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Home My WebLink About0561 SANTUIT ROAD - Health 5 61 S antuit Road C,otuit 1 TOWN OF BA.RNSTABLE 1 C.I.C)CATION JCo S/-�nTGi I 1`C' SEWAGE # ;VILLAGE C rrrUr�^ ASSESSOR'S MAP & LOT 04r7 Zook INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /6 LEACHING FACILITY: (type) I'iT (size) NO.OF BEDROOMS f I BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A GAtASt, FronT , O a B i Wo aa- 3 a /g 3a- 3 �1 Flo '-LOCATION5yry�`� �d SEWAGE PERMIT NO. ;VILLAGE INSTALLER'S MA ME i ADDRESS _ J04A7 R / a// 1 /S"b BUILDER OR OWNS 4, /Ylo Lot/ �t DATE PERMIT ISSUED 41._:2 -- 3/ DATE COMPLIANCE ISSUED_ e � r � e No........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... ------------.....OF............................................. ..................................... Appliration for Uiiipoiial Workii Tomitrurtion Vamit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: )-&// "-,/- ............................................................................................... .................................................................................................. 'L * Address a q -_:� — - Otto,A 1Z s 4� ........................... ....................... ......................................... W al tdd.�r 4 mot ............................... ........................ .......................................................................................... ...... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of.Bedrooms-______ ........................... -----Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures ....................................................................................................................................................... Design Flow...............:............................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length_ _-__ Width.................Diameter................ Depth............. Disposal Trench—No. .................... Width_._........_... Total.-I.,efi, leaching area....................sq. ft. Seepage Pit No..................... Diameter.._._............... .DepH below inlet.....__............. Total leaching area..................sq. ft. Z Other Distribution box Dosing tan Percolation Test Results Performed'.-ty................................................................... Date...................................... Test Pit No. I................minutes per inch Depth of Test Pit------------------_ Depth to ground water------------------------ f� Test Pit No. 2................minutes per inch Depth of Test Pit.......__...___.._.. Depth to ground water..._._........_......... ........................... .............................................................................................................................. 0 Description of Soil............................:�"o. .......................................................................................................................... U ........................................................................................................................................................................................................ ..........................................................-------------.............................................. ------------------------r.. i�"--------------- -------------------------- U Nature of Repairs orAlterations—Answer whep applicable------tjW. !��------ Z2 ....... 00 .-fV5/4-3......... ...... ........................... ................................................................................ Agreement: 7 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI_7'�L- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee i ed,.y the board of,4ealth ..............Signed............. .... _ board of .............. .... ...... Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:...........................................................I...................................................... .............................................................................................. ........................................................................................................ Date PermitNo......................................................... Issued_....................................................... Date No............� Fimim ......_-.- ................. A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................... ._. ......._.....OF....................................... ............................................. Appliratinn for Uii#nna1 World C ontitr tr#inn ratuff Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat: �,,// C or/�f��...-----•-••....................... ....J.i--•--............---........................-----•--•- ----...------------•----•-----....---•---......_........-----------•---�-------------•--------- ffLocati Address /moo oot o. �^ L W [ 1Y► ow /G. '0 f/��Ill /i e!/Tdd✓ a ' ....................... ..................................................................................•--------....... Installer Address d Tv pe of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures ----------------------------- - W Design Flow............................................gallons per person per day. Total daily flow..............._............................gallons. WSeptic Tank—Liquid*capacity------------gallons 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--___-_--__-_______-_--. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------ ---- -- ........................................................ DDescription of Soil----------------------------S apl� •--•------.........------•--••-------•---------------•-----------------•-------.......................................... W ._---•_____________________________________________________________________________________________•---_. -_---_ -----------__ -------•-•- UNature of Repairs or4lterations— wer when �plicable._.... �w a-0 _"J�` f t ��._.�«....... -•---•-•-•--------•-••••--•f .�I ------------ ---------- o s�f......-'7------�DQG► t..T 4-/l,�oG ,rr . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:TT p S of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be Is ed y the bo rd of lth- *. Signed---• .... • ••-•----••-----•-•----.......••-•------....-••-••..................• ................................ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:---•----••-•----•--•-------••--•---•----•-----------------•-----•--•--------•--•-------------•---------------- --•--------------------------•---....--------•--•--•---•-----------......-----••----=•-•=•-••-••••--......----•-•••---••--•--•-••-----••••-------•-----------•----•-••-••-•----..._......-•••-••••-•••- Date PermitNo......................................................... Issued....................................................... Date THE. COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cprrtifiratr of Tnntplittnrr T IS S TO ERT F ', That the Individual Sewage Disposal System constructed ( ) or Repaired In tall r. ------------------ has been installed in accordance with the provisions of TI7 j of The State Sanitary Code as descri d in the application for Disposal Works Construction Permit No._ .._.../_----k....... da.ted....._:_�`__�__..._. ......_........ THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT,BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY r w. f f Ins DATE................................ ... Inspector .---••---- - <p� � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT .........TjOP...�.. . ..........OF...........f FV................... .. ............. ........ ...... No.........../ FEE....Y.-•...... in�rn 1 nrkn _ :nn inn rrnnf Permission is hereby grante .._ _ .._ � to Construc -)/ r Rep ir` n Indio .u Sewage Di[ '°sal Sys e;n / r + at No.-- V�✓y!_f '� _ ::-. .................../__ 'ss_. G G�t!.�...� ! Street � / as shown on the application for Disposal Works Construction P rm- No. ; __ _.. Dated...... :.................-.............. �/ •► ,. Boarc16::2tHeaI DATE.........1.. i`.......--•---•--..........•--------•-••--•-•=----------• e' FORM 1255*`HOBBS & WARREN, INC., PUBLISHERS 4 1 7- 7 P/-<0 F LE I<E X AI,4 "Ell 174 17 4)1-1-1 0 RA A/r- 7u G. s 0 IR v ,, 7: OAVOA71C)AI 2 5 ,f,t I t-)/ . 1 .1 271 3)i�-O VA L 0 <V 0 WZ-TO /<'Al o AVL 70 At' f7- 7- Av 3 S-,r"Ej goo -0 7-7eg 4 -0 CALV. A N p - 40 J/VA L 0 R EIVE' 1-<N 0 Wl- 70 A/ c--Z.OATS ,4AIPM,4//v7-,e4/Al SAME 1AJ 0,E 7-A L CAY - L� $,:,A L .46A RAI,57?q 8,4,E- CC UN TY, MA SS SC,4Z—FS A 15 IE7,11C T A pZAAI--- OAr 111,97A,V LO.PY -r11-76.6F-R I A,'CF-e IV S9 1-0.4-7-,41AW,4Y Z78 Coca r-t e 4 fti COMMONWEALTH OF.MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTE` TIO 7 TITLE 5 , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSE MENKS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 561.SantuitRoad Cotuit, MA 02635 Owner's Name: Marianne Kelley Owner's Address: ST 3 Date of Inspection: October 19, 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Oste"ft MA 02655-0049 Telephone Number: (508)862-9400 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 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 Needs FuAer Evaluation by the Local Approving Authority Fails Inspector's Signature: y Date: October 23, 2005 The system inspector shall sub i a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of comple ' g 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 561 Santuit Road Cotuit, M.4 Owner: Marianne Kelley. Date of Inspection: October 19, 2005 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 CM 15.304 exist. Any failure criteria not evaluated are indicated below. I Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): r broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 561 Santuit Road Cotuit, MA Owner: Marianne Kelley Date of Inspection: October 19, 2005 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 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 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3.' Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 561 Santuit Road Cotuit, MA Owner: Marianne Kelley Date of Inspection: October 19, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"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 or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 561 Santuit Road Cotuit, MA Owner: Marianne Kelley Date of Inspection: October 19. 2005 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: Yes No ✓ _ 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(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 561 Santuit Road Cotuit, M.4 Owner: Marianne Kelley Date of Inspection: October 19, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 ` Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 7/17181 -per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 561 Santuit Road Cotu_it, MA Owner: Marianne Kelley Date of Inspection: October 19, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) I Depth below grade: 10" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 Qal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 5" 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: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any-sigans.o leaka e The steel inlet cover was 3"below Qrade GREASE TRAP: None (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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 n Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 561 Santuit Road Cotuit, MA Owner: _ Marianne Kelley Date of Inspection: October 19, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alann level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: J (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 level. No solids were present. PUMP CHAMBER: None (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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 561 Santuit Road Cotuit, MA Owner: Marianne Kelley Date of Inspection: October 19, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: _I-6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: i� 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.): The leach pit was dry. There did not appear to be any signs offailure The bottom to rade was 9 5' A video camera was used to inspect the pit. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY: None (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.): 9 Page 10 of 11 . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 561 Santuit Road Cotuit, MA Owner: Marianne Kelley Date of Inspection: October 19, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A GAiAj,- FrOA _3 a B �r ` as 3 a (g 3a 3 a� /o 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 561 Santuit Road Cotuit, MA Owner: Marianne Kelley Date of Inspection: October 19, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours mans Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours Wraps the mans were showing approximately 25'+1 to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 Fee—_�_------------ BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYicationArMelt Con0ruction'Verm- it Application is hereby made for a permit to Construct ( ), Alter ( )., or Repair (j.,,-an individual Well at:+ Lt Location — Address Assessors Map and Parcel SG Co A4 (' Owner rr Address cam`-'-------------------- Installer — Driller Address i f Lc C, Type of Building Dwelling—lLa'-f-C---------------------— --- - Other - Type of Building------------------------------- No. of Persons-------------------------------------- Type of Well Capacity--------------------------------- --—-- — Purpose of Well -------------- Agreement: The undersigned agrees to install the,aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a CertificatZj ante has been issued by the Board. of Health. Signed - date Application Approved B = ------_ ------ ---------------- - -- — date Application Disapproved for the following reasons:--------------------____________—_______-__-_-_�__� ---_---- ----- - --_—_ --------------- date Permit No. — - ---------------------- Issued--------�,�--'-'r date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance 'THIS IS TO C�RTIFY, That the Individual Well Constructed { ), Altered ( ), or Repaired ( -4 by—� ____c�,.�,�_l/ -- --------------------------------------------------------------------------------------------------------- —_------ Installer at--s-------- -------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit i—,�--y— /,,Ve-Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector------------------------------------ - No.---------�--�---/ Fee-- BOARD OF HEALTH a TOWN OF BARNSTABLE Zippiitation-*rIftl Cootruttion3pernut Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (,/, an individual Well at: t -- Location — Address Assessors Map and Parcel ----------------------------------------------------------—------------—---------- -------------------- Owner Address ! Installer — Driller Address Type of Building Dwelling--```°"-f - - --- ------------------------ Other - Type of Building--------------------------------- No. of Persons---------------------------------------------------------- JC Typeof Well-`�-- --------------:-------------------------------------------- Capacity----------------------------------------------------------------------- Purpose of Well �o r c 7-+e_ it/ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificat;,�ance has been issued by the Board of Health. Signed----- -N"-�-------- --__�_------------------ date V (J/ Application Approved B =- -d�'� �- --------------___ _ PP PP rove ----------------- --�------------date------- 1 Application Disapproved for the following reasons:--------------------------------------------------------------------------------------------- --- ---- --'----------------------------------------------------------------------------------------------------------------------—- - ---- date ''� --- Issued---------'�___-� ` �" --- -Permit No. ----------------- ------------------ - --- -- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compriante THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ------------------------------------------------------------------------------------------------------------- at L --------------- --------------- ------------ - -- f f / Installer S �� Qti t,4 / cJ -fc7 !i� / — -- -- — -- — — — — — —has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction PermitXl�' -," 7; !�, -Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. i - DATE--------------------------------------------------------------------------- Inspector-------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con5truttionpermit ---- � Fee------------------- Permission is hereby granted C ___ -- ----------------------------------------------------------------------------------------------------------- to Construct ( ), Alter or Repair ('-)an Individual Well at: No. ___ --- - - - - -------------------------------- - -- - -- - Street as'shown on the application for a Well Construction Permit r'? �' . ------- Dated- -� No.--/EGA''"---,-'-----�------/ ----------------------------- ----------------- --------------------------------------------------- � � Board of Health DATE-------�=------------ - ; ------------------------ ' { LEGEND 9 uirements PROPOSED Design Schedule ELEVATION Leaching Area Re •' ExlsriNc q -- Edge of Pavement - tia y TOP OF FOUNDATION 58.5 -- -- - - Sewer Pipe s Rp�� 00 FINISHED BASEMENT FLOOR 58.0 4 BEDROOMS AT 110 GPD/BEDROOM 440 GPD W Water Pipe w -- �pP� �N FINISHED GARAGE FLOOR 51.0 ADDITIONAL 507. FOR GARBAGE DISPOSAL -NA--GPD - = - Drain Pipe �� ,�� < �O LOCUS SEWER INVERT AT FOUNDATION 56.0 r; Gas Pie -------------G Pi pe Manhole Cover F P� P �� SEWER INVERT INTO SEPTIC TANK 55.75 PERC RATE _ <2 MIN. / INCH (CLASS 1 ) l: � Catch Basin "' O�' SEWER INVERT OUT OF SEPTIC TANK 55.50 Water Gate F 74 GPD/S. . N y Q = y � a; SEWER INVERT INTO DISTRIBUTION BOX 55.42 LIAR 0. 6 Light Pole 2 P o g �� SEWER INVERT OUT OF DISTRIBUTION BOX 55.25 F1'-� G �, MIN. LEACHING AREA OF S.A.S. Utility Pole �- t...L� < SEWER INVERT INTO LEACHING SYSTEM 55.0 25 _ _.-- Contours errs^'" - o Spot Grade lU I O I <� �? BOTTOM OF LEACHING TRENCH 53.0 440 GPD/ 0.74 GPD/S.F.= 595 S.F. MIN. V Test Pit I I. ' `'' WATER TABLE < 45.2 PROPOSED SYSTEM I 532 GPD W/LEACHING AREA OF 719 SF ` LOCUS MAP GENERAL NOTES : ` NTS / ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH _ TITLE V OF THE STATE SANITARY CODE DATED -f ---- ------ ----- _-- MARCH 31, 1995 & ANY LOCAL RULES APPLICABLE. IF ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING ------ BY JOHN K. HOLMGREN P.E. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, • • _ rT-- ----___ °NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT AM-PS-ONa MILL RO A;_- �� FOR INSPECTION. FOUNDATION ELEVATION MUST BE CHECKED WHEN COMPLETED. THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN l APPROVAL BY JOHN K. HOLMGREN P.E. 57 N 42'13'20" E 884.14' N 42*13'20" E ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4" PVC, SCH. 40. I 125.00' �, J 250.00' j 55 _....__...-. [-}2.0-- 24.0' -� 12.0'. o EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING o TP 2 SURROUNDING THE LEACHING FIELD FOR A DISTANCE OF 5', PER 0 0 56s m 310 CMR 15.255. •'l` ` I CB/DH FND o „•. Z o 54 ........ EL .^ 58.13' 1. TOP OF C B EL=58 13 ASSUMED ASSUMED -- -- ^, -- N -- -- r -- - - - -- -- - - -- . -- -- -- -- I. -- 12' � PRIMARY BENCHMARK PROJECT BENCHMARK . - " FINISHED GRADE I -fir-- - _ \\/\\/\\/\\j\\j\\j\\j\\j\\j\\j\\j\\j\\j\\j` COMPACTED FILL LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND 36"MAX.- 9"MIN. //\\//\\//\\//\\//\\//\\//\\//\\//\\//\\// // // // /• -- D \\\\ \\ \\� SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE 1 2 ...::............-:::::-.::::.-:::. ,.:....::::::::::..:.-: m - I UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. 21.7' PEASTONE 5 .9 > , a a 3/4" TO 1 112 " DOUBLE _ zi. 2 .o' --I a a° WASHED STONE I O• ;:' PROPOSED %� w •""� AM 39 PCL 84 TO "` SECTION v6. ' SINGLE FAMILY' , " O ?t• r ; F` DWELLING 1�.0 { TOF = 58.5; p � � NO SCALE „ E i AM 39 PCL 87 o41 a O , C 0 lr w 25.3' I m CUL'TEC RECHARGER 331) 10.a'R f p, AM 39 PCL 86 50,000+/- SQ. FT. , ALL PIPES TO BE SCHEDULE 40 PVC 1.15+/- ACRES 57 .O. - Iv 56 55 I �y .. �" I.. 02 ► �� F Septk Design son a �- " o Cotuit, Massachusetts 375.00' w. 94 S 42'13'20" W PREPARED FOR AM 39 PCL AM 39 PCL 95 AM 39 PCL 96 Chris Kosaba TITLE Sanitary Disposal System BAXTER, NYE & HOLMGREN, INC. P #9870 FINISHED GRADE 58t TYPICAL SYSTEM PROFILE SOIL LOGS DATE : 10/19/2coo ENGINEER BOARD OF HEALi-H AGENT • NOT To SCALE JOHN D. KUCHINSKI DONNA Z. MIORA.01, RS BAXTER, NYE & HOLMGREN, INC. t TOP DATION TEST PIT 1 TEST PIT 2 Registered Professional V. FINISHED GRADE OVER TANK 57 G.S.E. = 55.9 G.S.E. 56.6 Engineers and Land Surveyors FINISHED GRADE OVER D. BOX = 57 FINISHED GRADE OVER LEACHING SYSTHEM = 57 0 0 A 812 Main Street, Osterville,MA 02655 87MIN. 3" (mi . A LOAMY SAND L,DAMY SAND Phone - (508)428-9131 Fax - (508)428-3750 4" SCED. 40 PVC : ... 2„ 10 YR 412 2" 10 YR 4 2 FIRST 2 (TO BE LEVEL) € (TYPICAL) 4' SCED. 40 PVC 9' (min) Cover s•t .� B B PVC or OL2 min 36" (max) Cover LOAMY SAND LOAMY SAND k GAS'BAFFLE 6" SUMP 4" SC „ :. . . FINISHED CONSTRUCT ACCESS 10" CI TEES ED. 40 PVC 2"Layer 1/8 to1/2" 27" 10 YR 5 6 24 10 YR 5 6 Q' 20' 40' BASEMENT - MANHOLE OVER INLET : FLOOR TO TANK TO AT LEAST :- . ,, • -•s •. .:. C C Peastone LEACHING CHAMBERS ,. :., :. - WITHIN 6" FINISH G 6" CRUSHED - Slope 0.005 min ;.: ¢ REINFORCED coNCRET STONE MEDIUM SAND MEDIUM SAND FOOTING 4" PVC O O O O • O O O O O O 128" 2.5 YR 7/4 117" 2.5 YR 7/4 SCALE:1"=20' DATE: 2/28/2001 •Y SOD O O O O O O O10, O O REV. DATE: REMARKS A 3 19 2001 REVISE WATER SERVICE 1500 GALLON SEPTIC TANK DISTRIBUTION BOX 5' MIN TO BE INSTALLED ON A LEVEL STABLE BASE TO BE INSTALLED ON A LEVEL STABLE BASE DRAWING NUMBER �- SEPTIC TANK TO BE INSPECTED & CLEANED ANNUALLY 7 OUTLETS REQUIRED No Groundwater Observed NO WATER ENCOUNTERED I CULTEC& RECHARGER 330 PERC ® 37" H:\2000\2000-94\civil\base\200094sp.dwg RATE= <2 MIN/IN 2000-94 4 I i s