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HomeMy WebLinkAbout1500 SANTUIT-NEWTOWN ROAD - Health 1'500 SAO TUIT-NEWTOWN RD . — --- — - --- - -- - - — -- Cotuit A = 025 - 018 u i f as Town of Barnstable c iv& ,. Regulatory Services 210 Nathan n Highway a Richard V. Sca%Interim Director &St Falmoath,MA 02536 r IMMSTASM r Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 7,70 qV Sewage Permit#)g=..ga& Assessor's Map\Pareel Z l g Designer: 1 y{ �.� ,�D NS Installer: C — Address: b 7bX, q$ t Address: On \ issued a permit to install a (dA) (installer) septic system at 1 5ku}'I`" based on a design drawn by (address DC,-,rfeV\ MeA,(r­e' dated (designg) 1 I certify that i�� at the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 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. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certi that the system referenced above was constructed in compliance with the terms o the RA ap oval letters(if applicable) OF - (installer's Signature) '(DesiSignature) (Affix ere) _ PLEASE RETURN TO BA TABLE PUBLIC HEALTH D N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc No. i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpplicatiou for )Disposal 6psteut Construction 3permit Application for a Permit to Construct( ) Repair( pgrade Abandon( ) Complete System ❑Individual Components Location Address or Lot No. er's NameAddress, nd Tel.No. -�.-J`- � Assessor's Map/Parcel Installer's-Nw e, dress,and Tel.NQ_ Designer's Name,Address, h Type of Building: Dwelling No.of Bedroom�._ �� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Description of Soil —� z> Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance t afor described on-site sewage dis al system in accordance with the provisions of Ti 5 of the Environmen ode and of to Oace sy operation until a e Zcate of Compliance has been issued by�th Health.S Date Application Approved by - Date - Tr— Application Disapproved by Date for the following reasons Permit No. 01 0/L/" Date Issued � ��_ �'0 360 r No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: g PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for �DispoBAZ Opstrin Construction permit Application for a Permit to Construct( ) Repair( Upgrad_eAbandon( ) Complete System ❑Individual Components r Location Address or Lot No. Owner's Name,-Address,and Tel.No. Assessor's Map/Parcel <-- �< ` _ *••' (4 Installer's-Name,Mdress,and Tel No Designer's Name,Address,and Tel.No. TypeofBuilding: ._�.----Cc>.�-•-� Dwelling No.of Bedrooms—]L ( Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons i Showers( ) Cafeteria( ) Other Fixtures ; `x, Design Flow(mina.required) gpd Design flow provided �'"�, "� gpd Plan Date Number of sheets �`'a- Revision Date Title Size of Septic Tank Type of S.A.S.;." `'�-r �J Description of Soil � '��. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance1t e afo des ribed on-site sewage dis al system in accordance with the provisions of Title 5 of the EnvironmenTz ode and of to�Iace sy e n operation until a e ficate of Compliance has been issued by this•BB©ard-of Health. _ Signed c� Date �� Application Approved by Y Date / _ r Z Zy Application Disapproved by �- " Date for the following reasons Permit No. a D;�V- 3(00 Date Issued — (�j" l) - -THE COMMONWEALTH OF MASSACHUSETTS f< BARNSTAB'LE,i MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at - / ✓ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2-02 B' 6 dated 3 v Installer Designer #bedrooms 3 Approved design flow C) gpd The issuance of this peit shall 'of be construed as a guarantee that the system nc will io as desi ed. - Date 1 ► Inspecto --------------------------------------------------------------------- -- - No. a o,,-O 3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction i3ermit ,• Permission is hereby granted to Construct( I Repair Upgrade Upgrade( ) Abandon( ) System located at 1503 i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. i s Provided:Construction must be completed within three years of the date of this permit. �j Date (�_ Approved by �" 1 Town of Barnstable cavo�s3 Regulatory Services 210 Nathan Highway Richard V.Scali,Interim Director post Falmouth,MA 02536 " MAM Public Health Division 165 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: « Permit# _ 0Assessor's Map\Parcel 40u_ Sewage Designer: So IDS Installer: Address: b EQ7 Address: �• St�1�l�I Llht nil/� �-„ ���,��,_-�-__��O�S�3Co .._ On _ ssued a permit to install a (installer) septic system at 1 S�D based on a design drawn by (address D dated (desi er) P e,r Sv►-�s /0 C. I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 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. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I cedify that the system referenced above was constructed in compliance with the terms o the I\A ap oval letters(if applicable) (Installer's Signature) ER No. 11 (Designer's Signature) (Affix ere) PLEASE RETURN TO BA TABLE PUBLIC HEALTH D N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH TIfIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc . Commonwealth of Massachusetts D a5-- olg Title 5 Official Inspection Form F; Subsurface Sewage Disposal Systerrt Form-Not for Voluntary Assessments _ 1500 Santuit Newtown Rd . __......_ ......... Property Address Evans ' Owner Owner's Name Information is required for every Cotuit ✓ Ma 02635 J1I2620. ate - page. CrFCown St "Zip Code Date of Inspection ? Inspection results mint be submitted on this term. Inspection formt;s may not be altered in any way.Please see.completeness checklist at the end of the form, ' 4 Important.When A. Inspector Information �1� 1�-i�Lt� filling out forms ' on the computer, use only.the.tats Sean ttA..Jones . key to miove your Name of Inspector cursor--.do hot :S.M.Jones Title V Se tio'ins ction:. . use the return _.. Company Name :key . ' 74 6eldan Lane Company Addreszt _ - - Centerville - Ma, . 02632.� � CltYfTo m State Zip Code 774-248-4650 smaonestitle5tna1l.com $14522, sear onestitle5.com License Number` , . s q. B. Certification I certify that. I aim a DEP'approved system inspector in full compliance'with Section 15.300 Title 5 (310 C R 15.000); IL have personally,inspected.the sewage disposal system at the proper�r address; listed above;the inf€�rmation reported below is true;.accurate and complete as of the tithe of my inspection;and the inspection was performed based on my training,and experience in the proper function: and maintenance of on-site sewage disposal.systems.After conducting this inspection Lbave determiined -that the system: x5 1 ® Passes f _ 2. Q Conditionally Passes; 3. 0 Needs Further Evaluation b' the Local Approving Authority: 4, ❑ Fails; , . ..».M..„wad..A 4/112020 InspectorsStgnature -... Bate' ., The.system iinspecto shall submit a copy.of this inspection report to the Approving Authority(Board of Health or DEPp within 30 days;of completing this inspeetiari. Ifthe systerri has a design haw of 10"000 gpd ar greater,the inspector and the system Winer shah submit the report to the appropriate regional,office of the®EP.The original form should bo sent to the system owrner and caples sent;to the buyer, if applicable, and the approving authority. Please not e.°This report only.describes conditions at the time Of inspection and under the _ conditions of,use at that tiMe'L This inspectloin does not,addrestt how the system will perform,,' in the:future;under the same,or;different conditions of use. l insp foci Sev,7d2Pf2[1,1F1 i - Time S Off"t W inspedion Fcwm'S€bsidece 8#wapD1s0u13yst+emi-Paige 104 W!_ r 4 r Con hicii1 health"Of Massachusetts Title. 5 -official Inspection 'Fora Subsurface Sewage Disposal System Form Not:for Voluntary Assessments 1500 Santult Newtown Rd ..., _....... __. __ i5rapedy Address Evans Owner �._....,,,,.,... M Owner's Name requredfot.e Cotuit m� __. Ma' 02635'. 4111242't required foreuery ---�.-----, page, CityPfourn state 7jp Cade Date v#inspection C. Inspection Summary Inspection Summary: Complete 1,2, 3, cw5 and all,of 4-and 6. y^-SOtepi Passes: I Have not found any information'which indicates that any of the failure criteria described in 310`CHAR 15.303 or in 310 CMIR 15.304 exist. Any failure criteria not evaluated are indicated below. , Comments. 2 sets of 2 cesspools. Cess ols are cold but,in solid condition. No guarantee of future peef rrnance. 2) System Conditionally Passes: C1 one or more system components as described in the"Conditional Pass!'section need lobe replacad or repaired. The system, upon completion of the replacement,or repair, as approved by the Board of Health,will pass. +check the box for"Yee,"'W or"not determined"(Y, N, ND)f+or 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 exflltration or tank'failure ig imminent. System will pass inspection 4 the existing tank is replaced'with a complying septic tank as approved by the ward 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 tarok is less than 24 years old is available.. El Y Ej N Q NO(Explain below): - .......... t6lnsp,dac E rev,7126010, MR 5 Offroial hspecttot FWM SubstAce S a DispMJ Sy$Wn•Pop 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Sub surface Sewage disposal System Form -Not for Voluntary Assessments 1500 Santuit Newtown Rd Property Address. Evans _.. _... _•. Owner ____....__ ....:.�..� ...��... -m....,.,..�,_.�. . _........__.�......m Owner's Marne information.is required for every Gotuit _....._ _._. Ma 02635:W.. 411/202t} - _ page. citytrown State Zip Code Cate of Inspection C. Inspection Slurnmiary. (cant) 2) System Conditicsrtaily Pump Chamber pumpslalarms:not operational. System will'pan-with Board of Heath approval if pumpstalarrns'are repaired: Observation of sewage backup or break out or high staitiIc water level in the distribution box due, to broken or obstructed pipes)or due to a broken,settled or uneven distribution box, Systemmill pass inspection if()Wh approval of Board of Health: [] broken pipes)are replaced Q Y N (� .NQ(Explain below): obstruction.is removed E `Y '01 N rl ND(Explain belay); ( distribution boa€is leveled ar replaced [I 1Y '[] N ND;(EXplain below): ❑ The system required pumping more than.4-tirnes a year due to broken or,obstructed pipe(s), The system will pass'inspection if(with approval of the Board of Health): [-1:, broken pipes)are replaced ❑ Y E] N [] ND(Explaih below): obstruction is removed: E].Y - Q N 0- ND(Explain below): 3) further Evailuation is Required by the Board of Health: [� Conditions exist which require'further evaluation byr:the Board of'Health'in orerto determine�if' ; the system.is failing to protect:public health,;safety or the environment. a. System will pass unless Board i taf Health do in accordance rnrith 31t1 CMR, 1 3Q (1)(0)than tits system[ nit functivnin In a manner hicks will protect pubilc health ` ;safety and the enriironmentc . F tStnBj'-ooC kfro;,IffizIa.' ` ,. T de S O t W E dart Rams SubaGir ae SewbO DisgSsas9 3"at€t':+Pegs$.Qf 18 Commonwealth of Mlaasachusetts . Title 5 t ff is inspection �or�r suourface Sewage Disposal System Form•Plot for Voluntary Assessments 1500 Santuit Newtown Rd .,.. . _ mm. _. .....,.,..,....�, Property Address Evans Owner owner's Name information is eowit Maw f12635 4/1/202Q required for every page City/Town State. lip Code Date of tnspedion C. Inspection Summary (cunt. (� Cesspool'or privy,is within 50 feet of a surface water [Q Cesspoof or privy is within 50 feet of;a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Keakh(and public WAter ,Supplier, if any). determines that the system Is functioning in a manner`that protects the public health, safety and environmentx The system has aseptic 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. 0 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. El The system has a septic tank and SAS and the SAS is less than 100 feet lout 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 CHEF'certified'laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate:nitrogen is equal to or Tess than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. tither: 4). Systom-Fallu re Criteria Applicable to All Systems. You mud Indicate"Yes°'or O'Ne to each of the following for all iinspections Yes Nb Backup of sewage into facility or system component due to:,QverloaOed1 or 0. clogged SAS or cesspool E 9 Discharge or pondi tg,of effluent to the surface of the ground or surface waters due to an overloaded.or clogged SAS or cesspool 161*doo rev,7P16t 18 'Ciris S Mid inepeotlon Form:Subhftoa Sawsp ofspml Sysieisi+Page 4'of 78 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm Not for Voluntary Assessments 1500 Santuit Newtown Rd Property Address Evans Owner owner's Name information is Cotuit ._._. _. ..__. ".. Ma 02635 4f112020 required far every _ pag& Cityrrown Mate Zip Code Date oflnspection C. Inspection Summary (cant.) 4) System Failure Criteria Applicable to All Systernw icont.) Yes: Na Static liquid level itit�e distnbution box move 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 X day flow Required,pumping.more than 4 times in the`last year N0Tdue to.clogged or obstructed pipes). Number of times pumped. Q 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,taasurfac�e water supply: 7. ® Any Portion of aces pool or privy, within a Zane 1 of a public water supply. well; F El Z Any'portion i?f:a"cesspool or privy is within 50 feet of a-private water supply well. . Any portion pf s cesspool or privy is less than 1.0.4 feet but greater than 50 feet. from a private Water supply well with no acceptable water duality analysis.[This system passes if the well waiver analysis,performed st a.DEP certlfled laboratory,.for fecal coliforrn 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 analysle acid chain of custody must_ a attached to this form.] �- The systern is a cesspool serving:a facillty#4 a design flow of 2QQO gpde The system fails. l have determined that one or more of the above failure criteria.exist as described in 316 CMR 15.3Q3,therefore the system fails. The ` system owner should contact the Board.,of Health;to determine what will tie, necessary,to:;correct the failure, 5). .Large Systems: Ta,be eonaiderdd a large system the system must serve,a facility with a r design tlovu of 10,00Q gpd to 15600 gpd: For large systems,YOU must'indicate either°yes` or"no�`•to each of the,follo ing,,in.addition to the questions`i n:Section-CA.. Yes ldo n Q Q the system is within 400 Poet of a surface drinking water-supply the'system is within 200 feet of a tributary to a.surface drinking water supply I'i ❑ the system It located in a nitrogen�sensitive area(interim.Wellhead Protection p Area IWPA)or a mapped Zone ll of a;public water supply well tSErsp.dc rev„7f2frf 4i).; Title 5 dffc csre Farm$uEiswt at , Ql system k Wage Aelf 18 Commonwealth of Massachusetts . Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form-Not fdr.Vvluntary Assessments 1500.Santuit Newtown Rd Property Addre Evans thmei Owner`s Name . lriform d#k Cotuit m _ Ma 02635. 411l202Q require fisrevwy page. City,,own Stat® Zip Code Date of tnspe€ ion C Inspection Sumlmlar (cunt) If you have answered"yes"to any question in Section C-5 the system is considered a significant threats or answered"yes"to any question in Section CA above the large system has failed.The. owner or operator of any large system considered a significant threat under Suction C.5 orfalled under Section CA shah upgrade the system in accordance,with M CMR 15,304. The system owner should'.contact the appropriate regional office of the Pep-Prtment. 6; You must indicate"yes' or"no"for each of the following for all Inspections: Yes NQ Pumping information-was provided by the owner,occupant, or.Board of Health; El S. `Were any of the system components pumped.out in the previous two weeks? Q "Has the system received normal flows in the prevlous two week period? Have large volumes of water;been introduccedd to the system recently or as part of El 0. this inspection? Were as built.plans of the system obtained and examined?(if they were not available note as N/A). 0 0 Was the facility or dwelling inspected for signs of sewage back.up? (❑ Was the site inspected for;signs ofbreak out? Wgre all system components,excluding the SASt located on site? Were the septic tanW manholes uncovered, opened, and the interior'of the tank inspected for the condition of.the baffles or toes, material of constructiottk dimensions,depth of liquid, depth cif 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 an 'location of the Soil Absorption System(SASj on the site has been determined used on Existing information, For example; a plan at the Board of Health.. determined in the field (if any,of the failure criteria related to Pert C is at issue - - approximation of distance is<unacceptable)1310 CIVIR"15.302( )]; tSitt f.1 riBSr.,7t2617SR,1@ Tilt 6 QMCW Ini tsKi i Gllf1:&tr surC Smage 01WOW SysteM r 8$8,6.0118 k • , Commonwealth of Massachuse t Title 5 Official Inspection Form Subsurface Sewage disposal System Farm Not for Voluntary Assessments 1500 Santuit Newtown d. Property Address Evans _Owner Owner's Name_..T__ requir atiforon e Cotuit _ _ ---- Ma required for suety • 02635 4I112{�2Q page. Cityfrown State Zip Cade, Date of tnspeef an Q. System information t Residentlalflow Gonditidns. Number of bedrooms(design):, w:::: ..... Number of bedroorns,(actual}: 3 :. DESIGN flow based'on 310 CMR 15.203:(for example-110 gp of bedrooms): 330 9pd Description: Number of current residents. Does residence have.a garbage grinder? ❑ Yes No Deaes residence have a water treatment,urtit't ❑ Yes. 0 No If yes, discharges to: Is laundry on a separate sewage.system?(Include iaundry system inspection: infdr-mation.in t re his, porQ ❑ Yes ; No Laundry system inspected? ❑ Yes ° No; Seasonal,use? ❑ %Yes Naa Water:rneter readings,.if a.41.4ble(last 2 years usage(gpd Detail: Sump puevip ' ❑ Yes 0 No unknown i Last date of occupancy,, gate t5tw! •red-7 8.: Ftw s otfw a(trt�Mdkm Form:Sutr�ivw., b4paT system.0 7 of f8 Commonwealth of Massachusetts Title 5 Official al Inspection Form Subsurface Sewage Disposal;System Farm-Not far Voluntary Assessments 150Q"Santuit Newtawrt Rd Property Address Evans QWE98r Owner's Name regWrdfo is Cotuit Ma:.. 02635: 4/1/2020 required for every page, City/Town We 7jp Code: Pate of inspection D. System 110ofmation (cont.) 2. Commerclal/lndustrial Flaw Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203) Gallons per day(gpd) .Basis ofdesign flow(seatstpersonslsq,ft.,,etc.) Grease trap present? T11 Yes Q' :No Waiter treatment unit pressent? El. Yes ❑ 'No lf;yes„dischargesto: w...:., ...._...._ Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title S system? Q Yes [] No Watermeter readings, if available: Last date of occupancy/use; Date 'Other(describe-below); .. .. ..., .. .. . __ _....,, ._ .._ .. .._._ 3. Pumping Records.. Source af`infonration Was system pumped as part of tree inspection? ❑ Yes Z No ,If yes;volume pumped. gallons How was quantity pumped determined? Reason for pumping., t6i a dac•rsu 7P 6f 01$ Tft S,OfWal.hapecWn Form St6swi a QdWWW System'•Pago a of 18 Commonwealth ofasadhusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments: 1500 Santuit Newtown Rd Property Address Evans Owner Owner's Name required on is Cotuit .�__.._ __. ._______.. Ma f 2635 _ 41//2020 required for every page.. city1rawn State Zip Code gate of Inspection D. System Information (cant.) 4. Type.of Systems Septic tank'E distribution ix. soil absorption system D Single cesspool [ Overflow cesspool . Frtvy _ [ Shared system(yes'ar no)(if yes,,attacti previous inspectian:records, if any} [] tnt4vativelAiternatixe technology;Attach a copy of thLi current aperatiart 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 Q Tight tank.Attach.a copy of the DEP approval:' ti'Jther.(describe);,:� _ 4 cesspooIs: _� A 'imatd age of all.componehts date installed(if known)and:source of information: Unknown ... Were' ago. . .detecttsd when arriving'et tl��site? ❑ Yas No S. Building Sewer(locate:on site plan): Depth'below. grade. _ ._... _ feet' Material of construction: _ Rcast iron; ®40'PVC ®ether(explain): ..... Distance from private water_supply well of suction line: m ..... f8est ' Comments(an condition of;joints, venting,evidence of leakage,etc.g i } t5dnap.ctot•ram,;Y/26t2tti Tegq$c3iacrsn: uAsurEaae `' cispcs 5ystes•wage 0 of 18. CQmmonwea[th of Massachusetts Title 5 Official Inspect on Form Subsurface Sewage Disposal System Form»Not for Voluntary Assessments 15,00 Santuit Newtown Rd _.............. ....,.�. ..__ Property Address Evans Owner's Name infarrneUan is Cotuit Ma 026.35 _ 4/112024 required for every I29e CrlytTown_ StAte Zip Code Date of Inspection i System I formatio (cunt) . Septic Tank(locate on slte plan): Depth.'below grade: teat Material of construction. ❑.concrete ❑metal' ❑ fiberglass ❑polyethylene [ other(explain} if tank:is metal, list age: ,- .,....,., years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No. Dimensions: Sludge depth: ._ Distance.from top of sludge to.bottom o. outlet tee or baffle Scum thickness .._ Distance from,top of scurn to top of outlet tee or baffle - -µ- Distancefrom bottom of scum to bottom of cutlet tee or baffle How were dimensions determined'? Comments(on pumping reconimendations,;inlet and outlettee or baffle condition,.structural integrity; liquld levels as re.lated.to outlet invert evidence of leakage, etc,): __-� � _._ t&*,00*rov.9 9a. TEtW 5 EN€aW tnsp000n Fwm 5vowface Sswga Dfspmt$yslam Pop 10'of'I$ Commonwealth of Massachusetts � � a y Title Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1500 Santult Newtown Rd _. Property Address Evans Owner Owner's Name. Informatione ,for is Cotutt. �_...»,...,.»»,.,»»,»� _...» �a Q26 41112t121� required.for every »,m ..�, page. Cltyffown State Zip Code Date of Inspection D. System Informatia ll (cunt.) 7. grease Trap(locate on site plan): Depth below grade: feet__».... _ - " Material of constructi€lrt: E oncrete metal d fiberglass, polyethylene other(explain):' w Dimensions �— . Scum thickness:,. Distance from top of"scum to tap of outlet tee or baffle , Distance from bottom of scum to bottom tf outlet tee or baffle -T Bate cif last pumping. Dart "Comments(on purnpirrg rituccummendatIg6s, inlet and"outlet tes:or baffle condition,structur l integrity,, liquid levels 88 related;to outlet invert,evidence of,leakageP,etc.), > 8, Ti or H+gidinglank(tank im. usf be pumped at time of,ins 'on),(locate bn.site plan:; , , : Depth below grade,,, k a" p Material of consteuction:: ;} El concrete -.EIrnetiC r ❑fiberglass Q polyethyiene ,-, Q other(Okplain)1-4 e r e a , Capity: galisn rx Design Flow. getton d,y. ' r rids s owom Farm;suow!`ae ' !1lapasai,sy Pege"s t_ i8' , Commonwealth of Massachusetts Title 5 Official Inepe t n Ford $ubsurfa"ce SawageVisposal System Form«Not for voluntary Assessments 1500 Santuit.Newtown Rd pr"erty Address Evans Owner Ownees Name: requi.redfo e Cotuit Ma 02635 +411/24I2f1� required for every.: pigs Cityffown ststa Zip code [date of Inspe n 0. System Information (Pont) 8. Tight or Holding Tank(cone.) Alarm present; ❑ Yes ❑ No Alarm level: Alarm in working order; ❑ Yes ❑ No Date of jastpumping, pats Comments(condition.of alarm and float s itchesi etc.): --------------- "Attach copy of current pumping contract(required); is copy attached? ❑' 'Yes. ❑ No. g, Distribution Box(if present must be opened)(locate on site plan} Depth of liquid level`above outlet invert Comments (note if box is level and distribution to outlets equat any evidence of solids carryover, any evidence of leafage into or out,of box, etc), ... ..... .rv. .., x i6lr<sp d�•reu.7Cd6lX?1 R tilts 5 0 taal In lion Form S. S weir Dtspasa�SYs�em.'Fags t2 o t6. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurrace Sewage l3lspasail System Farm-Not for Voluntary Assessments ` 1500 Santuit Newtown R Property Address Evans Owner Owne(s Name information is Cotuit .._„........__, lea ,02635_ i 4/112020 ' required for every . Page, CityfTown .. state Zip Cade Efate of Inspection D. System Information (cunt.) 10. Pump Chamber(locate on site plan): , Pumps in working order; L Yes . ❑ No" Alarms in working order: Yes 0 No" . Commentsnate'candition cif pump;chamberg condition of purips and:appurtenances,etc.) If pumps or alarms'are not in vro€king'oroer, system is a conditional pass,: ' 11. Sall Absarpttoni Sy tem;(SAS)(locate 6 sits plan#excavation not required):' If SAS not located,explain wfy:: . 3 _................_. _ . .._.. TYpee leacrtg number; [p leaching chambers dumber. ` ( leaching galiories number 0 leaching trenches r number, length; Q :leaching fields number,dimensions, El Werllow cessp ool number innovativeialtemative system rr elttarrie.:af te6nol yl Qgy. 4ftElY 1 'f@Y:.712812f11$;;• - TWO 5 Qf�t at fmpp"fLC�h r~ArFFI`.�:.uUr}Atitf8CR..SWAMP Q�A}M84t�$p$IBFTf �B.�B 1,�;t�'[6 i "' - f Commonwealth of Massachusetts Title 5 Officlual Inspection, vo m Subsurface Sewage Disposal System,dorm w Natfor Voluntary Assessments. 1500 Santtlit Newtown,Rd Property Address Evans . Owner owner's Name lnfomietian is Cotuit Ma 0205 4l1t2020 M oired for every page: CWT a+ n Stain Zip Code Date of inspoOlon _ . D, VSteM Information (coat) 11. Soil Absorption System (SAS)(cant. Comments(note condition of soil, signs of hydrau lic.failure, level of ponding, damp sail,condition of vegetation:}etc. ; 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plant Nuriber aitd configuration 4' Depth:-top of liquid to inlet t inver D -- . Depth:of sands layer Depth of scurn layer Dimensions of cesspool i µ Materials ofconstruction cesspool block Indication of,groundwater inflow Q Yes No Comments(note condition of sail,signs of hydraulic failure, level of ponding :condition of vegetation, ete:) Dwelfn is servedby 2 sets of 2 cess Is.All cesspoe is were dry.attune of inspection. t5ittep.d o+taut 7/xBCigtB' 1"soe 6 QtfidW i�Fo Subaud".: s Di4osW Sysmn+Pia 1d:ci 18 ' Commonwealth of MasUchusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System,,Form-Notfor Voluntary Assessments 1500 Santuit Newtown Rd ———--------——------— ........... Proprty Address Evans Owner Owners Name information is required for every coluit Ma 02636 4/1/2020 page. CitylTown State Zip Code Date of inspection. D. System Information (cont). 13. Pr"(locate On site:plan),.. Matedals of.construction: bimens.lons. dep th of solids, Comments1note condition of'soil, signs of hydraulic failure, level ofponding, condition of vegetation, etc.} 150*1:166 MV,Tr Comrnonwealt1 of Massachlusetts. Title S Officiall In pectilon Farm Subsurfaas Sewage deposal Systen€l.l°orm•P1ot far Voluntary Assessments. 1500'Santuit Newtown Rd Property Addms Evans- ........... m, Owner _ ner'a Name:Wom ; roquir d tb is Cytuit Ma 02635 411/2020 required for every CiWTow n R�9a, State Z.ip Ocrda Grata Of lnspsdion Q. System InformattI on:(cunt.) 14, Sketch:Gf Sewage 01sp sal System: Provide a view of the sewage disposal Y 'sal s stem,including`ties to at least two permanent reference � 'landmarks or benchmarks. Locate all wells within 10.0 feet. Locate where public water supply enters the building. Check one of the boxes befavir:, hand-sketch in the area below C] drawing attached separately tfartsE?.4cu•rgv jrNt Nr4l.4 Tttfa 5 Qfctil:lnepe&wan Fo[ai:SubsW'a`Sewage Rtaposal System•Pis 1d 0..18 Commonwealth of Massachusetts' Title 5 Offi la1 Inspection Foam Ey Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1500,Santu t Newtown Rd _..„ Property Addresffi Evans Owner owner's.Name ' information is Cotuit ....... _.....,_. Ma _ 02635 w - 4/1/2420 _...... required for every. page. CitylTown State Zip Code l3afe of knsan D. System Information' coat. 1`& Site Exam: ] Check Slope Q Surface water: - ❑ Check cellar ;: Estimated depth to high,.grou r nd Wate : Please indicae alk'methods:used'fa deternin the high:ground Water elevation.:, Qobtained from system design plans::on record' If checked,.'date of design plan reviewed: Date Q' Observed site.(4bu ng property/obs+is.v.6 id hole Within 150'feet'of SA$} r Choclfeti with itcal Board of Health'-explain:. Q Checked ilfafitll local,excavatorsE.installers• attach documenta#iort} Q° f��cessed us�Sdatabase�-'explalt;,-. Yct must dsscribe:`hciwr.yd established the high ground9 water elevation. Groundwater,,was established b cress ,tvwri of E3atns f le round ratercontour ma s. • f a Befort filing,this Inspec ion Report,please see Report Gampleteness`Checklist en:next page Commonwealth of MassaGhuse Title 5 Offiicl 'Inspection Fai r Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments 1500 Santuit Newtown Rd< w ......... .. _,,,,_ ,,::- Proper€y,Add..rsss Evans.. fer owners Name: irequired.f6 r every Cotuit _,.. 020115. _ m 4/1/2024 d ;,., page, Cy/Town State Zrp Coe. Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this forth incluelve Of., U. A. Inspector Information; Completeall fields in this section. B. Certification;'Signed A t?ated arid`I, 2,3,ar 4 checked ® C< Inspection Summary, 1,2, 3, or,5 comp leted.as appropriate 4(Failure Cnteria}and 6(Checklist)corrlpleted Q.syster„ information: For O: Tight/Wolding Tank—Pu,mping contract Ached For 14: Sketch of Sewage Disposal System drawn on pg. 10 or attache '. .For,15; Explanation of estimated depth to high.groundwater h6l rded f5k't ,doa•W,,MAM18 TWO ffffl P rt ss m S , S"ge r}f"Sw sy&rw•Pop 1$,of 1R Assessor's map and lot number 2� ...�.J�...... .................... //— /t/- 77 � hhs - hkik�<< EXr•�ws.du- *46* c.�sr o� Sewage Permit number ................. ypF THE r0� P � TOWN O F BARNSTABLE Mjp e o Z BJHHSTAIL$ i ° "b 9 :a BUILDING INSPECTOR ' A-4�t APPLICATION FOR PERMIT TO _....... ./.................................................................................... TYPE OF CONSTRUCTION e.... ................... .......... ..................................... /.3...........19.22 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following ?rtfoa a o Location Q". Proposed Use .... ...................................................................................... .......... I. ...................... { t Zoning District ........................................................................Fire District ........ d" :41.4.��.................................-.....-....... Name of Owner .....V... :�. ..... ..LJ..4,0-!. ................Address .. ✓et�JG?. .........�`.. ........: �4. ^„Vt .. Nameof Builder ....: ....�..�:.:.....�......Z.•..(.a.�?:-:...................Address .................................................................................... Name of Architect �-� ....�..�..�'t .. ...�...................... ....... ..:........Address .......t,..:.............................`.`..................�................... Numberof Rooms . ... .. .. ......... ...........::............................Foundation .... .............:�............. .................... . �'�. Exlerior .. ................... ...... ........���...... ............:%':+..�C,-;S. .:f:,i......................Roofing '..........,�I.�� ...�'�-.-.t.'� ... . ..j.............. Floors � /?-.� .?1.. .. ,....... Interior .......5 .. ............ ..... ................................ .......... - r2. Heating ....: 4.0.. .......C! ??.. .....�.�:�.�f�� ......:.Plumbing .......P....O.V�............................................................. PPP Fire lace 0 ..........................................................Approximate. Cost ........i [�� o Definitive Plan Approved by Planning Board -------------------------------- .L?..-� ............ 19--------. Area Diagram of Lot and Building with Dimensions Fee .............. ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r y i 40 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... .... ..... . ......... ............................ , 19743 � �d�l±i / No -----.. Parnnhfor .-----..� -.---.. � ..' ......................................................... �Jan�Z�t�- ' Location ......Newrt='.Rd~..................................... ss"� "t � _~..~.—.--..-,.-..—.--.-_.--...—.--. ' Owner :�����.�����------------..^. Type of Construction -.FXAMC.----.----.. . ` _..—...,^~~,^._.---....--.--.—~.--.—. Plot ............................ Lot .........Z5....L...I8...... � ` i N v 14 �.�7 Permit Granted ------..�u----.—.]v Date of Inspection ------.----.—lV � Dote Completed ..—..--.---..—.--...l9 _ � PERMIT . REFUSED g . � .-- � —� ' | ' �~.. / k � `� ~~ �� ........... �CM7 � /Alf ~� ........... / ................... i / �� __—.. l� | ' pr~`, � ---.. —''��'',���-- � < , --`^—'----^---^'—'^^^^--^^~'~^---' � `---'---`---^—'—^'^—'--^^^~'~^'~'`^^ ! � . | � TOWN OF BARNSTABLE LOCATION\,,Mo�1,^ v;s��� S WAGE#gyp c 6 i VILLAGFC Z—V - ASSESSOR'S MAP&PARCEI INSTALLER'S NAME&PHONE NO.� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) \;t_, NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: < o Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility , Feet Private Water Supply Welland Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) =_7 Feet Edge of Wetland ac ung a ' ' f any wetlands exist within 300 feet o eaching facility). Feet FURNISHED J71 - - Y _ . l COTUIT - i PROPOSED CONTOUR ® PROPOSED SPOT GRADE SRE y EXISTING CONTOUR 1500 slwru►r-NEVowH + 96.52 EXISTING SPOT GRADE z W EXISTING WATER SERVICE TEST PIT Q 74,, WATER DSCALE: 1"=30' Q /STR/CT- ACC �. 26E58 R —74 ��� TEM EL. 74.3 R LL / DECK CORNER t Z _ � ,_ ---------- LOCUS MAP . Z H LOCUS .INFORMATION P-1 TP-2 ® TITLE REF: 32 0254 PARCEL ID: MAP AP 025 PAR. 018: 73.0 .. PROPERTY IS IN•ZONE II, IS IN ESTUARIES PROT. o - FLOOD ZONE: PROPERTY NOT IN. FLOOD ZONE 73.0 CP Lu SEPTIC SYSTEM , WATFR SERVICE 72 6 • Z 8.. . A REPAIR` PLAN' T.O.F. EL. 74. - LOCATED AT. 1500 SANTUIT-NEWTOWN RD.; COTUIT, MA 72—_ PREPARED FOR PAUL RHUDE AUGUST 25, 2020 . OF L DA M. o.1140 col) AVE I Afiist ° NITAR�a� MEYER & SONS, INC. P.O. BOX 981 73.8 y _ RD - EAST SANDWICH, MA. 02537 t PH: (508)360-3311 FAX: (774)413-9468 .L, meyerandsonstitle5@gmail.com SHEET 1 OF 2 J#1894 ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS FOUNDATION: BRING ALL COVERS TO WITHIN 3' OF FINISH GRADE (Existing) FINISHED GRADE (73.50) = 74.0 F.G.EL: 73.0 F.G.EL• 73.5 F.G. EL: 7.3.5 x l MAINTAIN 2% MIN SLOPE OVER LEACHING AREA r 2" OF.3/8" DOUBLE WASHED i " F.G.EL:.71.75 3/4 - 1-1/2 .. ; STONE OR FILTER FABRIC DOUBLE WASHED STONE A 6" .. 4" SCH 40 PVC 1o" 14 8 ® S 1 e(MIN. a®®®• o ®raa® �' TEES ARE TO BE aaasaMaaaaa INV. 70.2 ' aaa®sasses® :r 4" SCH 40 PVC 2 E F. DEPTH aaaaaaaaasa . .ai INV. 70.45 INV. 70.0 4' 2 ,X 8.5' 4. PROPOSED OUTLETS BAFFLE PROPOSED DB-3 " • •. ., DISTRIBUTION BOX EFFECTIVE LENGTH = 25' Q INV. 71 .50 INV.. 70.70 (H20) INV. ELEV. 69.50 Q INV. 71.50 PROP. 1,500 GALLON SEPTIC TANK of GAS BAFFLE TO BE INSTALLED ON BREAKOUT OUTLET TEE AS MANUFACTURED BY o D v, _ AR N ELEV.= 70.50 TUF-TITE, ZABEL, OR EQUAL M �, .. _ _ 'TOP LONG. ELEV. 70.50 NOTES.: � . 1 40 INV. ELEV.= 69.50 a® 1) CONTRACTOR SHALL VERIFY ALL EXISTING aaas®®® PIPE INVERTS PRIOR To CONSTRUCTION �� t�"-� ®®®®®®® 2) TANK AND D-BOX SHALL BE SET LEVEL AND TRUE TO ANITA0 BOTTOM EL.= 67.50 GRADE ON A MECHANICALLY COMPACTED SIX ' 3.75 5 FT. - 3.75' INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2) EFFECTIVE WIDTH 12.5' _ SEPARATION 5.10 FT. 3) INSTALL '"L� & OUTLET TEES Wi, SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM SECTION GAS BAFFLE AND ZABEL FILTER AS REQUIRED ' . BOTTOM OF TESTHOLE EL: 62.40 (500 GALLON LEACH, CHAMBER) SOIL LOGS P#: TPT-20-146 GENERAL NOTES: • DESIGN- CRITERIA *.IN ZONE II AND ESTUARIES PROT.,** . DATE: , . JULY 23. 2020 BY THE L S: 3 BEDROOM DESIGN G 1. ALL CHANGES TO THIS PdJW MUSE BE APPROVED LOCAL NUMBER OF BEDROOM SOIL EVALUATOR: DARKEN MEYER, R.S., CSE 1614 BOARD OF HEALTH AND YHE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: C ( .74 PD/SF) WITNESS: RAVE STANTON, BARNSTABLE HEALTH DEPT. OF THE STATE ENVIRONMENTAL CODE; TITLE V. AND ANY APPLICABLE • DESIGN PERCOLATION :RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS. DAILY FLOW: 110 G.P.D. X 3 BR 330 G.P.D. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Om' TP-2 Depth TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO (not designed for garbage grinder) TP-1 Depth Elev. � DESIGN ENGINEER. . 73.50 A 0" 73.40 A 0" a. ANY ooNDmoNs ENcouNiERED DURING CONSTRUCTION DIFFERING SEPTIC TANK: 330 gpd z 200X = 660 gpd, USE PROPOSED 1,500 GAL SEPTIC TANK LOAMY SAND LOAMY SAND FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LEACHING'AREA REQUIRED: (330)/0.74 = 445.94 S.F.. 10YR 3/1 1GYR 3/1 ENGINEER BEFORE CONSTRUCTION CONTINUES. 72.68 10" 72.65 9" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. , B B USE TWO (2), 500 GALLON PRECAST LEACH CHAMBERS W/ 4 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF LOAMY SAND LOAMY SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ' ' ' ' 1oYR t3/8 10YR 8/8 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. STONE ON ENDS & 3.75 STONE ON SIDES: 25 L x 12.5 W x 2 D 69.50 C 48" 69.58 C 46" 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. BOTTOM AREA: 25 x 12.5 312.5 SF PERC TEST 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED O EL 88.0 TO A CONDITION AGREED,UPON BETWEEN OWNER AND CONTRACTOR. SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF MEDIUM MEDIUM 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE , SAND SAND THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ D 2.5Y 6/4 2.5Y 6/4 CONSTRUCTION. DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 62.50 132" 62.40 132" 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PROPOSED SEPTIC SYSTEM UPGRADE P LA N AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. COTUIT, MA PERc NO GROUNDWATER"OBSERVED ON) 14. NO WETLANDS WITHIN 10D' OF PROPOSED LEACHING. 1 5OO SANTU IT-N EWTOWN ROAD, 15. ALL PIPING TO BE 4" SCH 40 • 1/87/FT (UNLESS SPECIFIED) Prepared for: POUT Rhude • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 Design and Site Plan by: SCALE DRAWN DATE to conduct soil evaluations and that the above analysis has been performed by me consistent with the that I have passed the Soil Evol. Exam in October, 1999. PO BOX981_ MEYER&SONS,INC. N.T.S. DMM 08 25 20 rtify requirements of 310 CMR 15.017. 1 further ce / / ' EAST SANDWICH,MA 02537 REV DATE CHECKED SHEET NO. 506,362-2922 DMM 2 of 2