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0026 OLD OYSTER ROAD - Health
26 Old Oyster Road cotuit P A = 036 001 i No. ac) -1 3 Sri ` Fee THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Disposal 6pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) 'Complete System ❑Individual Components Location Address or Lot No. (p (�LA (��Si CIZ u yO�wner's Name,Address,and Tel.No. P o B���S�.7 Assessor's Map/Parcel 0 3&—00 � 0'v,� '`1��� ?®��J� 1 is �-°vv ✓/--e-ice S�v.� ('U.l l/l ,-4"� die ' a ,`dd ess,and Tel.No. �/ �Q Designer's Name,Address,and Tel.No. I we bowl ��v &. Type of Building: AtAS;5 Dwelling No.of Bedrooms 3 Lot Size e � sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures :Design Flow(min.required) gpd Design flow provided gpd Plan Date do')0 l _Number of sheets Revision Date Title 51 %-e ? L Size of Septic Tank f� 6VO 6-d-t- Type of S.A.S. Description of Soile Nature of Repairs or Alterations(Answer when applicable) Date last inspected: /'e_S% 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 th nvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B ar o He th. i ed Date Application Approved by Date 2 h�i Application Disapproved Date for the following reasons Permit No. 1`� �� Date Issued 712Z/20I 7 No. dU I 3s 3 Fee,: ��j v f Entered in computer: THE COMMONWEALTH OF"MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftprication for -Misposa[ 6pstem Construction Permit i< Application fora Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Addressor Lot No. a(o O L A O M<2 VA Owner's Name,Address,and Tel.No. P O (/)C -34 7 j�► cttIl't/3 2GG S Assessor's Map/Parcel Q 3(p ""UU ( o'�' S U S 4 A/ d ti CC)/ U/ •f J taller ate,Add es and Tel.No. ��1 � Designer's Name,Address and Tel.No. Type of Building: btfl ?S Dwelling No.of Bedrooms 3 { '-,Lot Size ;.P i. / sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures d Design flow provided d Design Flow(mm.required) gp g p gp Plan Datel a�/��y Number of sheets ! Revision Date Title $/ I P ( �" Size of Septic Tank /, &/f-L Type of S.A.S. CAL- Description of Soil`-�C — .SU I L / e3 Nature of Repairs or Alterations(Answer when applicable) 1 Date last inspected: /'e,S/ /1-P L Agreement: 1 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title�^5 of the-Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B�ar o Health. N. i ed Date 90 Application Approved by ) Date 2� l Application Disapproved h / Date \ for the following reasons { Permit No. 5;D 1 01 `. 3!U Date Issued 912 f ZO t 7 f J THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(1-< Abandoned(Wy \ ' at 2(o C�C, (J `j S / E k (G t Ji % has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.o�U I i 3 3dated Installer Designer �U w r j ?G #bedrooms 3 Approved design flow ,3'3 gpd The issuance of this pe it shall not be construed as a guarantee that the system willtcti d ise gne r Date Inspector 41✓ 1 - No. y v'Z O 1 3S 3 -Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MIsposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ()� Upgrade(V< Abandon System located at a U L1 U Rd CO T(J/ / 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:Cons ctio must be completed within three years of the date of this perm Date > ! Approved by e, � �I Feb 27 20 05:01 p Clancy Const/Foundations 508-4446801 p.1 Town of Barnstable WE Qn Regulatory Services Thomas F.Geiler,Director 4 �uvsn�st8, i NAM .� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 509-862-4644 Fax: 508-740-6304 Installer&Designer Certification Form �i'. l ,``�. g p p f Date: L �=!! ,� Sewn a Permit# 2 19- 3 s 3 Assessor's Via V'arcel Designer: b`�'; Ni L"'.h r" �` i`e �.� '+� Installer: O r;.S.o 11 s III a ..�. R Address: =; �'i;`' Address: M��� �� M S, NA on 9 2'r> , 5. (Qr i s s u ll was issued a permit to install a (date) (installer) septic system at Gl;, ,��t C' 7!K.�C;.� : r !?'! j- based on a design drawn by (address) i_A f dated (designer - r— / 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. 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 designe o follow. (I aller's ignature) ' L lc (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE. PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/SeptidDesigner Certification Form 3-26-04.doe (D PO v .. N O LEE G ND 'SYSTEM PR0F0.E na x nr rlrsi�"°. oar..Ha rc.rr.m ' [¢_.r:...l,;•I`-��/\ "� mar,—T";a >, — ...._�,,�'�'�wrg ;��:�I� rra.•,1•,�,w w� �� ���. Iq��L'•4'1 0 L�� cam 'm •eeo way _.,r v �-rfr-TCC__.•. —�-- t p'RT - owl., l/ rG• N r.( i'. el.fe' b.\\' r ff-TC!_ p�p.1illy[. ppp�q !. j - 1 .�..e. ....) '•a n•��Y;u�a � OAP:;': 9HS:`::<i C JI___ t'..�.A � rr�_ra mca0i t5 LrY.i.aa l•lr4 t...... �ev u rwrL'e ayn•••'•rerrl wiR� ��r rxr r.a.T a..a W r, Q 9.W SEttPEAN'�WWI uD 0 (aeY(.0 �• "~ ca-lbn aa Px ro N-xs+.°.s. LOCUS MAP 0 PmIXI v RPMsslar (..' - '.i' - —u r-e]oD9= - - p , Ll�Rary LJ-.xntl LL9 eRsl m— rl:tf ms YM>s ;%1 SYSTEM DESIGN: ranrr: rw+r4r.l Ox— T°- —Wire Wr— • •^.0 ews 17 �c°m , Olrm•a u•Porx rs nor.uorn ++ •^•••• rfrsmc lernro9u Orv(ra I;.' - ..na�.Yinu eremP 0 uYc.nR 1.eG,xmu:a Ile PO-s]O ero - I, I :'irl: � ''.!'• _ 1ml. M A O3O M ee9d I•Yvr — 1 eawur•vuE axx w\(r?rJ1 sEPrrt v..3w OO(fl.ee0 `i Y4 A r}111O GL¢PM faNrt ' �1 ' e ' - l[aCxNR r 1 i .,:1 i 1• - wafw;eb°Cara N R n r®c•r.i n T � . sr_4sr a W lsula(Tn.11f ug 1 { �� ! s•. t f _.••..I , r,i wl Yt'l,�a Vet wll °191 TO j ., GOT Iw w.PALL7•1 j I i �..;.t i �Ir'� wn el•c•. ax am 1 1 i,•: '�•, I r• r' s na rw.vc.nn.a e..,-.•..c l•'x M sm c,,..A rx..9(In Insc m caAll r • jf , '� '+ '•I r: ' i rwaea w m rod Rc.m a rw w rAn un� ltti i AT qD3 ua a• i I� I I I I' i I 1 :.•'[+l t•�`•;� i 1• •I t ' -.J l �q�rx.cra o-u R�ro•runt di'=Afery ('- i ''1•; .1� I r`� 11 �• `I�I i. 'r'�uwnwv OIY��ro�IFiM�09 v�lr9i°w .u9Dw•f gal D1.09 rf M. ! ..+' �+ •\ ; 1 _` 1` `.)•• t � 4 'a a �OwnV reOurr sAws lwm9e _ �' ,'S .1 1'i'`t, 'I +_ i w< .\ ;'.`,l:r'•'' ?jr''t, •I ..r..as o %; - - ,- .'•;r .•,�' his ' .,+ '� _ '; `'y+• n�; M� ��e '.� ? ` `. - ^• + }N{r'zn,try.D ,m I..,11;!', 1`'• i's` J! S •,•r_.- r \ i +1I ZONNG SUMMARY ILIAIII ',`(. ` _ I :r:, / '' ;•r• `I,,-e. .`•i.I ''L;`:\1,"` t IOND 91TI00:ar IrLR0EI1nN-asTPoCT B7,120 a EIOPNG' 21I—A&F WT 9f1 9f.1I011. 2a111eaf. Za.HNGv. I I 11 + ,•,1',1 lrr'.m nIPIT.Ge lag' sm, 1e9.00' xAsoM .i• 'i �` I,� I, ',�,', xra mart:ATOaox ad \se' •e.c 7 ' i I' \ t '',y 1!J i. sa crnAn( u• fea• ww• . i� i (�. `��� � 4l"u..9aR ureAtx •s u.e n_ r•:,�• WQ1 4)5.,,.,•: •l, �.} .•`. t` wfi..xini ee.co.o�'c' x'Yi s:�� .• .,taf9m Matte 7n.. �`1. •N' '}, •'�. Il•' `•• •9M.ROM rJi4 MT0 Itm 0.00 •ILR 9110•111 7VS laa eplAS' . � I �KC. '3 1 I,I I'i.i i / I '.-/ ` D2 rl laC.99 wwx IK RCdAC H.r(tlmr u'vlrwT w:nacr MMG7 TE6T HULL LOGS 91E R letl=IIM IPE K"IA-0 Fft-M l fdRLAY •t t- _ I , IxWi?yl\R 1Y:.1[e rn9r 611euaP(.raTxgIEDS N(ParorES5e1 eAi, I106'aa,Cax:]fr8Ow.eC IIN)1 r, Q. ' ` +! 9.fa I[hr.YAesel.n COIi[Rla([RxFR O 00 Iell:.RAl•.� .x vr./.x:A __ ' � .� � j J 7� � .r SITE PLAN 4�- f • •� .° rnl a9 '''I` ei #26 OLD OYSTER ROAD > ;Mes::.• ; + COTUIT, MA o f/[ SV1W(t ID:A D/f \,p.( TTppo' 1 SOU. A]: �../: � •' `1j• i r .99 RICHARD RODGERS & SUSAN JACKSON asVu 1O'Mll a M'1 Tw9 nBe �.i , 8 PalstoRTwclo r'clfo'w®c. i Icr .:.•... .m M(T(:/1Rdf5'1 ID,z019 a..1. °\• / 7\e• Wr Ve rFl%6+�•_ _ :.+..,n°�xSCfe•T0.1ay'Cam' REV:SEPTEMBER 19.2010(SOIL W5PEC1104 NOTE) . rID11C[. J `(J .' ` '• •* leer r•.]d Q ,' Tf<m'l.F becofAO 4[tTrli rn••�� .M?�:'!V. C k..... ♦.:.i.. -. .. - r rl MD x; sIB }\�,, •, � � e aralrr+ir� S`: ... i:,F'•, "-' ve-au IMe _ter.. n wmTa,r `,r I 1 I•u' re ru' '� -. � ♦ ,•� 4 \. .,.o a-i m-K: �_ r., A en!nears ions augua)ws ro cwsaam([ntour991m \, t N •Rne9A[m ,. 1 ~mod DCB f 17-J9d 4 P �m $ S:mB F i0. m ym gy O p� R R N 8 ®�II WD O ® ac g 5; r Nk m D E o 0 I m^ I I I I mo I I I I r-a �R 9� E Dip dby: # DATE REVISIONS D SHEET: PROJECT: BUILDER: Mdin Street t llv9 datmar,royar,deck PROPOSED �`fq�.j��`�p 2 8I1L19 dame DaM away from parch y , 3 8115119 axlanded dormertt.p.pushed out SECOND FLOOR PLAN Custo Desi u CONSTRUCTION 8I,9/19 anam Donaowmana ROGERS 8 JACKSON 9 g .a............ 9I1319 finished basement/bath - RESIDENCE mwi,—st— 21TQIntonMe— YarmouthPort MA-M62S Felmo ,MA 02540 N ° 26 OLD OYSTER ROAD 4 COTUIT,W. twtia n� xo b� v.om�ymnm— . Aw,m—.- . pg / � { IZ 0 a In 0 z 0 02 z -el ol m ml z m CZA\ :f �JQ ) >1 MQ N11 o 44� Q1 Nk" FT 0 Q G IS) 0 ii�Rr z I D DATE REVISIONS SHEET' PROJECT. in treet BUILDER M 9 d—..".1,d�BjjVjq a 2 d�ck�y fmm pii PROPOSED CLARCY 3 $115119 e��W dff.p.pm�wt [ f �� ��| ` ° | § ! . \ CONSTRUCTION 811W 9—�.d--� A, FIRST FLOOR PLAN ROGERS&JACKSON -ter© .........ll.. 91 Wig_Mb—,w0bail, RESIDENCE Y 217 Cll��A COTUIT,M. 26 O-D OYSTER ROAD . I I d-------------q O O E�aK W '=0 Fa �r I -- gA �O T$ m O O g =�1 A o I I °3 I W mn' I I Q-------------- II II II II II II - II a m a� II II II ' II NPS LTI m— m-- z II II 44$v m o �k .F d�E 'sg m DevgnN by: Y DATE REVISIONS SHEET: PROJECT: BUILDER: 6 W119 e°rm<r,foyer,exk Main Street 2 9/1yig eolmer bakeway from Domh PROPOSED eLANCY 3 8115/19<#<ne<d ewmerfl.DDushee aW = BASEMENT PLAN Custom Desi uC CONSTRUCTI N 8119119 atru 9<seo m<sn ROGERS&JACKSON aal.ol.. a<.00a. 9113/19 9ma<a 6a«m<mtnam _ RESIDENCE P6�'''s°"'Sh 217CIinMnM.. 26OLD OYSTER ROAD Yh Port M,02675 Falmouth,MA 025E0 m � armout msxvar n N 4 COTUIT,MA Ile- w. ,.. Aepaxoa?gat Of RogwatoAy.semces t UTI!»;, PubRcCeazbi_ aSIOR Date 110 na�pv 2QQ Iv�nilz Slreet,HyanAls MA 07.607 at,Sohedul d Fee PdP- IN) DO Soil ,suitability A ssesSment or `e a e D�xspposal PerPanned sy:, � S �I�i6 Wxtnesscd By: LOCATION RAL- IocaLlon Address O'J o �Y Oyvner'aNanxc �s¢GSo talckaM Q.& "� Address Assossor'sTyYal,/i'azoez: �(p`j �nginQcr'sZ'Ia1CAc �tNAI APE (attU , NEW CONSTRUC Ioig .REPAIR �.,. Telephone# ' �6_3��-(fS 1 ` f r Land User 4 y�- �g�rt��� �a'''A Slopes�`�) -5 ��`a' suz�'acc Stoups Dlstances flnm: Open WaterBody ft Possiblo Wet•Area 'r fk DrIaking Water W,11 Drainage Way —ft. Property Line --�-�..�—ft Other �k i SIC 01- a;(str ex name,dimensions of lot,exact locadans of test holes&pero tests;locate wetlands to pzmxin-4 ty to lzolcs) c-4, . -... Pareatmateiinl;geola ic)�st./`r �� �GA.q -� ., _Depth tq}�atJr4e1� Depth to Gmundwaker SlandingWaterin hole: A/6&12 Weeplugfrom PltFuz Estimated Seasonal High Groundwater "►�~ JDtE']I"ER7.1�U'fidQ:N FOR,SEAS ON AL MGR WAIMA°,A-10LE. Mothod Used: Depth Observed standing in obs.hole: lay :Dieprizytsa.s1l xasz,tltsf. .* it1. Dv�th to wcopingfrom side of obs.hole: lla, brnundwatcl. dauetm nk f>• " Inder.Wall# Reading Date; lndoxWolilatiul AeJ,fit:td.C_Adj.!gr0ulltl;W1lt6rLav5l ]PERCOLATION'. EST Duke Thne Observation Hole 4 Depth ofPerc. '7 �.� r Timr.At6" Start Pre-soakTima @ - )vnd Prc-soak. `- ',.-.. � E�. '. :: .,•:. ;. _ ' Rate Mln.(.(n.ch WA r 9itpMtabiIity,Asaessmcnt: SiCvynascd Sit�Fnlled: Additional TosGiaiNveded(Y. II) y� t Original: Public Health Division `�� Obse6a:tioa Hole,Data To Be Completed on B ack---- ---- **'t°1f,percolattio' n test is to be c'maducted withal 10012of w� lead,you must first).otif'y the Eunstable oCousqyafton DiTision at-least one CI)wealt prior to begirming. Q.mBPT1CuT15RC.FORM.D0C 1 Dcpthirom Sdil larizon 9a11.Toxture Sd1IColor gall.. Othcr Surface(in.) , (U-SbA) (Nlunsell) Mottling' (Structure, Staring;Boulders, k rr o i to 2V.9b'Clravell IMF? S Dapthfrom SollHorizon S'allTexture Sall Color Soil Other Swfacc(in) (USDA) (Munsell) Mottling (gtract❑rn,Stones,Bauldnr. ConalsNpay,90 Grave 15 DepthTTom SoilHarizon SallTexturo Sail Color Sail 0Lbor' Surraco(in.) (USDA) (Munscll) Mottling (Str❑dtgo,Stones,Bouldars. Depth from Sail Hodzon Soil Texture Sall Color 5011 Clthcr Surfage(in.) (USDA) (Murtsell) mottling (Structure.9tonosr fioulders, • Ca s t b . 7 • f Y+'lood 7s��axlo�r�.afelt`�>�.�e AbavcStlCt•yea?jlwdboundary lVa_._, Yes x_ within 606yeafboundary. No .:K Yes.�„ Within l[]Oyear flood boundary No.� 1��5.•- - �,e��h df�ra�TcaYYy'�cct�ra�in>p�'erv�ous�at���•a� Does at least four feet of naturally'nccurdngperV ou ¢I rlt�l e7clstitm all Gratis nbs6rved rhrpclghaut the area proposed for the soil absorption syateml If not,what is the depth of}naturally occurring•perVlous materlall x certify that oil . -.•(date)Y haVepassod the soil,evnivator axamination approVad hY the Dopattm-ont of Environmental Proteotlon and tbarthr; above analysis was-perforimmod by me conslatent with . the required training,expertise an .rmparion o described in�10 ClIa 1.5.017. Signature natb 14-11> 1 y. LOCA''LQN al I sQ!' SEWAGE# bT 1I�sTA .LEK'S A &PxC31dE ivt3 �C SEMC TANI£CAPAciTY _,dam Cc r FtTiI.DER oR CwNER PEEAIITDATE. Ct3lVlT:IANCE DA' ' Scpatstton Drstanee Bet�reea:Fhe �ty Feet hiaxiritum � is Ated Groundwater Table to the Battom ofLeact ing FaGii J3rivatG SWaterSupplyell andLeacbiag Facie► �€;asy wed exist on site,me antlua?Atf fit of iea�hi�g faccy3 Teel. Edge g£Wetland and;I.eachin8 Faa'l;ty(If ariy wetlands exi5f witbia 300.'£eet d leachidg f ._ .. Feet Fut�tslnect by � CA r o ' �3 03b_ oO 1 llJ Commonwealth of Massachusetts Title 5 Official Inspection .Foem } ;Q Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments �f r kf rT1 IV 26 Old Oyster Rd Property Address h Rick Rogersf Owner Owner's Name +: information is �+ required for every Cotuit ✓ c '; MA 02635 9-14-18 . page. City/Town State. Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may`not be altered n any way. Please see completeness checklist at the end.of the form. A. Inspector Information Shawn Mcelroy Name of Inspector'. Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth r E f- MA-- .r r 02536 CitylTown State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty 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 conducOig this inspection.I have determined that the system: A.' ®- Passes' ,2. ❑ .Conditionally Passes • i � - 3. El Needs Further Evaluation by the Local Approving Authority .•- f, 4. ❑ Fails 9-14-18 nspector'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 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 how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 I c \ Commonwealth of Massachusetts A Title 5 Official Inspection Form Iw' r�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 page. City/Town 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ? MI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J 26 Old Oyster Rd Property Address - Rick Rogers t. Owner Owner's Name information is Cotuit MA 02635 9-14-18 required for every ' - page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): �- # ❑ Pump Chamber pumps/alarms 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 BoardW Health): " ` ❑ broken pipe(s)•'are replaced r ❑ Y ❑ ❑-ND (Explain below): ❑ obstruction is removed ❑ Y `❑N"'t ❑',ND (Explain below): ❑ 'distribution^box is leveled or replaced ❑Y` ❑ N ' ❑ AND (Explain below): .. . is 1 . f. • -- ..•�-. . R ❑ 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 ON ❑ 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: t5insp.doc•rev.W26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ;rat Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;." 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 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 ❑ ® 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts *� ,. Title 5 Official Inspection Form !u iI Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments r a 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 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 distnbution box above outlet invert due to an overloaded or clogged SAS or cesspool .' ' ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less J than day flow' ' ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® . Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ ® ` tributary to a surface water supply. ❑ ® Any portion of 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 Y• 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. ® 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. ` I 5) Large Systems:To be considered a large system the system must,serve a facility with a design flow of 10,060 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 ❑ ❑ 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of•18' l n Commonwealth of Massachusetts IYi Title 5 Official Inspection Form MI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is Cotuit MA 02635 9-14-18 required for every ' page. City/Town State Zip Code Date of Inspection 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 all inspections: r 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? ® ❑ Wasthe 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts .. . .� r. Title 5 Official Inspection Form r ' ,-i Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit .' MA 02635 9-14-18 page. City/Town State Zip Code Date of Inspection D. System Information _ 1. Residential Flow Conditions: µ r Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: } . . - • yr, '+r Number of current residents: 6 Does residence have a garbage grinder? I ,, r r +�' 4 ❑ Yes ® No Does residence have a water treatment unit? _ r j• ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection , a ❑ Yes ® No information in this report.) Laundry system inspected? - ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: •1 Sump pump? f ❑ Yes ® No Last date of occupancy: J;,•. ,-, , t , , f- r- ,; r' t 9-2018 Date t5insp.doc•rev.7/26/2018• Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 l \• Commonwealth of Massachusetts Title 5 Official Inspection Form 61 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): -- Gallons per day 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 occupancy/use: Date Other(describe below): , 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form. wa o,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- .? 26 Old Oyster Rd : Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) • :. 4. Type of System: ® Septic tank, distribution box, soil absorption systems ❑ Single cesspool ,. ❑ Overflow cesspool r ❑ 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): Approximate age of all components, date installed (if known) and source of-information: 1992 Were sewage odors detected when arriving at the;site? ., �., •• t { , ❑ Yes ® No 5. Building Sewer(locate on site plan): ;. }+ 24" Depth below grade: feet c,�+ t _, ,r :.. _ - y f { yr^ , t ' *, •J Material of construction: ❑ cast iron ® 40 PVC ❑ othW(explain)` a` v Distance from private water supply well or suction line: - feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7126/2018 y Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 ^. Commonwealth of Massachusetts Title 5 Official- Inspection Form .%I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r a <, 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) • 4 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 Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" 2" . Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee,or baffle ' 14" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 r Commonwealth of Massachusetts 1 f� Title 5 Official Inspection Form " PI Subsurface Sewage Disposal System Form Not for Voluntary Assessments 26 Old Oyster Rd Property Address _ Rick Rogers - 4, Owner Owner's Name information is I tUt CO a required for every MA 02635 9-14-18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: I i ❑ 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: I a, , �s Wit. t,;, Date— Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inv' ert; evidence of leakage, etc.)" r. a .a .l 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 ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 - L ' Commonwealth of Massachusetts ,w Title 5 Official Inspection Form Ili Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ? YW __� ? 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name - information is Cotuit MA 02635 9-14-18 required for every page. City/Town 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.): Good condition with water at working level and no sign of back-up from pit. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts 4. �. Title 5 Official Inspection Fora !� i-'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ". 26 Old Oyster Rd c Property Address n Rick Rogers Owner Owner's Name information is Cotuit MA 02635 9-14-18 required for every — page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 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.): * If pumps or alarms are not in working order, system is a conditional pass.1 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): . If SAS not located; explain why: r Type: ® '" ' leaching pits ` _, + ' ' number: ' ' 1-1000 gal ❑ leaching chambers- number: ❑ leaching galleries number: ❑ leaching trenches- number, length: ❑ 1eaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 ' Commonwealth of Massachusetts p Title 5 Official Inspection Form ► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 page. City/Town 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.): Leach pit in good working order and holding 12" of water with stain line at 24" below inlet invert. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert r 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts fp Title 5 Official Inspection Form ! i�M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1rr-•�-, , 26 Old Oyster Rd .� Property Address Rick Rogers Owner Owner's Name information is Cotuit MA 02635 9-14-18 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): f t5insp.doc-rev.7f26/2018- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 a c Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments sr.V 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 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 4 9e, _ a ' A .0 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 i Commonwealth of Massachusetts �a Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments : 26 Old Oyster Rd Property Address Rick Rogers r,•.-ry Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 + page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: j. ❑ Check Slope 1 r. . . t• t ❑ Surface water z ❑ Check cellar ❑ Shallow wells } r Estimated depth to high groundwater: , , •�, eeet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans onsecord 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: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7,26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Old Oyster Rd Property Address Rick Rogers Owner Owner's Name information is required for every Cotuit MA 02635 9-14-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector 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 ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 I Ilglo M1 COMMONWEALTH OF MASSACHUSETTS 'i EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m r DEPARTMENT OF ENVIRONMENTAL PROTECTION w RECEE-IVED ve MAR 2 3 2004 TCf,N OF BARNSTABLE HEALTH UEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Proper ty Address: 26 Old Oyster Road RECEIVED Cotuit MA 02635 Owner's Name: Barry West Owner's Address: Same MAR 2 2 2004 Date of*Inspection: March 5,2004 TOWN OF BARNSTABLE HEALTH DEPT. Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. �p Mailing Address: 189 CAMMETT ROAD (SAP ��3 MARSTONS MILLS MA 02648 PARCEL Teleph►ne Number: 508-428-1779 LOT CERTIFICATION STATEMENT I certif that I have personally inspected the sewage disposal system at this address and that the information reported below i true,accurate and complete as of the time of the inspection.The inspection was performed based on training and experience in the proper function and maintenance of on site sewage disposal systems. I am �'R' ttitOF approvod system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: �� ••..•••••• .;sS i,�; i •'CyG _X_ Passes Conditionally Passes can Needs Further Evaluation by the Local Approving Authority Q' NELL :•ra Fails r Inspec D Date: 3/5/04 Inspector's Signature: C�r�C �i,��T� 1��041z; INSQ The sysb:m inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)ui thin 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 authorhy. Notes an4 Comments: Observed 18"effective leaching in pit. ****Thhi 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 condithris of use. Title 5 Impection Form 6/15/2000 page 1 Page 2 A 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 26 Old Oyster Road,Cotuit Owner; Barry West Date o I'Inspection:March 5,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy item Passes: _XX_ 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. Comm:nts: B. Sy:stem 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. Answei yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain he 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 existin€,tank is replaced with a complying septic tank as approved by the Board of Health. *A met:]septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND exf ain: 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 approve of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND exf I ain: 1 he system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass in;r ection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND exflain: i Page 3 A I 1 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Proper ty Address:26 Old Oyster Road,Cotuit Owner: Barry West Date oi'Inspection: March 5,2004 C. Fu rther Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a :,urface water supply or tributary to a surface water supply. — The system has a septic tank and SAS and the SAS is within a Zone I of it 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 facteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. i 3. Other: f Page 4 A 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 26 Old Oyster Road,Cotuit Owner Barry West Date of Inspection: March 5,2004 D. Syr,tem Failure Criteria applicable to all systems: You mi.ist indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ 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 _;C Liquid depth in cesspool is less than 6"below invert or available volume--is less than ''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged.or obstructed pipe(s). Number of times pumped ;C Any portion of the SAS,cesspool or privy is below high ground water elevation. _,C_ 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 apublic well. _X— Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No_ 'Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. La rge 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a,tributary to a surface drinking water supply the system is located in anitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a.mapped Zone II of a public water supply well If you hace answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"it 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 shalt upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 )f I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: 26 Old Oyster Road,Cotuit Owner: Barry West Date of Inspection: March 5,2004 Check ifthe following have been done.You must indicate"yes"or"no"as to each of the following: Yes 1%5 _X_ ___ 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? _X_ _ _ 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? _X_ ___ 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? _X_ ___ Was the site inspected for signs of break out'? k _X_ __ Were all system components,excluding the SAS, located on site? _X_ __ 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? _X_ ___ Was the facility owner(and occupants if different from owner)provided with information on the proper maintetia;ice of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _XI __ Existing information.For example,a plan at the Board of Health. X_ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance;i:;unacceptable)[310 CMR 15.302(3)(b)] Page 6 )f 11 i `)FFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:26 Old Oyster Road,Cotuit Owner: Barry West Date o1 Inspection: March 5,2004 FLOW CONDITIONS RESIDENTIAL Numbe•of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIG J flow based on 310 CMR 15.203 (for example: 1 l0 gpd x#of bedrooms):330 Numbe of current residents: 1 Does re iidence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundr,,system inspected(yes or no): Season,i I use:(yes or no):No Water meter readings, if available(last 2 years usage(gpd)): 2002—56,000 gal.2003—43,000 gal.=135 gpd. Sump prunp(yes or no): No Last da:0 of occupancy: Currently Occupied COM111 ERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease d-ap present(yes or no):— Industriai waste holding tank present(yes or no):— Non-san:tary waste discharged to the Title 5 system(yes or no):— Water rn-ter readings, if available: Last da x of occupancy/use: OTHE R(describe): GENERAL INFORMATION Pumping;Records: Pumped every two years Source o:'information: Owner Was sy:;G.m pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE-D.F SYSTEM _X—Septic tank,distribution box,soil absorption system _Sir gle cesspool _Ov.-How cesspool _Pri✓y _Shared system(yes or no)(if yes, attach previous inspection records, if any) _InnoN ative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtainel from system owner) Tight tank —Attach a copy of the DEP approval —Ot1►er(describe): Approximate age of all components,date installed(if known)and source of information: Compliance date:6/26/92 Were s<:wE ge odors detected when arriving at the site(yes or no): No I Page 7 :)f 1 I 0FFICI4,L INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Old Oyster Road,Cotuit Owner: Barry West Date of'Inspection: March 5,2004 I BUILDING SEWER: X (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: 12' Comme nts(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 16" Material of construction:_X concrete_metal fiberglass polyethylene _othc;r(explain) If tank :;metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certifica ie) Dimensions:8'long x 5.2'wide—1000 gal. Sludge c.epth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum tle ckness: 2" 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: 13" How Here dimensions determined: STICK WITH HINGE FLAP. Comm(r is(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as relatod to outlet invert,evidence of leakage,etc.): Baffles intact and clear.Tank not in need of numling GREA'3)E TRAP: No (locate on site plan) Depth be low grade:_ Material )f construction:_concrete_metal fiberglass_jolyethylene_other (explain): Dimens is ns: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance tom bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as relatud to outlet invert, evidence of leakage,etc.): f Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Old Oyster Road,Cotuit Owner:Barry West Date of Inspection:March 5,2004 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth t elow grade: Material of construction: concrete metal fiberglass___polyethylene__other(explain): Dimens ions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: COMM sits(condition of alarm and float switches,etc.): DISTR t BUTION BOX: X (if present must be opened) (locate on site plan) Depth cif liquid level above outlet invert: 0" Commt n is(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage i nto or out of box,etc.): Box level,one outlet Dive PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Commem s(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 )f 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Old Oyster Road,Cotuit Owner: Barry West Date of Inspection: March 5,2004 SOIL ikBSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS tot located explain why: Y Type leaching pits,number:One 6x6(1000 gal.)pit leeching chambers,number: leaching galleries,number: ke ching trenches,number, length: I leaching fields,number,dimensions: ovj,,rflow cesspool,number: inc ovative/altemative system Type/name of technology: Comm(i its(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Observed 18"effective leachin with no hi ph stains.Soils are course sand no evidence of breakout. I CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Numbe•and configuration: Depth- top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimens ions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Commeros(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Commonts(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:26 Old Oyster Road,Cotuit Owner; Barry West Date of Inspection: March 5,2004 SKETCH OF SEWAGE DIS POSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchrr arks.Locate all wells within 100 feet.Locate where public water supply enters the building. �Id d tee . tvlG� i I 141 2 Cp O 3� Page 11 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Old Oyster Road,Cotuit Owner: Barry West Date o;'Inspection: March 5,2004 SITE I XAM Slope None Surface water None Check cellar Dry Shallov wells None Estimat:d depth to ground water: More than l5 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: _X_O served site(abutting property/observation hole within 150 feet of SAS) C;ecked with local Board of Health-explain: C lecked with local excavators,installers-(attach documentation) Accessed USGS database-explain: i You moat describe how you established the high ground water elevation: Low area at right side of property with no standing water considerably lower than bottom of SAS i I TOWN OF BARNSTABLE LOCATION_ A& SEWAGE # 9-78 VILLAGE ASSESSOR'S MAP & LOT (1�3�- / INSTALLER'S NAME & PHONE NO. !� , SEPTIC TANK CAPACITY 0o �Q LEACHING FACILITY:(type) (size) 1600&U NO. OF BEDROOMT PRIVATE WELL OR PUBLIC WATER y� BUILDER OR OWNER [� IA n� DATE PERMIT ISSUED: x DATE COMPLIANCE ISSUED: /_ -2fe - 2, VARIANCE GRANTED: Yes No I/� "L O w .�C v • l No..A___._f...{l Fps. _ ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH MPROVEO TOWN OF BARNSTABLE Appliration for Pispuia1 Workii Tonstrur to • r `� -�— Application is hereby made for a Permit to Construct ( ) or Repair ( ) an I dividual Sewage Disposal System at: ............ ....a 1, .:-•.............. .. ....... ............................................................... tion- ddress or Lot No. -- wner- 75 ddr . ................•---- nstaller Address d T of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( ) PL4Other—Type of Building ............ No. of persons............................ Showers — Cafeteria Pa Other fixtures -------------------------------- . w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/aea..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. V4r SxFr.. 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_-_-_____________-.-_--. Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a O Description of Soil---------- G y " - - -- - - - --- x w U Nature of Repairs or Alterations—Answer when applicable................................................................................................ 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 Complian as been issued by She board of health. / Signed .. -------- ------------------------ -fP-- ... � ! Date Application Approved BY .................... .. ... ...... ... A te .. Application Disapproved for the following easons- .............------------------.............................................................-------................................. .................................................................................................-..........................................------------------------------------------------------------------- ------------------------------------ Date Permit No. a...'... .-7... ' .......... .... . Issued ......................._ .............._------- ----------'-----------;-.......... Date .: i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F TOWN OF BARNSTABLE Appliration for Disposal Murks Toustrudw, uh ruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal tem at: Sys .............'� -- - ------- - -----------------------------------------ion: ddress or-Lot No. .............. __ -- ----------------- ......... ---•------------ I'w ner ddress. ppf .... .. Installer Address Typeof Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms_____.,_�.................. _____Ex anion Attic� g— ---------- p ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------•--------•--------------.-..--.-----------------------•---------------•---._...-------------------..._......_.._.............. W Design Flow_______________________________ ___________gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid'capacity/Va__gallons Length................ Width................ Diameter---------_...... Depth................ x Disposal Trench—No._�/ r . ���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........................................ aTest Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------•-----• ------ ------- ---------- •.......... -............ 0 Description of Soil--------------------------- = -- ---------------....--------._.......--------------............._.. U ------------------------------------------ _...... _----------------------- -•------------------------------------- ._...---------------------------------- _-------- .... .._...---.......---...... ........................................................................ W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --•------•----•-------••----•--•---------------------------•-----------•------------........------------•-----•----•-------------------------------------------------------------------...•--...--_..._. 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 as been issuueed� by the board of health. Signed ----------- - �I-. :..-l�ai ------------------------ Date Application Approved BY U �i` ��,^'.,."' ----- ..- l .. ................................................................. Date Application Disapproved for the following r asons- ------.................................. - -------------- ...------------------. ------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------....- ---- .......... Date Permit No. -_- --------------------- Issued ------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �ex#t#trrx#e >� C�IIm�ltttr�c.e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------- -4� , -----�----- Installer at .................. .. _ -------- =----------------------------------------------....... ------------------ ,� 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. _.....,tom. .-..r ..7.... ......... dated ...........---.---.............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - - Inspector ................................................. '�--'�'---`-'--::---------......•...............................--.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq TOWN OF BARNSTABLE No...l.r .:...d�..7 FEE..;. ...:. Disposal Workii Tons ruction Prrutit Permission is hereby granted...------- .......... ..........- to Construct ( ) or Repair ( ) an I ividual Sewage Disposal System atNo................ :. .... 0--t Q 0 4)__. .A---------� -------•-----...----••--------------•--------•--•------•......_......... Street �Qn �yz� as shown on the application for Disposal Works Construction Permit No._;I_-,_-.__________ Dated.......................................... --------•---------•-------------- �- .----------•-----......----._....._--••--....---•--•. DATE............l-•---- •--=•- ---- ...--•------------------------------- Board of Health FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS TOWN OF BARNSTABLE LOCATION 610 � e SEWAGE # f VILLAGE ASSESSOR'S MAP & LOT — L i .INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1600 LEACHING FACILI.TY:(type) .(size) !SOO NO. OF BEDROOMS'-3--PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER_ OaxAA DATE PERMIT ISSUED: az--� DATE COMPLIANCEISSUED. VARIANCE GRANTED: Yes No 1 ' i U, , TOWN OF BARNSTABLE ? LOCATION 0/40'O ySle•- R ly SEWAGE# 3s3 VILLAGE ('v)- ASSESSOR'S MAP&PARCEL 96 2 INSTALLER'S NAME&PHONE NO(�► ^e �(L�b Y®moo SEPTIC TANK CAPACITY LEACHING FACILITY.(type)2 L C. .SS-a!T n (size) /V X 3 V fi.Z NO.OF BEDROOMS ,? OWNER o c/3 SGS�t.�(��'fc �c SOAe PERMIT DATE: 3 COMPLIANCE DATE: a 0 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) LA)C) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY o � - C 3 3 d S -S6 Q q S a 3 ' LEGEND o s� ALL SYSTE 99 _ EXISTING CONTOUR SYSTEM PROFILE MARKED WITHC MAGNETIC TTAPE OR S SHALL BE X 99.1 (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. o EXIST. SPOT ELEV. PROVIDE MIN. 20 DIAM. WATERTIGHT � Locus ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE -[991- PROPOSED CONTOUR 2" PEASTONE OR GEOTEXTILE \ TOP FOUND. EL. 44.0 FILTER FABRIC OVER STONE o Q 198.41 PROPOSED SPOT EL. 43.1 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM a 43'-44' TH1 NOTE: 2" MIN. WALL BLOCKS OR PRECAST H-10 TEST HOLE A. RISERS (TYP.) THICKNESS REQUIRED COMPONENTS PRECAST RISERS O School 2'0 42.1 4"OSCH40 PVC _ 2% PIPES LEVEL 1 ST 2' 12" MIN. INT. DIM. ENDS BET. (TYP.) SIDES 41.0' SLOPE OF GROUND •'•.':: s" MIN. SUMP 4'-� l QD�l� C-Qb UTILITY POLE 41.24' 10" 14" Bay * 1500 GAL H-10 > o 0 0 0 o00 �000 000® ono o�®ol000 40,99' TEE TEE ° � +Y' SEPTIC TANK 40.74 o°o o°o oo°o°o 00000000 ti`� FIRE HYDRANT 4' LIQ. LEVEL o°°o°o°o°oo°o° WATERTEST D'BOX o >oog00000 0 0 0 0 o 0 00°0°0 o 0 0 0 0 0 ;o°o°o°o° GAS BAFFLE ., , o 0 0 0 0_ o 0 0 0 ❑�0®®����®� o0 =MF PF �0M0® o 0 0 0 Y ACME OR EQUAL p o�o o ^ p' FOR LEVELNESS N > o 0 0000 0 0 0 0 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 000000o0' I]®®0��®®��� 000000 ���®®®®®�00 00000000 , She// B/Uf 40.27' 40.1 ' °°°°°°°° °°o°°° , °°°°°0 38.0 > o o D o o00000 0 0 0 0 :.:i,• .VpopopopopopopppopopCpopopopopopopopopopopOp� L° oo ° ° ° poQ00000°o°o°o°o�o°o°�00000? H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. V *THE INSTALLER SHALL VERIFY THE 3/4"-1-1/2" DOUBLE 'NASHED STONE (2) UNITS REQUIRED LOCATIONS OF ALL UTILITIES AND ALL 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS Ti) OUTSIDE OF STONE: 30' X 9.83' BUILDING SEWER OUTLETS AND COMPACTION. (15.221 [2]) o ELEVATIONS PRIOR TO INSTALLING ANY ` LOCUS MAP PORTION OF SEPTIC SYSTEM -' SCALE 1"=2000't ( 2.5% SLOPE) ( 1 % SLOPE) ( 1 % SLOPE) 28.0' BOTTOM TH-1 TOWN ASSESSORS MAP 36 PARCEL 1 SYSTEM DESIGN. H-20 NO GROUNDWATER FOUND WELL NOTES FOUNDATION 10' SEPTIC TANK 47' D' BOX 12' FACILITY GARBAGE DISPOSER IS NOT ALLOWED 1. DATUM IS NAVD 88 EXISTING 3 BEDROOM DWELLING 2. MUNICIPAL WATER IS EXISTING DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. USE A 330 GPD DESIGN FLOW 0 4. DESIGN LOADING FOR PROPOSED SEPTIC TANK TO BE �"�� AASHTO H-JQ DESIGN LOADING FOR PRECAST CHAMBERS SEPTIC TANK: 330 GPD (2) = 660 TO BE AASHTO H-20. USE A 1500 GAL. SEPTIC TANK 5. PIPE JOINTS TO BE MADE WATERTIGHT. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH LEACHING: 310 CMR 15.000 (TITLE 5.) SIDES: 2 (30 + 9.83) 2 (.74) = 117 GPD 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BOTTOM 30 x 9.83 (.74) = 218 GPD BE USED PURPOSE.FOR LOT LINE STAKING OR ANY OTHER TOTAL: 454 S.F. 335 GPD 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) WITHOUT INSPECTION BY BOARD OF HEALTH AND WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' xo , PERMISSION OBTAINED FROM BOARD OF HEALTH. BETWEEN UNITS 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING q2 DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES 1� PRIOR TO COMMENCEMENT OF WORK. / 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED BENEATH AND 5' AROUND THE PROPOSED MA k LEACHING FACILITY. APPROVED DATE BOARD OF HEALTH c'� 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND 50 / �o REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. I EXISTING SEPTIC TANK TO BE PUMPED AND REMOVED TO FACILITATE PROPOSED CONSTRUCTION. h a 13. ENGINEER AND TOWN TO CONFIRM SUITABLE SOILS IN THE AP.EA OF THE PROPOSED LEACHING F!ELD PRIOR TO Z \ co INSTALLATION. MINIMUM 48 HOURS NOTICE REQUIRED. M P136 P 1 \ 8, 41± S.F o o ZONING SUMMARY ZONING DISTRICT: RF RESIDENTIAL DISTRICT `b REQUIRED: EXISTING: PROPOSED: BENCHMARK: \ �` 87,120 S.F. 28,441±S.F. 28,441±S.F. MAG NAIL SET `L MIN. LOT SIZE =48.6' NAVD88 MIN. LOT FRONTAGE 150' 140.00' 140.00' \ k MIN. FRONT SETBACK 30' 67.8' 68.6' 1 MIN. SIDE SETBACK 15' 28.5' 31.4' MIN. REAR SETBACK 15' 67.5' 77' y��• MAX. BUILDING HEIGHT 30' 25 -7» 6.4% EXIS ING HED TO\ o ✓ H ,�0 *MAX. FLOG ROAREAGRATIO 0.30 0.06 5 k9 B ELO ATED / N A9 p *PER §240-91 'RAZE AND REPLACE' 4. Q� SHED D K;-" ; N :� �. SITE IS LOCATED WITHIN THE RESOURCE PROTECTION OVERLAY DISTRICT TEST HOLE LOGS SITE IS LOCATED WITHIN THE WELLHEAD PROTECTION OVERLAY DISTRICT - SITE IS LOCATED WITHIN ESTUARINE WATERSHEDS FOR POPPONESSET BAY, ENGINEER: CRAIG J. FERRARI, SE #13871 �� - --- O O� `� N� THREE BAYS, RUSHY MARSH, AND CENTERVILLE RIVER WITNESS: DONALD DESMARAIS RS 5O \ 0 may` RINSING TATION o 2s PORTION OF SITE IS WITHIN ZONE I PROPOSED DATE: 12/1 1/2017 �� ������� DWELLING 8 . PERC. RATE _ < 2 MIN/INCH TOF=44.0 \ K CLASS I SOILS P 15547 �� %K�� � ELEV. 2 ELEV. �6 a y ONITE "LAN `� 0 39 0,. 4 39 OF FILL BENCHMARK: ��� 10 FILL g" NAIL IN TREE TO ��, �,10 #26 OLD OYSTER ROAD BE SET L tX A A =48.0' NAVD88 COTUIT MA LS LS ENGINEER ND XISTI G DWELLIN 10YR 3/2 10YR 3/2 TOWN T CONFIRM �� Q� 0 B RA PREPARED FOR 1 6pp 18 �sr � SUITA E SOILS IN O f ko B B TH AREA OF THE OO !y o PRO SED ISTI G WA RLI E T BE RICHARD RODGERS & SUSAN JACKSON t`x S NNECT F OM XISTI LS LS LEAC ING FIELD LLING, ROT CTED DU NG l0 TO DATE: AUGUST 20 2019 30" 10YR 4/6 36.5' „ 10YR 4/6 l �,� ^1 CONSNN ION AND ' w REV: SEPTEMBER 19 2019 SOIL INSPECTION NOTE 30 36.5 L ION. .CONN T T SE o � ) I 8 HO S 0, ti DNELLI G N IC UIRED. Q �< Scale: 1"= 20' PERC 61+4 C �� 0 k� 1 TI G OVE A ECT C `�NOFN7 � '��NOFM 0 BE ISO ECTED ROM Ssg ti jo I 0 10 20 30 40 50 FEET A. I<)�I� EI_. \ EX TIN INELLI G, ��o c��IaII=1_�e. ���, �,,r > ' ��r R0 I ED DURI G % OJMI a MS MS S rio � � C7.tAI_ � CO off 508-362-4541 ? C NST UCTI N D CIVIL i' R CON ECT D TO P OPOSE No 16102 <' No..r0t,s;0 r,� fax 508-362-9880 10YR 7 4 o`r ti\�1 F . o . i o w o �� / downcape.com O / 10YR 7 4 �� D ELLI G TS �is1CFG� t ! Ess oa / Q s/Ot0li IE down cope engIaeer1171f, lac. 32 28 132 28 EXI TINS PA ED - -- civil engineers �RI W, TO BE land surveyors NO GROUNDWATER ENCOUNTERED _ �. w. EL AT 939 Main Street ( Rte 6A) YARMOUTHPORT MA 02675 DICE > 7-334 f DATE DANIEL A. OJALA P.E. P.L.S. # 1 , 17-334 JACKSON-RODGERS REV.DWG