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HomeMy WebLinkAbout1254 SANTUIT-NEWTOWN ROAD - Health 11254 Santuit-Newtown Road Cotu.it ` ,), —„-- — - - --- A = 026 037004 r i TOWN OF BARNSTABLE LOCATION /2 I't S"4rterrr_ NC',r -&,"w R-0. SEWAGE # Q/ 2 79 VILLAGE C0-rU I _ ASSESSOR'S MAP.:& LOT �G� INSTALLER'S NAME&PHONE NO. 6leo, gukl hlo_ INC So?-YO—ci5>6' SEPTIC TANK CAPACITY i SOO 9Rs. LEACHING FACILITY: (type) og-�/LLD (size) /f x 30' NO.OF BEDROOMS BUILDER OR OWNER ''tts = Cjr ®t,-11 C-5 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility — Feet- Private Water Supply Well and Leading 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 ,__� M N 5 f. , a L,y 4 L . 71 Of Foundation Certification in Cotuit; Ma. Prepared" For : LAWRENCE E. HOLLINGS Assessor's Map: MAP: 26 Lot: 37-4 4 : Boxter Nye & Holmgren, Inc. Community Panel Number 250001 0015C Registered Professional F.I.R.M. Map Zone: C Engineers and Land Surveyors Plan Reference: Book: 535 'Page: 41 812 Main Street Owner. -bt-WRENCE E. HOLLINGS Osterville, MA 02655 2001-119cpp.dwg Scale: 1" = 60' Date: JANUARY 21, 2002 NB4'37'52"E 114.67' 0 0 0 QQ aa I CB/DH FND 51,638 sq.ft. upland (yl_J Cad 17,655 sq.ft.wetland 'P 1.60 acres total snc FND (rw) ��� per record plan a a LO X FOUNOA�O02 SZit � m o 1B- Loc. 1- 20,7 W m 0 z Oexisting —� ` silt a V fence 01 q o° f+ o 0 EDGE OF FLAGGED WETLAND ivssi, 246't ,s Pogo " Lo y�LL I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE FOUNDATION SHOWN HEREON IS IN COMPLIANCE WITH-"THE APPLICABLE BARNSTABLE ZONING DISTRICT SIDELINE AND SETBACK REQUIREMENTS, IS LOCATED IN RELATION TO THE MONUMNENTS SHOWN, AND IS NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. J R. Jr THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO .ESTABLISH PROPERTY-LINES. G1STfRE�J a{-tilt-'Loot, �L uk° ftGISTER11P PROFESSIONAL LAND SURVEYOR DATE - `2�� U t�jpew tl riD 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Nam information is Cotuit Ma 02635 5/10/18 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms +4 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Chad Hathaway use the return Name of Inspector key. H.P.S. Company Name P.O.Box 151 Company Address Forestdale Ma 02644 Cityrrown State Zip Code 774-274-2581 12866 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/10/18 s z z6OW-1ORT066 . 1 Inspec s ature Date The system inspector shZda -=ompleting of this inspection report to the Approving Authority(Board of Health or DEP)within this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the.approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 c Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: functioning as designed. no signs of failure B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass. inspection if the existing tank is replaced with a complying,septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments M < 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): e 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 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,�•' 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 . page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the-SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s•°� 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ 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. 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 5 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? P ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Citylrown State Zip Code Date of Inspection D. System Information Description: i I I Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type.of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) , Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-1 Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments M , 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) j Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner pumped 2 years ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool. ❑ Overflow cesspool , ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes E No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 30+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): good condition Septic Tank(locate on site plan): Depth below grade: 8"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) El Yes ❑ No Dimensions: 1500 gal Sludge depth: 211 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness less then 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pump every 2-3 years as maint. to protect leaching 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Citylrown 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form'Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•°°r 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Cityfrown 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.): in good condition camera inspected. no signs of backing up from leaching no high staining 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: probed stone bed no ponding or saturation. No inspection port added at time of system install t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal_System Form Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1) 15'x30' ❑ 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.): r 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Cityrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately S"C' S 97 i t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 0, 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: GIS maps from town website Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M a 1254 Santuit Newtown Rd Property Address Hollings Owner Owner's Name information is required for every Cotuit Ma 02635 5/10/18 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 1 l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 .......... Y6 'OA ----------- i ------- ----- -�q 6 -7-1 IF T- I I ; ; - I � � --- � -� � I -I-- I ; - i i j � i -25 jg� I�Mll 1-7 ---------- -------------------- ---------- TOWN OF BARNSTABLE LOCATION /2 S'/ S'An+rvrr- MC 4&k>,g ° R-0. SEWAGE # -01 79 VILLAGE - C2 t'C//I_ ASSESSOR'S MAP &LOTi.1 037_0!3 INSTALLER'S NAME&PHONE NO..6,eo° gok/110 r®✓c SEPTIC TANK CAPACITY. LEACHING FACILITY: (type) 062ELO J# (size) NO.OF BEDROOMS BUILDER OR OWNER 4-J4WR9^KA5 40CLIXIES PERMITDATE: COMPLIANCE DATE: -5 a20001 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 i Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) © Feet Furnished by I i 11 S f- �rd`3 I 'JV'+ I 1 7 Nojpa7�97/r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Mioozal *pztem Con!5truction Permit Application for a Permit to Construct( )"Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot Nol > ( 510"' �.�c!i &/\k a lccva/ Owner's Name,Address and Tel.No. ed Assessor's Map/Parcel �'I V /� , ^ vAo - 037-100 Co Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. c 0 Type of Building: Dwelling No.of Bedrooms 3 Lot Size CL sq.ft. Garbage Grinder( ) Other Type of Building L�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3® gallons per day. Calculated daily flow 3 33 gallons. Plan Date G Iti f z Number of sheets Revision Date 771�197 Title Size of Septic Tank /SZ ' Type of S.A.S. 1. t y, 3,C)t c� Description of Soil 2 01 1 5-5 Nature of Repairs or Alterations(Answer when applicable) 4Ct-t9,C 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 Tit h ironmental Code and not to place the system in operation unt' a Ce ifi- cate of Compliance has been issued is B Hea Signe Date Ar- e ® 0 Application Approved by Date Application Disapproved for the following reaso Permit No. �` Date Issued C. A r 5 I . .-.. ... ^t - n»`"^- t..µ, , .�-..• . _,r.. ( THE COMMONWEALTH OF MASSACHUSETTS a Entered m'computer: tf Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 's Application for Di�pogaf *p!tem Couttruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( -) ❑Complete System ❑Individual Components Location Address or Lot No) Sy ���'�'i�fU��i ("704.�/f Owner's Name,Address and Tel.No. Assessor's Map/Parcel '�d (� S y 1-4G U 0QO I V 9611CI �Q- 4, Mo. b ott 'j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: k r Dwelling No.of Bedrooms 3 Lot Size GL sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons - ` Showers( ) Cafeteria( ) ,a Other Fixtures Design Flow 310 .gallons per day. Calculated daily flow 55 gallons. . .� ' Plan Date' `1'g Number of sheets "� Revision Date Title ' Size of Septic Tank' S Uy Type of S.A.S. /�t Y To l ' -Description of Soil w Nature of Repairs or Alterations(Answer when applicable) ' 1 Date last inspected: Agreement: Tlie 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'ak*rtifi- -.,cate of Compliance has,been issued by-this Boardlof Health Signe A i l �, Date �� Applicatd!� Approved by :-� *" ���A//r�l� ( Date _ Application Disapproved for the following reasons� Permit No. � -'Date Issued -'THE COMMONWEALTH OF MASSACHUSETTS — ' BARNSTABLE, MASSACHUSETTS (Certificate of Compliance l THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed)Repaired( )Upgraded( ) Abandoned( ),by 1 at I l C 11 c"A, - bf�N�w� �C� t�ti,+`' h !pf n constructed.injaccordance �Jdated with the provisions of Title 5 and the for Disposal System Construction Permit N . - " ` Installer Designer The-issuance of this ermit shall not be construed as a guarantee that the syst wilYtifunction as designed. r Date h; i� by Z Inspector „LV 1N, No. g1rlq Fee /(2/ K2- THE COMMONWEALTH OF MASSACHUSETTS t PUBLIC HEALTH,DIVISION - BARNSTABLE., MASSACHUSETTS Wgpooal *p5tem Congtructton Permit Permission is hereby granted to Construct O Repair( )Upgrade( )Abandon( ) System located at -I-) Sty 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 this permit. Date: Sy h I t7 Approved by _7Z r _ 6 2 1/2 3 6 ' - 6 —2 1/2 7 —11 k - — — — 8'-4 � � • ._ r I m � DECK CSPD-6-0 CSPD-6-0 i CODE. 12 3214 �K 3214 CHES-6 I CODE 21 I w �_ N6Z BSD ,. s, SHEARWALL REQUIRED SEE DETAIL M22 OF BSD - (4 PLACES) - KITCHEN < _rt DEN - DINING..: MASTER BEDROOM ROOM N � M2 , SD DOWN -- -FlREPtACE AND AI Q N TH - - - - - - .:.._ .s. .-...-.._ ,«. _.. 4'.•.-.c- .•.'3 :..._......a..�..--`-,:.._< ... t r:_. .. ._.... .... .. :S'e'T.._ _. ....::..._ r.....-w '^ CN'd- µ t _ y cl -h i N �, E LIVING ROOM I i .. BEDROOM I SIMILAR F_ i DETAIL i -_ S BSD I ; Wl FL BSD — 1 3068 LH IFC36 W/ 2420-2 2420-2 2420-2 — ; (2) 12- FC6 SIDELITES PORCH - F I A 1 Ysm p SMTUI T 1 40 POW ` 4j I \�� L?J.ic`C✓:vim.% - LPOND S I � { APrROXIMATE EDGE OF WETLANDS j FOR REGISTRY USE ONLY (AS SH.OYN CN PLAN 1300X 535 PAGE 41)T�\ LOCUS P AP l \ NOT TO SCALE .v in CONTANCE BRACKETT '4 y �a LOT 2B p' Iy I certify that this plan aas y made in accordance with the rules N y oral regulations of the Registers a o \� w \\v ` of Deeds. zo`D r HOLMES AND McGRATH, INC i Z U U N APPROXMIATC LOCATION- /\_ OF EXISTIN(, HOUSE tj w PROTECTION DIS n TRICT �0 _ _ ! CV / „ i 9 / 1 Joe° ICubick 7— _ Reiistered Professional Date — Land Surveyor 411 APPROXIMATE LOCATION-,vl �© rF,.� \ y OF SEPTIC SYSTEM 1�, i\ /�• R.GARDitdG_�.9T DISBU RS b T:- FOR #1254 1 �, `r '� / O� b \ 1 �a\ ! PARCEL A iS --0 BE CONVEYED TO AND COMBINED 'MTH LOT 1S !'. 28 AS SL:Ovtri CM PLAN 8COK 535 PAGE 41. \ CB/DRILLHOL.E FOUND I =_\ ^� :ih\.-ri`�'•�.T'°QtiKi, r A XISI;N'G 1 STORM IS:: k ABOV -GROUND POOL ! RO AL UNDER THE ,uij;,,raiON CONTROL LAW NOT REQUIRED \ , -(3'r00jt S.F. PIAND y y oCTON 60,OODt .T F. TAL y v y / Date xv I SHAPE FA 1.0 / y /� rA� sr y /ram ^ °r' FORMERL V \s°' gib•� LOT 2A � y y y y (•,. NOTE: NO DETERMINATION AS TO \ COMPLIANCE LATH THE ZONING ORDINANCE � °FJ $ z " , y -v REQUIREMENTS HAS BEEN MADE OR EDGE OF PAID y INTENDED BY THE ABOVE ENDORSEMENT. 1' 'L y\ � yg9 1,h NiFRca'SPO`� _ 1� J�'''v�G�;`v ✓�`—�-f—�j�-L-�� BARNSTABLE ZONING BYLAWS RESIDENCE F DISTRICT (RF)/RPOD �� //_ -�C I ( N� DIMENSIONAL REQUIREMENTS REQUIRED MINIMUM LOT AREA (S.F.) 87.120 MINIMUM LOT FRONTAGE (FT) 150 MINIMUM FRONT YARD SETBACK. (FT) 30 DAZE DDC N DESCRIPTION A' row° fleck MINIMUM SIDE YARD SETBACK (FT) 15 ° R L.. V 1 J I D S MINIMUM REAR YARD SETBACK (FT) -15 I APPROVAL NOT REQUIRED PLAN MAXIA"LllA BUILDING HEIwST (FT) PREPARED FOR q� AW ENCE E. HOLL.IN^r E ° i,1254 SANTUI'I NEWTOWN ROAD I. HOUSE NUMBER: 1254 i IiJ 1 2. ASSESSOR'S NUMBER: MAP 26, BLOCK 037, LOT 004 { COTUIT, BARNSTABLE, MA 3. ZON!NG DISTRICT: RF RESOURCE P90TECiION OVERLAY DISTRICT I SCALF 1' 4C' 3A1€: FEB. 14, 201>; �M e Km ;tf. COTU11 -ALLAGE/f"IRE DISTRICT GR1FIM SC:A.i.E fie; 4. r'LOp HAZARD ZONES: X ' y��r�f 5. RrFFRENCE: PLAN BOOK 535 PAGE 41 4i? 2t1 Lti 40 +,�0 I J.. �'dolP7 e. and igrath, Inc. ; K�`t.`Y 6. PROPERTY 1S SUF1jFCT TO ZONING, 80ARD OF APPPA1_1 ll / "/ Grl�nbite�ca�sr�srlesurvsyccs __..._..._._. � � ;e7jx t VARIANCES 199?-62 (DEED BOOK 10878 PG. 16M ;"IIE'`�>!"') ". — �F 2G5+r txcrr.•d,itd •!xc+ h.r. G2Ao 5G8-64& �.1.com I.�aG AND af718—U07. i °.,,� w ao a 7. £XiSTIMG 'J?ILlTIES ARK NO''. SHOS'.rl. r.. DRAVA' u 1!1iC _ ACC: ����./ Adi.: �i38-8-66 b P ATTYS moo. POND S Z .Q� COVERS LOCATED TO WITHIN s� 6" OF F.G. TEST i HOLES BAXTER & NYE INC. ELEV.-48.5 5/28/98 TOP OF F.G.-4$'f TH #1 P-9155 ~ L.000S FOUNDATION .\ \.��,. \,�\ ra\ F.G. =47.5't 1711, F.G.= 48'f -0' ELEV. = 49.08 TH #2 LEVEL /,�.� r.. i ELEV. = 46.77 INV. = 1500 GAL. 4" DIAMETER LOVELLS 46.0 SEPTIC TANK Q A-LOAM POND $ INV. - 45.7 INV. -44.8 Blox CHfOULf P,�C ; C-MEDIUM SAND -6, INv. =44.6 A�pE 10 YR. 7/6 B-LOAMY SAND Fz lo.00'- ���_ INV. = 44.5 10 YR. 4/3 6" CRUSHED :: •; ' MIN. (AREA HAS :_-?' '"• ' :, .�.:;'.: s•' 0CUS -MAP BASEMENT FL EL. 41.0 STONE BASE � .a. ,� ;, : : ;., • STRIPPED OBEEN A & B) = _36" SCALE 1 25,000 . • BOTTOM El EV.43.5 ASSESSORS 48" PERC TEST MAP 26 PARCEL 37-3 RF & W.P. 0 EL. = 38.5' ADJ. WATER LEVEL C- MEDIUM SAND Z!E NO SCALE OBSERVED WATER _12' ELEV. 37.08 10 YR. 7/6 R F MINIMUMS -10' ELEV. 36.77 AREA = 43,560 S.F. FRONTAGE = 150' FRONT SETBACK = 30' 'SIDE SETBACKS = 15' 2.5' 5' 5' 2.5' REAR SETBACK = 15' / DESIGN DATA BUILDING HEIGHT = 30' �� � ����\��\� >)Q SINGLE FAMILY- 3 BEDROOMS NO GARBAGE GRINDER SEE BOARD OF APPEALS -NO.1-997-62 OR -FRONTAGE VARIANCE � °' �\ �\ �\ �\ �\ �\ �\ �\ �\ � � DAILY FLOW = 110 X 3 = 330 G.P.D. �(V= • SEPTIC TANK - 330 X 200% =660 G.P.D. 1 6„ .; . -. USE 150 0 GAL. SEPTIC TANK 3/4" TO 1 1/2" 4" SCH. 40 PERF. PVC - _ C.B. FND. WASHED STONE LZACMG P7= DESIGN _.. _ '� • N•:.;PPED WITH 2" OF PEASTONE -- ''pp #T ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED ° it©SS SGO1�1 USE 3 - 4" DISTRIBUTION LINES IN AN NO SCALE 15'X 30' WASHED STONE FIELD AS SHOWN 330 G.P.D./.74 = 446 S.F. OF BOTTOM AREA REQUIRED 44.5 USE 15'X 30'= 450 S.F. AREA PROVIDED CLASS 1 SOIL PERCOLATION RATE 1" IN 2 MIN. OR LESS ELEVATIONS ARE BASED ON N.G.V.D. SITE IS NOT LOCATED IN THE FLOOD PLAIN ANNUAL RANGE OF GROUND WATER ZONE B = 2'- 3' x 44.3 O rc Jv 4.0 44.0 / P�4. ° 6- 4 \ 44.9 / \ RELOCATE UNDERGROUND x 50.2 IQ- g � \ x 47.4 UTILLITIES AS NEEDED '--'� N g4•37'52"E rn 451 \ / n -0 f I �` \ \ ;\ t�, 7.8 49.t PROPOSED � 0 x 45. LEACH FIELD a 43.4 \ DIST. ,- EXPANSION Cn Y �48.1• >n r� wP� 47:1 . . d, ` ez Box AREA o C B. FIND. 46 1 1 x 47.0 \ te/ C` , Z �R 10 Q f x CA�Q •�____ �� \� 30 J #282 / / E O t1/ 30 45. 1i� ,,� k!Stj \\ ,, cv 1 1 E'ROP• DR \ \ or;vewa��_ (�' 2B t lW-4 \ \ \eJ \\ & 00 Vc 46.7 _6.8 x 46.5 \ t te/ c t -• -K- % y�4�° 46i1 �9 C1? "--• x 46.2 � 1 F � 45.3 x 46.1 6.7 S '� r v \ 44.2 T X 4 8 ¢, !� ° �. .�7D 47.3 \ 4 x 46.6/42.9 v • ?° GAR�,GE x 46.9 . o x 43.8 cp 44.0 x 47.2 P x 4 1 r c� ;. � o, �! 47.1 • , v I location digitized W W W '� 60.00 \ E \ from town G.I.S. PROPOSED D i ISOLATED B� lawn +� TO WELLING o VEGETATED 0o P OF FOUNDATION � 48.� �F x 44.3 ± o ` . WETLAND IRS j� OO ` 4G 47.1 43.9 6 o i II'FT 0.00 /42.5 ° 2� 43.0 W1250 n 47. a / 47.7 x 47.8 .47.2 4 / /42.0 51,638 sq.ft. upland RELOCATE UNDERGROUI,�,D X 9 1 6$s sq.ft. UTILITIES AS NEEDED!` 17,6-55 sq.ft.wetiond \ x 46.5--- , -DWELLING 1.60 acres total 0 - c) shape number = 16.18 moo• x 46.1 (n A2A a N O (31 .p Al J' A3 ' O N yA3 x 47.1 1+ m M y `W y. A 2 �5 w e pgL� J w V• V' y 4, 4, •i' V' y o f - V' y V' v- W y W W V• W W A v, 6arae�i •W n9 v. J• w y' v �' w v- J• J' w A' y, v A21 y J v v v v- v- V• v v v �egetOted v w v ft'19 y y v y y y' W W .L A%$ V' W V, V V' V' J, W Q 417 W W J• y W ti W W W J' V' V' A9 +L• V' W V' J' W W W W y W W J' W W W W _. ® ,V y Al 5 W J- ��A16 v v' .t-' v IV v- v- v' v, �' y v- v- .v W J� V• •:' y W W v W JW V, V• J' W 4, y V' v' Al J' 413 W J, A34 V' J. '1- W V- W e Y J v' W w 1• ti W W v v- J' i '4' '4' J' . V' V W y V' '4, W '4' J' u V• Y V V V- v v V' V J• '4' J v, J J• v' J• y . '4' v Y A.1 W W W J• W J' J' Y' J• W V' �' W V' W y W w y W W y V' V, - J' J W V' J' W J' J y' V V- y y J• J' _ _... - �,-- - -4,-- - w v' W V, v, V' V' W W V, v' V' y- v' J, y, V' V• w W W V, V v' V' J' W V v' v V' W v' V- .y. V. W W .:• y, V, J' � y. � y. W--_-. ._.J .. �._. ti- .:F-:-....__.,+-__ t` __._-'.-V' ___V' � W V' �.# V, ,,, V J. J J V V' V- `t y' y, •i 4, J+ W J' W V.. V' y: J J' y, y. y y V V• V' W J.' V• J' V• J• y W J' W i• V• W y W y y W J W •L W V' V' W J V. �J, V V V• y' y- J• V... W V- V- OM ,",.: - - 1.' .-.•__- y y J• W 4, W V• J, W V• y W .t- J• V,. J' V: •Y v- W y J- W 4 W V w V V• W W J' V- J- W V' W W W W -L V' V- J V J' W y V: ., ` v' J• V V• O\G\ y, y, y, V• y- y, y- V' V, y, y, y, W v V, W V, W J, V, y. y, y. y. V V V• �• V' y. V, J. �aG� r� 176 v y v y y y J• WETLAND y v ti v W �1 ��J, �•Y V' V' V' V; •y Y W Y V' V' Y L V' •1• V: •L L V' W' V' •L v- $ '7 O �� �S('+, V' V' W •L V• W V' U' V' V' V' V- J' •Y W W W W V' V' V' 4 ��A /•Yf• Y V' J' V' J' J' J• V' W +Y �i' •Y + 1���\/ v' V• v J, W W J' W V' W V' J' V' V• J• W y W L i-T1 E�� W J. v SITE PLAN CIO v' W J• W V- V' W W W W W W V- W v y v AT SANUT _ NEWTOWN ROAD J�I PLAN SHOWING PROPOSED DWELLING, TITLE 5 SEPTIC SYSTEM, AND DRIVEWAY 1160, IN (COTUIT) NOTES BARNSTABLE MASS. (1) REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED P- APPLICANT ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. 100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL TO BE APPROVED 1" = 20 ' Ai,, BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. j ILI�►11 REN C E E. H OLL�N GS (2) LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS GRAPHIC SCALE SCALE: AS NOTED HATE: JUNE 4 ,1998 PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE -0 20 40 THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE WATER DISTRICT TO DETERMINE UTILITY LOCATIONS. REV. AUG. 9,i 998 i (3) FOR ALL ASPECTS OF THE SEPTIC SYSTEM THE CONTRACTOR B A X T E R & N Y E INC, SHALL COMPLY WITH ALL GOVERNING CODES AND REGULATIONS. �I\AOFF,ggsS REGISTERED LAND SURVEYORS IN PARTICULAR 310CMR 15.000 THE STATE ENVIRONMENTAL CODE TITLE 5, ��P THE TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS STEPHEN 9y� CIVIL ENGINEERS ON-SITE SEWAGE DISPOSAL REGULATIONS AND THE BOARD OF HEALTH j �� / O S T ER V I L LE, MASS, RECOMMENDATIONS FOR ACCEPTED PRACTICE. axtnan `0.30216BAXTER ti (4) THE CONTRACTOR IS TO SECURE APPROPRIATE \� S6tSTE�NG����e PERMITS FROM TOWN AGENCIES FOR THE '�a �L` CONSTRUCTION DEFINED BY THIS PLAN. (5) ALL STRUCTURES BURIED DEEPER THAN 4 FEET OR SUBJECT TO VEHICLE TRAFFIC SHALL BE H-20 G LOADING. "I (6) FLAGS SHOWN AS Al-A22 ETC.& 65-138 ARE FRESH WATER WETLAND FLAGS { WETLANDS DELINEATION PERFORMED BY K. BARNICLE, ENSR, ON SEPTEMBER 6, & 30,1996. #96110A2A