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HomeMy WebLinkAbout0007 TRUMAN LANE - Health 7 Truman Lane ' - - — ---- - - - Cotuit A= 039 — 147 y l i _� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE Property Address JEANINE & TIMOTHY COLE Owner Owner's Name information is required for every COTUIT _ MA _ 02635 2/9/2021 3 page. City/Town State Zip Code Date of Inspection rl Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. ' Important:When filling out forms A. Inspector Information on the computer, use only the tab Christopher Maki key to move your . Name of Inspector cursor-do not Cape Cod Septic Services _ use the return key. p yan Com Name -- 350 Main St. Company Address — W Yarmouth _ MA 02673 City/Town State Zip Code eras 508-775-2825 SI-14423 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation,by the Local Approving Authority 4. ❑ Fails spector's Si ature 2/11/2021 Date 7 The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within'30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should, be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal system•Page 1 of 18 Commonwealth of Massachusetts l Title 5 Official Inspection Form - �; l� Subsurface Sewage Disposal System Form - Not-for Voluntary Assessments (s 7 TRUMAN LANE Property Address JEANINE &TIMOTHY COLE Owner Owner's Name. information is COTUIT required for every _ MA 02635 _ 2/9/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS IN WORKING CONDITION 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration,or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is'structurally sound, not leaking and if a Certificate of Compliance indicating that;the tank.is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): r l5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 or 18 Commonwealth of Massachusetts i� Ip Title 5 Official Inspection Form I'o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE Property Address JEANINE &TIMOTHY COLE _ Owner Owner's Name information is GOTUIT required for every __._ ___ MA _ _02635 _ 2/9/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ -ND (Explain below): ❑ obstruction is removed . ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution,,box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): El The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction,is removed ❑ Y : ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health; safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/25/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r . Commonwealth of Massachusetts Title 5 Official Inspection Form i. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............ : � 7 TRUMAN LANE_ Property Address JEANINE &TIMOTHY COLE Owner Owner's Name information is required for every COTUIT __ MA 02635 2/9/2021 " page. City/Town State Zip Code Date of Inspection C. Inspection Summary,'(cont.) r ❑ Cesspool or privy is within 50 feet of a surface water , ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system-has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is.within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". ^ Method used to'determine distance: `* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c, Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to.each of the following for all inspections: Yes No E ® Backup of sewage into facility or systern,,component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE Property Address JEANINE &TIMOTHY COLE Owner Owner's Name information is COTUIT required for every MA 02635 2/9/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded ' or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy-is within 100 feet of a surface water supply or tributary to a surface.water supply. ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 c.oliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described.in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No, ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-,Page 5 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection F®rrn Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .......... 7 TRUMAN LANE Property Address , JEANINE &TIMOTHY_COLE Owner Owner's Name — information is required for every COTUIT MA 02635 2/9/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant' threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No ® ❑ Pumping.information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of breakout? ® ❑ 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)] 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE Property Address JEANINE & TIMOTHY COLE _ Owner Owner's Name information is COTUIT ____ required for every MA 02635 _ 2/9/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 20- 16 GPD 19- 18 GPD Detail: Sump pump? El Yes ❑ No Last date of occupancy: CURRENT Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 ' r Commonwealth of Massachusetts --,t Title 5 Official Inspection Form I'o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE Property Address JEANINE &TIMOTHY COLE Owner Owner's Name information is required for every COTUIT _ _ MA' 02635 2/9/2021" page. City/Town State Zip Code Date of Inspection D. System Information (coot:) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to:- Industrial waste holding tank present? 0 Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? _ — Reason for pumping: l5insp.doc°rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts lip Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 7 TRUMAN LANE Property Address — JEANINE & TIMOTHY COLE Owner Owner's Name — information is _ re wired for every COTUIT ^_ _ MA 02635 2/9/2021 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy. ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1982 PER PLAN ON FILE AT BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer (locate on site plan): 1 Depth below grade: 36" feet Material of'consfruction: ❑ cast iron ® 40 PVC ❑ other(explain): - Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND PROPERLY PITCHED t5insp.tloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts -_-, Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE Property Address JEANINE &TIMOTHY COLE Owner Owner's Name information is required for every COTUIT __ MA 02635 2/9/2021 page. City,Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan)` Depth below grade: ' 14" feet - Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) 1f 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: 1 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle i— How were dimensions determined? ESTIMATED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 GALLON TANK IN GOOD CONDITION, CONCRETE TEES IN PLACE AND CLEAN. TANK AT NORMAL OPERATING LEVEL. 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 S f Commonwealth of Massachusetts r Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w � 7 TRUMAN LANE _ Property Address JEANINE &TIMOTHY_CO_LE_ _ Owner Owner's Name information isequired or every COTUIT _ ____ MA 02635 _ 2/9/2021 page. CityiTown State Zip Code Date of Inspection D. System Information (cont) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle 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.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: -Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - i h Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts ,/t� Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form'- Not for Voluntary Assessments % 7 TRUMAN LANE L,. _ Property Address - JEANINE & TIMOTHY COLE Owner Owner's Name T " information is COTUIT _ MA 02635_ _ 2/9/2021 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont') 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: - Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition.of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX LEVEL AND WATERTIGHT 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 ;1 Commonwealth of Massachusetts Title 5 Official Inspection Form 1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE Property Address JEANINE &TIMOTHY COLE Owner Owner's Name information is every COTUIT required for eve _ MA 02635 2/9/2021 page. City/Town State Zip Code Date of Inspection , D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: / ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* . Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): "* If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-6X6 PIT ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system T --ype/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of (Massachusetts I,/,� Title 5 Official Inspection .-Form J Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE - Property Address JEANINE &TIMOTHY COLE Owner Owner's Name information is COTUIT _ required for every ___-_-_ ___ MA 02635 2/9/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments-,(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,' etc.): 1-6X6 PIT WITH 2' OF STONE FOUND WITH 3'OF EFFLUENT DURING INSPECTION WITH NO EVIDENT STAINING. COVER IS 4" BELOW GRADE 1 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs.of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form„Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts l Title 5 Official Inspection Form13 10 Subsurface Sewage Disposal System Form- Not f Y or Voluntary Assessments" 7 TRUMA N LANE Property Address JEANINE &TIMOTHY COLE Owner Owner's Name — information is y COTUIT _ required for ever ___ MA _ 02635 2/9/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i 1 l5insp doc•rev 7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 1a Commonwealth of Massachusetts it� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 7 TRUMAN LANE Property Address JEANINE &TIMOTHY COLE Owner Owner's Name information is COTUIT required for every _ MA _ 02635 _ 2/9/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately r - � L • t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 TRUMAN LANE Property Address -- ---------,-- JE_ANINE & TIMOTHY COLE _ Owner Owner's Name information equir for is y COTU9T required for ever MA 02635 2/9/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope Z Surface water ® Check cellar ® Shallow wells , Estimated depth to high ground water: +14' 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: 9/3/1982 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: f ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: PERC TEST DATE ON PLAN AT BOH SHOWS NO GROUNDWATER AT 12'. HAND AUGER PERFORMED ONSITE AT TIME OF INSPECTION SHOWED NO GROUNDWATER AT 142" Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc'rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 7 TRUMAN LANE Property Address JEANINE &TIMOTHY COLE Owner Owner's Name required for is every COTUIT required for eve MA 02635 2/9/2021 page. City/TDwn State Zip Code Date of Inspection E. Report Completeness~Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 18 of 18 r, - - 1 c 11 //'" 25 e I� 0L Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r� °M 7 Truman Laney Property Address Silvamar LLC Owner Owner's Name n.7 information is required for every Cotuit Ma. 02635 06/20/2017 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information �'� (a 4 I I filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 Si3938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 06/24/2017 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and,the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. City./rown 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. Cityrrown 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 Failure S stemri ri Applicable y Criteria A pp cab a 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 '/z day flow t5ins.doc•rev.6/16 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 ,M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 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 El ® obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.]. ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails:The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 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): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): '330 l5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is Cotuit Ma. 02635 06/20/2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate.sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: .Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 21 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): •Depth below grade: 12°feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Standard H-10 1000 gallon septic tank Sludge depth: 1" t5ins.doc•rev.6/16 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 ,M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 " 06/20/2017 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 36" Scum thickness 1 Distance from top of scum to top of outlet tee.or baffle 511 Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I would recommend the new owner put the tank on a maint. plan with a local septic pumping co.The Barnstable Health Dept. has a list of local septic pumping co. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM s 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) r 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.): The H-10 D-Box had no visible signs of leakage or evidence of past hydraulic failure. 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: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection there was appx. 3 feet of ponding water and there were no visible signs of past hydraulic 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 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 GSM ,•°'r 7 Truman Lane I� Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. Cityrrown 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I h TOWN OFBARNSTABLE _ LOCATION_ / 'Tr✓r✓l,!�_n Lo.,n,t` SEWAGE VILLAGE 'Cis t'r ASSESSOR'S MAP&PARCEL CO? 14 r 7 l?1SaA4A&fi9 NAME&PHONE NO. ---lT r n O u, )17 9 SEPTIC TANK CAPACITY 1 LEACHING FACILITY:(type) i fi (size) JOac� NO.OF BEDROOMS 1 OWNER O�f�lA `I Q^Ff PERMIT DATE: (3®b¢PbhOfEE-DATE: 15 a7 Separation Distance Between the:1. 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 FURNISHED BY Truman Lane v.<n�Yfi&tt�S::r:Si..K�K>aa�5vrv`+.t^e'i:•�.;g.x... -a p hA k K J t ���y1���•Y,u�i�V'�jx.. `•r::;)-:;`i'st`�i!..':Sn"'.e.l:.. 20 41 1. 25 2 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 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: 14 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑. Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole to 14 feet to show 4 plus feet of seperation. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Truman Lane Property Address Silvamar LLC Owner Owner's Name information is required for every Cotuit Ma. 02635 06/20/2017 page. Cityrrown 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 OF Le<.�ti„v O J t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS z W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m d DEPARTMENT OF ENVIRONMENTAL PROTECTION ,W p�M Syev TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 7 Truman Lane Y Cotuit MA 02635 stl 76 Owner's Name: Marta Hallett t ; Owner's Address: 225 Central Park West New York NY 10024 Date of Inspection: March 15,2007 Job#07-39 Name of Inspector: PATRICK M.O'CONNELL co; - Company Name: SEPTIC INSPECTION SERVICES CO. = . Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _X_ Passes Conditionally Passes Needs Further Evaluation by the Local A roving Authority Fai Inspector's Signature: ,,, --- Date: 3/15/07 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. Notes and Comments: Leaching pit was empty at time of inspection, recommend pumping tank. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: ' One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no.or not determined (Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is,structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: f Page 4 of 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X Backup of sewage into facility or system component due to 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_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 _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of 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 1 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. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and.nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of .Health to determine what will be necessary to correct the failure. E. Large 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• You must indicate either"yes"or'no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 Check if the following have been done. You must indicate"yes"_or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period ? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection`? _X_ _ 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'? _X_ _ Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of Liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a'plan at the Board of Health. _X_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example` 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 18,000 gal. Sump pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _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: Compliance date: 10/14/82 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: V Materials of construction:_cast iron X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: l' Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5' long x 5.2'wide— 1000 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 27" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from'bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees are intact and clear,liquid level is at bottom of outlet invert. Recommend pumping tank. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: . Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (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.): No solids or high stains present. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching spits,number: One 6x6 pit. _leaching chambers, number: _leaching galleries, number: _leaching trenches,number, length: leaching Fields,number,dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Leaching pit was empty at time of inspection high stains indicate pit has 16-20"of effective leaching. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 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. Truman Lane R. 20 41 25 62 I Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7 Truman Lane,Cotuit Owner: Marta Hallett Date of Inspection: March 15,2007 SITE EXAM - Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water : More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.25 and topo map shows property at el.50. ;All 0 ,e 7ob 0A. Vu . ' DAN ev Y /f SCALE: APPROVED BY: I D s DATE: REVISED (30-77-e-1`7' DRAWING NUMBER ,/!/0' - na L4,Se _Gk CL J- v O-S CLI ove-C �i I y , C r � � �' -� �. - � _ �' i I i �i, �� ', I, '� � TOWN OF BARNSTABLE _ LOCATION `' Iry o !�,n L c rv— SEWAGE VILLAGE w b 'r— ASSESSOR'S MAP&PARCEL G2YC,? NAME&PHONE NO. `'s T-"(11c 4el SEPTIC TANK CAPACITY LEACHING FACILITY:(type) t (size) NO.OF BEDROOMS OWNER p-r+o, PERMIT DATE: ATE: S 47 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 FURNISHED BY Truman Lane I 20 41 25 2. o A N : C a w v ; a kA IN S c r" f 1 CP 1 Zs, ` M D 10 C iq s tti c �J Fss..'3 ..... fHECOM*MONWEALTH�� AO `�OFUASSAC Tu TS H7 TH ' �q, WS. Al Appliration for Uiipniial Workii Tome rur#ivit Famit Application is hereby made for a Permit to Construct ( ) or Rep, ir ( ) an Individual Sewage Disposal System a • ....... l..1.�!/1? zll.. lv v� '= ... .... ....... ............. L ion, � ---- � --y! or o i .. ��. ... A.:.._. :....... ............ �/ o �_ ...�gf,� � ..__..._ -- ... W / rie � 1'< A e s ; .. V.............. d �.._........ Installer Address /gyp Type of Building Size Lot_._. lo_ ____..Sq. feet aDwelling—No. of Bedrooms__________________________ _-_.::....Expansio Attic V/�'/ Garbage Grinder (/ p, Other—Type of Building ............................ No. of persons..._ ___._.._____.__.____.. Showers ( ) — Cafeteria ( ) a' Other fixtures ...................................................... Design Flow.. .Q_.. ------------------allons. W •g ...............gallons per person per day. Total daily flow_._._..... _._ ___ gal 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 ar .. ..... ......sq. ft. Z Other Distribution box Dosin k ) Percolation Test Results Performed by. �I ( - Date. ... <. a Test Pit No. 1... Z---minutes per inch Depth 6fJ Test Pit------tZ:....... Depth to ground water..�__ ...... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_-_-_-__--_:-----_:-' P4 --------- ... ------•.••--- O Description of Soil------------Q' �� � 41 ✓ ---•--••--•----------------•-----•---•-----.2z �Z----� 4-L": ��.a.Q----- - .- -t'�r W ----------------------------••------....--------•-----•-------------•----------------•�---------- ---•---•----....... . 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 TITIE 5 of the State Sanitary Code— The undersigned further agrees to place the system in operation until a Certificate of Compliance has been i*bDthhe'bQ,, heaSi ned. - •-•-• --- ---- Date Application Approved BY - � ............... Date Application Disapproved for the following reasons---------------------•----------------------------------•--•--------------------------------------------......._ ----------------------------------- .------ .... -------- ••------------------ --------------------- ---- ------------------------ •-------------- ••--------------------------------------------... .... Date PermitNo......................................................... Issued-....................................................... Date No-----491=505 Fw3.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR HWALTH ------ .............OF.......... .. ......................................... Appliration for Bilipaiial lgorkii Tomitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System A... ..... .... ... j74- .... ............... . .L.. ..i.o.n.....d... ........... ...... 6- 4... L-O--­-O AVIIL ................. ne Ad21- s ................ .. .. . .... .. .............................. ......... L ....... / . .................................... Installer Address Size Lot... Type of Building Z7_1-----I------Sq. feet Dwelling—No. of Bedrooms.......17.............................Expansion Attic Wo Garbage Grinder (440 Other—Type of Building ............................ No. of persons....34 - ------------------_- Showers Cafeteria QI Other fi&ures ......................................................................................................... . .................................... Design Flow............._K'.O...................gallons per person per day. Total daily flow.......... ..jV.................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length________________ Width__.__..._._.__._ Diameter..-______.___._. Depth............... Disposal Trench—No_..........o......... Width_____...._.__.__._._ Total Length..___._____.____._.. Total leaching area.,2--v-------sq. f t. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching ar;:9_7....sq. ft. Z Other Distribution box Dosin�t k A Date. ..... ...... Percolation Test Results Performed by.- v.....< .... .................................... Test Pit No. 1...:!;nZ---minutes per inch Depth of 'rest Pit Depth to ground water.. ...... Test Pit No. 2................minutes per inch Depth of Test Pit__.__.._________.___ Depth to ground water..____......__.___....._ P4 .......... ....tZ................ ... .... --------­-------------- - -----------*------ jf J--- ------- 0 Description of Soil............ .............. ........ ......cr. .......o4 r ---------------------------- ...........----------------------------------------------------- -----------14&t_� __ .................................................... .......... ..... 7---- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..........................................................................................................................................................................................0............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TMZ- 5 of the.State Sanitary Code—The undersigned further agrees xo'j to place the system in -operation until a Certificate of Compliance has b en issued b the b of licaltir? &�S* ApplicationApproved BY-------- ......................................... ....................................... ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR, OF LJEA LTH / —1 1 -..........................................OF...20kev�� ..................................... (Irdifiratr of Toutpliatta THIS IS Z -CE TIFY, That/t1he Ind;vidu ewage Disposal System constructed (Xor Repaired by........................5.. .......... . ...... ................711 . . ...... ---------------------------------*----------*------------ "W" , at............ . ......./_� ....... kzkl A 2 S e! V--------------------------------------------- _---_---------------------- has been installed in accordance with the provisions of TIT LE� 9f T--hS,?ate Sanitary Code as described in the application for Disposal Works Construction Permit No________________________...._____________ dated_...._..._..__._._.___.._._.___.._._.___.__._:._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A UARANTEE THAT THE SYSTEM WILL FUNCTJON SATISFACTORY. DATE....../nA ........................................... Inspector................................................................................... IV, ,e THE COMMONWEALTH OF MASSACHU TTS TTS BOARM.-nF HE4LT"r .........OF'2 WIV 7-A.-..I .............................. No......... a imyA )fAdt FEE....................... 1pV ,011 Imit Permission is �by granted... Z14 ......... ............. ............... to Construct (A.-) r Repair ),/,n Indivjdual Sewage Dis��all Syst .... ......7 at No....................Z:�n- _--_ ..... . . ............. ................................................................ street as shown on the application for Disposal Works Construction Permit No................... D ted.......................................... -------------------------------------------- DATE...............................FI)fl ............................._ oard of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS s b�/E Cao rrl4-xC1/ Y�0 �1,rr;;YAI 4 f-8 e56La � �3oZ7d.r 1 of C .•t�ffr�l(� P17 O 11i5 ;�'c'�/0 6 ?Obk,, ,Gvf11 , k R f/�f TE Ip�'°I �'3N G`xis OFU. .40 ­4 Zoe Or _ flPolb_�p 1 SD • • a o` E1���ti✓s+o rJ o h k op;= r j �o s U R� . \.i .+•7 • 4Vey' ' EL= roo;o TE T y /6 ofl a 'L 45.10 s 1�- 4 ' T. • � 4 f��°r � �`1JdfL �suAn�E� P�r�c-rr�� , ►s Q__' J ti �QAu b FtA i�4r-,L Ct A rSE:A' LC�bZ�1i0J - EXISTING SPOT ELEVATION OxO CERTIFIED PLOT PLAN 3 EXISTING CONTOUR --- 0 A —=- FINISHED SPOT ELEVATION �. o oRSE C0 7T( > f ' FINISHED CONTOUR 0 . No ,o�s14 APPROVED BOARD OF HEALTH A'Po�`��•tsYEP6`�, IN N FSSIONA1.�a AARS tAJ§L9,t1dA8Sa DATE ' ' AGENT SCALE, / = -v BATES 9I3/82- IrLDREDA-r ENGINEERING Ca INOBAys'�� CLIENT r ---M- ' . 1 CERTIFY THAT THE PROPOSED EGISTERE REGISTERED ,jOO po, BUILDING SHOWN ON. THIS PLAN E.W.B NEE CONFOFMS . TO THE ZONING LAWCIVIL LAND � t'dY BARNSTA LR E.ASS. cx�E r 712 MAIN STREET CM: BYE ` R AsNoi HYANNIS, MASS 2 `� a2 -- SHELT-L-OF DATE EG. LAND SURVEYOR _ 20 FT. Mi/r/.,'-` /VOTE /F E/TNER THE SEPT/C TAN.�C OR LE/fCN//Vr ?17' ARE MORE 77NA:"J /Z"SELO.4V . . /D PT. M/^/ " 1RA�F� sW 24 ..,p/AM ETER CONG'P. .ETE COiiER �_ S/lALL BE 9RC�UGNT TO GMA DE.��,✓ EX-77AFA CG/VCRL'_T�'" �+ -we* P/PC /-0ER V y CA S 7" ;`RON C 0 Ii.ER Sf��4 t-L 0-= USED M/N.. P/TCN IF/N DR/VElti<4 y O COYER.S /B PF.P FT 2 • M/a. CONCRETE A . G-� C d V E.�' CLEAN SA N 4'CAST� - • - • . /RCN ST /0 0 G o a o o a G1F I�8 -31B d MIN.:P/TGM G.4L.. a • • • . e . o r a •4. L %4"Pon ITT..- SEPTIC TAN/C D/sT. � ♦ s • • • r r •� • + WA SHEO STL?NE B is a ♦ ♦ • r •EfEECT/t'G r ` . ♦ .; ♦ • r • • G.l�PTN • • • v WA5NAFP STaNE ' - v., . s. . r • . • • ." • • • v O v PAGE .-7£r k `i,O. ,78 PRE4a5 T SE .� ' • • • � . • • � e PIT OR EQU/✓- � .. INi�B/�T.�L`ENAT/..OHS Fl-r CAPA uTy . s¢� 47A4,10,--X ♦ . • • . a E�. 90.0 E INVERT AT O O//Jl�. NG-, 00 O` FT. 1 . /NLE.T'SEPT/C T•4 V.A( 48 .6 FT r"T. O/rat M C(SEE TABULATION OtlTLET SEPTIC Tir►NK.. 9�•8 96.8 FT GROUND 0447' TAaL E /HEFT D/STR/B!/T/DN BOX - �" ,.SECT/G/V OF' � . Ot/TlETD/STRIBUT/4N ADX 96..CM FT C /NtEr cgACN/NG PIT' SELVAGE O/SPOUSAL SYSTEM LEACH/NO PIT TABULATION SCALE �4.~ l�/HENS/ON A 3 FT. DES/6N'CR/TERI�t O/M.E/Vs/aN NlJMBER OF 9EOROOMS" - O/MENS/ON C. 4 FT. lul Fn/. Rd,46ED/SPOSAL UNIT oN SOIL LOG $D/L TEST TaT.44 E?TI/rlATEO FL"�OI'V 3 3 0 G.4L.1DAy SO/.L TEST SOIL 71�ST .2 NUMBER aF 4AWACHtw4 P/7:5_1 fEtE✓ ffLFY, / ,DATE (IF' SOIL TEST 13 S/aELr'ACHlNG PER,P/T, l•ESQ PT., 2 RESIIL'!'S AV/T/VESSED dY BOTTOM LZ4CN/NG PER P/T L—O SQ. FT. F'ERCOL/'+T/D/v MATE At/ � =`' MINT//INCH �. TOTi4L LEACH/NG AREA ZG.6 SQ FT. u,g Sv"!L �COL,O77aV RATE } RESERi�ELE.4�'N/,Vd A/rEA 2 "b SQ FT , °jFT, ot. r�o� ro _ •7 — 4 FUEr BE O H OF M, of LEACH!w �%�F Af, P� sss � "�,�, ! 860 c ` ZC 7- -'' `� T'C �� 1:.�, A it 4fI ik= Co _� IV f^i l-i .L RSE v, •/ W�i ��(Sr.=t, r' t p No.1095k,�O i�ar "' R JV N ii A O F Q S I AFL RE / G O / C I 90F�SGIST C a 7 712 '"A//Y ST. , HYgAIAIIS. M.gSS. 1. Sl7R`1�y S10NAL ® NDGROI!/V0 YNi4TER E/VCOU/VTEREO ['L/ENT:8.4y-57" DATE : 9 3 9Z r �;• '.. C3 GR0 UA,10 LVATER AT ELE(/ - JOB