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HomeMy WebLinkAbout1560 SANTUIT-NEWTOWN ROAD - Health 1560 NEWTOWN RD Cotuit 024-016 �i r j f UPC 10230 No. HIE3 N4ii*�MaP �pN °t� sv C-0 'C �m s i , E f V I ��V/// � � V �V��r, Y ...�, d � � � - � .. .. - M _ _ t - .. � � t. 45 .. _ .. _ t .. _ -. .� G �' e S .. { � �:� - - �!�:�� � `t .� ,.�. ... _ _ � _ �A-3 E �. �. ., K ... ... r q.. .... �- _ :.. .. _ - ��� i. .. � 1 � � .. ... � .+ ,: .. - _. s .. ., y. .. x ..�. _ .. ; � 1 .. TOWN OF BARNSTABLE LOCATION Aj&k)JVWll laA SEWAGE # VILLAGE PO¢a0 71' ASSESSOR'S MAP LOT 'ZL{ — f(0 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: t DATE COMPLIANCE ISSUED: i VARIANCE 64t TED• Yes No r I ' t�� r Aug 05 2019 15:05 HP Fax page 4 Commonwealth of Massachusetts (o uo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f iy. 1560 Santuit Newtown Road Property Address. r1 r Fannie Mae Owner Owner's Na e information Is required for every Cotult MA 02635 8-1-19 _ page. Clty/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. Inspector Information N` s --- filling out forms p cSl�# l�fOc�y on the computer, �02 JA MES N�y use only the tab James D.Sears _ 4! :m_ key to move your Name of Inspector B :co -do not Ca ewide Enterprises 3* # use the return Com an Name C, O ' key. P y T 153 ••E Commercial Street s•' ••P �yyr� 1 N S ray Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8677 S1623 Telephone Number License Number B. Certification - I certify that: I am a DEP approved system inspector in full compliance with Section 1.5.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails , 8-1719 Aspect 's Signa ture Date 41 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable„ and the approving authority. Please note: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. t5insp,doc•rev.7/26/2018 Title 5 OMcial Inspecion Form:Subsurface Sewage Disposei Syslem•Page 1 of 18 Aug .05 2019 15:05 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form .i Subsurface Sewage Disposal System ronm -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 8-1-19 page. Cityrtown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found:any information which indicates that any of the failure criteria described . in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal.Tank D Box and six chamber's. 2) 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 ❑ NO (Explain below): 151nsp.doc•rev.7/2012018 Title 6 Officlat Inspection Form,Subsurface Sewage D!sposal System Page 2 of 18 Aug .05 2019 15:05 HP Fax page 6 Commonwealth of Massachusetts . Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name Information is required for every COfUIt MA 02635 8-1-19 page. City(rown State Zip Code Date of Inspection C. Inspection Summary (Cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms are repaired, ❑ 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced: ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below) 3) 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. a. 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: t5insp.doc•rev.7)2612018 rNle 5 OfAdal Inspection Form;Subsurface Sewage Disposal System•Page 3 0l 18 Aug .05 2019 15:05 HP Fax page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address ' Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02535 8-1-19 page, City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b, System will fall 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.712612010 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Aug 05 2019 15:05 HP Fax page 8 _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property.Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA f 02635 8-1-19 page. CitylTown State Zlp Code Date of Inspectlon C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No e ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in awop0l is less than 6" below invert or available volume is less than%day flow I-M101 'r ❑ ® Required pumping more than 4 times in the last year-NOTdue 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 water supply wet 1. ❑ ® 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 2000'gpd- 10,000 gpd. ❑ ® 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. 5) 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 C.4. 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 t5in4p.doc•rev.7/W018 Title 5 Official Inspection Form:Subsurface sewage Disposal system Page 5 of 18 Aug ,05 2019 15:05 HP Fax page 9 Commonwealth of Massachusetts L9 Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information Is MA 02635 6-1-19 required for every Cotu it page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has falled.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15,304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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 ortees, 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)] t5insp.doc-rev.712612018 Title 5 Official Inspectloo Form:Subsurface Sewage Disposal System Page 6 of 18 Aug •05 2019 15:06 HP Fax page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments kv.,",Y 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is i Cotut MA 02635 8-1-19 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: 1000 Gal. Tank D Box and six chambers. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 ears usage 2017-29,000Gals 9 ( y g (gPd))., " 2018-25,000Gal's Detail: I Sump pump? ❑ Yes ® No _Last date of occupancy: NA t5lnsp.doc•rev,7/28/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 18 i ' Aug• 05 2019 15:06 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments n 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every COtUIt MA 02635 8-1-19 page. Qty/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Comm ercialllndustriaI Flow Conditions: Type of Establishment: Design flow(based on 31.0 CMR :15,203): Gallons per day(gpd) Basis of design flow(seats/persons/sq,ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? y ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: tSInsp.dx•rev.7/26/2018 Title 5 Official InspectlOfl Faun:Subsurface Sewage Disposal System•Page!?of 18 Aug •05 2019 15:06 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form i' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is COtuit 3 required for every MA 02635 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 4. 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), Approximate age of all components, date installed.(if known) and source of information: Tank NA/Leaching'2000 permit # 2000-697 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on slte plan): Depth below grade: - 28" 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.): Pipeing is 4" PVC SCH --40. , t5insp.doc-rev.712512018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 16 Aug 05 2019 15:06 HP Fax page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owners Name information is required for every Cotuit MA 02635 8-1-19 page, CitylTown State Zip Code Date of Inspection. D. System Information (cost.) . 6. Septic Tank(locate on site plan): Depth below grade: 18 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: 1000 Gal. Precast H-10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 1. Distance from top of scum to top of outlet tee or baffle 12 Distance from bottom of scum to bottom of outlet tee or baffle 17 How were dimensions determined? Asbuilt -Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Two inlet tee's outlet baffle. Note: Tank seam reaealed. No sign of leakage. i5lnsp.doc•rev.712612018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Aug -05 2019 15:06 HP Fax page 14 Commonwealth of Massachusetts NRTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotult MA 02635 8-1-19 page. Clty(Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 1 Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 3 8. 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 t5lnsp.doc•-ev.7126/2018 Title 5 Official Inspection Fan:Subsurface Sewage Disposal System•Page 11 of 16 Aug•05 2019 15:07 HP Fax page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 8-1-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8_ Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence.of leakage into or out of box, etc.): D Box is 16"x16"-30" below grade wltwo lines out. Box is clean and solid wlno sign of over loading or solid carry over. t5irsp.doc•rev.7126/2018 Tale 5 Official Inspection Form Subsurface Sewage Disposal System-Page 12 of 18 Aug• 05 2019 15:07 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Q-1-V1560 Santuit Newtown Road Property Address Fannie Mae _ Owner Owner's Name information is required for every Cotuit MA, 02635 8-1-19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required):_ If SAS not located, explain why: Type: ❑ leaching pits number: 4 ® leaching chambers number. 6 ❑ leaching galleries number: ❑ leaching trenches d• number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp doc-rev.712(t2018 Tlde 5 Official Inspecllon Form:Subsurface Sewage Disposal System-Page 13 of 18 I Aug- 05 2019 15:07 HP Fax page 17 Commonwealth of Massachusetts ,lF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owners Name information is required for every Cotuit MA 02635 8-1-19 page. City/Town State tip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is six Cu'kec leaching chambers. Ck D Box prob. area and camera out to chambers. No sign of over loading or solid carry over. No sign of holding water. 12. 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 Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): tSinsp.doc-rev,T2812018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 18 Aug• 05 2019 15:07 HP Fax page 18 4'\ Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA. 02635 8-1-19 page. City/Town State .Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t t5lnsp.doc•ree.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sysbam•Page 15 of 18 f Aug•05 2019 15:07 HP Fax page 19 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 8-1-19 page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 14. 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 R&Ae a t ,G_ 040 A�a. 3 i R - ISinsp.doc-rev.7/26/2018 Title 5 Cffidel inspection Form:Subsurface Sewage Disposal System•Page 18 a(18 Aug 05 2019 15:08 HP Fax page 20 Commonwealth of Massachusetts k; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road -DY Property Address Fannie Mae Owner Owners Name information is required for every Cotuit MA 02635 8-1-19 page. City/Town Slate Zip.Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Po 10, Estimated depth t high ground water: 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 r ® Observed site(abutting propertylobservation 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: Auger T.H. 10' no G.W.. Bottom of chamber's at 4'-6"below grade. Bottom of chamber's at 5'-6" above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page, t5insp.doc-rev.71`2812018 Title 5 official Inspection Form!Subsurface Sewage Olsposal System'Page 17 of 15 Aag• 05 2019 15:08 HP Fax page 21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 1560 Santuit Newtown Road III ujq�tzf Property Address Fannie Mae Owner Owners Name information Is re ulred for every Cotuit MA 02636 8-1-19 Paw. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed&Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank-Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included Gr`i��f •7-,� 68 o�/m 0 Gw i 4 t5insp.doc•rev.7126MI8 Title 8 Official inspecilon form:Subsurface Sewage Disposal System•Page 16 of 19 I No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Misposal .6pstem Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System �Individual Components Location Address or Lot No.l S' $ftXJ PU cT.jVt7CML Owner's N e Address,and Tel No. / c a rav R� CU V tT ,=L lV iG Assessor's Map/Parcel v� O �37 c4y( LE It-0 E. Installer's Name,Address,and Tel.No. 1—�$77 Designer's Name,Address,and Tel.No. 8 ocp co , �1A I53 Co N- 6C Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building UU No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision D to Title Size of Septic Tank Type of S.A.S. Description of Soil a Nature of Repairs or Alterations(Answer when applicable) :56 4Cf 56R_rtL _r3WV— 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 Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date �— Application Disapproved by Date for the following reasons Permit No. 1120/1? �� /_5 Date Issued Tee THE COM VONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 'V� 9 lication, foY'Misposaf 6pstem (Construction Permit Application for a Permit to Construct( )° Repair(X Upgrade( ) Abandon( ) ❑Complete System Tndividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. I S60 SkntTU tT-lt1�wroua/ Assessor's Map/Parcel FL D• NA�TL,1"to Lk'r; A-SS'oC �lti,�a ra�c / (a/7b E Installer's Name,Address,and Tel.1,4o. SV S.W?Z—T%Z? Designer's Name,Address,and Tel.No. C/E��4J�•D�,� � OUP GO g^ . tfA _ - 1� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures { `• `, , t i Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision D to Title f Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) St73`r -�t� ::�)V - s-.. Date last inspected: /,- 1 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 Certificate of Compliance has been issued by this-.Board of Health. Signe Date - ,dts Application Approved by Date I; _ - ' Application Disapproved by Date '` for the following reasons - Permit No. 9 •—� L .5 Date Issued 1 l/ l- b f. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by CA&a,31 �r_- ��������.t�: duZL e_0 at �7 p &) C ti o-rhas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer 4:+AQ 6 E Designer #bedrooms Approved design fljtias gpd The issuance of this pe it ha 1 n t be construed as a guarantee that the system will designDate j Inspector No. ` /_l� Fee j THE COMMONWEALTH OF MASSACHUSETTS `T PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS disposal 6pstem (Construction permit Permission is hereby granted to Construct( ) Repair( A Upgrade( ) Abandon( ) System located at I ( k t%)077 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust7b'completed within three years of the date oft is permit.Date � Q Approved by r I - Gah�114-- USPS TRACK NG# { First-Class Mail 1 Postage&Fees Paid USPS Permit No.G-10 9590 9402 4798 8344 8569 67 United States •Sender: Please print your name,address,and ZIP+4®in this box• Postal Service 0� Town of Barnstable .p Health Division 200 Main Street Hyannis,MA 02601 I I a�91%IjI .11Ri.11IIliill]IM-11111iljIilll's1111111.1}1--111ii''11111 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3. r ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. C t ❑Addressee ■ Attach this card to the back of the mailpiece, � }> n C. Date of Delivery or on the front if space permits. A ""•^~ ~idress different from item 1? ❑Yes delivery address below: ❑ No FEDERAL NATIONAL MORTGAGE ASSOCIATION p d P O BOX 650043 6 A 0 i7 DALLAS,TX 75263-0043 f+ O duIt Signature IIIIIII�I/IIII'IIII'I�III'lllll'111l hIIIIIIIII 0Adult ig rN�� ❑PriorityMalExpresso ❑Adult Signature ❑Registered MaiIT^' g Restricted Delivery ❑Registered Mail Restricted 9590 9402 4798 8344 8569 67 ertified Mail®❑Certified Mail Restricted Delivery nReceipt for ❑G011act on Delivery P:t1i.very erchandise 2_Article-Number-(Transfer-from_service_lahen ❑Collect on Delivery Restricted Delivery ❑Signature CcnfirmationT ail ❑Signature Confirmation 7 0�15 i 417 3 0 0001, 4 9 8 8 2�0 E •x /ail Restricted Delivery Restricted Delivery 'r• PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Postal CERTIFIED oRECEIPT N Domestic 4 ru ` For delivery information, our • e - _ SE ca Certified Mail Fee E• $ t Extra Services&Fees(checkbox,add fee as'appmpdat �"�$POgr ❑Return Receipt(hardcopy) O ❑Return.Receipt(electronic) $ POStmaFli 0 ❑Certified Mail Restricted Delivery $ r Here N a 0 []Adult Signature Required $ 9� ❑Adult Signature Restricted Delivery$ O ^---- -- ------ -- ----- - - m „i FEDERAL NATIONAL MORTGA OCI' '"ION ra P O BOX 650043 C3 DALLAS,TX 75263-0043 ;t PS Form :00 —2015rr r,r•r; - - Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label), for an electronic return receipt,see a retail •A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this , delivery. USPS®-postmarked Certified Mail receipt to the, ■A record of delivery(including the recipient's retail associate. signature)that is retained-by the Postal Service"' Restricted delivery service,which provides �� for a specified period. delivery to the addressee specified by name,ors to the addressee's authorized agent f Important Reminders. Adult signature service,which requires the ` •You may purchase Certified Mail service with signee to be at least 21 years of age(not 2. First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is not available for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified •Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). `"� of Certified Mail service does not change the •To ensure that your Certified Mail receipt is _ insurance coverage automatically included with accepted as legal proof of mailing,it should bear a,' certain Priority Mail items. USPS postmark.If you would like a postmark on •For an additional fee,and with a proper this Certified Mail receipt,please present your _ endorsement on the mailpiece,you may request Certified Mail item at a Post Office"for a the following services: postmarking.If you don't heed a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion_ ofdelivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version:For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt,•attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. Ps Fom,3800,Apri)2015(Reverse)PSN 7530-02-000.9047 Town of Barnstable Barnstable P` ti AN-amnicaChy k � Inspectional Services 1 1ARNSTABLF, 9� b . ,�� Public Health Division m prF° 0�6 200 Main Street, Hyannis MA 02601 2007 Office: 508-362-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 2002 April 23, 2019 FEDERAL NATIONAL MORTGAGE ASSOCIATION P 0 BOX 650043 DALLAS, TX 75263-0043 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1560 Santuit Newtown Road, Cotuit, MA was inspected on 03/21/2019 by James D. Sears, certified Title V 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 V (310 CMR 15.00) due to the following: • The septic tank is leaking. Must seal septic tank or replace septic tank. You are ordered to repair or replace the septic system within two (2) years 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 T oma ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\1560 Santuit Newtown Road Cotuit.doc of THE r, Town of Barnstable s • • • BAMS[ABLE, 9�A ,�� Regulatory Services Department rfD MA't a - Public Health Division 200 Main Street, Hyannis MA 02601 d Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 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 DEADLINE CRITERIA ❑ 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 within 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 wellds free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool e4 y"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER M V 3 F cSl,- 4onk or r e [Ac e Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc r Mar 28 2019 0720 HP Fax page 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road f' Property Address - Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 3-21-19 " 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; out o forms A. Inspector Information on the computer, ���: JAM yN, use only the tab James C.Sears =�: ES :R,? key to move your Name of Inspector o ; cursor-do return not ret use the Capewide Enterprises Company Name 5.-A YT�r, key. 153 Commercial Street ��iFs iNSP� N�`�° Company Address Mashpee MA 02649 CitylTown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15,340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 3-22-19 olnspectoes 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 has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate w o regional office of the DEP.The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2612018 Tile 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page t of 1a Mar 28 2019 0720 HP Fax page 20 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owners Name iequired for Cotuit MA 02635 3-21-19 required for every page. CltytTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3,or 5 and all of and 6. 1) 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: , Conn Pass-Tank Leaking. The system is a 1000 Gal.Tank D Box and six chamber's j 2) 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 ❑ NO (Explain below): ensp.doc-fev.v2wo18 Title 5 Offidal Inspection Form:Subsurface Sewage 0 sposal System•Page 2 of 18 Mar 28 2019 0720 HP Fax page 21 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 3-21-19 page. City/Tom state Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ® 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): Tank leaking. Need to seal tank. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 3 of t8 Mar 28 2019 07:21 HP Fax page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is Cotuit MA 02635 3-21-19 required for every � page. City/TDwn State Zip Code Date of Inspection C. Inspection Summary (cunt.) ❑ 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 b. 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, i 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. c, Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.712612018 Title 5Officiial Inspection Form;Subsurface Sewage Disposal System•Page 4 of 18 Mar 23 2019 0721 HP Fax page 23 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments _J^v 1660 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name ieqti is every Cotuit required fo d for eve MA 02635 3-21-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in n 11, is less than 6"below invert or available volume is less than 'h day flow J. 151/A16 ® 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 water.supply wel I. ❑ ® 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 2000 gpd- 10,000 gpd. ® 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. 5) 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 CA. 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 t5insp.doc•rev.n26/2c18 Title 5 Official Inspection Form:Subsurface Sewage Olsposal System•Page 5 of 18 Mar 28 2019 0721 HP Fax page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 3-21-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: 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 NIA) ® ❑ 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, 13 ® 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)] tSlnsp.dm•rev.7126/i016 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 6 of 18 Mar 28 2019 07:21 HP Fax page 25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road t. Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 3-21-19 page- City/Town State Zip Code Date of Inspection D. System information 1. Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: 1000 Gal.Tank D Box and six chamber's. I Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 ears usage2017-29.000Gais 9 ( y (gPd))' 201 B-25,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc•rev.72612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Mar 28 2019 12:35 HP Fax page 3 °y Commonwealth of Massachusetts p Title 5 Official Inspection Form p Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name irdormatlon is CotUtt required for every MA 02635 3-21-19 page. City/Town State Zip Code Date of inspection D. System Information (cont,) 2. CommerciaUlndustrial 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3• Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5lnsp.doc•rev.712WO18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Mar 28 2019 12:35 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i-wll, - 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name requir d o n e Cotuit MA 02635 3-21-19 required for every page_ City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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/Altemative 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): Approximate age of all components, date installed(if known)and source of information: Tank NA/ Leaching 2000 permit#2000-697 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 28" 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.): R Pipeing is 4" PVC SCH -40, t5insp.doc rev.7126/2018 TiN 5 Official Inspection Form Subsurface Sewage Disposal system-Page 9 of 18 Mar 78 2019 07:22 HP Fax page 28 Commonwealth of Massachusetts Title 5 official Inspection Form la Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 3-21-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18" 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: 1000 Gal Precast 1-11-10" I Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 30" Distance from bottom of scum to bottom of outlet tee or baffle AT How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank level at seam.Tank leaking.Tank at 18"below grade w/both cover's at 8". Note: Covers are 30"cement.Two inlet tee's wloutlet baffle. Need to seal tank. ' t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 10 of 18 Mar 28 2019 07:22 HP Fax page 29 L\ Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every Cotuit MA 02635 3-2.1-19 page. City/Town State Zip Code Date of Jnspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene y El 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i 8. 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): r Dimensions: Capacity: gallons Design Flow: gallons per day 15insp.doc•rev.7128/20-18 Title 3 Official Inspection Form:Subsurface Sew Dis posal sposal System•page 11 of 18 Mar 28 2019 07:23 HP Fax page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is C"iOtUlt required for everyMA 02635 3-21-19 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Dace Comments (condition of alarm and float switches, etc.): i "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16'06"-30" Below grade w/two lines out. Box is clean and solid w/no sign of over loading or solid carry over. 15lnsp.doc-rev.7/2812016 Title 5 Official Inspection Form SLbUrface Sewage Disposal System•Page 12 of 18 Mar 28 2019 0723 HP Fax page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form 1a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name ingaiion is Cotuit re wired for every MA 02635 3-24-19 page, cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): i ' If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits' number: ® leaching chambers number: 6 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7UM(Ila Title 5 Official Inspection Forth:Subsurface Sewage Disposet System"Page 13 of 18 Mar 28 2019 07:23 HP Fax page 32 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name informatlon is required for every COtuit MA 02635 3-21-19 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is six cultec chambers. Ck D Box prob.area and camera out to chamber's. No sign of over loading or solid carry over. No sign of holding water. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation; etc.): t5insp.doc•reo.7/28/2018 Title 5 Official Inspection Form:Subsurtace Sewage Disposal System-page 14 o118 Mar 28 2019 07:23 HP Fax page 33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "PP; 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name infformaCion is CotUlt required for everyMA 02635 3-21-19 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7126/2018 Title 6 Official Inspection Forr:Subsurface Sewage Disposal System-Page 15 of 18 Mar 28 2019 0723 HP Fax page 34 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,j' 1560 Santuit Newtown Road W, Property Address Fannie Mae Owner Owner's Name information formation is squired for every COtuit MA 02635 3-21-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14, 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 D Ec K �f'AR o � 13 i R -a- 3�z A-3 = :38' t5lnsp.doc-rev.7126/2018 Tine 5 Ofi9cisl Inspection Form:Subsurfsoe Sewage Disposal System-Page 16 of 16 Mar 28 2019 07:23 HP Fax page 35 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information Is required for every COtUIt MA 02635 3-21-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth t4—high ground water: 10, 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: Auger T.H. 10' no G.W.. Bottom of chambers at 4'-6"below grade. Bottom of chamber's at 5%6" above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7M/20/8 Title 5 Official Inspection Form:Subsurface Sewage 0Isposal System•Page 17 or 18 Mar 28 2019 0724 HP Fax page 36 c� Commonwealth of Massachusetts Title 5 Official Inspection Form 1' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments vY 1560 Santuit Newtown Road Property Address Fannie Mae Owner Owner's Name information is required for every COW it MA 02635 3-21-19 page. City/Town State Zip Code Date of Inspecton E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2,3,or 4 checked ® C. Inspection Summary: 1, 2, 3,or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8:TighttHolding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included (gi g,41 s �f C NAMA1.4s , � r NO G, w r i 151nap.doc-rev.7126/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Map Page 1 of 1 Town of Barnstable Geographic Information System New Search Home Help Parcel Viewer Custom Map Abutters Map Size ® ®® Zoom Outilli 111111n 1=JPG Turn map layers on/off by Refresh selecting check boxes below - u ® Town Boundaries ® Road Names ❑ Voter Precinctsi ❑ Multiple Address House Numbers •� j ❑ Map&Parcel Numbers ® Parcels i ❑ FEMA Flood Zones Effective July 16,2014 $ VE-Velocity,Zone b r. 13 AE-100 year Flood- t ®AO-100 year flood 13 0.2%Annual Chance FloodV Open Water, 0 ® Neighboring Towns }�4 ❑ Water ❑ Streams 0 1 1 Fj(eet • f ❑ Jetties .®• $ �- ❑ Edge of Watery Set Scale 1" = 191 Aerial Photos v f MAP DISCLAIMER copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or 6omments to GIS Bam,t3bleMA v1.2.5333[Production] a 1 i I ro http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=024015 9/1/2016 Map Page 1 of 1 Town of Barnstable Geographic Information System New Search Home Help Parcel Viewer IF Custom Map IF Abutters Map Size i Zoom Out , In ` Turn map layers on/off by _ )PG selecting check boxes below. Refresh Town Boundaries .� f.. 1 � �-r Road Names ❑ Voter Precincts ❑ Multiple Address House Numbers ❑ Map&Parcel Numbers Parcels - 3 • ❑ FEMA Flood Zones - w - Effective July 16,2014 13 VE-Velocity Zone ` ®AE-100 year flood e r AO-100 year Flood F ❑0.2%Annual Chance Flood Open Water ® Neighboring Towns + El Water 0 -j ❑ Streams 0 1 1 F et ❑ Jetties S ❑ Edge of Water V Set Scale 1" = 191 -, �• Aerial Photos EJ I MAP DISCLAIMER - •- copyright 2005-2010 Town of Bamstable,MA All rights reserved.Send questions or comments to GIs BamsteblerlA y1.2.5533[Pr°duction] - F n . -s http://66.203.95,236/arcims/appgeoapp/map.aspx?propertyID=024015 9/1/2016 �-�No�� �� ,..,..., FEE Sa Board of Health, /�/$��I ��� MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) 'XComplete System ❑Individual Components Location 4-2 1, Owner's Name F/i '1�8�� Map/Parcel# ' Address /j7Q ��wi'f.e+N xe sW¢+t-S/V+J ^IlU Lot# Telephone# syes 4)L a" 6 79 Installer's Name ,�- Designer's Name 0,,f,,,,t FL J(4ff jjq,,*+ Address 4 � w. C Address 6 5 C.�r �Lg�Nl �� , �j Lv/Ctf: Telephone# Telephone# sU L���^ j9 Type of Building et 0:PC--7-(4 (L Lot Size sq.ft. Dwelling-No.of Bedrooms S LLtf T Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) AS� gpd Calculated design flow Design flow provided 6' gpd Plan: Date /®Z,(J�o D Number of sheets / Revision Date Title !✓ILf'RC� sE o-A-G-�` �!I P*'1Je C l yjm'� Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator ®. J d t' f°p Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS /z e-IL 4-(-C c 0j!P a a L f w I �,� L;.1 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system pe a'tion until a Certificate of Compliance has been issued by the Board of Health. Signed Date d Inspections _ d U 0 h ® V f'f- t.°% '�.iy...... �� ". a c---I -a..,' Y -K."-•'i e � ..._ --�^-iT•j-.%��.) t��'�.�3"��') �l�;;f �4n�`7,Mi`"ir '7.*'+'"-'",;;,.,,� -.� aka is No. Lf.;S/ d '. :} FEE COMMONWEALTH Of MASSACHUSETTS, t_ Board of Health, /0tZ z✓17t48L MA., APPLICATION FOP, DISPOSALSYSTEM CONSTRUCTIOMPERMIT Applicatiori fora Permit to Construct( Repair) Upgrade( Abandon( - Complete-System ❑Individual Components Location I p o- N�w7'b—1 i4 7 ! "�' Owner's Name e x Map/Parcel# 062 Address /S4'>0 i✓�i.�/�►riv ti 4� /t'44Silr�J n t ll L'ot# Telephone# mod, Q 'S (09 79 Installer's Name Designer's Name 0A.,,j r-L J�ff.�Jo/�J �r Address 1 mai, J < / Address 65 CArr, 4 CAJ CU71PPLV/l t_t! -Telephone# �' l O G ��a� �G -• » Telephone# sy o' Type of Building /�Ef t 7 e 7-(,4 L Lot Size sq.ft. Dwelling-No.of Bedrooms CNII [f T Garbage grinder O ='Other,-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) gpd Calculated design flow Design flow provided 6- s gpd ;) t Plan: Date �o'��S'��J Number of sheets / Revision Date 1�8!�� FA c e Sf •4-�(r e �l t r1.4 c J ytl l ' Title . . Description of Soil(s) x Soil Evaluator Form No. Name of Soil Evaluator 0• J ° 0"'f o/r Date of Evaluation? (w`o DESCRIPTION OF REPAIRS OR ALTERATIONS /t FfC A-(OE C BJ 1,f`a a C f w!77. rj-U 3 6:,te..L,.1�✓ m rAt4-#e`er vac . 4t C-A 49 C l;ir'w f 3 off . �! a a-.wy;,y..✓ ,�. 8. The undersigned agrees to install the above described Individual.Sewage Disposal System in accordance with the provisions of TITLE 5 and f further agr`e to not to place the system iu oper-ation until a Certificate of Co pliance has been issued,by the Boar&of Health. Si gne ..-- Date/ � R 'Inspections/ 17 7 (17 r I V No. FEE' 9COMMONW[AIT14 OF Ag "TTS Board of Health, eXA A.CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) , Complete System ;A 1 The undersigned hereby certify that the Sewage Disposal System; Constructed(.,a),-,Repaired (`),Upgraded ( ),Abandoned ( ) by: Lea ►'r2�1P0, rOwtdt%t t W4 , 1''0W1t0161L �A C GwR-VIfl ti at �� G 0 has been installed in accort al�ce with the p ovisi ns of 310 CMR 15.00 (Title 5) and th a,9,proved design.plans/as built plans relating to application No-? "�/_! dated �f 2 do Approved Design Flow s'76,S (gpd) Installer ` Designer: Inspector:( Date: /C: j -514111 hA The issuance of this permit shall not be construed as a guarantee that the system will function as designed. a No._1 FEE v � > COMMONWF-A T14 OF MASSAC14US ETTS ; 4 r [ Board of Health, DISPOSAU WSTIM CONSTRUCTION PERMIT Permission is herebyranted to; Construct Re Tir Upgrade( Abandon an individual sewage dis osal system, g ( p ( ) 1 ( g p. Y ,. at as described in the application for Disposal System Construction Permit No t'V b4ated Provided: Construction shall be completed within three years of the date of this"permitf�All zlocal c nditions'must be met: Date, ► t Form 1255 Rev.5/96 A.M.Sulkm Co.Boston,MA ! Il/i Board of Health ` r J. w�wlYi�llrr.� L`i� wIYIH:G�N.rrw1rt.P, � .�n. 1. ist t P+i h' d 7).vm�. .. bri�Kf CttSNoo� D-boY �1��JtnvF fE�v�F� ' 3,4„ Safof Etc. (AJIRe*rHA . �tta�tfcav+ aF jfhCE SEI r,c riwK � i 4 rlc Aj SMcc Ch a i SAS EXi3T� I 7 C - I LCIO r� L��� I TOWN OF BARNSTABLE LOCATION - 15 SEWAGE # Z 000 9 7 VILLAGE !Lf ASSESSOR'S.MAP& LOT &7-y-0 INSTALLERS RAME&PHONE NO. SEPTIC TANK CAPACITY d t? LEACHING FACILITY: (type) •� " (size) NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE:_ 6r l -7 z COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Feet pp y l g Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet i Sio 4�v sCQ6 a3' aka a 3 . q' G 01e'/ ' �► ' ecs C t' es TOWN OF BARNSTABLE . I LOCATION /�� A Lt '`x=- SEWAGE # VILLAGE 4=0zY/�a/ 74' ASSESSOR'S MAP LOT lb INSTALLER'S NAME & PHONE NO. 4C/)I v �f j SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVAT9'WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE TED• Yes No I � dti �ti i r TOWN OF BARIvSTABLE 4 LOCATION © �'c� SEWAGE # ZOOU � q 7 VILLAGE' �-�.x ���� ASSESSOR'S MAP & LOT 0 7 —OIL+ `f INSTALLER'S RAMS&PHONE NO. ;i✓r anl✓c— SEPTIC TANK CAPACITY B D d LEACHING FACILITY: (type) l •c P, v (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE:_- k 17 f COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and LeachingFeet Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility). Furnished by Feet SC,a 6 a�, jq' 36 V �l �c5- iS•.��r":3.. ..� t a,. iY.�'''.tlCx:'i.: '1^: ,a . .•. � �.�Jr..,z L.•. _ �• 44. ^.+{may . r '... .. Odle P40 p 4 ,. C�IfT�,y� ' 3,'w Safos Etc, (AJl R o f i HA7f'� *f°Arrov.► of tfhGE E�CrsTi,pt`r 1'Q� ���MQo �Q LF1SPo 4t � 1�f�vT >>f btu: SEI r,c TAN�c �JCNga w� •' � SMCf',V . 1 or"rE�y��j 6 �YoylE -tp�.ps eDPGK f r h f�� T6 C -r4l eff e u�- C,,("me- AS -TLe l S n.t-c r'02 JA,, y 'tom aeL�w�1 4S S s� Town of Barnstable P#J 0 ��J Department of Health,Safety,and Environmental Services Public Health Division Date , • �� G� 367 Main Street,Hyannis MA 02601 e,►RNSTABMSs. X/P 4 V rFoturA Date Scheduled /V`�l'/A�/Time Fee Pd. «/..✓✓/ Soil Suitability Assessment for'Sewage Disposal Performed By: /��}l�(�(riC S. J0 4"is0 J Witnessed By: DO r+"VA /✓,,(0/L4N40/ LOCATION& GENERAL INFORMATION 0 Location Address 15(O \�10/�� ��/y'�� J;�Owner s Name/�j��/\>� D A fL (C/ coi-v I/V J Address CI V�G��J _I/l9 VL Assessor's Map/Parcel: 0a.1 / o f (0 Engineer's Name) OA V f67L. J A 4'VS o -IJ y NEW CONSTRUCTION REPAIR _ Telephone# Land Use /LEI«Enc'rlrf L Slopes(%) Surface Stones /`b d GJ r Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft l Drainage Way ft Property Line 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) o L--F, Q(1./v�vJtQ•y j N � , Parent material(geologic) d Depth to Bedrock Depth to Groundwater: Standing Water in Hole: 0"I 0 8S Weeping from Pit Face Estimated Seasonal High Groundwater NO7—_.0 1?1 1 D+ TEIIN14't'tON; O A$I; Method Used: • Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#._ •Reading Date:.____--_ Index Well level _ Adj.factor- Adj.Groundwater Level XX pER+C.O .ATION TEST irate .;Io ? .Trine: z.4. .. Observation _ Hole# f Time at 9" T Depth of Perc 4 '6 �I _ �_ " Time at 6" Start Pre-soak Time @ l� rd: Time(9"-6") End Pre-soak :s� Rate Min./Inch Z;L&P7 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant BEEP OBSERVATION HOLE LOG Hole 1 ........... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface-(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° Gravel 7= 9 4 �vV 5 J to YAX18 ,,��r-�83 ed� y6 A 39 i3aV Cl /►1E'%�. rAWo 2-,rY;4; Na%oBj ./ 6:1-4V✓?"L DEEP OBSERVATION HOLE LOG Hale#; Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistenc °°Gravel r k ;DEEP ORSERVATION HOLE LOIG Hole All >; Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel 1 ' 1 , DEEP OBSERVATION HOLE LQ;G HOie.# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsel6) Mottling (Structure,Stones,Boulderes. nsistenc %Gravel) Flood Insurance Rate Mao: r > Above 500 year flood boundary No_ Yes - Within 500 year boundary No Yes t l Within 100 year flood boundary.No /� Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �S If not,what is the depth of naturally occurring pervious material? Certification I certify that on II (date)I have passed the soil evaluator examination approved by the - Y Department of Environmental Prote tion and that the above analysis was performed by me consistent will[' the required training, expertise and a erience escribed-in 310 CMR 15.017. Q`� Signature Date, I R —PLAN 01"' 5CPTI S C^L E' ; (''. / O' TEST PIT DATA 1500 GALLON SEPTIC TANK MODEL TK-15WISHEA CONCRETE) (OR EQUIVALENT "'-- Performed By: Daniel B. Johnson FINISHED GRADE Witnessed B .. j _ _ Donna Marandi ; ' Y• ,. 24"DIA 24"DIA. 90(►4!N) 24"DIA 99�q Date: August 30, 2000 3• 3 H-10 1 T/z l / Fxltr,N� TP-1 (EL. = 99.7) 6" 61, 4"SCH 40 _4 10' FLOW LINE 14" G�4- rEL LHA-,BE2i -�r _ j --- G" - 7" A, 10YR4/3 Sandy loam 4"SCH 40 ItA ,•�� (L.S M0 rJCL 33�� - `h--__- I QU D LEVEL 1 4' -_ _ 7" - 34" Bw, 10YR5/$ Sandy loam 4"SC401EE u I L REPT1�TANK TOMEE */A� F 34" -132" C1 , ,2. 5Y7/3 Medium sand EQU RfMENTS OF Civtk-g�c LEAC��ut� : �I G tl ►"w Y� At E No Observed ESHWT GAS BAFFLE 310 CMR 15.226 FOR 4"SCH 40 WATER TIGHTNESS, L S '+'Eo1 TEE ETC. RFF '-r� No Observed Groundwater ';; � _.__._ �, or �EML PERCOLATION PEST DATA r 6" IMIN I © �'•a- - MECHANICALLY t"Dt 71 '` ' CEJsP ell /~c, i '-•-'. 1"4 9tcn`f� t g I - � a U �' COMPACTED Date: August 30 2000 STABLE LEVEL BASE CRUSHED STONE it - y9/ 4 I Soil Class: Class I (0. 74 G/SF) SEPTIC TANK DIMENSIONS 10' b'L X 5' I3"W X 5VH a 1 — — _ - y9 Perc Rate: < 2 MPI (TP-1 ) ! DISTRIBUTION BOX 1 - Q -Ac f Depth of Perc Test: 49" 62' Soo SEP r,` Lv / _—. _ - - ------ ------ - - . _• -- - 10 H• ft. r.�,�,� ;' � REMOVABLE COVER t -� / S=, ��' f� SCHEDULE OF ELEVATIONS 4"SCH 40 OUTLET LATERALS TOP y� totic . SrofP C�� C SPq �'.ti,) 9dP.4 t REQUIREMENTS SHALL MINIMUM THEVLFORA Inv. Out Foundation (existing #1) 97 . 1 ' TWO ' 15.232(WATERTIGHTNESS, FEET AND CONNECTED 10 i Inv. Out Foundation (existing #2) 97 . 4 CONSTRUCTION,ETC). 2_ O EACH DISTRIBUTION LINE C Inv. In Septic Tank 96. 50 - WITH SOLID SCH 40 PVC PIPE NO OF OUTLETS. 2 4"SCH 40 6" Inv. Out Septic Tana 96. %S ; _ _....__._.._. Inv. In Distribution Box 96. 00 0 ° 6"(MINI o G `— MECHANICALLY CRUSHED iu Inv. Out Distribution Box 95. b3 .1 a °. _ _ o � � STONE V-3/4"DIA) £x:ST,N � � Inv. Begin of Cultec Chambers 95. 8061 � S f A9LE LEVEL BASE _ Bottom of Cultec Chambers 93• RO o�'J / Bottom of: TP-1 (No Obs. GW/ESHWT) 88. 7 a J J Ls�ND 7-f= c 7 �^ Existing Contour - - - 98 - - - 4" SCREENED VENT , Proposed Contour 98 1 Test hit 3' MINIMUM 4" LOAM Finished Floor Elevation F'FE 9 MIN. COMPACTED SAND FILL ; Basement Floor Fle�v<at i�)n END SECTION CU TEC FILTER FABRIC REQUIRED QU ED 3 f Water. Lino _._.._.. W--r---- + BACK FILL' WITH SAND •• _ -__.__.._.___ ______._._ _ I 24 SPLASH DEFLECTION REQUIRED - f �s CALCULATIONS UNDER INLET w 26" 26" i1 5 Bedrooms (Existing) To g E 4,+iG .•;I •.: .i 1G GPD/Bedroom X 5 Bedrooms = 55G GAD aw G��Sttm(r I CHAMBERS ARE TO BE LAID FVFt t I Percolation Rate - < 2 MPI (TP-1 ) soil, GA2 J J Fn j( Soil Class: Class 1 (0. 74 G/SF) i' 11 PROPOSED LEACHING AMA: CULTEC CHAMBER MODEL 330 Cultec Chambers : 49' L x I i' W x 2' H 6 CHAMBERS REQUIRED Side Area: 240 SF X 0. 74 G/SF == 177 . 6 GPD r Bottom Area: 539 SF X 0. 74 G/SF 398 . 9 GPD ;, Total Leaching Capacity: 576. 5 GPD W t SANTUIT ♦♦ � MARSTONt Y' NOTE: LAY—UP LENGTH ♦`�� G 6.26 /UNIT zq ?� �3 4* 1 %°� MILLS • IAnI i P1ar1LF' !roll i'vit"rNLrIR Z1EMLS �,v PON[;II .� �` ��b Sit. v �tA �� CN �8 �• 0� f t C /J1144)e4 f l_9r ') , �G •r 0 Q v� of G► �'' ? CSCwoo t �`✓.��� __w__-.-- -._ L h� E N •' sII I r ^ ro C+ � NOTES IIAMPE L�- ---a- ,% -- '� �,4-- I* • ' y 1 . A11 construction r..4.f;hods shall conform to the Title V ( 310 '() �D/� ----- ---_• t� jCh i 1 MIKE'S 4 i ;;►' tw Z SERVICE STATION � ,� I ; 1 at CMR 15) and the Barnstable Board of Health Regulations . ------- -__ i , <.>r • 2 . There are no known private or public wells within 100 feet t' �o =04 :J IJV > -1 oJ,Ci� t,Ilsr�n of ? t'" '') of the proposed leaching area. n� 01 'POND 28 C RIMER MIL} �p �6�` F yK I T.. �•<< ,^�flt► S ORBS � ` �� � 3 . Existingcesspools to be pumped and removed -• �•'-`'+'�^Z �.�° sn�ps f9 E � 1 I installn the new septic pr_aPk• prior to gt 4 . No changes are to be mane in the fiE� 1(9 without trlE? ��� ,r ,il I •Z'I CIA. IZ iJE(� /o pFs • v i� z 02` do��' J� �ri Cq s fie.• P i g - V CDUE'2 70 y • a 4, "'1� rl p" e t t•• Te 1 siAwr,t Ro r o ;" , . 9� _ O w , r tc c� .• of the Board of Health and t.h4:. design i rr car. • 6� G! �- IS S � T L M-• L la •� c c�S`cO'2. I st .� ' �• `> . Propt)sod Ieachiriq f ieId Is rio (i �i�grl. .i I .: t tl..; W1 t 1t 9a I W tireA••rl riff) i O 1 Jt � rowtN� •.� v �� ' �,J o �' .r �� •• a •' ( �:. t,i �� . I> t H 40 1 I r REPAIR : ff,,+T �v ?�o r a4•y oN �� ���I� 00 j S oyl i snr+�50M's nuc RO __oo A� �hwi J'�r•- f4 P`! R' I L Inc ry disposal . '�,GplllKlR�yY `� •— ._....._ - ..."_.'___—,<_Z , �i! '� 1. �.q . S . .. ;.v 5. hb . �' ,R�o+- {r� ��r�y` „ � �` „T� t, . (:or)Y r, -tot.. to notity Dig Safe 71 hours prior'_ to 6,a ; CO 4t:-ruction. (800) 344-7233, I LopC-r�ty 1inr; Intormatiot, taken Ir.om Flan of Land in i -► WIrristable (S�antult ) , MA, prepared key Bearse & Kellogta, D,.Itud Octobcyr 0, 194R , Referenco Plan book 85, Page 1'/ . I �4 -_ r- - -___ L_ __ �; . Remove any leach.ate impacted soil below t:he cesspools that _ 4) is within the proposed le�achir:g Ind replace with Title V tt j fill [Reference 310 CMR 1-5.255 for specifi-cations of fill (sand) ) . The total amount of fill required is to be 7 determined in the field. SEPrro T'•t/vK � , TE C CNA/''BE�•S (6 CNAM6Eh5, eoeeL 330) ovEf�RLL VACifrAlir : 9� L 71 I i W SUBSURFACE SEWAGE DISPOSAL SYSTEM �,. 1560 NENTOWN ROAD mmSTONS MILLS LL -Flt e vF SEPri c S/STD 1 _y�, a _ -_ .-- •GALE: APPROVED BY DRAWN BY w SCACE : AS SHow" `r, J ' GATE: 10/13/00 Denial s Johnson .B. Johnsosl r Rdger Tobey (300) 429-6979 war; 1540 Newtown Road, MArtsons Kills, UK 02649 W V a i z .. ___ b , 9 zr t2IC DESIAt, IIiC. (50•) 420-1904 DRAWING NUMBER O t A-� �+l^ G r.�0 a f 6 `90 Of So 046 9 i"•!01 or7 a �;i] pt.9C 1 .� i i I / Hr: 63 Captain &ldena LEA., Ostervilla, 1G1 02655 J-436 FiIC FL /4 N of 5cp 7-1 S c A LC ; f''. / a' TEST PIT DATA In AP ff 1500 GALLON SEPTIC TANK •- p� y p,q x c t C • p r �, i MODEL: TK•1500'(SHEA CONCRETE) (OR EQUIVALENT) ��.v, Performed By: Daniel B. Johnson _ FINISHED GRADE 5 Witnessed By: Donna Marandi - - TO di oT.h n vEcy ! - '� ., [Fn o� j 24"DIA 24"DIA gWIN1 24"DIA 1 99�q Date: August 30, 2000 1 31 3, H-10 ELT ` - CF:SgJ�`6 TP-1 (EL. = 99.7) 7 - _ 4"SCH 40 G LJ4- 1'E C C 04A,n6 C/2 j 3 4 i ~�_ �� 0" - 7" A, 10YR4/3 Sandy loam I 4"SCH 40 10 FLOW LINE 14" `t` 7" - 34" Bw, 10YR5/8 Sandy loam I 4"SCH40TEE PTIC TANK TO MEET Lr+AM(; �Lj MOr�CC33�� 4' r --� -- 39" -132" Cl , 2 . 5Y7/3 Medium sand 4'LIQUID LEVEL REQUIREMENTS OF GAS BAFFLE 310CMR15.226FOR �KUri�•�- Ff,v 1 No Observed ESHWT L.,jEk-ALL LEALM/N� �{f C 1 f Y�r' IA'N ~~_`� CE I 4"SCH Oil WATER TIGHTNESS, J41' i 4 r s�E°f Erc No Observed Groundwater TEE ETC. REF J �' PocT ati PERCOLATION TEST DATA IN MECHANICALLY O COMPACTED �70 �' � (M .) O �_�-__.___ I I G. STABLE LEVELOASE -' CRUSHED STONE q;L,�4� Date. August 30, ?_000 (-3/4't)IA. J BENT Soil Class : Class I (0. 74 G/SF) SEPTIC TANK DIMENSIONS IV 6"L X 5' 8"W X S'N"H � - xo Perc Rate: < OtSTRIBUTION BOX 1 _ -- �------------ i / Sep'. c�u,�/ Depth t . 94" 62" O n��9 X.•' `A % ------- - _ - o f Perc Test : _ 4 y r,,NK H 1 f p G fl. SCHEDULE OF ELEVATIONS REMOVABLE COVER 4"SCH 40 OUTLET LATERALS , L) =f' Gf CoNI .o ,o"ETC J' L s �� p ! DISTRIBUTION BOX TO MEET SHALL BE SET LEVEL FOR A TV � t. SPq � i Inv. Out Foundation (existing #1 ) 97 . 1 REQUIREMENTS OF310CMR MINIMUM OF THE FIRST TWO , I 15.232(WATERTIGHTNESS FEET AND CONNECTED TO ' Inv. Out Foundation (existing #2) 97 . 4 CONSTRUCTION,ETC). 2"0 EACH DISTRIBUTION LINE S I Inv. In Septic Tank 96. 50 VTH SOLID SCH40 PVC PIPE - Inv. Out SP^,tir T r.y 2M 4"SCH 6" r' 9�rs r Inv. In Distribution Box 96. 00 NO OFOUTLETS 2 _- O a 61. ' (MIN) o o MECWiWICALLYCRUSHED Inv. Out Distribution Box 95. 83 0 0 0 o STONE (<-3/4"DIA.I eA1 , Inv. Begin of Cultec Chambers 95. 80 STABLE LEVEL BASE sT�^'b- Hu Bottom of Cultec Chambers 93. 80 Bottom of TP-1 (No Obs. GW/ESHWT) 88 . 7 LEGEND Existing Contour - - - 98 - - - 4" SCREENED VENT _ Proposed Contour g8 f Test Pit / I 3 MINIMUM „ � 4 LOAM Finished Floor Elevation FFE 9" MIN. COMPACTED SAND FILL Basement Floor Elevat,i an BFE END SECTION CU TEC FILTER FABRIC REQUIRED 3 j W a t e r [:i rip ----- W- --- I BACK FILL' WITH SAND 24 SPLASH DEFLECTION REQUIRED �-- 1 UNDER INLET Jf w CALCULATIONS 26" 26. 5 Bedrooms (Existing) 110 :iPD/Bedroom X 5 bearooms = 550 HE'D aw C1`�STiN(r l I Percolation Rate - < 2 MPI (TP-1 ) su(I. CHAMBERS ARE TO BE LAID LEVEL i ( '1 sa2��tiJ i Soil Class : Class I (0. 74 G/SF) \ PROPOSED LEACHING AREA: CULTEC CHAMBER MODEL 330 Cult1 � SideeAreaa�e?.40 SF, X 0. 74 G/SF'N ].77 . 6 GPD 6 . CHAMBERS REQUIRED Bottom Area: 539 SF X 0. 74 G/SF - 398 . 9 GED - Total Leaching Capacity: 576. 5 GPD i 30.5 241 d 2•t�. 63 9 ' �2 �.,Ec o c`•`' \� c�`L v 3� a �'°' '�%; MARSTON$ NOTE: LAY-UP LENGTH 6.26'/UNIT s N r • e�r.T, co6sy t,C ; h11 Ya: ? .rrr `Yo I Z�M��LS `` � Am i �'loriLF f)k 6'vATNE& DETAILS f� r I to z1t . y1�/� Or GD SEC, P� r ► Z y�/ I r ! Lf• POND ' I f t> 1 ^mac ,lQ�� EUtFL� `r � E��► `c"t+� NOTES IASNPF P LE� I h dApgP OCR !� •O r m ZA - � "'" �"° r a i . All construction methods shall conform to the Title V ( 31 0 <iT --...... q scr+ `?J .� M)kE'S 4 A°• V yl Z o`" ✓ c �? SERVICE srATloN R CMR 15) and the Barnstable Board of Health Regulations . Y ea, 2 Np 'ti s ffF (V�r2IFS) °�: try -> ,�� E h ,� < < • , �t�4 �'� -wi % . There are no known private or public wells within 100 feet ` t to t rat v rooR `_ jjIST/N(r �,e>4DE 3C'^'"r1 of the proposed leaching area. r o - J J o �I Vowo 28 1p rrVlR pIU- R� I.. \ 6« 3 . Existingcesspools to be prior to 1 9 • ^'�L a �*' F v E p pumped and rcmovEd � ,` 1oN, 0 1.y s•_ ``o �1` ��e 0 M ; pomp I installing the new septic tank. �4e;rA. �r1fK ! o�� for �.►, c,,.,, �. a'ou 01 I 4 . No changes are to be made in the field without th(, .ipproval Taw 1 J«� e A. of the Board of Health and the design engirieer . 3 .t TM/N 6 u it `�' `:qk• Iwo , :. e(t4I)e�7•D if, i F!�-a z IA 4• r ! 6� c� I s Proposed leaching field i :, not, designe,i foi- w)` with ( �9JC \ IrtEVA1R _b o+'. <o sue~ t� �� ►� - : �i♦ 9� p ° t� c L 3 T b�l E` di 9 09c3 1 . A T U!T f ` . h 9� u D_BoIR sAnCsc,N's nr � R�� �, �DuE*,° �'�t�' I6'o� I.o � _ ��. Contractor to nit 1 f y D1g Safe '12 hours prior I (� • sI� � ..Nfi TRUOy f.. �, VI n t S r-onstruct:ion . (HOO) 344--723:3. F,�IsrovU 1 . Property line inf()rrrl,7tion t ;Akrrl front Plan of Land in Barnstable (Santu i t ) , MA, prepared by Boarse & Ko l.logq, I j [gated October 6, 1 49f; , kof erg:rwe Plan Bonk W), P ago 1 l . Remove any leachat e impactod soil below the cesspools that is within the proposed leaching and replace with Title V fill (Reference 310 CMR 15. 255 for specifications of fill I oo 5. 8:: �.80 (sand) I . The total arnount of fill required is to be determined in the field. 0 9 C r w I J G / r i T/4.N = C Jc_TE C CNA-UX' (G CIA^�6E�5/ r"OdEc 330) p�EjcALt. (,EAcrrrnrb : 91 t_ x !r vY x l h SUBSURFACE SEWAGE, DISPOSAL SYSTEM f 1560 NEWTO��IIfN ROAD, MARsTONS MILLS 9a pp'� O I oFlt,� of S 15TE^1 �_-- APPROVED BY SCALE: DRAWN BY W SCALE : A3 $ho%4N DATE: 10/13/00 Daniel s Johnson a. Johnson »urea tdger Tobay ( Ot) 420-6919 a ` For: 1560 Newtown Road, Martsons Hills, 101 02646 - L_ r ___f � _ � I d j 09 Prepared DOWSTIC 32PTIC DlSIM, rNC. (508) 420-1904 DRAWING NUMBER 17 p t 00 10 ot.ZO 0><3 u "`? 0�5 I p o Dp 1-.rp' �t7 1 V-AIJ ! by: 63 Captain k1dens Ln., Osterville, ►h 02655 J-636