HomeMy WebLinkAbout1493 SANTUIT-NEWTOWN ROAD - Health i ' t.ati Yeti -a ?
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1493 y'Santuit=Newton'Ruac � §`*°
y 1 k f Cotuit
I
c'"Tt,IT' TOWN OF BARNSTABLE
L r ATION Ci 3 �'2t�1" 41V\ CQ. SEWAGE # J U 05
l �LLAGE C—J40 t'+ ASSESSOR'S MAP & LOT a5 3
kIASTALLER'S NAME&PHONE NO. ����� A, 5CU Z S, So
SEPTIC TANK CAPACITY 1500 (0
LEACHING FACU-=: (type) LJ(M)500!cd (size) 2
'NO.OF BEDROOMS
BUILDER OR OWNER �T Cif�nX M-C:At o rra-A.
PERM T DATE: 130 110 S 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 eet of leaching facility) Feet
Furnished by
' I3
t `Z
131 = 4
BZace)6t-Cj if
53=
TOWN OF BARNSTABLE
LGATION ���� f\S�- }�c�,.)�f t��_ SEWAGE # - S
VIVILAGE Cat k I r ASSESSOR'S MAP & LOT db?vim'^ 00 3
INSTALLER'S NAME & PHONE NO. --TA- (,r,�l t
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (sie)
NO. OF BEDROOMS- 4— PRIVATE WELL CqcPUBLIC ATER
BUILDER OR OWNER SAS � iZ✓S1C�Lt.a a "j 7
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
�71
PIT' Prr
J
cc�.
No.., 4= 1 Fxs. � ............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Ton'strnrtiun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (A) an Individual Sewage Disposal
System at:
-_-Location.Addres or Lo1'No.
Address
..__..- .j-.---
a Installer Address yt�
Type of Building Size Lot � ...Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aa Other—T e of Building No, of persons............................ Showers
YP g ---------------------------• P ( )..— Cafeteria (---)-
dOther fixtures ------------------------------------------------•--------------------------------------------------------•--------.
W Design Flow..................... --------gallons per person per day. Total daily flow........... ..................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.-.--.-.-_--_-_-. --._.
44 Test Pit No. 2................minutes per inch Depth of Test Pit---:................ Depth to ground water........................
a -------------------------------- -----•-•-----•----------------....---------..............----------........................................................
O Description of oil............< :_-_c ____._.f.. ` �' off_�___
x � ,
._ ... c.., ��.. C c / ...............
U -------------------=------ -'
w
x ------------------------------------------------------------------------------------------------------------------------------------------------------------- ..................
V Nature of Re pa' s or Alterations Answer when applicable.......-e4EP06_.--_--_
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance b be issued y the oard of health.
Signed . .. ..-- N-
r Date
ApplicationApproved By ------------------------------------------------------------------------------ ------------------------------ ..--- ---------------- ------.............--------------------
Date
Application Disapproved for the following reasons- ------ -------- -------------------------------------------------------------------------------------------------------------------
....................... ------- .........-- .....-------...-------- ------- --------------------...........---........................... ------
C� Date
PermitNo. ......... .�a.`� ........................... Issued ................---.................-- -- -------........ ..
Date
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
_ TOWN OF BARNSTABLE
Appliration flat Disposal Works Tonotrur#inn Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair (A<) an. Individual Sewage Disposal
System at:
L Location-Address f�� T� or Lot"No.
,�_.ff.... �! - ....._�i ._....... ��/ ................... 2 ��.. 'aN �3
Owner Address-
...................................................wy /2./ �/�/f .-li///L.S /1�1
...................................
Installer Address
Type of Building Size Lot........4Qd ..Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a Other—T e of Building No. of persons............................ Showers
Pal YP g ---------------------•------ P (--->--- Cafeteria ( )
dOther fixtures -------••---------------------------------------------'--•------------•-----------------•-•-•----••-•--------- ......
W Design Flow......................._�.._.._.•...gallons per person per day. Total daily flow..........- .................gallons.
WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rZ4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water------------_...........
P4 ...•---•----•••----•••---••••-----•-------•----•--••----•- --------•-•-••------•-----•-•-------------•------------------------------------------------
O Description of oil............�� -------1[s/1 �`� `-•�t /-(.---... . ..
W
UNature of Repairs or Alterations—Answer.when applicable._______ . ...................... '
............�'v -` .....S�ZT ._. [J I Q�J }Q!fJC
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal;System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has be n issued by the oard of health.
I v-
ApplicationApproved BY --------------------------- .............-------------------------------- -�--- ------. .....................................
Date
Application Disapproved for the following reasons- ........................... --------------------- .................................................---------------------------
-------- ------------- --------------
Date
PermitNo. ------_----------------_ Issued ................................................... �..
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cfer#tftettte of (fantylianre k
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (k )
r r ---by �-�lz-7`��G0 17 - CI�.1-- �di� --------------- -------------------------------------------
Installer
at --------------------------------- ----------------------�1�5'.,� ...--------- ' J -6 J .1 2 0?'L
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .......Yc ... dated ------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATEGam--- ��` j /----------------------------------- Inspector ----------- ................... -----------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-- P
TOWN OF BARNSTABLE
No. ,�=- ���J� FEE..........lJ...........
Disposal Works Tonsiruction frrmit
Permission is hereby granted....................., O TG'GD C'
- ------•...............................................
to Construct ( ) or Repair (� an Individual Sewage Disposal System
at No--------------------------------------------- ............
.....------ ............................................tJ D%Z)
------------------------.....................................
Street
as shown on the application for Disposal Works Construction Permit No.....................
.._/-_---..•S Dated..........................................
..............................-......--�_--•-----------------------•------....--------•------•--.
^ / fir/ Board of Health
DATE-------•---�--=--�}-.-.-•------:/-�---------------------------•----......----
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
s
rkA
,� V4Commonwealth of Massachusetts PI
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�t✓rhJl-� -
°M 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
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 A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:key to move your ;
cursor-do not Jason A Souza-
use the return Name of Inspector
key.
American Excavating Contactors
,ga Company Name
637 Carriage Shop Road
Company Address
East Falmouth Ma 02536
City/Town State Zip Code
(774)-836-5774 S113636
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: LL Q
® Passes ❑ Conditionally Passes ❑ Fa'it
=->oa G`3
❑ Needs Further Evaluation by the Local Approving Authority
816/14
Is
cto ignature Date
The sy 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.
****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 perforrWin the future under
the same or different conditions of use.
q
t5ins•3/13 Title 5 OfficVlnspecti : surface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts 1
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,M 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
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:
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
i
1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
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 breakout 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):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
I.
Title 5 Official Inspection`Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit 'Ma 02635 8/6/14-
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 mater supply well"*.
Method used to determine distance:
**This system passes if the wellwater 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:
k
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
El
❑ 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 '/z day flow
t5ins•3113 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
1493 Newtown Road
Property Address
Jared,McMurray
Owner Owner's Name
information is Cotuit Ma 02635 8/6/14
required for every '
page. Cityrrown 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 ofscustody 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
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone 11 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
' r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M °r 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is Cotuit Ma 02635 8/6/14
required for every '
page. Cityrrown 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): Number of bedrooms(actual),
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
r
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposel System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
��M ,•''v 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14,
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3
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? 0 Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)): n/a
Detail:
Sump pump? ❑ Yes ® No
8/614
Last date of occupancy: Date
Date
Commercial/industrial Flow Conditions:
Type of Establishment: n/a
Design flow(based on 310 CMR 15.203): n/a
Gauons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): n/a
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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1493 Newtown Road.
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
page. Cityrrown 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
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)
❑ 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-3/13 Title 5 Official Inspeefion 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
,M 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.).
Approximate age of all components, date installed(if known)and source of information:
9yrs Installed 3/30/05
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2.0
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
4
Distance from private water supply well or suction line: n/a
feet
Comments(on condition of joints, venting, evidence of.leakage, etc.):
r ,
Septic Tank(locate on site plan):
Depth below grade: 2.5
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: 71x11'
Sludge depth: 36'
t5ins-3113 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
M 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
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 24 ,
Scum thickness
81.
Distance from top of scum to top of outlet tee or baffle
15„
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? measured on site
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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
.Title 5 Official Inspection ,Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
page. Cityrrown 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.):
System has been well maintained
Tight or Holding Tank(tank must be pumped at time of.inspection) (locate on site plan):
Depth-below grade: n/a
Material of construction:
❑ concrete ❑-metal ❑fiberglass El polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
r ,
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 Forth:Subsurface Sewage Disposal System•Page 11 of 17
4 ,
Ir
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,M 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is Cotuit Ma 02635 8/6/14
required for every '
page. Citylrown 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 0.0"
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.):
Appears to be in good working order
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.):
n/a
l
* 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
I - -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name r
information is required for every Cotuit Ma 02635 8/6/14 .
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2
❑ leaching galleries number: J
❑ 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.):
System was properly installed and maintained
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 1. ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
7M ,•'°� 1493 Newtown.Road.
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
page. City/Town 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.):
n/a
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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M , 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is Cotuit Ma 02635 8/6/14
required for every
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
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
t
' Y1LI:AG .G ' ASSES$QRS,MAP Ac(p�
9L7
nest RSNAA prtt?Nr tin Oak?,A,
Y ( AZ HlNC FAcfLrrr ftyOi F�clr9zl S(?C4,u 1 Zia
xn oaDRooMs � - —�
_ fi'IJJ1 DEIt OR OWNER C a rXf 4 til
_"�_' a
PER irmA'lE 3.i "t7 - coWtMCE tsAi<E
Separation pismnce Hetweeo toe
�Alaalm inpdiasudGrdugdWateiT2blcwlkftl"f..eacbit�r xiltty a r `
PnvariWaterSupply Wdiand'LeaccbinsFaedttq 4fany
site McUsaa M
On or within 200 feet of leaching faa7rry} `
Ede of and and Leachin Faerb ass[
wi 70U of leactung facility) +xetIands c
tlud $ s r
R
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t, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,M 1493 Newtown Road
Property Address
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635. 8/6/14
page. Citylrown 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: n/a
1 � 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: pate
❑ 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 groundwater elevation:
I"ve installed many septic systems in this area including this one.Groundwater is not an issue on this
site.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Forth: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
1493 Newtown Road
Property Address J
Jared McMurray
Owner Owner's Name
information is required for every Cotuit Ma 02635 8/6/14
page. City(rown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
IGNITED STA 94C66 '"9
Paid
•Sender: Please print your name, address, and ZIP+4 in this box •
I
aq Town of Barnstable
a + Health Division
200 Main Street
Hyannis,MA 02601
I
ss k{ i 1i j� ll 4 f!♦ii 11 }}*tj it j 4 i
1�1??i??�i4? 1?it ???i!i li4E?E�iiiE i???3?�i!41?iiiS?ii!lllil
COMPLETE THIS SECTION ON DELIVERY
SENDER: COMPLETE THIS SECTION
■ Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. X q Agent
■ Print your name and address on the reverse (,' ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Dat .of D livery
■ Attach this card to the back of the maiipiece,
or on the front if space permits.
1. Article Addressed to: D. Is delivery address di t m item f? ❑Yes
.A If YES,enter delivery a ss below: 0 No
Jared McMurray
PO Box 781
Cotuit, MA 02635 3. Service Type
Ofertified Mail ❑Express Mail
I ❑Registered fii!LRetum Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) Q Yes
! e + a R s i " i i=" i i i i i
(Transfer from service label
i f i7008i 3230 000�2:16177 i9 ,19iiiii
PS Form 3811,February 2004 Domestic Return Receipt 102595702-M-1 54 i
iv-* Town of Barnstable
' omstable
FtHE r Regulatory Services
�f -,
�P` o Thomas F. Geiler, Director _ Uf_V
° Public Health Division
* BARNSTABLE,
v MASS. Thomas McKean, Director
Argo , s 200 Main Street
Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
October 12, 2010
Jared McMurray
PO Box 781
Cotuit, MA 02635
As of October 1, 2006 a new rental registration ordinance was put into affect requiring
all property owners of rental units to register their rental units with the Town of Barnstable
Health,Division. According to our records, you own the rental property's at 1493 Santuit
Newtown Road, Cotuit Enclosed is an application. Please use a separate application for each
rental unit you own. Should you need more applications, they are available online at
wvy,w.town.b arn.stable.ma.us. Go to the Health Division page by looking-in the Department
Menu. There is a link to the Rental Registration information on the Health Division page. You
may print out as many as you need, and return them to the Health Division with the appropriate
2010 fees included. This must be completed within (14) fourteen days of your receipt of
this letter.
Failure to comply with this ordinance will result in the issuance of a non-criminal ticket
citation in the amount of$100. Each day of non-compliance is considered a separate offense.
Should you have any questions, please feel free to call 508-862-4644. Thank you in
advance for your cooperation.
Timothy B. O'Connell, R.S.
Health Inspector
Health Division
Direct #508-862-4646
u/NJ
i✓/�C�1 /�1 `fVL'J�O lA UL`�✓1
�rUF,%
Health Master Detail Page 1 of 1
In As: TOWN',£ Nay,€,� Health Master- CC {Detail 'g ✓�v�
r�Sp ...4t';0h C611ter. - Parcel Wooku J(.IE�€tio �ItC.(�c-,,
Parcel se ��� Re�� Well u �" r€�c
_ Per
Parcel: 025-€ 03 Location: 1493 SANTUIT-NEWTOWN ROAD, COTUIT Owner: MCMURRAY, JAR D
Business name: t� Business phone:
Rental property: Deed restricted Number of Bedrooms . 0'
i Contaminant released: r7 Fuel storage tank permit
Save Parcel Changes Return W,L4' kup�
Parcel Info, Parcel ID: 025-003 Developer lot:
Location: 1493 SANTUIT-NEWTOWN ROAD Primary frontage:83
Secondary road: . Secondary frontages
Village:COTUIT Fire district:COTUI I
Sewer acct: Road index: 1425`
Asbuilt Septic Scan: 025003 1 interactive map:"
Town zone of contribution:WP (Wellhead Protection,Overlay Di st.riCt) State zone of contribution:IN
Owner Info Owner: MC MURRAY, .TARED ,.Co-Owner:
Streetl:PO BOX 781 Street2:
City:CO..I..UI_.. State:MA Zip:, 02635 Count
Deed date: 1/27 2005 Deed reference: 19475/244
Land Info Acres: 0,75;Use: Two Family ' Zoning: RE Neighborhood: 010r_
Topography:Level Road: Paved '
Utilities:Public; Water,Gas,Septic Location:
Construction Info t?:.,ii,ire ` oYea Bus€ Gross A'-ea .€?:rq i, 3r:"
1 1930 2280 978 13 Bedrooms2 Full
Buildings value:S98,200.00 Extra features: "0 00 Land value: $120,900.00,
d.
http://issgl/Intranet/healthMaster/HealthMasterDetail.aspx?ID=025003 10/12/2010
V
.... .. • Y r f1'�;^ ! .i.{ fi•'. : •aJ.l. t�, •JJ� = .
BORTOLOTTI CONSTRUCTION, INC. C
Q 0
765 WAKEBY ROAD,MARSTONS MILLS, MA 02�
508-771-9399 508-428-8926 FAX: 508-428-9399 Q�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO
PART A
CERTIFICATION
Property Address: I y93 ow o d
Date of Inspection: G Inspector's Name: ,{Q
Owner's Name and Address: ,
�n S .//S
CERTIFICATION STATEMENT*
I certify that I have,personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true,accurate and complete as of the time of inspection.,The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
disposal systems. The System:
Passes Y »'r
Conditionally Pass
Needs Further al lion By ocal Aproving Authority
Fails
Inspector's Signature• Date:
The System Inspector shall submit a copy of this inspection report to the Approving authority within thir-
ty(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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable and the approving authority. .
INSPECTION SUMMARY!,-
A)SYST)RM PASSES. `
y I have not found any information which indicates that the system violates any
of the failure
criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated '
below •x. �, 2
,r
B)SYSTEM CONDITIONALLY PASSES;
One or moresystem components need to be replaced:or repaired. The system, upon comple-
tion of the replacement or repair, passes inspection.
Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If
not determined",,explain why not.
The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or
s t :exfiltration,or.tank failure is imn inent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The Board of Health.
Sewage backkup or breakout or high static water,level observed in the distribution box is due .
to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health): '
• 1 -
r
t
�-1j4-70 ..
, - a 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
/ 1 '`j CERTIFICATION(continued)
{ Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or replaced
The System required pumping more than four times a year due to broken or obstructed pipe(s).
The system will pass inspection if(with approval of The Board of Health):
Broken pipes)are replaced
Obstruction is-iemoved . _.
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 the public health,safety and the environment.
1)SYSTEM WILL'PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM'I&NOT FUNCTIONING IN A.MANNER WHICH WILL PROTECT THE
PUBLICMEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 Feet of a surface water
Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT-.PROTECT THE PUBLIC;HEALTH AND`SAFETY AND THE
ENVIRONMENT: .' {.._
The system has.a septic tank and soil absorption system and is within-100 Feet to a surface
water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with a Zone I of a public
water supply well:
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
d :
Feet or more from a private water supply well,unless a well water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from
the facility and the presence-of ammonia nitrogen and-nitrate nitrogen isequal to'or less
..3. than 5 ppm:. .
D)SYSTEMFAILS:`." , ,
I have determined that the system violates one or more of the following failure criteria as defined
in 310 CUR 15.303. The basis for this determination is identified below. The Board of Health
should be contacted to determine what will be necessary to correct the failure.
r. Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent to the surface of the ground or surface waters due to an
overloaded or,clogged SAS or cesspool. s
Static liquid level in the distribution box above outlet invert.due to an'-overload ed or clog-
ged SAS or;cesspool.' .F _ ,
' v
•Liquid depthjn'cesspool'is less than 6"below invert or available volume is less'thari 1/2
a,. day flow.
Required pumping more than 4 times in the last year NOT due to"clogged or obstructed
pipe(s). Number of times pumped
-2-
I
' �� '..i Y�., J.M,•• a .?r pert.. �:.A;�.. y�.' �Fly' e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a cesspool or privy is within 100 Feet of a•surface water supply or tributary to
a surface water supply.
'Any portion of a cesspool or privy is within a Zone.j of,a public:well..
Any portion of a cesspool or privy is within 50 Feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant: ,
threat,to public health andsafety and the environment because one or more of the following
conditions exist
n
• s, The system is within 400 Feet of a surface drrnking 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 IIof a public.waterIsupply 4we' ll'
The owner or operator of any such system shall bring the system and facility.into full compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local,
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
t CIIECKLI$T•,F ,
Check if,the following have been done:'
✓Pumping information was requested of the owner,occupant,and Board of Health.
_/ None of the system components have been pumped for atleast two weeks and the system has
been receiving normal flow rates during that period. Large volumes of water have not been
introduced into the system recently or as part of this inspection.
r✓ As-built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.r
L/ The system does'not receive non-sanitary or industrial waste flow.
r/ The site was.inspected for signs of breakout.
7:7 All system components;excluding the Soil Absorptioi System;have been'.located on site.
/ The septic tank manholes were uncovered,opened,and the interior of the septic tank was in
spected for condition of baffles or tees,material of construction,dimensions,depth of liquid,
depth of sludge,depth of scum. `
: The size and location of the Soil Absorption Systemlon the site.has been3determined based on
existing information or approximated by non-intrusive methods.
{_3-
- t, �X oa r4s f+� e p,4t*v' tiStu fib oils r- ' - -
a i i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
✓ The facility owner(and occupants,if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
RFSIDFNTIIAL:
Design Flow: 030 gallons Number of Bedrooms: 3 Number of Current Residents: �
Garbage Grinder: A/C Laundry Connected To System: Seasonal Use:
Water,Meter Readings,if available:
Last Date.of Occupancy � L»
A MF.R _IATAIND I T IAi "^
Type*of Establishment:
Design Flow: salIonstday Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present: _
Non-Sanitary,Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
.'•cSE. ,,a+ :. ;} :...e.
PUMPING RECORDS and source of infor:.mation:
System Pumped as part of inspection: n U if yes,volume pumped: Alons
Reason for pumping:
TYPZOF SYSTEM:• ., .
,Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool .. ,
Privy
Shared System(If.yes,attach previous inspection records,if any)
Other(explain):
APPROXIMATE AGE of all components,date installed(if known)and soK__ of-jnformation:
Sewage odors detected when arriving at the site: /1&
-4-
1
..,,.SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
as F GENERAL INFORMATION (continued)
SEPTIC TANK:
Depth below grade: Material of Constriction: concrete `metal FRP Other
(explain) _
Dimisions: Sludge Depth: Scum Thick_ness:
Distance from top of sludge to bottom of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
:; Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation to outlet invert, structural integrity,evidence of leakage,etc.)
GREASE TRAP:
Depth Below Grade: Material of Construction: '" concrete metal FltP Other
(explain) — — —
_Dimensions: - Scum Thickness: -
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
ievel in relation to outlet invert,stntctural integrity;evidence of le'tkage.�etc.) `•` '
TIGHT ORHOLDING TANK: r
Depth Below Grade: Material of Construction:_'_concrete_ntetal_FRP_Other(explain) .
Dimensions: Capacity: gallons Design Flow: gallons/day
Alarm Level:
Comments: (condition of inlet tee, condition of alarn and float switches, etc.)
DISTRIBUTION BOX:
Depth of liquid level above outlet invert:
Comments: (note if level and distribution is equal,evidence of solids carry•oder,evidence of leakage into
or out of box,etc.)
PUMP.CHAMBER
Pump is'in-working order. �`'a: €. F t, V 4_r
Comments: (note.condition of.pump chamber, condition of pumps and-appurtenances,1etc[)" --+
�y, x
1FA �?{rF,ph.Fa7'? - ..
SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):
(Locate on site plan,if possible;.excavation not required,but may be approximated by non-intrusive
methods) If not determined to be present,explain:
Type:
Leaching pits,number: Leaching chambers, number: Leaching galleries,number:
Leaching trenches,number,length:
Leaching fields,dumber,dimensions:
Overflow cesspool,number:
Comments: (note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation,
etc.)
CESSPOOLS: `
Number`and configuration:' 'Depth-top of liquid to inlet:invert:
Depth of solids layer: Depth of scum layer: Dimensions of Cesspool:
Materials of construction: Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:
Materials of construction: Dimensions:
Depth of Solids:
Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
x
-6-
SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)'`
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include des to atleast two permanent references, landmarks or benchmarks.:
Locate all wells within 100 Feet.
C4 y
gav
6, '
DEPTH TO GROUNDWATER:
Depth to groundwater: 7y�' Feet ,
MOW of Dete don or Approximation:
}
•
COmmonweaM of MOSSOChIsetts John Grad
ExecuWe Office Of ErMrOrvrientOl Affairs D.E.P. Title V Septic Inspector
department of P.O. Box 2119
Environmental Protection Teaticket,MA 02536
(508) 564-6813-;,.,. _1
0if J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Q
tfPART At J
CERTIFICATION
u i New ®tea Rod
.Property
Address: 1493 ddr Owner: H��TBg9N 1'9`9,
Date of Inspection:615197 (If different)
Name of Inspector:John Gracl Gerskowltz:75 Marshvlew Lane Marstons II
Company Name,Address and Telephone Number: S
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X Passes This Inspection is based on criteria defined In Title V
Conditionally Passes code 310 CMR 15.303.Myfindings are of how the system Is
_ Needs Fu er valuation 8 the Local Approving Authority performinq at the time of(he Inspection.My inspection does
y pp 9 ty not Imply any warranty or quarantee of the longevity of the
Fails septic system and any of its components useful life.
r .
Inspector's Signature: �L Date: 6110197
The System Inspector shall ubmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B,C,or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.)
_ The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street 9 Boston,Massachusetts 02108 9 FAX(617)556-1049 9 Telephone(617)292-5500
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1493 Newtown Rd.Marston Mills
Owner. Gerskowltz:75 Marshvlew Lane Marstons Mills
Date of Inspection:615197
D]SYSTEM FAILS(continued) „
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.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 1499 Newtown Rd.Marston Mills
Owner: Gerskowitz:75 MarshvlewLane Marstons Mills
Date of Inspection:615197
Check if the following have been done:
_X_Pumping information was requested of the owner,occupant, and Board of'Health.
X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
NaAs built plans have been obtained and examined. Note 1f they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up. -
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 111'15195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM `
PART C
SYSTEM INFORMATION
Property Address: 1493 Newtown Rd.Marstons Mills
Owner: Gerskowltz:75 Marshvlew Lane Marstons Mills
Date of Inspection:615197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 3
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: n1a
Last date of occupancy: n1a
COMMERCIAL/INDUSTRIAL:
Type of establishment: n1a
Design flow:0 gallonstday
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: n1a
Last date of occupancy: n1a
OTHER:(Describe) nla
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped in the last two years. '
System pumped as part of inspection:(yes or no)Yes
If yes,volume pumped: i400 gallons
Reason for pumping: Maintenance.
TYPE OF SYSTEM
Septic tank/distribution box/soil absorptions system
x Single cesspool
x Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
X _Other(explain) New pit Installed In1993
APPROXIMATE AGE of all components,date installed(if known)and source information:
Main cesspools original:with new pit Installed in 1993
Sewage odors detected when arriving at the site:(yes or no) No
(revised 11115195)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1493 Newtown Rd.Marstons Mills
Owner: Gerskowltz:75 Marshview Lane Marstons Mills
Date of Inspection:615197
SEPTIC TANK:
(locate on site plan)
Depth below grade: n1a
Material of construction:_concreate_metal_FRP_other(explain)
Dimensions: n1a
Sludge depth:nia F
Distance from top of sludge to bottom of outlet tee or baffle: n1a
Scum thickness:n1a
Distance from top of scum to top of outlet tee or baffle:n1a
Distance form bottom of scum to bottom of outlet tee or baffle: n1a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Na
GREASE TRAP:
(locate on site plan)
Depth below grade: n1a
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: n1a
Scum thickness:n1a
Distance from top of scum to top of outlet tee or baffle:n1a
Distance from bottom of scum to bottom of outlet tee or baffle: n1a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Na
r
i
(revised 11115195)
_ 6 _
f
n
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1493 Newtown Rd.Marstons Mills
Owner: Gerskowltz:75 Marshvlew Lane Marstons Mills
Date of Inspection:615197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade:Na
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions: Na
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: n1a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
Na
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n1a
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.)
Na
o
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
Na
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -
PART C
SYSTEM INFORMATION(continued)
Property Address: 1493 Newtown Rd.Marstons Mills
Owner: Gerskowttz:75 Marshvlew Lane Marston Mills -
Date of Inspection:615197
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)if not determined to be present,explain: µ -
nla
Type h
leaching pits,number: 6'x4•N10 ptt u
leaching chambers,number:n1a
leaching galleries,number: n1a
leaching trenches,number,length: nla
leaching fields,number,dimensions:n1a -
overflow cesspool,number:4'x5'rock
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The overflows are structurally sound.Pit C had 2'in It at the time of the Ins ection.Pit Shad some solids in tL
CESSPOOL$:x =
(locate on site plan) 1
Number and configuration: one
Depth-top of liquid to inlet invert: 7'
Depth of solids layer: 2• ;
Depth of scum layer: 7�
Dimensions of cesspool: Txs
Materials of construction: rock
Indication of groundwater: none
inflow(cesspool must be pumped as part of inspection)
n1a :
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc:)
Main cesspool and all components are structurally sound.Recommend pumping system every year for maintenance.
x
PRIVY:_
(locate on site plan)
Materials of construction: n1a Dimensions: n1a
Depth of solids: nia
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc) .' u
nla
� • vim` a '. •.i�'
(revised 11115105)
b ,
8 *`
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1493 Newtown Rd.Marstons Mills
Owner: Gerskowitz:75 Marshvlew Lane Marstons Mills
Date of Inspection:615197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
/T
al'
. T :a-g
BA sly
rc �g
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised IV15195)
No. `' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for 30igpool *pgtem clCottgtruction Permit
Application for a Permit to Construct Oepair)()Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. I1-1 q3 /1/e wfa Wr+ owner's Name,Address and Tel.No. jrA.,-1 C'i"14-y
Assessor's Map/Parcel 0 as 4�� a S.O p — ,3 } —y�v 6
Installer's Name,Address,and Tel.No.`j,1+5dy1 cS 0V Z�JG1_ Designer's Name,Address and Tel.No.£�J. I-Ao c S
a7 Ca&n-t`f/Lcf. 7t1a5t-ofe � �>✓�eICenty-f-
5"0 Cl 7 - 7 b 77- S 3 13
Type of Building:
Dwelling No.of Bedrooms Lot Size '/A 9a^d sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design.Flow 3 3 r) gallons per day. Calculated daily flow 3 3 O gallons.
Plan Date //t/o 5 Number of sheets Z Revision Date
Title
Size of Septic Tank >Sw Type of S.A.S.
Description of Soil r A--a. ev •
Nature of Repairs or Alterations(Answer when applicable) Ale 4i
Date last inspected:
Agreement:
The undersigned agrees to ensure.the construction and maintenance of the afore described on-site sewage disposal system
in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has b issued by this Board of He th.
Sign Date 3 z
Application Approved b V44 Date
Application Disapproved for the following reasons
,/A 7
Permit No. Date Issued
a
No
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: N
' Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication forlDigoal *pgtem Construction Permit
Application for a Permit to Construct Q Repair)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /1•/13 /1/P w-10 Wr+ tLcf. Owner's Name,Address and Tel.No. Ti./• �9C?b�///4
Assessor's Map/Parcel O o2 S —d O
3 sod - -25 + -t
Installer's Name,Address,and Tel.No.J 4 Sph Suv Z C. Designer's Name,Address and Tel.No.ijl J
Caen-f Y /I c/. Y1�a 5 o�e p�fe'Y�1C e ntY e
sad- y7� - 7V// Sod - ti�-�- 5313
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size /3.9ay sq.ft. Garbage.Grinder
Other Type of Building D4e1/1n o No.of Persons Showers( ) Cafeteria( )
Other Fixtures Design Flow Flow 3 y F allone r da . Calculated daily flow 3 3 U
gn g p y y gallons.
Plan Date Z// 0,5 Number of sheets Z Revision Date
Title
Size of Septic Tank /S w Type of S.A.S.
Description of Soil Si Y L
Nature of Repairs or Alterations(Answer when applicable) Al,'w 7,.-�/-t r/
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has n issued by this Board of Health.
Signe -.. :' /] a /? ,;. Date-
Application Approved by/ r / ✓1 U A .p-aw&If'I Date
r Application Disapproved for the following re sons �� k -
Permit No. Date Issued
——— ——— —— ————————————————— —
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Vl,ompliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( )
Abandoned( )by 1 4j .
at /54-4 3 4t)n t4q .7r, �C� �, has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.-::�'>r< 1//dated 3 a
Installer SeAn 5cw-7,-, Designer mC d-a ye -
The issuance of this perript shall not be construed as a guarantee that the syste • w`11<f,n'"fi� as designed.
Date yf,��S Inspectors
---- ---------------------------
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION . BARNSTABLE. MASSACHUSETTS
Mi5ponl *pgtem Construction Permit �
Permission is hereby At d to Construct( )Repair )U grade Abandon J
System located at �^ r,��nl�, I
- J j
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: Cons' ction ust be completed within three years of the date of this" er nit
� .Date:_ ��� Approved by � � �
TOWN OF BARNSTABLE
LOCATION I C� �r c'i�!�i't a b6� 1. = SEWAGE # tJ C5 ' l
VILLAGE % %t ASSESSOR'S MAP & LOT-I S_ w S
INSTALLER'S NAME&PHONE NO. C
SEPTIC TANK CAPACIT
LEACHING FACILITY: (type) t'i e-J W LM 506 C1 cd (size) 25'a-13• Z
NO.OF BEDROOMS .�
BUILDER OR OWNER VA LALC d fl!L4
1
PERMITDATE: '3 - 3e os 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(eet of leaching facility) Feet
Furnished by
Jr 0
i
��yl 1 a 1 I
v
.S ® I �
CS q
it
a �
Town of Barnstable
Regulatory Services
Thomas F. Geller,Director
Public Health Division
toy
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: al.4106 Sewage Permit# a005 -11 1 Assessor's MaplParcel
Designer: �q Ti�°� n 1�nn �� Installer:
Address: 1 Z- C46 SS Q_-9-\c, 01 Address: )-A coo►X+4
1=6r-k-$ 4c�'e. MA MA 9�LDtt.. 11W, o-,)-6 t-t cj
LN
On _ was issued a permit to install a
(date) (installer)
septic system at 1.4 q 3 • N based on a design drawn by
(address) i
M _�c��2 e dated 'Z
(designer)
1 certify that the septic system referenced above was..installed substantially according to
the design, which may include minor approved chaiges:such. as lateral relocation of the
distribution'box and/or septic tank. r
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. flan revision or
certified as-built by designer to follow.
• ���P�j N OF Mq`S'S
9�
PETER T: tiN
m
l.nstaller' 'gnature)
CIVIL
" WENT ti
,.
-o N0.35109,
STFA�a��'��� ,
L
(Designer's Signature) (Affix Designer's Stamp here)
PLEASE RETURN TO 13ARNSTARLE PUBLIC HEALTH DIVISI-QN CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FOAM AND AS BUILT CARD ARE
RECEIVED By THE BAItNSTABLE PUBLIC HEALTH DIVISION. IRANVA VOL1:
Q:Health/Septic/Designer Certification Form 3-26-04.doc
y,.
APN 2 5�003 LEGEND ,
0� 43,900-+- 5F 99 PROPOSED CONTOUR
(RECOe) 99 1 PROPOSED SPOT GRADE
Loy
119
34CoU EXISTING CONTOUR LOCUS
1 i 0 EXISTING SPOT GRADE
5TRI POUT 2,, \ �� TEST PIT 'pp
(5EE NOTE 1 1)
CO BENCHMARK z
e / r:.::: O � � hN p
�/----- EXISTING WATER SERVICE O �
.:..: O i N �s 40, R
EXISTING .OVERHEAD WIRECA
o
EXISTING CE55POOL co / / DIRT DRIVE ---EXISTING GAS SERVICE
(TO BE PUMPED, FILLED W/ ,� / DRIVE s
SAND, AND ABANDONED) , , `�,. '� BENCHMARK
LOCUS MAP N.T.S.
CORNER OF CONC. LNDG.
�4 EL.= 100.00 (ASSUMED)
TIE IN TO EXISTING 4" C.I. (�0 J GENERAL NOTES:
PIPE OUTSIDE OF HOUSE ✓ 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
INV•=98.05-* ® rl�.� BOARD OF HEALTH AND THE DESIGN ENGINEER.
r 2$� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
r y OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
r LOCAL RULES AND REGULATIONS.
r P
Rp
/� F' S,q•S. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
f r cv TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
fNO. 1493�, C FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
�/ I J/2 STY• / >- 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
/rWD. FRM.,/,, 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
/ T:ll 102.46 CA THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
r r N HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
0' l 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
J 03 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S.
COVERED n.r �,.
"" ®
PORCH 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
I t j I 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
I THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
_ h ,� CONSTRUCTION.
83�± 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
/ r IN THE AREA BENEATH AND FOR 5 FT: ON ALL SIDES OF THE S.A.S.
AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 2551
ti� a
S.A.S. LAYOUT
.. � /'�
_ 1 1
CATCH �< pp Fo
°F Mgssq� P��� of 414ss9�
BA5IN oz� RICHARD yes �`
---®F pA�Fm
f J. o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE
fa�e OWN ROAD o HOOD o McEN
CIVIL E 1493 SANTUIT NEWTOWN ROAD, COTUIT, MA
f, A, o o No. 35031
SANTU�-� N� 1 �,fc/S1���� �o No. 3510�9 Prepared for: Jared McMurray, 1493 Sontuit/Newtown Road, Cotuit, MA
rj
r L + S� Op �FC1S1�ftG �� Engineering by: Surveying by: SCALE DRAWN JOB. NO.
Engineering Works HOOD SURVEY GROUP 1 '=20 P.T.M. 105-05
12 West Crossfield Road 18 Route 6A
I Z�r,1J� Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO.
(508) 477-5313 (508) 888-1090 2/18/05 P.T.M. 1 of 2
4,
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
TOP OF FOUNDATION F.G. EL: 97.0t FINISH GRADE SHALL NOT BE < EL:94.0
EL.=102.46 FOR A DISTANCE OF 15' AROUND THE
EXISTING F.G.EL: 99.3t F.G. EL: 97.0t PERIMETER OF THE S.A.S.
MAINTAIN 2% MIN SLOPE OVER S.A.S. 36" MAX. COVER
mxmw
INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D—BOX TO —500 GALLON _LEACHING C. AMBERS IN SERIES INSTALL RISER OVER CHAMBER/S
70 WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE SURROUNDED WITH STONE — ALL SIDES SHOWN ON PLAN AND SET COVER/S
WITHIN 6' OF FINISH GRADE
HETSET LEVEL OVER L =13' MAX
� 4' SCH 40 PVC ,.... ........ .. .., . L 22' ( )
' 4" SCH 40 PVC FIRST 2 FEET
6" .: 4" SCH 40 PVC 2" LAYER OF 1/8" TO 1/2"
@ S= 2% (MIN.) 1011 Is., M3® P, ®® DOUBLE WASHED STONE
14• ® S= 1% (MIN.) ® S= 1% (MIN.) ®®®®®®®
PROPOSED
v 2' EFF. DEPTH „ ®®®®�®®
INV.EL: 97.25 1500 GALLON INV. ELEV.=95.50 3/4"-1 1/2"
SEPTIC TANK D—BOX INV. ELEV.=95.33 4' S.2' 4' DOUBLE WASHED
INV.EL: 97.00 W/ RISER EFFECTIVE WIDTH = 13.2' STONE
PROVIDE COUPLING INSTALL INLET & OUTLET TEES INV.. ELEV.=93.50
INV(OUT)=98.05
GAS BAFFLE TO BE INSTALLED ON
OUTLET TEE AS MANUFACTURED BY TOP CONC. ELEV.=94.3 —BREAKOUT ELEV.=94.0
TUF—TITE, ZABEL, OR EQUAL INV. ELEV.=93.50 Fa ig Is. gi coffiffam
MEH
mm W
SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=91.50 4' 2 x 8.5' = 17' 4'
GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF L EFFECTIVE LENGTH = 25'
T.P. EXCAVATION OR G.W.
(3) 5" DIA.OUTLETS SEPTIC SYSTEM PROFILE BOTTOM OF TEST HOLE EL.=83.2 LEACHING SYSTEM SECTION
N.T.S. As
15.5" O i1 DESIGN CRITERIA PETER T.
6„ U Mc CIVILEE
10'-6" SOIL LOG NUMBER OF BEDROOMS: 3 BEDROOMS No. 35109
DATE: FEBRUARY 10, 2005 SOIL TYPE: CLASS I
D—BOX 3 - 20" Dio. Covers DESIGN PERCOLATION RATE: 2 MIN./IN.
KT.S. 1 SOIL EVALUATOR: PETER MCENTEE C.S.E.
!{ INSPECTOR: NOT REQUIRED DAILY FLOW: 330 G.P.D.
CLASS 1 SOILS DESIGN FLOW: 330 G.P.D.
GARBAGE GRINDER: NO
Elev. TP Depth LEACHING AREA REQUIRED: (330) = 445.9 S.F.
96.2 A SANDY LOAM O .74
®®®® ® ®®®E3 Top View 95.2 1OYR 3/3 12" SEPTIC TANK PROVIDED: 1500 GALLON (PROPOSED)
®®®®®®®®®®® 33" B
INVERT. ®®� ®®®®®®®®®EO® SANDY LOAM
24' ® ®®®®®®® 4" Din. Inlets 4" 10YR 5/8 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES
102" 92.7 C1 42" SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 158.2 S.F.
BOTTOM AREA: 13.2' x 25.0' = 330.0 S.F.
4" KNOCKOUT SILT LOAM TOTAL AREA: 482.2 S.F.
20" DIA. COVER 5'-8" 4'-7' 4 3" Liquid Level 5Y 4/3
KNOCKOUT O/4" KNOCKOUT 62" 87.2 108" DESIGN FLOW PROVIDED: 0.74(482.2) = 357.3 G.P.D.
4�� 3s C2
4" KNOCKOUT MEDIUM SAND
1 2.5Y6/6 PROPOSED SEPTIC SYSTEM UPGRADE
section 1493 SANTUIT NEWTOWN ROAD, COTUIT, MA
1500 GALLON CAPACITY, H-10 LOADING
500 GALLON CAPACITY, H-10 LOADING 83.2 156" McMurray,for: Jared Prepared 1493 Sontuit Newtown Road Cotuit MA
SEPTIC TANK P y� /
CHAMBERS NO G.W. ENCOUNTERED Engineering by: Surveying by: SCALE DRAWN JOB. NO.
N.L9. PERC RATE: <2 MIN/IN. ("C" HORIZON) 9
En ineerin Worb HOOD SURVEY GROUP N.T.S. P.T.M. 105-05
12 west Crossfield Road 18 Route 6A
Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO.
(508) 477-5313 (508) 888-1090 2/18/05 P.T.M. 2 of 2
}
,V