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HomeMy WebLinkAbout0804 PUTNAM AVENUE - Health 804 PUTNAM AVENUE, COTUIT A= 039 ,975 TOWN OF BARNSTABLE L.-)CATION � icr.+� fi'yL. SEWAGE# VILLAGE C �� ASSESSOR'S MAP&PARCEL 39 �S- INSTALLERS NAME&PHONE NO. f� s�✓ S`1'� YZG SEPTIC TANK CAPACITY /,000 G;L G/�x�3s1 n f LEACHING FACILITY:(type),I�V)V I h i". (size) /06�f4 X ?o-v �42 NO.OF BEDROOMS 3 OWNE PERMIT DATE: 1lo-07 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r� 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 �Qd�/ � ; G4�s� �- ,� ��o �., ; O TOWN OF BARNSTABLE I RATION ®y SEWAGE# � LLAGE� A/ 1 ASSESSOR'S MAP &LOT F� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) xG � —(size)NO.OF BEDROOMS .� BUILDER OR OWNER PERMPTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t i i / 3c No. .'Zao - 2 R -( �(J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes giCOtiO for �bpgtem Construction it Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑.Complete System Individual Components Location Address or Lot No. TO "` Owner's Name,Address,and Tel.No.AW C 11/144.1 OCu 1//Q, n A9_ `c Assessor's Map/Parcel // ��++ b Installer's Name,Address,and Tel.No. /7Ar'4/4. C-P-,S Designer's Name,Address and Tel.No. S Y-`/�tS-f9 (' j// S� St 3GJ-C/3'u/Type of of Building: n Dwelling No.of Bedrooms p, Lot Size 'a, a,9/ sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) (;2 O gpd Design flow provided -35y gpd Plan Date ;TaT,aIx Z Number of sheets n Revision Date Title 7)4k T 5. A lca ti O $oLf jOall-,4 + c� ••� r / f Size of Septic Tank ItQGO 6"4 L !y Type of S.A.S. 36373 Description of Soil 51'r 042" Nature of Repairs or Alterations(Answer when applicable) R11101"_ Z WC j,,F jo_,_ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo d of h. / Signed Date 74//v Application Approved by . Date Application Disapproved by: Date for the following reasons Permit No. &'70$ 2 1 Date Issued �� O$ No. � Fee + 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ t ' ,.. a e �f Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Ti5po5dt *Vgtem Construction der Application lication for a Permit to Construct d pp ( ) Repair(Upgrade( ) Abandon( ) Complete System Indual Components Location Address or Lot No. To V/�� r✓ ��"`�- Owner's Name,Address,and Tel.No. r C �r 11q 4G.Y 7`79 37-doy/ �v Assessor's Map/Parcel ��' �f—" .' �' „ ,s? Installer's Name,Address,and Tel.No./. OW 41 4- C w� Designer's Name,Address and Tel.No.� ��° L'Nsi� ^ •`� • ys 1.rd,�,�. � 9'7 y ,rla,w S�- 4bY• ZG., jG]•G/S W Y''Type of of Building: Dwelling No.of Bedrooms C�, Lot Size ,'o, sq. ft. Garbage Grinder (W Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) © gpd Design flow provided 3Sy gpd Plan Date,Ta/l %;)r.0 z Number of sheets Revision Date Title O/7" o -, `BSc[/ pal- Size of.Septic Tank �,IiGO�6"4 e J�—X of/."Ir Type of S.A.S. y— 36YV TwF,C�io 7�Ah/ Description of Soil r r. Nature of Repairs or Alteration Answer when applicable) ✓ e« Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in I accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of t Compliance has been issued by this Board oWea'1"th. Signed ���" Date 74 t1;;,le� 16-11 Application Approved by i?�--�. G �_.� Date Application Disapproved by�! Date for the following reasons Permit No. Zoo 5 - et 1 Date Issued 111405 THE,COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by 1_ y.s�ic♦t Diu at 7oL� �1 ,r ��� r `� � '� has been constructed in accordance with the pro. iisio/ns'ofJTitle 5 and the for Disposal System Construction Permit No.Z00 1)" a dated Installer i� 41r,,,/'�l Designer Do,,,) #bedrooms C91— Approved design flow 3 rO / /� 9 d The issuance of this�rm'I//s(halall of be construed as a guarantee that the system wl unctio)n ass des.gned� (4 Date ��/(5f Inspector ✓ / /!//�/ `— � ���/ � No. 2� O 5 Z -9 1 Fee /Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=i5po5al 6pgtem (Construction Permit Permission is hereby granted to Construct ( ) Repair (" ' Upgrade ( ) Abandon ( ) System located at U d 7 j r,�11 )qc�F / � i 1 1Z and as described in the above Application f'or Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construotion must be completed within three.years of the date of this permit. 14::�;7 Date ✓�G�(J Approved by (/. Nowr� a" THE COMMONWEALTH OF MASSACHUSETTS + Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Ppgication for Ti5po5ai *pgtem Con truction Ver it Application for a Permit to Construct( ) Repair(*/ Upgrade( ) Abandon( ) ❑ Complete System 0 Individual Components Location Address or Lot No. I'-` ` "` � Owner's Name,Address,and Tel..No. Assessor's Map/Parcel /�`�s-' `� ` f �� Installer's Name,Address,and Tel.No. ,f/l�. w3 Designer's Name,Address and Tel.No. .� �I?y- `4)" k�t1 `'.. ,r9 > i//I 53rY 3G/ r/3'(4/ Type of Building:Dwelling No.of Bedrooms C Lot Size )a, �`�� sq, ft. Garbage Grinder (64 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided ' 5Z� gpd Plan Datey / I, Z Number of sheets l� Revision Date Title 7,-4 J �; f"c r ✓e'. a !7 tr 7C/Lr /fiww�.r IT" f'�r- ,4i• Size of.Septic Tank 1,47C10 t,,( Y Type of S.A.S. 4�/- 36321 r Description of Soil ,r ,r� Nature of Repairs or Alterations(Answer when applicable) r��aey- G, r �,wr !�•-- ��sLi Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of,Health. Signed T/} '� .'` .. Date 7/ /Xw Application Approved by /`fr-"'`a- !f G ""� Date !"�//6,10 Application Disapproved bye Date for the following reasons Permit No. r ( � Date Issued THE COMMONWEALTH OF MASSACHUSETTS T BARNSTABLE, MASSACHUSETTS Certtftcate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( l/) Upgraded ( ) Abandoned t/( )byfy / �<;r ,� < D t/f.{4/41/14*'11 at � /`✓�4uG�+ 'e' has been constructed in accordance / / with the proyisions of/Title 5 and the for yDisposal System Construction Permit No.Z00 ��- �1 1 dated -7/f(,/,) �. Installer s-r� i Designer D1 6a_✓ 1",0" #bedrooms Approved design flow -S r / gpd The issuance of this permit'�shall not be construed as a guarantee that the system will unction astdessignedf fia � Date ! f /r 1t Inspector , ` --------_ — ry -- -- �� U j 2 � t a --------------------------------------- No. Fee /0� � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Migoal lip.5tem Cow tructton Vermtt Permission is hereby granted to Construct ( ) Repair ((�) Upgrade ( ) Abandon ( ) System located ata7c/�`.rrc. rr-r s and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date 7 Approved by //0 Town of Barnstable Regulatory Services Thomas F. Geiler,Director sAMSTABM BUS& Public Health Division 16.39. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# 241p - Assessor's Map\Parcel 3�l 7 5 Designer: w Installer: b� Address: `�3 ,� Address: On "!^7 t b - O 6 C41�-V�was issued a pen-nit to install a (date) ` Installer) p septic system at �� �� � _ based on a design drawn by (address) 11 dated -1 l vtj (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. N OF 4f4ss9c � tiVA OF4/4 DANIEL ��° DANIELA. y�N o� A, (Installers Signature) o O,IALA OJAIA CIVIL Cn No,40980 ��No,465020sIMo'��� ONAL E WO (Designer's(Designer's Signature) (Af i igner's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc I -BORTOLOTTI CONSTRUCTION INC. DRAINAGE LAND DEVELOPMENT SEPTIC SYSTEMS May 30,2008 Bill Callahan 804 Putnam Avenue Cotuit,MA 02635 Telephone: 774-238-6081 RE: 804 Putnam Avenue-Cotuit,MA(BCI-2008-224) Bortolotti Construction,Inc., proposes the following Title V Septic System Repair as per the Town.of Barnstable Board of Health Requirements for a Three Bedroom Application (Pre- liminary Plan Review): Furnish and Install a new(H-10)distribution box,and 4 (H-20) infiltrator 3050 units with stone surrounding(Leaching Area: 10' W x 30' L x 2' D)-connect to the existing septic tank at the rear of the dwelling. INC: Permit Fee,Engineered Plans,Minimal Tree Trimming and/or Removal,Pump- ing and Filling and/or Removal of the existing leaching facility,all Materials and Labor,Backfill and Grade,Removal of excess fill,Re-Loam and Seed the disturbed grass areas. NOTES: Soil Conditions are assumed to be suitable and will be varified at time of Perc test. The following Items are considered to be outside the normal scope of work and may add additional costs: Removal of unsuitable materials and replacement sand,Relocation of any existing on-site utilities,Repairs to driveway due to heavy truck traffic,Irrigation Repairs for lawn sprinkler systems,Variances-if necessary. Top Soil and Seed will be applied once, however,Euarantee of growth and imainten, ance is owner's responsibility. CLAUSES: 1) Dig Safe only marks-out main roadways-if private mark-oRzoork re- � quired due to underground utilities,this will be billed at an addition2) A Finance Charge of 1.5%per month*-.It becharge? for any rhase 4M that is not paid in full upon completion. 3) Acceptance must be within 60 days of the above date- prices subject t . changes due to economic circumstances. cry co r ram; The Total Price for the above stated work will be approximately$6,675.00,with Payment Terms as follows: .$1,500.00 Deposit Upon Acceptance,Balance To Be Determined Upon Final Plan Approval. Thank you for the opportunity afforded us in offering this proposal. ACCEPTANCE: Sin ely, Date: ('D Hobert J.Bortolotti-President Bill Callahan Bortolotti Construction,Inc. P.O. BOX 704 • MARSTONS MILLS,MASSACHUSETTS 02648 o (508)771-9399 • FAX(508)428-9399 i oFs Tom,, 'down ®f Barnstable Barnstable � Regulatory Services Department M-ArnericaCity, > IARN. BLE. I 039. ��� Public Health Division 200 Main Street, Hyannis MA 02601 2007 I. r Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO June 4, 2008 William Callahan 804 Putnam Avenue Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 804 Putnam Avenue,Cotuit, MA was last inspected on May 16, 2008, by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF E BOARD OF HEALTH T omas cKean, R.S., CH Agent of the Board of Health CERTIFIED MAIL #7006 2150 0002 1041 9716 .4 Q:\SEPTIC\Letters Septic Inspection Failures\804 Putnam Avenue.doc COMPLETE •N COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si ture item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ddressee so that we can return the card to you. B.,Receive by(Printed Name) C. Date qf Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Rem 1 Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No W 911 tam 3. Service Type I 0 Certified Mail ❑Express Mail ❑Registered 0 Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) p Yes 2. Article Number I[ 7�0 0 6 '215 0 0 0 0'2= 10 4 r1 9 7616' ((Transfer from servlcelabeQ I PS Form 3811,February2004 Domestic Return ReCelpt` 102595 02-ht-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I I • Sender: Please print your name, address, and ZIP+4 in this box • I m -' � fV a T of Barnstable I _: P Health Division 20 ain Street H is,MA 02601 Ca..r j I1 I fill fill 111,1>>1}l,1 ilillif,11„f,loll] E U.S. Postal Service TM CERTIFIED MA►ILTh� RECEIPT (Domestic Mail�Ofil No Insurance Coverage Provided) IFo�,d®livery,information visit our,web`sitFa-t www.usps.comOFFICIAL USE i ------------- 1� PS Forte 00,August 2006 See-Reverse for,Instruct ions Certified Mail Provides: o A mailing receipt n A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider,Insured or Registered Mail. o For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required._ a For an additional fee, delivery may be-restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. It a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 �I Town of Barnstable Barnstable �r� �P` p AA-AmericaCity Y • Regulatory Services Department 1 BARNSTABLE, Public Health Division �639•39 ArfD MAC A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO June 4, 2008 William Callahan 804 Putnam Avenue Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 804 Putnam Avenue, Cotuit, MA was last inspected on May 16, 2008,by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF E BOARD OF HEALTH T mas cKean R.S. CHO Agent of the Board of Health . CERTIFIED MAIL#7006 2150 0002 1041 9716 Q:\SEPTIC\Letters Septic Inspection Failures\804 Putnam Avenue.doc Commonwealth of Massachusetts , Title 5 Official Inspection Form R a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 804 Putnam Avenue Property Address !` \\\ William Callahan Owner Owner's Name information is required for Cotuit MA 02635 May 16, 2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: When filling out A. General Information forms on the ' computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 Citylrown State Zip Code 508-428-1779 SI 12855 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 I F , �V May 16, 2008 c Inspector's Signature bate 1 ,� The system inspector shall submit a copy of this inspection report to the Approving AuthoribAl Boaf' of Health or DEP)within 30 days of completing this inspection. If the system is a`s" red sys m orb has a design flow of 10,000 gpd or greater, the inspector and the system owner II submi �te u, report to the appropriate regional office of the DEP. The original should be sent to t e system-owneF, 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 c editions of use r, at that time.This inspection does not address how the system will perform in the future under • the same or different conditions of use. 08.118 Callahan.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessmerits r 804 Putnam Avenue v Property Address , William Callahan Owner Owner's Name information is Cotuit MA 02635 Ma 16, 2008 required for Y every page. Cityfrown State Zip Code• Date of Inspection B. Certification (cont.) s Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ forthe 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' t 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 pipes)are replaced ❑ obstruction is removed 08-118 Callahan.doc-08108' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is Cotuit MA 02635 ' May 16, 2008 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ 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: C) Further Evaluation is Required by the.Board of Health: ❑T Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ~ 2. System will fail unless the Board of Health (and-Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: f ❑ 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. 08-118 Callahan.doe•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is COtUIt required for MA 02635 May 16, 2008 every page. Cftyrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): 0 The system has aseptic tank and SAS and the SAS is less than-100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 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 ® f ' Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ®, Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow Required pumping more than 4 times in the last year NOT due to clogged or ® obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 08-118 Callahan.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is Y required for Cotuit MA 02635 May 16, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy-is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design Flow of 2000gpd- 10,000gpd. ® , ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will,be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. , Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 08-118 Callahan.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yy 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is Y Cotuit MA 02635 May 16 2008 required for , every page. Citylrown , , 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 1.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? _ ® ElWas 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, ® 0 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)] 08.118 Callahan.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is COtUit required for MA 02635 May 16, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):. 330 Number of current residents: 1 Does residence have a,garbage grinder? ❑ Yes ® No Is laundry on.a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? - ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): - Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied 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: Last date of occupancy/use: Date Other(describe): 08.118 Callahan.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments pY 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is Cotuit MA 02635 May 16, 2008 required for y every page. CitylTown . State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped July 2006 Was system pumped as part of the inspection? ❑ Yes [D No If yes, volume pumped: '' gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and, maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 32 years. Were sewage odors detected when arriving at the site? ❑ Yes :® No 08-118 Callahan.doe•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is COtUIt required for MA 02635 May 16, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1 Depth below grade: 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: 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:'' 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 211- Distance from top of sludge to bottom of outlet tee or baffle 28" 21 Scum thickness Distance from top of scum to top of outlet tee or baffle 6-1 ' i Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Measured 08-118 Callahan.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 r Commonwealth. of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .•'° 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is y Cotuit MA 02635 May 16 2008 required for , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Baffles are intact, liquid level was observed at bottom of outlet invert. Tank appeared structurally sound. Grease Trap (locate on site plan): . Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert;evidence of leakage, etc.): 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): 08-118 Callahan.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 804 Putnam Avenue ` Property Address William Callahan Owner Owner's Name information is Cotuit r" MA 02635 May 16 2008 required for , 4 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) - b ' 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No t Alarms in working order. ❑ Yes ❑ No 08-118 Callahan.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 or 15 Commonwealth of Massachusetts- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 804 Putnam Avenue Property Address William Callahan a Owner Owner's Name information is Y ,Cotuit MA 02635 May 16 2008 required for ' every page. City/town State Zip Code Date of Inspection D. System Information (cont.) } 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: t Type; ® leaching pits number: One 6x6 pit ❑ leaching chambers number: ❑ leaching galleries number: j ❑ 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.): Liquid level in leaching pit is currently 10"below inlet pipe, observed historic staining over top of Strusture indicating pit is in hydraulic failure. 08-118 Callahan.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is Cotuit MA 02635 May 16 2008 required for y , every page. City/Town State Zip Code 'Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): rt Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of,ponding, condition of.vegetation, etc.): F i t i Privy (locate on site plan): Materials of construction: ! Dimensions Depth of solids - I Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 08.118 Callahan.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 ' t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is y required for Cotuit MA 02635 May 16, 2008 every page. City/Town State Zip Code Date of Inspection } . i D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties } to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building., + 4 l 43 i.. 36 , 26 4 . . r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r Water 4 Service Putnam Ave I • 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 804 Putnam Avenue Property Address William Callahan Owner Owner's Name information is y Cotuit MA 02635 May 16 2008 required for , every page. Citylrown State Zip Code Date of Inspection 1 D. System Information (cont.) Site Exam: ® Check Slope ® Surface water . y ® Check cellar ® Shallow wells f Estimated depth to ground water: feet Please .. - 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) j ❑ Checked with local Boardof Health -explain: ❑ Checked with local excavators, installers,-(attach documentation) ❑ Accessed USGS database-explain: a You must describe how you established the high ground water elevation: s < i - 08-118 Callahan.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 1 Town of Barnstable, 0�(Him regulatory Services BMWSTABLE, ; Thomas F. Geiler, Director ATEQ �A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction,Permit".. If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:ISEPTICTisclaimer Private Septic Inspections.DOC Y TROY WILLIAMS 6WA ftra ' . SEPTIC INSPECTIONS �8 1 � JUIV 2 'l , -! Certified by MA Department of Environmental Protection "` i1( � (508) 760-1819 40 Old Bass River Road = s ' South Dennis,MA 02660 '; :- Commonwealth of Massachusetts nop%7Executive Office of Environmental Affairs Department of Environmental Protection WNBam F.Weld Trudy Co" GoYwnwr 80er+twy Argoo Paul Celluccl David B.Struhs LL GoMrtwr Conrniwlorar SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ CERTIFICATION Property Address: 8o y /00 ¢ 161 0,, ,g,/L Co-�v I Address of Owner. 5�Gi u- LuK 9 CA. Date of Iospectiont 6�02 O IcI6 (If different) Name of Inapeoto .�✓Oy W, I— S (3G,r C Company Name,Address a5d Telephone Number. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inapectot'e Signature �^ � ' Date-- j /.2 Q /9 6 The System Inspector shall submit a copy of this inspection report to the Approving Aut(thhority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: Al `SYSSTTEM PASSES: V I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: A"14 One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exh1tration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A n �/ /� L CERTIFICATION (oontinued) a Property Address: b 1 /� v T�'l c.✓'� Owner. Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distnbution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for ooliform 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. 3) OTHER (revised 11/03/95) 2 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address 6 C/ Owner. Date of Ins portion: ( /.;?6 �y C D) SYSTEM FAILS: "VI-4 I haVe determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. — Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS 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 1/2 day flow. — Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped — Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. — Any portion of a cesspool or privy is within a Zone I of a public well. — Any portion of a cesspool or privy is within 50 feet of a private water supply well. — Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ooliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: A//,, The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: — the system is within 400 feet of a surface drinking water supply — the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECEI IST Prot-rty Ado Owner. Date of Inspection: Check if the following have been done: Pumping information was requested of the owner,occupant, and Board of Health. ,None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. �As built plans have been obtained and examined. Note if they are not available with N/A. jZThe facility or dwelling was inspected for signs of sewage back-up. _The system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. V All system components,excluding the Soil Absorption System, have been located on the site. -('fhe septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge, depth of scum. Vihe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. !'he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,p SYSTEM INFORMATION Property Address: �j� ( / u Owner. L ti Date of Inspection: RESIDENTIAL: FLOW CONDITIONS Design flow:3 a ons Number of bedrooms: Number of current residents: Garbage!fir(yes or no):.AL0 Lacey connected to system(yes or no):YL S Seasonal use(yes or no):/V O Water meter readings, if available: 0 � �os� `0 0 p Last date of occupancy: C G,✓`p,c COMMERCIA LAND USTRIAL• Type of establishment: Design flow:_____gallona/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discbarged to the Title 5 system: (yes or no)_ Water meter:'endings, if available: Last date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION [� PUMPING RECORDS and source of information: Al /v Q�a N'�I r� ,6� T L,�!.✓! ,J cr .�, r� �� i'cn' L. G F/� ?•t/3 t-�-. L�o wl� Cr'C�'L�„!�. Sps'em Pumped as pit of inspection. (yes or no) /l�U If Yes,volume pumped: gallons Reason for pumping TYPE SYSTEM —�� SeptictankA&kQ0AiQAJxWsoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of components, date installed(if known) and source of information: S )T.-//c a Sewage odors detected when arriving at the site: (yes or no) NG (revised 11/03/95) ' 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: Y �v 7L�ta., Owner. L Date of Inspection: / SEPTIC TANK:, (locate on site plan) Depth below grade: Material of construction:-L-115�ncrete_metal_FRP—other(explain) Dimensions: Sludge depth:. s „ / Distance from to sludge �•p of dge to bottom of outlet tee or baffle:,,L � 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: Comments: (recommendation for pumpi condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evid nce of leakage,etc.) ,��. ` r .-� o v )c, t. L V ar ✓ . O d� GREASE TRAP: ,j (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(e:plain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of cutlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structured integrity, evidence of leakage, etc.) (revised 11/03/95) 6 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �/ SYSTEM INFORMATION(oontinued) Property Address: p % Owner. I- Date of Inspection: TIGHT OR HOLDING TANK:&� /,,q (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRp—other(explain) Dimensions: Capacity:- gallons Design flow: ¢allons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: /lam (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,etc.) wat ho - �,orc S �wt- .4 QS - h ) tr Nov C' S; �c PUMP CHAMBER /11 (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. g Date of Inspection: / SOIL ABSORPTION SYSTEM (locate on site plan, if possible;excavation not required,but maY approximated PPmximated by non-intrusive methods) � If not determined to be present,explain: leaching pits, number: Oh 6 'X 6 ' «` (� p,-� !✓,-(� /cs�ti k-� . leeching chambers,number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number,dimensions: overflow cesspool, number: Co nts: (note condition of soil, signs of hydraulic failure, level of ' `, h a n�dmg, condition of vegetatio J W s h cA✓r of r� /c Av r -� L✓1 0. CESSPOOLS:'L11 (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) (revised 11/03/95) 8 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (.-ontlnued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: Indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 'VA c, k. 31 a� w3 ` ,36 DEPTH TO GROUNDWATER Depth to groundwater: feet adjusted high groundwater level method of determination or approximation: < ,-- 9-02 9 yy No..----Y/.......... •�Fs$ ll�../... THE COMMONWEALTH OF MASSACHUSETTS BOAR F HEALTH r� IJ............oF.............�4/...kc ..... ............................. ... , pphratinn -fur Dispasal Works Tonstrnrtinn Vaniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at* � L I— . ------------- -A .................................. ......................... Location- ress or Lot No. .O_5T.-----•------------------- /1 z Gc.P, /,�iQ�rti. Owner Addor ss Installer Address Type of Building Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms___.__..................................Expansion Attic (#Vv) Garbage Grinder Other—Type of Building ji_ll-V__W_._._-__ No. of persons_________________________- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------• -------------•------------------------------------------------------------------------•---------------------------------- W Design Flow............................................ llon per son per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity,�� f6�. allon ��0 ength................ Width................ Diameter-.....---------- Depth.-..______..__.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below 'nlet_.. ______- _.. Total leaching area..----.._--_______sq. ft. Z Other Distribution box ( ) Dosing tank ( ) e) ~" Percolation Test Results Performed by.......................................................................... Date-_..-------.--------------.------...._.. a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water_._._.__.--.-.-.-.--. -- f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ G ---•----------------- ,.._.. y ...... ' d .................... -------------=---- 11 Description of Soil = ��A - Cyr _____________________________________________________ L __h U . L--.--------------__._-----------_----_-------_---_---_-_.__-_-__-_---_------_____.-_-_-.-_---.-----.-_.----____-__.._... W V Nature 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be iss y the board health. Sig ed �°4 Date Application Approved By----.�. st �d ���� � - ��----- Da ' te Application Disapproved for the following reasons-------------------- -- - - - -- --- - -------------------------------------- --------------- -----------------------•.-------------------------------------------------------=....................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date •!!!!!O!!1f!!!!l YY�!'•���!!!! lHl��1l�1f.f!!!!!.!!f!!!! !!ems!!!!! !!•ln�1AI1�l��lll.y�w1�������l 00.60.0........ ............lam• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l....U... .. ..........oF....... . ..�.:7-/ ..1 J.G............................... Qwrtif irate of Okompliattrr THIS TO CERTIFY That theIA-W-fl ndividual Sewage Disposal System constructed ( ) or Repaired ( ) by-----_------•4!?'4.C---5---------C. �D-� - -------- ------------------------------------------------------------------------------------•--------------- -� /� /� at �.s+_ ...- ,-I�i�_ ht./� n 11V SFaII s1'.-----•---------------•---------•--------------------•-------------------- has been installed in accordance with the provisions of Art(�l I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------ �'_.___. _______________ d __ ---__-_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------•--------------•------------•----------------------------•----------• Inspector.................................................................................... r" 3.7 7 THE COMMONWEALTH OF MASSACHUSETTS BOARF HEALTH jt .���lirtt#i�an.�fur �i,��u�tt1 ,arks (��tt�#rttr#i�Yt �Ar�ti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage, Disposal System at: .....� -� '------...... + - ----•----------------------------- ............ .......................................................... Location- ress ! or Lot No. .._ .. .. ..!fit _._. � . �`,� _ /! ✓t ? ....Cz.�11� !f✓ ..`....:... O nn Address a Installer� Address UType of Building �, Size Lot............................Sq. feet a Dwelling—No. of Bedroo_ms.-.__-_--.-:�.............................Expansion Attic M0 Garbage Grinder (00) Other—Type of Building A__fv_A.J_1......... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------------------------------- ----------------------------------- - - ------- -- - W Design Flow............................................�Ilons per_pgson per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity,�w gallons b"flength---------------- Width................ Diameter................ Depth____-__--_-..- x Disposal Trench—No. .................... Width•___-_---_-_--.__. Total Length----__--_-_-..._---- Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth belowlinlet_.. ......_ Total leaching area..---.---_-----_--sq. ft. Z Other Distribution box ( ) Dosing tank ( ) D.# 1� ;L aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water-..------.-------.------ f� Test Pit No..2----------------minutes per inch Depth of Test Pit---__--.•-.___--__-- Depth to ground water...------------------- -------------------------------------•---------- :........•... Description of Soil _ = l-�'�-r �(��!'�" `'z�' :--4L-`�._4!!r �^ -.- -�-'- �`..... _C.c ----- �r xc ^,�r. ------ J . W U Nature 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be iss by the board," health.. , ✓/ � i��d Date Application Approved B �. Date Application Disapproved for the following reasons------------------- ---------- ------------------•-----•--------------••......................................... ..................... ---------------------------------------------------•--•----------•---------------------•--•-----------------•--------------•--------••------------------------•--•-••-------•----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ..(IV ..........OF..................... .r.7..: 5. ............................... UAr#ifirtt#r of f omli1tttnrr TIj S TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY --------- -� ... rF. 9t/ -Y' --••- ......---------• -------•--•--••-----•-•---•---•-•-------•----•-•-•-------------.............................. -��~~ _ nstaller has been installed in accordance with the provisions of Artie XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ................................ dated_ /_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH ............. ......OF..7A9...&.TJ4.16 .-----------------------._.... N ................ ��tt�#rttr��+li�tt �Arnti# Permission is hereby granted �J,lf: �f .:.. ( .l1- ----------------------•-------•-••-----------........ to Constr ct �( or Rep . an Individu -Sewage Disp U stem at No.r�4�- _.. $ � 2'�',�t t ZA_4 -_-�---•----- �-- --- --- --- Street r as shown on the application for Disposal Works Construct�V,67nit __ Dated--�.'._--4r _�._.......... --•--- .----•-•-•---------•---- DATE----- .._.. ........................................••. Board of Health . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS „,,,,,,,,,,,,,•,,,,,.,•u,"M„u".".",” ,",w",,, ,,,,..,,........,,,,M...m� w.a�,.,",",",,,.",,,,, ,,,,,,,,,,,,,",, ," „"„"„� �m�r,.•,,,,w,,,""..,..".,.,",.".,,,,",,,,,,,,,,,., M.�. "w.�m„�,,.•,,.,,,�",.,,""",",�."�m �,,;,.. ;,".•,,,..,,,,,,,,,,,,,,,r,., r ' r 1 4 1 f �y ID','rilirA/idlliln(Iii�iixplfCii�/�,%Ir7��Ht r.//J rr gr,ll,'.;nClj/f1r/'ni�p"a(i/rT! Iji Gv7u.;:9:�fl/6✓r1'r�f('i;'P!/+";!'r!'Sr<lnr'F/`rig (,� fF.i7(,ll�r•2,7f'i'%L'G6�"r':9diP�,.J,;ror l�-'�.r ";� �4� ^4y 1 /"�d7 7x t l � a 4h•a F ,r; ''�,<'j , �e• �w7".y�HOta•"7.3r�i� rG.e.'"0 f s:.•..•P r Ilk- 474 7 r e � :..s:W:....c� •r"q.,.:.'" u,„,.. ...$f,W�.::::ik".:.'4L,`n.ri..,r.:.;"^.W'i,.:r:LS.'.',.°J,::7,:sL,.:rLu,.:',.t.W�:b:.+...i.:d7f.'b°���.iui«.�Lul,'„'I1E:71ti:'w1:r�r.7itt$fu'hk':1i1,5G}7n';i;Nl/11fl.J11 1 F Foundation of seven 1(c-lu- above i'ta UYAi1.P; ll,v 7 , C�(+' /[ �••�{�!�l�; 5,q q p /p E F "0 U M-td G"i..7�J e........ ri..5.r�"tl- R,7/6,M NA Ph •....a.o... ..,# LOCAT60N i SCALE V1,orE--, PLAN REFERENCE T l) . .!1`' . '5 . . . . . . . $ f 1A NJI D { '., V �;�`7 lz,•,i 41 l �l t•'.'•,j,J��:^i•if. (r7 ls.i � 'p t r E:1 CERTIFY Ti-NJTHE . . . , . . ,,t•7C.,7W3fV ON THIS Plra 1a _0v/kTEDJd 6 TH": ,4 . } R > AS 7HtMIN HEREON AlOrfAp {I('C t''tx/RVItS TO R `i'.rus�, ass .. ,� t��g � �a 1 THE r���i1i��� ts�� ] r t {Q ' r 7• �•.l Jr '4.y1�.�M1 i IF.t .l�_.,!5�1��. . . �!•�1G",.1''6 (.�1 v �a 1 � � �F._t'f, ' m l.1. � aV1 6i't ir�'t::�� 1 a_ • `f w,w PETITIONER : l ,y"•<21 I.T'1 l S q.l l t:l;'.3 ac llu s o-t,�,^ g (,,..,,: ;, g SYSTEM PROFILE M ALL Wr'HCMAGNETICTTAP OBE NOTES COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE IF NECESSARY (NOT TO SCALE) 1. DATUM IS APPROX. NGVD (GIS) Rd ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE COVERS/OBS. PORTS TO WITHIN 3" GRADE 1nd�5tt1 \ TOP FOUND. EL. 43.4' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING MINIMUM .75 OF COVER OVER PRECAST' 2% SLOPE' REQUIRED OVER SYSTEM 44.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 0 2" DOUBLE WASHED PEASTONE 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Jti0 e OR GEOTEXTILE FABRIC UNITS TO BE AASHO H-Q Q P� `. 40.9' 4'OSCH40 PVC 8 PIPES LEVEL 1 ST 2' 39.5, 5. PIPE JOINTS TO BE MADE WATERTIGHT. RpU Locus 10" 14" 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE ,� a TEE TEE ;L�_ 39.03' 3.0 AT SIDES WITH*39.5 ooa000a00000 2' 1.0' AT ENDS310 CMR 15.000 (11TLE V.)GAS 000O'n.0o0- ' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND EXIST. 1000 GAL. $ 37.03 SEPTIC TANK ** 39.2' 39.03' (4) H-20 3050 INFILTRATORS NOT TO BE USED FOR LOT LINE STAKING OR ANY a OTHER PURPOSE. 3/4" TO 1 1/2" DOUBLE WASHED STONE s. PIPE FOR SEP11C SYSTEM TO SCH. 40-4" PVC. DEPTH OF FLOW = 4 TEE SIZES: 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS OF SAS 114CWDING STONE: 30.4' x 10.25' M 1V± 9. COMPONENTS NOT TO BE BACKFILLEO OR INLET DEPTH = 10„ COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD ' OUTLET DEPTH = 14" **THE INSTALLER SHALL VERIFY MINIMUM SEPTIC TANK SIZE AT OF HEALTH. 1000 GALLONS, AND ITS SUITABILITY FOR RE-USE 33.0' BOTTOM TH-1 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP ( 1 % SLOPE) NO GROUNDWATER FOUND VERIFYING ITHE LOCATION OF ALL UNDERGROUND & (G-W EXPECTED AT ELEV. 26't PER OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000'f FOUNDATION EXIST. SEPTIC TANK 30' D' BOX 1' LEACHING TOWN GROUNDWATER MAP) WORK. FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 39 PARCEL 75 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL SHALL BE REMOVED 5' BENEATH AND AROUND THE AP DISTRICT (NOT ZONE II) UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PROPOSED LEACHING FACILITY. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 12. EXISTING LEACHING FACILITY SHALL BE PUMPED ESTUARINE WATERSHED AREA (UP TO 3 BR OR LEGENDAND REMOVED OR PUMPED AND FILLED WITH CLEAN EXISTING NUMBER O.K.) SAN99- EXISTING CONTOUR +46.78 X 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR 46-� [98•41 PROPOSED SPOT EL. TH 1 7 TEST HOLE �45 + 5 SYSTEM DESIGN: + 61 2� SLOPE OF GROUND 44 + ° GARBAGE DISPOSER IS NOT ALLOWED jUTILITY POLE +44.2 CO �3 .16 DESIGN FLOW. 2 BEDROOMS ® 110 GPD = 220 GPD FIRE HYDRANT N USE A 330 GPD DESIGN FLOW (MIN. DESIGN REQ. NOTE: Nor ALL SYMBOLS MAY APPEAR IN R"NG -}-42.88 UNDER TITLE 5) \ + 8 SEPTIC TANK: 330 GPD (2) = 660 LP L---4-40.94 � LOT 8 t TEST HOLE LOGS - z 9 EXISTING 20,291 SFt �N RE-USE 1000 GAL. SEPTIC TANK (SEE NOTE) DWELLING LEACHING: BENCHMARK DAVID FLAHERTY R.S., SE2755 Top FNDN. ENGINEER: COR. CONC. BULKHEA ELEV.=43.4' /i� rn SIDES: 2 (30.4 + 10.25) 2 (.74) = 120 GPD ELEV. = 43.4' 3 // WITNESS: DONNA MIORANDI, RS 39 /+35.79 BOTTOM 30.4 x 10.25 (.74) = 230 GPD j JULY 8, 2008 6 DATE : +4 ti13 .31 // TOTAL: 474 S.F. 350 GPD PERC. RATE _ < 2 MIN/INCH 1.65 USE (4) H-20 3050 INFILTRATORS 45.2 �$' Gas w // WITH 1' STONE AT ENDS AND 3' AT SIDES CLASS I SOILS P# 12279 �5 METER . W SHED TH1 0.76� ELEV. ELEV. .17 �0' 4 4 GARAGE 0" 43.0' 0" 43.0' .26 (SLA8) w // A A 41 14� � 6. 6 TH 2 \ i4o.99 DRI ED _����3 �36A 36.31�1 LS LS O 1.9 4 -38_56 v +36 5- %15C�� ` MA 10YR 6/2 1 OYR 6/2 40 9 - - _ _ / // � APPROVED DATE BOARD OF HEALTH / / -S 2 B 3 B V� c V / t 39. 3 +Z6. \ / /� Q .29 // oy �3�/49 TITLE 5 SITE PLAN LS LS 5.05 / �'f 39.49 �� ^ /�-36.60� OF 10YR 5/8 10YR 5/8 X FFNc 760 �s 00 l/= 18„ 41.5 1 s" 41.5' x� 00, /k/� J 804 PUTNAM AVE. __-}-42.55 //� COTUIT C C a PREPARED FOR PERC PROP. VENT WITH CHARCOAL FILTER 9.33 // AND BUGSCRE IT (FINAL PLACEMENT BY Y° BORTOLOTTI CONST./CALLAHAN CONTRACTOR WITH HOMEOWNER // MS MS CONSULTATION) 7.6p JULY 9, 2008 2.5Y 6/4 2.5Y 6/4 �,/ y 37.36 OFMgs OF off 508-362-4541 s9cy � ZNiygss�c fax 508-362-9880 113 DANIELA �� moo`' DANIEL y�N I downcope.com o OJALA ; o A. CIVIL �' OJALA 90W#7 cape engineering, 14C. 120" 33.0' 120" No 33.0' o.4 s Scale: 1"= 20' �e��Fc, TeR�o ` O� o�P - civil engineers NO GROUNDWATER ENCOUNTERED �.r�1 Fly oSSRld0.( land surveyors 939 Main Street ( Rte 6A) 08- 149 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675