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HomeMy WebLinkAbout0015 OLD SHORE ROAD - Health -15 0 SHORE-R }� COtuit , A w 5 -:6 4 ,x f i .y Town of Barnstable Barnstable Regulatory Services Department AtAnmftCft B"NSTMMASS `E, * Public Health Division I i639 �,� 2007 200 Main Street,Hyannis MA 02601, Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0001 2273 3180 2/29/2016 Nancy J. Grant 7 H Riverview Avenue Mashpee, MA 02649 The septic system located at 15 Old Shore Road, Cotuit,MA was last inspected on 12/31/2015 by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The Health Division has determined that the system "Fails". • Cesspools have structural integrity issues, and must be replaced. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH cKean, R.S. Agent of the Board of Health I Q:\SEPTIC\Letters Septic Inspection Failures or Future EAU Old Shore Rd Cot Jan 2016.doc f f ' �TFtE Tp� Town of Barnstable i R BARN3fABI.E, 9 Phil,�$ Regulatory Services Department prfD hhA'i � ' Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6,•2007 ' Rev. 7/6/15 DEADLINES TO REPAIR-FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year.not due to clogged or obstructed pipe. o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA. ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS of cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation o Any portion of the cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution), TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components; etc) ❑.Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER ce'f o a') UI I%�u Q_ S.�r v 4, Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' °M 15 Old Shore Rd Property Address �.i. Nancy Grant v Owner Owner's Name Qy information is required for every COtuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection tV 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. . A. General Information 5-1 IW-b 1. Inspector: + t Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system,inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ,, ❑ Conditionally Passes,:, •® Fails ❑ Needs Further Evaluation,by.the Local Approving Authority: ft , f 12-31-15 I spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. s V Lystem.has two cesspools that are in poor repair with a third cesspool that is also in poor re Oi t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 L — t e Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Old Shore Rd r Property Address Nancy Grant Owner Owner's Name information is required for every iy Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts - W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is Cotuit (i MA 02635 12-31-15 'required for every - page. City/Town. State Zip Code Date of Inspection B. Certification (cont.) ti ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. " B) System Conditionally Passes (cont.): •. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)'are re-'placed ❑ Y '❑ Nr ❑ ND (Explain below): ' ❑ obstruction is removed' "e ❑ .Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ 'Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: '+ ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1.'System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, ` safety and the environment: i ❑ Cesspool or privy is within 50 feet of a surface water E ❑ Cesspool or privy is within 50 feet of a bgrdering vegetated wetland or a salt marsh t5ins-3113' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) , 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system asses if the well water analysis, performed at a DEP certified laboratory, for fecal Y p Y � P rY� coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or El' ® clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 I Commonwealth of Massachusetts i Title 5 official Inspection Form',, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Old Shore Rd ' Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection , B. Certification (cont.) , ` Yes No r ;i • , ❑ ® 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. El ® _� Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.' s ❑ ®: Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspoollor,privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply-well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- } 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For.large systems; you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. }. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to'a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water`supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes No ❑ ® Pumping-information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® •❑ Was the site inspected for signs of break out? ® 0 Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® El approximation in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins-3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form : Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' ,M 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name i information is Cotuit MA 02635 12-31-15, required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) ` Laundry system inspected? At, ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): r , Detail: Sump pump?. . .. - El Yes ® No Last date of occupancy: ;r 2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design,flow(based on 310 CMR 15.203): f ` Gallons per day(gpd) _< Basis of design flow(seats/persons/sq.ft., etc.):, 6 Grease trap present?'" ' ❑ Yes ❑ No Industrial waste holding tank'present? i r ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system??. = El Yes ❑ No Water meter readings, if available: h t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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: 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. F. . ® Other(describe): Two cesspools with a third acting separate. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts .r Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 15 Old Shore Rd - Property Address Nancy Grant Owner Owner's Name information is MA 02635 12-31-15t i t Cout ' required for every = page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t Approximate age of all components, date installed (if known) and source of information: 1960's Were sewage odors detected when arriving at the site? F ❑ Yes ® No Building Sewer(locate on site plan): 8" Depth below grade: feet Material of construction: ' ® cast iron ❑ 40 PVC . ' ® other(explain): ' Orangeburg Distance from private water supply well or suction line: feet Comments (on condition of joints, venting,evidence of leakage, etc.): Good working order. Septic Tank(locate on site plan): Depth below grade: See cesspools pg 13 feet Material of construction: 3 ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?-(attach'a copy of certificate) ❑ Yes ❑ No Dimensions: : F• ' Sludge depth: t5ins-3/13 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade:. '` " feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts - W Title 5 Official Inspection Fofm' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M 15 Old Shore Rd -. Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) r� Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,'etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: . gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.). *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No - 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 15 Old Shore Rd S Property Address - Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits+- r ' number. ; 1 ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions:` ® overflow cesspool number. - C 1-6x8 ❑ innovative/afternative system Type/name of technology: Comments (note condition of soil; signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Overflow cesspool has structural integrity issues. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2-inline Depth—top of liquid to inlet invert N/A Empty Depth of solids layer N/A Empty Depth of scum layer N/A Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools in good working order with structural integrity issues. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 49M , 15 Old Shore Rd ' •- ' - Property Address + Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately p . 10° a 13-Q^ a�� c- - .5X (-.3 ' l t5ins•3/13 Title 5 Official Inspection Form:Subsurface Savage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 204 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: USGS and town maps show groundwater at gre3ater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 15 Old Shore Rd Property Address Nancy Grant Owner Owner's Name information is required for every Cotuit MA 02635 12-31-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ]� Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 l a Qs SEWAGE'#. VILI: GEC �U r i4SSESSOR!S:3b &�.QT II��TiA�.LER 5�tAiil��P�i01�1�4 t S8M-C TAV CAFt3CITY S S LEA Acr N0.(��BFI��QOIYiS�r. EIJIID�R OR O�It�ER RI�hTO�iTE: OTtdPL1ANCE-DATE: araaon Distance Between Ehe Sap - Max�aumAduusted GmunifwaterTable to the Bottom of l€�achu�gEaci�tyce4` Pnirat water Supply'9dell.gOd gybing Facility (€any netts exist on sate or feet,: Edge offEtland and Leaching 1" cn'lity(If any wetlands exis wsttsta 3--fee f teacluaactl�ty) rbo Beet' Furnished by: (�q c v � L c V � . -0r o - a7 � a 4 TOWN OF BARNSTABLE LOCATION �Fe�—� stto3 41 SEWAGE# `VILLAGE � U, ASSESSOR'S MAP&PARCEL S"7 INSTALLER'S NAME&PHONE NO. C . I • 8�' ""T t'—� 9 SEPTIC TANK CAPACITY I SG_V n.A'L, / �U LEACHING FACILITY: ' (type) i (size) t�L"'>LfG Pam— .fit G biL NO.OF BEDROOMS OWNER 4 iZA=0 PERMIT DATE: 3•d —1 COMPLIANCE DATE: 3 b 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) tf A�, Feet FURNISHEDBY..2k6.1J C,01/1-ter..,.�� 1 f1 old Snore �7 7 0 o 79 b II t .a I- ( a ' No. d 1 P �n`r' 7 Fee 1 U o ' . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS -J.Yes 01pplitation for misposal *pstrm Construction vermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) [Complete System ❑Individual Components Location Address or Lot No.15 ©t Shore fuaVj Owner's Name,Address d Tel.No.(N Q�L Assessor's Map/Parcel S 4" KCQ wi G� fi t U Cloyry 9. tom(j g�j Installer's Name,Address,and el.No_PD1`�(7`�t MEC)M404 r's Name,Address,and Tel o. (� rn,,�nec�- CO �• i4 � � 77/9( JR6 Da�'7 Type of Building: Dwelling No.of Bedrooms (.p Lot Size I (B AC— sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) C, Cy (D gpd Design flow provided Lp(.0 y gpd Plan Date N dA f_8 L-{, ,)0 1 (p Number of sheets Revision Date Title Size of Septic Tank 166® LI I I Type of S.A.S. , J. � Description of Soil }� � ('n ( 7 See oao Nature of Repairs orAlterations(Answer when applicable) 0 e, eSS 60 5W a al . Date last inspected: Agreement: The undersigned agrees to ensure the constructions aintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental ode and not to place the system in operation until a Certificate of �X, Compliance has been issu7Signed----\,A1' y this Board of Health. Date .3 I f Application Approved by Date I 6 Application Disapproved by Date for the following reasons Permit No. l r() Date Issued b Fee o j No. r., r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ._ --I/-- POE BLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS i .Yes e Rpprication for JMisposal 6pstem Construction Permit - Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) &KComplete System ❑Individual Components Location Address or Lot No.15 Gl 5�� C ( ,(� Owner's Name,Address,and Tel.No.pt onL L C9��A t � U c i Kc.te", G rr�r>r- Assessor's Map/Parcel J -7 (4 wjoeh p C n Installer's Name,Address,and el.No,,.)��OO I" )C�'�'� 1 Designer's Name,Address,,ajnd Tel.No.j nr fC)i)j411F'C�iGtl 341C. fJ lzJ 7C '7O�-/ �h-gqlsl�F'Ci(V S/t• G35 ns 1�: I A,( �v877/9.3 Y v � Type of Building: Dwelling No.of Bedrooms (I:, Lot Size I, I (� A sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers(* ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided �D(y [./ gpd Plan Date Mr) I G Number of sheets 1 Revision Date �l Title f Size of Septic Tank��Q JQ Type of S.A.S. scexp 06 LywchlllwJ Description of Soil 1f- S1°e GlV1 r _l Nature`of Repairs or Alterations(Answer when applicable)(�� n<C v C, C ASS Deol9An 61AD�,���,'c, Jiff +( c x _�s' �00 / (II .cNl a\ Date last inspected: Agreement: The undersigned agrees to ensure the construction aintenance of the afore described on-site sewage disposal system in x accordance with the provisions of Title 5 of the;alth.' nvental ode and not to place the system in operation until a Certificate of ° Compliance has been issued y this Board of µ ySigne Date Application Approved by I t Date /t Application Disapproved by� Date for the following reasons Permit No. Q U Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the JOn-sitee Sewage Disposal system Constructed( ) Repaired( ) Upgraded(t� Abandoned( )by �'O10'�-P 1 at j G (- tl (� o O o iK_ `A has been constructed in accordance with the rovisions of Title 5 and for Disposal System Construction Permit No. )0/�_o 6 7 dated [�3/it& Installer x4c)(U` CI C cx�q 1q Jl Ul),I%,Y . Designer .I - #bedrooms L Approved design flow gpd The issuance o this ptit shall not be construed as a guarantee that the system will nctio asl designed. Date Inspector ( `l No. 0 -0 � 7 1 x Fee (j u THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) epair( ) Upgrade Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. / I Date //i ///„ Approved by / 1 t -r ^' t$a if 7--cry'L g+ 5 ]Psrnnrnas i1 !C e er�,Director � ` W -Ou'�lie Heaftch DiA,sign Thomas WMn ewn,Director 1Y1�1m S��Il`�et�9gr� g ilJT�1 ®26071 Fax: 5�]3-790-6304 OMce`. 50G-s62-4644 Twtal]lep&DesrggseIr ICeietn`ReRAOR r'mT i1 mil/ -0� / Date= �q e age L�e_°m�it IA ssess�ic�s ap\l'�¶eel y� Desigi i.en wvL. � I •►� �st�)l�e»`e Address. q,3 ( ��I k CJ t Address: / Ong /I / r�v/v issued a permit to insto ll a (date) Q (installer) septic system at /�� Ol(/t based on a design dzawnby (address) dated(desib ez) l celi�fy 1ihatthe septic system iefei:enced above eras installed t ialled subsmfially according to the design,which may include minor approved changes such as lateral Ielocation of the distibution bog and/or septic tank. 1 celery 1ihat the septic system Ieferenced above was installed wish Iaajoz changes (i=e. ,;eater than 10' lateral relocation of the SAS oz any vertical relocation of any cOMponent of the septic system.)but in accozdance�M:E State &Local Regulations. plan revigiou az ceaffied y designer to follow. W 0 F MA���c�G ©ANIELA. s a OJALA (InsfallPr's Signature) CIVIL N No.46502 � o � �O/S T ERA\ate �'�� 1. � (. � - ✓I�JI�! NAL ECG (�esigneI's SignatDip,) (� Designer'S Stagy i�Z<e1e) 1� +T-L ICI TO �1Y3►'T—KABIM �'—WIC !HE�"�iTt'9.H DIVIS1�Q..N. iER Tl�+ CA 1� O>L" ��i � �, �Zt�� �� ASS L'. LAjib O� � �!Ol� AND . -J3 � CAM RECEIVED D yZ TIE --i?, Td8Tt't LF P�LIC BCAL DI'VISIION- THANK�(�1U; [ . y -+gym ~ R Wig` . Rom. : X' \ [ / 76 . � ! i r% KlI+m . . ice• - �\ . . r . ...., f ® ƒ \ { } _ � ! . � ( / . I . | | , | � ■r6orn sitting Amy 1 X14 5 Hedrobin Guest TOWN OF BAR NSTABLE LOGL4T10N �� �L� SSE k D SEWAGE # VILLAGE COm ASSESSOR'S MAP & LOT C)35 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 2_ (size) GC� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ------------ GIs N"9 bk O pr u � D LktD 8L A .ti ,x C Departinont of Regulaitory Services > � Public Realth.DMISIon gate 200 Main Street,Hyannis MA 02601 CM �06 Date Scheduled � Time JFeeI'd F.. Soff Suitability AssesSmentfor ete"!sMsal, Performed By: �Q L 1 Ga)Sa I V G S Witnessed By: Location Address �� n ,� Owner's Name A), �d (� rt 1,5 Old L W l�,(� Address C6tu,r ./ Assessor's Map/ParceI:O3C4�4�[j �nglncor's Name N �1 -z NSW CONSTRUCTION •/ 1�E1'A]Ilt Telephone# LLLJJJ Land Use: L a wh Slopes(9b) /0 // Surface Stones Von I/ Distancesflom: OpenWaterBody �0y #t Possible WetAxea��0y fit Drin1dugWaterwa11�1 V ft Dralaago Way >IG ft Property Line �� ft Other, ft Sim,TCR.'(Street name,dimensions of lot,exact locations of test holes&perc tests;locate wetla@ds-in pznxirnity to holes) ' 0 I d S9��r-2 IeoaO . ti Al ti N ' 24,81 2y,68 5?,96 Parent material(geologic) U o Depth to l3edrvcit Depth'toGroundwater. StandingWaterin)•/tole: /1 weeping l'i'omPltFnan' till EsdMated Seasonal 91glt Groundwater DETERMUArEONFOR,SFASONALEaGUW4,T--Rg. TABLE Mothod Used: Depth Observed standing in obs.hole: In, Deptltto s411 CA79�CIta6y.. ill, Dcgth to wcepingfrom side of obs.hole: it,, drotindwaPr.�dJUetm�tik 1X IndexWell9# RcadingDakct index Well A,j. holoi-Adj,,Qi5ouiid.WatarLaval ]PERCOLATION TESIT D.60-Ming Observation 1 Hole# Depth of Pere. Time at 6" Start Pre-soak Tlmc @ Finis(9"-6") — - End Pre-soap Sit�SultabilltyAsSessment: S1teFa5secl Sit;Fallod:— AddldonaIlestingNeededCYll'I) original: public health Dlvisloa Observation Hole Data To Be;Completed ou Back---- --- ***1f percolation test is to be conducted with 1001 of wetland,you must fxst notify the. .Barnstable Colaservatdon Division at least one(1)week prior to begii g. Q.,18BPTIC\FSRCF0ItIvI'.D0C I —VS S /� Dc thfrom Soill�orizon Sail.Texture ShclColor 5oil•. Othcr one' P. Surface(in.) , (lrSD'A) (Mansell) Mottling (Strnaturc,Stones;Boulders, •ti^� _ o i'tcn,y,96'Cravcll ' 10 Dcpthfrom Sallr-nzou S'if Texture Soil Color ;'t� Soil"�'. Other Surface(in.) (USDA.) (Munsell) Mottling (Structure,Stones,Boulders. onsis m 1/5 Grave DEEP 013SER.�'.�.TION ROLE LOG Role W,. Depthfrom Soll.Horizon Sall Texture Soil Color Soil Other, Surface(in.) (USDA) (Mansell) Mottling (Struaturc,Stones,Boulders. Ca i tc c Q n Depth from Sail Knelzon Soil Texture Soil Color gait Other Surface(in.) (USDA) (Munsell) Mottling (Sfsacturd,Stones;Boulders, ` Co si Ean 6 • Flood InstsranewRat616 p:. Above 500•year;floadboundary No Yes_...__._ Within 500 year boundary. Na V+ 'Yes._ Within 100 year flood boundary No, Derth-aNatnraYi Oemm.ng orylousMmtorfal Does at least four feet of naturally occurring pervious mitmial exist iti all aretis observed throughout tho area"proposed for the soil absorption system'? y 5 If not,what is the depth of naturally occurring pervious material's — (:�i�tifs'catiag r certify that oxs /) 112 (data)r$avepassed the soil evaluator examination approved by the Department ofBn'viromnental Protoodon and tharthc above analysis was perfbnned'by me consistent with . the required training,expertise and experience described in�10 CUR 15.017. / Signature Datb V Q:M?rll PBRCV0RM n0C ALL SYSTEM SHALL SYSTEM PROFILE MARKED WTHC MAGNETIC TTAPE OR BE LEGEND (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. NOTES o, ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS NAVD 88 0 99- EXISTING CONTOUR 2" PEASTONE OR GEOTEXTILE s� TOP FOUND. EL. 41.9' FILTER FABRIC OVER STONE o 2. MUNICIPAL WATER IS EXISTING o Q X 99. EXIST. SPOT ELEV. *38.75t 37.0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 35.0 a #1 -[99]- PROPOSED CONTOUR PRECAST H-10 WATERTEST D BOX FOR LEVELNESS BLOCKS OR 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. PRECAST RISERS � `D RISERS OYP.) Q Locus 2 2'0 2" WALL 4"OSCH40 PVC MORTAR ALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS school 198.41 PROPOSED SPOT EL. THICKNESS REO. PIPES LEVEL 1ST 2' 4' COMPONENTS INVERT IN 31.17S ( TH1 3 *38.1f �ENDTMP') SIDES 32,0' TO BE AASHO H-1�( St. * •* 1500 GAL H-10 %oo�o a CObulb - 10" 14" ° ° ° ° ° 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEST HOLE ' ` *37.04't TEE SEPTIC TANK TEE ®®®® ®®®® ®®®®- ®®® '°°°°°°°° 32.75 0000°°°°0;°0 6" MIN SUMP °O°°O°°O°°°° ®®®�®®®®® ®®®�JL� J ] °°°°°o° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH �o Bay ° ° ° ° ° ° " '°00000000 °°°°°°° ®®� ®®®®® ®® uI I� °°° 310 CMR 15.000 TITLE 5. 33.0 GAS BAFFLE : ° g_�.� 12 MIN. INT. DIM. N �00000000 ®®®®®®®®®®® ®®®®®�®®®®® ;°oogog°o 2% SLOPE OF GROUND �'. ° ° ° ° ° ° ° ° ° ° ( ) +: 4' LIQ. LEVEL (ACME OR EQUAL) .': 32.19' 32.02' °°°°°000 29.17' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO UTILITY POLE ' ^'• . 0 ••;••� - '••• BE USED FOR LOT LINE STAKING OR ANY OTHER•''f ''' o°o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0�� P • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 °,o'o°00000,°,o°o'o°0.00000000009° 0000,',000°000009 H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. PURPOSE. FIRE HYDRANT ono o_o_ 00000 3/4"-1-1/2" DOUBLE WASHED STONE yYo FOUNDATION 2.5' AT ENDS AND 3.0' AT SIDES (5) UNITS REQUIRED HU/I C-_ NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 50.5, X 12.83, 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. (±-6% SLOPE) �- COMPACTION. (15.221 [21) ^ O INV. #1 - 125' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED (7.7% SLOPE) , ( 6 % SLOPE) ( 5 % SLOPE) ERMISSIONSOBTA NEDBFROMABOARD OF HEALTH OF HEALTH D LEACHING INV. #2 - 66' SEPTIC TANK 9' D' BOX 19, 24.0' BOTTOM TH-1 FACILITY NO GROUNDWATER FOUND _ 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING - DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES INV. #3 - 86 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL PRIOR TO COMMENCEMENT OF WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS (1.9 % SLOPE) PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 20--i 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE 'VI/`1r LOCUS MAP /� p REMOVED 5' BENEATH AND AROUND THE PROPOSED t7 21� LEACHING FACILITY. NOT TO SCALE SYSTEM STEM DESIGN" 12 EXISTING LEACHING FACILITY SHALL BE PUMPED AND 23 REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. ASSESSORS MAP 35 PARCEL 74 GARBAGE DISPOSER IS NOT ALLOWED ' = Y 2� 2A DESIGN FLOW: 6 BEDROOMS @ 110 GPD 660 GPD 19 �� 22 USE A 660 GPD DESIGN FLOW �0 SEPTIC TANK: 660 GPD .(2) = 1320 Y 2� O � USE A 1500 GAL. SEPTIC TANK LEACHING: SIDES: 2 (50.5 + 12.83) 2 (.74) = 188 GPD 3 29 BOTTOM 50.5 x 12.83 (.74) = 479 GPD 33 TEST HOLE LOGS TOTAL: 901 S.F. 667 GPD FN v 7.76 4 ENGINEER: DANIEL E. GONSALVES, SE #13587 USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) N) 33� WITH 4' STONE AL AROUND 3� WITNESS: DAVID STANTON, RS -- --� DATE: 2/19/16 35 'f < 2 MIN INCH �d 37�� 36 \ N PERC. RATE _ / `37 � ss CLASS I SOILS P# 14957 3a MA APPROVED DATE BOARD OF HEALTH 3q,6 o w ELEV. � ELEV. Opp 34.0' of, 4 34.0' g9 TH 1 • I q q �o \ I LS LS 1 CLEANOUT 3/2 10YR 1OYR 3/2 I (TYP.) CD TH2 6" 8" N II B B I II BENCH ARK LS LS COR B CK STEP 1 k� EL. = 4 .5' p \ 201p 1OYR 4/6 32.3' 22" 1OYR 4/6 � 32.2' DWELLING r, � TOF = 41.9' / W EL. 38.75* i C C (� 10 % / PERC 61.14 12 c1 M/CS M/CS r n 13 EL. 38.f* V 1 W W W W W EL. 37.04* W v RIGHT OFF O N 63 - / INV L 2.5Y 7/4 2.5Y 7/4 .. �_ EL. 35.4E CL OUT N 38 PAVED lYE 120" 24.0' 120 24.0' sLQ g NO GROUNDWATER ENCOUNTERED TITLE 5 SITE PLAN 03 _ T�T1\ OF 1OLD � SHED �� C(.31 T U I m 1' M A 7 PREPARED FOR 5 � N B 0 R T L " T I / 08, Q') GRANT 38 0 ' DATE: MARCH 4, 2016 CB 2� 3 FND Scale: 1"= 20' 0 10 20 30 40 50 FEET _Mq g �I OlMaFMgs� a� OFM c5' tv of ���k k � ¢;;,- ESN qs � off 508-362-4541 ass \1 fax 508-362-9880 9cS �� q�yr� DANIEL downca e.com ASSES ED o DANIELA. Gs /moo DAiNflE!_A A. P OJA L CUS CIVIL CI u_ I �a down cope engineefing MC. 40�J60� �: � No.46502 _ P .. a � Civil engineers XS c/sT�� ,� „ �` Es . ,, r p �� �o�, land surveyors 37 ^� 32• c1° '' �- l 939 Main Street ( R to 6A) DCE # > 6-036 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02575 16-036 BORT-GRANT.DWG ---- I