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HomeMy WebLinkAbout0341 POPONESSETT ROAD - Health >� 341 Pop�VI�; ett Rp�� �. Map-019, Pai. 1 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 341 Poponessett Rd. Property Address Chaudhary Owner ers information is Own ' Names✓ required for every Cotuit MA 02635 11/4/20 page. City(rown 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. A. Inspector Information Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR%000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 11/4/20 I nS&to1s_b1jr0TU2WDate The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts ,e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every COtuit MA 02635 11/4/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. i 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 FIND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ 0 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 t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments „n 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: 2 bedroom permit and plan on file Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? M Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: SeasonalDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments o L 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts ,A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �e u, 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2011 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts ,i� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •�� 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every COtuit MA 02635 11/4/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank with inlet cover to grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace-1/4" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts ,� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l ." 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts a Title 5 official Inspection Form 1a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 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.): H-10 D-box is 3' below,grade, poly cover to 12' of grade, no adverse conditions observed t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 16 infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: f ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts �. ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Infiltrators were video inspected, no indication of past hydraulic failure, chambers are dry at this time 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer , Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 . Commonwealth of Massachusetts �m �3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ,n%e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 11/6/2020 Assessing As-Built Cards ? TOWN OF BAR,NSTABLE LOCATION J e// A)06A)Z S.S6 j 7 U 4 SEWAGE#-72 b/1— (3 SJ, VILLAGE�D T v/ T ASSESSOR'S MAP&PARCEL /9-/25 INSTALLER'S NAME&PHONE NO.A 0-`H lo.JST SEPTIC TANK CAPACITY 150.0 LEACHING FACILITY:(tyype)/i, N.2o,.✓rlh4a7c4J (size)DL�AQ_S3 NO.OF BEDROOMS a 1 OWNER ' PERMTT DATE: /O / J l COMPLIANCE DATE: �5�j1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private water Supply well and Leaching Facility(ff 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 FURNL%M BY 3 by � Ao Ap LX a I � k � t https://www.townofbarnstable.us/Departments/Assessing/Property_yalues/HMdisplay.asp?mappar=019115&seq=1 1/2 f Commonwealth of Massachusetts �. ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ®• Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >132" 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: 2011 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4' seperation per 2011 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 24' msl and nearby surface water at 5'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 i Commonwealth of Massachusetts !� ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address Chaudhary Owner information is Owner's Name required for every Cotuit MA 02635 11/4/20 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts �x Title 5 Official Inspection Form Io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's 7ae information is Cotuit MA 02635 10/23/20 4 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information 1603A? filling out forms on the computer, use only the tab Richard T. Johnson key to move your Name of Inspector cursor-do not D&J Environmental Services _ use the return Company Name key. 10 Mt. Pleasant Street Company Address Plymouth MA 02360 City/Town State Zip Code 508-735-8740 S113545 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails _ _ 10/23/20 I pector's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form Igo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is Cotuit MA 02540 10/23/20 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form 14 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 341 Poponessett Rd. V� Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): N ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 341 Poponessett Rd. VJ Property Address Isabel Kerber Owner Owner's Name information is Cotuit MA 02540 10/23/20 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cost.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that ne other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doe-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form iI; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f; 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is Cotuit MA 02540 10/23/20 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ E Has the system received normal flows in the previous two week period? ❑ Z: Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plars of the system obtained and examined? (If they were not available note as N/A) ® ❑i 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: ® ❑l Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage N/A 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No unknown Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,.volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts ,p Title 5 Official Inspection Form 1, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r; u 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is Cotuit MA 02540 10/23/20 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): joints structurally sound, no signs of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Ike Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address p Y Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): < ' Depth below grade: 1feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Tank on riser to grade. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 34" <1" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Field Measurement/Mfg. Specs. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees in good condition, tank structurally sound, no evidence of leakage.Recommend tank be pumped regularly to extend life of components, inspection is not a guarantee of future system performance. t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I? is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f; 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts I �e Title 5 official Inspection Form `1, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): 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.): box level, no evidence of leakage, no evidence of solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J/ 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 16 H2Oinfiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts �d ,j Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): no evidence of hydraulic failure, no ponding, no damp soil, normal vegetation. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids 1 Comments (note condition_of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 01 8 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 oft cam, Commonwealth of Massachusetts Title 5 Official Inspection Form i1e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 9 P Y rY .......... 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 10/19/2020 Assessing As-Built Cards TOWN OF BARNSTABLE LOCATION y/ ssz/;' M SEWAGE Qd/ - 3S_V VILLAGE C G 71.1/ r ASSESSOR'S MAP&PARCEL INSTALIMV S NAME&PHONE NO. s a Y5 - SEPTIC TANK CAPACITY I S 0 615 g O Al LEACHING FACUM.(type)/4 Na o•,J r,hi a e7,A f (sue)15 X 2 S3 NO.OF BEDROOMS 2) D6s, 3 OWNER jg v"v"i $ //f tv PE 'NffrDATE: COMPLIANCE DATE: Separation Distance Betwom the: MaximaM Adoated i3mimdwater liable to the Bottum ofI.eachiag Faci tY Feat Private Water Supply Well and LeechingFacifity(If airy wells exist oll site or within 200 teat of leaching facility) Feet Edge of Wathlad and Leaching Facility(If et0'wetlands exist within 300 feat of t-ching facility) Feet FURNLMM BY 1 C 3=25;s"cl uy � r� n V 0 =�9.6 131 I httpsJtwww.townofbamstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar-019115&seq=1 1/2 ;?• se Parent material(geologic) 8%yk-La tit Depth to Hedmak.,, J A Depth to Ow .mdwater. Standing water in xole:- MOM-UPS' weeping It m Plc Face Acala-d urtped . Estimated seasonal high Groundwater_. d-�apt A ss�,ty.�# DETERMINA170N FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing is obs.hole: 1n. ®Depth to soil m 01n M, Depth to weeping f mn side of obs,hole: In. ©roundwater A im ment IL lhd=well a Reading Date: ledex well level,_ Act.f eW Adj.Choundwater Level,._, PERCOLATION TEST DAWN Observation Hole# NEITime at 9" !i„ 9 lmel Depth of Pm Start Pr"mk Time Q 11 top. - End Pre-soak Rate NfluAmah AMPS_ Site Suitability Assessment: Site Passed Si1A Palled: Additional Testing Needed(YIN) ' original: Public Health Division Observation Hole Data To Be CompleW on Back-- ***If percolation teat is to be conducted within 100'of wetland,you must first notify the Barnstable Conse"ation Division at least one(1)week prior to beginning. Q:ISBF1710 P8RCPORM.DOC Commonwealth of Massachusetts Title 5 Officinal Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is required for every Cotuit MA 02540 10/23/20 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 11+ 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: 2011 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: Obtained from site observation, visual elevation, Perc test data on record with BOH. Before filingthis Inspection Report, please see Report Completeness Checklist on next page. p p t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V � 341 Poponessett Rd. Property Address Isabel Kerber Owner Owner's Name information is 'required for every Cotuit MA 02540 10/23/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LOCATION 3T/ A 26_,yzS -E SEWAGE#�b� — �S . 7 VILLAGE Cd 74v/ ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.A(,t'e � ea kJ S,T ��- SEPTIC TANK CAPACITY SD 6 4 /o LEACHING FACI'LITY-(type)/(,`/)a d,.✓F 64 676AJ (size) NO.OF BEDROOMS �� /�=S nJ .3 OWNER J_'5"U'Vic% S_ /.r u/ PERMIT DATE: /O / /l 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 y� o - f o r 4 _ No. q Fee i/vim✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYication for ]Disposal *pstem construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( )X omplete System ,Individual Components r Location Address or Lot No. 3 A 1 `^�b?C 0e,55e* Owner's Name,Address,and Tel.No. C.JPT%D I T Xf cF� 3.c.}\2 Assessor's Map/Parcel 0,X 9, 1 115 SeKr< Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. A2Cli Goc�5�¢vCT1o►� CPkKv1E� ig"PAy s�8-1a94- 14 Type of Building: Dwelling No.of Bedrooms ? Lot Size sq.ft. Garbage Grinder ti/p. Other Type of Building ts\OC1 @ No.of Persons .3 Showers( W Cafeteria( Other Fixtures L_F4V0.—Q-CtA n2q S�C>1�. LG,.nnC1krS4 Design Flow(min.required) Z ZO gpd Design flow provided 3S� •O o� gpd Plan Date N }y` }i Number of sheets I Revision Date Title 769Cl S v Stic— 1S O. S Size of Septic Tank tl 2eul 1 Sb0 e10\ Type of S.A.S. 1 k 4 3 X a `J'�Czilri�oSS 42 (tk Description of Soil Nature of Repairs or Alterations(Answer when applicable) A_tl �an Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ltIL Signed Date /0/� /Za 1 Application Approved by Date /Q�/ 0// Application Disapproved y Date for the following reasons Permit No. ZOO — 35 4 Date Issued Lol/-7/7,o ►j ..�:7 �■■yy; _ _ _... ��.r _.... . ... 1 ,. .. .-e„�;,.,`i..,"!.tsfitry'x...-±:a.,. f� 1 �.,+'R. _ TTT n OK- sk }- .No.20 f( 3sq_ �' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compixicr: - - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppY cation for Misposal 6pstern Cone.tratct ort j)ermlit 1� Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) Complete System Individual Components c+,ri Location Address or Lot No. 3��1 Y c,�i��'� SSE Owner's Name,Address and Tel.No. CLTT Assessor's Map/Parcel C )\c( 11,57 Sacrc Installer's Name,Address and Tel.No. Designer's Name,Address,and Tel.No. r\1 C)AC vil S�J C.T\l; C.p, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder q)c" Other Type of Building No.of Persons 3 Showers( tom) Cafeteria( Vj Other Fixtures JG'K_� p Design Flow(min.required) ' 2_0 gpd Design flow provided , 3 5 'V gpd 's l Plan Date ` C Number of sheets Revision Date x' Title— t' .��c �.o C� J"� Ste:�,C C r, �SJG c r P \)�S�G 5 o, S STp fy\ ;f Size of Septic Tank �7C•U Type of S.A.S. "� �:: 3 x a 5 1 S �F\p`�S4�-(AA (1-k Description of Soil �� r Nature of Repairs or Alterations(Answer when applicable) F Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board oLUtalth. Si ed '.i Date /o li t�Za t Application Approved by Date ho/ rAec, Application Disapproved y Date j for the following reasons Permit No. z o 1 I — 3 5 y Date Issued f 0//9/Z a ►1 ---------- ----- ------- -- _ -- -- — ------- ----- -------- _ =--------_ 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 RI C r\ Cc-;--,�-!A c-v c c- at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.ZoI1-33`I dated /o/1'1 /Z,D Installer h l C H �e_c-�S C k•\(. r, Designer C 2 Mt S+Ie�y #bedrooms . Approved design flow -G.o gpd The issuance of this permit s all not Pe construed as a guarantee that the system Date J O�� Inspector ---- -------------------- ------------------------------------------------------------------------------------- ------------------- No. Oc7 Zo 1( — 3-5 Fee �'0. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS, Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(k) Upgrade( ) Abandon( ) System located at �� 1 �1 C `t t R E'�S�' � � CGT y f and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constr720 tiion must be completed within three years of the date of this permit Date f�// 1 Approved b �� ,~ J TOWN OF BARNSTABLE LOCATION 3��� / D�Jr 5 5 1 T U SEWAGE#__,) 6/ 1 — VILLAGE --� 7 v/ > ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY / 5- O 4 LEACHING FACILITY:(type) I( 41.2 v%�% � (74 o e," (size) �S A NO. OF BEDROOMS( 2 1 .D OWNER 37L"U/NrY PERMIT DATE: / i ",/ COMPLIANCE DATE: Jib 5hl 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 hO 17 A)Z 3 414 )3 17 b ! �S c vV Loo I Town of Barnstable P 0 Departiment of Regulatory Services J� rar�� Public Health Division Date arAM 16n �� 200 Main Street,Hyanais MA 02601 Date Scheduled // �� Time` Fee Pd, C/CJ Soil S ' ability Assessment fog- Se e disposal Performed By: f Witnessed By: LOCATION& GENERAL']NFORMATION Location Address 3y Owner's Name Address Assessor's Map/Parcel: �� ! s Engineer's Name NEW CONSTRUCTION REPAIR Telephone# —L5?9 4 Land Use:-- Slopes(96) Surface Stones Distances from: Open Water Body—LI�TIP�ft Possible Wet area Aft—ft Drinking Water Well A-th—ft Drainage Way ft Property Une __m24L _ft Other ft SKETCH:(Street name,dimensions of tot,exact locations of test`holes&perc tests,locate wetlands(n proximity to holes) .T Parent material(geologic) 00*tA.X1S h Depth to Bedrock A Depth to Groundwater Standing Water in Hole: N)MI10-,U95' Weeping from Pit Face ORst 2e 9( Estimated Seasonal High Groundwater 1_'?) DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: —In. Depth to soil mottles: In, Depth to weeping from side of obs.hole: In, Groundwater Adjualment f. Index Well# Reading Date: Index Well level Adj,&Ctor— Adj.Groundwater Level, PERCOLATION TEST Dille�Oftme jjj= Observation Hole# 2th Time at 9" �•. � Depth of Perc Time at 6" Start Pre-soak Time @ it iO Time(9"-6") End Pre-soak Opp Rate MinAnch L MPS Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---- - ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC r DEEP-OBSERVATION HOLE LOG Hole#—�—_ Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,'Boulders. o i ten:;v.%Gravel) LS a o e no DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis en %Grave L3LQ3 O h s YU4Lt DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenev.%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, Flood Insurance Rate Map: ( / Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious rpaterial exist in all areas observed throughout the area proposed for the soil absorption system? 25 If not,what is the depth of naturally occurring pervious material? _ Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Env' n e do and that the above analysis was performed by me consistent with . the required train' g,exp tise d x er nce described in 10 CMR 15.017. Signature Date Q:)S.EPTICTERCFORM.DOC Town of Barnstable' `pFTHE Tpk� Regulatory Services Thomas7F. Geiler, Director * BARNSTABLE. .Public .Health Division 9 MASS. 1639. A Thomas McKean, .Di.rector TfD MA'S 200 Main Street, Hyannis, MA, 02601 Fax: 50,8-790-6304 Office: 508-862-4644 Dater O SS��� Sewage .Permit#' p' -35 Assessor's Map/Parcel O � D � Installer & Designer Certification Form Desi gner: A 2W1 E►J �J — Installer: -- 5'TiLJeT1D^, -- Address: - --- Address: was as issued a permit to install a On — installer) (date) septic system at __ •�� ne�3e" based on a design drawn by (address) p dated _lDl l- -f 1t (designer) I certify that'the septic system refeie.nced above was installed substantially according to g such as lateral relocation of the the design, which may include mirre:ir approved changes . distribution box and/or- septic tank. Stripout. (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 10'.1ateral relocation of the SAS or any vertical.relocation of any component of the septic system) but in accordance wish State & Local Regulations. Plan revision or certified as-b;_ult by designer to follow. Strip0LIt (if required) was inspected and the soils �F were found satisfactory. (Installel`S ,ion, e) ( b r s Signature) (A f(`i� ) 1-lete) Desl ne stiFE�ST����w�, 4 PLEASE RETURN TO BARN�TAB:LL PUBLIC H.LALTJl DIVISION. CERTIFI:CA'CE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTCH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC :HEALTH DIVISION. THANK YOU. q:\()Price forms\designercertircation Ionn.doc e w �° ✓{,p�,(.mac-v'�� 0�'rr�L-� S �.,�¢.�O�v_....�.._�a-�^ erv,J � G.r�� ��.:D� LOA a `� �e ti-. i�u�� wti�r-�►-�a�J'��/��Hwy°1 h�_ 13 s 3ul T`h \ a a4 5 '^ C t�c�(w v�J �wr•__��,�d� ��?-w�,,_. r i t +� - , c �. s, � f Town of Barnstable -�• Department of Health, Safety, and Environmental Services DAMSTABM I, Public Health Division sbJ9- �� h 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Jenny E. Sellew 341 Poponnessett Rd., December 10, 1997 Cotuit,MA 02635 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE,AND 105 CMR 410.00 STATE SANITARY CODE H-MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 341 Poponnessett Rd., Cotuit,listed as Parcel 015 on Assessor's Map 019,was inspected on December 9,1997 by Glenn Harrington,Health Inspector for the Town of Barnstable,because of a complaint. The following violation of 310 CMR 15.00,the State Environmental Code,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code H-Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02(207)AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty- four(24)hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven(7)days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance could result in a fine of up to$500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH omas A. McKean Director of Public Health Town of Barnstable ,vntY �i` 'M '"'".{ 'k"� `a '+~.4"fb- �'•. d�',�,,'s P• 1 fig' e r k p Iti Does Your Home Need a New Roof, a Se is S stem or Some Other F3asic Repair? pt y p . r Are You Short on Cash? If So, This HOME- - Funded, No-Interest. Deferred Payment Loan ,'� May Be For Youl Read On..... 3.0 , . �r Housing Assistance Corporation, through the Barnstable County HOME Consortium and the Cape Cod Commission, is pleased to offer a home repair Loan to qualified homeowners. This loan carries no inter- eet and is forgiven over a fifteen year period if the homeowner contin- ues to own and live in the home. A loan may be made fora maximum of ,. $&,000 to cover essential home repairs. The loan is open to income and housing eligible residents of Barnstable County. ]{j Toqualify: 1x' • You must own and live in your own home. • Your home must be assessed for no more than $124, 575. w • Your mortgage plus the value of the home improvement must be no more than the assessed value of your home." , . • You must be income eligible. k x . � aY Income eligibility levels are determined by HUD. In the Barnstable- Yarmouth area, for example, atwo-person family which makes no more than $30, 450 annually would be income-eligible for the loan. k4 .^ To receive more information or an application packet, call Larry Dineen at Housing Assistance Corporation: 771-5400, x275. Funding for this program is limited. Apply now to be certain that you 1 . will be Served in this calendar year. i" ` # •In Some caeee,the cost of the repair may not be included if it does not increase the value of your property. �k a t R 4'. LMYy a +- � ,x. .. . � ���,4� +rR�, S'6 � y. d y tip • A RESOURCE - FARMERS HOME ADMINISTRATION r ; The Federal Farmers Home Administration (FmHA) program has f available a grant and/or loan program under Section 504 that may provide assistance to very low and low income citizens. The program can be used to offset costs of sewer betterments, sewer P hookup and other health and safety hazards. A program information session will be held at the Barnstable Senior .Center on Tuesday, September 22, 1992 at LOAM. Applications for the program are available at the Senior Center or from the Pocasset County Farm Home Administration office (508- 564-6356) . ' The following is a summary of the eligibility guidelines. Grant A one time maximum grant of $5,000 available if: i a) 62 years or older b) single household income of $16,500; up to 8 person household income of $31,200. Liquid assets not to exceed $7,500 (This excludes house, car, and household contents) . c) a completed FmHA budget showing inability to repay. d) , if home is sold transferred or vacated within three years of grant, the grant must be returned. Loan A loan maximum of $15,000 at 1% fixed annual interest rate may be given if: a) • are at least 18 years old and a United States citizen or legally admitted alien. b) single household income of $26,500; up to 8 person household income of $49,950. Liquid assets not to exceed $7,500 (excluding house, car and household contents) . c) the loan is generally secured by real estate mortgage. d) loans are for health or safety hazards, but may include general home improvements. e) must have a suitable credit history and complete the FmHA application. Completed applications include written income verifications and proof of property ownership (copy of deed, property tax bill, etc. ) . FmHA will schedule a home visit. If you think you may be eligible for this program, contact the Barnstable Senior Center at 790-6365 to make an appointment with the County Supervisor and to attend the information session on September 22nd at LOAM. Summary prepared by Town of Barnstable senior services Department SITE LOCUS 3-le DIA17. ACCESS 111"01tS w VENT PIPE (O Least 24 Inches toll) » . �• , «,a,. .+ �`j`Q (� O�NESSE(( NOTE: ALL PIPES ARE TO BE 4 SCHEDULE 40 P.V.C. Schedule 40 PVC w/ChorcoeI Odor Fkter 6r"� "�a i P O 10' min. from ��� ,y��,..s• Existing Foundation house to septic tank c TOP OF FOUNDATION ELEV. 100.D0 loin covers must be 0--sox 5° SITG STABLISHED VEGETATIVE COVER ;� �� b 5 in. of finished grade finished Grade•v.Septb Tank-WOO Ograderoe.am 0-11o„-e0.00 am 2"-ee.00 � "AT / 1 l 1 l ,• � • ,. BACKFlLL WITH CLEAN SAND `' `/ `/ `/ LAN y• , .' ,., N•.. ,•..... j THE ACCESS COVERS FOR THE SEPTIC TANK, JIrk :;•;�,rr• ,•ir'' •t''.�;•1 :;^' t .�`�'�, • r :� • . (NATIVE OR PERC SAND) �. DISTRIBUTI a t, '�.. ..�+•:::". :.»,_,�. •}%Y,; .. •;r, t•; �. i...•r` ON BOX AND LEACHING COMPONENT / O� •'s; t r' • :t ? F:;, a' ti•:+�:,:'' .�, ..� SHALL BE RAISED TO WTHIN 8 OF 8 Q02 5 HOLE H-2O � ..p'r'." ••. ,�,� ..2•. .t a..• S'• „��.Gs•. .. � � t.t ... •S t • • �QOi Or ST. aoX 3' Nmdmum Cover M, ''.{r+•:r '�w.{.7r•�•.:«�M1 '�'; ,y:...• Y' .. •'•: : A.nr'~:• •' ''",V T�+4"•+7r,�.. h. ''T�a.• �., NEW stealer 4•PVC cAPPm iii3PEcnoN PORT Tn s>: _ :,: ;R .. �:. ,.2 r s; c to' c ) TOP OF UNIT ELEVATION 96. `S x�:•`; : » "' »,. «; r rim-P K N 1500 GAL �. S. QOl• ,•r `•: .• '„{y tf .' ��ti• ,.S t• � { ,, `� i I FINISHED ORADE NSTALLED AM TO ME W11NIN e'�eRAOE •�'» r ..�i•r�• A'r-;....;. .t ! .ti+v y.. � .�;•.':« •tii,::': r'».''t.'�;.w:�.w � �►' IRON EXIST. rauNOATtoN SEPTIC TANK S per 7bot r��'1'a .i.«•,..:k, �:.«:r't L" r's;:•.•,, r• ?' ' STEEL REINFORCED PRECAST CONCRETE INSTALL ��' r; INV. ELEVATION - 95.50 S ALL TUF-TITS GAS BAFFLES OR EQUALS o x :�. *.� jn °'>' PLAN VIEW ON ALL OUTLET TEE ENDS CgNCREIE rul �' N H-10 ei g ui 5' ;:"s; `:;.:..1lN a,;n,�a 1 1 of .,:;;r? : t t' / 3-24 IIF7,Wv o0VER4 >o 5 M.of 3/4'-1 1/2' 6' BOTTOM ELEVATION - 94.58 » ate GENERAL NOTES W r compacted stone > $ a •min.deurona 4 1. Contractor is responsible for Digsafe notification, Verification of Utilities - 'B 1• 5 ROWS OF 4 UNITS AT&25'/UNIT+2 Endow•25.25' ' min. 2'min. Met to outlet .Z p = SYSTEM PROFILE � 5 MIN ABOVE BOTTOM OF IiaET _Ir 'r and protection of all underground utilities and pipes. Not to Scale Bottom of Test Hole 1 Elev.- 88.00 TEST PIT OR GROUND WATER 4" B 4• ` .+, UWT >r ou7LET IT' 2. The septic tank a distri ,#;on box shall be set 5 in.of 3/4•-t t/2• BFF. wIDTB fA.B9' E7tlS'IMG suTAsuE NAIEItlAL �_r �� ., , 5'-T level on 6" of 3 f4 -1 1�2 stone. NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE stone GROUNDWATER NOT OBSERVED ;, L44 , 3. Backfili should"be clean sand or grovel with no .. depth stones over 3 in size. BOTTOM OF TP-1.• - 88.00 SOIL ABSORPTION SYSTEM (SECTION) L4. This system is subject to inspection during installs#ion by Carmen E. Shay - Environmental Services, Inc. Groundwater Observed - NONE OBSERVED HIGH CAPACITY INFILTRATOR CH-20 LOADING)/ GEORGE O'BRIEN . •,• +. • •s• s , + •: •• ''t 5. The contractor shall install this system in accordance (OR EQUIVALENT) 10'-a' s'-s' with Title V of the Massachusetts state code, the approved plan CROSS SECTION END-SECTION and Local Regulations. NOTE OVERALL HEIGHT OF MIFlLTRATOR IS 18' Y 6. if, during installation the contractor encounters any NOTE: EFFECTIVE DEPTH IS 11" soil conditions Or site conditions that are different TYPICAL (H-10 LOADING) 1500 GALLON SEPTIC TANK from those shown on the soil log or in our design NOT TO SCALE installation must halt k immediate notification be made to Carmen E. Shay - Environmental Services, Inc. O FP'ONE'.S'SE T T .R O.A..D 7. se vehicle m heavy machinery shall drive over the PERCOLATION TEST septic system unless noted as H-20 septic components., Date of Percolation Test: 11/18/2011 S. Install Tuf-Tate gas baffles or equals on all outlet tee ends. (40 FOOT RIGHT OF WAY) Test Performed By: CARMEN E. SHAY 9. All Distribution Linea shall be 4" diameter Sch. 40 NSF PVC pipes. -------------------------------------- _______________ ------------------------------------- Results Witnessed By Donald Desmarais - BARNSTABLE BOH 10. All solid piping, tees do fittings shall be 4" diameter 1 EXCAVATOR: SHAY ENVIRONMENTAL SERVICES. INC. Schedule 40 NSF PVC pipes with water tight joints. Percolation Rate: <2 NPI ® 30" 11. MUNICIPAL WATER IS CONNECTED TO THE SITE and Surrounding S 78D 29' 20"E I� �, 1 Test Hole Test Hole Properties. 80.00 1 No. 1 No. 2 FAILED I i DEPTH SOILS a". DEPTH SOILS ELEV. CESSPOOL I I 0 99.00 0 99.00 lag. 99------------- I I SANDY SANDY THE PROPERTY LINES ARE APPROXIMATE AND t I LOAM LOAM 3 to rR 3/2 to rR 3/2 COMPILED FROM THE PLAN BY FRED JOYCE, C.E. t 1 ENTITLED "ReSubdivision of Cotuit Hi-Ground, Cotuit, MA A DATED March 20.1950 LOAMY LOAMY AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 00 NEW i` i sand Sand iT SHOULD BE USED FOR NO PURPOSE OTHER THAN 1500 gal. I r�� 1 to rR s)Id to rR 5/e THE SEPTIC SYSTEM INSTALLATION. Septic Tank I i 8'-30• 1 � e.:so 6•-30• 1 16 9&501 1 , 1 Mod-Ooorse Med-Coarse L I Sane sand NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 1 1 2.5 r 7/4 as r 7/4 FROM THE EXISTING CESSPOOL TO BE DISPOSED BSISTIXG I ' ,i 3W- 132 C, $&Do 30'- 132 G 88.00 2 BBDR00Af I ►I OF AS PER BOARD OF HEALTH SPECIFICATIONS. iBDUSB �• EXISTING CESSPOOL TO BE PUMPED DRY do #841i FILLED IN PLACE "., ASSESSORS MAP - 019 PARCEL 115 ZONING - RESIDENTIAL L _ Perc #1 Depth to Pere: 30" to �48" I Pert Rate- <2 MPi t PROJECT BENCH MARK Groundwater Not Obsw-%d NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY ' Ne Observed E tWT TOP OF FOUNDATION 42 ELEV. 100.00 ADJUSTED HO iev. ku'tie �z-5 _HOLE i • _ s ELEV.- 99.00 ALL OUTLET PIPES FROM THE O w DISTRIBUTION BOX SHALL BE tl, SHED Vent t;'J SET LEVEL FOR AT LEAST.2 FT. 12` CONCRETE COVER LEGEND w O Pipe I •Ell, 8�,_ 5" OUTLET bM..tx'.ti ..�..�� 2IWOCKOUTS 'ta:. s` ; • OUTLET i 12" iNL.ET XDENOTES PROPOSED _i. 7: e" Ir ' SPOT GRADE 2DENOTES EXISTING 1.75� X 104.46 - SPOT GRADE rq t PLAN-SECTION CROSS SECTION PL PROPERTY LINE o 6 HOLE DISTRIBUTION BOX -- H2O PROPOSED CONTOUR py TEST HOLE #2 % O NOT 10 SCALE ELEV.- 99.00 ; 97------97 EXISTING CONTOUR q Design Calculations U o DEEP TEST HOLE & Number of Bedrooms: 2 Equivalent to 220 Gal/Day (3 Bedrooms min design per Title U Garbage Grinder: No PERCOLATION TEST LOCATION �f Leaching Capacity Proposed: 220_Gal./Day Minlrilum a< Septic Tank : - 2 x 220 Gal./Day -440 USE NEW 1.500 GAL. TANK FENCE 0 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch PRIVATE DRINKING WATER WELL Bottom Area: 0.74 gal/sq. ft. -x 473 sq. 1t. - 350.02 gallons t Sidewall Area: NOT USED REVISIONS - Provkiinl: - 350.02 gallons Use: 4 ROWS OF 4- HIGH CAPACITY CHAMBER UNITS WITH NO NO. DATE: DEFINITION STONE FOR AN SAS HAVING THE DIMENSIONS: 1283' x 25.0' j Bottom Area: (General Use Approval for 4.50 SF/LF of INFITRATOR t 4 UNITS + 2 END CAPS per ROW '25.0 FT 4 ROWS x 25.0 x 4.73 SF/LF - 473.00 DESIGN FLOW PROVIDED: 0.74(473 S.F.) - 350.02 GPD PREPARED FOR . PROPOSED SUBSURFACE SEWAGE DISPOSAL SYSTEM LOT #157-B �•� OF 24,840 Square Feet +, MS. JENNEY SELLEW #341 POPONESSETT ROAD 341 POPONESSE17 ROAD COTU IT7 MA Bedroom Living Room \�� C OT U I I , MA 0 2 61-3 S PREPARED BY: OF A?q CARMEN E. SHAY e.I<, go Kitchen Bedroom Dining 0 20 40 50 ENVIRONMENTAL SERVICES, INC. � � n A N P.O. Box 1576 s s9d 88' 40 � oISTr's MASHPEE, MA 02649 E SCALE: 1"-20' sANITAR\ad TEL/FAX : 508-539-7966 2 BR HOUSE FLOOR SCHEMATIC SCALE: 1"-20' DRAWN BY: CES DATE: OCTOBER 19, 2011 (Description Provided By Owner) PROJECT#SD-2025 FILENAME: SD2025PP.DWG SHEET 1 OF 1