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0115 PINQUICKSET COVE CIR
Pinquickil Covey%. ir, E 1` Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: - �PINQUICKSET COVE CIRCLE" Please specify well type: Building Lot#: Assessor's Map#: Irrigation ------� Assessor's Lot#: ZIP Code: Number Of Wells: 02635 Cityrrown: Well Location BARNSTABLE In public right-of-way: GPS ("�Yes l'No North: West: 41.60130 70.44925 Subdivision/Property/Description: Mailing Address: �V,click here if same as well location addres Property Owner: Street Number: Street Name: PENTA 115 PINQUICKSET COVE CIRCLE City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02635 Board of health permit obtained: t±Yes C Not Required Permit Number: Date Issued: W2021 010 `� 03/09/2021 J Massachusetts Department of Environmental Protection Bureau of Resource Protection-Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock uger i-Choose Bedrock- WELL LOG OVERBURDEN LITHOLOGY _ 7From(ft) TOM Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid �... _ 15 Fine To Coarse S >�..� Brown =11 ( Fast>' Slow - - YES NO Loss Addition 15 25 Silty Sand Brown I °Fast�'Slow ( J YES NO Loss Addition ....._.................. ........... ... .......... -- -- 25.-.. 35._ �Silry Sand �i wn r^, (^ -- (^, (•. • Yellowish Brown ( Fast f Slow YES NO _ Loss Addition -..- ............ 35 �40 � (Medwm Sand � Yellowish Brown:�� C � �'�Fast�Slow Loss Addition WELL LOG BEDROCK LITHOLOGY Lrom(ft)" .. .... ......... ........... ......... .............Dropin Extra fast or Loss or Visible Rust Extra TOM) Code Comment addition of Large drill stem slow drill rate fluid Staining Chip s Choose Code 17�1; - -- -- i Yes! Ye Fast Slow Loss Addition -� -- [.. ................. r ADDITIONAL WELL INFORMATION Developed Yes C No Disinfected Yes ("No Total Well Depth 40 Depth to Bedrock Surface Seal Type None racture Enhancement ''Yes (:No CASING IF Is Casing above ground? From To Type Thickness Diameter Driveshoe 37 Polyvinyl Chloride --�! Schedule 40 4 r Yes SCREEN r No Screen .............................................. Type ................... . . ......... ... .........._. .......... . ....... . .. ...... - - - - From To T Slot Size Diameter (37 L[4— Stainless Steel Well Point 0.012 4 WATER-BEARING ZONES r DRY WELL From To-..w Yield(gpm) K.-- -] 40- -- t�.2._............. PERMANENT PUMP(IF AVAILABLE) Wire Constant Speed Pump Description Horsepower Submersible 3/ I Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Pump Intake Depth(ft) 35 Nominal Pump Capacity(gpm) 15 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement Choose Material _± = Choose Material Choose One— WELL TEST DATA Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) 04/12/2021 Constant Rate Pump JI 12 (1„30 WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured 04/12/2021 17 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. WILLIAM Supervising Driller DESMOND, DrillerURQUHART Registration# 877 Monitoring[M] Signature PATRICK, DESMOND WELL Firm DRILLING INC. Rig Permit# 0551 mate Job Complete` - OS/07/2021 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. f ENWRO TECH IABORA TORIES, INC. MA CERT.NO.:M--MA 043 8 Jon Sebastian.Drive Unit 12 Sandwich,MA 0256-3 (508)888-6460 1-800-339-6460 F.4X"(508)888t 6446 - Client Name: Desmond Well Drilling Location: Address: PO Box 2783 115 Pinquickset Cove Circle Orleans, MA Cotuit,MA 02653 Lab Number: DW-211340 Collected By; DWD Date Received: 04/13/21 Sample Type: Well Will Specs: Irrigation 40717' C oeattott'Source,, , Hate"Collected Tt»te Cnllct red ''' i �CUrttmerids> <�ati , Analysis Requester! Units Recommended Limits. Analysis Result' Method ,Ante Analyzed Analyzed By Totat Coliform CFU/100mL 0 0 SM92228 04113/2021 NB @ 1100 pH pH units 6 5-8.5 8.71 SM 4500 H B 04/13/2021 SD ......... :,_ ... ....,... _ ._.:.-. Specific_C.,o...n..ductance° _ umhos/cm 500 83 EPA 120.1 04/13/2021 SD _ .. .. m. .Nitrite-N mg/L 1.00 _ <0.006 EPA 300.0 04/13/2021. SD _ m Nitrate-N mg/L 10.0 0.03 EPA 306.0 04/13/2021 SD — -- Sodium - mg/L 20.0 13 EPA 200.7 04/15/2021. KB Total iron mg/L 0.3 0..03 EPA 200.7 04/15/2021 KB Manganese mg/L 0.05 0.0181. EPA 200 7 04/15/2021 KB Comments: pH is above recommended limit and should be adjusted. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge, Water meets EPA standards and is suitable for drinking for parameters tested. Date 4/19/2021 Ronald J.Saari Laboratory Director M=Below Reportable Limits "See.Aaached Page 1 of 1 o edification ds not ovoilable for this atialyte for potable ivaler samples.. Fee BOARD OF HEALTH TOWN OF BARNSTABLE? Zipplication _for Yell Con.5truction Permit Application is hereby made for a permit to Construct(X), Alter( ), or Repair( an individual welh at: I i 5 f►nQ�jjC_KS--+ Cove C,1 Vd-,e, C0tvi 1+- - ®i`7 oa i Location-Address Assessors Map and Parcel :t C har l 5t , &P-)ftn+ ly1 A o 2179 Owner Address USMY-r l \Jvf It 611 i'y _, ► ham° pQ Abx 7_7�3 o r�ecins . Ivy PC 0Z6 53 Installer-Driller Address Type of Building Dwelling jC Other-Type of Building No. of Persons Type of Well `y LV4 � �YL Capacity 151 `iDm Purpose of Well ►�r t/�to�I �1 Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certi cate of Compli ce has been issued by the Board of Health. Signed �' 3 -zozi Date Application Approved Date Application Disapproved for the following reasons: Date Permit No.Ogeo Issued 3 / Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed, Altered( ), or Repaired( ) Installer at 111—n covei�- has been installed inVaccordance with the provisions of the Town of Barnstablq Boar of Health Private Well rot ction Regulation as described in the application for Well Construction Permit No. - �^ 01 Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector i 1 - � No. � 0% Fee BOARD OF HEALTH 1 �` TOWN OF BARNSTABLE ;. . ZIppYication _for Veer Cou5truction Perk it Application is.hereby made for a permit to Construct oO; Alter( ), or Repair( an individual well at: 1�5 +nGUlc �3 CoVe Clyd-e, COf-v►'1+ C517 U Location-Address Assessors Map and Parcel Pe_nf A 1 -7 t p r c�c�,d Sr rae)fy-&m 1 o a { 78 Owner Address ulc__Irnorlct we0 I PQ BOX Z7� 3 0f >eca`IS Mir P1 G� s3 Installer-Driller J Address f Type of Building f' Dwelling X Other-Type of Building No. of Persons . .. _Type..of Well JC;}`1PG ` Y1. ,_ - Capacity t'"t Purpose of Well Y l l l I 0 h v � Agreement: f The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certi cate off Compliance has been issued by the Board of Health. Signed Date Application Approved, Date Application Disapproved for the following reasons: (,� Date Permit No.V ,9,50/ —off 0 Issued Date ��—�-- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed,(,,), Altered( ), or Repaired( ) by �`.Q��rn 6 n�Ite 11Cri iIi YlA l Ift� ./ Installer _ at V1 n oty i(_K�fi Cove C.t Yc,)-G i (�.Z.7`fi-u t+ has been installed id accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.t\k 1 Dated \_3 Iq - - y r THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD.OF HEALTH TOWN OF BARNSTABLE Vern Cougtructiou Permit No. L,� --0 v Fee Permission is hereby granted to y1 t . Installer J, to Construct( Alter( ), or Repair(.)` an individual well at: , Street e as shown on the application for a Well Construction Permit No. �� _G l e? Dated ��ll Date / / 1 Approved By � i IM l N V a J I / 1 UNREGISTERED PAGE LAND 78 �O PLAN BOOK 562 D O c •365, \ 34 _ 100 63se 99 L \ \ 3� \ \ 98 l,� y�' 0 — I6421 \ o.o \ / PROPQ9ED / ST HOUSE / 98.js 65.4' T.F. 1Oi.5 I i g tagj I I / 98 LLI \ / g138 \ /� CENTERLINE OF GOAD � a iS PROPERTi-� LINE \ + C 1 \ LOT 12 \\ 9 \ \ �y10F v E SN OF 14A UN 29976 Z3 + IG CONTOUR g5.g5 r _ ' r TBM NAIL(FND) 94 34 �9 ELEV- 100.00 rJr ASSUMED OATUM N ` d ` UNREGISTERED LAND i f9p 9`'L I PLAN BOOK 562 PACE 78 �6 w f 1 00 v Lcp 346368 /D0 / I '9 9 y4 W \ 3� 64.2' if i E OPOSED Sr 65.4' T OUSE 101 5 1011, T /9 \ / 9 / I 1y, Q 111 �.0g DB // ir9y9 \\ Y/ I WOOds food } cn 1 / 1 '. 1 F OAD a CENT LINE 0 �.s � 9 \ / IS'PROPERV LINE : \ a edge ofpcwm�-? \\ LOT 12 CmL LEGEND l r_ Q9 —— EXISTING CONTOUR r x 994 EXISTING SPOT ELEVATION [993_ PROPOSED CONTOUR \ \ \ \ dry• , �[99.51 PROPOSED SNOT ELEVATION \\ \ \ \ ® TEST PIT LOCATION ` \\ TEST PITrr-ERC TEST LP —W— WATER SERVICE PLAN REF: it. +�,"1 t � PLAN OF LAND IN BARNSTABLE (COTUIT), MASSACHUSETTS r'�? 9 h�; PLNOUICKSET COVE ROAD, SUBDIVISION OF LOT 112 LCP 346388 JANUARY 23, 2001, BARNSTABLE REGIS RY PLAN BOOK 562 PC 78 j SITE_AND SUBVEY DATA ZONING REQUIREMENTS: ZONE RF LOT AREA........87.120 SF / AFSESSORS MAP 17 PARCEL 26 FRONTAGE'... 150 FT f PLAN REF: LAND COURT PLAN 34636E LOT 12 FRONT SETBACK.. .30 FT ' 4i DATE OF SURVEY: NOYEMBER 22, 1999 SIDE SETBACK... 15 FT REAR SETBACK....,A5 FT LOT AREA: 87,210tef 2.00±oc POPPONE55ET BAY !r 40 0 70 W [off ��M� uses — coTUIT ounD I ( IN FEET ) rsj w R� 1 Inch - 40 ft. = PROPOSED SITE PLAN GRAFTER:PST'DCT REVISIONS: m co 129 PIN UICKSET COVE CIRCLE CHKD BY- OCT 2/2�101-UM HW%ANO SEPTIC DAVID C. THULJN, PE, PLS � I DESIGN: 0T LOT UNES PER ANR PLM!/SAN p COTUIT, MASSACHUSETTS MILL ROAD SCALE AS NOTED E2EAAST SANDWICH, MASSACHUSETTS 02537 rn FOR CARL GRASSETTI MARCH 26 2000 (500) B88-2345 FAX (508) 888-7259 N PO BOX 1310^_OTUIT,WA.02835 le L!LHEET I- Fee 115- 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Disposal *pstrm ConstCULtion 3per mlt Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ,Individual Components Locatio dress or Lot No. O ner's N e,Add re�ss,and Tel.No. Assessor's Map/Par l taller'sZlanbe,,Address,and Tel.No. Designer's Name,Ad ress,and Tel. �' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil u Nature of Repairs or Alterations(Answer when applicable)� '� i Date last inspected: Agreement: The undersigned aAensurecons uction and maintenance of the afore described on-site sewage disposal system in accordance with the provisioEnvironmental ode and not to place the system in operation until a Certificate of Compliance has been issuedeal — Date Application Approved by ' Date7/4 Application Disapproved by Date for the following reasons Permit No. r— Date Issued No, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes-�< PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftprication for ]DisposaY pstrm Construction Verrnit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) El Complete System Individual Components , Location-Address or Lot No. _ , \, Owner's Name,Address,and Tel.No. ^t4 Assessor's•Map/Parc 1 ` p Installer's Name,Address,and Tel.No. Designer's Name,Ad ess,and Tel.No.�C;�►.. 272a Type of Building: '• `' —�Cw—�.,�j vQ O`' v Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures f^, Design Flow(min.required) gpd Design flow provided gpd YY ,... - Plan Date Number of sheets ,, ,j Revision Date Title .. Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) $= Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5rof the EnvironmentalCode and not to place the system in operation until a Certificate of Compliance has been issued by thi oardof Heal Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.��ct o Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(� Abandoned(p,. )by at . /I ��✓ �� 1 L/� r` � � 2(�has been constructed in accordance p, with the provisions of Title 5 and the for Disposal System Construction Permit NQ q -L1 1 dated 1 Installer Designer #bedrooms Approved design flow gpd The issuance of this permit hall not be construed as a guarantee that the system,will funs �}ct^ �i as designed. Date ? � Inspector \ �` ----- -- -------- - - ------- ------------------------------- Nooclq 1 Fee 15CJ_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) . System located at I¢ r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu be co leted within three years of the date of this ermit. Date / Approved b a �� �� f �-��Y��_�����r, �; .,.,...� .-```�, �i���` i Ivan ":. Iti 91fic,i t5g8j 42$=3344 P.i3 �gxa9.�71'l lU@ain Streiet;`�stervifle, l,dA 02655'. secigsullivanengpnxom www:sulfivanen in;com. March 11, 2019 Health Department Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: 115 Pinquickset Cove Circle, Cotuit To whom it may concern, As a result of our discussions, it,has been brought to the attention of the current property owner that the allowable vehicle loading rate of an existing leaching chamber located below the existing paved driveway is unknown. The system which has existed since'.2001,has withstood standard vehicle loading and construction equipment including cement trucks, and was issued a passing Title 5 Inspection at the time of transfer in 2013. We are not aware of any regulation or policy requiring further action at this time. We would request any pending Building Permit Applications for the pool project be released. Very truly yours, Jo O'Dea, P.E. Sullivan Engineering& Consulting, Inc. Page 1 of 1 TOWN OF BARNSTABLE LOCATION (� �j 6•tn QF�(�f XC, t`°e X1 WAGE# ,/► VILLAGE �441 �' ASSESSOR'S MAP.&PARCEL /7 r Q "U0/ INSTALLER'S NAME&PHONE NO. e�46ft!%__ SEPTIC TANK CAPACITY I LEACHING FACILITY- NO.OF BEDROOMS OWNER _ t V PERMIT DATE: / COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY � �r-pI'�j �� � 13' s�� ��� 00 !^G TOWN OF BARNSTABLE �7`3 CATION !FF ,-� ��CIeSEWAGE I' 0 (o LLAGE. ASSESSOR'S MAP&PARCEL ,`� INSTALLER'S NAME&PHONE NO. �/�5�7'c� j�C4'l✓ T/G'/!� SEPTIC TANK CAPACITY '19envaA.1- LEACHING FACILITY.(type) size) NO. NO.OF BEDROOMS OWNER 4amcZ �T m PERMIT DATE: 0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY gufq , ROOM i � A1-:?y A4 4 4 31 -�� AC -67 W " Fr. No. �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for Nsposaf *pstrm Construttion i3Ermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. (j 15 ,r t s !-�,,,yQ °� �w n is Name,Address,ano Tel.No.(ei'7-67/ `v3` q n"�'`�' . >--�.oa�h Sv1lr'a -tom �1/ .%�r1� CxAE2 Assessor's Map/Parcel017--6P �.�rt�u 0 O, 360 Installer's Name,Address,and Tel.No. �"i©Ef-9-0/-?31?_9 Designer's Name,Address,and Tel.No. (?Vr+olcs - Mai5+tym Mids MA OUqir Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) g)f:3 gpd Design flow provided /l U gpd Plan Date Number of sheets Revision Date Title l J Size of Septic Tank d IO ISOO c€?� Type of S.A.S. lal +rtne1 ll�te iat/� r�rg e Description of Soil Nature of Repairs or Alterations(Answer when applicable) applicable) dk 6 Q 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 Co place the system in operation until a Certificate of Compliance has been issued 's Board of Health (INgn4d., Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued -------------------- --- --- - - - - �— - — —,.._... �,.,.,..: , „ „k.�.+..SJ,t;W,.�.Tanw..r?an..r.�crt..-.wr ,+�^o+-•++«+.:�a+...++•,....•+.•�- No. J0 3 ads Fee f �U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. 1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes a 2pplication for Disposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) !Abandon( ) ❑Complete System []'Individual Components Location Address or Lot No. i t$ jCkSe,1-(yam Ci r Owner's Name,Address,and Tel.No.(el'')-S)� � 037 V 9. IJI)6 .t-a'.g ph 501 11'eatn y/ Assessor's Map/Parcel 619-OX 'CIO/ C.r4L a_'�- 'pi r s$-Q-% O P 360 I�nsstaller's Name,Address,and Tel.No. 5 U E 90/ g3 9 G Designer's Name,Address,and Tel.No. (:_4,_,>1,otbL 0vv23�'f`1J��7�(n�Zv+c [jS1 (c�SJ Ifd ar5Fv►nS ills MA 0)4-q Sr Type of Building: Dwelling No.of Bedrooms Lot Size sq.-ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) U gpd Design flow provided gpd ,-Plan Date Number of sheets Revision Date ' Title d E 77 / ff 1 Size—'of Septic Tank )4-IU [So09 a7 k Type of S.A.S. Description of Soil J i Nature of Repairs or Alterations(Answer when applicable) f t 1p 15- ebO f,�J{ a.rt�n J R t 0 cal i St r r kv'h i on 6 X e o n oec" `0 J _j 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-nor o,place the system in operation until a Certificate of r ..Compliance has been issued by-tliis Board of Health./ / gned Date // 3 Application Approved by / / Date r Application Disapproved by (/ Date j for the following reasons "- • v �� ` 1 Permit No. i Date Issued `-� IV THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE.,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓") Upgraded( ) Abandoned( )by' (10r 40 at ,)'C-k S J— C'rr• C0+U_ .- •has been con` d i4acco cewith the provisions ofTit��le 5 ann/d the fortDisposal System Construction Permit N . dafed Installer � r4C>j'ST,I,c. 0.vn5f roe.+ic h , 1...nC Designer �r #bedrooms Approved design flow The issuance of this permit shall noblie construed as a guarantee that the system willl fti cctioJn.as' /designed. Date /�67 ._l Inspector 1`I` 11j'�lf � l` �, ,` k .�- ��- - - ----- ----- - - -No. *Vb Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION 7 BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction i3ermit Permission is hereby granted to Construct( ) Repair(/) Upgrade( ) Abandon( ) System located at (J ..t mN la 1 o '/�,Sp'1 r jl}Q (2-i r 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. f Provided:Construction, {ast b4clopp eted within three years of the date of this permit. Date Approved by l t✓, 0 V TOWN OF BARNSTABLE LOCATION c 6,SEWAGE# =, S VILLAGE .rSZ—Z ASSESSOR'S MAP&PARCELQk -6-D C �or'.3 ;=F-zS z�.'S NAME&PHONE SEPTIC TANK CAPACITY r (e LEACHING FACILITY.(type) Sc� rn\�l�„o,��letr'� (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Q�0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 3 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �yCA � ry kc�c t,w � 33 � OWN C � J r� 1 .10 0� Commonwealth of Massachusetts Title 5 Official Inspection FormCn PY Subsurface Sewage Disposal.System Form- Not for Voluntary Assessments 115 Pinquickset Cove Circle Property Address Linda Sullivan =r Owner Owner's Name information is g required for every Cotuit MA 02635 August 9, 2013 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 filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Patrick T. Sullivan Y n' p use the return Name of Inspector key. } r-� r�Read Rooter Excavating ' ILA Company Name P.O. Box 89 A Company Address. - 'I R; Forestdale MA „02644 �P City/Town State Zip Code y� 508-_888-6055 SI 12843 c a 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 _ August 9 2013 Inspector's Signature ' r 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. **** conditions of use This report only describes conditions at the time of inspection and under the p Y at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. LZ t5ins•3113 Title 5 Of1r, on Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Pin uickset Cove Circle Property Address Linda Sullivan _ Owner Owner's Name information is required for every Cotuit MA 02635 August 9, 2013 - _ page. Cityrrown gState Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or.E%always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon 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. k 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 i❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Elm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Pinquickset Cove Circle Property Address Linda Sullivan Owner Owner's Name information is g required for every Cotuit MA 02635 August 9, 2013 _-_ 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 pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced/ ❑ Y ❑ N ❑ ND (Explain below): i ❑ obstruction is removed 11, ❑ Y ❑ N ❑ ND (Explain below): i ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): R; ❑ 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 1. System will.pass unless'Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool ou/p ivy 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,..'' 115 Pinquickset Cove Circle Property Address Linda Sullivan . Owner Owner's Name . information is Cotuit _ MA 02635 August 9, 2013 required for every _ _ 9 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. - El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well... Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Pinquickset Cove Circle Property Address Linda Sullivan Owner Owner's Name information is Cotuit MA 02635 August 9, 2013 required for every __. _--_ 9 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ N. Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For'large systems, you most 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Pinquickset Cove Circle Property Address Linda Sullivan Owner Owner's Name information is Cotuit MA 02635 August 9, 2013 required for every _. _ 9 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the.system obtained and examined? (If they were not available note as N/A) ® [] Was the facility or dwelling inspected for signs of sewage back up. ® p] 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? ® El 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 3710 CMR 15.203 (for example: 110 gpd x#of bedrooms): 563 GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115—Pin uickset Cove Circle Property Address Linda Sullivan Owner Owner's Name information is Cotuit _ MA 02635 August 9, 2013 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information Description: System�designed for 4 bedroom in main house and 1 bedroom in "future"guest house. Number of current residents: 3 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 Seasonaluse? ❑ Yes ® No water meter readings, if available last 2 ears usage d 2011= 822 GPD* 9 ( Y 9 (gP )) 2012=685 GPD* Detail: * High water usage dur� summer months due to pool and irrigation. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq�ft., etc.): Grease trap present? ❑ Yes ❑ No r Industrial waste holding tank present? ElYes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,..°" 115 Pinqui_ck_set Cove Circle Property Address Linda Sullivan Owner Owner's Name information is Cotuit MA 02635 August 9 2013 required for every ___ __ g , 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: Ready Rooter records: Pumped September 2012 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Pinquickset Cove Circle Property Address Linda Sullivan Owner Owner's Name information is Cotuit MA 02635 August 9 2013 required for every -- = 9 , page. CitylTown State Zip Code _ Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Main house septic system installed 03/08/2002. Certificate of Compliance on file at Board of Health. Guesthouse 1500-gallon tank added Aug. 5, 2013. COC on file at Board of Health. Were sewage odors detected when arriving at.the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: Main house: 2'6"Guest house: 2' feet Material of construction: ❑ cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line. N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Main house: 1'8" Guest house: 1'2" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) Main house: 2000 gallon tank Guest house 1500 gallon tank. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 12.5'X 5.5'X 6' 2000 gal. Sludge depth. 2 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Pinquickset Cove Circle Property Address Linda Sullivan _ Owner Owner's Name information is Cotuit MA _ 02635 August 9 2013 required for every __ 9 , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 36 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Main house: Inlet and outlet PVC tees in place. Liquid level at outlet invert. Tank in good condition. Tank measures out to 2000 gallon. 1500 gallon on file at BOH. Riser' on inlet within 3"of grade. Outlet has 1" irrigation running over center of cover. Guest house: Inlet and outlet tees in place. Not at operating level at time of inspection. Just installed). 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,,6 top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Pinquickset Cove Circle Property Address Linda Sullivan _ Owner Owner's Name information is g required for every Cotuit MA 02635 August 9 2013 - page. Cityfrown 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.): i Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: L ❑ 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•3/13 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Pinquickset Cove Circle - Property Address Linda Sullivan Owner Owner's Name information is Cotult MA 02635 August 9 2013 required for every _ 9 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 01. 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.): Two inlets, three outlets w/speed levelers in place. No solids carryover. No high water staining over outlet inverts. Riser brings cover within 12"of grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: - ❑ Yes ❑ No* Comments (note condition of plum/ chamber, condition of pumps and appurtenances, etc.): 1z 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 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Pinquic set Cove Circle Property Address Linda Sullivan_ Owner owner's Name information is Cotuit MA 02635 August 9, 2013 required for every ----- page. City/town State Zip Code Date of Inspection D. System Information (cont.) Type. ❑ leaching pits number: 5-500 gal ea. w/ ® leaching chambers number: 3'of stone. ❑ Jeaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil; signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Hand probing in grass area.over SAS found dry sandy soil with stone. No sign of ponding. Part of SAS appears to be under driveway area. No vent found on SAS. 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/ nflow - ElYes Subsurface Sewage Disposal System Page 13 of 17 ❑ No t5ins 3113 Title 5 Official Inspection Form: Commonwealth of Massachusetts Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Pinquickset Cove Circle Property Address Linda Sullivan Owner Owner's Name 1 information is required for every Cotuit MA 02635 August 9, 2013 — ------ page. Cityfrown _ _ - 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 a ❑ drawing attached separately fib - 3 Io �1- - - 33 t o t 15 i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts fD Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments If 115 Pin uickset Cove Circle Property Address Linda Sullivan Owner Owner's Name information is Cotuit MA 02635 August 9, 2013 required for every — ---- --- State Zip Code Date of Inspection page City/Town --- D. System..I nformation (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check-cellar ❑ Shallow wells >3 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 11/10/99 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: www.terraserver com ma.water.usgUov You must describe how you established the high ground water elevation: Test hole to 11' (elv= 86)found no ground water in 1999. Base of SAS at elv= 83 per engineered plans. Accessed local ground water contours and topo mapping. No high ground water in area of s stem. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 16 of 17 t5ins•3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Aj 115 Pinyuickset Cove Circle Property Address Linda Sullivan Owner Owners Name information is required for every Cotuit MA 02635 August 9, 2013 _— — — page. City/Town State Zip Code Date of Inspection E. Report,TCompleteness 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:Subsurface Sewage Disposal System•Page 17 of 17 ' f TOWN OF BARNSTABLE l LOCATION IGL 1" CD'(r� SEWAGE # Z®0� VILLAGE ASSESSOR'S MAP & LOT 017 -Oa J INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY lS^4G LEACHING FACILITY: (type) C`"4, (size) f/ NO. OF BEDROOMS BUILDER OR OWNER l�iJrl PERMITDATE: '1-4— 0 COMPLIANCE DATE: 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Eurnished by 70.0 foe �v a � o rho. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS -041uplication for Mfi6pool *p.5tem Conztruction Permit Application for a Permit to Construct(VI'Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Locationdress r Lot No. - C�� (kjf— (ol Owner's Name,Address and Tel.No. C A"i y�Pit�ilfl Asses or's ` el QvittK9211Q. 1 r�1 N ST g Installer's Name,Address,and Tel.No. Designer's Name,Address and el.No. Z rl M I 1 Ck o , cgs 2 345 0 Z.5'37 Type of Building: Dwelling No.of Bedrooms Lot Size 2l 0 sq.f.. Garbage Grinder.{--}, Other Type of Building No. of Persons Showers._— Cafeteria" Other Fixtures ISL A. t Design Flow gallons per day. Calculated daily flow �5Z3 gallons. Plan Date 5 12-4 It 000 Number of sheets Revision Date ��4 200/ Title A 2 ✓ C Size of Septic Tank 1410D Type of S.A.S. e A t- Description of Soil �,/� .q Ov)ZD+1 rh D � i -Z$ SQ Nature of Repairs or Alterations(Answer when applicable) A-ZA Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y thi io of Health. Signe Date Application Approved by r� Date r� Application Disapproved for the following reasons h}. Permit No. �742�2 1� �� Date Issued — —� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: " 'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS,` Yes ' !� T* Z(ppCicati�ott for 0i.5 opal *pztem Construction Permit �. Applieation for a Permit to Construct(�epair( )Upgrade( )Abandon( ) El Complete System El Individual Components Locano Address or Lot No. (D,V (o — . � Owner's Name,Address and Tel.No. w•-' C AP-V IA N A PA-M -Assessor' �� el 1�1"Urrl ZZ MN5 PrN0WcK92�� '2, Hm SIAt.. ' � 1 g120s. '. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. q ! Zi► '` III 12c1 L.. . Sc, clwtcI, �Z537 Type of Building: Dwelling No.of Bedrooms Lot Size 87 Z I o sq. ft. Garbage Grinder..}_. Other Type of Building _ No.of Persons Showers(_--.a-Cafeteria() 1 Other Fixtures N.A. Design Flow 5 S U. gallons per day.%Calculated daily flow S(-,3 gallons. Plan Date 3 /29 7_'000 Number of sheets `"2. Revision Date 2 ZZo0/ Title . 122 J1,4< ✓; e ✓G � Size of Septic Tank /5^001 Type of S.A.S. �G l e h n i n b e Lc Description of Soil �P A )0r1-Z o h � h 0�-, -7 Qr-1 T � a t:`� /. U✓/ �_Dl7 /'1'1lG SGi'1 2 s' �""' /l� i?O � ✓i���n�//vG�r/ " Nature of Repairs or Alterations(Answer when applicable) ,- t Date last inspected: Agreement: ti I-N The undersigned agrees to ensure the,construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-' cate of Compliance has been issue ,=this ar of Health. // x Signe - Date ,31,�I Z Application Approved by '" � _ Date Application Disapproved for the following reasons Perinit No. Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(/(j )Repaired( )Upgraded( ) Abandoned )by at /�. �! 71,Kq_ias been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No °'� /e.1 dated .• ' ' Installer 9. r r - .� Designer v The issuance of this permit shall not be construed as a guarantee that the sysewction as deigge . Date o'�- Inspector w � V v No.;Vo I�11"_1 — _ Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5p0al *p5tem Construction Permit _ Permission is hereby granted to Construct( )Repair( , )Upgrade( )Abandon System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to". comply with Title 5 and the following local provisions or special conditions. ' Provided:Construction must be completed within thiee years of the date of thi ermit. r Date: 11�jp Approved AsBuilt Page 1 of 1 TOWN OF BARNSTABLE �. OCATION J/]g,044 *61— CtlG&_' SEWAGE# 7-990/ VILLAGE CDI T ASSESSOR'S MAP&LOT 1 2 STALLER'S NAME&PHONE N0. 1b15`;ZOf.3T . 7 7/ EPTIC TANK CAPAC= OO i IEACH3NG FACMIW: (type) ��5�9Q l C61l1/lJ�. (size) O.OF BEDROOMS //r_ BUILDER OR OWNER . �DIRZ ERMITDATE: 2'a4' 01 COMPLIANCE DATE: Separation Distance Between the: aximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Frivate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet I . ge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet i •shed by Q, I -7 i I htp://issgl2///intranet/proodata/Drebuilt.aspx?mappar=017026001&seq=2 7/1/2013 D5 O AR SANK , i .. _. .__. ..i .. •' 0 — .. MUD RmM C � I. REF. MR-SFFL 2 ".D Rco/,A Ii: FRM11--1 tZroM —I V1,Vol DESK fTEP. C1v5ET ..-. Fo Pr WET Lies rt D,w ' v - (aWMA 1. e MPsgA H i i � wwoEP_min 0 n— I ---- I : ---EEI — . j �rv1L NTH C, ;I f. ttlit Fire @(3'uF$R?c i1 LiV�N6- 2ocM up To Fo'(E R - ' 4 REVIEWER !! F�� ti,�.N� Roc , , W Location Number/"type Li w 1st Floor ,, o v, 2nd Floor i I fti�z 2 =— 1......_ U Other Total i.Z I N b Notes: �} 1-6 ► A��,�crz' ( -- 5M �vr1�� a 1.--,1 v gT NG i 2� �CY Reviewed By: c ���S ►v\ a" 0 Q UU C7 G�Dq I I I i i I - m x N I ♦ y T /I A / : pn Tj ao :uc f j 0 �.. ^ z 1 .1 I1ri g - M IL ❑ _ I � 1 i 115 PINQUICKSET COVE CIRCLE COTUIT,MA 02635 j ._......... GRASSETTI BROTHERS BUILDERS sull R d : iva FROM David Thulin PE PLS FAX NO. 508 8987259 fug. 17 2001 10:38AM P1 • a 5 ..' � a d SOLO NEW CONCRETE FOUNDATION TBM NAIL (FND) f ELEV= 100.0 N ASSUMED DATUM ' f TO THE COMMUNITY BANK; a / I I I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THAT 1 HE PROPERTY SHOWN HEREON COMPLIES l WITH THE ZONING BY-LAWS OF THE TOWN OF f BARNSTABLE AND LIES WITHIN THE FLOOD ZONE l INDICATED BELOW. f l OFFSETS TO PROPERTY LINES FROM NEW I ` CONCRETE FOUNDATION, ` LOT AREA: 87,210:t:SF 52 21' ASSE5$ORS MAP NUMBER 17 LOT 26 so 0 25 5a 100 200 IN FEET ) TOP OF FOUNDATION ELEVATION: 100.7 I+LOOD ZONE: 1 inch = 50 ft. FOUNDATION LOCATION DATE: B-16-01 THE 5UBJEC r LOT IS SITUATED IN FLOOD ZONE C (AREA OF MINIMAL FLOODING) CERTIFIED PLOT PLAN SEE COMMUNITY PANEL .25001 0022 .0 REVISED JULY 2, 1992 PLAN REF- LAND COURT PLAN 346366 LOT 12 PLAN OF LAND IN BARNSTABLE (COTUIT), MASSACHUSETTs 115 PINQUlCKSET COVE CIRCLE PINQUICKSET COVE ROAD, SUSOIVISION OF LOT 112 LCP 346.388 COTUIT, MIASSACHU ETT PETITIONERS PLAN DATED MARCH 2, 2001 , ' WE,, SCALE: �" — a0 I DAVID C. THULIN, PE, PLS �� I HEREBY CERTIFY THAT THE NEW CONCRETE 211 MILL ROAD FOUNDAT ON I$ 9CATED IN RELATION TO LOT LINES AS SH AND AS SUCH IS IN EAST SANDWICH, MASSACHU5E I'7S 02537 CONFORMA T�-I THE C31 I-NS10NAL REQUIRE N OF T N 0 ARNSTABLE PREP. FOR: CRASSEYTI DRAWN SY' PST ` C,HKD RY: OCT /,t ZONIN Y LA ' ,p J09 No, 99 075 REV. SHEET 1 OF 1 � a r � T��t�dl7QU-'sae EU�OH DAv�P.t�1iv�� P�- ?1,5 r� �e-rY �dN �AT�B�-ol 1'`�� �o ° 12 � 2 L0 V/A U �4 e16"c''. � \VrIH MP N t9 6i-PAN 2,c4 2u� - L,lo - w N f G't✓.G F::M 11NGt _ ale '/8°=tA� �G?�� �P-�.MI SSA I • �K :•• � �3�2xt2'S c' r'12-tip ,� - - - ---�2=vg4H'l�t11�Qa, -. .. . _ �. _..- .. • �21.• . . $II.Co-r°(r'�tG - +• 1' ...- -- - ULJ Hai ---D 0-4 I At ,N o UtQET7 , - tz •p O — - - - - - 2-0 N ly•8 I Td; �"-� .itt { f 9`-O°- 2 I n „ t o a 1 . 4ipu } � . • i { " �� Q I .Q. 1-8 �t-8 8 � -ALA-r(M i W t.G i D Its _N � �.,�&IiwL;.. ` 2�Q." _ .i• Q� ' tL5 ' � I � N .� � "��:�."l �CO�- � `�. N - � I � U _�a��i-1�-��-• _ --ihif.�X3apXlt:'Ga�SA.A -.171IL � IP till - MAss. 4g Gz�-ti° 2�aolvtyfo_ of -- _. . r_�—� r I T q::� • I I .�� -- • Ix2f 1x8 --.�-X�����P-off-__ _ . .—llztafe��+os.P B4�c�'15� . IFH rU rmllEE EZLI� [E 2 LL DA '- � — =-�— - i "-_ - � _=-_._ qMP. _ - —•---_: -���._ mot- . -- ATV TIO� � - . • r TBM NAIL (FND) 94•34' _ ELEV= 100.00 ASSUMED DATUM f0 ��J e \ UNREGISTERED LAND 110 PLAN BOOK 562 PAGE 78 -6- upo 99.T8Cp \ \ 46369 0 / 99 3 W + \ �, 98 / cv-9 64.2' 0 99 \ PROP�D / ST HOUSE 98. �� I 6 5.4' 1.5 10 o T.F. / S I tas7 [10D.s] j 8 ` . 9782 \ j / T LLJ _ > 1 0 / \ I / L) / Cy) gy \ / Woods rood I 97.38 �\ / o CENTE�PROPERV LINE OF GOADlb I IS LINE Edge o/povemen/ ' 1 . ' • _ .. � \� LOT 12 ,- � h� \ \ t •s • _,qH OF�� qN OF/yq� ,\ ILD o T>H LIN g65 No. 2ss76 y % GVIL g6 O' + LEGEND i — 99 — -" EXISTING CONTOUR 95 95 \ / / 4-gah \I \ x 99.4 EXISTING SPOT ELEVATION �[99]— PROPOSED CONTOUR [99.5] PROPOSED SPOT ELEVATION \ \ I TP \ ® TEST PIT LOCATION \ PT 5 9 69 ® TEST PIT/PERC TEST t I oo s� J' — W— WATER SERVICERu \ PLAN REF: ""s' PLAN OF LAND IN BARNSTABLE (COTUIT), MASSACHUSETTS Z� PINQUICKSET COVE ROAD, SUBDIVISION OF LOT 112 LCP 34638E JANUARY 23, 2001, BARNSTABLE REGISTRY PLAN BOOK 562 PG 78 SITE AND SURVEY DATA ZONING REQUIREMENTS: ZONE RF ASSESSORS MAP 17 PARCEL 26 LOT AREA.........87.120 SF FRONTAGE..........150 FT PLAN REF: LAND COURT PLAN 34636B LOT 12 FRONT SETBACK......30 FT DATE OF SURVEY: NOVEMBER 22, 1999 SIDE SETBACK.......15 FT LOT AREA: 87,210tsf 2.00tac REAR SETBACK.......15 FT POPPONESSET BAY 40 0 20 40 90 160 USGS COTUIT QUAD ( IN FEET ) 2000 0 1000 2000 4000 9CME IN FIXT 1 inch = 40 ft. I N PROPOSED SITE PLAN DRAFTER: PST DCT REVISIONS: m 129 PINQUICKSET COVE C co IRCLE CHKD BY: OCT 2/24/01 — MOVE HOUSE AND SEPTIC DAVID C. THULIN, PE, PLS I DESIGN: DCT LOT LINES PER ANR PLAN 2/5/01 o COTUIT, MASSACHUSETTS 211 MILL ROAD SCALE AS NOTED o 0) FOR CARL GRASSETTI EAST SANDWICH, MASSACHUSETTS 02537 PO BOX 1310 COTUIT, MA. 02635 MARCH 25 2000 (508) 888-2345 FAX (508) 888-7259 N WPOi SHEETI 1500 GALLON SEPTIC TANK _V)"J CL Lo rn �s• cr 07 O C4 r\ SEE PROFILE FOR TOTAL TRENCH LENGTH - - - - - - _ _ O w N a EDGE WASHED STONE /T ( 00 CIO - Ld CIO - COMPACTED Z ` A STONE SPLASH PAD I A Z = 00 EARTH REMOVABLE ACCESS COVER v I X: O BACKFILL _J Q Lo < I w < 4" PVC INLET / I : N X A,Q = Q Q�I SEE PLAN FOR LOCATIONS V) < 0 0 o c o 3" PEASTONE I I I , y OQQ 00000vovv vovovo ovov v I _ __ _ ,�_ - _ _ I I O O 00 oO 00 GOO 000000 0=00 •�, �Sn�O • O 0 0 o v o v v v o 0 o.d o 3/4"- i t/2" Z `� C�n ` l O E WASHED l• V LEVEL BASE SPLASH PAD STONE - - - - - 5 - - -- - - 1 0 4" INLET INVERT h Z Lro V 500 GAL. LEACHING CHAMFER E NOTE: UNSUITABLE SOIL REMOVAL t` -� Q I LEACHING CHAMBERLt) Cc SECTION A - A PLAN WHERE REauIRED TO EXTEND AT / Ii 5ao LEAST 5' 7EYONC LIMITS OFao STONE TRENCH. Q N Q LEACHING CHAMBER,�:CfETAIL - o zN W cc NTs DISTRIBUTION BOX ,c 5 - 500 GALLON CHAMBERS F W/3' STONE ALL AROUND in • � N ts SEPTIC SYSTEM DESIGN DATA SEPTIC SYSTEM DIMENSION DETAIL SEWAGE FLOW ESTIMATEy < SOURCE UNITS GPO/UNIT OTY GPO COMMENT GENERAL NOTES if ifN 1 SINGLE FAMILY RESIDENCE BEDROOM 110 5 550 310 CNR 15.02 13 - , � Z y I. ALL MATERIALS..ANO.CONSTRUCTION METHODS SHALL 4. THE LOCATIONS OF UNDERGROUND UTILITIES SHOWN 6. REMOVE ALL UNSUITABLE SOIL, Oe, A. AND B C) o = TOTAL ESTIMATED PEAK DAY FLOW 550 CPO - NO GARBAGE GRINDERCONFORM TO THE PROVISIONS OF THE COMMONWEALTH ON THIS PLAN ARE APPROXIMATE. AT LEAST 72 HORIZONS FROM BELOW THE SAS INVERT ELEVATIONS in 5; : z) HOURS PRIOR TO ANY.EXCAVATION FOR.TMS 5 SEPTIC TANK OF NASSACHUSETTS ENVIRONMENTAL CODE TITLE V. AND WITHIN 5 FEET OF-THE PROPOSED LEACHING w PROJECT WORK. THE CONTRACTOR SHALL MAKE THE SYSTEM. REPLACE WITH CLEAN SAND FILL MEETING fY 2. EXCEPT AS'OTHERWISE NOTED. ALL PROPOSED REQUIRED NOTIFICATION TO DIC SAFE (1-800-322- THE REQUIREMENTS OF 31OCNR 15.255. TOTAL FLOW X DET. TIME 660 CPO X 2.0 DAIS - 12120 USE 1500 GALLON TANK SEPTIC*SYSTEM PIPING SHALL BE 4' • SCH40 4844), AND THE COTUIT WATER DEPARTMENT428-2687 I- FOR VERIFICATION OF LOCATIONS U O O PVC SET TO THE LINE AND INVERT ELEVATIONS WATER SUPPLY FOR THIS LOT IS MUNICIPAL WATER. THE w O SHOWN. THE MINIMUM PITCH OF PIPES CARRYING 5. CONSTRUCTION OF THE SEPTIC SYSTEM SHOWY ON PROPOSED SOIL ABSORPTION SYSTEM IS NOT LOCATED WITHIN F- ~ F- ~ SEWAGE OR SEPTIC TANK EFFLUENT SHALL BE 1/8TH p Z CN LEACHING FACILITY INCH PER FOOT IF NOT OTHERWISE NOTED. THIS PLAN IS SUBJECT TO THE INSPECTION OF THE 150 FEET OF ANY KNOW PUBLIC OR PRIVATE WATER SUPPLY Up N TOM OF SANDWICH HEALTH AGENT. NO PART OF WELL W CHAMBER TRENCH LEACHING AREA CAPACI 3. PRIOR TO CONSTRUCTION OF THE SEPTIC SYSTEM THE SEPTIC SYSTEM SHALL BE BACKFILLED OR MADE } Q N = NO. LEN WDTH DEPTH SIDE BOTTOM SIDE BOTTOM TOTAL DEPICTED ON THIS PLAN, THE CONTRACTOR SHALL INACCESSIBLE UNTIL INSPECTED AND APPROVED BY UJ M cn R It ft a d pd :08TAIN A DISPOSAL WORKS CONSTRUCTION PERMIT THE HEALTH AGENT. THE CONTRACTOR SHALL w U SCHEDULE INSPECTIONS AS REQUIRED. Q ]C 1 48.5 10.8 2.0 2J7 525 175 388 56J :�FROM THE TOWN OF BARNSTABLE BOARD OF HEALTH. ix 2 w U PERCOLATION RATE: 2.0 MIN./IN. LEACHING RATE: (CPO/SF) SIDE - 0.74 BOTTOM - 0.74 O LI O f/) m 3 105 SOIL TEST DATA TOP FO OATION 101.5C DATE: 11/10/99 P9584 101.50 EXCAVATOR: BOUSFIELD RE RISER W/CON COVER To IN 6' OF FIN GRADE PROPO FIN. GRADE F - - B.O.H. AGENT: DONNA (BARNSTABLE HEALTH AGENT - N rn 100 EXI NC GRADE LEVEL PIPE SE. ON ENGINEER: D.C. THULIN ZQ N LOCATION: TP-1 J w �o - - LOCATION: TP a � N I - - - - - - - - - - - � - - _. - _ ELEV. DEPTH = �� - 98.3 0.0 ELEV. DEPTH OaA - DUFF, LOAMY SAND FW- U Q 9a00 � _ - - 95.06 ( - - 97.3 1.0 Ot/1 - ��• LOAMY SAND 97.8 0.0 N Q �� 97.38 '' TOP EFF.DEPTH 95.0 B - LOAMY SAND 96.8 1.0 N O 95 97.1J �� 95.5 2.8 B - LOANr SAND p NQ J OU LLJ NED. SAND 95.0 2.8 Ln Q INLET TEELOW LOW OUT T TEE SOT EFF. DEPTH 93.0 C - NED. SAND _ O U 93.0 5.3 U 01D�LEVEL 14' BELOW 9 OU T DISTRIBUTION BOX PERC 2 Mov./IN 0 ~ 1500 GALL U ID LEVEL 5 - 500 GALLON CHANGERS Q O W/3• STONE ALL AROUND LL O L�CO SEPTIC TANK � 90 W OUTLET O GAS BAFFLE -Ina 48.5' 30.8 5 .6' 87.3 11.0 11 37.6• LONGEST RUN BOTTOM 1 R 0 I 85 NO GROUNDWATER BOTTOM I NO GROUNOWATER -10 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 SECTION TH RU SEPTIC SYSTEM 99-038 SHEET 2 OF 2