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HomeMy WebLinkAbout0044 DOGWOOD LANE - Health 44 Dogwood Lane , Cotuit } s i TOWN OF BARNSTABLE LOCATION 0 " SEWAGE # VILLAGE ASSESSOR'S MAP & LOT D 0 c r e rr S.1`1AME&PHONE NO. L J SEPTIC TANK CAPACITY o LEACHING FACILITY: (type) (size) 1® NO.OF BEDROOMS dJ nrm nFR OR OWNER PERMITDATE: r�.n DATE: ls �Dy S aae �i. 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 I clQ I } 51 , �y ` COMMONWEALTH OF MASSACHUSETTS -' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS F p. W M DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM I PART AICD CERTIFICATION f ;rD Property Address: 44 Dogwood Lane i r Cotuit MA 02635 r Owner's Name: Debbie Dunn c� Owner's Address: Same Date of Inspection: June 13,2005 Job N 05-176 k ) )'Y Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: OF If _X_ Passes ``��� ►��........ . Conditionally Passes Needs Further Evaluation by the Local Approving Authority :*:g: PATRICK N Fails :M; M yc�)�. O'CONNELL Inspector's Signature: Date: 6/13/05 OFRT�F1V.oQ���� INver,����`� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Iy�dltlmnit11N%% 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. Notes and Comments: Observed 2'standing water in leaching pit with no high stains.Tank not in need of pumping at this time. ****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. Title 5 Inspection Form 6/15/2000 page 1 r - Page 2 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Title G Tncnontinn T:nrm All VIM) 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: Tito+S Tncnprfinn Rnrm 6/1;nnnn 3 Page 4 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections:. Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X Any portion of the SAS,cesspool or privy is below high ground water elevation. —X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. —X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] No_(Yes/No)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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. Titla C Tncnartinn Fnrm 411 VIMO 4 Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X_ _ 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: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. _X_ _ 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(3)(b)] Titla S inonartinn Fnrm 4/1 VIAAA 5 Page 6 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 ,FLOW CONDITIONS RESIDENTIAL 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` Number of current residents: 1 Does residence have a (Y or no)garbage grinder es :No g Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2003—23,000 gal.2004—21,000 gal.=60 gpd. Sump pump(yes or no): No = Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None. Source of information: Was system pumped as part of the inspection(yes or no): 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) ` —Tight tank _Attach a copy of the DEP approval _Other(describe): x Approximate age of all components,date installed(if known)and source of information: Compliance date 9/15/83 Were sewage odors detected when arriving at the site(yes or no): No - I It�P G 1rlCrla�tlnn Fnrm(./)C/7(1M 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: V Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: - Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 8" Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5' long x 5.8' wide—1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffler 32" Scum thickness: trace 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: 14" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles intact and clear, liquid level at bottom of outlet invert GREASE TRAP: No (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): Title S incnr+rtinn P—m j<il si,7nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (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.): No solids or high stains. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Titla c Tncnantinn Rnrm 411 cnnnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. leaching chambers, number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions:° overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Observed 2'standing water with no high stains. CESSPOOLS: No (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 or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,•etc.); PRIVY: No (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.): Title i lncnartinn Rnrm 611 GP)nnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. Dogwood Lane Driveway Water service f #44 Garage Porch 27 6 42 33 51 44 Titla C inenartinn 17nrm All VIOnn 10 Page 1 I of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Dogwood Lane,Cotuit Owner: Debbie Dunn Date of Inspection: June 13,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you esta blished abllshed the high ground water elevation: Town groundwater contour map shows water at el.35 and topo map shows property at el.60. T41a C Tncnartinn Rnrm ail ci�nnn 11 & OVo---6-7 Commonweotth of Massachusetts ,John Grad Executive Office of Ernironmentlai Affairs D.E.P: Title V Septic It pector Department of P.O. Box 2119 Environmental Protection Teaticket,M�102536 r (508) 564-6813 9 ' rya n ,® SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A RE�'E�VEi CERTIFICATION t� Property Address: 44 Dogwood Lane Cotuit Lot 9 Address of Owner: r0WA10F , 1997 Date of Inspection:7123197 (If different) y64iTH0 sTA8LF Name of Inspector:John Gracl McDaniel Company Name,Address and Telephone Number: A ~ E Z CERTIFICATION STATEMENT 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 y _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is performing at the time of the inspection.My Inspection does _ Needs Furt r EvAluation By the Local Approving Authority not Imply any warranty or quarantee of the longevity of the Fails septic system and any of its components useful life. Inspector's Signature: Date: 7123197 The System Inspector shall su mit 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. 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, cracked, structurally unsound, show s 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 11115195) One Winter Street a Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 Dogwood Lane Cotult Lot 9 Owner: McDaniel Date of Inspection:7123197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): 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 water supply 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 is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or lesss than 5 ppm. r 3) OTHER D] SYSTEM FAILS: _ 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. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the Surface of the ground or sulrfar:R waters fte to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued). Property Address: 44 Dogwood Lane Cotuit Lot 9 Owner: McDaniel Date of Inspection:7123197 D] SYSTEM FAILS(continued) 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: 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: 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 11115195) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 44 Dogwood Lane Cotult Lot 9 Owner: McDaniel Date of Inspection:7123197 Check if the following have been done: X 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 N/A. 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. X 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 existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 1 lit 5/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44 Dogwood Lane Cotult Lot 9 Owner: McDaniel Date of Inspection:7123197 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: 2 Number of current residents: 1 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: n1a Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: Na Design flow:9 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: n1a Last date of occupancy: n1a OTHER:(Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes,volume pumped: 9 gallons Reason for pumping: n1a 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) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 9/15183 Sewage odors detected when arriving at the site: (yes or no) No (revised 11115/95) 5 i . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Dogwood Lane Cotult Lot 9 Owner: McDaniel Date of Inspection:7123197 SEPTIC TANK: X (locate on site plan) Depth below grade: 1' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'6'H 5'7"W 4'10" Sludge depth:1' Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness:0 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: 0 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 septic system every two years for maintenance. GREASE TRAP:_ (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: Na Scum thickness:n/a Distance from top of scum to top of outlet tee or baffle:n/a Distance from bottom of scum to bottom of outlet tee or baffle: nia 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.) nla ` (revised 11/15195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Dogwood Lane Cotult Lot 9 Owner: McDaniel Date of Inspection:7123197 TIGHT OR HOLDING TANK: (locate on site plan) Depth.below grade: n1a Material of construction:_concrete_metal_FRP_other(explain) Dimensions: nla Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: n1a Comments: (condition of inlet tee, condition.of alarm and float switches, etc.) nla DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) nla PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n1a (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Dogwood Lane Cotult Lot 9 Owner: McDaniel Date of Inspection:7123197 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: nla Type: leaching pits, number: 1,000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number, length: nla leaching fields, number,dimensions:nfa overflow cesspool, number:n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The overflow is structurally sound and functioning properly.lt had 2'orwater in it. CESSPOOLS:_ (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: nla Depth of scum layer: n1a Dimensions of cesspool: n1a Materials of construction: n1a Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) n1a PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: nla Depth of solids: n<a Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) nla revised 11/15195 ( ) 8 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Dogwood Lane Cotult Lot 9 Owner: McDaniel Date of Inspection:7123197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' � g r10 E3 )AAAC a3` 0 �A `�� e � CC 3-1 DEPTH TO GROUNDWATER Depth to groundwater: 12 feet method of determination or approximation: USGS Maps and Charts-12+feet (revised 11115195) 9 ION � SEWAGE A E PE 12VIT 130. l0 CAT G ' -10 r 2T T7�1L -- n n y �j" 1lILLACE o f "T 0 INSTA LLER'S NAME S ADDRESS Oc90 :;L#6;7o Z-Z P I D � BUILDER OR OWNER �. DA T E PERMIT ISSUED DAT E COMPLIANCE ISSUE p J U R'et)° *;vK cl 4 l ; 1 r ti 6,O� T THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M 7 Ll� DATA 1 No........& Z� Fss............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .o (� Town...............::....OF...............Baez:stab.i.e------------------------------------------ Appliration for Dig as al Works Tonstrurtinn Vamit Applicati is hereby�j�'ade for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: p �!✓�QIJ• Lot 9 a��.mP-_, Cotuit, Ma. .....-• -................. . -..... ............................. .......-••---•-----••••-•--•--.....••------•••-._.....•--•-•------•-•......._•----...........--•-- Theo Cons tructoiaE�fl-?ftes.s 24 Great Pond °brt.;o S. Yarmouth, Ma. w Theo Constructi rie�0. 24 Great Pond )err., S. Yarmouth, Ma. .................... '. q. Installer Address UType of Building Size Lot..2Q. 30.0_._.._._..S feet Dwelling—No. of Bedrooms...........3..............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers Pa YP g ---------------------------- p ( ) — Cafeteria ( ) Pa Other fixtures -------------------------------- . w Design Flow........................5.5..........._...gallons per person per day. Total daily flow..330..................................gallons. WSeptic Tank—Liquid'capacity..D 0.0zallons Length................ Width................ Diameter.-.----.----_- Depth................ Disposal Trench—No..................... Vidth.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter..--.--............. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed by....NDr-Ilan....Gxossman-..P.-E................ Date.....9/16./-.82............... a Test Pit No. 1.....2.........minutes per inch Depth of Test Pit.-11'--6.". Depth to,ground water---none--------- (i, Test Pit No. 2................minutes per inch Depth of .Test Pit.................... Depth to ground water........................ ---•-•---------------------•--.........................---•- ••--•--------•---•-•--•-••................................................................ O Description of Soil....0.11-8��--loam.......8."_ .,....2-4-n-13s3."..:�c1I1L� x w 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 iITL . p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu by the,' 0a 'rd of health. r .� r� = Signed' . .......- '� .......... Application Approved B Date Date Application Disapproved for the following reasons:................................................................................... _ ....---••••......................••••---......-------------------•---•--......-----------...•--------••-.---------------------•--•-•---.....------• PermitNo......................................................... Issu No—,... ....... A Fps........................... THE COMMONWEALTH OF MASSACHUSETTS a• BOARD OF HEALTH Town.....................O F.................Barnstable---------------------------------------- Appliration for Disposal Works Tontratrtion Vprrmit Application is hereby made for a Permit to Construct ( 'or Repair ( ) an Individual Sewage Disposal System at: Lot 9 Ash Circle, Cotuit', Ma. �. Theo Construc��.t�i�iA�i�s: or rAt N°' 24 Great Pond Dr. ,._S._..Yarmouth.,.,_Ma. • •--•------ -----.. ............................. - ... .........- --• . ......... Theo Constructi8ff'rCo. Address �...Na. W . 24 Great Pond Dr. ,�. Yarmouth ,-� •......................................•---•---•--------••-•-•----•--_.... Installer Address U Type of Building Size Lot.. W.........Sq. feet �-1 Dwelling—No. of Bedrooms-__:.------q,3-----------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ._......... No. of persons............................ Showers a YP g ----------------- P ( ) — Cafeteria ( ) dOther fixtures -----•------------------------••---•----------------.......------------------•-----------.._..__._.....--------------------......---------........_... WDesign Flow........................r.53...............gallons per person per day. Total daily flow---�3.30.................................gallons. WSeptic Tank—Liquid capacity.lOO-Ogallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed by....NormaI1..Grossman V..,E ............. Date......g. } ;fig .............. a Test Pit No. I......2........minutes per inch Depth of Test Pit... Depth to ground water....} orle,......__. Gil Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---------------------------•---•---•----.............--•--------..........._._........---•--.._........._..................•--........---•••-•••-.......-•--- O Description of Soil.....0 ". "... .Qai61,_...5.'.'_-24.".... ubsoih 24-'-'---131�'.`---aand............................................. x w UNature 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................•--•--..................-----•--•---.._...._----••---•-------.----• .......................... Application Approved By................:: �� .-a1 .... ...._.__. _. - � ................ Date Application Disapproved for the following reasons:--..............................••--......----------------------•------........................................ ---------------------•-•----------------------------------...-------------••-------------..._...------....--------•------------------------------------------------------------......................... Date t- Permit No......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................TOWA.............OF..............Barnstable........................................ �rr�ifirtt�e of �ont��i�anr�e THIS IS TO CE TIF,Y, TjW the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................... •• --•..�t........-••------------------------- ----------------------•--•----•=-•----............_.......----•--------•-•••---------•--•---•-•--° Installer ce at................... ------ .......... .......0 s- ... "'-•...........= --------------------------........-•---•-•------------.......-- has been inst'sled in accordance with the provisions of T _LE `" of The State Sanitary Code as described in the >iU. r' application for Disposal Works Construction Permit No......................................... dated................................................. THE ISSU„ C CTION SATISFACTORY. F THIS,CERTIFICATE SHALT. NOT BE CONSTRUED GUARANTEE THAT THE ' SYSTEM�A1 F DATE... V...--.. :..T----•-------------------------------------•---•--- Inspector......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........Town.......................OF..............Sarns.table....................................... FE��.°r............ No......................... Disposal Works Ton#r ion rruti# Permission is hereby granted............The.Q.-CQnatrCuati_®D...CQ....................................................................... to Construct ( X) or Repair ( ) an Individual Sewage Disposal System Loat No......... t..s..Ash_•Circled.._cotmi.t'...Xa................................................................................................... Street as shown on the application for Disposal Works Construction�Permit No..................... Dated........................................... •..•----E .' . fir' /� �✓ and of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y i NOTE 15 . _�6'. g t NolvtJ A" MEAa! SEA L.E�I.. e>a.s�v a�a ,-; . ,, ; <, Du.-r v*°1 Pt1.►.i�E, PITC�i ALL U W ES A .� _ � , / �; l�T►-IE�vtJ is E S�EG.►1F 1 ED. ��� �- AL- F%PIE.S To .AWv r•.J THE SYSTEM sNA.LL F/rj/ 2d, 1 -_ -�.—_ DE CAST 12.b►J � SG�►+��CJLE AO P�/G " . % -r C � O � (� *�-- ALL. gEPTIIC TAu1cS, pl�r2,guTioJ 80><, A..ao . o ",` 'G j`f -- __ - 1 I.E�C►-1i.�E. Pfr� SHALL (� /� �1 >tiE ioe,- C%c .IEO Fog N— q l/ © of ) `.l - - --- --� SQ-- f�6Nb✓E Au_ u�S��ra3LE MATE�IAI.. 6E�E.aT1 1 I O � � �) U � � � � �+E. t...,�1Eer E�-EVA•T'toaS OF LEACt-►i._lE� PrTS r-oe_ �T o 30 _r �' TµE r.�Ts%a:;-Tf.t; E�2 b o� I-4fr L_TN MUST 3 0 C) Q Sy I j I �1 T 4 c. `i STEM lS f-A EA r— zc> iZ"�- T__ 1°�--ic — I \� .! I I O o Q c c) 1 �, ® rlj ���M ETtotJ A.�O P2%o2 Tp L LK Fig i i.J� V U v► lt✓E55 oTNE��tiSE I�SOTED, At , SYSTEr­j O Go C ) cc CowtPbl.JE►.►TS S►dJ►L� ,3E ItaSTP.��cL7 1+.1 TYPICAL _ _ . 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