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0043 CRAWFORD ROAD - Health (2)
/ + 43 Crawford Road Cotuit " A= 005 -:030 i I dF BSTABLE A r� '� SSE3S02t'S&tAP Laic O .a� IMUL LO�1f :,.��._ s dC T CAPACI'tht S �'( - i�tt3 ft. .OF Is, ` �er �t apt v I ►' CpPI iC DATA: Sepa�attat�lpts�aws Bstweeg�� . 40 Adax{mumt �audwaterThtatu+ fattwnaLshCngcilh� ' .�. -... Scrt4s�i" � aa�iingt aos a�ta a uv) t a�iacE�a► fitp� E dR'�fetU�ad opiE Leas o my> tie�cla sRisE t{als�304 het Of l�acs�upg13►) 7� C046 ft?li�5yt�.b3► ° C G C -3 3s D -3 - �G Doi- O30 0-Lj � Commonwealth of Massachusetts z:,. 4 _ ! . � t� Title 5 Official . Inspect ldn for m.. 4 i�-i Subsurface Sewage Disposal System Form:-Not for Voluntary Assessments . 43 Crawford Rd , Property Address Sandra Myrick •_•, ,, r.. Owner Owner's Na , information is _ required for every Cotuit '^ MA 02635 2-25-21 + - page. City/Town - State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information .1151 Shawn Mcelroy ' Name of Inspector " t , •...,,. . :. , .f ..r f Upper Cape Septic Services A Company Name P.O. Box 73 Company Address East Falmouth MA r - 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify thata am a DEP approved system inspector;in full compliance with Section,15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system'at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed 6ased`on my training and'expedence'in the'proper function and maintenance of'on-site sewage disposal systems.After conducting this inspection I have determined that the system: i�'+` t` f, •. A. ® Passes`' ' I !. r' - �,. rl :. r 4y ? ' • + :fir' . 2• ❑ Conditionally Passes:.,,, x r • £i .3., •❑ Needs*Further Evaluation by the,Local Approving,Authority. 4. ❑ Fails 2-25-21 Inspector's Signature " ` Date ' The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c . Commonwealth of Massachusetts {-►>> ° - "' ! ' Title 5 Officoai inspection 'Form. f ` f ' F�l Subsurface Sewage Disposal System Form=Noffor:Voluntary Assessments - r ;ray 43 Crawford Rd Property Address Sandra Myrick - Owner Owner's Name information is Cotuit MA 02635 2-25=21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary i.+ 1, 1 r+i . I —,i. t.r I . _ 1 ,a+ i ..u.,. Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria.not evaluated are indicated below. ". Comments: 'System is in good working order with no sign of failure. 2)° System Coriditionaliy"Passes:' ,❑ One or more system components as described in the "ConditionalPass",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. r t *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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts � � •�;,;_ w,� s ,; ;:+ �.. fr Title 5 Official, lnspe tidn -.Form- '1 0-1 Subsurface Sewage,Disposal:System Form;-Not for.VoluntaryAssessmentsr 43 Crawford Rd Property Address Sandra Myrick _, -•:�t; ,. Owner Owner's Name information is required for every Cotuit MA 02635 2-25-21 : r' page. City/Town+ State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if - '1 pumps/alarms are repaired. + 3� f ,.t' L' •1_ ..►{r�x �t,ti��` , ...'.} r�`+., r. : i.l ,, to•q •ra .. S.r `��'�, +'c's ,..* ,! J, �.a,'I}r. ,Y. to .7.w � c�.ri..r7' i s.i •� Tri-a - .�+Y f.` «1' s• .«s'r.. +`. Itl,J:. ❑ 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): 4 " r4 " 't ,L = -' '.' e 'El- broken'pipe(s) are replaced, ❑`'Y ❑NT ❑ ND (Explain below): •�` ,` ' ' ' ❑ °'r obstruction"is rem"owed �"' fir't ' '"❑"Y "'❑N `t-y❑°;ND (Explain below): fl ❑'' ' ' distribution box is leveled or replaced `�❑Y ` ❑MN" ❑ `ND (Explain below): f •".f.-.'r.:x+. r `t-'e ;.... ha t..it . '. ' '1:ir'. _ :i 1: ,i t �-r.ta •"l. J �, .�,.,J e .tc:' .ft1� .t. t.df...>~ ... 'ani fFrr.r-t . ,dad ,}' ❑ The system required pumping more than 4 times a year due to broken or.obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required:by-the Board of-Health:- ❑ Conditions exist which require further evaluation byL theBoard of Health in order to determine if ' `the systemis 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: .. .. ix a � �. # . - #- Fri r',r l f• - rt .. ,a +.,�,r t5insp.doc•rev.7/2612018. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Foi 0 Subsurface Sewage Disposal System Form-Not•for.Voluntary Assessments 43 Crawford Rd Property Address Sandra Myrick Owner Owner's Name information is Cotuit `- MA 02635 2-25-21 t required for every ' page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water l� ❑ Cesspool or privy is within 50 feet of a bordering vegetated wefland 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: 1I I . . , . , . ❑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 SA_S 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: j .i� • ,},. , ,� 1. .,- !, ,nc� Ai1 tl w 4) System Failure Criteria°Applicable to All Systems: You must indicate,"Yes",or"No",to each of the following for all inspections: - 'Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection F®rm �I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r v 43 Crawford Rd Property Address Sandra Myrick Owner Owner's Name information is required for every Cotuit MA 02635 2-25-21 page. Cityfrown -t State Zip Code Date of Inspection , C. Inspection Summary (cont.) • ,� �: , ; . _- 4)„ System Failure Criteria Applicable to All Systems: (coot.)-.•, s• :► Yes ±No .1 <. 0 ® Static liquid level in the distrlbution'box above outlet invert due to an overloaded or clogged SAS or cesspool' ` invert, due depth in cesspool is less than 6" below invert or available volume is less ❑ r ® than '/Z day flow f ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: - ;� - a❑.,, .. ®- , Any portion of the SAS,,cesspool or privy is below high'ground water elevation. Any portion of cesspool or.pdvy is within 100 feet of a surface water supply or Ell .'�f Any 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 r• 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 ❑ .t F ®' r 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 I,necessary to correct the failure. .^ � i '. (:. up rE"9t� `"` . +.,"S• .tl t C"i.. '!, �t: [ 1` '3E:l.�p.�- `°•. •d 5) Large Systems:To be considered a large system,the system must serve a facility with a design flow of 10,000 gpd to'15,006 gpd. I Al -' -For large systems; you must indicate either"yes or,"no"to-each of the following, in addition to the t•,-,questions in Section C.4.• 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 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 I Commonwealth of Massachusetts .,•'=x' • j' f' x-:'` y Title 5 Official Inspection' floram', p Subsurface Sewage Disposal System'Form -Not for Voluntary Assessments 43 Crawford Rd ►" Property Address Sandra MyrickI Owner Owner's Name information is required for every Cotuit a-a MA 02635 2-25-21 page. City/Town n' ^ 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? ' i i ® ; ❑ Were as built plans of.the system obtained and examined? (If they were not 't "available note as N/A) ® tzEl t '.t Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ®'° ❑j Were all system components, excluding the SAS, located on site? T ' cl r` ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank n inspected for the condition of the'baf�es or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® E] Wasthe 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f Commonwealth of Massachusetts Title 5 ®ffflcoal Inspection Form 1_� Subsurface Sewage Disposal System. Form:.,Not for Voluntary,Assessments , tit 43 Crawford Rd Property Address r Sandra Myrick E Owner Owner's Name information is required for every Cotuit MA 02635 2-25-21 _ � page. CitylTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number,of bedrooms,(actual): 4 DESIGN flowbased on 310 CMR 15.203 (for,example_ 110 gpd x#of bedrooms): 440 Description: Number of current residents: Does residence have a garbage grinder?,. ❑ Yes ® No Does residence have a water treatment unit? :,� ,- ❑ Yes ® No If yes, discharges to: z. Is laundry on a separate sewage system? (Include laundry system inspection d ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? y�� . ,�, ; } ❑ Yes ® No Last date of occupancy: 2-2021 Date t5insp.doc•rev.7/2 812 01 8 ��,. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts rill ,:;1 Toile 5 Official. Inspection F®rrm` s N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments,, +' 43 Crawford Rd r t F Property Address Sandra Myrick - Owner Owner's Name information is 2125 2 it MA 02635 t ou . - - required for every C ; 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): ' r 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): ` 1 sr 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 � Commonwealth of Massachusetts i:r,,,. = :;, • : - , ; a f Title 5 Official. Inspection fohn �. I hI Subsurface Sewage-Disposal 3 stem Forma-Not for Voluntary Assessments.., r K, 43 Crawford Rd Property Address }, Sandra Myrick Owner Owner's Name information is i Cotut , MA 02635 2-25-21 required for every i page. City/Town i; State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® 'Septic tank, distribution box, soil absorption system!.,,.•, r.;,, ❑ Single cesspool �. •a ❑ , ,,.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, r ❑ s, r ,Tight tank.-Attach a,copy of the DEP approval. ❑ ' 'f' Other(describe): w P Approximate age of all components,.date installed (if.known) and source of information: 2008 Were sewage odors detected when arriving at the site? t , �, ,, ,, r ❑, Yes ® No 5. Building Sewer(locate on site plan):_; 18" Depth below grade: "' { ' , ''' -`feet a y Material of construction: ° J ❑ cast iron at ® 40 PVC' , ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official In'spec$ion-form � } �► Subsurface Sewage-Disposal System Form -Not for Voluntary Assessments + 43 Crawford Rd Property Address Sandra Myrick Owner Owner's Name information is r , required for every Cotuit - MA 02635 2-25-21 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12" t `feet Material of construction: G = ® concrete ❑ metal ❑ fiberglass '❑''polyethylene' ❑ other(explain) If tank is'metal, list age: ' f " ' years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1500 gal Dimensions: Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle- '` . 20" Scum thickness 2" • , Distance from top of scum to top of outlet tee or baffle ' 'L, w 5" Distance from bottom of scum to bottom of outlet tee or'baffle" 15" f. How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no,sign of leakage.. .t t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts a f. Tole 5 Official BnspeC$loh .Fot� ? IQ Subsurface Sewage.Disposal System.Form -Not for Voluntary Assessments 43 Crawford Rd Property Address Sandra Myrick , Owner Owner's Name information is required for every Cotuit r ,. t MA 02635 2-25-21 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): �, , �,; .t,--;w ,,., . r,.: r Depth below grade: "- feet Material of construction: .. t ❑ 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 i Date of last pumping:. ,,, , t i t .. ,� , , f., Date— i Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related'to outlefinvert, evidence of leakage, etc.):`) '") a :+i!_ .!Nt• y ,.. t_. :�. f ..l'.' tc; y 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 t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts - w41, Title 5 Official Inspection Form _ ! i�M Subsurface Sewage Disposal System Form'.;-Not for Voluntary Assessments- 43 Crawford Rd Property Address Sandra Myrick Owner Owner's Name information is Cotuit MA 02635 2-25-21 ' required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ' 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes _❑' No ' Alarm level: Alarm in working,order,"-,' ' ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): Good condition with water at working level and no sign of back-up from field. r I t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts f Title 5 Official I nspecti®n fovin Subsurface Sewage,Disposal System Form,-Not for Voluntary,Assessments 43 Crawford Rd Property Address Sandra Myrick r Owner Owner's Name information is required for every Cotuit t,• MA 02635 2-25-21 s' - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): _ t , t� r Pumps in working order: ❑ Yes ❑ No* ►! ,. Alarms in working order. - i '' ft`'" ' " ' '' ' ' ❑ 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: r' Type P�- ❑ r.�f.{ leaching.pits' ,. ® leaching chambers number: 12-Biodiffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7J2M018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts ,. Title 5 Offidal Inspection F®-hrfi` %I Subsurface Sewage Disposal System Form -Not-for.Voluntary Assessments ' 43 Crawford Rd Property Address Sandra Myrick Owner Owner's Name information is Cotuit - MA 02635 2-25-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) I • 11. Soil Absorption System (SAS) (cont.) '' + ► °a, �' ' Comments (note condition of soil, signs of hydraulic failure,.level of ponding,.damp soil, condition of vegetation, etc.): Leach field in good working order with no sign of back-up into d-box or surrounding stone. I S 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and'configuration' - r ry i 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.): Y f: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 ' 4� Commonwealth of Massachusetts �... - ,, �, ;w ° - -,. ti Title 5 Official Inspection Form. - ' Mi Subsurface Sewage Disposal,SystemTorm-Not for,Voluntary;Assessments r 43 Crawford Rd Property Address Sandra Myrick ,,,;• ;,, r Owner Owner's Name information is Cotuit t} y�_ ri� MA 02635 2-25-21 „•.t;. required for every _ page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): • ' "' j* = +�:; - - il^ "'Materials of construction: Dimensions :G Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t 1 S t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts - ,' Title 5 Official inspedidhMForoil' t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Crawford Rd }� ' Property Address Sandra Myrick Owner Owner's Name information is Cotuit 4 MA 02635 2-25-21 required for every 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 _ t A, 1 3s ,�3 . e) f t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 ' I 4 Commonwealth of Massachusetts Title 5 Official Inspection Form F ! a Subsurface Sewage.Disposal System Form -Not for Voluntary,Assessments- � , 43 Crawford Rd Property Address k Sandra Myrick Owner Owner's Name - information is required for every Cotuit - i•. MA 02635 2-25-21 ,+ page. City/Town .:. State Zip Code Date of Inspection D. System Information (cont.), -;, F r,�; , ,. , M -]F� _- 15. Site Exam: • «,. *.s a. :+cif. °1; ❑ Check Slope ❑ Surface water .;s3°+ r t _•. ►. t. : ❑ Check cellar ❑ Shallow wells r a- r Estimated depth to high ground water:. , .ila, :: r 12 feet ' " - '' Please indicate all methods used to determine the high groundwater elevation:, ® Obtained from system design plans on record If checked, date of.design plan reviewed: ,-tr=; :Date' ® ;Observed site (abutting property/observation hole within.150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts ', j r} �� '' `� it ' #- ���, Ti$ie 5 Official inspection 17orm' i hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments { ._ ' 43 Crawford Rd �} • r ' `` Property Address Sandra Myrick Owner Owner's Name information is required for every Cotuit - MA 02635 2-25-21 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist F _• =� 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 4 checked = 3 ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed tit : n t " ® D. System Information:•C - 1 + 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 jr ° t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .'( 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is Cotuit Ma 02635 1/30/2012 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your I -4 U11 cursor-do not Sean M. Jones use the return Name of Inspector key. Capewide Enterprises ITV Company Name 153 Commercial St. Company Address Mashpee Ma. 02649 Cityrrown State Zip Code 508-477-8877 SI 4522 Telephone Number License Number B. Certification I certify that I have;personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. l am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails r.., ❑ Needs Further Evaluation by the Local Approving Authority ,R x 1/30/2012 212 Inspector's Signature Date - 7; R The system inspector shall submit a copy of this inspection report to the Approving Au'thoritym(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•11/10 Title 5 Offlaal Imtpedi ortn:Subsu.08 Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. Cityrrown 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: El I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was found to be in good working condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will.pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 .t: Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Crawford Rd Property Address Paul.Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): 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 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. City(Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface•water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen.and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the.failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area=IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM ,e''y 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts H v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma. 02635 1/30/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2010.= 116,000 total = 318 gpd 2011= 106,000total =290 gpd Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 43.Crawford.Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system repaired 11/20/2008 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron N 40 PVC ❑ other(explain): 10+ Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 811 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: 1500 gallons 11 Sludge depth: 5 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 35 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers and took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years as maintenance. Water level was ok, tank was not leaking and was structurally sound. Outlet tee was intact and in.good condition. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Crawford Rd M Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635. 1/30/2012 every 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 Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order` ❑ Yes. ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Distribution box was found to be in good condition, no high water marks indicating that the box has never been hydraulically overloaded. No solids carryover. 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:): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 3'x30'w 12 bio-diffusers ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): soil surrounding leaching facility was probed and found to be dry with no sign of past hydraulic overloading. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 43 Crawford,Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •��t 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is Cotuit Ma 02635 1/30/2012 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 - Y t3 3 8( 22 t Z A-Z 8_3 z(_. C-3 3s6`, - Y 5-7 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: r ❑ Check Slope ❑ Surface water ❑ Check cellar i ❑ Shallow wells Estimated depth to high ground water: 20+feet Please indicate all methods used to determine the 9 high round water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 11/6/2008 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water.elevation: Groundwater elevation was established by accessing design plan dated 11/6/2008. Plan shows no water encountered and system is designed to have a seperation of 54 between bottom of s.a.s. and adjusted high water table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Crawford Rd Property Address Paul Roche Owner Owner's Name information is required for Cotuit Ma 02635 1/30/2012 every page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ®. Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 G� �ff OF_+BARNSTABLE LOCATION "e' SEWAGE# VILLAGE L 104�f- ASSESSOR'S MAP&PARCEL S �3 INSTALLER'S NAME&PHONE NO. Cz Me f ;"o 2,F SEPTIC TANK CAPACITY /&dU 4410 LEACHING FACILITY:(type) L 3,u D r a, (size) X 30 NO. OF BEDROOMS OWNER P / n PERMIT DATE: //"�/®g COMPLIANCE DATE: / Z® 0 8 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,wv !� 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 L.aching Facility(if any wetlands exist within 300 feet of leaching:facility). feet FURNISHED BY SEW i c �'2itaQ,fT BLS G[-Ce G !' 2 t3� z2•� c3 3 s�. s"" QZ �S•c� � (�r,� �33 z�•c� s 8 0 . No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z1ppYication for �Digonl 6pgtem Cori.5truction Permit Application for a Permit to Construct( ) Repair(,A) Upgrade( Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. �3 (�'��,j Owner's Name,Address;and Tel.No.A�" :2 err Ct, 43 CxU�6-vA (Lo" Assessor's Map/Parcel U Installer's Name,Address,and Tel.No. C 1^e.Vw i 6a Fr i Designer's Name,Address and Tel.No.J t Sib%• qZ-6. `- a" � �,�x ��� 5 ea•z-13 ���1 zf,54 Type of Building: Dwelling No.of Bedrooms Lot Size Uiq:Saja ;fit sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) TS�Is® gpd Design flow provided 3(AU i7S gpd Plan Date i��• u. Zto% Number of sheets ` Revision Date Title "!�1�yU-iS65-S\. t-�,• Size of Septic Tank b Type of S.A.S. \L prrc c 31da "L Description of Soil ga & f1, ' C, C_ i� Nature of Repairs or Alterations(Answer when applicable) x kCs.c�.` .� �>g n (�,_b,1_ a,r, 5A3 Date last inspected: ?w b Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sig Q0, ate 1/—7— 1-0 0(� Application Approved by ate i Application Disapproved by: Date for the following reasons Permit No. , ) Date Issued No. !� 1 Fee M. I ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for �Biopooal 6p!gtem Con5tructiou Permit Application for a Permit to Construct O Repair(-.,) Upgrade( ) Abandon O ❑.Complete System,❑Individual Components _ 1 Location Address or Lot No. NQ) G c Owner's Name,Address,and Tel.Nof.�j e�2a� ZeX..h le. Cate �3 G4� A Rv� Assessor's Map/Parcel \A Installer's Name,Address,and Tel.No. In o Gw t' c� c.k~ i C \ � Designer's Name,Address and Tel.No. L �n'b• Ljr�• yoZ1S n�� .x Spa.-Z-1.5 7-1-7 zg5y C,�.��.�v� FJt �r1 `\ .w. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3kk(a gpd Plan Date '�• Z uU�ttS Number of sheets Revision Date Title �a w$aize of Septic Tank ,o p p , Type of S.A.S. 7 pr-Ne "L Description of Soil So n\�1 r. ' ( . G 30, ' s `Nature of Repairs or Alterations Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has bees issued by this Board of Health. Sig O Q� ate ! ' 7— Z P F O Ci Application Approved by p Date Application Disapproved I Date T!� for the following reasons + '" -- t i Permit No. ) Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance y THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( C ) Upgraded ( ) Abandoned( )by G o Pxy.\ P. 1� cN\ --q< .,`>c J at L���a 1 w1�4 Y r�G n 6\It has been c nstructed c ordance r with the provisions of Title 5 and the for Disposal System Construction Permit No. `-- dated Installer Pik c-',-s Designer #bedrooms 9J Approved desig� 07 ow Q� gpd,- 1 The issuance of thi ermi ha111 not be c nstrued as a guarantee that the system w 1 fu ctio as d signed. 11 Date (�( Inspector ----- ------------ --- ------- ...-- -- No. Fee / (/ THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS =i!5pogal *p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) System located at o• ?� �� �. ( � �-+ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction m st be complete within three years of the date of this Date / Approved by ) 1 fown 01 IfOasta t�V Regulatory $ervi&s i Thomas F. GeiADM. ir, Director Public Health DI isiob •�.. ; Thomas McKea' h►i�rect r P q , 200 Main Street,H alnniis I1'i�► 2 Y �O1 Office; SU:.t�62-4644 Fax; 508-790-6304 Instaerc Designer Certi£icaition aim i Date: f Z-01 -0$ Designer: ZG C-n cncadri Insta'� Address; zES+I �cc�n�OQ.'-'1'"• ry ILU ft ,38 (fin � L�0, '-•�F' i ,-� Jl was issued a. ermit to d tle� , P install a } (installer) 4 septic syt tf m at H'3 Crow Fad� S�Cee-� based on,a design drawn by ( s) elated -ktV-U ble r. 6 _�10 (designee) I u rtify that they septic system referenced abovle was insulted substantially according to tie desig�� which may include minor approve cl�a�get3 such s substantially antral relocation in the d:siriOUti box and/or septic tat k• of i I curt £y at the .septic systc n referenced above was in$t llecl with major changes g'eater th n 1�'' lateral relocation of the SAS or 4tiYvertibal relocation o£any component o. the sep is system) but in a4cordance with $tote & Local Regulations. Plan revision or cor�ified a -built by designer tb follow, i r JCIE „- is igriati�rLD 008, . er's I i e) ainp Here) EASE: T 'O ARNST� LE IC E' Iyi S CERT CATS I N BUIL { g . ' S Q: Haald>I�cpiic�l]esi�ner Certification Form 49£0 2LZ 80S : ?NIN33NIIJN33f' Wd 8£: To aeon-To-oaa �3 LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S ME A ADDRESS i ® U I L D E R OR OWNER e DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �1�L� ii 7 Town of Barnstable P# Department of Regulatory Services • B,.V8TM4 KASI Public Health Division Date i �,7f: A 200 Main Street, nis MA 02601 Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: M�eNAEt- r1N�Ew�rrt� �.1.T. �,s<Y Witnessed By: ��/u% LOCATION& GENERAL INFORMATION 6 Location Address 4 3 Cqz4o,)(�wd 2o,44 Owner's Name LJ.CW,fr<?,^ � e T- Address Assessor's Map/Parcel:5p5' 4 Cs� �T 30 ,. Engineer's Name / NEW CONSTRUCTION REPAIR V Telephone# Land Use '7filff4rrgl.1 LAW/a Slopes °!0 0-Z`�a P ( ) Surface Stones V/19 Distances from: Open Water Body ft Possible Wet Area ! ft Drinking Water Well �t50 ft Drainage Way '10 ft Property Line r� ft Other ft SKETCH:(Street name,dimensions of lot exact locations of test holes&pert tests,locate wetlands In proximity to holes) SEA or tACKo 'IAA u Parent material(geologic) Depth to Bedrock. aG.3. Depth to Groundwater. Standing Water in Hole: '>130N 'B.[s.S. Weeping from Pit Face "B 5 Estimated Seasonal High Groundwater r�.� R•(e•S. DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: _'r>REtr 011se¢u4no0 Depth Observed standing in obs.hole: �13d•� �.Cr S• in. Depth to soil mottles: s r so—?,0•S, In Depth to weeping from side of obs.hole: 130� ,G.3. in. Groundwater Adjustment___"LA ft. Index Well# Reading Date: — Index Well level AdJ,thctor Adj.Oroundwater Level PERCOLATION TEST Datellsleb �'lole r5 nnA Observation Hole# l Time at h" Depth of Perc _ Time at 6" Start Pre-soak Time @ 16145 AM — Time(9"-6") End Pre-soak to:Z, Ain Rate Min./Inch Z MPr Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at.least one (1) week prior to beginning. QASEPTICTERCFORM.DOC • DEEP-OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel 0-`' �ict Cv*_to A r_ Wmv 5*mo 10'-3p" LOAMY 5*4 �U s'6 V '12_I'St)-. -2 MONA-CoARse Ift L.SY 4 �� DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi en % ve 0_G tYt� A Ye sl1 to'^_ � j t-oAw►v SAND Vp Y S -'20' C-Z mea-t w-W, Salvo z.SY (oil a-ac�sE DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Cons' en I Flood Insurance Rate Map: Above 500 year flood boundary No— Yes . _ Within 500 year boundary NoV" Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material 1 Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? ..._ Certification I certify that on fd-27-1 2 (date)I have passed!the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise an xperience described in 310 CMR 15.017. Signature Date �� Oo Q:�S.EPTICIPERCFORM.DOC PROVIDE PRECAST CONCRETE GENERAL 1 V O'"1"E S T.O.F. EL.= 40.0' ± EXTENSION RISER WITH CONCRETE /-FINISH GRADE OVER D-BOX= 39.0'± 4"SCHEDULE 40 PVC MIN.SLOPE 1% FINISHED GRADE OVER INFILTRATION= 39.0' - 39.3' COVER TO WITHIN 6"OF F.G.OVER INLET AND OUTLET COVERS. REMOVABLE COVER OVER RISER TO SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION BOX TO WITHIN 6"OF F.G. (ONE WITHIN 6"OF FINISHED GRADE INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL, 39•0 FINISH GRADE ,'�' FINISHED GRADE OVER TANK EL.= 3 -I_- 5 DIA. OUTLET(S) PER TRENCH) 8,4' " CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE } DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 9"MIN. I 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL » w PVC SEWER PIPE 36 MAX. TOP OF SAS/B.O. = 36.43 9 MIN. SEWER PIPE » ' SYSTEM UNLESS OTHERWISE NOTED. -- - - -- » 3"DROP MAX » PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN lal_ 3 2"DROP MIN 3 9" MIN.SLOPE ,% JOINTS (TYP.) ELEVATION =36.43' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 4"PVC IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE 70P OF I 14" ' SEPTIC TANK 4"PVC OUT TO 1.33' nJTYP w THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 3�.3 _ � LEACHING FACILITY (TYP.) 6 TYP.90' 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. x CONTRACTOR CONTRACTOR SHALL 12 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. OUTLET TEE 36.27 MIN. 36.1 O I SHALL VERIFY SIZE 4W VERIFY CONDITION OF 36,00' 35.10' (LAID FLAT) 2.875'(34.5")--I---- -5.75'� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6"CRUSHED STONE 5 0• (TYP-) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE (TYP.) 5'MIN. 11.50' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 30.0'(TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 40.00'ESTABLISHED -- TO BE INSTALLED ON A LEVEL STABLE ON A HYDRANT BONNET BOLT AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 28.17' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) G r BIODIFFUSER (END VIEW), 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE 12 ARC 36HC #3616BD BIODIFFUSERS TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL (oT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING NOTE: ENTIRE PROPERTY IS LOCATED WITHIN A ESTUARINE WATERSHED. ;x v #4 .° � REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM MAP 5 � � TEST PIT DATA APPROPRIATE AUTHORITY. ' s PERC NO. MAP 5 12408 '� 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS PARCEL 36 � Ux N u �► _ „ _ � � � i INSPECTOR: Donna Z.!Miorandi, R.S. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE ► x �� THEY SHALL WITHSTAND H-20 LOADING. / PARCEL 37 � ` x EVALUATOR: Michael Plmentel, E.I.T. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. DATE: November 5, 2008 N TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM,SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON AL SIDES OF LEACHING FACILITY. ELEV TOP= 39.00' L 1 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ELEV WATER= 28.17' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). PROPOSED INSPECTION PORT WITH sx yam ` a rn S68° ACCESS BOX TO GRADE TYP OF 2 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN M ( ) ? PERC RATE_ <2 min./inch a �8 p 32p•F £w � n SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 9 ' ' DEPTH OF PERC= 30"-48" - M , 16. PROPOSED PROJECT IS LOCATED WITHIN: N PROPOSED TOTAL 12 ARC 36HC BIODIFFUSERS " ' 122 co (6 BIODIFFUSERS EACH TRENCH) r y y k, TEXTURAL CLASS: 1 ASSESSORS MAP 5 PARCEL 30 ' � � g TRH . _ OWNER OF RECORD: HELEN M. ROCHE Fcri � -* w ADDRESS: 43 CRAWFORD ROAD 0 39.00 Fill COTUIT MA 02635 6" 38.50' I. - A/E L FEMA FLOOD ZONE C �`. Loamy Sand \ Benchmark £ t 4 ►� 10w 10Yr 3/2 38.1T COMMUNITY PANEL# 250001 0021 D a S ss. Hydrant Bonnet Bolt B Loamy Sand MAP 5 Elevation=40.00' � r - _ 10Yr 5/8 17. DEED REFERENCE: BOOK 7921,PAGE 339 SHED w ,} 30" 36.50' PARCEL 38 A rox. M.S.L. / ` ( 3 18. PLAN REFERENCE: PLAN BOOK 223, PAGE 39 .�. 4 iN r'r if d lF P 2\ / PP.rC. $91 - GARDEN . ' F 48» 35.00'\ T { aka 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. d w � T `� C-1 Fine Sand 20 PROPERTY LINE INFORMATI©N IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY R 2.5Y 6/1 a` `° $ ` °�� FOR SEPTIC SYSTEM UPGRADE.. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY Uk 9 Q `-� .: ; FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. - MAP 5 r y+ 72'K 1ST r yr xa': 'T k �I w 33.00 PARCEL30 BH % 45,020 S.F.t 1 . : .. . •.,,. ,. ._ } :, . . oti�ti EX. HYDRANT C-2 Medium-Coarse �"^ � c/ UP 1025/3 yy 2.5Y 6/1 /- LOCUS PLAN (Loose) MAP 5 , #43 L ' SCALE: 1"= 1000' 130-1 28.17' PARCEL 39 1 EXISTING \ o \� No Mottling, Standing or Weeping Observed l 3-BEDROOM I�I o FLAGPOLE DWELLING 0 DESIGN DATA TEST PIT DATA LEGEND 3� TOF=40.0'± PROPOSED DISTRIBUTION BOX '`-APPROXIMATE LOCATION OF EXISTING PERC NO. 12408 50xO EXISTING SPOT GRADE LEACHING PIT TO BE PUMPED AND NUMBER OF BEDROOMS(DESIGN) 3 INSPECTOR: Donna Z.Miorandi, R.S. _ _ 50 - - EXISTING CONTOUR 0 / / FILLED WITH CLEAN, COARSE SAND DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, E.I.T. ° APPROXIMATE LOCATION OF EXISTING TOTAL DESIGN FLOW 330 GAUDAY DATE: November 5, 2008 50 PROPOSED CONTOUR DISTRIBUTION BOX TO BE REMOVED DESIGN FLOW X 200 % = 660 GAL/DAY TEST PIT#: 2 ❑/H/W EXISTING OVER HEAD UTILITIES _ � ISTING 1000 GALLON SEPTIC TANK TO GARAGE 4 `� / EX EX UTILIZED AS PART OF lIS DESIGN USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 39.10' GAS EXISTING GAS LINE ELEV WATER= <28.27' W W EXISTING WATER LINE / SWING-'VIES PERC RATE_ � TEST PIT LOCATION BIT. DRIVE �4- \� QO DESCRIPTION HCA HC-2 INSTALL 12 -ARC 36HC (#3616BD) BIODIFFUSERS DEPTH OF PERC= LP EXISTING LEACHING PIT O O\ 4" ",Q\ BIODIFFUSER CORNER(1) 29.6' 29.1' TEXTURAL CLASS: 1 �Q �OJ SYSTEM CAPACITY EXISTING 1,000 GALLON SEPTIC TANK S BIODIFFUSER CORNER(2) 57.4' -58.3' v� � BIODIFFUSER CORNER(3) 61.5' 57.T (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD 0" 39.10' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE ` BIODIFFUSER CORNER(4) 36.2' 27.7' 6° \ (60.0)(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING/DAY Fill 38.60' AlE Loamy San D PROPOSED DISTRIBUTION BOX �F d O � / 3/2 TOTALS: 10" Loamy S 10Yr San'd 38 2T PROPOSED ARC 36HC(#3616BD)BIODIFFUSER � "+ (2) o B 10Yr 5/8 UP 4 o TOTAL NUMBER OF BIODIFFUSERS: 12 30" 36.60' (3) TOTAL NUMBER OF COUPLINGS: 0 / ho TOTAL LEACHING AREA: 468.0 SQ.FT. REV. DATE BY APP'D. DESCRIPTION TOTAL LEACHING CAPACITY: 346.3 GAL./DAY Fine Sand � 0� (') C_1 2.5Y 6/1 PROPOSED SEPTIC SYSTEM UPGRADE 411,2° �O NOTE: PREPARED FOR: `72� HCA EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE MAP 5 7��997� / / (4) DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER 72" 33.10' CAPEWIDE ENTERPRISES PARCEL 29 BH "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3,2003(LAST Medium-Coarse MODIFIED JULY 23,2008). TRANSMITTAL NUMBER=W000052. C-2 Sand 1, LOCATED AT 2.5Y 6/1 43 CRAWFORD ROAD (Loose) / #43 C-2 COTUIT, MA EXISTING 130" 28.27' SCALE: 1 INCH = 20 FT. DATE: NOVEMBER 6,2008 3-BEDROOM t, No Mottling, Standing or Weeping Observed 0 10 20 40 80 FEET DWELLING / TOF=40.0'± N L. PREPARED BY: / RESERVED FOR BOARD OF HEALTH USE 8 CH RRCHILL JC ENGINEERING, INC. 4 2854 CRANBERRY HIGHWAY 4 I NOTE: EAST WAREHAM, MA 02538 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG SITE PLAN SWING-TIES PLAN 508.273.0377 THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. SCALE: 1"=20' SCALE: 1"=20' Drawn By: BSM Designed By:MCP Checked By:JLC JOB No.1523