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HomeMy WebLinkAbout0148 MAIN STREET (COTUIT) - Health 148 MAin Street Cotuit �- A = 023 - 066 �I i _ d � -OCn(U Commonwealth of Massachusetts �n Title 5 Official Copy Ins ection Formp Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Main Street Property Address NJ Guillaume Jesel Owner Owner's Namf 0 information is Cotuit t/ MA 02635 September 17, 2018 r required for every __ —_. -- — page. City/Town State Zip Code Date of Inspection 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 A. Inspector Information -H• 133a-� filling out forms on the computer, use only the tab Patrick T. Sullivan key to move your Name of Inspector cursor-do not Ready Ex_cvatin use the return Company Name key. PO Box 89 r� Company Address _Forestdale MA 02644 City(Town State Zip Code 508-509-0802 SI12843 Telephone Number License Number B. Certification certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. Z Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Member 19, 2018 Ihspec or'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7f26I2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 113 Commonwealth of Massachusetts Title 5 Official Inspection Form -� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is Cotuit MA 02635 September 17, 2018 required for every -- page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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 olds 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 tan_ k as approved by the Board of Health. j , " 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. El Y ❑ N ❑ ND'(Explain below): i j t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 16 Commonwealth of Massachusetts yn= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is Cotuit MA 02635 September 17, 2018 required for every — page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ap oval of Board of Health): ❑ broken pipe(s) re replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstructioni 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): i i l ; I 3) Further Evaluation is Required by a Board of Health: ❑ Conditions exist which require,, urther evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts n Title . 5 Official Inspection Form �i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Main Street -J` Property Address Guillaume Jesel Owner Owner's Name information is required for every Cotuit MA 02635 September 17, 2018 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health/(and Public Water Supplier, if any) determines that the system is functioning i a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soilabsorption 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 add SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tanl and SAS and the SAS is less than 100 feet but 50 feet or more from a private water sup ly well**. Method used to determine distance: ** This system passes if the ell water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates sent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, pro ided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® 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 t.5insp.doc•rev.7/26/2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form r. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is required for every Cotuit MA 02635 September 17, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. Yes No 1 ❑ ❑ the system is v ithin 400 feet of a surface drinking water supply ❑ ❑ the system i�w ithin 200 feet of a tributary to a surface drinking water supply the syste n/is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ El -IUVPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is required for every Cotuit MA 02635 Se tember 17, 2018 — _ � page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form j(c Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 4"P 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is required for every Cotuit MA 02635 September 17, 2018 - page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 GPD Description: 1 Number of current residents: Does residence have a garbage grinder? ® Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 2016=696 GPD* Water meter readings, if available(last 2 years usage (gpd)): 2017= 734 GPD* Detail: *Very high water usage during summer months due to irrigation. Sump pump? ❑ Yes ® No Current Last date of occupancy: Date t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts � Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •/ 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is Cotuit MA 02635 September 17, 2018 required for every -- page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 2. 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/s .ft., etc.): Grease trap present? / ❑ Yes ❑ No Water treatment unit present? / ❑ Yes ❑ No If yes, discharge to: — Industrial waste ho/ncy/use- nk present? ❑ Yes ❑ No Non-sanitary wasterged to the Title 5 system? ❑ Yes ❑ No Water meter readivailable: Last date of occup Date Other(describe below): 3. Pumping Records: Source of information: Ready Rooter records: Pumped Aug. 2016 Was system pumped as part of the inspection? ® Yes ❑ No 1000 If yes, volume pumped: gallons How was quantity pumped determined? Site tube on truck Maintenance Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is required for every Cotuit MA 02635 September 17, 2018 -- — — page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: Septic tank>30 years old. D-box and leach system installed 03/19/2010. Certificate of compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 2.5 _ Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line n/a. feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 4� 148 Main Street u Property Address Guillaume Jesel Owner Owner's Name information is Cotuit MA 02635 September 17, 2018 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 15" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age. years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 8.5' x 4.5' x 5' 1000 gallons Dimensions: 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 5" inlet, 2" outlet Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 101, How were dimensions determined? Dip tube and 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.):. Inlet cross section baffle and outlet PVC tee in place. Liquid level at outlet invert. Risers bring covers within 6" of grade. Recommend maintenance pumping every two years. Irrigation lines over both covers. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 4 Main Street� 1 8 Property Address Guillaume Jesel Owner Owner's Name information is . Cotuit MA 02635 September 17, 2018 required for every -- —p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: / ❑ concrete ❑ metal iH fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to op of outlet tee or baffle Distance from bottom of s m to bottom of outlet tee or baffle Date of last pumping. Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26120111 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is Cotuit MA 02635 September 17, 2018 required for every _ _ p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: �;' ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and floc switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): One inlet, two outlets. (3rd hole capped). Speed levelers in place. No solids carryover. No high water staining over outlet inverts. Riser brings cover within 10"of grade. Irrigation line runs over cover. H- 10, 38" below grade. i5inso.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts �^ ;, Title 5 Official Inspection Form - I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L(,N 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is required for every Cotuit _MA 02635 September 17, 2018 _. _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump ch ber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located. explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: t ❑ leaching galleries number: ® leaching trenches number, length: 2-3' x30' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 148 Main Street _ _. Property Address Guillaume Jesel Owner Owner's Name information is Cotuit MA 02635 September 17, 2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS is 2 rows of 6 ARC 3616 leach chambers. Camera used to inspect units. No standing liquid at time of inspecton. No sign of ast hydraulic failure. Units are just over 3' below grade. No vent found. 12. 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 Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundw er inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 ng � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is required for every Cotuit MA 02635 September 17, 2018 _. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan)/soil, signs Materials of construction: Dimensions Depth of solids Comments (note conditio hydraulic failure, level of ponding, condition of vegetation, etc.): 15inw.cloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Main Street Property Address Guillaume Jes_ el Owner Owners Name information is Cotuit MA 02635 September 17,2018 required for every — — page. cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 14. 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 i i i --fo O f a � f _ I 1 i j 6insp.doc•rev.7r26R018 Title 5 ofaw kwpedion Famr Stbmrface Sewage DiaposW SYStem Page 18 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �l 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is required for every Cotuit — MA 02635 September 17, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 5 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: 2010 Date ❑ 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: maps.massg is.state.ma.us/oliver.ph p You must describe how you established the high.ground water elevation: Test hole in 2010 to 11' found no ground water. Base of units 4.5' below grade. Accessed local around water contours and topo mappin . No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Main Street Property Address Guillaume Jesel Owner Owner's Name information is Cotuit MA 02635 September 17, 2018 required for every p page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 ritle 5 official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 o TOWN OF BARNSTABLE , o LOCATION /Y /' ayn S t SEWAGE# o?0/0 (�'� VILLAGE h u1Yl r / ASSESSOR'S MAP&PARCEL o2 3 — INSTALLER'S NAME&PHONE NO. 91k yoay SEPTIC TANK CAPACITY 1 LEACHING FACILITY:(type)(f x fire 3(0/& (size) NO.OF BEDROOMS OWNER PERMIT DATE: N TQ IQ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility o tJ Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY I i VZ G1 �S•3 eZ - 83 z� 2 p,3 rq,c9 SQ � a �I No. p �:. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computw. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zfppfitation for Misposaf *pstrm Construction jermit Application for a Permit to Construct( ) Repair K) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 y S ty,tq,o gr,- (,+,,,T Owner's Name,Address,and Tel.No.0"� Srz..F - 1,15 Mary, S1 Assessor's Map/Parcel Z 3 (O fo co fi,iT" rh✓9 Installer's Name,Address,and Tel.No.CYew`4 �; ��r y�S Designer's Name,Address,and Tel.No. �SC A Qqn., Type of Building: Dwelling No.of Bedrooms Lot Size Z• 13 } sq.ft. Garbage Grinder( ) Other Type of Building S i-YU!e `T No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 3® gpd Design flow provided 3 y(o.3 gpd Plan Date 3 i 3 ZO►p Number of sheets ( Revision Date Title 1 y$ nj POI 5 Size of Septic Tank 160a Type of S.A.S. CZ Description of Soil Choy, of Nature of Repairs or Alterations(Answer when applicable) 6a 11 t Tb 10 -30,E Tb 3c, }I c_ (#36 t�-6 Date last inspected: �ZQ I 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. SiRnK A Date Application Approved by & IX 0 2 Date 33 —/L Application Disapproved by Date for the following reasons Permit No. 2d i d — U "1 Date Issued (b ".20/o d!� No. 0 I() U � f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:C/' - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes All application for Disposal 6pstern Construction Permit a Application for a Permit to Construct( ) Repair K) Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. J H� M0,vj tT. (�,•{ ,C Owner's Name,Address,and Tel.No.� � Sn,E 1Q(" "r l y b `1)v_1,d, ST Assessor's Map/Parcel Z'3 (p(o co}v;T t-h ra Installer's Name,Address,and Tel.No.eq&,, Designer's Name,Address,and Tel.No. -,5•C. el)AAZn �Ac o Sox ?Y'?_ dZ C e v1 k✓ le (W Z s �' l Type of Building: + Dwelling No.of Bedrooms ,j Lot Size ZS l 3 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 o gpd Design flow provided .3 gpd Plan Date :3- 13- 20 i y Number of sheets ( Revision Date Title 1 W`d M R•,Yi :5 C , Size of Septic Tank 160 o ,ot 9Yis Type of S.A.S. CZ S krJ' .-(r5S l(Q,-lCJle3 Description of Soil Nature of Repairs or Alterations(Answer when applicable) C'X•L j 4vo, Tb /w"-) \) - 13oa T k ns t e.15 -ri-*-od e> bf 2C-. 3(. }•I G. (4k. 3(6 k-13� Date last inspected: J 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 r Compliance has been issued by this Board of Health. Sigma Date -17// �2olt7 kt ` Application Approved by- n 12 Date Application Disapproved by Date for the following reasons" ..- Permit No. 9 ul d - Oro ( Date lssued _ - -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site` Sewage Disposal system Constructed( ) Repaired(x) Upgraded( ) Abandoned( )by e,ant,.,0,6 �n-1 C,Q�/17�S LL-c at t"( O M A� S Sls LC,� (��kj has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 u/p -o dated � -16-2 o/J Installer CLAD-9 wiJ C 1A.4 0✓e}cj ( l L Designer J . L• .04 C►W Ski 1 #bedrooms Approved design flow 3(46. gpd The issuance of this permit shall no be co strued as a guarantee that the system will fun=�dls-( ._Date Inspector\.. ---------------------------I----------------- ----------------------- No. 2 G 1� (��� e_ Fee 6 U - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair' Upgrade( ) Abandon( ) System located at { C Im�� 5�I/C`G'C CA l� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co struction must be completed within three years of the date of this permit Date 1 i /,) A roved b r� I 3 pP y C i No. 2 0f o —V 7 C Fee 1)d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS cs application fo Disposal *pstem Construction Permit Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) ❑Complete System fidividual Components Location Address or Lot No. Z(GJ 1/4/f e Y r t h/( Owner's Name,Address,and Tel.No. Assessor's Map/Parcel lI/ U4 ,�' A&✓ !fa &-,jt f-�,63 J I taller's L1�ame,Address,and Tel.No. S-5,? 121)r p lJyly( Designer's Name,Address,and Tel.No. R C - K1Ss& G Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 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. Si Date --asb Application Approved by Date Application Disapproved by Date for the following reasons Permit No. )0 to —0? Date Issued G/ No. (/w —V 7 1 / f Fee 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 'PUBLIC-HEALTH,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �S applicatia fo �isposaf *pstem Co tstruction Petmit Application for a Permit to,Construct( Repair( ..),.Upgrade( ) Abandon( Complete System ndividuali Components Location Address or Lot No. q lj 4 r d h 16 Owner's Name,Address,and Tel.No. 1\til. Assessor's Map/Parcel j j. LQ^ cR. (0 4 ✓ d 6 61, ,( Installer's I3jame,Address,and Tel.No. 1�p S//�// Designer's Name,Address,and Tel.No. �R� c. Kis �, G Type of Building: F Dwelling No.of Bedrooms Lot Size ' sq.ft. Garbage Grinder( ) t Other Type of Building No.of Persons Showers( ) Cafeteria,-( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets "< Revision Date Title Size of Septic Tank Type of S.A.S. j Description of Soil r Y� J 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 `='t Compliance,has been issued by this Board of Health. Sire. t \'' Date 3 _ ,S-,�fj Application Approved by Date - A-)Application Disapproved by Date for,the following reasoils. }:;fi'" `f a c 4 r `4 PermitNo '; Date issued, /0 5Y ' THE"COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Y Certificate of Compliance . L THIS IS TO'CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by at 'has been constructed in accordance with the provisions of Tit e 5 and the fo Disposal System Construction Permit No. )W-071 dated Wit: Installer_ k Designer #bedrooms 1, Q Approved design flow A))A gpd The issuance f this ermit shall not be construed as a guarantee that the system Will fu cti In as Aigned. QQ Date 3 1avo f Inspector -------------------------------------------------- No. 2 _0:7 _ Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construrtlon ]VIlPrmit Permission is hereby granted to Construct( .) Repair Upgrade( ) Abandon( ) System located at t and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permi . Date�� /!D Approved by 1 Town of Barnstable Regulatory Services Thonnar{ F. Geiler,Director 1 l Public Health Division� RARNaTABl.6� ' \ `:Fg. i°34• Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 oMcc; 508•M62.4644 Fax: SOh '�>l.� c:•'(,s Date: ., `� C Sewage Permit# ZOCy® s�� Assessor's Map/Parcel 1,.:3 I (c(I- Installer & Designer Certification form Designer: �L: ��� ctiei:ci r� Tric.' Installer: i. ....._......_.._.._....._.._.. Adcires�; ..Sy CCcnb> r il�hu,:> Address: PO 3D--r, -7to ?> Gc:st wnr--horn l� A C2%3� t' e ,;t� � -2,Dtc� II on l b �,da :t� (�FGf ��� was issued a perrnit to install a (date) llcr Wptic systen, at_ I `/ ! 1't�i��__.`'{-�._k� based on a design drawn b (address) ,C L-n ir)eer(()c 41G. dated 2010 (designer) ( 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. Stripout (if required) was inspected and the soils N\ere found satisfactory. I certify that the septic system referenced above was installed with major chariges (i,e. greater than 10' lateral relocation of the SAS or any vertical relocation of any CuiTihonCni of the septic sysiern) but in accordance with State & Local Regulatioiis, Plan revision far k:ertitied as-built by designer to Follow, Stripout (if req nspected and the sail, were found satisfactory. I""F""�s,� .Installer`s ign i ire) No isicc'`` ,:..... --- )esigncr's i natur (Affix_ esig e s ' nip Here) PLI.AS1: iZETURN 1 O n ANTS wrA,m-L PUBLIC 13EALTH DIVISION QMTIFICAT_1l• OF C()MPLIANCIE 'WILL NU7' BE ISSUED UNTIL BOTH -- IS 1F0lZ1VI AND AS- 13UI1,T CAIZD AIZ.I^IZIr.UEIVI�D BY THE BARNS'TABI.)!.PCJBI�IG IIEALTI3 DIVISI()�.; THIA.NK QU) { lP�rc!'mr,•lla,ni±gti niii.a:.;rl.i'l+tmdu� T0 'd L.9£0 2 -z 809 DNIN33NIDN33f Wd 09= 20 010Z-6Z-2AQW a Town of Barnstable P# � Department of Regulatory Services Public Health Division Date v >,AES. 200 Main Street,Hyannis MA 02601 Date Scheduled 1 a o Time r-I Fee Pd. 0 0 Soil Suitability.Assessment for Sewage isposal Performed B r l c4 1 R av►e11�2 CT- ( C.S C � Y: t ! Witnessed By: Location Address LOCATION& GENERAL INFORMATION ; Owner's Name �„� L Se. Address Ir18 }Y A,Sk, C01kA4-j KA Assessor's Map/Parcel: Q 2��®(vjo Engineer's Name �w�e�.ioc�. c5r SG E �rt��nS NEW CONSTRUCTION (` REPAIR V ` Telephone# S®T_`{ZF 1029 50$-Z73-0377 Land Use `"!Ij Slopes e- �m�L/ 4'0 ------� P ( ) �' i Surface Stones Distances from: Open Water Body. ft Possible Wet Area ft Drinking Water Well ft Drainage Way — ft Property Line 71 D ft Other — g SKETCH:(Street name,dimensions of lot,.exact locations of test holes& ere te sts,ests,locate wetlands in proximityholes to ) See a-t.chest e( Parent material(geologic) 00�5y) Depth to Bedrock '7 1 2 8 A-$5 Depth to Groundwater. standing Water in Hole: 71 Z b "5S Weeping from Fit Pace 7 12�4 b35 4 Estimated Seasonal High Groundwater 7 i 28 �OjS DETERARNATION FOR SEASONAL HIGH WATER TABU Method Used: A�Cc- 6'wSIN12f1lwn Depth Observed standing in obs.hole: 7 t2 8 ___.'in. Depth to soil mottles: 712.6 in. Depth to weeping from side of obs.hole: > t -6_ �..R,o,in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level_�ry Adl,factor � Adj.Grvufldwater 14vel PERCOLATION TEST We ao 'lhne !(qn Observation Hole# Time at 9" Depth of Perc 4• 9 u Time at 6" Stan Pre-soak Time@ Time(9"•6") End Pre-soak �� Rate Min./Inch Z Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) Original: Public Health 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. Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistent % ravel g-l2 A lou'r 3/2, - I . i l2'3� LS -5/6 _ 3 b-t 28 C_ P-c 2..SY6/6 - kose- r DEEP OBSERVATION HOLE LOG . Hole# Depth from Soil Horizon Soil Texture Soil Color s .r Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ors ra ��(2 ALS 1 d�r 3/2' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling• (Structure,Stones,Boulders. Consi to c Gravel) ` DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi en Flood Insurance Rate Map: -Above 500 year flood boundary No_ Yes Within 500 year boundary No—Z Yes Within 100 year flood boundary No..j✓ Yes Depth of Naturally Occurrine 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? q e S --- If not,what is the depth of naturally occurring pervious material? -- - Certi_ fiication I certify that on 9.? (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertis§and a rience described in 310 CMR 15.017. Signature Date Q:\SEPTICIPERCFORM.DOC T.O.F. EL.= 68.1'± PROVIDE EXTENSION RISER FINISH GRADE OVER D-BOX= 67.4'# GENERAL NOTE WITH COVER OVER INLET& PROPOSED VENT WITH CHARCOAL 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER DIFFUSERS= 67.3' - 67,8' �7 FINISH GRADE OUTLET TO WITHIN 6"OF F.G. - FILTER TO ABOVE GRADE INSPECTION PORT WITH ACCESS BOX TO SLOPE @ 2%MIN. I. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION ' FINISHED GRADE OVER TANK EL. = 67.2'+ REMOVABLE WATERTIGHT COVER OVER WITHIN 3"OF F.G. (ONE PER TRENCH) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 67�3� RISER TO WITHIN 6"OF FINISHED GRADE CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE I DESIGN ENGINEER. EXISTING 4" PROPOSED 4" _ 9"MIN. OUTLET PIPE PVC SEWER PIPE 36' MAX." SEE NOTE 21 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL 5 DIA.OUTLET(S) 42 MAX. TOP OF SAS/B.O. 64.20 SYSTEM UNLESS OTHERWISE NOTED. 3"DROP MAX " " 6" 3" " 3 g PROVIDE WATERTIGHT 4. TO PREVENT EVEN BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN ---�- - 2 DROP MIN MIN.SLOPES 1% JOINTS(1'YP.) ELEVATION=64.20' FOR A DISTANCE OF IV AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4"PVC IN FROM 40 MIL GEOMEMBRAN E LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF -�- 14" �` j4,3"-1- SEPTIC TANK 4"PVC OUT TO 1.33' T ^ THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. *CONTRACTOR TO REPLUMB �" LEACHING FACILITY 0 (TYP) nJTYP 6 TYP O90 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. SEWER PIPING FROM 12" 6"CESSPOOL&CONNECT TO CONTRACTOR SHALL CONTRACTOR SHALL OUTLET TEE 64. T MIN. 64,00' 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. OUTLET PIPE DISCHARGING VERIFY SIZE AND 48" VERIFY CONDITION OF , INTO SEPTIC TANK CONDITION OF EXIST. EXISTING TEES " 63.77 62.87 (LAID FLAT) 2.875'(34.5")--#- 5.76 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK SEPTIC TANK AND REPLACE AS 6 CRUSHED STONE 5.0' (NP•) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY NECESSARY (TYP.) , NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH COMPACTED BASE 5'MIN. 11.� AND DESIGN ENGINEER. d 5 OUTLET DISTRIBUTION BOX 30.0 (TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 70.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN A 28"DIA. TREE AS SHOWN ON PLAN. EXISTING 1,000 GALLON CONCRETE SEPTIC TANK BASE. TO BE TWO D LEVEE F OUTLET GROUND WATER ELEV.= < 56.63' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW l ) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE 12 ,ARC 36 H #3616 B D BIODIFFUSERS O D I F F U S E RS H-2 V TO THE DESIGN ENGINEER. DISTRIBUTION BOX DETAIL ( ) ( } TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. TEST /� 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING SWING-TIES SCALE: 1"=20' s . ` `+ ''• TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM �, ,. � PERC NO. �� 12861 APPROPRIATE AUTHORITY. DESCRIPTION HC GC INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS BIODIFFUSER CORNER(1) 27.3' 19.5' =w EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE ° THEY SHALL WITHSTAND H-20 LOADING. Oct.271999 BIODIFFUSER CORNER(2) 34.2' 10.1' � " � �� � � � � " " ' „ C.S.E.APPROVAL DATE: ' 000� BIODIFFUSER CORNER(3) 25.0' 38.4' ° DATE: March 12,2010 13. DOUBLE WASHED CRUSHED STONE SMALL BE FREE OF ALL DIRT,DUST AND FINES. BIODIFFUSER CORNER 4 .0' 41.9 , } v % TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM,SUBSOIL AND UNSUITABLE O 14 ' ' ELEV TOP 67.30 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. 1 =�' ` �' 4 N REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY ) ELEV WATER= <56.63' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). w EXISTING t .- � ZONE 2, 2 _ , % w ' PERC RATE <2 min./inch 3-BEDROOM 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN _ _ ` "k SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. o. �`' � � %x �. m�;� � �° � � , DEPTH OF PERC= " ai DWELLING � ��:.. N GC EXISTING v 36 - 16. PROPOSED PROJECT IS LOCATED WITHIN: o TOF =68.1'± .;1 4 GARAGE - TEXTURAL CLASS: 1 ASSESSOR'S MAP 23 PARCEL 66 z OWNER OF RECORD: GEORGE H.&LOUISE B. SNYDER s LOCUS �- (3 � • '" � " ADDRESS: 148 MAIN STREET � k Fill COTUIT MA mo% 8" 66.63' Loamy Sand r 4k A 10Yr 3/2 12^ 66.30' FEMA FLOOD ZONE C Loamy Sand COMMUNITY PANEL# 250001 0021 D k B 17. DEED REFERENCE: DEED BOOK 2411, PAGE 179 36" 64.30' 18. PLAN REFERENCE: PLAN BOOK 259, PAGE 13� Perk 54" 62.80' 19. ALL DISTURBED AREAS�SHALL BE RESTORED TO ORIGINAL CONDITION. ~�,. ���s� � 1 ,. ���,�� 'may � +��� �%� a ;:* ,i• w ` ` 20. PROPERTY.LINE INFORMATION IS ONLY APPROXIMATE.`THIS PLAN IS TO BE USED ONLY ° FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY • Medium-Coarse Sand C 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. f (loose) 21. IN ACCORDANCE WITH310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE PROPOSED 40 MIL. IMPERVIOUS GEOMEMBRANE LINER(TOP EL. =64.2') A MAP 23 APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): 67x1 \, PARCEL 11 (1.) A 0.6'WAIVER(3.p-3.6')FOR THE MAXIMUM COVER OV�THE LEACHING AGILITY. �+ PLAN. ( -.)o+ Ve4pr-� EXISTING LEACHING PIT TO BE PUMPED & FILLED � LOCUS 1-" L�'"�N 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE WITH CLEAN COARSE SAND&ABANDONED / \ APPROVAL IS REQUESTED FROM 310 CMR 15.211: \ N , SCALE: 1"=1000' 128" 56.63' (1.) A 7.5'WAIVER(20.0'-12.5')FROM THE HOUSE CRAWL SPACE TO THE LEACHING FACILITY. EXISTING 1,000 GALLON SEPTIC TANK TO \ (��'ntt-P � ) BE UTILIZED AS PART OF THIS DESIGN ` ` aa'o �� " No Mottling, Standing or Weeping Observed E 000 REPLUMBED SEWER PIPING TO BE LP 12„ s�cs�was \ N�1�o3 6' DESIGN DATA TEST PIT DATA CONNECTED TO EXIST.SEPTIC TANK 128 1 LEGEND 1 m �\ 67x2 67x0 ROP. "D-BOX" MAP 23 PERC NO. 6 a e c> Benchmark INSPECTOR: David W. Stanton, �£ i67 ,�g5�� � 67x2 Nail Set in 28"Tree PARCEL 66 NUMBER OF BEDROOMS(DESIGN) 3 EVALUATOR: Michael Pimentel E.I.T.R 192 50xO EXISTING SPOT GRADE � � AREA=25,213 S.F.t TP 1 Elev.=70.00 MAP 23 DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E.APPROVAL DATE: Oct.27, 1999 - - 50 - - EXISTING CONTOUR 24" 67 4 Approx. M.S.L. TOTAL DESIGN FLOW 330 GAUDAY 67x2 s 6 .3 2$„ PARCEL 12 DATE: March 12,2010 --- 5 PROPOSED CONTOUR #148 CRAWL w w DESIGN FLOW X 200 % = 660 GAUDAY TP 2 � rn .� TEST PIT#: 2 y EXISTING P201 ❑/H/W EXISTING OVER-HEAD UTILITIES 3-BEDROOM �c?s /6 .3 �= tr USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 67.30' '-� s 10.1' PROP. 4" PVC VENT PIPE; DWELLING 67x4 r W W EXISTING WATER LINE TOF_68 1'+ EXISTING EXACT LOCATION PER OWNER ELEV WATER= <56.63 Goo\\ GARAGE � � ��0 PERC RATE= GAS -- EXISTING GAS LINE BASEMENT \ 's INSTALL 12 -ARC 36HC (#3616BD) BIODIFFUSERS (H-20) 4L�y a ` DEPTH OF PERC= TEST PIT LOCATION SYSTEM CAPACITY TEXTURAL CLASS: 1 �•' ti� \ EXISTING 1,000 GALLON SEPTIC TANK PROP. TOTAL 12 ARC 36HC BIODIFFUSERS (H-20) (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD cS' (6 BIODIFFUSERS EACH TRENCH) (60.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING/DAY 0" 67.30' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE -67" �. Fill �� \ _ PROPOSED INSPECTION PORT WITH ACCESS 8" Loam Sand 66.63' ❑ PROPOSED DISTRIBUTION BOX 00 �� � �` �C©¢, s BOX TO GRADE (TYP OF 2) TOTALS: A 10Yr 3/2 , G,ySA0 � 12" 66.30 Q PROPOSED ARC 36HC(#36166D)BIODIFFUSER(H-20) LP TOTAL NUMBER OF BIODIFFUSERS: 12 B Loamy Sand 10Yr 5/6TOTAL NUMBER OF COUPLINGS: 0 'Oh O c \-APPROX. LOC. OF EXIST. CESSPOOL TO TOTAL LEACHING AREA: 468.0 SQ.FT. 36" 64.30' �O \yam BE PUMPED & FILLED WITH CLEAN TOTAL LEACHING-CAPACITY: 346.3 GAL./DAY REV. DATE BY APP'D. DESCRIPTION COARSE SAND &ABANDONED N-,2'Za PROPOSED SEPTIC SYSTEM UPGRADE y 195� MAP 23 PREPARED FOR: �.a PARCEL 67 NOTE: C Medium-Coarse sand CAPEWIDE ENTERPRISES gcP�/ EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE 2.5Y 6/6 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER (loose) "MODIFIED CERTIFICATION FOR GENERAL USE"ISSUED TO LOCATED AT NOTES: \�o ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3,2003(LAST MODIFIED JUNE 30,2009). TRANSMITTAL NUMBER=W000052. 148 MAIN STREET 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE _TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. �o �l(�I2o t o y� z " SCALE: 1 INCH = 20 FT.COTUIT, MA DATE: MARCH 13, 2010 2.) CONTRACTOR SHALL VERIFY`SOIL CONDITIONS IN THE 128 56.63 0 10 20 40 80 FEET ti No Mottling ��M� LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE ° Standing or Weeping Observed � NNOWNI CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. °r JOHN La PREPARED BY: REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS �°s RESERVED FOR BOARD OF HEALTH USE cHUReHiuJV JC ENGINEERING, INC. ARE NOT CONSISTENT WITH TEST PIT DATA. .-� No 4,L 2854 CRANBERRY HIGHWAY 5�-�-E PLAN EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED 508.273.0377 ZONE 2 AND THE ESTUARINE WATERSHED. SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1771