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HomeMy WebLinkAbout1374 SANTUIT-NEWTOWN ROAD - Health 1374 Santuit-Newtown Road Cot lit - A= 025-011 I I TOWN OF BARNSTABLE 9 C I'I nn ";�LOC -RONf SEWAGE #V ll " VILLAGE Q•t Lt4 nn ASSESSOR'S MAP & LOT ",...INSTALLER'S NAME&PHONE NO. R-S ! ✓i l�.��cca � . ���- ��99 SEPTIC TANK CAPACITY «00 lq/0 y' LEACHING FACILITY: (type) 7 - `/ate k "r-S (Size) NO.OF BEDROOMS j BUILDER OR OWNER l PERMITDATE: COMPLIANCE DATE: 1421 V 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 �CWO� G 1• � _ 0(7 . J � t i a 1� � TOWN OF BARNSTABLE L`OCATI�N l T VGA w n SEWAGE# VILLAGE t_(U►Lt 1 AS MAP & LOT INSTALLER'S NAME&PHONE NO. Q !1�U114-:� a. (1—' 7%1 . �3 74 SEPTIC TANK CAPACITY / /Y00 LEACHING FACILITY: (type) 7 " Fly�C "rS (size) X3 6 )C ' NO.OF BEDROOMS BUILDER OR OWNERS PERMITDATE: COMPLIANCE DATE:. .. D 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 r .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. 5q. v! 33/ ry`t � S-Z Y TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT r INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 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 I TOWN OF BARNSTABLE LOCATION ?? 21T i 60 (, 1< SEWAGE It .VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. R-S !1e'✓���C� c�� ���- `f�%�I SEPTIC TANK CAPACITY /Yv0 HID LEACHING FACILITY: (type) 7 - /OUilf r �S (size) NO. OF BEDROOMS BUILDER OR OWNER -04 91� f' Mel- 7J PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet I Private Water Supply Well and Leaching Facility (If any wells exist i 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 �® -ZS bZ h Fee P CAS f'7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for jBiopozar *pgtem Construction Permit Application for a Pe to s ct( )Repair( )Upgrade( )Abandon( ) O Complete System ElIndividual Components Location Address or Lot No. A,p'f � rjA t-wru P r _ N(ek*rPu, Owner's Name,Address and Tel.No. Assessor's Map/Parcel Z5; /1 Installer's Name,Address,and el.No. Designer's Name,Address and Tel.No. _�Ca viE5 /ff iW©,@%ill �� � REc�'t.aE t 104� :300 73���s�s C-11 f � i ,���ap d -�►-,,n� eZ� Type of Building: Dwelling No.of Bedrooms Lot Size 5 '11 Z-sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� _ gallons per day. Calculated daily flow -.53:7 gallons. Plan Date Number of sheets Revision Date Title I1 t- S 4 ` &6!t4 0 r— kP, +T - er�.. Size of Septic Tank In Type of S.A.S. .1 Description of SoilG�Y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agree ure the construction and maintenance of the afore described on-site sewag osal system in accordance with the provisi s of ' le 5 of the Environmental Code and not to place the system in operat' n til a Certifi- cate of Compliance has been issue d of , Signed Z®®O Application Approved by Da 6_ t1. 1J Application Disapproved for wing reasons 14 Permit No. yQ® [j 3 Date Issued (�� O� _--- ; }~� Fee Cad 'THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t Yes ` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ' Application for Miopaal *p5tem"Congtructio Permit Application for a Pernnt,to Go slquct(�)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components off Location Address or Lot No. LnT"` 4 .0 t ru l r lyf4'tt+u yOwner's-Name,Address and Tel.No. Assessor's Map/Parcel 1 ' Installer's Name,Address,and Tel.No. D�^esi�_g"n''er'`,s Name,Address and Tel.No. � r •��i �GQvF� /Y- /u®.Q/�� Yv�+� "`�"'� 1'C�hc I.�.�g.lLtti.lCZt j+NG-- 30 � rs t wy ak 1ta � vS � c��€�•-r�.�n� O�'?5 Type of Building: Dwelling No.of Bedrooms Lot Size ` Zsq. ft. Garbage Grinder( ) 1" Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ` �j3o gallons per day. Calculated daily flow 33 1 gallons. Plan Date 1 17 qcl Number of sheets Revision Date 12 1 41 'Cl Title ITS t S�. �1L�,� 0 t� i 1 �7e� 1+' -t - t,tT—ri . 1 ==Size of Septic Tank t"ga� Type of S.A.S.1��/� Q�� l��✓ r Description oV§oif f. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: c Agreement: 1 The undersigned agree ure the construction and maintenance of the afore described on '-site sewage osal system in accordance with the provisI s of e 5 of the Environmental Code and not to place the system,in operaf n u tilliaCertiffifi- cate of Compliance has been issue d of Heal- x Signed -- - _ l (I ZC904 ,# Application Approved by Da — CJ ,,'Application Disapproved for wing reasons Permit No. 0,0 - y 3 tY f Date Issued ------------------------ ----- ,. ------------- THE COMMONWEALTH OF MASSACHUSETTS N ~-- BARNSTABLE, MASSACHUSETTS ` r Certificate of Comphartce THIS IS TO C RTI ,Ofi7t tMeOsite-Se agte�:sposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( , by �� (/ �5 at I-OT ! .5�A" has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - 03 y dated Installer j -A Designer AM A ? The issuance ofIs,pq a j �sha�l no construed as a guarantee that the t rn will functionas�desig e, jC � Date /r 1 Inspector --------------------------- ----------- ----+ No. Oto U 1�# `- �` 1 Fee 67 !.7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS -Migpo.5ar *pgtem Con.5truction Permit S Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at o' 1 .5 �;�. iA h4 evA-L and as described in the above Application for D0osal 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: Approved by , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °�,M •'` 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 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. Important:When filling out A. General Information j forms the computer, r,use 1. Inspector: only the tab key to move your Robert Paollnl cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 'ERA City/Town State Zip Code (508)477-8877 S14454 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 CM 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails. ❑ Needs Further Evaluation by the Local Approving Authority 3/14/2011 Inspector's Signatdre Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is,-a�shared system or has a design flow of 10,000 gpd or greater, the 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. --s M s •`s t:� ****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. 77 ( C . ,-- t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage TDiosal System•Page 1 of 17 r 1 t i Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. Citylrown State Zip Code Date of Inspection r` B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D F 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: The septic system is in proper working order at the present time. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. City/Town . State Zip Code Date of Inspection B. Certification (cont.) 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 FIND (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 jf 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 he Ith, 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 ' f 3 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ;M 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every 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 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 1/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. City/Town 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- 1 0,000g pd. ❑ ® 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 ❑ ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every 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? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. Cityf 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? [if yes separate inspection required) ❑ Yes ®, No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA g ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3/14/2011 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. CitylTown 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: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured 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. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments .1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed in 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from, rivate water supply well or suction line. 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 2 Depth below grade:p g 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: 1500 gallon 4" Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 C f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ^M 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. City/Town 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 28" Scum thickness 2" 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 12" How were dimensions determined? Measured 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 tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments � 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 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 No 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.): Box is Ievel.Box has four outlet Iaterals.No evidence of solids carryover.No evidence of leakage. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 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 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-Flowdiffusors ❑ 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.): Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil.Leaching had 1"of water on bottom at time of inspection. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14'of 17 • • i / • / stolid 111r.111 to ago .• .. • t�� I C �' s WNT 1 -1 �� '-�a�'-.ri•.t'a•W�le -- ate"=s"�,y. }�'., wt �.x R' .rz; 3s L°.' s f s y ,ix�^r•yrt+����y^!-Z`�L ifi*� � f t� � aY s>r `s5 �-.a'��4 X�t v-"�S.!�F 9'�•�r ry 4,�. q Fes" �?�a • tt"'3 E Ko '�"'�� a •�' 3� ¢ > r .rd �5 � rfr '•",1C"' i{'Y H r�-•'J., a ,,,;> `'� � x x+ 3� r �� ,�" �x R, -AR ;g: F�Sr 1- ,j Jk�.Ms�' r+, £� 7 q f .i.� Y ^i. +r - t 'T�+."+'✓'+ �R 4� ro �q���. r w 4•�tt� � c x y v r- } S F ,� 5. � c w k -,� :� aa.. varCk z'`i-._# r•",� f+b'o s y tq '',y,, .. y 4��ph w gG zv s kr • �». `��,w v��' �� fit' � " y'"�,�r'�c `fig YW ........... 9 . 9 1 0 1 s J3 �4 kr,�r ^rr' Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form- Not for Voluntary Assessments C1,N ,•°°- 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of FF 50' 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: As-Built ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. next a Before filing this Inspection Report, please see Report Completeness Checklist on e t page. t5ins•11/10 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 M 1374 Santuit-Newtown Rd. Property Address Robert Franzen Owner Owner's Name information is required for Cotuit Ma. 02635 3/14/2011 every page. City/Town 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ' f r w TOP FNDN. AT EL. 58.0 SEPTIC PROFILE TEST HOLE LOGS �= -- _-. ACCESS COVER TO FIN. C-RAL,E_ {rvpT TO SCALE) _ ACI:Es' COVEP (WATERTIGHT) TO ENGINEER: RICHARD LEARNED x F'q GRADE JERRY DUNNING ? Q' MINIMUM .7:5 OF COVER OVER PRECAST / 2 o SLOPE REOUIRED OVER SYSTEM _ WITNESS: 56.0 -- ------ - — -- -------- ---- i � LOVELL'S POND 4/17/97 RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE ' DATE: z C5 / FOR FIPST _ 3' MAi . PERC. RATE - 2 MIN INCH PROPOSED 1500 y -- / / z GALLON SEPTIC c z '7 H-4� -FLOW DIFFIJ50RS i& )_-. , 5' 5.,•G' CLASS _ I _ SOILS P# Locus � 54. TANK (H- -�A-� I BAFFLE 53.0, �� 2.83' -- � _- 3.5' AT SIDES G7 C] C� C� ' i 9_% SLOPE) _ F" CPIJ%SHED STONE OR MECHANICAL ��o Q a a L� COMPACTION (15221 (2]) oo'.5ao G.96 o00 51 .54' 1 ELEV. 2 ,/Ftpv - Q 56.8' Q 55.3' DEPTH OF FLOW - 4 ( 5 % SLOPE) -Q U TEE slzEs 3/4" TO 1 t/2" DOUBLE WASHED STONE ' i A �1 INLET DEPTH - _ 10 " A - 14 , LJ l_S OUTLET DEPTH _- j 10YR 4/3 LOCATION MAP ' 10YR 4/3 1L � _ LEACHING 16" FOUNDATION--- 1 1 ' SEPTIC TANK 14 D' BOX t 4' FACILITY i B B ASSESSORS MAP 25 PARCEL 11 LS ZONING DISTRICT: RF 9.24' 12,54 LS 30 101•'R 5/6 YARD SETBACKS: 5�.8' ' FRONT = 30' -40,• OYR 5-6 53.47' C 1 0 SIDE = 15' #1 LS N/F O REAR = 15' #2 cj C 84" 10YR 5/6 PLAN REF. - 532/63 HOSTETTER , � w uj 42.3' FLOOD ZONE: C ��. C2 G--W EST. t� EL 39.0 f MS / \\#3 EL 63.0; _7 •. \\\\�\\\ TOP FNDN 5 .0' � MS 2.5Y 6/8 SLAB ® EL. 50.0 <"o I EDGE WETLAND EL. 39 0' \\ \_ LOTI_ i b5 S 45�72 Ft 50 1V ' v v 5 �� � 156" - _ _ 43.8' 156" � _ 4`-3'- NOTES: PROP. ROCK WALL \ �La AT 1:1 ,LOPE _ �NO WATER ENCOUNTERED ---- � \ \ , CATCH �''~�r \ RK 41MIT INE ��\ \\ SECTION A-A t APPROXIMATED FROM I C)iUlT C)UAi� BASIN \ F TAKF�D ItT. >a } �\ g - SEPTIC DESIGN_ (GARBAGE DISPOSER 1S NOT ALLOWED j 1 . DAT .. M I , —_ _ DESIGN FLOW: 3_ BEDROOMS ( 1 10 GPD) = 330 GPD 2. MUNICIPAL WATER 1', _AVAILABLE. / \ 1 -. T \A USE A. 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1 /8' PER FOOT. LOVELL'S POND ��---- c 4. DESIGN CARING FOR ALL PRECAST UNITS TO BE AIASHU H- ' #7 EL. 38.0't SEPTIC TANK 330 GPD ( 2_) = 6F�0 o 5. PIPE JOINTS TO BE MADE WATERTIGHT. T USE A 1500 GALLOI'l SEPTIC TANK (H- �O) PROP. ROCK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. _ RETAINING WALL LEACHING: ENVIRONMENTAL CODE TITLE V. —= PROP RET. 8 7. THIS PLAN IS FOR PROPOSE[ WORK ONLY AND NOT TO BE i \ AA = 330/.75 = 440 SF .-- WALL ---"-'-- !� '� _ _---" �'" �, / \ STAKED SILT FENCE _ F � <_ USED FOR LOT LINE STAKING. PROF % - a (i + 36.5) x (1 + 1 1) = 450 _F 7 5 �9 #g 8. P►PE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ✓�� \1 �rH1 \ 450 3 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT p2� PROP. 3 BR �`� TOTAL: _.F. _ GPD N \\C-D �� '". DWELL. �`' �;G --- - INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED Ldt aT/t, \` \p\� ice, UaE 4 FLO D1FF1_)SOR WITH ___ TONE AT tNDS 323 FROM BOARD OF HEALTH. TI n 1\ ;� TOP FNDN k� AND 3.5' Al SIDES 10. ALL ROOF RUN-OFF TO BE DIRECTED TO DRYWELLS OR DRIPLINES POLE --- \ T /� .\T l\4 y 5s o' / j�f j�� #10 #11 -__ _--------___ __------ --- TO STONE TRENCHES \\ ' vE�(r ,� I ;, DIRECT ALL RUN-OFF AWAY FROM p RES / / i� / `f FOUNDATION BENCHMARK: CATCH 1\ 'ro . / , �ri �� }A - L_�GE�•ID i BASIN AT EL. 59.1 ' \\` - '� _ Sl TE AND SEWAGE PLAN \ L % E100.0 PROPOSED SPOT ELEVATION OF P,rCr, DRIVEWY Yu ' ; sa �I _LOT 1 SANTU IT— N EWTOWN ROAD r i C 10Gx0 EXISTING SPOT ELEVATION r EDGE OF WETLAND IN THE TOWN OF: 11 , A/o DIZI L-1r� \> h / ___ 100 PROPOSED CONTOUR (COTUIT) BARNSTABLE � mOR� \ 100 - EXISTING CONTOUR PREPARED FOR: NEIL FRANZEN 1 ' " E I� WATER FLOW SUSAN MAURER F � H _G_ 40 0 40 80 120 1 BOARD OF HEALTH \ '.r \ _ MA SCALE: 1 ' = 40' DATE: DULY 17, S 999 �TIUTY 1 F.PPROVED DATE POLE REV. 9/10/99 (EXTEND WLL) �\ S REV. 10/18/49 (NEW HSE) off 508-362-454i .. REV. 12/14/99 (HSE) fox W 362-9880LOT 2 f ARNE H. down cape engineering, Inc. �`� aAu I 4f OALA CIVIL ENGINEERS w LAND SURVEYORS 939 main st. varmouth, ma 02675 , :.