Loading...
HomeMy WebLinkAbout0874 MAIN STREET (COTUIT) - Health 2tr, )yster Place Read, Cotuit 77 �—. k I k� �� k p36-e p8 c Commonwealth of Massachusetts Title 5 Official Inspection Form l' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 20 Oyster Place Road(Cottage Only) Property Address c *- Alec&Aubrielle Tesa Owner Owner's Na e = information is Cotuit Ma 02635 6-10-2020 required for 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. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer,use only the tab Daniel Hawkins key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 ra Company Address Sandwich Ma 02563 City/Town State Zip Code rrn (508)477-0653 S114324 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Dan Hawkins Digitally signed by Dan Hawkins Date:2020.o6.7207:35:40-04'00, 6-10-2020 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Road (Cottage Only) emu, Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ■❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/2612W8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y. ❑ N ❑ ND(Explain below).- obstruction is removed' ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to'determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t, I 20 Oyster Place Road (Cottage Only) V� Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020- required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: i 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ a Discharge or' ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I; 20 Oyster Place Road(Cottage Only) u Property Address Alec&Aubrielle Tesa ` Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Q 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 '/2 day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water,supply. ❑ a Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El 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 2000 gpd- 10,000 gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 I Commonwealth of Massachusetts w Title 5 Official Inspection Fora �1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Road(Cottage Only) V� Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is.considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6.. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ 0 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? ❑ E Has the system received normal flows in the previous two week period? ❑ O Have large volumes of water been introduced to the system recently or as part of this inspection? El ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? F ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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? ❑ Q 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: ❑ El Existing information. For example, a plan at the Board of Health. o ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts +n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Road(Cottage Only) v� Property Address Alec&Aubrielle Tesa Owner Owner's Name information is required for every Cotuit Ma 02635 6-10-2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: No design plans 1 Number of bedrooms (design): Number of bedrooms(actual): NA DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: No design plans or permits available at local Board of Health. 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes rol No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes Ej No Seasonaluse? ❑ Yes IF No See below Water meter readings, if available (last 2 years usage(gpd)): Detail: Shared Meter with main house Sump pump? ❑ Yes N No Last date of occupancy: Sept. 2019Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspec ion Form:Subsurface Sewage Disposal System•Page 7 of 18 / i Commonwealth of Massachusetts Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Road(Cottage Only) u Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment.- Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Owner- date of last pump is unknown Source of information: Was system pumped as part of the inspection? ❑ Yes X No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635. 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 4. Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. 0 Other(describe): Septic tank and Pit Apprpximate age of all components; date installed (if known)and source of information: unknown due to lack of record Were sewage odors detected when arriving at the site? ❑ Yes ®❑ No 5. Building Sewer(locate on site plan): 3010 Depth below grade: feet Material of construction: - r ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town waterfeet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.R26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3 u 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2011 a Depth below grade: feet Material of construction: ■❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) x If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 000gallons 10" Sludge depth: 2611 Distance from top of sludge to bottom of outlet tee or baffle 311 Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 13" Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? r Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u- 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is required for every Cotuit Ma 02635 6-10-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ±= — 1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ I 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.). , 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): NA Depth of liquid level above outlet invert 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.): t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 it Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .......... � 20 Oyster Place Road(Cottage Only) v� Property Address Alec&Aubrielle Tesa Owner # Owner's Name information is Cotuit t Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ W Comments(note condition of pump_ chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: Elleaching'pits number: (1) 6'x6' pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: -4. ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - 11. Soil Absorption System (SAS) (cont.) s Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. The leach pit was dry with a stain line 3/4 up from the bottom of pit. _ �k 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 rr" Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Road (Cottage Only) v� Property Address Alec&Aubrielle Tesa Owner Owner's Name information is required for every Cotuit Ma 02635 6-10-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): 'Materials of construction: NA Dimensions Depth of solids t Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): M� l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotui4 Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ■❑ hand-sketch in the area below ❑ drawing attached separately Front of cottage A B j 1 Al-10' 81.16' A2-46't 82.44' a o e t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Forma Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �C\vj 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code . Date of Inspection D. System Information (cont.) 15. Site Exam: ■❑ Check Slope ❑® Surface water ■❑ Check cellar FM Shallow wells Estimated depth to high ground water: No GW @ 10' feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record - *plan for main house on same,property If checked, date of design plan reviewed: Date 0 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: t , You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. The perk was done for the main house on property. Perk showed no ground water at 120". Bottom of SAS is above high ground water. Plan dated May-10-2006. f r Before filing this Inspection Report, please see Report Completeness Checklist on next page. J t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form ,I; Subsurface Sewage Disposal System form -Not for Voluntary Assessments 20 Oyster Place Road(Cottage Only) Property Address Alec&Aubrielle Tesa Owner Owner's Name information is Cotuit Ma 02635 6-10-2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: �■ A. Inspector Information: Complete all fields in this section. ❑e B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑s C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed On D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Town of Barnstable Barnstable ti Regulatory Services Department aitaCity 9`A i639.16 `Er Public Health DivisionRNS �m �@ 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO I CERTIFIED MAIL#7015 1730 0001 4987 6414 December 13, 2017 TESA,ALEC R&AUBRIELLE 210 ISLAND DRIVE MIDDLETOWN,RI 02842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 20 Oyster Place Road, Cotuit, MA was last inspected on 10/13/2014,by Paul Martin, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00)Due to the following: • A system component (septic tank) is located beneath the driveway. It has been determined that this is an H-10 and should be replaced with an H-20 which is designed for vehicular traffic. • The leach pit is also partially under the paved driveway. It is not known if it is constructed of heavy duty loading(H-20)which is designed for vehicular traffic; this too should be an H-20 component. The septic tank issue must be rectified before April 26, 2018. The leaching pit may not be constructed of heavy duty loading. When it is unknown whether or not a particular system component which is"located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20),the system shall also be deemed as a"conditional pass." Oothe:Board OF THE BOARD OF HEALTH ea S. CHO of Health Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Conditionally Passes Letters\20 Oyster Place Cotuit Third Notice.doc I 4a First-Class Mail Postage&Fees Paid USPS Permit No.G-10 f 9590 9402 193j36123 1789 27 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service - - I I Town of Barnstable I Health Division 200 Main Street I I Hyannis,MA 02601 I I l.�f;�1,1�1�11rr11�1��IIt1�1������t���al�ll,t�l����111a11��1+�1:t wismamniffio ■ Complete items 1,2,and 3. 7Signture■ Print your name and address on the reverse ❑Agent so that we can return the card to you. ❑Addressee ® Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. I I D. Is delivery address different from item 1? El Yes If YES,enter delivery address below: ❑No I TESA,ALEC R&AUBRIELLE 210,ISLAND DRIVE I MIDDLETOWN,RI 02842 I `- 3. Service Type ❑Priority Mail Express® II I�III�I III I�I I II I II I I 'ItI I(�I�I)I IIT�I II� ❑Adult Signature ❑Registered MaIITM ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted Certified Mail® Delivery 9590 9402 1933 6123 1789 27 Certified Mail Restricted Delivery YQ Return Receipt for ❑Collect on Delivery 1 Merchandise 2.-Article_Number-(Transfer-from__service/ab-- ❑Collect on Delivery Restricted DeltvPpy F❑Signature ConfirmationTM I ❑Signature Confirmation 7015 17 30 0001 4 9 8 7 6 4`14 t{ �'Restricted Delivery 'Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Doifiestic Return Receipt [�- OFFICIAL USE ep Certified Mail Fee Er $ 03 Extra Services&Fees(check box,add tee as appropriate) 1;S ❑Return Receipt(hardcopy) $ ,, 0 C3 ❑Return Receipt(electronic) $ r Postm5HIO� ••'' Certified Mail Restricted Delivery $ ��; + 3 ❑Adult Signature Required $ • �� []Adult Signature Restricted Delivery$ �1• p Postage -- -- m r- Total Postage an �5e� $ TESA,ALEC R&AUBRIEL E U1 Sent Tr-qo 210 ISLAND DRIVE O SfieetandApt N MIDDLETOWN.RI 02842 .w""..:" r— Ciry Stafe,ZIP++ Certified Mail service proviiies the following benefits: ■A receipt(this portion of the Certified Mail labeill for an electronic return receipt,see a retail_, ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,presentthis delivery. USPS®-postmarked Certified Mail receipt to the- ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period, delivery to the addressee specified by name,or to the addressee's authorized agent. .1 Important Reminders. Adult signature service,which requires the L ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail",First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified. ■Insurance coverage is notavallable for purchase by name,or to the addressee's authorized agent:, with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a l certain Priority Mail items. USPS postmark.If you would like a postmark on o For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mall item at a Post Office-for � the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion, of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt attach PS Form 3811 to your mailpiece; IMPORiAP17:Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 pmci ru ru C3 0, Certified Mail Fee 0r $ Extra Services&Fees(check bar,add tee as appropriate) ❑Return Receipt(hardcopy) $ O ❑Return Receipt(electronic) $ Posirnad(,,, • O ❑Certified Mail Restricted Delivery $ 4 Here -_ 0 ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ O Postage m $ rqTotal Postage and Fees L� Ln Sent i a TSA,'ALEC R AUBRIELL.`E'" r. 2104SLAND DRIVE.. MIDDL"ETOWN, RI 02842 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail •A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. 9, , •—% USPS®-postmarked Certified Mail receipt to the •A record of delivery(including the recipients retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the •You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified.. ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). f of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a) certain Priority Mail items. USPS postmark.If you would like a postmark on,,r, •For an additional fee,and with.a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for r the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barooded portion, of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply c- You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.L-.1 electronic version:For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. PS Form 3800,April 2015 tReverse)PSN 7530-02-000.9047 U Town of Barnstable Bafiigtabi Regulatory Services Department A&MeficaCfty ABm I MAS& Public Health Division 200� 200 Main Street, Hyannis MA 0260.1 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4990 2281 May 10, 2017— SECOND NOTICE ' TESA, ALEC R&AUBRIELLE 210 ISLAND DRIVE ` MIDDLETOWN, RI 02842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 "S The septic system located at 20 Oyster Place Road, Cotuit, MA was last inspected one 10/13/2014,by Paul Martin, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system."Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • A system component (septic tank) is located beneath the driveway. It has been determined that this is an H-10 and should be replaced with an H-20 which is designed for vehicular traffic. • The leach pit is also partially under the paved driveway. It is not known if it is constructed of heavy duty loading (H-20) which is designed for vehicular traffic; this too should be a H-20 component. When is it unknown whether or not a particular system component which is located beneath a parking area or driveway, is H710 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20), the system. shall also be deemed as a "conditional pass." Failure to repair/replace the septic system with the deadline period will result in future enforcement action PER ORDER OFT E BOARD OF HEALTH �an .S. CHO oar o ea h.._ . Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\20 Oyster Place Cotuit Second Notice.doc a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd. (2 systems on the property this is the main house) _ Property Address Mycock r+ Owner's Na e �+ Cotuit ✓ MA 02635 3/24/16 35. Cityrrown State Zip Code Date of Inspection 45- W Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 93 1. Inspector: Frank Nunes III Name of Inspector „ saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification } I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/24/16 Inspector igna ure 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. 20 Oyster Place (main house)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 �0 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y` 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Citylrown 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: Pumping suggested every 3 yrs to prolong the life of the system 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: n/a ❑ 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 20 Oyster Place (main house)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 . C Commonwealth of Massachusetts Title 5 official Inspection Forme Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): „ ❑ distribution box is leveled or replaced ND Explain: n/a ❑ 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: n/a 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. 20 Oyster Place (main house)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityrrown 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: n/a 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 20 Oyster Place.(main house)•03108 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 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityrrown 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 than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply . ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 20 Oyster Place (main house)-03/08 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 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 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? ❑ g 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)] 20 Oyster Place (main house)-03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual). 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpdYx#of bedrooms): 330 Number of current residents: 0 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 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: vacant 1 yr per owner Commercial/Industrial Flow Conditions: . Type of Establishment: n/a 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): n/a 20 Oyster Place (main house)•03(08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No pumping per 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2006 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 20 Oyster Place (main house)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-,Not for Voluntary Assessments 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owners Name Cotuit MA 02635 3/24/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 18 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): >10' 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: 12"feet Material of construction: ®concrete ❑ metal El 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: 1500g 3 Sludge depth:' Distance from top of sludge to bottom of outlet tee or baffle >12' l Scum thickness trace-2" Distance from top of scum to top of outlet tee or baffle >2� >2„ Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured 20 Oyster Place (main house)-03108 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 N 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24116 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): n/a 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.): n/a 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): n/a 20 Oyster Place (main house)•03/08 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 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityfrown 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.): n/a "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Oil Depth of liquid level above outlet invert 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.): D-box is approximately 6' below grade, was video inspected and appears to be in good condition. It was not excavated due to its excessive depth Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 20 Oyster Place (main house)•03/08 Title 5 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 M 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: . Type ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ 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.): ' 3 chambers per BOH record. The SAS was probed and soils are compact and dry, no indication of backup 20 Oyster Place (main house)•03/08 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 M 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 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 5 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): v Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure;.level of ponding; condition of vegetation, etc.): n/a 20 Oyster Place (main house)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 r - ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 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, i o A (a 20 Oyster Place (main house)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 . F Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Rd. (2 systems on the property this is the main house) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Per elevation of home F 20 Oyster Place (main house)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,.•� 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owners Name py< Cotuit MA 02635 5/7/16 City town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered iin;any way. A. General Information S1# 11UP- 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/7/16 Insp s Signa re 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. 20 Oyster Place Rd (cottage)•03/08 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 �y 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 Citylrown State Zip Code Date of Inspection B. Certification (cont.) w 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: Pumping suggested every 3 yrs to prolong the life of the system 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: ❑ 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 20 Oyster Place Rd (cottage)•03108 Title 5 Official Inspection Foam: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 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): 0 distribution box is leveled or replaced ND Explain: n/a ❑ 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: n/a 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. 20 Oyster Place Rd (cottage)•03108 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 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 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: n/a 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 ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: , ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 20 Oyster Place Rd (cottage)•M/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 official Inspection Form { Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 Cityrrown 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 than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No , ❑ ❑ the system is within 400 feet of a surface drinking'water supply - ❑ ❑ 'the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection ❑; El Area—IWPA)or a mapped Zone 11 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. 20 Oyster Place Rd (cottage)•03/08 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 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owners Name Cotuit MA 02635 5/7/16 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 NIA) ® ❑ 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)) t • 4 20 Oyster Place Rd (cottage)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 f — Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 City town State Zip Code Date of Inspection. D. System Information Residential Flow Conditions: Number of bedrooms(design): n/a Number of bedrooms(actual): 1 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 110 Number of current residents: 0 - 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 : 9 ( Y 9 (gP )) Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a Design flow(based on 310 CMR 15.203): Gallons per day(9Pd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? e . ❑ 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): n/a 20 Oyster Place Rd (cottage)-03108 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 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: no pumping per 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): No d-box Approximate age of all components, date installed (if known)and source of information: ' 1997 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No F 20 Oyster Place Rd (cottage)•03108 Title 5 OfFcial Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts 4 Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �y 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 517/16 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑cast iron Z 40 PVC ❑ other(explain): >10' 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: 12,Efeet 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: 1000g Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle >12' Scum thickness trace Distance from top of scum to top of outlet tee or baffle ' Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? Measured 20 Oyster Place Rd (cottage)•03/08 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 � < 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): n/a 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.): n/a 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): n/a 20 Oyster Place Rd (cottage)•03/08 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 M 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7116 Cityrrown 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.): n/a *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 n/a Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No d-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: 0 Yes ❑ No . 20 Oyster Place Rd (cottage)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owners Name , Cotuit MA 02635 5/7/16 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries. ' number: ❑ Teaching trenches number, length: ❑ leaching fields number, dimensions: ❑ 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.): Leach pit is of H-20 construction and is partially in the driveway, pit is 3' below grade, cover raised to 6", dry at this time, no indication of past backup 20 Oyster Place Rd (cottage)•03/08 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 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 517/16 City/Town 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. t— o 1 � r V f NO � c 20 Oyster Place Rd (cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high groundwater elevation: Per elevation of home 20 Oyster Place Rd (cottage)•03/08 Title 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 15 of 15 I� Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 5/7/16 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.): n/a t. 20 Oyster Place Rd (cottage)-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 9 1 0"'L-C-R- ca. TOWN OF BARNST'A LE , Health Division—200 Main Street - Hyannis, MA 02601 0-p THE T. -17 v� ti ` 1.2 D/ ��� Date: I4 HAS& ►��0 Number of pages including cover sheet: FO MAy 2 . . . -2-q TO: FROM: ecl�� Town of Barnstable r Health Division' Phone: �5" !Z�3�� rj31U Phone: 508-862-4644 Fax phone: Fax phone: 508-790-6304 , CC: REMARKS: ❑ Urgent ❑ For your ❑ Reply ASAP ❑ Please comment review o ("'A _] IC d F t� CudQ- 1,, our Uc,� sQ 1 l I n f { Co TOWN OF BARNS TA LE y, Health Division—200 Main Street - Hyannis, MA 02601 pp THE FAX 9`bpTya Date: L �., : ,, Number of pages including cover:she]et: .;_]v TO: nn FROM: 17 _ cd�CJ' Town of Barnstable r Healtl`Division' Phone: ~ Pb: ne: 508-862-4644 Fax phone: ,S0y_4AC _ '�� Fax phone: 508.790-6304 CC: REA ARKS: ❑ 'Urgent ❑ For your ❑ Reply ASAP ❑ Please comment review r Town -of Barnstable 13arfistable `0 Regulatory.Services Department Ift MASS snxxsresce, ; V Public Health Division a D. s6;9 1 200 Main Street,Hyannis MA 02601 200� Office: 508-862-4644 h I - 'I�. o £� Richard V.Scali,Director FAX: 508-790-6304 Q. S f �Z Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4990 4827 " +D 0 � Ph� C-A April 25,2016 Ellen F. Mycock PO Box 955 Cotuit, MA 02635 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5. The septic system located at 20 Oyster Place Road,Cotuit, MA was last inspected on Cih—V2014;by Paul.-Martini-a-certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • A system component (septic tank) is located beneath the driveway. It has been determined that this is a H-10 and should be replaced with an H-20 which is designed for vehicular traffic. • The leach pit is also partially under the paved driveway.. It is not known if it is constructed of heavy duty loading (H-20) which is designed for vehicular; traffic; this too should be a H-20 component. When is it unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is ,located beneath a paved driveway without an accessible steel cover to grade and.there are no records on file indicating whether the system component is H-10 or H-20),the system shall also be deemed as a"conditional pass" �s Q:\SEPTIC\Conditionally Passes Ltr\20 Oyster Place Cot Apr2016.doc I �• 0 Failure to repair/replace the septic system with the deadline period`will result in future enforcement action PER ORDER OF THE BOARD OF HEALTH.. ?ean, R.S. CH Agent of the Board of Health Encl: Public and Environmental Health Program Policies, Procedures, and Guidelines ; T Q:\SEPTIC\Conditionally Passes Ltr\20 Oyster Place Cot Apr2016.doc I ) Ron's Excavating Inc Invoice 508-477-0177 81 Echo Road,Unit 1 Date Invoice# Mashpee, MA 02649 5/5/2016 1230 Terms Bill To Ellen Mycock 874 Main Street Cotuit Ma. Customer Fax Customer Phone Project Description F Qty Rate Amount Project location; 874 Main Street Cotuit. Excavate down and locate existing leach pit located beside the driveway and found it to be H-20 and empty. Install new riser and cover to 6" of grade. 400.00 400.00 Price Includes; a.2'of ads pipe$50 b.New concrete cover. $40 c. Special ring for pit. $75 0.00% 0.00 . Total $400.00 Payments/Credits $0.00 Balance Due $400.00 . t. 1 Page 1 of 1 Stanton, David From: Chris Fitzgerald [chris.fltzgerald@nemoves.com] Sent: Thursday, May 05, 2016. 8:07 AM To: Stanton, David Subject: 20 Oyster Place Rd Hi Dave, Attached is the septic report for the cottage located at 20 Oyster Place Rd. It received a conditionally passed status because the septic tank is an H-10 and the leaching pit was partially under the driveway. As you can see in the before and after photos, we dug up the driveway that was over the septic tank and had another licensed inspector look at the pit. You can also see in the pictures the leaching pit is 7 inches, which I understand is a H-20 pit. Could you please advise how we can move forward with a passing title v? C3 . . '. RESIDENTIAL BROKERAGE 'a The information in this electronic mail message is the sender's confidential business and may be legally privileged.It is intended solely for the addressee(s).Access to The sender believes that this E-mail and any attachments were free of any virus;worm,Trojan horse,and/or malicious code when sent.This message and its attachmer Nothing in this email shall be deemed to create a binding contract to purchase/sell real estate.The sender of this email does not have the authority to bind a buyer or se . i . 5/5/2016 r. r� u: 7•a - I 4 41 ..- I ,, `*., �,�T�-Y,. `# �4��,�f�p `,?� 'S .� ... �.. tom+• � "��. '�' a,,y. L✓ yr„ �Z���,i'�a�'M���i '�� t 5 3w • I I(I� h.:..Y t .t•• i 46 1' 1 I•F r • g �•. I� k�fa y � fill 17. �� 4 iaM +'G r 7 , t �� �, •.�•y o -� `. ..,..• mod., i r �r eF .� r-r // �yyfj�► .c x r 3 J y jj f r I r r'a�Yt rr�eiSR4'q tik4M e�+"l a Jt. v'' 4!"- K Ir , � ,� �,,a i��*k ,n•�+r"<y'w�`°"'�s Y�tita',�tr.4rti���ri x�6`«C'f �.e+, �p+,�,9y .wb`�� "ti;;.�+y�,Fy1�.t G,,, +•y..ryrrf,�R�{�„��.�.a���FF� _. 4'. 'r"1''L����'M .. �!c :t� F' `r i d+�4✓4ev'?p]� � a 1 Y r ♦ 1 Y 9 r �4 F 4 t: ei� '� fi+�"ryrSa'�,r�� �, •'��.'C�4+ y!�,t?'►�`�� -Yy�tyt.�`r t xr, }y tC•P• k .'fit$Vlf L Ir, Jj I 4 001 N ! n° 06c4) w nt 'I O I i ; Commonwealth of Massachusetts r Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 20 Oyster Place Rd 2 systems at property this is the system serving the cottage) 5 ,• t Property Address y. M cock S' Owner's Name Cotuit ✓ MA 02635 3124/16 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. A. General Information s 9 # POO 1. Inspector: Frank Nunes III - -� Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code i 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/24/16 Inspe or'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. 20 Oyster Place Rd (cottage)•03MB Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 0� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 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: Pumping suggested every 3 yrs to prolong the life of the system 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: The septic tank is of H-10 construction and in the paved driveway. The leach pit is also partially in the paved driveway. The load rating of the leach pit is undetermined ❑ 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 20 Oyster Place Rd (cottage)•03/08 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 M � 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ 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: n/a 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. 20 Oyster Place Rd (cottage)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 L_ — — , - - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name y Cotuit MA 02635 3/24/16 Cityrrown 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: n/a 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 El ® 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 El Z . 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. 20 Oyster Place Rd (cottage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityrrown 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 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 Elthe 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 oroperator 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. 20 Oyster Place Rd (cottage)•03108 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 5 of 15 a Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3124/16 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? ❑ 0 . 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)] 20 Oyster Place Rd (cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owners Name Cotuit MA 02635 3/24/16 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): n/a Number of bedrooms(actual): 1 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 110 Number of current residents: 0 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 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a 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): n/a 20 Oyster Place Rd (cottage)-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 1 f Commonwealth of Massachusetts Title 5 Official Inspection ForM Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA . 02635 3/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information a ' Pumping Records: Source of information: no pumping per 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): No d-box Approximate age of all components, date installed (if known)and source of information: 1997 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No r P . 20 Oyste lace Rd (cottage) 03/08 Title e 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s ' 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12"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: 1000g Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace >2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured 20 Oyster Place Rd (cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property address Mycock Owner's Name Cotuit MA 02635 3/24/16 CitylTown 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a 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.): n/a 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): n/a 20 Oyster Place Rd (cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 r . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cunt.) 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.): n/a "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 n/a Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): ' No d-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 20 Oyster Place Rd (cottage)•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 f . Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ug 20 Oyster Place d 2 R systems at roe this is the system serving the cottage)Y ( Y property Y 9 9 ) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ 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.): Leach pit is partially under a paved driveway, load capacity is undetermined therefor there is the risk of collapse, it was video inspected, it is dry at this time, top is 3' below grade, no indication of past backup 20 Oyster Place Rd (cottage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 l .. Commonwealth of Massachusetts • - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 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.): n/a 20 Oyster Place Rd (cottage)•03f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 l_ , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Citylrown 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. C> A i j �- A Li I << 20 Oyster Place Rd (cottage)•03l08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 L - Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �( 20 Oyster Place Rd (2 systems at property this is the system serving the cottage) Property Address Mycock Owner's Name Cotuit MA 02635 3/24/16 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Per elevation of home 20 Oyster Place Rd (cottage)•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 L , TOW OF BARNSTABLE T,' y; TION Z® 611J7rfC 191A-ce R64d SEWAGE# ;7 Q / %I LA.(3E (f(37 ASSESSOR'S MAP&PARCEL Sl RgSTALLERS NAME&PHONE NO. 'S dseDk be SEPTIC TANK CAPACITY 15ZO I I LEACHING FACILITY:(type) (size) 36 X!q, 2 NO.OF BEDROOMS OWNER �lG'bl �'l✓CoG�C } �T PERMIT DATE: S' �b COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY N \ N i .9 Li Qk '`X TOWN OF BAA/RNSTABLE Lo'c"hION X6 Arse'► &e SEWAGE # VII,LAGE �TO'i� �i SS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY D LEACHING FACILITY: (type) o11��� �� (size) NO.OF BEDROOMS /' l BUILDER OR OWNERG� ��lald PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 aching Facility(If any wetlands exist within =Z�M fac' ) Feet Furnished � O C� . � �/ �� � � � �a � � � i -� . :�.� ._ , TOWN OF BARNSTABLE I`JCATION 4er" AACt, SEWAGE # . VILLAGE r-6 I U►+ ASSESSOR'S MAP & LOT _ INSTALLER'S NAME&PHONE NO. 90StRDVo�Fd` SEPTIC TANK CAPACITY �CIGD LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 3 BUILDER OR OWNER h LLNO,YL. Y �'� C-0-Ci pp PERMITDATE: la- 0- Cab COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching.Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �. �� $ � _ - r -� �'� � S . C Fj t �� � �t 2 �� � _ , a �a� aa+ Bi r �� �/ �� G3=��� 1Y-3 - 3a"Gh x .. _ ..,�. � � + `L.Y. . ... . .. . . . 3 -� No.._" if, — Fee 1190 i N `"''' 4. Entered in computer: THE COMMONWE ►LTH OF MASSACHUSETTS .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYicotiou for MigposW *p5tem Cougtructiou permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No..219 L91J_r4"" /5:�7_" Owner's Name,Address,and Tel.No. �oru,r ,��/�,✓ �yco�k Assessor's Map/Parcel 13— Installe — ti 0L,1 ,vo a Designer's S r' ��+�� Name,Address and Tel.No. -�Y Name,Address, nd Tel.No.®- 'ice 50$-y2o-9738 e ng: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) )egZ,4&irC, grus& v � Sry iy Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Signed ,Gl Date Application Approved by Date 'Application Disapproved by: Date, for the following reasons Permit No. '' Date Issued104/Y1 6 —his. � /V tF• V`; ���// r �^ 3 No. Feed/ ' K THE COMMONUVTf OF{MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION i TOWNS OF BARNSTABLE, MASSACHUSETTS Yes 2ppricatiou for M.igpogaYd,pgtem Cou5tructiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components p, x Location Address or Lot No., D �ys r�Y //�G/= Owner's Name,Address,and T.1.No. CoTvr f Assessor's Map/Parcel Installer's Name,Addr`essland Tel.No."/0j e/011 v{ ���r�S Designer's Name,Address and Tel.No. y2a- (/ 973 /. li9ryi�.a �T � ///r3r,fT1/.�.7 `O:urJ c_'^I�D/- l=r✓/tiyli=!-'✓^i�» Type__of Building � j Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building, ' No.of Persons / Showers( ) Cafeteria( ) Other FixturesI/,j rJ . Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title rf Size of Septic Tank Type of S.A.S. s Description of Soil t / r Nature of Repairs or Alterations(Answer when applicable) /2��a s�Tr /_^r<i5 T/.?ram �i-.��l�liy,G c 4•/ �T _ *. �'ty� ��v r� ry �1��1/%ate �t� �v� •!1 ro is • w. Date last inspected: �. Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system.in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Za a Date Application Approved by �1 / Date !p Application Disapproved by: ( { e. Date � for the following reasons Permit No. /�� + Date Issued _ J r � THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance A y i THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by t/0.5r7,<6�1' � gyp 6/,,, C,, S at �d (�i/STi=d' � �/_ �:/� C_ 011/i r has been constructed in accordance with the provisions f Title 5 and the for Disposal System Construction Permit NOD11 `+� dated Installer /o.S�,�� �� I�.��r'U. S" Designer 1Jll�.f/H� r i #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will f nctio a designed. Date I a'"I D-fo A, Inspector THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS I.5 0 �p!tem Cougtructiou erluit Permission is hereby granted to Construct ( ) Repair ( )_ U grade ( ) Abandon ( ) System located atIn, and 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: Consttruccttioop musts be completed within three years of the date of this peg Date /C/y/ //�� Approved by �� 7 dq %No. s %.� ,, Fee THE COMMONWEALTH OF 1MASSACHUSETTS Entered in compu±er: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rptication for Migogal *_ pztem Con.5tructiou Perron Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. , Own is Name,Address,and Tel.No. Assessor's Map/Parcel �y Z Ins ller's Na a ddre s,and TeL No. aoa"y'��'4�J� Designer's Name,Address and Tel.No. " � �ty� Ovcv t L,*A_' �i� '�n,�Fs/1'�lfi+/NG jw4w 17 v d r Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. i Description of Soil Nature of Repairs or Alterations(Answer when applicable) i h Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe ,� " Date Application•Approved by Date ,Application Disapproved by: Date for the following reasons Permit No. 119 Date Issued ., s ANo. s � /� � "��`'��=� '� r" �� � Fee THE COMMONWEALTH OF MA SACHUSETTS Entered in computer: I � J PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for Oigogdr IPpztem Cott�truCti01� ermit Application for a Permit to Construct(E)��-Repair-(Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No.A. 0y s r r 12144/^ Owner's Name,Address,and Tel.No. ° Mew Mye ack Assessor's Map/Parcel .as, y2o�49�8 InJ�re's�me„�1ddr�s,and Tel.No.S2)8 Designer's Name,Address and Tel.No. Type of Building:' f V Dwelling No.of Bedrooms Lot Size. sq. ft. Garbage Grinder ( ) `Y Other Type of Building No.of Persons ? Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow pro ided,' .{ +` gpd Plan Date ! Number of sheets i Revision Date Title Size of Septic Tank V Type of S.A.S. ° Description of SoilIlk p Nature of Repairs or Alterations(Answer when applicable) 2 '' �'i= Sr'�•�� -Date last inspected:' Agreement 'The undersigned agrees to ensure the construction and maintenance of the afore described or-site sewage disposal system iri accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of ,:Compliance has been issued by this Board of Health. �..° � w Signe Date Application Approved by ! '� �.?,� ���� .gj-� ` ! i Date Application Disapproved by: Date for the following reasons ., , Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( � _Upgraded ( ) Abandoned( )by d -e-e -o-, v4 S z -at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r1 -0 40 `cam � dated Installer./ "4,gZ S Designer b""��� ��/9F /4w4!54'ri,h4!� .1,y #bedrooms Approved design flow �— gpd`- The issuance of this permit shall nnot 9/mc ' ed as a guarantee that the system w< ct ans desig R .Date / /� Inspector �—--- � .----------------------- --� No. �Qc Fee �+ THE COMMONWEALTH.OF MASSACHUSETTS � tp PUBLIC HEALTH DIVISION=BARNSTABLE, MASSACHUSETTS O Digoml �&pgtem Consstru' lion Permit Permission is hereby granted to Construct ( ) Repair (4—) Upgrade ( ) Abandon ( ) System located at np � and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Const r ction m ss}t be completed within three years of the date of this permit. Date_ /-/ Approved by / pp SHE Tp� Town of Barnstable Barnstable + BARNS-TABLE. ASAmedcaCfty'MASS. Board of Health 039. ♦� OI., AlF0 MP't A. 200 Main Street, Hyannis MA 02601. 2007 Office: 508-862-4644 FAX: 508-790-6304 October 9,2012 Revised November 20,2013 Public and Environmental Health Program Policies,Procedures, and Guidelines H-10 Components DiscoveredBeneatli`Parking Areas and'=Driveways During Septic System Inspections Conducted Under 310 CMR 15.301,State Environmental Code,Title 5 - No. 2012-005 When a DEP certified inspector discovers an H-10 septic system component located beneath a parking area or driveway during a septic system inspection, conducted under 310 CMR 15.301 State Environmental Code Title 5, the system shall be deemed as a "conditional pass." The system owner will then be ordered,by the Board of Health,to correct this problem within two(2) years and will be provided several options to rectify the issue, including by: a.) replacing the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway, and properly abandoning the discovered H-10 component; or by F b.) replacing the septic system component with an H-20 component beneath the parking area or driveway, and properly abandoning the discovered H-10 component, (or in the case of leaching pit,replacing the top of the leaching pit with an H-20 slab top); or by c.) relocating the parking area or driveway in such a way that no vehicle will have access or i the ability to drive over the existing H-10 septic system component. If it is unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20), the system shall also be deemed as a "conditional pass". In this case, the seller must make the potential buyer(s)aware of the "conditional pass" status, the unknown construction of the septic system component(s), and it's safety concerns. . r r Wayne Miller,M.D. Paul Canniff,D.M.D. Junichi Sawayanagi Q:\POLICIES\H I OComponentsBeneathDriveways&ParkingAreasRevised2013.doc l ' 06/23/2006, 14:26 5085405102; THE UPS STORE PAGE 02/03 FROM :down cape engineering ins I FqX N0,- :15083629 ,H80 86123/20e9 Tun. 23 2006 e1:01PM p2 16:�3 5085465192 THE UPS 'STORE I j ! PAGE 92/93 TOW of Bar'bstable R L,9W, atory, services > Thom F.Gsller,Director d Public I�ealth Divlislon j Thofi$e MCK4411;Director 200 Main 96W4 Nyall a i MA 02601. Office:.30�-862-4644 } t r Fax: 509-790-6304 �re tle +0 Date: 6 --/�[ Sewage Permi t# Assessor's Mapl,Parcel'i�--{--� Designer: ><nstaller; � ! Address:: Address: ( te nsfall�r} Nat issued a pemh to install a i ' septic system at (Z based on a iesign drawn by osa er) dateda rt,. 6 Z x th 6f tt>$t the �ettce I i septic system re d above w in®ta?led s dwt,o, which may include minor a u atiall according to 4'• �sttt-but>to0 boR And/or s ti.c tank. fd1ed cltar�gos such as lateral rQ�pegtion of the w�c found satisfactory, �t�iipovi (ff inquired) w" 9 peeted and the soils af' tllat the septic system referenced above greater than 10' lateral relocation of the SAS of a vMs ,installed with m '� Of fhe septic system) bot in accordance with State do Local ny ertil e location a anges (i.e. cer"Icd as-built by dealer to follow. Y component wete found satisfa�y, . Stripo,rt(i f le Nations. Plan rm+ision or required)was,;meted and the soils i n er's state - � ESN or�s � i ARNE H, cy > OJALA CIVIL m No.30792 5 (Des' er's Sip tune) ��'c Q/&TE e , TO BA L P P ) N C E UN B U. R NE Q:1&eptiel�eei t eenificRtion Form Rev 03 09-o6.aoo I Town f Ba rnstable arnstable Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 - Wayne Miller,M.D. FAX: 508-790-6304 Sumner Kaufrnan,MSPH Paul Canniff,D.M.D. May 6, 2006 Ms. Sarah Ojala Downcape Engineering, Inc. 939 Main Street Route 6A Yarmouthport, MA 02675 RE x Bedrooms/2Qbyster Place=Road C© uit � � R 13303 Dear Ms. Ojala, You are granted permission, on behalf of your client, Peter Evans, to construct an onsite soil absorption system designed to be connected to six bedrooms proposed to be constructed at 20 Oyster Place Road, Cotuit. The septic system shall be constructed in accordance with the submitted plans dated April 6, 2006. Sincerel ours, ,;V4 Way a Millk, M.D. Chairman VP BOARD OF HEALTH d TOWN OF BARNSTABLE Q:HEALTH/WP/Sixbeds e 'P tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 Gown cape enfineering civil engineers& land surveyors structural design Aril 6, 2006 p Arne H.Ojala P.E., P.L.S. Daniel A.Ojala, P.L.S. land court Barnstable Board of Health Timothy H.Covell, P,L.S. surveys 200 Main Street Hyannis, MA 02601 site planning Re: 20 Oyster Place Road, Cotuit "---sewage system Dear Board Members: designs The above-referenced site contains a 3 bedr000m Cape, with a detached one bedroom cottage. The Cape has a cesspool septic system, while the cottage has an older Title 5 inspections system with septic tank and leach pit. permits It is proposed to demolish the cottage, keep the*Cape(re-modeling to 2 bedrooms) and construct a new dwelling containing 4 bedrooms, for a total of a 6 bedroom design. The floor plans are enclosed. On behalf of our client, we hereby request permission to construct a 6 bedroom septic system. The lot lies within an Aquifer Protection District, contains approximately 22,328 square feet and is served by town water. The base of the system is greater than 20' above the estimated groundwater elevation. No variances are requested. Thank you for your consideration. Very truly yours N Arne H. Ojala, PE,PLS Down Cape Engineering, Inc. cc: Peter Evans { e ems:- l • s a ;,1 - - - - -- -, �Y � ��� C�J-, i DOWN CAPE ENGINEERING, INC. 939 Main Street (Route 6A) _--- YARMOUTH PORT, MASSACHUSETTS 02675 DATE (508) 362-4541 Fax (508) 362-9880 I} "1 t7 (o TO SUBJECT ............................... .............. ................. . .................... ........... ..........................................__........................................... ......._ ., .s .........t._. � ..................................................... .` - .. ....................................................... .................................................................................................................................................................... ........... ��-r- o. .. ................................ ............................................................................................................................ > 1 G� _ w�- ._�:.: .::.:....... -.. ............. .................................................... ......................................_ `'S!�'.^........................._� .._ '� ........................... �'`e°u''� f.._ ............ ..................-,........... - - _- _ .. .......- --4: ................... ................ ............. .............................................................................................. ............................ ...... .... ...I.............. ............. ................ ............ -------------- ........... .......................................................... ............... ............................... ..................................................... ............................................. .................. .................. ........................ .............. .......................................I........... ................. ................ ..........................I--................. .............................I...........................I-'............... ............... ................. ...................-,......................................I...........-:.....................I..................... ................ ........................................1-1.......................................................................................... .....................-.................................................... ��s �� '-�� � i � � s £r SIGNED .� � s� ✓ ��� - � �� ��� � �' PLEASE REPLY �❑ N0 REPLY�NECESSARY,���� � .�:���, f,,�� "�u\�a� ���� ����� ��� �� �;��� ��,`� � �, N E - lD m " M m s lD !9 N m i Q BEDROOM I � - ` 1 j � I I CD - -Jj® -------------- ' I - CD all OD 4&ASe M LIVING 01) UP 1767ci24' m IrrI BA.-HH I6'9"94' —•---���-1 GLOS - ----------- a�x --- crux .1 1 LOI O BEDROOM— Z ---= F�4nD iQ X DN 9ri 17. e Q ' --------- _�----� CL I I HALL i I reYl2a' SITTING ------------ 1 C ; Q1 C 0i QJ - C v FIRST SECOND 0' FLOOR PLAN FLOOR PLAN U C 912 SQF7. 472 S-F. 0 LL I9 t . e%'' �d0 000 4u 2 To ylv 6 1991 �A4Ty FPSTge�f N BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 0264 A � 508-771-9399 508-428-8926 FAX: 508428-9399 E y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: /4 Date of Inspection: Ins ctor's Name: Aza ix_ Owner's Name and Address: 121� ap(0L&5 i. CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection.The inspection was per- formed b n my training and experience in the proper function and maintenance of on-site sewage . disposal stems. The System: Passes Conditionally Passes Needs Further E, nation B the Local Aproving Authority Fails Inspector's Signature: --- Date: 9� The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. A)SYS M PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONAL ASSES; One or more systemponents need to be replaced or repaired. The system,upon comple- tion of the replacement or repair,passes inspection. Indicate yes,nor,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,cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the ekisting sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - - 1 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four 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 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 the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MAN NER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. absorption system and is with a Zone I of a public The system has a septic tank and soil water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has aseptic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private.water supply well,unless a well water analysis for coliform bacteria and volatile-organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.30 .3 The basis for this determination is identified below. The Board of Health ill be necessary should be contacted to determine what w to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool: Liquid depth in cesspool is less than 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 -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 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. 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 less 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,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 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: 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. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314•CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ,-CHECKLIST. ' r •. . -,,-CHECKLIST. Check if the following have been done: //Pumping information was requested of the owner,occupant,and Board of Health. ✓None of the system components have been pumped for atleast two weeks and the.system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. v'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, The system does not receive non-sanitary or industrial waste flow. t/'The site was inspected for signs of breakout. ,/ml ssystem components,excluding the Soil Absorption System,have been located on site. _ The septic tank manholes were.uncovered,opened,and the interior of the septic tank was in- spected for condition of baffls or tees, material of construction,dimensions,depth of liquid, pth of sludge,depth of scum. : y The size and location of the Soil Absorption System on the site has been determined,based on existing information or approximated by non-intrusive methods. -3- #r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) ,/The facility owner(and occupants, if different from owner)were provided with information on. the proper maintenance of Subsurface Disposal System TI Y INSPECTION FOR M SUBSURFACE SEWAGE DISPOSALS SYSTEM INSPE O PART C SYSTEM INFORMATION FLOW CONDITIONS RFSIDENTLAI V Design Flow: allons Number of Bedrooms: Number of Current Residents: Garbage Grinder: Laundry Connected To System:� Seasonal Use: 1� Water Meter Readings,if a 'fable: / 5- �OUO OZE',3 6- 9 Last Date of Occupancy: 61 COMMERf IAi ODUSTRI_AL: w Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System Pumped as part of inspection: AU if yes,voluiVe pumped: gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes, attach previous inspection records, if any) Other(explain): APP OXIMATE AGE of all components,date installed(if known)and source of information: c3 _ Z�Ina Sewage odors detected when driving at the site: -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: 1U Depth below grade: Material of Construction: concrete metal FRP Other (explain) Dimisions: Sludge Depth: Scum Thickness: Distance from to oif sfndge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 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:. Depth Below Grade: Material of Construction:_concrete_metal . FRP Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle:, 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.) TIGHT OR HOLDING TANK: /�LJ Depth Below Grade: Material of Construction: concrete metal_FRP_Other(explain) Dimensions: Capacity: gallons Design Flow: = gallons/day Alarm Level: , Comments: (condition of inlet tee,condition of alarm and float switches,etc.) i M DISTRIBUTION BOX: Depth of liquid level above outlet invert: n • note if level and distribution is equal,evidence of solids carryover, evidence of leakage into Comme ts. ( q or out of box,etc.) PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5 � e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS): 'Z/d (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches, number, length: Leaching fields,number,dimensions: Overflow cesspool, number: Comments: (note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation, etc.) CESSPOOLS: Number and configuration: -l� _Depth-top of liquid to inlet invert:• /3 Depth of solids layer: 9 Depth of scum layer: "I Dimensions of Cesspool:& 'Wy Materials of construction: ^Pja t, Indication of groundwater: A,.)/ 2_� Inflow(cesspool must be pumped as part of inspection) Comm nts: (note condition of soilk, igns of hydra lic 11,H , level of ponding,condition of vegetation, etc. Q� - PRIVY,- Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) I -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchnmrks. Locate all wells within IOU Feet. DEPTH TO GROUNDWATER: Depth to groundwater: l CA Feet Method of Determination or Approxi ation: i© C -7- r .. COMM ONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. MA 02108 617.292.5500 W ILL1.4Nt F WELD TRL DY COVT Govcmor Sc:rc:arN ARGEO PAUL CELLUCCI +y B STRL FL Lt Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F (R § o rnISS onc: PART A CERTIFICATIONProperty Address:20 Oyster Place Rd, COtUlt Address of Owner:Date of Inspection: 7 /3 /97 (If different) 97Name of Inspector: Joseph P. Macomber Jr .I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR Company Name: Joseph P. Macomber & Son, Tnc ,Mailing Address, BOX S� en erville , Ma . 02632-0066 Telephone Number:5U$—'/'/5j33 CERTIFICATION STATEMENT I certify, that I have personally inspected the sewage disposal system at this address and that the information reposed below is uue, 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-site sew a disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the local Approving Authority _ Fails a Inspector's Signature: i'/ Dater/ The System Inspector shall submit a copy of this inspection report to the Approving Authority 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 of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM P SSES: . i have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15 303 Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: �U 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 �d 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 ex-filtration. or tan: failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic Win- as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: hnp:/Iwww.magnet.atate ma uyaep Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Oyster Place Road, Cotuit, Ma. 02635 Owner: Frederick Clauson Date of Inspection: 7/1 /9 7 B) SYSTEM CONDITIONALLY PASSES (continued) ,,( e.-' 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). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced VO The system required pumping more than four 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 C) FURTHER EVALUATION 15 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 the public health, safety and the environment. 1 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ,J The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or 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 public water supply well The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance 6-(approximation not valid). 3) OTHER I (r.vlrr.d 04/25/97) P&sfe 2 of 10 l �r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR,10 PART A CERTIFICATION (continued) Properly Address: 20 Oyster Place Road, Cotuit, Ma . 02635 Owner: Frederick Clauson Date of Inspection: 7/1 /9 7 D) SYSTEM FAILS: You must indicate er,•.er "Yes or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CHAR 15.303 The bas s for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correc'. the failure. Yes h'o / Backup of sewage into facility or system component due to an 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 01 cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in Ge55pee4 is less than 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 obstrucled pipes) 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 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, r v water I well An onion of a cesspool or privy is less than 100 feet but rester than 50 feet from a private ate supply e t o YP P P W g acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: 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 i.`{!L/TJ the system is within 400 feet of a surface drinking water supply la 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00, Please consult the local regional office of the Department for further information (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: 20 Oyster Place Road, Cotuit, Ma . 02635 Owner: Frederick Clauson Date of Inspection: 7/1 /97 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No , —K/ Pumping information was provided by the owner, occupant, or Board of Health. _ _,I / None of the system components have been pumped for at least two weeks and'the system has been receiving normal now rates during that period. Large volumes of water have not been introduced into the system recenti, 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. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components,4WIuding the-Soil Absorption System, have been located on the site. t The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, 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 The facility owner (and occupants, if djHerent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System ZExisting information. Ex. 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) (15.302(3)(b)) (revised 04/25/97) P&y• { of 10 L r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address: 20 Oyster Place Road, , Cotuit, Ma . 02635 Owner: Frederick Clauson Date of Inspection: 7/1 /9 7 FLOW CONDITIONS NTIA RESIDE :l Design flow 116 g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents Garbage grinder (yes or no).m� Laundry connected to syste lyes or no):195 Seasonal use (yes or no),—MAk, water meter readings, if available (last two (2) year usage (gpd): J 'lam Sump Pump (yes or no):_ e�,cJ Last date of occupant-•. COMMERCIAUINDUSTRIAL: Type of establishment: AIX Design flow: AM Aallons/day Grease trap present: (yes or no),IX industrial waste Holding Tank present: (yes or no)" ',on-sanitary waste discharged to the Title 5 system: (yes or no)� waier meter readings, if available. AIA Last date of OccupancY. IVR OTHER: (Descr,be) Last date of occupancy GENERAL INFORMATION PUMPING RECORDS arld so�u,ce pf)nformat on: /110�e 751(� I kr;L.4&" System pumped as pan of,inspection: (yes or no),&b If yes, volume pumped: _—/ allons Reason for pumping: TYPE 91 SYSTEM J Septic tan soil absorption system / Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspeclion records, if any) I/A Technology etc. Copy of up to date contracil Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) ir.vi..d 04/75/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ProperlvAddress: 20 Oyster Place Road, Cotuit, Ma . 02635 Owner. Frederick Clauson Date of Inspection: 7/1 /9 7 BUILDING SEWER: (Locate on site plan) Depth below grader Material of construclion: _ c st iron 40 PV _ other (explain) Distance fro �lvale wat r supply well or suction line Diameter _ ents: icondition of oin s, vent in , evidence of leakage, etc.) S L > T' SEPTIC TANK: Cj`SU� (locate on site plan) << Depth below grade: Material of construction: _Yconcrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age /jcjL;L Is age confirmed by Cenificate off/Compliance l/ _(Yes/No) Dimensions' Sludge depth: Distance from top of sludge to bonom of outlet tee or baffler Scum thickness e� Distance from top of scum to top of outlet tee or baffle: g Distance from bonom of scum to bonom of outlet tee or affle: How dimensions were determined: �J� Comments: (recommendation for pumping, conditi of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidernce of leakage, etc.) '— / GREASE TRAP:& e (1ocate on site plan) Depth below grade:Q Material of construaonvL concrete netaV,XFiberglasse jPol yet hylene�l other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bonom of outlet tee or baffle:,�/Q 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.) (r.vl..d 04/35/97) P.9. 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Oyster Place Road, Cotuit, Ma. 02635 Owner: Frederick Clauson Date of inspection:7/1 /9 7 TIGHT OR HOLDING TANK; ''(Tank must be pumped prior to, or at time, of inspeaion) (locate on site plan) Depth below grade Material of con struion;(J oncreted�neta14AI Fiberglass�Polyethylene.other(explain) a Dimensions: ,CIA Capaciry:____,f2j4_ gallons Design flow:--.,4J�{_ gallons/day Alarm level._Alarm in working order Yes;,V NO Date of previous pumping: A— Comments (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX;�'/� (locate on site plan) Depth of liquid level above outlet invert:_ Comments (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) /C 'V'1UT— PUMP CHAMBER:41b� (locate on site plan) ,Q Pumps in working order: (Yes or No) 'Ill Alarms in working order (Yes or No)� Comments: (no�e.�ondition of pump cham r, condition of pumps and appurtenances, etc.) (r•v1••d 01/�5/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Oyster Place Road, Cotuit, Ma. 02635 Owner: Frederick Clauson Date of Inspection: 7/1 /9 7 SOIL ABSORPTION SYSTEM (SAS):,L--� ;locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) li not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: C2& v) Comments: I to con Lion of soil, signs of hydraulic failure, level of ponding, condition of veg cation, etc.) T 1 i 6 " OOl S:C E S S P /(locate on site plan) Number and configuration: /JJI'"ly Depth-top of liquid to inlet invent 421!! Depth of solids layer: 4,14 Depth of scum layer: dzlez Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) )/? ti Comments: (note c ndition of soil, signs of hydraulic failure, leyq of ponding, condition of vegetation, etc.) p SAS ,�JT�,� Sr��J 7" PRIVY: zZwc-- (locate on site plan) Materials of construction: Dimensions:_ Depth of solids:,A,&1— Comments: tnote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (r•v1s•d 04/25/97) ➢ag• 8 of 10 SUBSURFACE SE"'ACE DISPOSAL SYSTEM INSPECTION FORM PART C SYS1 EM INFORMATION (continued) Propeny Address: 20 Oyster Place Road, Cotuit, Ma. 02635 Owner: Frederick Clauson Date of Inspection: 7/1 /97 SKETCH OF SEWAGE DISPOSAL SYSTEM: m;;ude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) I I �k k i III \ I � \ o v oYst�r PGA' Pay• 9 0l 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Proper} Address: 20 Oyster Place Road, Cotuit, Ma. 02635 o,.ner: Frederick Clauson Date of Inspection: 7/1 /9 7 Depth to Groundwater '/Feet Please indicate all the methods used to determine High Groundwater Elevation: 1/0btained from Design Plans on record tl Observat,on of Site (Abuning property, observation hole, basement sump etc.) �ete(mine it from local conditions Check with local Board of health Check FEMA Maps heck pumping records Check local excavators, installers use uSGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) 3►py)qW'-opt bar �- 50,) -�C-_ - .f' u� Sy 3ie� i Oy5� l�i�iAe.r. AlAe� /a/r,, ev�^ � �Ce;�► Tr�.r.�1z�s K,ere �,u s��11�, (r•vij•d 04/2S/97) Y&9. 10 of 10 TOWN OF Barnstable WARD OF HEALTH SUIISURFACF SFHAGF DI ST'OSAL SYSTEM I NSI'FCTI ON FORM - PART D -TYPO OR PRINT CLEARLI'- PROPERTY INSPECTED &—41--7- STREET ADDRESS 20 Oyster Place Road, Cotuit, Ma. 02635 ASSESSORS MAP , DLOCK AND PARCEL OWNER ' S NAME Frederick Clauson PART L) - CCRTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAHE Joseph P. Macomber & ton , Inc . COMPANY ADDRESS Box 66 Centerville , Ma . 02632-0066 Street Town or City St,t, COMPANY TELEPHONE (508 775 -3338 FAX ( 508 ) 790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa-? system '• is address and that the information reported is true , accurate , and complete as of the time of .-inspection . The inspection was performed end "ecoininendationS regarding upgrade , maintenance , and repair are consiste7: : with my training and experience in the proper function and maintenance 0 . s : te sewage disposal systems . .eck one : _ZSystem PASSED The inspection which I have conducted has not found any informatics: which indicates that the system fails to adequately protect pub! i _ heal0i or Lhe environment as defined in 310 CMR 15 . 303 , Any criteria not evaluated are as stated in the FAILURE CRITERIA sect : this form . System FAILEDx \\ The inspection which I have con �icted has found that the system t,� ; ! s ProtecL the E�ublic health and the environment in accordance 5 , 310 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . �:slector Signature Date ;ne copy of this certification must be provided to the OWNER , the DUYER ..hero applicable ) and the DOARD OF HEALTH . : r the inspection FAILED , the owner or "oporator ahalI upgrade the eye . T•- : i.h ., n one year of the dnte of the inspection , unle9s allowed or req e o .neruise a provided in 310 CFiR 15 . 305 i , , �G W tJ) Z7 7 � y THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF E ONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualificatigns as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. Junc 8. 1995 Acung Dircctor of the ►on of Witcr Pollution Control FROM :down cape engineering inc FAX NO. :15083629880 Dec. 27 2006 09:27AM P1 I I ' 12/27/2006 09:02 FAX 1@ 001 I . r iI Tom o Irl�stole Regulato ides = s Thomas p. $r, ' e�tor I Public Eta t4 D isi� n Thomas Mc cc►r 2001►Saip Street, y nib,�4.02601 I I Office- 50B•8624' 644 Fu_ 508-7904304 Inialler Desirner C rtmcitj n Date; Li:4--66 Sewage Permit# s �®D� - � sessor's Map ar eI �l� 6 j ' i I Desipar: cJ Cue $nytai et ! a C 6 ....e.7 III i Address: fA Xddi,�sq; C i A -on -d d il6�caS z Wv i�su�d a permit to a (daw). ler) 77I i septic System kit_z4a"; i eC ReC-ct.- baked on a desi ( dress wn b y e, , e jCg6dated /� gn sier) 1�,� X I certify,that the septic system referenced al�ve wI" inttalled subs yy according to the design, which -may include minor approved changes such as lateral miocation of the distribution box eadlor septic tank. I oetti_ fg that tlie septic system referenced a'ove -.Ws Lastalled with Ina or changes (i.e. greater;than 10' lateral relocation of the. SAS,or an' Vertical relocation Q any conOonent of the peptic system)but is accordance with' tate&Lo6al Regulatiois. Plan revision or certified as-built tnr designer to follow. I 1F\OF MA OANIFLA. —Iffistillees S nature) OJALA 1 CIVIL N 'ON o.46502 / /I ( !ONAL E� �__Tesigne 's Signattia) / (Aaix DWIMs Stall p ere) ; E RET�M TO ]BARNSTABLE PUBLIC E' TAi DIVISI N. LTIFICATE OF .:0MPLIANCEi WILL NM E ISSUED UNTIL HOT %jS'M_RM AND S TCARD_ ARE MCEIV]ED BY THE BARNSTABLE PUBLIC HEr THANK�i ' i I . ?,lice]EWSeptie/Ddilper Ceniflcru ion Form 3-26-04.doe I 04/15/1998 14:24 508-428-0202 COTUIT FIRE DEPT PAGE 02 Cotuit Fire Department 0T tfl Fire, Rescue & Emergency Services G ?► O0"m 64 High St. - P.O. Box 1.632 nu Cotuit, MA 02635 •8 Paul A. Frazier Phone (508) 428-2210 AW -Chief of Q-epaftment 508) 428-0 02 TO: Tom McKean, Director of Public Heaalth Town of Barnstable, Board of Health P.O. Box 534 Hyannis, MA. 02601 FROM: Chief Frazier, Cotuit Fire Department SUBJECT: Tank Removals, et al DATE: September 25, 1997 The following tanks have been removed/abandoned since my letter dated June 25, 1997. If you need further information, please feel free to call me. Thank you. b DIE � Claussen 4�A'3,'00 2200 Oyster Place Rd. 07/23/97 2000 gal. tank removed, Cult, MA. 02635 no contamination or odor � present. Rotstein 0q-(- 0� 68 Bay Rd. 08/25/97 275 gal. tank removed, Cotuit, MA. 02635 no contamination or odor present. McGeoch 0' 865 Main St. 09/08/97 275/500 al. tank removed, Cotuit, MA. 02635 no contamination or odor present. Rogers . 5(SpY6 908 Old Post Rd. 09/17/97 1000 gal. tank removed, Cotuit, MA. 02635 no contamination or odor present. J� / 7 -- /-D _ �j ✓ P.O.Box1121 ield West Springfield, MA 01090 Phone:(413)781-7474 P.O. Box 450 Pocasset,MA 02559 21 South Main Street (508)564-6607 Acadia _ Sharon,MA 02067 FAX: (508)564-6610 Environmental Services, Inc. Phone: (617)784-1326 1-800-834-2330 DATE: July 31, 1997 T0: Frederic P. Clausen, Esq. RE: FUEL STORAGE TANK REMOVAL RECEIPT LOCATION: 20 Oyster Place Road, Cotuit, MA OWNER: Frederic P. Claussen, Esq. TANK SIZE: 2,000 Gallon FUEL TYPE: #2 Fuel Oil FDID # 01921 DIG SAFE # 972805339 MASON ENVIRONMENTAL SERVICES, INC. , - PROJECT # T1464 (:_DATE REMOVED: 7-23-97 TANK TRANSPORTED TO: Mid-City Scrap Iron FIRE DEPARTMENT INSPECTOR: Chief Frazier COMMENTS: No contamination was observed at the subiect site' at the time of the tank removal. :::D FOR: MASON ENVIRONMENTAL SERVICES, INC. Environmental Services • Tank Services • 21E Site Assessments Site Remediation SUBSURFACE SEH'ACE DISPOSAL SYSTEM INSPECTION'FORM PART C SYSTEM INFORMATION (continued) Propen7 Address: 20. Oyster Place Road, Cotuit, Ma. 02635 Owner: Frederick Clauson Date of Inspection: .7 1 9 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: ,ndude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) rho ri v O/s �.g. s or lc - 4c+ f�� -• r.�,r%�Y,.r``a„�/,s,";ds.h"�y.s';l���n�s'ra'� y � � �•yjY�r�h-rep• / �.mAJ,ea.� r_� ��� + f �YGf ��at7y+fir✓o��,6y-'.=�ii sk�Y����� •; �. . ,f•.Rr�lJ'4'1�'}f ��s,1/0 0= a�_ '..Y° ., Gar�"•>�ay/'�w. '�ir7o.��OF �^, a i r �. * ,Y •J .�,c=•-•`�f9•,j'°/.r v�y� .Is;.6r'''� � �`'�,.fi Y - F,„�r•�'d�e^a�R �` � '?' Ste.� e�,� • 111 1 '�.af 6inx',�P r as41e' 6'�j'tea 4� � _ a _ a � ' .. .�S' T •pn,9'.4]�*�.a7s�i� ar�O 1 0���.��Viz. z\ova ■ cw�3J>`ma`zJs0 Ml ai it I ZA R2�d �•+n (� t't.� � �,`'yam '".��,�-., � wT';` �'_----. -- Ire �"�w f �a.Ffs7✓ �9s�`p`^v ' ! rIRM l 71 .c- ,=�:.fix'^► 1 ��p n��>.cc�;• h " aIN �.. ��' t �,�� .1 (.�+•` ��`�'�r�, �! +'' A I 1 ail "'".. r� f — ,x,� ilk Al � r Al. •�j• ! -�� � 1' ►!`(i� �; � .•. : it Ne , ILI t 4 .t ♦y \ : t r •�• ,�► � 1 f, `<� 1F t 'fir F} �7 { } 6' , t � •� r` , � � c 1t t `r j V ' i �P r d �, �� �_ k. s{f. i• 2- $_ 1` . TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS 10lsy �(/1(J ASSESSORS MAP NO. 03S PARCEL NO. fmr R ADDRESS: �C3 ®,y S DER C'G,4C ,�7} VILLAGE% ^�®7'� NAME;_._ . ✓ v. ✓t.h.. .. _... h__ _L: 4 S CONTACT.PERSON PHONE NUMBE& .?�-��I® �1 C� ��s LOCATION OF TANKS;. CAPACITY: .TYPE- OF- FUEL AGE: TYPE: LEAK OR CHEMICAL: DETECTION SYSTEM' y/ �C� /7�r�CfirJ.9-i' .�2'.4/'✓ftl C?®o 1 DATE OF PURCHASE OF EACH: 1. r 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT:_42 7°� TESTING CERTIFICATION SUBMITTED:,4'�,,z,,q� /, r ,J PASSED DID NOT PASS lo PLEASE PROVIDE.A SKETCH SHOWING THE LOCA I N OF K �T BACK OF THIS CARD. (Y/ 7Z o 5 74 f za, AW006P % ilea AMP- 'lap Aeavr-.)�vev A le, CIO jr .4roar .7, IF "N, till �7 f u N, 5rd- .9 aw I HEREBY CERTIFY THAT THIS PLAN WAS PREPARED FROM THE 'LATEST AVAILABLE "PLANS AND DEEDS OF RECORD. THE ;STRUCTURE, !SHOWN HEREON, WAS LOCATED IN THE FIELD, ':SHOWING , STRUCTURE Z 4v ON .5-c,07 4 1979 AND DOES .tildT Op _CONFORM TO THE ZONING SET-BACK REQUIREMENTS ....... :4-OF THE, r_7 TOWN OF 9WeW_r;rA&A MASSACHUSETTS., N QA.PiYS7A f"STERED LAND SUR OR SCALE 4 dF.APr 19 If *CrxlvsA%6 Aw-lat. DA OF At X -C -ff p" 0) COD SURVEY .*rCONSULTAI-JAMES YTS; o LAPSLV. —4 ROUTE 132 40 No.22597 HYANNIS MASS 01STFO' so f5 COMMONWEALTH OF MASSACHUSETTS � THE TRIAL COURT PROBATE AND FAMILY COURT DEPARTMENT BARNSTABLE DIVISION REPLY TO: PROBATE COURT FREDERIC P. CLAUSSEN MAIN STREET-BOX 346 REGISTER - BARNSTABLE,MA 02630 TEL.362-2511 EXT.217 To the Board of Health: On October 5th 1979 I purchased the property located at 20 Oyster Place Road, see copy of Deed attached. On or about Nov first of 1979 Niemi Fuel Co of Mashpee installed a 2000 gal tank in my driveway, see attached plot plan. Niemi Fuel went out of business several years ago and a call there indicated no records are available at all. A call to the Fire Chief at that time revealed that the inspector operating at that time one Grady Rogers has disappeared some time ago. A thorough search of the furnace area did not produce any records. .The only record I could obtain is attached which I got from the fire station. A telephone call to Leonard Niemi did reveal that he recalled the tank was indeed inspected as several days went by as I recall before it was filled because Nieme was waiting for the inspector. A statment from him can be obtained if you wish--please advise on this. Frederic P. Claussen April 2nd 1988 -F I i CENTERVILLE-OSTERVILLE APPLICATION FOR PERMIT FIRE DEPARTMENT TO INSTALL—ALTER 'FUEL OIL 8 RNING EQUIPMENT Date..��.. _..-.... . To the Head of the F'Ire Department: Application Is hereby made in accordance with the provisions of Chap. 148, O.L., and Regulations made under authority thereof by the undersigned for permit to install- alter, for the person or persons and at the location named herein, certain equipment for the keeping, storage or use of fuel or other inflammable liquid products used for fuel as described below /hA��Sj���`'_.: NAME-.J!'.�F�� 1i� NAME. �LZ`t.�......-.t�....-._._.-..--. ....- ,...�� (Owner or Occupant)_ Inst le ADDRESS /..�f............ Description— Name ...._.._ _. t _ __..__.. .......... Manufactur Burner: Type ......._. ...Model or Size.___-- Location - Locatio�n�.............`. ...... ass. Approved No...--------• Storage Tank: Type .J-1-FF-�I......Zrrlposei . .......--- Capacity�lr.,2?,�.�gals. (or) Size.._......... Location .� �Gl :L' ........-.._....._..... ........._. _..._�._-. Amount of fuel required for testing .. ........gals. This application is made with full knowledge of the current requirements of the -,,regulations governing such installation, which will be.made in compliance therewith ;dote: If this application involves alterations to existing equipment r a escribe fully:•on reverse side: s = y. a' 3e - +Sf i `Y{ iyvy ' � .. - N. •� Fes.+ o , • � 1. rA y4. t oN:.fonaladaroo jo.aseoii{31a0 I , `r ` - ad �•��� s a1PDY -�;-� vx- As ycso1TQQ`/rjo aatu4g;1} " s t ' t IL VP k lip 'k4t"` .�' t «`. v '. #.xr+t w. S FALF a x mv t I, ALFRED -H. gCLIFFQRD of New Orleans, Louisi°ana, for41 , s consideration' paid in full, cons derati.on of NINETX-FOURtY =: F THOUSAND ($94,000.00) DOLLARS grantn to ., FREDERIC,.P. CLAUSSEN of, Main Street, Barnstay(' b,CEf (Co.tuit) , Barnstabl'e County ,Massachusetts with .QUITCLAIM C.OVENm S, a., certa_n,;,parcel of .land together with the buildings and appurtenances thereon' situated at 20 Oyster ` Place Road, Barnstablkey Cotuit)`, arns tab 16 Count ; Massachusetts. ,3... �.s,x r -i [ being bounded and described as follows. NORTHERLY f by ':hand .shown on Land Court Plan No. "19 6 0 6E' one hundred thirteen and 72 (113.72) feet; r. SOUTHEASTERLY, by two: ,c:oursess by. land .shown.on Land .Court ' Plan No. 19606A, one hundred eighteen and 49 100 (118 .49) feet .and one hun ' f�a dred eleven and 60/100 (111. 60) feet, t SOUTHWESTERLY ' by. Oyster Place` Road.} a public way, one hundred et4hteen end 95/100 '(11$.9: ) 1,,feet; Fri P% 4: NORTHWESTERLY ' by "land§ now' 'or formerly of Roland E. and FPP . Madeline E. Barnaby as shown on a plan hereinafter referred to, seventy eight and 69/100 ._(7:8.69). feet;' and k WESTERLY ;by` sa d`Barnaby land as shown on said' r, - �? plan, one hundred and 09/1QQ , (1Q0.09) CONTAINING. 23;"7.90 Square feet more ;or less. Said premises are shown on a plan entitled ='Plan of z: Land in Cotuit, Mass r axe Survey.ed. for Alf red •H. .and Alice e.C, v t Clifford,,dated October. 9, 197.4, Drawn 'by Nelson Bearse-Richard Law,,• Surveyors,0.and. recorded in the' Barnstable .Registry of Deeds r In Plan Book' 288, Page .93 b6in the same, remises conveyed by. , x g • g P Y Y t ; deed' of }William :H. Prentice `to. Alfred H. '`Clifford et�U;Kr dated, Sep:tember -24, 19741• recorded in said deeds in Book 2100, Page 122. , Said land being also. shown as Lot .B on a plan of land . V entitled ;?'Plan of Lang :gin Co.tuit-Barnstable-Mass Sub."Division: of ,a Property of Helen W. Robinson, Scale '- 20 Ft. to an inch, July 1947, 41 . Charles .N. Savery, C.E. Cotuit" , which``said plan is recorded t JOHN R. ALGER ATTORNEY AT LAW r 770 MAIN STRB6T TE4VILL6, MASS.02555 • _ .. f - .. c. 54 x "si R411i _ LL ` <' �"^` �a,w' ' 4'. " with Barnstable: County R gJ x of}Deeds"inµ Book 11Q, Page 5.5 e a str. Wit' 4f The above premises are conveyed together with an appurten ant right off way as described: in a -deed^ of Helen W. , MacLellan to.''"' p the Sellers 'dated October: , 1974 and .ecorded with. the Barnstable County Registry of Deeds ii took 2110," Page 158. , Said premises are conveyed subject to and with the 1 ,e`# s _ L•,.,.t: <;' •` �Kt,J benefit, of an agreement +b : weep AlfredY' I,}, Roland E.''Barnaby dated $rptember 3q, 1974, recorded in7,said' f Barnstable Deeds in Book 21"07, Page 53,, d ' � For title, s.ee deed. o William H',' Prentice-to Aldred H. Clifford` and Alice C. Cl>` f ord, husband and r�ri'fe ^ as tenants _ - rg ` - f Y, by the entirety, dated September 24, 1974 and recorded in Barnstable Deeds, Book 2100 ' Pa 122, said'Alice H. Clifford s` ` g�• wN Cam- 1V ak 29 r s+ix having died June 11, 1976, Af WITNESS my hand end seal this > `/ day of 1979 4` ` -. - � j�A 5 0 t. ::t i. 4 r a r•- 5"� .a�� r 5 �' � .t}.-. COMMONWEALTH. OF MASSACHUSETTS Barnstable, ss. Then personally appeared the above named ALFRED; H. ` r r "s... CLIFFORD and acknowledged the forego>ng instrument to be his free r, f. J act and deed, .before men: # , t }y 'pile: ."714a eli a3 pit a} $ i f aAis .t`i ! i4a a`' Sy,. `Put ' P b c .,r.>.,.. � •1{ f +waits :<� (i'y.l' i..�,! i � My eo iss>rou r>'t >>kx '° ��,women'f� }•��WA:1.Pi tawKb..„ ,WyyM� .H�++�5 a='� ` f r. } . +... ..t:.a:.L.-�n.:..it:1;::..a,.+e 'r,.,.t t..s:... r.. ..+✓ <.,.a .... k.....:"...; .c'. •a S,..ni.w4uM1 ....5w.i.w.5..h..a>.si.�wM...a...c.,. ._.�7 . it c s. .� > ` '-Y' i���. Ot L fl{ 2 •P rG a RECO p c r Zi Ttifi `r ,a t x tgp s a a011 ij Pr€* y r f 1 m A Oar _ Ar P(a C/J= w- p X SMEA KEEPING YOU ORGANIZED No. 10334 2453L MADE IN USA GET ORGANIZED AT SMEAD.COM TOWN OF BARNSTABLE L.JCATION SEWAGE # � — � cIILLAGE ASSESSOR'S &LOT � TDh-NAME&PHONE NO. - � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDR BUILDER O OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet I. 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� � /���y 7 ,,�, � , W fv� L, `_: i ■■ INS ■�� _ ■�W■11: _ �.:� _:.�.:s�•■■■.ma's ' r:: _ �� M s=- AM ■■ ,_ ■■� ■■■ W -- - iMARINE - 0111],11M. son -- 10. ONE —'iY._.. son -f-Yi Ann PAS -L.-�� :: , :s::•.� :ate ..tss •.II lj - t mow•: - • a. ��� � .. L!! : I ■■ - ■■ �:�r s: iii�s:_ads;- - - - - .S.� Y�Y.'r'Y'�:• J:RYA- - --- '-. --- ---------_---- - -'ASPHALT15• ROOFING ASPHALT ROOFING ASPHALT P AP ER 1/2"PLY SHEATHING I/2 PLY.SHEATHING -. '-xxxxxxsTING -xxxxxxx --- .� 6 __ c-- ----------------------- ------------- NOTE: TTP.HANGERS _ - _ —DRIP EDC:: DRIP EDGE / NEW FOUNDATION I � � �- 5"GUTTER >< 5"GUTTER BELOW EXISTING .." n -.__---_._"'--_-___-_'-_.__-^-!^_ HOME fdlmamloneper Bulld�.) a. . --IXB FACIA � Ac8 FACIA TYP.RIM r.P.2>t6 PT SILL .. 5400 VENT i-- 5400 VENT EXISTI?S / ----- -- 'j• IX SOFFIT IX SOFFTT FIREFL.CE qTFF - �� - 1-1/2"PE7 N;L Cl. , FOOTIN, : L/I I II I I D _ 1-1/2"BED MLDG. '11J IX FREIZE (� E4VE': IX FREIZE 1 EAVE 2 u - . •�-•2XS'e•I6 C� I : II II II lii'I I i DETAILS EAYE DETAILS • •� - - GIRDER BELOW / eTAine , I T 2 I it III I-' �x�33 "_ i�V i - II 'I TYVEK OR EQUAL A$pHALT120OFINCs.. . : }2.12 ___- __ <--2XS'e s I6"O.G.—s - / LY THING - PAPS2 l-. a ._ .._ ______ 1/2"P .SHEA _ ASPHALT A Irr 15• PLY.SHEATHfNG, 11 m SHINGL- .. ----•- - _ - 2-0 - II'-0 . S-0 GOARSESTARTER - - - DRIP EDGE . .v . - --- - - - GUTTER .FLOOR FRAMING �-� 2x6 P.T.PTSILL .ytf ==as===aE• - _ TYP.HURRICANE TIES - . __T___xx _ -�-� 9/2"X6"SILL SEALEZi• ' 9'-Id'' -----:T•_2" -DdZe" ---- -1-- j u."D I - ' 'e• :-•�TOP RING 2"CLE-,R - 1 n be - _ " D • 5/5"X12"ANCHOR BOLTS ix8 FACIA. Q 4"THICK FOUNDAT�10 O EXIST F�10�1.1E e.,LL, O.G. 9400 VENT • aCONC.SLAB - _ \ IX SOFFIT T-4" T'_4' ' T,_4,: : I (^: - - D `-1-1/2"BED MLDG. i •. : .... -. . - - - - 1 FROZE I SILL DETAILS . s. 4 � I' ! i - AT10N F�Ntw Aoomold AV_\II\ X - 3-2x12'e - . rauND - - TYP.3o•'x3o'•x12�-" -- fi. � SAVE DETAILS - -Gs� VENT _GONG.FTC.W/3-I/2' RD. -•-- L7 -- -•- - RIDGE - - _ :Q CONC.FILLED COL. �A i _ .. Y .._. 2X@ RIDGE i ------- - ' - - __ - RAPTERS7 16"O.G. p •. : : : - -- I/2"PLY,SHEATHING ' io� _-__ - PHA SHINGLES E • U -., W u0 �. AS ASPHALTASPHALT PAPER 2X10 RIDGE T -1 0 �qI 5'-0" IT'-0" • =d' e - - - `1 - 2X8 RAFTERS o 16 O.C. 22'-0" - li • ._O m _--- ____ •_... _ I/2".PLY-SHEATHING '• -- _`� - R30 INSUL. 6XS_FIR BEAM _ _ _- __ -, a� 15•ASPHALT PAPER NEW FOUNDATION PLAN A -- = yl RD P V AL _SHINGLES ,. _- - ^ 'IX3 STRAPPING ---® ASPHALT SH "WALLBOA T` 2X e C J e I FAMILY ROOM • 1/2"WALLBOARD R30 INSUL. ? 2X 'e•16"O.G. IX3 STRAPPING®� 777 1/2"WALLBOARD j' > ��II - .•I - - RI IN I '-WALLBOARD / 2x10'e a 10"O.G.—� _ I Id"PLY.SHEATHNG J 2 4'I • L O.G. TY EK WRAP OR EQUAL RI INSULATION e 3/4"T/G PLY. VEK WRAP OR EQUAL i /"CONCRETE WALL 4 / .I _ 51C ING II.. 1/ PLY.SHEATHING ) DAMP.PROOFING GSA/ _ NAILED 3 GLUED. - - - 3/d"T/G PLY. /APPOVED. a�. - - - I ::I _ • O.G• ' _- y NAILED a GLUED. 91 ING 2XI I GE - • - ._ 2RD 2X9e I O. _ rr g a-- • J _ y_ IL / _�� � RI9 NSUL. � _- /// ' / 3 2X a GICD_R- RI9 INSUL.-� e �/ // •� LOILLY COLUMN.�JI' /• // - I:'I/ � I 4"POURED GONG SLAB I 2X6 KEY O it �� !) /�' s' I BASEMENT CONC.FTC. 9 "y ! 2Xi0'e m 16"O.G.a 4"CONC.SLAB'• a COPiPAGTED GRANULAR -- / / d�CGNG.SLAB j FOOTING �!� DETAILS C" CONCRETE WALL � I " GRCS_5 SECTION lA, f�00F Fr?AMIitiCs PLAN _ _ CROSS SECTION CBJ TK� ! W s 2O CYST,ER i �E I�OA>7 I U __•` - - _. _ GATE �EVIS�'1N DRFLiJ EYC:E SCALE i _ . __m��gqr ; I, ELLEN M GOGK o r ^ 3 l 'ROPOSED RESTORATION J �'j� � ' _ CCJrUIT) �..4R� :.�BL MA. �. � _ Q It l E m I /U FL'RLNdlE Cr LliAl'i.W")/.E4 VE9 PidYVLDER RFD D.BLE•':•R C.�'TT lANCP Wl/!Al.f. Z EXILT e%E i.m REMFO.QLET.. •T Li.dL_LO`C4�TE F0'JT•:ua rW Au.FG 11 $Y1.1[L IX:VC 9a—/#TLl7: 11 I+ � 1 LX.4f.eU1.YG LOCI!dh[7 CPD,h'JNLED..'9 CE -�, P.O.BO%.�5 •/50D19 u-PS)O 1•-...- ,i 2� YGN9 T'3� �T tle.E D 4EEfLNe'GLF .HW)eE DEID•K•:FD 6r[OGK[`�>c LCVDr�•!aYD,tLLFP:Je[E /J1 VECY.^Y J.'.C.L11..4N.6: �Y S'YP C_9Xv V 15'_E II ILL9T B-tR.Y9TAe[_HA O:l•d• _ i L FCQ 5/>F IGNO/nOW O.Q fCR iFE LL1E OF lNE9E�A4•NG9:'.-.•.i:0A5fF.'LTiA•l PRdC11LE1 Q LOMSIRtL^ISOK vL.7 ADEtlLN WTN ICCAI EY-:�£FR WM IOCdL ENG,h'^�.Q,1..�2W[O/hG d�L'4!. 'yyF r. ara•s . �� { - - - -- SYSTEM DESIGN: — - _ _SYST€M- PFOrIL€ NOTES_ -_ -- LEGEND TOP FNDN. AT EL. 33.6'f PRONOE INSPECTION PORT W HIN 6 Of FINISH (FOR MAIN DWELLING ONLY) ACCESS LOVERS TO WITHIN 6'OF FILM.GRADE (NT.TO 6GA O GRADE 100.0 PROPOSED SPOT ELEVATION SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) (WATER IGH11)To - t. DATUM IS NGVD ACCESS CODER 31.0' INIMUN.TS'OF COVER OVER PRECAST WITHIN 6'OF FlN.GRADE 100x0 EXISTING SPOT ELEVATION DESIGN FLOW: 3 BEDROOMS (110 CPO) 33O GPO 2R SLOPE REouIREO OVER srsrEM 27 0' 2. MUNICIPAL WATER IS EXISTING USE A 330 GOD DESIGN FLOW IIyI��TI RUN PIPE LEVEL 2'DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 1 an sHova:v°1D 100 PROPOSED CONTOUR 29.50'• �roR FIRST 2' I SEPTIC TANK: 33�GPD (2 ) = 660 „vncP,Mlrv. L Ll 3' MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H=10 °U� h 100— EXISTING CONTOUR USE A 1500 GALLON SEPTIC TANK 28.0' 75 ITEE 25.0' s � 5. PIPE JOINTS TO BE MADEWATERTIGHT. LEACHING: FLE 2429'' C7 C7 C7 C7 O�O O 117 9 24.46' SIDES: 2(30+ 9.83) 2 (.74) _ ys 24.20' CD CD CD CD o o n o 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 30 x 9.83 74 = 218.2 (�R SLOPE) CO CRUSHED STONE OR MECHANICAL { ED 0 I=O ED O O O O o ENVIRONMENTAL CODE TITLE V. wnr BOTTOM: (' ) MIN coMPACTION.(16.221[z)) (, 2' ED ED ED ED O d 1--- O O us 22.20' 454 336.1 DEPTH OF FLOW- 4 (8_4 R SLOPE) (�z SLOPE) 7, THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE s, msTu vu TOTAL: S.F. _GPD TEE SrzES: 3/4"TO 1 1/2^ DOUBLE WASHED STONE USED FOR LOT LINE STAKING. D1°OL "0�0 USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR INLET DEPTH-10_ ' EQUAL) WITH 2.25' STONE AT ENDS AND 2.5' AT SIDES OUTLET DEPTH- 14" 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. - - 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED-WITHOUT LOCUS MAP LEACHING 5.2 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED NOT TO SCALE FOUNDATION— 40' SEPTIC TANK— 44 D' BOX 11' FACILITY FROM BOARD OF HEALTH. MA - 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE ASSESSORS MAP 35 PARCEL 86 APPROVED DATE BOARD OF HEALTH - LOCATION OF ALL UNDERGROUND& OVERHEAD',UTILITIES PRIOR, LOCUS IS WITHIN FEMA FLOOD ZONE BOTTOM TH 2 EL. 17.0' TO COMMENCEMENT OF WORK. A13 ELEV. 12 AND C -THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL - BUILDING SEWER OUTLETS AND ELEVATIONS EadrnraaW. SEPTIC S - ' PRIOR TO INSTALLINGINSTALLING ANY PORTION OF ' - Alt IN LARGE WE[ ! _ - TEST HOLE LOGS afv7=330' - - ENGINEER: DAVI WITNES_ Ir_ - + • S. D. DEBMARAISR RS R S4 DATE: 3/10/06 �/ PERC. RATE _. < 2 MIN/INCH _ c [yay r CLASS 1 —SOILS P(/ 11238 ELEV. ELEV. ep� --- =�, -- 4 4 .P S I _ \ '. i A L c • ,�EENCE --- , _ LS IOYR 2/1 •10YR 2/1 St.vc EX16T.150o GAL 1 1,a.!'.G ? /I ! /T`• • B B SEPTIC TANK PROP.NEW /// EXISTING TITLE 5 FOR COTTAGE(IN ' - _ LS LS Q FNDN UNDER DRIVEWAY)TO-REMAIN O 30" 10YR 6/8 29.0' 22" 10YR 6/e 1. SLEEVE SEWER UNE FOR ^. +=,• - , • '+ 25.17' _ 10'EITHER SIDE OF _ / . CROSSING W1T1 ' ' ATERUNE - T PROP. I• H // :/i� 1 - C (FULLL FNDN) PERC PERC G A E-T.30's SW TIil / LEACHING FACIutt ' MS MS TO BE MOD HERE.TO - BE 20'MOVE Do PROP, y�� -J' n ?:`� 10YR 6/4 10YR 6/4 . WATERL.E TO BE \ RE-ROUTED WHERE W THIN 10 MI SEPTIC—_ 120" 21.5- 120^ 17.0' SYSTEM COMPONENTS __ oY \ 25'� -- - /TIES! 12 1 - NO GROUNDWATER ENCOUNTERED • \ PROWDE APPRON.,So OF y T \ 60 N11,LINER AT 5 OFF- �'\ SAS N'•AREA SHOWN TO .. 4O2.AREA MIlGATE ANY CHANCE OF 22,3TB3 BREAKOUT_ =LE 5 SITE ' PLAN of \ 2 \ -- \\ r ��f \ 20 OYSTER PLACE ROAD (COTUIT) BARNSTABLE PREPARED FOR 0. \\ 1 ELLEN MYCOCK DATE: MAY 10, 2006 A�l/� \ - REV 12/11/06 (ADDN, MOVE SAS) STATE COASTAL BANK - ELEVATION 12.0' _ �\ oR 1.SOB-J506-362- r•� f62-M988o ? ' + down cape engJneering, inc. - , CIVIL ENGINEERS � LAND SURVEYORS p 939 main st. yarmouthport, ma 02675 06—121 ' , DATE ARNE H. OJALA, P.E., P.L.S. fe c 14'A e ur 6'.r s'.e yr DECK `"[C 1 1 DECK ---o ------------------------- 1 1 MASTER BR 1axs6" I I t� BEDROOM I 1 I 1 INI xt - ----------- LIVING BEDROOM 2M16' I - 3J - 1 _ I _ 13x147' b 1 F - - OPEN TO BELOW 1 J L R 3 SEASON I 1 � CLOS 1, ---- ——— ----- I .' - '. , ————————— HALL i CL. LAN i _CL-- BATH LOFT 0 O I 1 ttIS i 0 � L--------------- a _ BATH LINO 1 KITCHEN -- PWDR CL. MBATH 1 i 131x1171 - I 1 13'6'x1010" n `-i - I FOYER I / ----- FOYER CL, I I 1 `. ---------- -- —————— 1 I 1 o PORCH _. LND I 1 1 _ ------------------------------� , �• :r :• MUD FIRST 11 SECOND ; I 4 , FLOOR PLAN = FLOOR PLAN �. STORAGE GARAGE 2,319 S.F. LIVING SPACE 24'z24' 1,034 S.F. i 1 576 S.F. GARAGE 108 S.F. PORCH 488 S.F. DECK TOTAL FOOTPRINT=3,003 S.F. 1 r , I\J II OFFICE BEDROOM 15'6"X2l' 12'6`x19110" FAMILY ROOM 11 20'x 16' 1 _ CRAWL { SPACE r HALL 71-"=Q 0 Q iiiiiw� CPS 11111 t t' UTILITY CLOS. BATH ; ' I 1 cL�s 1 UP 1 I 1 L----- -- --------------'- . y - -- -- - - CRAWL SPACE } BASEMENT , FLOOR PLAN , � . _ GARAGE _ SLAB 1,520 +/-S.F. - s s FOUNDATION— ' 40' SEPTIC TANK 39' - MA D F HEALTH THE INSTALLER SHALL VERIFY THE OCATIONS OF ALL UTILITIES AND ALL UILDING SEWER OUTLETS AND ELEVATIONS 9ENCHMARK.• RIOR TO INSTALLING ANY PORTION OF NAIL IN LARGE 1REE EPTIC SYSTEM ALTERNATE BENCHMARK: USE TOP ELE'V = 3 O' BRICK FNDN THIS AREA AT ELEV. 325' PROVIDE CLEANOUTS AT / BENDS BETWEEN DWELLING AND SEPTIC TANK OCF CRAVE[ Rpq� ��J Oil CESSPOOL I (PUMP AND REMOVE) / METER EXISTING PROP. 1500 GAL 1 DWELLING `0 / SEPTIC TANK I T.FNDN.=325' SLEEVE E FOR / "'j` 10' EITHER' E OF / J CROSSING WITH �\ / PROP. WATERLINE ' SUNROOM \ CRAkSP PROP. 30'x 9.8' \ TH1 LEACHING FACILITY / J o WATERLINE'TO'BE�=- TTAGE RE-ROUTED WHERE \ ` ."EXIST/NG•CC WITHIN 10' OF SEPTIC 6,6•� 1.4' SYSTEM COMPONENTS 0 2Z328t ??\ �\ \ \ \\ \\ \ 1 \ o \ EXIST. RAISED . DECK i �13 SHED DECK \ \ \ \ \ \ ABOVE \\ \ \ \ GARAGE \ \ \ \ ® \ 2� EXIST. GARAGE \ \ IPA STATE COASTAL BANK o L \ ELEVATION 12.0' ,J40 0 /10 \ LEGEND SYSTEM DESIGN: TOP FNDN. AT EL. 33.6'f SYSTEM PROFILE NOTES (FOR MAIN DWELLING ONLY) ACCESS COVERS TO WITHIN 6" OF FIN. GRADE (NOT TO SCAM) PROVIDE INSPECTION PORT WITHIN 6" OF FINISH GRADE 1. DATUM IS NGVD 100.0 PROPOSED SPOT ELEVATION SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ACCESS COVER (VATERTIGHT) TO 31.0' INIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN GRADE 2. MUNICIPAL WATER IS EXISTING 2% SLOPE REQUIRED OVER SYSTEM 100x0 EXISTING SPOT ELEVATION DESIGN FLOW: � BEDROOMS ( 110 GPD) = 330 GPD 27,p USE A 330 GPD DESIGN FLOW RUN PIPE LEkl- 2" DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO, BE 1/8" PER FOOT. J- ; SHOW RDA 100 PROPOSED CONTOUR 330 GPD 2 = 660 �29.50'* FOR FIRST 2', 3' MAX. I y SEPTIC TANK: ( ) (PROP. ON. T PROPOSED 1500 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H 10 100 EXISTING CONTOUR 1500 " 128.uO O �1 GALLON SEPTIC USE A ____ GALLON SEPTIC TANK ' TANK (H- 10 ) 27.5' I� 5.0' 5. PIPE JOINTS TO BE MADE WATERTIGHT. LEACHING: ;. 24.46' 24.29 _ 2(30 + 9.83) 2 (.74) = 117.9 vmpes we, 0 24.20' O 0 0 0 O 0 0 O 0 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. WAY SIDES: ( 2 xsLOPE 0ED00 0 DODO 30 x 9.83 74 - 218.2 ) ems" CRUSHED STONE OR MECHANICAL 0 0 O O CI 0 O O O ENVIRONMENTAL CODE TITLE V. BOTTOM: (• ) MIN COMPACTION. (15.221 [2]) 2' 0 0 0 t� 0 I� 0 t� 0 22.20' LocUS DEPTH OF FLOW = `I 8.4 1 4 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE 454 336.1 ( % SLOPE) ( % SLOPE) oYSTER �� TOTAL: S.F. GPD TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE USED FOR LOT LINE STAKING. �+� ST USE (3) 500 GAL. LEACHING CHAMBERS (ACME-OR INLET DEPTH 10" EQUAL) WITH 2.25' STONE AT ENDS AND 2.5' AT SIDES OUTLET DEPTH = 14" 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT LOCUS MAP LEACHING 5.2' INSPECTION BY BOARD OF 'HEALTH AND PERMISSION OBTAINED NOT TO SCALE FOUNDATION 40' SEPTIC TANK 44' D' BOX 11' FACILITY FROM BOARD OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE ASSESSORS MAP 35 PARCEL 86 MA LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR APPROVED DATE BOARD OF HEALTH TO COMMENCEMENT OF WORK LOCUS IS WITHIN FEMA FLOOD ZONE . BOTTOM TH 2 EL. 17.0' Al ELEV. 12 AND C *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1- PRIOR TO INSTALLING ANY PORTION OF BENCHMARK.- SEPTIC SYSTEM NAIL IN LARGE TREE / BXV= 33.0' TEST HOLE LOGS / ENGINEER: DAVID FLAHERTY, RS WITNESS: D. DESMARAIS, RS / DATE: 3/10/06 - --- ��,/ PERC. RATE _ < 2 MIN/INCH Eo���RA�EL Rogoay Iv CLASS I SOILS p# 1 1238 � 6; -31 r \I ✓ -' (i - _ _ / __ - ELEV. 2 ELEV. p" 4 31.5' p" 27.0' A A METER / /. LS LS �, 10YR 2/1 " 10YR 2/1 EXIST. 1500 GAL. I' EXISTING i�32 /�0� 12 10 SEPTIC TANK / DWELLING / �� / / , B B / PROP. NEW I ��1 EXISTING TITLE 5 FOR COTTAGE (IN LS LS / FNDN UNDER I / / / // EXISTINGDRIVE-KAY) TO REMAIN ; / 0 " 10YR 6/8 10YR 6/8 SLEEVE SEWER LINE FOR 30 29.0' 22" 25.17' 10' EITHER SIDE OFCROSSING WI WATERUNETM / ai / / PROP. � �, _ C C .: ADD'N - - / / / / r PER& PERC (FULL FNDN) a EXIST.30'x_9_$' . Tut LEACHING FACILITY TO BE MOVED HERE, TO s BE 20' OFF PROP. ADD N. 30 l 1 OYR 6/4 1 OYR 6/4 WATERUNE TO BE RE-ROUTED WHERE \ EXISTING COTTAGE / WITHIN 10' OF SEPTIC SYSTEM COMPONENTS � .A/ \ 25 / 120" 21.5' 120" 17.0' NO GROUNDWATER ENCOUNTERED \ \ \ \ PROVIDE APPRM,50' OF \ 4' Wlb 40 MIL UNER-AT 5' OFF ISAS IN AREA REA SHOWN,`TOP AT ELEV. TOP' (SAME ELEV. AS / TITLE- 5 SF SAS� ITT ''LA� r EXIST.RAISED OF .p A \ \ DECK j 20 OYSTER PLACE ROAD vL -'13 SHED DECK (COTUIT) BARNSTABLE \ ABOVE ° GARAGE \ \ \ \\ PREPARED FOR 2/ EXIST. \\\\\ IP GARAGE ELLEN MYCOCK DATE. MAY 10, 2006 \\ \� REV 12/11/06 (ADDN, MOVE SAS) STATE COASTAL BANK j \ ELEVATION 12.0' Scale: 1"= 20' .p 0 10 20 30 40 50 FEET ( \ off 508-362-4541 fax 508-362-9880 down cape engineering, inc. �rw A CE �� g 4��� oJA 7 ARNLA 6 CIVIL ENGINEERS Ido, 5� o� l �' IL LAND SURVEYORS . 3 1.�2c 1I Zoe i ��op � �'� G\a�� 939 main st. parmouthport, ma 02675 DATE A. & . OJALA, ON 06- 12 > ' 06-121 SP.DWG .___ _ _.._..._- ._ .ter;'....r...,�...x-.xiA^°•.....-.. - TOP FNDN. AT L. 32.0' SYSTEM PROFILE PROVIDE INSPEC11ON PORTS TO NOTES k LEGEND SYSTEM DESIGN: (NEW DWELLING FINISH GRADE (MIN. 2) ACCESS COVERS TO FIN. GRADE (NOT TO SCALP) NGVD 100.0 PROPOSED SPOT ELEVATION GARBAGE DISPOSER IS NOT ALLOWED ACCESS COVER (WATERTIGHT) TO 1. DATUM IS _ 30.2' INIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRTE �► (TO GRADE IF UNDER DRIVE) 2% SLOPE REQUIRED OVER SYSTEM 2. MUNICIPAL WATER IS AVAILABLE 100x0 EXISTING SPOT ELEVATION DESIGN FLOW: 6 BEDROOMS 0 110 GPD = 660 GPD 31.0 Rom 100 USE A 660 GPD DESIGN FLOW _ _ RUN PIPE LEVEL 2" DOUBLE WASHED PEAsroNE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. PROPOSED CONTOUR �29.00 FOR FIRST 2' SEPTIC TANK: 660 GPD (2) = 1320 PROPOSED 3' MAX. 4. DESIGN LOADING FOS ALL PRECAST UNITS TO BE AASHO H—20 100 EXISTING CONTOUR 28.22' GALLON SEPTIC 7.97 "-�D 28.0' s USE A 1500 GAL. SEPTIC TANK TANK (H— 20 ) \ 5. PIPE JOINTS TO BE `MADE. WATERTIGHT. I BAFFLE 27.59' 27-4240 LEACHING: 2 0 27.20' a a a �0 0 O 0 O C3 o 6. CONSTRUCTION DETALS TO BE IN ACCORDANCE WITH MASS. ` SIDES: 2 (58 + 10.8) 2 (.74) = 203 GPD (—x SLOPE) �6" CRUSHED STONE OR MECHANICAL 0 O O O � O r O 0 ENVIRONMENTAL CODE TITLE V. O1ST� , MIN COMPACTION. (15.221 (2]) 2' 0 C3 0 0 0 0 0 0 0 25.20' sa+oa sr. BOTTOM 58 x 10.8 (.74) = 463 GPD DEPTH' of FLOW = 4 ( 1 X SLOPE) ( 1 X SLOPE) 7. THIS PLAN IS`FOR PROPOSED WORK ONLY AND NOT TO BE TOTAL: 900 S.F. 666 GPD TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE USED FOR LOT LINE STAKING. INLET DEPTH 10" H-20 CHAMBERSUSE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. .WITH (3 5'SSTONE A00 GAL T ENDSAND 3ACHING M AT SIDESBERS FROM OR EQUAL) ouTu=r DEPTH = 14" LOCUS MAP FROM EXIST.WELL 34, 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT FOUNDATION SEPTIC TANK 38' LEACHING 8.2' INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED NOT TO SCALE D' BOX 24' FACILITY FROM BOARD OF HEALTH. I FROM P. 16 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE ASSESSORS MAP 35 PARCEL 86 MA LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR APPROVED DATE BOARD OF HEALTH LOCUS IS WITHIN FEMA FLOOD ZONE I BOTTOM TH 2 EL. 17.0' TO COMMENCEMENT OF WORK. Al ELEV. 12 AND C - i , `Try_ BENCHMARK. / s TREE/N LARGE TEST HOLE LOGS ELEV = ,�0 ENGINEER: DAVID FLAHERTY, RS / WITNESS: D. DESMARAIS, RS RETAIN EXISTING DWELLING 0 / 06 3 10 , DATE: / / PERC. RATE _ < 2 MIN/INCH PROPOSED DRIVEWAY CLASS I SOILS P# 11238 qp J/ METAL ELEV. f� ELEV. CO Q I 3i�2• I — 0" 31.5' O" 4 27.0' CESSPOOL (PUMP do / METER ` / A A REMOVE) J A �% `• / PROVIDE VENT WITH CHARCOAL FILTER LS LS PROPOSED RE—ROUTED Cf /,<� .• / AND BUGSCREEN (FINAL PLACEMENT WITH l OYR 21 l OYR 21 / HOMEOWNER CONSULTATION) �� / / PLUMBING pp � EX/STING �32 12 10 O DWELLING TOF=32.5' / 10 i B B (No •( / NOTE: PROPOSED LEACHING FACILITY IS IN LS LS I / BASE) .•I / / AREA OF EXISTING SYSTEM FOR COTTAGE 30„ 10YR 6/8 10YR 6/8 (PUMP AND REMOVE IN ITS ENTIRETY; w oi[ l / / REMOVE ALL CONTAMINATED SOILS WITHIN 29.0' 22" 25.17' \ NK / / 5' AND REPLACE WITH CLEAN MED. SAND) C GARAGE ? :...; ;• �^ PERC PERC \ : _ �. : ... L .... ...a -! 1 - _ MS -M5 - - 9 ' 10YR 6/4 10YR 6/4 s� 120" 21.5 120 17.0' TH2 / EXISTING COTTAGE TO BE NO GROUNDWATER ENCOUNTERED PROPOSED DWELLING /ryoi RAZED \� 'TOP FNDN = 32.0 ---� N \ ? o \ / \\ \ ? 3 SEAS. / RM. / / / BASEMENT BATHROOM TO BE \ ��9 ` 3 0 / SERVED BY SEWAGE EJECTOR I \ ` w�• ti• S9• PUMP (<25% OF TOTAL FLOW). CONSULT PLUMBER FOR L.Or-AAE-A ��� \ ` DECK \\ DESIGN/INSTALLATION 22,928 9'f� \ \ TITLE 5 SITE PLAN EXIST. i RAISED OF DECK Foc SHED 20 OYSTER PLACE ROAD \ \ \\ \ \ \ \ \ \ DECK \ \ �� - (COTUIT) BARNSTABLE >> ABOVE GARAGE \\\ \ PREPARED FOR �►IP 2 EXIST. GARAGE �� �jB PETER EVANS Aso, DATE: APRIL 6, 2006 7'0Q7 oL 0 \� STATE COASTAL BANK ELEVATION 12.0 Scale:1"= 20� A 5� \ \ 0 10 20 30 40 50 FEET a ( \ off 508-362-4541 fax 508-362-9880 OF* d 0 wn Cape engi 1 E'G'l ing, inc. N of M ARNE ��'� AScy H. �o A E H•. CIVIL ENGINEERS oJAL. ALA LAND SURVEYORS No.26 8 R IVIL � 0792 939 main st. yarmouthport, ma 02675 D TE JALA, P. J�. •EN 05-313 .05-313 SP.DWG