HomeMy WebLinkAbout0049 RENDEZVOUS LANE - Health (2) ��49 RENDEZVOUS-LANE (Rear#49)
Barnstable
A = 279 — 024
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Crocker, Sharon 9- Vuyv-k.2 Zh
From: McKean, Thomas on behalf of Health
Sent: Thursday, July 18, 2019 10:10 AM
To: Flynn, Judith
Cc: Crocker, Sharon
Subject: FW:Town of Barnstable- Change of Address- Barnstable Village
Attachments: 47 &'49,Rendeyvous.Lane BA.PDF
From: Sumner, Matthew
Sent: Wednesday, July 17, 2019 3:04 PM
To: Barrows, Debi; Benoit, James; Ahern, Carolyn; Conservation Mailbox; Consumer Affairs,r ailbox; E911- Verizon;
Pulsifer, Frank; Gorenstein, Michael; Health Huxter, Shirley P - Barnstable, MA; Judith Grimley; Keeler, Marie T(Marie T
Keeler); Notify911Address(a)state.nia.us; Richard Pfautz - Deputy Fire Chief;Shea, Sally
Subject: Town of Barnstable- Change of Address- Barnstable Village
Hello all,
We have added multiple addresses to Map Parcel 279/024t
47 Rendezvous Lane, Barnstable (main house)
49 Rendezvous Lane, Barnstable (rear house)
Please see the attached site map to confirm locations.
N.B. This parcel is scheduled to be subdivided in the next tax year and 47 and 49 will be separate properties.
Thank you,
Matt
Matthew Sumner
Barnstable DPW- Engineering Records and Assets Manager
Office: 508-790-6400 x4942
Matthew.Sumner(a)town.barnstable.ma.us
1 .
n
, o The Town of Barnstable °�
Department of Public Works H �,
i Y 1B4,RxsTasLE, i
Mass. 3 82 Falmouth Road,Hyannis,MA 02601
16
Arab M. s 508.790.6400
Daniel W. Santos,P.E. Robert R. Steen,P.E.
Director Assistant Director
June 28, 2019
Caroline F, Coggeshall
P.O. Box 461
Bar Mills, ME 04004`
SUBJECT: Numbering of Buildings
Parcel No. 2791024
Dear Property Owner,
Notice is hereby given in accordance with the Code of the Town of Barnstable, Chapter 51,
Numbering of Buildings, adopted August 18, 1994. Public convenience and necessity require
the assignment of numbers 47 to the front residence and 49 to the rear residence on your property
located on Rendezvous Lane, Barnstable.
This number should be affixed to your building so that it is visible from the street as outlined in
Exhibit "E", Town of Barnstable Rules and Regulations for Numbering of Buildings.
Barnstable Fire Department has agreed with this change of address to comply with the Town of
Barnstable Rules and Regulations.
The previous address for Parcel No. 279/024 was 49 Rendezvous Lane,Barnstable only.
Sincerely,
Griffin Beaudoin, P.E."
Town Engineer
Encl: Town of Barnstable Rules and Regulations
Common Address Questions
Site map
Assessors Change Form
May 3,1994
EXHIBIT E
TOWN OF AARMTABLE
JZULM AND 3?EGTTL1iTI NS
Pon j
NUMBERING QF BUTwIl mB'
IIE71 GENERAL ORDINANCES ARTICLE V
., II
Assignments (Refs . Section X Article V). The Assignment �of
buildipg numbers wall be .under the direction of: Tpwn Encrineer.
. i
Met sod of Number Est�l sh tnents ` (Ref; Section Z, Artioia V) .
The town will ut lize -a system.-of numbers issued by roadway
stationing. Whereas, a number may be assigned every 10, along
the centerline of the `roadway. The hegiani ng of stationing will
start at (A) the main road in which the new road -originates, (B)
the entrance of the road ®alasest .to the nearest .District l•irb
Department or (C) the cul-de-sac closest to the main road (in`the
event of a double .ended road) '0EM11 nwaibers will be *issued to
lots priularily on the north or east aide'-of the roadway. "ODD11
numbers will be, issued to.;lots .primarily on: the south ..west
sine of the roadvray.
garner,Lots: Building numbers are assigned to all roads that the
property abuts. However, access ,io 'aritiaal to propezty :loeation
therefore, field inspection'main, ;be required to clarify proper
number..
Unnamed., aj�51 :Unnamed roads, easements, rights of ways will b.e j
addressed from the main road in `w`hloh' the way 'takes acoeffa.'
"Ways off of" will not be ro aagnized *far ifidi.vidual acldresairig. '
Nptes. Unofficial road names. will not be recognized for hssigning
bulidi g numbers.
_P be assigned to. all roads abutting'a i
lot orCarcel.. ��etown�will'not be responsible, to prove. Legal.
j
access for number assignments for 'abuttin_g- xoada. Howevex,
numbers will not be assigned 'for lots that do spot `abut the road 3
in question unless an alternate-legal access man be proven by the
Property owner. Driveways in common will only be recognized for
numbering with proof of legal access over other lots. Lots that j
abnt roads outside of town boundary linen must obtain building
4iirbexs from that. partiaula>r town to avoid differanoes in
numbering-of those roads: }
,
EXHIBIT $
Multiple Bualdinas arnd/or C7n.itss ohly.nne assigned etxeet tumbex
w3.11 be issued pet lot Or parcel.. -Multiple buildings or units
will be unitized. The- Engineering Division will not be
responsible ,for .recording unit numbers. Should previQualy
-assi:gned .numbers . to existing buildings prove confusing for
emergency responge departments; the unit niAmbers may 'be-changed
to eliminate .confusion, Otherwise this section' applies bnly. to
new strictures.
Numbers: ' The objective•of this' seotion is to insure the posting
of numbers adequate in size and color- so an to be visible -from
the road on which the number was issued..
Size: The size of the numbers shall- be not less than three
Inches nor more .than twelve inches in height.
Colori The, color of the numbers shall be of high contrast with
the background material. Black on white is optimum, brass
numbers on neutral colored background or .unfinished siding is not
aoceptabl,e.
Shane: The shape of the n mbe_rs shall. be Arabic. Roman
Numerals, script or written shall -hot be used.
Nocjtion: Numbers shall be visible from both directions from the
main road that the numbers were issfted. Numbers shall be posted
on the building at eye level., preferably at the' main entrance.
Au tld_ings which are not visible from the road, or not located
within 100 feet of the road shall, have the numbers: affixed on the
buildinq so that they are visible from the driveway and tit the
road entrance of the driveway. A mail box, post, wooden sign or
other approved device at the xoad entrance of the `driveway
visible' from the.inain road may.be considered suitable.
Assignment of Enforcement: Notice of incorrect or nonpost3.ng of
numbers may be forwarded to the Police Depaztmen•t for issuance of
noncriminal citation as outlined in Seciion 6, Article V. If, .
after 30 ,days of notification of violation,_the property owner
has failed to affix visible street numbers as ass.i;gned by the
Town Engineer, a noncriminal citation shall be issued.
ADIR IM 7yTT na,
CORWaLOT BU DINU Nf R bS51 GNNl 'IVm
I2FFr Town OfBlirnstable Rules andItngulatlons for Numbering.of Buildings, 3( meral
Ordinances Article V
Corner Lou.,33uilding numbers are assigned to all roads that the property abuts.
Howevar,aceessis Critical to pr0•p011ylocatio%Therefore,field inspection may be
required to-verify proper number.
Discussion:Comer lots pose
problems for issuance beoause'of dMrent options:for,
identifying a building:looation by appearance.Since plaeenseat of'tbe building,landscape
contours,driveway access and fences,foliaga or other obstruotion causes a building of
this type to be viewed differently;the following wM be-used for proper determination of
correct assignment of buildinj nummmbera.;
1)primary attempt for assignment wilf.be for what is detertnined as the front door
entrance ofthe building.
2)Buildings that cannot be accessed fi=the mad thatthe front faces(because of'
property•elevations,fences,fbliage or other obstnrctions)will be assigned a numbed•from
the road for its primary driveway access.:
3)Buildings that are placed cator-comered Onto lot may.utilize the driveway entrance as i
the detennining factor for which load will he used for assignment of bWldingnumbers t
(NOTE:refer to items 1&2 for borderline dete=haafions.)Only catet�cox reclplaaed' t
buildings mt oracular-driveways will have the option afnur berh:oad assignment:
4)Conditions that may change the"appearance of location."may require re-assignment of j
number/road combuzations. ' y
Conclusion:Addressing is of vital importance for proper field identification of a
building,especially in the case of em.eirgenoy,Standardized techniques are repired.to.
understand some of the eouxplq plaQemeAfis and alternate acoesses.provided to buildings.
Utilizumg these methods;should reduoa the oovfuszon of locating-these buildings in.the,
field. .
C.)bam.B-911.doe: �r
t
•
Legend
h
Parcels
` . Town Boundary
#49` #2.5' #fS #143` Railroad Tracks
M
_. a° Buildings
Approx.Building
_1,Buildings
#.12a
" -R Painted Lines
Parking tots
Paved. I• -- - ----- .. —_ Unpaved
Driveways
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Paved
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t Road
P
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3
s. Unpaved Road
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Bridge
Paved Median
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Map printed on: 7/10/2019 This map is for illustration purposes only.It isnot - Parcel lines shownon'this map are onl graphic'adequate for legal boundary determination or y representations of Assessor's tax parcels.They are. n of Barnstable GIS Unit
_._.,.,...,.:='; Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi
0 16y 333 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 08-862- 62
reflect current conditions,and may contain such as building locations. 5 4 4
Approx.Scale: 1 inch= 1.67 feet cartographic errors or omissions.
' t gis@town.barnstable.ma.us
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279024 47 RENDEZVOUS LANE---Main House BARNSTABLE 1364
1279024 49 RENDEZVOUS LANE---Rear House
BARNSTABLE,. 1 1364
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Parcel Detail
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Parcel ID: Sewer Acct: r'; _:
TAR Q Update
Devel Lot:
Owner: a
;...
Co Owner: 0 0C : V.
Street: , ...: i 4 .
City, 3AR GP;'_LS State:
Zip
---------------
.................. __.
Location: 49 ,RENDEZVOUS L .......ANE
r Village: ,Barnstable v
_._..._ J
Road Index: 1364w""..._t Prl Frontage49, ."
To set road,you can also enter road index and tab out of field.
Secondary Road:
Sec Index: 0000 _ ? Sec Frontage: 10
i
Visions Location:
Last Updated: s...
---------------
No. Bldgs: Account No: pt',;, Lot Size(acres): 2:
State Class: Year Added: 1_<q
Fire Dist: 1
Deed Date: Deed Ref:
Land Value: Bld s Value: Extra Features:
Condo Complex: Building:
Unit:
Update
http://issgl2/intranct/propdata/pledit.aspx?ID=PL21841 7/10/2019
f
Commonwealth of Massachusetts 42 79- oa
Title 5 Official Inspection Form
k�Tr- ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49 Rendezvous Lane,?
`J Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
information is /
required for every Barnstable 1/ MA 02630 3-20-19
page. City/Town State Zip Code Date of inspection p_,
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.
rWnt:WhenCCII /� v,��ptHlHlFltry��j�i
filling out forms C J l' r 84,4L4 �•������cp Ssgo2'�.
A. Inspector Information •• •�• •.
on the computer, a g�:• JAM E S
use only the tab James D.Sears
key to move your Name of Inspector v; EARS y z
cursor-do not Capewide Enterprises
use the return �� '•• �.—�4.=t�`_
key. Company Name ����1� ..,RTIF�. •�O .
153 Commercial Street 4��i�F 5 INSPEC������
_�I Company Address
Mashpee MA 02649
FIL CitylTrnun state Zip Code
-- 508-477-8877 S1623
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
3-25-19
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 has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
t regional-office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer,if applicable,and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time. This inspection does not address how the system will perform
in the future under the same or different conditions of use.
15insp,doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection . Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�C
r 49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
information Is Barnstable MA 02630 3-20-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The system is a 1000 Gal.Tank and Trench.
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes","no"or"not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5insp.doc-rev.7126/2018 Tille 5 Official Inspection Forth:Subsurtace Sewage Disposal System-Page 2 of 18
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Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;zV 49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggesheli
Owner Owners Name
Information is required for every Barnstable MA 02630 3-20-19
page. City(rpwn State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumpslalarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health,safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.726MI8 Title 50Bicial Inspection Form:SubUdace Sewage Disposal System•Page 301 18
bZ abed xeJ dH S£Z 6 6 LOZ LZ Jew .
Commonwealth of Massachusetts
M Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
s 49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
requiratifore Bamstable MA 02630 3-20-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cunt.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well'.
Method used to determine distance:
"This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
4 ❑ ® 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
t5insp.doc•rev.7,120018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System Page 4 of 18'
5Z abed xed dH 9E'ZI. 660E LZ JeW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form • Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
information is required for every Barnstable MA 02630 3-20-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
IVA ❑ ❑ 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 1/2 day flow A 64-4(147
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal 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 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes'or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc-rev.7126/2018• Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
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y Commonwealth of Massachusetts
Title 5 Official Inspection Form
I6 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy) Coggeshell
Owner Owner's Name
information is required for every Barnstable MA 02630 3-20-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no" for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® 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) r
® ❑ 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)]
15insp.doc-rev.712612018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 6 of 16
LZ a6ed xPJ dH SEZ 6 6 60Z LZ JeW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
information is required for every Barnstable MA 02630 3-20-19
page. City/Town State Zlp Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): NA Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x of bedrooms): 330
Description:
1000 Gal.Tank and trench.
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes,discharges to:
Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: NA
Date
t5insp.doc•red.7/26/201 B Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 7 of 1e
- 92 abed xed dH 9£:Z 6 6 60Z ZZ JeW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
on is
required
for every
Barnstable MA 02630 3-20-19
requir
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records: r
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc.rev.V2612016 -nue s omdal hspecdon Form:Subsurface Sewage Disposal Systam-Page g of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form•Not for Voluntary Assessments
;v
49 Rendezvous Lane
Properly Address
Ellen (Lindy)Coggeshell
Owner Owners Name
information Is required for every Barnstable MA 02630 3-20-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box,soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/AHernative 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 IIA system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
NA
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
. 28'
Depth below grade: feet
Material of construction:
❑ cast iron ®40PVC ® other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.): e
Pipeing is 4"PVC SCH -40 and Orange Burge
t5insp,doc•rev.7l26f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 18
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c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
information Is required for every Barnstable MA 02630 3-20-19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 18"
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
T.
Sludge depth'.
Distance from top of sludge to bottom of outlet tee or baffle
27'
oilScum 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? -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 and outlet cover at 18" below w/inlet cover cement at grade, In and
outlet baffles No sign of leakage or over loading.
t5insp.doc•rev.72612018 Tide 5 Official Inspection Forth Subsurface Sewage Disposal System-Page 10 of 18
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c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Cog eshell
Owner Owners Name
information is required for every Barnstable MA 02630 3-20-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan);
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan);
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other (explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
t6in3p.doc•rev.712&2018 Title 5 Officid.nspection Form:Subsurface Sewage Disposal SYslem•P898 11 0(18
Z£ a5ed xed dH L£:Z I. 61,02 LZ JeW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
information is required far every Barnstable MA 02630 3-20-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert 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.):
Wrisp.doc rev.7i2612015 Title 5 Official Inspeacin Form:Subsurface Sewage Disposal System-Page 12 or 18
66 abed xe� dH LEZ 6 6 Me LZ JeW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Co geshell
Owner Owner's Name
information is Barnstable MA 02630 3.20-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No'
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
*if pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
® leaching trenches number, length:
1')at 36' at 10"
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/aRernative system
Type/name of technology:
ti
t5nsp,doc-rev.W2812018 Title 5 Official Inspection Form:SuGsurlace Sewage Disposal System•Page 13 of 18
p bE abed xed dH LEZ 6 6 602 LZ JeW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
Information is required for every Barnstable MA 02630 3-20-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System(SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching is 4"Orange Burge 36'long . Ck Tank-Prob area of field and Dug up to top of line.
Camera out line. No sign ofover loading or holding water.
12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
K
t5insp.doc•rev.712612018 Title 5 Of dial Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
r-'
Subsurface Sewage Disposal System Form•Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
information is Barnstable MA 02630 3-20-19
required for every
page City/Town State Zip Code Date of Inspection
D. System Information (cunt,)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
tbinsp.doc•rev.7/2612018 Titte 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
i
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Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r 49 Rendezvous lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
Information is required for every Barnstable MA 02630 3-20-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49 Rendezvous Lane
Property Address
Ellen (Lindy)Coggeshell
Owner Owner's Name
Information is Barnstable MA 02630 3-20-19
required for every
page. City/Town State Zip Code Date of Inspedlon
D. System Information (cunt.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 4
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 propertylobservation hole within 150 feet of SAS)
❑ Checked with local Board of Health - explain:
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Hand Auger T.H. 3-20-19(Full moon high tide)4'to water. Bottom leaching at 3' below grade.
Bottom leaching at V above T H Depth
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
Nnsp.doc rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
g£ a5ed X2J dH 8£Z6 660E LZ .JeW
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
F�
49 Rendezvous Lane
Property Address
Ellen (Lindy) Coggeshell
Owner Owner's Name
information is required for every Barnstable MA 02630 3-20-19
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. inspector information:Complete all fields in this section.
® B. Certification: Signed & Dated and 1,2, 3, or checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6 (Checklist)completed
® D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater Included
GRAD� 7 N.
FAIL)
i
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