HomeMy WebLinkAbout0635 OLD POST ROAD (CT & MM) - Health r635 OLD POST ROAD, COTUIT
A= 054 015.002
APR-20-2007 10:55 P.02
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I CERTIFY THAT THIS PLAN HAS BEEN
PREPARED IN CONFORMITY WITH THE
RULES AND REGULATIONS OF THE
REGISTERS OF DEEDS OF THE
COMMONW�.ALTH OF MASSACHUSETTS.
— or Dote:y Professyonof'rL'i>,,Td'Suf. y
O/d Post
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LOCUS MAP
KEALLY, FRANCIS T do
JULIA B TRS '$o
KEALLY OLD POST RD
I REAL EST TR
C 10 GLENRIDGE .RD ' r
DEDHAM, MA 02026 PIEPER, CHARLES P.
PIEPER, CAROLE J.
721 OLD POST RD
RODGERS, CHARLES S & Lot 3 COTUIT, MA 02635
RODGERS, FRANCENE
SUSSNER (Assessors Map Sa Parcel 15-2) Ce/lu/
100 BELVIDERE ST APT 8G 1.14 Acres
BOSTON, MA 02199 635 Old Post Road
Cxi9(ing Sivlrs .
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(TO Or I?EMOVt•Q)
Moorrnp� (� J Scale:1 50,
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PLANS ACCOMPANYING'PETITION OF` ELEVATIONS ARE`BA5ED ON M.L.W.
FRANCIS & JULIA KEALLY
TO CONSTRUCT AND MAINTAIN A PIER,
RAMP, FLOAT AND PILES IN \
COTUIT HARBOR
COTUIT, MA
DATE: OCT. 25, 2006 SHEET 1 OF 3
A.M. VALSON ASSOC:, INC. JOB NO. 2.1105.0
APR-20-2007 10:56 P.03 #
I CERTIFY THAT THIS PLAN HAS BEEN
PREPARED IN CONFORMITY WITH THE
RULES AND REGULATIONS OF' THE
REGISTERS OF DEEDS OF THE
COMMON1pJH OF MASSACHUSETTS.
PrOfe gipno I gjg9 SwIV r Dote:
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Existing 5(oi�r - _ ,. m
Cxizling Stone -
Aowlmon l -
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r Exierling Plo!/wm• - - - - - -
� M.H.W. EL.o2.8 - �_--_ - �It/n"IL°h�/•!:�. i
curAcut Poet
To B OitcGnYinued TRIANGULAR DECK EXTENSION
a + 7 STAIRS TO GET TO BEACH CRAVE,
• pJJ 3' WIDE WITH HAND RAIL$.. -
REMOVE STAIRS IN
THIS LOCATION.
32' SECTION - - -
LEvEL
i
0 24' SECnON
RAMPE9.` .
0.
•24' SEC71ON LEVEL
M
w A/uoring
18'x3' RAMP
PROPOSED
�r G' DIA POSTS
\ PROPOSED
8' x 16' Scole:l"-20
TIMBER FLOAT
DATE: OCT. 25, 2006 SHEET 2 OF 3
A.M. WILSON ASSOC.. INC. JOB NO. 2.1105.0 ELEVATIONS ARE BASED ON M.L.W.
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D PROPOSED WOODEN STAIRS.
PIER DLCK REVADON = 5.9' PIER DECK ELEVATION = ♦.9,
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"• EXISTING STAWIPAY PROP 2'x4'HANGRAIL PROP. 2-x4-GVARDRAIL ON EDGE
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cr/I EXISTING
C / TO BE REOVEO r r
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HOR. SCALE: I'=10• TYMAL FIXED PER SECTION != C m -+ D
VER. SCALE: (NOT TO - `p _ Ln
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WN BARNSTABLE
LOCATION SEWAGE#
VII.LAGE r ASS/�7 S�ESS 'S MAP&U� `'OT
'L ME&PHONE N '1`-�I�`ASSESS
ol
SEPTIC TANK CAPACITY d
LEACHING FACILITY: (type)` (size) 6 _
NO.OF BEDROOMS m
BUILDER R OWNERF C� �� T
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
f
Maximum Adjusted Groundwater Table and 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) /V /1 Feet
Edge,of Wetland and Leaching Facility(If any wetlands exist
.within 3 et of leaching fac' ) I/V1 1W Feet
Furnished by,46L26, 00 , �tlC'a
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Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department. of
• Environmental Protection
YVIII Gaw F.mor ao CEI VFo
Trudy Coxe
e•«• ly.Eon OCT 1 9 199:
David B.Struhs
Commiplorwr C 4r,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMTN
PART A
CERTIFICATION
Property Address:(o G�� soead �Oi p� S
/ Address of Owner:
Date of Inspection:/0—/3—95 '° (If different)
Name of Inspector'f p6e.r.�L J, Jar j
Company Name, Address and Telephone Number.<Sp/-/o/trA4 L2/X�/2�. � .ZNC
CERTIFICATION STATEMENT Mlkr'S7/1045 /Vi//S, 1;?W 0 j25/00.
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 inspection. The inspection was performed based on m trainin and experience
i Y g in the proper function and
maintenance of on-site sewage disposal systems. The system:
I�Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection.
The original should be sent to the system owner and copie, Sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C, or D:
A] SYSTEM PASSES:
1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is
imminent. The system will pass inspection if the existing.septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/iS/9s)
One Wlnbr Street a BoatAn,Massachuaatb 0210e • FAX(611)555-1049 a Telephone(517)252-d500
10 Printed an Rwycted Pq,w
•
SUB
SURFACE
SU RFACE SEWAGE DISPOSAL SYSTEM INSPECTION,.FORM
PART A
i
CERTIFICATION (continued)
Property Address:(LV'-45-- (5// ) Cfl
Owner: pj;6n4.L Xt,., �/7 /77i I)ae-C
Date of Inspection:/0—
B)SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Healk:
broken are replaced
pipe(s)
obstruction is removed
distribution box is levelled or replaced
The system will ass
n four times a year due to broken or obstructed pipe(s). y p
_ The system required pumping more than Y
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
i
obstruction is removed
i
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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
i
_ 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 APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply ui it to a
surface water supply. —
_ The system;has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
bacteria and volatile o
well water analysis for coliform organic compounds indicates that the well is
supply well, unless a e Y
free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5
PPm
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Backup of sewage into facility orrsystem component due to an overloaded or dogged SAS or cesspool.
_ Discharge or ponding of effluentlto the surface of the ground or surface waters due to an overloaded or dogged SAS or
cesspool
2
(revised 6/15/95)
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address. ' 6/4)
�
Owner.. 2,11 /17i;0Qrd
Date of Inspection:DI SYSTEM.SYSTEM FAILS(continued): '
_ 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), i
Number of times pumped
_ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
_ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a`mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 9/15/9s) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:�p �G/v J
Owner: rtVIX P 4,;,w/I �,%7Ct/`O'
Date of Inspection: /p`13 -9
Check if the following have been done:
44:�Pumping information was requested of..the.-owner, occupant, and Board of Health.
c..-IVbne of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
v n n introduced into the s
during that period. Large volumes of water have of been stem recently or as part of this inspection.Y
Vbuilt plans have been obtained and examined. Note if they are not available with N/A.
_,,Tife facility or dwelling was inspected for signs of sewage back-up.
4-The system does not receive non-sanitary or industrial waste flow
the site was inspected for signs of breakout.
vl(II system components, excluding the Soil Absorption System, have been located on the site.
I—The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
L_The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
L�he facility o•. re- (and occupants, if differen! from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
lzevieed 6/15/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: CDs C%7"'��d� � . � /oG
Owner.7-yi/I K V- 2-wo lnl%X I-d
Date of Inspection:/0—13— r
FLOW CONDITIONS
RESIDENTIAL:
Design(low: 3 3D�allons
Number of bedrooms:
Number of current residents:
Garbage grinder(yes or no):
Laundry connected to syste (yes or no):�CLS
Seasonal use (yes or noM -
Water meter readings, if available:
Last date of occupancy:
COMMERCIALANDUSTRIAL:
Type of establishment:
Design flow:_gallons/day
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:
OTHER: (Describe)
last.date of occupancy:
GENERAL INFORMATION
PUMPING RECORD d Source of informatio —�
�,;/0ex),-q V�
System.pumped.as p'a rt,.of-iRaliection.-(yes or:no) O �
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF 0TEM
dSeptic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Or'�5/`�
Sewage odors detected when arriving at the site: (yes or no)
(revised 0/15/951 S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: Ole0��� /
Owner: fir�!IK t[-
Date of Inspection:
SEPTIC TANK:_✓
(locate on site plan)
-- —ee (h below grade-,/ �J�
Material of construction: _concrete _metal _FRP—other(explain)
Dimensions: �' x✓`
Sludge depth:_
Distance from top of sludge to bottom of outlet tee or baffle: 36
Scum thickness: 6P v
Distance from top of scum to top of outlet tee or baffle: ?i
Distance from bottom of scum to bottom of outlet tee or baffle: Q
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structu al
integrity, vidence of leakage, etc.) WAS Cz- boyin
GREASE TRAP:`
(locate on site plan)
Depth below grade:
Material of construction: _concrete _,metal _FRP —other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom n( cnim in hnttnm of outlet tee or baffle
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(revised 9/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION,, ((continued
Property Address: t�p3� �Q� 7 CJ� (7�� �3 VC,/
Owner: F/-»h GL?CJ
Date of Inspection: l0_/,_Fs.
TIGHT OR HOLDING TANK:,/i�
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP—other(explain)
Dimensions:
Capacity: gallons
.Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches; etc.)
DISTRIBUTION BOX:JL�
(locate on site plan)
Depth of liquid level above outlet invert:lark/� /eC
Comments:
(note if level and distrib Dior is equal, evidence oi col ids car over, viderce of leaks e i or out of box, etc
Cbz-
PUMP CHAMBER:,/
4.
(locate on site plan)'
Pumps in working order.(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 6/is/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
(continued)
Property Address: ��j ce 6j `-C, �`'C(/ 7/
Owner: �ok qL 4c w o �i e?a—O'
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS)/:_&�,'
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:_
leaching galleries, number.
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
to o dition of soil signs of hydraulic failure evel of ponding, condition f vegetationetc.)
o ec.
Comments: (no g y
�d
CESSPOOLS:'
(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 (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: 1�
(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)
(revised 8/15/95) 8
•
P . .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFO '� TION (continued)
C)
Property Address: / 3 a� s� a
CD
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
� SLr
01
�t
DEPTH TO GROUNDWATER
i
Depth to groundwater:Q2L�feeC
od of determination r approximation:
,Wh
(revised 9/15/95) 9