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HomeMy WebLinkAbout0695 OLD POST ROAD (CT & MM) - Health 695 OLD POST ROAD, COTUIT ;( A= 054 011.001 _--- - -- i 4 1 695 OLD POST ROAD, COTUIT ;( A= 054 011.001 _--- - -- i li 4 1 Df -. A.M.'WILSON ASSOCIATES, INC. 911 Main Street OSTERVILLE, MASSACHUSETTS 02655 i DATE JOB NO. (508) 428-1450 ATTENTI N RE: TO S7Wt�Cd= � OF �fGjtf > WE ARE SENDING YOU VAttached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ,P For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR- BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 1071e �y1c_fT�rn ee� cS` LDT // l 74 ors 2 ,� T i� COPY TO SIGNED: PRODUCT 2/0.1 EBE laa WE.MM 01471 If enclosures are not as noted, kindly notify us at once. t,. 1 -- COMMOINWEALTH OF 1V SSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A C CST-o T CERTIFICATION Property Address:695 OLD PUSI -kQtil Name of Owner Fi4L�u/UE rti J}P 5 a P/1 R. tk//,U17 Address of Owner: Date of Inspection: 9-- -Co Name of Inspector:(Please Print) 6&t;ARD cr 60vsF16t_L) am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: _6',f,*, LAQD Mailing Address: O;Z LV C O j9U& S141VDi,tll c►-I /19 . G SE,3 Telephone Number: QQ tri3 r�.3 CERTIFICATION STATEMENT I certify that 1 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 my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature, 1,,'I� / `/_�:;✓5xiY Date: — —� The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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 copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS dlU .S - 1-)-e Tod 8 revised 9/2/98 Pagel of II A 40 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:69S octo SOS► AD, Date of Inspection: 8-9-cc INSPECTION SUMMARY: Check A C, of A A. SYSTEM PASSES: v I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components es 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. Indicate yes, no, or not determined(Y, N,or NO). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is 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 complying septic tank as approved by the Board of Health. 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 Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:(Spp 15' OLO I�G RD, Owner: Date of Inspection:Q —OD J' 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 IN ACCORDANCE Wn'H 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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..Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3orn SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:(2,G5 L IL D f©5 i R D; Owner: FA L MO N Date of Inspection 'w D. SYSTEM FAILS: You must indicate either"Yes" or "No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described 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. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an.overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded.or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 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 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 orprivy 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. E. LARGE SYSTEM FAILS: 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: The system serves a facility-with a design flow of 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:. Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a,nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information: revised 9/2/98 Page 4oril SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ? Property Address:(&9 OLD PC6 I R01 owner: FALZGNC Date of Inspection: Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. • _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this l� inspection. �'/ 'Y k As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, a have been located on the site. 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. The size and location of the Soil Absorption System on the site has been determined based on: xExisting information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)] _ The facility owner (and occupants,if different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C // SYSTEM INFORMATION Property Address:�G9S OLD 1�1 Ri) Own": FftZGNt Date of Inspection Q FLOW CONDITIONS RESIDENTIAL: Design flow: l I C g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual):3 Total DESIGN flow v Number of current residents:_ Garbage grinder(yes or(19):No r; Laundry(separate system) (yes o<jr): SV; if'yes,separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no):-W-Ce1(tc'ND Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or&:NC Last date of occupancy:5 r QC(;LIP160 COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: god ( Based on 15.203) Basis of design flow 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 RECORDS and source of inform tion: PV'MPcD Mow-IHS AGD System pumped as part of inspection: (yes or��,�'� If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM _ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: it y 1L»VE S'ep< pt-4A) Sewage odors detected when arriving at the site:(yes o rl ) ti�l 4 revised 9/2/98 Page 6of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:6 1((]�J OLD POST RD, Owner: FALZON E Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage,etc.) SEPTIC TANK:Z_ (locate on site plan) 11 Depth below grader Material of construction: concrete_metal_Fiberglass Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance (Yes/No) Dimensions• S,!G't L LI'l I WI<5+y'I 14 Sludge depth:Q_ G� Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: a Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: a 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.) Ll(_ Q10 VP In CufL61— RtPt_ NO SDc 10S JUST C.L"416-13 o0 + c.�n�cQ�rt F�c�s GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete=metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C va SYSTEM INFORMATION(continued) erty Prop Address:CAI S � o D v�l RA Owner: F&T-DA&c Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete metal_Fiberglass_Polyethylene_other(explain) Dimensions: ` Capacity: gallons Design flow: gallons/day - Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX.4 (locate on site plan) Depth of liquid level above outlet invert: Al- BGMM Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) ONL PFA it GNE PjPr L)7- PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) _ Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8oftt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C � SYSTEM INFORMATION(continued) Property Address: 6"I S OLD POSI RDr Owner: FALZOIULF Date of Inspection: 8-9- 0 SOIL ABSORPTION SYSTEM(SAS)-4 (locate on site plan,if possible;excavation not required,location maybe approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:©luc— leaching chambers,number:_ leaching galleries,number:_ leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil;condition of vegetation, etc.) 501L Is DRY rE�T OF c.IQ�fD W I✓ FOOT PIT, LgERY a- 70D WORKIN61 u DiT iOA! 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:_ (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 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 5' PART C SYSTEM INFORMATION(continued) Property Address:6(4-5 OLD POST RD, Owner: FALZON6 Date of Inspection: _oO SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) ' c } F 1 , 6 lo ,Cl revised 9/2/98 Page 10or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C // pA. SYSTEM INFORMATION(continued) Property Address:b�5 GL D �1 0 r Owner: FALZOW6 i Date of Inspection: j,OD . I NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater.Elevation. (Must be completed) wq,T6-K IMP revised 9/2/98 Page 11of11 Ll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM Address of property 695 Ole, Post Rld., Cotui.t (Assessor's lap 54, Lot 11-1) Owner' s name Charlene Allen Date of Inspection 1/30/95; Additional research March-April 1995 PART A CHECKLIST Check if the following have been done: -X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. . X The facility or dwelling was inspected for signs of sewage back-up. X The site was inspected for signs of breakout. X All system components, excluding the SAS, have been located on the site. 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. X The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance -of SSDS.* J a { r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION - �= FLOW CONDITIONS If residential 4 number of bedrooms �- number" of current residents no garbage grinder, yes or no yes laundry connected to system, yes or no no seasonal use, yes or no If- nonresidential, calculated flow: Water meter readings, if available: from Cotuit Water Dept. 1993 - 174,000 gal. 1994 - 106,000 gal _present Last date of occupancy GENERAL INFORMATION Pumping records and source of information: Town of Barnstable Septage Treatment Facility .No record of pining 1985 to present no System y pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system x Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) ' Other (explain) Approximate age of all components. Date installed, if known. Source of information: From record of Barnstable--.Board of Health 8/9/82 no Sewage odors detected when arriving at the site, yes or no • g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM s' PART B SYSTEM INFORMATION continued SEPTIC TANK: x (locate on site plan) See ataached, septic installers card and plan by A. M. Wilson Associates, Inc. dated 1/30/95 depth below grade: +1' material of construction: x concrete metal FRP other(explain) dimensions: 1500 gal, capacity n/a sludge depth n a distance from top of sludge to bottom of outlet tee or baffle 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 occupant had been absent for over 4 weeks at time of April inspection. Ap 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, recommendations for repairs, etc. ) Based on discussions with owner/occupant and site inspection, no structural problems are likely. LNm ing is recommended for regular maintenance purposes DISTRIBUTION BOX: x See attached (locatel. on site plan) X. depth of liquid level above outlet invert Comments: .(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER• n/a (locate on site plan) pumps in working order, yes or no _ Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance .or repairs,etc. ) • 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 3 PART B " SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : x (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) See attached If not determined to be present, explain: Type. 1 pit 1000 gal cap leaching pits and number leaching chambers and number leaching galleries and number " leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) No signs of hydraulic failure observed :lan site CESSPOOLS (locate on plan) : N/A 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, 'recommendations for maintenance or repairs,etc.) PRIVY: N/A (locate on site plan) materials of construction dimensions depth of solids 'Comments: level o f pond ing, e 1 , (note condition of soil, signs of hydraulic failure, 1 p 9 condition of vegetation, recommendations for maintenance or repairs,.etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE i=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' See attached Installer's Card from records of Barnstable Board of Health.* Based on records of Barnstable Board of Health and Cotuit Water District there are no drinking water wells on-site or off-site within 100' of the septic system. DEPTH TO GROUNDWATER 6 depth to groundwater method of determination or approximation: The septic system leach pit is +340' north of MHW in Cotuit Narrows. M8W is elevation 4.8+' NGVD in this area. Sediments are,based. on experience in, the area, very highly permi.able uniform sands below the subsoil. Ground water, based on observation in the vicinity and studies by USGS would be expected to be only slightly higher than NEW. We have estimated an elevation between 3.5' and 4' NGVD. The SAS is a standard 6' pit. Based on invert elevations, the pit bottom would not be expected to belower than elevation 11' NGVD. .. 1: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) N Backup of sewage into facility? N Discharge or ponding of effluent to the surface. of the ground or surface waters? N Static. liquid level in the distribution box above outlet invert? (based on evidence that no back up into house or overflow at tank is occurring) N/A Liquid depth in cesspool <6" below invert or available volume< 1/2 da; f low? - No cesspool N Required pumping 4 times or more in the last year? number of times pumped b N Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? N Is any portion of the SAS , cesspool or privy: below the high groundwater elevation? N within 50 feet of a surface water? N within 100 feet of a surface water supply or tributary to a surface water supply? Based on records of Board of Health and Cotuit Water Dept. N within a Zone I of a public well? Based on records of Board of Health and Cotuit Water Dept. N/A within 50 feet of a bordering vegetated wetland or salt marsh- (.cesspools and privies only, not the SAS) ? - SAS is Title 5 (1978) system, however, it is more than 300' from BVW. N within 50 feet of a private water supply well? P PP Y Based on records of Barnstable Board of Health and Cotuit Water Dept. N 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 ana' for coliform bacteria, volatile organic compounds, ammonia nitro(; and nitrate nitrogen. Based on records of Board of Health and Cotuit Water Dept. i J ' n 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Christopher Jolly, P.E. Company Name. A. M. Wilson Associates, Inc. Company Address 911 Main Street Osterville, M. 02655 Certification Statement I• certify that I have personally inspected the -sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and . maintenance of on-site sewage disposal systems. Check one: 1 X I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature `1• 2' Date of'13�� Original to system owner, P. {r n7� CW •i Copies to: `0 Buyer (if applicable) Approving authority Attachments: Installers Card Plan Dated 1/30/95 r' r L0CATION SEWAGE _PER . T N0. al) m5 : V'ILLAGE t`NS A LLER'S NAM i ADDRESS i.U1lDER OR OWNER 11,11 1101 j. 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'''6. e n .*. xa",a-• , . t�' r e`^ r �.' ..�T .r..z..}' �• ,� MSESS04510PRw0:__//.._7y , PMCLLIIO:�C� — — Fait-JOV THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH TOWN OF BARNSTABLE Applirliliull furisainuufl 3bhui(1 (�uuufrltctiLmlrrutit 4 Application is hereby made for a l'enuil to L mistrtic, ( ) or Kq,;tir ( ) an Individual Sewage Disposal System at: I•NP 54 Lot 11 1 _595_Ulcl_Qo [ [{oacl,.(otuit.................................... ............................_..-..- .....i- _..— __... L'" "'-'s.M-1 G95 Uld Post toad,w�o[ut _....................._....... C1aarlette Allen .................................. ................................_. Add—, W ..................._.....1i„i aiie. Size Lot.......................__Sq.feet Type of Building Garbs Grinder ) U Dwelling—No.of Betlrounhs....5.............................__._..Exlrutsrou Attic( ) Ca Cafeteria( ) "1 Other—Type of Building ....................._.....No. of persons.............-_...........Showers( ) t a o Other fixtures.................................. .................�._................ Q 110 gallons pert JRy'A per day. Total daily Bow..i?rovidec:..97 ........._gallons. Design Flow. .. I oG Septic Tank—Liquid wpaeil)-.15.( .,gallons Length..............-Width................Diameter................Ut tlh................ u1 Disposal'french--Nq.....1..............bVidth..}........_..... I nlnl Lcngth....._30�.......Total leaching uw...-.4�?........sq.It. x 1-existin 3 Seepage Pit No......_:.._........Stan...Wi........ .........Ilrpth hduw inlet....................Total leaching arm..................sq. t. Z Other Distribution box(X) Dosing tank( ) 7113/81 Percolation Test Results Performed by..�!L?S.-...Isla(..):(._Survey,--_................. Dat....................................14 j Test Pit No.1...._z........minutes per inch Depth of Test Pit-..................Depth to ground waterNONG,FOUND P g NONE FOUND 1 W Test Pit No.2.._.2,.......minutes per inch llcpth of Test Pit.................Depth to ground water........................ .......................................................................a..........----- --- a ....................... _ _._.. O Description of SoiL..3�.._C4P..and_subsoil.;-,.9-'_rae ;i.san................................._..... ................__._..__._..__.._... .................................................:................................................... ................. ....................................................:....._..............__.... V Nature of Repairs or Alterations—Answer when appliwble11Gd1.tlOA..Q1:...LCPOSIT.-.t.Q..;aC::.Y..CP....2C9DOr71:S1.. bedroutn_acd'Cion............................................................................................................................................................. Agreement: The s to install the aforedescribed Individual Sewage Disposal System in accordance will, undersigned agree the provisions of TITLE 5 the State Gnvirunmen(aI Code—The undersigned further agrees not to place the Ile in operation until a Certificate of GnyJianee has been issued by the board of health. ..................................... Signed y- 11;:�. . - Application Approved B ............................ Application Disapproved for the following reannr: __.._..................... ................... ............. ............................................ ............._.......... ..............................................................................._........................... p y.. .........9..�r......7....y....I .......__.__..........._....._.........._...Issued._...._.....3.. .*1....7._�./..✓.............. Permit No. -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (Qerlificule of C&IIII Tliuuce THIS 15 TO CERTIFY,That the Individual Sewage Disposal System constructed( )or Repaired( ) by.............:.................................................................... ....,....._..............iM.i............._................................_......................... 695 Old Post Road, Cotuit (vial') 54, lot Yl-1.).........................................................._...................................... ar........e.................._.d._.n.............................._.......................__ has been installed in accordance with'the provisions of TI'fLC•5 of The Store Environmeleh lal Qde as describe m 9 y I.�... the application fur UisOF Works CERTIFICATE Permit Nu. .__.C0 ST THE ISSUANCE Of THIS CERTIFICATE SHALL NOT BE NSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... _ ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Fee..1611........... P No.......7•...�r..�.��.I(/ '. �liupuuul �fCiurlt)3 (90un1ruriiun Permit Permission is hereby granted........................................................ to Constn�q (( or Repair( )u, ludivi4ual Sewage DispQos,l System ......•..-.--.•.-.- UY�UJA Post Roadz..Cot tit.(rarh._54.,._11..>,1.......................................Rted......... . atNo........................_................... s,,.,, b 1 v as shown on the application for Disposal Will Conslrutlion Permit No.. c.............. ................................................. DATE................................................................................ r0_ ................ae..runusuens - , L0 CAT 10-0 SEWAGE PER T NO. �'Qoi� P vim, e� VILLAGE INSTA LLER'S NAME i ADDRESS C.0IR6` (4, f0a/ RUILDER OR OWNER = A NC DATE PERMIT ISSUED DATE COAA_PLIANCE ISSUED p�_ 1' /CW GILL Ptf J J 4 w Se • Explained • • • - AReference Guide Date Work Done Contractor Septic systems are individual wastewater treatment systems that use the soil to treat small waste- water flows, usually from individual homes. They are typically used in rural or large lot settings where t centralized wastewater treatment is impractical.There are many types of septic systems in use today. While all septic systems are individuallyYOUR designed for each site, most septic systems are based on the same principles. SEPTIC A Conventional . SYSTEM stem Se tic S P Y J lorHomeowners i 1I A videotape version of this brochure,also entitled "Your Septic System: A Guide for f, Homeowners,n is available through the EPA Small Flows Clearinghouse.Call 1-800-624- 8301. ` o o For more information about maintenance j or inspection of your septic system, contact your local board of health or the Department , MR, of Environmental Protection: }_ Central Regional Office: } ` - (508) 792-7650 Northeast Regional Office: A septic system consists of a septic After the partially treated wastewater (617) 932-7600 tank, a distribution box and a drainfield, all leaves the tank, it flows into a distribution Southeast Regional Office connected by pipes, called conveyance lines. box, which separates this flow evenly into a } network of drainfield trenches. Drainage ( (508) 946-2700 Your septic system treats your household holes at the bottom of each line allow the was- Western Regional Office: wastewaterby temporarily holding itin the septic tewaterto drain intogravel trenches fortempo- (413) 784-1100 tank where heavy solids and lighter scum are rary storage. This effluent then slowly seeps Boston Office: allowed to separate from the wastewater. This into the subsurface soil where it is further separation process is known as primary treat- (617) 292-5673 treated and purified(secondary treatment). Published 1990 b the Northern Virginia PlanningDistrict merit. The solids stored in the tank are decom A properly functioning septic system does not - commission with assistance from Virginia Water Control Board, posed by bacteria and later removed,along with pollute the groundwater. National small Flows Cleannghouse,and the Northern Virginia the lighter scum, by a professional septic tank Health Departments. Reprinted 1994 by the Division of water DEP Pollution Control of the Massachusetts Department of Environ- pumper. mental Protection. 94�1— COMMONWEALTH OF MASSACHUSETTS Piled—Recycled Pap., DEPARTMENT OF ENVIRONMENTAL PROTECTION. �y Caring for Your - • •s toAvoid TroUble 'The accumulated solids in the bottom of • be very expensive to repair, the septic tank should be pumped out every •- DO have your tank pumped out and DON'T allow anyone to drive or park • and,put thousands of water supply users system inspected ever 3 to 5 ears b over any part of the system. The area three to five years to prolong the life of your y p y y y at risk if you live in a public water supply a licensed septic contractor listed in the over the drainfield should be .left undis- system. Septic systems must be main- watershed and fail to maintain our s s- p ( tained regularly to stay working. tem. y y yellow pages). turbed with only a mowed grass cover. Roots from nearby trees or shrubs may Neglect or abuse of your septic system Be alert to these warning signs of a failing clog"and damage your drain lines. can cause it to fail. Failing septic systems system: DO keep a record of pumping, inspec- can tions, and other maintenance. Use the • sewage surfacing over the drainfield back page of this brochure to record DON'T make or allow repairs to your • cause a serious health threat to your (especially after storms), maintenance dates. septic system without obtaining the re- family and neighbors, • sewage back-ups in the house, quired health department permit. Use professional licensed septic contractors • degrade the environment, especially • lush, green growth over the drainfield, DO practice water conservation. Re- when needed. lakes, streams and groundwater, pair dripping faucets and leaking toilets, • slow draining toilets or drains, run washing machines and dishwashers • reduce the value of your property, • sewage odors. only when full, avoid long showers, and DON'T use commercial septic tank use water-saving features in faucets, additives. These products usually do not shower heads and toilets. help and some may hurt your system in the long run. • DO learn the location of your septic system and drainfield. Keep a sketch of DON'T use your toilet as a trash can it handy for service visits. If your system by dumping nondegradables down your has a flow diversion valve, learn its loca- toilet or drains. Also, don't poison your rnspectlpn:(PumP.:Out).Pgris:. tion, and turn it once a year. Flow septic system and the groundwater by diverters can add many years to the life pouring harmful chemicals down the - Tee of your system. drain. They can kill the beneficial bacte- ria that treat your wastewater. Keep the Inlet sewage s •s <.K �:,_ Outlet:Treated wastewater following materials out of your septic Enters from House rs rK* , Goes to Distribution Box e DO divert roof drains and surface water and Drain Field system: from driveways and hillsides away from W " ` wastewater ;F the septic system. Keep sump pumps . -% � x•: and house footing drains away from the septic system as well. µ � 'a [jese,.dispos4ab • DO take leftover hazardous household astics, etc. chemicals to your approved hazardous P waste collection center for disposal. Use gasoline, o , bleach, disinfectants, and drain and toi- thinner, pes , let bowl cleaners sparingly and in accor- dance with product labels. r;x THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............. .... .......----.....OF.............................--....__.------------------------------.-.-.-.......-...---- Appliratiou for Biopooa1 Works Tom "Witt rantit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: d Location-Address, or Lot No. ---•_...ST_L r--••..2C R.fV�KeU.V----...-••--•-_•-•- ner Address ................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......................................._----Expansion Attic ( ) Garbage Grinder (PL4 ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures __________________________________ .' d ._....••------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons -Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by........... •-•-------•---•-•-••--•••-----•--••---••-•----••---•-••-••---- Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water______________________-. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------=------------------•---...-------••-------._._..__...._............------•--•--••--......................................................... Descriptionof Soil........................................................................................................................................................................ W •••----------------------------------------------------------=--------------- •-----•-----•-......•-••---- UNature of Re airs or Alterations—Answer when applicable___Add---------l--------&ol?_ts4 1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIL- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed b the board of licalth. Signed._ -----------------------•- ....��.............ek..---- Date Application Approved By....... � ......... .......... Date --�Y_�Applieation.Disapproved for the following reasons----------------------------•-------------------------------------------------------------------------........._. --.................................................... •---•-----•--------••--------•-•••...._._..._••--•----_-•- Date Permit No.......................................... Issued.._..._..___ ._ ................•-------...--•--•------- " Date--•'Y-'--•--•......_^__._... �+�. No.....J11..! ." Fps.......5.off...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... -• .............OF.............................................----.----- Appliratiou fur Ilippoii al Works Touli rtiott Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at ......76+._�. ......-.&o 11L.---.-Q--o..----.A.w........................ ---- Location-Addressp or Lot No. 'z:,� .P' a '!*c�.............................. -•-----•-•--......--•------•----.... .----...--------•--.....------....--•-•----•----.... ner Address a ...... ----•------------ -------------- ..... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of BuildingNo. of persons............................ Showers — Cafeteria a :..;. Other fixtures ---------•--------------------------------------•--........------------------....-----= •--------- WDesign Flow............................................gallons per person per day. Total daily flow_........._:.'_...::...._:.._._.___.__._.._g Mons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter,._____.._..._ Depth..._............. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------­--------- Diameter.................... Depth below inlet.................... Total'leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►, Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ z P4 ......................................................... ....................... ............................................•-•••......------------------••-----•-----•----••---------•----. -------------..-... 0 Description of Soil........................................................................................................................................................................ x U •--•--•---•---•---•---------------------------------•...--------------------------........_...-•--•-•-••------------•------•--•-----•-------------•-••-•---------------------------•-...--•------------- W o. U Nature of Repairs or Alterations Answer when applicable...._ -___I........1 _ .�JO ...... e.j4f-�1 .. lP ' ..0. mr..- 'OPd3? (................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed b the board of ealt . 4;:!1046j!� Signed__ Dat Application Approved BY---------- .................................. ......... ------ Date Application Disapproved for the following reasons:........................................---------------•----................................................. .........................•-•---------•---••----------••-----..........----•-----------•-.....-----------------------.........---------------•---•---•--•-----------------•-------------•-•----•---•---•- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................1.................................... %Tertifirab of Totuph attre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� bY.................................................................................................................................................................................................... IV 10" Installer at---2.6 --------------- i has been installed in accordance with the provisions of TI`= 5 o The State Sanitary Code as described in the application for Disposal`Works Construction Permit No._, ..RM5JA3 dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. . DATE.............................. ---------------- Inspector._��..... .le. .--------•--•-----._......----------.-•-- THE COMMONWEALTH OF MASSACHUSETTS 2-13 BOARD OF HEALTH a?- ...........................................OF....................:................................................................ No............:........•--• FEE........................ DisposFa orkv �u�,�nyi_Artution erutit Permission is hereby granted- •- 0,'�0.o- ...e! _ ------------------------------------------------------- -------- to Construct ( or Repair ( ) an Individual Sewage Disposal System atNo....t7/0..... f? lbey 'It--------•--.....--.-•-----•----------------------------•-•------------•--••-----....----------•--•----.........:._ Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... off�rrd of Health DATE.... ow r'> ..................- FORM 1255 HOBBS & WARREN. 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AS is EO f% lEs Wit:•_' •g'i 4 .4as•'- r. .an-•; i.2' Q - p`•. 4 - _'1. `S' .r :P 7 -'L•!.P.- w ,pe,.l'1. >C`• .+.. �,�sA.� J<••• •,,t1.. y�% '.41� ..4-•' ..? ,3« , •.•�.- „(c'ti' r a .c•.z�r't�R.'ALn-, ,.,,i. 7'.ti'�h}i'-�'i�- .•C4'^!5. :v?•-''•Wss.. 7,y ,r',�.ry`-� >.9• - a :t' ti v Revisions: DATE 120.14' �9 •O Ro p,D 4 •� o, C' / 16 O / . W 4b N 0964103 8 References: / , . L — — Plan Book 350 Page 5 4z— ti ,�' — 14 6 — — — —� 26`' (—' Proposed Sewage Disposal System Plan 18 �.- �® � For Charlene Allen 10/21/81 By Cape 20 And Islands Survey Inc. OAF ose 4 ose Proposed � 22 —0 ddition Garage 0 ` \ // 24 osear Existin \ Screen \ Garage00 o \ / pvrCh Refirrre'sedNOD q 20 `— — 00 r/ Stone Driveway �.� Ic 4 3e WPprox. Waterline W/`h� /r— / rn a Exist. 1,50Q' Gal. W �Xis� c Septic To 22 f / Project Title: 4 Exist. —Box r �QQ ,�oQ PQ Exist. 1,000 Gal. 2s5'+ / #695 Leaching Pit \ MNw � Proposed 30'L x 3'W x 2'D I ✓ / Leaching Trench Old POSI" 0 45�'f Road O r;- I S 03'4 ,'17" W 22 24 In 18 18 Proposed 4" PVC To Existing D—Box 20 tomb/e) (Bamsm MA tui t' PREPAM M. Charlene Allen Top Of Foundation El.= 23.0'f SEE SEWAGE PERMIT 182-293A ,Test PIt Q-qtg Existing FOR EXISTING SYSTEM. Indicates Indicates �558 4" PVC 01/8"/ft 911 Main Street First 2' Laid Level 4" Perforated PVC ® .005 ft/ft Slope Osterville, MA 02655 Perc Groundwater 2" Of Peastone LaiTest 19.0'fSep tiC Tank o 0 0 0 7- - 0 0 0 0 0 0 0 0 Box Ground E/.=20.8 1�500 Gal. 18.5'f17.7' "•: :";.;i: ::•' :;';::, ';: ::; ::.. Topsoil 7EEx=i,ting 17.9'f A. �. Wilson Associates Inc. 19.8 1 18.8'f Existing 18.6'f Pit NO. 508 428 1450 FAX 420 1856 Sand TCSt B Cape & Islands Survey 2' Of 3/4" — 1 1/2" Washed Stone 15.7't Y Proposed 301 x XIV x 2'D Clay 17.8 Test Dote: 7/13/81 Witness: R.Gifford 8.0.H. 10't 10'f Leaching Trench Drawing Title Medium Sand Perc Rate. <2 Min/Inch Foundation — Tank Tank - D—Box Design Flow: Notms• 110 GPD/Bedroorn x 5 Bedrooms = 550 GPD (4 Existing Bedrooms And 1 Proposed) 1. Unless otherwise noted, all construction 7. Existing septic tank to be pumped prior methods and materials shall conform to to start of work. No Water 8.8 Title V of the state environmental code 8. Location of existing system per "ASBU/LT" Septic Tank Requirements: and any applicable loco/ regulations card obtained from B.O.H. files Sub Zs ur fa c 550 GPD x 1.5 = 825 GPD 2. Precast concrete septic tank, d—box, 9. Existing d—box to be watertested for Existing 1,500 Gal. Tank and leaching facillty to withstand H-10 /evellness after new 4" line /s added. wage Ground D. 20.3 � OF loading unless under pavement, drives, 10. Proposed 4 line added to d—box to Sol Topsoil 19.3 mal 2 or travelled ways where H-20 loading be mortared for watertightness. c Pit No. P. JOLLY Sand Cape & Islands Survey Leaching Facility Requirements:550 GPD shall apply. 11. Exfst/ng conditions token from referenced Dispu & Test B . J. All 1 es in the system shall be schedule plan and to be verified in field prior to start V Clay 17.3 Y P P Ys Test Date: 7/13/81 Sidewall Infiltration: 2.5 GPD/SF 40 or equal. Of work. i Witness. R.Gifford B.O.H. Bottom Infiltration: 1.0 GPD/SF 4. No field modifications to the sewage 12. Thls plan is to be used for permitting Perc Rote: <2 Min/Inch disposal system shall be made without purposes only and not to be used for Medium Sand prior written approval of the engineer construction. Leaching Facility Pit P/2' Stone and the local board of health. Zom C. Existing 1 — 6 Pit W 2 Stone 582 GPD 13.Chve//�ng is in FEhlA flood 9 / his system Is not designed for a Proposed Leaching. Trench (30'L x 3'W x 2'D) 5. T Side: 4 SF/Lf x 2.5 GPD/SF x 30' = 300 GPD garbage disposal unit Bottom: 3SF/LF x 1.0 GPD/SF x 30' = 90 GPD 6. All utilities to be verified In field No Water 8,3 TOTAL = 972 GPD prior t0 start of work. Scale: 1"= 20' o0 40 50 FEET Date: Janua 30 1995 Dwg No: Field: Design- C.P.J. Check: Drawn: J.V.B. Job No: 2.0742.0 Sheet ! of I