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HomeMy WebLinkAbout0573 SANTUIT ROAD - Health 573 SANTUIT ROAD Cotuit A : 01 - 007 f Town of Barnstable Barnstable BARNSU` Regulatory Services DepartmentC�' MA�1639. 1. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4988 0213 March 23, 2018 JONIS, RUTH E TRUSTEE PO BOX 51 COTUIT, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 573 Santuit Road, Cotuit, MA was inspected on 03/07/2018 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Must relocate driveway or replace components with H2O. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH CEas cKean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\573 Santuit Road Cotuit.doc ` �* Town of Barnstable + AI pNSTIAf£_ 4 '"� Regulatory Services Department +679- ,b�' Public Health Division 200 Main Street,Hyannis MA'02601 0$ca: 508-862.4644 Richard Scab,Dircdar FAX: 508-790-6304 Thomas A McYzar�CEO Feb 6,2007 Rev. 5111116 DEADLMS TOREPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ �.n`(x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or pondiag of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis.*(This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool I y"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER -Repair deadline: _ Q:1sEPTIc1DEADLINES TO REPAIR FAILED SYSTEMS.doo oaf -oa�. d Commonwealth of Massachusetts r ,'�t Title 5 Official Inspection Form Ce,'f Subsurface Sewage Disposal System Form =Not for Voluntary Assessments J' 573 Santuit Rd Property Address Ruth Jonis OwnereO Owner's Name z information is Cotuit MA 02635 3-7-18 required for every 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. A. General Information 1. Inspector: r ,,. + . , ,► a T,, Shawn Mcelroy' Name of Inspector " Upper Cape Septic Services ,T Company Name P.O. Box 73 IF . • .; Company Address E. Falmouth MA 02536 City/Town State Zip Code 1=508-495-0905 S13971 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 15.340 of Title 5 (310 CMR 15.000).The system: ` ❑ Passes - ® Conditionally,Passes . ❑ Fails r ❑, Needs Further Evaluation by the Local Approving Authority + , 34-48 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t"H-10 D-box and,leach pit in driveway.** t5ins.doc-rev.6/16 o Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 1Afilcd VS Commonwealth of Massachusetts 4. ,. Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. City/Town state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ® One or more system components as described in the "ConditionalPass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): H-10 D-box and leach pit under driveway. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Oisposwl System•Page 2 of 17 Commonwealth of Massachusetts ;w Title 5 Official. Inspection Form , , 0 Subsurface Sewage Disposal System Form --Not for-Voluntary Assessments = ' 573 Santuit Rd t,; Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit m MA 02635 3-7-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) - ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if ' pumps/alarms are repaired. B) System Conditionally Passes (cont.): 4 ❑ Observation of sewage backup or break out or high static water level in'the distribution box due to broken or obstructed pipe(s) or dine to a.broken, settled or•uneven'distribution box. System will pass inspection if(with approval of Board of Health): ' ❑• ` "broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below): ''❑ obstrudion'is removed' " ' ' ' `` ❑ Y ` ❑N,' ❑ ND (Explain below): ❑ distribution box is leveled or replaced - ❑Y ❑ N ❑ ND (Explain below): 4 ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced - ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N. ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. " ` I 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 mannerwhich will protect public health, safety and the environment: ❑ Y Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts s r� 611 Title 5 Official Inspection Form ! ;i�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 573 Santuit Rd Property Address h Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ' • . - 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: , - . ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the a SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all•inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Fora N Subsurface Sewage Disposal System Form :Not for Voluntary Assessments "4 r 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit i MA 02635 3-7-18 ' page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No t ❑ ® Required pumping more than 4 times in the last year NOTdue 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,portionrof cesspool or.privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ [E Any-portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy 1 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 tsystem owner should contact the;Board of Health to determine what will be c 1k necessary to correct the failure., E) Large Systems:To be considered a large system the system must serve a facility with a design ,flow of 10,000 gpd to 15,000 gpd. - For large systems, you•must indicate either"yes" or"no"to each of the following, in addition to the questions in Section'D: Yes No ❑ ❑ the system is within 400 feet of a surface drnking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f.p r a l 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were•any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ' ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ' ❑ Wasthe 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 flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Y t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit - - MA 02635 3-7-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: } Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) r' Laundry system inspected? ❑ Yes ® No Seasonal use? El Yes ® No Water meter readings, if available (last 2 years usage (gpd)):, _ r Detail: Sump pump? ,, , ❑ Yes ® No Last date of occupancy: t 3-2018 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203):. ,,s• Gallons per day(god) Basis of design,flow (seats/persons/sq:ft., etc.): - s Grease trap•present? - r ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 4e Commonwealth of Massachusetts y Title 5 Official Inspection Form i b I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. City/Town 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: Owner--pumped within last 2 yrs Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? — y Reason for pumping: Maintenance 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. ❑ puler(describe): tFins.fim 4 iev:6/16 'titi@ 6 otflFfel Iiign nflon rot,l:SuhsviNom Sewage Oiproral:^ryofroi ry N of 17 Commonwealth of Massachusetts t Title 5 Official Inspection .Form .. 0 Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. City/Town t. State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known) and source of.information: 1980 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): t 3,, Depth below grade: 18" feet Material of construction: 7 ' ❑ cast iron ® 40 PVC , ' ❑'other''(explain):' Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 1•v 12" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ' ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate), ❑ Yes ❑ No Dimensions: 1000 gal -Sludge depth: 12 - t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I.,I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. City/Town State Zip Code Date of Inspection Q. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1". Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle -- - - Distance from bottom of scum to bottom of outlet tee or baffle — — - Date of last pumping: --- Date t5ins,dor lev,Rt16 wie fi otri^ioi rnim-$Ai orgri R-WAgy Dirpnn€il$ystpin raga 10 6 17 Commonwealth of Massachusetts + Title 5 Official Inspection Fora rf• Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ r1_.� , 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit { MA 02635 3-7-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet'invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): ' Dimensions: Capacity: gallons Design.Flow: , . ' gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): r "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts r� 4. ,wl Title 5 official Inspection Form I.I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is Cotuit MA 02635 3-7-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate•on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up from pit. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 ��°'•, Commonwealth of Massachusetts µ Title 5 Official Inspection Form ,1 ibi Subsurface Sewage Disposal System Form -Not for Vol u ntary'Assessm ents _��,✓ ;> 573 Santuit Rd Property Address a Ruth Jonis _ f Owner Owner's Name information is Cotuit j MA 02635 3-7-18 required for every - - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: w . ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 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.): Leach pit in good working order with water level at 18"off bottom of pit, and stain line at 24"off bottom. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form ,> ai Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins,doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts >s Title 5 Official Inspection Form' i,,l Subsurface Sewage Disposal System Form -Not for.Voluntary:Assessments. 573 Santuit Rd Property Address Ruth Jonis 1,..v.. Owner Owner's Name information is required for every Cotuit ►' MA 02635 3-7-18 page. City/Town r 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 117 Cr !:r 0 " t5ins.doc•rev.6/16 Title 5 Official Inspec5on Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form ;c�li. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 573 Santuit Rd 4 mil*'Ti% . Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain:. ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form: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 573 Santuit Rd Property Address Ruth Jonis Owner Owner's Name information is required for every Cotuit MA 02635 3-7-18 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist' ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 �� 5�' �� f � 1 V� , . --; t USPS TRACKING# .. If 1 it r! 3�. � �i.1i j1� {1 1 Mill First-Class Mail it Postage&Fees Paid � Permit No:G-10 f9590 9402 1933 6123 1784 77 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service - Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 I I I I I I. , ■ Complete items 1,2,and 3. A. Sign ture ■ Print.your name and address on the reverse ❑Agent so that we can return the card to you. .� ❑Addressee ® Attach this card to the back of the mailpiece, B. Receive by rir,%g5IF�f P)j- � C. Date of Delivery or on the front if space permits. �r 1• " ` '` D. Is delivA add s different from'em 1? Yes ,If YE enter elivery address belo • No JONIS,-RUTH E TRUSTEE MAR 2 9 2018 P0 BOX 51 CO UIT, MA 02635 3.I II I�Ili�l I8I ICI I II I II I I I IIIII I II�I OII ICI III ❑ dultSCgnatureTypeRestricte alive ❑Reyes Bred MatMail pRest®Restricted ❑Adult Signature 9,2635 egfstered MaiIT"' ertified Mail® elivery 9590 9402 1933 6123 178477 Certified Mail Restricted Delivery tetum Recelpt for ❑Collect on Delivery Merchandise �—A.t;,'--Nl.imh,-.r.ffransfer-frQm� ❑Collect on Delivery Restricted Delivery ❑Signature ConflrmationT SBN/Ce label) ❑Signature Confirmation 7 015 1730 0001 4988 0 213 `. ' Ed I Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 ' Domestic Return Receipt m •• • r-4 ru C3 'cCl Certified Mail Fee $ � Extra Services&Fees(check box,add fee as appropriate) -� -❑Return Receipt(hardcopy) $ ❑Return Receipt(electronic) $ �Q-'ostmark „� 3 ❑Certified Mail Restricted Delivery $ t Hefei 3 []Adult Signature Required $ y ❑Adult Signature Restricted Delivery L-3 Postage - m Total Postagi $ { JONIS, RUTH E TRUSTEE_ to Sent - ' ra To ( P 0 BOX 51 N StieetandA+ COTUIT, MA 02635 City,State,Z - ""'" :.r r r r rrr•r. Certified Mail service provides the following benefits: In A receipt(this portion of the Certified Mail label), for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. , USPS®-postmarked Certified Mail receipt to the •A record of delivery(including the recipient's retail associate. F' signature)that is retained by the Postal Service" Restricted delivery service,which provides L' for a specified period, delivery to the addressee specffied by name,or a to the addressee's authorized agent. Important Reminders: -Adultsignatureservice,whichrequiresthe lam* •You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). _ or Priority Mail®service. -Adult signature restricted delivery service,which- ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mall. and provides delivery to the addressee specified't ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal prodf of mailing,it should bear a� certain Priority Mail items. USPS postmark.If you would like a postmark on,y ■For an additional fee,and with a proper this Certified Mail receipt,please present your _ endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply ( , You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 J 'T )l3tN OF BI 1ST BLC LOCATION" 5 7 3 SBW. A0E V .,LAGC �� INSTAL '1-RR'S NAl!Jt��I'>�49NE NO SEI�I'tC 7CA1�11�CAP.�►CIT�C �.—!�� �. DMJI>.DE opt O Ik'.. I, 1RNdIT13A`TE CC1Pifi'U;1F,S�1C SaPL!"ion%'is tanGe Betvieen�tl�a' Maxi�aml }ustEdG�auiacfwate�'!'altetotlacHaitornufLeaGhin�pa ility. 1"cae l lv a 9K/at c Sad ly 11Yail did Leaahateg acYltfy tn�y,viel9s cxlst Few a� alto ac within�QA feataF loastuaig f�tc�ty) : .--�--�-�-�'---- cluc cy� { Wetland and:Leachtptt i�ncilitry IEr+y watland5 exgst zvitl�ui 34}0 fG ot`ledaUipg tuclk�ty) � � � ram. � _ �, � � a `� r ;l p � o i — -� I I i � � �� / _ �3 � �. �. � Y ���� � r (O /� 7 _ .365- _LOCATION 73 SEWAGE PERMIT NO. VILLAGE , t�, T/ / INSTALLER'S NAME & ADDRESS �r,4 sly 0 UIL0EIII OR OWNER Mg 3S, DATE PERMIT ISSUE0 7- DATE COMPLIANCE ISSUED xVUo S7- moo ' s.i a ` S�J _ e No..............._....... ..........................._ THE COMMONWEALTH OF MASSACHUSETTS 0 01lp01 � BOAR® OF HEALTH ' " ...............oF..... C-�...-..._.-_. ApplirFation for Diapaii al ork i Tomitratrttun Prrutit Application is hereby made for a Permit to Construct (. ) or Repair �4 an Individual Sewage Disposal System at: W- ��L r � �...7 3Z). 4•• i ocation-Add s or Lot No. -- ...... ........_ -----•-••----_--••----•- -----•---------------------------- ........-------------------- ---------------...---- ��� ne Address W ' .......... ..................... Installer Address UType of Building Size Lot............................Sq. feet Dwelling_=No. of Bedrooms__________ ___ __ ...................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Buildin Other—Type g -,�� ___ ______. No. of persons____________________________ Showers ( ) — Cafeteria ( ) POther fixtures ----'ro --------------••- ---•--•----•-•--••--•--•-----------•••------•-----••-•••••••••-•-•-----•-••-----•--....-•-••--••._..._.._--_... Design Flow........_ _....Z1 6•:._gallons per person per day. Total daily flow....... __ ..................gallons. WSeptic Tank—Liquid capacity__(__ allons Length________________ Width................ Diameter__-__________-_- Depth................ 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........................................ `j Test Pit No. i... _ __minutes per inch Depth of- Test Pit____________________ Depth to ground water................... __ 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ aI --•••--•••--•-•••...••----•--•-••••••--•-•-•-••--•••...............••--.........._------••--•-_..._......................................................... 0 Description of Soil.........................................................................................................................................................._....... ..__. x V ------------------------------------ •---------------------------- •---------------------------------------------------------------------------------- •--------------- -------- •-••-•••••--------- W UNature of Repairs or Alterati - Answer when applicable............... _{___.__.._.__._-___ `2-Gen . $......... 6...^ .1�_.... t Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Cod The undersigned further agrees not to place the system in operation until a Certificate of Compliance h en i e 'oard of health. P ---•-------------- •------•---------•---------- •-------•---- / to Application Approved By . ------------ y1 ` _ Date Application Disapproved for the following reasons.....--•----•--•---••-•-•-•••-••---•••••---•-•----•-••••••---•••---•-•-••••---••---•••••-••••••--•--......---•- ...-•••-••-•-••-•--•------...•---••-•-•-....••-•••-•••••-----••••---•-•-••••-----•-••-••-------••------= ----...................................................................................... Permit No.. .._...._ Issued.... ... Date L. Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliratiaan for Dispaa,ittl Marks Tonotxnrtiaan Vamit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ------------•..---...------...........*. r•^Y•- �' j eerLocation-Adams ............. ......1.:: Rcyr.? ....................... ..__..........._..._......................or Lot No. .....-_ ............................................--. Address Installer Address d Type of Building - - Size Lot Sq. feet >r•z-r ----------------•-------•-- Dwelling No. of Bedrooms-__-- ................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin rn i, a Other—Type g ...�_:..:_.:-%__. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ... f ------------per person per day. Total daily flow....... ...................gallons. WSeptic Tank—Liquid capacity.1 allons 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 ( ) aPercolation Test Results Performed bY----------- .............................................................. Date........................................ a Test Pit No. I.. .__-minutes per inch Depth of Test Pit.................... Depth to ground water-----._._____•_------... �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ............................. ••••-••••-•••••••-••••--•--•••-••••-•••••-••••.....-•-••-•-•-••••••.....••-•-•-•••••••••••-•--••..................••--••--•-••. 0 Description of Soil....................................................................................................-----------------------------------------------------••-•••--•••--. x U -•---- w -------------------------- ---------------------------------------------------------------------•---------------------------•-----------------------------•-• . -- U Nature of Repairs or Alterati '^�Answer when applicable------------------ -� .................. °r. ✓ t— r.^ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Cod, f The undersigned further agrees not to place the system in operation until a Certificate of Compliance h een i e. VI/oard of health. r ----.................................................. -••---•• ••--•••••....•••- Date Application Approved B .... ................. a /` PP PP Y / /.� z._ _ Date Application Disapproved for the following reason .---•'-----------------------------------------------------------------------------------------------------••••-- •..........•••-••-•••••••••--••••--•••-•••••••-••••-•-••.......•••••-•-•-•----••--•...----•--•-•-•-•••••.---••••••--••••-•••--•-•---------•------••--•--•-----•-•---••---------•••••----•--•••••••••••-- Date PermitNo................................ ,' ':.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7Ti ;77.OF � NF . . ............ .....................................—...................... CO.rrtifiratr of (fin mptinnrr THE INTO CERTI , Th the Individual Sewage Disposal System constructed ( ) or Repaired (A'r is ... f . y............. •„� ---.._._.......-�-•---------....------.......---....-•---••-- Installer has been installed in accordance with the provisions of T1 T1Z 5 of ee State Sanitary Code as descri ed in the application for Disposal Works Construction Permit No..__'!E�`' _.-------___�' �_. dated-------- �_f_. � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY. DATE._ .... f� .._.r� -------..----•-••----•-------------- InspectaGgC:<-_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................!?..`...:......OF........ ..� "!`:.. i t�-•----......... t�J NO... - ....:� Z FEE........................ �ia��aa� aark� inn �� iaan rrnti� Permissionis hereby granted------.. ...... ----- •••---•----•---•-••--...---••••••••-......-••••--•---•---•-...• ................... to Construct ( ) or Repair ( '��an_Individual Sewage�T�Ystem a— - Street as shown on the application for Disposal Works Construction Permit N .............'`t_---�-..2Dated........-__ I i Board of Health+ DATES 1 ---1-`"�' J VN /09------------------------------------------- FORM 1255\HOBBS & WARREN, INC.. PUBLISHERS VDU �ir his Ol „ t ' 1 l i J UJINDOUI 4 DOOR SCHEDULE ID QTY MANUF. MODEL ROUG+4 OPENING NOTES - —---- A 4 TW2432 Ex16nNG __ --DECK- 1 6 I FWGr 0 L - — --' --- ..: �— G I 0335 - .. - --'---— H 2. TW2632 K 4 CW135- 2 LEFT :2 RIGHT - - _- �I I 3060 RH - e 1M le O u04 TING NOTE- vERiFy QTY, mANur-. AND BRAND.BEFORE ORDERING. ; ----------- _ LIALLIIMT .. E:l .. .. .. -. —T. C .. .. FOYER .. EXISTING EXISTING ... - BEDROOM 'ExOTING FXI6TI EXIBTrw. GARAGE OWNG EXISTING - . - ___ ❑ 4- - _ -..._— __0 5 —_.. —._."6'-10h"— -�l':SK". .. - --_©_ --- -- — - ©- C - ——- --- EXISTINCs FIRST FLOOR PLAN {f� 4 -------- DEN — _ --- - ------------•-- ------- LINE'---- ------- ------- --- DINING LI - ff VING ALLTED.. II .. MASTEfit BEDROOM q wiI 4'-3SyF - N MASTER BATH nd _ KIR'CHEN EXISTING mRaw ; 31-9 , • 2'-ll}• Q ___v.�a.T®_-'-'�cEu.INc'uNe---- - GARAGE \� LAv. FOYER EXISTING WALLS :O. '-------• CaroTd, T'-015" lOq a I aTaRers - -- ----- ------- - . —2X0 G.J.--o- - - - - _ v —d- -- l OC.NEl NEW U WALLS y _ CO EKED PORCH cu6Ton coumNe PRO - OS FIRST ---- PROPOSED D R FLOOR PLAN s ,L�II $' lo',ml. 1p16" I BUILDER JOB ADDRESS DESIGN DATE REVI810N DRAWN.BY PAGE SCALE - - SEXTON RESIDENCE RENOVATE AND REBUILD ^��ovvo 8`21-19 « JB: •-2-oF-.r2- 1,4°.i'o° da Desgn`g 513 $ANTU I T RD. EXISTING COVERED PORCH. W N P ROi M OF DRAUNW LEAVE6 PIRPIA6ER REBP"OLE FOR corwLw cE WTI ALL O)M ACT 0 AND RE6waeCEr®+T oP ALL eD naeTe FODT NDe ml ALL PDDT6m6 WALL E%TE m Bsw FR06n m vHi PY DEPT. COTUIT, MA. 1 I LOCAL B mn6+o rmas AND o.- AHGED,B DE6 6 uT NOT NEID REBFV 6�,° M BT BE DE sag e D By LOCAL 00 cDNDmDNe AND ACCEPTABLE (,>Vex.r 81R CTNRK P18 EN 6 FOR DEN".am iFOR 6NE co m rn»oR FOR,NE BE aP T EDE DRA,-A LiRMO C TRUCTION. PRACTICED OF COk6 CWK vMi CEO"u LOCAL 9I EH2. W N LOCAL END08}]¢AND soup ND oFacwn. ®!f 6A®dl1IBLE MA oaw I . . r . EXISTING DECK ABOVE .. .... •1111111CPi11lI1111Q11111111116111l IIIIIIIIiii1t111111111111111111p 1111ltlllli1111111111!Rilll 111111EillIt"I[loll 111 llllt1111E - DOSTING GARAGE EXISTING DECK ABOVE .. - .. ,• :. ., EXISTING PORCv!AREA - EXISTING BASEMENT PLAN UA .. e '. 0 - .. BEDROOM m .. .. ^ .. LIVING _ BEDROOMv - - - - 76• e - - .4X6 a ALL6 O CD R21 INSULATION $ q'-ab° q- $ATN IX WOOD.CAP aD .: . UNFINISHED - .. ... .. u Q � EXISTING GARA GE - _ 8 CONCRE TE WALL .Q - I/2°WALLBOARD AMP PROOFINC GA 2Xq'e o 16"O.G., .. RI3 INSULATION 4"POURED GONG.BLAB KEY d P d FXI$TING PORCH AREA .. / / / / /10°X22"CONC.FTG. 17 4 Q o p /COMPACTED GRANULAR - NEW PORCH AREA D FomIN� FINISHED. BASEMENT DETAILS 1 PROPOSED BASEMENT PLAN ' (/�� //%�j/{/���//Ql/� // ,, DATE REVISION DRAWN BY PAGE, SCALE BUILDER JOB ADDRESS .. DESIGN. llpllp l{p//////p//Q��Q //JJ {p�JQ j���//{`/�J C!.�1._�0 \3L% �/�� //�/�Q. UJI.✓1...%oC/�,�..°(0M, E O 8 2�-is M .� OF��'. V4 P-0° �7/(..q1!�7 SEXTON RESIDENCE RENOVATE AND REOUILD _/ . .. f9)au POOtMGB BNALL 1.%TEND Mm4w FgOelL91H Vf9iIFY 1�TN. 513 SANTUIT RD. EXISTING COVERED PORCH. Sul � � to v6 6Y B R C diAl ELEt B e FOR D6NGN.d2E PA.Q®t 9a! (SOW a}Q 9G ¢Eer auaariNte,u a91ee �iOTUI T; 1 I wA A. Z rOR ertE eoi mmoNa oR caR tNe uBE ac ngsq ppAuoNG9 WRING coNeTRuctioN. PR.ee*ir.F9 os coNeTRuc*wN.vaa�+'omimn wrN iGCK enGn�R. oarN i�eAL B+GIr�nNo enntpiw olacini.e.