Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1820 SANTUIT-NEWTOWN ROAD - Health
1820 NEWTOWN RD, COTUIT� �� TOWN OF BARNSTABLE LA'CA4ION A � N P epi SEWAGE # VILLAGE Q- 1 A— ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) f e��SkQ i Y (size) /60(:) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet 77aQC4, Furnished by Li a AA p4 Re 3� A C 4D yk M ql �a S-7Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .10V.A.,).............OF.... ...... ......................................... ....... Apfiration for Disposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 64 att a/ . . ............ .... ..... 11,0calion A �. ..../ or Lot No. .......... ............... .......... . ................. ............................. caner................ ..................... ...... ................................................................................................. Installer Address Type of Building Size Lot.10 9.3 .. 1 it ,I_! felt Dwelling—go. of Bedrooms Expansion ttic Garbage Grind ............... a Other—Type of Building No. of persons.._._..... ._._.._.___..... Showers Cafeter?i' ! Otherfixtures .............................................................................................*-------------*......................................... Design Flow.....................5--5 ..........gallons per person per day. Total daily flow..........3%�.......................gallons. Septic Tank—Liquid*capacity/40.10.gallons Length................ Width........_._.... Diameter._._____-___-___ Depth................ Disposal Trench—No..................... Width./J6. .... Total Length...S. Total leaching area.. / <-6,5----At-4t Seepage Pit No..........j-------- Diameter.......Y......... Depth below inlet.....W - Total leaching e;k.................sq. ft. Z Other Distribution box Dosing to 5L Percolation Test Results Performea by-----.. .. ... Date.. ......... Test Pit No. I.... minutes per inch Depth of Test Pit.................... Depth to ground water-.,#e/YE. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.___._..........._.. Depth to ground water........................ ---------------------------------"---------------*0-------------------------------------------**----------------------- 0 Description of Soil--- ......................................................................I......................... U�4 ................................................................................................. ....................................6_ ...............................�30-.=A ......... ................................................................................................ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'L 1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ssued by th!,Vrd of �yalth. .... . ....... . ... ... ........................................... .../// �/_ 0 Date . ......... Application Approved By...... . . . ....... .. .V.........A.. ................... Date ........... Application Disapproved for the following reasons:......................................7 ............................................................. . .........................0....................................................................:......................................................................................................... Date PermitNo......................................................... Issued.....................................0................. Date L r No...................... FEs.. (,t.9'"14) THE COMMONWEALTH OF MASSACHUSETTS °= BOARD OF HEALTH ..........................OF......./. ...v(... L..)...:.CA `'���. Appliration for DivVniial 10orkii Tonstrurtuan Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at• r J ✓ 'Location-Address or Lot No. r �� v;t.�� l.�! . l ^cr �- ----------- - -----.. ... ....... .. Ownerlddfe -(� ,W1 ••----•.......�<.__-_l_-_._a_ ` .....�.....G.� ..� hZ....:...-•-•-•---•--....-•--------•----•-----•---•-----•--- l Installer Address UType of Building Size Lot_.;,22 3._3.�:,,�__._Sq. feet �-, Dwelling—No. of Bedrooms..................................•.._...._Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building �� 'j ��< p +!_ ( ) ( )p.l yp g .�...::..:::....:'._... No. of ersons__.....____�._....__.___. Showers --- Cafeteria Otherfixtures�--••---•-• ------_..J._..---•••-•--••------•.-•---•----••-•-•------•---•---------••--•-•----•-•----------. W Design Flow................. ..........gallons per person per day. Total daily flow..........M(>...................gallons. WSeptic Tank—Liquid ca.pacityfZ��-' ..gallons ,Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width_��..r........ Total Length..... Total leaching area... _d sq..ft. Seepage Pit No___________ _______ Diameter....... Depth below inlet.....�/_ ........ Total leaching area...... ....sq. ft. Z Other Distribution box Q ) Dosing tank( ) Percolation Test Results Performed by...._../��!C-( l e'l_x .." ?:!`�%'.fry' .... Date._. ....................�- _ ..__._._. a a Test Pit No. 1...... .......minutes per inch Depth of Test Pit.................... Depth to ground water.___./� .r.:. e--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water..........: �L ---------------------------•----•---------•------•-•------------..........------•---•---•----------------------------------....................•------ O Description of Soil ......jffs:. .......................•-•-.--•- U •-••--•-•-•••--•--•-•--_ / .. / 1 . UNature of Repairs or Alterations—Answer when applicable._.............................................................................................. --------•---------'-------------------------------•----•-•---------------•--•---•---•---•-------•------------•------------------------------------------•---------------•----------------------•-•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAITA IS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in •operation until a Certificate of Compliance has been issued by the board of health. Signed- .... r Date Application Approved By....... r° Date Application Disapproved for the following reasons: . •----•--•--- •....................•---•------•-•----•----•------------....:•-•-•---•---•-----•.....-------•----------.••----•--------------•-----•-•-------•----------••----••--•-•-----•-----•--------••-----•----•- Date ' PermitNo......................................................... Issued................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD]OF HEALTH ., .�G:. ... :OF.... / t........ �.f(ts............................................ ..�,.. ..ter. Trtif irdti laf Bout liunrr Vr.' TH7 IS TO CBR4TI`FY, That the I,ndividual'" Sewage Disposal System constructed (}t)� or Repaired ( ) by....:/ 1 ?' - /fir-2 1 �[ /(:�..... -------- ------------- ` \_ .. 1 Installe ' f / / /' at !�' . - .�`� /.fit,/, 1r r �l r� � ?� uA7, l`-e�-----.-..-..-.-.-......A..... •--. .._ ...... has been installed in accordance with the provisions of ` of The State Sanitary Code as scribed in the application for Disposal Works Construction Permit No __ _..__� de �+��_____..__. dated___.�,2__-_�....._dc j........... THE ISSUANCE OF JHIS CERTIFICATE SHALLWOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM VlIILL FUITI N SATISFACTORY. v DATE..... �....v....yI 0 x ��. ..�_ ......---- af Inspector 1 THE-COMMONWEALTH OF MASSACHUSETTS B�?�•R-D�-YOI��•-H.EA�LrT H-/� / / i� c�fl Ids" .........�1�....................OF....../{c:�� ..................._.................t............... N ------ am' '"J FEE...l--......... . DisposalWorks-fTuitu#r tan rrinit Permission is hereby granted.... .__r i!1 ..._ ,1: xc!_.:._ r._ 7% .........................e ')... to Construct (,XS or Repair ( ) an Individual Sewage Disposal Systemat _ ,F1 Jig y - ° Street as shown on the application for Disposal Works Construction Perm' o-------- -- ----- ted.... ..`. .------------•_-----... ............. ... _ ---.......----` DATE_ Board of ealth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI 3 DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 9 PART A 10 CERTIFICATION �r Property Address: 1820 NEWTOWN RD. COTUIT O Name of Owner PETER CARDILLO MAY 1 Address of Owner: SAME 4 1999 N Date of Inspection: 4/22199 .?►QFer Name of Inspector:(Please Print)JOHN GRACI �QpNQ�j 1 am a DEP approved system inspector pursuant to Section.15.340 of Title 5(310 CMR 15.000) '` Company Name: n/a Mailing Address: n/a Telephone Number: n/a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection is based on criteria defined in Title V ` _ Conditionally Pass s code 310 CMR 15.303.My findings are of how the system is _ Needs Further Ev uat' n By the Local Approving Authority performing at the time of the inspection.My Inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: M Date:4127/99 The System Inspector shall iubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS 1 THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING SYSTEM.EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9!2/98 Page 1 of f1` G SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1820 NEWTOWN RD.COTUIT r Owner: PETER CARDILLO Date of Inspection:4/22/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: - _ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. t COMMENTS: System passes Title V inspection f B. SYSTEM CONDITIONALLY PASSES: n1a One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.'If"not determined",explain why not. n1a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n1a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced I Wa The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced ' _ obstruction is removed - revised 9/2/98 Page 2 of 11 x SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART A CERTIFICATION(continued) Property Address: 1820 NEWTOWN RD.COTUIT Owner: PETER CARDILLO Date of Inspection:4/22/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nla(approximation not valid). 3) OTHER Wa revised 9/2198 - Page 3 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1820 NEWTOWN RD.COTUIT Owner: PETER CARDILLO Date of Inspection:4/22199 , D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No ` X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. ' X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or,cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nfa. X Any portion of the Soil Absorption System,cesspool or privy,is below the high groundwater elevation. X 'Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. , X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: " You must indicate either"Yes"or"No"to each of the following: A The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 : Page 4 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B r CHECKLIST Property Address: 1820 NEWTOWN RD.COTUIT Owner: PETER CARDILLO Date of Inspection:4/22/99 t , R:. Check if the following have been done:You must indicate either"Yes"or"Noy as to each of the following: N Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have'been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. ! X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, - X All system components,excluding the Soil Absorption System,have been located on the site.' X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C'is at issue,approximation of distance is unacceptable) (1 5.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C `SYSTEM INFORMATION Property Address: 1820 NEWTOWN RD.COTUIT - r Owner: PETER CARDILLO u Date of Inspection:4/22/99 � OW CONDITIONS - 3�d��,r► RESIDENTIAL: *' �U� ' Design flow:-M g.p.d./bedroom Q Number of bedrooms(design): 2 Number of bedrooms(actual):'2 To GN flow: 22Q 'a' �{+� e Number of current res ants— Garbage grinder(yes or no):MS2 .}-�'�(� 71 Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):JLQ Seasonal use(yes or no):JLQ Water meter readings,if available(last two year's usage(gpd): n/H v�( Sump Pump(yes or no): NQ Last date of occupancy: nta COMMERCIAL/INDUSTRIAL Type of establishment: Wa Design flow: Wa gpd(Based on 15.203) Basis of design flow: n!a Grease trap present:(yes or no):JLQ c s Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n/a „ Last date of occupancy: nLa w OTHER: (Describe) ' Last date of occupancy: Wa GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS LAST PUMPED IN 1984 System pumped as part of inspection:(yes or no):XE� If yes,volume pumped JUL gallons Reason for pumping: MAINTENANCE TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool r Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nta APPROXIMATE AGE of all components,date installed(if known)and source of information: SYSTEM IS 16 YEARS OLD.INFORMATION BY OWNER Sewage odors detected when arriving at the site:(yes or no): NQ +' j revised 9/2198 Page 6 of 11 - y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1820 NEWTOWN RD.COTUIT Owner: PETER CARDILLO Date of Inspection:4/22/99 BUILDING SEWER: (Locate on site plan) - k Depth below grade: V 6" Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: nLa Comments: (condition of joints,venting,evidence of leakage,etc.) Wa r . SEPTIC TANK: X (locate on site plan) Depth below grade: 1' Material of construction:X concrete_ metal_ Fiberglass Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): N-Q` Wa Dimensions: L 8'6"H6 7"W 4'10" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32' Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: r Distance from bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) F Depth below grade: -. Material of construction:_concrete metal Fiberglass _ Polyethylene_other(explain) Dimensions: nla Scum thickness: n/A Distance from top of scum to top of outlet tee or baffle:_nLa. Distance from bottom of scum to bottom of outlet tee or baffle nLa Date of last pumping: nLa Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nja revised 9/2/98 Page 7 0f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 9r Property Address: 1820 NEWTOWN RD.COTUIT Owner: PETER CARDILLO - Date of Inspection:4/22/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nlal Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) Wa Dimensions: n/a Capacity: n/a gallons Design flow: n(a gallons/day Alarm present: NO Alarm level:jit& Alarm in working order:Yes—No—: DLO Date of previous pumping: nla Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH 130TTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: N (locate on site plan) Pumps in working order:(Yes or No): MO Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa f. revised 9/2/98 Page 8 of 11:: - ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1820 NEWTOWN RD.COTUIT Owner: PETER CARDILLO Date of Inspection:4/22/99 °. SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: _ nLa Type: _ leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: jVA leaching galleries,number: jVa . leaching trenches,number,length: nLa leaching fields,number,dimensions: n!H overflow cesspool,number: n1a Alternative system: nLa Name of Technology: jiLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT HAD V IN IT AT THE TIME OF THE INSPECTION PIT HAS NOT HAD MO CESSPOOLS: _ (locate on site plan) Number and configuration: nLa Depth-top of liquid to inlet invert: n/a Depth of solids layer: nLa Depth of scum layer. nLa Dimensions of cesspool: nLa Materials of construction: nta , Indication of groundwater: nta inflow(cesspool must be pumped as part of inspection)nLa i Comments. (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:nLa Depth of solids: nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) - Property Address: 1820 NEWTOWN RD.COTUIT Owner: PETER CARDILLO _ Date of Inspection:4/22/99 ` { o NRCS Report name: nLS Soil Type: n1a Typical depth to groundwater: nLa USGS Date website visited: nfa Observation Wells checked: N-Q Groundwater depth:Shallow _ Moderate Deep SITE EXAM _ Slope r _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High.Groundwater Elevation.(Must be completed) w USGS MAPS AND CHARTS AND VISUAL n revised 9/2/98 Page 11 of 111 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ^ PART C SYSTEM INFORMATION(continued) Property Address: 1820 NEWTOWN RD.COTUIT Owner: PETER CARDILLO Date of Inspection:4/22/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a r—C] y AD yy cc sl O Q 57 • z revised 9/2/98 Page 10 of 11 ' Commonwealth.of Massachusetts W Title 5 offidal Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1820 Santuit Newtown Road Property Address Garry Pierce _ _ Owner Owner's Name information is Cotuit MA 02635 6/24/15 required for every ----- -- -------- -------- -— ----- ----- ----------- 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. k Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain___ 18b Company Name 8 Johns path.--- - -- ----------- —-- --- -- —-- Company Address arum S Yarmouth _ _ MA _ 02664 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number $'_ d 3;sly �vd ae B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/24/15 16spector'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. ? l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address Garry Pierce Owner Owner's Name — -- -- - ---------------------- ------- - information is required for every Cotult MA 02635 6/24/15 page. City/Town State Zip Code. Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system contains a 1,000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The leaching is made up of a single leach pit. Staining inside pit shows level has never been higher than within 20 inches of the invert pipe and had only 1ft of water in it at time of inspection. B) System-Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as�approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Gommonwealth of Massachusetts W Title .5 Official, Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address Garry Pierce Owner Owner's Name ---- - ------------ - ------ -- -- — information is required for every Cotuit MA 02635 6/24/15 --- -- -------- ---------- ------- — -- - -- --- page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health):, ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•3/13 Title 5 Official Inspection Form!Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \a °r 1820 Santuit Newtown Road Property Address Garry Pierce _ Owner Owner's Name information is required for every Cotuit MA 02635 6/24/15. -- - _—_ page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the'public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy.of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® . , Discharge or 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 1/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address ----- ----- ---- - -- ---- --------- Garry Pierce Owner --- ----- --- - ---- --— --- ------ Owner's Name information is required for every Cotuit MA 02635 6/24/15 - page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet, from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you.must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is,within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.,The system owner should contact the appropriate regional office of the Department. t51ns•113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a,a' 1820 Santuit Newtown Road Property Address Garry Pierce Owner Owner's Name information is required for every Cotuit MA 02635 6/24/15 � — -------- -- - ---- ----- page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or."no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site.inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3- ----- Number of bedrooms (actual): 3- ------- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 setts Commonwealth of Massachu Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address Garry Pierce Owner Owner's Name information is required for every Cotuit MA 02635 6/24/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system contains a 1,000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The leaching is made up of a single leach pit. Staining inside pit shows level has never been higher than within 20 inches of the invert pipe and had only 1 ft of water in it at time of inspection. -------- ---- -- ----- — Number of current residents: 2- ----- Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No ,000 12 II Water meter readings, if available (last 2 years usage (gpd)): 2012013 12,000 Detail:. 57.7 GPD Sump pump? ❑ Yes ® No Last date of occupancy: eD teupied Commercial/Industrial Flow Conditions: Type of Establishment: ---- — - — -- Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): --- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — — t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 a Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address Garry Pierce Owner Owner's Name information is Cotuit MA 02635 6/24/15 _ required for every -------------- ----------------------._-- - ---- ------ -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: e-- Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: ---- — — -- gallons _ How was quantity pumped determined? --- Reason for pumping: — ---- — -- — -- Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road _ Property Address Garry Pierce Owner Owner's Name information is Cotuit _ MA 02635 6/24/15 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 32 years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer (locate on site plan): Depth below grade: 18 's -- 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.): System is vented throught the roof Septic Tank (locate on site plan): Depth below grade: 1 ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,000 gallon If tank is metal, list age: ---__ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gallon _ Sludge depth: 3"s l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address ` Garry Pierce Owner Owner's Name information is required for every Cotuit MA 02635 6/24/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24"s Scum thickness 3"s Distance from top of scum to top of outlet tee or baffle 42"s Distance from bottom of scum to bottom of outlet tee or baffle "Sludge stick Measure M How were dimensions determined? Tape- --- - 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 was pumped in 2011, 12, 13 14 Grease Trap (locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — — ---- Scum thickness -- - Distance from top of scum to top of outlet tee or baffle --- ------- — Distance from bottom of scum to bottom of outlet tee or baffle -- -- -- - Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road _ Property Address Garry Pierce___ Owner Owner's Name information is required for every Cotuit MA 02635 6/24/15 -- -- - -- --- 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.): No evidence of leaking_— _ Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: —. Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: -- -- Capacity: gallons - — ---- ------------ Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: - ------ Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date T Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address Garry Pierce Owner Owner's Name information is required MA 02635 6/24/15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at proper level 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.): Very little scum in D box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•313 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road _ Property Address Garry Pierce Owner Owner's Name information is Cotuit MA_ 02635 6/24/15 required for every _. - _._ _ page. City/Town State Zip Code Date of Inspection. D. System Information (cont.) Type: ® leaching pits number: 1 — ❑ leaching chambers number: --- El leaching galleries number: ❑ leaching trenches number, length: - — ❑ leaching fields number, dimensions: ❑ overflow cesspool number: - ❑ innovative/alternative system Type/name of technology: ---------------- ---- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of carry over. no signs of hydrualic failure 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address Garry Pierce Owner Owner's Name -----— ----- ----- -- information is Cotuit MA 02635 6/24/15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of ponding or hydrualic failure. 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.): 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address Garry Pierce _ Owner Owner's Name information is required for every Cotuit MA 02635 6/24/15 - -- - - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Assessing As-Built Cards page 1 0]' � n-Z `' LpdT °S Lq/V7c�� rni�c✓� �c/EnRIT�� . VILLAGE C 0 _r0 r INSTALLER'S NAME A 0 D A E S S 8 U I L 0 E R OR owNEl1 • Y/�fZ 1�11D�i :N �J�/�� f DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 'Z n • __ i?! 7 S 7 9�STt� rr� vv � • ��f 3S http://,,ww.town.bat-nstable.nia.us/Assessing/HMdisplay.asp?ni.appar=023041&seq=1 6/16/2015 Commonwealth of Massachusetts Title 5 Official Inspection Form =i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 1820 Santuit Newtown Road Property Address Garr Py fierce Owner Owner's Name ------------- --------------------- — --- information is required for every Cotuit MA 02635 6/24/15 — —__ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20+ ft 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: usgs maw- —------- -- —.... You must describe how you established the high ground water elevation: Property sits 20 ft above nearest water venue. According to usgs maps system is approximately 20 + ft above ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1820 Santuit Newtown Road Property Address ----- ---------- --- --- _ Garry Pierce Owner Owner's Name information is Cotuit MA 02635 6/24/15 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I '�i N } 1 '-- ,d b - n in• r N Ln Cr y 14 d Lj-ton ��dr,� EQ �Q r LJ f �_' rl (rim.. . rp °p I{Y/jv 'L-Z�X ID A�ot� ( op �l / v v Gt'd 2 3.'. 1- �!-(v l ...GW►3y. �� Co. *CLAP $Q1� I7~GIDE� L�ttCJ.. . I1 :02 . „J� Q `ill c 21" \ 2��� � a' �%si � L. � i �/zu•Y, tR 2 - -- - - .�f�`f H' `'('! Dl U 1 . ...F%MPl- ImS S `'/ -- O well- �3O — Ly • Nr=W 3 � o AR 4 -ZZT:..�-- .......�I;f=t.�.G>= . AID rr- nape �Y o _ MI<SHP SI=�--IEF-5 (.d,tj. �vl.P� LtGN t e VLLNOF l2 w --03 /`"�- g r .. - - __ -..--, .-., _.. ._..- ....... .. ..._ .,. -..«..... ;u-. .. . s. ..eu- ..,.,i ,'�. ,yr.. . .y�r:;L�r,'a F• ..ri�'?P♦"r*" � X�1'1 ...-... . . .. -.+ ... .+F._+k"., ... Y..,., r. -+^s. , -. .C;.-. Y: -i" .. SY ,. .._31M�'r., . �e�'7 r1•..r,+C �r .°~ '�, ---- - --� ` �""'IILL E.UE�/. ��oti./•�i �i2'�iC N4i'�Ar..� 1 �► �• 4 G•'S . a�c�- vt�.�,,,1 iE � �-- VtTGW /►L-%- ti,.t t.#ES ^ M ItJ tMt. wb"/rat' / �...� hti1 t�SS [�Tt►d�i�+��t3 fG "" -t act�. i= A L.l_ P%Pis TO A.►J O I xJ T* W *f°ST*M S OA•� _ � c.AST t R.�•..S Sc.�tsvu►. •4o P. c . T'� Q ® C V T A%.L `5 E PrtG. TA 1 V-S, aS-rem CJf a� ex::x, x t�o nn �,�I�Ga..1t.J�► Pn bS 3KAL1 �y� O e►J F+d� _ � ,• • ' ., N ,. ' �J � (D o ® o) c o !-� - 20 �.Jt.1�1E t_ t,.,o1�L71�l�lS • ... R EWCKAE ALA- UN SUtTA.S'-e M^I MI XL- !'W""TW _ _ ot � t � �' _ .y • � � � 0' A f2.D►T�1 uS of z s �,.�o �'ic.Ft t..i. W rt�1 Gt..Ay-Fes' ti `,'L _i _ _ - -� ' o a O t SI4JU /►r•1 fl 65•�• � 00 •- -~ _ �, ih � Gt�►,�QLIETtp�.l ,er..ct� G'C10� TO d►�c.X.lrt Vl..l r.i�ii1 o 00 ® � ® vim,tr.�cSS oTH ,,u 1'b tscrc-E fl, A JN� 00 o � � � � �1� � ,�.., ��.& , _ QL�� ►J OT TO SC n.t_E � .��-----•-_::�:•;r e-=- _ :�--'--� � � --- ---.« �clN l G N M Atr! A�-1�. "C-XT T r-t 6t YT-1 c1&A 80C►L At"v l o oo C--*IL4. -TZ(P l GA t✓ t cao Ca�t- SrGP r tc_, rP•f.1 k �P t C s�,tr ►_I�1 C G-• Q �T ta4.-4voezAzra SP, m-i G Tt+,l k gy AM E�►G,4.� 1�FGhST ►.k7T Tn S A tom. ►1�T To �c�E CW- 6C1u�•4. E Ta..lKS tiL�vFOt�fct7 T4}QOcX,,HOv G' ;',� _ W R•N C�.6C'T'i2.tG w�t�,co �.1��E w t T'F-t Z A - fit" trr i m*r- OTC: AGC�S� MI�r.1NUf~ZS 'Tb (C") � 'CdP � �Q'rti O►`/I. OOt.JL 1S �CX�O P '� TAT + J VWXLCKA- ,�� r „ , . -- F t�t SN G¢t,.vir. �t,_i�S t•� �x�x F t..a t�+�► 6c1 �ai�. 1_c .APB`•, XQ oVeo- 94xS a1�t7�4� c �,ac-µ1�.►� a i L) . X Q . c. li"' . � • �j • S 'se.rL (D A A s a$` a /7 • 1 8 mrt 0 0 0 --->} t" w /4� ,$L x.0 �EPTt G TA t,-J ' • 14-0 �+5- -' m r.i�� ��H� - IiDJ , 'fO tyE t��6�� �'AL�� L °��., A►T�' - � ln�l +►.1 ttilCu S -1 o�.JGrt AG# P� Pi'cf�C©c....A i©►�.. L'- / / cvc�z- _ ._ ---�_,. r fv '' -- ..` a�s�2.v'A.-rto►�s �� . -���,�- /�u7e 1e a `( -4-W \ t..►o�2M +►.1 GAS A ►J E, . L Lo 4on o j De:5I (strJ CV--►T-E QtA. u P;z o Pom Lc�� K AF- X, fz ���pUt � PID �-e PAC-- H ►n_)EA ,4 �, PPr�/t OG O, 5C Al.L.E A3 Nlcfmt) o v, P i 9 8 O I X „ y` G � Io0'�. E�.PA►�.t 51 ow U '1/v'�i (� f -D L,,t; .j C. �1� rr '`0 "Q�- �� �� has 4G�� �T Po 1` �, P�, t S �` �yL /YEA 5 PLOT- � [) ,f X !'j Jrr-° `(� NORMAN `� fJORNA r g GROSSMAN t c p GRQSN �`�^ ! 127A.LAC 30 t ) 22705 • 2 t_.L. 1+ Lo7 SNov.Itj oKi FI-A �.I _r'UTt 1 , F' -