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0046 PINEVIEW DRIVE - Health
46 PINEVIEW DP�v A= 040-083.015 h i 1 TOWN OF BARNSTABLE F LOCATION° 'LI P f A" (e.w Or l�Ae, SEWAGE# 2 0 17 �. VILLAGE CCi� ASSESSOR'S MAP&PARCEL 00 > INSTALLER'S NAME&PHONE NO. (�C.riS �y-ca �177-�177 SEPTIC.;TANK CAPACITY LEACHING FACILITY:(type) LC 5 01 (size) NO.OF BEDROOMS OWNER UM 11 PERMIT DATE: 2 3 b COMPLIANCE DATE: sk LIP p 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 •"s Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY T �- 5N _ 3 4 �3 �.5 6q 3 77.5' �3,5 fimvie-w drive. T4a ,O.1F BARNSTABBLE (� Pryis LWAGE VILLAGE . slrssoits Loxes, INST�JLLEVS NAM. Bc T�NQNE NC .. SJEF'I"�C'X'A1'lk CA P�C ;.. LAC AC19:TP Y: .( ,!!) NO O BEDRdoNis M. Sep►amt�oe �9seaa�c;Between tef 1b11sXlmpml�djUBCetlGputgdwatec'1'at�le�atl�eSattarnufilLes�c,henl�f�r�iliry.. . ..rim.scut iva44 Wtur Supply, l �ldeaa�ingacgl�ty �JC arty:��ts195 exist ?rare: ap eit�s a� wStllln�Atl feet of lsacluo►tg;�t�cHi . &66 d�i�/et(a�ttt;tntd LeacWg 1~iciliey(kE wy a lands e41. f wlt{���;3Q4�CG4 Q 14tc�aln��a,ctyAli ) c uq�a��wl n � I � C- .20 -C- 93 � o- S'-1 49-9 a7 ' 00 - 3a '6 TOWN OF^^B'' 11 TABLE L �TI to SEWAGE # OCATION � VILLAGE ASSESSOR'S MAP & LOT�y^ INSTALLER'S NAME&PHONE NO. 'f SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS ^^ UILDER OR OWNER `� \ PERMTTDATE: 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 1 ue r �A o � A4 Ag3a` O AD qT ® 't No. o l Fee v i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphLation for VispoB Y O- pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ; nLl Components Location Address or Lot No.`1 l ae_ V few ,r^ Owner's Nam Address,and Tel.No. S Assessor's Map/Parcel Q Fj� p U � h� Installer's Name,Address,and Tel.No. S—O Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 10 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) (J gpd Design flow provided 3s--2- gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sol Nature of Repairs or Alterations(Answer when applicable) �- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental ode and not t lace the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date :!5r�- ,9,?4( Application Approved by Date J —.2 Application Disapproved by Date for the following reasons Permit No. �-fi 6 Date Issued V / ee No. _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1.11 ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Disposal 6pstem Construction permit , Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System BIXndi,idual Components Location Address or Lot No.gb n e V i'eu) D(^ OW;X ' ddress,and Tel.No. s� Assessor's Map/Parcel `i Q es �6�v,� _ 01�17a n 1.10 Installer's Name,Address,and Tel.No. ` —061 7 0/ Designer's Name,Address,and Tel.Now.—�31ow( E� -- / re, /G. vlM� ��10- Save Type of Building: Dwelling No.of Bedrooms 3 Lot Size rC� COd sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2 (� gpd Design flow provided 352 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil -P l , Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: � The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordar►cc with the provisions of Title 5 of the Environmental ode and no!.! place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date.75 Application Approved by t' o �A Date S-1 Tom_ Application Disapproved by cr Date for the following reasons Permit No. '? G ( 6 ' 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 16 Fa ra iJGc 1 Ct A C, —7t yt C at_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -14 2..dated S / / Installer�C�s x �'�y-Q�l 4!g J: OL Designer #bedrooms _� Approved design flog 3 o gpd The issuance f thi permit shall not be construed as a guarantee that the system �11 fun tion as desi ed. \ �Date Z�� 1 Inspector v\/` - No. 2 d ` ' l FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstrm Construction permit Permission is hereby granted to Construct( ) Repair(✓� Upgrade( ) Abandon( ) System located at��!��(,�C� a r , and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with j Title 5 and the following local provisions or special conditions. Provided:Construction mustjbe completed within three years of the date of this permit. Date � , Approved by Town of Barnstable IKE Regulatory Services Richard V. Scali, Interim Director * BARNSTABLE, • 9� i63S. `�$ Public Health Division At fo 3,t s Thomas McKean,Director 200,Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form 22 ---Date: v - l Sewage P rmit#" Assessor's Map\Parcel � �l Designer: MInstaller: Address: Co— 4V Address: VV�� On was issued a permit to install a (date) (installer) . septic system at '1VJ VY-V)e" [X lam' L 'based on a design drawn by ll,^, _(address) V&s dated v IV �b (designer) I certify that the septic system referenced above-was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank_. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 100'>lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. .Strip out(if required) was inspected and the soils were found satisfactory. I certify that thej�ystem referenced above was construct e with the terms of the IAA ap .offal letters(if a icable) ( staller' Signature) 19 iJ ( esigner's Sig (Affix Designer amp Here) PLEASE UI�N TO BARNSrABLEBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT.,CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc k� �, .- %\ 'v'\ �_ ,tit; it ��" � 13P- i I Town of Barnstable Barnstable Regulator Services Department g rY p 1 . MLZ1639. 0 D Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V. Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7015 1730 0001 4990 4834 June 21,2016 Hugh N Oldham 46 Pineview Drive Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 46 Pineview Drive, Cotuit,Mills,MA,was last inspected 2/26/2016, by Sean Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Single cesspools automatically fail in the Town of Barnstable.. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the.septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Ltr not sent system already repaired Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\46 Pineview Dr Cot Apr2016.doc Town of Barnstable • » �-srXeLE, Regulatory Services Den artineilt rFt1 MPS. r . Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6,•2007 - Rev. 7/6/15 DEADLINES TO REPAIRFA.ILED SYSTEMS To Code 360-44 and Title • 3 0(Town § V. 1 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑BacImp of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or.cesspool ❑Any portion of the SAS, cesspool, or privy, below high groundwater elevation ❑Any portion of the cesspool within'a Zone 1 to a public well ❑Any-portion of a cesspool within 50 feet of a private water supply well with no acceptable water.quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO 2 YEAR DEADLINE CRITERIA Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components; etc) o Leaching pit or-cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER ..Repair deadline: WSEPTICUEADLINES TO REPAIR FAILEDSYSTEMS.doc b �� J Commonwealth of Massachusetts , ibb� Title 5 OffidaAl Inspection Ford Subsurface Sewage Disposal System Form -;Not for Voluntary Assessments l M 46 Pine View Dr _ Property Address Hugh Oldham h Owner Owner's Nam information is t required for every Cotuit - MA 02635 2-26-16 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.T A. General Information f 1 1 Inspector: .. + •, , . Shawn Mcelroy ` Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number Ucense 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 f Conditionally Passes ,,. . ®-Fails , Needs Further Evaluation by the Local Approving Authority. _ • , _,.2-26 tc r -16' , I pector'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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 M 46 Pine View Dr Property Address o: Hugh Oldham Ober Owner's Name information is Cotuit MA 02635 2-26-16 rq,kpired for every pege. City/Town State Zip Code Date of Inspection ', B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D ' A) System Passes:,, ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. ` Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): r t5ins•W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts , °,-z i Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form :Not for Voluntary Assessments 9M 46 Pine View Dr -• 'F Property Address Hugh Oldham . r Owner Owner's Name information is Cotu'it = MA 02635 2-26-16' ' required for every - page. City/Town t State Zip Code Date of Inspection B. Certification (cont.) • + ❑ iPump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. " - B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or High static waterlevel in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or#u_neven distribution box. System will pass inspection if(with approval of Board of Health): ` , ❑ brokW pipe(s) are replaced ElY ❑ N,r ❑ ND (Explain below): ❑ obstruction is'rernovedf ❑ ,Y, ❑ N . ❑ ND (Explain below): ❑ distribution box is leveled or replaced r❑ Y ❑ N ❑f ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: . ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment.-. + 1. System will`pass unless Board of Health determines in'accordance with 310 CMR 15.303(1)(b)that the system,is not functioning in a manner which will protect public health, safety and'the environment: ' ❑ Cesspool orprivy is within 50 feet'of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 46 Pine View Dr Property Address Hugh Oldham Owner Owner's Name information is required for every Cotuit, MA 02635 2-26-16, page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ; 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: 1 ❑ 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r , Commonwealth of Massachusetts Title 5 Official InspectionForm Subsurface Sewage Disposal System'Form =Not for Vol u ntaryAssessm ents f 46 Pine View Dr p, I Property Address w Hugh Oldham ' Owner Owner's Name information is required for every Cotuit t MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) j ; Yes' No Required pumping more than 4 times in the last year NOTdue to clogged or obstructed i s . Number of times pumped: P PeO P P ❑ -- ' ® 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. El ® An onion of'a cesspool or privy is within a Zone 1 of a public well. Y p P P vy ❑ ® 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 witli 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 EJ ❑ the system is within 400 feet of a surface`drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a1surface drinking water supply the,system is located in a nitrogen sensitive area (Interim Wellhead Protection s, ' ❑ Area— IWPA)or a mapped Zone 11 of a public water supply well If you have'ariswered "yes"•to any question in Section'E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 ^ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts f W Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Pine View Dr Property Address Hugh Oldham -Owner Owner's Name information is required for every Cotuit - MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection C. Checklist s 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? 11 ❑ ® 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts = ! + Yt w Title 5 Official Inspection Form Subsurface SewageDisposal System Form-Not for Voluntary Assessments M 46 Pine View Dr Property Address Hugh Oldham - Owner Owner's Name information is required for every Cotuit MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder?- ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection .,. information in this report.) • ' ❑ Yes ® No Laundry system inspected? ` 9 ❑ Yes ® No + Seasonal use? i. El Yes ® No Water meter readings, if available (last 2 years usage (gpd))- Detail• il' t' ' -to t Sump pump?' .. t . w , . .' '"_ `.;'. ❑ Yes ® No 1-2016 Last date of occupancy: ,, Date Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310-CMR 15.203): ^Gallons per day(gpd) . .+ :Basis of•design flow(seats/persons/sq.ft.;etc.): Grease trap present?, W, ❑ Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system?. ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 — Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments b 46 Pine View Dr Property Address Hugh Oldham Owner Owner's Name information is required for every Cotuit MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system , ❑ Single cesspool ❑ Overflow cesspool f ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts '•' ' ' . Title 5 Official Inspection f6m Subsurface Sewage Disposal System Form =Not for Voluntary Assessments- .tt, M 46 Pine View Dr "r Property Address Hugh Oldham , Owner Owner's Name information is i t out' ` MA 02635 2-26-16 required for every C r. -`�' ' _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1984 Were sewage odors detected when arriving at the site? r ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24" feet Material of construction: ❑'cast'iron , ® 40:PVC , 1 ❑ other(explain): Distance from private water supply well or suction line: ..�~feet • j Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: _ ,, , 16" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene, ❑ other(explain) 1f tank is metal, list age: - years Is age confirmed by a Certificate of Compliance? (attach a'copy'of.certificate)` ., ❑ Yes ❑ No 1000 gal Dimensions: Sludge depth: 12 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Pine View Dr Property Address Hugh Oldham Cwner Owner's Name information is required for every Cotuit MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) T, Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top.of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts •'` • _ _ Title 5 Official. Inspection' Frorm Subsurface Sewage Disposal-System Form -Not for Voluntary Assessments 46 Pine View Dr Rroperty Address Hugh Oldham r: €- Owner Owner's Name information is Cotuit ] ' l MA 02635 2-26-16 'required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or-baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 9 ( p P P ) ( p ) Depth below grade` Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons .Design Flow: , F . . s ;.•, gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 46 Pine View Dr Property Address Hugh Oldham Owner Owner's Name information is required for every Cotuit MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan):- Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level. There is evidence of back-up from pit with stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑. Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Pine View Dr Property Address Hugh Oldham Owner Owner's Name information is required for every Cotuit MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ 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 was holding 24" of water at inspection with clear evidence of back-up with stain lines above inlet invert and into surrounding soils. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Pine View Dr - Property Address Hugh Oldham Owner Owner's Name information is required for every Cotuit MA 02635 2-26-16 __-__---____ _— page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: - - - - - - - - - - Dimensions - - --- - Depth of solids - - --- --- --- Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Al a . ' . Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form -;Not for Voluntary Assessments 46 Pine View Dr _' Property Address Hugh Oldham ^ Owner Owner's Name information is , required for every Cotuit i.'u MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately - C jP i— CK -0- c kf t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts 10 w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Pine View Dr Property Address Hugh Oldham Owner Owner's Name information is required for every Cotuit MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Pine View Dr Property Address Hugh Oldham Owner Owner's Name information is required for every Cotuit MA 02635 2-26-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file f t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f e Town of Barnstable Barnstable �tHET Regulatory Services Department • snnxsreaM ; D K"S Public Health Division 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO i CERTIFIED MAIL # 7015 1730 0001 4990 4834 Apri127, 2016 1 Hugh N Oldham !/ 46 Pineview Drive Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at.46 Pineview Drive, Cotuit, MA.1 ,MA, was last inspected 2/26/2016, by Sean Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Single cesspools automatically fail in the Town of Barnstable.. You are ordered to repair or replace the septic system within sixty (60) days from the ; date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD'OF HEALTH i lomas c dean, R.S. CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures or Future 13046Pineview Dr Cot Apr2016.doc Town of B astable P# S Department of lte nlatory Services ? = Public3[ealth Division Bate �ARNarABLB, r ¢ �e 200 Main Street;Hyannis MA 02601 aq Date Schedules( ' Time Fee Pd.- O? S Fes► 0 Soil Suitability Assess ml eat fog- tSew e Disposal Performed By: `1t'" �l' / Witnessed By: L • i i LOCATION & GENERAL'INFORMATION Location Address 46 P `' D _ Owner's Name (��+ t5 L�H 1�M ll LT /r l I Address S A IV�1 Tom' Assessor's Map/P4rcel:04 D /p,o,3 I Engineer's Name M Ey E 2 S�� NEW CONS11ZU�`i;ION REPAIR X Telephone# SOS ��— 3 I Land Use �'" ' " Slopes(9o) (J"S �" Surface Stones ;A) Distances from: Open Water Body ft Passible Wee Area �lei/U ft Drinking Water Well �M_ft Drainage Way v ft. Property Line _ft Other ft SKETCH:(Street name,dimcnsionis of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Sew S>° I i i i i i i I �QVt d✓t �rS(�l Depth to Bedrock r'vV Parent material(geologic' Depth to Groundwakdr. Standing Water in Hole: Weeping from Pit Face Estimated Seasonali1Iigh Groundwater D TE TION FOR SEASO�AL MGH WATER TALE Method Used: In. Depth db�served standing in obs.hole: in., Depth td Sall mottles: ik i in, Groundwater Adjustment Depth toiweeping from side of obs.hole: , _ Adj.{setor, ,_ Adj.(Jroundwater level index Well# _ Reading Date Index Well lev6l - . I PERCOLATION TEST . Datr_,_....e. Observation Time at 9" ---- Hole# -n i Time at G" Depth of Pere LQ o 3 I -Time(9"-6') Start Pre-soak Time.@ 1 h�--y-- iEnd Pre-soak i - , i Rate MinJInch � ' Site Suitability As Site Passed , �___ Site Failed: Additional Testing Needed(Y/N) Original:.Public ielth Division Observation Hole Data To Be Completed onBack-- -- ***If percolation test is to be condracted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1)week prior to beginning. �o �!C DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other a. .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. �. Consistency,3'o Gravel Loa o Yl „ G 7l3 2 2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil, Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gra el Lt— a �DEOvt 4 2. 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Hor izon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc 35 Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra IFlood Insurance Rate Map: Above 500 year flood boundary No Yes _ Within 500 year boundary No Yes . Within 100 year flood boundary No -Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist,in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious material? Certification I certify that on J Q �� (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the required`rai ,expertise d exper'enc described in 3,10 CUR 15.0 7. r Signature Date Q:ISEPTIC\PERCFORM.DOC i COAMONWEALTH OF MASS SACHUSETTS ExECUTivE OFFICE OF ENS RO�NTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTEC r R'ECEIV/E® PARCEL [NOV. _ NMAP OV .3 2004 L0T TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A �CERTIFICATION Property Address: fi !J o Q Kev Yr 1i\# j Owner's Name: _ Owner's Address: e ` Date of Inspection: 42 Cot Name of Inspector: 1 print) ` Company Name.- has f�a5 Mailing Address: 10114 6 Telephone Number: CERTIFICATION STATEMENT 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 off 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Rate: a5 D 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address ltow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/152000 page I i Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IHSPOSAL`SYSTEM INSPECTION FORM PART A ,CERTIFICATION(continued) Property Address: XeW tr c Owner: Date of Inspection. Inspection Summary: Check A,B,C,D or E!ALWAYS complete all of Section D A. System Passes: I havemot found any information which indicates that any of the failure criteria described in 310 CMR 15: 3 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the B of Health,will pass. Answer yes,no or not determined(Y,N,AID)in the for the following sta# nts_If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic (whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank . is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approv by the Board of Health. *A metal septic tank will pass inspection if it is structurally d,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availab . AID explain: Observation of sewage backup or or Ingh static water level in the distribution box due to broken or obstructed pipes)or due to a broken,seal uneven distribution box.System will pass inspection if(with approval of Board of Health): ea pipe(s)ar xgdaced iixetnoved distrtbutieri beat is leveled or replaced ND explain: The system r ed pumping more than 4 times'a year due to broken or obstructed pipe(s).The system will pass inspection if( approval of the Board of Health): broken pipe(s)are replaced . obstruction is removed ND explain: y 2 I Page 3 of i 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:__ e7 A l/i e Owner•. Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in ord 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 w' 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public h th,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 vegetat wetland or a salt marsh 2. System will fail unless the Board of Health(an Public Water Supplier,if any)determines that the system is functioning in a manner that protects a public health,safety and environment: _ The system has a septic tank and soil sorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a s ce water supply. _ The system has a septic tank an AS and the SAS is within a Zone i of a public water supply. _ The system has a septic d SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well** ethod used to determine distance **This system passes if well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile is compounds indicates that the well is free from pollution from that facility and the presence of nia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are 'ggered_A copy of the analysis must be attached to this form. 3. Other- 3 G Page4ofil OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DIMPOSALSYSTEM INSPECTION FORM PART.A- '1L'M' `ICCATION(continued) Property Address: Owner. I h'>MJP 6 Date of Inspection: — — A 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 j Liquid depth in cesspool is Iess than 6"below invert or available volume is less than%Z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. u Any portion of 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 1 of a public well. — S Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 t3boratory,for germ 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 Iess than 5.pM provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)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 fa '' with a design flaw of 10,000 gpd to 15,000 gpd. , You must indicate either"yes"or`no"to each ofthe wind (The following criteria apply to large systems in on to the criteria above) . yes no — _ the system is within 400 f of a surface drinking water supply the system is within feet of a tributary to a surface drinking water supply _ the system is in a nitrogen sensitive area(Interim Wellhead protection Area—IWPA)or a mapped Zone H of ublic water supply well If you have eyed"yes"to any question in Section E the system is considered a significant threat,or answered "yes„in n D above the large system has failed The owner or operator of any large system considered a. significan eat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. a system owner should contact the appropriate regional office of the Department. 4 I ` Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B r j�CHECKLIST Property Address: Y 4 A h 1F 1 ew D",,/.-C Owner. Date of Inspection. Check if the following have been done.You must indicate"yes"or`fro"as to each of the following: Yes No 1K _ Pumping information was provided by the owner,,occupant,or Board of Heahh 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 Iarge 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 Lenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ Existing information.For example,a plan at the Board of Health. K ___ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance Ts unacceptable)[310 CUR 15.302(3)(b)] 5 Page 6 of I I OFFICIAL INSPECTION FORM NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: I i p ��►� Owner: Date of Inspection a?e, FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms):�� Number of current residents: V Does residence have a garbage grinder(yes or no): /Ilb Is Iaundry on a separate sewage system(yes or no):A [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):Ilfo Last date of occupancy: Cyr� COMMERCfAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): d Basis of design flow(seats/personslsgft,etc Grease trap present(yes or no): Industrial waste holding tank prese (yes or no): Non-sanitary waste discharg the Title 5 system(yes or no):_ Water meter readings,if a able: Last date of occupanc se: OTHER(de be): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,da talled(if n wn)and source of information: l fay 1A G3 ; Were sewage odors detected when arriving at the site(yes or no): 6 f Page 7 of 1 I OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 416 ?;,a Owner: p Date of Inspection: BUILDING SEWER(locate on site plan) . Depth below grade: Jot Materials of construction:_cast iron k4o PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of}oints,venting,evidence of leakage,etc.): SEPTIC TANK: Y (Iocate on site plan) a Depth below grade: �.2� Material of construction: Z concrete metal_fiberglass,_polyethylene _other(explain} If tank is metal list age:i Is age confirmed by a Certificate of Compliance(yes or no)._(attach a copy of certificate) Dimensions: /('Q Cam- Sludge depth: 02 Distance from top of sludge to bottom of outlet tee or baffle: 3 0 Scum thickness: . c? ' _ Distance from top of scum to top of outlet tee or baffle: 2 Distance from bottom of scum to bottom of outlet tee or 'e: /{ How were dimensions determined: R C&Av� Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related t utleti invert,evidence of leaka e,etc. 4141 ileAW GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal 2 glass_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scuXendanions, ee or baffle: Distance from bottom off outlet tee or baffle: Date of last pumping: Comments(on pumping inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invertge;etc.): 7 Page 8ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Vf Owner: _ Date of Inspection: TIGHT or HOLDING TANK: (tank must be p time of inspection)(locate on site plan) Depth below grade: Material of constriction: concrete fiberglass_polyethylene other(explain): Dimensions: Capacity: ons Design Flow: allons✓day Alarm present(yes or no): Alarm level: AI in working order(yes or no): Date of last pumping: Comments(conditio f alarm and float switches,etc_): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: -," Comments(note if box is level and distnbution to outlets equal,any evidence of solids carryover,any evidence of leakage intoAAor out of box,etc.): 1 / PUMP CHAMBER: (locate on site Pumps in working order(yes or Alarms in working order(y r no): Comments(note conditi of pump chamber,condition of pumps and appurtenances,etc.): t 8 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: R— ✓rf✓ Zi '(fQ .r Owner: gq Date of Inspection: Q IL SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type OC leaching pits,number. 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. L(y etc.): 4< 7 G �!E/' -1�• i CESSPOOLS: (cesspool must be pumped as part of tion)(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' ow(yes or no): Comments(note conditio 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 o oil,signs of hydraulic failure,level of ponding,condition of ve-etation,etc.): 9 Page 10 of 1 l OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: `►.� I i�, V/11,iv /�t G� Owner.� ho4 ` Date of Inspection: 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 ebters the building. 6? 3q a3 r qq r • V M/ A to Page i I of l 1 OFFICIAL INSPECTION FORDS-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: e- �Q Owner: Date of Inspection: SITE EXAM Slope ►J O Surface water 00 Check cellar Shallow wells 00 Estimated depth to ground water &6-feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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) . a Accessed USGS database-explain:_ You must describe how you established the high ground water elevation,n l7Sa V11r�,��„S,_S�n�ta ckt� et,Q�1a�'to� pis OV� 7�� �, lI 4,11 VO eggg�g 'yQ}q <10,n , COMMONWEALTH OF MASACHUSETTSAj # r EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Address of Owner: 46 PINEVIEW DR COTUIT,MA 02636 Date of Inspection: 8/1/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 CERTIFICATION STATEMENT + 7 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 Inspection.Ttie Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluation y the Local Approving Authority Fails Inspector's Signature: Date:812/00 The System Inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this Inspection.If the system is a shared.system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The Inspection Is based on criteria defined In Title V code 310 CMR 15.303.My findings are of how the system Is performing at the time of inspection.My inspection does not Imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE_V INFECTION.RECOMMEND PUMPING THE EVERY TWO YEARS AS NEEDED TO PROLONG THE SYSTEMS USEFULL LIFE. P i fi!� Ak arc `K 7 y S<oo f a, revised 9/2/98 ' . Page 1 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined',explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was Installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health. nia Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed distribution box is levelled or replaced Wa 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 .t I` a an3 revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1/00 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 IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 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 ANY AND PUBLIC WATER SUPPLIER.IF( )DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 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 n&(approximation not val'd). 3) OTHER I' n/a c ti • roit i rt revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: a I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 0. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. - X Any portion of a cesspool or privy is within 50 feet of a private water supply well, - X 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: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: 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 orpore of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. t revised 9/2/98 Page 4 of 11 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner: MR.AVGIS Date of Inspection: 8/1/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X - Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least 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. X As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X - The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ 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: X _ Existing information,For example,Plan at B4O,H, X - Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X - The facility owner(and occupant`s,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2198 Page 5 of 11 f. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1/00 FLOW CONDITIONS RESIDENTIAL; Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:1 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a CO M M ERC IAL/IN DUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO I Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1980 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 30" Material of construction: _ cast iron _ 40 Pvc X other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 24" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 5'7"W 4'10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED 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.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. 4' GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a . 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.) n/a .•t revised 9/2/98 Page 7 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene other Explain: n/a — Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: condition of inlet( tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) E Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out cf box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a ,X revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1100 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required;location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 3'OF WATER IN IT AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: tit (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a i . f revised 9/2/98 r Page 9 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 644 I 39jiiL �I R 00 � D uC AA boy 46 �5` Rr- 3a ,40 �s a gc �S N revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 PINEVIEW DR COTUIT, MA 02635 M40 P83 Name of Owner MR.AVGIS Date of Inspection: 8/1100 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2/98 Page 1.1 of 11 . TOCAT ON ��e U/ems✓ . )r�u e Lot /,- Avis 40- f-2 _ NO. VILLAGE Cotuit Mass . _ DATE APPLICANT FEE � __f ADDRESS Great Pond. Road S . Yarmouth TELEPHONE NO. 398-8510 (Non-refundable) ENGINEER Norman Grossman : TELEPHONE NO.— L DATE SCHEDULED September , 1982 _ _ (Applicant' s signature)� SOIL LOG - SUB-DIVISION. NAME Pine View Villiage DATE C6ro 1A17�� TIME EXPANSION AREA: YES .!/NO _ ENGINEER:?. =_: TOWN--STATER X PRIVATE WELL BOARD OF HEALTH - EXCAVATOR SKETCH: (Street name,etc. dimensions of lo.t-, exact location of test holes and ^ percolation tests, locate wetlands in proximity to test holes) A NOTES: -�-r I2S'•oc , - - 12�•00 • PERCOLATION RATE: TEST HOLE NO: LEVATION: TEST HOLE NO: ELEVATION: 1 1 2 bw 1 11 - - 3 . 3 4 4 - 5 5 6 6 7 8 8 9 9 10 i 10 11 11 12 i►�L N 1j, 12 13 E J jJ`'�t'J� 13 14 14 15 15 .16 _ _ 16 V - SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS = LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST AP ICATION ORIGINAL: ' COMPLETED IN ENTIRETY BY P . E AND RETURNED TO B ARD F HEALTH copy: RETAINED BY APPLICANT _ "l0CAT10 SEA! PERMIT E RIMY D0. V IIAGE 0�� I N S T A LLER'S MANE & . ADDRESS �EFR n :;2 E0 /-f - 910/ _ SOYA 0 y 7-/-/ y ® UILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r �,... »__ 0►� � .L�� �� ���x �� �° a . ',� i2EA2 ���- os Z �2-z 3 S� THE COMMONWEALTH OF MASSACHUSETTS � o BOARD OF HEALTH p ``��i�✓.. ....................OF....., eiv;5e 1? .��....................................... r Appltra#tnn for Uhipog al Works Tomitrur#tun Prrutit Application is hereby made for a Permit to Construct pC ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address n' C�i!Ni .i!3!2.._.. Qr„3rRuc�!_P�✓.....•.... �S�o���dixT.. ,r:G� _ wner Address ...................................... ............................................. ............................................... Installer Address Type of Building 3 Size Lot..�.���------Sq. feet Dwelling—No. of Bedrooms. .........................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building P6.. . . r_ No. of persons a —Type g P No. f P (. Showers ( ) — Cafeteria.(..._). Otherfixtures --------------------- ---.....--------•-----------•-------• --- -•--------....._.--.-- W Design Flow...... .J�............................gallons per person per day. Total daily flow............. ..................gallons. WSeptic Tank—Liquid capacity...havftallons Length.fo.'.(a..... Width...5. __.__.. Diameter---L'�..... Depth..L....3.._. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by .e� .... ................ Date., /. . . Test Pit No. 1-----v......minutes per inch Depth of Test Pit---- ------- Depth to ground water--y ! ------ fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •----•-•----•--•-------------------------•-•-•----------•••---------•----------....----••--••-............................................................... O Description of Soil......Sub..:...:La_k.../....... ^'-_>>.............. ----------------------------------------------------------------------•----•------•-----•..----- x w UNature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------------•---------------•-•---------------------------------......-----...------•-----------------------------------....----------------------------------------.....•---------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with j the provisions of TiT:.L ; p 5 of the'State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has�bbeeniid by e b and of health. ........... / � ... Application Approved By--//gned .........---.........----------•-•-----------------•----------......-- �D Lo Si 2�- -------- ---- -------•--•--- Date Application Disapproved fo reasons--------------------------------•----------------------------------------------------------------------...._..._ ----------------•---........-•----...---...-------------------------------------------------•----....---------•--........----•-•-------•--------------•---•-•-----------------------• .................. Date PermitNo................... --. Issued....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �(�C�"- LI DATA No. , ...... Z.Z F�$............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.. r-� ' 1...�'...r.......'........................ ......-- ...... .............. ................................... Applira#inn for Disposal Works Tongtraretann Prrmit Application is hereby made for a Permit to Construct (y') or Repair ( ) an Individual Sewage Disposal System at: ,[. Location-Address or,Lot-No. i- ,r /�. .. .. r r r.r• f i/'., - i!� .._.!�t �7�/r,f•i i iy{ Owner / Address '-�.. f'✓.....__....'.:%'��•/..... 'r./_........................................ ........•----•-•---•----............. ............•---/.................._..... Installer Address Type of Building Size Lot__ .....Sq. feet Dwelling—No. of Bedrooms..........._............._..................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of- Building Z�......................... No. of persons.__.r_____________________ Showers ( ) — Cafeteria ( ) 4 QI Other fixtures -------------------------------•------...------------------•••-----•--•••-•----------••------•----•---_...._. ------------ -•-•---------------- wDesign Flow_______ ___................................gallons per person per day. Total daily flow......._._.__:::. __-___-___-___....._.___gallons. WSeptic Tank—Liquid capacity.__ :_.___.gallons Length.-!........ Width..._............ Diameter...�.___:__--_ Depth...r_____`.... x Disposal Trench—No..................... Width.._.._._._._______.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..../ ':.__%...... ....:..'__:.:�_:.'............... Date...!' %,_�___�......:................ Test Pit No. I.._._r........minutes per inch Depth of Test Pit...__f_ __________ Depth to ground water_._ ....... fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a O Description of Soil____._`.___c__________. = F f , x ---•------------------•-------.........----•-•---------------------------------•-------------....--------•--•-••-•--•••••--------•-_•---- w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------•-------------._..-.-._...--•-•-•--------_. Agreement: The undersigned agrees to instaff,the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:IT:.� p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ....................r....__._____.__.________....•...._..__........_________._ ................. Application Approved By......;effollowing . ............................................................... ----- Date Application Disapproved f r t reasons:................................................................. ....................................... .....--•--•---•--------------•-------......---------------....-•---------...------------•......----•----- Date PermitNo......................................................... Issued_........................................................ Date .r THE COMMONWEALTH OF MASSACHAJSETTS X.' . BOARD OF HEALTHr (In#ifiratr of ( i i anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) y... f/ r .• i .s f Installer at. `':...---•-_'``-----•--o ----'Z.......-•r�-•-•----(I f `fi r has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod as scribed in the application for Disposal Works Construction Permit No. _".�a_ -______________ dated. p �.. , f!. _._..-_.__._.___-___- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... .'._L _`..1��. ........................... Inspector........A___�.�._...... THE COMMONWEALTH OF MASSACHUSETTS BOARD/OF HEALTH .z ...OF..... .....- N/ /U L - r a ::iY y N ._.......-••••...-•--•-•. a+r, • FEE..-- ............ innl` nrk %Unnnrinn anti Permission is hereby granted...:..........................................................` •' �' ., ' - ('°`:).`an Individ to Construct ol) or Repair ual Sewage Disposal System r at No J f - �l r r Street as shown on the application for Disposal Works Construction Pe mit No .' /Bo,� Dated/..Q.- __ft'. ...... ___________ f Health DATE................................................................................ �' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LEGEND COTUIT PROPOSED CONTOUR o p� ® PROPOSED SPOT GRADE ar , p'Ops 0� - -- 98 -- EXISTING CONTOUR TRO,y� LOT 12 N 15 + 96.52 EXISTING SPOT GRADE Z3 LOVELLS LOCUS } W— EXISTING WATER SERVICE cn Z ;. POND TEST PIT SCALE: 1"=20' 6 LOT 15 �, b S AREA=20,000. S.F. �� oo LOT 13 6� f \t LOCUS MAP — LOT-16 LOCUS INFORMATION \ I PLAN REF: 282/27 TITLE REF: 20279/212 PARCEL ID: MAP 40 PAR. 83 \t ZONING: "RF" TOP TANK , FLOOD ZONE: "X" i I' COMMUNITY PANEL: 25001C0539J DATED:07/16/14 SEPTIC SYSTEM °°' , + �' N REPAIR PLAN 2 � A � o a 5 \ LOCATED AT: �� �F 46 ' PINEVIEW DRIVE N 0 I O \ r \ �. o N COTUIT MA. W f '9 00� ,. o EXI T. 1 O�lOG Tp SEP TANK y r N PREPARED FOR TP-2 HUGH N . OLDHAM �l .�" TBM=SILL #4'6 �� � '` EL=55.0 9 MAY 10, 2016 REV. MAY 20, 2016 - •-TOF=57.5 W / �., -9� �,� OF• fn 'y< , LOT 14 y! \UPOLE 1 MEYER & SONS, INC. s P:O. BOX 981 - ,Q5 GRAPHIC SCALE 80 EAST SANDWICH, MA. 02537 N 20 ° 2040 PH: (508)360-3311 5S \ >= „ FAX: (774)413-9468 >=- meyerandsonstitle5@gmail.com IN FEET ) - 1 inch = 20., ft --'-- SHEET 1 OF 2 J 1826 .. .. f NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT THE PROPOSED FINISH GENERAL NOTES: TOF SEPTIC TANK GRADE SHALL NOT BE < EL:48.60 FOR A DISTANCE 15"AROUND THE PERIMETER OF THE S.A.S. INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL EL INSTALL RISER & COVER =57.50t OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED S.A.S. BOARD OF HEALTH AND THE DESIGN ENGINEER. INSTALL A RISER OVER ONE CHAMBER MIIN INSTALL LOCKING COVERS IF AT FINISH GRADE SET TO 6" OF GRADE ( ) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS F.G. EL.=55.5t AND SET TO 3" OF F.G.1 OF THEAL RSTAAT AND REGULATIONS. CODE, TITLE V, AND ANY APPLICABLE • F.G. EL.=55.5t F.G. EL: 55.10f I F.G. EL: 55.0(MAX.) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TOINSPECTION SPE TI NEER.D APPROVAL BY THE BOARD OF HEALTH AND THE 9" MIN COVER/ DESIGN 36" MAX COVER L = 30' L = 40'(MAX) r 4• ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING ® S=1% (MIN.) EL.=54.02t 0S=1% MIN.) ® S=1% (MIN.) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 4"SCH40 PVC 4"SCH40(PVC 4"SCH40 PVC 2" OF 3/8" DOUBLE WASHED1-1/2" ENGINEER BEFORE CONSTRUCTION CONTINUES. STONE OR FILTER FABRIC 3/4" 1-1/2" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 1a" DOUBLE WASHED STONE e" / 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF INV.=52.97 14" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 48"UGXJID EAL STR CTION. tEVFt INV.=52.74 ®®®®• O ®®®® PROPOSED ®®®®®®®®®®® 7• DWELLING IS SERVICED BY MUNICIPAL WATER. GAS BAFFLE ®0E3EM ®®®® 8,ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED D-BOX INV.=52.20 ®®®®®®®®®®® TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. INV.=52.40 DB-5 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE jH2O) ' LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. EXISTING 1,000 GALLON SEPTIC TANK 4 ( 2 X 8.5 4 1 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. EXIST. SEWER OUTLET EFFECTIVE LENGTH = 25.0' REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION INV. ELEV.= 51 .75 'i 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY I BREAKOUT. AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP CONC. ELEV.= 52.75 EL. 52.75 14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. ) PIPE INVERTS PRIOR TO CONSTRUCTION A ` 15, THE DESIGN OF THIS SYSTEM DOES NOT ALLOW INV. ELEV.= 51.75 ®a 2) D-BOX SHALL BE SET LEVEL AND TRUE TO. ®®® . FOR THE USE OF A GARBAGE GRINDER. GRADE ON A MECHANICALLY COMPACTED SIX a®®�®®® 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM EL.= 49.75 tastes®®® 310 CMR 15.221(2) 4' 5 FT. 4' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 5.40 FT. EFFECTIVE WIDTH = 13' DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 43.80 _ (500 GALLON LEACH CHAMBER) GAS BAFFLE AS REQUIRED N.T.S. DESIGN CRITERIA SOIL LOGS P#:15019 NUMBER OF BEDROOMS: EXISTING 3 BEDROOOM SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) DATE: APRIL 26, 2016 ` SOIL EVALUATOR: - DARREN M. MEYER, RS, CSE WITNESS: DAVE STANTON, BARNSTABLE HEALTH �� OF DESIGN PERCOLATION RATE: <2 MIN/IN . MASs9�yG DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO (not designed for garbage grinder) Elev. TP-1 Dept Elev. TP-2 Depth o D M E SEPTIC TANK: 330 x 200% = 660 d EXIST. 1 SEPTIC TANK 54'a A 0" 54.80 0" 14p E C gpd gp USE E S ,000G SE C AN LOAMY SAND �' A LOAMY SAND LEACHING AREA REQUIRED: 330 0.74 = 445.94 S.F. 53.98 1oYR a/2 10, 54.05 10YR 4/2 �-y ST USE TWO 2 500 GALLON PRECAST LEACH .CHAMBERS LOAMY D 3 " B LOAMY s$D SANITAR�aa C ) 52.13 . W/ 4' STONE ON ENDS AND 4' ON SIDES: 25' L x 13' W x 2' D C1 MEDIUM 52.05 33' C1 MEDIUM l- - SAND' �1 --- - --- PERC TEST 2.5Y 7/3 SAND ! BOTTOM AREA: 25 x 13 = 325 SF ® 49.02 2sY 7/3 SIDE AREA: (25 + 13) X 2 X 2 = 152 SF TOTAL SQUARE FEET PROVIDED = 477 vs. 445.94 REQ'D PROPOSED SEPTIC SYSTEM UPGRADE PLAN DESIGN FLOW PROVIDED: 0.74(477 S.F.) = 352 G.P.D. vs. 330 G.P.D. req'd 43.80 132" 43.80 132" 46 PINEVIEW DRIVE, COTUIT, MA PERC RATEL MIN/IN. (-Cl- HORIZON) NO GROUNDWATER OBSERVED Prepared for: Oldham System Design and Topography Plan by: SCALE DRAWN DATE MEYER&SONS,INC. N.T:S. DMM 05/10/16 • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MAOEP pursuant to 310 CMR 15.017 PO BOX981 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EASTSANDW/CH,MA02537 REV DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 508-362-2922 05/20/16 DMM 2 Of 2 C�E&J E 2 Al- W OTE 15 --4iL Ei V 5"OviA3 Ae.0 MEc,Q SEA. LEW�L SSE D O►.l t C7A.T U" PL-A."ie —•- FYI ��--- P17CN ALL. t..IR,IES A MINIMu'l-A C.F ti J� l P1P_5 TO .AWD r.d ThfE SVSTEM SAO P�/C n ; - ALL 'SEPTIC TAblIC5, 1 0K, AOrST21g�TTIo�J ►JD /� �1/ l..E�Cr•I�.JEa Pr[�, SHALL >�E DES�G...1ED Ft�2. t4 - ZO �c1++EEL_ Lo•�G�.JC�S yar�i4ta, nr C .b I r �---- - - --- _ a-- iZEMD✓E Au� U•ISJ�rA3�E MATEIZIAt— BEVF�TL I O rl+E Irl�/ESZT ELE1/ATIo..1S of L.EACk41._IEj PrTS F-OC - +r A P1.a US of o Aw)o 54. r_F%L._ w 1TJ 4 C Ls.y-F3?ciE r � l� . ( P�c�AZ� o f t�F�a L.TN MUST . - Sy _ r -I � � bfc NCSr1FE'I] wNE�.� T►+� �ySTEM �S rvEAt� h -� 1 a— V►JL..ES'S oT1-►E2�ISE ^loTED, AL-.L_. SVSTE.►� � G L S.q.JrALy ---rem i Z�1G' 0 lY U CI O �M�h1�►JT� �v►te.Ll V>E 1�1STA��-cV ►�.1 f /RCC©�DA•�L E w ITI4 T I T L-E S o F -rv4 E �TgTE d ^iYZ. TYPIG4L. 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T 1 l o o °% E x PA KI s 10 N 4 .�.d�'"7"L•1"7' :t .i'v�' � ..a© G':7p'.� � � � ' S d •.y�.�/`1ta�JT�/`1/`,7S.r` �'1:�'7"f i�`��L�.�, ���'`�.:F•,�' aptµ Of N NO(IA OR G N^.i� SCALE: DATE SHEET 10 ,p No 05 O 3e 6.Jc: / /.�.i c3 .�► �4�, a DRAWN By CHKD By: APPO BY PLAN NO