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0476 PUTNAM AVENUE - Health
47b:Yutnam=Avenue Cotuit .� j — — - — — A = 038 020 j s ,A 1 LTUi 4 BARY�STABLE Lt�CATiON SEWAGE:.. ViLt:AGE ``' AS5FS.SLiR'S i�iAF&LQT MALLER'S MAW SBI�TdC TANK LEACI:3Il�iG FACISa't'K ttypr} e:IJCF Csze) :51C . O PLO (?FBEI3,RQOtVIS �" ..; Herut� o�oar RAOT . . cc� rrtc `DATE: Separation Distance Baweeti ire 1�iaxdYtum Ad—"-w Groundwater Table to the:Bottom_of Lea:0 Fac ty Feet Pnvate V�latar Supply;Walt and Itng Fatty (IE any gaits exist an�'sits nr anthia,?�0 feet.of Jesisivag far.�ity} � _ 3Feet Edge of WEtand and°Leaching£ac�tty(If ariX wettaads exist withta 3(l0 feet a teaciui�fa ") r: ` Feet. Furt►s ed by:,; , I D 000 c , i l D � ' - 19 TOWN OF BARNSTA.BLE ION �tio `GtT nu✓V+ y@ SEWAGE # rfLLA GE �D �GL i � _ _._._ASSESSOR'S PAP &L,Ox NSTALT..ER'S NAME&PHONE N0. .�. ;EMC TANK CAPACITY 2 ,EACHING FACILITY: (type) CI (size) (S' 40.OF'BEDROOMS_—a--. MILDER OR 'ERMITDATE: COMPLIANCE DATE: �apar►ttion Distance Between the: Aaxim m Adjusted Groundwater Table to the Bottom of Leading Facility _ eel �rivate Water Supply Well and Leaching Facility (if my iv►;lls exist on site or within 200 feet of leaching facility) idge of Wedand and Leaching Facility(if any wetlands exist within 300 feet urni�hed by o���leaching fa nary) �Z ./fit eGl , 3j 03 -vao -� 8 Commonwealth of Massachusetts f Title 5 Official Inspection Form - � I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 476 Putnam Ave I'' Property Address =P�1i Jeffrey Wilson ' Owner Owner's Name information is it MA 02635 t ou 5-3-17 r, required for every C %� �> page. City/Town State Zip Code Date of Inspection is Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information �i is a�SJ 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 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. 5-3-17 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 Title 5 official Inspection Form I-I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name i information is Cotuit MA 02635 5-3-17 required for every page. City/Town State Zip Code Date of Inspection B.,Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® ;I have not found any information which indicates that any of the failure criteria described 3 in 310 CMR 15.303 or in"310 CMR 15:304 exist`Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: El 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. I Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. I� The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I i t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts _ a=1 f Title 5 Official Inspections Form h�r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 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): ❑ 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): J ' , fit C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface'Sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is lt i required for every COtu MA 02635 5-3-17 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. El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. 0 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: i 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 El 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 'h day flow t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 4 of 17 i f Commonwealth of Massachusetts - 1a=1 Title 5 Official Inspection Fora WN Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address _ Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 page. City/Town 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. 1�-i , , c s .-1 'k kr, ❑ ® 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 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 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered'a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a' 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is Cotuit MA 02635 5-3-17 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® 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): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220-- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts , ,a=1 Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address `-� Jeffrey Wilson _ Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 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? (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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2017 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ 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 , Commonwealth of Massachusetts Title 5 Official Inspection Form 1A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 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: Town--2009 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- 476 Putnam Ave L !" Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 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: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): - Depth below grade: 24"feet Material of construction: ❑ cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good.condition. Septic Tank(locate on site plan): 18" 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: 1500 gal Sludge depth: 12" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts :+l Title 5 Official Inspection Form 21 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 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 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- �,_�_�,!„ 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 , Commonwealth of Massachusetts f Title 5 Official Inspection Form �. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v% 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 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 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form - I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ate 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-30'x15' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field in good working order with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 476 Putnam:Ave Property Address Jeffrey Wilson Owner Owner's Name information is Cotuit MA 02635 5-3-17 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): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i i Commonwealth of Massachusetts ,- Title 5 Official Inspection Forte Subsurface sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) r 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 _7A R WN --� env s . R t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form W. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments JW! 476 Putnam Ave Property Address Jeffrey Wilson Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 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: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) El Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. a t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts ,a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 476 Putnam Ave Property Address Jeffrey Wilson _ Owner Owner's Name information is required for every Cotuit MA 02635 5-3-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater . ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 , 1 DATE: 10/24/01 PROPERTY ADDRESS: 476 Putnam-Ave Cotui t ---------------------- Mass.02635 ------------------------ On the above date, Inspected septic system at the abov e address. I ins p the p y This system consists of the following: 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. 3 . 2-Flow diffusors in series. 20 'X8' Based on my inspection, I certify the following conditions: 4 . This is a title five septic system. ( 78 Code ) 5. The flow diffussors are presently. 0(y ' 6 . After reviewing the pumping history.-- We found that the leaching , was pumped on 4/9/01 . System was in hydraulic failure at that time. ; 7. Recommend that a new leaching area be. installed at this location. SIGNATURE:1 _J G� Name:_J_P _ Macomber Jr_______ Company: Josej)h_P. Macomber_& Son , Inca Address: Box 66 Centerville , Ma . 02632-0066 Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY Y p1T JOSEPH P. MACOMBER & SON, INC. ` vp0 �� Tanks-Cesspools-Leachfields OkgNo�P Pumped & Installed �pNN�P� Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 S.� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION I TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 476 Putnam Ave Cotuit,Mass_ Owner's Name:Rolin smith Owner's Address: South 1 24th East Avenue Tulsa Oklahoma Date of Inspection: 1 0 24 01 Name of Inspector: (please print) J.P. . Macomber Jr. Company Name:Joseph P. Macomber & Son Inc Mailing Address: P_n_ Box 66 S.entarv, > > e Ma 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time 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 SS don 15.340 of Title 5(310 CMR 15.000). The system: r! �� Passes _ Conditionally-Passes _ Needs Further Evaluation by the Local Approving Authoriry _ F Is Inspector's Signature: V c Date: The system inspector shall it a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner'shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments f••'•This report only describes conditionsat 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 6/1 S/2000 page I Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 476 Putnam Ave Cotuit,Mass. Owner: Rolin Smith Date of Inspection: 1 0 2 4 01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A ystem Passes: ®rm3�1 �15.3 informatio hich indicates that any of the failure criteria described in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: After reviewing the past pumping history. ( hydraulic failure took place on . This means leaching was tull an pumpe -_ at this time. It is recommen e t at a new leaching area e ' be installed at this location. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. �The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the . existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: A Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed 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: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 476 Putnam Ave Cotuit,Mass. Owner: Rolin Smith Date of Inspection: 10/2 4/01 C. Further Evaluation is Required by the Board of Health: �2 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: 4140 Cesspool or privy is within 50 feet of a surface water d Cesspool or privy is within 50 feet of a borderLtg 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: . /IJOThe system has a septic tank and soil absorption system(SAS)and the SAS is within I00 feet of a surface water supply or tributary to a surface water supply. Vd The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. 4?h The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. .410 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 dilaAz "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. F 3. Other• .WW411� 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ackup 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 disrnbution box above outlet invert due to an overloaded or clogged SAS or �esspool , k� A 1)e4(fS6Rt 1461.81 C0/`y-2 �iquid depth in is less than 6"below invert '1A or available volume is less than day flow �equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped :ky portion of the SAS, cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ater supply. y portion of a cesspool or privy is within a Zone I of a public well. �ry portion of a cesspool or privy is within 50 feet of a private water supply well. 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 form.) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a 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 now 1✓ the system is within 400 feet of a surface drinking water supply Ae system is within 200 feet of a tributary to a surface drinking water supply v 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 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. 4 Page 5 of 1 1 , OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:476 Putnam Ave Cotuit,Mass. ' Owner: Rolin Smith Date of Inspection: 1 0/24/01 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 componentsl,4�luding 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: Yes ,/no/ . 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(3)(b)j . 5 Page 6 of 1 1 a OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 476 Putnam Ave Cotuit,Mass. Owner: Ro in Smith Date of Inspection: 1 0 24 01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): A Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):-,d.—V, _ Number of current residents: J6 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system�(yes or no):,(O [if yes separate inspection required] Laundry system inspected(yes or no):Iris Seasonal use: (yes or no): �� Q Water meter readings, if available(last 2 years usage(gpd)):r � � Sump pump(yes or no):� f`"��� �4/$ Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): ZO end Basis of design flow(seats/persons/sgft,etc.): �!L Grease trap present(yes or no): A& Industrial waste holding tank present(yes or no): 00 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 Tank- pumped 4/27/98 & 5/1 2/99 Source of information:Complete sytem pumped 4/9/01 Hydraulic failure at this timee - - Was system pumped as part of the inspection(yes or no): If yes, volume pumped: 0_gallons-- How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM Septic tank,distribution box,soil absorption system tJZ Single cesspool 4&Overflow cesspool Privy /Vd 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) A,bTight tank i(JJ�Attach a copy of the DEP approval Other(describe): :e1>1 APRroximatp age of all corr. onents,date installed(if known)and source of information: k Were sewage odors detected when arriving at the site(yes or no): 6 Page. g � OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 476 Putnam Ave Cotuit,Mass, Owner: Rolin Smith Date of Inspection: 10/2 4/01 BUILDING SEWER(locate on site plan) it Depth below grade:J� Materials of construction: _cast iron ±'40 PVC NJoth er(explain): V4 Distance from private water supply well or suction line: 7t' Comments(on condition of joints, venting,evidence of leakage,'etc.): Joints appear tight.No evidence of leakage.System is vented through the house vents. SEPTIC TANK: d (locate on site plan) Depth below grade: Material of construction: �'concretef/J metal A40fiberglass R/4polyethylene ,!! bother(explain) /c If tank is metal list age: 41, Is age confirmed by a Certificate of Compliance(yes or no):A6(attach a copy of certificate) Dimensions: Sludge depth:L�tfL Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage, etc.): Pumpthe septic tank every 2-3 years. Inlet &outlet tees are in place.The tank is strurtura1 1 V GnnnrJ anr9 Ghnws nn evidence of leakage. GREASE TRAP (locate on site plan) Depth below grade:Ax Material of construction:,�concrete&metal Mfiberglass e polyethylene,/other (explain): 100f Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: 160 Distance from bottom of scum to bottom of outlet tee or baffle: gH Date of last pumping: Ao Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Grease trap is not prPsPnt S L 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 476 Putnam Ave Cotuit,Mass. Owner; Alin Smith Date of Inspection: 1 0/2 4/01 TIGHT or HOLDING TANK(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 4M Material of construction: Wconcrete&Y metal.t14 fiberglass polyethylene 41.4 other(explain): AIA 1 Dimensions. 'di-4 Capacity: allons Design Flow: gallons/day >' Alarm present(yes or no): Alarm level: Ahf Alarm in working order(yes or no): A//p Date of last pumping: Wd .Comments (condition of alarm and float switches, etc.); Tight or holding tanks are no-t-present. DISTRIBUTION BOX: Zif 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.): Distribution box has one lateral.No evidence of solids carry over.No evidence of leakage in o o . PUMP CHAMBER(locate on site plan) Pumps in working order(yes or no):_Iy Alarms in working order(yes or no):_[d Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump c am er is not present. 8 f - Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 476 Putnam Ave Cotui.t,Mass. Owner: Rolin Smith Date of Inspection: 10/2 4/01 SOIL ABSORPTION SYSTEM (SAS):Zlocate on site plan,excavation not required) 2-flow diffussors in series 20 'X8 ' If SAS not located explain why: Located see page 10 Type eaching pits,number:Q Vleaching chambers,number:.21r,1o40 e)1 i0U/d9-SdRS 12M leaching galleries,number: C7 leaching trenches,number, length: C Ak leaching fields,number,dimensions: Cp M overflow rksspool, number: 4 l At b innovatWe/altemative system Type/name of technology: %/ i[P, 4 ZFz6 7 Comments(note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to fi np sand Nn si qns of hydranl i c failure at this time Plow di ffiiasors areP resently rT P] QaRQ note that they were in hydraulic failure on 4/9/01 This septic system was pumped at that. time That in 1 c uded. th flow ,diffu ors. . 41, CESSPOOLS��(cesspool must be pumped as part of inspect ton)(focate on site plan) Number and configuration: O Depth-top of liquid to inlet invert: Depth of solids layer: Am Depth of scum laver: A)A Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not present. PRIVY rL (locate on site plan) Materials of construction: Dimensions: d Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present. 9 Page 10 of I 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM_ PART C SYSTEM INFORMATION(continued) Property Address: 476 Putnam Ave Cotuit,Mass. Owner: Rolin Smith P Date of Inspection: 10/2 4/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. / do y? P 14aW, c Cowl -... Z i A-MR of �- d _ 10 Page 11 of 11 r OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:476 Putnam Ave Cotuit,Mass. Owner:Rolin Smith Date of Inspection: 10 24 01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record - If checked, date of design plan reviewed: _Observed site(abutting property/observation hole within 150 feet of SAS) _Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) _Accessed USGS database-explain: You must describe how you established the high ground water elevation: Ground USGS 9 —000-1 Plate #2 USGS Observation well data Top of Ground . ;eet Groundwater:/Peet Below Bottom of Pit High Groundwater Adjustment // _ Therefore, the vertical separation distance between the bottomd of the leaching pit and the adjusted groundwater table is feet. 11 t ='n.nr..,—I.T,r-.,,—,.,..—,T•,...i..n„T,,.,.,..,,i-.,,-.,....,,.....,A,,,RM17,T..-.,.,C1i.,, _ .t,.-.T.—..-R-:.. ....1 TOWN OF Barnstable BOARD OF HEALTH i SUI)SURFACR SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D • CERTIFICATION «•T•'t•T••. •.•,—l.1. ^.�TrIT1T1'R.'MrlT+1/rJR'11T''TT1'r�t'i rlVTTt7.T,.f—TwRRATR.w.�'I�Pt lR..A ..�trT'T•�. .�..� -TYPO OR PRINT CI,EARLY- PROPERTY INSPECTED STREET ADDRES$ _476 Putnam Ave Cotuit,Mass. ASSESSORS MAP , BLOCK AND PARCEL . 038-020 OWNER' s NAME Rolin Smith PART D - CERTIFICATION NAME . OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME Joseph P. Macomber & S,an_ Inc ------------- COMPANY ADDRESS P.O. Box 66 Centerville Ma 02632 Strevt Town or City SUt• E I P COMPANY TELEPHONE (508 ) 775 3338 FAX ( 508) 790 -1576-. Rl CERTIFICATION STATEMENT I certify that I have personally- inspected the sewage disposa`1 system at . this address and that the information reported is true , accurate , and omplete as of the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent" with my training and experience in the proper function and maintenance of on- site sewage disposal systems a Check one : _ . �_ System PASSED The inspection which I -have "conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe envirohmenft as, defined in 310 CMR 16 . 303 . Any faililre criteria not evaluated a re ' R9 ,stated 'in the FAILURE CRITERIA section of this form , System FAILED* \, The inspection which ,.L, have con Vcted�� has found that' the "system fails to Protect the jitiblic health and the environrfient in accordance with Title 5 , 310 CMR P5 . 303 , and as specifically noted on. PART C FAILURE r3. CRITERIA of this inspection form . r Inspector Signature r Date Otn e copy of this certification must be provided to the OWNER, the BUYER where applicable ) and the 130ARD OF HEAL1'll. * If the inspection FAILED, the owner or operatorshall upgrade ' the eyetem within one year of the date of the inspection , unless allowed or required otherwise 'as provided in 3.10 CHR 15 , 305 . partd .doc Mar 14 02 12: 39a GLEN E. HARRINGTON 508-428-3862 p. 1 Attention: Mr. Thomas McKean Date: 3/14/02 Company: Number of Pages: 3 Fax Number: 508-790-6304 Voice Number: From: GLEN E. HARRINGTON Company: Fax Number: 508-428-3862 Voice Number: 508-428-3862 Subject: 476 Putnam Avenue, Cotuit, Title 5 Variance Hearing Comments: Dear Tom, Please review this letter and let me know what you think. I will be at work 508-539-1400 x555 or at home tomorrow afternoon 508-428-3862 but I am leaving for vacation tomorrow night. If you °4 Town of Barnstable ,# Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Susan G.Rask,R.S. Sumner Kaufman,MS Wayne Miller,M.D. March 22, 2002 Mr. Glen Harrington, R.S.. 9 Leda Rose Lane Marstons Mills, MA 02648 RE: 476 Putnam Ave. Cotuit A= 038-020 Dear Mr. Harrington, You are granted variances, on behalf of your client, Robin Hock-Smith, to construct an onsite sewage disposal system at 476 Putnam Avenue Cotuit. The variances granted are as follows: 310 CMR 15.211: The septic tank will be located five (5) feet away from the crawl space, in lieu of the minimum ten feet setback required. 310 CMR 15.211: The soil absorption system will be located only five (5) feet away from the easterly property line, in lieu of the minimum ten feet setback required. The.varia_nc_es_are..granted with the following conditions: (1) The septic system plan shall be revised to show an impermeable liner located between the soil absorption system and the crawlspace. (2) The septic system shall be installed in strict accordance with the revised plans. (3) The registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health Q:Harrgton L that the system was installed in substantial compliance with the revised plans. This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to the fact that wetlands adjoin the property. The proposed new septic system is designed to meet the maximum feasible compliance standards contained within .the State Environmental Code, Title V. Sincerely yours, umner Kaufman, M.S.P.H. Acting Chairman Q:Harrgton tr`CECt�,;' DATE: •.r FEB 2 8 2002 FEE: ��- TOWN _. REC. BY F-I q Prt ;:HBLE f Barnstable t ' able,.. DATE: Board of Health f 200 Main Street,Hyannis MA 02601 Office: 508-962-4644 Susan G.Rask,R.S. FAX 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address: y 7 Assessor's Map and Parcel Number: 3 of 2 Size of Lot: Z 3> 7S-V S9• Y Y Wetlands Within 300 Ft. Yes ✓ Business Name: No Subdivision Name: APPLICANT'S NAME: 12o '— Sw. `u► Phone Did the owner of the property authorize you to represent him or her? Yes lam' No PROPERTY OWNER'S NAME CONTACT PERSON Name: b 1 ki t70 C/4— S",141-7 Name: Cy j2 , bf� rrlll j&17 Address: •Z F Z y u/A'j!�-as-t- Address:.-? LeIC114 99.l�z", '4110, azog Phone: q/9'"�3 7—�/Xq Phone: S 0 �- VARIANCE FROM REGULATION(List Rea.) REASON FOR"VARIANCE(May attach if more space needed) /V Cal z /9-- ;yos" S.i 3 , �"© !cp-e�p 44// C&9-n4ahew4J 9ee�x-*- —CVC4*-1 ,r C,4A 0 /0'r d L�U' r K lu�..lol bars . 10 Lit.e- / , S S 5 ' /fD NATURE OF WORK: House Addition 1] House Renovation-0 Repair,.of Failed Septic System Chee&Iist(to be completed by office staff person receiving variance request appl icmion) _ Four(4)copies of the completed variance request.form Four(4)copies of engineeredplsn submitted(e.g.septic systemphms) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property omaer.authorized you to represent h=&er for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense q (for Title V and/or local sewage regulation variances only) Full menu submitted(far grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals ,[same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,RS.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. C \Documents and Settings\decollik\Local Settings\Temporary Internet Files\OLKFB\VARIREQ.DOC , . ....... ... � C o - -- -- Mar` ;4 02 12: 40a GLEN E. HARRINGTON 508-428-3862 p. 1 GLEN E. HARRINGTON, R.S. 9 LEDA ROSE LANE MARSTONS MILLS,MA 02648 March 13,2002 Thomas A.McKean,CHO,Health Agent Town of Barnstable public Health Division 367 Main Street Hyannis,MA 02601 Re:476 Putnam Avenue,Cotuit Septic Design Plans Dear Mr.McKean: I am•writing to inform you that I will not be present to represent the above mentioned design plans before the Board of Health on March 19, 2002 as the meeting fills during my vacation. The owner resides in Tulsa, Oklahoma and will not be able to attend either. I would Ike to explain my basis for design so the hearing may still take place as the Property is in a pending state of sale and further delay,I believe, is not warranted as this is a straight forward repair. The septic tank is proposed to be within five feet of the crawl space to maintain 100 fleet from the resource area and protect an approximate 40 foot high maple tree. The maple tree is sizable, provides shade and character to the property and the owner has requested of me to try to save the tree. The proposed septic tank location works well with the topography of the site directly adjacent to the structure. The proposed location of the SAS was determined to save the maple tree. In order to do this, the SAS was pushed toward the roadside property line. This location also works out due to the site's topography. Please understand that this two-bedroom property was built in the 1930's. An upgrade was installed in 1997 in the near same location as the proposed SAS but the 1997 SAS is one and a half feet lower to the groundwater table. Mar 14 02 12: 40a GLEN E. HRRRINGTON 508-428-3862 p. 2 The abutters were not notified for the Board of Health meeting as the only abutter erected by the variance was the town and the town was notified by the submittal of this application. The other setback variance to the crawl space is requested according to Local Upgrade Approval and does not require abutter notification. The abutters were notified for Conservation Commission and no abutters contacted me or were present at the public hearing. The Conservation Commission granted a negative determination on the Request For Determination of Applicability. If you should have any other questions or concerns,please feel free to contact me @ 508-428-3862. Sincerely, Ila Glen E.Harrington,R.S. hock.doc I oFIME ra,; Regulatory Services Thomas F. Geiler,Director * BARNSTABLE, * B Public Health Division ATFo �°i Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 p, i DATE: March 14, 2002 NUMBER OF PAGES TO FOLLOW: None-.- TO: FROM: Glen Harrington Thomas McKean PHONE: PHONE: (508)862-4644 FAX PHONE: (508) 428-3862 FAX PHONE: (508)790-6304 cc: 3°3'dz. - y k ry;R NOTES/COMMENTS: RE: 476 Putnam Avenue Hi Glen, -The plans, which you prepared were thorough and complete- well done They appear to meet the maximum feasible compliance standards contain d within the .State Environmental Code, Title V. During our staff meeting on Monday morning, we all agreed that the Board should grant the variances which you requested. In regards to your letter received today, I(personally) don't foresee any problems and don't see the need for you to be there. So, have a nice vacation! Sincerely ou s, *hos A. McKean QABEALTRTax Form.doc i� TOWN OF BARNSTABLE I.-39CATION SEWAGE # :2002—Ir6 '!VILLAGE 62rmd' ASSESSOR'S MAP & LOT 038-020 INSTALLER'S NAME&PHONE NO.��1= q Z;-e SEPTIC TANK CAPACITY /SOa / LEACHING FACILITY: (type) L.Ji1;4 �i l� (size) 30 k ts$-. NO. OF BEDROOMS 2, �� F BUILDER OR OWNER PERMITDATE: 3=Z�-U2 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Faciliiy 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 • :a S � eN.o�.�I .ppn�r r � 4• .r- { � ,� !o ��� ,� S �� 1 . • _ � i c.�yc% F�r! �� �,:-� =� a: fq No.� �� n'� FEE Board of Health, G l"S �/,� MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) - Complete System ❑Individual Components Location 4-7 Ip �cV ft1C�+,�? Q N,y Z, L� �e'(� Owner's Name !H Hock— Tw-l'4-t'n Map/Parcel# 3 O — o Z (� Address Z 1, 1 2,14*11 �L� f-J�k�� 11 (/k Lot# Z Telephone# Installer's Name pS ()S Designer's Name Address Address 0 Telephone# �,� �Z Z Telephone# Type of Building Re.► i U D Lot Size �� 7 S-0 sq.ft. Dwelling-No.of Bedrooms Garbage grinder (4-0 Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) Z Zia gpd Calculated design flow Z-ZO Design flow provided gpd Plan: Date Fe-L. Z-i ZoU z— Number of sheets ( Revision Date Title Description of Soil(s) Soil Evaluator Form No. D Name of Soil Evalu j.,5611 Date of Evaluation 3 Z-- DESCRIPTION OF REPAIRS OR ALTERATIONS nFSIGNING ENGINEER MUST SUPERVISE _- INSTALLATION AND CERTIFY IN WRITING THE SYSTEM WAS INSTALLED IN STRICT ACCORDANCE The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the syst m in operation until a Certificate of Compliance has been issued by the Board of Health. Signed s Date S u�� 31, �No. .t .� r , + . � $!r FEE µw ,,., ttUAA �tA til?a . f f Board of Health, f)C t.(-V+S L L6!� MA. x.•A L. LICATIO FOP, DISPOSAL®V AL SYSTEM CON5TJL U.` CTIO V PERMIT U.l" I ` ;*1 Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) -AComplete System ❑Individual Components Location 4'7 fo a-v„7 A t Owner's Name �1�„ oG a -- I&t,,!�•� (" Map/Parcel# �— 0 "Z o Address Z, Y'Z C f S, z y ft- E'C,s v :m/j 01< Lot# Z. Telephone# Installer's Name r oSG Lr D6 U 0 S Designer's Name ffa t.e(N ft tct. 06, f Address& Address o tea. Telephone# Z 7 Telephone# � " Type of Building 1 1 (D Lot Size 2 ?� 7 S sq.ft. Dwelling-No.of Bedrooms _Z Garbage grinder 4-1C, Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) 1 Other Fixtures Design Flow (min.required) Z- Z•U gpd Calculated design flow ZV"ZO Design flow provided 3-T gpd [ Plan: Date t�e- io Z•, Z Uo Z Number of sheets ° Revision Date Title Description of Soil(s) p Soil Evaluator Form No. J� S/ Name of Soil Evaluator U 0.r r i�,5 6XI Date of Evaluation Z 3- DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 2 FEE COMMONWEALTH ®F MASSA 14USETTS V'V' o 3 8- o Z.V Board of Health, ���`1 @ C� MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ,Abandoned ( ) by: at q 7 �* �-.- }� E A 7117-,,:r has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow 3 3 7 (gpd) Installer a = r Designer: Inspector: Ll A, er 14 Date: a ) ( I-I s 3- o s—` The issuance of this permit shall not be construed as a guarantee that the system will function as designed.No. Z ��� O FEE S l. e COMMONWEALTH OF `MASSACHUS* 63 F"0 Z 0 Board of Health, LL�c . 0 oSYs TiON��iNF Rp Fiy wq�0 C R�(/ u DISPOSAL SYSTEM CONSTRUCTION PEP 'oFrop iNSTRT��Ts�p Xll� i F ��ccn jv Permission is hereby ranted to; Construct( ) Repair( ) Upgrade(C�Abandon( ) an individual s age d�pr�s � 5- at '7 (� >> (�D 1�f/i �— as described in the applicatitS6 r Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health TOWN OF BARNSTABLE �c LOCATION 2Z6 2aT%N I/✓X&4dl" SEWAGE # 00,1 �G VILLAGE 62r d' ASSESSOR'S MAP & LOT 038-020 INSTALLER'S NAME&PHONE NO. � ��7�$ ✓ds � (,c`��4�d'� SEPTIC TANK CAPACITY LEACHING FACILITY:. 6�1G�1 (size) SO X l� (type) NO. OF BEDROOMS 2, BUILDER OR OWNER PERMIT DATE: —y2 ! COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 51 Lac • V., s GLEN E. HARRINGTON, R.S. 9 LEDA ROSE LANE MARSTONS MILLS,MA 02648 April 29, 2002 David Stanton, Health Inspector Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 RE: 476 Putnam Avenue, Cotuit, Septic Installation Dear Mr. Stanton: A sufficient inspection has been made by me so I hereby certify that the above referenced septic system was installed in substantial compliance by Joey's Septic Service with the approved septic design plans, Title V -of the State Environmental Code and the rules and regulations of the Barnstable Board of Health. Should there be any questions or concerns, please do not hesitate to contact me at 508- 428-3862. Very truly yours, Glen E. Harrington,R.S. 1 No.- l='-� �-� F�s..., ®:.. .......... THE COMMONWEALTH OF MASSACHUSETTS O-� BOAR® OF HEALTH s Appliration for Disposal Works (foustrurtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: '',1.7.b ••7 u.i. fin! ,........A. ..�....................... ................ : S !-............-----...----------.......................... Location-Address or Lot No. ................. 2 -- -AS..K........................................... Owner Address 0�-�®................................................ 3So ._Yhw.� _..__�:�. �?.:.._ P _.. Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.......).................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of.Building ............................ No. of persons.......--................... Showers ( ) — Cafeteria ( ) Q, Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------_---- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 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........................ ------------------------------------ --------------------- -... -........ -----... ------- ------------------------------------ ---------------------------- ------ 0 Description of Soil----------------------------------------------------------------------------------- -----------------------------...................................................... x U .....-•---.....•--------------------------------------------------•---••---------------------••----------------•--••-•------•-------•-------•-••...-•................................................... x ---•-•---•-•---------•----------•---•----------------------•--------•--------•-•-••--------•••---••-----------------•----------------••-------------.................................................. U Nature of Repairs or Alterations—Answer when applicable...-T!J-s. .....1AP®-... "A-N_K_...: p- ��°�?-_-.-.•..... .....(A)...f-c.�ys���=F�S.�'� 5---...�4--3------ -------------------------------------------------------------------------------------------------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bo,,n ' sued by the board of health. Signed........... . .....•-•--------------------•---.......-•----....-•----•-••-•-- .. ................... •---- Date Application Approved By............ J ,,.°.- ----------------------------------- ........... Date Application Disapproved for the following reasons------------------------------------------------------------- `_ -----------------------------------.............................................................................................-------------------------'-------------...------------.......-- Date PermitNo. ..... -.j-�-�....................... Issued-....................................................... Date No...71Y^-_.� F-Es.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............O F.......................................................................................... Appfiratiun for Diipuuaf Works Tunutrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .............. ---•- ..........................................._...._.... - -------•.... Location-Address or Lot No. ......................_.......................................................................... .....................•----••••-•---•••---•••-•--..............._................................. Owner Address W Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................. .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria G4 Other fixtures -----------•--•------------------•-----•------ W Design Flow............................................gallons per person per day. Total daily flow......................._....................gallons. WSeptic Tank—Liquid capacity_...........gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----_-------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ � Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --•••-----•--••-•---------•-•--•--••---------•---•.............................................•--•........................................................... 0 Description of Soil........................................................................................................................................................................ x U ---•--••-••--•-•---••-•••---•-••--•....-••-••--•--...-----•••--•-•--------••----•••-•...•••••-•--•--.....---••-•--••••-••---•••-----•-•------•---••----•----••--••-•...............•.............--••--- W ---- -------------- -------- ........---••--•-----•-•-•••--------••-•--•--•-----•---•----•••••--•-----•----•--------•--•--•-----••--••••--•--••--•----••-•••••--•---••--•......---•••-•-•-•------••--- UNature of Repairs or Alterations—Answer when applicable................................................................................................ ---------------------------------------•--•---------------------------------•--•--.............--------••-------------------------------------------------------------------•---••----•••----••-•••-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... .......................... Date Application Approved By---..... •--. ................................... ......... Date Application Disapproved for the following reasons:............................................................................................................. =-------•--.......--•--•••--•••....................•---•••-••---•---•---•--•-----------------•-------•----•-----•-•--....---•-•---•-••----••------•-----------•••-•••--••---•----•--••-----•--••-- q / Date PermitNo......... - 1 C ------------------------ Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH %5nrtifirtt#r of Toutpfianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired k�C) by....._......&-b......65__ -e................................................................................................................................................. at-------•...i�.76.•.-•-- ,cam �x~�1---------------------------------- I-nstall------er er....------------------------------------------------------------------------------------------ has been installed in accordance with the provisions of TIT FF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-___f?_!__"--_l�.!ir............. dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FT ACTION SATISFACTORY. _\� DATE....................�.. ��.._._.__�_ ............................ Inspector................... -_•�,,.,J................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C- L19............OF............. ---...._........................ No..LL.'-�rad.. FEE... Q.-. �tu�ro,�ttf or�u �onu�riun anti# Permission is hereby granted...........A.,-i'2�-------- ------------------------------------------------------------------------------------- to Construct ( ) or Repair �' an Individual Sewage ispos� System atNo. ._. ._..... � 1�--------------•-•• . --•-----------------.....--•--------------••-----.......... Street ��,,�� as shown on the application for Disposal Works Construction Permit No.I!__:_fk... Dated...................:...................... C� DATE----------------------- •.•-_ Bo ard of Health FORM �_r._...IL.-.f' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �7 IIN SITE PLAN SCALE: 1 "=20' 3 01 X I 5"W X 0. 5 ' BENCH MARK on corner of concrete D step elev. 100.00' assumed lecching fleld,p SITE CIO I9 9.7 8' Capt. Samadro Rd.Lo 100 6;�k-c: a6, kerice Capt. Isiah's Rd.CD 6,57' LOCUS 94, Design Calculations NO SCALE 99, 51 00 Number of Bedrooms: 2 7e 7' Garbage Grinder: No 97,2 0 k__� Leaching Capacity Required: 220 Gol.lDay 3- Leaching Area Required- 220 Gal./(0.74 GcI./Sq.Ft.)=297 Sq.Ft. 00 —301 X 15'W X 0.5'D Leaching Field 91. 3' 10 _% 1 0. 2 Proposed Leaching Structure: 1 Leaching Area Provided; 450 Sq.Ft. 50 Proposed Leaching Capacity: 333 gpd > 220 gpd. req'd.0 0 0 9 6.7 8' 0 Z_LO Little River y 0) GENERAL NOTES 1 ADDRESS: 476 PUTNAM AVENUE CIO 2� ASSESSORS NUMBER: MAP 038, PARCEL 020 95,06' 3. DEVELOPER'S LOT: LOT 2 4. TOPOGRAPHIC INFORMATION WAS COMPLIEDFORM AN loog 0 -2� ON THE GROUND INSTRUMENT SURVEY. I5. MUNICIPAL WATER IS PROVIDED TO SITE AND n LOT 2 SURROUNDING PROPERTIES. ,6. REFERENCE PLAN: LAND COURT PLAN 34623A_H0 AREA 23,750± SO.FT. 7. NO POTABLE WELLS ARE LOCATED WITHIN 100 FEET: OF SAS.CONSTRUCTION NOTES 1. Contractor is responsible for Digsafe notification.70 and protection of all underground utilities and pipei.5 91,23' 2.,. The septic tank and distribution box sholl be set level on 6" of 3/4"-11/2" stone.-k 1, be clean send or gravel with no 3- Bo,I fill shoijid 9 4 stones over 3" in size.'Jed I 4. This system is subject to 'inspection during installation;,_91.70' by Glen E. Harrington, R.S.,5. The contractor shall install this system in accordance 0 with Title V of the Massachusetts Environmental Code and the Regulations of the Town of Barnstable.6. Provide a H-10, 1500 gol. septic tank if existing 1000 gol.septic -tank is structurally unsound after relocation.6 �7. No vehicle or heavy machinery shall drive ovC-r the.—20 septic components.septic system unless noted as H.02 8. Install gas baffle or equal on septic tank outlet tee end.9. Existing SAS, D—Box and leochate contaminated soil to be removed and disposed of properly off site.10. All existing inverts and site conditions shall be,verified by contractor.11. Contrctor to remove soils considered to be unsuitable or impervious and replaced with soil according to 310 CMR 25.255, as necessary.12. Washer drain to 'be connected to main building sewer.13. Relocate plumbing to -north wall in crawl space at proposed SOIL EVALUATION invert elev.=99.4�'14. Provide double—staked hay bales and silt fence as LIMIT OF WORK,6' O.C. 6' O.C. 6' O.C. 3' Date of Soil Evai.: January 23, 2002 Test Performed By: GLEN E. HAPRINGTON, R�S_ CSE Witnessed bi Stanton, ealth Inspector: ,David Excavator eph DeBorros LOCAL UPGRADE 310 CMR 15.4n"2" OF 1/8i' TO 1/4 9 Setba e is r q es PEASTONE (WASHED)' Test Hole 1. 310 CMR 15.211 cks. A varfanc e u ted to rovide 5', in lieu P10,15 p= A No. 1 of the required 1 O'Jrom the SAS to the property line.2. 31 O CMR 15.211 Setbacks. A variance is r 1 e r e '5' i n lieu DEPTH SOILS ELEV, equ sted to'p'ovid 6" 'Ml of the required 10',,from theproposed septic tank to the� foundation,:woll.0 6.78'IA d 6-, oYR4/2 96,28 WASHED STONE 3/4" TO',,11 'E,12" 95.78',PERFORATED 4" DlkSCH:��D, C (TYPICAL) Ow, OF YK . IC SYSTEM UPGRADE 10 94.78 24 PREP�RED FOR 90.78'72' ER SS' SECTIO LEGEN LEACH ,1 FIELD,: CRO N -ep] by 03 ROBIN HOC c 1 NO SCALE EXISTING 1()00 GAL. SEPTIC I AN C6 K SMITH -:TO' BE RELOCATED.'rne sand d.YR 0 0 A 87,78 AM VENUE REMOVED AND BACK EXISTING SAS TO E 68 10 I : " ,, . �, I , ,Perk Odle a'ssurne @<2 rnpi_, FILLED--NbTE: I ,PROPOSED 15W GAL LL�� (CbTuM,�,Mk:t PIPES ARE TO,BE 4" DlA. SCHEDULE40 PVC BARNSTAB AFFLE OR EOUAL ON SEPTIC_TANK OUTLET TE Fo 00 5 VARIANCE INSTALL :,H—JO SEPTIC TANK OAS 13 ll�' NE6ESSAR Way "a e oyer Sys em— ��Iope 0, �X1044 6 of grade DIST. is ing rode Ele, 7.6 95 GLEN E NGTO' ', i Box: E tSPOT GRADE',DENOTES EX T 'Wit 0 pished�gr 0" b tai5 HOLE Existin Ettv HARRI N � 'R EXISTING CUN I IJUK;nv L A N E 9 , ILEDA ,'�'�RGS elev.- 9.62' for 2'elowlei ptu ;ng to 7_1 eo 1 __ S. I d Top Peostone DEEP TEST HOLE th all 0 propqtp, A 99 42 I)N&� M M olev.- Invert rlev.4 ... ..... ....... L 13' a6 28' IAPPROX LO NSTAU t6 01 lEXISTING:,.WATER�SERViCEF ield flev,=C OF 3/4- I 2 ST(,)NE HOLZ-D-;-Bu�b ni ini r_CT.V `20,IN' b 02 S ------U/SILT IiE ROFIL Y JEM P E OCK.,D U M I sc I D I E T Sa a d'a Rd- L isich 4sRd i190 t SITE PLAN Rove Zg � SCALE: 1 "=20' l � BENCI- MARK on corner of concrete 1 - 301 X 15 'W X 0 .5 ' D LE step elev. = 100.00' assumed I ea''C h 110g f I e i d o `0 �-) SITE �z \ t Samadra Rd. 0 �J 99,7g Ca p 0 6 ' terae 1 0cuade 0 Capt. Isiah's Rd. CD a CD \(Cl_ 94, 57' 0, � C U S 99 S Design Calculations NO SCALE 97.87 X) 45 MIL Number of Bedrooms: 2 rubber Garbage Grinder: No 97.2 ' 1O membrane O Leaching Capacity Required: 220 Gal./Day IT h \ o` Ace Leaching Area Required: 220 Gal./(0.74 Gal,/Sq.Ft.)=297 Sq.Ft. '� 1 0' 2 cRpm`_ Proposed Leaching Structure: 1-30'L X 15'W X 0.5'D Leaching Field 91,53 R ' 0 S\ N Q Leaching Area Provided: 450 Sq.Ft. T,H #1 2 C� Z Proposed Leaching Capacity: 333 gpd > 220 gpd. req'd. 0 0 9678' 30 U Little River _y 0 cv GENERAL DOTES B 0 M o W 0-) overheod O utlGties �� 1. ADDRESS: 476 PUTNAM AVENUE 91,E � `Q 95,0i�@ \ 2.� 3. DEVELOPER'SNLOBER:OM�P 038, PARCEL 020 a_ \ 4. TOPOGRAPHIC INFORMATION WAS COMPLIED FORM AN \ bOC� Q ^ / ON THE GROUND INSTRUMENT SURVEY. \\ LOT '/J , ''� � 5. MUNICIPAL WATER 1S PROVIDED TO SITE AND I � �C -7 50± � � 6. REFERENCER SURROUNDING PROPERTIES. COURT PLAN 34623A j \ } A E A = 2 3, / 0• " \ 7. NO POTABLE WELLS ARE LOCATED WITHIN 100 FEET OF SAS. CONSTRUCTION NOTES 1. Contractor is responsible for Digsafe notification 5170, and protection of all underground utilities and pipes. 91,23 2. The septic tank and distribution box shall be set t\R'�---- \' level on 6" of 3/4"-1 1/2" stone. I e�a 1 3. Backfill should be clean sand or gravel with no dC stones over 3" in size. 9 4 0 ,P,6 4. This system is subject to inspection during installation 91'70, by Glen E. Harrington, R.S. \ 5. The contractor shall install this system in accordance with Title V of the Massachusetts Environmental Code /�C� �7C` 9 and the Regulations of the Town of Barnstable. �0 6. Provide a H-10, 1500 gal, septic tank if existing 1000 gal. septic tank is structurally unsound after relocation. \ 7. No vehicle or heavy machinery shall drive over 1:he septic system unless noted as H-20 septic components. ��' 8. Install gas baffle or equal on septic tank outlet tee end. \\ 9. Existing SAS, D-Box and leachate contominated soil to be removed SvpERViSE and disposed of properly off site. r ER Must y� ,11iNG 10. All existing inverts and site conditions shall be verified by contractor. S,B, fn �, LO 11�GENG1tNE Avlp �{ 1N�S.1R1CT 11. Contractor to remove soils considered to be unsuitable or impervious DE$1GN �10� AND St-,`�o and replaced with soil according to 310 CMR 25.255, as necessary. S,iAti�` WAS 1N P�'�' 12. Washer drain to be connected to main building sewer. 1N 51 'r► pLAN• 13. Relocate plumbing to north wall in crawl space at proposed SOIL EVALUATION SHE®RDA��v�T� invert elev.-99.42' A(',G 14. Provide double-staked hay bales and silt fence as LIMIT OF WORK. 3' 6' O.C. 6' O.C. 6' O.C. 6' O.C. 3' Date of Soil Eval.: January 23, 2002 15. Install 45 mil rubber membrane between SAS and crawl space as shown. Test Performed By: GLEN E. HARRINGTON, R.S., CSE P" OF 1/8" TO 1/4" Witnessed by: David W. Stanton, Health Inspector Excavator: Jose h DeBarros EASTONE (WASHED) _ TeNo Hole P10,159 LOCAL UPGRADE APPROVAL (51 0 CMR 15.405) DEPTH SOILS ELEv. 1. 310 CMR 15.211 - Setbacks. A variance is requested to provide 5' in lieu 6 MIN' of the required 10' from the SAS to the property line. 0 96.78' q p p Y j o«�Ase d 2. 310 CMR 1 5.21 1 - Setbacks. A variance is requested to provide 5' in lieu 6" 10Yea12 96.28' of the required 10' from the proposed septic tank to the foundation wall. 3/4" TO 1 1 12" WASHED STONE 12" E 9578' REVISED: 3/27/02 - ADDED IMPERVIOUS LINER PERFORATED 4" DIA, SCH 40 PVC (TYPICAL) Bw °;o5 ed `, PROPOSED SEPTIC SYSTEM UPGRADE 24" 94.78' ��cl O� PREPARED FOR LEACH FIELD CROSS- SECTION 93, E-,d� p g 89.08' LEGEND o � "ENt , ROBIN HOCK-SMITH NO SCALE 1 TOISTING 1000 BE RELOCATED CATEDL. SEPTIC TANK O T AT sand 10gjoy"] 6/6 87,78' G Perk Rate assumed @ <2 mpi C EXISTING AND BACKFILLED To BE REMOVED SAS AN N0. 070 476 PUTNAM AVENUE � � s �t'� *NOTE: ALL PIPES ARE TO BE 4" DIA, SCHEDULE 40 P.V.C. o 0 o PROPOSED 1500 GAL �Q t;IcS1 BARNSTABLE (COTUIT), MA �Q. 5' VARIANCE 'NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. H-10 SEPTIC TANK, IF NECESSAR /V house to septic tank raise covers to within Finished grade over system=2% slope away DENOTES EXISTING Existing House 6" of grade 5 HOLE x 104.46 SPOT GRADE PREPARED BY: First FI oeu=1Gi 4 ` [� f T EXl$T/ ADE DtST. BOX Existiricl Grade Elev-97 8 GLEN E. H A R R I N G I O N c R.J. CRAWL SPACE. ... �. ,,..,,.,,.,.,.,,�.,,,,,..., 95 EXISTING CONTOUR exisiinq .62' S _ 36 max. 9 E E D A ROSE LANE efev= 9.62 0.0 elocate pka bir.q to S=.Ot Levet For 2' Min. 2-1%8"-1/2- DEEP TEST HOLE q c c orth won 9 proposed 5' 1500 GAL. 6, 5=.01 washed stone TOp-Peastone Elev.-96.78' Top Liner Elev.=96.78' M A R S TO N S MILLS M A 02648 nverl elev.=99.4L' SEPTIC TANK _ a H-10 a 13' Invert I v,= 6.28' rn SEE NOTE g6 a -E-�- a APPROX. LOCATION N GAS BAFFLE �I O1 �.."'�"' Bottom o= Leach £ EXISTING WATER SERVICE TEL: 508-428-3862 a OR E©UA.L �. ° ° d 30' Field Elev.= 95.78" 1. v b FAX: 508-428-3862 > - LEACH FIELD 5.0' Bottom of � 5 HOLE D-BOX 6" OF 3/4"-11/2" S70Nf. It `e Liner Elev.=91.78 c e a; S�ttes @TH 1 Efev.=90.78' SCALE: 1 "=20' DRAWN BY: GEH FEB. 2, 2002 DOUBLE-STAKED HAY BALES SYSTEM PROFILE 6" OF 3/4"-11/2" STONE W/SILT FENCE AS LIMIT OF WORK Not to Scale DATUM: ASSUMED FILE: HOCK.DWG SHEET 1 OF 1 '. �'� II