Loading...
HomeMy WebLinkAbout0109 RALYN ROAD - Health 109 Ralyn Road LCotuit -- A= 022-060 l ORA- 0(e0 Commonwealth of Massachusetts �M1 Title 5 Official Inspection Form �= I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 r- v— Property Address 4+ Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name ham"+ information is a° required for every Cotuit ✓ MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection ! Inspection results must be submitted on this form. Inspection forms may not be altered in any4 way. Please see completeness checklist at the end of the form. Important:when A. Inspector Information S 1 139.30 k filling out forms ` on the computer, use only the tab David D. Coughanowr, R.S. key to move your Name of Inspector cursor-do not Eco-Tech Rapid Response use the return Company Name key. 155 George Ryder Road South rae Company Address Chatham MA 02633 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Furth r-- by the Local Approving Authority ? ti 4 ElFails o G p ID cs� COUGHA No.1 80 Ap - August 16, 2018 Inspector's Signat• l of INSP Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of,Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 t aye v 1 Commonwealth of Massachusetts Title 5 Official Inspection Form iin Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a comply nggeptic tank as approved by the Board of Health. �+ ""' �•x r *A metal septic tank will pass inspection if it is stru t, rally sound, n;ot�leaking and if a Certificate of Compliance indicating that the tank is less thane 0 fyea6s old is a�v ilable. ❑ Y ❑ N ❑ ND (Explain belo� '+.� ee•°*$ 7' •�,yeeV.,+ +? t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settle_ d or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form �i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 u— Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *`This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev;7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts ,p Title 5 Official Inspection Form '= IIb Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 A c Commonwealth of Massachusetts Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 V� Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of an large system considered a significant threat under Section C.5 or failed p Y 9 Y 9 under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts �x Title 5 Official Inspection Form m i I System Form - Not for Voluntary Subsurface Sewage Disposal Sys y Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts �x Title 5 Official Inspection Form i, r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is 9 required for every Cotuit MA 02635 August 16 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged_to.the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of-the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 7+ years. Certificate of Compliance for a new system was issued 2/4/2011 (Permit#2011-15 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts i, Title 5 Official Inspection Form =, �10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 V Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 1 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: 10.5 ft x 6 ft x 6 ft- 1500 gallons Sludge depth: 6 inches Distance from top of sludge to bottom of outlet tee or baffle 28 inches Scum thickness trace Distance from top of scum to top of outlet tee or baffle 10 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time. Maintenance pumping is recommended within 2 years and every 2-4 years thereafter with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .............« 109 Ralyn Road Assessor's Map: 22 Parcel: 60 v- Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from-bottom of scum.to bottom.of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l; 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): No adverse conditions observed. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �x Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments U— 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is required for every Cotuit MA 02635 August 16, 2018 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or-alarms are not it working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why.- Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system i Type/name of technology: t5insp.doc-rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �x Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel. 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is g required for every Cotuit MA 02635 August 16, 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): J t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 'I c � Commonwealth of Massachusetts Title 5 Official Inspection Form r, �i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is required for every Cotuit MA 02635 August 16, 2018 — — ---page------ -Clty/Town--- ----- ____ _ State______-Zip_Code_- ______Date-of-Inspection._____ D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately G3AL YNN ROAD LOCATIONS 2 � Q -OF SEPTIC COMPONENTS 3 cc -DISTANCES IN DECIMAL FEET A B W � 1 34.5 34 Q 2 34 41 a 3 64.5 78.5 LS W�e�Ja y�anpNV�a THIS SKETCH IS 0 BEST VIEWED IN DWELLING CLL ING COLOR FORMAT 1®1 W T ti B - _ - 2 O 1 1500 GALLON ® SEPTIC TANK NOT TO RcSF SCALE 508 364-0894 D-BOX 3 ,11TIC INS® AT �C®-TECb.US LEACHING GALLERY t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road .Assessor's Map: 22 Parcel: 60 L� Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name information is 9 required for every Cotuit MA 02635 August 16 2018 page -------City/_T_own -.-_-__- _-_-_—__T- .—__State__--Zip_C.ode__ .Date_oflnspection__ E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D, System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14' Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included GEOHYDROLOGICAL PROFILE - NOT TO SCALE 2 Q 2 O h c Z O BOTTOM OF LEACHING PER DESIGN P PLAN ,'LEACHING ABOVE HIGH I - - \GAOUNDWATEA _ NO GROUNDWATER MOTTLING NOTED ON DESIGN PLAN t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18'of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Ralyn Road Assessor's Map: 22 Parcel: 60 V� Property Address Sharon A. Meninno 2013 Irrev Trust, Robert M. Meninno, Tr. Owner Owner's Name required for is Cotuit MA 02635 August 16, 2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10.5 ft+ 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: 1/24/2011 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 5.86 feet above the bottom of a witnessed test pit in which no water or groundwater mottling was encountered. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 No. 20 f l ' 0�� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLatlon for Misposal bpstem Construction 3pPrmit Application for a Permit to Construct( ) Repair( ) Upgrade(✓f Abandon( ) N(complete System ❑Individual Components Location Address or Lot No. j 0q IZA i-,f n 2 J Ca 7-v r 7 Owner's Name,Address,and Tel.No. sh,avo✓t Assessor's Map/Parcel Z. 2— (p d ak �'t ^�0 Installer's Name,Address,and Tel.No. o De-signer's Name,Address,and Tel.No. �au5fie.(d SAAi4--A-4S°c.._v, sia� c t=NV ok b �{ SA�woa-% o25'63 ��2610 F STSAe� wick 933 Z( -77 Type of Building: Dwelling No.of Bedrooms T Lot Size sq.ft. Garbage Grinder(1)6 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4q a gpd Design flow provided $` gpd Plan Date I—((� Number of sheets r Revision Date Yl 6N -2 Title Size of Septic Tank ( S-6 O Type of S.A.S. MA e (e,S S 3 Z Y 11.95 Description of Soil (At•✓1 Nature of Repairs or Alterations(Answer when applicable) i2P_P(A,(-e.. rc,, l eol (eeckLl( v I FCC-(6C-+-r P2 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si9nd, Date 1-21-11 Application Approved by Date a Application Disapproved by Date for the following reasons Permit No. 7 11 U /r Date Issued — t9 �_— - --- - ---- - -�� —— — — — -- —— _ ;:-..- ,,,,-�-.+lei-v:+:.n...�c:wp's+.."�n'.9"1�B+.;a*i.ei"'o..r.�t...,r.,..-.<-.-..--.....^-,.-..�.,..Y.,..�.M ..r..-,..-:.,...._._ _ ,d.. - -.. .'*w,•...,�....-'-ay�^gA.n.e.r•w�++.�,.. .,,�.,,.T....,.,...-„ ,.� - No. 2 0 // � �. Fee i THE COMMONWEALTH`OF.MASSACHUSETTS Entered in computer:1�/, PUBLIC HEALTH DIVISION -TOWN OF B ARNSTABLE, MASSACHUSETTS ,l` Yes ftplitation for BispoBal *pstrm Construction 30trinit Application for a Permit to Construct( ) Repair( ) Upgrade(V Abandon( ) ®Coin lete System p y El Individual Components Location Address or Lot No. IOq go,V y yl 1Z ci �-l-u T Owner's Name,Address,and Tel.No. - Assessor's Map/Parcel 2 2- 0 b ���✓on N o 54A Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. pt�aUS4:�ie I4! S'An+-4-n.Gj 5,i,V 5����� "T�y,gc ENVi. ?oX loci SAnctw+cln oZ5'r,3 z°f° E�STSpnc�wich �33 Z/ 77 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(1)0) Other Type of Building No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided t{` S gpd } Plan Date Number of sheets Revision Date h GN Title Size of Septic Tank I �0 O Type of S.A.S. 05 f o/t e (eS 5 3 Z N i I, 75 Description of Soil " Nature of Repairs or Alterations(Answer when applicable) K_c> (A, e 1 e. Ke(o C-A 7 e_ i Date last inspected: _ Agreement: 4 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 'Signed, !I ,. -. _ Date Application Approved by VI Date Application Disapproved by Date for the following reasons t' Permit No. 7 r i 1 -0 0— Date Issued -------------------- ------ - - - - - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded V) Abandoned( )by - Sou 54 e /cj f P-n 1 `�i.-u re i-Vj uz 77_—,c- at 1 O q P.A Ls4 ri 12-L9 (Q '7 u t T has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. _?0 P -0 dated Installer o u S'C+e Designer l)fz C. N V I #bedrooms Approved design flow 1.4 e.(S end The issuance of this p7mi t shall not be construed as a guarantee that the system will fi((inc1tiodl as designed. p Date a i Inspector ! .)/ kw (C J L7 No. v f 1 - / f Fee �Uu THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal bpetem Construction Permit\ Permission is hereby granted to Construct( ) Repair( ) Upgrade(,X) Abandon( ) System located at /G e le `+.U 1�7 1,d co-r u t T and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this perm l Date ! 2 V- If Approved by / Town of Barnstable y� Regtrlatary Services Thomas F.Geiler,Director )ARlI.SIA$bE, ' Public Health Division oa 1 '. rFo. a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644. Tax: 508-790-6304 Installer & Designer Certification Form Date: Designer. C>A�10 U Dt_II Installer: `at 'RELD 1 Address: Address: On 1 - Z�- II �l' 6jVjLwas issued a permit to install a (date) (installer) septic system at l� O '� based on a design drawn icy ( ddress) 43, �"6� 4 dated (designer) ZI-certify that the septic system referenced above was installed substan a11` acc�rdin g t y o design, which may include ninon approved-changes such as lateral r ocatioz� of the d sb ibution box and/or septic tank I cerW that the septic system:referenced above was install with'mafor clianges (;.;e., greater thin 10 lateral relocation of the SAS or--any vertical relooat,6n of airy compon t of the septio system)but in accordance with State&Local,Regdations. Plan revisiozk of certified as-bui t y designer-t6 follow. S 1 F 4f 2 DAVID (Installer's Si ature) WSW rn 116t 066' : Sq�,TAA�P� (D er s Signature) 4 (Affix e finer',s Stamp Here) ' PLEASE RETURN TO BARNSTA�1PEJIBLIC-IIEALTH.kWISION. LE I�TYF.ICAT E OF. COKPLIANCE� WINE, N® ': _= SSUED BOTH -TH[S°FORM A,S_ BUILT LARD ARE RECEI=VEO BARS STABLE PUB '�'T13E: IRIEALTt3[DIISI0IY THANK YOUL Q:P.eal&Septic/Desib erCertificafi0n_Form , of Town of Barnstable # 317S Department of Regulatory Services HUIPublic I�ealth Division 200 Main Stree Date t,Hyannis MA 02601_ -`` ri e 7 r Date Scheduled e f Tlm.. %b e Fee Pd; �r Soil Suitability A sessment or F f , Sewage Disposal Performed By: r�l(v Witnessed BY: LOCATION& GENERAL�O Location Address.' � RAY fy� INFORMATION Owner's Name S;54 re),2 /7e01 r' Address Assessor's Map/Parcel: _ ,` (_ d / T U `Y Bngineer's Name b f1,14 fdvj NEW CONSTRUCTION REPAIR , Tele. hone#P. Z Land Use / 77 Slopes(9'0). _ �,r Buaface Stones Distances from: Open Water Bod ' y----___ft' Possible Wet Areaft Drinking Water Well Drainage Way --.-�_ft ft Property Line Y -----------. ft .. Other. ft SKETCH: (Street name,dimensions of lot,exact locations of test holes&pere tests,Locate we tlands in proximity to holes) } Pa ent`materiaI(geologic) IAJ / ]] (-� Depth to Bedrock `' 6 V® Depth to Groundwater- Standing Water in Hole: Weeping from Pit Fpce ' Estimated Seasonal High Groundwater DETE _ `. RMINATION FOR SEASONAL HIGH WATER TABLE Method L'scd:., ,,,.:. Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: in. Depth to soil mottles: Index Well# In,. GroundwaterAdJustrnent tn, Reading Date: Index Well level ft. AdJ,factor AdJ,Groundwaterl..evel , Observation PERCOLATION TEST Date Hole# --� Time at 9" Depth of Perc Time at G" F Start Pre-soak Timc @ _ _`"• ; .r-. Time(9°,w) x End Pre-soak Rate Min./Inche r A3 Sites uitabi 11 ty Assessment: Site Passed_ Site Failed:_ Additional Testing_ o Needed(Y/N) Original: Public Health Division ` ' Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland, you must first notify Barnstable Conservation Division at least one (1) week prior to beginning. y the. Q:�EPTI CAP E R C FO R M.D OC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling• (Structure,Stonea,Boulders, ppConsistency.% ravel) C0*7 DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil'Color Soil Other Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones:,Boulders. CQ nsiste c % yel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.To Oravel) t i _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o si ten Flood Insurance Rate Man, Above 500 year flood boundary No— Yes Y Within 500 year boundary No 1' ' Yes Within 1D0 year flood boundary No L�l Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us�jorial exist in all areas observed throughout the area proposed for the soil absorption system? - _ If not, what is the depth o pat rally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with . the required training, ex ertise an ex erience described in 310 CMR 15:17, Signature Date (0 ZO C� Q:\S P PTIC\PERCFO RM.DOC TOWN O,F1 BARNSTABLE LOCATION�D� ��` , '/C SEWAGE# VILLAGE CQ:nu/�% "a,-,ASSESSOR'S MAP&PARCEL �' C� t) rT INSTALLER'S NAME&PHONE NO. t5t�.��rr2 r� PiF -Z4)l0 SEPTIC TANK CAPACITY 15-�© LEACHING FACILITY.(type) SfO a e-/z. -f (size) X 75 LJ NO.OF BEDROOMS OWNER dl r iV 0 PERMIT DATE: /- 2 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) /V Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin_.. cility) , Feet FURNISHED BY�< , Ila Ll 3 76 , 0 r�W Y, ✓ - _ � � ��if - ASSESSORS MAP : - Zz— -- NOTES: TEST HOLE LOGS PARCEL : - 1 SO 1 L EVALUATaA : -PA vt ,1M W L t3AsnS+ab(c FLOOD ZONE ^/C — �C� _ ; n/ 1) The installation shall comply with Title V and Town of oard of _._ _. _. . .__ .. _._._.:_._ ._. _ _.._. __ _-__ WITNESS :� ��.; � Health Regulations. ���� � j REFERENCE:FERENCE: ate' cZ�� /7/58 f #SSG DATE: V 6I G _._._._ .. _._ __ .. �1. _ . - ..._._., _ _.__.. 2) The installer shall verify the location of utilities, sewer inverts and septic C- �O/G ZZ� �jySJz aTz Z PERCOLATION R TE. ,G. Z 1 components prior to installation and setting base elevations. r, j3,�D 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first a h TH TH-2 two feet out of the d-box to the leaching shall be level. I77, 4) This plan is not to be utilized for property line determination nor any other �r purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. l� LD►A4�( JbA4 C> b La �lp 6) Parking shall not be constructed over HI septic components. I� 7) The property is bounded by property comers and property lines. LOCATION MAP V 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed -7 lL approval.of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material � per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. \ ! �tlLL� I I � _ 10 System y components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service SEPT I SYSTEM DESIGN line. The line is to be sleeved as aforementioned and maintained in place. 11) If garbage grinder exists it is to be removed and is the responsibility of the FLOW EST I MATE owner to ensure such Z ' / 12)The installer is to take caution in excavation around the gas line if such 4 exists. BEDROOMS AT �ID GAL/DAY/BEDROOM -� GAL/DAY 13)The installer shall verify the location,� ` �^ � C/ � � �'' �✓����� 1. ify n, quantity and elevation of the sewer roes exiting the dwelling prior to the installation. SEPTIC 1ANK 01 Q Gi1/DAY x DAYS4+tt USE 3ALLON SEPTIC TANK �a -4—_ _CQ- 4 WTI` k `a��1 LiSORPT 164 SY�- L�M .._._. I FAT �7 3 o Jl1 � �1R0� ,:lI ....u. .g...S...... DQkA �, _ U� r 5 ,l o to ( 1'� ('�, - �.► 5�� �� Tz �I �" —r55q woe ( 0O GAL �3.LI � 3Z i1,3y' ' — —— SEPTIC TANKYZ 1. LaL `2�7 X Gf buqI-Itp "fV �E il i I r-Vail J Nis 9 0 , � �y'► �i � aotvoo ;701WRD 'Poftre SITE AND SEWAGE PLAN LOCATION : Ii — Z`15�✓ — ' PREPARED FOR , Llrl) Z- L f� SCALE: 111% LU DAV I D B . MASON 1\II DATE: I !co !I PIP DBC ENV I RONMENtAL DESIGNS --- E W DATE HEALTH AGENT AST SANDWICH . MA W ( 508 ) 833- 2177 Z .I,