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HomeMy WebLinkAbout0968 MAIN STREET (COTUIT) - Health 968 Main Street Cotuit A= 035-096 �y SMEAD No. 10339 smead.com o Made in USA ��cvci.eo�y 6 i i V Q C^, \` f j I Q � I M V9 P �� TOWN N OF BARNSTABLE LOCATION SEWAGE SEWAGE# -� VILLAGE Ca-,-u� ASSESSOR'S MAP&PARCEL C997—O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Gk l nj lit-E'c LEACHING FACILITY. (type) (size) <46 k.M.23 .XK 4-' NO.OF BEDROOMS I Imo- _ 'IC.i_5.4JC,.%Z OWNER 4.4- 12�0 4 AI-- CRA.:0Z41VT PERMIT DATE: L.N--i; COMPLIANCE DATE: 2/1/L-2- 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) L, Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) gp Feet FURNISHED BY 57 o `0 ' rL- Gl`3" �S" 1 ,1=7 1 .� Y } L --11 No. �UosU-�7 D Fee SU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS ftpYication for Misposai *pstem Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade(41�Abandon( ) ❑Complete System EETIndividual Components Location Address or Lot No. Co Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 035 -cry f, ()C-all View 1 P40A, LAX4,0} Installer's Name,Address,and Tel.No. So$-q.�$- F Designer's Name,Address,and Tel.No. CvnsFrUC{-1'cm, c 'i5:r4 Lm—nq � l;Gan `erg n�e�;n5 �coa�suQ�,' CS s ' t. o�tF -q a`6- 33YV Type of Building: Dwelling No.of Bedrooms oZ Lot Size LXiQ sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 1320 gpd Design flow provided 1 �3J gpd Plan Date Su ne-14 -.,Do Number of sheets Revision Date /J- aS- DODO Title Si'he-'A.1,, �fv(m T--y n Dt't 9 UY UAn Size of Septic Tank 5L Q, �,Q Type of S.A.S. Ja-S(x3Gcell C6Mj grS t n a tat X �a Description of Soil 15 E,' - a 5 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maint of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro Code and not place the system in operation until a Certificate of Compliance has been issued by this Board of igne Date Application Approved by Date �- Application Disapproved by Da —__ for the following reasons Permit No.AOo?G 37'Z Date Issued 1-�'II5 6)10 f No. a Ua(f- . 71� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: el" Yes PUBLIC HEALTH DIVISION 'TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposhi *pstem Construction i3ermit Y Application for a Permit to Construct( ) Repair( ) Upgrade(a')Abandon( ) ❑Complete System ®Individual Components Location Address or Lot No. q4 S Mo 00+1 �-(- Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 63 Uct(, �C` �''f'�°rt' ° (,,Z•i.t }"i Installer's Name,Address,and Tel.No. 50t-tl,�S-�i�i t C� Designer's Name,Address,and Tel.No. Inc 14S'T..C1L6tr 1 Type of Building: , Dwelling No.of Bedrooms oZ. Lot Size y5 (�,)bf) sq.ft. Garbage Grinder( M? Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) /3 RU gpd Design flow provided gpd Plan Date,�-,112. 14 Number of sheets Revision Date it- S' r�XOD J Title Ca Ar't v-, j i r)i X .rC. �1�1i(J\1�ttV17E A!i S Size of Septic Tank 10 G, 03 Type of S.A.S. I a i4- 5w .O C7,1w o G", 1 L x 7 Description of Soil (0„�- 15 LI as l_ ea t:l.P Ii. t`In Or" " 5�A .J-t4 e,,U Nature of Repairs or Alterations(Answer when applicable) Date last inspected: `f 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 Envir�nial°Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed- -��� . _.-.._. Date Application Approved by Date Application Disapproved by —Dare'- for the following reasons Permit No. ;t Oc�?6 "3ci'{ti Date Issued - ----- IS)o1 //.VV,*-j THE COMMONWEALTH OF MASSACHUSETTS �- BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(d) — .Abandoned-( .)by Zn 4,anf f�, r cV rT�r at �(��S �I,4j,� sy has been constructed in accordance k• with the provisions of Title 5 and the for Disposal System Construction Permit No.,'k9t)- -49 y • dated Installer Ri,r �,In1AA un<f j 1 �nrnr Designer ��G!�l'iti�t.p, S• ,-�^, ,nr� ri'rtk' r #bedrooms - Approved design flow _ i`? .. gpd { The issuance of this pa°e``rmit shall not be cons2 .trued as a guarantee that the system will funotirs designed Date ( X- ' Inspector - --- - - ------- ---------- ,d - No. 5� Fee 156). THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposai �6pstem. Cone.truction 3permit Permission is hereby granted to Construct( ) Repair( )y Upgrade( Abandon( ) System located at. (� ; T /C1,41 `�� • 1l:` �t a and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions-. } Provided:Construction must be completed within three years of the date of this permit. <Date / J/ fJ Approved by \-,, ~� �� FEB-27-2021 07:35 From: To:150B7906304 Pa9e:1,'1 Town of Barnstable a Inspectional Services _ P Public Health Division � +pe ' �' Thomas McKean,Director a 200 Main Street,Hyannis,MA 02601 Office: 308-862.4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 01123 It I Sewage Permitdf d Oa`U Assessor's Map�Parcel D _(S9. Designer: S G ' Installer: — L ""Art) �d,k s� V_lk - " Address: �.� �� � r ��+ Address: On a permit to install a (date) (insta er) , septic system at �- based on a design drawn by (address) 4�w v l�'l k % I�;dated � t 161D . ( gner) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils -were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or. certified as-built by designer to follow. Strip out(if requited) was inspected and the soils were found satisfactory. I certify thAAmNstem referenced above was constructed in compliance with the terms of the ppmga letters(if applicable) tH OF' . i CIVIL. nsta er's Sign a re) NO.40188 s/ONAI f�A� Designer 7s Signature) (A x Des tamp Here), PLEAS RET RN T BARNSTABLE PUBLIC II TH DIMS 9N. CERT LATE F -COMPLIANCE WILL NOT BE IS UED QINT11, J1OTfJ THIS FORM AN - B ILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HE LTH DIVISION. THAN Y U. \UooWcpts\FiFA1.TRSEWER connectl9EPT[(1DeslgnetCcrti0en11on Fomt Rev 6.I4-0.DOC r 7,11.7 THE COMMONWEALTH OF MASSACHU36 TS r t"�n14 d'�•---�• i '� ` - PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE.MASSACHUSETTS 'Xpolim loft for.Misposal oystelill Coilstructio"30crinit t . hppt cadon 1prl PclnNt to C.otatrw t( Y Itelzair( ), Upgrade(if Alwndun i,) ocoo rl"Is system e^ t wlduat cdmt wms ff Location Address or Lot No. N 51', (t1MYt- �wlRt Uwncr'e Nntnt,Addtwa:and'ra1.Nu^ _ Assessor's MaplPareel SYIKI. Installer's Name,Addross,end'IYI.No. Ueyil(ner'�Nome,AQ r�}w uul'ftL N,, s r •1 - �u.1VAM !'/IJi�+�GyW!-�.�NS3L1tiVfi . y _ - 'tt Dwelling No.ofbodrooms_/7— L,otSlru pd ; Type ofBuildi (iarbap Orindes Woj • Other ng No.oflaraons Showanf+ f ...,.�. }Cafeteria( ) t, . .��. $/ OtherFiztures y„ Dasign Flow(min.required) ZI - � - X-J � LiedDesign nowprovidedPlae Datc ll� NunnbCrafehcetX-, kevisionDate Title v nLA,�, .ia4914? tafj, ( Sim of Septic Tank 'I t D 21 s YPe of S A.s.1i ,., 'k�in pC�S l M s Description of Soil r .. t It ` - �„�..��(►�tta �•�,srR{::�.....Y!1�....��b1}/ Nature of Re airs orAllerationa Answer when applicable-) Date last inspected: ------------- Agreement.• o- The undersigned agrees to ensure the construction and maintenance of the afore described O"he sewage disposalsysaem in accordance with the provisions of litle 5 of the Lnvironmental Code and not to place the ttystem in operation until a Certificate of Compliance has been issued by this Board orHeaith. - J, Signed Date ± !Y Application Approved by Tn Date Application Disapproved by Date for the following reasons ,r .-_ Permit No .... .. ,.Date Is.sued THE COMMONWEAL9'H OFMASSACHIIJUTTS BARNSTABLE,M.ASSACHUSE7 rS Certifirate of Compfianre TEAS IS TO CERTIFY,that the On-site Sewage,Disposal �Zv ., ag posal system Constructed( j Repaired( PB��(�} ' Abandoned{ }by U at has YY>rtA3T otuCC� . "•'^�--..�, —s—�--.--- haa,been eoruwcted in accordance , with the provisions oflItle 5 and the for Disposal Systeili-Construction Permit No. dited Installer - ~ ' Designer Atbedrooms�17 Approved design flow! p The issuance of this permit shall not be construed as a guarantee that the system will furulion_as designed. Date Inspector ... 1 ._ - .......... _ - - - No. -- - f ------- �- THE COMMONWEALTH OF MASSACHUSETTS Fen PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS . �-`',��� - '° 3�isposaT�p�tem �onstruttorr ertnit Permission is hereby granted to Construct( .j Repair( j Upgrade(_I Abandon{ j F System located at and as described in the above:Application for Disposal System Gonstnlction'Perm:d Tbe- �icar�rec(rgrliud}�yi><T duty,to comp)) f ' Trtie 5 and the following local Provisions or special conditions. wM Provided:Conatm ion U9 be cam feted within three earl afthe date of this IL. } s Dale p y P Appfoved June 8, 2020 To Whom It May Concern: I am writing this letter to inform you of a 300 person wedding happening in the village of Cotuit, Ma. The wedding is going to be on June 20`h and the address is 968 Main Street. How can this wedding actually happen? I thought the maximum number of people for gatherings was limited to 2S. I'm concerned for our town beaches and stores. How can we as resident's social distance when we have . that many people in our town? Plus the people coming are from all over the country. Many people have had to postpone parties, weddings etc. due to this pandemic. Some people think that because they have a lot of money they don't have to abide by the rules. I think it's appalling. A concerned resident. Bu ILp1NG pEP�. ,u� 12 202� . �gARNSSABL� TOWS 4 r D36-05� Commonwealth of Massachusetts Title 5 Official Inspection Form . .f� Subsurface Sewage Disposal System Form Not for Voluntary Assessments; �+'• 1 968 Main Street - ` Property Address Kevin Starr s Owner Owner's Nye ; information is Cotuit MA 02635 8-22-19 required for every �rf page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered In any way. Please see completeness checklist at the end of the form. Important:when filling out forms A. Inspector Information 5"/ N ��: �y. useon only the tocomputer, James D.Sears ' JAMES : ,= use only the tab key to move your Name of Inspector s v; :r„H cursor-do not Ca swideEnter rises a key the return Company Name �' •. , '< `�. y 153 Commercial Street F b I sPE���.�`� m ilV Company Address Mashpee MA 02649 ' 11111,10 City/Town State' Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification j I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 �.- (310 CMR 15.000); I have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as,of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails (Z2 9 L'4- 8-22-19 pectors 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address howthe system will perform In the future under the some or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 61, a5ed xed dH 8 6:L0 6 XZ 62 6rnd I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 968 Main Street Property Address. Kevin Starr Owner Owner's Name information rfo otuit MA is C 02635 8-22-19 requireded for every � page. city(rown state Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2,.3, or 5 and all of 4 and 6. 1) 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: The system is a 5000 Gal. Tank- Pump chamber D Box and three pits. ' 2 System �y 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): F 15insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 OZ a5ed xezI dH 2[:LO 61.0Z £Z 5nd I c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L;- 968 Main Street Property Address Kevin Starr Owner Owner's Name information is Cotuit MA 02635 8-22-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: isinsp.doc-rev.7/2612016 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 or 18 lZ a5ed xe: dH 61,10 660Z EZ 5nV i Commonwealth of Massachusetts P Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8-22-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic.tank and soil.absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No OBackup 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 t5insp.doc-rev.7/20018 Title 5 Ofticial Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 ZZ abed xe� dH 66:L0 660Z £Z 6nV Commonwealth of Massachusetts Title 5 Official Inspection Form ^I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8-22-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than 1/2 day flow /°/77S ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. 5) 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply f ❑ ❑ 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 t5insp.doc•rev.71`2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 t:Z abed xP� dH 66:L0 660Z £Z 5nV Commonwealth of Massachusetts ,io Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8-22-19 page. City/Town State Zip Code Date of Inspectlon C. Inspection.Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat,or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes"or"no"for each of the following for aH inspections: 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? 0 ® 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)] t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 bZ a5ed xed dH OZ10 6 MZ £Z 5nV Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owners Name nform requir on Is Cotuit MA 02635 8-22-19 i requiredd for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions:: Number of bedrooms(design): NA Number of bedrooms(actual): 12 DESIGN flow based on 310 CMR 15.203(for example. 110 gpd x#of bedrooms): 1320 Description: 5000 Gal. Tank- pump chamber- D Box and three pits. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2017-60,000Gals 9 ( Y 5 (gp )) 2018- 0 Gal's Detail: Sump pump? ❑ Yes ® No na Last date of occupancy: Date lWsp.doc-rev.7,12612018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 SZ a6ed xed dH OZ10 660Z £Z 6rnd i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name information is Cotuit MA 02635 8-22-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design now(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancyluse: Date Other(describe below): 3. 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: 15insp.doe•rev.7/2612018 Title 5 Official Inspedton Form:subsuraw sewage Disposal system-page B of 1B 9Z a5ed xed dH 210 660Z U 5ny i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8-22-19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 4. 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) El 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): Pump Chamber Approximate age of all components, date installed (if known)and source of information: 1993 Permit # 93-29. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): K Depth below grade: 3'fit 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. 6nsp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal System-Page 9 of 18 e LZ abed xed dH 0210 660Z 62 6nd I Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8-22-19 page. city/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): - Depth below grade: 2 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: 5000 Gal. Precast 'Sludge depth: 2-1 Distance from top of sludge to bottom of outlet tee or baffle NA" Scum 'thickness 1 Distance from top of scum to top of outlet tee or baffle NA" Distance from bottom of scum to bottom of outlet tee or baffle NA" How were dimensions determined? Asbuilt-TapeSludge 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.): Tank at working level.Tank at 2"below grade. Outlet cover steel at grade. In and outlet tee. No sign of leakage or over loading. t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 gZ a5ed xed dH OZ:LO 660E EZ 5nV Commonwealth of Massachusetts 02 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name Information is required for every COtUIt MA 02635 8-22-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 ❑ pol eth ene y yl ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Nnsp.dcc rev.7126(2018 Title 5 Official Inspection Form:Subsvrace Sewage Disposal system-Page 11 of 18 6Z @Bed xed dH OL0 61,U £Z 5r1V I • • f 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u4�/ 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8-22-19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. 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 H-20 in stone drive way. Box is 15"below grade w/steel cover at 7".Box is clean and solid w/three lines out. No sign of over loading or solid carry over. t5insp.doc•rev.7126M18 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 0£ abed xed dH 210 Me £Z 5nV I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 968 Main Street Property Address Kevin Starr Owner Owner's Name information Is required for every Cotuit MA 02635 8-22-19 page. City/Town State Zip Code Date of Inspection D. System Information (coat.) 10. 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.): Pump Chamberis TxT-80" below grade w/steel cover at 4" in grass area.One pump. Pump and alarm working .Chamber is clean and solid. No sign of solid carry over. If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ill Type: ® leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 15inap.doc-rev.7/26/2018 Title 50f1icial Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 a 6£ a6ed xed dH 210 660E £E 5nV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8-22-19 page, CltyfTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont,) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is three H-20 precast pits. Pit#1 at 32"below grade wi'steellcover at 8"dry. Pit#2 at 22" below grade w/steel cover, at 6". Dry#3 at 5' below grade under raised area. Camer out pit.dry No sign of over loading or solid carry over in pit's . No high stain line 12. 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 Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Sutsurface Sewage Disposal System-Page 14 of 18 Z£ a6ed xeJ dH OL0 ME EZ 6ntf Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main,Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8-22-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plane Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ti. I i 15insp.doe-rev.7/26/2018 Tile 5Otficial Inspection Form:Suosurfece Sewage Disposal System•Page 15 of 18 ££ a5ed xed dH OL0 660E £E 6rnd Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main Street v Property Address Kevin Starr Owner Owner's Name information is required for every Cotud MA 02635 8-22-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.&c-rev.7/28/2018 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System Page 16 of 18 �£ a5ed Xed dH ZZ:LO 660Z EZ 6rV Aug 0619,02:29p Capewide Enterprises 508-477-4977 p23 Jun 2215 07:23a C P,16 /YA 11V s T Page i of 2 eofU lT " :.'Town of Barnstable Geographic Information System Parcel newer CaNISIM Map Abutters ftO Sk- Zoom Out i I III l I IIn tv Fd .; O �V d --- • , O QL ar: f' :•i':r ;�•.,.'L'f:•-�.fit:••,...:..�•:.�- .r -- �,_ e1�.1�''-aim.i.�. ,•l'^�.`r;n..+:Tr' � .l.i`':'S''_�.i:.;a�..;. 20 Fees, `- Set Seale 1" = 20 MOW Photos i 94"DUCLAIMIR . - rnw.L�.loMt7m,0 t.......14o n..rw. �.la •II AwMe roe.n.. 5£ a5ed xed dH Ze:LO 6�N £Z 5nV f r Commonwealth of Massachusetts Title 5 Official Inspection Form V�R Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 B-22-19 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N C, 201+ Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,-date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Rear of lot drop's off 20'+. Front of lot 20" higher then rear. F 1 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t6insp.doc-rev.712612O18 Title S Official Inspection Form!Subsurface Sewage Disposal System-Page 17 of 18 g£ a5ed xe:1 dH ZZ:LO 6602 £Z 5nV I,L Commonwealth of Massachusetts Title 5 Official Inspection Form r !•I Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 968 Main Street Property Address Kevin Starr Owner Owner's Name information is required for every Cotuit MA 02635 8.22-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspeclor Information: Complete all fields in this section. ® B.Certification: Signed &Dated and 1, 2,3,or 4 checked ® C. inspection Summary: 1,2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed i ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included aL 151nsp.doc-rev.M612018 Title 5 Offidal Inspection Form:Subsurface Sewage oisposat System•Page 18 of 18 L£ a5ed xe� dH ZZID 61.0Z £Z 5W IKE Town of Barnstable P# 16q w Department of Regulatory Services BAMSTABM : Public Health Division Date 1z UNAM 7 z = ., 039. 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd.777 I oil Suitability Assessment for Se e Disposal xF �lJW } (0 ft ' t � Witnessed Performed o By: i LOCATION'&GENERAL INFORMATION Location Address 9{�� �1/\al ,4 ee Owner's Name .�*eT{A e- � p P (�. 9 Address 14.XJ Assessor's Map/Parcel: U2>5ocj\D En inee's same § m NEW CONSTRUCTION REPAIR Telephone# ) f, � "' " $ vyi5 j K Land Use _DES\ixw\\occ-_ Slopes(%) "76`fn Surface Stones e�- ' �e_ Distances from: Open Water Body 7� ft Possible Wet Area .,eft Drinking Water Well /UA- ft {3AW;, ec' Drainage Way A A— ft Property Line Coo ft Other V01 ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) 00 9 " r r � _ w € } 4 r E Parent material(geologic) Depth to BedrockCt Depth to Groundwater: Standing Water in Hole: A!jk- Weeping from Pit Face AIA- Estimated Seasonal High Groundwater 4.5}� 3 � to `�} a DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: A)ib Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION!TEST" Date 7161q Time Observation ,-, Hole# Time at 9" Ttr') , Depth of Perc Time at 6" Start Pre-soak Time @ Z Gip\w1 Time(9"-6") End Pre-soak Rate Min./Inch n Site Suitability Assessment: Site Passed - Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC ,�o vs r ' DEEP OBSERVATION HOLE LOG Hole# ! Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ig i \�PG.i^oyY� b._, I 1, DEEP OBSERVATION HOLULOG r ;,Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel ~i3z t L M-eDSNki 2,S�f G i DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent ° Gravel 1N' -10 c=iU— DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) I Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes G-1' Within 500 year boundary No/ Yes Within 100 year flood boundary No ✓ Yes Death of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Vk:6' If not,what is the depth of naturally occurring pervious material? Certification I certify that on L (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Sa 'Z`l Signature' Date ZS' Q:\SEPTIC\PERCFORM.DOC i mmun 22 1`11107:18a p•1 3 Commonwealth of Massachusetts Title 5 Official inspection Form lw�i —Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street 43 .Property Address 0',1 John Buckley �,aa Owner Owner's Name Information is Fes: required for every COtuit MA 02635 6-19-15 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information `�tti��nnnrr�up olni the comout prmsuter, `,\�A....OFl fgsgy�'.��� use only the tab keyto move your 1 Inspector o . G s � sue: JAMES •.N cursor-do not James D.Sears use the return Name of Inspector key. CapewideEnterpdses,LLC 3 •�'� �� - Company Name gi� F S INSPFGp�`���� 153 Commercial Street �����uutuh►tta`` Company Address Mashpee MA 02649 City/Town State Zip Code 508477-8877 S1623 Telephone Number License Number i B. Certification i 1 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 i sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16,340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority. 1 6-19- 5 • it AfjWpectoes Signature Date i 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 V and copies sent to the buyer, if applicable, and the approving authority. i ""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 wiff perform in the future under the same or different conditions of use. • � y . A\ T 5 Official Inspection Form:Subsurface Sews DisposeI S ey age l 0117 . 15ins 3113 We P � � • i Jun 22 1507:18a p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley — Owner Owner's Name information is required for every Cottrit MA 02635 6-99-45 page. Cityrrown state Zip Code Date of Inspection B. Certification (cons.) 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 16.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 5000 Gal.Tank-Pump chamber D Box and three pits. _ 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 f 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 I Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): i I i I l f5ins-3h3 Till&5 Official Inspedion Fomc Subsurface Sewage Disposal Syslem-Page 2,Y17 Jun 22 15 07:18a p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley - Owner Owner's Name information is COt MA 02635 6-19-15 uit required for every State Zip Code Date of Inspection page City/Town B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (Explain below): f t t I ❑ 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 ❑ NIA(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): i i Cj 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 j the system is failing to protect public health, safety or the environment. j 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 tstns-3l13 7itla 6 official Inspection Form:Suhswlece Sewage Disposal System•Page 3 of 17 Jun 22 15 07:19a p•4 Commonwealth of Massachusetts I Title 5 Official Inspection Form a — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley --- Owner Owner's Name information is MA 02835 6-99-15 required for every Cotuit page. Citylrown State Zip Code bate 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. ❑ system sysm has a septic tank and SAS and the SAS is less than 100 beep 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: i D) System Failure Criteria Applicable to All Systems: I You must indicate"Yes"or"No"to each of the following for all inspections: i i I Yes No if 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 ClLiquid depth in his less than 6°below invert or available volume is less than 2 day flow R/7a I5ins•31`1 3 Tills 5 Official impaction Forth:Subsurfaca Sewage Disposal System•page 4 of 17 . j Jun 22 15 07:19a p.5 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owner's Name --- --- information is required for every Cotuit Mil 02635 6-19-15 page. Citynown state Zip Code Date of Inspection S. 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. ❑ 9 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 fairs. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. I For large systems, you must indicate either°yes"or`no"to each of the following, in addition to the questions in Section D. j I Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply i ❑ ❑ 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 considared 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. i t5ins-3113 Tille 5 Official Inspection Fart:Subsurface SAwage Disposal System•Page 5 of 17 I I t I i 3. I t r Jun 22 1507:19a p'6 Commonwealth of Massachusetts um- 10 Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 968 Main Street Property Address John Buckley Owner Owner's Name information is required for every Cohtit MA 02633 6-1 9-43 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? i ® ❑ 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. j ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CMR 15.302(5)) I 0. System Information l Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 12 I DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 1320 i E t5ins r X13 Title 5 Or6dd Inspecdon Form:subsurface Sewage Disposal System•Page 6 of 17 i 1 E i I Jun 22 15 07:20a p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form . , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owner's Name information is cotuit AAA 02635 6-19-15 required for every page. citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 500.0 Gal. tank-pump chamber-D Box and three pits. Number of current residents: '1 Does residence have a garbage grinder?. Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes No information in this report) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes 0 No • 0,OOOGaIs Water meter readings, if available(last 2 years usage(gpd)): 20 2013-6 13-6 000GaPs Detail: { t i i Sump pump? ❑ Yes ® No i Present Last date of occupancy: Date Commercialiindustrial 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 l Water meter readings, if available: =--- Bins•3113 Title 5 Official Irepedion Farm:Subsurface Sewage Disposal Svstem-Pape 7 of 17 • f I I • i l Jun 22 15 07:20a p.g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owner's Name informationrequired is Cotuit MA 0263'5 6-49-15 requlned for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) Last date of occupancy/use: Date Other(describe below): f - General Information i 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 I ❑ Overflow cesspool I I ❑ Privy i I ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Inn ovativeffi temative 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 YA system by system operator under contract { ❑ Tight tank.Attach a copy of the DFP approval. I Other(describe): i I Pump Chamber _ p Mrs•Y13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 j I1 k 7 Jun 22 15 07:20a p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street _ Property Address John Buckley Owner Owner's Name information is required for every Cotuit MA 02635 6-18•15 page_ cityrrown State Zip Code Date of Inspection D. System Information (cont,) Approximate age of all components,date installed (if known) and source of information: 1993 Permit # 93 -29 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet i 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.): Pipein is 4" PVC SCH-40 Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: t ® concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) E , If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5000 Gal" Precast 3" Sludge depth: ISina 3113 Tide 5 Official Inspection Form:SubsuAaca Smaga Disposal System•Pape S of 17 i E t E f f Jun 22 15 07:21 a p.10 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i W�Wi- 968 Main Street Property Address John Buckley _ Owner Owner's Name information required far every Cotuit MA 02635 6-19-15 _ - page. City/Town State Zip Code Dale of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle na Scum thickness 1" j Distance from top of scum to top of outlet tee or baffle na' Distance from bottom of scum to bottom of outlet tee or baffle na How were dimensions determined? Asbu*-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.): 1 Tank at working level.Tank at 2' below brade,outlet cover steel at grade in raise bush area outlet tee. No sign of leakage or over loading. Note: Tank in raised over growen brush area, could not locate inlet cover. Could not cut out bushes. i i i i Grease Trap(locate on site plan): i ' Depth below grade: feet Material of construction: I fiberglasspolyethylene other(explain): concrete' meta ❑ ❑ ❑ ❑ ❑ g i 1 Dimensions: i i Scum thickness i Distance from top of scum to top of outlet tee or baffle - i Distance from bottom of scum to bottom of outlet tee or baffle j Date of last pumping: Late 15ins•U13 Title 5 Official Inspection Fotm:Subsurface Sewage pisposai System-Page 10 of 17 t Jun 22 1507:21a p.11 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owner's Name information is Coturt MA 02635 6-19-15 required for every page. Cityfrown State Zip Code Date c4 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.): I t Tight or.Holding Tank(tank must be pumped at time of inspection)(locate on site plan): i Depth below grade: Material of construction: i ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: l Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. M 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 E tI t5ins-113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of IT ! • I j Jun 2215 07:21 a p.12 Commonwealth of Massachusetts Title 5 official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owners Name information is required for every Cotuit MA 02635 6-99-15 page_ Citylrown 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 H-20 in stone drive way. Box is'i5" below grade wlsteel cover at 7". Box is dean and solid w/three line's out. No sign of over loading or solid cant'over. - i i 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.): Pump chamber is TxT-80" below grade wlsteel cover at 4"in grass area. One pump, pump and alarm working. Chamber is clean and solid. No sign of solid carry over. i i "If pumps or alarms are not in working order, system is a conditional pass. i i Soil Absorption System(SAS)(locate on site plan,excavation not required)- i If SAS not located, explain why: j i i I 15ins-3113 Tine 5 Official inspection Forth:Subsurface Sewage Disposal System•Page 12 or 17 � ES I4 C Jun 22 15 07:22a p.13 Commonwealth of Massachusetts' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owner's Name information is Cotuit MA 02633 6-19-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: I ❑ 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 H-20 precast pits. Pit#1 at 32" below grade w/steel cover at 8"3' water in pit. `I Pit#2 at 22" below grade w/steel cover at 6". 1'water in pit. Pit#3 at 5' below grade under raised area. Camer out to pit,l'water. No sign of over loading or solid carry over in pit. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): f Number and configuration --- • Depth—top of liquid to inlet invert • R Depth of solids layer • i Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 151n3-3113 Title 5 Official Inspection Form:Subsurreoe Sewage Disposal System-Page 13 of 17 i S i Jun 22 15 07:22a p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owner's Name information required for every Catuft MA 02635 6-19-15 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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.): t 4 !� I i i I i i i tscls-3H 3 Tine 5 official Inspection Forth;SLbsurface Sewage Disposal System•Page M of 17 Jun 22 15 07:22a p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owner's Name information is eotuit MA 02635 6-19-15 required for every page. Citylrown Stale Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately s k i i I s i i i is s } t E i i bins•3M 3 Title 5 official Inspection Form:subsurface Awwage Disposal System•Page 15 of 17 Jun 2215 07:23a p.16 ' 7-- Page 1 of 2 Town of Barnstable Geographic Information System Parcel Vlewer Custom Map Abutters Map Size t Zoom Out M,1 1 1 1!1 NIn ev 3 o , ' a - --- ' _1 7 .! r 4 _ I 20 Feet' Set Scale 1" = 70 Aerlal Photos MAP DISCLAIMER r,,,.,..t.,tii�nn��nno-rr,,...,.,ru�...�r-�tiie pan on r�„tif�re�e,.r• I I j I i f Jun 22 15 07:23a p.17 a Commonwealth of Massachusetts -- - - Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 968 Main Street Property Address _John Buckley . Owner Owner's Name information is required for every Cotuit MA 02635 6-19-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells )Vo Estimated depth to igh ground water. 2 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record i .. I If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: i - i i You must describe how you established the high ground water elevation: I Rear of lot drop's off 20'+. Front of lot 20' higer then rear. i I i f Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins•3113 Title 5 Official Inspection Form:Subsurface Selvage Disposal System-PWe 16 of 17 i i i Jun 22 15 07:24a p•18 Commonwealth of Massachusetts -- - - Title 5 Official Inspection Form - Subsurface Sewage Disposal!System Form- Not for Voluntary Assessments 968 Main Street Property Address John Buckley Owner Owner's Name Information is Cotu�t MA 02635 6-19--15 required for every -- page. Cityrrown State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D,or E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page_15 or attached in separate file i i ' f • f t - ffI `E i tsins•3113 7Ne 5 Official Inspection Forst Subsurface Sewage Disposal System Page 17 cF 17 i i I 1 ' (i �iN Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 968 Main St. Property Address John Buckley Owner Owner's Name , information is required for Cotuit Ma. 02635 8/18/2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the computer, r,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 r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/18/2009 Insp tor's Sig ure 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. U t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 -X' Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map IF— Abutters Map Size MEN Zoom'Out In ffrlk 'Al NA `E� -= fA 71r+ f � r � ���A=- f U W, 3t $ 1 ti{ Oe f` 13,5 35� 36 L , O e cS32 C ' by 5fiA t '��6 �7 �`''- '` ,' ,� .�«',.�•.� � �s��iVh ���rS�..1-y,��.I f ,.e^'#a�xpr r�t �� 1' IMP ,' ,�� er:'"` �'�. �,�'m;.fivary�.�� '}�-'+5 n,9S�S��"•��€'x'`3 v 0 all; - ` .rr >•,+rt rNk �' rren7 { r z�ic+l�4 �9 s' gi Sq F , ' xar HOP /W 1 �tg '�"ia�t? aw "k a H ."Saald ' t' 5;.,F a-- , ��Y x o ram-2� '-ate -i ' y�� A dpp'if � ,htTa J x at fN ^J .Lr Feet-, '�•'±w' k' ; `'`k�`KA'lf-ra'fir" .r�' "pi-ry xr zrr,4�';�.r7,ors"$.c�, Set Scale 1" = 20 ( Aerial Photos I MAP DISCLAIMER (`nn,frinhf 7f1l1F_7!1l10 Tn�•rn of Po fnhlc KAA All Hi hfc rr conn I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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: 1993 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3' 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 leakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 2.5' 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: 5000 gallon Sludge depth: 0 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: 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 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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: ❑ 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 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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 4 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %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 'GSM ,.•''r 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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): 10 Number of bedrooms (actual). 10 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1100gpd t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 5000 gallon septic tank,pump chamber,distribution box and three leaching pits. 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 ears usage d 2007:46,000 g ( y g (gpd)): 2008:6,000 Detail: 2007:126 gpd 2008:16 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 8/18/2009 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 5000 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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 NA Scum thickness 0 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Tank pumped at inspection. 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 septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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 into or out of box. 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.): Pump chamber appears structurally sound.Pump,floats and alarm are in good working order. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.No signs of hydraulic failure.Pit#1 had 1' of water with stain line 48" below invert.Pit#2 was dry with stain line 5' below invert.Pit#3 was dry with stain line 11' below invert.Pit#3 is 6'x16' 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,• 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 14' 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.USED:Technical Bulletin 92-001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 968 Main St. Property Address John Buckley Owner Owner's Name information is required for Cotuit Ma. 02635 8/18/2009 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 �I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I • ] No... _�. ..� F $....3.0..00.. THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH TOWN OF BARNSTABLE Application is hereby made for a Permit to Construct ( ) or Repair NXX) an Individual Sewage Disposal System at: ✓9..c...�...Main Street Cotuit _..---•-------•----•----•.......................................................................•- Location-Address or Lot No. JohnBuckley.....................................•-•••-----•---------------------------- ------- ........._....._ W J.P.Maeomber Jr. Owner Address Installer Address �Q Type of Building Size Lot............................Sq. feet Dwelling X No. of Bedrooms._-_--_---_-12 --------------------------Expansion Attic O Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fi(tl{re Y Design Flow... _ -- - - - - -- ---gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity----_-_---gallons Length---------------- Width---------------- Diameter................ Depth................ 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........................ Gi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ------------------------------------......-....................-••-----------------•------------...---................................................. 0 Description of Soil------------- .........••-•----------------._..__.....----•---•-----------------------------...------------•--------------------------••••----...---•.._.•. v ...............................................Sand•---- p L e.. t K---�/T.................................................................................... W ----•• ------------------------------------------------------------------------------------------------------ --------------- ------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable..l-pump chamber--new---line- -•-. o...e- j,sing leach pits. 1-distribution-box. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has be n/i�ueedd by the bo d o health. , Signed .. ..:. ...... . ....��!.�...................... (/l8/93 ...................... -....-.......Da[e...-....-.-...... Application Approved By ................ .-...... -------�..: ...........- .. �.- �- e--13--- Dit Application Disapproved for the following reafonr: ...... .... ................... .. . ... ...................................... ................................ . ...................................................... . ......................... ............-...... . .................................. --.................. ........................................ DI?are PermitNo. .....c�.3............ . ..�.......................... Issued ......-----.:......................-.......-...--...--....-......... Dare :rw�3rcu-.^--^•.q- �,�.s<w...�:�++,r�+.+sr.�;c: er„rise-��it�Y�'��.a�+c��+e+.....a+�e.r•�..v�.*��arala'•�.�iiw�axti.�+.a.,r#.;:Lz,�:,u �esay; •�+ws�:xrst.s.-«.rw��v� q �� / F�s... ....30.00............... No..- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE -7 Appliration for Diripaiial W► ork,i Tomitrurtion Prrutit Application is hereby made for a.Permit to Construct ( ) or Repair X(XX) an Individual Sewage Disposal System at: 968 Main Street Cotuit Location-Address or Lot No. John Bucklev ......................_....................................... .................................. ----•--------------•••-----•-•-•-----••-•-----•--••••-•........_..........................-••••-•. Owncr W J.P.Macomber Jr. Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms............. 102.--------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _____________________•- No. of persons------------................ Showers ( ) — Cafeteria ( ) d Other fixtures -----s+.!_. Design Flow.._ ,:_'.'._�'_�!_ " __f- �\...galloiis per person per day. Total daily flow............................................gallons. WSeptic Tank I iquid capacity-____.__---.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........................................ 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........................ �. •---•-----------------------------------•---------------....------...-----------.....--------...---........................-•----........-•--•....•---.----•- 0LDescription of Soil................•----------------------•-----------•--.............-------•--------------------------------------------•-------------------•-•---......-•••••.......--- U � Sand .. , .... r R ,— •••. W � UNature of Repairs or Alterations—Answer when applicable._1-pump...chamber-_new---lines_..to._-ex s Ang leach pits. 1-distribution box. .......-....---.................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bo rd of health. Signed .. ..- ...F�l�/93 Date Application Approved BY ............ .r_-�.<. `t��. e, . .................................. .- .-.�_.t..-... . .. '"""'�'•�..---...................... Date Application Disapproved for the following reasons: ........................... . . . --. ........................... . ............................--.--...... .................................................. ............................................................... ---------.-...... .............. ................................. c� ............................................. •" Dare PermitNo. .......%�..3.............� ?../....... .. Issued ....................................................... Date -- ----.--_.__,----.—_—_—---—____--_—_—.--------..--.—,.—.—_--------.--_i----_. �._,. •--,.--� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Q1ertif rate of Toraylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constricted ( ) or Repaired (XXX) by .........J.P.Macomber Jr. ......................................... . ............................. 68 Main S Insta er at ........9..... ......._........treet....C.otuit...._..................._.....: has been,installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........ .. _�........ dated ............................................ THE ISSUANCE OF THIS,CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................._................. ,1 Inspector A � t __. . ......_.... .. ft . ...._.__.....!...... _............_....... ............ l --————————--———————--———————————————————————————————————————---————————— a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq TOWN OF BARNSTABLE $ 30.00 No...1..- -.a.v- FEE........................ Mipmttl Works �onotr rtion rrnti� Permission is hereby granted------- .,P,Macomber__.Jr.....------------------------................................ ............................. to Constr ct ( ) or Repair (X ) an Individual Sewage Disposal System atNo �•••Main_ Street-- Cotuit..-----------•..................._..----------._...----------------•----•--------. •--..•.........-- street as shown on the application for Disposal Works Construction Permit No.Z3-Z L_. Dated........................................... .............. ......... ...3 B Board of Health DATE--------------- ' `a-/..-.. - ................................. 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J � I II II 1 1 /i 1 REF. ____ � ______-_______ _,_ �l c \ _ __ _______ _ ______ ___ ------- _----------------- < I ID 8�61/B" N RTH m I g z -n � s BEREZNICKI ARCHITECTS y r §; STARR RESIDENCE RENOVATION a= m c O n ARCHITECT Z O = & 968 MAIN STREET � �+ ;v Z COTUIT,MA 9WENDELL STREET.CAMBRIDGE.MASSACHUSETTS,02138 Z, ,z • - TEL:(617)354-5188 FAX:(617)868-5764 of --------------- , / m z O - -- --------------- >>A —— _• I .. boo � n0 Fm8 _ z 0 0 _= z c 8; •I - - - ass z O • nod r---cif , � � � e -zG S , j 1 � m , 71 • I —____ ____ __�_� dig ' r_--_-_______/ J l\J ­" ? " -- --�1---- --�� � ------------ I I - - , 1 � a® m o p ' / 6 - 9 r F .. �p ,, • - jl O "aa n o II F y I O i t R t • I I a ' . • 10 4- IS ED PEN N ------ • e I—------- ------------013 • _ a _ �. , . i ` i r I n I i 5 -------- ---- -- II • I11 - r l m • y r =� n fli loll , 11 6. CASE01, ssua {' ar11 eva � 2t t x - :I r-�.,a.# }I� :"}• � mom = •" � 3 F s .1 ....ITD OPNG r N� (MdTCH ENLRY MDT 2 /4' - --- ------- ,-- ----- I a{ I I i y r ____ -1, i' 5 , • � '. S BEREZNICKI ARCHITECTS STARR RESIDENCE RENOVATION ARCHITECT " - 968 MAIN STREET ---------------- ----- .- �� to Z O COTUIT,MA RV 9WENDELL STREET.CAMBRIDGE.MASSACHUSETTS,02138 ~ Q - TEL:(617)354-5188 FAX:(617)868-5764 M1 1 I 1 I I I I I I I I I I I I I I a � , 0 .+ { k •• , ) I Z it � '� � 6 F. • I I 1 I I it I i ♦ _ S��c^£ i I y I on • I znF > I I A I I . / I I /• $ ❑ I I Q I J I T A L--------- , - s BEREZNICKI ARCHITECTS 0 0 8= STARR RESIDENCE RENOVATION a ARCHITECT 968 MAIN STREET F N mi Z O Z 6 COTUIT,MA V 9 WENDELL STREET,CAMBRIDGE.MASSACHUSETTS,02138 e TEL f617)354-5188 FAX(617)868-5164 NE, , t i I N i Wo 1 ` `D ---------------------------- ------------- -- ------------- i Z _ I I I I 1 ' 1 1 ' l I I > i -Z— • :ie i . —a Ll ----- I I 11 g jR kyky �_ to _..,�I•..,, cO Q 1 1 I 41T. .t I ox Z O I c .-. Ril W ------------ It I i m � m I I I I =F I I �Fv I II I I I I I IL x --r�-- --- -_-Jy- -----oN__ - iII U i ..... I _ �� ;, Iq� Ig I I • I rl SySy`y ! n • n --1 � W _ o zel%ea DR I � W i d v C I n ---------- -- -I�- ♦j �T ---------- ----------- I I I 11•'�;' I i i �I 1 I • I I 1 I I I I I I I I I _ '' m g O � _ §�� STARR RESIDENCE RENOVATION n� BEREZNICKI ARCHITECT ITECTS Rom. � 0 ?• ; 968 MAN STREET W s COTUIT,MA R-' 9WENDELL STREET,CAMBRIDGE,MASSACHUSETTS.02138 Z � � '§ TEL:(617)354-5188 FAX:(617)86B-5764 M 1 • 3" Family Room 20'-0"x 20'-0" Ceiling Height=13'-0" I Terrace 30'-0"x 42'-0" 1 - I UP Ref E (Wine 1 ® 1 I Kitchen_ 29'-9"x 17'-10" DN . Breakfast Area l 11'-2"x 20'-4" Covered Porch 18'-0"x 17'-6" Library Y. 24'-6"x 18'-0" Living Room 26'-7"x 19'-7" I � Ref 1 \ ® I I Dining Room t Bar Diw ' " ' " I 25-7 x 18-2 . i I 1 I t owder Room Op Catering Ref 4'_9"xT_5" O Kitchen 0 15'-9"x 10'-1" UP UP Office 1 18'-1"x 18'-2" Hall Deck Foyer 9'-5"x 12'-0" 21'-6"x 9'-6" 11'-0"x 19'-7" Bench —-Closet— UP I der Room y ' 6'-2"x 64" Wet Bar Closet Closet e 9,9„x 5'-10" 1 I I Laundry Ill. U 1 -Room W JJ,h UP -6"X ' i? Bedroom 23'-3"x 12'-0" 1 I , Bath First Floor Plan 6'-2"x a Ceiling Height=9'-10" 7'-5' I 968 Main Street . Cotu it, MA 02635 2' 4' 81 Scale S 1 Note:Dimensions are not N I:W OR P Ai19r1t.1 --t�1-i?�tx guaranteed and are provided Lr4yy_,_•. Completed:September,2013 for informational purposes only. &.t'HOTOGR AVIAY - N (800)328-0217 t .a I Deck - 6'-6"x 18'-0" Bedroom 15'-8"x 10'-11" - I Closet I I I I • I 1 Sitting Room J Bedroom 16'-4"x 16-1" Walk-In Closet 16'-4"x 13'-7" Bath 8'-6"x 7 8" 0 8'-1"x 10'-9"Bath 4' 0"x 10'-0" (� Closet Q I . Closet Bathx -7" L_ DN ° 1 I Bedroom 1 15'-0"x 15'-10" Attic 1 Area 1. I .0 r— *cIroom 10'47"x 10'-0" Open To 1 I Below DN Third Floor Plan ; Ceiling Height=8'-0" D r Deck 12'4"x 17'-6" I Closet I ' m o Bedroom 15'-7"x 19'-1" I Master Bedroom . 17'-2"x 19'-7" - Master Sitting Room I C) 16'-4"x 18'-2" Bath 7'-11"x 9'-8" --- Walk-In Closet -- 4'-8"x 14'-2" , ------------ Master Bath Hall 16'-0"x 7'-3" 19'-6"x 19'-7" Bedroom " 14'-1"x 10'-1" I Bedroom d 15'-1"x 16'-1" up N o I Bedroom Open To Below Y Closet 10'-7"x 14'-1" -Closet- I v Closet DN I • I m 0 7 V Sitting Room Second Floor Plan 10'-1"x 8'-0" �` - Ceiling Height=9'-0" Bath Bedroom O 10'-1"x 13'-7" Bath 4'-3"x 4'-0" _ Closet 968 Main Street , Cotu it MA 02635 ` Scale S t F Note:Dimensions are not 2 NrwENCILANl) guaranteed and are provided -�--P[00tt nLANS Completed:September.2013 for informational purposes only. IV N (800)328-0217 Game Room 40'-2"x 15'-7" ' UP Bar 15'-9"x 16'-0" Storage 15'-0"x 17'-0" Storage --------, T-3"x 25'-0" I I Win Cel ar T-0"x 9'-0" O ❑ Storage 10'-0"x 15'-3" El F Sauna T-2"x 8'-6" - i i I i edar Close , Rec Room Rec Room ® r-3"x 9'-8" I 61-8"x n11^ I 16'-7"x 34'-7" 15'-10"x 27'-2" UP -- Storage Utility/Storage I 12'-0"x 16'-0" I I a0 ® I Lower Level Plan Ceiling Height=7'-6" Storage 8'-3"x 15'-8" 968 Main Street Cotu it, MA 02635 2' 81 Scale S } 3 Note:Dimensions are not N I:W F�. dC l Fih11 guaranteed and are provided --..r•tti� I`fLAN1) Completed:September,2013 for informational purposes only. 44 VI10TC)t3RAVI lY N (800)328-0217 LEGEND IONS: PATIO.& SPA MITIGATION:. DIRECT ASSESSORS REF.: Catch Basin round \ From Hyannis - Continue down. Main ® (round) Holy Tree 0-50 Buffer � Ce DH Map 035, sew U � , Street Hyannis, At the West End Rottar / Parcel 096 Existing Patio: y Y �� ,F� •;' , 2 ,����� take the second exit onto West Marl a SB/DH x = 1,250 SF Street. At the light take a left on to Rt. O PK nail ZONE: Deciduous Tree 28. Turn left onto Putnam Ave and left -fl Guy Approved Patio: 0 RF (RPOD) onto Main Street. The locus is on the left Utility Pole 1,295 SF "= Area (min.) 87120 SF nh #968. Utility Hand Hole + Light Post Coniferous Tree Frontp e (min) 150' Proposed Patio: Width. (min) no 1,207 SF © Gas Gate (round) OHW- Setbacks: . d 25- - Elevation Contour Overhead- Wires - Front 30' `. y.4� ,. �• „� �r" .�'� `'RYA k. 50-100' Buffer Side 15' Existing Patio & Walkway. , 265 SF= Rear 15 -� l a , Proposed Patio & Walkway .. . = 238 SF ZONING OVERLAY DISTRICTS: FEMA FLOOD ZONE & VE(EL 14) r RPOD -Resource Protection Overlay District Zones X, r \�L Dock and Pier Overlay District FEMA Map #25001CO756J � •°, � � . AP Aquifer Protection District July 16, 2014 Location Map 1"--2000'f Existing 5,000 Gal. Septic Tank Proposed ZOOO Got, Pump Chamb Proposed Existing 450 Got. --35-- a M Ei=35.8NAVD water & Gas Pump Chamb f \ roP•"b&CB/OH Nlp To Be Removed 960 Main Strust \ Li 8/DH `` 15.7' Daniel J Pozen & Heather P Gami Trs » , tt " \ S49 32 2 262f to Bulkhead \ \ \ F ood Bulkh d - 3 ^- ' 3 Privet edged \ `1 ' � 7 61 6 ., > 1 3D,�' .B' rs ,, r.� "-. isx to ni Lawn1 , _ .,_:r-• GCS-` -•:: �,,. . _ ., 1 �2 ..,,, "• �> „won a x x \ ! � 1 _ Lift To 5�„5 1 Sleeve 3`s,5 -k:.w t N ' trueture ` '\ - 4 4 SE3-3 - Repl D dcStairs,Te es Walkway �- o yV I Proposal `I s Required 1 � \\ ' � � l 1 Slob �0"38.0 Pr°I?°mod l •`'Spa. Dra`lid law oc;. w 20 x40\ > \ r ex� 1 Sty w/f ............. ... : �- woad neck . U,1 ruarl� \ �'S \ -- Existin ecking V Garage `,�. \ \o \ To R lac \ , o u c ood P. _ \ �OO ` `3 st - OF Proposed �27- , er W WowND&..Equlpment 13 Patio & \ s\\\ o r Berdw Deck 0_` Walkway \D` \ sa Areas arage �,\\\\ \\ QO $ilt Fencing \ �\ \\\ sE3-2786 Pier Extension, Dock/Pler ion ►% X� _ t _ \ \0 For Limit Of Wopk \\\\ \ 1 \� 1 SE3-1995 Pier, Bulkhead, Floats, \o \O \� N CES, Dock/Pier\� , SE3-27 - Stara9 a uildin9 to Lawn 1 ,•038 o �P o `� \.`' 21. "'� -. i,�---fix\ �\ C 8x8 \ \\\\ \\\ o . , O i:L Sao o M Elect c I- V. -, \ � f \ PrbvJ .� j�_ 968 ^\i p \\ r--4` o I As it 3 Sty wf i_�------ c� Parc Area Remove Ubsultab(e Sod $ Dwelling \ Proposed 9 \\\\�\\\\ \ 1 1 45,.00 SF NN?thln 5' Of SA. Prop --J Patio °e \\\ \ d do Replace With eeling D-B \ \\\ p n q�c i Areas \ \\\ \\\\ \ cp Q �- To Bulkhead F e 310 CMR .255( \ \ New / o W 1 Deck \\\ '�:J 8�t a iI / .� \ i SO ' r " Gate Pad 2X° 60 Stare wo O .._..: '9 w� � N \ - _ = - '. \ .. 3 f",` \ a�3g6 \ IV Lawn \� \\\\\\\\\ \\\ \ -01 t a to It ` \ AEG.- -." \\\\ Bone Cobbiestona Ed rn o __ _.. _.,_ _ Ven � \ `a. -, `' J,, \\\\\\\ \�\�. Mttlgon Area roposed o _41> \ Hed e ..: \ 23.T Lawn �.........1l ABull \ ...._..... \\\ \\\\ \\\ \ \ \\ x (180 sf) g \\ \ b 37x `. .. ` Y . ... �. . \\ \ \\\\ (3 gal / 3' oc) o t, 10 Inkberry S49 48 E10� \ \\ \\\ \\\\. i\ x 12xs 184f `\\\\ \\\� \ f0 Posture Rose Stone Existing�4ccess & Utility Easement ` '_ x x ° \ - � \\\ \\\\ \\\.. (2 god / 3 oc) Drive _ - ( ee Deed Book 112241136) � \ ,< p �- k�i \ o � 142:58 \ \\\ \\\\ \ \ NIF CB H Fnd N465540 W 148.17' .11) /Joseph S&Elizabeth Cer�etanr/ w #97s I \ 1 \\ \\ N , 2 Sty w/f \ Top of CPsta/ Bonk\ 11 il � � � ,� . coturt Frye District Dwelling (Town Definition) COUNTER VARIANCES Town of Barnstable 360-1-Setback to Water Body 100'Required to Bank-79'Provided ' Locate Junction Box To Proposed Outside of Tank Pump Chamber Pump Power & Float Control Upgrade Cables Installed In Accordance With Federal, State & Local Bldg. & Elec. Codes Alarm To Be On 'Separate PERC TEST: 15,420 Service From Pumps 1/2"0 Gal v. Pipe PERFORMED BY:JOHN ODEA,P.E. SULLIVAN ENGINEERING For Float Support SOIL EVALUATOR NO.2911 WITNESSED BY:DONALD DESMARIAS,KS.-TOWN OF BARNSTABLE 5' Q To D-BoxJULY 21,2017 SEPTIC NOTES a SITE PASSED 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Prior to Any Excavation For This Project the Contractor Shall Make 4"0 Sch. 40 PVC the Required Notification to Di Safe 1-888-344-7233 and contact From Septic Tank 24"0 Opening Above q g ( ) p For Manhole TEST HOLE - 1 TEST HOLE'- 2 TEST HOLE - 3 Sullivan Engineering&Consulting Inc.(508-428-3344). Compartment EL.34.5 EL.35.0 EL.''3.5 2.The Contractor is Required to Secure Appropriate Permits From Town Frame & Cover Agencies For Construction Defined by This Plan. ....... DRIVEWAYLFIIL 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall I _ 10" 34.7 Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to t� 10 1 - DRIVEWAY/FILL _..B LAYER.IOYR 5/6 Assure Watertightness. In General,Water Lines Shall be Constructed in DRIVEWAY/FILL YELLOWISH BROWN Coordination With Cotuit Water,and Shall be in Accordance 38" 31.8 28" LOAMY SAND PUMP COMPARTMENT With 248 CMR 1.00-7.00&310 CMR 15.00. C LAYER 2.5Y 6/6 4.A Minimum of 9"of Cover is Required for All Components. OLIVE YELLOW 5.All Structures Buried Three Feet or More or Subject PLAN VIEW DETAIL 56" 29.8 MED.SAND to Vehicular Traffic to be H-20 Loading.It is the Engineer's C LAYER 2.5Y 6/4 PERC TEST 33.0 Recommendation that H-20 Always be Used. �+ OLIVE YELLOW 25 GALLONS GONE IN 5 MIN.30 SEC 6.Install Watertight Risers and Covers to Within 6"of Finished Grade NOT TO �7 SCALE C LAYER 2.5Y 6/6 MED.SAND PERC RATE<2 MIN/IN(LTAR=0.74) Over Septic Tank Inlet and Outlet,D-Box,and Six Leaching Chamber, OLIVE YELLOW and to Grade Over Pump. MED.SAND All covers are to be maximum 18"for concrete or 24"Cast Iron. Conduit Thru Chamber For 7.Septic System to be Installed in Accordance With 310 CMR 15.00& Power & Float Cables 24"0 Manhole 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable Frame & Cover H Finished 9 Min. 120" 25.5 Board of Health Regulations. Grade Cover 120"• 24.5 132" 24.0 8.All Piping to be Sch.40 PVC. NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum Sump of 6"• 10.The Separation Distance Between the Septic Tank Inlets and 4"0 Sch. 40 PVC Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend From Septic Tank 1 8"0 Hole a Minimum of 10��Below the Flow Line.Outlet Tees Shall Extend 29 alv. Chaff Drill For Drain Below the Flow Line,and Shall be Equipped With a Gas Battle and Inv To D-Box Department Approved Filter. Emergency Storage Min. 2' Cover 11.All joints connecting pipes to foundation,tank,d-box and SAS are to be Volume 1,320 F Sealed with hydraulic cement. Alarm On EL 20.25 r, s C Pump On El. 19.75 r, 1 w ,i Pump Pumps Off El. 18.87 ' °o .Q 12"0 Sch. 40 PVC Finish Grade o'CD Threaded Pipe Check Valve 3' Max. DESIGN DATA 9„ Min Compacted Fill Filter Single Family Bottom EL 17.67 Fabric -12 Bedroom @ 110 GPD 2„ And/Or No Garbage Grinder Secure Pipe at Top & x 1 Pea Stone" Bottom of Chamber" Total Daily Flow=1,320 GPD Stable Com acted 3' H-20 H-20 Existing 5,000 Gal Septic Tank i/2 H.P. Myers Pump Base 3/4" - 1 1/2" or Approved Equal LEACHING LEACHING Double Washed LEACHING AREA _ *Prior to Ordering Pumps the Contractor CHAMBER CHAMBER Stone Must Confirm the Compatibility of the- 1,320 GPD/0.74(LTAR)=1,783 SF Required Existing Electrical Service & Pump Curve 4' �-1 4' - 10" �- 4' ��-- 4' - 10 �T 4' Sidewall=2'x(178.64')=357.28 SF Bottom Area=(25.00'x 39.32')+(21.66'x 25.0U'> PUMP COMPARTMENT d=1,8.505E CROSS SECTION OF CHAMBER Total Provided=1,881.78 SF(1,392 GPD) LEACHING CHAMBER DESIGN SECTION DETAIL ,. NOT TO;SCALE All Pipes to be Schedule 40. Use - 12-500 Gal.Leaching Chambers in a NOT TO SCALE Double Washed Stone Field as Shown. Vent See note 10 See Note 6 (typ.) Approved Filter$ F.G. EL. 34.00 - 36.00 FF EL. 35.60 F.G. EL. 26.5 Required F.G. EL. 28.0 } Flow Equilizers 32.30 � As Required pas ToD EL. 32.75 H-20 D-Box EL. 32.13 Remove & Replace EL 24.50 Ta Meet31.0 CMR T5255 3 EL. 4 - Proposed All Unsuitable Soils Within 5' of Installer To Existing EL. 24.00 Proposed 31.75 H-20 The tinter Perimeter of The System: Confirm Prior 5000 Gallon L Leaching Fill ` To Any Work (See Note 5) 2000 Gallon Chamber JK Pump Chamber g _ Bo 9.75 H-20 EL. 17.67 LO V011 1;f4wcsq N To Be Installed On "�5 3 H C. '` o e ompac a use Bedding,„T„s _EL. 24.0 _A Y. Inspection Port, No Groundwater & Boffels Per Test Hole 2 rs;611 �ry as Per Title 5 a' EL. 1.5t r J a Groundwater n Per T.O.B. Maps DEVELOPED POOFILE OF SYSTEM Add Septic 12708 20 NOT TO SCALE Update Patios 03103120 Eliminate Proposed Pool & Add Proposed Spa 11106117 s REVISION: Add Proposed Pool 09 19 17 TITLE PREPARED BY. PREPARED FOR: NOTES: Site Plan Proposed Improve.0ments eeCapeSurvOcean View Real t Trust 1.) The property line information shown was m Sullivan. E y compiled from available record information. At Consul Ins �- � P. O. Box 406 Wayland : 968 Main Street ' ' 'u""ie1w ,"�,°° 0 23 West Bay Rd, Suite c ' 2.) The topographic information was obtained Osterville MA 02655 MA. 01778 from an on the ground survey performed on (508) 420-3994 / 420-3995fax or between 16 DEC 16 and 22 DEC 16. o www.copesurv.com Bamstable ��otL,,t) Mass. Draft: JOD/CTR Field: WHKIASK 20 0 10 20 40 80 3.) The datum used is NA VD 88, a fixed mean DATE. sea level datum. Lune 14, 2017 CALF 1 rr _ 20r Review: JOD/CTR Comp.: RRL/WHK �! Project: 2007028 Drawing # C859_1 gl Ex1 - -- -- DIRECTIONS: LEGEND • a % � •_ " �rt'�� � � z, From Hyannis ASSESSORS REF.:Continue down Main ® Catch Basin (round) Holly Tree Street Hyannis, At the West End Rottory El CB/DH Map 035, Parcel 096 z take the second exit onto West Main o SB DH Street. At the light take a left on to Rt. O PK nail Deciduous Tree ZONE: `` � • ••, �r 28. Turn left onto Putnam Ave and left - Guy0 RF (RPOD) onto Main Street. The locus is on the left C} Utility Pole 968: hh y Area (min.) 87120 SF # Utility Hand Hole , � + Coniferous Tree Frontage min 150' DESIGN DATA SEPTIC NOTES Light Post 9 ( ) 1.Location of Utilities Shown on This Plan Are A rox.At Least 72 Hours c Width th (min) no PP O Gas Gate round1 Single Family ( ) • _• Prior to Any Excavation For This Project the Contractor Shall Make Setbacks: .Overhead Wires -25- - Elevation Contour the Required Notifications to Dig Safe(1-888-344-7233)and contact Fron t 30' No Garbage Grinder +» • Sullivan Engineering&Consulting Inc.(508-428-3344): Side 1 Jr' "" y Total Daily Flow=1,320 GPD EI1u + 2.The Contractor is Required to Secure Appropriate Permits From Town + is Use a 1500 Gal Septic Tank Rear 15 Agencies For Construction Defined by This Plan. 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall LEACHING AREAPipe .. , , Be Constructed of Class 150 Pressure and Shall be Water Tested to � 1,320 GPD/0.74 LTAR =1,783 SF Required MITIGATION: FEMA FLOOD ZONE _ ( ) q Assure Waterti tness. In General,Water Lines Shall be Constructed in a y m a Sidewall-220'+72'2'-368SF ZONING OVERLAY DISTRICTS: * ''( ) Coordination With COMM Water,and Shall be in Accordance � � � € � is � Bottom Area=(20'x 72')=1,440 SF With 248 CMR 1.00-7.00&310 CMR 15.00. 0-50 Buffer RPOD - Zones X, & VE(EL14) Total Provided=1,808SF 4.AMinimumof9"ofCoverisRequiredforAllComponents. Building to be Rebuilt No Change in Hardscape Resource Protection Overlay District 5.All Structures Buried Three Feet or More or Subject Timber Stair Construction No Change in Hardscape Dock and Pier Overlay District FEMA Map #25001 CC 756J LEACHING CHAMBER DESIGN to Vehicular Traffic to be H-20 Loading.It is the Engineer's Removal of Chimney 16sf Reduction AP Aquifer Protection District July 16, 2014 All Pipes to be Schedule 40. Use Recommendation that H-20 Always be Used. Total 16S f Reduction Location Map 12-500 Gal.Leaching Chambers in a 6.Install Watertight Risers and Covers to Within 6"of Finished Grade , 20'x 72'Double Washed Stone Field as Shown. Over D-Box,and Two Leaching Chambers. 50-100 Buffer 1"=2000't All covers are to be maximum 18"for concrete or 24"Cast Iron. Addition to Building 64sf Addition 7.Septic System to be Installed in Accordance With 3 10 CMR 15.00& Removal of part of Deck 43 Sf Reduction 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable Total 6 4-43=21 s f Addition Board of Health Regulations. Required Mitigation 8.All Piping to be Sch.40 PVC. q g 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum 0-50' Buffer Sump of 6". 16sfx4=64sf Mitigation Credit 50-100' Buffer 21x3=63sf Mitigation Required Total No Mitigation Required Stairs to be Relocated to Existing 5,000 Gal. New End of Deck Septic Tank 43sf of Deck Existing 450 Gal. to be Removed ---35- M Ei=35.8 NAVD Pump Chombe J \ Top` �B/DH Rebuild As Required f \ 960 MainFStrust For Construction Access \ B/DH ^� 15.7' Daniel J Pozen & Heather P Gorni Trs S49.3%3 -� 262f' to Bulkhead .. - _-- F m r r _ 'Wood Bulkhead 3, Privet Hedge94 1- �. , / Iv3 Lawn O 30.8 / ,?, r o \ �.. one ` all fx .. � f ro r PPOYi @ Crushed Finish Grade \ \ ,I Thrust Blocks Gas > _ : \ l�- - �k S�c� Drive \ \ As Required \ o� Walkwo l !\ ,>.......... i....... ...... . 33 3.._... „.,., t.-._, >>.-..,, ,-w-- „,.-..-, ! ,..,..: ;.,� �' SE3 30' O Iw € 1 € \ \ 1 - - 3 Max. ��)--•- -�€���€ �I-W. 1;:---1T;- 1 _.. �!---�€�--3�� l� Imo. � -�;� ,1.�� � I)���t€-,.: :w,���;==�€�;>r-:�� ._s �1 3�l,I:�I -_,3 �I � 5 , .- , 9 Min Compacted Fill 1 St W f Sleeve _=i __: __. `^`^ ~` \.\ \ \ ` G Filter y 1 ��- .. �.*\ . As Required �,� � Wood Deck - „'� - - a•`\ '.c.n'; ,, Fabric Garage And/Or ' ~~ / I ` 2"EM 118 - 112 021411111111111 Existing D-Box / 03 ti� oer Pea Stone \ 3.y &-3 Pits Water ? \ f \ \ o ��o w o 3 H-20 H-20 - \ Q, \ L n 3/4" _ 1 1/2" To Be Rem.Ve Elec. Q I \12 ti \ LEACHING LEACHING Double Washed CIOi ` water < I s\\ ...e i ..,-. Stone ; ./. I ".a 3.._ 5_1 '3' \\`\ .; `• CHAMBER CHAMBER thin a 1 ' a ea. To Mee t: p\ � Q 3 x9 \ I SE3-2786 Pier Extension, Dock/Pier 2 - 2 r 4 10 T 6 T 4 - 10 2' - 2 E Istin .tiara e I 1 �, x 9 \. \ \ --� 1 :r \\ „�; - SE3-1995 -Pier, Bulkhead, Floats; 20' "'�, :, - ._". ,,FS \ N: �. CES, Dock/Pier t be Reb t /n a \ o t __. \ _ Footprin \? \ I -- _ I 3� . c� ,c o \ N\ r 9 9 " • ._. 1 , ,\',,t, m s 5"E3'-278S Storoge.Building I. \ I E(/'�_TI N F CHAMBER CROSS S V O O V . .-.., � " � . ,, . , ., , i 4;- 3,x4 � I ry �`; � � \ u \ Covered .. iO \ \ 1 rk \ _J I Porch Parcel Aroma \, NOT TO SCALE a r. I _ $.A 41 45,002±SF To Bulkhead Face \ P posed tr 1 , . ------- •a .. ^ Vent w O I Box � \ �N U ltabl@ 7 1^ to i - y I 968 \ - ( _.._ Ie�'! \� ,,\`• \, 1 ',l\,`\ p �O Q t� I _ I # �.. o ra e & S irs ~� \o I / nth € 5 f S.A.S. IN 1_ �w i 3 Sty wf \ { eplaced� & Repla .Fill IDwellingr Deckin ! i 310 MR 5.2 � ) rH 2 / 35 6 �o ( I ,� 5 \ b.. r See Note 6 (tYP) 'Gate --` ".� try i' \L 3axi1 tone way, F.G. EL. 34.00 - 36.00 , Pad c _ �1t, '?? / rH v� r \ I $ ` �W\' --- --, ------ - -------- Area to\be \,,, t` ;• :`1 a ....� Rebui/Vrovide Leaching Structures For�_ / .� a\E\ \ 11 \\,l:l` W. i ` , :_;\ / I sco Roof Runoff \', Splash late & Crushed Stone Drive / \ Flow Equalizers \ ---- As Required 1\\ TO EXIStin q �`' -- Cobblestone Ed in i \ Lawn i'Q \ l 2 / ' Propo�e� A.c. ----- ` \ 4q 9--- Bench /` - Venl L A.c. ..... .Pump _�. .. � _-�., _ � �. _ Chamber Tom EL. 32.75 Stone ___". „ , d Itlo 0 H-20 � ._,;'' � Hed. -. -. ". � `,. �-"'�. Lawn �'� �:.r `�,� `•�;\ � �'�\•�\\t`�y�5`� \ EL. 32.13 - e 23 7' \ 64sf Additi Fire Rlace_t �\`\ D-Box } _-- - _ xs l R x \• H-20 -- _ \ Co be e_,ov�d ` \ o o - - - 16sf Reducti \ 31.75 Leaching \ ; I Stone EXIStIII �`..., 7- \ 4xs 48 E n, \ \ g�Access & Ut�l�t Easem -�._ . _., , . _ x 3 ;s49''t�:. � �` ```; �� •�',�� To Installed On Chamber tr Drive zxs 184f Stable Bee I n acte ase � n p _ Bot. EL. 29.75 \ I ---- _-_-__-__ ( ee Deed Book 11224/136) 1 �^ _ "s Bedding,,,@„s �� - _- ____-__ _-_ 'j O W 0,. \ is 142.58' i%' 1 \ \ 1 \,`l ` \ \ i.t ;\ \ Inspection Port, If Encountered Remove & ReplaceIn ce DH 1 I N �k o \ X, \'< 1 \ \ !, & Baffels All Unsuitable Soils Within 5' of r\ / -_ 1 N/F LO Fnd N46 55 45 , �� /Joseph S & Elizabeth Cer etoni \ ,` , , '`• l\ o as Per Title 5 The Outer Perimeter of The System N W 148.17 r7 / t d \ Top of Costa/ Bonk 1 Cotuit Fire District 2 Sty w/f Z NIF EL. 24.0 No Groundwater ' Dwelling \�, (Town Definition) Per Test Hole 2 \' DEVELOPED PROFILE OF SYSTEM EL. 1.5f Groundwater Per T.O.B. Maps : NOT TO SCALE PERC TEST: 15,420 PERFORMED BY:JOHN O'DEA,P.E.- SULLIVAN ENGINEERING SOIL EVALUATOR NO.2911 WITNESSED BY:DONALD DESMARIAS,R.S.-TOWN OF BARNSTABLE OF MASSgc JULY21,2017 y o ,1QH1'J C. G SITE PASSED CDC'.rIL C/) .481 68 r r: TEST HOLE- 1 EL.34.s TEST HOLE-2 EL.35.o TEST HOLE - 3 EL.35.5 /OtdAl- DRIVEWAY IFILL 10" 34.7 DRIVEWAY/FILL B LAYER I OYR 5/6 DRIVEWAY FILL YELLOWISH BROWN . REVISION: Add Septic Upgrade 107131117 NOTES: PREPARED BY. 38" 31.8 28" LOAMY SAND 33.2 PREPARED FOR: C LAYER 2.5Y 6/6 T/TLE: Site Plan OLIVE YELLOW 1.) The property line information shown Was MED.SANT compiled from available record information. c} 56" 29.8 C LAYER 2sY 6/4 PERC TEST 33.0 p Kevin J L a rr Proposed Improllinments OLIVE YELLOW 25 GALLONS GONE IN 5 MIN.30 SEC Engineering& C LAYER 2.5Y 6/6 MED.SAND PERC RATE<2 MINAN(LTAR=0.74) 2.) The topographic information Was obtained 130 Common weal th Ave. b` b CapeS u rV L� OLIVE YELLOW Sullivan Consultin Inc. Atfrom an on the ground survey performed on �� O Boston MA. 02116 ( � 968 Main Street �- MED.SAND 508 428-3344•seci@sullivonen rn.com or between 16 DEC 16 and 22 DEC 16. � 23 West Bay Rd, suite c / / / / PO OsteBox rville•MA 02655 7 Porker Road Ostervil/e MA 02655 www.sullivanengin.com (508) 420-3994 / 420-3995fox 3.) The datum used is NAVD '88, a fixed mean www.copesurv.com 120" 24.5 132" 24.0 Bamstable120" NO GROUNDWATER ENCOUNTERED 2s s sea level datum. (COtu1t) WNO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED ZO 010 20 40 80 Draft: JOD CTR Field: WHK ASK Mass. LQ Review: JOD/CTR Comp.: RRL1WHK DATE: SCALE: Project: 2007028 Drawing # C859-1 g1 Ex1 June 14, 2017 1 �� = 20�