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HomeMy WebLinkAbout1075 OLD POST ROAD (CT & MM) - Health 1075 old Post Rid cotuit Lot. 8 A= 075-00�-X02 - t r 1 r Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f ' 1075 Old Post Road Property Address David Ammen Owner _. _... ,a Owner's Narr}e information is �/ '•+ required for every Cotuit Ma 02635 5/20/2020 = page. Cityrrown State Zip Code Date of Inspection r-, r, Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Se tic Ins action use the return key. Company Name 74 Beldan Lane Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-2484850 smjonestitle5@gmail.com, SI4522 sear@smjonestitle5.com License Number,.._.. -- B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails inspector's Signature - 5/20/2020Date 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. l5insp.doc-rev.7/26/2018 Tide 5 Official Inspection farm!Subsurface Sewage Dispose,system-Page 1 of 18 , Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1075 Old Post Road Property Address ,mm._.._.. David Ammen Owner Owner's Name information is required for every Cotuit Ma 02635 5/20/2020 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 1075 Old Post Rd Cotuit is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 8 500 gallon leaching chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 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): t6insp.doc•rev,T{W018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1075 Old Post Road d Property Address - - David Ammen Owner Owner's Name information is Cotuit Ma 02635 5/20/2020 required for every ---._........._._. _...._......._,....._____. page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (coot.): ❑ 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 Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N- ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation;by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(9)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t8insp.doc•rev 7W2018 Tille 5 Official Inspeotlon Form:,subsurtace sewage Disposai system-Pape 3 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen Owner Owner's Name information is required for every Cotuit _ Ma 02635 5/20/2020 _ page, Cityfrown _. State Zip Code Date of Inspection C. Inspection Summary (cons.) ❑ 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 115vtsp.9ac-rev.i/2 MIS Title S rtffir.4al Inspection Fam subawraco Sewage oiaposai system-Page 4 of 18 Commonwealth of Massachusetts t Title 5 Official Inspection Form IP --- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen OwnerOwners Name __.._ .__._ _..........................................._._--- Information is required for every Cotuit Ma 02635 5/20/2020 require page, Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ z Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less ❑ ® than Y2 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. ❑ [D Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section C.4. 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,doe•rev.7/2612018 Title 5 Official Inspection Farm Substeface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road _ Property Address David Ammen Owner Owners Name information is required for every Cotuit Ma 02635 5/20/2020 ---- 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: 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 Unccovered, 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)] MhV.doc•rev.7rM2018 Title 5 Official Inspection Fo nrc Sudsurt8ce Sewage Disposal System•Page 6 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen Owner Owner's Name information is Cotuit Ma 02635 5/20/2020 required for every _ ..__ page, CItyfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to:Is laundry on a separate sewage system?(include laundry system inspection ® Yes ® No information in this report.) Laundry system inspected? ❑ Yes [D No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? --- El Yes ® No Last date of occupancy: unknown Date t5insp.doc-rev.7/WO18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 1075 Old Post Road Property Address David Ammen Owner Owners Name information is Cotuit Ma 02635 5/20/2020 required for every page. Cityrrown state Zip Code Date of Inspection D. System Information (coot.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: - —=---- Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No 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: oats --- Other(describe below): 3. Pumping Records: Source of information: ----- Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? - -------._ -- Reason for pumping: - t5 .doc•rev.7P2Sf2018 Title 5 Official inspection Form Subsurface Sewage Disposal System•Page 8 of 10 msP Ra 9 P Y H Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 1075 Old Post Road Property Address David Ammen Owner -...... — Owner's Name information is _...- required for every Cotuit Ma 02635 5/20/2020 page. CityRown State Zip Code Date of Inspection D. System Information (cunt.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ 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: unknown Were sewage odors detected when arriving at the site? _ El Yes ED No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 feet 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.): Joints in good condition, no leakage, vented through roof. t5lw.o=+rev.T126/2ois title 5 Ofti¢sal Ins peaion Fans;Subsurface Sewage Disposal System•Page 9 a?18 r Commonwealth of Massachusetts A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen . Owner Owner's Name Information is required for every Cotuit Ma 02635 5/20/2020 _...................................._..._._. page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No l 1500 gallons Dimensions: --- 5" Sludgedepth: :.... —----m................................._..-__.� Distance from top of sludge to bottom of outlet tee or baffle 3 --- Scum thickness 2" — 7 Distance from top of scum to top of outlet tee or baffle -- - -___._................................ _.__. Distance from bottom of scum to bottom of outlet tee or baffle 10" -- - -_ - Now were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Septic tank is h-20 in driveway with steel cover to grade. Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet,tank was not leaking and was structurally sound. t5inso'doc-rev:msmia Tuts s ufftctat Inspootion roan;Subsurface Sewage oisposal System•Paue 10 ur is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen Owner Owner's Name information is required for every Coltuit Ma 02635 5/20/2020 per. cityrrown State Zip Code Date of Inspection .D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: M concrete El metal M fiberglass El polyethylene [I other(explain): ....................... Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): .................... .......... ................................ 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: concrete El metal D fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: .................... gallons per day Title 5 Offi6al Inspectiom Form-Subsurface Sewage Disposal System•Page 19 of IS Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen Owner Owner's Name — .. _.•_ _ _._._._ information is required for every Cotuit Ma 02635 5/20/2020 _ � page, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cant.) 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.): _._.. _......_ ...... _m_........... ... . .....mm. ._... - -. -....�-_�_ *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 11 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.): Distribution box wasvideo inspected and found level and in good condition with no rot. Water level was even with outlet invert with no signs of past bacKup. t5inwdoc-rev.?12M18 TWO 6 Off al trVection Form:Subsurface Sewage DiWasal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen Owner Owner's Name __--- information is Cotuit Ma 02635 5/20/2020 required for every _ page. Cityrrown 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. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 8x500 gals ❑ leaching galleries number: ❑ leaching trenches number, length: -................_..-- ❑ leaching fields number, dimensions: w ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: _._.. 15insp.dw•rev MA12018 Title 5 official Inspection Form Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen Owner owners Name information is required for every Cotuit Ma 02635 5/20/2020 page. CityfTown 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.): s.a.s. consists of 8 precast leaching chambers. leaching facility was opened and was found dry with no signs of past overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration -- Depth-top of liquid to inlet invert Depth of solids layer — --- Depth of scum layer Dimensions of cesspool - Materials of construction -- Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Tifte 5 Official lnspeclion Form;Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4• s� 1075 Old Post Road Property Address David Ammen Owner Owner's Name --- information is required for every COtUIt Ma 02635 5/20/2020 page. Cityfrown State Zip Code Daie 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.): tShsp.doc•rev.7J2=18 Title 5 Official Inspection Form:Subsurface Sewage disposal System•Page is of is Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road Property Address David Ammen Owner Owner's Name information is Cotuit Ma 02635 5/20/2020 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cant.) 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 r QI 31. y { i32 34 S r 3 �5-� � 4Y l S IoZ � I cs /Co. a l t5insp.doe•w 712UMI8 Tills 5 Official Inspection Farm Subsurface Sewage Disposal System•Page 16 of 18 r Commonwealth of Massachusetis - - Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1075 Old Post Road _— Property Address David Ammen Owner Owner's Name information is required for every Cotuit Ma 02635 6/20/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 15. Site Exam: ❑ Check Slope Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+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: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.d=•raw-7/2812010 Me 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 17 of 1 S Commonwealth of Massachusetts �.. r.. _ Title 5 Official Inspection Form - _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ., 1075_Old Post Road Property Address David Ammen Owner Owner's Name information is Cotuit Ma 02635 5/20/2020 required for every —_- _.._._.�.._._.. page. Cityrrown 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 16: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7(2WM18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE - LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL O 7 -d-2 7- XU) INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r TOWN OF BARNSTABLE q • LOCATION_ Tom - SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL O INSTALLER'S NAME&PHONE NO. . Cp�A 4k yrzy SEPTIC TANK CAPACITY LEACHING FACILITY,(type) S W�tC—k,,�,AbQr-r(size)NO.OF BEDROOMS . OWNER PERMITDATE: COMPLIANCE DATE: 2 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«ells exist on site or within 200 feet of leaching facility) Feetr _ Edge of Wetland and Leaching Facility(If any wetlands exist within NO feet of leaching facility) Feet FURNISHED:BY �Ak139 103 Li � C i i 11171117 y 9 9S-iS .tea A/i ;ah � /goo —/.�eo /5��,,,��� OlJ �r l - hit . Imo_ Nod e , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ;e, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS ZippYication for Dizpooaf 6peum Cone;truction i3ermit Application for a Permit to Construct( )Repair(.k)Upgrade( )Abandon( ) MComplete System O Individual Components Location Address or Lot No. I tV'1 S' Old f�vs f- 2cl Owner's Name,Address and Tel.No. Assessor's Map/Parcel O Z 9.40 1 1�Y I ����� �� o x 7- 211b 6) 06 Installer's Name,Address,and Tel.No. ✓ /e�, i CosE r Designer's Name,Address and Tel.No. s sc.IIt"aK Z-IIkte�:Kg r3 g28- 3349 Type of Building: ---j��/ Dwelling No.of Bedrooms Lot Size A hC_ sq.ft. Garbage Grinder(N ) Other Type of Building to F6."_ No.of Persons Showers(_ ) Cafeteria( ) Other Fixtures Design Flow G6 O gallons per day. Calculated daily flow G 6 6 gallons. Plan Date 6-3"49 Number of sheets ( Revision Date Title Size of Septic Tank is'oo Type of S.A.S. - a 1e "-41,.,c Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued, � d of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE. ,1.OMMONW ,���t�F MASSACHUSETTS- ` Entered in computer: e.._ ��- Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHU`SETTS 0(ppYi ratio n for,Migpoal 60tem con.5truction Permit ` Application for a Permit to Construct( )Repair( jc)Upgrade( )Abandon( ) [complete System O Individual Components Location Address or Lot No. l V 1 S Qt A Pet:fi P_C� Owner's Name,Address and Tel.No. ectv�r Assessor's Map/Parcel Q Z 7 xU Installer's Name,Address,and Tel.No. /a t Designer's Name,Address and Tel.No. !/ Q✓roc kr .3319 Type of Building: Dwelling No`,of Bedrooms;,- Tilt Size pG sq.ft. Garbage Grinder( dU) Other Type of Build g .:ncA�' aw. No of Persons Showers Cafeteria( ) Other Fixtures y i -•Design Flow G6 O d��, e}gal ons per day. Calculated daily flow 6,G � gallons. Plan,Date 1,-3-T Number$of sheets F 1 Revision Date Title I ''Size of-Septic Tank i sap s ft yp T e'of S.A.S. 2�i < �Sbo e w � Lon Description of Soil. 1 a y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and,maintenance of the afore described on site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued J.v of Health. Signed Date /'L—.7-9 p Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued J ------------------=:r.-------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliante- THIS IS TO CERTIFY,that the O site ewa a Dis osa/l S em onstructed(paired( )Upgraded( ) Abandoned( )by 1i3 " at D O.S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of thi pe t al of be construed as aJguarantee that the sy t {n ,ikl functi n�js d - ned Date Inspectors ©�P/wAdk/ No. 22- 5-/s- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS -Migogar *pgtem Cougtruction Permit Permission is hereby granted to Constru,gt/( �epair( ) pg ade( )Abandon( ) System located at /d 7S'" /� f'�S 74 ���, (_� Oli I and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this t. Date: Z '��r / Approved by e NEW STf('S X(il Ric, !0 / Wr3 _ p r q 1 � c XD IO � EN iaY. W 6ATH K/TCHEN.M+aL+f-yrr nt,.r-s..a rNfF. R wr rr.q-v.,wrrr- / L XD9 rrl e+vcso�ner.. a.. Y wc.r. v 4TUDY K'l - unpr SOH HALL p.p - 3. PLANTING �.. . 8E05 XDR rDIICH IIIr .1 -�A D/2 MNING l XD 7 CO_ l ty •-�;; _ XDE I XOS LIVING boor-in swf Var— . - i � -I .. raw.-s.rs�Res-R..✓,. . wn rs>l.wr . vuap+ay.+.ar-srarron->.. W4 D4 BLUE XDA —XU3 �i O _ BULKHEAD ,- � N w STEPS MASTER B£Da0014 w7 wL XD2 —_ �PLn I:71Ni -_ '- r POCK-'T5 NEW STEPS BRICK WALKWAY (R>rrnrl nr..� �I HrICk TE7u7ACE .p. . n...s...w..r vo u,r'Imi�iv..s oeGwe.. B alolm Ry Q _ SvKo�g 4D8ers u)Ma BvAY RM Ov�ly'W ClbfS L/yts ' � � �� v � � • — f7oorRm-N.in L.w1 . 1,77 ^A-7 S �3.ec� '"_' � , � ��� I Departm ent of.Environmental Management/Division of Water Resources WELL COMPLETION REPORT WELL LOCATION t A GEOGRAPHIC DESCRIPTION Address ���5 a1f�: �S�• Q0. D© S E W of (feet) (circle) Clty/Town . G! Po ST Well owner; R616R.AS 4: `L&r,4Z_� (road) A'.,dress, ess S N W of d €� (m.Imtenths) (circle) QSU- Board of Health permit obtalried: yes no intersect.❑ (road) WELL USE WELL DATA Domestic Public❑., Industrial El Total well depth 1 ft. Mdngoring❑ Other Depth to bedrock ft. Water-bearing rock/unconsolidated material: p(� Method dnlled �• _ �C)OfS2 SAN(Jl t Description 'Date-drilled: T Water-bearing zones: CASING 1)From To Type �- ' 2) From To 'r 3 From To Lerjgth _ft Dia(I D.) _in: ) Length into,bedrock ft. Gravel pack well: dia. Protective well seal:; dia. J. Screen: f�^ Grou14 t ❑ Other Slot# length from to STATIC WATER LEVEL (all wells) �. . Q y Static wator)eivel below land surface-ft. Date . WELL TEST.(production wells) Drawdown_ '`ft after pumping ,hr. min. at a—gpm How measured Recovery .':'after— hr. min. L,OG of F.ORMA.TIONS ;COMMENTS Materials Froml To �, a t :SGMi✓t ICD Driller V SX Firm tAAMt C i ` Address U iCity/Town IMPrs�= MA 4Z6�1 Supervising Driller Reg.# r�5� Signature of supervising registered well driller Pease print firmly BOARD OF HEALTH COPY TOWN /OF BARVSTABLE - UNDERGROUND FUEL- AND CHEMICAL STORAGE REGISTRATION / OWNER AND, I NSTAL_LER._INFORMATION �` S' ADDRESS: / n 7 S t) MAP NO. Cam' . PARCEL NO'. _ A,'W ra Y -7 lY 7- 4, OWNER NAME: kk At G. t4 VILLAGE: _ wr , INSTALLATION DATE: /V vv. a, /9/3 f- BY: ADDRESS: CERT. NO. \ TANK INFORMATION LOCATION OF TANK: ! >)..A�. r�n� 7 -_(-{ �vs/= N , . P CAPACITY Sd ' '� S TYPE `� ! L AGE 5�` FUEL/CHEMICAL / TESTING CERTIFICATION C I PASS C I FAIL DATE LEAK DETECTION C CHECK IF N/A T,>YPE/BRAND ZONE OF CONTRIBUTION C I YES Cam] NO DATE TO BE ,REMOVED FIRE DEPT. PERMIT ISSUED C ] YES C, ] NO DATE '. CUNSERVA i ION C�] CHECK IF N/A 4 DATE s ,? BOARD OF HEALTH TAG((ENO. / `9 C ]C'. ]C -]C •] DATE f�lll.7 /�(, w 1" ► 171 PLEASE PROVIDE' A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ALP R _ter sl V �Lo nos s fro i{� Marmot �#s;�, �r f� .��y weaKt P'o a4p . Sox 't vZ4 L-C� OAKS Wu fill n � Rog n& g r o 4 nd Took a t 1015 040P O W E ------_` lam 8 . our Tecorns inScato th4t your Werpoo , INK W C � � � Cs t n a� fewl�!t ��& and ,has qq ,� ��. �',��6 ed I _- rnwaUeSelth Regulation Rovording Feet end ignIU . A40g0 ASKS You dre direct d 0a 'rLOQ ' Sotj ev Pvtopy : *)t' t • �a ` from the d U��r ;= teak is PROMv0d* as furnish this office I Idany. art the a of a erml r t0..ICS� Hr to rt �+ � �¢ hith n n nety 9 days o ,z .. .. . . w +., ..r XNYC 1 - 4 '�,.C" tCri : ro+nd ? n . i._-# i. :� ek�,Gs4ri•„. •,x�"-a� }� :�'y'�t"�5.<-;�,�'�� *i' �.Xi i c r ,,,now; .: •,> 14h r s a :7� < e *� £" .a,•„ .N t. � �;,r„ d z Y,yT siT� �..�."� �'. .,�' B � i -� i � .s � 8 �.th ,A ♦,r` �..a <�, �j...r,�. y.r � i � }tea r � a.S. t �. r -,fit., '4 � �F u:r:� a ..,� '`•� �: ,� ,..,,r�^-r�..� :3 a � �,� ; .tt r•�3` r�'+��, ' y„ r ,�+ 1 ; .,..i � .�5 s,5_ ., � s.• n��. j x ._h. �'�'`�,�' M���§.�3�$-�i ,,,[e�i,yam �6�.✓q$��� � 5 � .f,� 1 a3 z�� '''_ i �fy. .a- tat•�'`r; t i, ?. _ C #y sir*�4i.+�� �', f ` .. �,,b -:q � ' r LT.. {, � y ; '+ i No.— �^_ �_ Fee----�--------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Melt Con0ructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ('Ian individual Well at: J Location — Address r Assessors Ma and Parcel s Owner Address 9-1-0 � � --6Y"Z. _-------------------- Installer — Driller Address Type of Building Dwelling ----------------------------- Other - Type of Building ------- No. of Persons--------------------------__—____________ Type of Welly ---- - ----—-- - Capacity------------------- — - — - --— Purpose of Well--2n"'`i�r --='`� -r-------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificfte .of Compliance has been issued by the Board of Health. Signed. --------- ----- — -- date Application Approved By --_------ r �" tce"I�___ date Application Disapproved for the following reasons: -------_--_-------_____________—__—_—__--_ ----------- — -- 1 date— Permit No. a ---- Issued-------------- date _ BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (-I Installer at 10 -) old /10 T- 1• G0 z has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No� y-,:-Z®—_-Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—----- — -- Inspector—_----—-- ---- -- No.-- �__ �_ . r L_-�--------- ? Fee------ -- II BOARD OFj.HEALTH TOWN OFARNSTABLE x pplfi tion,*r e1C �on�tructiott ermit Application is hereby made for a`permit'to Construct (' ) Alter ( ..), or Repair (''Ian individual Well at: tocahon Address Assessors Map''and Parcel Owner Address_ ii. . - - ---------- Installer — Driller Address Type of Building Dwelling2 1—c—--------------------------------------------- Other - Type of Building No. of Persons--=--------------------------___ Type of Well k A) G--- ------ P Y-- D0AST•< --- < G�cgr Purpose of Well ---------—--- -- ------ Agreement: j The.undersigned agrees to.install'the'aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of'Health Private WeII Protection Regulation — The undersigned further agrees not to , place the well in operation until a C tifi to .of Compliance has.been issued by the Board of Health.' Signed .. - --- — — --- - - -- : date . Application Approved By date Application Disapproved for the.following reasons:= ------'------------------ ----------__—__ ate Permit No. Issued--------- -- -- ---- — - date r bn MPi!i9e9�4o12a43VpliQM�b Y'4 !e4iiQi4i4b4eyf¢goaiMgq�4iQEi.Jit6lbP6T64i4Mi2�Y!..t4SS¢T6RY44fim�Bi!}p48iBi!)ii4%Ve2;l�RiO�.tiysy"sii�tiQi9i47i4i}i4iT.¢R�ritiSTili�:.T.e4AY'i!iii'iq�Qe!iA it. BOARD OFF HEALTH TOWN , OF ' BARNSTABLE Certificate Of Compliance" THIS IS TO CERTIFY, That the Individual Well Constructed ( ) Altered ( ) or Repaired, Installert at— --�a=S .0 -- - — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. tf--��2=--Dated----- -------- THE ISSUANCE OF THIS CERTIFICATE-SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE.WELL 'E SYSTEM WILL FUNCTION SATISFACTORY. DATE------ - Inspector---- -- -_- __ 'S w�giji.�qiy»4a4ii4i44446Fi9ifiliQi!ititigi8i4YQtlQ6:1i!�i�4'4i4�iili@i9!BTilit3Q,ofi4fiiKQiR64�6!V4igiCi4i4SgieQ6409hQi46Q¢Qigim¢!'i'9iR4!S�9!:'.6�(�b¢i4iryilb4i4i19d4{i4¢a!5±¢!!04i W}4ip4$!i!i'I - - BOARD OF HEALTH TOWN` OF.' BARNSTABLE Ve[i Con5truction3pPrmit E No. —C Fee— _Permission is hereby granted'= cG'� ` _— to Construct,( ), Alter ( ), or-Repair AO an Individual Well at: No. Street _ as shown on the application for a Well Construction Permit No.- Dated— , _10-_�---/- 5' DATE Board of Health — H SOIL EVALUATOR& PERCOLATION TEST FORMS Page I of 4 Town of Barnstable = BARNBTABUL Department of Health, Safety, and Environmental Services e�: �� Public Health Division AIEp�� 367 Main Street, Hyannis MA 02601 Olrice: 508-790-6265 FAX: 508-775-3344 ' ' 1 b&yAssessment for bee e Dls -) sal Sv11Su AssESWRS MAP Na� p PARCM NO. �'' f1 p V / Date: y3z-, ��3q �3 G Date: Performed By: �-` ��;/j' Witnessed By: i.ocalion Address / 7 Q`� � �� Owner's Name N �7' Address,and �� Z 8 Lot N: n 9 � • of 93G _ Telephone N Assessor's Map/Parcel: NEW CONSTRUCTION REPAIR 4fflcp Review Published Soil Survey Available: No Yes x oov Soil unit Gc C Year Published Publication Scale Z ZS map Drainage Class e —* gSoil Limitations P���z Surficial Geological Report Available: No Yes uf� GE��<'� ti A""""'G" Year Published /9�S_ Publication Scale GoTvi T C-, q� /Z/3 Geologic Material(Map Unit) f'�irsH�EG Fi IT /���i�✓ �S«f Landform Flood Insurance Rate Map: X Above 500 year flood boundary No Yes Within 500 year boundary No X Yes Within 100 year flood boundary No u Yes Wetland Area: National Wetlan' &InventoryMap.(magunit) Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USG§): Month ScPT 9 6 Range: Above Normal 51- Normal Below Normal Other References Reviewed: /vi-✓�S� �sr<<.,,,A7�r� i�roa rp7�• Ai�.vS /MASS G/S Ale&-vS U SGS �< C4..q ID 2A/v 6 L,, G'o - DEP APPROVED FORM-12/07/95 s • FORM 11 - SOIL EVALUATOR FORM Page 2of3 ' Location s or Lot No. �cw Pus; Z �rle� ' C SuN T W JF�/J�S UL h I`�__2S'_l_ /C•..Ii.p� t. On-site Review Deep Hole Number Date:: P-5 .9- � Time �_ Weather Location (identify on site plan) dim,, F�.�F Slope (%) 3-: Surface Stones Land Use V� Vegetation �.•.!'!f :,r,,��r� vp�z I (7• �J Landform �„ w.�sii : gyp/J .vo s�6tit r�c•� .F�ir%�,ec PQ Position on landscape (sketch on the-Q4 - r srbe�^ i Distances from: 4 � Open Water Body `x' feet Drainage way 71 ', . feet Possible Wet Area ��.: feet Property Line feet Drinking Water Well ':) 0.-.) feet Other —i DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Bounders, Consistency, Grav 0 3 n LEA GiN� 1,Y2 q/(, 1k719S Si✓�� / Lour �Ne /uYe G/ Sd Ye i.. �_� Parent Material (geologic) oti%w�oSH `z-Al—I 4')9i"uliTl DepthtoBedrock: you Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: .(/) Estimated Seasonal High Ground Water: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or. Lot No. -v7 —.o - / ono F� 2oAD On-site Review Deep Hole Number 9�' Time:.: WeathL�4rA r r e�� ! !��'� r3?' ber Date / ::.-.5- y Location (identifyon site plan) Land Use /2,G,r✓ ,. o2 ST Slope (%) 31 3 Surface StonesVegetation Gv; Piiv�:::. :. fibi9 / J Landform ,Position on.landscape (sketch on the-ba&k) -- Distances from: 7 "� feet Drainage way 7 z5feet OWater Body _: feetPro ert Line 7"' feetPossible Wet Area p yDrinking Water Well ��°`' feet Other T IZ10 DEEP OBSERVATION HOLE LOG* Depth.from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones,G avlel,rs, Consistency, /V v vL2y 2iiv�c..l3 ✓ �var y /dip I oYa N/6 i Z �A 1,-4 y2 4 j ri u�r^ !Z Zv ��✓ S�Nd /S�/o l J/26/ si�6c,8 _G�:pi� Ga2e�i?L- ,�= ' ..- ... t Parent.Material (geologic) O� v✓i7.5 H � �" / S DepthtoBedrock. "YVJ Weeping from Pit Face: Nu Depth to G�oundwater: Standing Water in the Hole: N� Estimated Seasonal High Ground .Water: ,'t A DEP APPROVED FORM-12l07195 Y; f FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 04--o POST 10QA,0 n p 6.�u �s Determination for Seasonal High Water Table Method Used: C;2O(/�I✓0 [,.�'iv7d2 rv�T L4„c,Uvi.Ur ��[ � kG ❑ Depth observed standing in observation hole........ inches EJ Depth weeping from side of observation hole.. . ......... inches ❑ Depth to soil mottles .::: ::::::::: inches "" -- ❑ Ground water adjustment ................... feet N' Index Well Number .................. Reading Date .................. Index well level .......... ...... Adjustment factor ................... Adjusted ground water level ........................................................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring..pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YFS If not, what is the depth of naturally occurring pervious material? — pp Certification w,j I certify that on 6-Y6 �9S (date) I have passed the soil evaluator examination #` approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience 'descr.r5ed'in 310 CMR"15.017.- Signature Date i s- 3 DEP APPROVED FORM-12/07/95 ..�,�� ` } � � I FORM 12 - PERCOLATION TEST 4 Location AW&W or Lot No. ,CJ- 9 0�_, /90 COMMONWEALTH OF MASSACHUSETTS )S�a vsrAQ`, , Massachusetts Percolation Test* Date: Time: -s q ii•,�s�b . .:. .. 0b.servation foie r Depth of Per'c Start Pre-soak J O End Pre-soak Time at 12" Time ;at 9" Time at Time -(F 6") cam. �v �• /� Rate Min./Inch 31o��2is.i�sG�)) * Minimum.of. 1 'percolation test must be performed°in-both the primary area AND r reserve,-area. Site Passed Q= Site Failed..; ❑ ..................................... ....... ........................................................ ,- Performed By 4j Witnessed By " :' /- /3b e :Comments: #R4 ! }* # PEP_APPROVED FORM 12/07/95 a { �d�e , . :I.I,."��,I�_I,-­I1�II,III,�,I 1."I I�-I�"II,,,II.,1.:.":..,I,I-,I,.I.I,I�1,_,-I�. 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F. , t---0 ,f . t 5 a . , rt i . �7 " \ RaS6R 0 , - < . rode „ W 5 Finish G 2 s 1_ A 0 1 - v ` _ " 1 , t, f . 1 . ' .. , . 2 Filter ' r _._--• 'f4 \ Fabric Compacted Fill - ! � r r op " NOTES � � - 1 -, L „ � �t f .� �•�, .•. _ _.,..,._ �.....rs.� -----ram- ! E - ( 2 ...... .. _ , ` , 1.Water Su F r DPIy orThis Lot is Private Weil SinQte Family-g Bedroom .. ' i' ` With no Garbage Grinder ' 2 Locaf ion of Utilities Shown on This Pion t_r;Approx. _ / Daily Flow=I Io x 6=660 GPD to ti � / ,/ ' \ At Least 72 Hours Friar to AnyExwvaticn For This = e - \ Projject The ControctorShait Make The Rsquired Septic Tank 660 GPD x 200/0=1320 GPD Leaching « «. \ •Notification to Di Safe(1•B00-322- p Tank ,3 3/4 - I in g 4B44Use 1500 Galion Se tic .t Chamber) :. .. N Double Washed 3, e . Th Contractor is`Re uired LEACHING q to Seturo A ate .. _AREA Stone Per piprl t �--'" snits From Town Agencies For t Constr coon 6�0 GPD/0.74=B92 F PL.A N VIEW EVV Defined byThis Plan. S Requirad i 4 10 . _{ � . - Use Bottom Area Oni , M - w°Y I0 Scale I -50 4 Install Risers o « t3ottom A = y._ i .0 ,,.1- -� n privy \ a Requtredto Within 12 of - reo 12 x.75 900. S,F. xisti 9 E Rod _ - Finished Grade . . 900 SF.Totai Provided •• - - . . • ; , Po st o Old _ _LEAC 1 - , 5 N NG CHAMBERD , .Ali Structures Buried ESiGN Fottr Feet orMae trFwb ect o _ t.A t Plpeftabesched f 0 C AMBER t venituta�Trattic�obeH 2oLoadi ule40. Use CROSS SECT ON F H n , ---` _ , - 8-500 Gal ■.._.. - " .Leachin 6, Se tic $ q Cho as inc , p System to be Installed to A - _ ... • ccordance With 12 x75 .Was f>od Sfone Feld Shown Shown - .NOT TO SCALE 310 CMR 15.00 Latest e R vjaion And - TtMa Torre of •,. _ .. . Barnstable B -oord of Health Regulation A . II , ,T. Pi to be Sc 4 y tag h 0 PVC. , . , , . , " 2 y . SAN G p . . . - - L,OAM .� , : <; . b % 0t . _ S� , - t' .,`; i O N O �S' ,; [3R w G Al2SC ,�" t, S ND -tOYR S i` .4 Pi:rft; . tJ, - , y t-t_bw BROWN GbARSE I .. ., - - 1 SAN IoyR,s t; ., N0.29733 -� t .t C / 8 f. 30 CIViL i .. BvkOWN%S N YEt-.CCA S E ,. .o ,e n t R _, . � i,. .kC ,k. CZ y _ SAtJQ 10 R L !. ,� �l/S,C. . ,� / . . .. _✓ �- . \ k /. , /a , • Lt. Vt~LLOwISN'l3RtJ �, . _ r- _. _ CD R E SAN py t 31 .� ;. . C.�3( s Y 9 T, t3 5,E,1 b 3 `7 . - _ I . - _ N C-ROUND WATER , _ - . SIT PL N , E 1 ., _ . SEPTiC SY EM UPGRADP , . , A7 " R . . , 1075 OLD POST ROAD , . _ : , There ore'wetlands ,within 100 feet of the ro osed leachin facilit . - , COTUIT, MASS P A leaching facility. , . , FOR , , _ ,There sere no rhr�te . otasble weirs '�rithin 150'feet'of the ro o�ed ee tfc s e4em. . - P # R R 1r • . DAViD AMMEN t f the ate e r . _ The dean 0n o ag/ m i, bs>s ed an bottom • ea only. I SCALE: AS SHOWN DATE: JUNE 3, 1999 . . , 'Tt18f8 {S f14 iMXEtASs lit flow and/or ct�ang� 1i1 US8 �XOpOSBd. LL I VA N ENGINEERING INC. - .1I I II II 1,III . SU ,' , . • , . ,. . OSTERVILLE,MASS �+` �",,w.wy ter•• -�,,.,,,,,,... �'`"°�,-r� ' , Q �y'� � g � � N 24 44 09 W —�— — 410_ \ 1� C� - 100 Year Flood Plain as Mapped by FEMA �` oQ �o.� �•-� �°� o � + �-- \ v ...� Panel No.2500010018 D Map Revised July 2,1992 ,, OCUS Zone All (elevation 11.00 NGVD) ' 'u ( " Islsn 10 \ • \ o '' Please note that the elevation of the top of Swale will not allow the passage - \ of flood waters into the low area . St aXd i \ u �' s � Is snd Possible to of State coastal bank . 0111 / / ta Lot Area \ • '� "`\ \ 6\ J'P� 4.89tAc I �o \ — m LOCUS PLAN �` \ \ \ - ` Scale: 1 =2000' Assessor Map 74 Parcel 27xD1 81 2 7 x O 2 Connect Exist.House Sewer ��� !�� .\�9/ �� � / � \ �1 _` to New Septic Tank F.G. 22.0 o rl % j to9e � / ar \ \ \\ \ \ 18.3 . X\SN o Gj'L� T�R��� Top EI. 19.3 E 5� T MA 20.5 1500 Gallon 20.3 VXG��PN r� \2y 1 ' Septic Tank 18.7 %�•` 18.5 Bot.E1.16.3 pROPOSeo Ig'X3©' ` I / y,,•, . ..,,.�,: � ' Beading 6 5.2' ADD\TION \ 1 / Per Title �10 � M o J 150' 10.5' 8 0' \o 10' Pt\� 12� a / S� MIN• NL-W WE L Bottom Test E I. I I.t 0 CAT 10 No Groud Water.L ►e-- , , '�-� tiz DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Existing 0x 20� / 9-50 � House p,26 Not to Scale Finish Grade 1 \v v2�� 1 \� Filter III Fabric CompactedF _ NOTES iv I/8 1/2 DESIGN DATA f ; Pea Stone / l \ I.Water Supply ForThis Lot is Private Ws 11. Single Family-6 Bedroom 2 Location of Utilities Shown on This Plan Are Approx. With no Garbage Grinder � in\ At Least 72 Hours Prior to Any Excavation ForThis Daily Flow=110 x 6=660 GPD -. Project The ContractorSholl Make Th Required Re uired Septic Tank: 660 GPD x 200%=1320 GPD Leaching Use 1500 Gallon Septic Tank a Chamber Double I she Notification to Dig Safe(I-800-322-4844) Double Washed � 3 The Contractor is Required to Secure Appropriate LEACHING AREA Stone Permits From Town Agencies For Ccastructton 660 GPD/0.74=89 2'SF Required ( 4-Id' _I PLAN VIEW Defined byThis Plan. Use Bottom Area Only �— Driveway to \ Scale: 1" 50' 4. Install Risers as Required to Within Ir"of Bottom Area= 12'x.75'= 900 S.F Finished Grade. 900 S.F.Total Provided Ex d po Road �- LEACHING CHAMBER DESIGN 01dPost _ 5.All StructuresBu�ied Four FeetorMoreorSubject' CROSS SECTION OF CHAMBER to Vehicular Traffic tobe H-20 Lo�ding. AI I Pipes to be Schedule 40. Use 8-500 Gal.Leaching Chambers ina NOT TO SCALE a Septic System to be Installed in Accordance With 12'x75' Washed Stone Field as Shown 310 CMR 15.00 Latest Revision Aad The Town of Barnstable Board of Health Regulatiois 7. AI I Piping to be Sch. 40 PVC. 2, SANDY 0 LOAM •a �. O• x s '� BROWN R 6/Z G B SAN IO'-/Y fZ S/3 ',/MLLOW BROWN CQARSE fw"D C, SAND 1C)`IR 6-1& C2 gRowN\SN YEI_. COARSE SA t.1 D % 'v R G/4. Lis LT, VELLOWI514 [3)QW& O 3 COAR51= SANG IovR G/y 131 NO CYROUND WATER SITE PLAN SEPTIC SYSTEM UPGRADE Directions to Site: Route 28 toward Cotuit; Take a Left onto Old Post Road and House AT is on the left 91075 1075 OLD POST ROAD WTUIT, MASS There are no private pots ewes within 150 feet of the proposed septic system. FOR DAVID AMMEN The design of the system Is based on bottom area only. SCALE AS SHOWN DATE JUNE 3, 1999 There is no increase in flow and/or change in use proposed. SULLIVAN ENGINEERING INC. OSTERVILLE,MASS ATTACHMENT A [7 ' . ... t`Ira -}' � .3Y ti�':•+ • N 24044'09"W \ \ _, 410/, r Lxus .74 / Lot Area \ \ or \ s / 4.89fA�_ 'LOCt�S~"FLAN ' f11:20001 ' No ) Aistt istr Mop . �g-r- .r1 Parcel� \ \ � � \ . • 2TxDl & 27x02 ZO 46 --• '_'- �� � \ E><iit:Moasii,5ewer . 1 f * w ' �..... 119� ~ ` ` ,\ New Septic 22.0 . Y El �•,Gba P O Rsa\A� \ \ `` \ t ''•GV.�H .. iJW1Wiioll^ s / - k Y dot`Spa AN �A` / �. � 1 � .. - ic�'1`dtllts ;3 '' 16.3• Goa / VOSd x�l !, / 66' fOD1?ION 1•l \�G�VDE4� lwrkew ��, ` r Per ��Title�,r NrwW;N-L, at Hole EI.,,11.1 / Pal M P� �T�` .t►.e► o CAT 10 rt1� l „ »No Gro ud VMaf fr DEVELOPED .PROFY ` - 0 PROPOSED: EP.Tf SYS`hEI . '�� Existing .x t �Ca House a26 Not to .:, le, - all .Q i �= RCSsRvt• 1 a Oil 0Mh de Gra 2 y o a I ,.w:Fabrlt tbiltpeirtid r ,--.W. } � - .. �y,.;: q..q.,.--.- - -. .... -r_.rwy • Vi.i�.iTARtCnt,!t; :'_,?,,.N :a-..-./. :,n,`Sy «c o-e= FrT' n »..'' ...- ,4:, . } ..�. ... r �. 7w.re1► I.Wafer Supply ForThis Lot Is Private Well S - ' Pea Stone 4 1 H t=omilr,-.6,Cedteo�n t •t Y ... nq 2 Location otUdlitift hownonThlsPbnt;bApprox, Withne Garbage 6rMder t At Lsast 72 Hovn Prio►to Any Excavat'on t crThis moil Flown 110 x b Q 560 6#'D Pro ed The Controctor shall Mccke The 13e wind SEpt�CTantc►6608Pbit 200'/a13208pp Use IS00 8aeion• NotfkaftantoDl9Safe(1-800-322•�•8�4) �pficTenft. ` i ChonlDir 3/4 -11/2 . 3 The Contractor is Required to Secure A riate LEA IiK� AREA a Double Wb*.od m�oopp Stone Permits From Town Agencies For Con:: fiction ! 6�O 8PD/0.74 a 892',SF 1lpu'6d ~' 4-t0 S_ PLAN VIEW Defined brThls Plan. P USA 9ottof"A►�d1IDAJ Sco le I"=50' 4 Install Risers at R ►r� w equiredfo Within 12 rvf' < ewa7 8ottbnlAreoe 12 xJ� 900 SF.1otdPrWdfd , oietPost Road \ Finished Grade. ._LEACHING CHXjiill 1ttfESlbw. - _S.All Shi dares rained be FatorMae p.Subject All Piph 11be8dw".40.use : -CAOS9:"SECTION .0�'.CH 1�111 ER : to Vehicular Troftie to H-20 Leadtr�s• 8—b00 Got.U+ioii Clh11111&. inn - - - B Stptie System to De Installed Accord( With 12�xTS� Wadrb Sials Meid os ShaMn NOT'TO SCALE 31 C M R 15.DO Latest Revision And"he Town of Barnstable Boord of Heatth Regulations ` T. All - Piping to be Sek 40 PVC. T,14 . tL/ 2-2.0 O LOAM O = to bF g BROWN C RS6 Rai WL 9A N A I OY Fk ft S/3 1 YULLOW 13ROW►d CIAARSG . stn Lnrnn 30 1 SAND 10`/R S/b • � : N0.29733 CIVIL , C�• SAND N10 V Rs [,/L ARSE ^Iw�� LT. '/BLL0W15N oa*11 G3 CAi1RSE SAN O IoyR L/y �� '� � NO G-ROu?40 WATER SITE PLAN SEPTIC SYSTEM UPGRADE AT �075, OLD POST ROAD . I There are wstlnds wain tao-ieet of`the po+r.e l..chh,y`t:zanr, . 0OTU{T, MASS There ore no private potoble welle within ISO feet ef% ,the propound esptle erttett+.. FOR: The dal of th iyeti►m It btsd on DAV I D A IVI M E N :.. tnt bottom duels'only. °. - SCALEf'AS "WN� . OAfE:.JUNE 3t 1999 i There Is t'f0 k absae In fk*'Andit Chat" In U".. pr pMd. ` SULLIVAN ENGINEERING INC.;' '