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Home My WebLink About0055 CAP'N CARLETON'S RD - Health 55 CAP'N CARLETON ROAD, COTUIT ; A= 038 059 - --- ---- - I� un 0215 09:24p p.1 � P 639 q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Cap'n Carleton Property Address = 1 Paul McGrath , Owner Owners Name ca information is Cotuit MA 02635 5-26-15 _. required for every , page. CitylTown 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. Irnpo Whenfli A. General Information on r ng out forms the computer, 1K OF'P4,q use only the tab 1. Inspector: v -1 02� �� ' Al key to move your '�� JA M ES G cursor-do not .lames D Sears =�- tm use the return Name of Inspector key. CapewideEnterprises,LLC •.o o: Company Name -- '�i ! `• 153 Commercial Street ''�� ,fill. ..it Company Address Mashpee _ MA 02649_ City/Town state Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes [❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority � 6-2-15 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only.describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Offioal Inspection Fom Subsurface Sewage Dsposal System•Page 1 of 17 I Jun 02 15 09:24p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner owner's Name information required for every Cotuit MA 02635 5-26-15 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 19 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal.Tank D Box and pit 13) 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. 0 Y Ej N ❑ ND(Explain below): t5ins•3f13 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Jun 03 1510:05p p.19 Commonwealth of Massachusetts -mum- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Capin Carleton Property Address Paul McGrath Owner Owner's Name information required for every Cotuit MA 02635 5-26-1 5 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms are repaired, B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken; settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 31.0 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ni ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt ' arsh N . t5ms.W 3 Title 5 Officia Inspection Farm Subsurface Sewage Disposal System•Page 3 of 17 un 02 15 09:28p 1 P. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Cap'n Carleton _ Property Address Paul McGrath Owner owner's Name information is required for every Cotuit MA 02635 5-26-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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. Q 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. I 3. Other i i D) System Failure Criteria Applicable to All Systems: i 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 pondiing of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 0 ® Liquid depth in conspool is less than 6" below invert or available volume is less s than %day flow P.,T I t5ins-W3 Title 5 Official kmpedlon Form:Subsudace Sewage Disposal System•Page 4 of 17 Jun 02 15 09:28p p,2 Commonwealth of Massachusetts _k Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name infforrnation is required for every Cotuit MA 02635 5-26-15 page. CitylTown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation_ ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. j ❑ ® 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 CNIR 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. I For large systems, you must indicate either"yes"or"no'to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered 'yes"to any question in Section E the system is considered a significant threat, or answered"yes'in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ms•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 I i I I Jun 0215 09:28p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G 55 Capin Carleton Property Address Paul McGrath Owner Owner's Name information required for every Cotuit MA 02635 5-26-15 page, Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or trees, material of.construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN Flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 f Mrs-M3 Title 5Official Inspecticn Form:Subsurface Sewage Disposal System-Page 6 of 17 i Jun 0215 09:29p pA Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name information is required for every Cotuit MA 02635 5-26-15 page. CityrTown State Zip Code Date of inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and pit_ 6 Number of current residents: 2 Does residence have a garbage grinder? L] Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes No information in this report) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2013-45,000Gals g ( y g (gPd)) 2014.60,000Gal's Detail Sump pump? ❑ Yes ® No Last date of occupancy: Present j Date I Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) I Basis of design flow(seats/persons/sq.ft,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? [:1 Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official inspection Form Suhaurface Sewage Oispoaal Syslam Page 7 of 17 i f Jun 02 15 09:29p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name information is required for every Catuit MA 02635 3-26-15 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: 8130112 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): i t5ins-3113 TAle 5 Official Inspection Fonrz Subsurface Sewage Disposal System-Page 8 of 17 � Jun 0215 09:29p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - -- 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name information is required for every Cotuit MA 02635 5-26-15 page. City/Town State Zip Code Date or Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 86 Permit#86-210 / New D Box 2015 Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: "feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting,evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 20" feet I Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) JI If tank is metal, list age: years !I Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No j Dimensions: 1000 Gal. Precast H-10 Sludge depth: 3" t5ins-U13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I I Jun 02 15 09:30p p.7 Commonwealth of Massachusetts Title 5 Official ,Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments _55 Cap'n Carleton Property Address Paul McGrath Owner Owners Name Information is required forevery Cotuit MA 02635 5-26-15 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 27' Scum thickness — Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape-Plan Slunge 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 covers at 20"below grade. Inlet tee, outlet baffle. No sign of leakage or over loading. i Grease Trap(locate on site plan): Depth below grade: feet - Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Scum thickness Distance from top of scum to top of outlet tee or baffle ---- Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ms•3113 - Title 5 official Inspection Form:Subsufece Sewage Disposal System-Page I of 17 tI II I Jun 0215 09:30p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name information is required for every Cotuit MA 02635 5-26-15 page. Cityrrown State Zip Code .Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tanis(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): i Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: oate Comments(condition of alarm and float switches, etc.): I I i Attach copy of current pumping contract(required)_ Is copy attached? ❑ Yes ❑ No ,Sins•3/13 Tale S Official Inspection Form:Subswfaw Sewage DisposS System•Page 11 or 17 { I Jun 02 15 09:30p p,9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name information is required for every Cotuit MA 02635 5-26-15 _ page. CltyrTown Stale 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16'x16"-33"below grade wlcover at 6". One line out. Box is new 5-15. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.)-. *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15im-3113 Title 5 Official impaction Form:Subsurface Sewage Disposal System-Page 12 of 17 Jun 02 15 09:31 p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner . Owner's Name information required for every Cotuit MA 02635 5-26-15 page. Cityrrown state Zip Code Date of inspection D. System Information (cons.) Type: ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions-- El overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leaching is a 4'precast pit w/4'stone. Pit at 35" below grade w/cover at 16". 6"water in pit w/stain line l'off bottom of pit. No sign of over loading or solid carry over. No high stain line. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert I Depth of solids layer i Depth of scum layer Dimensions of cesspool Materials of construction 4 Indication of groundwater inflow ❑ Yes ❑ No t51ns-3113 Title 5 Olfidel Inspection Form:Subsurraoe Sewage Disposal System-Page 13 o117 Jun 0215 09:31 p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name information required for every Cotuit MA 02635 5-26-15 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids — Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i I i .Sins•3113 Tree 5 Official Inspection Farm:Suburface Sewage Disposal Syslem•Page 14 17 1 f Jun 02 15 09:31 p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Votuntary Assessments 55 CaQn Carleton Property Address Paul McGrath Owner Owner's Name _ information is Cotuit MA _02635 5-26-15 required for every page- City/Town state Zip Code Date of inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below drawing attached separately 1 I e '3 33, I t 3 I i ; I I I i i ' I I l usins.3h3 Title 5 Official Inspection Font Subsurface sewaoe Disposal System•Page 15 of 17 Jun 0215 09:32p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments a 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name information required for every Cotuit MA 02635 5-26-15 page. C41rown State Zip Code Date of Inspection D. System Information (cont.) Site Exam.- Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells NO Estimated depth to 12'+ Es p i�h ground water. 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: 1-20-81 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) L] Accessed USGS database-explain: -- I i You must describe how you established the high ground water elevation: T.H. on Design Plan 1-20-81 no G.W. at 12'+. Bottom of pit at T below grade. Bottom of pit at W above T.H. Depth. i II, I 1 GefoTe filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 1 I Jun 02 15 09:32p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Cap'n Carleton Property Address Paul McGrath Owner Owner's Name information required for every Cotuit MA 02635 5-26-15 page. Cityrro" State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed I ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i L5ins-3113 Title 5 official Inspection Fort Subsurface Sewage Disposal Systam•Page 17 of 17 Commonwealth of Massachusetts Executive Office of Envirolunental Affairs ON Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 .John Septic D.E.P. Title V Se Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508) 564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor I e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART AC(4 CERTIFICATION , S Property Address: 55 CAP*MtCARLETON RD.COTUIT ,' \ � �ddress of Owner:Date of Inspection: 11124/98 different) Name of Inspector: JOHN t3RACl (JOHN ANDERSON 1�9R T 0 I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) � 0F$9gp Company Name,Address and Telephone Number: 9tny0Q,TAB(F � 4 CERTIFICATION STATEMENT E y I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This Inspection Is based on criteria defined In Title V _ COnditl0 a1 Pa55e5 code 310 CMR 16.303.My findings are of how the system is performing at the time of the Inspection.My inspection does _ Needs ur er Evaluation By the Local Approving Authority not Impyany warranty or guarantee orthelongevltyofthe Fal#submit septic system and any of Its components useful life. Inspector's Signature: Date: 11124/98 The System Inspector she[ a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank. failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 55 CAPTAIN CARLETON RD.COTUIT Owner: JOHNANDERSON Date of Inspection:1112419E _ Sew.aae backup or.breakout or high.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health'in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS.THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:. The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. n0charge or ponding of effluent to the surface of the ground or surface waters due to an ov(,rloedf=d nr ring0erl cesspool. SAS is in hydraulic failure. (revised 04127197) r I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST 1 i Property Address: 55 CAPTAIN CARLETON RD.COTUIT Owner: JOHNANDERSON Date of Inspection:11124199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with NIA. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, 'If different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H: x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] 1 (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 55 CAPTAIN CARLETON RD.COTUIT Owner: JOHNANDERSON Date of Inspection:11124109 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day. flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127)97) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 1 Property Address: 55 CAPTAIN CARLETONRD.COTUIT Owner: JOHNANDERSON Date of Inspection:11r24199 FLOW CONDITIONS RESIDENTIAL: P d./bedroom for S.A.S. Design flow: 61e 9• . Number of bedrooms: 4 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): nfa Sump Pump(yes or no): No Last date of occupancy: rda COMMERCIAL/INDUSTRIAL: Type of establishment: nia Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: nra Last date of occupancy: We OTHER:(Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS LAST PUMPED 2 YEARS AGO BY ABCO System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: r9a TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no).( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date installed(If known)and source information: SYSTEM IS 11 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no) No (revised 04121197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 55 CAPTAIN CARLETON RD.COTUIT Owner: JOHNANDERSON Date of Inspection:11124198 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate_metal FRP Polyethylene_other(explain) If tank is metal, list age ma . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le'e'H57'w4'10" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness:+" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS. GREASE TRAP:_ (locate on site plan) Depth below grade: r9a Material of construction: _concrete_metal_FRP_Polyethylene_other(explain} Dimensions: We Scum thickness:We Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: rda Date of last pumping, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) We BUILDING SEWER: (Locate on site plan) Depth below grade: rs Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction line•TOWN Diameter. n1a_ rlv�mments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04127)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 55 CAPTAIN CARLETON RD.COTUIT Owner: JOHNANDERSON Date of Inspection:11124199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nra Capacity: n1a gallons Design flow: n1a gallons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nfa DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: non Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) n1a (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 55 CAPTAIN CARLETON RD.COTUIT Owner: JOHNANDERSON Date of Inspection:71124199 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits, number: 1000 GALLON LEACH PIT leaching chambers, number:roe leaching galleries, number: rda leaching trenches,number,length: rva leaching fields, number, dimensions:rya overflow cesspool,number:nla Alternate system: rda Name of Technology._Wa Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE LEACH PR WAS EMPTY AT THE TIME OF THE INSPECTION.PIT HAS NOT HAD MORE THAN V OF WATER IN IT. CESSPOOLS:_ (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: rda Depth of solids layer: iva Depth of scum layer: rya Dimensions of cesspool: rda Materials of construction: rya Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) n!a Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY:_ (locate on site plan) Materials of construction: rue Dimensions: Na Depth of solids: Iva Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc) rda (revleed 04f27)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 55 CAPTAIN CARLETON RD.COTUIT JOHN AN DERSON 11124/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: E, include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 'CIA E011 �� ac AA 17� ae 'ov, 4 Pay ! of 10 - (rev1eed04f27197) - - - 4 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 55 CAPTAIN CARLETON RD.COTUIT _ JOHN ANDERSON 11124198 Depth of groundwater 72} Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS � r (revleed04127197) 1Ikge 10 of 10 c oA) TOWN OF BARNSTABLE LL. TON m✓ n SEWAGE #! VILLAGE ASSESSOR'S MAP& CO '1k INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /Wy LEACHING FACILITY: (type) (size) NO.OF BEDROOMS - BTJILDER OR OWNER PERMTTDATE: 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 y o ® vo� �� J vv j No. Fss........ . ...�......_ THE COMMONWEALTH OFMASSACHUSETTS � O J �� //`""ACC RR® OF HEALTH t b Appliratio fear Dhipvii ai Works C omtrnrtinn lirrutit i Application is hereby made for a Permit to Construct (K or Repair ( ) an Individual Sewage Disposal System at: 3.9.......C ,� _ q�� oti tS./�/ co , f_ .. `.___ -------- ------.•--......-••---------------- ......--------------.•-------.---......_. Jartatico,-)Lddr s or Lot No. .. ......---• ................................ W Ow r Address Installer Address d Type of Building Size Lot..44.6.q ._Sq. feet Dwelling-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................... Design Flow.................. 5........._..gallons per person da Total daily flow _, ...... ............gallons. W Septic Tank—Liquid'capacity./.?.m.CLallons Length........6.... Width!K Via- Diameter................ Depthr�.7..... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......�_........... Diameter./Z-�_-.4.... Depth below inlet..'91. .. Total leaching area.Z.�Z.sq. ft. Z Other Distribution box (X) Dosing tank ) / '-' Percolation Test Results Performed byATX •• ' G...../k:5-....... Date.... ...... aTest Pit 'No. 1......Z....minutes per inch Depth of Test Pit.... �� .. Depth to ground water./-Ye_-".'f.'0.t.-9T- (i Test Pit No. 2................minutes per inch Depth of Test Pit.......................Depth to ground water........................ a ...........V................................................................................................................................................ 0 Description of Soil.....A.—�P_.....L d 4&.-......_ Sv 6 s e-_ - 1. S 34 — /Y .9.........: c��.....--- `�Q `� ---_-e ..T4 :...... --------------•--- ------..... VNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned. agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI.E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h been issued by the bQard of health. soh.. 6 Date,/ Application Approved -Date,/Application A ...................................... 17--/ Date Application Disapproved for the following reasons:............................................................................................................... ..............................••---••-•---=---••.....--•--•-•••••-••••••-------••••-•.......--•---•-•-----••----•••-••--••-•••••...---••---•-•---•--•----••••••••••-----•-----•••----••-•-••-•••------- Date PermitNo.---•-•-••-�G...... ..... Issued-....................................................... Date �No.'_.�llr2 1 0 Fzs... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7�o L4./ ij -- ... OF....................................... _.....�.. ApplirFatiun for Disposal Works Tonstrurtiun ramit Application is hereby made for a Permit to Construct (><) or Repair ( ) an Individual Sewage Disposal System at: ? / -• .. ._.................... '. .. ........................................... ...---•-•---..........--------.....- ---- -------••------......----------•-••-•---- \� J1 cation-,1ddr d's or Lot No. .......... �..v _./.. ...... -----------•-•---------------- I' Address Installer Address Type of Building , Size feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria W� Other fixte _-•-•Design Flow_ gaons per person �r day. oadaily o_w.............. : Q..........gallons. ....WSeptic Tank—Liquid ca acitYle .. .�allons Len h......G.... Width! . .. Diameter---------------- Depths..... x Disposal Trench—No..................... Width........... . ._.... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____ ____________ Diameter.l ..' ..... Depth below inlet. ............. Total leaching area.Z..e� ..t..sq. ft. Other Distribution box (X) Dosing tank Z Percolation Test Results Performed by a'?� : .................,f e........................... Date..._.�/z...-'•,1--.............. ,a Test Pit No. I......:?;.-.....minutes per inch Depth of Test Pit....f -` __. Depth to ground water."�l.g�'_ti. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...........10,................................................................................................................................................ D Description of Soil......36 -3G 4 u r<°`~', ' S-, ��o / -----------------------------•-----------•---------------•------- >' V .-----•--• - -------•--- --• ----•-•--- -. - U Nature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL is 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h /been issued b the board of health. Si .... -----------------------•---•---••-------•• ....9M . .. ..�. _Date) Application Approved BY---..---= =-•--•-•-••--•-•----....•--------•---------•-•-••••-•................••-•-----••-•-- - ..... / Date Application Disapproved for the following reasons:------•-------•-••--------------------------------------------•------------------------------...------••---••••. ..------•---•...........-•-••••--•---•------------•-•--•----•.....-•---•---------•-•.......................•--•---------....----••-•--•---------••-------•-----•--•-----•---•--...._........•------•---- Date r—" PermitNo...............C::. -'> C�--------------�...!- -----.. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF HEALTH ..../C.?�?I!t/.............. .....OF...� T".1^ Trr#ifiratr of TVIMpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Dispo al S�t'stem constructed ( ✓ror Repaired ( ) �� (J 1... S Gi t.... l io_.I/...-----•--•----•------------•.................................•---------•-- // Installer -7�— at f:./' � c,4 P--7_Cc-r vi L= ELF ��? 5 �� /, G 4%X v.!.1.... has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........... ?:'� ......-'_.L'D dated-....�:._�..�. . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ATISFACTORY. DATE...................................../-.. .-'•-. - Inspector----��-..........----•------------------...--------...........-•-•---•-•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `,/lt�. OF........ ............. .................... Dispos al Works 4onutrnr#iun antic Permission is hereby granted........... h-`1`'� �Mv,..... .....................••-•-•-•---•-•--- to Construct ( ) or Repair an Individual Sewage Disposal System at No............ `` `== ! C A c C.C--ft.0-f-......... Street as shown on the appli tion for Disposal Works Construction Permit No.-... - Dated....... YL Board of Health DATE.................... ....f-k --- - FORM 1255 HOBB & WARREN, INC.. PUBLISHERS SSESSOR'S MAP NO. ®3 PARCEL Pr CA T 10N �PsY SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS B U I L D E R OR OWNER e w�CCU DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Q EXCAVATe 135Mt PLOOR A5 NEa55APY PXI5TIN6 f0 ACCOMXAfP POP 5NOMP,f01LPf WASH ANP eJeCTION PUMP PIPP f0 SEPTIC ESSEX ASSOCIATED CONTRACTORS ----------- ___________= LTD. EX151ING N L 300 Middle Road W� , i PUMP Se PLOOt2 `�� Haverhill, MA 01830 (978) 373-4550 PIPE i 4(911 X 5011 UP 5HOMF PLUMBING WALL ` s _ POPCH FnNT ' µ� PROPOSED PLAN CAA or'EN 51'O � 55 CAPT N CARLTON . ROAD McFLOOP �°- �t COTUIT, MA 2v " 7 S TY LINEN CL 'S�1 1/4" - V-0" 3 —3 UPPER ur' x C105Ef CLO5Pf SfOt?Xk� �5f07AL� _______ L,1111.II r . ------ BEAM C7 L - - - - - - - - - - - - - Anf7 AJ7f? ACJI7 NEW =NEW NEW POSE NEW P0' r 5fo AGE UNMP REMOVE PemovE EX15TING EX15%6 ; P05f P05f co PLA 5CMe f N rn FAMILY pOOM Tv CARPET PL00R . I o c 'Oc> 11 /17/2otc) EX15VNG 51112ER EX1511NG WMNDOW5 E451ING PO R F1N15HN213A5FMFNf PLAN L 1 Ex1snNG WA5TE ESSEX PIPE ro 5MC ASSOCIATED ---------- CONTRACTORS LTD. EXISnNG � � 300 Middle Road WA5 j - Haverhill, MA 01830 ' PIPE (978) 373-4550 j uP - - - p01?CH FPN EXISTING PLAN 55 CAPT'N CARLTON ROAD I COTUIT, MA NOVEMBER 10, 2010 �X151'ING 5�M1-�INISN�b FLAW00M U15nN6ry �X151M FUpNACE HW TANK �XIM6 FAN�L�n WALLS ' ANn PPOPM2 OILING WITH LUH 5 EXISnNG SI IPER EX15M6 WINPOWS EX15nN6 POOR ONE 51EP TO GRADE �XIS�'ING M5FMFNf PLAN ti 35'-0" 18'-0" 22'-0" I I I I up I I I ii I I MAS1-F,P �fnF00M LIVIN6 p00M I . I-- - - - ---------------J I " n • II� I. I n i DN CATN�f7t?AL OILING III I. II LINEN LAUNnFYI o� C�A11-I ❑ p` PINING F"OOM °O VCH�N I °° II �D o° LEJ ACTIWnook EXISTING 51.117Et? ESSEX � I � I t_ �45 ING r\5f LOOP-TAN t ASSOCIATED CONTRACTORS EXISTING PLAN �� LTD. 55 CAPT'N CARLTON ROAD 300 Middle Road COTUIT, MA Haverhill, MA 01830 (978) 373-4550 NOVEMBER 10, 2010 .. J 35'-0" ESSEX ASSOCIATED CONTRACTORS �,W�5FAC� LTD. 300 Middle Road Haverhill, MA 01830 - I (978) 373-4550 I ii II I I II II I I II II I I II II I EXISTING PLAN I ;; II I 55 CAPT'N CARLTON ROAD I II COTUIT, MA NOVEMBER 1.0, 2010 DN Ln 13ATN °O 13M'ooM �X151"NG 5�COW FLOOI? FLAN r _ S YS jjROFILE NOT TO SCAi_E TOP FON. FINISH GRADE -:-' . 1 INISH GRADE OVER EL . =� ;o::.ae;.,: FINISH GRADE OVER DIST. BOX FINISH GRADE OVER SEPTIC TANK "= ' J :o'�:.o:.,• LEACHING PIT 4�• '� :::a. VARIES / o 0;a: :o '�: ''0-'4: a•'e':':a:':et:�: :o:.: :q..a;i•;.•.e::•. e: o.r: ••. : 3" OF 1/8" - 1/2" ASHED PEA STONE .�Q•:_:°-_�.;_•:•=• PRECAST CONC. OR ••' • ••` BRICK 6 MORTAR s; OUTLET PIPE LEVEL TO 12" BELOW GRADE o:p•'.'0 4 :Q.•,•..:0:'O:'O: ;D...4.: 'D•':b:'O•'o.'•':-.•o •D 0. FOR 2 FT. MIN. s o". A.: o "0:::l:•.i..'o...i O:'p:.b.',o.,�.o.o: 'd! "� .p'e', b. O.O. o' . 0 .o • ' .-o o,� .O •oe - D •-D .0 p C. I. OR PVC TEES -r_o. o. .o." e: . o.D. ° BSMT. FLR. GALLON o...o..•.: .: J, DISTRIBUTION BOX EL . INSTALL ON LEVEL BASE 3/4" TO 1-1/2" Q ° o.o- s:.c o: •�.' C .� o: PRECAST CONCRETE :a ° � PRECAST a WASHED :a ° H— /0 REINFORCED o CRUSHED CONCRETE 't o. a: ?•O.o .eo c:o�o-:o a'o:o o:oe.o'o.po:eo o•Qc°,o,•o:•a.o:d.00.ovogoo: STONE 's .. • b::o: H— '0 REINF. b, SEPTIC TANK a0- INS TA L ON L EVEL BASE NOTE.' EXCA VA TE TO EL EV. OR LOWER TO REMOVE ALL IMPERVIOUS MATERIAL BENEATH THE LEACHING AREA REPLACE EXCA VA TED MATERIAL WITH CL EAN. CL A Y FREE SAND , EFFECTIVE DIAMETER I GENERAL NOTES LEACHING PIT ---�---- 135. oo ----• — INSTALL ON LEVEL BASE 1. ALL EL EVA TIONS SHOWN AAE BASED ON F/L L� TO Ao 2. AL L PIPES IN THE SYSTEM MUST BE CAST IRON OR SCHEDULE 40 PVC. OBSER VA TION PIT _ . 3. THE BOA -,-!04 L TH MUS T BE NO TIFIED17 rG -- ----.� �1' •`""-•-- ---•_ ..,�. `��` - - ,2 v WHEN CONSTRUCTION IS COMPLETE PRIOR TO BA CKFIL L ING PERCOLATION RA TE.' LOT 39 �..._ -.,-f MIN./IN. 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED �--� .E/� 600 -t- 3..�'```- __,�` `z BY THE c'�4RD OF HEALTH AND CAPE 6 ISLANDS WITNESSED BY.• liteSURVEYING CO., INC. �� -�� ` `- --_ _ ___ `�•-- '`-z� 5. MA TERIALS AND INS TALLA TION SHALL BE IN .c--— - - COMPL IANCE WI TH THE S TA TE SA NI TARP " ``�" '= BRO. OF HEAL TH DESIGN DA TA CODE - TITLE V - AND LOCAL APPLICABLE DATE: RULES AND REGUL A TIONS -��' n ----- _- o -e. - ?•�=�_, NUMBER OF BEDROOMS �• o -� �- �o 6. NORTH ARROW IS FROM RECORD PLANS AND °-- - '� '---- - �, - IS NO T TO BE USED FOR SOLAR PURPOSES GARBAGE DISPOSAL L o.v�► No `. 7. FL 000 HAZARD ZONE �:;' ``' DA IL V FLOW 30, .--i. " �a B. WA TER SUPPLY 3�,. � 3 ',a,� SEPTIC TANK REO 'D. O� wz. ( SEPTIC TANK PROVIDED �•�• 000 GAL 44 LEACHING RECJUIRED _5�,RO GAD, �r PRECAST ONCRETE A'f6 6 1 TIC TA W 10, .i .�� DEWALL AREA � ' .44� SI S. F. G/S. F. _ • GPD \moo �� 4� BOTTOM AREA i S. F. Q LEGEND _=: s. F. X GIS. F. _ /.e3 GPO oo _ - --J i. / ' r`f`� /_"l-'' N 38'44 '40"N LEACHING PROVIDED .f/B GPO `------- -_----•- --- --- PROPOSED EL EVA TION 7- , ;. � •� —— �' —— EXISTING CONTOUR OBSERVA TION PIT SINGL E FA MIL Y RESIDENCE 5a - 0 DISTRIBUTION BOX PROPOSED SEWAGE DISPOSAL SYSTEM (a PRECAST CONCRETE PREPARED FOR i`EACHING PI T 0 o SEPTIC TANK v'A/1ifE,j GUI L D iR? RESERVE ,• �IA O�- ; L U T 39 CAP 'N CA RL E TON 'S ROAD ESA Rl`v' ,�A BL E - CO TUI T - MASS . -= PIPE INVERT ELEVATION CHAk DA TE:. ' CAPE 6 ISLANDS SURVEYING, INC. PLOT PLAN SCALE., 1 " 3 8 3-9 SCALE AS NOTED P. 0. BOX 334 W -� TEA TICKET, MASS. MAP SEC O T��:: HSE PLAN NO. .� ..