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HomeMy WebLinkAbout0011 GROVE STREET - Health 11 Grove Street Cotuit F 020111 I. kv 1 10 10 7 OC GROVE ST)K E,ET TOWN OF BARNSTABLE LOCATION r (Arusc. 5 SEWAGE # 0�4� `'PILLAGE C®-Fv,t ASSESSOR'S MAP &.LOT INSTALLER'S NAME&PHONE NO. wru, e. 1266w 0,4 507tj S;e.rvice Sing MY-27 SEPTIC TANK CAPACrrY /5 LEACHING FAcu rrY: (type) 3X SVo Prye e, b (size) 33-J Xg,,,rXtn?, NO.OF BEDROOMS BUILDER OR OWNER h le-i� J PERMFTDATE: S/dId/0— ' 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 Z—h9 C�/s r /A,4 K 33' r S SA$ El ►3y3=3�B C� � I �" LOCATION SEWAGE PERMIT NO. 0 G,ovf_ 5'T , V I L L A G E ASSESSORS-MAP NO: � O s t AP,CEL NO.: I N S T A LLER'S- 4N-AME A ' '�h,DDRESS 40 B U I L D E R OR OWN ER DATE PERMIT ISSUED DAT E COMPLIANCE . ISSUED , c , �� , No. Q d 06 a �'� Fe�1 00 .00 r. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS �. . 01ppYication for Zigozar bpgtem Con5truction Vamit Application for a Permit to Construct Repair(X )UPgrade Abandon ❑Complete System ❑'Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 61 7—9 21 —0 4 8 5 11 Grove St, Cotuit Tom Klein Assessor'sMap/Parcel ® / 24 Denton Rd, Wellesley, MA Installer's Name,Address,and Tel.No.7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4-0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(X ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title n Size of Septic Tank Type of S.A.S. Git"' telr Description of Soil Nature of Repairs or Alterations(Answer when applicable) We will install a new Title 5 septic system to plans of Ec-Tech, #ETE-2019 . 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 Certifi- cate of Compliance has been issu d by this o of Healt - Si ned Date Application Approved b Date Application Disapproved for the following reasons Permit No. Com- 00 J �' Date Issued bd �-5 ,._.� .. ,. .,:,,,.,.,• �.. ,.- ,..�?-,.�-,�'-.,,.3�;..•,-.y„; ..�, ���:_, .. - .. � _ , r .. ..,.___.. . .... ...... r. �*mow-, No. )C6 S FA 1 00 001 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Replication for �Biopo!gar bpgtem Construction Permit X Upgrade Abandon ❑Com lete System. ❑Individual Components - Application for a Permit to Construct( )Repair( )Upg ( )Abandon( ) ppo 'l Location Address or Lot No. Owner's Name,Address and Tel.No. 61 7—9 21 —0 4 8 5 11 Grove St, Cotuit Tom Klein Assessor'sMap/Parcelt -1to-n Rd , Wellesley, , MA Installer's Name;Address,and,Tel..No'.7 7 5 G5 3 1. i ' Designer's Name,Address and Tel.No 'G— a 9 4� Wm E Robinson .Sr Septic ` Eco-Tech PO Box 10891? Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling . No.of Bedrooms Lot Size sq.ft. Garbage Grinder(X ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date 1 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. r,^t1Z.,/1'ed �Ad G u X, c k n�•l r. Description of Soil Nature of Repairs or Alterations(Answer when applicable) We will install a new Title 5 ` septic system to plans o Ec-Tech, ETE-2019. ,a 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 Certifi- cate of Compliance has been issu d by this o9d of Health? ✓ Si ned Date Application Approved by Date Application Disapproved for.the following reasons Permit No. ,.Go 5 Date Issued S THE COMMONWEALTH OF MASSACHUSETTS Klein BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Abandonedl( )b Wm E Robinson Sr Septic Service 1 Grove 5 reet otuit at ' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.� U(1 ^` dated S 11 Installer Designer l\ 1, k. i The issuance of this permit shall not be construed as a guarantee that the system)will fu1nction as�designecL r Date a VU � Inspector i /~" 1 j No. Fee1 0 0.0 0 Klein THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS i1i.5poeal *pg;tem Con!5truction P°ermit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 11 Grove . Street, Cotuit 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:Con�stzuchion mu of within three years of the datQby his e t. Date:_ Approved --�=-" G Town of Barnstable F� Regulatory Services Thomas F. Geiler,Director BAMSraBLE, • Public Health Division A'fD 1A0�s Thomas McKean,Director - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: Eco-Tech Installer: Wm E Robinson Sr Septic Address: 43 Triangle Circle Address: PO Box 1.089 Sandwich Centerville On Wm E Robinson Sr Septigwas issued a permit to install a (date) (installer) septic system at 1 1 Grove Street, Cotuit based on a design drawn by (address) Eco-Tech dated 05-02-05 (designer) 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 &-Loc l Regulations. Plan revision or certified as-built by designer to follow. ZN OF MA&C, DAVID tiGN ' (Installer's Signature o D. COUGHANOWR No. 1093 sANITAR\P� (Designer's Signature) (Affix Des'fig ti_ ." tamp 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 f 9/16/03 Y Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM d ;Hereby certify that the engineered plan signed by me dated 5 2-1 OS ,concerning the property located at re Ire �3f U 1 f` meets all of the 1 e following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business.uses associated with the dwelling. • The soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: f A) Top of Ground Surface Elevation(using GIS information) 3 B) G.W.Elevation S,0 +adjustment for high G.W. DIFFERENCE BETWEEN A and B SIGNED . r DATE: NOTICE 4 Based upon the above information, a repair permit will be issued for bedrooms maximum.: No additional bedrooms are authorized in the future without engineered septic system plans. q:\Septic\percexemp.doc TOWN OF BARNSTABLE L :,ATION C � t�QO�/ S I �L` SEWAGE# L VILLAGE CrTu T ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. ON L ENE SEPTIC TANK CAPAC �(0 )4 A-2 LEACHING FACILITY: (type) Q )S �L�,`'TG✓L� (size) NO. OF BEDROOMS BUILDER OR OWNER ro �- PERMTTDATE: � 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 33 r6 3 O ( ' 37 i -t1 2ef%� FAILED INOPECTION COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL A I 'S Z DEPARTMENT OF ENVIRONMENTAL PRO I RECEI A � d OCT 0 5 2004 TOWN OF BARNSTABLE' TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 11 GROVE STREET COTUIT,MA 02635 bab i 1 Owner's Name: ESTATE OF JAMES KIGGEN Owner's Address: JOSEPH KIGGEN 17 HOWARD DR.PLYMOUTH MA 02360 Date of Inspection: 8/31/04 Name of Inspector: (please print) JOHN GRACI,INC. l Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 2 C�'3 co Telephone Number: 508-564-6813 FAX 508-564-7270 { (Y, CERTIFICATION STATEMENT , = I certify that I have personally inspected the sewage disposal system at this address and that the informati n reported belo is true,accurate and complete as of the time of the inspection. The inspection was performed based on my tlaining 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 _ Conditiona y asses _ Needs Fu Evaluation by the Local Approving Authority X Fails Inspector's Signature: Date: 8/31/04 The system inspector shall submit c py of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspect n. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner sh 11 submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner,nd copies sent to the buyer, if applicable,and the approving authority. . Notes and Comments SYSTEM FAILED TITLE V INSPECTION. METAL SEPTIC TANKS DO NOT MEET TITLE V CRITERIA,SYSTEM NEEDS TO BE REPLACED. ****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. Titles. 5 Tncnartinn Fnrm 6/1 v?nnn 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: I l GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 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: SYSTEM FAILED TITLE V INSPECTION. METAL SEPTIC TANKS DO NOT MEET TITLE V CRITERIA, SYSTEM NEEDS TO BE REPLACED. 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. n/a 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: n/a n/a 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: n/a n/a 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: n/a r Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11 GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 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. c _ 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 n/a "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. Othe'r: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11 GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. 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 l 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.] YES (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: Y 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 _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply ' X 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 abovethe 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. a Page 5 of 11 - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 11 GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 t Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? i 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)] ' 4 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 11 GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 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): NO Seasonal use: (yes or no): YES Water meter readings, if available(last 2 years usage(gpd)):j¢a 0, j — Sump pump(yes or no): NO "� Last date of occupancy: 6/30/04 0 lz�- A L; COMMERCIAL/INDUSTRIAL Type of establishment: n/a . Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO . Water meter readings, if available: n/a Last date of occupancy/use: n/a , OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--,How was quantity pumped determined?n/a Reason for pumping: n/a 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): n/a Approximate age of all components,date installed(if known)and source of information: 35+ YEARS PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO a Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 BUILDING SEWER(locate on site plan) Depth below grade: 0" Materials of construction: Xcast iron _40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): } TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 0" Material of construction:_concrete Xmetal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 4'X4"' 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: 0" Distance from bottom of scum to bottom of outlet tee or baffle: 0" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): METAL SEPTIC TANKS DO NOT MEET TITLE V CRITERIA-SYSTEM NEEDS TO BE REPLACED. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a ( ; Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): " n/a DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a ' R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 GROVE STREET COTUIT,MA 0205 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 i SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a 3'X4' OVERFLOW overflow cesspool, number: n/a innovative/alternative system Type/name of technology: n/a I Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): SYSTEM NEEDS TO BE REPLACED.MAIN CESSPOOL IS METAL AND DOES NOT MEET TITLE V CRITERIA.OVERFLOW WAS EMPTY AT TIME OF INSPECTION. BOTTOM IS AT 5 FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 0 Depth—top of liquid to inlet invert: 0" Depth of solids layer: 0" Depth of scum layer: 0" Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 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. W .. °gut c% I LA-6 Page 11 of 11 r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 GROVE STREET COTUIT,MA 02635 Owner: ESTATE OF JAMES KIGGEN Date of Inspection: 8/31/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans(on record-If checked,date of design plan reviewed:n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a. You must describe how you established the high ground water elevation: HAND AUGER- 10+FT. x• 11 38 154,94 ft ' corurr. MA m= r ti r. PLAN. REFERENCE )$CHOOL, m Z N PLAN BOOK 125 PAGE 125 STREET v 38 . R O -ASSESSOR'S MAP: 20 re-o O CLEANOUT t \� \ LOT: III wo a PL UG \ 40m ° ro r ;, � � CONTOURS `'LOT 35 O - - - - -E—jAREA - 17600 s f +- \4.0 EXISTING - - 50 'v EXISTING n O MINIMAL GRADING PROPOSED Goo 3 BEDROOM LOCUS MAP DWELLING n.3 r / � \ NOT TO SCALE TOP OF FNDN / �- - EL - 39.36+— \ . \ O y un o ' 42 0I 24 ft x 12.5 ft x 2 ft i LEACHING GALLERY �j IN GROUND SWIMMING P N O T E POOL [� C /� I LAUNDRY PIPE IS \ L C GL I v D 1 3 TO BE TIED INTO \ 1500 GALLON s�o PROPOSED SEPTIC SEPTIC TANK o O O BENCH MARK SYSTEM. TOP OF FOUNDATION O,Q�` \ D-BOX ELEVATION - 39.36 r m F� k _ TEST PIT USGS DATUM ASSUME 4 {�' _ - EXISTING 195.00 f t 40 2 CESSPOOL UTILITY POLE 8- EDGE OF PAVEMENT i STREET PLAN TREE GRO VE k Ni 1Nf.'UMBER REFERS TO DIAMETER ��FLOW PROFILE SCALE: I in = 20 �t IN OHES. LETTER, DENOTES TYPE -OAK M-MAPLE P-Plf\E FOUNDATION RAISE COVERS TO WITHIN LOT IS NOT IN A ZONE TOP OF r 6 in OF FINAL GRADE 2 OR GROUNDWATER / EL - 39.36 RAISE ONE COVER ON PROTECTION AREA t LEACMNG GALLERY _ PDR 2- LAYER OOF 1/8' SEWAGE DISPOSAL SYSTEM PLAN D BOX 1/2 ST E3' DROPL r =TO SERVE EXISTING DWELLING FLOW LINE 1 3/4--I 1/4" 'cNoE 1O - 4' ST STONE JAMES H.. KIGGEN cjpm 48- GAS LL D. R 11 GROVE STREET COTUIT. MA BAFFLE 6 in BOTTOM OF CC, ir' R. coo F.)5 34.93 LEACHING SOS ABSORPTION = ECO-TECH ENVIRONMENTAL. 36.85 STONE SYSTEM Ex)STM)G BASE A �P'� 43 TRIANGLE CIRCLE SANDWICH MA 0256 35.4 6 in STONE BASE 35Jo GALLERY 3a.80 s.00-n• %oj �S 508 364-0894 IS00 GALLON (END VIEW) j ETE-2019 MAY 2 . 2005 17 1 I/2 SEPTIC TANK 3.5 r, a) 5 M /2 h- 6 in ��057 T145 PLAN IS TO BE.CONSIDERED A DRAFT PLAN LKESS IT b) 12 f' 5.9 v ADJVSTED �,/ BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER SEASONAL HGH ORIGINAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD GROUNDWATER OF HEALTH WILL BE SIGNED N BLUE AND STAMPED N RED. SOIL TEST LAG g DESIGN CALCULATI ONS DATE OF TEST: APRIL 25. 2005 e SOIL EVALUATOR: DAVID D. COUGHANOWR, RS WITNESSED REQUIREMENT WAIVED - NO VARIANCES SOUGHT DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD NO OUMNDWATER ATERIAL: EPROGLACIALDOUTWASH SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS TEST P i T I PARENT ELEVATION - 37.78 .- PERC AT 50 In 2 MIN/INCH IN C SOILS INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH 37.78 0-5 O LOAMY SAND 10 YR 2/2 NONE FRIABLE A b O t - ( 24 x 12.5 ) - 300 s f 5-7 E LOAMY SAND 10 YR 5/2 NONE FRIABLE A s cI w - ( 24 + 24 ; 12.5 - 12.5 ) x 2 - 146 s f Atot - 446 sf 7-10 A LOAMY SAND 10 YR 4/3 NONE FRIABLE Vt 0.74 x 446 - 330.04 GPD 10-34 B LOAMY SAND 10 YR 4/6 NONE LOOSE 3a.95 USE A 24 ft x 12.5 ft x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD_ REQUIRED 34-148 1 C MEDIUM SAND 1 10 YR 6/3 j NONE LOOSE 25.45 GROUNDWATER ADJUSTMENT 500 GALLON DRYWELL LEACHING GALLERY DMNSIONS AID DETAL EXISTING GROUNDWATER LEVEL BASED ON TOWN OF BARBSTABLE CONSTRUCTION DETAIL WE H-10 cwr GIS DEPARTMENT RECORDS. INSTALL ONE INSPECTION DRYWELL UNIT INDICATED OW 5.00 STONE RISER TO WITHIN SIX 8'-8'x 4'-10'x 2'-9' I+ INCHES OF FINAL GRADE NDEX WELL MIW-29 2 ft EFF. DEPTH AND INDICATE LOCATION ZONE A 24.0 ft ON AS-BUILT PLAN READING DATE MARCH. 2005 READING 7.1 ADJUSTMENT 0.9 M ADJUSTED GW 5.9 ` u'• N 000� 0 000� n4. o coc�oo©oozoc� 0000� 0000r—c_j 0 ��0 NOTES o0000 0 3.5' 8.5- 8.5- 3.5- G)� 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 24.0 ft NOT TO ��2 in 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. SCALE 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) - 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED..-AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND�FREE OF IRON. FINES AND DUST IN PLACE SEWAGE DISPOSAL SYSTEM PLAN 7) LINES EXITING D-BOX TO RUN LEVEL FOR_':2'-O' BEFORE PITCHING DOWN -TO SERVE EXISTING DWELLING 8) ECO-TECH ENVIRONMENTAL RECOMMENDS'THE INSTALL#ATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING,10F T.HE SEPTIC TANK JAMES H. KIGGEN 9) SYSTEM IS NOT DESIGNED TO WITHSTAN VEHI.CMA' LOADING. DO NOT PARK OR DRIVE VEHICLES OVER .SEPTIC SYSTEI`1 II GROVE STREET COTUIT. MA D 10) INSTALLER TO OBTAIN DISPOSAL WORKS" PERMIT BEFORE STARTING WORK. ECO-TECH ENVIRONMENTAL 11) SEPTIC TANKS SHALL BE INSTALLED' LEVEL AND TRUE TO GRADE ON A LEVEL STABLE .BASE THAT HAS BEEN MECHANICALLY COMPACTED AND, ON TO WHICH 43 TRIANGLE CIRCLE SANDWICH MA 02563 ,SIX INCHES OF CRUSHED STONE- HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING ETE-2019 MAY 2. 2005 2/2 - A , O 0- 1 �, C , 41 i s --- - =----- ----- - — —a o: L,L-ILA ----------------- Rid 47 Vic— r 2'� ZsiB to lu - mcop N elf t 'lr � 5r.p�� - �►,gin -