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HomeMy WebLinkAbout0114 FURLONG WAY - Health 11_4 furlang.-Way.2jtrit Cotuit A = 008 016 l .II l Commonwealth of Massachusetts W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 114 Furlong way SyO Property Address IJ TENAGLIA, MASON & LAURIE W i Owner Owner's Name " information is required for every Cotuit Ma 02635 10/10/17 -0 page. Cityrrown State Zip Code Date of Inspection "d 1--, t11D 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 cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain r� Company Name 35 Content Ln Company Address Cotuit MA 02635 City/Town State Zip Code 508-364-9587 S113522 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/10/17 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 hO � J Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is Cotuit Ma 02635 10/.10/17 required for every page. CitylTown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 gallon septic tank. As well as a concrete distribution box and two 500 Gallon leaching chambers in stone. The system is functioning as designed. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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): ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Furlong way M Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. City/Town 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 Y day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. Cityrrown 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. ❑ E 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•3/13 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 �M 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. Cityrrown 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 218 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: . 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Not provided 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•3/13 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 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: - Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/1,17 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 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42 11 Distance from bottom of scum to bottom of outlet tee or baffle " Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe 10of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is Cotuit Ma 02635 10/10/17 required for every page. City/Town 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 Level and at normal level 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 500 Gallon ❑ 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.): No ponding no breakout 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 i Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 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 �M 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma -. 02635 10/10/17 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 T t5ins-3/13 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 114 Furlong way Property Address TENAGLIA, MASON & LAURIE W Owner Owner's Name information is required for every Cotuit Ma 02635 10/10/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1 Daatete ❑ 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 10/17/2017 Assessing As-Built Cards !I c� 'TOWN OF BARNSTABLE LOCATION II'7 ! ur/O-V6 (.t)6kY SEWAGE# VILLAGE_ CaTU 7r ASSESSOR'S MAP&LOT_IWF-0/6 INSTALLER'S NAME&PHONE NO._ T4m es C6a c.e 5,3& 5..?7 _d0A SEPTIC TANK CAPACITY 15-00 LEACHING FACII iTY:(type)-Tre,u $Lb/�,t/i � SZ�(siu) o)S,' NO.OF BEDROOMS_ Cac h i,*C 1m ,-, f BUILDER OR 0 ' A p✓ PERMTTDATE: 3 Oz- COMPLIANCE DATE: Separation Distance Between the: ++ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /y Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /",5 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet ol leaching facilit} Feet Furnished by ' r lA Y" I DCa(v C, 9 (�6rc16� c�c r )c - $ a1� .33 Sir http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=008016&seq=1 1/2 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 114 Furlong way r Property Address TENAGLIA, MASON & LAURIE W . Owner Owner's Name ` information is required for every Cotuit Ma` 02635 10/10/17 page. CityrTown 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 ° q •:- 9r r - • i t5ins•3113 Title 5 Official Inspectiori Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION I flu d` Lo�i0� SEWAGE"# VILLAGE 'O.T ASSESSOR'S MAP &.LOT INSTALLER'S NAME&PHONE NO. '44M es rule G SEPTIC TANK. CAPACITY /�Oo (XAI r LEACHING FACILITY: (type) PPotl e, 5-co Q X--(size) za NO. OF BEDROOMS 3 ltue k4 vnhr'- . BLUDER OR O PERMITDATE: I4 DZ- COMPLIANCE DATE: Z Separation Distance Between the: t' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `y Feet Private Water Supply Well and Leaching Facility (If any wells exist. on site or within 200 feet of leaching facility) ��"o Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet o leaching facility) t 16 Feet Furnished by F - 1_ 5-16P �. 179 cp�® .33 � � .ya No.0_00a— 0 0 Fee � OQ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplicatton for Migpoe;al *pgtem COngtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon(l Complete System 0 Individual Components Location Address or Lot No. / /(/ )A:5�1r-1UP1 JA,4 '`i Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size ZS sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow O gallons per day. Calculated daily flow gallons. Plan Date / -z Number of sheets l Revision Date Title Size of Septic Tank /3­0 0 Type of S.A.S. Description of Soil '3 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 o Title 5 of the Environmental C de and not to place the system in operation until a Certifi- cate of Compliance has been is of Health.sue this Boaz _ Signed Date Application Approved by 1 L Date Application Disapproved for the following reasons Permit No. 0-00a- 567 Date Issued la —03—02- . No.�00�- S�7 „=� G /j Fee 0 Q 0 THE COMMONWEALTH O MASSACHUSETTS Entered in computer:(/ \ t Yes . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pphratton for MtopoM 6petent Construction Permit APPlication for a Permit to Construct Repair )Upgrade(( )Abandon andon( -I ❑Complete System ❑Individual Components nents - Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Uog- o l� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. .,� fj r HAS x6ozV-s 7-i),9/e 1,k9 Type of Building: , Dwelling No.of Bedrooms _ Lot Size a sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 O gallons per day. Calculated daily flow gallons. Plan Date / U Z Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. -7'1 VlekJ Description of Soil 3 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersignefd,agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions o Title 5 of the Environmental C de and not to place the system in operation until a Certifi- cate of Compliance has,been issued b this Boa4l of Health. Signed v r, _ Date C -a� Application Approved by-1-),L1 /�Jo ...r.a. i ., Date Application Disapproved for the following reasons �` // " Permit No. Q 00 ate- 5677. Date Issued 1 a - 0 3-Ua ——— ———— —— ———— —— ————————— ——— THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS Certiftcate of Compliance THIS IS TO CERTIFY, that the On-site_Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )ny t at P[.c-r-I 1&& ) _ r- has been constructed in accordance with the provisions of Title 5 andqhe for Disposal�System Co nstructtii,odPermit No 0'2 `S_(0)r dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste �wl�,f c&' a nedeS Date 2/03 Inspector V; X ----------------------------------------- No. aoo.-) -- s(,o7 Fee /00• 0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Xioogal *y5tem Con5tructton Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 114 EQP Lo N& W/A V e o n IT 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 must be completed within three years of the date of this permit. Date:- Approved by TOWN OF BARNSTABLE LOCATION r`L©A16 e.e� SEWAGE # ! ' 1 VILLAGE_ 0 t ASSESSOR'S MAP & LOT 601? Alil INSTALLER'S NAME&PHONE N0. .� �S e-�ia G SEPTIC TANK CAPACITY LEACHING FACILITY: (type) PsU�• � Jco 64-4 (size) a / NO. OF BEDROOMS_ 3 /e(Ac -erf f BUILDER OR O1.,2,010T % A ff PERMITDATE: t D�- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ry Feet Private Water Supply Well and Leaching Facility (If any wells exist ,�yr� on site or within 200 feet of leaching facility) —I withinFeet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet o leaching facili ) Feet Furnished by RONALD J. CADILLAC, PLS,RS PROFESSIONAL LAND SURVEYOR REGISTERED SANITARIAN Page 1 P.O. BOX 258 WEST YARMOUTH, MA 02673 No. __fools.. Date ........_/...... Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Disposal y Performed By:: -- --RONAiD J:CADILLAC.-PkS;IDS................... ............................ Witnessed By: jJwA y:::::: :: 1,r?e. ...-.... .......................::::::::::.........:.......................... :.... Location Address or 114 V y-!V�y� �4L/ / .I� Owrc ////�y r's Name. /r c'� CO'e Loi o /�. J ' / rJI v Address.and g �'1% Telephone r � f1 A1' ' wr B '1�/�•-u,� �(o '► . „ . r,� New Construction Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published _1113 Publication Scale . Z 1000 Soil Map Unit . EXt. Drainage ClassD�4��SSo(�o�il Limitations ......._ Poor-....7 /4er.....-...Q' ci.P�y-...(�•4R,(E., Surficial Geologic Report Available: No ❑ Yes Year Published —1.86 Publication Scale .-11' 00/cOno Geologic Material (Map Unit) .. . qmp. _—. mAj4JpPe .,..LJ��ac�J�.t5.... Landform . _ ..0 (uc(.._. % Gji+ .;a._ . osi Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ❑ Yes ❑ Within"100 year flood bouhdaN No\O Yes ❑ Wetland'Area: ` National Wetland Inventory Map (map unit) ................../7.01'L.. .................................................. Wetlands Conservancy Program Map (map unit) :............................... ............................................................... Current Water Resource Conditions (USGS): Month ...ND0. Range : Above Normal ❑ Normal ❑ Below Normal Other References Reviewed: (�-S� S �y¢� -�1ee,� r-. c • 7 Page Z \ ' Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole.....A1119 inches ❑ Depth weeping from side of observation hole ..V14-. inches ❑ Depth to soil mottles ....G 14.. inches ❑ Ground water adjustment k jt+ feet �S r► nit*, ^ F)00 0 6%ev. (� i ,' N G vD —7'�i- l vL 3 4 f TH Z U L 3 2- Index Well Number .......�4 Reading Date ................ Index well level .................. Adjustment factor ................. Adjusted ground water level ........................................................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �Izf�S If not, what is the depth of naturally occurring pervious material? Certification I certify that on Nov• Icig3 (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by m'e consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature c.. Date / ZG 9 G RONALD,I. CADILLAC, PLS,RS PAOFESSIUNAL LAND SURVEYOR f' REC'ISTERED SANITARIAN \ N.O. BOX 258 WESTYARMOUTH, MA 02673 Page 3 On-site Review Deep Hole Number ..... 1 Date: 11/ZB19S Time: IP4-7 Weather Ccgq-r- e61gI Location (identify on site plan) .. -SPe...p4y.. ....d4kd 51 /qf6 _ .. . ... . ._.. _.... Land Use ............. Sloe (%) /. Surface Stones ....... ......... .:... Vegetation ..... LwE/4 - _ ..:.. ... _. L a n d f o r m t 7 46-0 _P/4+< ......4X4P0.1/? ... / Position on landscape (sketch on the back) _28 �.o.".`F /9.'t.�$ �S6 '. p. . .L�,.f'.96 .. 1-... Distances from: it Open Water Body . ..13Stfeet Drainage way ....�Sv.�feet � 6�fA 64,JA-) Possible Wet Area /.35 feet Property Line .....2.8 feet Drinking Water Well .tV/lq feet Other DEEP 1 HOLE LOG Depth from Surface Soil Horizon Soil Texture, Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure, Stones, Boulders, Consistency, % Gravel) O aoy X0,t"7, /0Yoe f/Z /8 Yr S16 Z,S 613 y %32 " ' n / i Parent Material (geologic) •`��..�� l,� �i9-ClA.. ... ..0.11 Depth to Bedrock: Depth to Groundwater: Standing Water in the Hole: . ti�� Weeping from Pit Face: til� Estimated Seasonal High Ground Water: DOWN 2,3 t COMMONWEALTH OF MASSACHUSETTS &izlu,04-8 cC E_ , Massachusetts Percolation Test Date: Time: 1 M Observation Hole # Depth of Perc Start Pre-soak '_ 00 End Pre-soak 23 4 8 Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch Site Passed Site Failed ❑ ..,........_........_....._............................... ........................................ . ............... Performed By: RONALD J. CADILLAC, PLS, RS Witnessed By: � Per UI.G.G, Comments: rYl e��v�►1-J� ,p GO y � loe rc, c7e f/,"� d I Page Jr- On-site Review . Deep Hole Number # Z Date: ///2 8/'jS Time:/. �LD ji? Weather CIM,-140�d Location (identify on site plan) .I'e e P/4n d4AJ �1 , Land Use. _.A_).oCq pE0 Slope (%) .LS.. Surface Stones .......... Vegetation ......!-?/"aF/o 4�. ... _ ........................ L a n d f o r m .... .P ���rt,clP�.c�/i./.. .......... i Position on landscape (sketch on the back) _70. ....0 f� 40 T..JS� 72., o-ff Lot q s .... Distances from:Open Water Body . � feet Drainage way feet �� h,'4J11U Possible Wet Area ...//O."�eet Property Line ._.3$_Jtfeet o-10r"' Lot/3 Drinking Water Well A,/f}" feet --Other -......... DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure, Stones, Boulders, Consistency, % Gravel) 0 Son 4 lam /b yr 4/Z V 46 ii C Gr,�, Z, 5 6/ 11'4 wAk--- Parent Material (geologic). .4/l�v' (0 .hZ9t7. ��.4.C, .....b5pojTDepth to Bedrock: _A)/� Depth to Groundwater: Standing Water in the Hole: :/U -. Weeping from Pit Face: .. Estimated Seasonal High Ground Water: COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test Date: Time: Observation Hole ## Depth of Perc Start Pre-soak End Pre-soak Time at 12 Time at 9" f Time at 6" Time (9„-6„) Rate Min./Inch Site Passed ❑ Site Failed ❑ ................................ __............ .... ........ .......... F 1 _ RONALD J. CADILLAC. PLS, RS Performed By: - Witnessed By: Comments: ... ,� e } t r E ( r • )1 i . y • � Ef � �yy • 17. _ y , • # to iµ - { _ R 1 All : vV , " r: , a" M _ 3 .o n e , : 7::t a i r s 11 J r � i 105 4 •� t 3 _.. y 77 r II } •� ya� ,. �... :�., e ,, ., �. � ..: 41 110 ..,,,�_ _ �;-.gip '�''�-=-- -^.�.•.+ r D. ! �.,. r , _S S - i ' I i i I i f i t a , i i I a , .. ... . ..... _ M1 9 1 LEGEND ;- Y t ,z - .,•;� EXISTING fx}.hr�r1 PROPOSED -n�,.,, rti.� � �, 'I�� ° ,,� :� N.;_ �. .•s,-�r SOII, LOGS DATE:htay 7,2002 ` P# ? Stake & Tac Set/Found ENGINEER LTH: BOARD OFHEA AGENT: PK Nail Set/Found v a• y. I ^r •,i 1 John Churchill,P.E. Dave Stanton ° Concrete Bound •'� .;.M s. �Q' O Gas Gate `^r f F�'t- TEST PIT 1 TEST PIT 2 ® Electric Meter Y G.S.E. = 33.7f G.S.E. = 32.6t Catch Basin Water Gate 0 0 ® TV/Cable Box A A » Loamy Said ® Telephone Riser Loamy Sand r - .��� r; / /2 8" 10 YR 312 Utility Pole ,. 1 '.;: �, o? ap 200 Contours 0 1 A. >< '�, II n N Sand Loam t P +� .�;►;ra �' r, •,r: N co B B 200xOO Sot Grade - `, • r-- . + �,, < . y Sandy Loam o » 10 YR 5/4 10 YR 5/4 Test Pit ,, J M til._i.,r •i f• 1 •1 f''yr. •Oy l , ' J-'ti' `Y.'T (/� ._ •.I l�' O M -. ; % •�4. �, ,a%*-�,i !-J `� J C ZONING DISTRICT: RF & RPOD B.M. `C ` Med.-Coarse Sand Med.-Coarse Sand J � r• ti 4 ar p _ Q. 132" 2.5 YR 6/4 32» 2.5 YR 6/4 BUILDING SETBACK REQUIREMENTS ! TAG BOLT OF -1 ...,. ... r- �", 4 _• � '. ' X_ HYDRANT 0 n r ,•i5; + . �+ r .r; -t^.'�. �,., 4 EL.EV.= 30.91 o FRONT= 30 SIDE= 15 REAR= 15 f �, i,, E N.G.V.D. ; OVERLAY DISTRICT: AP AQUAFlER PROTECTION .71 <' ;:�4"`r�' ,; : '�..• j }„ ,' YI Yj N PERC O 40' P �� '; ' .� _ y ERC �� LOCUS PROPERTY IS COMPRISED OF: •r RATE= <2 MIN/IN RATE= <2 MrN/IN ASSESSOR'S 16 c DEED RFERENCE: BOOK 37L 81 PAGE 151 LOCUS MAP �_ PLAN REFERENCE: BOOK 268 PAGE 4 1 " = 2000' __.-__! No Water Encountered No Water Enccuntered K . ,„�•�• A EL. 22.7 O EL 21.6 �..--._ • - _ 4�9` ���, TOPOGRAPHY TAKEN FROM A SITE PLAN FOR MARK & NOEL COLE • PREPARED BY RONALD J. CADILLAC, P.LS. & S,00 •,•• \Mc ••. T\'�, _ REGISTERED SANITARIAN, P.O. BOX 258 y i�r�o �,� " '`�' ^r WEST YARMOUTH, MA 02673, DATED JAN. 5, 1996. / I A,,•� ` y �o " TOPOGRAPHY IN AREA OF PROPOSED CONSTRUCTION VARIFlED BY JOHN R. FARREN P.L.S. • s�`FJ 17 SOUTH ST. PLYMOUTH, MA 02360 PLAN DATED JUNE 3, 2002 £ • 'Sj• • ` i z� THIS PLAN DOES NOT REPRESENT ANY FIELD WORK BY BAXTER, NYE & HOLMGREN AN ,. ,0 ? •'• / s WETLANDS FLAGGED BY KATHERINE S. BARNACLE, P.W.S OF ENSR / �, �F` •,•.•' f � JULY 11, 2002. LOCATED BY JOHN R. FARREN, P.L.S. o COMMUNITY PANEL NUMBER 250001 0022D Gam/ 7', 1,,: " THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS "YO�,• In -�.�I f' 1.�.� / ' AN tiso s�so �, _ ry ZONES: A 11 (EL. 11.0) & C. A-11 GENERAL NOTES . 00 ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH TITLE V OF THE STATE SANITARY CODE DATED MARCH 31,1995 A r2 ANY LOCAL RULES APPLICABLE. • ' " `; 1 •'� ao� 4 O t" ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING LOT 14 � 48, 325f S.F. BY DESIGNING ENGINEER /o -� c• E� o A _ 0 WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT FOR INSPECTION. %S' s A-7 ' '•- '•'� FOUNDATION ELEVATION MUST BE CHECKED WHEN L,'OMPLETED. 3/4 -1.5' WASHED STONt . a ' . ` ' 1.: 12' THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN A-6� APPROVAL BY DESIGNING ENGINEER EDGE OF , 1, 'V��•"'p SYSTEM G O BE 4" PVC., SCH 40 VEGETATED WETLAND I ! I ' - r �� ALL SANITARY DISPOSAL SYS M PIPING T �' I t' ' ' `: 1 I ••.` ,."T PLAN OF LEACH CHAMBERS EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING SURROUNDING 1NE LEACHING FIELD FOR A DISTANCE OF 5', PER .r oF,•••• _ NO SCALE 310 CMR 15.255. PROJECT BENCHMARK DATUM = NGVD TBM = TAG BOLT ON HYDRANT EL. = 30.91' F,p A-4 ?�.:;,?, `., LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND ` 1 \ SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE \ ( ,' !f''•; '` , 12 UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. FINISHED GRADE A-3 d. o \/\/\/\/\/\/\/\/\/\/\ \/\/ COMPACTED FILL 36 MAX.-9 MIN. //\//\//\/\// // // // // // // // // 2" OF PEA STONE 114 Furlong Way o.. - #N3/4" r0 ' '/2 ' Cotuit, Massachusetts 24" DOUBLE r, EFFECTIVE WASHED STONE PREPARED FOR DEPTH E C;-• , --RvATIO' SECTION Ladd & Company / NO SCALE �D.E.P. #SE '4 PLASTIC LEACHING CHAMBER DETAIL TWetland P rmit PI n ■E■ e a House Construction Cu TYPICAL SYSTEM PROFILE DESIGN SCHEDULE ELEVATION BAXTER, NYE & HOLMGREN, INC. ' FINISHED GRADE = 38.0t Registered Professional o NOT TO SCALE TOP OF FOUNDATION 40.0 FINISHED BASEMENT FLOOR 32.5 �jH pF Cj FINISHED GARAGE FLOOR 32.0 Engineers and Land Surveyors / �P M s OF FOUNDATION SEWER INVERT AT FOUNDATION 29.7 812 Main Street, Osterville,MA 02655 �•0 FINISHED GRADE OVER TANK 32.Ot SEWER INVERT INTO SEPTIC TANK 29.5 )428-3750 Phone-(508)428-9131 Fax - (508 No �O 6 _ = y FINISHED GRADE OVER D. BOX = 31.5t SEWER INVERT OUT OF SEPTIC TANK 29.2 � 9 C«/ FINISHED GRADE OVER LEACHING TRENCH 31.0t Leaching Area R e u l re m e n t s �� F'/S TER�� 3 87MIN. SEWER INVERT INTO DISTRIBUTION BOX 29.0 ass/ Era 3" (ml oNAI SEWER INVERT OUT OF DISTRIBUTION BOX 28.8 4" SCH. 40(TYPICAL) PVC ® SCH. 40 PVC FIRST 2' (TO BE LEVEL) g" min Cover / /3 oZ a•t,,,;,� F-then 0 2.OX ( SEWER INVERT INTO LEACHING SYSTEM 28.6 3 BEDROOMS AT 110 GPD BEDROOM = 330 GPD 30 0 30 60 OL2 min 36" (max) Cover BOTTOM OF LEACHING TRENCH 26.6 SCALE IN FEET 3 O 2.0% PVC r ADDITIONAL 50% FOR GARBAGE DISPOSAL --NA-GPD o FINISHED GAS 10• CI �t�S BAFFLE 6' Su1�P 4" SCH. 40 PVC WAFER TABLE: NONE OBSERVED AT ELEV. 21.6 CONSTRUCT ACCESS 2"Layer 1/8'to 1/2" PERC RATE _ � MIN. / INCH (CLASS 1 ) SCALE:1 " = 30' DATE: 9130102 �, BASEMENT MANHOLE OVER INLET Peastone LEACHING CHAM o FLOOR TO TANK TO AT LEAST L '• - CU WITHIN 6" FINISH G 6• CRUSHED „ REINFORCED CONCRETE. STONE LTAR = 0.74 GPD/S.F. REV. DATE: REMARKS FOOTING 4" PVC -1- 11 13 2002 Revise Work Limit CD •' O O O MIN. LEACHING AREA OF S.A.S. Uj 330 GPD/ 0.74 GPD/S.F.= 446 S.F. MIN. 26.6 DRAWING NUMBER 5' MIN PROPOSED SYSTEM : SIDEWALL (12' x 25) x 2 x 2' = 148 SF 1500 GALLON SEPTIC TANK DISTRIBUTION BOX + BOTTOM 12 x 25' = 300 SF H:\2002\2002-062\survey\worksheet\2002-062ws.dwg o TO BE INSTALLED ON A LEVEL STABLE EASE No Groundwater Observed O Elev. 21.6 TOTAL 448 SF TO BE INSTALLED ON A LEVEL STABLE BASE Job # 2002-062 S. 0 r n n