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HomeMy WebLinkAbout0067 EAGLESTONE WAY - Health ~v7 Ea.glestone Way - - -- _-- - cotuit, MA P261 a 00 r'tl E f I ` `,� [TOWN O�F/BARNSTABLE n ' LO(�AnON/CO7' ''�7 GQQ��ST�7rJe- �p�, SEWAGE # VILLAGE& �:.� � ASSESSOR'S MAP & LOT06-9- 00 -(Z G INSTALLER'S NAME & PHONE NO.KAr/ 1 V,14j Cons SEPTIC TANK CAPACITY /•CoQ G401101� LEACHING FACILITYAtype)/i on) (size) Lo r y p NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER CUIE OR OWNER DATE PERMIT ISSUED: /� 9 DATE COMPLIANCE ISSUED: p VARIANCE GRANTED: Yes No � � v'\ i SZ I� 74� O�. � - y7 , 6 o � / ' 1 60 9 , 6,,; � l Fas...... ....... �..... THE COMMONWEALTH OF MASSACHUSETTS 76, BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diti-pw3al lVarkii Cfoustritrtion ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ,1 V 1 .....L�.T..._.Y...,............... !S'Gc c'�` -� F...... ---- -- ------------------------...----........T_----------------.......... Location-Address / or Lot No. 7�� \.l11.TaS4 �!_•• NN�N--------•----------------- .......... __...:Q�l� ------..... t t� ��rr — .` / Owner _---•- (� Address ve 2 G Lo_.L. j•• 1 .......... °�-. -•---- t /?LY�!I.STo= S ?!!!l.ldet3 Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--- -_-..--.-L----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---o2.------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- w Design Flow.............LI ___._._- _._ .___..gallons per person per day. Total daily flow-.---.--_--� `{U__-_--- ._.------__--..gallons. W Septic Tank—Liquid capacit--- _. .` 6.-gallons 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.......................................................................... Date...----------------------------------... Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -..----- -------------------------------------------------------------- •------------ -.............. ._.. -----------------_ ------- Descriptionof Soil pig `�-j-------•----••-------------------------------------------------------------------------------------•----------- U 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 nvironmental Code—The undersigned further agrees not to place the system in operation until a Certificate of ompliance been issued th rd of health. Signe - ..4�,e................ .: Dace Application Approved By . ............................... ................................... ..... - ---------------�`e------------------ Application Disapproved for the following reasons: .. ... ................ ............................. .................... ......... . . ......... ---------... ....................................................................--------------------.........------------------------------------------------------------------------------------ ........................................ Dare,_a.` Permit No. ----- -----ts- ------------------- Issued -------------------------------------------------------- Daze �.� - � J t - - NO--Xy... 4_�.. Fx$.... .f ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Diripn!3ttl Work.5 Tomitrnr#inn trrmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: .. --------- --------------------------------••-----••----•-- Location-Address or Lot No. ....�f LT-,;//�/1 c et 0.. ...:� L LF2% ✓vt r c 9. C ���71//CL l Owner Address u�til7`�L.t.a lu hr'C.!3 i- I/r�: Ll w7e ST r..S ?1A l t(3 - -------- -------- -------------------- --- ------------==- � Address d Type of Building Size Lot.................... q. feet Dwelling—No, of Bedrooms------------�__--------------------f_-__Expansi+on Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. ;of,persons -----------_---.------- Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------------------------------ W Design Flow.............1__!v........................gallons per person per day. Total daily flow----------- v_______..____........... WSeptic Tank—Liquid capacit�_ G...gallons Length-__---_______ Width____F/---______ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-__-_-.______-__---__--- f-t Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a ----------•---------------------------------------------------------------------•-----------........--...--------------...-----•-----•-----............------ D Description of Soil..................fJFA............ 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 Stat\Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Sompliancee has been issue by the-board of health. Sign ------//..� 4�-� .. f/ // Date ApplicationApproved By ------------------__-----------------------------...---...-------------v------------------------------------------------------------------- ---------------------------------------- Date Application Disapproved for the following reasons: ..................................................... .............................. ........... ......... ... . ....................................._.... ........................................ Permit No. .....9..�"�---.-.._... .., Issued ------------ -------- ------- Date \ 77 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 'lertifi ak, of 01-110 pliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ><) or Repaired ( ) by ............. . .. L ----------...._...-.-------------- ------------- ----------------------- --------- ------------ ------------------------------------------------- Installer L O r^ at ........................ ........-f------------ PJ�" r?x t o......: _.. ' -------------------------------------------- has been installed in accordance with the�isions of TITLE 5 o he State Environmental Code as described in the application for Disposal Works Construction Permit No. ....._- .-_... �1�... dated ----- --------------_........_._-------.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------- -4�- -------------------- Inspecto ------------------------ --------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS U ,jam- 009 -- 001- BOARD OF HEALTH c� ¢._ TOWN OF BARNSTABLE No...../.. .!1 FEE .... �/).-•-- Rojivii l Workii Tomitrudinn rrmit Permission is hereby granted..........f;� ---- ......... ----- ...................................... to Construct (x) or Repair ) an Ind,ivid, al Sewage Disposal System atNo.----...--- T.....�---....... I`C.-------•------•---------------------------------•--------- Street 5� as shown on the applica ioX Disposal Works Constructioi�ermit No "._f�?. D2ted................�_. ................... �-�. Board of Health DATE '.•--••- -----------------------•--•---- FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS 6• TOWN OF BARNSTABLE LOCHT1ON 7 f talc.Sfolc w SEWAGE # : 05Ae-1000N VILLAGE do�ue r ASSESSOR'S MAP & LOT NAME&PHONE NO. ' � C�.o,�,wfl yz6- t771 SEPTIC TANK CAPACITY /5-00 LEACHING FACILITY: (type) (size)(size) /o�� NO. OF BEDROOMS L BUILDER OR O PERMIT DATE: GQ&940=vE DATE: O Sr Separation Distance Between the: I- 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 16 Gar `J� I 5(� 5ti -i1 A Massachusetts Department of Environmental Protection Bureau of Resource Protection £ Well Completion Reports ._- Well Driller , Please specify work performed: Address at well location: �w Well Street Number: Street Name: 67 EAGLESTONE WAY �. Please specify well type: Building Lot#: Assessor's Map#: ' Irrigation 054 009—ooto µ Assessor's Lot#: ZIP Code: Number Of Wells: 006 02635 Cityfrown: Well Location BARNSTABLE In public right-of-way: GPS C`Yes f" No North: West: 41.62972 70.42179 Subdivision/Property/Description: Mailing Address: click here if same as well location address _........ _.._.__..........._......_................................- Property Owner: Street Number: Street Name: FRANCES PARKS 67 EAGLESTONE WAY City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02635 Board of health permit obtained: C7-Yes tr Not Required Permit Number: Date Issued: W2020 007 iO3/12/2020 Massachusetts Department of Environmental Protection . Bureau of Resource Protection—Well Driller Program, ! ' Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD 4 Overburden Bedrock auger Choose Bedrock-- WELL LOG OVERBURDEN LITHOLOGY _ — I Drop in drill !Extra fast or slow Loss or addition !From(ft) I To(ft) Code I Color Comment i stem i drill rate of fluid I i TRACE COARSE i r r. � (" f 0 20 Fine To Coarse S I�. I Brown i f C Fast f"Slow �— YES NO ILoss Addition � �---- � TRACE COARSE r' r" 7_t 20 140 Fine To Coarse S • Brown Fast t"Slow I i YES NO ? Imo- Loss Addition j — — TRACE COARSE r r �" f 40 I i 60 Fine To Coarse S I Brown i C Fast r Slow -..---- ..--1 i � YES NO Loss Addition �60 63 (FineeTTo Coarse S�� I Brown • TRACE COARSE (` f ,1� � C" � �� t.. ��..._ . _� " C Fast t`Slow -- � ; YES NO III Loss Addition ....................._............________..._..__.___._.__.__L_____�____...._....-........___ _r . _.................._.--_-_--- ..............:......::.::::::.::-:....,..........-.___-................_...._..............-...._.._......_...- WELL LOG BEDROCK LITHOLOGY ... .......l.._....................................._..............__........_....... ......,.......__._..............._._........_.__._.._..........................-----... ....._................................ ..__..._..._...................................................... I 1 Drop in 1 Extra fast or Loss or Visible Rust From(ft) !To(ft) Code Comment addition of I Large drill stem !slow drill rate I Staining I I fluid I Chips �......."...... ��...................................................... f' .........E I � is ((Choose Code I I I ��Ir Yes; ' L� _ a YES NO I Fast Slow Loss Addition I i i ADDITIONAL WELL INFORMATION Developed t:Yes r No Disinfected t ✓Yes !"`No Total Well Depth 63 Depth to Bedrock Surface Seal Type None Jracture Enhancement Yes f No CASING Is Casing above ground? From To Type _ Thickness Diameter Driveshoe 0 �59 i Polyvinyl Chloride E Schedule 40 � 4 Yes j SCREEN tf�;No Screen From To I Type Slot Size Diameter 59.....................! 63 Stainless Steel Well Point 0:012............... I i4.........._.................! j _..___....._.._................_-_........_..._........_...... ..........--..._.............................--_....-. WATER43EAPJNG ZONES r DRY WELL ................._. _......................._.._................... From To Yield(gpm) 36 I Y i 1 12 .._.........._.�) PERMANENT PUMP(IF AVAILABLE) Pump Description 2 Wire Constant Speed Horsepower Submersible � I1 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Pump Intake Depth(ft) 58 Nominal Pump Capacity(gpm) 15 ANNULAR SEAL/FILTER PACK --------------_---------------.-----------..---..-- ---- -----------------......--_---_-_..__......._.__..e_..._.._.._.._..__................._._... --------...._.........................._..._..........._...................._......__... __._---- j Water Batches Method Of From I To Material 1 Weight Material 2 Weight j (gal) (count) Placement ........j Choose Material �� Choose Material I i--Choose One • ' ................ ---.._... _.-_. __________ ____ _ ______ ______ ________ -_________ _ ____._ _ _ _ WELL TEST DATA Time Pumped 'Pumping Level(ft ;Time To Recover Recovery(ft Date Method Yield(gpm) i (HH:MM) j BGS) (HH:MM) BGS) 04/15/2020 Constant Rate Pump 12 01:30 j40 • 100:01 38 WATER LEVEL I Date Static Depth BGS(ft) Flowing Rate(gpm) I Measured i 04/15 22029 38 12 i COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. DEREK Supervising Driller DESMOND, DrillerGOODWIN Registration# 877 Monitoring[M] Signature PATRICK, DESMOND WELL Firm DRILLING INC. Rig Permit# 0551 Date Job Complete ;04/28/2020 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. FINVIR0 TECH LAA BORA TORIE S, l;NC; IVA CER.T, N0.: Al-/V/J 063 8 Jart Sehastian.Drive Vnit 12 :Sandwich,ALL 02.%3 (508)888-6460 1-Nttli-33.4_6460 F:X(a08)8.88-6446 Client Nirrne: Desrrrrrrul►Pell Drilling Location Aeldress: PO Box 2783 67 Eagle Stone Way Orleans, MA Cotuit,MA. 02653 Lrrh iunher:: DW7200922 Colleefed By: DWD Date Received. 04/16/20 Sarnple 7;vpe; Irrigation !fret/Specs:: 40i60 AantysisRerlrresCc=rl Llnrt.+ fCcfltimrtrerrrtef!/rrrtits .frtrtlysis csrrtr 41et/rrtt! ChrteAnalszeti Anaryzetl1�r Total Coliform CFU/100rnl- 0 0 SM9222B 04/16/2020 KF @ 16:45 pH pH units 6.5-8.5 5.90 S.M.4500-ti-6 04/16/2020 KF _ . Specific Conductances umhos/cm 500 82 EPA 120A 04/16/2020 KF Nitrite-N mg/L 1.00 <0.006 EPA 300.0 04/16/2020 KF Nitrate-N mg/L., 10:0 0.04- EPA 300.0 04/46/2020 KF Sodium. mg/L 20.0 11 EPA 200.7 04/20/2020 KB Total Iron mg/L 0.3 0.14 EPA 200.7 04/20/2020 KB Manganese mg/L 0.05 0.048 EPA 200.7 04/20/2026 KB Corrrtrrents: Low pH indicates high corrosive characteristics. All samples were analyzed within the established guidelines of US EPA approved methods with ail requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge., Water meets EPA standards and is suitable for drinking for parameters tested, � ( Dille 4121/2020: Runrrlrl J.Saari Laburatary L)irectu BRL=Below Relmi•tbble Limits. *See,4ltaci ezl Page 1 of 1 ❑Cerlifrcalion is Trot availabk for this ana 4e for potable,eater samples;. No. b Fee l i BOARD OF HEALTH TOWN OF BARNSTABLE 0(ppricatiou ff or Yell Cou5tructiou Permit Application is hereby made for a permit to Construct()d), Alter( ), or Repair( ) an individual well at: 054 1 o0�1 ®U( Location-Addresi Assessors Map and Parcel Owner ress S r� 4���Csi , :1,, �-o Pox �-"1�3 �VAY)l IM c�z6 d Installer-Driller Address Type of Building r Dwelling J Other-Type of Building No. of Persons Type of Well 4,rsy0 - Capacity �5 q Purpose of Well �'t'1�o7�1 thin Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certi ate of Compliance has been issued by the Board of Health. j l Signed I�t I Zak Date Application Approved By Date Application Disapproved for the following reasons: Date Permit No. W 0�-ij Issued Date --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(so, Altered( ), or Repaired( ) by S,-�; �.►��,1 b-CM iris ,l)"' Installer has been installedJin accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector t Fee No. BOARD OF HEALTH r TOWN OF BARNSTABLE 0[pphrottou jFor lVell Con5tructton Permit Application is hereby made for a permit to Construct(M), Alter( ), or Repair( ) an individual well at: �"1 �.g1es ® •�.�J�w . Co ve o5q odq oo(. Y v Location-Address) Assessors Map and Parcel Vicar P�`�..s „l �CKg 6-d-®� W (L4 t (JV��- . A aL�35 ,I Owner A41'dress e�w r•d �l�I��� 1�cA\ Z IB3 ;Of VoW MA b-z653 Installer-Driller , Address Type of Building Dwelling J I Other-Type of Building No.M of Persons Type of Well ���t.�CEO ���- Capacity t5fi��Y'n Purpose of Well ,C'V�CV- i 0" Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. f^y- Signed . Date ! aF Application Approved By 1(�.��, �,�,,//�1 l ID,f�'o ` ✓I �� /Date 'k Application Disapproved for the following reasons: Date. ,'` { Permit No, U BTU ' ; Issued — F D r A� ate BOARD OF HEALTH t TOW4N OF BARNSTABLE Certificate of Compliance i THIS IS TO CERTIFY,that the individual well Constructed()<), Altered( ), or Repaired( by Installer has been installedJin accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection , Regulation as described in the application for Well Construction Permit No. Dated i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL w SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector_ i BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con5tructton Permit No.W aQ U -507 Fee Permission is hereby granted to . 1 Q }-Y1p1(�t V V�,� i w Yt,91 t Y)L Installer to *Construct M), Alter( ), . or Repair( an individual well at: No. Street as shown on the application for a Well Construction Pern`iit No. WD-Ua Dated ���- ;1- .Date /1�- � �i Approved By 11��i' V - �!�'��,( •' J COMMONWEALTH OF MASSACHUSETTS v EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS M d DEPARTMENT OF ENVIRONMENTAL PROTECTION F 7 5<•v TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 67 Eaglestone Way , �r - e Cotuit MA 02635 n-, Owner's Name: Charles& Nancy Connon Owner's Address: Same co Date of Inspection:June 3,2005 Job#05-152 �1 rU w 'Name of Inspector: PATRICK M.O'CONNELL r- 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 amPm�p approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste L\N�� F _X_ Passes �• Conditionally Passes PA IC Needs Further Evaluation by he Local Approving Authority Fai 's v 'C L Inspector's Signature: Date: �'�.k•r Q'*� INSI tu��``� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Leaching pits have2' standing water 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 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Eaglestone Way,Cotuit Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 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: Titles G 1nc.+antinn Fnrm lii�i�nnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 67 Eaglestone Way,Cotuit Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 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: T;f1a S Tncnartinn rinrm 4/1 G/)nAA 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 67 Eaglestone Way,Cotuit Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 1 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 '/z 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. Ti}lo C Tnonan}inn Fnrm 411;/Innn 4 Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 Eaglestone Way,Cotuit Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 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? — P P P _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)] Titlo C in--tinn Fnrm 4/1 si,)Ann 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 Eaglestone Way,Cotuit Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No 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): Yes Water meter readings, if available(last 2 years usage(gpd)): Two years usage: 399,000 gal.=546 gpd. Sump pump(yes or no): No **water usage includes irrigation.** 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: Tank has never been pumped Source of information: Owner 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 _X_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): ` Approximate age of all components,date installed(if known)and source of information: Compliance date: 6/10/94 Were sewage odors detected when arriving at the site(yes or no): No TiYIP S incnar}inn Anrm!/I, imnnn 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Eaglestone Way,Cotuit Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron X40 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: 4' 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: 3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: 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.): Tees intact and clear,tank not in need of pumping at this time 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.): T41P i Tncnprtinn Rnr A/1 ci,)nnn 7 Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Eaglestone Way,Cotuit Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 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: allons 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 hieh stains equal flow to both outlets 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.): TWA C Incnortinn Fnrm ail ciinnn 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: 67 Eaglestone Way,Cotuit. Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: Two 6x6 pits 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.): Both pits have 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 C Tnenartinn Fnrm 4/i ai,)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: 67 Eaglestone Way,Cotuit Owner: Charles& Nancy Connon Date of Inspection: June 3,2005 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. Eaglestone Way 3 2 G Driveway arage a 1 A #67 B A-1 =40' A-2=60' A-3=71' A-4=56' B-1 =47' B-2=52' B-3 =70' B-4=37' Title G Inancntinn Fnrm 611r�ijnnn 10 V Page I 1 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Eaglestone Way,Cotuit Owner: Charles&Nancy Connon Date of Inspection: June 3,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 25 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 established the high ground water elevation: Town groundwater contour map shows water below el. 10 and topo map shows property above el.40. I r TIt1P C inc nortinn Fnrm Aii,;nnnn l 1 f � r N69 7339"E N69 02'39"E 46.39' _ I , 3' WIDE FOOTPATH / - - -- - - - - - - 7- - 45 I I ' � m j K16. i Cs 22.0 20. 0 ` )FROPOSED-- � o LOT T 4 49.2P _ H USir, I 53, 700-i-sf 49.5P td i O ` ' i/ // OF OF 49.8P �- p f �> ioHN I ! �� RS CAULEY LANDE o� PF1�L I� 9.5P I ry I \ ' v CIVIL H MERIa�HEW RESERVE I 49.3P f `DPI ,. \ No.35101 No.3 AREA . /'mil I I o i o �� `� �� \� O GISTER��tk�� 9Fs '�EGISTEa LA TIZ ® \ f" \ \\\ \ \ PROJECT LOCATION SEPo i . D BOX a- 1500 gal g ` '� — TANK �� .� '� `, ti �\ \ LOT 4 \u� "I `� EACLESTONE WA Y. \ ` I,/ \\ �� `1 \ COTUIT, MA LOT 3 � �LEACHING ; PIT � � . , --- - l. APPLICANT ABBOTT CO. `�- _I — \ ► PO BOX 719 4- , HASHPEE, MA PH 508 477-5580 \ I I YANKEE SURVEY CONSULTANTS +� LOT 5 UNIT 5, 40B INDUSTRY ROAD HYDRANT }rn� . 0. BOX 265 0 _ P Ak MARSTONS MILLS, MA. 02648 TEL. 428-0055, FAX 420-5553 BENCHMARK y NAIL IN 12" PINE SCALE I" = 30' DATE 04105194 ASSIGNED ELEV.=50.0 REV REV- JOB NO. 5044:1= SHEET 1 OF 2 ASS. MAP 54 LOT 9-6 N697339"E ___�i / - N69 02'39T 348.12 46.39 1 PAUL yc A. WIDE FOOTPATH No. a i — � — _ - - - -- - - _ _ _ / / i , g ion 3 — - - - �_ - - T - -�- - - - - — � / / / / sJ '�C/STEREO aF. LAND Ry III \ Proposed:-; \ \ House- LOT 4 ` \ \ `\ � o" -, o. "'=; �' i' � � 4ti �\tH ©F asJOHN 9 \ GARAGE- \ 9A\ �p \ ` I o LANDERS-CAULEY. CML 500 No.35101 1 a� �t / � \ ,o \\sep tlo1STER�a,�`� \ reserve \ \ , /ONAL TP <�'st�� ti y area - _ PROJECT LOCATION . \ \ �� �. � -i � ►� A \ LOT 4 \ EAGLESTONE WA Y L O T 1` —-- ° \\ \1 COTUIT ° �� APPLICANT ROSS BUILDING CO. 4728 FALMOUTH ROAD COTUIT � s l - / 508 420 0500 PH Vmoo i I I YANKEE SURVEY CONSULTANTS HYDRANT \ LOT 5 UNIT 5, 408 INDUSTRY ROAD I O P. O. BOX 265 BENCHMARK MARSTONS MILLS, MA. 02648 NAIL IN 12" PINE X.TEL. 428-0055, FAX 420-5553 ASSUMED ELEV.=50.00 Y1 SCALE. DATE 3/7/94:Ll. �l UTILITY V/ SERVICES REV �:JREV- ASS. MAP 54 LOT 9-6 JOB NO. 50441 SHEET 1 OF 2 !► `x EL —_4_7.5 proposed TOP OF FOUNDATION 20' MIN. 10' min CONCRETE CO VERS . 2 LA YER OF 46.9 proposed 46.6 f WAS ED STONE XX.Xf CONCRETE COVERS 7T7 / 46.5E 4" CAST IRON 12'VAX OR SCHEDULE 40 4" SCHEDULE 40 PVC.V C PIPE DIST L2 » M N. s= d=11' BOX O.02 s=0.02, d=24.1 FLOW LINE - s=0.02, d=17.4' PRECAST INVERT 110 ,23" / � LEACHING MIN. EL.=_44.43_ INVERT Z' W ` c EQUOALENT INVERT EL.= 43. 70 q °0 — 439 --- LEVEL °� ° EL.—__ INVERT INVER INVER ° 6 �' ° 314" TO 1-112" 1500 GALL ONS — 43.48 EL.= 43.31— EL = 42.96 0° °c WWASHED STONE `: -------- EL.------ SEPTIC TANK 0 W c EL.= 37.0 _ LEACH PIT I --— 1• 6' 1' PROFILE OF - 8' DIAM--- SEWAGE DISPOSAL SYSTEM - - - - - = - - - - - - NOT TO SCALE BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL=__33.0* ALL ELEVATIONS ARE ASSIGNED P# 7532 SOIL LOG • PETER SULLIVAN WITNESSED BY: ED BARRY THE CONTRACTOR SHALL EXCA VATS FOUR FEET BELO W THE PROPOSED BOTTOM OF THE LEACHING SYSTEM AND THEN NOTIFY THE ENGINEER TO INSPECT THE SOIL GENERAL NOTES CONDITIONS. PERCOLATION RATE 2 MINI INCH OF I THIS PLAN IS FOR THE CONSTRUCTION OF A SEWERAGE DISPOSAL SYSTEM. a �+ �0 JOHN yG 2. PLAN REFERENCE BOOK 465 PAGE 73, LOT 4, BARN. REG. DEEDS DATE 02_27-90 DATE _ c LANDERSCAULEY `�� THIS PLAN IS FOR INSTALLATION REPAIR OF SEPTIC SYSTEM CIVIL 3. / H AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. TEST HOLE 1 TEST HOLE 2 No.ss,o� EL. = 47.5 EL. = DESIGN DA TA. 9FC/STER 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO DER TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS four 7YJP & SUB FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 1 0' SOIL 46 NUMBER OF BEDROOMS 5. ALL COVER TO SANITARY UNITS SHALL BE BROUGHT .TO WITHIN , 12" OF FINISHED GRADE. GARBAGE DISPOSAL none 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW 440 GPD SAME, UNLESS NOTED BY FINAL CONTOURS. 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE ( -110 -GAL.IBR.IDA Y x _4_ ER.) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING mm SAND SEPTIC TANK CAPACITY 1500-- SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. UNLESS NOTED. 11.5' 36.0 LEACHING AREA REQUIREMENTS 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. SIDE WALL AREA 150 - GAL.IS.F. 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH.. BOTTOM AREA 50 - GAL./S/F DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO LEACHING CAPACITY (BOTTOM & SIDEWALL)_425*GAL. OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. -- 10. THE EXCA VA TOR�CONTRACTOR SHALL VERIFY THE LOCATION OF ALL ( 3.14 X 6 X 12 X 2.5 ) f ( 3.14 X 62 X 1. 0 ) UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. RESERVE LEACHING CAPACITY 425*__ GAL. • *. CAPACITY PER PIT SHEET 2 OF 2. JOB NUMBER ---- _