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HomeMy WebLinkAbout0058 OXFORD DRIVE - Health 58 Oxford Drive Cotuit P A = 021 064 'i TOWN OF BARNSTABLE d 12 'A i c 6 SEWAGE # ' :.AGE `71 ASSESSOR'S MAP & LOT I _Obi INSTALLER'S NAME&PHONE NO. :�M COAZ �02 q�0 VAPA SEPTIC TANK CAPACITY 2—id,0 7 LEACHING FACILITY: (type) Zz� A) f657 C aldsize) "P A X IV NO. OF BEDROOMS 5— BUILDER OR OWNER TD,4P ht f_y PERMITDATE: 3A, 2-0� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `,7- Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) kjjj9 Feetl Edge of Wetland and Leaching Facility (If any wetlands exist vvi hin 300 feet of Ching f c'h ,L�j�D Feet �, Furnished by ' J j M td , } Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 every page. City/Town 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 out0 forms on the (I„I computer,use . I only the tab key 1 Inspector: to move your David D. Flaherty Jr., R.S. cursor-do not Name of Inspector use the return key. Flaherty Environmental Services y Company Name P.O. Box 81 Company Address Yarmouth Port MA 02675 'BOA" City/Town State Zip Code 508-362-1657 S14713 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 Eval tion by the Local Approving Authority November 1, 2007 Insl ctor 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. t5insp 58 oxford dr cotuit.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 M ,•°'p 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: two large irrigation systems reflects unusually high water usage P B) System Conditionally Passes: ❑ One or more system components as described n the"Conditional Pass" section need to be replaced or repaired.The system, upon com etion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, N in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over years old*or the septic tank(whether metal or not) is structurally unsound, exhibits su stantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if t e existing tank is replaced with a complying septic tank as approved by the Board of He Ith. *A metal.septic tank will ass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicatin that the tank is less than 20 years old is available. ND Explain: ❑ Observa ' n of sewage backup or break out or high static water level in the distribution box due to brok or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass ' spection if(with approval of Board of Health): broken pipe(s) are replaced obstruction is removed t5insp 58 oxford dr cotuit.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 : October 27, 2001 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced w ' ND'Explain: ❑ The system required pumping more than 4 times a ye r due to broken or obstructed pipe(s) The system will pass inspection if(with approval of the and of Health):' - ❑ broken pipe(s)are replaced ❑ =obstruction is removed ND Explain: M1 . C) Further Evaluation is Requir by the Board of Health: ❑ Conditions exist which requir further evaluation by the Board of Health inorder to determine:if the system is failing to prot ct public health, safety or the environment. 1. System will pass un ss Board of Health'determines in accordance with 310 CMR 15.303(1)(b)that the s stem is not functioning in a manner which will protect public health, safety and the envir nment: El Cesspool privy is within 50 feet of a surface water ❑ Cesspo I or privy is within 50 feet of a bordering vegetated wetland or a salt marsh, 2. System ill fail unless the Board of Health (and Public Water Supplier, if any) determine' that the system is functioning in a manner that protects the public health, safety an environment: ❑ he system has a septic tank and soil absorption system (SAS)and the SAS is within 100 fee 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 supp . ❑, The system has a septic tank and SAS and the SAS is within 50 feet of a private water _ supply well. t5insp 58 oxford dr cotuit.doc•08/06 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 ' M 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (c ): ❑ The system has a septic tank and SAS and the SAS ' less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance; **This system passe/heen lysis, performed at a DEP certified laboratory, for coliform bacteria indicates ab of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, prolure 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: r 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 '/z 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. t5insp 58 oxford dr cotuit.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27 2007 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. ❑ .0 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 CM 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 sy tem 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" o"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is withi 400 feet of a surface drinking water supply ❑ ❑ the system is hin 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system ' located in a nitrogen sensitive area(Interim Wellhead Protection Area— I A)or a mapped Zone It of a public water supply well ` If you have answered "yes" any question in Section E the system is considered a significant threat, or answered"yes",in Sect' n D above the large system has failed. The owner or operator of any large system considered a si ificant threat under Section E or failed under Section D shall upgrade the system in accordance ith 310 CMR 15.304. The system owner should contact the appropriate regional office of th epartment. t insP 58 oxford r dr cotutdoc•08I06 TitleOfficial5 Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27 2007 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 ❑ ® 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? El ® 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? ® El 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)] t5insp 58 oxford dr cotuit.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 M 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number.of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): >550 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d "07: 546 gpd; '06: 9 ( Y 9 (gpd)): 696 gpd Sump pump? ❑ Yes ® No Last date of occupancy: _ present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203 . Gallons per day(gpd) Basis of design flow(seats/persons q.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding to present? ❑ Yes ❑ No Non-sanitary waste dis arged to the Title 5 system? ❑- Yes ❑ No Water meter readi s, if available: Last date of oc upancy/use: Date Other(de ribe): t5insp 58 oxford dr cotuit.doc•08/06 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 M 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: owner 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: 2004 (upgraded) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp 58 oxford dr cotuit.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 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 every page. Cityf town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >50 feet Comments (on condition of joints,venting, evidence of leakage, etc.): joints seem watertight, venting through housw adequate, no evidence of leakage Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ® polyethylene ❑ other(explain) primary tank concrete; secondary tank poly If tank is metal, list age; years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: both 1000 gallon Sludge depth: 3„ Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 13" ' How were dimensions determined? sludge judge, tape measure l5insp 58 oxford dr cotuit.doc•08/06 Tice 5 Official InspectJon 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 ,M 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is Cotuit MA 02635 October 27 2007 required for every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (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.): pumping noy necessary at this time, septic tank info above from primary tank, secondary tank had neither sludge nor scum, both tanks had inlet and outlet tees in good shape, both tanks had appropriate water levels, neither tank had evidence of leakage Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete El metal El fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outl tee or baffle Distance from bottom of scum to bo om of outlet tee or baffle Date of last pumping: Date Comments (on pumping reco mendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to ou et invert, evidence of leakage, etc.): Tight or Holding ank(tank must be pumped at time of inspection) (locate on site plan): ` Depth below g de: Material of onstruction: concr to ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): t5insp 58 oxford dr cotuit.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 -wM 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 every page. City/Town State, Zip Code Date of Inspection D. System Information(cont.) Tight or Holding Tank(coat.) 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 (conditio f 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): a n/a Depth of liquid level-above'outlet invert - Comments (note if box is level and distribution to outlets equal,any evidence of soilds`carryover, any ; evidence of leakage into.or-out of box, etc.): dbox seemed level, no evidence of solids carryover, both lines seemed equal, no evidence of leakage a, Pump Cham/on Pumps in wo ❑ Yes ❑. No Alarms in wo ❑ Yes ❑ No' t5insp 58 oxford dr`cotuit.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15' w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 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: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: r ® leaching fields number, dimensions: (2)see below ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): westerly field 10'x28'w/3050s, easterly field was 12'x24'w/3050s, both had no signs of hydraulic failure, both had typical vegetation t5insp 58 oxford dr cotuit.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 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate o 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 f hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan . Materials of constructi n: Dimensions Depth of solids Comments ( to condition of soil, signs of hydraulic failure, level of pond ing,condition of vegetation, .etc.): t5insp 58 oxford dr coluit.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 ' 58 Oxford Drive Property Address David J. Brown Owner Owner's Name information is Cotuit MA 02635 October 27, 2007 required for every page. CitylTown 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 1 Opleet. Locate where public water supply enters the building- -=-A a-t- W S Er2vlr,E L 0 i ic Q0 0 5 sr 1� 5s% poll 07" �0 t5insp 58 o)dord dr cotuit.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Oxford Drive Property Address a` David J. Brown Owner Owner's Name information is required for Cotuit MA 02635 October 27, 2007 every 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 ground water: >10" 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: pate ® Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: ❑ Checked withnlocal excavators, installers-(attach documentation) ❑ -Accessed USGS database-explain: You must describe howyou`established the high ground water elevation: hand augered to 10', no groundwater encountered a t t5insp 58 oxford dr cotuit.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15of 15 Town of Barnstable 11HE Tp� ti�p� ti� Regulatory Services Thomas F. Geiler,Director �$ ��� Public Health .Division ATE'D MA'S p Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. � 1 \ 111 a sd � i No. 00 / Fee 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for MigoOl bpztem Construction Permit Application for a Permit to Construct( . )Repair Upgrade( )Abandon( ) El Complete System El Individual Components Location Addresss,or Lpt,�j0. Owner's Name,Address and Tel.No. Assessor'siiap/Pazcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms _ Lot Size I � sq.ft. Garbage Grinder( ) Other Type of Building Sc� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow�� �, gallons per day. Calculated daily flow Sf Z gallons. Plan Date 22- - (x 1. Number of sheets i Revision Date Title` VP— Size of Septic Tank Type of S.A.S. Description of Soil, a, . Nature of Repairs or Alterations(Answer when applicable). �Ly� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions Title 5 o the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by thisazd Health. Signed Date Application Approved by Date L/ Application Disapproved for the f ll ing reasons Permit No. 2 b 0 y /a �- Date Issued 3 3 0 y.- .- ..�:., y ... � ..P i�..:yw,iv+"'•Y.+:.-.:r--a.�=.�^^...r-.�,;^.--.. _ -a-....'-ten- `, _ _-vi-....�..�--,.��� aY...._ _.J,..a.-�.,r-i.•-;y..,,,y..yr�r.-..r�...,.� ,�._•-vs:•-.,, .,.,...,.�. - a U- �No. (w � � �',.�`''_ � •� ,�:._•� ..�.. Feed ¢ " �^ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWWOF BARNSTABLE., MASSACHUSETTS.- Yes - 1 2pplication for Migpogal.6pgtern Congtruction Permit Application for a Permit to Construct( , )Repair( )Upgrade( t)Abandon( ) E Complete System El Individual Components Location Address or Lot o. kDesigner's ner's Name,Address and Tel.No. Assessor's 1GIap/Parcel O Zlv j �� 5 c\ a bl��t " 4- oaLD,Installer's NameAddress,and Tel.No. Name,Address and Tel.No. \os �\,��c��X a \01C_ 50`6- \ Q6 c� / S� .� Type of Building: i Dwelling No.of Bedrooms �i Lot Size�o sq.ft. Garbage Grinder(� ) Other Type of Buildings No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 515,0 gallons. Plan Date —2�- a - (,)Q Number of sheets 1 Revision Date Title C' M � ca\ TN ( `A-,--�_ _ Size of Septic Tank %_ z T-, Type of S.A.S. ' Description of Soil ex Nature of Repairs or Alterations(Answer when applicable) Date It inspected: Agreement: _ i �� 4 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions df Title 5 of the Environmental Code and not to place the system;in operation uriiil a Certifi- cate of Compliance has been issuk by thi,B and o Health. Signed �r 11 ��� Date - g r Application Approved by , I 1", c Q,). Date Application Disapproved for the foll 1 ing reasons v Permit No. .2 U U L/—l a o2 Date Issued 3/��' 0 y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( ) Lr at {—k n ( �v� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No..2, up,4'/a a dated Installer ' Designer— The issuance of 1his pe6dt shall not be construed as a guarantee that the system will(unction as d ystgned. Date �1'�S Inspector� �� '1�. /ll I C -- - . — �. )�� --------- ---------------------- No. Fee t)U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogaf bpgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) t �� 0 )rj r r/ Or r.,L and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons cti n must be completed within three years of the date of thisTerrmit. Date: 2 3 i L Approved by ) �`'�ii TOWN OF BARNSTABLE /ACATION LEE ® //.� SEWAGE # 00 VILLAGE ��Ty/ T ASSESSOR'S MAP & LOT _qb INSTALLER'S NAME&PHONE NO. mJ o G/dGiAl D22- !/ Z/F-A SEPTIC TANK CAPACITY /,0a LEACHING FACILITY: (type) a � 6v .1'b57 C'"&4ze),i®iLle 1-44V NO. OF BEDROOMS BUILDER OR OWNER y ® Gl PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater ble to the Bottom of Leaching Facility. 7, 6 Feet Private Water Supply Well and'LeaChing Facility (If any wells exist on site or within.200 feet of leacWng facility) _ Fe 'bd e of Wetland and Leaching Facility (If an wetlands exist 8 g tY Y %%4iin 300 feet of hi ng f c lityF ® FLet Furnished by I 6� o� 16 p, i y Nam,, Ito k �y9 0 I W C � b n• x; x V y` O. C No. 9Zu o�-j . Fee U U ._ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS Migogal *pMem Conztrurtion Permit Permission is hereby granted to C tnict )Repair( )Upgrade( ' )Abandon( ) System located at S 0 ) rd and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con cti n must be completed within three years of the date of thi rmi Date: a� 0 Approved by I � � .� ��Q�� U�'" v ., ., . ' Town of Barnstable �pI ff Tp , Regulatory Services Thomas F. Geiler,Director * BARNSfABLE, , 9� MASS. �e� Public Health Division ATFp3�° Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 3 ZS f 3 261v-f i Designer: ,�(44i'/10:, Installer: Address: Address: Id. *rfnelb_,�_k 0267-3 On 3 23 ll �j(}� # 6I�F&+< was issued a permit to install a - (dale) ry �(installerr)) /°' septic system at se CCxIZ,) Der. w771r/ based on a design drawn by T� •/ (address) /�.J, CA C(1614y dated 3 Lz 3 La!it, (designer) �I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. AIC-6�0 7D IR 41 SI 6✓-4e f gr_ C-16Z.AJ S/opC_, o f I-6AC# 6 7D/» i E�/7GAf=off. S5KX:m IAA 7.ei�60 /o.SS Q� eta S'p s./ - I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. % '�N OF As RONALD cs� JAMES N taller's Signature) 0 CADI.LLAC v 9 #1060 p y (Designer's Ygnature (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form Town of Barnstable P# d pF THE Tpk Department of Regulatory Services . ' s.+rwsraers. Public Health-Division Date Z / D MSS . �00 200 Main Street,Hyannis MA 02601 059• pTED MAC A Date Scheduled �' 0 Time J M Fee Pd. Soil Suitability Assessment for Sewage Disposal Rc)Nald J- 1, d r1a ` Performed By: Witnessed By: LOCATION & GENERAL INFORMATION Location Address ST o4�9"A 4r;ka Owner's Name Sp'�Z L Address Co�•7 a Assessor's Map/Parcel: I 6�� Engineer's Name Ro, Ad,1&,_ r�Tt)/2E. 50 6_7 7S—`i'"Ion NEW CONSTRUCTION Il REPAIR l/ Telephone# / �(� — �Q Land Use �1},,��/ `Y )✓G0d fS Slopes(%) Surface Stones 2 Distances from: Open Water Body /4 Jz'H. Possible Wet Area ft Drinking Water Well1.171 ft Drainage Way, 5 ft Property Line ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to,holes) f TN- i Lot' -7 7 J Aiz,\ Qf/ s - Parent material(geologic) Depth to Bedrock�l��ri /!� � Depth to Groundwater: Standing Water in Hole: /-T• Weeping from Pit Face Estimated Seasonal High Groundwater 6',4q4� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: //" Depth Observed s nding in olis.hole /f///� in. Depth to soil mottles: Adjustment ft• Gv UJ.✓�tl/N7C�- Depth to weeping from side of obs.hole: in. Groundwater / Index Well#Zo gReading Date: G Index Well level _ Adj.factor 2.(o Adj.Groundwater Level_ l¢ PERCOLATION TEST Date w4h#Time /0:Z7 6e /v�v Observation U/A 6 Time at 9" _ems Hole# Depth of Perc So Time at 6" Start Pre-soak Time rQ ��•Z 7 Time(9"-6") End Pre-soak o. 3336 2 4 6)101'6d,�c +. G ; 3D</ Rate Min./Inch -4� 2 m' /NA Site SuitabilityAssessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) Al Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,You must first no the Barnstable Conservation Division at least one(1)weep prior to beginning. Q:HEALTH/WP/PERCFORM 4 I DEEP OBSERVATION HOLE LOG Hole# 1 Depth.from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.°A Gravel .. /, 32�� ( /? Lc/�m .�Rr�l ©�r S�(o h c -�uy 6 3 �/ elf 7" C � fitr�9 2,Sy 614 h0 G p ✓�-sT-Ale ,4 P-'U'o GU440 - 4"'- 6-Z, /3.6 ' 2,6 `4� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) �3 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ,1 Flood Insurance Rate Man: Above 500 year flood boundary No _._ Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? l'F� If not,what is the depth of naturally occurring pervious material? Certification / 2 I certify that on /(/ C 3(date)1 have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the require aining, xpertise and ex eri a described in 310 CMR 1.5.017. Date .3Of /- Signature Q:HEALTH/W P/PERCFORM TOWN OF BARNSTABL E b j2 -tt-o6 OCATION SEWAGE # VILLAGE / 7�17-,/17 ASSESSOR'S MAP & LOT-al '(?b INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ;2—4z)j LEACHING FACILITY: (type) Ze d By . S''c�5c��'fh�s9 size) /p Y2,G /<,,x x4 I y� NO.OF BEDROOMS S BUILDER OR OWNER / PERMITDATE: 3, 74'.3/ d COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `7 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Fee f lAge of Wetland and Leaching Facility(If any wetlands exist %ithin 300 feet of hing f c'lit} 4 Y- Fp t Furnished by I Dnn� 'J V Ole . d5 o J �. P 14x24 KITCHEN 12 x 16 SUNROOM FIREPLACE ENTRY O UP `l) 11 x 10 v BEDROOM BATH 0 11 x 14 12 x 14 BEDROOM BEDROOM ;f 26'8 EXISTING FIRST FLOOR PLAN DAVID BROWN MD 58 OXFORD COTUIT, MA BASEMENT GAME ROOM DAVID BROWN MD 58 OXFORD DR. COTUIT,MA SPECIFICATIONS 2 x 4 wall framing 16"oc Pressure treated bottom plates throughout R-13 fiberglass wall insulation with vapor barrier Install new Anderson double hung window unit..TW2432-2 '/2" sheetrock,taped,primed,painted all framed surfaces 5/8"fire code sheetrock to utility room and under stairway Full louvered bi-fold doors to utility room with furnace Electrical wiring/fixtures/smoke detectors to code All plumbing(washer only)to code I S Jxrord qq d� d DATE: 6/3/99 PROPERTY ADDRESS: ----------------------- 58 Oxford Drive Cotuit, Ma. -- --------------- tad On the above date, I inspected the septic system at abo eSS. This system consists of the following: N 9 1999 6D 1 . 1-1000 gallon septic tank 2. 1 -1000 gallon leaching pit IM87L 3. 1 -distribution box - Based on my Inspection, I certify the following conditions. d 4 . This is a .tt_i__ tle five.', septic.sys.tem.. (_ ,78. Code ) 5.,Ther'se7pf c,-system is An proper- working -o{rder l(-,at the present time . - O A / d G 6. Pumped septic tarik' at time of inspection . 7 . The leaching pit is dry at the present time . SIGNATURE:f Name:_,�� _ Company: Josej)h_P. Macomber_& Son , Inc . Address: Box 66 -------------------- Centerville , Ma.-02632-0066 Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • (7JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections 66 Centerville, MA 02632-0066 775.3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ` ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 I ' TRUDY COX Secret.• ARGEO PAUL CELLUCCI DAVID B. STRUH Governor Co iss:oa SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:58 Oxford Drive, Cotuit Name of Owr-Qawn Spitz Ad&ss.e of owner: 125 Foradalca Road Data of trtspection: 6/3/99 Scarsdale, N.Y. 10583 Narrw of Inspector:(Please Frnr ) Joseph P. Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Trtia 5 (310 CMR 15.000) Company Name: Joseph P. Macomber & Son, Inc. MarTuig Address: Box 66, n ryi 1 1 e, Ma _ 02632-0066 Telephorse Nurrsber:5 0 A—77 9-3-3 1 R CERTIFICATION STATEMENT 1 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 Inspection. The Inspection was performed based on my training and experience in the proper function and maintenance of on- It s wage disposal systems. The system: a 3es Conditionally Passes Needs Further Eva uation By the Local Approving Authority _ Fails )) �j Inspector's Sigrtaarre: ( Date: 1"J` / The System Inspec shall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department ohfnvironmerttai Protection. The original should be sent to TrR system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS revised 9 2 98 Pe eIof11 " Printed on R"Ic d P,pe, • I 14 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 58 Oxford Drive, Cotuit Owner: Dawn Spitz Date of Inspection: 6/3/9 9 INSPECTION SUMMARY: Check A, B, C, o/ D: A. SYSTEM PASSES: I have not found any Information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure .criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: XA 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. Indicate yes no,or not determined(Y, N, or ND). Describe basis of determination In all instances. If "not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced ��- The system required pumpirlg•tnore than'fourtimes-a yeardue to broken or obstructed pipe(s). The system wHfpess-- inspection if(with approval of the Board of Health): - broken pipes) are replaced obstruction is removed revised 9/2/98 Page 2of11 ' SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (cominuad) Nop.MAddrass: 58 Oxford Drive, Cotuit 0wr'er. Dawn Spitz Ddrta of 4up c%"V 6/3/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD.OF HEALTH: Concildons exist which require further evaivadon by-the Board of Health In order to detern-Jne If the system Is lulling to protect tr public health, safety and the anvtronmant. 1) SYSTEM WILL PASS UNLErSS BOARD OF HEALTH DETE)WINES IN ACCORDANCE WfTH 310 CMR 16.3,03 (1)(b) THAT TX.E SY IS NOT FUNCTIONING W A VLAXXER MUCH.WILLPRO.IECT THE PUBUC 8ZALTUAND SAFETY AND THE &O[ 0N1.tE?!7_ Cesspool or privy is within 60 feet of surface water Cesspool or privy Is within 60 fast of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBUC WATER SUPPLIER. IF ANY)DETER3.tiNES THAT THE SYSTE FUNCTIONING IN A MA"ER THAT PROTECTS THE PUBUC HEAL-Ai AND SAFETY AND THE ENYIRONwENlT: �Q The system has a septic tank and soil absorption system(SAS) and the SAS Is within 100 feet of a surface water suppl tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a pubic water supply weu. The system has a septic tank and soil absorption system and the SAS Is wlWn 60 fist of a private water supply weu. The system has a septic tank and soil absorption system and the SAS Is Isss than 100 feet but 60 feet or more from . private water supply well, urtlsas a well water analysis for coliform bacteria and volatils organic compounds Ind;cates v,. well Is free from pollution from that facility and the pis a ca of ammonia nitrogen and Nuats rtltrogen is equal to or le r than 6 ppm. Method used to dstsrmine distance- �(// (approxJmadon not valid).- 31 OTHER A1,) R revised 9/2/98 Page 3of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (corrdnued) PropeMAddre": 58 Oxford Drive, Cotuit Owner: Dawn Spitz Data of Irupaedon: 6/3/9 9 D. SYSTEM FAILS: You must Indicate either 'Yes' or 'No' to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination Is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup oFsewage into iacili"r-vTstem componentdua¢o an overloaded orcbgged'SASor•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 q��rfb�o box above outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth in 6*"P"is fess/+'th(an 6' below Invert or available volume Is less than 1/2 day flow. Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s). Number of times pumped�. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. _v Any portion of a cesspool or privy Is-within a Zone I 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 lots than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable• anach copy of well water analysis for coliform bacteria, volatile organic.compounds, ammonia nitrogen and nitrate nitrogen. I . I E. LARGE SYSTEM FAILS: You must indicate either 'Yes' or 'No' to each of the following: The following criteria apply to large systems In"addition to the criteria above: ivri The system serves a facility with a design flow of 10,000 gpd or greater'(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No OVA the system Is within,400 feet of a surface drinking water supply the system•la wlthks 200 1&st ol-rt«butaryAo a surf&Oo dririkirag.watw-6upP1Y the system Is located In a nluo9en sensitive area(Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further Inforfrtation. revised 9/2/98 Page 4of1► SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 58 Oxford Drive, Cotuit Owner: Dawn Spitz Data of Inspection:6/3/99 Check if the following have been done: You must Indicate either "Yes" or 'No" as to each of the following: Yes No A Pumping Information was provided by the owner,occupant, or Board of Health. None of the systemsompowanu ka"baen purnpad4*ratJa4st two-wea,"and•the'system hasba.eaaecaiuiag.rsa.al tlow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this Inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was Inspected for signs of sewage back-up. 41 The system does not receive non-sanitary or Industrial waste flow. >i1 — The site was inspected for�signs of breakout. _ All system components,.0%ftluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffle! Of Was, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on,the site has been determined based on:- Existing Information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C Is at issue, approximation of distance is unacceptable) / 115.302(3)(b)) The facility owner.(and-accupa=,If d)fiaraw frnat.osunatl.weraprvuided.wiih ininunatioaon 1 a���Plnainta��� �( SubSurface Disposal Systems. I revised 9/2/98 Page sof11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreas:58 Oxford Drive, Cotuit Owner: Dawn Spitz Date of Inspection' /3/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: )l0 g.p.d./bedro Number of bedrooms NMI) ): Number of bedrooms(actual):ff Total DESIGN flow , Number of current residents: Garbage grinder(yes or no): Laundry(separate system) ( s or If yes, separatelupaction.required Laundry system inspected _ e or no) r I` �[}© �"�� f�o� ��CT�P- Seasonal use(yes or no):..111i,�+' Tr L / Water meter readings,if avail ble (last two year's usage(gpd): Sump Pump(yes or no):�� Last date of occupancy: COMMERCIALANDUSTRIAL: Type of establishment:_ Design flow:_d gad ( Based on 15.203) Basis of design flow 1. �/q Grease trap present: (yes or no)—A/* Industrial Waste Holding Tank present: (yes or no)A)Y Non-sanitary waste discharged to the Title 5 s stem: (yes or no)_A�4 Water meter readings,if ava'la le: Last date of occupancy: OTHER:(Describe) Lest date of occupancy: GENERAL INFORMATION PUMPING RECORDS afid source f nformation: System pumped as part of inspection:(yes or no) If yes,volume pumped- gallons �) Reason for pumping: IM"dD �Z4& � �T eAvy TYPE OF YSTEM 'T 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) � i/A Technology etc Attach copy of up to date operation and maintenance contract Tight Tank � / Copy of DEP Approval Other APPROXIMATE AQX of all pompons , date(nstalfed{if known)-end source.of4Aformation: 1,�6�- Sewage odors detected when arriving at the site:(yes or no) revised 9/2/98 Page 6of11 i SUBSURFACE SEWAGE DII° OSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropaMAddre": 58 Oxford Drive, Cotuit Owrw, Dawn Spitz Dsts+of Vapoctson: 6/3/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade:, Materlal of construction: _cast Iron 40 PVC _other(explain) Distance ho .privats water supply well or auction line Diameter . . — Comments: (condition of joints, venting, evidence of leakage,-Gtc,) Joints a . s em is SEPTIC TANx: Q9 (locate on site plan) Depth below grade:rl Material of construction: concrete_me al—Fiberglass _Polyethylene_other explain) If tank Is (metal,list Jage • Is.age.co_nfru�med by Certificate of Compliance (Yes/No) Dimensions: i / tr 7 Sludge depth: — Distance from top of al ,dge to bonom of outlet tee orbafite: t/ Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bon of o tie tee or baffler How dimensions wets determined: Comments: (recomrnsndstion for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level In relation to outlet invert, structuto"ntegrity evidence of leakage, etc.) P-i m'D"tank"eyePy 2-1 ;ears T n I ct- R. a„r'l or tees are in GREASE TRAP: (locate on alte plan) Depth below grade: Matsr(al of construction-/wconcretell fmsta&FiberglasrVIPolyethylene?:dother(explain) Dimensions: Scum Wckneaa: Distance from top of scum to top of outlet tee or baffle: �A Distance from bottom of } um to bottom of outlet tea or.baffle: Date of last pumping: • Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level In relation to outlet Invert. structural integrity evidence of leakage, etc.) Grease trap revised 9/2/98 Page 7ofll t <} SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Nop-tyAd&—: 58 Oxford Drive, Cotuit owner: Dawn Spitz Data of Inspection: 6/3/9 9 TIGHT OR HOLDING TANK.A"(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grader Material of consuucuon�concteta)apetal,IQFibergia3&VAPolyethylene,&other(explain) AM AM Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes4 NoA0 Date of previous pumping: 1,0 _ Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tight or holding ranks are notpFeeent . �J DISTRIBUTION BOX k (locate on site plan) Depth of liquid level above outlet Invert: Comments: (note-if level and distribution is equal, evidenoo of solids carryover, evidence of leakage Into or out of box, etc.) Distributi nn hhy _hns ga® evidence of sultds carry nver Nn id nee _ems__7 i s.�a[ a 1DOX . PUMP CHAMBER:�r(NQ� (locate on site plan) Pumps in working order:(Yes or No) V,4 Alarms In working order(Yes or No)� Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) ump chamber is not =rpgpnt revised 9/2/98 Paee8of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropanyAddreas: 58 oxford Drive, Cotuit Owner: :Dawn Spitz Data of Irupectia,: 6/3/9 9 SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,If possible:excavation not required,location may be approximated by non intrusive methods) If not located, explain: Type: leaching pits,number., leaching chambers,number: leaching galleries,number: Q leaching trenches,number,length: —�t— leaching fields, number, dimensions:_ C overflow Cesspool, number: Alternative a �C ) Namee of o1 Techno ogy: �•�Us•,(�.D1 Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) Loamy saaf. te--i ifte—e-6'Sr'9'E--send'--No signs ozE hydrattlie failere 017 P0111111g . Solls are dry. Vegetation is normal . CESSPOOLS: y (locate on site plan) Number and configuration: Q Depth top of liquid to inlet Invert: ADJJ Depth of solids layer: Depth of scum layer: Dimension's of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of Inspection) Cesspools are not present _ Comments: (note condition of soil, signs of hydraulic failure,.level of.ponding,condition of.vagetation, etc.) Cesspools are not present , PRIVY: /tom. ,lam (locate on site plan) �Q ,�)�J Materials of Construc 'on: �'r Dimensions: /!//, Depth of solids:` dorrirnenW (note condition of soil, signs of hydraulic failure, revel of ponding, condition of vegetation,etc.) Privy is not nrpsent _ revised 9/2/98 Pa ee9 of 11 i SUBSURFACE SEWAOF.DISPOSAL SYSTEM INSPECTION F0RM PART C SYSTEM wr-oR1d.AT10N (c"drek4d) PITyA�,�,; 58 Oxford Drive, Cotuit op60%Wr-n Da-wn Spitz 0.L cl 4up.coon: 6/3/9 9 SUTCH OF SEWAGE DISPOSAL SYSTEM: lncluds tlss to at Isast two psrmansnt tslsrsncs landmarks or benchmarks local$ all wells wlWn 100' (local$ whs(s public water eupply comas Into hou+e) 0x ro,-d �r revised 9/2/98 Pip 10of 11 �I ` h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 58 Oxford Drive, Cotuit owner: .DaWA Spitz Data of Inspection: 6 3 9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater L Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site (A�Ioc.l property observation hole, basement sump etc.) Determined fromnditions Checked with local Board of health cked FEMA Maps Checked pumping records : Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map . Gahrety & MIller Model . revised 9/2/98 Page 11 of 11 A 1 1r•w.nr•�.-nir►r••�rrn'-yew•nmr�-wn+�.�.r►..wn�.•+��.rnw�.nm r.�rwv.s'�irn ws+ .. .rn-.-.--►-.a^.n-'..� .- TOWN OF —B A RNSTABI R WARD OF HEALTH 11� SUIISURFACR MAUR DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION ' t�•T1�T•'.::.-1.IIn�.tTRTr'll•.I.l'1T1fIRil..wT:r11."{VT11" �—T�R1��I/l�1TRfr1 lrT flYRTTT.T�TT'r��•.�..•T' +-�. —..� -TYPE 0A PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 58 Oxford Drive Cotuit ' ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Dawn Spitz PART D - CERTIFICATION 1 NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAME Joseph P. Macomber & Son', Inc . COMPANY ADDRESSBox 66 , Centerville Ma . 02632-0066 Street Town or C1ty scat. ZIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 ) 790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate ) and complete as of the time of The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one ; -A Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have concocted has found that the system fails to protect the public health and the environment in accordance with Title 51 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature - � Date One copy of this certification must be provided to the OWNER, the BUYER ( uhare applicable ) and the BOARD OF .IIEALI`ll. If the inspection FAILED, th'e owner or"*operator shall u within one year of the date of the inspection, unless allowed dortrequiredm otherwise as provided in 3.10 CMR 16 , 306 . partd . doc Sewage Permit No. Location: Village: l k E' g N- . Installer's Name & Address Hr-.41k7)!!� C. LAffje7—,6� -Z-e-. 1 /67 M,41r#RA R^-- MA Builder's Name & Address /�G��yi4A� CaNSm- erzotv Date Permit Issued Date Compliance Issued �� jdyz �4 .-407 J f i I ' ` "'tea' 34 i „l,fc o o _ TOWN OF BARNSTABLE LOCATION��' '00'0 i'' fc.d !'�'i¢SEWACE #_ VILLAGE ® ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY__ LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER . BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ca 0 0 No..E. G.... s Fxs...3.J.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH OF...................................... ............................. Appliration for Bi-qVviial Worls Tomitrurtion Errant Application is hereby made for a Permit to Construct ((,)/or Repair ( ) an Individual Sewage Disposal System at: _ • .... ..'�... }?5:..�'.9.. ...-� .......-- �-7 ...........-•----------------------------------- -----------•---------•----•------------------- � . - ocation- ddress or Lot No...1R..� .. ....LT.2=..................:................ ..........•----••-•--------•--- ---•.....----...--------•------•- -..-.. Olej � Address ------------•------------- -------- �-.--.---.----.-•------------.-----•---------- Installer Address Type of Building Size Lott _ /..... ....Sq. feet U Dwelling—No. of Bedrooms_....................................Expansion Attic ( ) Garbage7,Grinder ( ) � Other—T e of Building g _____.....,v.,,..___ No. of persons____________________________ Showers !( ) Cafeteria ( ) Otherfixtures --------•---------------------- ----- - - --------•--•----------.------------�--------•-------------- --------= ...------------------ W Design Flow.n ............•..............gallons per person per day. Total daily flow..... .c ....................gallons. R; Septic Tank—Liquid capacity allons Length.............•.. Width.................. Diameter................ Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................." Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......._................ Q+' ••-••-••••-•-•-•-•--•-------••-•••....._..••••••••••••••---•-•-•••.................................................•••..__...••----......•.._..._......'- . 0 Description of Soil........................................................................................................................................................................ V .....•-••••-•••---••••-••••••--•--•••....--••-----.....--••••-••••..................•••...... -• ••=-•-•-•••••••••••-•--•••••••••-••-•••--••-••--••-------...•-•••-•--•••....................••--_-•••• -- W •••••••-•-••------------------•-•-•••-••••-••---•••••-•--•-----••••--•••-•••••---•-•-•••••••••-----•----••-••••---------....------•••••••-•• --•-•-••................................................ U Nature of Repairs or Alterations—Answer when applicable_____________________________________________••-•-•--•_.••-•- ................................. -•------•-----------------------------------------•-------••-•--•-•-•--••--•-•--•----•........--•••--•••--••-•••-••••--------•-••-----•.....•-•••••-•••••-••••-•-•••••••-•-•-•••••••-••......•----...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of _1 Z' 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe ° r c - rte ...........Application Approved By•• •--- --••••. . ............... ----- r� �� �........ Application Disappr ed th following reasons---------------••---------•--•-•••---•--------------------------••.............................................. ..............•••••......•....• •----•• ......••• •-••••••••-•-••••••••-----•••.............-•••-•••--.._............................................................................................. Date Permit No.. ...................•-••--- ............... Issued........................................................ Date � �' .No. E ` aZ Ea.... ..............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... .........................OF........................ ............. AVVftratiutt for UhipasFal Works Tomitrurtiutt Vamit Application is hereby made for a Permit to Construct ((-,)'or Repair ( ) an Individual Sewage Disposal System a7 � Cho A4.L7`, .............. kocatlo/ fs or Lot No. ........ ......... .............i ................................................ .........................................................................................._..... W � 01 /. es ....................................................... �r�-- ...-:..........-. �..........------------••..................--------- Installer Address. J �/ d Type of Building Size Lot..__..._._/_...............Sq. feet Dwelling—No. of Bedrooms_ .....................................Expansion Attic ( ). Garbage Grinder ( ) A4 Other—Type T e of Building ... No. of persons............................ S a, yP g ------=--- --- P la(;)) — Cafeteria ( ) a' Other fixtures ............................ W Design Flow ...:................. . .gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacitr..........gallons - Length................ Width.'............. Diameter................ Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R,' :.. Descriptionof Soil... r`. .....--•---•----------------•---------------•-----••----------------------------------------------------------------------•--•-•------------- �l ....................................................................................................`_n....-----...----------....---.............._..._.....__.._........................................ UNature 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 TITTE 5 of the State Sanitary Code— The undersi nedhi e agrees noto place the system in operation until a Certificate of Compliance has bee the bof . ��_Sign ....... ......_.... D Application Approved B ��`" ---•--.....----•--------------------------------•---•--••------•------ Date Application Disapp ve . r t following reasons----------------------------t.................................................................................. ............................. ••... ......... .........•--------•----•----------------•-•--••••----•-----••------•---•--•---------•-•-•••-----------•-----•-•-•-•-----------•-------------•••-..--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS �..,�' BOA OF H A H ............................................�.... O F ........::....::.......... .......................................... rrtifiratr of Toutpliatta 1 IS T RTVY, T} t ividual Sewage Disposal System constructed or Repaired ( ) by........_ ��...° .....--- ------------------------------------ ------------------......----------•------------------........-- Installer GO---_�"' '�--••-•--- �......•----•-•------.._...-•-...... ¢ gut,*� , at...... :... I( -- has been installed in accordance with the provisions of TIC: 5 L+} e State Sanitary Code as described in the application for Disposal Works Construction Permit No-----__.. _ ^- ...._.._._. da.ted_._/............ .......................... ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRU_0 S G�V ARANTEE THAT THE SYSTEM WILL F14NCT40N SATISFACTORY. r, DATE.......... .. Inspector . . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NoV ................ J ................. Uispo a)Uprl notr iuri amit Permission�i ereby granted.---- ------------•--•------•-----(1�....................................---.................................................... to Con�ru�c - ss ),,.�Reie* � Ind irkal Sev%��g��ispq�System at No ...�r dd �� LL//�� // ..----•-------------• -... ....................................................................................................go Street as shown on the application for Disposal Works Construction Permit No.... _.r la_•-._ Dated_.__.___.. 1A ,4........... .............................. 1 ` ..... .......... Q .. ........ Board of Health DATE.......... •---•---.......... 1_r(�.-- "---9-_-� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 24' 6LECTRICAL io unUTY ROOM HM UP 0 1 1 \SMOKE LL:J;=-= SCALE: 1/4"= 1 FT. LIVING AREA 657 sq ft BASEMENT GAME ROOM DAVID BROWN MD 55 OXFORD DR. COTUIT, MA x 26'10"2 13'0"2 1310 NEW ANDERSON TW21042 CLEAR OPENING 4.92 SQ. FT. - / 9) BEDROOM LIVING ROOM ' 0i V EXISTING c N U� 00 KITCHEN co v is \V/ UP k` Eo r N r� N PROPOSED GAME ROOM ti (SEE ATTACHED FLOOR PLAN) r a 26'10"2 ` LIVING AREA 1177 sq ft + DAVID BROWN MD 58 OXFORD COTUIT, MA 4 Arr) ALWAYS DIG SAFE PRIOR TO CONSTRUCTION--UTILITY LOCATIONS SHOWN INCOMPLETE. JOB NO. B04-02 c NOT TO NOTES Gibson.dwg o` Eon. SCALE co REDUCE GRADE OVER LEACHAREA too B OR USE EXTRA PEASTONE ON 1. LOCUS IS A.M. 21, PARCEL 64. �� 2. ELEVATIONS SHOWN ARE ASSIGNED. c� *CAUTION: THIS IS A SITE PLAN Q o UPSLOPE SIDE SO COVER IS 3'. 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED JULY 2, 1992. gV S41. a' SURVEY, AND NOT A PROPERTY O 4. ALL PIPES TO BE 4„ SCH 40, AND PITCHED AT 1/4 PER FOOT. (UNLESS NOTED) i!zN LINE SURVEY BY THIS OFFICE. a 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. ADDING 2.00 TO THE DEED O N/F 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. m 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". -6 O FRONTAGE OF 164.84 PRODUCES O 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW 6° A LOT CONFIGURATION WHICH F- -H GRABSCHIED D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. CLOSES. (HEAVY LINE SHOWN.) ET AL 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. °ro M COVERS: BUILD UP COVERS TO 6" BELOW GRADE--2 ON TANKS, 2 ON LEACHING AREAS. o 23.8 24 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH. 2- MIN. 1/8 TO 1/2„ PEA STONE ON TOP. LOCATION MAP -- 24 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. BENCH MARK--TOP OF CONC. x 24,6 12., IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING ® CORNER= 32.07 ASSIGNED x 24 9 IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST HOLE 1 x 25,6 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN 26 6 �' LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. DEPTH (inches) ELEV.(fe6t) 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. .. 0 310 N/F TEST HOLE DATE: March 15, 2004 8 Fill BENCH MARK-TOP REAR CENTER PERFORMED BY: Ron Cadillac, Soil Evaluator „ X 2 8 JOB B 2 x 27.2 GRABSCHEID SEPTIC TANK = 30.75 ASSIGNED WITNESSED BY: Dave Stanton, Inspector B layer 10yr 5/6 / 0 S t►3, 9 PERC RATE: <2'-00"/inch (C layer) loamy sand 9 •�29. SOIL SURVEY(1993): Carver coarse sand 32„ .00. GEOLOGIC MAP(1986): Mashpee pitted plain deposits 28.3 U N F 29,3 JO 0 //� Invert 29.53f Invert 27.80 a / x 29,3 / I �J 3 Use Gas Baffle 6 Infiltrator 3050's BLAKH / �\ 4 ,a N O 6 Existing Psoposede Gas Baffle Invert 27.53 C layer 2.5y 6/4 0.75 / \ Proposed A-27.5 A X 3 ^O 29, B-26.3 medium sand 9 1.6 TH / 1 Existing Top Peastone„ (5% gravel) 16 -9 0 0 1000 Gal. Proposed S=13/8 /ft „ 4 Inspection 30,6 0 Conc. ....._ � '5,15 Plastic S=1/4 /ft ----�ort 3 Jobl]� \ 1000 cal. - - De S=1 1/8"/ft 24" „ no water 18.8 Deck/ to Invert 2$.05 147 � x 31,1 '� Proposed P.6 i o "_'.......:..::..... a p Invert 27.70 Invert B 25.80 CD D A-6 2' B-23.8 / ,� .8 EXISTING HDv � 32 6" StOn i Or compact iroposed Proposed r .v B-5; Bottom / SE 2.51 I 1 rv_I A-26' w°/k N 5 3' Bot. TH1=18.8 x 35.0 / T°Out B°S8 en - ` r- 1 I < I B-19' i Hi h Groundwater=16.4 p I t -Tl/ 7� °b-32 s cn 2.6 USGS Adjustment �, q 36.2 E DESIGN DATA XIS :::..... "" Mash29-Feb.04-Zone B 8... Pond El. ( / / ) =13.8 3 q 3 15 04 1- 3 .� GAR BEDROOMS: 5 �O L� �� :::... ..... 4,6 x 38,7 37,4 GARBAGE GRINDER: No H71)P .3>+ ev / x 35,6 REQUIRED CAPACITY. 550 GPD LEACH AREA Zi1 07 37' x 37.9 2 SEPTIC TANKS: 2000 GAL. USE 6 INFILTRATOR 3050'S IN TWO - ` 3 ,30 3 N�F BOTTOM LEACHING AREA: 557 SF LEACH AREAS. LEACH AREA A USESi - 3 3050'S WITH APPROX. 4' STONE ON36,8 I - -�- x 37.8 �o ,�3 ROJEE [(23.5' X 12')+(27.5' X 10')] THE SIDES AND APPROX. 1' STONE ON L_ - = 37.1 I x T7 M o 6 SIDE LEACHING AREA: 292 SF , - - _I THE ENDS FORA12 X23.5 X2 3 � 37.8 �' ;� � � [2(12'+23.5')+2(10'+27.5') X 2' DEEP)] LEACH AREA. LEACH AREA B USES 3 3 / -� ( 8 DESIGN CAPACITY: 628 GPD 39,5 38,3 RESERVER AREAS �38,4 x 38,3 3 3050'S WITH APPROX. 3 STONE ON THE BOTH 10' X 25 x 37 8 [(557 SF + 292 SF) X .74 GPD/SF] SIDES AND APPROX. 3' STONE ON THE \ X 2' DEEP 8,06 ENDS FOR A 10' X 27.5' X 2' DEEP 39,6 � 38,3 .�- _ 38,64 3 ,4 LOT 77 LEACH AREA. r� VIU k'''le'r�- Zp p \ / 1 jp / o 39 6 38.9 BOARD OF HEALTH REQUIRES \ 39,59 39, 410 40,5 R.J. CADILLAC TO INSPECT O PRIOR TO BACKFILL 0\ � 4 x c \ /1,5 40,85 0 417 " UNDERGROUND ELECTIC 4 41.7 NOT SHOWN SITE PLAN 41.17 x 42,2 42,1 42 x 42, .6T FOR �40A7 p 5.45'So' w THIS PLAN IS A VALID COPY ONLY IF IT BEARS AN ORIGINAL RED STAMP AND SIGNATURE. JOSEPH & DIANE GIBSON r A44DRI jHOFMgssgcy LOT 779 58 OXFORD DRIVE, COTUIT, MA LEGEND 40,56VE �° RONALD Gym ��� ON LE) \ MARCH 23, 200�- SCALE. 1 "=20' 0 JAMES o JA ES CADILLA " A LLAC •0} TH 1 TEST HOLE LOCATION, NUMBER 1 0 # a �✓ o WATER LINE MARKINGS /S V- � Fc Al S`s�° e G GAS LINE MARKINGS S'gNiTA?,\N q O suRVE�o RONALD J. CADILLAC, PLS, RS x 9.5 X $,7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) r -6-- EXISTING CONTOUR Z �j I PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN g-- PROPOSED CONTOUR P.O. BOX 258 ® EXISTING DRAINAGE CATCH BASIN WEST YARMOUTH, MA 02673 x - FENCE (IF SHOWN, NOT ALL SHOWN) (508) 775-9700 TREE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL DATE PAGE 1 OF 1 C 2004 BY R.J. CADILLAC NO?' TO .,`C„74 E" TGIF? 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