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HomeMy WebLinkAbout0091 SANTUIT ROAD - Health 91 Santuit Road - — Cotuit ✓ 1 -- - - -- - - A= 021 090 No. ' Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 7r PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for Di5po5al i§pgtem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4 1 �� 9_�_ Owner's Name,Address,and Tel.No. C'.OTU w Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms—� Lot Size 'ZX I (3,V'— sq.ft. Garbage Grinder ( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3Jt1 gpd Design flow provided 9 gpd Plan Date Z!R o0-6 Number of sheets J Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. Signe Date T .Application Approved by ate Application.Disapproved by: Date . for the following reasons Permit No. Date Issued Ip. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . . .PUBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes y R Zipplication for �igpogar 4, p5tem Con5truchott Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. Q I S4C�� R Owner's Name,Address,and Tel.No. Co`U Assessor's Map/Parcel V-, 111E11 /0 C/C- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size Z1 i 13.r_ sq. ft. Garbage Grinder ( / Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided 3y� gpd Plan Date ZS,200-6 Number of sheets I Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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.. Signed o..��l J ,a�.�, Date a Q4 T -0 4 Application Approved by �/ _ _, �� j/ ater�� Application Disapproved by: Date for the following reasons Permit No. (O /7 .0 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comphartce THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ('' ) Repaired Upgraded ( ) Abandoned( )by (lot,T at ���\ ti`c_ tZQ'U"C^ has een constructed in- ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ' dated Installer to t 4_-Z C� �g" Designer "So Cq�.. #bedrooms !7 Approvedfdes-gn-hion gpd The issuance of this permitsh not a construed as a guarantee that the syst�will fudesigned. Date %�{p //7 Inspect)or r --------------------------------------------- Nc. � Fee /11? THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Digogat *ppggtem Con5tructioH Permit Permission is hereby granted to Construct ( ) Re air ( ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constru Pion p ust •e completed within three years of the date of is pe. at.. 4 V Date r Approved by 1 '°'� Town of Barnstable Regulatory Services Thomas F. Geiler,Director NAB& Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# z5W6 Assessor's Map\Parcel -�1 0 Designer: Owv,- /fin Installer: Address: 9,3 /Ia4 Address: 3S &C ' On was issued a permit to install a ate) (installer) septic system at U CLvtu" based on a design drawn by (address) aw-0k. dated /a? Q 6 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ,SH aF r,�,yS Qcy �o ARNE H c� (Installer's Signature) oJALA 0 CIVIL N No. 30792 a °c FG�sTE?- aG (Designer's Signature) (Affix s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc S U r rlJ1/WI p r1 I LI . � - C HEil �EI I; 9'r 1 • I� o� 4 PI -I J GOB-' 6i/.z TOWN OFB/ARNSTABLE LOCATION SEWAGE ViT,LAGE OArZJl7 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO, /,��-,J,d SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 02 (size) NO.OF BEDROOMS OWNER PERMIT DATE: _Al COMPLIANCE DATE: ZF 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 leaF,Ja4,Qg facility) Feet FURNISHED BY C r3 0� SY'y � t �.�3'� G� o : � -, ,,,; a'j TOWN OF BARNSTABLE LOCATION �� 5,4ATi l7 0a SEWAGE # VILLAGE---C-09 ► ASSESSOR'S MAP &LOT 01 1' D�O INSTALLER'S NAME&PHONE NO. il _ PA C y `I°)S ' dv SEPTIC TANK CAPACITY i: < LEACHING FACILITY: (type) (size) 4``'? ± NO.OF BEDROOMS BUILDER OR OWNER 72�/T/y R-V"f63, PERMITDATE: �'1�'oa COMPLIANCE DATE: 3• Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �S� Dick y3° i 3> o No. FeeaL�J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Zigoar 6potem Con6truction Permit Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) Complete System [Individual Components Location Address or Lot No.?/ �����'� �, Owner's Name,Address and Tel.No. .mod.'-yaY`-sr�y_ Cv� / £ i ' Assessor's Map/Parcel �T le/js7- F2 Install is Name Address,and Tel.No. Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ®x �'£/®d,6C foq f.'— 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 Certifi- cate of Compliance has been isyq by this Board of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Z 1-1 Date Issued 4 s R!I� TOWN OF BARNSTABLE 3 i LOCATION SEWAGE # °vo• 5/�/ VILLAGE a-7—# yT , ASSE SSOR D /- O S MAP 1 0 , & LOT � INSTALLERS NAME&PHONE NO.__!L_[1 PA Al r o s�S •�p ev SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS C BUILDER OR OWNER PERmrrDATE: COMPLIANCE DATE: 3 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 2W feet of leaching facility.) Feet Ed a of Wetland and Leaching Facility-, g (If any wetlands exist within 300 feet of leaching facility) j' Furnished by Feet 4 J r o - NO. Fee 54�-Q°`I� (( THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC.HEALTH DIVISION -TOWN OF ,BARNSTABLE., MASSACHUSETTS j 0[pprication for Mioozar *pgtem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System [Individual Components Location Address or Lot No.Q/ �'}�' �� Owner's Name,Address and Tel.No. '61,iP y;p'- Assessor's Map/Parcel -^" 021-6 Y10 7/ �r #7Vt7 f) n.14,1 ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. mid r.4A000 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) 4. Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil s, Nature of Repairs or Alterations(Answer when applicable) t 40X t~foq f x.!; Date last inspected: J 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 Certifi- cate of Compliance has been iss by this Board of Health. cs- Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No.Zorno — / Date Issued 17 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CE TIFY,that the On-site Sewage Disposal System Constructed( )Repaired(„t*l Upgraded( ) Abandoned( )by ,�,6 rw*cG '' ,fo 'e w - ko e- - v at e 5X M70/"r of 2) has been constructed in accordance with the pro isions of Title 5 and the for 'sposal System Construction PermitV /�,':� dated ' Installer Designer . The issua ce of this pe ' shall not bee.construed as a guarantee that the systetrk'ill function as d gned/�, Date a✓ ! { Inspector 1,�1,I ?.: t !.,� _ r c;' ---------------------------- --------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwi.gpogaf *pgtem Conotruction Permit Permission is hereby granted to Co ct( )Repair W)Upgrade( )Abandon( ) System located at A1,40 '//T 403 P"!✓-7—w/7— and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of hii rmit. Date: �` �` l� ApprovedY'z n G COMMON WEILI, 11, OF NIASSACHUSETTS �. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS D.EPARTMLNT OF ENV]-IZONMI,N'CAI,P.RO'1'.EG'I'ION k _ ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXF, MAR 2 1 20 Secretary 350 MAIN STREET f: 00 ARGEO PAUL CELLUCCI WEST YARMOUTH, MA OFg, N DAVID R S'I RUBS Governor e 508-775-2800 Nn10�T` CE Coninusaioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION MAP 021 PAR 090 PROPERTY ADDRESS: 91 SANTUIT ROAD, COTUIT ADDRESS OF OWNER: DATE OF INSPECTION: MARCH 8, 2000 EDITH HERBST . NAME OF INSPECTOR : JAMES D.SEARS I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME. A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 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: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: MARCH 9,2000 The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(W) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the.buyer,if applicable and the approving authority. NOTES AND COMMENTS: SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. revised 9/2/98 1 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION(continued) Property Address: 91 SANTUIT ROAD, COTUIT Owner: HERBST, EDITH Date of Inspection: MARCH 8,2000 INSPECTION SUMMARY: Check A,B, C, orD: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A 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 ND). Describe basis of determination in all instances. If"not determined",explain why not) 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 is failure:s imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): . broken pipe(s)are replaced obstruction is removed revised 9/2/98 2 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 91 SANTUIT ROAD, COTUIT P Y Owner: HERBST, EDITH Date of Inspection: MARCH 8,2000 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A 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)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 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 and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 91 SANTUIT ROAD, COTUIT Owner: HERBST, EDITH Date of Inspection: MARCH 8,2000 D]SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. 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 into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded 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%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any'portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS:N/A You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 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 information. revised 9/2/98 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 91 SANTUIT ROAD,COTUIT Owner: HERBST, EDITH Date of Inspection: MARCH 8,2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,including the Soil Absorption System,have been located on the site. X 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: X Existing information.Ex.Plan at B.O.H. X 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)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 f • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 91 SANTUIT ROAD, COTUIT Owner: HERBST, EDITH. Date of Inspection: MARCH 8,2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 3 Number of bedrooms(actual): 3 Total DESIGN flow N/A Number of current residents: 1 Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): YES Seasonal use(yes or no) NO Water meter readings,if available(last two(2)year usage(gpd): 1998 68,000/1999 74,000 Sump Pump(yes or no): NO Last date of occupancy: N/A COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: Gpd(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 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known)and source of information: SYSTEM INSTALLED 1985, PERMIT#85-77, NEW D-BOX 2000 PERMIT Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 91 SANTUIT ROAD, COTUIT Owner: HERBST, EDITH Date of Inspection: MARCH 8,2000 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction _ cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: X (Locate on site plan) Depth below grade: 12" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A How dimensions were determined ASBUILT&TAPE NOTE: OUTLET COVER UNDER DECK 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: N/A (locate on site plan) Depth below grade: 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: 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.) revised 9/2/98 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 91 SANTUIT ROAD, COTUIT Owner: HERBST, EDITH Date of Inspection: MARCH 8,2000 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction _ 'concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order Yes; No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X_ (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) - D-BOX IS NEW MARCH 9,2000.BOX IS 9"X15",T BELOW GRADE.ONE LINE IN,ONE LINE OUT. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) ti revised 9/2/98 8 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 91 SANTUIT ROAD, COTUIT Owner: HERBST, EDITH Date of Inspection: MARCH 9, 2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type: Leaching pits,number: 1 Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: 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.) ONE(1)1,000 GALLON PRE CAST PIT,PIT AND COVER 3'BELOW GRADE.2'WATER IN PIT.NO HIGH WATER MARK.NO CARRYOVER,WALLS CLEAN. CESSPOOLS: N/A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure,,level of ponding,condition of vegetation,etc.) PRIVY: N/A (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.) revised 9/2/98 9 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 SANTUIT ROAD, COTUIT Owner: HERBST, EDITH Date of Inspection: MARCH 8, 2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) II I revised 9/2/98 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 SANTUIT ROAD, COTUIT Owner: HERBST, EDITH Date of Inspection: MARCH 8, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater 51 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) USGS WELL DATA. WELL SDW 253-51', ZONE C revised 9/2/98 11 No...� Fss.... .. .Q� THE COMMONWEALTH OF MASSACHUSETTS �� �1 - ® BOAR® OF HEALTH QOF...............r6 . .. .................... d Appliration for Diipusal Works Tnnitrnrtinn Prratit Application is hereby made for a Permit to Construct (4) or Repair ( ) an Individual Sewage Disposal *4 ....... at_.....�. fJ d . ................... ...........lr d ... �.. ...--••--•---------------.._........ Loc lion-Address or Lot No. a.....�s,x0. ac----------------------------------------- ------1:��J...h 0.:5�1��'�'r. br :11�iNt� %.... ------...s.�b. (3wner ' Address a ..............N.. ....... ....... (� ............................ ........-•--------------------•---••-----.............----............................------. Installer Address Type of Building Size Lot.................... .....Sq. feet V Dwelling-1--lClo. of Bedrooms...._. .................................Expansion Attic ( ) Garbage Grinder ( ) U-, Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ...................................................................................................................................................... W Design Flow........Jr ..........................gallons per person-per day. Total daily flow-----------� �_-------._._____.__.gallons. WSeptic Tank—Liquid*ca.pacity.lU�gallons Length..e..ka Width._..../®_Diameter________________ Depth.r`!." x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.__._........._.__._sq. ft. Seepage Pit No.....__.-_1_._____-- Diameter....®!5..... Depth below inlet....6._-......... Total leaching areal �< sq. ft. �s,�:D. Z Other Distribution box (K) Dosing tank ( )Percolation Test Results Performed by.............0_ C>__ ....U.J.t"¢�h C......... Date....U/17.1 ey........... 4 .. Test Pit No. 1______ ___ _minutes per inch Depth of Test Pit.���........ Depth to ground waterl-2_4.....H.2_o fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.'!�6! 4 a ----------------------------------------------------------------------------•-•-......----•-------....-------•----...............----•------•----------•----- Description of Soil....... �.... V ....--•----•----•-•--•-••--•---------------•--•..........--------------------------...•--......----••--•-----••-••--•---------•------------...--- 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 provisi 1 of'''I'l LZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operati t' Certificate of Compliance has been issued by the board of health. ` -Signed ---- :.. �_ ��� 1 Date PPlication Approved By.....- ••-- --------- - ............ .....I ��.�. . Date Application Disapproved for a following reasons---------------•------•-•---••---••-------------•----------------•---------------•-----------------•-••••--...--- ................................................................•----•----...---------........-•----•------------•------•-----------•-•-----------------•-----•--•----------•-----------•----••.......-- Date Permit No....--- .............7.......................... Issued_...........1.... ?� ... ........... Date ----------------------------------- --------- �z..�.. .tY No-95. — .7 .w Flcs....................p LTH THE B®AIZ®AO . OF!—I HEALTH MASSACHUSETTS ,� �tratta�a t f or iiiVoo al Works Tomitrnrttnn. Famit Application is hereby made for a Permit to Construct or Repair .an Invidual Sewage Disposal System at �n......W f . .................... Lo tion-Address c7 ?! .....-•----------------•-•--------------- ..-----. ---......---------.... .-- ...... ..... - -......._ �y� a .............i:.k+_ .............................t 4 V1 ress • Add .........................._ Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling-t'�Vo. of Bedrooms...........:................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures --------------- --- ------------------------ ----------- ----------- '4 Design Flow.._.... 'v ._._.._._... gallons per person � dy Total cj�>j�Oflyyw._._.._. W571�50 `� opt WSeptic Tank—Liquid capacity] gallons Length................ Width.... ... . Diameter................ Depth................ x Disposal Trench—No............:........1V1�ldt� Total Length 49........ Total.leaching area.__.. sq. ft. Seepage' ee a e Pit No.. 1 -- Diameter �-_� Depth below inlet...��._.._...... Total leaching ar ,�. � .sq. ft. %�"P g. P g ems• e ' Z Other Distribution box;(K) Dosing tank W Percolation Test Result Performed by.. ......... .. ....... lVe/m Date.... ' Test Pit No. I................20 minutes per inch . Depth of Test Pit- �� . Depth to ground water p fwaterC.ut.r s, Test Pit No. 2................minutes per inch Depth of Test Pit..........._._..___. Depth to ground __........__..._......... D Description of Soil..... %.. ?.. ........................................ x ..........................................................V t ...--------------- ----------- •-------------------------------------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 provisi i of'"ITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operatio t'1j Certificate of Compliance has been issued by the board of heal . ..'2- Signed •••• -•- 'a '+t� ate PPlication Approved By ......................... ___ Date Application Disapproved for a following reasons---------------------------•--......-••-•--•----......----•-•-----------•..... ::-....................... ® Date Permit No.------ .p _.__l.. -• Issued_------1:. :; .._... ----...------ Date:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... (9rrtifirdr of ftuntlrliFanrr THI IS TO CERTIFY, That the Individual Sewage Disposal System constructed l ' or Repaired Installer- at..........- - -�f ..... - ------ has been installed in accordance with the provisions of TITLE 5 of The.State Sanitary Code as described in the application for Disposal Works Construction Permit No........ ............. dated.......17.a-s' ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE . SYSTEM WILL FUNCTION SATISFACTORY. DATE.........37�:"I-�.- ..................... ... y� -----.-•-- Inspector........ "¢ ............................. 4 . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..OF..................................................................................... O0 No...4. �"._.t..7 FEE--- 50 . �• � � �i��rr�aa irk �nn�trnr�ilan �erntf ..... Permission is hereby granted � E')r........... h.h..1... ••-••-••-•-----••-...- ................. to Construct ( or�Repair ( an I. divi ual Sew e Disposal S st at No.......... c� C i ' . . ........ s W .--•---..••.•---..•-••-•..-•.--.•••...............•••.•--.••--..•.•- . :, Street as shown on the application for Disposal Works Construction Permit o..�". Dated.._....___.....5�'_�.+P ....... Board of ealth DATE......... -•-- 3...•0--------------- -------== FORM 1255 A. M. SULKIN, INC., BOSTON ' a L.0CATION j � 5 SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME- ADDRESS `}r�k"''a B U I L D E R 0 R OWN ER a $ VA DATE PERMIT ISStIt:ED ,. 2 � S g DATE COMPLIANCE 'ISSUED <3- 4`"`� r GAR 'x �' ooG-vqt d° � 9C, TOP roj"P eL c)5.00 -- i 90- 1000 GAl - 88 91.00 � 90.23 E?lo 90.75 TAn1K 90-40 WA5*4eP - 84 No 8Z So 8Q.co75 I t — 1 - _ ------ -- - - -- i_ ti0TE — - - --- -- e xl5tin,c� 9r'ovnd Pr-oF1 !e EXT�,�,':� "q4- L- F) PPL!G--- t31 .HOAR10 SC,9L / _ /O --- S � CT- 1 o � -- — V �e T' S �- �9 E / = /O' r?A,VHOL E �CoVERS TO —` - '--- -- Pr-oPosed c�rovnd Profile /2" OF r !�/iSNED G �AG� E . S C Nc D. 4 0 P ✓ C. O,2 ----- E Q UfaC ;ri SE P T,c Cr?n 1 n i rn c,,rn X4- 2 Cr.J 5TA ICE \ LOT 3Co e c D/ST BOX ° e d1Q.-- e • . of• /OOO _ Sc:�T; Tf� �J/C 20 � 3/[j — ��2v 0,5 ° ° ° • `�� 7 -- G��.. — ki S.1 4 I I - _ LE f� CH A-r1T J °1 S c F�C E T- 9S•o pL;ELL . 111 1918A !' ;" LJW 1 1 A ! - 33O 't _S I'Df3"k- ELE EPTI-� 89.3 GAC'AGE T�ti �_ 330 495 90. -- _--- LOAM E- 88.2 StJB5O1L ,4. - - 93.7 7. Z 1c00.00' g9 LOT S4 SArJD I i 'A4 A./ r / /, ,-- -a^,/ r ,r. LOT 35 S A►,1TJIT 20AD 60-TLJIT 1=3t 2- eJSTA$LE) }'L Ar l SOOIC Z 7 1 PA.6 1- S(� f3fiC,E� ,fJF_ c�v� •� "f= / �F:�J7S c�F r f /F _r��•JAJ of S3,&X.JSTAISL� A STESE- 1,-4Li Too ) #4f74 �f�. r rt'.t• > r1 I f `J I IS A O �� /`3 C - 1 �' f r-F' el- r �S I t SYSTi M-'- PROF 1 TES TOP FNDN. AT EL 43.6' LOCUS ACCESS COVER TO WITHIN 6 OF FIN. GRADE (NOT TO SCALER ACCESS COVER TO WfWtt r OF FIN. GRAM- 1. DATUM_ IS APPROXIMATE NGVD ACCESS COVER (WATERTIGHT) TO O 43.5' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6' OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING 2% SLOPE REQUIRED- OVER. sYST€M I3:T g 2" DOUBLE WASHED PEASTON " RUN PIPE LEVEL OR GEOTEMLE FABRIC. 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. FOR FUtST -2! **ExIsnNG 1000 f 3' MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO GALLON SEPTIC �4Q•3� H- 10 �o 12}J55! (TO BE RELOCATED) GAS , .74► 39/95M .99 5. PIPE JOINTS TO BE MADE WATERTIGHT. BAFFLE 40.16 0000 0000 , a 34:84� 0-10.C7fD I. C3 00pQ Q SLOPE) �6" CRUSHED STONE OR MECHANICAL 0 l� 0 0 C� 0 0 0 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH school COMPACTION. (15.221 [21) 2' C3 0 C3 0 E3 Elm 0 0 MASS. ENVIRONMENTAL CODE TITLE V. DEPTH OF FLOW - 41 37.94 cotuft. TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO Ba s �a" BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. INLET y OUTLET DEPTH - 14" ( 1 7G SLOPE) ( 1 X SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Buff ' LEACHING 5.14' 9• COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FOUNDATION 18 SEPTIC TANK 14 D' BOX 7' FACILITY, WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION SCALES 1" �aaa'_ - OBTAINED FROM BOARD OF HEALTH. *THE. LNSiALLER SHALL VERIFY THE **THE INSTALLER SHALL CONFIRM MIN. 10. CONTRACTOR SHALL BE RESPOUSkBLE FOR CALUNG ASSESSORS MAP 21 PARCEL 90 LOCATIONS OF ALL UTILITIES AND ALL SEPTIC TANK SIZE AT 1000 GALLONS AND DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION BUILDING SEWER OUTLETS AND ELEVATIONS ITS SUITABILITY FOR RE-USE -BOTTOM TH-1 EL 32.8' OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO LOCUS IS WITHIN AP OVERLAY DISTRICT PRK)R. TO. tNSTALUNC ANY PORTION-OF SEPTIC SYSTEM COMMENCEMENT OF WORK: 11. EXISTING LEACH PIT %+ALL BE PUMPED AND FILLED WI;TH-- LEGEND CLEAN SAND OR PUMPED AND REMOVED. LEGEND 12. EXISTING"SEPTIC TANK TO BE'R`E-USED AT ELEVATIONS' 100.0 PROPOSED SPOT ELEVATION SPECIFIED. IF TANK IS FOUND TO BE UNSATISFACTORY FOR 6 RE-USE.:REPLACE,WkTti A 1500 GALLON- SEPTIC TANK TO, +100.00 EXISTING SPOT ELEVATION /� ELEVATIONS AS PER PLAN. -0 / �j 13. 'Aft ` Ui�fSUtT'AB`LE MATERIAL EFtCOU�tTERET3 SffALL BE 0- 0PROPOSED CONTOUR k6/ p� REMOVED 5' BENEATH AND AROUND THE LEACHING FACILITY. EXtsflNG CONTOUR. � moo•�, �67 SYSTEM DESIGN: w -EXISTING •WATER LINE 100% RESET EXISTING S:T., TO BE GARBAGE DISPOSER IS NOT ALLOWED RELOCATED ' O. EXISTING. LEACH PIT DESIGN FLOW. 3,BEDROOMS 0-114 GPD 330 GIRD co DMH EXISTING DRAINAGE MANHOLE COVER ^• 1� USE A 330 GPD DESIGN FLOW gyp' SEPTIC TANK: 330 GPD (2) = 660 TEST SOLE. LOGS. a **RE-USE, EXISTING 1000 'GAL SEPTIC TANK / gyp• � ENGINEER: DAVID. FLAHERTY, .R.S. LEAC>•IING: TFt-2 WITNESS: DON DESMARAIS, R.S. BENCHMARK: .�" ' - DOING OH WIRES SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD -- DECK DATE AUGUST 25'. 2006 NAIL IN 12" 'OAK / �. ¢`3T- -� �/ ; BOTTOM 25 x 12:83 (.74) = 237 GPD PERG..RATE = < 2 MIN/INCH El = 45.9' i ' EXISTING PROPO TOTAL 472 S.F. 349 GPD CLASS I SOILS P# 11402 � .�- rp ADD 0 � OR R F WELLING � �'") ��b 0 F DN �� / USE (2) 500 GAL LEACHING CHAMBERS =EL.. 416' �' /' ' (ACME OR EQUAL) WITFF 41" STONE ALL AROUND " ELEV:. " - zrt_ , ELEV._ . . /GARDEN. } ---42 / � �L LOT 35 / 43.8 0 44.0 - �. / 21;135 SFf Q � Q I A A Ar3 / LS LS MA l DYER 4/2 10YR 4/2 APPROVED DATE BOARD OF HEALTH 7w, 43.2 8" 43.37 _ �¢�!� / r , A; LS LS �/ /' f / DIVE �� / 23" 10YR 5/6 4t:9' " 1 OYR 5/6 . 11 5 SITE PLAN, OF C / / � ` / c i -�39' rI 91. S-ARTUT R.D.- .Pmc rvrs r _ � I oMH (COTUIT) BARNSTABLE M Ms T �.36 Q 00 "' PREPARED FOR 10YR 7/4 10YR 7/4 % KE V IN MAMLOCK off 508-362-4541 fax 508 362-9880 / I H OF4%. DATE: AUGUST- 29, 2006 down CO' e engine eerie ll7 c. ; °�� ARNE hR• 9�yG ��ZO f F s 132" 32.8' 120" 34.0' p 9 9� �s NO~GROUNDWATER Cl VIL EIVGll =S _ _ OJA �` °�� ARNE 9cy�N ROU ATER ENC"TERED Scale:1" ' 20' C H. � LAND SURVEYORS No. 7 333 Main Street - YARAQOUTHPORT_. AMASS. 2 Pad OJALA y No.26348 DCE #06-187 0 10 20 30 40 50 FEET DA ARN si �\ .E., P. �aa Oar lgHQ SS SVE�O� 06-187 MAMLOCK.DWG (DDF)