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HomeMy WebLinkAbout0040 NICKERSON DRIVE - Health °`40+�N7}ICKERS'ON.DRIVE w r'r i i '�I LAW OFFICE OF MICHAEL FORD JEFFREY M. FORD, ESQ. 72 MAIN STREET, P.O. BOX 485 , WEST HARWICH, MA 02671 TEL. (508)430-1900 FAX (508)430-9979 EMAIL: jford2l@verizon.net ' -----Original Message----- From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Thursday, May 22, 2014 9:35 AM To: Jeffrey M. Ford Subject: RE: Emailing: As Built / 40 Nickerson Drive system Hi Mr. Ford: The as-built for the 40 Nickerson Drive still does not show the cottage connected to the septic tank. That is my only problem with this. Donna Miorandi -----Original Message----- From: Jeffrey M. Ford [mailto:jford2l@verizon.net] Sent: Monday, May 19, 2014 4:27 PM To: Miorandi, Donna Cc: 'Jeffrey M. Ford' Subject: FW: Emailing: As Built / 40. Nickerson Drive system . Hi Donna, Thanks again for taking the time to review this site with me. I have attached a copy of the As Built prepared by Jason Souza for the system that is located on the 40 Nickerson Drive site. Again this system was shown on the 2000 plan prepared by Sullivan & CapeSury (which was for a 4 bedroom plus 1) . If you have any questions or need anything further just let me know, Jeff LAW OFFICE OF MICHAEL FORD JEFFREY M. FORD, ESQ. 72 MAIN STREET, P.O. BOX 485 WEST HARWICH, MA 02671 TEL. (508)430-1900 FAX (508)430-9979 EMAIL: jford2l@verizon.net ---Original Message----- From: Law Office of Michael Ford [mailto:lawofficeofmichaelford@verizon.net] Sent: Monday, May 19, 2014 4:20 PM To: 'Jeffrey Ford' Subject: Emailing: As Built 2 No. �— Qir 1T' Fee `6f� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes MPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS \O Zipprication for Mgogar *pztem Construction Fermat Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Now.. -- — - Owner's Name,Address and Tel.No. f_,ZDvt, 9,4.L) _ GeojCe_ Assessor's Map/Parcel tip�J �� A7 C] 16-0 ( — �li t tLt✓ Installer's Name,Addres P,and Tel. No. Designer's y� De er's Name,Address and Tel.No. G_7EQ, J c9 LC Type of Building: 4�t� �l0 T I&A /� ��;�t. Dwelling No.of Bedrooms "� Lot Size sq. ft. Garbage Grinder( <p Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow IS�Yo gallons per day. Calculated daily flow j S 2 gallons. Plan Date i l A to ?_000 _Number of sheets i Revision Date 77/2 -;k Title W0,06cED S t,P i LC_ J't5 SLC M UPC V_,M)C S7o 6(6 H c�T CO'A191.T Size of Septic Tank 151)r-) Type of S.A.S. t Z.KA4 Description of Soil O^4 " 0e_&N tok-CS - oG -2& 6 CcAes c c_c_. 5A i,_L Q z&-- 40 NaC,,►re of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has issued by this d ofagalth. Signed Date (0 Application Approved by Date 1 _ (%, Application Disapproved for the follo ing reasons Permit No. 20470— b 0-!6 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERIJFY, that t On-site ewa a Disposal System Constructed( )Repaired( )Upgraded('�) Abandoned( )b at sr" �t6tA 57- T"6 IT' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a 6 3.8 dated Installer Designer The issuagicg/of thi p rmi hall no a co trued as a guarantee that the t m will n ti s gne . a, Date — Inspector ° Fee 6C� . - THE COMMONWEALTH OF MASSACHUSETT$ +Entered in computer: Yes`PUBLIC HEALTH DIVISION = TOWN OF BARNSTABLE, MASSACHUSETTS a Zipprication for r3igpo.5al 6pgtem Congtruction Vermit Application for a Permit to Construe ( )Repair(X)Upgrade( )Abandon(' ) ❑Complete System El individual Components Location Address or Lot No-5.6, 4-y-G Owner's Name,Address and Tel.No. r Assessor's Map/Parcel 4k �,j k A,_5 vV CJ Cx.1T---e- t cLG Q, Installer's Name,Address,and Tel.No. Dp4er's Name,Address and Tel.No. Type of Building: 1\l o Z t.Q /�. �• tr y. Dwelling No.of Bedrooms L ot Size sq.ft. Garbage Grinder A(p Other Type of Building INo.of Persons Showers( ) Cafeteria( ) Other Fixtures t - Design Flow 5�5D gallons per day. Calculated daily flow �5 5 2 gallons. Plan�.Date A 1 JArQ 2Oo0 Number of sheets _I Revision Date f�=�- 7 JVo> r Title 1�20`P6S S t-Pit C. JYS--c Size of Septic Tank 1 St_'n Type of S.A.S. ', I Z K A 4. Ga t_L Gam( Description of Soil 0-4 �t2G4-.N.tC.S SE �SP. A7 IG -26 6% iSkesc ` C- LL Sp",_'o Z8- gO U /�IELLo-� �9t\r2sc 5P,&10 40- lZO LT `fCL4.0,� ?�e C.0t\ C ` v Nature of Repairs or Alterations(Answer when applicable) t Date fast inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has'b• n issued by this :oard of Health. Signed Z - Date w tF Application Approved by Date ' ... ) - Application Disapproved for the follo.���ing,reasons- i� t. VN y , Permit N6' ovaa D o Date Issued f - ---— e , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance � ;THIS IS TO CERT ,that the On-site Sewage Disposal System Constructed(. )Repaired ( )Upgraded(�) Abandoned( )'b`y� J _�/�/ C.lzzl at CU t7 �J T IJZU lT has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.jrD -4 A.9 1 dated Installer Designer r The issuanc of thi ,6rrni shall no a co trued as a guarantee that the ;m will fun do as f }�gned� �r !1 Date Inspector —.----------- -----------= -------'----- No. PLe—Y)fJ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ]Digpogar *pgtem Congtruction 3permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at See, 1 C�l-t S T GCS TL9 t T and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction roust be completed within three years of the date of this Date: /!�// 9/d 2. Approved by IJI 4 1 1•T VV.LJt] # Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive Property Address Paul Grover " Owner Owner's Name information required for every Cotuit MA 02635 4-16-14 page. City/Town Stale 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. mportaft When filling out A. General information Out forms \��gHf3rnr►pq� on the computer, ������w OF Mq 774i,,i use only the tab 9�p �•�`s`�. SSq�,% 1. Inspector- key to move your T�?, y` cursor-do not James D Sears _ JA M E S m use the rettwn -- ;— — key. Name of Inspector =c�; :'4 pewideEnterprises,LLC A�% Cl_, o Q. Company Name a ,,� I. • ' 'l .�. . ! ' " 153 Commercial Street '�a,���INStPtiG�.��`� Company Address Mashpee MA 02649 Cfty/Town State Zip Code 608-477-8877 S1623 Telephone Number � License Number B. Certification I certify that I have personalty 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 (2 �1eai_j e 4-19-14 jApector's.Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the 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. tSra•3113 Title 5 Official Inspection fare:Subsurface Sewage Oisposel System•Page 1 of 17 f- A� nNi I-1 1-rvv.c.vs1 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive Property Address Paul Grover Owner Owner's Name information is Cotuit MA 02635 4-16-14 required for 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: Inlet cover should be raised. Note: Leaching is five 500 Gal. dry well chambers. 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): f t5ft-3/13 Title 5 Oftial trtspeabn Form:SubaOaco Sawage Disposal System-Page 2 of 17 l � Commonwealth of Massachusetts Title 5 Official Inspection Form %vim Subsurface Sewage Disposal System Form- Not for Voluntary Assessments vj- 4 40 Nickerson Drive Properly Address Paul Grover Owner owner's Name information re>;u aed for every Cotuit MA 02635 4-16-14 page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpsialarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired, B) System Conditionally Passes (cant.): ❑ 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 t5ine.3/13 Tift 5 Waal 1nspecUon Form;SuOatafeoe awm9a 01*o3at Srlem-Papa a of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form iE Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive Property Address Paul Grover Owner owner's Name information is , Cotuit required for everyMA 02635 4-16-14 page. cityrrown State Zip Mode Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, If any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth inis less than 6" below invert or available volume is less than%day flow .. b,9C/I//vG *rns-3h3 Tire 5 Omdel hapecton Form.S WaurfPCO Sewage Olapoeel Syelem-Page 4 0117 e-I I vv.wa Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive Property Address --� — Paull Grover Owner Owner's Name irlfonnetion is required for every Cotuit MA 02635 4-16-14 page. CitylTown 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 ty analysis. (Thi s 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 ❑ El the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone I I 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. I&n -3113 Title 5 9Nldal Inspection Form:Stbswlace Sewege D?ispcsal System•Pago 5 of 17 Jun 22 14 03:51 p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive 0i Property Address Paul Grover Owner Owner's Name information is required for every Cotuit MA 02635 4-16-14 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has th'e system received normal flows in the previous two week period? ❑ ED Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 1 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 15ina•31t3 Title 5 016aal Mspec bon Forth:Subsurface Sewage Disposal system•page 5 0117 ryl LI 1-tVV.e_Ia p Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive Property Address _ -- Paul Grover Owner Owner's Name _ - ---- — informaton is required for every Cotuit MA 02635 4-16-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal.Tank D Box and five 500 Gal dry well chambers Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2012-11,000Gals g ( y g (9p ))' 2013-11,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment - Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatsipersons/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: -- MM-W13 Me 5 OMnal inspection Form:S WOW10ce Sowap Dispoval Syalem•Pago 7 al 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive Property Address Paul Grover Owner Owners Name required foon r Cotuit MA 02635 4-16-14 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (I yes, attach previous inspection records, if any) [] Innovative/Altemabve 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): i51ns-3113 Title 5 Offtcio inspeclion Form:Subsurface Sewage Disoasai System-Page 6 of 17 III nNi c i f-r vv.c i s M.. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Nickerson Drive Property Address —---�— Paul Grover _ Owner Owners Name required r otuit MA 02635 4-16-14 requirr for C ed for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grader 3' --- Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 2T' _ feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast Sludge depth: Z t5ins-3/13 Tile 5 Oftal hspection Forth:Suhsutiaee Sewage Disposal System Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive Property Address -- Paul Grover Owner Owner's Name information is required for every Cotuit MA 02635 4-16-14 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cost.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 0.. .- __... Distance from top of scum to top of outlet tee or baffle 8 — --- Distance from bottom of scum to bottom of outlet tee or baffle 18" — How were dimensions determined? 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.): Tank at working level. Tank and inlet cover at 27" below grade wloutlet cover at 6" in an and outlet tee. No sign of leakage or over loading Inlet cover should be raised 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 �� � Title 5 Olridat Inspection Farm'Subsurface Sewage 0•sp0301 System•Page 10 or 17 nNI L I I Y VV.LVQ N, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage disposal System Form- Not for Voluntary Assessments kv�ew 40 Nickerson Drive__ Property Address Paul Grover Owner Owner's Name —_..--.-.-- required foon r Cotuit _ MA 02635 4-16-14 required for every _. _.___—__ page, CitylTown 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 t5ira•313 Idle 5 Offciel Inspector Form:Subsurface Sewage Disposal System-Page 11 of 17 L I I-t VV.LVO Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Nickerson Drive Property Address Paul Grover Owner Owner's Name — -- — — Information is required for every Cotuit MA 02635 4-16-14 page. Cltyfrown State Zip Code Date of Inspection D. System Information (cost.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x21"-32" below grade wlcover at 16". Box is clean and solid wltwo lines out. No sign of over loading or solid cant'over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *if pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•W13 Tlwe 5 Official►tSpCCtiOn Form:SuL>wreoe Sewage Disposal System•Page 12 0117 h�1 c I 1-r vu.c70 r• � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i vt�;_ 40 Nickerson Drive Property Address Paul Grover _ Owner Owner's Name iequiredfo is Cotult _ MA 02636 4-16-14 required for every page. CIryrrown State Zip Code Date of Inspedion D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number, length, ❑ leaching fields number, dimensions: ❑ overflow cesspool number: --- ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is five 500 Gal. dry well chambers. Chambers are 42" below grade. Chambers are clean and dry. Wall's like new. No sign of over loading or solid cant' over. No high stain line or holding water. Cesspools (cesspool ( spool must be pumped as pars 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 15ins•3113 Title 5 Official Inspection Form:Subsrtface Sewage Dlspcsal System•Page 13 or 17 Commonwealth of Massachusetts ug Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Nickerson Drive l ., Property Address Paul Grover Owner Owner's Name -informatio n Cotuit MA 02635 4-16-14 required forevery _ Page. Cityfrown Slate 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.): LSYq-303 TM 5 O CI&mepeawn Forth Suosurtace Sewage DiapoW System•Page 14 of 17 hN1 c I I-►vU•c0a r• CommonweaM of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Nickerson Drive Property Address Paul Grover Owner Owner's Name ----- -- — —- information is Cotuit MA 02635 4-16-14 required for every _..__ page. City/Town State Tip Code Dale of Inspection D. System Information (cunt.) 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 - 117 = a A f- u� -s - 31 -�2 0 0 3 T-0 0 0 E�o�Icc) f 2 y 5 i 151nw-3113 The 5(M0 Inspector.Form.SLcmrraw Sewage DIeposal SyNem•Page 15 of 17 IV Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Nickerson Drive Property address — — Paul Grover Owner Owner's Name information is required for every Cotuit MA 02635 4-16-14 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) SRe Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells NO Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Hand Auger T.H. 10'-5"no G.W.. Bottom of leaching at 6'-5" below grade. Bottom of leaching at 4' above Auger Hole.u o e. Before filing this Inspection Report, please see Report Completeness Checklist on next page. :5ins-30?3 Title 5 Official Inspecdon Form:Suow--ace Sewage Disposal Syslem-Page 16 111 17, f1fJl L I IY VV.JV0 r. r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Nickerson Drive Property Address Paul Grover Owner Owner's Name information is required for every Cotuit MA 02635 4-16-14 page. CRY/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 We 5 Otrldel Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Miorandi, Donna From: Jeffrey M. Ford, Esq. Oford21@verizon.net] Sent: Friday, May 23, 2014 4:17 PM To: Miorandi, Donna Cc: 'Law Office of Michael Ford' Subject: RE: Emailing: As Built/40 Nickerson Drive system Thanks Donna, I appreciate your help and -suggestion on this. I will pass this on to the owner and let you know as soon as we have an update for you. Have a great weekend, Jeff LAW OFFICE OF MICHAEL FORD JEFFREY M. FORD, ESQ. 72 MAIN STREET, P.O. BOX 485 WEST HARWICH, MA 02671 TEL. (508)430-1900 FAX (508)430-9979 EMAIL: jford2l@verizon.net -----Original Message----- From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Friday, May 23, 2014 4 :06 PM To: Jeffrey M. Ford, Esq. Subject: RE: Emailing: As Built / 40 Nickerson Drive system Hi Jeff: Yes, if you can have the inspector change that from 1 to 4 that would be great and perhaps he can also just open up tank, turn plumbing on in cottage and show that it is connected that way rather than digging it up. Then on his diagram he can reflect that change by showing the connection from cottage to tak. Thanks! Donna -----Original Message ---- From: Jeffrey M. Ford, Esq. [mailto:jford2l@verizon.net] Sent: Friday, May 23, 2014 11:07 AM To: Miorandi, Donna Subject: RE: Emailing: As.Built / 40 Nickerson Drive system Hi Donna, I have called the owner to see if they can locate anything showing when the connection was completed. If they are unable to locate this would we need to have another inspection done? The owner would like to avoid digging it up if at all possible, but does want to get this resolved. Also, the inspection report you have on file indicates a one bedroom (however the system is for a 4 bedroom) . Should we have the inspector who prepared everything update their report to reflect the 4 bedrooms for your records as well? Thanks again for your time & consideration, Jeff 1 ^fay 02 05 0514 47a Rbove Grade 5084571 258 p. 1 00 J - i Y t t i j s mil } 1 . h t V fr •, l ' f Miorandi, Donna From: Jeffrey M. Ford Uford21@verizon.net] Sent: Monday, May 19, 2014 4:27 PM To: Miorandi, Donna Cc: 'Jeffrey M. Ford' Subject: FW: Emailing: As Built/40 Nickerson Drive system nog , As Built.PDF(87 KB) Hi Donna, Thanks again for taking the time to review this site with me. ' I have attached a copy of the As Built prepared by Jason Souza for the system that is located on the 40 Nickerson Drive site. Again this system was shown on the 2000 plan prepared by Sullivan & CapeSury (which was for a 4 bedroom plus 1) . If you •have any questions or need anything further just let me know, Jeff a LAW OFFICE OF MICHAEL FORD JEFFREY M. FORD, ESQ, 72 MAIN STREET, P.O. BOX 485 WEST HARWICH, MA 02671 TEL. (508)430-1900 FAX (508)430-9979 EMAIL: jford2l@verizon.net -----Original Message--- From: Law Office of Michael Ford [mailto:lawofficeofmichaelford@verizon.net] Sent: Monday, May 19, 2014 4:20 PM To: 'Jeffrey Ford' Subject: Emailing: As Built Your message is ready to be sent with the following file or link . attachments: As Built Note: To protect against computer viruses, .-e-mail programs may prevent sending or receiving certain types of file attachments.- Check your e-mail security settings to determine how attachments are handled. • � 1 N Install Concrete NOTES DESIGN DATA l FG.42.2 Risers Test Hole Elev. 28.5 i 1.Water Supply ForThis Lot is Municipal Water. Single Family-4 Bedroom a FG. 30.0 0 0 Organic Material 2 Location of Utilities Shop-110 GPD lities Shown on This Plan Are Approx. Daily Flow= 110 x 4=440+110=550 G PD 4' At Least 72 Hours Prior to Any Excavation ForThis Septic Tank:550 GIRD x 200%=1100 GPD �132.,, c E Brown Coarse Sand q Use 1500 Gallon Se tic Tank 26.5 IOYR 5/3 Project The ConlractorShall Make The Re wired p Top E1.27.5 16" Notification to Dig Safe(1-800-322-4844) 27.3 1500Gallon 27.1 BI YelPish.Brn.Coarse LEACHING AREA Septic Tank Sot.E1.24.5 Sand IOYR 5/6 3° The Contractor is Required to Secure Appropriate 26.9 , 28" Permits From Town Agencies For Construction ' 550 GPD/0.74=744 SF Required 26.7 B2 Brn'ish.Yel.Coarse Defined by This Plan. Sidewall=2(12'+44�)2= 224 S.F. j L Bedding as 6, Sand IOYR 6/6 Bottom Area=12'x 44 = 528 S.F. Per Title 5 40 C Lt. Yell'ish.Brn-Coarse 4. Install Risers as Requiredto Within 12 of 752 S.F.Total Provided Finished Grade. LEACHING CHAMBER DESIGN 47 10.5: 10' 10' 12' Sand IOYR 6/4 Bottom of Test Hole EI.18.5 120 5.All Structures Buried Four Feet or More or Subject All Pipes to be Schedule 40. Use ) No Ground Water No Ground Water Observed. to Vehicular Traffic to be H-20 Loading. 5 -500 Gal.Leaching Chambers ina Test Hole By S.E.I. 6 Septic System tobe Insialledin Accordance With 12'x44' Washed Stone Field as Shown DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Jan.13,2000 310 C MR 15.00 Latest Revision And The Town of Barnstable Board of Health Regulations Not to Scale 7. AI I Piping to be Sch. 40 PVC. q; Finish Grade Filter Fabric �—I—•Compacted FI11 � Fabric sN I/8=I/2" No Stone F Leaching 's Chamber Double Washed Stone 4-10' I #64 I 12'-0" 'Cotuit/Fire District" CROSS SECTION OF CHAMBER Xj "NOT TO SCALE. cone CB 84.27'22" E /bH Drive w_ r�.. Fnd 147.1 c,t CNSB - _ one all 5.6' -__ -� �t ass __�, c;7.8' Fnd I 4D.a' N � y W� 152.'00' 7. 18'00 E 1 Sty Garage _ ; q 9 ;-cBjoH 0 i1 ® 11 Fnd c - - Out 1, �� r� I�� °�- i House 1Sty W/ 10 4y I # oPETER a !o*r W ` :j Workshop �• ( �' N ISULUVAN .. 11 ---------------- 1 - I o0 % - �N— lJ" ' NJ ?30.29M CA l J/ 56 rn 1, De. r O I RESf=12V= O �. liKa `\ avel 1-112 Sty'W/F o vac 1 _ r_1`low _-•,' o R W Drive w FF=44.2 _�.T-_ Fit -•--- 1. ? 0 4 Fnd it 1 ` ,N 89.03'35' E cNse 3.O t% Garden Z W t" I Asssssoag N+�;� 3�" - 2-1/2 Sty Dwelling o ! 1 �EMCVs. EAIST. SEPTIC SYSTEM $AGK�«—!_v/1TN C>_EAN MAT�R\A� 0 15 30 45 60 FEET 18M EI=47.20' MSL(approx) top of CNS Bound S�Fv 15t o�t 07/29/O L �1gT1<13U TlON =-1l:E.S �. Prepared 6y: Prepared For: Ti'le: v North Scale Sheet # Sullivan Engineering, Inc. CapeSury PAUL GROVER # PROPOSED SEPTIC SYSTEM UPGRADE Date 1�=30' PO Box 659 7 Parker Road 4 W I A N N O AVE. 56 HIGH STREET 111JANIOO 1 Of I Osterville, MA 02655 Osterville MA 02655 (508)428-3344 (508)428-3115 fax (508)420-3994 (508)420-3995 fax OSTERVI LLE, MASS, COTU I T, MASS PSullPE@coi.com capesurvOcapecad.net Dwg # C202pl t 99053 l �•=--�►"t�; sib.'"_—_ `�'.i St't:.) I w..-. .-_ •\ ��3 ��k 2e:!A�fG'E- �u-bd) ...„. C.t.:J�er ,-�'�n•ew_�&- ,, _ + PROJECT TITLE 14 .............. ,r✓z�l ►ems! � rC tier C 3c t o J14, /1 1 � NCo- — s. S Fe { r - ,_ \• - t - � 1 .. v 4 —' • - �i�ERA FOR \� All tMI consovokmo.e L:_��,=fig a Preside r:i : � � v: . "rhe ExeWment is. vikOng" �ma�l�a�ntrascar��tfiuctl tt �'riall earn Webalta: +.c,6ntr;alcapeconi3trucbon,00m SCALE 0� �����'���•„---max' a �. !a, _.__._..�9wG sac;. : low 10 N/F Cotiut Fire District ha I St 7026/85 & 2967/328 PARCEL 8 LOCUS MAP NOT TO SCALE 5 F2 22"E NJ 12' ROW TO MAP in LE STREET 147 N8T 18=00"E N87 1_8 00"E .. 118.00, 152.00' PARCEL A :4 La �►► PROPOSED 8,737 S.F. r- QASTING ADDITION -N M DWEWNG (908 S.F.) ---- 47.8' 040 0 00 C N ICICERSON DR.)' FULL FDUNDATTON a �- r? PARCEL NF © 1 C4 soNo noes Forrest & Madeline Daniels TING :� 1361/645 — 4:T in {— EXISTING DECK r COSTING S.A.S. ( I LL1 � AND O BE REPLACEDWITH 10 l——TI n, ( (LOCATION DESIGN P'UW� � ml RESERVE AREA -. L1 -. — --- ---� LL C� PROPOSED ADDITION ` `1 v L—————--—.,._._ o 1— �- (165 S.F.) A 142.09' 0 S89'03'35"W = U ; S89"03'35"W PROPOSED STAIR EXTENSION M THIS PLAN MAY NOT BE ADDED TO. DELETED FROM. OR ALTERED IN ANY WAY BY ANYONE OTHER -T � '»?f v�41,, THAN CAPE#ISLANDS E NGPIEEIWG, *W_ CL N/F WINLESS AND WIL SUCH TIME AS AN ORIMAL(RED) STAMP APPEARS ON THIS PLAN NO PERSON Harold & Eleanor Smith OR PE16004 MLI OPAL OR PUBLIC OFnCUL MAV IaY UPON THE WORMAIM CONTM*D 1476/483 WWW. AND THIS PLAN REMA116 7W PROPEIM OF CAPE AND ISLANDS 840IIIEE74K INC. GENERALNOTES 1 12/23/16 PAM fdmom AREA MC Mc LOCATIONS ARE BASED ON AN "ON THE GROUND" INSTRUMENT SURVEY. 1 12/16/16 REVISED PROPOSED ADDITION Mc MC nvmtwl Aura DXSCRfi3=' N Br APPR SEPTIC SYSTEM LOCATION BASED ON DESIGN PLAN OF RECORD. SYSTEM O iDr ACCOR& TO BE LOCATED AND OFFSETS CONFIRMED PRIOR TO CONSTRUCTION. PATRICK CHAMPAGNE 3217 i?NOr PlrtCs ZONING DISTRICT. RF SnRlsor�, PL s4.�Ys N APPAWANP. z PROPERTY IS LOCATED WITHIN AN AREA HAVING A ZONE DESIGNATION OF NON--HAZARD ZONE X. BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY PATRICK CHAMPAGNE (FEMA), ON FLOOD INSURANCE RATE MAP NO. 25001 C0756J, WITH A MAP =17 IMr NACs EFFECTIVE DATE OF JULY 16. 2014. SARASOrA, n SU" PRONcr: LOT COVERAGE: CERTIFIED PLOT PLAN LOT AREA = 8,737 S.F 40 NICKERSON DRIVE EXISTING DWELLING AND DECK = 839 S.F. (9.6%) by COTUIT, MASSACHUSETTS PORTION OF EXISTING DECK TO BE REMOVED = 165 S.F. PROPOSED ADDITIONS = 1,073 S.F. Sxsar No.: 1 or f Jurs: 12 9 OIS LEGEND PRQfBC?'PM.- JUCXZMSON_40 AS NOW TOTAL PROPOSED LOT COVERAGE BY STRUCTURE = 1,748 S.F. (20X) AFPRQVX0 BE. ife pmwx By, MC EXISTING DESCRIPTION DEED REFERENCE: BK. 29209 PG. 77 ., PRBPARSD BY: O CONCRETE BOUND PLAN REFERENCE: BK. 573 PG. 77 CAPE & ISLANDS ENGINEERING BK. 238 PG. 69 aVn.ENGWEERM-LAND SURVEYING-ENViRONMEWAI.PERMrrrMG ■ STONE BOUND nVC0RFC A7W 1 HEREBY CERTIFY THAT THE ABOVE DWELLING IS LOCATED ON THE GROUND AS SUMMERFIEIA PARK (508)477-7272 • IRON ROD SHOWN AND THAT THIS MORTGAGE INSPECTION WAS PERFORMED IN ACCORDANCE s00 HPEE,FALM A 0 ROM,SUITE 301C v o@ CapeE G com WITH THE TECHNICAL STANDARDS FOR MORTGAGE LOAN INSPECTIONS AS ADOPTED MASHPEE,MA 02649 email:info@CapeENG.com DRu>t Q IRON PIPE BY THE MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL • IRON ROD W/ CAP 0 20 50 100 ENGINEERS, INCORPORATED. CERTIFIED PLOT PLAN PROPERTY LINE SCALE: 1 " = 20' MATTHEW C. COSTA P.L.S. DATE Z3 t� ASsssFgw JJN""Arrav: MAP 035 BLOOC 60