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Home My WebLink About0007 OXFORD DRIVE - Health 7 Oxford Drive ,r Cotuit A= 021 — 045 -— I i i� TOWN OF BARNSTABLE LOCATION ®I�C �GQ��`�� SEWAGE VILLAGE .n"tul pi— ASSESSOR'S MAP&"PARCEL 'S NAME&PHONE NO. L�� S—/7%1 SEPTIC TANK CAPACITY �C?O LEACHING FACILITY: (type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: C DATE.,Ty,SP 5_ 90 iI 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 4 k \ ♦ \ \ 4 \ k 4 \ \ 4 t \ 4 \ \ \ \ ♦ h \ 4 \ \ \ 4 \ f ! f J ! J J f f f J J f f / J f f J J ! f \ t 4 \ ♦ t \ ♦ t t ♦ h \ t ♦ t t t 4 \ \ \ t \ t \'\ t \ 4 k \ 4 ♦ \ \ \ ♦ \ 4 \ \ h 4 t \ h .\ \ 4 \ h 4 \ \ T 4 \ h \ 4 4 t \ 4 4 4 \ 4 \ 4 h \ k \ \ \ \ \ \ \ 4 4 t \ \ 4 t t \ 19 35 32 31 5 32 Water 28 9Service 1 TOW�N OF.BARNSTABLE LOCATION SSE VILLAGE L0 `,t— ASSESSOR'S �MAP&PARCEL., 'S NAME&PHONE NO. cR , �t'�'t,iC ��v i�u l� SEPTIC TANK CAPACITY 1000 QLJ LEACHING FACILITY:(type) c- i (size) NO.OF BE OOMS OWNER �xS PERMIT DATE: ATE:-�ei� 3 3 ®q Separation Distance Between the: '30Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility'(if any wells exists 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 �� i Y v 4 t t' t \ t ♦ t't 4 t Y t *. h \ 'v \ \, \ t v. t t t �•: 4rt t \ k ♦ t t 4 k t t 4 t ♦ 4 \ ♦ ♦ t hit ' r ! f f f v! ! r f f f f•vi / ! f ? ? / f f f f 4 k \ 4 v t t tr1.�• k h h h 'v 4 t 4 +. t \ h t ♦ 4 ' h v. v 4 v. h. \ h h h h v. t `. t ♦. t t t 'v Y t \ t . \ t v. 4 t. t t 4 t t t t 4 k t 4 t t ♦ Y k h h Y ♦ t - 4 4r t 4 h t Y t k t t h \ Y Y Y Y t h Y Y Y Y Y h - f / 4 t k t t t t 4 4 4 t 4 Y h 4 h•♦ \ k ♦ t i ' Y. t 4 trY hrh 4. k 35 19 .: 32 31 5 32 Water 28 9Service r ; a ri Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is Cotuit MA 02635 May 20, 2011 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out I r I (I forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 n Cityrrown State Zip Code 508-428-1779 SI 12855 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 16.340 of =- Title 5(310 CMR 15.000). The system: CD f 64 — ®r Passes ❑ Conditionally Passes ❑ Fails 4�wy ✓�� S T ❑ ;:Needs Further- Evaluation by the Local Approving Authority CD -- 't i€ May 20 2011 CD Insp? s Signature Date E" 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. t 11-87 Papsis 7 Oxford.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is Y required for Cotuit MA 02635 May 20, 2011 every page. Cityrrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time, leaching pits are functioning properly. 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: 4 ❑ 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 ❑ obstruction is removed 11$7 Papsis 7 Oxford.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. 11-87 Papsis 7 Oxford.doc•08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 11-87 Papsis 7 Oxford.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is Cotuit MA 02635 May 20, 2011 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow.of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ 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. 11.87 Papsis 7 Oxford.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is Cotuit MA 02635 May 20, 2011 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) i 11-87 Papsis 7 Oxford.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2011 every page. Cityrrown State Zip Code Date of Inspection i D. System Information s em Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): } Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 11 E7 Papsis 7 Oxford.doc-08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'l 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is rewired for Cotuit MA 02635 May 20, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped two years ago. 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Second leaching pit added 10/28/92 Were sewage odors detected when arriving at the site? ❑ Yes ® No 11-87 Papsis 7 Oxford.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: Years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. 2" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" Trace Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle ' 14" How were dimensions determined? Measured 11-87 Papsis 7 Oxford.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 f Commonwealth of Massachusetts M Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is Cotuit MA 02635 May 20 2011 required for Y every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, tees are intact and clear. Recommend annual pumping with use of garbage disposal. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene _ ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): 11-87 Papsis 7 Oxford.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present liquid level at bottom of both outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 11-87 Papsis 7 Oxford.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 111 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2011. every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: Two 6x6 pits. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool a number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit#1 was found with 6-8"of standing water with a stain line at 50%capacity. Leaching pit #2 is partially under driveway and was not opened. 11 A7 Papsis 7 Oxford.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is required for Cotuit MA 02635 May 20, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): 11-87 Papsis 7 Oxford.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis __.`---------:----- --- -- - Owner Owner's Name information is Cotuit MA 02635 May 20 2011 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Sketch Of Sewage Disposal System-. Provide a sketch 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. r 4 •\•\ \ '\• f /\r / ,? 35 - 19 ..r 4' 32 31 5 32 ater 28 9 u ervice F Oxford Drive I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'° 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is y required for Cotuit MA 02635 May 20, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 30+ feet 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: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 10 and topo map shows property at el. 50. 11.87 Papsis 7 Oxford.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Commonwealth of Massachusetts Title 5 Officia Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford•Drive . , . t� •.r , F, .. ,.:1 r = A. r,. Property Address ._ ': „ , �R P�,�r sr' nk c Gloria'Papsis Owner Owner's Name ; information is required for Cotuit ''. . '' ' MA 02635 March 23, 2009 every page. Cityrrown A - State- Zip.Code-- Date of Inspection.. Inspection results must be submitted on this form. Inspection forms may not be altered in any way n impotent: A. General;Information When filling out ^. f forms on the computer,use 1. Inspector: only the tab key to move your -Patrick M. O'Connell-. cursor-do not Name of Inspector use the returii -- key. Septic Inspection Services Co. Company Name _ 189 Cammett Road try Company Address ° Marstons Mills . MA 02648 Cityrrown State Zip Code 508-428-1779 SI 12855 Telephone Numbers License Number B..Certification- . ceitif that"h ave pe.rsonally in spected 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 March 23, 2009 Inspector'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. 09.41 Papsis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owners Name information is required for Cotuit MA 02635 March 23, 2009 every page. Cityrrown 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.in form.ation 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: Tank was pumped as part of inspection leaching pits are functioning properly. 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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.nl.d is available. ND Explain: ❑ 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 ❑ obstruction is removed 09A1 Papsis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owners Name ' information is Owner's required for MA 02635 March 23, 2009 every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) ' B) System Conditionally Passes (cont.):, ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 tim es a year due to broken or obstructed s i e . Th pP ( ) e system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced - ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the.environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. 0941 Papsis.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 3 of 15 r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments- 7 Oxford Drive Property Address Gloria Papsis Owner Owners Name information is COtUIt required for MA 02635 March 23, 2009 every page. City/Town State Zip Code Date of Inspection B. Certific ation (c ont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This'system passes if the well water analysis, performed at a DEP certified laboratory, for coliform - bacteria indicates absent and rthe presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool' ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ` ® Static liquid.level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed.pipe(s). Number of times pumped: ❑ ,. ® Any portion of the SAS, cesspool'or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 0941 Papsis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 15 ex r. x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is f required for Cotuit MA 02635 March 23, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification-(cont.) D) System-Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. , ❑ ® Any portion of a cesspool or.privy is less than 100 feet but greater thans50 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 owneror 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. 09-01 Papsis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owners Name information is Cotuit required for MA 02635 March 23, 2009. every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were`all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has- been determined based on. ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 0941 Papsis.doc-0=6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 7 Oxford Drive Property Address Gloria Papsis Owner Owners Name information is COtUIt required for MA 02635 March 23, 2009 every page. CitylTown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d g ( Y 9 (gP )) Sump pump? ❑ .Yes ® No Last date of occupancy:, Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft. ,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 09A I Papsis.doc 08106 } Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owners Name information is Cotuit required for MA 02635 March 23, 2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont) General Information Pumping Records: ,Source of information: None Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Size of tank Reason for pumping` Excessive accumulated solids Type of System: v ® 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Second leaching pit added 10/28/92 Were sewage odors detected when arriving at the site? ❑ Yes ® No 09AI Papsis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owner s Name information Is required for Cotuit MA 02635 March 23, 2009 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: 8" feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years P Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No --------------------------------------- ---------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 8" Distance from top of,sludge to bottom of outlet tee or baffle • 22" Scum thickness 4" + Distance from top of scum to top of outlet tee or baffle 11 Distance from bottom of scum to bottom of outlet tee or baffle 10 How were dimensions determined? Measured 0941 Papsis.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `f 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is required for Cotuit MA 02635 March 23, 2009 every page. Cityrrown State - Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was pumped as part of inspection. Liquid level was found at bottom of outlet invert, tees are intact and'clear. Recommend annual pumping with use of garbage disposal Grease Trap (locate on site plan).- Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ lene pol eth ❑ y y 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 related1c,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 El other(explain): 09-01 Papsis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commo nwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria PalPsis Owner Owners Name information is Cotuit required for MA 02635 March 23, 2009 every page. Cfty/rown State Zip Code " Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 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.): No solids or high stains present liquid level at bottom'of both outlet pipes. Pump Chamber p (locate on site plan): � Pumps in working order: ❑ Yes. ❑ No Alarms in working order: ❑ Yes ❑ No 0941 Papsis.doc-08/06 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address Gloria Papsis Owner Owners Name information is COtUIt required for MA 02635 March 23, 2009 every page. Cltylrown State Zip Code Date of Inspection D. System Information (cost.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 6x6 pits. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leachingfields number, dimensions: ❑ overflow cesspool number: ❑ innovative/a.lternative system. Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit#1 was found half full with no high stains. Leaching pit#2 is partially under driveway and was not opened. 09411 Papsis.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is COtUIt required for MA 02635 March 23, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): 09-01 Papsis.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System Page 13 of 15 ' Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Oxford Drive Property Address -----------------_.--------------- Gloria Papsis Owner Owner's Name -- - "-"-- -"- - information is required for cotuit MA 02635 March 23, 2009 --._._.-------------.-------._--- every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. a; .. • 35 19 32 31 32 5 ater 28 g pFar, Service ;n k, Oxford Drive Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 7 Oxford Drive Property Address Gloria Papsis Owner Owner's Name information is COtUIt required for MA 02635 March 23, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 30+ feet 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 bf SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 10 and topo map shows property at el 50 r 09.41 Papsis.doc•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE LOCATION SEWAGE # `,2 - VI .I;AGE �f ® T ,? ASSESSOR'S .MAP & LOT(�'�,�•- (��lrj�. INSTALLER'S NAME & PHONE NO. �L '� M-2 �? F SEPTIC TANK CAPACITY 'L1EACHING FACILITY:(type) (size) ze 00 6 qi NO; OF BEDROOMS PRIVATE WELL OR'PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: f Q - l?- q6L, VARIANCE GRANTED: Yes No `� s a O, 4 i f 9� sex `ati r No.. .... THE COMMONWEALTH OF MASSACHUSETTS d �vr BOAR® OF HEALTH 0 TOWN OF BARNSTABLE Appliration for Pispviial Workii Towitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ........ C�`'� ! 'J.........o.t................................................. --....------...� .6-I - •-.......... ............::.............................. - --.Location-Address, � or Lot � I ............. sis.....------••----............. -•---...-----.... ..4 om.......... er Address a .................... ..... ......•.....--- ..—............................-----^•- ..........................................................................................---^•-- staller Address Type of uilding Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------------------------------------------------------------------------------------------------------ w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth........... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--_-_---_____-__-.._---. 44 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ a ------------------------•----------------------------------•---------------......------.......----•-......................................................... 0 Description of Soil...................................................................................................................................................................... x U w V Nature of Repairs or Alterations—Answer when applicable-----------^Ui;,) •----- -----------------------------------------------------------•------------------------..........--------------...-•--•--------------------•-------------•--•-----------------------------•---------•------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isu d b he board of health. Signed ........ f... :... ti ............................................ ........................................ Date Application Approved B ! ...--"--"- ---'--- -- --- ----- ---------------'--- .« ------- -------Date -- Application Disapproved for the following reasons: .....................' " ........--"---........... -'-- --...........---...............--------------- -'--'----.....-- -'------'......................'.'--...........................................---- '-------........---'----....----- -- -- ---'--......--'---"--"-----------'----'-. -- ........................................ 9 �/ Date Permit No. 6 �'. /"..-....--".................... Issued ..--"---'--- -�J------`--`.....--..1��'�'' ..-'- '---'----------- Dare i ......................... 16 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s �r TOWN OF BARNSTABLE Appfiration for Dispoga1 Works Tnnitrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 1�.........9�............................................... ................�b-x ' = - ........... Location-Address, or Lot No. - " .. �. S2._ ' t�......- . if --•••-••--• ......: - 5 i. Q--.. -.........- �r ' Address W -•-•••-•-----•----.......••-•-•..................•••..............-•-•.... nstaHer Address Type of `wilding Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a` Other—T e of Buildin 4 YP g ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .. W Design Flow........................................••__gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---_-_........ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total _eaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth.below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-----------------------------------------------------------.............. Date........................................ 14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth t:) ground water..........---------_-_. (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------:................. a •-•-•-•--•••------------•••----•-•••-••--••--•--•••••-••••••••••••••--•-.....-••---•........._-•-------------•---••••-......_.........= 0 Description of Soil............................................................................................................................. ",4 ._ V ................................................................................•••-••••......•--•-••-•--•--•--•--••••--•-••-•-•••-•-••-......••--••................................................. ----•------------------------------------------------------------------------------------------------------------------------------------------------------•••--•-...--•---.........:......-----•..... U Nature of Repairs or Alterations—Answer when applicable------------p,. �)---------�Qc,� �.(�.... .tyk �. �`D ----------------------------•--------------•-------------------------------•••-•-•••••••...------•••••--•••-••••••-••-•••••-•---•••-••••-----•••-----•••••-------••-•-••-••-•••-•=..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued�by t-the board of health. f�.'....... r Signed ---------- --- ..--- --�^---- ------- � Dale Application Approved B :._-- �. ...---.... _- 2 . �',-- - Date Application Disapproved for the following reasons- ....................................... ---------------------......................................................................... -- - ---------------------------- ---------- --------------- --- ------ ----------------- -------------- --- ------------------------------- ------------------------------------- ........................................ �/ Date Permit No. --- /` ------- Issued ------------ ..117--- .1F___ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . TOWN OF BARNSTABLE Gerttftrate of C ontylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (. ✓) by'----------------------- -------- -- -------------------- -------------------------------------- -- ---- ---------------------------- - ------------ ---------------- ----------- ------------------------------------------- nInstaller at .............................f fz .....----'�- - �p u.�T.. .......hq_ ft has been installed in accordance with the provisions of TITLE of The-jSSte Environmental de as described in the application for Disposal Works Construction Permit No. �-.-----r = ��----........ dated C ....---- ."�� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION� SATISFACTORY. DATE...................... )A...,g U...�.-.T�.------------------------------ ---- Inspector .... ................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...................... FEE........................ Disposal Works Tnntrndion prfttt Permissionis hereby granted----•=-•••---•-•-• --•-•••••-•••-•-----•-•••---•••-•-••-•••••---••--•••••---•••-••••••...................................................... to Construct ( ) or Repair (Kan Individual Sewage Disposal System at No.. -•--�?''(,-\;{L�J t.. 1�........._. , -.----..__y "� sue ..__... Street as shown on the application for Disposal Works Construction Permit N6. 7- _ Dated.... '._ �-� .. J ---------- ------- DATE............ Board of Health / - � s�-......... FORM 36508 HOBBS♦4 WARREN.INC..PUBLISHERS :e f ASSESSOR'S MAP NO. PARCEL G 5/.3 LOCATION . SEWAGE PERMIT NO. VILLAGE--� �o TV,-r— r INSTA LLER'S NAME A ADDRESS R U I L D E R OR OWN ER i Q DATE PERMIT ISSUEDi/, 1p-4e DAT E COMPLIANCE ISSUED �Zl� ` -JFA14clL Cl Soj x® ° i L� L f �S SSOR'S MAP NO. PARCEL 6 (/,5 ,- -� �OCAtt t ITION �r/q, r� SEWAGE PERMIT NO. Lo 1 in 0 NY��Z.n �K_�,e �V V1LlAGE O,7- t/`INSTA LLER'S NAME 6 A 0 D R f S S I � 8UILDER OR OWNER DATE PERMIT ISSUED Zp, DATE COMPLIANCE ISSUED �.t i �' -�. Q �S �t V �ya � 7— �� i� �� r�� -_- "�� T �_._._. �'� _ , G Assessors Map`# 0Z X�l7 E �1�lK �X rXr. ,Fa c # 0- p� Q(� F$s......... .._ S THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH 1 1 AJ Town Barnstable / ........ ---- .... ... .--- ................OF..........................._............... 3 6� Appliration for Disposal Warks Tonstrurtivit Errant Application is hereby made for a Permit to Construct ( X ) or Repair ( ) an Individual Sewage Disposal System at Lot 66 Oxford Drive Cotuit LOt 66 ................___..__...................................................................... --•--••---•••..._......_......----•----------•-•...---•--•••...-••--•------•-•-----.....------••-• Edward Ptiop-Address C/O Coy t s Brook Inc °2�'Y'o"rsyth Ave S. Yarmouth ......................___........................................................................ ...------•••--------.....--•--•-•-•-•-----•-•----•••--•-•-•-•-•-•................................. / QQ��q Address ......_1... ..................V4a!e`�IGPW�... �iS !� ............ ............. Installer Address ..................... Type of Building 20,025± yP g Size Lot............................Sq. feet V DwellingNo. of Bedrooms...._...3.................... .....Ex Expansion Attic— --------- p ( ) Garbage Grinder ( ) Other—Type T e of Building .............. No. of ersons..........._.__......._.___. Showers a yP g ----------•--- p ( ) — Cafeteria ( ) d gn Other fixtures - Ob ... 1 : ..... 330--------- ------•----------. ---. W Desi Flow..........:............................. .gallons per person r day. Total daily flow.......•...........__.........___...__. ....gall WSeptic Tank—Liquid capacity._.......... allons Length................ Width................ Diameter......... Depth................ ons. x Disposal Trench—No. .................... Width.................... Total Length......... ....... Total leaching area.... ft. Seep Other box X Diameter---Dosin tank below inlet................... Total leaching area..................sq. ft. Z ( ) g ( ) Percolation Test Results Performed by...Richard Bertrand, P.E_Cape & I� d Survey 4/23/84 Test Pit No. 1.....2........minutes per inch Depth of Test Pit.....14 . none p p ��..__. Depth to ground water- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a _•••• •-•••--•-•.......--•-•••-•---•••-•••-•••--••-••••------------------------------------------------------------------------------------------••••....... 0 Description of Soil.................0„-- •-12" Topsoil-------------------------------------------------------------------------------- � 12" — 24" Subsoil •............................... V ..............••-••-•••....--••.....••............-•--'.•••_-•--------_.---------------- W 24 - 144 Medium Sand x ...................••-••----•••••••-•-••--•-•-•-•••••-••-----------•••••••••-•---•-••-•-••••-•••...•--•--•••••••-••••••••••--------•-•-•••....-•-•••.....................•.......--............••...... U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. ---------•................................................-............................................................................. . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operatiorl until a ertificate of Compliance has bee iss e y and of health. frovg St ned...------ Date APPIi tioned By.... Date Application Disapproved or the following easons:.............................................................................................................. ..............................•-------••-••.........-•-•••-•------••.._..--•--•-•••----•••...•-••-••--•-----•-•-•---------•••-•••••--••-•---•••-•-•••••••----•-•••--••••••-•••-•••••---•••--•........... Date PermitNo......................................................... Issued-----•------•------•----...................---........ Date Asses=ors Map # XXXXXXXXXXXXXXXXXXXXXXX "'-t. ,__ M ggXX XX XXggxx ' - -:;� X�3�XKXXXXX XX " ` - �:XXXXXXXXXXXXXXXXXXXXX THE COAAM NWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable r ................. -.. ...-.... oF......................... .......... Appliratiun for Disposal Works Toustrtirtion rumit Application is hereby made for a 'Permit to Construct ( 0 .or Repair ( ) an Individual Sewage Disposal System at: -1, Lot 66 Oxford Drivo Cotuit LOt_ 66 •...............-_...._.-...........---....--•--..............................---•------_------ -----•----••--................--------••------•---------•---•-----•---...----........... Edward PaocaJtT�•Address or Lkt No. ••- - ......................___............--ji ...---•---••-••-----•------...---••--•--........C/O Coy's Brook Inc 24 Forsyth Ave S. . Yarmouth • .............•------•--•---• ..-•-- Owner Address - .................. ... ` -------------- t e ,��.A�• = {.' '..... .................................................................................................. l Type of Building Ingtaller Address Lot....?M, 22 .Sq. feet 3 U Dwelling—No. of Bedrooms......._ -_:- _-_.--_------_-_._-•_-Ex Expansion Attic Garbage G '-' P ( ) rinder ( ) a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -----•-•---••-- •--•.........................•--- W Design Flow........... '�......................... allons per person 8per day. Total daily flow.... gallons. WSeptic Tank—Liquid capacity.....100allons Length._.._.v........ Width.... 4..__. Diameter................ Depth..... ......._. x Disposal Trench—l -_o. .................... Width..._.........._.... Total Length..........i........ Total leaching area-_-_-_---._-_-----sq. ft. 3 Seepage Pit,No..................... Diameter.......- .-.------- Depth below inlet...... Total leaching area.19 ........sq. ft. Z Other Distribution box ( X) Dosing tank ( ) Percolation Test Results Performed by...R chart--Bextrand_,._P.E,Cape_& I a�d__Suryey 4/.23/84 Test Pit No. I.....1--------minutes per inch Depth of Test Pit......14+&....... Depth to ground water _n0nBP/ •---- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------------------------------•-----------------------------------------------------------.....---------•---------•---------..-..--------------- 0 Description of Soil...---•••-••....-�f.----..12'.�..ToPsoil x -----•-------•-•••-•...................... V 12"..- 24" Subsoil --....----•---------••--------------------------------------------- ---------------------------------------•--••. •••••-••• •-•--------••................ .......24"_ — I44" Medium Sand . U Nature..of Repairs or Alterations—Answer when applicable............................................................................................... -• ------------ .......................-----•------------------------------------•----•-•-----••----- --- Agreement: The undersigned agrees to install the afor described Individual Sewage Disposal System in accordance with the provisions of TILE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a 'Certificate of Compliance has bee, issue by-the board of health. �ro..... ._. . I . - � Date1 v A lieation A/�'lp�"rdv ed BPP PY •;••. ................. -- ........................... Date 1 ',wl� Application Disapproved for the follow Ong reasons: -- _ Date PermitNo......................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f � 1AA,.r ........�.............. ............OF............. -. � .afi '° ,. ' v .i.�r.••f , .._............................................ �rr�if ir�t#e of &utpljattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructel ( ) or Repaired ( ) by - :.:... '= --------• = ...... `..... ...................................... .........................•--..... 1 ` Yti� Installer h )e ---------•-..........•-••----- has been installed in accordance with the provisions of �11 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.m--•-__--__-........................ datc(L............. i_ : ............. THE ISSUANCE OF THIS CERTIFICATE SHALL>NOT 6E'CONSTRUED AS A GUARANTEE' tTHAT THE SYSTEM WILL FUNCTIONS TISFACTORY. -f DATE................. �..Z `��?.--•------------- Inspector.._.._.._:_.:.:... ! ....)v -�� ----•---••-•••..._..•---....•..........................•---••- THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH COr ..............oF................ PW1..... ► "�4.+7P /FEE........................ Disposal Works Ionstrudion "prrutit ?S a_ Permission is hereby granted..............._..1.i..................:. _ to Construj( ) or Repair ( ) an Individual Sewage�Disposal�System atNo.........:.......... ----- d`- ::......... ----------------" to U k r r�r l l�stt«t,�-�' t C) i k�I as shown on the application for Disposal Works Construction Permit No..................... Date(................... 6 -... l � i Imo ,, - ----------------------- Bu:1rd pit lfeallh DATE...... ` 4 _ L �h DATA 4 DESIGN SOIL TEST DATA 3� ti �. �/ 2 Number of Bedroans 3 Date of Test y 20 jgT �j� 4j Total Design Flow 330 8Pd Tested by R I c H A R D T. t5 E R-7R/1n/l> P,E, v Witnessed by M P,, P, . G IF FORD {�� Septic Tank Required 1.503� 2 Gj Septic Tank Provided /0 o O gal, o 4 Q Percolation est v 64�� y�4 y� I Depth o test ow 4 Rate 2 min./in. g w p K, Leaching Facility Provided: Type LEACHING PIT 1 Test Pit Data Number Dimensions 8' A b' �4x 4Test Pit #1 "Test Pit #2 4" Grade S/o e 07 Garbage Grinder WMA411 Not Be Used Elev.: 30,3 Elev. 40 Pt '� "�� /' In I n• P l Q (5C% area increase is req d with grinder) /2' Topsot/ Leaching Area Provided: 4 sob�5ol24 Bottom 50 sgft Stptic Tank I . Sidewall /S O sq ft /DOD al f1 2" layer Total 2 00 ft .00 8 • Dist. 6 � is Box 3/4Stone 1/ 4 '�' /8 to 1/4 r s�?.-cb :j. �; Leachin f Stone Leaching Capacity Provided: z: + a Pit ' Bottcm,�Q sgft x /_0 gpd/sgft -_0 gpd l LLWO 8a Sidewll�0 sgft x�gPd/84ft jfg Pd2 3.55 �Totalfi� 9 Pd m5e a dn Ivd r 1 Bottom of Pit Breakout Calculation: 7 " 150 - 20 NOTES l�,3 1. All installations shall conform to the ndninim Observed water AVoNF Observed water requirements of The State Fnvirm ental Code, E.S.H.W.L. IV,4 E.S.H.W.L. Title 5, and the Town of Barnsroa61e Board of Health. 2. This is not a property line survey.'Boimdry. NBenchnark Elev. 3.0 ASSuMed Q'op "QPvi-re-re E50vn0 information from Plan BooK 271 Pu5es .56,5715-8. fx15"TInU CorrroUrs 3• Rase 0,11 applicable manhole cover$ -To WITh►1} Zq P'ropo."ed Con o r Q^� ++ 11 �Q"-y-- Propsecl WgTer Service ; I S vG �� J`J� _]�--- �, Remove all ToPso,1 Subsoil, ctnd de lererlou5 I o ,� maTLYlu' IL dow�1-ro six, (b Ih(. cs bt Iow/ OO.D0 sur�4cG a ' -rye Y1courckj peima6)e &Di1 arld\ TD a d�sfan(C 1 Arc 1 IT ' W►T� C ItaYj 5U.y1Gl �y'et YOYY) 'T1y1C IQ I , ' � \ � O havl� G perc.olart�oh raze -rwo LZ� \ or ftt�Tef. I - I o Proposed TP 4 e 3 Bedroom � O yayse a LOCUS a oU- --i A SEWAGE E DISPOSAL SYSTEM N DESIGN L0 T 6 s�P TIc on oT66 for : �dWar q POP'S l5 for DrIve / CDYS BROOKOx o,STacIh 1 2�- Fors r h Avesox axb 1 c° M ALtPTng y COTU i � j ` / N �Q / SO�T�'1 y0rmoU7j7� MA 1 o �, y , '�v 1 2 /3 55 E ,,� 135, 00 OXFORD DRIVE en g eering /� o��P4SN OF MAS`�o ' 9 / L n Al SCALE / 2 0/ a GREOGE G. f� LOMBARDO Cl SANITARY A ,A No. 32533 Q ONAL Envirnomental Consultants 24 Forsyth Avenue # South Yarmouth # MA # (617) 398-5215