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1559 SANTUIT-NEWTOWN ROAD - Health
1559 SANTUIT-NEWTOWN RI? _T A= 024 009Li Y TOWN 05 BARNSTABLE �ATION SAA U k 4W I DW SEWAGE # VL,-.LAGEAA r C Iv ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY UUu I LEACHING FACILITY: (type) �� 1 X�+ (size) 17'a Q NO.OF BEDROOMS 3 BUILDER OR OWNER C /"� It✓� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachpg facility) Feet Furnished by ' rifSleci y!1V` —T7 U/ - (l a107 8 s io ay y a as a� 3 3� qo y S9 C�- r TOWN OF BARNSTABLE LOCATION ! bV SEWAGE # �( � 910C V LLAGE U 1 ASSESSOR'S MAP & LOT -00 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 00a Q /i I LEACHING FACILITY: (type) IdOO P=A Z.(size) NO.OF BEDROOMS ®� t BUILDER OR OWNER 60� J "! � PERMTTDATE: COMPLIANCE DATE: _ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) NO Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet f Ieaching fac'I*ty) _AJ0 Feet Furnished by � _ .. y • TOWN OF BARNSTABLE ALpot,'r LOCATION rs S /Ve w Tnw /1 iR SEWAGE # c; VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. S. 14Jon',sl 2ir5 i - �,s93 SEPTIC TANK CAPACITY 000 �Gl 6)(6 LEACHING FACILITY:(type) /V 20 (size) J 000 �ra/ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER �— Jr BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �/ '. -:... �. �IoVSC __�t JS I � 41,. �� ���" l!� \ �Y 1 1 � c� 1 `� S �� � � � ���� � „ + � �' •./ ����� �� '�7 m i p� Town of Barnstable , - Barnstable Regulatory Services Department " 8 Public Health Division i63 - I�A�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V I Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL,# 7015 1520 0001 2273 3364 May 18, 2016 Eliabeth Hatton TR c/o Patrick Mullins,Noonan Real Estate 618 Route 28 Yarmouth, MA 02673 ; The septic system located at 1559 Santuit-Newtown Road, Cotuit,MA was last inspected on 4/14/2016 by Trevor Kellett, a certified septic inspector for the State of Massachusetts.The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The Distribution bog needs to be replaced. You are ordered to repair or replace the-septic system within one (1)year from the date you receive this notification. ' Failure to repair/replace the septic system within the deadline period will'result in future - . enforcement action. PER ORDER OF THE BOARD OF HEALTH (akm?i R.S. CHO Agent of the Board,6f Health Q:\SEPTIC\Conditionally Passes Ltr\1559 Santuit-Newtown Rd Cot May 2016.doc TO'N'M of Barnstable i + lA.RN9r11HLE, • , Regulatory Services Department rEa� Public Health Division 200 Main Street;Hyannis MA 0260.1 Office: 508-8624644 Richard Scab,Director FAX 508-790-6304 Thomas A McKean,CHO Feb 6,•2007 Rev. 7/6/15 DEADLINES TO REPAIR-FAILED SYSTEMS ' (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑is the failure criteria and,associated repair deadline 60 DAY DEADLINE CRITERIA' ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe.. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLM CRITERIA o Static liquid level in'the distribution box above outlet invert due to an overloaded or clogged SAS or,cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of-the cesspool withiri•a Zone 1 to a public well ❑Any-portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This-system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components; etc) o Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9:1) OTHER //X I d -,6x Repair deadline:. uPof WSEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Parcel Detail Page I of 4 ,, on : "At Logged In As: Parcel Detail Wednesday, May 18 2016 Parcel Lookup Parcel Info Developer r02 Parcel ID 4-009 I Lot ELO.T 1 Location 1559 SANTUIT-NEWTOWN ROAD I Pri Frontage Sec RoadI Sec Frontage village COTUIT I Fire District fCOTUIT Town sewer exists at this address NO I Road Index 1425 ......, I Asbuilt Septic Scan: Interactive 024009_1 Map 1 6 s 5 Owner Info owner;HATTON, ELIZABETH TR I Co-owner[—CLIFF ELIZABETH REVOCABLE TRUST I Streetl 68 WINTER STREET I Street2 I city YARMOUTH PORT I state FM�Al Zip,',026 country Land Info Acres 1.07 use.Single Fam MDL-01 Zoning RF x...w—- Nghbd 10105 Topography]Level I Road ,Paved Utilities iPublic Water,Gas,Septic „ Location Construction Info Building 1 of 1 Year ri 950 --� , Roof Gable/HipW ( ext Wood Shingle Built Struct Wall Living�155I Roof As h/F GIs/Cmp Type Central Area Cover p �I Style Conventional I Int Drywall I Bed j2 Bedrooms I _ 0 Wall Rooms °�,� ` " •'5 na r 12FE{ Model Residential ( Carpet I Full-0 Half ( It Bath 10 Floor Rooms Heat Total�4-ROOMS - �BAS"`2 I Type Hot Air �I Rooms OmS I 3 4.,., �, kF Grade rAverage s Heat FoundaB.a Stories 1 Story I Fuel GaS ation Mixed xq ; Gross 2883 talk .7g Area i Permit History Issue Date Purpose Permit# Amount Insp Date Comments 2/22/2007 Remodel 20065238 $0 6/30/2008 1.2:00:00 AM FAMILY APT http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1298 5/18/20.16 r ' toommonweann oT massamusens 02'f DD�I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 1559 Santuit Newton rd ac Property Address W Hatton Owner O N+ wner's Name information is = required for every Cotuit 1/ MA 02635 4/14/16 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 S/* 11-5 7® on the computer, T use only the tab 1. Inspector: key to move your cursor-do not Trevor Kellett use the return Name of Inspector key. TK Septic Inspections Company Name 38 Vacation Lane `f Company Address West Yarmouth MA 02673 City/Town State Zip Code 5085795502 S113744 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9 4/26/16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of,completing.this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '*This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 t�o 4W 1 toommonweam or massacnusens ' Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1559 Santuit Newton rd Property Address Hatton Owner ,ar-; Owner's Name information is required,.for every Cotuit MA 02635 4/14/16 page. t, City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all'of Section D A) System Passes: ❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 \ %,.ommonweann or massacnusens ' - Title 5 Official Inspection form, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1559 Santuit Newton rd Property Address Hatton - Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. , B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled,or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N. ❑, ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): no replacement needed just light patch work on the sides ❑ 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 l.ommonweann OT massacnusens Title 5 Official Inspection.-Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is Cotuit MA 02635 4/14/16 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ondin of effluent to the surface of the round or surface waters 9 P 9 9 ❑ ® due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 q.�ommonweann or massacnuserts ' J Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is Cotuit MA 02635 4/14/16 required for every r page. City/Town State Zip Code Date of Inspection B. Certification (cost.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ®' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to'a surface drinking water supply ❑ ❑ the system is located,in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section.E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under,Section E or failed under.Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 5 of 17 • 1 , Vommonweann oT massacnusens Title 5 Official Inspection Form: Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 \ t ommonweann or massamusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °,M z 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? r ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title'5'system?` ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 0 t.,ommonweann oT massacnusetts Title 5 Official Inspection ,Form: Subsurface Sewage Disposal System Form -Not.for Voluntary Assessments wM 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: - 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 Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 \ kpo m onweann OT maSSacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G1M , 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is Cotuit MA 02635 4/14/16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t Approximate age of all components, date installed (if known)and source of information: 2005 according to limited info at town hall Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1.5 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: .9 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: 1000g Sludge depth: 2" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 \ %,ommonweann oT massacnusens Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, .1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is Cotuit MA 02635 4/14/16 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle ` 32" 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is structurally sound and water tight with liquid at the outlet invert, both tees are intact, no need to pump 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 Forth:Subsurface Sewage Disposal System-Page 10 of 17 trommonweann or massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 tommonweann or massacnusens . Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam -Not for Voluntary Assessments M 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is Cotuit MA 02635 4/14/16 required for every , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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.): d box is level and water tight, it is down 23",with a little carryover and scum inside Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5iris-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 t�ommonweann or massamusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There is one 6x6.leach pit that is down 28"the bottom is at 9 feet there is.8 inches of liquid with a 22 inch stain above it leaving 3+feet of usable space Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer, - Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Tille 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 toommonweann or massacnusens Title 5 Official Inspection.,Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 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.): 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 O t.,ommonweann or massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. City/Town 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 A Deck(enclosed) B S 1 H ' E D 2 3 A1)16 A2)21 A3)35 A4)59 4 B1)38 B2)38 B3)44 B4)60 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 il..,ommonweann or massacnuserts Title 5 Official .Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 40+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS Maps shpw GW at 40+feet Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Offiaal Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 %.ommonweann or massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M s 1559 Santuit Newton rd Property Address Hatton Owner Owner's Name information is required for every Cotuit MA 02635 4/14/16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. ;"w S V ✓ Fee T// THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, M'ASSACHUSETTS 9pplication for Ofi5p gal *pgtem C on5truction Permit Application for a Permit to Construct(`)'Repair( )Upgrade( )Abandon( ) O Complete System CP�Ittdividual Components Location Address or Lot No. IsTq i(la i ow i IZ4 Owner's Name,Address and Tel.No.Ch`OW .d//C.M Assessor's Map/Parcel Go r $4 !1/Gt✓fea y�e i2tl Lmei'f r �q"®Q AGE-Ll llgl0 Installer's Name,Address,and Tel.No.3/+s m A .Sa+Ve" Designer's Name,Address and Tel.No. Jc<,e'Lte,cdds 6ie00 a 7 cOIAlt-j /t o(. aZ��rq -7k83 6-5, �o6-SYo-�®2z Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building s'fdd%0 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow gallons per day. Calculated daily flow -gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 be issued by this Board of Health. Signe Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued S 55 Fee ` " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Digpool *pgtem Coni5truction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) O Complete System I�'rndividual Components Location Address or Lot No./553 q 1/e4✓-10W,1 ft& Owner's Name,Address and Tel.No.(//' !i Assessor's Map/Parcel Cote i—f ?Y—6<3,7 5aa-'-i ZJ,-9yiv Installer's Name,Address,and Tel.No.�J/�•w A .Sev ep,— Designer's Name,Address and Tel.No. J—,re['L".,cl�S r!*01V P -7 C101'1 A off. 144 4,5 A# e c kt c. r3o�c?Gc/ t.�/• l=G lr�ni f�,!dt c` o1cNq 7�H83�-3'77`/ r700'-Sc/o-3o2Z Type of Building: 4+. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other - Type of Building No.of.Persons —Showers( ) Cafeteria( ) .. Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date • F. Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 notjo place the system in operation until a Certifi=. cate of Compliance has b issued by this Board of Health. d'" ` Signe Date Application Approved by Date Application Disapproved for the following reasons Permit No. - d 5 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Lertificate of (Eompiiance THIS.IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by JiN-sw, A SWZ at_ 1552 1Ue111-rc7t1,,n f aP. (4e-4-4,'—F has been constructed in ccoodance with the provisions of Title 5 and the for Disposal System Construction Permit No.c;boo55 S dated Installer �Asu� A • Sic,z Designer Jk.e k At, / _ The issuance of this permit shall not be construed as a guarantee tha the sys e designed. Date_ ed. Date Inspectorm » ------------------ ---- -- No.CgLco 5 5 Fee / 5® �••- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS li5pozal *pgtem Congtruction permit Permission is hereby granted to Construct11(� �};tepair( )Upgrade( )Abandon A) ( ) System located at 15�� IM r� r.V, and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to y comply with Title 5 and the following local provisions or special conditions. Provided: Construction /mussq be completed within three years of the date o�f thi p i=mit. Date:_ ( �,r'r Approv�_v COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS,. John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 1559 NEWTOWN RD. COTUIT Map "` Name of Owner SARAH DOWLING All Address of Owner: SAME • �F Date of Inspection: 11/12/99 NO Name of Inspector:(Please Print)JOHN GRACI TO 1 7 19 J}A I am a DEP approved system inspector pursuant to Secdon 15.340 of Tide 5(310 CMR 15.000). r ^ 'OFq�N 99 Company Name: n/a - Qrke Mailing Address: n/a r' Telephone Number: n/a �� - 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 The inpection Is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:11/13/99`^1 The System Inspector sh II submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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. NOTES AND COMMENTS ' THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM FOR MAINTENANCE EVERY TWO YEARS. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1569 NEWTOWN RD.COTUIT Owner: SARAH DOWLING s '" Date of Inspection:11/12/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: p I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated " are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: Wa' 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior.to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank , failure is imminent.The system will pass Inspection if the existing septic tank i3 replaced with a complying septic tank as approved by the Board of Health. nta Sewage backup 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). broken pipe(s)are replaced obstruction is removed _ distribution box is levelled or replaced'; Wit 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 pipe(s)are replaced obstruction is removed r • � revised 9/2198 Page 2 of 11 4 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued)" Property Address: 1559 NEWTOWN RD.COTUIT Owner: SARAH DOWLING Date of Inspection:11/12/99 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of 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 ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n/a.(approximation not valid). 3) OTHER > nIa Z •' revised 9/2198 Page 3 of 11 AA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A �.. CERTIFICATION(continued). . r Property Address: 1669 NEWTOWN RD.COTUIT y Owner: SARAH DOWLING Date of Inspection:11/12/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 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. . Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool X' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. " X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below Invert or available volume is less than 1/2 day flow, ,Ty X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes)." F Number of times pumpeded v c` e X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. s . X Any portion of a cesspool or privy Is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well;' " X 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 ompounds, ammonia nitrogen and nitrate nitrogen. q` X The liquid level in the SAS isaover.the invert pipe,is in Hydraulic Failure. { E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following The following criteria apply to large systems in addition to the criteria above: 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: Yes No X the system is within 400 feet of a surface"drinking water supply : X the system is within 200 feet of a tributary to`a surface drinking water supply X 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) , y The'owner or operator of any,such system shall upgrade the system in accordance with 310 CMR15.30412).Please consult the local regional office of the Department for further information. J ` s " revised 9/2198 Page 4 of 11 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddress: 1669 NEWTOWN RD.COTUIT Owner: SARAH DOWLING Date of Inspection:11112/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least 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. As built plans have been obtained and examined.Note if 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.The size and location of the Soil Absorption System on the site has been determined based on: X Existing Information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)1 X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2198 Page 5 of 11 s. .. ,# SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1669 NEWTOWN RD.COTUIT Owner: SARAH DOWLING Date of Inspection:11/12/99 FLOW CONDITIONS RESIDE TIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):2 ` Total DESIGN flow: 220 Number of current residents:2 Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no)M Seasonal use(yes or no):JLQ Water meter readings,if available(last two year's usage(gpd): nta Sump Pump(yes or no): NQ Last date of occupancy: n& COMMERCIAUINDUSTRIAL Type of establishment: nLA Design flow: n&gpd(Based on 15.203) Basis of design flow: nLa - Grease trap present:(yes or no):JLt2 Industrial Waste HoldingTank resent: es or no NQ P (Y ) Non-sanitary waste discharged to the Title 5 system:(yes or no):hLQ- Water meter readings:if available:n1a Last date of occupancy: nLa OTHER: (Describe) nLa a' Last date of occupancy: nLa GENERAL INFORMATION PUMPING RECORDS and source of information: nLa } System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa_ gallons Reason for pumping: n(a TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nLa APPROXIMATE AGE of all components,date installed(if known)and source of information: NEW SYSTEM IN 1992 ` Sewage odors detected when arriving at the site:(yes or no): NQ j revised 9/2/98 - Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1669 NEWTOWN RD.COTUIT Owner: SARAH DOWLING Date of Inspection:11112/99 BUILDING SEWER: (Locate on site plan) Depth below grade: ]'! Material of construction:_ cast iron X 40 PVC other(explain) Distance from private water supply well or suction line: TOWN Diameter: Wa Comments: (condition of joints,venting,evidence of leakage,etc.) nta SEPTIC TANK: X p (locate on site plan) Depth below grade: i Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ Wa Dimensions: L B'B"H 5'7"W 4'10" Sludge depth: 1" . Distance from top of sludge to bottom of outlet tee or baffle; . 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: 17" How dimensions were determined: MEASURED 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.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING.EVERY TWO YEARS FOR MAINTENANCE GREASE TRAP: (locate on site plan) Depth below grade: w Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Wa Dimensions: nLa Scum thickness: nLa Distance from top of scum to top of outlet tee or baffle:,n!a' Distance from bottom of scum to bottom of outlet tee or baffle n(a Date of last pumping: n1a s` 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.) nLa revised 9/2/98 Page 7 of 11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1669 NEWTOWN RD.COTUIT Owner: SARAH DOWLING Date of Inspection:11/12/99 i TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,Inspection) (locate on site plan) Depth below grade: WA Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_'other(explain) nLd „ Dimensions: nLa Capacity: n& gallons Design flow: nla gallons/day Alarm present: MS2 Alarm level:jiLa. Alarm in working order:Yes_No NO ; Date of previous pumping: nLa Comments: (condition of inlet tee,condition of alarm and-float switches,etc.) nLa DISTRIBUTION BOX: - (locate on site plan) Depth of liquid level above outlet invert:nLa Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or of box,etc.) IlLa PUMP CHAMBER: NQ t (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): MQ } y Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM + - PART C SYSTEM INFORMATION(continued) Property Address: 1669 NEWTOWN RD.COTUIT Owner: SARAH DOWLING '`'^ . k, Date of Inspection:11/12199 w SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods), = If not n: at located,explai Type. x S leaching pits,number: 1000 GALLON LEACH PIT + leaching chambers,number: m ='t leaching galleries,number: ..n/a leaching trenches,number,length: na . l leaching fields,number,dimensions: nla Y, overflow cesspool,number: lVa F Alternative system:' n/a Name of Technology: jVA ti Comments. P (note condition of soil,signs of hydraulic failure,level of ponding,Adamp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONINC PROPERLY THE PIT HAS NOT HAD MORE THAN V OF WATER IN IT CESSPOOLS: _ e,.• � 'V a # u '" (locate on site plan) Number and configuration: nLd r s k Depth-top of liquid to inlet invert: nl8 Depth of solids layer: Wit r �r Depth of scum layer. Wit ,x Dimensions of cesspool: nla " Materials of construction: nLa 'v Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)n(akk Comments: •. (note condition of soil,signs of hydraulic failure,level of ponding,`conditionof vegetation,etc.) < ; nLa T , x 1 Z7 4' a PRIVY: k (locate on site plan) . . Y �" z , Materials of construction:N3 Dimensions.13& Depth of solids: nLd $ 'k 4 .fi _ •1 3 Comments: 4d. (note condition of soil,signs ofhydraulic failure,level of ponding,condition of vegetation,etc.)A' x- . a - t{ revised^9/2/98 Page 9 of 11 d ry SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued' Property Address: 1559 NEWTOWN RD.COTUIT Owner: SARAH DOWLING Date of Inspection:11/12/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks yA locate all wells within 100'(Locate where public water supply comes into house) . ., � .. „' �..is S 4.Y Y • .. , k. y '.- . y 1 "y i L revised 9/2198 " Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART C SYSTEM INFORMATION(continued) Property Address: 1669 NEWTOWN RD.COTUIT Owner: SARAH DOWLING Date of Inspection:11/12199 NRCS Report name: Wa Soil Type: nLa Typical depth to groundwater: n1a USGS Date website visited: n!8 Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep SITE EXAM _ Slope _ Surface water _ Check Cellar , _ Shallow wells 1 Estimated Depth to Groundwater 2 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2198 Page 11 of 11 ! I a .°°oar iCOd,� a to ca �O CD co It i + ' i r s 1 t ► °cos � . 1 f , CO CD r— CIO ♦ \� ♦a a � a a t• t a t a ♦ ; \� �\ t a � i t a i t t t a a � t s ;� , � , t � � a � , \` ``•SaA a , t a ♦ a L a t , a a t a a , � t a >♦ � � \` \ � \ , l t' 1 , a � i ; � 1 •� '�.\_i- ,-- � rovr�/ g p �� , a a a s 1 a c ` a ♦ \ \ \ a l r a t '-a ►..i , ' ` �. ,-' � //r •i r� !► � \ a a \ a ♦ � t a , a ♦ \ a a t a , .� a ♦ , -, a �` �. �--� �� �' ��i rr �it � a \ a a ♦ \ a a t t ♦ � ♦ \ \ + a v a a a a a 1 / / / � rr Jf/,, b� �`\ i � t ♦ a a , \ a ; t♦ \ as \ � \ ` a ` t t ` .t \, \ � /� .' i� / �err �/i/r �-- a a a a t t ♦ a t \ \ a \ �a � ♦ ; a , a � a + � a \ \ �\,� / / �- ,/ /f rrfir to16 co to —��� —`=�_�•`��\ 07 0 • V t w I lol d 1 :r rt ,aa s iorl ao V Date: ��c TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: � �e�n�n - i+/�� BUSINESS LOCATION: MAILINGADDRESS: Mail To: TELEPHONE NUMBER: 1K2 Board of HealthTown of Barnstable CONTACTPERSON: ��Gt�Cti. f� ��rD� P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: S39-3,6 00 A, 2.0112- Hyannis, MA 02601 TYPEOFBUSINESS: O Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash .detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes X— Laundry soil & stain removers Other products not listed which you feel (including bleach) m be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers' �(�,d 'WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 23- 552, Date: k /3 �y y� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM :. �- NAMEOFBUSINESS: � �� ����G{ �,v 4 BUSINESSLOCATION: /SS'9 ����&fin MAILINGADDRESS: 5'a191 ..- Mail To: Board of Health TELEPHONE NUMBER: 5K2 f` - Town of Barnstable CONTACT PERSON: �cc/Gc- ���ri-J'4� P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS:. TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity . Quantity •Antifreeze(for gasoline orcoolantsystems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid _X Disinfectants Engine and radiator flushes Road Salt (Halite) 4 r Hydrauiicfluid (including brake-fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED `'fl Other petroleum products: grease, } Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for.driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine - Rust roofers Ly e ye or caustic soda Car wash detergents - Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes,,stains, dyes ' PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW �--USED== f-� (inc. carbon tetrachloride) Paint& varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners Floor & furniture strippers (including chloroform, formaldehyde, Metal polishes hydrochloric acid, other acids) J X Laundry soil & stain removers,, Other products not listed which you feel (including bleach) _ m be toxic or hazardous (please list): Spot removers & cleaning fluids Elkc�4_1 (dry cleaners) _ Other cleaning solvents Bug and tar removers I � � 'WHITE COPY((-�HEALTH DEPARTMENT/CANARY COPY-BUSINESS 4'a No.... Fss...... THE COMMONWEALTH OF MAE �' U SAI�H SETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration' for Elispoiial Works T owitru tiun lirrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: 40 .. - . __..._.__........-- �....................•-------•-- --........---•-----•-•---•••-•---••--•...... .------. ----------...........------ Location-Address or Lot No. .... A�o - ------------- --•-_... ------- ................. .........::_..... Owner Address W Installer Address Type of Building Size Lot_3_....1?�:�.....Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures ------------------------------------------------------•••••---------•----••••-•-•-•••-----••••••-••-•••-•••••-•••••••-•-•...........-•-•-..._......- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity......_.....gallons Length................ Width................ Diameter---------------- Depth................ W 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........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ a ---•••--•--•-----------------••••...•••••••-•••••--•-----••••-••••••----•-•-•••......--••---••••-•••................................. -------------------- •••-- 0 Description of Soil...............................................................................--------------------------------------------------------•---------------------------•--- x U W __________________________________•__---___-__-____________-___. ____-_-----•••••--__.._..-_.........._________._________.3.______.___..._.____._____�.__._______._..________.._.........._._. rxj Nature of Repairs or Alterations—Answer when a plicable_.. - !..___. .... ............................ ---------------------•••--- •- r-��r--:---` ....Gs !!�ii.....••-..................................... -Ss ........2�....--- i-C�.----�--------------------------------- 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 been issued by the board of health. Signed Date Application Approved By ..... ....... . -- ---- ----------- ----- - ................................................... Date Application Disapproved for the following reasons-' ------------------------------------------------------------------ ---/-���------ ---------------------------------------------- Due Permit ........ Issued ............. ------------ � ------------------------------ No. t THE COMMONWEALTH OF MASSACHUSETTS BOARD &F HEALTH TOWN OF BARNSTABLE t Appliratiun for Diiipos al Works Tunutrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) of Repair ( \an Individual Sewage Disposal System at: S"r'7 f1/��Tr>c��l 49 C�Tvri ........... ..........�-•---------•.................•--•-•---..... -•--....---------------...-------------------------------•---•-•--•---•----•--•ram;•---••-- Location-Address or Lot No. ...................... ---- 1� ..................................................... ...../S_5 �7!�-1-�rc /�v ��..............------ Owner Address 1.4 9Q Installer Address Q Type of Building Size Lot..3_.S_ C Sq. feet U Dwelling—No. of Bedrooms-__..._Z..............................Expansion Attic ( ) Garbage Grinder ( ) 9k Other—T e of Building ............... No. of ersons............._.__.___....._. Showers a —Type g --------•---- p ( ) — Cafeteria ( ) t dOther fixtures ----------------------------------------------------------•-•-------------••-•--•---•------•-------•................................................ 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•-----••-•---....----•---•-•••-•--•-------•------------------------•-••-------------•-----_------...............................................?......... 0 Description of Soil.................=....................................................................................................................................................... x W U Nature of Repairs or Alterations—Answer when applicable._-__/ __._ ........................................................... S trc.......... � ��` -��c�- ...... Ss ----- --- .. ..-- 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 been issued by the board of health. Signed .....19 — Z_ .............. ............ � Date Application Approved By .... ✓ ... --- -------- ---- - :. .. . --------------- Daie�j. Application Disapproved for the following reasons- ......................................................................... ------------------------------------------------------- ------ ...................................... ................................ -----....................- ------------------------------------------------------------------------------- ..................... n l� D Permit No. ... .------..�--------------------------------------- Issued ... ... .--. . ./.. ........... V/Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V ertiftrate of tT11ont llianrP Ti�_IS �0 EER �Y hat the Individual Sewage Disposal System constructed ( ) or Repaired ( X) bY.. -.......... -fe . �----�----at ............. .. .. /.. ...'��'9 �A��.\nstal(_�� .1......�..........--.....-................. .................__ .----- ................ has been installed in accordance with the provisions of�TITLEP e St0t�P ironmental Code as described in the application for Disposal Works Construction Permit No. .. 1...... ..`mac% dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. '-- C ' DATE.. .- /...�------------------------------------- Inspector -------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......... .....v 1 � �iu�ruu�al r u .�n��rnr#�ux� ernti� Permission is herebyranted. //. -- ------ ---... /...---- .................................................... g `.. C� � ��v 1 to Construct ( ) or Repair ( ' ) an Individual Sewage Disposal System atNo. ------•. /......--..............------•-----------------•--.----------------•-. �-...Rated . ...-----------� /------------- as shown on the application for Disposal Works Construction Permit Street No.a.�._�' .._.: / /.................. DATE Board of Health . --------.------.....�= FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS - i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS " s f DEPARTMENT OF ENVIRONMENTAL PROT CTIO U9 p Q TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY AS SSMNTS ' SUBSURFACE SEWAGE DISPOSAL SYST EM FO PART A CERTIFICATION Property Address: 1559 Santuit-Newtown Road Cotuit MA 02635 Owner's Name: _ Clifford Allen Owner's Address: Date of Inspection: October 28 2005 Name of Inspector: (Please Print) James M FFord Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville MA 02655-0049 Telephone Number: (508) 862-9400 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs rther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: October 31 2005 The system inspector shall sub i 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. Notes and Comments ****This report only describes conditions at the.time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform•in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 r ` Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1559 Santuit-Newtown Road Cotuit MA Owner: Clifford Allen Date of Inspection: October 28 2005 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: Observation of sewage backup break g P or out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of I 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1559 Santuit-Newtown Road Cotuit AM Owner: _ Clifford Allen Date of Inspection: October 28 2005 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 ass unless s Board of Health determines system is not functioning in a manner which will protect publ c health,safety and the environment:the 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 i 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 I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1559 Santuit-Newtown Road Cotuit MA Owner: _Clifford A11en Date of Inspection: October 28 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow ✓ 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 groundwater 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 it mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 i f: Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST J Property Address: 1559 Santuit-Newtown Road Cotuit MA Owner: Clifford Allen Date of Inspection: October 28 2005 Check if the following have been done: You must indicate" es"or"no"as to each of the followin 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: Yes No ✓ _ 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(3)(b)]. 5 r e Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1559 Santuit-Newtown Road Cotuit MA Owner: Clifford Allen Date of Inspection: October 28 2605 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n1a . [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Cnavailable Sump Pump(yes or no): No Last date of occupancy: _ Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): _,.gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no):'` Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Tank and pit were numbed after the ins ecti m for maintenance Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: A repair was done in 1992-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 , • Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1559 Santuit-Newtown Road Cotuit MA Owner: _Clifford Allen Date of Inspection: October 28 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): certificate) (attach a copy of Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 101, Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Cement tees were present. The 1i uid level was even with the outlet invert. There did not a ear to be an si ns o leaka e.The tank was yum ed after the ins ection for maintenance. GREASE TRAP: None (locate on site plan) Depth below grade: 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: ' Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 41 OFFICIAL INSPECTIONYORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1559 Santuit-Newtown Road Cotuit MA Owner: _ Clifford Allen Date of Inspection: October 28 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete —metal fiberglass-_polyethylene _other(explain): Dimensions: , Capacity: gallons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no):` Date of last pumping: Continents(condition of alarm and float switches,etc.): ` DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to ouilets equal,any evidence of solids carryover,anyevidence of leakage into or out of box,etc.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) m t Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps`and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYST EM INSPEC TION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1559 Nantuit-Newtown Road Cotuit MA Owner: Clifford Allen Date of Inspection: October 28 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I-6'x 6'(1000 Qal)H-20 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): The j2it had S'o liquid on the bottom. The scum line was at the same level. There did not a ear to be any si ns o ailure. The it was puniped and cleaned a ter the inspection for maintenance. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer; Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 t Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1559 Santuit-Newiown Road Cotuit MA Owner: _Clifford Allen Date of Inspection: October 28 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. 1/4 a o Q s Ra CZ y 3 3s qo 10 Page I I of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1559 Santuit-Newtown Road Cotuit MA Owner: _ Clifford Allen Date of Inspection: October 28 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 28+/- ' feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: tonoaranhic and water contours mans Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable to o ra hic and water contours maps, the ma s were showin a roximatel 28'+/-to round water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,'either expressed,written or implied,relating to the system, the inspection and/or this report. 11 7 SUBSURFACE SEWtGE DISPOSAL SYSTEM INSPECTION FORM n Address of property /�g �°AU�to'Tot )k) a0J O'L�TU OTC Owner ' s name /3jeeTT �� Date of Inspection ,7_�y_ ��- PART A �/G` / ►��. �D / CHECKLIST / ( Cheek if: the following have been done : �919. / requested of the owner, occu antN d Board of l/ Pumping information was req p Health. -� is None of the system components have been pumped for at least two vee s 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 . (/ As-.built plans have been obtained and examined . Note if they are not available with N/A. _LZThe facility or dwelling was inspected for sigrIis of sewage back-up. _ The site was inspected for signs of breakout . { i _(//A11 system .components, excluding the SAS , have been located on the site . -1L The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of1baffl.es or tees, material of construction, dimensions , depth of liquid, depth of sludge , depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by nonyintrusive methods. _Z'I'he facility owner (and occupants , if different from owner) were provided with information on the proper maintenance of SSDS . 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIPN FORM PART B SYSTEM INFORMATION i FLOW CONDITIONS i If residential number of bedrooms number of current residents garbage grinder, yes or no ' laundry connected to system, yes or no Fj A-Ij seasonal use, yes or no If nonresidential , calculated flow: i Water meter readings, if available: 1 I Last date of occupancy II GENERAL INFORMATION ;I Pumping records and source of information: A ik • �1 /,,lr—) System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping : IE Type f system eptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) ( if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components.' Date installed, if known. Source of information: 1� �4 Sewage odors detected when arriving at the site, yes or no i . 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: ( locate on site plan) depth below grade: I '- - material of construction: concrete metal FjRP other(explain) i� dimensions:�,f�6� 14 - �sludge depth 43�2,n[hdistance from top of sludge to bottom of outlet tee or baffle ,9 3-iadf.cum thickness j�listance from top of scum to top of outlet tee or, baffle / i' distance from bottom of scum to bottom of outletjtee 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, recommendations for repairs, etc1j) MP �i Ii DISTRIBUTION BOX: (locate on site p an) depth of liquid level above outlet invert Comments: (note if level and distribution is equal , evidence of solids carryover, evidence f leakage into r out of box, recommendation for repairs, etc. ) x /_t r, PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs, etc. ) �r {d 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIOJ FORM PART B II SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : ( locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) 4 If n t deter ined to be present, explain: /,P/'iCfit AOi± C < Cti CLS h�i � t M� t Type l leaching pits and number leaching chambers and number leaching galleries and number �4 leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance Or repairs, etc. ) �4 M9 CESSPOOLS ( locate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer M4 dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) y� Comments: (note condition of soil, signs of hydraulic failure, levee of ponding, condition of vegetation, recommendations for maintenance, or repairs, etc. ) it PRIVY : ( locate on site plan) materials of construction dimensions If depth of solids Comments : (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) • b 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued •, SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' ------------- TOP �Oq 0of/E c�2 9 ;i DEPTH TO GROUNDWATER depth to groundwater ����-1fo,,,,, p`� 14 Gc hi� method of determination or approxim tion: . 1, v (r 1 P� r? 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION �ORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances . If "not determined" , explain why not) Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? V"Static liquid level in the distribution box above outlet invert? �- Liquid depth in cesspool <6" below invert or available; volume< 1/2 day flow? A/ Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? � Is any portion of the SAS , cesspool or privy: _/V/_ below the high groundwater elevation? within 50 feet of a surface water? - V within 100 feet of a surface water supply or tributary to a surface water supply? / V within a Zone I of a public well? -A/ within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? 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 analysi for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector CiOsebj MAks Company Name ��? Company Address P Q. &K 0S4&rt/j,J1E> Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper fZnction and manitenance of on-site sewage disposal systems. Che one: I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15 . 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector ' s Signature Date -71� Original to system owner Copies to: Buyer ( if applicable) Approving authority I f R T.) - ' A(p - `! 48 • Q �S �7 r� n x - f ,-' t Ldlw 1 E SCALE: APPROVED BY: DRAWN BY REVISED e ,,,;.-•�"r DATE: 7 DRAWING NUMBER ,- Pi IIA"O q�-aoG 'WOOD PRODUCTS It's all about the wood Windows: Miratec Primed 30 x 68' Insulated Steel 9 Lite Door Brosco Insulated 30"x 49" Double Hung Composite Trim Brosco Insulated 30"x 29"Fixed (above) Brosco Insulated 30"x 29" Fixed (above) 32' 6' 6x6 Corner Post 8' 6' 2 st Studio 6x6 Top Plate 6x8 Posts support 6'0" x 6'8" Steel 6x10 Center Girt Insulated Outswing Full View Atrium Door, Brosco Insulated 30"x 49" Double Hung 6x6 Support Post on Footing 3' SHED STUDIO 4x6 Window Post Ladder Type Stair r a y (for storage access) Brosco Insulated 30"x 49" Double Hung g"Nigh Landing L 6, Windows: Windows: 112" OS8 6x8 Corner Post Brosco I►tsu/ated 30"x 49" Double Hung Brosco Insulated 30"x 49' Double Hung Brosco Insulated 30"x 29" Fixed (above) Brosco Insulated 30"x 29"Fixed (above) White Cedar Shingles Miratec Trim _ Tyvek ,,.,,.•,.-„.-,,.•. .. 2"Hi-R Foam Insulation 16' x 24' STlJDIO with 8' x 16' She 2"x 2" Spacers Located at: 2"x 2" Spacers 1559 NEWTOWN ROAD, COTUIT, MA 02635 6x6 Top Plat 1"x 12" Vertical Siding Scale; 1/4"=V - Chris Ellis - August 9, 2005 2.5"x 8"Purlin (FIRST FLOOR FRAMING PLAN) WALL DETAIL 6x6 Corner Post r i T �A) t JJ, PINE 11A.. "OR N WOOD PRODUCTS .It's all about the wood 6x6 Top Plate 4x8 Loft Framing Shiplap Flooring Elevation = 2'on Centers 3'above Loft Flooring - —.: .—,-,—.-.—. -. --. . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PINE HARBOR, INSULATED SHED ROOF (see section plan) Bronco Insulated 3032 Bottom sits on Top Plate Shed Rafters: Z.SxB @2'oc = ( Oven t0 Below Pitch 4112 Bronco Insulated 3032 Set tight to Rafters i Railings: 3'high with _ Ballusters @ 4"spacing i -- - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . Y h — - — - 4x6 Window Post (aligns with window . Outline of wall below 6x8 Corner Post framing below) 16' x 24' STUDIO 'with 8' x 16' Shed Located at. 1559 NEWTOWN ROAD, COTUIT, MA 02635 Scale: V4"s!' - Chris Ellis - August 9, Z005 (LOFT FRAMING PLAN) I F GREENBE i Ss�a I LOT 3 11 \ y to �2.g• 73� a. LOySpEM r 40 02 E 9 I T o m cv ��'` �NS ASTB N S 5 1g 1 � x Fp _ , ym R M OUTN LOT 1 I 1 LOT 2 ` '_ 0 46455f S.F. o T! 1 !N EX plPE EX1 i IQ �EpTIC SI�T11�` Np ING v SE 4 0co Nt 1 O E e c C9 , �— � \\� `� 0 XIS !R �—- 1 9 5_ \ UNDT NG --------- A IV Op a, orj, 1 co a co ` t\ ' LEY \ I '// // ,�/!r♦ r, ,' \ \ , `, �1 ', ` �, 1 \ \, \i `, \ 1 \ \ \ \ \ `, `\ 'I `� `` L-CD 1 0.3 01 cv?co `\ �jcy STE _ \ 1 ro Ot—... 1 - 1 1 ` ' ' ` ` '1 ' \ FOUNDATION LOCATION PLAN \ 1 1 1 1 PREPARED FOR ; \I \I , `\ CLIFF ALLEN �NI 11 1 1� � I I I 1 � 1 � \ \ 1 I of / ; ,► ► / 1559 NEWTOWN ROAD BARNSTABLE MA J. E. LANDERS—CAULEY, P. E. 0S' cOco CIVIL ENVIRONMENTAL ENGINEERING oco! 1 , ; ; ; I ; ' / P.O. BOX 364 WEST FALMOUTH, MA 02574 t-co ' (508) 540-7733 ph. (508) 540-3022 ph. , NCO , ',tam 508 540 — 3344 fax 1 �o ASS.# 024-009 DATE: 09113105 4�00• 5�P- 11 / SCALE: 1" = 30' DRAWN BY: JDR v��'�� JOB NO. 1431—ASB SHEET: 1 OF 1 y � t L y pp J .i `j,-_� }_ - •�.. I PIS - — (� i�� - i _ .ate `•; � „"�� - � � I��, ` `,�J' 'i i• f r� •' c_— ;;;, .. � it �.����;� 1' !l') `�L / ri%• j�, t ,` rI j �+9-e WAKEBY RD LOCUS INFORMATION REVISIONS: q NO. DATE DESC. Q 2 CURRENT OWNER: CLIFFORD ALLEN, Jr. OVERLAY DISTRICT: WP — Z D I D LOVELLS NITROGEN SENSITIVE -n POND TITLE REFERENCE: DEED BOOK 12728, PAGE 336 — ZONE: ZONE 11 z PLAN REFERENCE: PLAN BOOK 492, PAGE 54 FEMA FLOOD 39 2 LOCUS "Cn, DATED ZONE DISTRICT: PANEL 50001 /0021 � D N �+ ASSESSORS MAP: 24 Z PARCEL: 9 — (' MINIMUM LOT SIZE: 87,120 S.F. ZONING DISTRICT. RF 28 SETBACKS: FRONT 30' EXISTING LOT SIZE: 46,456t S.F. , SIDE 15' EXISTING LOT COVERAGE: 1,919t S.F. (4.1%) REAR 15' PROPOSED LOT COVERAGE: 2,227f S.F. (4.8%) LOCUS MAP I CERTIFY TO THE BEST OF MY NOT TO .SCALE PROFESSIONAL KNOWLEDGE, INFORMATION AND BELIEF THAT THE LOT CORNERS, DIMENSIONS AND SETBACKS TO THE STRUCTURE AS DETERMINED BY INSTRUMENT SURVEY AND AS SHOWN ON THIS PLAN ARE CORRECT. of I LOT CRAIG A. y No.3B039 Qo• IAO � I �• PROFESSIONAL'', LAND SURVEYOR DATE N7 . CERTIFIED SEPTIC LOCATION As DEPICTED BY OTHERS ON EXISTING PLOT PLAN A 2005 SITE PLAN GARAGE WITH r�� PROPOSED 00 ADDITIONS / PROPOSED / 2 STORY AT 5'x11' ADDITION / OD DWELLINGPROPOSED 559 # 1 559 8 x1 r DECK / ESC EENEGD �,� SANTUIT-N EWTOWN m - _-_---- _ _ 1 _ / PORCH ROADPROSED L O T 2 I 9 1OPs' ADDITION IN as < ( EXIS'ING l STUIy10 COTU IT EXISTING ! _ PORCH MASSAC H U S ETTS GG (BARNSTABLE COUNTY) SEPTEMM 11, 2006 -__4 , - LTDT 1 , � , v PREPARED FOR: 461 456 ± S. F. ^ , MR. CLIFFORD ALLEN O1559 ! ~ SANTUIT NEWTOWN ROAD COTUIT, MA 02635 / (508) 428-4410 BSC k 349 Main Street, Route 28, Unit D West Yarmouth, Massachusetts 02673 s s3 ti�� 508 778 8919 4 �D• �" © 2006 The BSC Group, Inc. SCALE: 1" = 20' 0 0 2.5 5 10 MEIM 0 10 20 40 Fw c� PROD. MGR.: CRAIG FIELD 3 FIELD: D. GAZZOLO / J. MCCARTIN L 0 T 2 \ ' CALC./DESIGN: K. HEALY 21 DRAWN: P. HAGIST CHECK: CRAIG FIELD FILE: 9162—CPP.DWG DWG. NO: 5758-01 � JOB. NO: 4-9162.00 SHEET 1 OF 1 A: