIID, & 3 INTERMEDIATES.330S LESLIE B. & NANETTE S. LEWIS
USE 2000 GAL. SEPTIC TANK TYP. 3301 3�)E
5.75' 7.5' 6.25 6.25' 75'
CUM TEACHING CHAFER DESIGN 1-1.5" WASHED STor E SCALE: 1 " = 20' DATE: SEPT. 28 , 1998
RECHARGER MR OR EQUIVALENT -' -' REV. J U L Y 19, 1999
����
N �(lF�L?_44`1
REV. AUGUST 19, 1999
ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED c1 �TEPHFN
WITH CAPPED ENDS
USE 1 - 4" DISTRIBUTION LINE IN 5 RECHARGER UNITS 44' � ,, '' `i t� `- 741 BAXTER & NYE INC.
I' "`"t'
IN A 12' X 44' WASHED STONE TRENCH AS SHOWN REGISTERED LAND SURVEYORS
�o ,� �,,,� �
PLAN OF LEACH TRENCH �' .� ,,�1 F c•, �� CIVIL ENGINEERS
LEACHING AREA REQUIRED �.
550 G.P.D./.74 = 743 S.F. SCALE: 1" = 20' '> - ❑STERVILLE, MASS.
2(44 + 12) X 2 = 224 S.F. SIDEWALL AREA
(12 X 44) = 528 S.F. BOTTOM AREA
752 S.F. TOTAL PROVIDED
#98092