Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0178 SANDALWOOD DRIVE - Health
178 SANDALWOOD DRIVE, COTUIT A = 010040 _ i 97(, Barnstable Town of Barnstable Regulatory Services Department `ft • WRNST"M 1 I I I ,�39. Public Health Division 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1971 7071 November 24, 2015, 2015 Victoria L. Zeglen 178 Sandalwood Drive Cotuit, MA 02635 The septic system located at 178 Sandaewood Drive, Cotuit,MA was inspected on, • June 6, 2015 by James Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet (per Town Code 360-9.1) • The distribution-box is rotted and needs to be replaced You are ordered to repair or replace the septic system within one (1) year 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 THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\Septic\Letters Septic Inspection Failures or Future Eval\178 Sandlewood Dr Oct 2015[Type text] �11HE)Ow,lo Town of Barnstable ,�`c per, W T Public Health Division g'�P' -RN LE, 200 Main Street ,} � �_ ��_© Hyannis,MA 02601 j , PITNEY BOWES 02 1 P $ 006.735 7014 1200 0001 0358 5890 0000873431 OCT 14 2015 MAILED FROM ZIP CODE 02601 l Victoria L. Zeglen 130 Lewis Bay Road #2B Hyannis, MA 02601 e...L.4'«!w.•�i.t. w-22:2 8 i.. 1. •':} '1�1.,If'.iil3.I'�fj i' 1111. _i I.l j�l�7�_It l�Il;tll��•.��11 1i.1,�'10 l�� t 1, _ ® Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent i a Print your name and address on the reverse X ❑Addressee so that we can return the card to you.m Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I I I I � I Victoria L. Zeglen 130 Lewis Bay Road#2B 3. Service Type Hyannis, MA 02601 Q Certified MOP 0 Priority Mgil Express'" Registered ❑Return Receipt for Merchandise 0 Insured Mail ❑Collect on Delivery 4. Restricted Deliver y?(Extra Fee) ❑Yes 2. Article Number I ( 7014 1200 0001 0358 58900"" ] 1Pansfer from service/abeQ x ; T i PS Form 3811,July 2013 Domestic Return Receipt ra a r'- Certified Mail Fee Q^ ra $ �� P Extra Services&Fees(check box,add fee as eppropdate) C3 ❑RetumReceipt(hardcopy) $ `� C3 ❑Retum Receipt(electronic) = $ Postmark 01 C C ❑Certified Mail Restricted Delivery $ Here[ C',?- C3- ❑Adult Signature Required $ I NOV 3 O 201J �. ❑Adult Signature Restricted Delivery$ l O ru Postage rLn-q Total Postage and Fees �/S P S Victoria L. Zeglen C 178 Sandalwood Rive i 79 Cotuit, MA 02635 Certified Mail service provid� the following benefits: ■A receipt(this portion of the Certified Mail*e(i. for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. �assoclf for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt far no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the, ■A record of delivery(including the recipient's retail associate. - signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the in You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retatq. or Priority Mail®service. -Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mall. and provides delivery to the addressee specified" e Insurance coverage is notavallable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retaip. of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bears' certain Priority Mail items. USPS postmark If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion= of delivery(including the recipient's signature). of this label,affix it to the mallpiece,apply F a You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece r';3 electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save tAis receipt for your records Ps Form 3800,April2015(Reverse)PSN 7530-02-000-9047 C3 .. • Q' CO , U1 M Postage $ C3 Certified Fee f Zj4p (y+Return Receipt Fee OCT'C3 (Endorsement Required) Restricted Delivery Fee (Endorsement Required)f� AS W Total Postage&Fees / Sent To _____________ Victoria L. Ze len ' p Street Apt N g r. orPOBoxNr 130 Lewis Bay Road #2B City,State,Z Hyannis, MA 02601 Certified Mail Provides: e 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: n Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®: e Certified Mail is not available for any class of international mail. ' o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipf 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 LISPS®postmark on your Certified Mail receipt is required. o 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. If 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 ,» Town of Barnstable Barnstable Re ulatory Services Department P Q 9q,� , Public Health Division A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 5890 October 15, 2015 Victoria L. Zeglen 130 Lewis Bay Road#2B Hyannis, MA 02601 The septic system located at 178 Sandlewood Drive, Cotuit,MA was inspected on, June 6, 2015 by James Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the'following: • Leaching pit or cesspool with high liquid level, <12" below inlet (per Town Code 360-9.1) • The distribution-box is rotted and needs to be replaced You are ordered to repair or replace the septic system within one (1) year 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 THE BOARD OF HEALTH homas McKean, R.S., CHO Agent of the Board of Health QASeptic\Letters Septic Inspection Failures or Future Evah]78 Sandlewood Dr Oct 2015[Type text] Town of Barnstable Barnstable Regulatory Services Department A p �STAS �, 9 Public Health Division ' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 5890 October 15, 2015 Victoria L. Zeglen 130 Lewis Bay Road#2B Hyannis, MA 02601 The septic system located at 178 Sandlewood Drive, Cotuit,MA was inspected on, ® June 6, 2015 by James Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet(per Town Code 360-9.1) • The distribution-box is rotted and needs to be replaced You are ordered to repair or replace the septic system within one (1)year 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 THE BOARD OF HEALTH homas McKean, R.S., CHO Agent of the Board of Health Q:\Septic\Letters Septic Inspection Failures or Future Eval\178 Sandlewood Dr Oct 2015[Type text] f T Parcel Detail Pagel of 3 RALAN sr ALBI E �e w. Logged In As: Parcel Detail Tuesday,October 13 2015 Parcel Lookup Parcel Info Owner Info Owner�TEGLEN,VICTORIA L Co-Owner I Streets r130 LEWIS BAY RD UNIT 2B 1 Street2 City;HYANNIS State EA j Zip t02601 Country Land Info Acres r.77 � use �Si�ngle4Fam MDL-01 Zoning RF ._,_. .. —I Nghbd 0�107 � Topography i.Leyel I Road 1,Paved Utilities•Public Water,Gas,Septic I Location Construction Info Building 1 of 1 Year�978 —I Roof iGabl p Ext .Clapboard Built Struct Wail Living?i397 Roof A sph/F GIs/Cmp AC None woK ° g' Area} 3 Cover " TypeIn t Style Cape Cod all Drywall �I Bed Rooms Wall 3 Bedrooms Yq5, �fQ5� e`fRS S _ Int Bath " �'�" A? �A 6>" BAST 412 Model,Residential ( Floor!Carpet ( Rooms 2 Full-1 Half you. Total Grade lAyerage I Type Hot Water I Rooms 6 RoomS IHeat 90 stories,1 1/2 Stories I Fuel cGas I F�ation Poured Conc. Gros '3362 Area Permit History Issue Date Purpose Permit# Amount Insp Date Comments 12/21/1999 Swimming Pool 43186 $15,500 12/19/2000 16'6"X 34'6" INGROUND 12:00:00 AM VINYL POOL 4/1/1987 Addition B30650 $30,000 1/15/1990 CO ADD'N 12:00:00 AM 11/1/1977 Dwelling B19766 $0 1/15/1979 CO 2 STOR 12:00:00 AM Visit History Date Who Purpose 8/21/2014 12:00:00 AM Anne Leonelli Change of Address 8/20/2014 12:00:00 AM Pamela Taylor In Office Review http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=306 10/13/2015 r Town of Barnstable + SARNEW"LE p 4 ,0� Regulatory Services Department rfp MA'I� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed Pipe o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet.invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation o Any portion of the cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) . s Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code SS §360-9.1) OTHER eo . P� ✓UX Repair deadline: - � WSEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc i+ , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Sandlewood Drive Property Address Victoria Ze len Owner Owner's Narrl'e t,�z information is . required for every Cotuit MA 02635 6/22/15 :X.- page. City/Town State Zi Code l�: P Date of Inspection ? CA Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1, Inspector: key to move your cursor-do not James Ford use the return key. Name of Inspector F'rab Company Name P.O. Box 49 Company Address Osterville MA Cityrrown 02655 State Zip Code 508-862-9400 S 12482 Telephone Number License Number B. Certification anon 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 Ev luation by the Local Approving Authority 7/6/15 Insp t 's Signature Date The s em inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal S t Page 1 of 17 - Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owners Name information is required for every Cotuit MA 02635 6/22/15 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface'Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .r 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owner's Name information is required for every Cotuit MA 02635 6/22/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owner's Name information is required for every Cotuit MA 02635 6/22/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters . due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded El ® or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Yz day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' N 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owners Name information is required for every Cotuit MA 02635 6/22/15 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered 'yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° a 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owner's Name information is required for every Cotuit MA 02635 6/22/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® . ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts mom Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 178 Sandlewood Drive Property Address Victoria Ze len Owner Owner's Name information is required for every Cotuit MA 02635 page. City/Town 6/22/15 State Zip Code Date of Inspection D. System Information Description: Number of current residents: . n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts INN Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owner's Name information is required for every Cotuit MA 02635 6/22/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: pumped within the last couple of weeks Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract '` ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Sandlewood Drive Property Address Victoria Ze len Owner information is Owner's Name required for every Cotuit MA 02635 page. City/Town 6/22/15 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed - 11/14/1978 - per as built card Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): 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: 12" feet Material of construction: ® concrete ❑ metal ❑fiberglass 9 ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal. Sludge depth: 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 0'17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owner's Name information is required for every Cotuit MA 02635 6/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 10 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There were no sign of leakage. Grease Trap (locate on site plan): Depth below grade: n/a 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 178 Sandlewood Drive Property Address Victoria Ze len Owner Owner's Name information is required for every Cotuit MA 02635 page. City/Town 6/22/15 State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete El metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/a 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form- Not for VoluntaryAssessments ssments 178 San dlewood Drive Property Address Victoria Ze len Owner Owner's Name information is required for every Cotuit MA 02635 6/22/15 page. Cityrrown State Zi Code P Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-Box was broken down and needs replacing. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 178 Sandlewood Drive Property Address Victoria Ze len Owner information is Owner's Name required for every Cotuit MA 02635 page. Cityrrown 6/22/15 State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1000 gal.: ❑ leaching chambers number: ) 1 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative sy stem . Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The pit had 5.5' of water on the bottom. The scum line was up to the inlet pipe, signs of failure. A camera was used for the ins ection. 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • 178 Sandlewood Drive Property Address Victoria Ze len Owner Owners Name information is required for every Cotuit MA 02635 6/22/15 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a f5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a •''• 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owners Name information is required for every Cotuit MA 02635 6/22/15 page. Cityrrown State Zip Code Date of Inspection - D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ABC. �AfA A- _Q r Poo a 3 � a 99 q0 3 a 61 l5in 1 s 3/3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �A. .•'' 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owners Name information is required for every Cotuit MA 02635 6/22/15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 40'+/- feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Topo and water contours map ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 • Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Sandlewood Drive Property Address Victoria Zeglen Owner Owners Name information is required for every Cotuit MA 02635 6/22/15 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE -LOCATION Wooe/ SEWAGE# VILLAGE �prr1ir ASSESSOR'S MAP&PARCEL 0/0- Oy0 INSTALLER'S NAME&PHONE NO. y20-973g 1as1�:ej P,r SAW-os SEPTIC TANK CAPACITY MOO LEACHING FACILITY.(type) 2— i1X,* r'jS ,S0Oe,,4(ize) 2SX 13 NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: /2- l Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY S14144/ _LTJ 2 Its" i 19- 2 =93. l3—l =9�`f�G„ � •3 N / Fee- Ot7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Zisp9sal *pstem Const union Permit Application for a Permit to Construct(4-r Repair(Arl-upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./7$s14y 14 woo Owner's Name,Address,and Tel.No. Assessor's Map/Parcel D/0—O`/U Ca fa r Installer' Name, ddress, nd Tel.No.Sa 8- 't°—y93 S Designer's Nan)e Address,and Tel.No. Sob-3G0-33l> crea S/ s4m -a R&O0 `Yliv!"s oI1S' syJi//s �`1�1td�cLl Type of Building: Dwelling No.of Bedrooms j Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 O gpd Design flow provided 342 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil � j Nature of Repairs or Alterations(Answer when applicable) sue! O. 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. e 41� Date d Application Approved Date Application Disapproved Date for the following reasons Permit No. 706 yZ( Date Issued (� -P'"�e..i+sifl-r S 4 �f�.-r+'..J i'Y l,4 .—.►+r'i: i N �� � � a�;:< ., ,,,� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Disposal 6pstrm Construction Permit . . Application for a Permit to Construct(�^-Repair( Upgrade( ) Abandon( )' El Complete System ❑Individual Components Location Addre s or Lot No./9 DA- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 6/0- Installer's Name,Address,and Tel.No.re Z-41eo- 770 F>' Designer's Name,Address,and Tel.No. ,50E- 36D-33// Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) , Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3y 2 gpd i Plan Date Number of sheets Revision Date .,y Title h' Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �T ZZ 0,o �z-ll 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 i Compliance has been issued by this Board of Health.. a Date Application Approved.. r Date Application Disapproved Date for the following reasons Permit No. �tj y Z a Date Issued ------------------------------- - - - 7 - -- - - - ------------ --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(c-)- Repaired( d_�- Upgraded( ) Abandoned( )by at 1Z9 ,�, ��i��i� /��;,j,//j" has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. C i dated I Z�1�3 j1 c� Installer,��c�,9� /�� /,avyi� S e Designer ,,�/-�1/=/Q Svd✓S /_`iVl #bedrooms F Approved design flow 33 G7 J gpd The issuance of this permit shall not be construed as a guarantee that the system wi' fun tieWas designefl. Q Date [_ +L I I f Inspector r ----------------------------------- - - - - -- - ----- - ------ --------------------- No. 26 5 _ Fee`" Od THE COMMONWEALTH OF MASSACHUSETTS •. PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction Permit Permission is hereby granted to Construct(L ) Repair Upgrade( ) Abandon( ) System located at /'�j ��,o//��,,,,,� l�- % 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 permit. I Date 17- ill 24!c Approved by DEC/081/2013-ME 09:04 AID FAX No. P. 002 d Town of Barnstable Regulatory Services Richard V. Scab, Interim Director � snexsrnsx�: � • Public Health Division 16.19. ®� Thomas McKean,Director 200 Main Street,ByanWs,MA 02601 Office; 508-862-4644 Fax; 508-790-6304 Installer &Designer Certification Form Date; *A Sewage Permit# Assessor's MaplParcel (910 a D Designer: P y�� l��� Installer: Address: �( r .'c �� Address: . Saw (1A - 62_' 73 4 On was issued a permit to install a (date) (installer) septic t�&D � ►1-based on ads'systez�a,at � A'�.,W �{L design drawn b � � y (address) l/Yt C dated ll1410- (designe!b&rY%eX.,MejW 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. Strip out (if required) was inspected and the soils were found satisfactory, I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocationi of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system,referenced above was cons ir. fiance with the terms of the AA.approval letters(if applicable) OF D yy REN `l W( er's re) 40 I $ (Designer's Signature) A tamp Mere) PLEASE RETURN TO BARN ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT M ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RXCEIVED BY THE BARNSTABLE PUBr.,1CC MALM DIVISION. THANK YOU. QAScptfc\Desimer Certification Form.Rev 8-14-13.doc I Town of BAr nstable P# � 3� Department of Regtilatory Services - • Public Health Division Bate—9 I ibsy `b$ 200 Main Street,Hyannis MA 02601 r Date Scheduled U Time A 1 r-�- Fee Pd. 2 S` I_T7 I� oil' Suitability As* es or �`e�v a DISPOsar y �,.. A Performed By: Witnessed By: i LOCATION & GENERALINFORMATION L-ocation Add:ess Owner's Name .'2 Cb�L�T �✓� Address - 630 L-EvNlS 6Ay FA. VN1 Zt> H-4+, -V-j. 5 W Assessor's Map/P4rcel: �f�/O 7 I Engineer's Name M elm+ NEW CON [;ON REPAIR Telephone# Land Use / E v// Surface Stones Distances from: Open Water Body ZOO ft Possible Wee Area! �� ft Drinking Water Well Drainage Way ft Property L.inc C(� _ft Other ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) Sergi Prop 're'lofi C-- 1 p110Y3 ///VP '7 � ` i ° I I I i F . i i I I i 1 �.� Parent material(geologic Depth to Bcdroek •��. ,q Weeping from Pit FACe — Depth to Groundwater. Standing Water in Hole:' `l Estimated Seasonal;gigh Groundwater eV ! Dt 'E TION FOR SEASOiNAL HIGH WATER TADLL Method Used: ± in. Depth to soli Mottles: Depth db�served standing in obs.hole: i iri• groundwater Adjustment tl• Depth toiweeping from side of obs.hole: 1 A�,factor - Adj.(Lroundwater Level Index Well# Reading Date: Index Well level -. j PERCOLATION TEST D"te T4n,' Observation I I Time at 9" °` Hole# r f. Depth of Pere Time at G'°Y_ ;---- —' Time(V-6") A/ Start Pre-soak Time.@ End Pre-soak Rate Min./Inch Site Failed: Additional Testing Needed(YIN) Site Suitability Assessment: Site Passed __'1_ i Observation Hol original:.Public l e$1th Division e Data To Be Completed on Back---- of wetland,you must first notify. the ***If percolai0n testis to be conducted within 100' Barnstable C44servation Di*ision at least one (1)wedk prior to beginning. VS DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel Lim �vrL� tl mil'- 2-" �, ! ► DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gra el R hol 9 ti ,1 q'' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten .t Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes, Within]00 year flood boundary No—I Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist,in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the require ini ,exper ise and experience described in 3.10 CUR 15.0 7. Signature Dat� V\- V�k � � Q:\.SEPTIC\PERCFORM.DOC OWN OF B STABLE � 1 LOCATION pw `SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY A LEACHING FACILITY: (type) t. (size) / wa NO.OF BEDROOMS BUILDER OR OWNER c ` � PERMITDATE: 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 wetl ds exist within 30)feet o lg hig cility) Feet Furnishedb r i F -��� 1 1 �. � ,� , �� i ��� i � �� . � �$e e. � \ x � . ,' / - \ � � �\ �Q � � . � •�s' ot 016 o o DATE: , ./3/.9.9 PROPERTY ADDRESS: 17'8-Sandlewbod Drive Cotuit ,Mass . 02.635 On the above dale, I Inspected the "ptic systom at the above address. Thls system conslets of the following: 1 . 1-1000 gallon septic tank. 2. 1-Distribution box. 3. 1-1000 gallon precast leaching pit . 1V Grp\ • �ECEIvE�J Based bn my Ine�ractlon, I certify the following o id1A1Eo§s, 4 . This is a title Five wN0 Septic System. (-"78rOode ) TO 2 1999 5 , The septic system is in 'p.roper 'working order �,\ •' at the present' time . 6 . Th•e - septic tank was pumped at time of inspection . �> 7 . The leaching pit was dry at time inspection , SICNATUR!7 A Name: J P.Ka C 0 m -1--b tr JrJ_ Company:_• P_Macogber b �Son• 'Yrtc ,, •; .• • , address• ' __�en�•e�rv�lLe�"1,�3.i_Q�.b32 '� ' •. Phone:_ 33a------- -- THIS CERTIFICATION' DOES NOT CONSTITUTE A CUARANTY OR WARRANTY JOSEPH P. MAC014BER & SOR INC, T+nka-Csw;>ooh,Lsachfloldi •. PUMW L Instslled Town Sower Connections P.O. Box 66' Centervllle, MA 02632.0066 77.6-33M 77 412 COMMONWEALTH OF-MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVM B. STRURS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 178 S a n d l e w o o d Drive Name of owner Bill C a r i e Cotuit ,Mass . 02635 Addressof Owner: 15 Dicarlo Road Date ofbtspection: 2/3/99 Hopkinton ,Mass . 01748 Name of Inspector:(Please Print) Joseph P .Macomber J r . 1 am a DEP approved system irupector purwant to Section 15.340 of Title 5(310 CMR 15.000) company Name: J. P.Macomber & Son Inc . Mailing Address: R n x 66 (..P n t P r v i 1 1 P ,M a e c 02632 TaIal*one Number: 7v8 7 7=5 3338 CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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 4upectols Signature: Z�L�/I Data: The System Inspecto shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)wWn 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 ofr£nvlronmenttd Protection. The original should,be sent touts system owner and copies sent to the buyer,If applicable, and the approving authority. . NOTES AND COMMENTS revised 9/2/98 Page Iof11 C,Printed on R"Ied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:178 Sandlewood Drive Cotuit ,Mass . Owner: Bill Carrie Date Of k►apecd0n: 2/3/9 9 INSPECTION SUMMARY: Check A, A C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 1.6.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: /1�D 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. Indicate yes, no,or not determined(Y, N, or NO). Describe basis of determination in all instances. If "not determined", explain why not. N� The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection;or the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box Is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). broken pipets) are replaced obstruction is removed distribution box is levelled or replaced - The system required pumping-more than fourtimes a.-year due to broken or obstructed pipets). The system wiitpeas-- inspection if(with approval of the Board of Health): - -- broken pipets)are replaced obstruction is removed revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 178 Sandlewood Drive Cotuit ,Mass . Owner: Bill C a r i e Date of Inspection: 2/3/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and 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 WH1CHWiLLPAO=THE PUBLIC HEALTH.AND SAFETY AND THE EMMONMENT: �Ll�} Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 60 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 AND SAFETY AND THE ENVIRONMENT: Vd 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. 20 The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 60 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid).- 3) OTHER revised 9/2/98 Page 3of11 • 0 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 178 S a n d l e w o o d Drive Ownw: Cotuit , Mass . Data of Inspection: 2/3/9 9 D. SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: ivy, I have determined that one or more of the following failure conditions exist as described 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. Yes No „ Backup of•sewage intofeciR"-•system component-due an overloaded orcleggedSAS-or-cesapod. ='•--% Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Z Static liquid level in the istribution box above outlet invert due to an overloaded or clogged SAS or cesspool. �r- 1Z Liquid depth in aeesp"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 `(Z. 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. I/ Any portion of a cesspool or privy is within 50 feet of a private water supply well. 4 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 -coliform bacteria, volatile organio-compounds, ammonia nitrogen-and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems In addition to the criteria above: /14 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: Yes Noa dCl� the system is within 400 feet of a surface drinking water supply /h the system-is-witWm 200 feet of-*tributary4O-6*Urfaoe•drirJciwg-awtW-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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further infor nation. revised 9/2/98 Page 4orli i SUBSURFACE SEWAGE DISPOSAI,SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Ackleass: 178 Sandlewood Drive Cotuit ,Mass . Owner: Bill C a r i e Date of Inspection: 2/3/9 9 Check if the following have been done: You must Indicate either"Yes" or"No" as to each of the following: Yes No/' _ �/ Pumping Information was provided by the owner,occupant,or Board of Health. _ None of the systemcomposonts kauabaan pawWsd49P4AJoast two•awoww and&O-irystom hasbaaoascaiaiagwsasal.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. _ The facility or dwelling was Inspected for signs of sewage back-up. _ The system does not receive non-sanitary or Industrial waste flow. _ The site was Inspected for signs of breakout. _ All system components, 0"luding the Soil Absorption System,have been located on the site. _ The 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. The size and location of the Soil Absorption System on•the site has been determined based on:- Existing information. For example, Plan at B.O.H. Determined In the field(if any of the failure criteria related to Part C Is at issue,approximation of distance is unacceptable) [15.302(3)(b)) The facility owner.(and.^^pnt.1f dMaraat trnm.mwnerl.twara4uauidad with tnfo«*+=r oann rhA proper Maint f SubSurface Disposal Systems. I i revised 9/2/98 Page sof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 178 Sandlewood Drive Cotuit ,Mass . Owner: Bill C a r i e Dow of Inspection: 2/3/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: //a g.p.d./t m. Number of bedrooms( as! Number of bedrooms(actual):, Total DESIGN flow Number of current residents Garbage grinder(yes or no): Laundry(separate system) (Yes or If yes,separaia lnapection.required Laundry system Inspected Ayes o 0 Seasonal use lyas or no)T5 Water meter readings,if available(last two year's usage(gpd): Sump Pump(Yes or no):_a 4Z66 6W4jK 97W Last date of occupancy: CO M M ER CIA L/INDUSTRIAL: Type of establishment: Design flow: d ( Based on 16.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no)-' Non-sanitary waste discharged to the Title 5 a am:(yes or no)::12) Water meter readings,If available: .Ll Last date of occupancy: 1t)e OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of Information,_ _ 1-1414?0 TaX hV /ter DID System pumped as part of ins lion: (yes or no) If yes, volume pumps 47AUanon t rr f qq � Reason for pumping: IF J � >1 TYPE OF YSTEM Septic tank/distribution box/soil absorption system ti6 Single cesspool Overflow cesspool �� Privy Shared System(yes or no) (if yes, attach previous inspection records,if any) 1/A Technology etc.Attach copy of up to date operation and maintenance contract ,/ Tight Tank ,Copy of DEP Approval Other 0� E of all component, data InataNediif known)-and Bourse of iwformation: .�,� � i�l�/ �_ Sewage odors detected when-arriving at the site:(yes or no) revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Pr.pWyAd*eu: 178 Sandlewood Drive Cotuit ,Mass . Owner: Bill C a r i e Data of Inspection: 2/3/9 9 BUILDING SEWER: (Locate on site plan) l l Depth below grade:' Material of construction:_cast iron I ZOPVC_other(explain) Distance frorrl private water supply well or suction line /0 Diameter_V, _ Comments:(condition of joints,venting, evidence of feakase,-etc.) Pipes appear tight No Pvidenr.P of leakage SEPTIC TANK: 40 !f /U (locate on site plan) Depth below grader Material of construction:/concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is(natal,list age 13.age.confrmed by Certificate of Compliance (Yes/No) r l SV�d rlU' !i Dimensions: /X� l� Sludge deptlla---o _. Distance from top of ludge to bottom of outlet too or baffle Scum thickness:_ Distance from top of scum to top of outlet tea or baffle: Distance from bottom of scum to bott p of outl t tea or baffle:_ How dimensions were determined: Comments: (recommendation for pumping,condition of Inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, structures integrity, evidence of leakage,etc.) Pump tank every 2-3 years Inlet & outlet tees are in place The tank is structurally Gound and shows no _ Pvidpnre of 1pak on Tank covers are 18" hPlnw grndp Pnvarc should GREASE TRAP: (locate on site plan) Depth below grade: /:l9 Material of constructionJL concretemetab� FiberglassPolyethyleneother(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tea or baffle: Distance from bottom of sc m to bottom of outlet tea or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Grease trap is not present revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(conthwed) Property Address: 178 Sandlewood Drive Cotuit ,Mass . a+nw: Bill Carie Date°f I bOe: 2/3/9 9 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grader Material of constructionAX concrete4,,+metal.(AFiberglassN/4 Polyethyleno U&ther(explain) .t iq M Dimensions: Capacity: gallons Design flow: AJA gallons/day Alarm present jh— Alarmlovel: Alarm in working order:Yes Now Date of previous pumping: * Comments: (condition of inlet tee, condition of alarm and float switches,etc.) iQ t or holding Yankg are nc�t pre6e144 DISTRIBUTION BOX:-Z (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note-if level and distribution Is equal,evidenoe of solids carryover,evidence of leakage Into or out of box, etc.) — - — Distributinn bnv hnQ 0N® later-al-.—Pie ev�-dettee of sa±±ds NO avi donro 9-=—Teak c `e 8 �� cover is two feet below grade . euver stloul� e raise . PUMP CHAMBER:.,�JVe_ (locate on site plan) Pumps in working order:(Yes or No) N A Alarms In working order(Yes or No) N A Comments: mote condition of pump chamber,condition of pumps and appurtenances,etc.) umD chamber is not =rPgPnt M revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART d SYSTEM INFORMATION(continued) Property Address: 178 Sandlewood Drive Cotuit ,Mass . owner: Bill Carie Daft of knpectkm:2/3/9 9 SOIL ABSORPTION SYSTEM(SAS) / (locate on site plan,If possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimension overflow cesspool,number: Alternative system: Name of Technology:' - Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to sand _ Nn cQignc of hydraulic f2i11ise gr i nn_din S Soil i g QQt; dgmp . yegetet: of3 �i5 fterfita n- __ ce _ is d __11 CESSPOOLS: kl (locate on site plan) Number and configuration: Depth-top of liquid to Inlet invert: Depth of solids layer: 1 Depth of scum layer: Dimensiohs of cesspool: Materials of construction: 44 Indication of groundwater: /08 inflow(cesspool must be pumped as part of Inspection) 0 Cesspools are not =raeant _ Comments: (note condition of soil, signs of hydraulic failure,.level of ponding,condition of.vegetation, etc.) Cesspools are not present - PRIVY:4•Ue. (locate on site plan) Materjals of construction: ,�li� Dimensions: Depth of solids:—d,?Z— Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) Privy is not present . revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P,.opwtyAd&"s-J78 Sandlewood Drive Cotuit ,Mass . ownw: Bill Carie Date of I"Psct" 2/3/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes Into house) i I i0 \ / % \ ' 4L. N � I I� �I revised 9/2/98 Page 10of11 �I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTt SYSTEM INFORMATION(continued) Property Address: 178 Sandlewood Road Cotuit ,Mass . Owner: Bill C a r i e Dane of Inspection: 2/3/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells 1 Estimated Depth to Groundwater ,L Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property, servation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records t/Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours Map . Gahrety & Miller Model 12//16/94 revised 9/2/98 Page 11 of 11 �a•.T.farrla-ntrer.•rr arnrmr Imrlrnrt+snrs+�rnfr-r lrmrlltRs+amars•*n�rT�l�!'f-tRn TT'r'r�r-1n1r�:,.�-.r•` TOWN OF Barnstable BOARD OF HEALTH SUIISUItFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I �_ F•••rn�T••r::a-r..rr.••.�a-nnarm•rtrn rs+r+ssatt+rTn�-.t•t r-umer�wvwr--r+rmwrvr esnt t r..•ara-a-•r.•ter.-..A —TYPE OR PAINT CI.EARLY— PROPERTY INSPECTED STREET ADDRESS 178 Sandlewood Road Cotuit ,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Bill Carie• amp PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . . COMPANY NAME J. P.Macomber & Sdfi - Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or C1ty State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 1 790-1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate, and complete as of the time of .-inspection . The inspection was performed med and any recommendations regarding upgrade , maintenance , and repair are Consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check ne: ' ys m te PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public Health or the environment as defined in 310 CMR 16 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con toted has found t-hat the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature - Date One copy of this certification must be provided to the OWNER, the BUYER ( Where applicable ) and the BOARD OF H$AL711. * If the inspection FAILED, the owner or"'operator shall u pgrade ' the system within ohe year of the date of the inspection, unless allowed or required otherwise as provided) in 3.10 CHR 16 . 306 . partd .doc y = io 40 LO C A,T ION SSE W A G,E PERMIT NO. 3 � 732 VILLAG E i INSTALLER' A E i ADDRESS. B U It D E R- OR OWN ER ems . r . DATE PERMIT ISSUED to-?7 DATE COMPLIANCE ISSUED •l 4 �1Nwl r" No....... 3.�.... THE COMMONWEALTH OF MASSACHUSETTS �- BOAR® OF HEALTH ........^ .. . . �............................•--.---- VZ Appliration for Disposal Works Tomitrnrtiun famit Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal System at: ..... '_.. .Y`..-' ..,/.......... CGI ...... ..P....................C-_�rar._:� Locati ddress or Lot N • ... l�P�y .. ............i` ya..e. a .....k2_3. &>�c.1�e,�t,./le W Owne /�. ` Address a .................. Installer Address Type o Min Size Lot............................Sq. feetCQ wellin No. of Bedrooms.___..................................ExpansionZ tic (�2.� Garbage Grinder (r7� Ot er—T e of Building No. of ersons._._...._ ............. Showers — Cafeteria yP g P ( ) ( ) Q' Other fixtures ...................................................... W Design Flow.................S—b..................gallons per person per day. Total daily flow........ j�.�5....................gallons. WSeptic Tank—Liquid capacity_J&a0gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../----------- Diameter-_ ...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (/,,,) Dosing tank ( ) Percolation Test Results Performed by...................... --------------------•----•----------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.____.._............ Depth to ground water........l, 5-Pli __- fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•---•---•--•---------•-------------------------'------..........------------'--'••--'--•••--•...............••---............_---.-------•---•----.------ O Description of Soil............... .. _ x Il/= s ------. / .��7 - �--- -----------•--•�-G 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 iITi!Z- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed!M,64,e 7 0 . -•-•---- .................. f Date Application Approved By--------- ...14.......a.................................................................. Date Application Disapproved for th following reasons--------------------------------------------------------•----•-----------...---- ......................... '----...•-•---•--------------------------------------•-----.....-•---'---••--•--------'......-----------•--•--•--....---'------------------•--------•-----------------•-•---- .......................... Date Permit No.. -�--••'-......-•-••---•----'....... Issued-------'-•--------------- Date r� No---- - ... Fizz j +4� . THE COMMONWEALTH'OF MASSACHUSETTS BOARD OF HEALTH OF..... . �.. .. .f ............. 4 Appliration for Rgtos ai Works Tonstrurtion amit Ap,t cigtion is hereby made for a Permit to Construct (d ) or Repair ( ) an Individual Sewage,Disposal System at,: ` .J...tu` .J./'....... ........ .. ......... 45 5: .6. °„° ......40r.................... �_.�:�'..7.. ._._._... �.. r _.._. ,r /. Location—Address p�.- or Lot N f _ —n ... � '�'A"`-Jd -------f=-`_ - C--:_-_,n� A.c.--•-•------.1: .a _..... _.. ._.l._A 1.$..... Owner Address '{f¢''' `f�`�. 5 '�p pin }rya /�/fp' .. , .................a..... �..�_ ._._ :p Y............................. j �. O,�I_$X�........................................................... Installer Address d Type o . Ing Size Lot.................... ......Sq. feet U Dwetli No. of Bedrooms..... ......._. .....___._..Expansion ttic ( ) Garbage Grinder (?a) Other—Type of Building No. of ersons._.._____ Showers QI � yP g ---------------------------- P --------------- ( ) Cafeteria ( ) P4 Other fixtures -------------------------------- . W Design Flow................� ...................gallons per person per day. Total daily flow......... .....................gallons. WSeptic Tank—Liquid capacitylfhz0gallons Length-__--___-_----: Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No......./............ Diameter._ ...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (.j) Dosing ta#k ( ) Percolation Test Results Performed by............: ......................................................... Date........................................ ,.a Test Pit No. 1................n mutes per inch Depti of Test Pit.................... Depth to ground water•-_•_. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4Y'> ---'........................................................................................................................................ Description of Soil-..._._. � � + -- ---- ----------------------------------------•----------------- ca ��' ... ---------••••---•--------•------------•----•-....----••......--•- -------------------- - - --- ---- -- .�».... --••-------------------- ,Y` . ------------------------•••. -----------•... -r xT �4 ------------•------------------------ U Nature of Repairs car{Alterations—Answer when applicable________ _________ ........................................... v.. ...... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL i, S�Qf the St Ote,_Sanitary Code—The undersigned further agrees not to place the system in operation until a Cert ficate%frCorr plisnce has been issued by tl e'ooa>d"of health. Signe _.... ern �R »' Date Application Approved By...- .................................... Date Application'Disapproved for t e following reasons:............................................. --•--•--------------- ---------------- --.........-•--•......................•- :••_. .......---••------------•.....---------•----••---------•----•---•---•-------•------•-•-----•. .............................................. Date PermitNo......�, .`' .................................. Issued....................................................... Date THE"COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ..,. . : ?. ?........OF......-4Z C. 8.. ..... .., . .. ........................... C�rrtifiraab of Tompliaanrr THIS IS TO CE TIFY That the Individual Sewn is o 1\S- co 'tructed or Repaired g P �A' �, ') ( ) by................. : .. -`% ........ ........................................................ 17 In taller, at-----•---•-•---•-•--•-••--•-------- ... _t _ _ r. _�t. �� has been installed in accordance with`the provisions of TITLE j:of The State Sanitary Code as described in the application for Disposal Works Construction Permit N;o,•.............._.-.__...... dated--------- ______........._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......*....---��• ....................................... Inspector.--•-P_Ya!------•--•------------------...•................------•--- 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ......O F..-_.._. ,�` .7. 1 .:.. ........' ........ ..... •,-- } y No..... I.......... FEE....f3r+ �l Disposal k n lid rrV Permission is hereby granted-------- _= .. = •••--P.V------------------------ to Construct V-) or Repair ( ) an Individual �Se gage Disposal System at No.. ...• �=� ' Street as sho,,� :;the application for Disposal Works Construction Permit No..................... Dated..//f!X • ' „� a 4 .. � . ..........--•--...--•---•---...-•----...-----•---------------------------------••--•-•----.._..........� Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS LOLE _ 7- ;.6- 77 fl Tssr ` gi b .r HOZ ECli _ •". �i tit r�.' LENCN. n x i s r %o rc- PIT Qt1PdQ J0��0 l O-3h" LOAM 3, AIVD 5'VC90iE ; � � v TR�r a 0 4„ , �E5ERVE 3 S Mzb UM 5ANP 4A)b.GRAVE( i2 ! _ ExraT �� 84 - /44 [JENUP' { EXIST J_ I well . LE�/ LOTS ; ` : F 5. 7 j 4 `M 41) • r r - p r eOAt 7 % S`/DE. - )Oe47Z BEf2C?cOv/S SEP TIC° 5.yS TE,M CONS T2 04C 7-1ON "- SHA :NF�2M .0 .IhJ GAL Y ENOii/MENT,4L TOP OF �11'G7 ,�1 FCC UL dilJ/VSLE<tCAI413�l�96IT,y G Y M'O uNDAT/ON _ . "1•q;Nf41 QLE }�G[>1/E� 70X;7E�l1 �Q T d,/T .+�✓N- '; 3.5 15 2 4"co�1G-sr1.5 b 'Q G<15T ,. MMfw/ D/q Tb�2 MlN/ T/�R/LT -u— --- !D - c a .a/7�f/ �LOtu L,i�IE M. .�iTCN 4 FOOT /¢ 4 �FDOT p/rcf/., Y_ �Qa M1AJ .80 ���"%xocr � ©O0 #;(l 5HEO GALL0'&-/ /At✓ ' 1/V VE.�T GA A / r.:y ' ' 5E,QT/C T�1 i�f V. .�1 O fJNQ CWA TG'1�T/6 HT� !/k�VE.�27* - __ ! N I�LI11U t�s✓iC31C �SEPT/C TAN.�� 17/ST.t /BC1T/ON 60X �$OGlTL.E7- A/t/D 6rE.4C.4//NG .a/T FO� 7`"O B� OF ,TEE/n/F4.2C�Z'7 Ca.<JC.2ETE Cdn/C ATE S'T,eEAASr/ 3000 X' / M/A/. J!t �''t "' r STEEL .. 20000 ' /O LOA p/nlc5 -'�". n e/VE WAY n/O'T r0 eE L.00A7- a. z7E S I GA/ 4 O,4 4D/A/G /S C15ED. RONALD ARTH€�R Pla. 3/( Z>A TE A1E.4 L 7;L1 ,AGE.v T ApP�O�/.4L 1 MARSTONS MILLS o 'LEGEND 3 g PROPOSED CONTOUR ti 98 PROPOSED SPOT GRADE SITE wP� cuRu�+ — 98 -- EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE ,Q ® TEST PIT oG F '.l 0 - RaV'(E 28 LOCUS MAP EX15T. 1 ,000 GAL LOCUS INFORMATION SEPTIC TANK r - IfYISI . 1 ,000 PIT TITLE REF: BK 120 PG PARCEL ID: MAP 010 10 PAR.. 040 78 m _ (5ee Note 10) 78 SEPTIC SYSTEM D > I r--- — —It 33°.86' z mI _ � REPAIR PLAN J � C I ,— PAVED DRIVEWAY w �� _ — LOCATED AT: D --- M � � . _ 178 SANDALWOOD DR. 0 t — i _ r� p ) i , X l . * X � ��, � COTUIT, MA F-_ o �-I1-0 I PREPARED FOR O . z z 20 ft O O + �N RICE I y5 BENCH MARK G ----~- % PAINT SPOT ON NOVEMBER 4, 2015 j ' T PATIO CORNER . y 78.44 �O \? BARNSTABLE GIS DATU ' OF ,yAS'y I t 0 ti i LOT 31 / o DA R N M. s I AREA = 33421 sf+- I. PLAN BOOK 284 PACE 42 O I - i NO. - i ASSR MAP 10 PCL 40 - p o S4NI TAR\�`� - __--------------__--' - t 2700' MEYER,,& SONS INC. r P.O. Box 981 E. SANDWICH, MA 02537 PH. 508 360 3311 • fax (774)413-9468 meyerandsonstitle5@gmail.com www.meyerandsons.com SCALE 1"=30' SHEET 1 OF 2 J 1491 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC :MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE ' . .FINISHED GRADE (78.0) 79.97 F.G.EL: 78.7 F.G. EL: 78.2 F.G.EL: 78.20 .. a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a2" OF 3/8" DOUBLE WASHED 3 4" - 1-1/2" .G.EL: 77.29 1: ': STONE OR FILTER FABRIC / . . ti DOUBLE WASHED STONE 6' 4" SCH 40 PVC 4. 14 S= 1% (MIN. ®®®® p ®®E A' TEE'S ARE TO BE ®®®®®®®®®®® 4" SCH 4o PVC INV.75.:80 2 E F. DEPTH ®®®®®®®®®®® INV.75.195. Ti 1NV.75.60 q' 2 X 8.5' 4' GAS ;PROPOSED DB-3 EXISTING OUTLET BAFFLE EFFECTIVE LENGTH = 25, . .. .:...�-.. �, ...�. . �.•. � - DISTRIBUTION BOX , INV. 76.20 } (H20} INV. ELEV.= 74.50 ; EXISTING 1 ,000 GALLON SEPTIC TANK - --- - - -- - GAS BAFFLE TO BE INSTALLED ON P��� OF MAssq BREAKOUT OUTLET TEE AS MANUFACTURED BY �`� �y a ELEV.= 75.50 TUF-TITS, ZABEL, OR EQUAL DARKEN M. s x TOP CONC. ELEV.= 75.50 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING I Y'1`+cN� INV. ELEV.= 74.50 �®®! ®® 1313E3 EA no E3 PIPE :INVERTS' PRIOR TO 'CONSTRUCTION \ - O ®®®®®®® 2) D BOX SHALL BE SET LEVEL D TRUE TO C/ST ®®® GRADE ON A MECHANICALLY COMPACTED SIX NITAR��� BOTTOM EL•= 72.50 INCH CRUSHED STONE BASE, AS SPECIFIED IN d 3.75 S FT. 3.75 310 CMR 15.221(2) 111��,'\ it _ 3) REPLACE EXISTING 1,000 GALLON sEPrlc TANK SEPARATION 5.58 FT. EFFECTIVE WIDTH 125 WITH 1500 GALLON SEPTIC TANK IF FAILED, DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE _ SOIL ABSORPTION SYSTEM (SECTION) _. 4) INSTALL INLET & OUTLET TEES W/ _ BOTTOM OF TESTHOLE' EL: 66.92 GAS BAFFLE AS REQUIRED :1 (500 GALLON LEACH CHAMBER) GENERAL NOTES: SOIL"`_ LOGS x DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL - P#• '14836 NUMBER OF BEDROOMS: 3 BEDROOOM = NO ADDITIONAL'.FLOW PROP. BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: SEPTEMBER 30, 2015 SOIL TEXTURAL CLASS:. CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DESIGN 'PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS. _ SOIL EVALUATOR: DARREN MEYER, R.S., CSE' #1614 ' DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFlLLED PRIOR WITNESS: DAVID STANTON, BARNSTABLE B.O.H. = TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE ;, GARBAGE GRINDER: 'NO (not designed for garbage grinder) DESIGN ENGINEER. SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING TP_1 Depth Elev. TP-2 Oeoth FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Elev. ENGINEER BEFORE CONSTRUCTION CONTINUES. 77.92 0" q 77.96 0" (330) = 445.94 S.F. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. A LOAMY SAND ° 1 A LOAMY SAND LEACHING AREA REQUIRED: 10YR 3/1 {1 10YR 3/2 .74 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 77.25 8" ! 77.46 6" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF B LOAMY SAND w B LOAMY SAND HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. USE TWO (2) '5OO GALLON (H20). PRECAST` LEACH CHAMBERS W/ 4' -10YR 6/8 { tOYR 5/8 , , , , 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 74.59 C 40" 74.71 c 39" STONE ON SIDES & 3.75 STONE ON. SIDES: 25 L x 12.5 W x 2 D 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED MEDIUM SAND MEDIUM SAND BOTTOM AREA:• 25 x 12.5= 312.5 SF TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. PERC ® EL. 72.8 2.5Y 6/6 1OYR 6/4 ' 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 71.92 72" ( 71.78 74" SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. C2 I` CZ TOTAL SQUARE FEET PROVIDED = 462 vs.. 445.94 REQ'D 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. I COARSE SANG COARSE SAND DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 2.5Y 7/3. I 2.5Y 6/4 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PROPOSED SEPTIC SYSTEM UPGRADE PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 66.92 132" 66.96 132"13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 178 SANDALWOOD DR., COTUIT, MA 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN; ("Cl* HORIZON) Prepared for: Rice 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) NO GROUNDWATER OBSERVED Engineering and Survey by: SCALE DRAWN • 1, Darren M. Meyer, R.S., CSE, hereby certify-that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX &SONS,INC. N.T.S. DMM to conduct soil evaluations and that the above anal sis�has been performed b me consistent with the PO BOX 981 SHEET NO. y pe Y DATE CHECKED requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil;Eval. Exam in October, 1999. EAST SANDWICH,MA 02537 r 508-3622922 1 1/04/15 DMM 2 of 2' h ,