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0089 WAQUOIT ROAD EAST - Health
89 WAQUOIT ROAD EAST COTUIT ----- A=018-084 I I i r G� WA TOWN OF BARNSSTABLELOCATION I Ql16% E. SEWAGE# VILLAGE GQ_r_U ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. pj G�(2- CUB ST 5-06 -2 7 4- 1-7s3 SEPTIC TANK CAPACITY 1500 ?e y&v6_E`2- LEACHING FACILITY. (type) -7T_,e,4J G l4 (size) //X NO.OF BEDROOMS �- OWNER L f/JZT 1A,( PERMIT DATE: COMPLIANCE DATE: 2�4 Separation Distance Between the: ¢— Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1, 0 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) A,- Feet FURNISHED BY �i - 4 - 44 48 � X , -Z y- 23 Irv% 1 35 T�1 -14 Z- rl Y Z-7 No. Dl9--l9G 1 Fee 50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Y s 2ppliCation for Vspo8al ,*pstem Construttivn permit Application for a Permit to Construct( ) Repair( ) Upgrade v� Abandon( ) [Z/Complete System ❑Individual Components'g Location Address or Lot No.M W&iu o jr Q. Gocs 1' Owner's Isame,Address,and Tel.No. t' Assessor's Map/Parcel �� �j�j'-� ��J uv�� Lww t� r Installer's Name,Address,and Tel.No. V 4N C-E CONS T, Designer's Name,Address,and Tel.No. : RD Q vrH A- 62-S3 b 5"a-Y f7 53 Type of Building: r Dwelling No.of Bedrooms 4 Lot Size tall 1 (D sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) \0 gpd Design flow provided lAdN, gpd Plan Date 4��� �� Number of sheets Revision Date Titles 1 ` Size of Septic Tank ��(�(7 1-1' to Type of S.A.S. JCS"C4r—(ACM be?.r S Description of Soi1l)- 2 � c�✓1 1(k), � t21-3�7`��V�31° �l i�'WU 5 iu a_ J—I7,0 '`/31"-11A"Q)UCL Sa_8— tom— , /T �, 3 3`'-12o'A3 -I id iYt��ss,d ( `) �—\�i (�`�t��� can lOc�itm 14-�'�i"/i'x''-31i'' �uc3ywt..tS:Jn� � �� , Nature of Repairs or Alterations(Answer when applicable) 'IN 9 AN►D UAL 15 T S-E?71 G vsfi ct- Ntv✓ 150 Thn/ � A,/7 Sys. r�' x 37.E Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ed .v- Date dS Application Approved by Date Application Disapproved by Date for the following reasons t Permit No. (�����c Date Issued No. �Dl / F " i` " A y ::v is i ' r4, Fee N! J'✓ j� v i M t ` ` Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH_DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1 � 2pplication for disposal 6psteiri Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade(/ Abandon( ) 2/complete System ❑Individual Component Location Address or Lot No<�GlOct: " "'''.f, ' W by O �-�'G`s� Owners Frame,Address,and Tel.No. s 3. Assessor's Map/Parcel t�l�� �j�,.!-{ L/V� � (op,,yi CA,4 AC I Installer's Name,Address,and Tel.No. V lAN i�0— CONS 7 Designer's Name,Address,and Tel.No. �? 4� (waw4(L 120 I-,. F-At,111ov114 11 0 �36 ��� z�4 °�7s s VjE ,,�� d� &V L , -k Type of Building: Dwelling No.of Bedrooms Lot Size 4l, %(O sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) \�D gpd Design flow provided L�C�'z gpd Plan Date LALA A-I('1 Number of sheets ` Revision Date Title�I �• A Sp,, 2 P�Ojn Size of Septic Tank D0 -I0 Type of S.A.S. 5-1)-C110`A ICN1 Description of Soill�)--1Z` �cL t IUc� , I U-3 �1?:'��1` 11 N h t I S r� i� 3�"- t 2 0"/31"-1 lyaimS�rd- r Nature of Repairs or Alterations(Answer when applicable) J-\K AN 7 0A) L)e' I' + ( S y S 1 E Z f� S'T A C L N vv 15`0 T/ ,/ L_ S A.S. /1 ' X ,. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ed .rr Date US Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Zy Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(✓) ICI Abandoned( )by at W ca(1 U 01 J_:�L� L�_ 60�U i �- has been constructed in accordance i, with the provi ions of Title 5 and the for Disposal System Construction Permit No. 2.,e )dated G t( Installer i u, 9i o Designerc�cw kA4I I #bedrooms y Approved design flow GjZ J gpd The issuance of this`permit shall not be construed as a guarantee that the system wil fun design d. w Date Inspector ------ ----------- - - ---- - - - - - — ------- - � v ------------------------ No } � _ f �� - Fee F� ,�, , , r, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 33is#osal 6pstrin Construction permit Permission is hereby granted to Construct( +) Repair( ) Upgrade(✓) Abandon( ) System located at C� j/� (n I)U l f) (())_j)-; and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con truction must be completed within three years of the date of this permit. Date I Approved by Town of Barnstable Regulatory Services Richard V.Scali,Interim Director anatvsrnsu. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax:508-790-6304 Installer&Designer Certification Form Date: 4-28-20 Sewage Permit46/I M � Assessor's Map\Parcel 018-084 _Designer: Cape&Islands EngineeringL Inc Installer: Dalpe Excavating Address: 800 Falmouth Rd, Ste 301C Address: 11 Tradesman Circle Mashpee,MA 02649 East Falmouth,MA 02536 .. On Brian Revenger was issued a permit to install a (date) (installer) septic system at 89 Waquoit Road East, Cotuit based on a design drawn by(address) Cape&Islands Engineering,Inc. dated 9-1-17 (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the septic system referenced above was insed with major changes (i.e. greater than 10' lateral relocation of the SAS or any verticaVrelocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the RA approval letters(if applicable) A Z11 OF b I �� o � RAUi. yc g L17ARDr-RrVERA m (Installer s.Sig.,a . e) 0 crvri_ r / N0.46W co G1STE¢�� (Designer's Signature) (Affix Design ere) PLEASE RETURN TO BARNS-TABLE PUBLIC HEALTH DIVISION CERTIFICATE QF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU, QASeptic\Designer Certification Form Rev 8-14-13.doc ■r 24 2016 19:07 Jim The Inspector Man 5085349919 page 1 ■ ■ 019-- 08� Commonwealth of Massachusetts µ1 A Title 5 Official Inspection Form #1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19J 89 Waq unit Road r Property Address Marjorie White Owner Owner's Name information is ~` require.dforevery Cotuit t/ MA 02635 4-21-16 page. City/Town State Zip Code Date of Inspection m` 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:ut When A. General Information filli ng the computer, J \\```` ��N otFl.... �i use only the tab .� 1. Inspector: a _ .o key to move your o G IS ' cursor-do not JAMES James D.Sears .m — use the return Name of Inspector s c>: :ti key. Capewide Enterprises, LLCM Company Name trT! •.• r1T1.,' 153 Commercial Street ,,, 51 N StPEG� 0 Company Address Mashpee MA 02649 Cityrrown Stale Zlp Code 508-477-8877 81623 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 �12c.a- 4-21-16 spector'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. t51ns•31'3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Apr 24 2016 19:07 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts U?V1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 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: The system is a 1000 Gal. Tank and pit. 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): t5in3•3113 TIIIe 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Apr 24 2016 19:07 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waq u oit Road P rty Address Marjorie White Owner Owners Name information is COtUIt required for every MA 02635 4-21-16 page. City(Town State Zip Code Date of Inspection y 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 (cunt.): ❑ 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): i ❑ 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. I. 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•3113; Title Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Apr 24 2016 19:07 Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waquoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 page. City/Town State Zip Code Date of.lnspection 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 5 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 is less than 6"below invert or available volume is less than Y2 day flow Piz 15ins•3/13 Title 5 Olflual Inspection Form:Subsurface SewageDisposal System•Page 4 of 17 Apr 24 2016 19:07 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waquoit Road Property Address Marjorie White Owner Owner's Name information is COtult required for every MA 02635 4-21-1.6 page. City/Town 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. El ® The system falls.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•3113 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 f Apr 24 2016 19:07 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate'yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. � ® 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): NA Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 (Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 5 ' Apr 24 2016 19:07 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °V . 89 Waguod Road Property Address Marjorie White Owner Owner's Name information Is Cotuit MA 02635 4-21-10 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank and pit. Number of current residents: 0 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 ears usage d 2014-18,000Gals g ( y 5 (gp �)' 2015-8,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commerciallindustrial 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: tSins 3113 Title 5 Official Inspection Form:Subsur'aoe Sewage Disposal System-Page 7 of 17 Apr 24 2016 19:07 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waquoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 09/11 05/14 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,IMEMENINEEM 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): tSins•3/13 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 8 of 17 . I Apr 24 2016 19;08 Jim The Inspector Man .5085349919 page 9 4,*\_1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' r 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: Around 40 years+. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 40" feet Material of construction: ❑ cast iron ®40 PVC other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.) Pipeing is PVC SCH 40 and orange burae: Septic Tank(locate on site plan): Depth below grade: 29" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: t5ins•3/13 _ - Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 9 of 11 Apr 24 2016 19:08 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 89 Waquoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21=16 page. City/Town State Zip Code Date of Inspectlon D. System Information (cont.) Septic Tank(cone) Distance,from top of sludge to bottom of outlet tee or baffle 29-1 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 29" below grade w/covers at 10". In and outlet baffle's. No sign of leakage or over loading. I 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 [Sins 3/13 Title 5 oRcial Inspection Form:Subsurface Sewage Disposal System•Page 10 or 17 Apr 24 2016 19:08 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 89 Waquoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 page. City/Town Stale 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: o gallns 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17. Apr 24 2016 19:08 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owners Name information is required for every Cotuit MA 02635 4-21-16 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Box 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.): 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•3/13 Tltle 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 17 Apr 24 2016 19:08 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts w _ Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ' 1 leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ inn ovative/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 is a 1000 Gal Precast Pit no stone. Pit and coner at 23"below grade. Pit is dry w/stain line around 1'. No sign of over loading or solid carryover. No hgh stain line. 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 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Apr 24 2016 19:08 Jim The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary 9 P y u tary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owners Name information is required for every COtUIt MA 02635 4-21 A 6 page. Cilyrrown State Zip Code Date of•tnspection 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•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Apr 24 2016 19:08 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Waquoit Road Property Address Marjorie.White Owner Owners Name information is Cotuit MA 02635 4-21-16 required for every 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 o ` 151ns•3113 Title 5 Official inspection Form.Subsurface Sewage Di sposal System•Page 15 of 17 Apr 24 2016 19:08 Jim The Inspector Man 5085349919 page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rf 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 page. City/Town .State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /VO Estimated depth to high ground water. 12+ 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: r You must describe,how you established the high ground water elevation: Area and abutting property high. Bottom of pit at 8' below grade Before filing this Inspection Report, please.see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Apr 24 2016 19:08 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 4-21-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)'completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Sutnurtace Sewage Disposal System-Page 17 of 17 DATE- �3.0.19A. �® Mq y CEO PROPERTY ADDRESS: .,• 89 Naquoit• Road. 23 1997 Cotuit,Mass . �' � D� 02635 On the above date, I Inspected the septic system at the above address. This system consists of the ffoiiowing: 1".* 1-1000 gallon septic tank. 2. -.1-1000' gallon leaching pit. Based bn my Insr-ectlon, I certify the following conditions: 1 . This is a title five septic' 6y6tem, ( 78 Code ) -2. The septic system- is in proper working order • at tke. p_resent time. 3• Replaced broken cover-on the leaching pit. l, . The leaching pit is dry. SIGNATURE: Name J P Macomber Jr_.. i Company:_' • P_Macomber & Son_Inc. ; Address: ------ Cente_rvi11,eLMass__024632 ' Phone:___508..�Z7 .3338------- ---1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH P. MACOMBER- & SONS INC. Tanks-Ceupools-Leachfields Pumped & Installed Town Sewer Connectlons P.O. Box 66' Centerville, MA 02632-0066 775-3338 775-6412 Commonwealth Of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection 09"Morlam F.Weld Trudy Cox* Aryeo pawl C*uuoc! David B.Strube LL Gorsrnot � • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION P,,p,"Addresa 89 Waquoit Road Cotuit,Mass . Add.«sofOwner.169 Ministerial Drive Date of Inspectlon:4/3 0/9 7 (It different) Concord,Mass . 01742 Name ofIaspeotor.Joseph P.Macomber Jr. Company Naaue,Address and Telephone Number. J.P.Macomber & Son Inc.Box 66 Centerville,Mass . 02632 CERTIFICATION STATEMENT 508-775-3338 I certify that I have personally icspectad the"wage disposal system at this address and that the information reported below is true, aoctiurat* and complsts as of the time of inspection. The inspection was performed based on my training and experience in the proper function and msiatsaance of on-sitasssswage disposal system,. The system: Coaditioanally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fads iaspoctor's Signature: 1fh*"11 *ta1- Date: y 7 The System Inspector submit•copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspeaion- If the system is a shared system or has a design Dow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Departmsut of Environmental Protection. The original should,be"at to the system owner:cad copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Chock A. B. C, or D: A) SYSTEM ASSES; ' I have not:Quad any information which indicates that the system violstas any of the failure criteria as dsDned is 310 CUR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: ,..tfjjl Gas or more system components need to be replaced or teinrpscd Paired. The system,upon oomplstiou of the replao"Nut or repair,passes Tndicate M ao,or not dstsrmiaW(Y. N,or ND). Describe basis of determination is all instances. If*not determiner,explain why not) The septic teak is metal,cm ked,.tructurelly unsound,shows snbetaatial inDltr ation or wdUtration,.or tack failure is imminent. Th*system will pass inspection if the existing septic task is repUced with a ponforming septic task as approved by the Board of Hsalth. (revised 11/03/95) 1 One winter Street a Boston,Massachusetts 02106 * FAX(617)556-1049 * Telephone(617)292•S300 ��►riM.d on N.cticMa►.pv SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Prop.rtyAddr..s: 89 Waquoit Road Cotuit,Mass . Owner. Marjorie White Data of Inspootloar 4/3 0/97 B)SYSTEM CONDITIONALLY PASSES (continued) �fJ�Ue. Sewage backup or breakout or boh static water level observed in the distribution boa L duo to broken or obstructed pip.(,) or due to a broken,settled or uneven distribution boa. The system will pass inspectlan if(with approval of tba Board of Health): . broken pipe(&)are replaced obstruction is ramoved distribution boa is levelled or replaced UD Ths system required pumping more than lour times a year duo to broken or obetrwtd pipe(s). Tbs system will pass inspedion if(with approval of the Board of H"hh): broken pipe(s)are replaced obetructton is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTEU VO Conditions exist which require Author evaluation by the Board of Health in order to determine if the systam is failing to protect the public health,safety and the oavironmeut. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 19 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: &P Cesspool or privy is within 60 foot of a surface water se Cesspool or privy is within 60 fosOf a bordering vegetated wetland or a salt mush. 3) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER IF APPROPRIATE) DETERMINES THAT THE SYSTEM 1S FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT•. 10 Tha system has a saptle tank and soil absorption system and in within 100 test to a surface water supply or ubwy to a surface water supply. !W Tha system has a septic tank and*oil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil al)+orption system and is within 60 feet of a private water supply wall. �Q The system has a septic tank mad soli absorption system and is leas than 100 feet but 60 foot or more from a private waur supply well,unless a well water analysis for coliform bacaria and volatile organic oompounds indicates that the well is &W from polbAloa from that facility and the presence of mmmonia nitrogen and nitrate niUvpn is equal to or Las than 6 ppm 3) OTHER (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: RQ Waauoit Road Cotuit,Mass . Owner. Mari orie White Date of Inspeotloa./,/3 0/97 D) SYSTEM FAILS: 4/0 _ I have determined that the system violates one or Mon of the following failure criteria as AsAmad in 310 CMR 16.303. The basis for this determination is ideatided below. The Board of Health should be contacted to dst=dw what will be necessary to correct the failure. Backup of"wage laic facility or system component due to an overloaded or clogged SAS or cesspool Discharge or ponding of sMusat to the surface of the pound or surface avatars due to an overloaded or cloggd SAS or cesspool. Q, Static liquid level is the distribution box above outlet invert due to an overloaded or clogged-SAS or cesspool. l A&A Ar Liquid depth in avenges!Is lass than 6'below invert or available vohums is less than W day Cow. /� Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -*VD Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. &/ Any portion of a 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 I of a public wall. Any portion of a cesspool or privy 6 within 60 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 fest but greater than 60 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 compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above•. The system wives a facility with a design Cow of 10,000 gpd or peaty(Large aystsm)sad the system Is a a{gniScaat threat to puhfy health and safety and the anvironmaat because one or more of the following conditions edst: the system is within 400 feet of a.surface drinldng water supply the cystsm is within 200 feet of a tributary to a surface drinldng water supply the system is located in a nitrogen sensitive arw(Interim Wsllhsad Protection Area WPM or a mapped Zone II of a puhl;c water supply well) The owner or operator of any such system shall bring the system and facility laic Ar11 complLaoe with the gsoundwatar treatment program requiremeats'of 314 CUR 6.00 sad 6.00. Please consult the local regional o111oe of the Department for Ai thar Information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropartyAddr..a 89 Waquoit Road Cotuit,Mass . Owner. Marjorie White Date of Inspection: 4/3 0/9 7 ' Check if the following have been done: ` ,,Pumping information was requested of the owner,occupant,and Board of Health. /Nons of the system componagts have been pumped for at least two weeks and the during that period. Large volumes of water have not been introduced into the em has been receiving normal now rate, recently or as part of this inspection. ,LAs built plans have been obtained and examined. Not@ if they are not available with N/A. 1C T�facility or dwelling was inspected for sues of"wade back-up. Tim system does not receive nou sanitary or industrial waste flow JL"1'ne site was ins for of pooled ,,,/suns breakout. -k All system Components.i aWing the Soil Absorption System, have been located on the site. z4bs septic tank manholes were unwva:ed,opened,and the interior of the.optic tank was inspected for condition of bafaes or tees,material of construction,diaunsions,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 edsting information or /7naUPfU0&,dcx"by ted by non•intrusive method owner(and oocupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) C5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreas: 89 Waquoit Road Cotuit,Mass . Owner. Marjorie White Date of Inspeotiaw 4/30/97 FLOW CONDITIONS RESIDENTLkU Deaip flow-4 y ns.pe l A/*Y e Number of tz) m.: Number of Current resident, Garbage grinder(yes or no): Laundry Coaaected to system(pr or no):,d Seasonal use(yes or no):_Z % �} Water meter readings,if available: % D l JZTn r nt Last date of oocuPanC7:1dd COMMERCIAL NDUSTRIAL- Type of ertablis at: Design Dow: 4 h9 p1loWday Grease trap present: (yes or nOW0 Industrial Waste Holding Tank present: (yes or no)AW Non-sanitary waste discharged to the Title 6 system: (yes or no)&4 Water meter readings, if available:_ Last date of occupancy: OTHER (Describe) Last date of oocupanry:_�� GENERAL INFORMATION PUMPING RECORDS and source ofInformation: Syst&m pumped as part Of inspection:(yes or no).,W If yes,volume pumped: .c6/ ns Reason for pumping: TYPE OF SYSTEM &P t /soil absorption sy tem ._.W,!9 Single Cesspool —,d,bL Overflow Cesspool Privy Shared system(yes or no) (if yea,attach previous inspection records, if=y) Other(explain) APPROXIMATE AGE of all component&,date LL#AnW(if known)and source of iaformatioa sewage,odor*detected when arriving at the site: (yea or no) (revised 11/03/95) 6 C� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• • SYSTEM INFORMATION (continued) Property Address: 89 Waquoit Road Cotuit,Mass . Owner: Marjorie White Date of Inspection:4/30/97 SEPTIC TANK:-&WS7 co v 408,�XC 7,9a1A e (locate on site plan) Depth below grade:_ material of construction: ._concrete _metal _FRP—other(explain) Dimensions: d TEE / Sludge depth:, I ' Distance from top of sludge to bottom of outlet tee or baffle:,�,�� �Scum thickness: Gc Distance from top of scum to top of outlet tee or baffle:-2—=�9. Distance from bottom of scum to bottom of outlet tee or baffle.'/ia-re Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles. depth of liquid IPvel in relation to outlet invert, structuralrity, evidence of leakage, etc.) Pumn tank •every 2-3 years :Inlet & outlet tees -aXp J n 1,.r-Q!T,; quid liquid level l �o�` ,�o�utle invert is 51 1 : Septic +�nlr i +ri n+.nrally aniind o eyiUenoe or eleakage. GREASE TRAP. /VVA)t— (locate on site plan) �g Depth below grade:414- material of constmrion O.oncrete metal _FRP _other(explain) Dimensions,, Scum thickness: Distance from top i scum to top of outlet tee or baffle:-Ald Distance from bosom nt trum 1n honom of outlet tee or baffle-. AO — Comments: (recommendation for pumping, condi—rl of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, et • Grease trap is ri-o nT,. I , (revised 1/1$/95) 6 I� . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropestyAddre.w 89 Waquoit Road Cotuit,Mass . owner. Marjorie White Date of Iaspsotiow 4/3 0/97 TIGHT OR HOLDING TANI{:/0Cf (boats on site plan) s Depth below Material of�4 _nstal_FRP_otber(uplaia) Dimas:ions: AlA Capacity:_ AIA gallons . Design flow: ns/day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,stc.) Tignt or rioling DISTRIBUTION BOJLAAWe, (locate on site Plan) Depth of liquid level above outlet invert:�l`�_ Comments: (note if level and distribution is equal,evidance of solids carryover,evilancs of leakage into or out of boa,etc.) Are sent, PUMP CHAMBER:,&6Jr-- (locats on site plan) Pumps in working o:der:(yes or ao) J/ Comments: (note condition of Pump chamber,coalition of pumps and appurtenances,stc.) ump c am er is not preSenU. (revised 11/03/95) SUBSLWACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(000tlnued) Prop.styAddr.ss 89 Waquoit Road Cotuit,Mass . owuor.. Marjorie White Date of IDip.oNou: 4/3 0/9 7 SOM AMRP 1ON OYSTER GSAsIc�Q�1.�0.t.�Qri c4 ST 1 r Oocate an she Pla4 if Poosib3e;cmvation not nqulsrd,but mqi be appra imatd by wa4ubmalve methods) If Dot detw=luod to be prevent,arplaia TyP« U&Ph l P4 number Laehia j chambers,anmbar. �p►ilesiee,number. l.ach�tr.acb.e,astmber,leD�th: Lac>siM a.3da,number,dimeasioae: c� nf mm��r mraow orsspool,number._, Meaium sa II-eo&O'f1&e°t�"a4 � s g s�iydrauilT a 0!` or pon ing- All vegetation is normal T.aar•hing ;it, is dry CFSSPOOL9s (beats on as plan) Ntsmbaz and tea_ i11i4 Depth-top c(bgWd to inlet invert:_ h24 Depth of solids Iyv_ A1A Depth of grim l+Var. Dimaasi= cf owpool: Materials of Construction: Indication of pvuadwaur._ JU inflow(oe.epwl muet be pumpd as part of iaspectioa) Cesspools are not presen Commsats:(Dots oonditian of veil,nips+Of hydraulic fakwo,level of poadin&Condition of v goution, etC.) CAssnnols are not present. PRrvy,/J&,t, - Qocate as ate plw Mater4L of oanat:tisdion:_ Dims d=-:_ I.y14 Depth of solids:_ Commaatr:(note wadid=ad.ofl,sip i of hydraulic UUM,level of pondinp oondhtloa of v.�tacioaa.:tc.) Privy is not present. t� (revised 11/03/95)• i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION •FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L_SPOSAL SYSTEM: include ties to at least two permanent references landmarks. or benchmarks locate all wells within 1000 Cotuit Water Company 428-2687 t i DEPTH TO GROUNDWATER .a12!.++_ depth to groundwater r+gthod of determinesion or approximat Ni water_ excountere . •,k -n-_-8 s; :gym:rW°g S.;,i sly. I •n.M1T•.r•R1T�r"TT�111R—!Rf'RTIf�TIT1RfJ'RRI:'TTT.w►l�T�.'.IR1fRRYI��IAT �,���—...�-.r. TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION F._•TT'1�T•••::t—T.IIR�TTRR'If1R'R.TII T7/rJR7/7f."717T.T—t•I T'IVTR'\�R�—T�7AA�I�I�IA�lt�1 tw11 !.+'rT'T�•�..�. —TYPE OR PRINT CLEARLY— PROPERTY INSPECTED STREET ADDRESS 89 Waquoit Road Cotuit,Mass . ASSESSORS MAP, BLOCK AND PARCEL OWNER's NAME Marjorie White PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Sd'h` �nc. COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 . Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( 508 ) 790 - 1 578 CER'rIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: .XXXXXXXXXXX Systeui PASSED t The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con tcted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 4/3'0/97 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH, * If the inspection FAILED, the owner or operatorshall u d within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3,10 Chjn 16 , 305 . partd .doc THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. Junc 8, 1995 IIII Acting Director of the ion of Water Pollution Control f yay 13 14 09:51 p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form ' i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 5-9-14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important When A. General Information filling out forms ``��uuunlrrryr�r� on the computer, `\`��SH OF M,gss,����� use only the tab 1. Inspector: �I 0er� qc key to move your 7 1 g p ; y cursor-do not V lV = = JAMES u' use the ieturn James D.Sears 3 Name of Inspector z key. % 63 Ca ewideEnterphses,LLC �•., c o.�* ' Company Name 153 Commercial Street �iF�s 1NSPtEG, Company Address � Mashpee — MA 02649 City/Town Slate Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification W 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems: 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority/�2x�- -� ✓Ii2� 5-9-14 ,,;115spector'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 g p d 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 buyerjf applicable, and the approving authority. 'i ""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. t51ns-3r13 A/ Tile 5 Of idat Inspection form.Suosurraw Sewage uisposat System•page 1 of 17 May 13 14 09:51 p p.2 Commonwealth of Massachusetts Title 5 Official; Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owner's Name "-- Information is required for every Catuit MA 02635 5-9-14 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): !Sins-3/13 Tifle 5 official InTedion Fomr.Sibsuface Sewage Disposal SyVam-Page 2 of 17 May 131.4 09:52p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie.White Owner Ownet's Name information is Cotuit MA 02635 5-9-14 _ required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms 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 pipes) 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): Elobstruction is removed ElY ❑ 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)ae 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(l)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: Y ❑ 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•3V 3 Title 5 Miicial Inspection Form:Subsurtace Sewage Disposal System•Page 3 of 17 May 13 14 09:52p p,4 Commonwealth of Massachusetts Title 5 Official- inspection Form qWSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waguoit Road Property Address, Marjorie White Owner Owner's Name information is required for every COfUIt MA 02635 5-9-14 page. CitylTown State Zip Code Date of Inspection B. Certification (cons.) 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 aseptic 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. k ❑ The system has a septfcwtank 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 analysisi 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: ., r D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"ors"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 Ej ® 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 W is less than 6"below invert or available volume is less than Yz day flow PST tSins-3I13 We S Official inspection Fmm:Subsurface Sewage Disposal Syetem•Page 4 of 17 ,t. May 13 14 09:52p p,5 Commonwealth of Massachusetts Title 5 Official' Inspection Form _ f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 5-9-14 page. CrtylTown 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 pdrtion of the SAS,cesspool or privy is below high ground water elevation. El . . ® 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.] ®3 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000g,pd. . El The systems 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 systerri 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 .:. i ❑ ❑ the systernis within 400 feet of a surface drinking water supply ,V El 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 11 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 b above the large system has failed. The owner or operator of any large system considered a significaht threat under Section E or failed under Section D shall upgrade the system in accordance with 3fO CMR 15.304. The system owner should contact the appropriate regional office of the Departn ent. 15;ns•3113 + Title 5 Mist Inspeclon Form:Subsurface Sewage Disposal System•Page 5 of 17 May 13 1,4 09:53p p.6 . r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Waquoit Road Property Address r Marjorie White Owner Owner's Name i information is required for every Cotuit i'a' MA 02635 5-9-14 page. CityfTown 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: i Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ® Were an"y '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? ® 0Were as built plans of the system obtained and examined?(If they were not available note as NIA) 0 ❑ 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? 0 ❑ 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: N ❑ 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 Condition"s: Number of bedrooms(design): NA Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 15ins-M3 Tille 5 Official Inspection Form:Subsurface Sewage oisposar System-Page 6 cf 17 f May 13 114 09:53p p.7 Commonwealth of Massachusetts Title 5 Official, Inspection Form F _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waquoit Road Property Address Marjorie White Owner Owners Name information is required for every COtUIt MA 02635 5-9-14 page. City/Town State Zip Code Date of Inspection D. System Information Description:' The system is.a 1000'Gal.tank, D Box and pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? z ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): 2012-21,000Gals 2013-22.000Gal's Detail: Sump pump?. ❑ Yes ® No Last date of occupancy: NA Date Commerciallindustrial Flow Conditions: i Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.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-3M3 Title 5 Ofriaal tnsoecrion Form:Subsurface Sewage Disposal System•Page 7 of 17 May 13 14 09:53p p g Commonwealth of Massachusetts Title 5 Official* Inspection Form — ' - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owners Name information is required for every Cotuit MA 02635 5-9-14 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: 09/11 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: al ® 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): ;Sins-3013 Title 5 Official Inspection Fora[Subsurface Sewage Disposal System-Page 9 or 17 May 13 14 09:54p ' p,9 Commonwealth of Massachusetts Title 5 Officials inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments k 89 Waguoit Road Property Address Marjorie White Owner Owners Name information is required for every Cotuit MA 02635 5-9-14 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: Around 40 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 40" feet Material of construction: El 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.): Pi,ei+n*-is 4" PVC.'SCH 40 and orange burge. Septic Tank (locate on site plan): • 29' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) _y If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal_ Precast Sludge depth: 311- 15ft-3113 Tile 5 Ofri6al Inspedion Fomt Subsurface Sewage Dispcsa;System-Page 9 or 17 May 13 14 09:54p p.10 Commonwealth of Massachusetts Title 5 Offic ial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waquoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 5-9-14 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 27" Scum thickness 1° Distance From top of scum to top of outlet tee or baffle 12' Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 29" below grade w/both covers at 10". In and outlet baffle's. No sign of leakage or over loadin .Note: Maint pump after inspection. k Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): p 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 Uns•113 Tne 5 Official Inspecfion Form Subsurface Sewage Disposal System•Page 10 of 17 May 13 114 09:54p p.11 Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 89 Waquoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 5-9-14 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•3113 Title 5 Officlal Inspection Form:Subsurface Sewage Disposal System.Page f 1 of 17 May 13 14 09:55p p.12 Commonwealth of Massachusetts Title 5 Officials Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waquoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 5-9-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present,must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): s 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-3113 Tt:e 5 Official Inspection Form:Subsurface Sewage Disposal Syslem-Page 12 of 17 May 13 14 09:55p p.13 Commonwealth of Massachusetts Title 5 Official; Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owner's Name -' information is required for every COtUIt MA 02635 5-9-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of.technology. ---- Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leaching is a 1000 Gal. Precast Pit, no stone. Pit and cover at 23" below grade. Pit is dry w/stain line around V. No sign of over loading or solid carry over. No high stain line v 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 El Yes ❑ No t51ns•3113 Title 5 Official Inspection Form Subsurlace Sewage Disposal System•Page 13,of 17 May 13 14 09:55p p.14 Commonwealth of Massachusetts Title 5 Official', Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owners Name information is required for every Cotuit MA 02635 5-9-14 page. Cityrrown 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-W 3 Title 5 Official Inspection Fcrrn:Sut%uftoe Sewage Disposal system-Page 14 or 17 r May 13 14 09:56p p.15 Commonwealth of Massachusetts Title 5 Official Inspection form Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 89 Waguoit Road Property Address --` Marjorie White Owner Owner's Name information is Cotuit MA 02635 5-9-14 required for every page. CitylTown 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 13-c�-=3 , Eck I 0 0 0 � f t5ins•M3 Title 5 Official Inspection Form:Subsurface Savage Disposal System•Page 15 of t 7 May 13 14 09:56p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 89 Waguoit Road Property Address Marjorie White Owner Owner's Name information is required for every Cotuit MA 02635 5-9-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar E ❑ Shallow wells Estimated depth tp(high ground water 12't 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 your established the high ground water elevation: Area and abutting property hi' h. Bottom of pit at 8`below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5iis-3113 7llle 5 Official Inspactfon Form:Subsurface Sewage Disposal System-Pape'6 of 17 May 13 14 09:56p p.17 Commonwealth of Massachusetts Title 5 official- Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 89 Waguoit Road Property Address Ma 'orie White Owner Owner's Name infomlatton is COtllit required for every _ MA 02635 5-9-14 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 F< t5ins•W 3 TAIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# 15 Department of Regulatory Services ? BARNSTABLE, Public Health Division Date ldu)-h Vr 200 Main Street,Hyannis MA 02601 Date Scheduled t' l Fee Pd. I d Time DiN1 '" mr Soil Suitability Assessment for Sewage Disposal Performed By: ��� '"r��ver'f�y Witnessed By: ✓'� v �N Y n �1 LOCATION&GENERAL INFORMATION Location Address Kevin Curtin wner'sName 89 Waquoit Road East, Cotuit _ Address Assessor's Map/Parcel: Map 018-084 Engineer's Name Cape&Islands Engineering,Inc.NEW CONSTRUCTION 0 REPAAIR X Telephone# 508-477-7272 Land Use �� V1 +t. i. 0 Slopes(%) Surface Stones �0 Distances from: Open Water Body -�® ft Possible Wet Area -00 ft Drinking Water Well- Drainage �� ft l Drainage Way a00 ft Property Line ft Other ft SKETCH: Street name dimensions of lot exact locations of test holes& er( p c tests,locate wetlands in proximity to holes P h' ) 6 ..� J X d0 QQ 'PL v Parent material(geologic) ' Depth to Bedrock > 0 Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face @� Estimated Seasonal High Groundwater `? ( , DETERMINATION FOR SEASONAL HIG_H WATERTABLE Method Used: "ra w.1 f�`tl��f��IF�(o Depth Observed standing in obs.hole: ey,�� in. Depth to soil mottles: 1f/A- in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST, Date w . e �: � Observation - _ Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak + Rate Min./Inch �" � °g I Site Suitability Assessment: Site Passed Oi Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC • f DEEP OBSERVATION HOLE LOG Hole# i Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) l� ►� . is-30 ;, �4 16 7,.- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Teel a q Consistency,%Gravel D -)2 ®3! 31 - 1Ro Al Or DEEP OBSERVATION HOLE OLE LOG Hole# i Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ Consistency,%Gravel) oa, ?6 14 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) ay. Flood Insurance Rate Map: Above 500 year flood boundary No Yes z Within 500 year boundary No Yes Within 100 year flood boundary Noz Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? _ If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tra' ' g,experti and ex rienc escribed in 310 CMR 15.017. r Signature ' Date /9 Q:\SEPTIC\PERCFORM.DOC Legend x Spot Heights(NAVD88) — Intermediate Contours(NAVD88) #455/� #,tll — — Index Contours NAVD88) .� � X #124 ., � ( #`469 _ 7.53 L_ # O Parcels �f '' 90 "" Town Boundary 485 ' �+� � Railroad Tracks )' 10.37 #216 #2D0 , Buildings 10 Approx.Building #533 4 0 B _ logs � �� -� #�1®� 89 Painted Linesui Buildings ?t o P#236 ; 5.3E Parking Lots X'h7 #{ E3 Paved �A.Pi& 140 0 Unpaved " #� 3, ✓ � Driveways X 252- .55 I 13 Paved 0 Unpaved Roads p Paved Road 38:G 1 : ,,, �� �•. � ❑ Unpaved Road C 0 Bridge It#71 #® [3 Paved Median _Streams 3Es8 y Marsh Q 37.09 �f#259 = ^k #90 G #0 13 Water Bodies 3,1 g cJ 'w #285 37,28 #89 '� } #{2 X 36.&5 _ #255 , + W. # 89 Ct 309 3'7:28 4 t #'271 27.5 `` 3 35,56 #21 r33.1 y 9 #:A # G541 #290 #250 .67 #314 4.93 #230, 35,11 '' 35A5 �' X /642. Map printed on: 1/29/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi J O 167 333 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 167 feet cartographic errors or omissions. gis@town.barnstable.ma.us s f TOWN OF BARNSTABLE OCATION SEWAGE #lgh� ILLACE 6 r1e4� lQ� ASSESSOR'S MAP & LOT VSTALLER'S NAME & PHONE NO. _ 'EPTIC TANK CAPACITY EACHING FACILITY:(type) (size) IO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER-. iUILDER OR OWNER )ATE PERMIT ISSUED: SATE COLfPLIANCE ISSUED: ' ft.IANCE GRANTED: Yes No _ ���-}•. _ . � ,,, . �� .� _., L�. -, . - ��� �� .� � � � � � / ��i �.�� � � . .' � � � - � �-� �� �� . , t i i L1 2,01 _ rrz, ,.,..�... .,.ry �:..�.,...,...__._ ,il. _'.'".�5...3,',�:�.'� 3"i - `L�.,'�"h t•fP''C�, ,',':'H< '#� i w cw N . _ 6 �u � e•r ��k L c�c: • � '__�_ ._�_� +_�_ y -�- . .is I �`�'"�� ��' arise L-Krimmoll is A41IN r �. ' �rti:t��t,'fA�'��4'FYC:Rfi�3 FAA�W µe�G�-0wITR+SFt�t ild'a19.II>'4.13YA t t 3 TITLE ./ •l3 #, _ Sal J �6:4 dyt «�t Centmi n ...:.,. ....ter.�:_. . :, ... ;,:::. o .:--^-_.,.^.4._,..,:..,.,-T--ae�,.—„-�.Y,......•.�w-..,.--.................__ ...,_._,.n. We -11 TWO Ill Cotuit,MA- b ; i�,ATEL,J2 �.... w. ..... K?wr Na:', Giv CHEC, DRAWN 'JO13 i i t. a F �°�' •:,. ., y. __ � SCHEDULE OF ELEVATIONS EXISTING SEPTIC SYSTEM NOTES s ;fir & SEWAGE SYSTEM PROFILE & DETAILS ���,•, �.,�: . ,�� _, =c' NOTES: 1. ALL CONSTRUCTION AND MATERIALS SHALL CONFORM TO THE STATE 1 FIRST FLOOR= DWELLING NOT TO SCALE 1. RISERS AND COVERS TO WITHIN 6"OF FINISH GRADE. tw> °� ENVIRONMENTAL CODE,TITLE 5 310 CMR 15.00,AND THE LOCAL BOARD OF _ 2. H-10 SEPTIC TANK,H-20 D-BOX AND H-10 CHAMBERS AND SCHEDULE 40 PVC PIPE THROUGHOUT. ( ) tF _ , 2 TOP OF FOUNDATION- 3. THE CONTRACTOR SHALL BE RESPONSIBLE FOR OBTAINING A TRENCH PERMIT FROM THE LOCAL HEALTH. - a 2 MATCH f r 3 PIPE INV.AT FOUNDATION= MUNICIPALITY IN WHICH THE WORK IS BEING PERFORMED. ' a a. �• - ,, COVER SET TO WITHIN 6"FROM FINISH GRADE 2. THERE SHALL BE NO CHANGES MADE IN THIS PLAN WITHOUT THE WRITTEN 4 INV.OF PIPE AT SEPTIC TANK INLET= PERMISSION OF THE ENGINEER AND LOCAL BOARD OF HEALTH. \ 1`. * =/ ' .. c :'&' _ ', 13 35.8 5 INV.OF PIPE AT SEPTIC TANK OUTLET H-20 RISER AND COVER TO BE SET TO 11 34-35 .r 12 34.8 WITHIN 6"OF FINISHED GRADE 3. ALL ERRORS,OMISSIONS,AND CHANGE OF CONDITIONS AT THE SITE SHALL BE ;`�. 6 INV.OF PIPE AT D-BOX INLET= _ " 14 36.5 COVER TO SERVE AS INSPECTION PORT 10 32.0 BROUGHT TO THE ATTENTION OF THE ENGINEER PRIOR TO PERFORMING THE 4 31.87 RELATED WORK. a j,:,• 7w f 7 INV.OF PIPE AT D-BOX OUTLET= r t l :;.. r _ S=2%MINIMUM FILTER FABRIC 4. ALL DISTURBED AREAS ARE TO BE LOAAED SEEDED AND MAINTAINED TO o g •, 8 INV.OF PIPE AT LEACHING FIELD INLET- -..,,..M.a°" rig•' / / / � c i PREVENT EROSION. f7 9 BOTTOM OF LEACHING FIELD /t- � ,_. . � :• :»� . ; , 5. FOR PROPER PERFORMANCE,SEPTIC TANK SHOULD BE INSPECTED ED AT LEAST' 10 TOP OF STONE // A Y N THE TOTAL DEPTH F M AN SOLIDS EXCEEDS\l\ \/�\/\ ONCE YEAR AND WHEN E O D O SCUM D SO I S ` "`� ` ' 11 FINISHED GRADE OVER LEACHING FACILITY= H-20 D-BOX \/\ 15'MIN.BREAKOUT GRADE •, , BACK FILL WITH \/\ 1/3 THE LIQUID DEPTH OF THE TANK,THE TANK SHOULD BE PUMPED. EXISTING .,. 12 FINISHED GRADE OVER D-BOX= 5 31.62 WITH SPEED , :. NG BUILDING SEWER TO REMAIN `� •� 9"MIN.36"MAX. � �\\/\\ ` LOCUS LEVELERS gr 4 'a •, .# , -. CLEAN MATERIAL / �� / \ 6. THIS SYSTEM HAS BEEN DESIGNED FROM DATA REVIEWED AND I 13 FINISH GRADE OVER SEPTIC TANK= 16 EXISTING �. S=0.025 L=4' \ �, 5=0.01 L=VARIES \�\�\\\ _ ACKNOWLEDGED BY THE MASS.D.E.P.AND THE LOCAL BOARD OF HEALTH; --► t / //�/ AND CONFORMS WITH THE REQUIREMENTS OF THE STATE ENVIRONMENTAL �� s; 14 FINISH GRADE AT FOUNDATION= . ... O O /�\ \ � ®� '. -J+I- ( CODE,TITLE 5.NO GUARANTEE OF PERFORMANCE IS EXPRESSED OR IMPLIED. �' 15 BOTTOM OF SEPTIC TANK= , o Gl © O ® O c LOCUS MAP NOT TO SCALE 16 TOP OF CELLAR FLOOR= •.•.• .; SCH.40 PVC TEES _ ¢ ® ® � ®� `' w 7. TEST HOLE INFORMATION SHOWN HEREON IS LIMITED TO SOIL CONDITIONS v vc�� '_ Oo © © © OO > _ :.,. a w LU ® © 51 ® ®O O FOUND AT THAT PARTICULAR TEST HOLE LOCATIONS AND IS NOT CONSIDERED SCH.40 PVC TEES U.p GAS BAFFLE U-- AN IMPLIED OR EXPRESSED WARRANTY OF SOIL CONDITIONS BEYOND LIMITS w PRECAST H-10 500-GALLON CHAMBERS 6 31.52 7 31.35 OF SUCH TEST HOLES. ^, G3 EXISTING ----- 8. ALL ORGANIC AND UNSUITABLE MATERIAL MUST BE REMOVED FROM THE PROPOSED 1,500 GALLON H-10 TANK 4 FEET OF NATURALLY 6"MIN.CRUSHED STONE BASE g 31.20 AREA DIRECTLY UNDER AND 5 FEET BEYOND THE PROPOSED LEACHING >r 15 27.12 USE SHOREY PRECAST UNIT OR EQUAL OCCURRING PERMEABLE SOILS FACILITY.THIS AREA MUST BE BACKFILLED TO THE ELEVATIONS INDICATED ON EXISTING SEPTIC TANK TO BE REMOVED CONTRACTOR SHALL INTERCEPT INLET 9 29.20 THESE PLANS WITH SELECT ON-SITE OR IMPORTED SOIL MATERIAL, PIPE AND EXTEND TO NEW SEPTIC TANK CONSISTING OF CLEAN GRANULAR SAND OR OTHER GRANULAR MATERIAL, FREE FROM ORGANIC MATTER AND OTHER DELETERIOUS SUBSTANCES. MIXTURES AND LAYERS SHALL NOT BE USED.THE FILL MATERIAL SHALL 'EXISTING BUILDING SEWER NOTES USE(3)500-GALLON CHAMBERS WITH 37"DOUBLE WASHED CRUSHED CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5-310 CMR SECTION 1-BUILDING SEWER PIPE INVERT ELEVATION TO BE CONFIRMED PRIOR TO CONSTRUCTION. STONE ALL AROUND AND BETWEEN EACH CHAMBER 15.255(3)AND SHALL HAVE PERCOLATION RATE OF BETWEEN TWO AND FIVE 2-CONTRACTOR SHALL INTERCEPT EXISTING BUILDING SEWER WHEN REMOVING EXISTING EFFECTIVE DIMENSIONS:HEIGHT=2.0%WIDTH=11%LENGTH=37.83' MINUTES PER INCH,BEFORE AND AFTER PLACEMENT. �j TANK AND EXTEND SEWER WITH NEW PIPE TO REACH NEW 1,500 GALLON SEPTIC TANK. cci 9. ALL STONE MUST BE DOUBLE WASHED AND FREE FROM FINES AND ANY Q ORGANIC MATERIAL AND MUST HAVE LESS THAN 0.2 PERCENT MATERIAL FINER THAN A NUMBER 200 SIEVE. DESIGN DATA 10. THE DESIGNER HAS NOT BEEN RETAINED BY THE CLIENT TO CONSTRUCT OR _ SUPERVISE THE CONSTRUCTION OF THE SYSTEM.THE CONTRACTOR IS 1. TYPE OF ESTABLISHMENT:EXISTING 4-BEDROOM SINGLE FAMILY RESIDENCE RESPONSIBLE FOR MAKING ARRANGEMENTS FOR INSPECTION OF INSTALLATION OF THE SYSTEM WITH THE LOCAL BOARD OF HEALTH. 2. SEWAGE SYSTEM DESIGN FLOW:110 GALLONS PER BEDROOM=110 x 4=440 GPD 3 11. THE GENERAL CONTRACTOR IS RESPONSIBLE FOR ALL HORIZONTAL AND . NOTE:THIS SEPTIC SYSTEM IS NOT DESIGNED FOR A GARBAGE GRINDER VERTICAL CONTROL OF ALL SYSTEM COMPONENTS. 4. SEPTIC TANK CAPACITY REQUIRED,MINIMUM OF 2D0%OF DESIGN FLOW OR 1,500 GAL. =200%x 440 GALLON=880 GALLON USE 1,500 GALLON TAN 12. TIGHT JOINT PIPING MATERIAL TO CONSIST OF POLYVINYL CHLORIDE(P.V.C.) ( SCHEDULE 40,UNLESS OTHERWISE NOTED. 5. DESIGN PERCOLATION RATE:ASSIGNED LESS THAN 2 MINUTES PER INCH BENCHMARK - e BENCHMARK 6. SOIL ABSORPTION SYSTEM TYPE.CHAMBER SYSTEM 13. THE CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER FOR CONSTRUCTION TOP OF CONCRETE BOUND LOT 92 - INSPECTION AFTER EXCAVATION FOR THE LEACHING BED(PRIOR TO THE _ SERVICE BY TOWN WATER TOP OF CONCRETE BOUND 7. LEACHING AREA REQUIRED:MINIMUM 440 GPD/(0.74 GPD/S.F.,CLASS(SOIL)-595 S.F. PLACEMENT OF STONE)AND ALSO AFTER PLACEMENT OF PIPE&STONE PRIOR ELEVATION-36.85 NAVD88 ( ) ELEVATION=32.16'NAVD88 TO BACKFILLING. I ) 8. LEACHING SYSTEM PROPOSED:2'HIGH x 11'WIDE x 37.83'LONG SYSTEM LEGEND CBDH / J r BDH / BOTTOM AREA PROPOSED=I V x 37.83' =416 S.F. 14. DESIGN ENGINEER SHALL CERTIFY CONSTRUCTION OF SYSTEM AND _-_____ FOUND / °-'; / \ ND 5 / _ ,+ = MATERIALS INSTALLED.THE CONTRACTOR SHALL PROVIDE A SIEVE ANALYSIS ■CB CONCRETE BOUND N 67 11 46 E 2 SIDE AREA PROPOSED 2 x(11 37.83)x 2 195 S_F. ■SB ---- STONE BOUND } / zo OF THE FILL MATERIAL REQUIRED. AN AS-BUILT PLAN SHALL BE SUBMITTED TO - 1 ( 226.08 / \ TOTAL AREA PROPOSED=416 S.F.+195 S.F. =611 S.F. THE LOCAL BOARD OF HEALTH UPON COMPLETION. O RC ------- ROD CAP �- / / OIP ------- IRON PIPE FOUND - PROPOSED 11'W x 37.8'L x 2'H -- -. / 9. LEACHING SYSTEM CAPACITY PROPOSED=611 S.F.x 0.74 GPD/S.F.=452 GPD 0 o SOIL ABSORPTION SYSTEM \ ---� f 15. NO RUBBER TIRE CONSTRUCTION MACHINERY SHALL DRIVE OVER THE Qr ------ TELEPHONE MANHOLE l es a N J°c PROPOSED SEPTIC BED EXCAVATION DURING CONSTRUCTION. 0 ------- UNKNOWN MANHOLE ) 88' ® ------- CABLE TV MANHOLE -� 37 8 100' ��`� l 16. DIG-SAFE AND ALL OTHER NECESSARY AUTHORITIES SHALL BE NOTIFIED FOR ® --- --- METAL COVER \3 5 34.0 - ���O �' B.O.H. SALTWATER ESTUARY REGULATION THE PROPER LOCATION OF EXISTING UTILITIES PRIOR TO ANY EXCAVATION. ------ HYDRANT 50, 6; TP#2a ++ *+ + ++ , +++* + + + -34- �Z#1� q O OK�N - RESERVE AREA + + + - o) Q ------ WATER SHUTOFF c + + + cr, Q 1. LOCAL REGULATION:§360-45(1)(b)MAXIMUM ALLOWABLE DISCHARGE OF SANITARY SEWAGE 17. WATER SERVICE LINE SHALL BE LOCATED AND MARKED PRIOR TO ANY ® ------- WATERGATE - ®TP#1b ON�N 32.9 EXCAVATING AND 10 MIN.SETBACK DISTANCE FROM SAID SERVICE TO THE TP#2b +++ + + + + ' + + ++ MAXIMUM WASTEWATER DISCHARGE ALLOWED=440 GALLONS PER DAY PER 40,000 S.F. I ® ------- WELL / + + 34.5 SEPTIC SYSTEM SHALL BE MAINTAINED. APPROXIMATE LOCATION OF 35.0 34-6 SALTWATER j + =42,956 S.F.x(440 GPD 140,000 S_F.)=472 GALLONS PER DAY ® ------- WATER METER PIT / 35.6 T 8,RAIL FENCE ONE 18. ALL WATER LINES WITHIN 10' F SEPTIC COMPONENTS S = O S C SHALL BE O EST A SEPTIC SYSTEM FROM TIE-CARD P ESTUARY UP ® ------- GAS GATE PROTECTION =440 GALLONS PER DAY SLEEVED WITHIN 4"PVC SCHEDULE 40 PIPE. ® ------ CATCH BASIN SQUARE / EXISTING SYSTEM TO BE REMOVED AREA O 36 ° 2. EXISTING&PROPOSED WASTEWATER DISCHARGE N i ® -- -- CATCH BASIN ROUND + CONTRACTOR SHALL EXPOSE EXISTING _ 0 ® ------- TRAFFIC CONTROL BOX I BUILDING SEWER AND INSTALL NEW 36.5 .t� �Y \ ------- TRAFFIC SIGNAL SEWER PIPE WITH 2%MINIMUM SLOPE 20.0' O� D R1V E r G SOIL EVALUATORS `LOG P# 1594� Q> ---- -- UTILITY POLE I PROPOSED 10'x 12' 10.0" G�w El f: 18 p- ------ GUY POLE 2 DECK x PROPOSED } / a s; \ � Depth from surface in Soil Texture Soil Color Soil Mottos Other Relative �- - ---- GUY WIRE m �,g ADDITION 7� �'�_ _ inches Soil Horizon (USDA) Munsel and Depth Factors E ------- LIGHT POLE ( co co a G �� PROPOSED /'� O 99, �) `10.0' o! o STEP& o�� ! DEEP OBSERVATION HOLE TP#�1 is"Z TP#1 b, ELEVATION 34 ❑EHH - --- ELECTRIC HANDHOLE N w W ❑ LANDING THH ------- TELEPHONE HANDHOLE , EXISTING SEPTIC TANK TO BE REMOVED -� \ GAS SERVICE W 1 TP#1a TP#1b ❑ CHH ------- CABLE TV HANDHOLE - CONTRACTOR SHALL INTERCEPT INLET G x 36.4 ❑ HH ------ UNKNOWN HANDHOLE PIPE AND EXTEND TO NEW SEPTIC T 83.5' w ' 0-12" 0-12" A/E SANDY LOAM ------- SIGN 12"-30" : 12"-31" B LOAMY SAND 7.5YR4/6 FRIABLE ` -� GAS METER W \ APPROXIMATE - " „ " " ---- FLAGPOLE -� - / EXISTING DECK ELEC.METER „ LOCATION OF o - I Q 1 30 -120 31 -120 C MEDIUM SAND 10 YR 7/6 NO SINGLE GRAIN ( ----- CONIFEROUS TREE LOT 100 `� &STAIRS o o ------- DECIDUOUS TREE (SERVICE BY WATER SERVICE d Q a, _ BRICK ° Q DEEP OBSERVATION HOLE TP#2a&TP#2b, ELEVATION 35 --- TREE STUMP TOWN WATER) o #89 p LANDING 36- N Q TP#2a : TP#2b ----- SHRUB }.°od O EXISTING DECK 1 STORY rn - DWELLING„ 0-14" : 0-13 A/E SANDY LOAM ------- CONIFEROUS SHRUB o TO BE REMOVED X 37.4 11-1 O ^ CV \ BULKHEAD FIN.FL.U.=39.1` " ,� . „ �N OF V ------ ELECTRIC METER cN / \ \ w 14 -33 13 -33 B LOAMY SAND 7.5 YR 4/6 FRIABLE A�' 4s ,, ------- SEWER CLEANOUT Z \ \ z Q „ " „ " � O� ,r S ----- SEWER MANHOLE "6' _�'' > 33 -120 33 -120 C MEDIUM SAND 10 YR 7/6 NO SINGLE GRAIN RINSE STATION MATTN C. ® ------- p-Box ti LOT 93 > a o co TA o r�Au> 8 ------ SEPTIC VENT a �-- PERCOLATION RATE_ <2 MINUTES/INCH ASSIGNED TO C LAYER 0 Na '-' �� L}�,gRphRfV1 RA 116.2' 42,956 S.F. ❑ ------ UNKNOWN HANDHOLE U_ -- w DEPTH TO GROUNDWATER=NONE ENCOUNTERED CML ------ SEWER MANHOLE x 36.4 w 0 ADJUSTED HIGH GROUNDWATER= ESTIMATED AT ELEVATION 4 FEET(NAVD88) 'p u N 46845 x 37.3 (9 �' OBSERVATIONS BY:RAUL LIZARDI-RIVERA P.E. ------ DRAIN MANHOLE - p _ o WITNESSED BY:DAVID STANTON,R.S. ------- LIGHT POST � DATE TESTED:APRIL 9,2019 " • � �� O ------ POST NATURALLY T ------ TEST PIT VEGETATED . EDGE OF CLEARING Q -el-1w ;=Hw EXTREME HIGH WATER MHw MHw, MEAN HIGH WATER NATURALLY VEGETATED 35.6 NOTICE MLLW MEAN LOWER LOW WATER S THIS PLAN MAY NOT BE ADDED TO,DELETED FROM,OR ALTERED IN ANYWAY BY ANYONE OTHER THAN CAPE& MLw MLW MEAN LOW WATER 89.9' �s��Fa \ GENERAL NOTES / "\ SF \ ISLANDS ENGINEERING,INC. TREE LINE / LOCATIONS ARE BASED ON AN"ON THE GROUND"INSTRUMENT SURVEY AND ELEVATIONS BASED ON UNLESS AND UNTIL SUCH TIME AS AN ORIGINAL(RED)STAMP APPEARS ON THIS PLAN NO PERSON OR THE NAVD 1988 DATUM.COORDINATE SYSTEM USED IS THE MA-MAINLAND COORDINATE SYSTEM, CATV CABLE TV LINE PERSONS,MUNICIPAL OR PUBLIC OFFICIAL MAY RELY UPON THE INFORMATION CONTAINED HEREIN;AND THIS� COMI COMMUNICATIONS LINE / \ } PLAN REMAINS THE PROPERTY OF CAPE AND ISLANDS ENGINEERING,INC. ' DD D- DRAIN LINE �. ----'- / , � DATUM:NAD 83.UNITS:U.S.SURVEY FEET. E E E ELECTRIC LINE ` J _ _ - 38 ---- - - } COPYRIGHT(C)BY CAPE&ISLANDS ENGINEERING,INC.ALL RIGHTS RESERVED -' � \ } THE FINISHED FLOOR ELEVATION(FIN.FL.EL.)SHOWN HEREON IS BASED ON AN ASSUMED 1"LOWER OHW OVERHEAD WIRES / _ Q \\ THAN THE SURVEYED THRESHOLD ELEVATION. AN INTERIOR INSPECTION OF BUILDINGS WAS NOT OE OE OVERHEAD ELECTRIC \� / JP / DATE DESCRIPTION BY CHK Err FJT ELECTRIC/TELEPHONE / r7�•o= / \ PERFORMED. PREPARED FOR: CD UE UE - UNDERGROUND ELECTRIC t 0, / \ 1 ZONING DISTRICT;RF Err/C - ELEC.rrELE/cATV / ��, i \ KEVIN&EILEEN M. CURTIN --F - FIRE ALARM LINE \ ���o / \ PROPERTY IS LOCATED WITHIN AN AREA HAVING A ZONE DESIGNATION OF NON-HAZARD ZONE X BY 12 WESTWOOD STREET FM FM SEWER FORCE MAIN � \ i �Q- Q h•, / THE FEDERAL EMERGENCY MANAGEMENT AGENCY(FEMA),ON FLOOD INSURANCE RATE MAP NO. $URLINGTON, MA 01803 G - G GAS LINE \ / 25001 C0752J,WITH A MAP EFFECTIVE DATE OF JULY 16,2014. / IR IRRIGATION LINE PROJECT:� � / �': RD RD ROOF DRAIN \ / / / THIS LOT IS NOT LOCATED WITHIN A DEP APPROVED ZONE 11 WELLHEAD PROTECTION AREA. S S S SANITARY SEWER LINE e / / , / THIS LOT IS NOT MAPPED WITHIN A MESA NATURAL HERITAGE AND ENDANGERED SPECIES AREA. T T T TELEPHONE LINE .. 226.08 N ..,}. THIS LOT IS LOCATED WITHIN THE RESOURCE PROTECTION OVERLAY DISTRICT. 89 WAQUOIT ROAD EAST THIS LOT IS NOT LOCATED WITHIN THE WELLHEAD PROTECTION OVERLAY DISTRICT. oT OVERHEAD TELEPHONE LINE / S 67 11 41 W // BARNSTABLE(COTUIT), MASSACHUSETTS T/C TELEPHONE/CABLE TV / THIS LOT IS NOT LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY DISTRICT. W W WATER LINE / } A PORTION OF THIS LOT 1S LOCATED WITHIN THE SALTWATER ESTUARY PROTECTION DISTRICT. STONE WALL / SHEET NO.: 1 OF 1 DATE: APRIL 9,2019 WET WETLAND LINE / LOT 94 / \ WIND EXPOSURE CATEGORY:ZONE B --A--- FWR-A ZONE / (SERVICE BY TOWN WATER) / LOT COVERAGE: DRAWN BY: JVB, RLR CHECKED BY:MC -B- FWR-B ZONE / / I LOT AREA=42,956 S.F PREPARED BY: --V -- FWR V ZONE / l - FZ - FLOOD ZONE EXISTING LOT COVERAGE BY STRUCTURES(HOUSE AND GARAGE) =1,520 S.F.(4%) CAPE & ISLANDS ENGINEERING --CB -- COASTAL BANK BLOCK WALL PROPOSED LOT COVERAGE BY STRUCTURES(HOUSE,GARAGE&ADDITIONS): =1,800 S.F.(4%) CIVIL ENGINEERING-LAND SURVEYING-ENVIRONMENTAL PERMITTING - - - - - - - - _ INCORPORATED. POST&RAIL FENCE DEED REFERENCE:BOOK 29725 PAGE 149 SUMMERFIELD PARK STOCKADEPENCE 800 FALMOUTH ROAD SUITE 301C 508.477.7272 PHONE info@CapeEng.com x x x 508.477.9072 FAX www.CapeEng.com PICKET ROW PLAN REFERENCE: BOOK 19 PAGE 143 MASHPEE,MA 02649 ' xx xx CHAIN LINK FENCE GUARDRAIL O 20 50 OO OWNER: KEVIN CURTIN DRAWING TITLE LOW LIMIT OF WORK EILEEN M.CURTIN SITE & SEPTIC PLAN 12 WESTWOOD STREET (NO INCREASE IN FLOM ° ° o ° ° ° ° n ° ° ° ° O ° ° ° ° ° HAYBALE ROW - - - SCALE: 1�� = 20� - _ - _ _ - _ BURLINGTON,MA 01803 - _ _ ASSESSORS INFORMATION: 018 084 i