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HomeMy WebLinkAbout0032 GERALDINE ROAD - Health 32 Geraldine Road Cotuit - — -- -- — - -- — —- — - — A= 040 008 a it Town of Barnstable P# Department of.Regulatory Services ? Public Health Division' • nr$, ; Date KAS& �6$` 200 Main Street.Hyannis MA 02601 ` Date Scheduled - i Time JL ---• Fee Pd, Soil Suitability Assessment for Sewage Pis osai .S' Performed By: — - " Witnessed Byc v LOCATION& GENERAL_ INFORMATION Location Address" r Owner's Name M 1 C 4 fA�) Co 1 r 3 Z. C;6R19 ,DI�13. kpo o l /.L Address w r Assessor'sMap/Ptcel: ��� Engineer's Name �o - f _ NEW CONSTRUQ" ION REPAIR V' Telephone# Land Use I i - - Slopes(%) �0 - Surfacesiones- V�O�i` e i - Lot) � (ODt l4D-p . Distances from: Open Water Body ft Possible Wee Area ft Drinking Water Well 1 ft = ; Drainage Way 1 oo ft Property Line 1(2 + ft Other ft :X 3. SKETCH:(street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) co �a f I t I GROUNDWATER ADJUSTMENT I EXISTING GROUNDWATER LEVEL I rP-z® TP-1 BASED ON TOWN OF BARNSTABLE { GIS DEPARTMENT RECORDS. ® INDICATED GW 32.00 INDEX ZONE WELL COW-253 1 READING DATE MARCH. 2006 I 1 READING 48.4 ADJUSTMENT 3.5 m ADJUSTED GW 35.5 �i 1� 19124 rk. GERALDINE ROAD f o Parent material(geologic) r j Depth to Bedfoek L Depth to Ground waldr. Standing Water in Hole: ,V 0�l�^ - I Weeping from Pit Face Estimated Seasonal:High Groundwater DtTEMNATION FOR SEASONAL HIGH WATER TABLE Method Used: PAI' "T!}W-l C i 5 M,A AS SCE ". ftn Depth dbscrved standing in obs.hole: _in. Depth t0 Sall M0ttlts7 in. Depth to weeping from side of obs.hole: in. Oroundwn[er Atjuitment ft. Index Well# Reading Date: Index Well level m e,.e.. Adj.factor,._ Adj.0-nundwater Level PERCOLATION TEST Date Observation )A G( Hole# Time at 9" Depth of Perc _ ��' t top Time at 61' �- `((� 'rime(V-6-1) Start Pre-soak Time.@ /j End Pre-soak �Q n i� •, -. ;` __ _'' ;, . � _0" SV' Rate Min./Inch Site Suitability Assessment: Site Passed Y Site Failed; Additional Testing Needed(YIN) Original: Public Hehlth Division Observation Hole Data To Be Completed on Back -- ***If percolation test is to be conducted within 100'of wetland,you must first notify the -- - - - - — t-...-!_--!-..Umv;"n9n0,_--- DEEP OBSERVATION HOLE LOG Hole#_,__ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) _ (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ED Yet)_ TEST PIT 1 POARENOTUMAATER ALEPROGLACA L OUTWASH I — ELEVATION = 64.75 +- PERC AT 52 2 MIN/INCH IN C SOILS 6 DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER. (INCHES] HORIZON TEXTURE (MUNSELL) MOTTLING _ 64.75 0-5- O LOAMY SAND 10 YR 3/2 NONE FRIABLE I 5-7 E LOAMY SAND 10 YR 4/2 NONE FRIABLE I 7-10 A LOAMY SAND 10 YR 3/3 NONE FRIABLE 62.08 10-32 B LOAMY SAND 10 YR 4/6 NONE LOOSE 32-126 C MEDIUM SAND 10 YR 6/4 NONE LOOSE 54.25 NO GROUNDWATER ENCOUNTERED Dep TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH ELEVATION = 65.50 Surf 2 MIN/INCH IN C,.SOILS ilders. � +- _ t DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL] MOTTLING 65.50 0-6 0 LOAMY SAND 10 YR 3/2 NONE FRIABLE 6-8 E LOAMY SAND 10 YR 4/2' NONE FRIABLE 8-12 A LOAMY SAND 10 YR 3/3 NONE FRIABLE 12-34 B LOAMY SAND 10 YR 4/6 NONE LOOSE f + 62.67 34-120 -C + MEDIUM SAND 10 YR 6/4 NONE LOOSE — i i ;DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel 'DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc Gra el Flood Insuranie Rate Map: Above 51D0 year flood boundary No____ Yes Within 100 year boundary No 1/ Yes es Within 100 year flood boundary No Z Yes Depth of Natutatly Occurrine Pervious Materlal Does at least fo r feet of naturally occurring pervious material exist in all areas observed throughout the area proposed fbr the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification 1(O/Gl 5 I certify that on. I _- (date)I have passed the soil evaluator examination approved by the Department of Nnvironmental Protecdon and that the above analysis was performed by tie consistent with the required.training,expertise and experience described in 310 CUR 15.017.. Signature �J �' �^'" S Date Qm.EPTICiPERCFbRM.DOC �I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature %^ item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse E ,. . ❑Addr ssee so that.we can return the card to you. B.dReceived'by(Printed Name) C. D of liv ry ■ Attach this card to the back of the mailpiece, :;r ' " 1 or on the front If spacepermits. �, - I�' s "3,deliyery address different fom item 1?fs 1. Article Addressed to: If YES,enter,ldelivery address below: ❑No M4&Mrs Michael Curry 32 Geraldine Road 3. Service Type ❑Certified Mail ❑Express Mail Cotult, MA 02635 ❑Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes C2. Article Number 7�0 0 5:it l'6 0:.i 0 0 0 0 i:0,'1 R i +s E i i (transfer from service label) 91 15,3 6 J r I PS Form 3811-,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail .. Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box• PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE i 200 MAIN STREET HYANNIS, MASSACHUSETTS 02601 m �. • Ln rl cr OFFICIAL D' ra Im Postage $ _3 Certified Fee 8S ��'���� � ]q O Return Receipt Fee �l `r Postmark E3 (Endorsement Required) ' ��R ;ere O Restricted Delivery Fee I tl J�g (Endorsement Required) y r-R r'q Total Postage&Fees $ •�.� s Ps Ln Sent T. h-i Cha c � Tieet,Apt No.; � ------------------------ •-------- orP ..... .3� L7�irQL��/�e— C7Q C sta�e.Ztt dt u •�' h��1 d 63s~ Certified Mail Provides: a A mailing receipt (esi-,9H)zooz eunr uae W,Qd Sd o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years f Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-DDelivery. o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information1s not.available on mall addressed to APOs and FPOs. TOWN OF BARNSTABLE LOCATION �^+3a Garaldlnt (2VAa SEWAGE# 2004-7-1S tJ ., VILLAGE l,o T ASSESSOR'S MAP&PARCEL O v ooT INSTALLERS NAME&PHONE NO. eAeo>i d Q Gn SEPTIC TANK CAPACITY t O O O LEACHING FACILITY:(type) (�q ;he L��kh4seds (size)(3 ) 5-0-0 q,4 NO.OF BEDROOMS y OWNER RArvt.onOy T2 PERMIT DATE: S— 9- 'Loole COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist', on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist ` ' # within 300 feet of leaching facility) Feet. FURNISHED BY �1 •�e-5 I ' 131 2c° 191 Sa°I 4 Re-AQ- 13 4 3S!�11 zC S3' M �' s �4'ASt Nro iT G,orvir 13 TOWN OF BARNSTABLE LOCATION JOoZ Gera-L 41 d'e-- ' d SEWAGE # PILLAGE �OZ-(4 ASSESSOR'S MAP & LOT 0_1�D O0yr' SEPTIC TANK CAPACITY QQ� LEACHING FACILITY: (type) _ "O (size) NO.OF-BEDROOMS 2 OWNER �Lt /'�C11ae 4 J- PXQ170- uNr � PERMITDATE: MPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by No.. o© I ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for i 5o *v5tem Cong4ructton Permit Application for a Permit to Construct( ) Repay grade(v)"'Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. 3 2 'L-vAt Owner's Name,Address,and Tel.No. L' evrr`( 5—, APe.,L 2�'1'r`1 .�rosC Assessor's Ma /Parcel / C''T� i� 3Z G�!�Icl,ire p. �� e,a , ivt to -7 3 7- alivZ i Installer's Name,Address,and Tel.No p Designer's Name,Address and Tel.No. C GO A T,_-C,�, Type of Building: " `-C("_L8 `� Dwelling No.of Bedrooms l �I Lot Size s 1 O sq.ft. Garbage Grinder (IQ7� Other Type of Building S: l� (J4 1 t, No.of Persons Showers(Z.) Cafeteria(k/S Other Fixtures Design Flow(min.required) �'� gpd Design flow provided =p gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ow Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed---,, Date 5 Z6to Application Approved by e _ Date S 01 2 oQi'!. Application Disapproved liy. Date for the following reasons Permit No. 1006, 2(� Date Issued No., lw I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppYication for Digpoga *pgtemc Cow5truction Permit Application for a Permit to Construct (Repair rade Abandon ❑Com lete S stem I 'v' pp O ) pg (v}� O nd> )dual Components � � P Y � P f Location Address or Lot No. 3 Z G-W A{J l n.Q—(�'cy,7i`c( '~� Owner's Name,Address,and Tel.No. 0-vrr S--Ag_A (l2.a)1—A Tr,s u, o✓iaic�+rQ, R Assessor's Maji7P [)arcel !� 'z- rt,AA fYt t�f -i 3 -7- oc'v-L Installer's Name,Address,and Tel..NO.. p Designer's Name,Address and Tel.No. (�C 0- Te c-L l� - EaTE -T P-tS -�.r y 3 T r°'an 51� ;fc,I r �. t 3 — o oZ s> �lw,c el'i01 -,,,,,,,,,,Type of Building: olv4ze Z$ r Dwelling: No.of Bedrooms T4 ti.. Lot Size �� / d sq.ft. Garbage Grinder ) Other i Type of Building 5.�,{e ( 1� _ No.of Persons (1� Showers(v Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided `f-` & gpd Plan Date to 0 (o Number of sheets Revision Date Title Size of Septic Tank l 000 Type of S.A.S. W 6&L 1120 { Description of Soil <4,f QL 5 5 ° Nature,of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: ,, The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health::a,� Signed Date Jr"r�� Application Approved by f.9N• Date S—'! ' 2 e06, Application Disapproved by. Date for the following reasons Permit No. ©0 '^ 2 1 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Constructed s Sewage Disposal System Const Upgraded " g P Y � r ( )(Repaired/( ( ) Abandoned( )by C.�c� t 1 -T' at 32 E has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?ODb —.Z/ dated s111,14 Installer t!�E ���5� Designer 1 6OG N A44 bW 0--- #bedrooms Approved design flow L,) oa, gpd o` The issuance of this permit shall not bp construed as a guarantee that the system willf n do 8� Date ° 5- 114 Inspector -------------------------------------------- No. ()Q Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lwigonl *pgte t uction permit Permission is hereby granted to Constru/ct ( 4) 'Reprair grade (f) AbandonSystem located at ?2 (-.)p 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 th' ermitt Date r�011 Approved by rfw d i Town of Barnstable Regulatory Services Thomas F. Geiler,Director saaNsrneM Public Health Division .i639 �� 39 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: � Sewage Permit# ,a���w a l� Assessor's Map\Parcel 040 Do O Designer: C C 0 - 'T e.Ln Installer: O-Aeg,L, d e G411-pr�5e�, Address: Ll 3 T(I e' C,;r'c.)a Address:' O 3 o x 7co3 w avv& J;c" AMA S � o i-C 2- On 5-�=2en� _C�o ogll .(P✓t.�e) was issued a permit to install a (date) (installer) septic system at 2 ar_V,1-Id i✓Le 20 based on a design drawn by (address) cco -.1 e c,� dated s 1 ZAO�.. (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank: , I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. (�A OF MASS q o� DAVID cti� o� D. nstaller's gnature) - COUGHANOWR N � No. 1093 SgNI TAR\P� (Designer's Signature)' (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF. COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc e vv i rve S� Town of Barnstable THE 1p� do Regulatory Services Thomas F. Geiler, Director * BAMSTABLE, 9�b 69' .��a Public Health Division ArEO MA'S Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 13, 2006 Mr &Mrs Michael Curry 32 Geraldine Road .Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 32 Geraldine Road, Cotuit, MA,was last inspected on April 8th, 2006 by, Sean M. Jones, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"unde he guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Septic system fails inspection because leach pit has 0 inches of available leaching. .You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. 4BARNSTABLE HEAL H DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health .y Commonwealth Of Massachusetts Executive Office Of Environmental Affairs Department Of Environmental Protection TITLE 5 Official Inspection Form -Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A Certification Property Address:32 Geraldine Rd.Cotuit Ma.' 'y. 0 O O Owners Name:Michael&Ramona Curry Owners Address:32 Geraldine Rd.Cotuit Ma. Date of Inspection:4/8/2006 Name of Inspector(please print)Sean M.Jones c^ ry Company Name:S.M.Jones Title V Septic Inspectors �w1 Mailing Address:74 Beldan Ln. . • �. -�; Centerville Ma.02632 `. �3-1 Telephone Number:508-7784597 � 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: Passes. ` Conditionally Passes Needs further evaluation by the Local Approving Authority X Fails Inspectors 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. Notes and Comments:Septic System fails inspection because leach pit has 0 inches of available leaching, ****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 willliperform in the future under the same or different - conditions of use. Page 1 3.-, 10 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address:32 Geraldine Rd.Cotuit Ma. Owner:Michael&Ramona Curry Date of Inspection:4/8/2006 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B.System Conditionally Passes:N/A 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 the 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 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: - ! r i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address:32 Geraldine Rd.Cotuit Ma. Owner:Michael&Ramona Curry Date of Inspection:4/8/2006 C.Further Evaluation is required by the Board of Health:N/A 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 31OCNM 15.303(1)(b)that the System functioning in a manner that protects the public health,safety and the environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet-of a Surface water supplyor 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 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: f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 32 Geraldine Rd.Cotuit Ma. Owner:Michael&Ramona Curry Date of Inspection:4/8/2006 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 '/2 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 cesspool or privy is within Zone 1 of a public well. X Any portion of cesspool or privy is within 50 feet of a private water supply well. X Any portion of 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 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _X_ (Yes/No)The system fails.I have determined that one or more of the above 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:N/A 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: Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you 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 CM15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:32 Geraldine Rd.Cotuit Ma. Owner: Michael&Ramona Curry Date of Inspection:4/8/2006 x 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 system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? 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 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 tee,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)] r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:32 Geraldine Rd.Cotuit Ma. Owner:Michael&Ramona Curry Date of Inspection:4/8/2006 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 GPD Number of current residents: Does residence have a garbage grinder(yes or no):—No Is laundry on a separate sewage system(yes or no)_No_[if yes separate report required] Laundry system inspected(yes or no):—No— Seasonal use:(yes or no)No Water meter readings,if available(last 2 years usage(gpd):2004=61000-2005=71000--=183 GPD Sump pump(yes or no):—No— Last date of occupancy/use: Current COMMERCIAL/INDUSTRIAL:N/A 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 Source of information: Was system pumped as part of the inspection(yes or no):—No— If yes,volume pumped: gallons—How was this 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 the 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: 1991 Were sewerage odors detected when arriving at the site(yes or no):—No n OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:32 Geraldine Rd.Cotuit Ma. Owner:Michael&Ramona Curry Date of Inspection:4/8/2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 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:_X (locate on site plan) Depth below grade: 3.5`+/- 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: 1000 Gallons Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): Septic tank was not examined thoroughly because leach pit was full resulting in automatic failure. GREASE TRAP: . N/A (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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:32 Geraldine Rd.Cotuit Ma. Owner:Michael&Ramona Curry Date of Inspection:4/8/2006 TIGHT or HOLDING TANK: N/A (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:_X_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of Leakage into or out of box,etc.): Distribution box was not located and excavated because of leach pit being full resulting in automatic failure. PUMP CHAMBER: N/A (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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:32 Geraldine Rd.Cotuit Ma. Owner:Michael&Ramona Curry Date of Inspection:4/8/2006 SOIL ABSORPTION SYSTEM(SAS)_X (locate on site plan,excavation not required) If SAS not located explain why: Septic System fails inspection because leach pit has 0 inches of available leaching. Type X Leaching pits.Number:- 1-Leaching chambers,number: Leaching galleries,number: _ Leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Septic System fails inspection because leach pit has 0 inches of available leaching CESSPOOLS: NIA (cesspools 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: N/A (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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:32 Geraldine Rd.Cotuit Ma. Owner:Michael&Ramona Curry Date of Inspection:4/8/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)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) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was not determined because system fails inspection which will require leach field to be repaired. Groundwater will be determined by designing engineer. • OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 32 Geraldine Rd.Cotuit Ma. . Owner:Michael&Ramona Curry . Date of Inspection:4/8/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building Cr REAR OF HOUSE B A TANK ❑ 2 1 A-1=45' B-1= 0 D-BOX 8-2=23' 3 C-2=49' LEACH PIT B-3=38' C-3=61' l ` � n • • � � Pam: ►k. t . i y9 r^ I COJ`ORE:�F THIS-PROPERTY IS NOT IN A WELLHEAD PLAN REFERENCE A` f • CONTOURS OR GROUNDWATER PROTECTION DISTRICT= PER BARNSTABLE GIS DEPT. RECORDS. PLAN BOOK 17B PAGE 151 EXISTING - - - - - - - 50c2� ASSESSOR'S MAP: 40 MINIMAL GRADING PROPOSED o OJ< LOT: Bo<w Woz 33.5 Ft x 12.5 F L x er F't _ cocus _��<O LEACHING GALLERY - 1 cr °°} °uwi 19�.86�--�65 �: _� m 1 Z \o N 64 coLOCUS MAP � I / i NOT TO SCALE ww m Z 'r':•;:;:: Ln SHED *20-0 1 ww co F~— J\ z � I 12-0 W W-i T w w LEGEND 1 w Nu3 U J > , ` 1 EXISTING I— =W} � � C] ni ]8-O Lp Lm `` It O W W I O T 1 1000 Gfi L L ON Z �' J 64 1 TP-2 ! L— SEPTIC TANK w z EXISTING AREA = 2014 0 sr\+— H-28 D-BOX o =w O m = ?'` I TP-1 ROOM i BED O Q m ' 1 VENT I TEST PIT w �ry �} :�- PIPE DWELLING ( I \ U �- wZ_j N �`` 3 TOP OF FNDN \ EXISTING O U7 Q O- W m u� 65 1 EL = 6 7.78+ LEACH PITff7 u< cD o W L wz coI i \ DRAIN e GO Zo F�zo �1 t HYDRANT J W C ZJ ! \ y W OI PAVED , TREE (D 1 / -NUMBER REFERS TO ILJ 1 I ` \ DIAMETER IN INCHES. 18-P I 2 1 � w , DRIVEWAY ''"' � --J66 LETTER DENOTES TYPE 66 y Z O-OAK M-MAPLE P-PINE J Z °' , -- WATER—�-- + � — — m 67 67 GATE 191.24 f t z V EDGE OF PAVEMENT LL z J — _-- n z —' RDA SEWAGE DISPOSAL SYSTEM PLAN 3 ;m Q INE -TO SERVE EXISTING DWELLING GERALD n 0ory z 0 m X `� FLAN i CURRY STARR REALTY TRUST Q "' 111 t 32 GERALDINE ROAD COTUIT. MA Z coW SCALE: I t n = 2� F t 20 e ID 20 40 _� �"°FN �r®����� HO-TECH ENVIRONMENTAL 0 1, co ' ��� OD. G�, EST. 43 TRIANGLE CIRCLE 0 a 1a 2a BENCH MARK o 0 z P COUGHANOWR N SANDWICH MA 02563 w N W X VARIANCE REQUESTED TOP OF OUNDATION No. 1093 �� I995 50B 364-0694 o W W ELEVATION = 617.7B �F �i �`� �, MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR, USGS DAT.UM ASSUMED c►STEM �ON�� ETE-2321 MAY 6. 2006 1/2 DE CHT FINISH — COMPONENT SgN�TA LPN I1 THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED DEPTH Q FINISH GRADE. 36 in wry �} SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM MAX REQUIRED — VARIANCE TO DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING 60 in OF COVER REQUESTED. may � Z©0/ PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER ��L w SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. DATE OF TEST:- 26. 2006 SOIL Q TEST L=�O G SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. DESIGN C A L-C fL- A T I 0 N S WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. NO GROUNDWATER ENCOUNTERED TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH DESIGN FLOW: 4 BEDROOMS X 110 GPD = 440 GPD ELEVATION = 64.75 +- PERC AT 52 in 2 MIN/INCH IN C SOILS SEPTIC TANK: 440 GPD X 2 DAYS = 880 GALLONS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONDITION. IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) 64.75 0-5 O LOAMY SAND 10 YR 3/2 NONE FRIABLE DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 5-7 E LOAMY SAND 10 YR 4/2 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 33.5 Ft, x 12.5 FL x 2 f t LEACHING GALLERY CAN LEACH 7-10 A LOAMY SAND 10 YR 3/3 NONE FRIABLE A b o t = (3 3.5 x 12.5 ) = 418.7 5 s f 10-32 B LOAMY SAND 10 YR 4/6 NONE LOOSE A s d w = ( 3 3.5 + 3 3.5 + 12.5 + 12.5 ) x 2 = 18 4.0 s F 62.08 Atot = 602.75 sF 32-126 1 C MEDIUM SAND 1 10 YR 6/4 NONE LOOSE V tt 0.74 x 602.75 = 446.03 G P D 54.25 USE A 33.5 FL x 12.5 Ft x 2 Ft- GALLERY. Vt = 446.03 GPD > 440 GPD REOUIRED NO TEST PIT 2 PAARENTUNDWATE MATERIAL: PROGLACIRAL OUTWASH ELEVATION = 65.50 + 2 MIN/INCH IN C SOILS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 65.50 0-6 O LOAMY SAND 10 YR 3/2 NONE FRIABLE 6-8 E LOAMY SAND 10 YR 4/2 NONE FRIABLE 8-12 A LOAMY SAND 10 YR 3/3 NONE FRIABLE LEACHING GALLERY CONSTRUCTION DETAIL 500 GALLON DRYWELL 12-34 B LOAMY SAND 10 YR 4/6 NONE LOOSE DIMENSIONS AND DETAIL SHOREY PRECAST CONCRETE 62.67 500 GALLON DRYWELL USE H-20 UNIT 34-120 C MEDIUM SAND 10 YR 6/4 NONE LOOSE LEACHING UNIT OR 55.50 EOUIVALENT S T O N INSTALL ONE INSPECTION ^ RISER TO WITHIN SIX INCHES OF FINAL GRADE 33.5 FL ONOAS-BUILTECARD.LOCATION m � m NOTES O O� O 0 34 DODO OR In N - LEI ooa�000 oOoa Q�000 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN m a00000Qoaoo OQQ L� 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/B INCH PER FOOT MINIMUM. � 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 4.0 8.5 8.5 8.5' m 10 OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 33.5 f t 2 4) INSTALLER TO VERIFY LOCATIONS OF,ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED, AND FILLED. OR REMOVED 61 ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0" BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES GROUNDWATER ADJUSTMENT SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMPING OF THE.SE1 T5 TANK y -j �� .d EXISTING GROUNDWATER LEVEL 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING DO NOT BASED ON TOWN OF BARNSTABLE -TO SERVE EXISTING DWELLING PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM.-"`,,: GIS DEPARTMENT RECORDS. CURRY STARK REALTY TRUST la) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE)' Sl'ART. NG WORK. INDICATED GW 32.00 32 GERALDINE ROAD COTUIT, MA INDEX WELL SDW-253 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE%aT&TGRADE ON A LEVEL ZONE C STABLE BASE THAT HAS BEEN MECHANICALLY COMPAC,TEDNA.ND ON TO WHICH READING DATE MARCH. 2006 ECO-TECH ENVIRONMENTAL. SIX INCHES OF CRUSHED STONE HAS BEEN PLACED 'T`O- M,INIMIZE UNEVEN SETTLING READING 48.4 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF `SYSTEM-'REPAIR -`AND 'CHECKED ADJUSTMENT 3.5 43 TRIANGLE CIRCLE SANDWICH MA 02563 FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET -TEE -FITTED WITH GAS BAFFLE. ADJUSTED GW 35.5 ETE-2321 MAY 6. 2006 2/2