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1783 SANTUIT-NEWTOWN ROAD - Health
1783 S intuit-Newtown Road Cotuit - - - — - - - — A= 023-065-001 _ _ . TOWN OF BARNSTABLE 010 ® I LOCATION '79SN1"t>iT-)JZwfU ,Jg VI4,LAGE � er i ASSESSOR'S MAP&PXR Cn� INSTALLER'S NAME&PHONE NO. c3y\l s SEPTIC TANK CAPACITY �G� LEACHING FACILITY:(type) Ck LZ fJ' CYC� (size) `-J NO.OF BEDROOMS f� OWNER oar G PERMIT DATE: ° f J COMPLIANCE DATE: I 1 /0 Separation Distance Between the: ^ ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,� y Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) /V Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �I too all t �ds�r ,. r TOWN OF BARNSTABLE L� ON _ br793 /loP�✓_fa�.✓� R� SEWAGE # a000"o2�ty` VII,LIA�E / � ASSESSOR'S MAP LOT��-197# INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACFFY /O .LEACHING FACILFFY: (type) CA --(size) 6; •'�`/,�,? NO.OF BEDROOMS 3 BUILDER OR OWNER e r PERMFFDATE: Y/y-2000 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) _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i gar" �— �� � w S '7ti� PARCELS LOCATION [ WAGE PERMIT NO. V I L L A C E INSTALLER'S NAME d ADDRESS B U I L D E R OR OWNER' DATE PERMIT ISSUED C-41-30leg DATE COMPLIANCE . ISSUED / �� 1 =��� � +SSESSORS PEA? N0: 3 S.- OARCEL [,,0... od No....................... Fxs............................ THE COMMONWEALTH OF MASSACHUSETTS kj"' BOAR® OF HEALTH ........................ . -----------...OF.........................:............. Appliration for Dtspuga1 Works Tonstrnrttnn Vamit .� Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal 'System at: 3 -* 1.7....--------.�..----. "--".4P......Go ------------------------------------= ---------------------------------------•---•----------- Lo 'on- dress or o wn Address -- .......................... .........---------•-••...----•---••--•---•- •--•-•-•--•--•-•--•-•--•------------•--- Installer Address Q Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms-------:73..............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria C, Other fixtures _-------------------- ---------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ �-] Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--__-______---_.----.--_ O Description of Soil................S4`.. __.._ . U ---•----------------------•-----------•-•---------------------------------------•-•---------------....-------------------•--------•---=-------•-----------........................................... __________________________________________________________•-__--_------_____-___._..................___.._.......__.F.._..._ __ U Nature of Repairs or AlteratignAnswer when�pp_Ucable.____. .si.S �-I-_.--� Oe7-f / / // I---------- �41 be Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiTl:t. p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee board of lthSigned----...-Q* /edythe ............... -.-.1..-------•----...-------- Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------_ ....----•-•----------------------------•-----------•-----------------•---------------•-----•----••--------•...............---••-•----...-------------•-----------••••-•-----••---------•----•-....------ Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................... ...................OF......--.--...............--•---...... .................................................. ; Appliratiou for Bhipoii al Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: ---------------------- ------- ----- ~ ...-......_........------....-••••-----------......._.......-----...-•--••--••-----------..-..-•-- LoTon- " dress Q or r No. rn"�.......................o �' ------------------------------------ ---------- G? ..�fJ. 4" �^ Address yj�wne -------------------------------- . Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms_______.._3________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) p-' Other fixtures -----•••••••-••••-••-•••••••-••. - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth...._........... x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water-----------------____--. 444 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--____-_______________- ------------ - Descriptionof Soil Sir 7-----------------------------•----------••••--------------------------------------------------------------------------•-------_----- U ••••••••••-•••-••--••-•••••-•••••••••••-••••••-••---••••-••.............•--•---••-••-•---....•••••••••-•-••-••••••.._....-••--•---••••-•-•••••••--•••--••-••--•••--••••••...••---•--••-•••--•-•-----•-- W •••-•••••-••................•-----••-----••••••••••••-•••• --------••--•---•--••••••••-••••-•••••••---••--- -------- U Nature of Repairs or Alter n —Answer whe _pplicable_____.�_h__3-l�__�_/...... 0?42 v_s�._....�_____�_ . 40 Agreement: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1 i- p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee s ed y the bo rd of 1 lth Signed- -------••---- ------------------••••---••••-••••••••••-•• ............Dat.e--� -_�� Dat ApplicationApproved By-••--•••-•--•••••••••••••••••••-•....-•-•••---------•-••-••••---••--••--••---•----•-•--•-•---•-•- --•-•-•-••-•••-•--•-•-----••••••••-••••- Date Application Disapproved for the following reasons----------------•----••------------------------------------------------------------------------------....•------- --•••-••-•-••--••••••--••----=••-•-•••••...•-•--•••••---•••------•••-•••-...--•--••-----•----------------•••--•••--•••••-•-••••••-•--•-•-•••-•-•-•-••••-------••--•--•-•••-•••••-•------•-••••••---••--- Date PermitNo....................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Turdifiratr of Tomplianr THIS IS TO CERT FY That the I dividt}al Sewage Disposal System constructed ( ) or Repaired ) by............................ ..................................., - C7--•••-•••. ••••••. -...._.._._.......--•---••--••-•• -•----•--......._....-•••----•=-•--•••- Ni ��,,'C�s, Installer k .& /` -i at----------•------------------------•-'------- • �-----.._......+.1--/-------------------•. ........................................t` 1Eiv.-------7-v --- has been installed in accordance with the provisions of MILE _ 5 of The State SanitaryC odej as described in the application for Disposal Works Construction Permit No.___.__�_._ ('___-��______._____ dated_.... �. ��___ _.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILh FUNCTION SATISFACTORY. DATE................... ......S.......................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ` N O._.... ..........�.. �. FEE........................ r Dislimal orkii Tomitrnrt#ion rrmit Permission is hereby granted---------------- v��' ------•---- 'i n ----------....---•.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System � U v 1 at No......................f ' ------- -----------------------.._...••••-•••- Street 1�_IU as shown on the application for Disposal Works Construction Permit No..................... Date . .................................... -------- GIU oard of Health 66 > is DATE............----�•••=-•-.... •••...••••--••••--••••••••••__••'•= . FORM 1255 HOBBS & WARREN. INC., PUBLISHERS No. Z.���— �►a`Z(o Fee Sre2 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for Migozal *p5tem Cou5tructiou Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /' �j/����,E, ,Vc e,,, f Owner's Name,Address an¢Tel.No. 793 e 7 Assessor's Map/Parcel 7` '3 X4-" 7' i_li /?G/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1?19 i3ac` 33 y ,�ls� S'�o�'J'. '/f5 U d F v Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .3 30 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /00O�-, 'ry. 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 been issued this Board of Health. Signed Date Application Approved by `ao Date Application Disapproved for the ollow g reasons Permit No:"----'? "L Date Issued TOWN OF BARNSTABLE LOCATION / 78 3 Ale,.l f9.✓,1 R4 SEWAGE # o�O�O'ola�v VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. S �• An ��� SEPTIC TANK CAPACITY /000!; I. LEACHING FACILITY: (type) e A (size) i NO.OF BEDROOMS 3 BUILDER OR OWNER l�✓�. :-, PERMITDATE: /y 7p4L COMPLIANCE DATE: 1 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) .- Feet Edge of Wetland and Leaching Facility(If any wetlands exist I within 300 feet of leaching facility) Feet Furnished by • , a, r X w Ar x7 09 £#k, fi ud o l ; - No. �L dy0- 2-`oZ�o m Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for &goml *pztem Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �T�3 �w�/9, tJ� fv,f Owner's Name,Address an¢Tel.No. Assessor's Map/Parcel ®a / / tn R� 3 Got ;t .�A '12X- `rd 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J. C, P, //fo Ly,t o /'0. 13N y3 y Mav storr.�//s A0 .28- 7 y5— Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /OOOy 4Y.'s)'.'q Type of S.A.S. Description of Soil r. Nature of Repairs or Alterations(Answer when applicable) i 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 been issued hy this Board of Health. Signed 4 rf 7,, 4L' Date `7'1,3-,,?000 Application Approved by Dater Application Disapproved for the ollo g reasons Permit No: �, n�,E �'_ �.2 Date Issued ------------- ------------------------- THE COMMONWEALTH OF MASSACHUSETTS '4 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired)Upgraded( ) Aban (ned( )by has been constructed in accordance WAo the provisions of Title 5 and the for Disposal System Construction Permit No. �,;x 6 _dated Installer Designer a 1 The issuance of this pel�nit shayl not be construed as a guarantee that the system wI 1 function as designed./ Date Inspector ——————————————————————————————————————— No. .l��r;->- Fee ��— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION"- BARNSTABLE, MASSACHUSETTS xligpoml *pgtem ConMruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 7 a 2 g,,� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by `� +� 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, S��n .C. ��l�iz ,hereby certify that the application for disposal works construction permit signed by me dated ,concerning the property located at 179 ���, fv�✓„ /'��. �07`�,.f meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the or table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 0 B) G.W.Elevation +the MAX.High G.W.Adjustment. _ 319 DIFFERENCE BETWEEN A and B 3.D SIGNED'. DATE: y /3'2©0V [Please Sketch posed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder.cert fr: G L�-1 Ob ell I i R` BIt'S. 25221 P:o 121 0,5454 SAMPLE . To be used as a Guideline NOTICE: The Town of Barnstable ..f�!�tDO7ends that tha��� seek legal advice to prepare a Property worded deed restriction document. Y DEED RESTRICTION ' WHEREAS, /UCr - //CLa 11 ` )`'� of (otvnees name) l 7e 3 5Q n 40 g c.� CO y., /_- MA (address) is the owner of r, 7y'/%! located (address) at Co7� rll MA (hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in MA, Property of et al, duly recorded in Barnstable County Registry Of Deeds inBook Page Or on Land Court Plan Number WHEREAS, Zvic0S7e/as the owner of said lot has (o nees name) agreed with the Town of Barnstable Board of Health to a restriction as to the fl number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining: a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health,as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the,restriction on the number of bedrooms in any house constructed on the lot be put on record witl the Barnstable County Registry of Deeds by recording this document, dtedr Bk 25221 Pg 122 #5454 NOW, THEREFORE, IUG/v ✓K �gtta woes hereby place the (owner's name) following restriction on his above-referenced land in accordance with his agmerttent witb the.T_wn ea4th,whieh'_restrictionzTfaff run with the land and be binding upon all,successors in title: 1. !���3 tf may have constructed (address) upon the lot a house containing no more than bedrooms. /LO n� g "c", agrees that this shall be permanent deed (owners name) restriction affecting located on MA,.and . being shown on the plan recorded in Plan Book' , Paged Or on Land Court Plan For title of see the following deed: Book , Page . Or Land Court Certificate of Title Number Executed as a sealed instrument day of Owner's sig, e Owner's Sig tur Owne s ignatu e COMMONWEALTH OF MASSACHUSETTS .ss 20_ Then personally appeared the above-named known to me to be the person who executed the foregoing instrument and acknowledged the same to be free act and deed, before me, ` Notary . Public My commission expires: (date) BARNSTABLE REGISTRY OF DEEDS decdr a. MapOG 00 , Iz �.. � �"no 1' ,� �jtt,�Zm��Pi+31 rul�ac.a,�3 ty v VY (C� ;{ 6--vr 'v 3 t,0-6k UGC 60 � = C � No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1 Application for �3i!5pogaY *paerrt Cougtructiou Permit Application for a Permit to Construct O Repair( ) Upgrade O Abandon( ) ❑ Complete System ❑Individual Components Location Address or of No. 11"7,P3 U Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / Installer's Name,Address,and Tel.No. SgW �/ �/0/ Designer's Name,Address and Tel.No. /l r 'A go erllr Type of Building: Dwelling No.of Bedrooms Lot Size '70'� sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soilc,P Nature of Repairs or Alterations(Answer when applicable) S"O'e pid in Date last inspected: Agreement: `q 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 Healt Signe �_ Ja Date .0 /v/ Application Approved by Date ' Application Disapproved by: Date for the following reasons s Permit No. / Date Issued i CA J No. � \. Fee THE C_OMMONWEALTH OF MASSACHUSETTS Entered in computer: J P BLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfication for � gpogal *pgtemc Cowaruction Permtti Y'Application fpr a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) -❑Complete System ❑Individual Components Location Address or Lot No. 17,P3 U r Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Innjs-t'alller's Name,Address, S"^ and Tel.No. I �/79 G�2 Designer's Name,Address and Tel.No. Type of Building: { Dwelling No. of Bedrooms Lot Size �y�U2- sq. ft. Garbage;Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) ,-Other Fixtures "Design Flow(min.required) . -7� (n gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title t Size of Septic Tank J € Type of S.A.S. Description of Soilt. 1l' Nature of Repairs or Alterations(Answer when applicable) P1 a ki {Date last inspected: `Agreement:~ Thelndersigned 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 �Q l —lel Application Approved by / Date Application Disapproved by:-u• tl J Date for the`following reaso s PerNo. Date Issued 11161-1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance - a THIS IS TO CERTTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (x) Upgraded ( ) Abandoned )by ~/( S Ca at has een constructe n cc rdance r with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer 1?0,W4 , &e46,476"0g y`� 4c Designer #bedrooms �J Approved design flo "T gpd The issuance of this per,jshall not be construed as a guarantee that the system will n tibn asides gned. f Date Inspector ✓� No: /��7 l THE COMMONWEALTH OF MASSACHUSETTS — PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS =igpogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Aband System located at 7t3 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construc`ti h m st be completed within three years of the date of this e t. Date �/ / Approved by ) ~� r r Town of Barnstable Regulatory Services Thomas F.Geller,Director Public Health Division ago► Thomas Mc,Keaa,Dinctor 200 Main street,.HMO*MA 02601 Fax: 508-790-6304 ofca: 3084W-4644 Deft: 11141 tv Sewage Permit# � is Map/Pared ` 1 &RaismerCeaMUNW11 brig Designer JA t Installer: s _ rrc3, Addrm: rL. !N, crq d st`' w C<A Address: OIS 5 -e /mot ft 0 2 W on S is C1a.� ` was issued a permit to install a septic system at 3 Scx-%: z{ —f� 'R 4 ''14 9dA based on a design drawn by (address) fie4e_T:M C-F,r-e.,e f dated l o sigmer PC- I certify that the septic system referenced above was installed substantially according to the design,which may include minor approved changes such as lateral relocation of ft distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes &motor tlmn 10 lateral relocation of the SAS or any vertical relocation.of any component of*0 septic system)but in accordance with State&Local Regulations. Plarevision�� cartifwd as-built by designer to follow. stripout(if required)was inspected were found satisfactory. PETER T. �.s ) WENTCE : CIVIL Affm lgm'3Signature ( )P NCELUMAU 110 39Vd SMOM 9NId33NI9N3 ET69LLb80S 09:ZT 0TOZ/E0/TT l �0 4WtRbie o B 3�: ,6 l Department of Regulatory Services .jbc H,ea1th Division vale 200 Mam Street,Hyanuss MA 02601 :.. Date SchedWed �2 Time�o_. Fee Pd 1� cJ Soil IVIL Sutab >f�ty Assessment for Sewa` e Dis e�sal g � Performed By b�-- i Wi tnessed By'' A✓!� ,l✓ f LOCATION&GENERAL INFORI�ATLQ�1 Loeagon Address j?83 . C.nfv�`i r= t /Nq , S}-e✓ Own r Add mss Assessor's Map/Earcel �4 ®a i r Engineer's Name NEW CONSTRUCTION; REPAIR, Telephone# Land Use ►1}ti C1 Slopes(96) ✓���'��t Surface Stoney �� Dsstances from Water Bsx1 - M y.�_11 Possible Wet Area�ft' DriAM Water Weq l rz a Drainage way ;7 Property Lm ~/ � . ft e fty Other g ft ST�ETc'IIc(street naive,dimensions of lot,exact locations of test holes 8c perc tests,l to e r • V Z _ B e .0 _ ,p i• Paneat mateaai 1 c v `'°�111 (�°° ) Depth to 13es1rock Depth to Groundwater Standing Water in Hole: N /�— r Weeping from pit RQCe � Estimated Seasonal High Groundwater " f DETERAM NATION FOR SEASONAL HIGH WATER TABI, Method Used: Depth Observed standing in oby.hole: - in, Depth to loll moitles s to Depth to weeping from side of obs hole index Weli# Rsadm to _ )ndex mall s xet. ......:' undwnrar�►diurrttn in Gttl t nt gt ---- . s PERCOLATION TEST Observation Hole# 1 Depth',Of S n Time at 6" �} .. , ( Start Presoak Time(� End Pre=soak UI Rate mifij r Site SustabtlitkAssessment Site Passes] Site Failed Adsiidonal Testing Needed(Y/N) Original: Public HeaithDivlsion Observation Hole Data To Be Completed on;Back - **Ifpereolation test is to be.conducted within 1009.of wetland,you must first notify the.Barnstable Conse>rvation Division .at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC �'� - � . I 4 .. * � :�:1 , �..I I.�� I I� . .I. - . . DEEP I' .. �1` ON.HALE LO�` Hole# Depth trom SoIl.Horizon So►t Teittun Soil Cc►lar So►l Other ,L..i..,*t�,j.'...:,�' .—�...,"""_%��...:...*r���",L r:,.,"�1:�:.1..,,'.I.��.:,�..,�,"j:..��...'IL�1L.7-I,,I:,r,-1'..�1..� ..:a 7-,�?-�-1,1I_�L.,:r,r�,,':L.,r�L..�.''.1,,f.L�I-'_,t,_ Surface(ta.) (t1SDA) (Miu►setl) Mottltog (SUruc4ture,stones,Boulders r _ ;�..,I"-,,A�:�.=��%. eta,, ,. a . b'�-Co 4 .a Ste; l , . 1 4lz_. . I. IjO , :` S lt} =mil I. III IL r. II I. C • , ' # 1 • ,Y�.34 - Pam- :S rzv r�wg �.yI, _ I . . �,I�r..1v-.:1L,,;.7:I:II�.�,"�...1I,,Ir.r,.�.�4��..,,.L1".._-..."�.r-.I'I,%..�:�1,.r:�I,.,.�1,�I.�%I.���-,,'��1.,I-;�—.�r._..,.II.:""`I.�:,I.,�I..-.r L.1:. ay .: ` ' IIEP OI RAfiGN HOLE Y.OG Hole# 2 , I. p frai►► So►I Horizon Soil Texture SoiF Color So►1 Other }= -- - - -77 SDA3 -- =M""'11 ttiing� .(Structure�Stones.Bnuldets _ - - -- —A4o . I. I. 6w-co A �c i s ,-'O/r .. '3 5 to7�SL . -'1.3 M. �Ste. Z` S_ �r't>, '? °7- �`",r` . 4 :: ., .:. .( .. .. a. t - ,aJt.. - _ .. ill . .:.. .. .: . . .. _ ,w::" 4 .., a DEEP OB,8ER �ATION HOLE LOG Hole# _ a Depth fiam Sotl Horizon Soil Texture Soil.Color.. Soil Other . Surface(in) r? (USDA) (Munsel) Mottling (Stn►cture,Stones,Boulders: { . .; ,. . .. . . ' . _ . . . r . -... -- �___ ._:ems.-v. , _:.::. S t,.:r` . z • .. r } DEEP OBSERVATION HOLE LOG , Hoie# it 0 er lyeptlrfrom So►I Horizon. So►l Texture 3o1 1 '0 1 or 1 " So th `"'v ' lVtottlin Structure,Stones.Boulders. . .. Surface(in.).'. (USDA) ..,... . - (Mansell) !; . . . r . . . . { _ • _.. _, . - :: . . . . . .,, - _ ,,,,. . , . ond�Ifistt>�ant:etAte„_g», earfl4odgbour� s a- Yes . Abrive 3(t(t Y �' - .k tf W;fain SQO ear bouadary - No Yes . y Wtthiti l'OO year flood boundary No_,. 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Date. 21 ' U ...d ` fi - .. �. :9 ., :. . .. ..:. .. .. ,.,. - - .: .,.. Q�y�1�I'll(.1P$RCFORM DOC' �-03 Commonwealth of Massachusetts Title .5 Official Inspection Form : � Subsurface Sewage Disposal.System Form-Not.for Voluntary. Assessments 1783 Santuit-Newtown Road Property Address Mark&Nancy Lancaster owner Owner's Name information is Cotuit MA 02635 9/23/2010 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be-altered in any way. Important:When filling out forms A. General Information on the'computer, _+ 1 use only the tab 1. Inspector: I � i key to move your o O cursor-do not Peter T. McEntee PE, SI" o use the return Name of Inspector key. C> Engineering Works, Inc. Company Name p.�► W 12 West Crossfield Road ..9 Company Address 3 Forestdale MA 02a,44 Cityrrown State Zip Codeoo (50.8)477-5313 SI 1480 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: { ❑ Passes ❑ Conditionally Passes Fails ❑ Needs Further Evaluation by the Local Approving Authority 14 9/23/2010 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. TS Insp Report-1763 Santuit-Newtown Road.,Mashpee.doc.12107 _ Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspetion Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1783.Santuit-Newtown Road Property Address Mark& Nancy Lancaster Owner Owner's Name information is required for every. Cotuit MA 02635 9/23/2010 page. CityrTown 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 completionof 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: F ❑ Observation of sewage backup or break out or high static water level in the distribution.box due y 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 T5 Insp Report-1783 Santuit-Newtawn Road.,Mashpee.doc•12/07 Title 5 Official iInspection Form:Subsurface Sewage Disposal System-Page of 15 r Commonwealth of Massachusetts Title 5 Official Inspec#ion Form Subsurface Sewage DisposallSystem Form-Not for Voluntary Assessments 1783 Santuit-Newtown Road Property Address Mark& Nancy Lancaster Owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ 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 ti ND Explain: 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 El 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, 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. T51nsp Report-1783 Santuit-Newtown Road.,Mashpee.doc•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of-Massachusetts Title 5 Official Inspection Form Assessments Subsurface Sewage Disposal System Form-:Notfor Voluntary. . - 1783 Santuit—Newtown Road Property Address Mark& Nancy Lancaster Owner Owner's Name information is Cotuit MA 02635 9/23/2010 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): The system has aseptic 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each.of the following for all inspections: Yes No ® ❑ Backup of Sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool • ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less ❑ ® than day flow • ® Required pumping more than 4 times in the last year NOT due to clogged or El obstructed pipe(s). Number of times pumped: r ❑ ® 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. T5 Insp Report-1783 Santuit-Newtown Road.,Mashpee.doc•12/07 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 4 pf 15 Commonwealth of Massachusetts Tithe 5 Official Ins:pec i,on Form Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments 1783 Santuit-Newtown Road Property Address Mark& Nancy Lancaster owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 greaterthan 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.6..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 150000 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. T5 Insp Report-1783 Santuit-Newtown Road.,Mashpee.doc•12/07 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official 11nspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 1783 Santuit Newtown Road Property Address Mark& Nancy Lancaster owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the_following: Yes No ❑ " ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ -Has the system received normal*flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not . available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the'SAS, located on site? ❑ ® Were the septic tank manholes uncovered, opened,and the interior of the.tank inspected for the condition of the baffles or tees,.material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? • ❑ Was the facility.owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: • ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] T5 Insp Report-1763 Santuit-Newtown Road.,Mashpee.doc•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts -� Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 1783:9antuit-:Newtown Road Property Address Mark&Nancy Lancaster' Owner Owner's Name - information is Cotuit MA 02635 9/23/2010 required for every page. Cityrrown state Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of'bedrooms(design): h 3 .Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms)., 330- Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection.required] ❑ Yes .0 No Laundry system inspected? ❑ .Yes ❑ No Seasonal use? ❑ Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): n/a . t Sump pump? ❑ Yes. 0 No Last date of occupancy: 7present a Date Commercial/industrial Flow Conditions: Type of Establishment: 7 n/a 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 n Non-sanitary waste discharged to the Title 5 system? ❑ Yes .❑' ,No x Water meter readings, if available: Last date of occupancy/use:; Date Other(describe): TS Insp Report-1783 Santuit-Newtown Road.,Mashpee.doc-12/07 Title 5 Official Inspection form:Subsurface Sewage.Disposal.System-Page 7 of 15 Commonwealth of Massachusetts Title 5Offici=al Inspection Form Subsurface Sewage-Disposal System Form Not1lor Voluntary.Assessments 1783 Santuit-Newtown Road Property Address Mark& Nancy Lancaster owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: i Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined?'y Reason for pumping: Type.of System: Septic tank, distribution box, soil absorption system Single cesspool ❑ Overflow cesspool El Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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: 39 years(1971)for Septic Tank and 10 years for d-box and SAS(4/2000) Were sewage odors detected when arriving at the site? Z Yes ❑ No T51nsp Report-1783 Santuit-Newtown Road.,Mashpee.doc•12/07 Title 5 Official Inspection Form:Subsurface Sewage Dis posal sposal System•Page 8 of 15 , Commonwealth of Massachusetts Title 5 Official Inspec#ion For Subsurface Sewage Disposal System;Form-Not for Voluntary Assessments 1783 Santuit-Newtown Road Property Address Mark& Nancy Lancaster Owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1-3+/- Depth below grade: feet ,f Material of construction: ❑ cast iron 0 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: 30"feet Material of construction: Z 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: 8.5'x 5.2'x 5.8'(AS-BUILT CARD) Sludge depth: 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 How were dimensions determined? T5 Insp Report-1783 Santuit-Newtown Road.,Mashpee.doc•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official ;Ins=pection Form Subsurface Sewage Disposal:System Form--Not for Voluntary Assessments 1783 Santuit-Newtown Road Property-Address Mark&Nancy Lancaster Owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Measurements not required since a new`1500 gallon septic tank will be installed as,part of the septic upgrade.' Grease Trap(locate on site plan): Depth below grade: n/a feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ ethylene„pol, eth ,y y pother(explain):. Dimensions: Scum thickness - 4, 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.): 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- y ❑other(explain): YT5 Insp Report-1783 Santuit-Newtown Road.,Mashpee.doc•12/07 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title- 5- Official Inspection Form Subsurface Sewage Disposal_System Form-Not for Voluntary Assessments 1783.Santuit-Newtown Road Property Address Mark&Nancy Lancaster Owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. Cityrrown State Zip Code Date of Inspection D. System information (cont.) Tight or Holding Tank(cunt.) 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 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.): One inlet and 1 outlet. Water level OK at time of inspection, however, inner circumference of inlet pipe very stained and 114"of solids were resting on top of the inlet and outlet pipes indicating that the SAS has surcharged with effluent on several occassions due to SAS hydraulic failure. Pump Chamber(locate on site plan): _ Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No T5 Insp Report-1783 Samuit-Newtown Road.,Mashpee.doc•12107 Title 5 Official Inspection.Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title, 5 Offici-al Ins 1 ection Form P Subsuirface;Sewage.Disposal System Form-Notfor Voluntary Assessments, 1783 Santuit-Newtown Road Property Address Mark& Nancy Lancaster Owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of.pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: r Type: El leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: ❑ leaching fields number, dimensions: 1 (6O'x4'x2') ❑ 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.): Hydraulic failure due to evidenece of surcharging back into d-box T5 lnsp Report-1703 Santuit-Newtown Road.,Mashpee.doc•12/07 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Ins� .n Form Subsurface Sewage:Disposal System Form-Not for Voluntary Assessments 178.3 Santuit--Newtown:Road Property.Address Mark&Nancy Lancaster Owner Owner's Name information is required for every Cotuit MA 02635 9/23/2010 page. Cityrrown State Zip Code Date of'Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration. n/a 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 E]. No Comments(note condition of soil, signs of hydraulic failure, level.of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: n/a Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): T5 Insp Report-1763 Santuit-Newtown Road.,Mashpee.doc.12107 Title 5 Official Inspectlon Form Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of.Massachusetts 1 OEM Title 5 Officinal tn -pection Form Subsurface,Sewage Disposal System Form-Not for Voluntary Assessments 1783 Santuit-Newtown Road Property Address Mark&Nancy Lancaster Owner Owner's Name information is required for every Cotuit MA 02635 9123/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. 11733 TOF=100.91 (Block) (Assumed) ID Porch •d- L �95 Barn ?• ANI ►�i CY LEACHING TRENCH D—BOX s T5 Insp Report-1783 Santuit-Newtown'Road.,Mashpee.doc•12/07 Title 5 Official Inspection Form:Subsurface Sewage:Disposal system•Page 14 of 15 Commonwealth of Massachusetts ` L Tit lte,5 Official inspection Form Subsurface Sewage.Disposal System;Form ,Not for Voluntary Assessments 1783 Santuit-Newtown Road Property-Address Mark& Nancy Lancaster Owner Owner's Name information is required-for every Cotuit MA 02635 9123/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site:Exam: Check Slape `, _ 1 Surface water 4 `,Check cellar } Shallow wells _Estimated depth to 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: pate Observed site(abutting:property/observation hole within 150 feet of SAS) El 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: Town GI$,database show groundwater to be> 12'below grade TS Insp Report-1783 Santuit-Newtown Road.,Mashpee.doc•12/07 Title 5 Official Inspection Form:'Subsurface e.Disposal System.-, e Sewage posal .page 15 of 15 jl LEGEND N o — 20 ——EXISTING CONTOUR x 20,12 EXISTING SPOT GRADE °��P Ro �Le PROPOSED CONTOUR LDcu ¢46 —W— EXISTING WATER SERVICE o� U) °° �'o . pC 9S --0.H.W.— OVERHEAD WIRES01 a (6 N TEST PIT `° 1�23 O BENCHMARK j pee SA/V;rU r /-1 LOCUS MAP bnj // �C �/1f/ I NOT TO SCALE \ 101 Edge �j//�I//�O� " ' ' 1 of DAD1 k i pvement 1003°1 t _ 102.38 0 q-�8 1 gg I T 8. Big, k 99 5� tone Drive 10 5 .' k S 1'05" E- / 124.67' 24,702f S.F. ' Ma '�jo ko ,' Parcel 657 '0' o0 oo ? , �`�11 gIN �/ CBS c>, I 103 0' ZI 3 61.5 EXISTING ( I _ U_ Stockade Fence_ cn o 1 16' ' HOUSE(#1783) W 1, 2 .6 TOF=100.80/ I Apron 1 (Block)/ PROPOSED- r7 i 10 5 DECK I 9g A9 4' I IN-GROUND I I v 1 k PROPOSED j I I t �� S.WLMMING- QOL_ ADDI ON.. „�y 50.1' l �.g � 1= I.. _ Deck °i �I PFxis t. Z 16.2'I orch d , Barn 'Chatn`I;n`k fence��1 0 1 / k 1 EXISTING PORCH N ,/� 1 °� NO \T-Q BE REMOVED o20Q �' 98 SEPTIC 3 55' EXISTINS_._A. TRENCH �'-�__ I EXIS77NG S.A.S. �� �� ���'� \ 74- TO BE ABANDONED EXISTING SEPTIC TAAIK BEEC��`. 3 `t a TO BE REMOVED �� 2F .... �\:k TP-2 1� o �♦ It 15-7 :ram` L..'< O 0 4 --PRO.S_A.S- I 14' 10 _ Sandbox k 25'-=-�- C\A 4 100 - 00 Shed : . .............. BEECH 95 \V3 , 10�' 145.53 102,65 N 17°15'00" W 104 k 0 of Mgss Benchmark Set yr Top of Conc. Bound o PETER T. G� EL.=102.65 Assumed McENTEE CIVIL No. 35109 PROPOSED SEPTIC SYSTEM UPGRADE PLAN A F STE��� F 1783 SANTUIT—NEWTOWN ROAD, COTUIT, MA to Prepared for: Mark Lancaster, 1783 Santuit-Newtown Rd, Cotuit, MA 02635 Engineering by: Surveyinging by: SCALE DRAWN JOB. NO. ZONING CLASSIFICATION: ZONE RF FLOOD PLAIN DATA Engineering Works,Inc WARNER SURVEYING 1"=20' P.T.M. 206-10.1 SETBACKS: FRONT YARD=30' NON HAZARD 12 West Crossfield Road 20 Long Road SIDE/REAR YARD=15' Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. MAXIMUM BUILDING HEIGHT = 30' WIND EXPOSURE CATAGORY: Exposure B (508) 477-5313 (508) 432-8309 9/24/10 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:96.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET INSTALL WATERTIGHT RISER & PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" AND SET TO 6" OF FINISH GRADE. OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F. PROVIDE ACCESS TO GRADE OVER OUTLET COVER COVER SET TO 6" OF GRADE EXISTING F.G. EL.=100.1 t F.G. EL: 99.8t F.G. EL: 99.8(MAX.) /MINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 27' L _ 45' L = 5,(�) ® S=1% (MIN.) p S=1% (MIN.) S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 6" 3 L 6a14" 6 aaam aBBaINV.=97.0048" LIQUID aaaBaaa LEVEL GAS 4' 5.2' 4' CONNECT TO INV.=96.307oonon,zkrr, --- D-BOV.=96.13 EXIST. SEWER INV.=96.75 EFFECTIVE WIDTH = 13.2' INV.=97.50 iNV.=96.00 PROPOSED SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=96.8f BREAKOUT ELEV.=96.50 NOTES: INV. ELEV.=96.00 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE z a ease eases eases ease aaaBa INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=94.00 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON 4' 1 . 2 X 8.5'=17.0' 1 . 4' A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 25.0' BASE, AS SPECIFIED IN 310 CMR 15.221(2). T.P. EXCAVATION OR G.W. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION 4) CONTRACTOR SHALL INSPECT EFFLUENT FILTER ON NO GROUNDWATER, EL.=87.5 - OUTLET TEE AND REPLACE IF NECESSARY. 3/4" TO 1-1/2" DOUBLE WASHED STONE SEPTIC SYSTEM PROFILE 3o UBLE WASHED STONE2" (OR APPROVED FILTER FABRIC) N.T.S. GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL rUE3 ®EA® ® ®®®® 33" BOARD OF HEALTH AND THE DESIGN ENGINEER. �t Lu ®®® ® ®®®®2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 04 Z ®®® ® ®®® OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 102" DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 4" KNOCKOUT ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED. 20" DIA. COVER 6. THE DESIGN ENGINEER IS .NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 4" KNOCKOUT / 4" KNOCKOUT ' HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 62' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 4" KNOCKOUT AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 500 GALLON CAPACITY, H-10 LOADING THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CHAMBERS CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE'SOILS ' IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). SOIL LOG 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY HEALTH DEPARTMENT PRIOR TO SACKFILL. DATE: SEPTEMBER 21, 2010 (REF#13,086) 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND SOIL EVALUATOR: PETER McENTEE PE IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. WITNESS: DAVID STANTON R.S. HEALTH AGENT ELEV. TP- 1 DEPTH ELEv. TP-2 DEPTH 100.0 A 0" 99.0 A O„ SANDY LOAM SANDY LOAM e DESIGN CRITERIA 10YR 4/2 6" 98.5 B 10YR 4/2 6„ - 99.5 SANDY LOAM SANDY LOAM NUMBER OF BEDROOMS: 3 BEDROOMS 1OYR 5/4 1OYR 5/4. 97.5 30" 96.3 32" SOIL TEXTURAL CLASS: CLASS I Cl 40" Cl DESIGN PERCOLATION RATE: <2 MIN/IN 52R� M . SAND M-C SAND 2.5 5Y 6/4 DAILY FLOW: 330 G.P.D. 2.5Y 6/4 20% GRAVEL DESIGN FLOW: 330 G.P.D. 20% GRAVEL GARBAGE GRINDER: NO PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY 88.5 C2 138" 87.5 138" LEACHING AREA REQUIRED: (330) = 445.9 S.F. PERC RATE <2 MIN/IN. ("C" HORIZON) NO GROUNDWATER ENCOUNTERED .74 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 783 SANTUIT-NEWTOWN ROAD, COTUIT, MA SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 152.8 S.F. BOTTOM AREA: 13.2' x 25.0' = 330.0 S.F. Prepared for: Mark Lancaster, 1783 Santuit-Newtown Rd, Cotuit, MA 02635 TOTAL AREA:..............................................................482.8 S.F. Engineering by: SCALE DRAWN JOB. NO. NTS P.T.M. 206-10.1 Engineering Works, Inc. DESIGN FLOW PROVIDED: 0.74(482.8) = 357.3 G.P.D. 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 9/24/10 P.T.M. 2 Of 2 ` P R up 1- z • • :p ti 110 MPH EXPOSURE"B"WIND ZONE: The Proposed Architectural Drawings are to be in Compliance with the Building Code-Referenced ANSI/AF& PA 2001 Wood Frame Construction ( �• O V V Manual (WFCM)for 1&2 Family Dwellings. O J o REFER TO WFCM 110 MPH CIS EXPOSURE B WIND ZONE GUIDE NEW WINDOW .� 7. GENERAL NOTES: CL A. 1. Before final Drawings and Specifications are issued for LU 0 construction,they shall be submitted to all governing building _ - C agencies to insure their compliance with all applicable local and -- S national codes. if code discrepancies in Drawings and/or co Specifications appear,the Designer shall be notified of such - P pp 9 � N discrepancies in writing by Builder or building official,and allowed to alter Drawings and Specifications so as to comply with governing code§before construction begins: FLU 2. Upon written receipt of approval from the governing official, approved final Drawings and Specifications shall be submitted to the Builder by the Designer. PRIVACY FENCE 3. If code discrepancies are discovered during the construction process,Designer shall be notified and allowed ample time to C remedy said discrepancies. (0) 4. All work performed shall comply with all applicable local,state t Q and national building codes,ordinances and regulations,and J all other authorities having jurisdiction. Following is a partial cc a list of applicable codes in force: I W ('3 a. Massachusetts State Building Code,780CMR,7th edition, ILLU 2 a H cc�r) = •— B. All contractors,subcontractors,suppliers,and fabricators,shall be J c� Co responsible for the content of Drawings and Specifications and for U Z X 0 u7 the supply and design of appropriate materials and work ] O U performance: Q m J V C. All manufactured articles,materials and equipment shall be applied, F-- 0 Q installed,erected,used,cleaned and conditioned in strict LL W 0- F— accordance with manufacturers recommendations. p Z Cl) D. All alternates are at the option of the Builder and shall beat the 0 Builder's request,constructed in addition to or in lieu of the W typical construction,as indicated on Drawings. PROPOSED REAR>t ELEVATION � CC Q E. SPB Design LLC Is not responsible for any plan discrepancies. -- SO Builder&Homeowner to review plans before start of construction. TH U 4 . . - LI.UTIT O IN LLILy J /yam Z. D PROPOSED RIGHT ELEVATION Z M 0 CO 0 SCALE 1/4"=V-0" DATE 7 26-10 + ; DRAWN BY SPB IE Ll Jfl ` L= zL REVISIONS: }}} PROPOSED LEFT ELEVATION DRAWING NUMBER Al V U O c U = EXISTING WALLS PROPOSED WALLS -cl) 12'-0" 19-6" 16'-0" �y 3'-6" 12'-6" 3'-6" ol Q PRIVACY FENCE 2442 A61 AWN 2442 co Jc UPi ; N � w , , V , -----------=----------------------- ------------ -------- DN -- - ------- ---- 4 TO ¢ °° POOL > cc NEW MASTER 0. N x V BEDROOM Q z -��, 0 C33 T . z cc EXISTING w w 0 o Dw --�, DECK — `o . ��j LZ r T Aco o o. O C3 = X ~ °0 Z ON T-9" 3'-2" i 8'-7" �o i � o � � � m � NEW KITCHEN a o o Q °° LL od DN 6'-0" i 6'-0" i i ; D Z � ... N w - - , •--- , _ /� Q REMOVE g� ; NEW DECK \,� LINEN 3'-2" i WINDOW REF b i ---- I EXISTING BALL I� 3 6 " BATH ' � NEW 4'�u2" , " EXIST 2-10 1/2 U , BATH �' MUDROoMl 48"V� , i , i co DN NEW FLUSH BEAM�OVc— 16'-0" lei hi 1 17'-0" .. NEW EXISTING DINING w cr- LIVING R0011�1 ito - z O o w W w -"' UP Z w 0 _ O Q Q � r U) 0 Z M A ------- Q � � O T PROPOSED FIRST FLOOR PLAN SCALE 1/4"=1'-0" DATE 7-26-10 DRAWN BY SPB Zoo"/ REVISIONS: DRAWING NUMBER } U O U O c� ANCHOR BOLTS TO BE 5/8"AT 39"MAX.SPACING. BOLT EMBEDMENT TO BE 7"MINIMUM. 0) WASHERS TO BE 3%3%1/4"THICK. Z BOLTS TO BE W-12"FROM END OF PLATES 6"CONCRETE PAD @ ALL 19'-6 16'-0" EXTERIOR STAIR LANDING NOTE:FOUNDATION CONNECTION C' BETWEEN EXISTING&NEW TO HAVE 345 = ( C --------=--------------------------------------------------• REBAR SPACED VERTICALLY r-- v pc 'f-- A. EXTENDING 5"EACH WAY W/HIGH STRENGTH GROUT �. .` L f 1 r-_-----_-•-__ -_.----------- co ---------------- --------- 1 n 1 1 1 8"X7'-10"CONCRETE ----------- ---=----- v 1 1 v i 1 WALL W/20"X10" 1 0 0 i CONT.CONC.FOOTING i ��. ._ a ., pea i ————^———— 1 ——' •———————————————-———-—`4. . ----------- -- "Cj r- ------------------ ----J �- --- — -1— 7 ^�------ 1 rl 1 G 1 --------------------- Q i Ni 8"CONCRETE WALL W/MIN. uai i i i C i 4'-0"BELOW GRADE W/20"X10" wm a ; o CONT.CONC.FOOTING _ i v Z I NEW BASEMENT 1 1 '-----------------------, - r I 1. `------------------------------------r--------- -• U IL 4"CONCRETE SLAB i EXISTING CONC.WALL = LLI cc (� 1 p r-------------------------7----------r------ 1 3,000 PSI @ 28 DAYS 1 1 , ► , ,� W z. M r- g ------- co 3/4"AGGREGATE. i ; i ; a �.:. M J p N ao 10'-01, Z 1 d 1 1 I t V ol 10"CONCRETE FILLED — (_/) O Iln ; ;o SONOTUBE 4'-0"BELOW Z m 22 09 1 1 r; CRAWL SPACE GRADE = O i o . a 0 1 , I 1 SIMPSON ABE66 W/ Z CL LL p e ; 5/8"ANCHOR BOLT W 0 oLS F— y O , 1 1 3/4 AGGREGATE W% , 1 I @ EACH SONOTUBE Q to O ter,-a,7: i so '�, 6MILVAPORBARRIER ; �' Z tA 1 0 LOCATION TO BE DETERMINED BY BUILDER 1 _ EXISTING Nil) , CRAWL SPACE Z ' EXISTING BASEMENT . •, 1ZA" ��y. o , Lu 1 , 1 1 1 Q i U z 1 Z O 1 W , W W 1 UP ' W Q cc o Q � A --------; O Q � U r PROPOSED FOUNDATION PLAN �1- DCALEI/4"=1'-0' DATE 7-26=10 DRAWN BY SP13 REVISIONS: DRAWING NUMBER