Loading...
HomeMy WebLinkAbout0015 SANTUIT ROAD - Health ly5 Sailtuit Roael {,, ' - } COtult, tv i1 t w AsBuilt Page 1 of 1 0f - LOCAATION WAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS ^� I UILDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED H Ov i+ �k_c r. F http://issgl2/intranet/propdata/prebuilt.aspx?mappar=021084&seq=1 10/21/2014 L O CATION E W A G E PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS �}� ' t/Y) `'t= i Lry , . I UIIDE R OR OWNER DATE PERMIT ISSUED ' �4 �2G4-V DATE COMPLIANCE ISSUED ,+ I 1 1 i rf� � V t.. 0 F N. ��YV 30'.00 No..- --...- ..._....... Fxs.............................. THE COMMONWEALTH.OF MASSACHUSETTS O BOARD OF HEALTH w oa /4 ..............OF...... . ,,�4.2-. �. fL .....-.. Applirathin for Dispwi i Iforks Tonstrnrtinn 11amit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System,at: . ......_. �I..t �T••-• ............................................. � ........................... Location- ress r L No. a O Address 1 .. d� , •--•...-•:::............. ....... �----------- ---•--•-•-•--•---------.......----..... .................................... Installer Address Type of Building Size Lot-------90,,AQ0..Sq. feet �. Dwelling—No. of Bedrooms...............__�_______..............Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building No. of ersons____________________________ Showers 0.� yP g ---------------•----------•• P ( ) — Cafeteria ( ) Other.-fixtures ......................................................... ------------------ W Design Flow.................. �._.___pp.,------gallons per person per day. Total daily flow---_._.______._______��®_.___.___gallons. WSeptic Tank—Liquid*capacityl 0gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width..................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No........... ........ Diameter........ Depth below inlet.....5..... Total leaching area.... �_.sq. ft. Z Other Distribution box Dosing tank ( ) n f n /01 Percolation Test Results Performed by. 47ZZ-.f-. YE .__._.__1 :-J.�?!V -�"�Date____2 a Test Pit No. 1___._.Z.....minutes per inch Depth of Test Pit......1-Z.,.___. Depth to ground water...... ............ (i Test Pit No. 2................minutes per inch Depth of Test Pit......./Z.______ Depth to ground water----'--............... a --------•--•-•---------------------•----•••-•---•...•--••--•---.....------..._...••---••-•---••••....•--•-•-•-•---•---•-•••••-•••----••---•••••••••--••------ O Description of Soil....................... •-•--- ... - --- .... ---------- --------•--- ----------- U W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI U 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. Sig -d_ ''0 .. --af............. •---••--•---•-ate-•..... .... _ Application Approved BY = ..-� -;�---�--- -------- ADate Application Disapproved for the following reasons: -•--•-•--•-------------------- ---•--•-•-•--•••-----•-------•••-----•••--•----------------------•-------•...••--•---._......-•-----•__•- Date PermitNo......................................................... Issued._....---....•-••---------- ^ ^ _..--••-- --- -....------ Date a N No......................... FE$..........$30.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...---�10.t4J..............OF....... Appliration for UiipnsFal Works Tnnstrurtiun ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: Location ress or Lot No. Owner -------------•---_._-----•-- Address ........ ........................................•. Installer Address UType of Building Size Lot.......ZOAQOD..Sq. feet Dwelling—No. of Bedrooms.................Z.....................Expansion Attic ( ) Garbage Grinder ( ) PL, Other—Type of Building No. of persons............................ Showers Cafeteria Other fixtures ----------------•-------•--.........------ Design Flow..................��. ....... gallons per person per day. Total daily flow.._...........__.. �__ gallons. W `� WSeptic Tank—Liquid capacity.....? allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Vidth.................... Total Length.................... Total leaching`area....................sq. ft. Seepage Pit No............/-------- Diameter........!Z...... Depth below inlet..... '.5._... Total leaching area....:;� 1..sq. ft. Z Other Distribution box Dosing tank ( ) nn aPercolation Test Results Performed by.BAXxr---4___1.t� C_.....__4 JeAles r�Date....Z.........�gl............... ,...a Test Pit No. I.....Z.....minutes per inch Depth of Test Pit...... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit......./.&__.... Depth to ground waten...�!.............. a •------------------------------- -••--•...••••--. Description of Soil ----------------------------•------ ------ . .---••------.---•- 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 TIT12 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. Si d. `44.-. ( - - ate --Application Approved By...... . -----------------.-.-.- _ Date Application Disapproved for the following reasons---------------•--------•--------------------------------------...------------------------------...............-- ---------------------------•-•-•----------•-•------------•--...---•--------------•----.....-•------------'-----•--•-•--.....-----•---------•-----...----------------------•------•-----•••----•--••.••--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........../..Q..!lV.! ..........OF.............8A.!Z!..J�;a.3..L.dam.........--•--............... TrrfifirFatr of T.untplitanrr THIS IS T CE Y That the Individual Sewage Disposal System constructed (K) or Repaired ( ) bY-----•--------•••------�ohn a fei......-•--•-... .. ._ lot #41 Santuit Road, CT& i at......................................................................................... `"` � t .. has been installed in accordance with the provisions of TITIE 5 of The State Sa.niXary Code as described in the application for Disposal Works Construction Permit No......................................... dated-__ ---4�C__/.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................•----•----•-•----.......---------•-•-----...... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH'. 7sr ...................����4....OF..------. A"2CfJ,7/JJa.Lr ....... $30.00 ..... ........ No......................... FEE........................ Raposal Worka vcn rttr#i�an lernti# Permission is hereby granted..................JOhn Maf f@1 to Construct (;)t r.,Repairs( _)aq �03 luzj �evA ye Dis s System 1D �}l ST1 . a, tALU / at No -----it .. as shown on the.application for Disposal Works Construction P rmit o ..... .......... Dated..,Z ........................... Board o ealth . DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "S 1" L7A:1 Imo. SIQ4L� •T7,0, ntL>-( . i'�5-Zt=>ZO0Nk 1,.10 C••=AR"F�,oG.� C��1�.tD�1Z -�1 a: (2C7 �• , 1>&1 L:14 I`LOw _ t to -4 3 z 33O G•P-v `;c.�rlc -rA+--i►c = 33ov ISc % • 4-9� r2 G.P.D. ioZ.o AlUSE- t o 0� GAL-. Y .zlsp &L PIT - USE r, Gam-.. I l�CJ� J32 13 Z- SF 2.S = >"t�c7 G.P.D. O EXP• _ rW Ata r Srs'. 'c� t .o _ (( 3 �.RD.'' pp PROP ToTAf✓' �ESIGt1 = L(� 3 G.RD. V /ol.o�' 13 -T'oTQ L t�,a l L�f Fc.ow s 330 6.PD. MflGDLQTIOQ Z&TE �� Iv Zm tJ'OR ' ' I� • Q 86D. 40 .. �z 14 444 •ri A, ~ �4:v / fir• 1 ' �'� r { i Am it `TesT P. 205 ' �'G //} TOP 1-ND a 100.o t-loc. - 2�23�B t7 EG-/oo .i.. 4 P� .-Y :.i .', tuv.• 9'7.v �.:' LoAnp Roe 100o INV ' 4' 2' 'Box 4a•G SEPnC IWN. W. IW LEASH Cam• PIT a� t MOD wlr�t •� 54Alb WAu+ED 2 t 'STOWS 9Z.5 ..i •fi � I C;6QTtF1ED pLbT P_L./.atil FiZOF1 L ty Co Tu T . t IoGATto t t ! L!o Sc a,t_t= AL - (��� La 0 bAT 4= 2I2rjI8t . Alo -047- {�20 �� 4 , cGiZTi I=� Ts4A-r TI-iG 'Cw+ G Stlorvu ; t-i�.i_t=OtJ CvWvLPL`!S WInA TWA 51t)E-.t_IW� -OT AI M A►.lta -:ETLACIG �GQvtCEAAawT.; cF T�1� c Tower V-4� R[GIS-ct-tLmD t.Awo 5u2vaY(os ' TI-1t5 C7(_AI-1 1; LlOT ZA'SGV7 ; VL4 AN 0STUZV%LLr-- o MASS• e a IW,C►?Jl✓�Ca.�T �iu1= /1_ { Ti�G UFG'��Z"�i St�GWI.D APPI_1'C_Ah.l"T' t' �.(;t' (?,C- U">CI� Tc, 1�n 1'CC_MI�Ik- t,.oT t_IN� •� 014 tJ a:yT-0 r' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Santuit Road Property Address John and Hazel Newton Owner Owner's Name information is required for every Cotuit MA 02635 March 30,2012 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: II key to move your cursor-do not David D. Coughanowr, R.S. use the return Name of Inspector key. Eco-Tech Environmental ry Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town state Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority March 30, 2012 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspectorand:the system owner shall submit the report to the appropriate regional office of the DEP TF%e'briginal 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 add`,r`•ess�houir`tl e{system will perform in the future under the same or different conditions of use. IDNU P� I t5ins•11110 Title 5 Official Inspection Form:Subs ace Dis posal sposal System•Page 1 of 17 Co .monweg1iK of"Massachusetts -r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments N 15 Santuit Road Property Address John and Hazel Newton Owner owner's Name information is required fvr every" Cot" MA 02635 March 3Q,2012' page. Cityrrown. State Zip Code Date of Inspection B. Certification' (cont.) Inspection Summary: Check A;B;C,D or E'l always complete all of Section.D A) System Passes:, © I`have not found any information which indicates that any of thefailure criteria:described .in 310 CMR 15.303'or in 31.0 CMR 15.304 exist. Any failure criteria not;evaluated are indicated below: Comments: Inspector's Note==> 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, 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 dayr it was"inspected: No estimate or guarantee of system longevity is made:or implied by a passing determination: 9 B) System Condi ionally 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 ank(whether.metal or not) is,structurally unsound, exhibits substantial infitration or exfiltration or tank failure is,imminent. Systern.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 Q ND (Explain.beiow): 15ins a.11110 TAIe 5 official Inspedion Form:Subsurface SeWbge;pisomal System a Pagel oF17 Commonwealth bf=Massachusetts _ - Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form -Notfor Voluntary Assessrrlents 1.5:santuit Road Property Address. John and Hazel Newton Owner Owner's Name information is required for:every Cotuit MA 02635` March 30,201:2 page. City/Town a ::State Zip Eode Date of Inspection B:. Certrficatlbn (cont,) B) ;System Conditionally.Passes (cone) :Observation of sewage backup or breakoutor.high static water level.'.in the distribution-box due to broken or obstructed pipes)or due to a broken,settled or uneven.distribution box:System will :pass inspection_.if(with approval of''Board_of'Health): _ El 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 systern,required pumping more:tham4 times a year due to broken ar obstructed p pe(s):The 'system will pass'inspection if(.with approval of the Board;of Health); ❑ broken;pipe(s) are replaced` ❑ Y ❑ N ❑ NO (Explain'below): obstruction Is removed ❑ Y ❑ N ❑ ND(Explain below): x C) f(!q er.Evaluation is Required,by the Board of`:Health ❑ :Conditions exist which require further evaluation by the.;Board of:Health in.order determine.if the:system:is:failing.to protect pub[it-health-,safety or the_environment.. 1... System wlll.:.pass`unless Board of Health determines m 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 Ovate_r El Cesspool or prIvy iswithin 50 feet of a botde`rin;g vegetated wetland or a salt tnats4 t5ins _11110 Title 5'Offcial Insp&lion Foim`.Subsudace Sewage Disposal Sysfe'm`FPaga:3 of 17 Commonwealth;of:Massachusetts - -L Title 5 Official Inspection Form J _ Subsurface Sewage Disposal.SystOn'Form - Not for Voluntary Assessments �., 15 Santuit Road Property:Address: John and Hazel Newton Owner Owneft Name information is required for every cotuit MA 02635 March-30,.2012. page. Cityfrown State' Zip Code Date of Inspection B. Certification (cone) 2: S..ystem-will,fail unless the.Board of-.Health (and Public Water Supplier,if any) determines,that the system is functioning in a manner that pro..tects,the,public,health, safety and environment: ❑ The system has aseptic 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 ofa private water supply.well. Ej 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 certfed 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,ofthe following for all inspections: Yes No ❑ 0 Backup of sewage into facility,or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to.an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or.clogged SAS or cesspool ❑ Liquid depth..in cesspool is less than 6".below invert,or available volume is less than 1/day flow 15ins•11110 Tille 5'.0fficial Inspedion Form:Subsurface Sewage Disposal SyMein o Pag'eAof 17 I f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Santuit Road Property Address John and Hazel Newton Owner Owner's Name information is required for every Cotuit MA 02635 March 30, 2012 _ page. Cityfrown 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. R 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 11 of a public water supply well If you have answered"yes"to any question in Section.E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Olhctel 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 15 Santuit Road Property Address John and Hazel Newton Owner Owners Name information is required for every Cotuit MA 02635 March 30,2012 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes 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 gpd t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commcinweaith_of.-Missadhusetfs -- T'ifile 5 0fficiaI Inspection Form. Subsurface Sewage Disposal System Form -Not for Vol,untary`Assessments 15 Santuit Road Property Address John and.Hazel Newton Owner Owners Name information is required for every Cotuit MA 02635" March 30', 2012 page. Cityrrbwn State Zip Code:. Date;of Inspection D. System Information - 'Description: Number ofcurrent'residents: Does.residence`have.a garba9e grinder? ❑ 'Yes No is laundry on'a separate-sewage system?[if yes separate inspection'required] ❑ Yes [0 No Laundry system inspected? ❑ Yes ❑ No ,Seasonal use? Yes 0 No Water meter readings, 'if':available(1ast:2 years.usage(gpd)) 81-gpd Detail: 2010,;2011 Sump pump? ❑ YeSr 0 No Last-date of occupancy: 6 months:ago Date Commerciali.Industrial Flow Conditions: Type of Establishment: Design flow(based-on 31. CMR'15.203):' Gallons,'per day(gpt) Basis,of;design flow. (seats/persons/sq.ft,etc:); Grease trap',present? ❑ Yes ❑. No Industrial"waste holding farik present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11f10 Title 5 Official Inspection'_Form;.Subsuriace Sewage Disposal System•Pege 7 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Santuit Road Property Address John and Hazel Newton Owner Owner's Name information is required for every Cotuit MA 02635 March 30,2012 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: 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•11f10 Title 5 Official►nspedion Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth,bfi'Massachusetts _ Tithe 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not•for•Voluntary Assessments. 1.5 Santuit-Road Property Address John and Hazel Newton Owner Owner's Name information is required for every Cotuit MA 02635 Match 302012 page. Cityrrown State, Zip Code Date of Inspection D. System Information (cunt.); Approximate_age of-all components,,date installed (if known)and:source of information: Age: 31.years.,Disposw Works Permit issued 2/,26/1981 (permit# 81 75 , Were:sewage odors detected when arriving at,the site? ❑ Yes ' No Building Sewer'(locaie on site pi_an) 2 Depth below grade, feet Material of construction': ❑cast iron 0 40 PVC, ❑other(explain): Distance-from private water.supply well or suction line: feet Comments (on condition ofjoints, venting, evidence.ofleakage etc.): Sewer line appears structurally sound with no'evidence of leakage or backup into dwelling. Septic Tank=(locate on site plan): 0.5. Depth below-grade feet Material of construction: concrete ❑ metal ❑ fberglass ❑ polyethylene ❑ other(explain) lf�tank.is metal, list age;' years Is age.confirrried by a Certificate'of Compliance? (attach a copy of;certificate) ❑ Yes ❑ ,No 8.5 x 5;x.6-`1000 gallon tank Dimensions; Sludge depth 4 in t5ins•,11110 Title;5'Otficial lnspectionF,orm:subsurface Sewage Oisposal System•Page 9 of 17 Commonwealth of Massachuse#fs r Tiffe 5 Official Inspection Form. Subsurface Sewage Disposal System Farm -Not for Voluntary. Assessments 15 Santuit Road Property Address John and Hazel Newton Owner Owners Name information is required for every Cotuit MA 02635 March 30,,2012` page. CityTTown State Zip Code Date of ln'spedtion D. System Information (cost.) Septic Tank(coot,)" Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 4 in. Distance from top;Of scum to`top of outlet tee or baffle' 8 i'n Distance- bottom of scum�to bottom:of outlet tee or baffle 12 in; e Now 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.): Liquid level at outlet invert. Pumping not required at this.time, but maintenance pumping is recommended within and,every2 years,Tank and tees appear structurally sound and functioning as intended.No evidence of lea kage'in or out was observed. Grease Trap (locate on,site plan}; Depth bel.ow;grade-' feet Material of construction; ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness. Distance from top of scum to top ofoutlettee or baffle Distance from.bottom of scum to bottom of outlet tee or baffle` Date of last pumping: ate 151ns-11110 Titles OfreW Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts v,-- Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form-.Not for Voluntary=Assessments 15 Santuit Road PropertyAddess; John and Hazel Newton Owner Owner's Name information is required for every Cotuit MA 02635 March 30;2012 page, CitylTown State Zip Code, Date of Inspection D. System Information (cony): Comments (on pumping recommendations, in let,and outlet tee or baffle.condition, structural integrity, liquid levels.as related to outlet invert, evidence of leakage,.etc.); Tight or Holding Tank(tank must be pumped at.time of`inspection) (locate on-site plan): Depth below:grade;, Material,of construction: concrete [ metal' Q fiberglass ❑ polyethylene ❑ other(explain): Dimensions: :Capacity: gallons. Design Flow; :gallons per day Alarm present: F 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), ls,copy attached? ❑ Yes ❑ No 15ins•11110 -Title.5 01ficial lnspk ion Form:Subsurface Sewage Disposal_System Page 11 of 17 'Com.monwealth:of"Massachusetts Title 5 Officinal Inspection Form — — Subsurface Sewage. Disposal System Form --Not for Voluntary Assessments 15 Sarituit Road Property Address John and Hazel Newton Owner owner's Name information is required for everyCotuit MA 02635 March 30 2012 requir page. CitylFown State Zip Code Date of Inspection D. System. Information (cont ). Distribution Box (if present must be opened) (locate on site plan): Depth of liquid Jevel.above outlet invert at outlet inverts Comments(note_ if box is level and distribution to outlets equal, any evidence of solids,carryover, any evidence of leakage into-or outof box;etc.)': D-Box appears structurally sound,and functioning as:intended. No evidence of leakage In or out was. observed. Some solids in sump. 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 Arid"appurtenances, etc.); Soil Absorption System (SAS) (locate on site plan, excavation'not.required): If SAS not located, explain why: 15ins•13110 Tille S Official Inspection Form;,Subsurface Sewage Disposal System+Page 12 of 17 • ' Commonwealth dif`�Massachuse'is Tit[6 5 Official Inspection For Subsurface Sewage Disposal S-ystem Form -Not for Voluntary Assessments 15 Santuit Road - Property,Address' John and Hazel Newton Owner Owner's Naryie information is required for every Cotuit mA 02635. March 30; 2012 page. City/Town State ZOp Qode. Date.of Inspection D. System Information (cont:), Type'. leaching pits, number.: 0 leaching chambers number::. leaching galleries number: leaching trenches: number; length: 0, leaching fields number; dimensions; overflow cesspool number: ❑ innovative/alternative system Type/name=of technology; Comments (note condition of soil,.signs of-hydraulic failure;.level of ponding, damp soil,:condition of vegetation, etc',):, Soils above feaciiing pit appear unsaturated...No evidence of surface ponding; breakout;lush vegetationi or other-evidence of hydraulic.failure was observed. An .observation hole was dug into leaching pit stone and no effluent.contact staining was observed in the stone or overlying soils. No standing:effluent was observed.to a deptir,of 2 feet below the top of the leach pit. Cesspools (ces"spool,must be pumped.as part of inspectfonj;'(orate on siteplar) Number and configuration Depth--,top of liquid to inlet invert Depth of'soiids layer Depth:of,scum layer` Dimensions of cesspool Materials.of construction indication of groundwater inflow ❑ Yes ❑ No t5ins. 11110. trt 5',Of tdal.Inspec ion Form:Subsurface,Sewage Disposal System-Pagel1 3.of 17 Commonwealth of Massachusetts Title 5 Official InS.pection Form Subsurface Sewage Disposal System Form -.Not.for Voluntary Assessments �.0 15 Santuit Road Property Address John and Hazel Newton Owner Owners Name information i required for every Cotuit MA 02635 March 30,2012 page. City/Town State Zip Code Date of Inspection D. System Information ,(Pont.) Comments (note condition of soil, signs of hydraulic failure, level of'ponding, condition of vegetation, etc.),: Privy(locate on site plan); Materials of construction: Dimensions Depth of solids Comments(note condition of-soil,.signs,of hydraulic;failure level of ponding,condition of vegetation, etc.). t5ins-11110 TMe 5 Official Inspection Form:Subsurface Sewage Disposal Syslem•.Page:14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °f 15 Santuit Road �s Property Address John and Hazel Newton Owner Owner's Name information is required for every Cotuit MA 02635 March 30,2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately tufte-k p tT e �v C�` 74. S wT u tT Ro(+D Wins 11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Santuit Road Property Address John and Hazel Newton Owner Owner's Name information is required for every Cotuit MA 02635 March 30, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 25+ 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. 2/26/81 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: USGS topo maps 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 4.5 feet above the bottom of a test pit in which no groundwater was observed. USGS topography maps indicate property is over 25 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Santuit Road Property Address John and Hazel Newton Owner Owner's Name information is required for every Cotuit MA 02635 March 30, 2012 page. CityrFown 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 15ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 :15'-MCIJ:::.4r2E:YA_CV __., ._._JSI. U NFOO.M_..__.._._.. _ . 1{ MEW ADDIttoN• II a fswEz:aur i I 71 Lx-� . t o.-) L �- A � O 1 . • ercclt�a- ---->zrtafNG:. ' it _ F ° 9.0 ltl rod 0 L--'t PtlLI�D°WN - ' LAUD - 1h0vER.�0 A1TAr. UyING ROOM I cfe , 1 I 1 0 4AAt*41L o RATt� v 1 tam v V I I 1--------- I - sQ -4LQOR. PLW SCAL6G- _he O" - LOT 41 i 55%4' --mL15ttwd CN6- 5•r02`C -VGJtrcV--ta.:F1ELR';" Is�to 72'-to" 3Et8" O ° General Notes: s � — 1.All work to be performed in accordance with Massachusetts State Building Code,780 CMR, I Eighth Edition,IBC 1009,and applicable codes included by reference.Framing to be in accordance with the American Wood Council Wood Frame Construction Manual,110 MPH IIG^ N Zone.All work to be as approved or directed by local authorities having jurisdiction. 2.Contractor to secure all permits,and to arrange for inspections by local authorities having NEW-AURlrlou n jurisdiction,as may be required. v 3.Work to be left in clean condition,ready for use and occupancy.All debris to be disposed off site in a legal manner. 126' ' 4.Contractor to install or upgrade all plumbing,electrical,healing and venting systems as . required,per code.Install and upgrade all fire protection systems per applicable codes,or as may gANTu�T. _CZO'hD be required by local authorities having jurisdiction,including smoke and carbon monoxide detectors. Andrejs R.Strikis Architect 85 River View lane,Centerville,MA 02632-Telephone_(509)790-0920 Floor Plan with New Addition 15 Santuit Road,Cotuit,MA 02635. o6 _a --z,n�RnoMf Poecrt-":_— -�SLu�Fy'Q -- ----------- r___----------T I D I L^ --- wN I : I - tk'A--efRnW -- � 4„ I 6.4 4.a' Jew — - UP 1 I - I I I "M-_ R9_QL�- M"rF7r� pub -3-T3— �a�-----��+f"-ter,a„- —_.`�.P��►.�Xl-�?1NCs_$Fl`zEM-�C'C---�L�12vST10�.1__— u i t I PEV3 -ioc fS=1'4: -- _-_ Andrejs R.SoWs :./n. Archited .I'�p".. as Rive view Imo,Cmovville,MA 02632•TdN> m'(5M MOM Eoundation_and Framing Plans 15 Santuit Road,Cotuit,MA 02635 L ,J i Certified Plot Plan in Barnstable , MA Address : 15 SANTUIT ROAD jPrepared For: T ler & Tra wick Buildin Co Assessor's Map: 021 Lot: 084 Baxter Nye Engineering & Surveying Community Panel Number 250001 0752 J, Dated 07/16/2014 Registered ProfesSlonal F.I.R.M. Map Zones: X Engineers and Land Surveyors Plan Reference: Plan Book 271 Page 56 Lot 41 7$ North Street, 3rd Floor Deed Reference: Deed Book 26758 Page 197 Protective Covenants: Deed 'Book 1852 Page 186 Hyannis, MA 02601 Deed Book 2315 Page 181 Phone — (508) 771-7502 Fax - (508)-771-7622 Owner: Valentine P. & Christine G. Foti Job Number. 2014-084 Scale : 1" = 20' Date : 10-31-2014 NOTE: LOCUS. LIES IN ZONE: RF. OVERLAY DIST: RPOD PARCEL 021-071 SALTWATER ESTUARY. PROTECTION N/F DUGGAN PARCEL 021-070 MIINIMUM REQUIREMENTS: BK 13927 PG 065 N/F WE RE LOT AREA 87 120 SQZFT N 31.53'20" E BK 10436 PG 256 LOT FRONTAGE �--150 FT 125.00' FRONT YARD 30 FT ---�5 REA 15 FT NOV �;,. PARCEL 021-084 20,000f S.F. � O0 N E _ APPROXIMATE ONLY PARCEL 021-083 PARCEL 021-085 Z EXISTING SEPTIC N/F LARSSON N/F DOHERTY BK 24544 PG 219 , BK 8169 PG 308 00 O O 0) � 00 _, (n O / 00 00 O . O 0 / 13.83 0 / 3T O PROPOSED to / ADDITION 3.67 / _ rm b �� / EXISTING LGASJ o I DWELLING #15 / AC EXISTING DECK AND STEPS TO BE REMOVED 17 5' LLEC, 15.9' 11 / Lj Oy PAVED DRIVE N \, Oy X X \ 125.00' S 31-53'20" W — — SANTUIT ROAD 0 WID TH VARIES I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE EXISTING STRUCTURES SHOWN HEREON IS IN COMPLIANCE WITH THE APPLICABLE BARNSTABLE ZONING DISTRICT SIDELINE AND SETBACK x�%: • ��, REQUIREMENTS AND IS LOCATED IN RELATION TO THE MONUMENTS SHOWN AND 1S NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. r l IvIA.I_LO N r-•,, A _� \n v n�Ly a:�, �l Jlftvj f- Y.dT REGISTERED PROFESSIONAL LAND SURVEYOR - BAXTER NYE ENGINEERING & SURVEYING DATE