The URL can be used to link to this page

Home My WebLink About0005 PUTNAM AVENUE - Health 5 Putnam Avenue ,< Cotuit v A = 036,: 034 r I 1 �I D 'I 1 i b 5 PUTNAM AVE, COTUIT VARIOUS ACTION PLANS AND OUTCOMES FOR PUBLIC WELL WATER FROM ATLANTIC ENVIRONMENTAL TECHNOLOGIES INC. APRIL 1995 IN STORAGE BOX #41 ADDITIONAL INFO HAZARDOUS MATERIALS ' TOWN OF BARNSTABLE ( - OCATION 5'RA rN,,- m A-0C SEWAGE# 'Zoln -ZO3 VILLAGE Qo-1u, ASSESSOR'S MAP&PARCEL 3f. - 3y INSTALLER'S NAME&PHONE NO. A 4e B EXQmVb-+0^ y 1`7-O G 53 SEPTIC TANK CAPACITY 1 p0 0 9m) LEACHING FACILITY. (type) S'OOg�JC (3) (size) 13 x 33 x 2 NO. OF BEDROOMS y OWNER J PERMIT DATE:- [,- zv7- in COMPLIANCE DATE: l 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 Al - 14'S eL S 20 !o g2 143' 36 0 .r N / ✓ Fee D� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pplication for Disposal �6pstem Construction permit Application for a Permit to Construct( ) Repair .Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No of ' Otiavio er's Name Address,and Tel.No. Assessor's Map/Parcel �lv q � , j9hnson 1'gl-2S8 - 139 S Ins ller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.'No. cti ua�r l� 5 0066 ` Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 9 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 20 et /) Nze 4jaambw 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 vironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa Sign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. s Date Issued 'D ' Q NA Fee ' - THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer: PUBLIC HEALTH DIVISION =TOWN .OF BARNSTABLE, MASSACHUSETTS Yes t 2ppYicatiou for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.� Owner's Name Address and Tel.No. . f vt�1QrYl;�,.�11 ,d.: r. , `7$1-2 5 8 - 1,38 q , Assessor's Map/Parcel 3 CGVU� Q VI rj e!O has on J Insstta�aller's Name,Address,and Tel.No. 55 OCgQ.�e y 77 Designer's Name,Address,and Tel.No. t'�i u S n ua4 wn 50�- — -S09 1 O1�5 A Type of Building: Dwelling No.of Bedrooms L Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures L i Design Flow(min.required) L1 1) gpd Design flow provided '/L) X gpd Plan Date, Number of sheets Revision Date Title Size of Septic'Tank Type of S.A.S. v� Description of Soil Nature of Repairs-or Alterations(Answer when applicable) Z 0 3 1 V 00 1 i ) 1 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-finvironmental Code and not to place the system in operation until a Certificate of / I Compliance has been issued by this Boar =of salt . i Sign Date —Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued -- ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS certificate of Compliance THIS IS TO CERTIFY,Ht the O -site Sewage Disposal system Constructed( ) Repaired(/k) Upgraded( ) Abandoned( )by 713-t X(_n 66 C 6 `te at 5 C UTO 1 has been constructed in accordance r 2 r with the prowsi n f Title 5 and the for isposal System Construction Permit No- I . .. dated �'} 'cy 7/�19 , Installer (��1 ]� Designer #bedrooms Approved design flow L 4 gpd The issuance of this pe i hall no be construed as a guarantee that the syst m will c o as e 'gned. - Date / Inspecto i ------------------------------------------_-------------------------------------------------------------------------------------------- i No.,, e / '°"" Fee i ✓0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal �bpstem Construction permit Permission is hereby granted to Construct( ) Re air( (,Upgrade( ) Abandon( ) System located at T u+n 0—M W�1..AX 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. f Provided:Constructio m st be co pleted 4 in three years of the date of this ermit. Date 1 Approved by w- Town of Barnstable Regulatory Services r Richard V. Scali,Interim Director r r r BAHNSTABM • MAM 1639. 61 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 7 iz—,, 7 Sewage Permit#-2 t f 7—;2 0 3 Assessor's Map\Parcel 6 3 Designer: y/�/ / �d'GPq _S Installer: Address: �?Ll? � f f/ � Address: On (G 7/ 7 15 ZY4�Cj ,ov Jwas issued a permit to install a (date) (installer) septic system at ��, 4 162GL11 based on a design drawn by (address) � S�CGCI � dated (designer) --Zi 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. Akk : 4V*` �/ZPI S'torrlill( MAW/Z." SA^O,'W I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. t I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) sIn AW (Installer's; Signature) o VON HONE 0 9 #106810 ZL (Designer's Signature) (Affix Desi mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIISION. 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 f Town ofBarnstable r ,- ._ ,P,# --- ( S-3`85 # of'Department of Regulatory Services .f, ,+'°,l Public Health Division _ Date i63P , 200 Main Street,Hyannis MA 02601 Date Scheduled &00;0$� < Time _ Fee Pd. J 00 AcEh Soil Suitability Assessr�aent for S a e Dispose �Perfotmed By: Witnessed By: _�� ._ ___.___. •- -LOCATION'&"GENERAL INFORMATION Location Address /—�� ,Q,,,, � ' Ownet'`s Name ..',:I1rJr h r"(�.7GG/ z•.t '. Address J, /l+f y ,1 7 _ z Assessor's Map/Parcel: 36/3� Engineer s Name '/ ;/^� nf5 NEW CONSTRUCTION REPAIR ✓ Telephone# ff-�7 4 7,/ Land Use - S C �' Slopes(%) 0. Surface Stones I v/ {Distances from: Open Water Body eft Possible Wet Area _ft' _Drinking Water Well Drainage Way ft Property Line .2 7/ ft Other a ft t SKETCH:(Street name,dimensions of lot;exact locations of test holes&pert tests;locate wetlands in proximity to holes) -J .TQ4_,,fff1�T...1_ - \ i AS t � � s _ 77 i Parent material(geologic) oz&wv >'I Depth to Bedrock t i Depth to Groundwater: Standing Water inHole: Weeping from PifFace i Estimated Seasonal High Groundwater 4A _ - i DETERMINATION FOR SEASONAL HIGH WATER TABLE-- - - "- Method Used: Depth Observed standing in obs.hole: in. Depth to soil inoities:.• ` Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: inde Well level Adj.factor" r'' Adj:'Groundwater Level_ ERCOLATION TEST ante Observation Hole# / Time at 9" c .t rk D,pthofPerc, l b. / aitf r_1. tlrzlj t .t= tiJ a.i fit,?P tl tad �rz t�sal Time at 6 ! .•f' ltSri Smart Pre-soak Time Q .dG 'Tmie(9 -6.) -Al cl;r `a.lc r.� t t J st` It.l,'1$f,f.,rutit,t":naJ !'C:t >rtJlt> r r ; End Pre-soak �_&L %'/1 % 'i1 /fif Rate MinAneh /�/P b 7 ... .z-. ,. ..> .,,. :.. .. ,. •#�rsi t. t•r.r° _ ' __ u ISSN I3.iJ Yt] U } ;Site Si itabil6 Assessmerit:'"Site Passed r,re+. 'Site`Failed hr., ;l(..3t Addiiional.Testing Needed(Y/l)+r, r• 1 rr f l Original: Public Health Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within ibO' of wetland,you must-first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEYnC\PERCFORM.DOC DEER OBSERVATION G ... . Depth from Soil Horizon Soil Texture •• Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. Consistency,%Gravel) 1/ 14 5&A v f2 - "7,&f .7 S /3 Ale 40*r DEEP OBSERVATION HOI`V r", , Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel /w mvOZ 40V-- S ,7,s 3 ,e DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) '(Munsell) Mottling (Structure,Stones,Boulders. Consistency,o o Gravel) _ DEEP OBSERVATION HOLE LOG v_ Hole# from Soil Horizon Soil Texture Soil Color Soil Other Depth i P Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders, o Consistency./o Gravel)„ Flood Insurance Rate Man: Above 500 year flood boundary No_/ Yes Within 500 year boundary - - 'No f/ "Yes Within 100 year flood boundary No_L,'� Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ro 5 If no .what is the depth of naturally occurring a o�rial? >� P Y g P Certification','. I certify that on" " (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis.was performed by me consistent with the required training, ertise and a erience described in 310 CMR 15.017. Signature Date 4p / 7 Q:\SEPnC\PERCFORM.DOC Town of Barnstable ��FtHE T�ti o� Regulatory Services BAMSTABLE. ; Thomas F. Geiler,Director 9 MASS. g �'OrF10 N3190. Public Health Division Thomas McKean, Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 27, 2006 To: AttorneyCarol Kenney Y From: Donna Z. Miorandi, R.S. Health Inspector Re: 5 Putnam Avenue, Cotuit Assessor's Map 036, Parcel 034 4 This memo states that proper documentation has been provided to this department showing that 5 Putnam Avenue, Cotuit has always been a 4 bedroom dwelling. The septic permit, #86-70, issued as a repair on January 24, 1986 was inspected on January 28, 1986. The system installed at that time was adequate for a four bedroom. This was also verified by state certified inspector, Gary Rabesa of Warren Cesspool per his inspection on May 26, 2005. In closing, this property has a passing septic system for a four (4) bedroom dwelling. i I!k THE Town of Barnstable Barnstable . Regulatory Services Department Mftedcafty STABLE- MASS. 1 ' 1 ,�� Public Health Division lF°Ma�� 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 4987 6148 June 5, 2017 JOHNSON, DAVID G &ELIZABETH T PO BOX 254 COTUIT, MA 02635 f ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 5 Putnam Avenue, Cotuit, MA was inspected on OS/11/2017 by Matthew Gilfoy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines r of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. ti Failure to repair/replace the septic system within the deadline period will result in future enforcement action. 0 PER ORDER OF THE BOARD 0 HEALTH Thomas McKean, R.S., CH0 Agent of the Board of Health . r Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\5 Putnam Avenue Cotuit.doc l t • 3 Town of Barnstable 039. ,�� Regulatory Services Department { Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-8624644 Richard Scali,Director FAX: 508-790-6364 Thomas A McKean,CHO Feb 6, 2007 'Rev. 5/11/16 • S DEADLINES TO'REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 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 ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool 1 YE DEft INE CRITERIA Static liquid level distn utlon. ox a ove outlet invert due to an overloaded or clogged SAS or cesspool E ❑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 Q Single Cesspool , ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation' of a driveway due to H-10 components, etc) , ❑Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1) 1 ❑Leaching facility,with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER - r f t Repair deadline: ' - Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ry ,E: 5 Putnam Ave.7M Property Address David Johnson sh,; Owner Owner's Name !' information is Cotuit Ma 02635 5-11-17 N"k required for every N" page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information S - fz3cf-(P ' on the computer, ` use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation � Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-11-17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or.DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump 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 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): 1 ❑ 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): E 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: { t ❑ 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 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: ❑ 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. Cityrrown State Zip Code Date of Inspection I B. Certification (cont.) Yes No ❑ ® 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. f ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have-determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. C E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the, questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim.Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 5 Putnam Ave. _ Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °w 5 Putnam Ave. M Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ®' No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2016-82,000gallons 2015-83,000gallons Sump pump? ❑ Yes ® - No Last date of occupancy: - CurrentDate Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i Commonwealth of Massachusetts z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 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: Owner- last pumped 2013 _ t i Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: f Type of System: ® Septic tank,Aistribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) I ❑ 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 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: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): - Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 7 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inve rt, evidence of leakage, etc.). Tank was in working order at time of inspection. Tank is in need of pumping at this time and should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NA 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 I ' Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 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 11 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was in poor condition when inspected. 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.): NA * 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cw10 5 Putnam Ave. M Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (1) 6'x4' ❑ 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.): Leaching was in hydraulic failure when inspected. Liquid level was over inlet invert and leaching will need to be replaced. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments f M 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is Cotuit Ma 02635 5-11-17 required for every ' 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): t . Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): a a t 4 r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7M 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is Cotuit Ma 02635 5-11-17 required for every - 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 REAR A ti B Al-29' 131'-14' A2-36' 132-21' A3-41' 133-26'6" ! 3 i V t t5ins•3/13 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W'k Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 5 Putnam Ave. M Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check.cellar ® Shallow wells Estimated depth to high ground water: >3' below SASfeet 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: A previous inspection report showed groundwater to be greater than 3' below SAS ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A hand hole was augered and a seasonal adjustment added and groundwater was found to be greater than 3' below SAS. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 P I A ,Y 1 Commonwealth of Massachusetts W l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 Putnam Ave. Property Address David Johnson Owner Owner's Name information is required for every Cotuit Ma 02635 5-11-17 page. CityTrown 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 t5ins•3/13 M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 Y 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken 'Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Cityrrown State Zip Code Date of Inspection 4 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. General Information filling out forms on the computer, I use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of inspector key. Aardvark Environmental Inspections ras Company Name PO Box 896 Company Address East Dennis MA 02641 City/Town State Zip Code 508-385-7608 SI 3742 Telephone Number license Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection:The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspe oes 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-11/10 Title 5 OVon :Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Cityrrown State Zip Code Date of inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any 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 r indicated below. Comments: i 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 i 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 F Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): k t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Notfor Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Cityrrown state Zip Code Date of Inspection B. Certification (coot.) B) System Conditionally Passes(cont.): ❑ 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): 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 mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11110 Tide 50Yicial lnspecbun Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Cityfrown 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: ❑ 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 ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �t 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered`yes"in Section D above the large system has faded.The owner or operator of any large system considered a significant threat under Section E or faded 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 DeparhTtent. t5ins•11/10 TRIe 5Official Inspedfion Form:Subsurface Sewage Disposal System•Page 5 of 17 I` I Commonwealth of Massachusetts Title 5 Official Inspection Form 6, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information.For example,a plan at the Board of Health. ® ❑ Determined in the field Cif any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)1310 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•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's flame information is required for every Cotuit MA 02635 02/20/13 page. Cityrrown 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?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings,if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10/12 Date Commercial industrial Flow Conditions: Type of Establishment: Design flow(based on 310.CMR 15203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins-11/10 Tdle5Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every cotuit MA 02635 02/20/13 page. CitylTown 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: 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 lank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ 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 VA system-by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5Oftial inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 01/23/86 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3.5 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 2.0 feet Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,000 gal Sludge depth: 4" t5ins-11110 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address NealTonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" 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 1 6" 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.): The tank was sound and tight with tees in place and liquid at outlet invert. 1 Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete 0 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•11/10 Me 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Citylrown 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): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 . Title 5 0111mal Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is Cotuit MA 02635 0220/13 required for every 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 even 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.): The box was level and tight with no sign of carryover. 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.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Flame information is required for every Cotuit MA 02635 02/20/13 page. City/rown State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ teaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation,etc.): This system has a 6'x4'precast pit surrounded by three feet of stone.The pit was dry with 14" between the inlet invert and the stain line. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form E Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): I 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•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every CotuR MA 02635 02/20/13 page. Cityfrown 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 t } rear ` 21 38 41 27 I 40 48 } I l t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i ` 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 7.3 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: I augered to 11.0 feet andfound no water. I adjusted to 7.3 feet. Bottom of leaching is at 6.8 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11/10 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 Putnam Ave Property Address Neal Tonken Owner Owner's Name information is required for every Cotuit MA 02635 02/20/13 page. Cityfrown 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I oate• permit Number---- --- , HIGH GROUND-WATER LEVEL COMPUTATION { �•�. �� P Lot No. E Address: ner: Address: ws: re to __........ oats �.;;;1013 to nearest 1/ua ft- ---:_- --- . SP 2 Using Water-Level ROW Zone and Index Well Map locabz � site and detaffni"e- Appropriate index a(hater-teyel ......._..._..__....__.._....._.... MP 3 using nw thly mport 'Currem %later ftem ces Cand'ttior te:tnic�a-ment&Pth w 1 vjmtw level for index v► H - _.. _.�._.... m Z/-egw 11 �. SEP 4 Using Tale-af Water4evel Acipstments for index Yuen (STEP 2A).current dWth' to vmw level for index vvetl (STEP U. d water-le-jel zom(STEP 28) _......._.... .. --...._ determineeterrrdeterminewater-level adl�_...---...................... :TEP 5 Estimate depth m h*h der _ by subtsaCti"S the water- ' kwl adjustment(STEP 4) frvrst measured dkpth to wa►ter .................... ..._...._......._......: :..._.._ level at si .....6........ � y � k it Town of Barnstable OF THE rp� Regulatory Services * BARNSfABLE, » Thomas F. Geiler, Director 9 MASS. g E139- Public Health Division Thomas McKean, Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 27, 2006 To: Attorney Carol Kenney From: Donna Z. Miorandi, R.S. Health Inspector Re: 5 Putnam Avenue, Cotuit Assessor's Map 036, Parcel 034 This memo states that proper documentation has been provided to this department showing that 5 Putnam Avenue, Cotuit has always been a 4 bedroom dwelling. The septic permit, #86-70, issued as a repair on January 24, 1986 was inspected on January 28, 1986. The system installed at that time was adequate for a four bedroom. This was also verified by state certified inspector, Gary Rabesa of Warren Cesspool per his inspection on May 26, 2005. In closing, this property has a passing septic system for a four (4) bedroom dwelling. COMMONWEALTH OF MASSACHUSETTS A EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS'j d DEPARTMENT OF ENVIRONMENTAL PROTECTION A Za S —8 PPI 12: Ifl 1M SVev ��, l0� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 5 Putnam Avenue ✓ffotuit)Barnstable.MA Owner's Name: Arthur Perry Owner's Address: PO Box 228 Cotuit,MA 02635-0228 Date of Inspection: May 10,2005 Name of Inspector: Gary J and/or Jane E Rabesa Company Name: Rabesa Subsurface,Inc dba Warren Cesspool Service Mailing Address: PO Box 2302 Teaticket,MA 02536-2302 Telephone Number: 508-540-7143 CERTIFICATION STATEMENT I certify that 1 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date: May 26,2005 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. t .. Notes and Comments: Title V system with leaching of up to 450 gallons per day. ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 5 Putnam Avenue (Cotuit)Barnstable.MA Owner: Arthur Perry Date of Inspection:May 10,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: YES X 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: NO One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: , ' The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Warren Cesspool Service 508-540-7143 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 5 Putnam Avenue (Cotuit)Barnstable.MA Owner: Arthur Perry Date of Inspection: May 10,2005 C. Further Evaluation is Required by the Board of Health: NO 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. m 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone l 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. e 3. Other: Warren Cesspool Service 508-540-7143 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:5 Putnam Avenue (Cotuit)Barnstable,MA Owner: Arthur Perry Date of Inspection: May 10,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to 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 '/z da — _ q P P Y 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. —X_ Any portion of 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 1 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. (This system passes if the well water analysis, performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma NO (Yes/No)The system fails. 1 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 f Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) 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 a the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well F If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Warren Cesspool Service 508-540-7143 T;.io c r--+;,.,, r•,.,.,,,fii c11nnn 4 I Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST r Property Address: 5 Putnam Avenue (Cotuit)Barnstable,MA Owner: Arthur Perry Date of Inspection: May 10,2005 Check if the following have been done.You must indicate"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 Were any of the system components pumped out in the previous two weeks? x — Has the system received normal flows in the previous two week period? x Have large volumes of water been introduced to the system recently or as part of this inspection? x _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) x Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of break out? x_ Were all system components, including the SAS, located on site? x_ 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? x _ 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: Yes no x_ Existing information. For example,a plan at the Board of Health.. x _ 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(3)(b)]. r Warren Cesspool Service 508-540-7143 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 5 Putnam Avenue (Cotuit)Barnstable,MA Owner: Arthur Perry Date of Inspection: May 10,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): three Number of bedrooms(actual): four DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330 gpd(450 provided) Number of current residents: two Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no [if yes separate inspection required] Laundry system inspected(yes or no): n/a Seasonal use: (yes or no): no Water meter readings,if available(last 2 years usage(gpd)): 2003 averaged 115 gpd,2004 averaged 107 gpd Sump pump(yes or no): no Last date of occupancy: occupied. COMMERCIAL/INDUSTRIAL: N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: (owner)December 2004. Was system pumped as part of the inspection(yes or no): no If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: c TYPE OF SYSTEM x Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy _no Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 1986 permit on file. Were sewage odors detected when arriving at the site(yes or no): no Warren Cesspool Service 508-540-7143 f, Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 Putnam Avenue (Cotuit)Barnstable,MA Owner: Arthur Perry Date of Inspection: May 10,2005 BUILDING SEWER: locate on site plan) ( P ) Depth below grade: 24" Materials of construction: x cast iron 40 PVC other(explain): Distance from private water supply well or suction line: town water line. Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X(locate on site plan) Depth below grade: 8"(over 12" riser)/20" Material of construction: x concrete_metal fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: standard 1000 gallon septic tank with concrete tees Sludge depth:4" ; Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: none Distance from top of scum to top of outlet tee or baffle: ------------ Distance from bottom of scum to bottom of outlet tee or baffle:------------- How were dimensions determined:onsite Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):The tank has no failure criteria. The DEP recommends r pumping every three years,depending on use. The tank was not pumped at time of inspection. GREASE TRAP: NO(locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Warren Cesspool Service 508-540-7143 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 Putnam Avenue (Cotuit)Barnstable,MA Owner: Arthur Perry Date of Inspection: May 10,2005 TIGHT or HOLDING TANK: NO(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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: s Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: YES(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of { leakage into or out of box,etc.): Viewed by remote camera,no failure criteria noted. The cover is 27" below rg ade. r PUMP CHAMBER: NO(locate on site plan) Pumps in working order(yes or no):------- e Alarms in working order(yes or no):-------- Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Warren Cesspool Service 508-540-7143 T;rlo 4 F.._411 vinnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 Putnam Avenue (Cotuit)Barnstable.MA Owner: Arthur Perry Date of Inspection: May 10,2005 SOIL ABSORPTION SYSTEM(SAS): YES (locate on site plan,excavation not required) If SAS not located explain why: t Type x leaching pits,number: one 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.): The 4'deep by 6'wide precast leach pit(with 36"to 40"of stone around,verified onsite,capable of providing up to 450 gpd leaching at time of installation)has liquid level 16"below the inlet. No signs of higher staining. The cover is 8"below grade over 22" riser. CESSPOOLS: NO(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 or no): no Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: NO(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.): Warren Cesspool Service 508-540-7143 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 Putnam Avenue (Cotuit)Barnstable,MA Owner: Arthur Perry Date of Inspection: May 10,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM NOT TO SCALE Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. IN Roo 7 3 � ZF �- � S�P-rrc TAN� '� b' EoI A 3 - ; 7' 83- ya'8'' _LEAN 0 r-l'' Warren Cesspool Service 508-540-7143 T41. c i„�„o *�,,, a,,..,�ii c��nnn 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 Putnam Avenue (Cotult)Barnstable,MA Owner: Arthur Perry Date of Inspection: May 10,2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water is greater than 20 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: x Observed site(abutting property/observation hole within 150 feet of SAS) x Checked with local Board of Health-explain: records on file Checked with local excavators,installers-(attach documentation)Engineer's certification x Accessed USGS database-explain: town topography maps.USGS survey mans You must describe how you established the high ground water elevation: Grade to bottom of leaching is 618". From area plans and reports on file(#49,#55,#59 Putnam Ave.) for properties at similar elevations,no groundwater found 132"and more below grade. u L UrN 01,N -ro Liu N c-AND►��' Warren Cesspool Service 508-540-7143 P lr E GVt/ ovex, /0"moze FOUNDATION BSMT. & ATTIC PLUMBING PRICING Conc.Walla Fin. Bsmt.Area LAND COST Bath.Room Base 21PIA0 Conc. Blk.Walls Bsmt. Rec. Room St. Shower Bath BLDG..COST LAtfic c7 170 pURCH. DATE. ;onc. Slab Bsmt.Garage St. Shower Ext. PURCH. PRICE. Brick Walls Attic FI. &Stairs Toilet Room RENT Stone Walls Fin.Attic Two Fixt. Bath .. 'iers INTERIOR FINISH Lavatory Extra 3smt. �F 1 2 3 Sink l?% V2 r/a Plaster Water Clo. Extra ®' EXTERIOR WALLS Knotty Pine Water Only _ S )ouble Siding Plywood 'No Plumbing Bsmt. Fin. / f�� y. f0 •( � Single Siding Plasterboard Int. Fin. ) VGY3.� Shingles .','T1LI^!G :cnc. Blk. G F P Bath Fl. /7 7 _ Heat =ace Ork.On Int.Layout Bath &Wains. . —_ � Auto IIt..Unit Veneer Int. Cond. Bath Fl, &Walls Fireplace '•� 4— U�� ,om. Brk.On HEATING Toilet Rm. Fl. "-- Plumbing �0 Solid Com. Brk. Hot Air Toilet Rm.Fl. &Wains. , — Tiling Steam Toilet Rm. FI. &Walls _ 31anket Ins. Hot Water St. Shower toot Ins. Air Cond. Tub Area Total - Floor Furn. ROOFING COMPUTATIONS f- 1sph. Shingle Pipeless Furn. o S. Mood Shingle No Heat S. F- a7, /O Sya 1sbs. Shingle Oil Burner - - Slate Coal Stoker S. F. 'ile Gas �a• 9 ROOF TYPE Electric A10S.F. Mo /U (o. OUTBUILDINGS ;able Flat S.F. 1 2 3 4 5 6 7 8 9 10 11213141516 7 81 9 10 MEASURE[ S.F. Pier Found: Floor Sip Mansard FIREPLACES � -ambrel Fireplace Stack Wall Found. 0.H.Door II LISTED' FLOORS Fireplace _ Sgle.Sdg. Roll Roofing ;onc. LIGHTING Dble.Sdg. Shingle Roof _arth No Elect. DATE �Ine Shingle Walls Plumbing T.4;o`od ROOMS Cement Blk. Electric �7A 1sph.Tile Bsmt. 1st }�� TOTAL yOGSv Brick'. Int. Finish" PRICED Single 2nd 3rd FACTOR - - /.�19S ,p - REPLACEMENT OS,( OA OCCUPANCY CON STR UCTIONr SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. ND. ;q S a oG ' 3a 760 2 3 4 5 - 6 7 8 9 - 10 - RESIDENTIAL PROPERTY MAP NO. LOT NO. 3 fwTwer"7 1941e. FIRE DISTRICT_ SUMMARY STREET l2?! :e: Ylain 5t. CO'tuit 3-."b 34, -- LAND 7so O rn 3 BLDGS. a 76,9 0 / OWNER rfa. 1Gi?�a- t�a J. � tC�d�aY! TOTAL• _ 3sioa RECORD OF TRANSFER DATE' sK PG I.R.S. REMARKS: LAND BLDGS. t a. B TOTAL .22a LAND BLDGS. 01 Myers, Theodore J. & Porta Leonard (jt,tens ). 8-24-77 2569 1 65 $33,50 �". �'��_�- ' � /',' ''✓� � � TOTAL LAND Oa6 3 S- BLDGS. TOTAL �— LAND �. BLDGS. TOTAL - LAND BLDGS. TOTAL LAND . BLDGS. TOTAL LAND INTERIOR INSPECTED: , �z A BLDGS. TOTAL DATE: 7` -��<""�- � LAND ACREAGE COMPUTATION'S BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT �' �,z S .� 6) LAND CLEARED FRONT BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR. LAND BLDGS. TOTAL LAND m BLDGS. LOT COMPUTATIONS L ND FACTORS - TOTAL FRONT DEPTH STREET PRICE DEPTH % FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND ROUGH TOWN WATER BLDGS. Y. GRAVEL RD. TOTAL 1. 0 CAT ioN A-s6 s A+�GE PE HM D, parr�. IPSTA '. !. EIl'y 'HAPAE ADDRESS 47 /rig U I L D E R DID DINH ER DAT E COMPLIANCE ISSUED / �� 1 ��iV EY.1Py f �q �V iO�GFl1 �c�P►LINk �1Si24aunur� b�ca 29 f MU-CM-1 PiT �RoNT No.�... ... F:n$.........................._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratiuu for Dispuiittl Works Tuustrurtiutt Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... Z_...... .. .: ..... ............. �'-1••--•................... _....... -. ..CD ..............._. Location-Address or Lot No. - '� . .x:....._... . u-. -------------------------- -------------- ..... - '1�. ,. ca. ..> ::�.�:�..... �►. ..... p�� Oivn Address � a ---------..—�' �: . ...... -_- ---2,m VA--s------- ------------ ...... =..V6'.):,-v-•S S---- � ........... Installer Address Type of Building ',� Size Lot............................Sq. feet Dwelling—No. of Bedrooms.... .................................Expansion Attic ( ) Garbage Grinder ( ) p`4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...................................................... Design Flow............ ---....._...._.....gallons per person per day. Total daily flow.............. ..............gallons. WSeptic Tank 4-Liquid capacitylODO.gallons Length... ........... Width._.�S_... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length............. Total leaching area....................sq. ft. Seepage Pit No......../........... Diameter.....JP.'...... Depth below inlet...... .......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...............-•...••-•-••........-•---------•--•--•-•...............•..... ...._................._..-•-•••--••--•••••---............_..••-•.....•--•-- 0 Description of Soil.....................................................•--......--•------•-•-•---•--•-•---•----•--------•----........-•-•-----------------------------•-•-•••••......•---- x V ----------------------------------------------- -------------------------------------------------- •--•--•------------------------------------------------------------ •------------------- •--------------- x --•- •. .... ._ -•-----•-•----••-•-------------•-------•--....-----...----------•-------•---•-•--•---•..-•-•-•-----•-•----..............................._.....-•-•-------••-----.. U Nature of Repairp or Alterations—Answer when applicable___-__---/ll�'�!.._ `'.L.v __-.3e,�-......_Xi:�.. .......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system'in operation until a Certificate of Complia a as een i by the oa of health. �" r 3 ....... - ------------- --------- ...... . -- -- .......................... Application Approved By............. -- ......... ............... ••--•--------•--•- .............. l r Date Application Disapproved for the following reasons:................................................................................................................ ..............................•--•-----------•--......--••----------------------•-------•--•----•----•------------------•-----•-•-----------••--•--------------•--------...---•--••---•-••------•------- Date PermitNo...... ......................................... Issued........................................................ Date a MORE No. Fps............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD `_OF HEALTH - .. ......0F.........4..�G�.�.�..`��h1--,_�................................ Appliratian for Diapagal Workii Tomitrurtian Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -- C7 Location-Address or Lot No. r �� . e Y v �� > ill �.... P -*...r ,'t ✓i; fa11��7 -• __.. .... r-•---_.... .... .. ......................... ............... ��._........ !^.�.: . -- -... OGJvnEr"-{- �. Address � (� a � 1::....... 5 �,' 5✓�.c� �"'�.-..-c. ...�� .w�_�••�5... . : 1._1:.......... Installer Address Type of Building Size Lot.................... ......Sq. feet ,., Dwelling—No. of Bedrooms.._....................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers 0.1 YP g --------•------•---..._....- P ( ) — Cafeteria ( ) G4 Other fi,xtures -------------------------------• . W Design Flow.............:�_✓__._..__.._...___..gallons per person per day. Total daily flow__._.........7::�i.....�.............gallons. WSeptic Tank--Liquid capacity 11"KQ.gallons Length---�_'......... Width.... l.. Diameter________________ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................. Total leaching area....................sq. ft. Seepage Pit No......../.......... Diameter.....J;,:2 ... Depth below inlet...... ......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....-.................. 9 •-••-•--•-•••---------•...........................•-••----•••-......----•-•........----••---•-•......•-••------•--•--••-••-•---.......---••••---•-•-•..__---- 0 Description of Soil.........................................................-•-•---•-•-------•--••--------------------•-•-------------...-•---------------------.............._._......--- x w --------------•---. ....--•-----...-------------------------------------------------------------------------•---- -----------•---------•---------•-------•-------------------••••••-------------••••-- U Nature of Repairs or Alterations—Answer when applicable-______---/7 �._ ..- c__...s ...........e f% ......._.. Zq. r v im• �..G t !�a r's`. !............. 1 ti, I a (c- ! (............................./(� 1 U --........- 1 ._....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE: 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Complian_e has been Issu by theoar of health. �� Sirned. Date --.._ Application Approved By................. ?__rr:. .: rr'IfC. t- l a ------------------------------•--..._._.......•-•--• ---..........`•••... .............. Date Application Disapproved for the following reasons:---•-•.............•--------------------••-•-----•-----------•••••••-•-•--------•---•--••-•...•-----••••_------ ---------------------•-------------._.....--•-•---------......-----------•-•-•••------•••-••--------•-•-.--------------.....------•-------.........•••---------------•--...---•--------.....---....••--- Date Permit No................. / �- r......•.----...---••--•---••-_. Issued------•---•------- ............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..N.1!�....0 F..........4`� ri..!!...v'.'aZ.`5�?�.: .......................... (9rrtif iraft, of T amplianrr THIS I-S TO-. ERTIFY, That th'e Individual Sewage Disposal System constructed ( ) or Repaired ( ) Installer at...................................... `1 } cJy t '! .\ram ._.---------•-..................has been installAd in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._ _<__r__`_..°_.....�"�..... dated___._...._- z -- - - - •--• - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM WILLU CTIIOSATISFACTORY. DATE.................... �% %� --- � ................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,:- .. _ ...... 1 YV�...........OF.... .. ....`C..� No...:. ............... 14spasat- arkii Tous#rudian rrrmit J^ Permission is hereby granted----•-----�--------== -•-C: •- ---- ----•----------------•----........---•--•--........ to Construct ( ) or Repair (L-)-an Individual Sewage Disposal System _ _ at No...__..._... '� ��'---[-r 1.� . In.� ! t -�._ <'-a!> 1 t'.. ---------••---------------•----•--....--------...-•--•-------...... Street --- --•----•--------------•---•-•--- as shown on the application for Disposal Works Construction Permit N°_, ✓ _,. Dated ? �.1 C �/ Board of Health DATE... =f`!�l!il..--- - � ...................................•---- �. FORM 1255 �• m. SUl_KIN, INC., BOSTON` i 0 C A i i0llf E �7 S `-W A- c g RI ice N"jE VILLAGE A %rR'5 Al 225 NIL c 8 A99 �1 �s � • 1J D t11 t 0 f R ON OWNER' DATE PERMIT iSaUiv I j 0AI E COMPLIANCE ! SSUI V PROW giwv 2V i r �«s��►►Twn� NIA 211 FIT. I w�3,04 7"smHr. j :r I 't E 'd ��SZB�S80S ANN3>1 -10HU3 A11H e80s60 90 9z des i a 6 L� APPLICATION and CERTIFICATE OF COMPLIANCE iCE 1Yt.G.L.,CHAPTER 148,$t=C T IONS 26E, 26E, 26! °z City or 1ovvm 'CO3UIT Date: e Application is hereby made for the inspection of smoke detectors and/or carbon monoxide alarms as required by Massachusetts General Law, Chapter 148,Section 26E,Section 26F, Section 26F YZ and 527 CMR 31 et. secs. Location: -fit, j.a I I V -� L__ i ,/4-14 6 Owner: ,,t.�,�• Inspection Contact& Phone info: Signature of Applicant -ff1�/1�; � L� This certifies the above property has been equipped with approved smoke detectors and carbon monoxide alarms and was found to be in compliance with M,G.L., Chapter 148, 0 Section 26E Q Section 26F 0 Section 26F Y. and 527 CMR 31, et seq.on the date tested. Note:This certificate expires sixty(60)days after d t Number of Dwelling Units: Devices Inspected: WO RN Alarms InspectionfTesting completed on:(Z ' H . 1 . Y Irnspesto Fee Paid(M.G.L.Chapter 148.Sec. 10A): Head of Fire Department; Chief Paul A, Frazier Thls form meets the requirements for F.P.SC as revised 1/06,MA oFS. Form a3trioution:white-Sg;i4cr,6 cdpy,'idtigai-Fare C. .;,r27i2r,Cs copy YWA! 7i1 iAi47i . ..,,,,7 r� d �ZSZBtaSt3OS AWW3>1 1OHUO A11H et3O :Go 90 92 dos t 81 GENERAL NOTES: 1. VERTICAL DATUM: __ASSUMED ------ 2. MUNICIPAL WATER IS AVAILABLE. 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT i SYSTEM UNLESS OTHERWISE NOTED. 4. ALL PRECAST UNITS TO CONFORM TO AASHTO: _ H_10 & 20 n Putnam Avenue ��y 5.`PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE Pave. WITH MA ENVIR. CODE (TITLE 5) AND LOCAL /e' ------ 4854 48.63 REGULATIONS. 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES P TO CONSTRUCTION. 82.00' PRIOR \ nd. 48.24x F 45 I :3 LEGEND: FLOOR PLAN 3 ss PROPOSED CONTOUR Existing 4 Bedroom Dwelling y ❑ 3 Top Fndn. El. 48.3' . ,.. , I 9s PROPOSED SPOT GRADE N.T.S. w / x 7.6 — 40 — EXISTING CONTOUR 47.36 Drivewa ' '' X 30.23 EXISTING SPOT GRADE x • . � : - '. Parlor Living TEST PIT Room 'Gas Benchmark: use Bed 1 L © ,:Meter corner conc. at ® EXISTING WATER SERVICE m bulkhead at EL. _. o / 47.89 47.8' o X o WORK LIMIT LINE Kitchen o s BH I:•...; :.' .,: _ w Lot: Area:.:..:.. 0.4717 _ 8;620-t SF +, °' 7 Elec.Outlet Tst Floor �' �� l on Post OF M N w x' r`� "Lau, N : Exist. 2., 47.72Hedge 21 .Bed 3 Bed 2 v : TankI ` -�^^" Plopx 47:78''" x' water Spigot/Post p AMY L.+, v . -+ Plantings. ' x VON HONE= Plantings. g 4) �r V) " z 47,3s j x,• H Bed 4 o Hall C: No. 1068\ + o +°'r --------Relocate Waterline and Sleeve o 27. within 10' of Leach Facility PSI IER� 2nd Floor \� : 1.� O .81 b T \/ S 7.73 _2 15 0 x 46.71 LP 1' m p — y ASSESSOR'S MAP: 36 X.47.27•o PARCEL: 34 R s•... 7.74 Shwr NOTE: This plan is to be used for septic REFERENCE: PL. BK. 103 PG. 59 �� x 47.0s 4710x�Owr•x 4 .3 { Shed .31 system purposes only and is not to be PL. BK. 96 PG. 35 23' x 47.40 used for any other purpose. FLOOD ZONE: X Town of Barnstable Lg. Decid. Tree Plantings :47.17 x 47.58 x a. 25001 C0759J(07 16/14) F nce Lg. Maple 5 P U TN A M AVENUE o—Ave• LOCUS 90 ,.,�t cJa6.97 ° 's8C d. V C 0 TU I T, MA F Putt % associates PREPARED .. Pnc sYs1eM oe�cNs FOR: B & B Excavation 320 Cotuit Road Septic System and Cn Sandwich, MA 02563 Cookid9 o Site Plan David & Elizabeth Johnson Scree // ��/�� / j (0) 508.833.0041 i� t� (C) 508.274.0074 P.O. Box 254 NOTE: Pump and backfill Sh° //��8' /� / P s�n�i�g C o t u i t M A 02635 erso Odd /// �y/ //� failed leach pit. Re—use , existing 1000 gal septic tank. AH Ojala Surveying ArneH. Ojala,P.L.S. AT REVISED 211 Maple Street DATE SCALE SHEET N0. West ear-362 eoe334 MA owes 06 20 2017 — LOCUS MAP N.T.S. I 508 asz / / 1" — 20' 1 Of 2 Provide Riser over D-box NOTE: All components to be marked with NOTE: To prevent breakout, final T.O.F. (Full/Crawl) to within 6" of final grade magnetic tape or similar prior to final cover. grade of EL. 44.75 to be carried EL. 48.3 (Cover to be watertight) ' out a minimum 15' beyond edge F.G. EL: 47.5-48.0f F.G. EL: 47.5 F.G. EL: 47.75 Maintain Min. 2% slope over leach facility to of leach facility.(Existing grade .Existin revent ondin F.G. EL: 47.75 meets breakout.) Install risers w/covers over inlet and Min. 2" of 1/8" - 3/4" Washed Stone or Ins ection Port within 6" to grade outlet to within 6" of final grade Geotextile Fabric ; L=15' (Access Covers min. 20" diam. per Code) •� Exist. invert 4" SCT L=20 3/4 - 1 1/2 Double Washed Stones_, 4" SCH 40 PVC �. L=20 Top of Peastone or Geotextile Fabric EL. 44.75 Sch. 40 4 :.: ®g=7. 4 SCH 40 PVC .. . -PVC Pi e 14. ®S=1.65% 1 6 Ba $ aB24" Eff. De th P CADS=1.25% 0.5%MIN pEL. 45.88 EL. 44.5 EL. 44.0 41.75 EL. nstall Gas Baffle EL. 44.17 PROPOSED DB-3 EL. 43.75 Use 3 - 500 Gallon Precast Chambers H-20 DISTRIBUTION BOX (H-10) with Double Washed Stone 7.05' Am AM(Install PVC Outlet Tee) Watertest for levelness 4' Ends, 4' Sides EXISTING 1000 GALLON if more than one S E P.TI C. ..S YS TE M PR 0 FI LE _ (33' x 12.83' x 2') outlet EL: 34.7 H-10 SEPTIC TANK N.T.S. Bottom of TH-1 & 2 ADDITIONAL NOTES DESIGN CRITERIA SOIL LOG SOIL EVALUATOR: AMY L. VON HONEI, S.E. #2517 1. Contractor to confim soil suitability prior to installation. Contact BOH and Number of Bedrooms:Existing 4 Bedrooms INSPECTOR: DONALD DESMARAIS, R.S., BOH Design Sanitarian in the event of varying soils from original soil test. DATE: DUNE 20, 2017 11:00 AM Soil Type: Class I PERMIT: #15388 2. Pump and backfill Failed Leach Pit. Any contaminated materials within 5' Percolation Rate: <2 min/Inch PERCOLATION RATE:<2 MIN/INCH IN C1 of proposed Leach Facility to be removed. Replace with clean fill per Title 5 specifications. Daily Flow: 110 G.P.D./Bedrm x 4=440 G.P.D. TH - 1 TH - 2 Design Flow: 440 G.P.D. (Min. Required) 3. Water line to be sleeved at any sewerline crossings and within 10' of any EL. 47.7 EL. 47.7 septic components, as needed, per Water Department requirements. Private Garbage Grinder: Not Allowed Water line servicing Outdoor Shower at Rear Shed to be relocated and Fill Fill sleeved. Contractor to verify location of water line prior to construction. Leaching Area 16 46.37 14" 46.53 Required: (440)/0.74 = 594.59 S.F. " Sand Loam Sad Loam 4• Distribution Box to be placed on 6" crushed stone or compacted, level 440 G.P.D. x 200% = 880 G.P.D Sandy 2 Sandy 2 Septic Tank Required: (Existing) base. Minimum 1000 Gallon 25" 45.62 23' 45.78 B e Use 3 500 Gallon Precast Chambers H-10 with Loamy Sand Loamy Sand SEPTIC TIES Double Washed Stone: 33' x 12.83' x 2' 10YR4/6 10YR4/6 36" 44.7 34" 44.87 0�� Sidewall Area: 2(33' + 12.83')2= 183.32 S.F. C1 Perc C1 °F a� Bottom Area: 33' x 12.83'= 423.39 S.F. Medium Sand ® Medium Sand a�° 606.71 S.F. 2.5Y6/3 56" Bottom 2.5Y6/3 �'°c� �� 2' Desal nAFlow Provided: 0.74 606.71 S.F. = 448.96 G.P.D. a ca ( ) 0 1' S' 5 PUTNAM AVENUE COTUIT, MA 1' �a PREPARED �r 4 associates FO R.R: \ O 156" 134.7 156" 134.7 sEanc SYSTEM oEsiays 14 B & B Excavation ' 3' 320 Cotuit Road Septic System and No Groundwater Observed No Groundwater Observed \^ 3 Sandwich. MA 02563 p (0) 508.833.0041 Site Plan David & Elizabeth Johnson <9" @ 4: 20 min. PERC RATE: <2 MIN/INCH C1 Horizon ��,�� (C) 508.274.0074 P.Q. BOX 254 I, Amy L. von Hone, S.E., hereby certify that I am currently approved by �283• Surveying by: Cotuit, MA 02635 the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and AHOjalaSurveying that the above analysis has been performed by me consistent with the ArneH. Oja la,P.L.S. requirements of 310 CMR 15.017. 1 further certify that I have 211 Maple street DATE REVISED SCALE SHEET NO. q y west Sornstabie. MA 02668 successfully passed the Soil Evaluator's Exam on November, 1995. WS-362-0934 06/20/2017 1" = 20' 2 of 2 { i