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HomeMy WebLinkAbout0682 POPONESSETT ROAD - Health 682 Vu ponesse'p Road Cotuit, MA A= 006- 015 f e r TOWN]OF B ARNSTABLE LOCATION S' SEWAGE # VILLAGE ASS SSOR'S MAP& OT INSTALLER'S NAME&PHONE NO. &rbbla+�,,r (SA-18) �11 - 9 SEPTIC TANK CAPACITY +� '�'�� LEACHING FACILITY: (type) J dr r, (size) NO'.OF BEDROOMS 3 BUILDER OR OWNE PERMIFDATE: OMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by O il � s ' 3 6 0-1 fj* / zn ek T. p'�J s � V' Ilee Y a No. v� THE COMMONWEALTH OF MASSACHUSETTS FEE / J® j BOARD OF HEALTH 1 OF A iI i APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (" ) Repair ( ) Upgrade ( ) Abandon ( ) - /Complete System ❑Individual Components a Location Owner's Name ti Map/Parcel# ddress ` Telephon # 'sName� Desig-ners�• ame �d%S dress I — 1 1//dr L 'telephone# Telephone# Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures I Design Flow min.required)= N�/ gpd Calculated design flow gpd Desi-gn flow provided gpd Plan: Z�d , Number of sheets I Revision Date Title_ L n _ �k/A i-. Description of Soil(s) b-IZ, IGL 12°=2 �` Cln Z _ Zv 1. Soil Evaluator Form No. Name of Soil Evaluator .SGIM C6r G Date of EvaluationIn loq DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not tg4place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed � Date Inspects FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No:* �!� -v THE COMMONWEALTH OF MASSACHUSETTS FEE / �© -4 BOARD OF HEALTH/(rnju OF 4 APPLICATION FO,R�.DISPOSAL SYSTEM [?"CONSTRUCTION PERMIT PP �" J P Upgrade ) � ) �ry Application for a Permit to Construct Repair U rade Abandon [?Complete System ❑Individual Components tv Location Owner's Name Map/Parcel# ddress QA�f� (A�1 +xp ® Loh# / Tel phon # J�',, nt r "#sipInstaller's Name,, /"""' ��� Designer's ame 7,7 . . dress Addr s � Telephone# Teldpy"hone# n Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow�.,r in.requi ed� 'J gpd Calculated desi n flow gpd Desi n flow rovidedAR gpd Plan: ` ate Z`� Number bf sheets _� Revision Date �-4P_ Title t• r Description of Soil(s) - 2 -Z�( !u• 4l. - dSa� S Soil Evaluator Form No. Name of Soil Evaluator SaIU-G .Date of Evaluatio DESCRIPTION OF REPAIRS OR ALTERATIONS ,w r: The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of ' TITLIV and further a rees not ap ace the system in operation until a Certificate of Compliance has been issued by the Board of Health. " Signed Date a Y yi Inspect] a Yt .. FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 xr --r--of�---a--arY---a:s a•.>o— ——r——s——r, —Ps as. —---'ins-->---—r�.—a�.a_r. NO.�/" � 5&� THE COMMONWEALTH OF MASSACHUSETTS FEE 50 6;;y/l'S �"eBOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) Complete System The undersigned hereby certify certify that the Sewage Disposal System;Constructed(Repaired( ),Upgraded( ),Abandoned-( ) by: at �' �Z dp" �J" _ LCJ 12:yl has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. '-t< 91I dated / Approved Design Flow 33 (gpd) Installer Desiner:g C� � � Inspect Date - QA The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 THE COMMONWEALTH OF MASSACHUSETTS FEE dgWhof!52C7,A/BOARD O F HEALTH --•'/ DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct (Repair ( ) U rade ) Abandon ( ) an individual sewage disposal system at 4�Z .��i�, L a, eee/ > - as described in the application for 'sposal System Construction Permit No. C9 W`+ 56 ( dated 'S �I S00 5 Provided: Constructio shall be completed within three years of the date o this p m't -llo ocal conditions must be met. Date 15fU`5 Board of He lth FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN rM PUBLISHERS- BOSTON A X$ r-�y N T 7 'I own of Barnstable P# 0 Department of Health,Safety,and Environmental Services �irlEJp,- Public Health-Division Date v 3G7 Main Street,l lyannis MA 02601 {" -t BAFWB'UBI,E, fv ► Date Scheduled `� J� Time�V Fee Pd: Soil Suitability Assessment or Sewage Disposal-, .�� � L Performed fay: ' a ' Witnessed By: "V, LOCATION & GENERAL INFORMATION ddress Location AWU-L r� LQ S1 Owner's Name Tohn �11��a� / S l t 1 u L., Address Assessor's Map/Parcel: �� `��� - / Engineer's NamcCaPQ. NEW CONSTRUCTION *0" REPAIR V Telephone H ^)_'7271L ( Land Use.- /7e,s- We, tee, Slopes(1/0) Z Surface Stones Distances from: Open-Water Body (I Possible Wet Area 1. Drinking Water Well• fl Drainage Way R Property Line n Other (l SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) ° I f� t� , oI Parent material(geologic) �`� �"� f Depth to Bedrock Depth to Groundwater: Standing Water in Bole: Weeping from Pit Face , Estimated Seasonal High Groundwater ICEmli ri]7�� rr r�rr:rnly A c"NA I aGII�.'A_ Ei::TA1SL -1 L' 1.ZP1 INA i' 1\ 1'0118 t]UV1\! u - Method IJsed. Depth Observed standing.in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs..hole: in. Groundwater Adjustment R. Index Well H Reading Date: Index Well level Adj.factor Adj.Groundwater Lcvcl PERCOLATION TEST date ; a i itn�/o r%, Observation Hole N 2- Time at 911 Depth of Perc ,7 Time at 6" Start Pre-soak Time a /O,%G : l time(9"76") End Pre-soak Rate Min./Inch < Z Site> tiitability Assessment Site Passed Site Failed: 4 Addrtion5l Testing Needed(YIN) Original: Public Health Drvrsron ;: Observation Hole:Data To`Te Completed on Back --�• Copy: Applicant X l � . DEEP OBSERVATION HOLE LOG Hole # '6�-/ Depth from Soil I lorizon Soil TCxlUre Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,[outdoes. a Consistency,% n I) �. yrj Z/Z /z 40 4°8 • 9 L G S.re yR 7/4/ 96 — izo C Gayt 7/V /Y rnd✓ t✓ DEEP OBSERVATION HOLE LOG Hole # Z Depth from Soil I lorizon Soil"texture I Soil Colo[ Soii Olhcr Surface(in.) (USDA) (Munsell) Monling, (Structure,Stones,Houlderes. Consistency,% r vel a — /z ua• �r z .tl S L Y z s lY A/z-�Y c� a0 ye7/y C i—s /m r,z 7fY o .+alw/✓ DEEP OBSERVATION HOLE LOG Hole # Depth from Soil I lorizon Soil•texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,13oulderes. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole # Depth from Soil I lorizon Soil•texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°° ravel I I Flood Insurance Rate Man: Above 500•,•ear flood boundary , ,• --- Within 500 year boundary No— Yes t/ Within 100 year flood boundary No 1, Yes :Depth of Naturally Occurring 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? YGT If not, what is the depth of naturally occurring pervious material? Certification I certify that on `� ✓� (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, expertise and experience described in 310 CMR 15.017. Signature Date °Ft ' ti Town of Barnstable Regulatory Services * • anxxsrnace, 9� 16 S& ��g Thomas F. Geiler, Director AT fo Public Health Division Thomas McKean, Director ' 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Designer Certification Form Date: f7-A'OS Designer: it l CIO. � Address: POD IT�CM 4-ki 4k,301 C W"kA« M14 a Z(o h�q On baybU LafE (MSL- was issued a permit to install a (date) (installer) oo(� per\ olc> septic system at t8 ZboD on Psse� � based on a design I drew, (address) dated 1-Z2-a� Cev �•. °l—Z b� V I certify that the septic system referenced above was installed substantially according to the design. I certify that the septic system referenced above was installed with changes but in accordance with State & Local Regulations. Revision or certified as-built by designer to follow. 0r h1gSJ,,�y 9 DAVID CHARLES � SANICKI CA 28085 _ 9£GJSTE i� j 1 AMS� (Designer's Signature) p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL'BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form Commonwealth of Massachusetts 1 (� Executive Office of Environmental Affairs Department of Environmental Protec '® F REC::" MLEC INSPECTION OCT 0 12003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM r PART A MAP �0 CERTIFICATION PARCEL LOT , Property Address:-682 Pononessett Rd Cot�ri+ MA 02635 Property Owners Address:682 Panonessett Rd Cotuit.MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 Name of Inspector:(please print)Brace Butterworth Company Name:_ Wind River Environmental _ Telephone Number:978-262-4500 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the Propel'function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: ate: Cl t l o The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared systemor has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report--o the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments:System is overtlowinfg into the river "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—same or ditierent conditions of use. 0FFICL41L INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:682 Poponessett Rd Cotuit,MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 Inspection Summary:Check A,B,C,D or E ALWAYS complete all of Section D System Passes: _I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system,upon completion of the replacement or repair,as approved by the board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the____please explain The septic tank is metal and over 20 years old or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exh1tration or tank failure is imminent.System will pass inspection if the existing tank isreplaced with a as ov oar o *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. 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,shifted or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced for the following statements.If not determined" ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Not Determined explain: I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(continued) Property Address:682 Pogonessett Rd CoDA MA 02635 Owner.Elaine Ewing Date of Inspection:09/11/2003 Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in orderto determine if the system is failing to protect public heath,safety or the environment. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not hinctioning in a manner which will protect public health,safety and the environment: Mop=ur privy is within —of a s ace water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System Will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 fcet 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 and SAS and the.SAS is within 50 feet of a private water supply well- The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well Method used to determine distance *this system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from said facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. Other: I .. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address,682 Poponessett Rd Cotuk MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 System Failure Criteria applicable to all aPP systems; You must indicate"yes"or"no"to each of the following for all inspections: Yes No x _Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool x w Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —— cesspool is less than invert or available volume is less than 1/4 day flow _ x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ,cesspoo or privy is c ow ff water elevation. _ x Any portion of cesspool or privy is within TOO feet of a surface water supply or tributary to a surface water supply. T x Any portion of a cesspool or privy is within a Zone 1 of a public well. 2L Any portion of a cesspool or privy is within 50 feet of a private water supply w(—. x _Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well'water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis must be attached to this form] YES (Yes or No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system falls.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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. You must indicate either yes"or no"to each of the following. (The following criteria apply to large systems in addition to the criteria above)yes no 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{Iftim Wellhead Protection Area-DEP)or a mapped wetland Zone R of a public water supply well if you have answered"yes"to any question in Section E the system is considered a significant threat,or answered des"in Section D above the large system has failed The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in axordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:682 Poponessett Rd Cotuit,MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 Check if the following have been done You must indicate yes'or no as to each of the following: Yes No x _Pumping information was provided by the owner,occupant,or Board of Health _ x Were any Of-the system components pumped out in the previous two weeks? x Was the system received normal flows in the previous two week period? xHwv4 0 on x Were as built plans of the system obtained and examined?(If they were not available note) x _ Was the facility or dwelling inspected for signs of sewage back up? x — Was the site inspected for signs of break out? x Were all systemcomponents,excluding the SAS,located an site? x Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the bales or toes,material of construction,dimensions,depth of liquid,depth)f sludge and depth of scum? x Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no x_Existing information.For example,a plan at the Board of Health. __Determined m the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15-302(3)(b)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATIONFLOW-CONDITIONS Property Address:682 Poponemett Rd Cotuit,MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system yes or no): No (if yes separate inspection required) Laundry system inspected(yes or no): No Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no): No Last date of occupancy: Currently Occupied INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15203): -- Basis o esu sea gn ow persons sq etc. Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):No Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Owner saoolied R mped yearly Was system pumped as part of the inspection yes or no): Yes If yes,volume pumped:gallons gallons How was quantity Pumped determined? —Reason for pumping:To examine tank condition TYPE OF SYSTEM Septic tank,D-Box and soil absorption system Single cesspool X Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _bmovative/Ah=ative technology.Attach a-copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1957 46 Years. Were sewage odors detected when arriving at the site yes or no): Yes f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contiAaed) - Property Address:682 Poponessett Rd Cotuit,MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:(locate on site plan) Depth below grade: Material of construction: —concrete`metal fiberglass or Polyethylene other(explain) copy of certificate) Dimensions: Lu Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structure integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Is age confirmed by a Certificate of Compliance(yes or no): No (attach a copy) 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:682 Poponessett Rd Cotuit,MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 , 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 LAZIgn ow: gallons/day -- Alarm present yes or no): Alarm level: Alarm in working or-der(yes or no Me of last Comments condition of alarm and float switches etc.): DISTRIBUTION BOX:_ (if present must be opened and locate on site plan) ) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 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.): I f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:682 Poponesset Rd Cotuit,MA 02635 Owner.Elaine Ewing Date of Inspection:09/11/2003 SOIL ABSORPTION SYSTEM(SAS):—(locate on site plan,excavation not required if SAS not located explain why: Type leaching pits,amber leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions:_ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of pondin&damn soil,condition of vegetation,etc) CESSPOOLS: (cesspool must be Pumped as part of mspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):_ -Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:—(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.): r OFFICIAL INSPECTION FORM-NOT FOR VOLINTARY ASSESSMENTS_ 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INFO FORM PART C System information(continued) Property Address:682 Poponessett Rd Cotuit,MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters tie building. L OFFICIAL INSPECTION FORM-(NOT FOR VOLUNTARY ASSESSMENTS) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:682 Poponessett Rd Cotuit,MA 02635 Owner:Elaine Ewing Date of Inspection:09/11/2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _ Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-H checked,date of design plan reviewed Observed site(abutting property/observation hole within 150 feet of SAS) ____Checked with local Board of Health-explain: _Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Title 5 Inspection Form 6/15/2000 DEPARTMENT OF ENVIRONMENTAL PROTECTION Mycock Real Estate 0 School Street, P.O. Box 437 u totuit, MA 02635-0437 PHONE 1-508-428-3484 FAX 1-508-420-5584 E-mail RJMycock(a,AOL.COM October 2;'2003 Thomas A. McKean Director of Public Health OC-� Q 6 Z003 Town of Barnstable 200 Main Street Towl or' H.DEPT.��'"'"�"TpSL� Cotuit, MA 02635 HEAL Re: Elaine Ewing 682 Poponessett Road, Cotuit,`MA Dear Director McKean: I am responding for Mrs. Elaine Ewing concerning the failed septic system located at the above property. I have been authorized to inform you that Mrs. Ewing has the subject:property under agreement to be sold; closing is to occur within the next 31 days. The.owner's son has.occupied the house but as of October 1, 2003 he has vacated the home. A' In response to the four(4) directives in your letter 1. The system was pumped on September 11 2003. 2. There has been no additional overflow since that time. 3. The future owner of the property presently has Cape & Islands Engineering of Mashpee designing a new,septic.system.for the property. 4. The new owner is presently scheduled to take procession of the property on October 31, 2003. The new owner will not be occupying the existing home, the home will be vacant while the new.owners go through the regulatory process to renovate/tear down and rebuild the existing home. The present owner is in her 80's. The home is no longer being occupied and thus it is no longer a danger to environment. Could you please advise if this is enough to correct the situation until the property transfer can take place and the home enters the regulatory process? Very my your Ronald J. Myco for laine Ewing Via: Fax, Original via Postal Services White, Samuel To: RJMycock@aol.com Cc: McKean, Thomas Subject: Septic System at 682 Poponessett Road, Cotuit Mr. Mycock, I have received your request for passing on the obligation of repairing the failed septic system at 682 Poponessett Road, Cotuit to the new owners who will take posession October 31, 2003. This request has been approved, however, please submit confirmation that the new owners have been notified that the system must be repaired immediately. If you have any questions, please feel free to contact me. Thank you. Samuel H. White, R.S. Health Inspector Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Phone: 508.862.4644 Fax: 508.790.6304 1 rr ,Town of Barnstable Regulatory Services . snxxsrnaIE, v MASS. g Thomas F. Geiler,Director c 39. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 11, 2003 George &Elaine Ewing 372 Hatchville Road E.Falmouth, MA 02563 NOTICE OF VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REOUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE The property owned by you located at 682 Poponessett Road, Cotuit, was inspected on September 11, 2003 by Wind River Environmental because of an intended property transfer. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation: 105 CMR 410.300 AND 310 CMR 15.02 (207): Septic system is in hydraulic failure. Raw sewage has been observed at ground level and running directly into water less than fifty (50) feet away. 1) You are directed to hire a licensed septage hauler to pump the overflowing septic system within twenty-four.(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary(daily if need be) to keep it from overflowing onto the ground. r 3) You are further directed to contact and hire a professional engineer to design a septic system which meets local and state regulation requirements within fourteen (14) days of receipt of this letter in order to repair this system or connect to town sewer. 4) The newly installed septic system shall be completed on or before October 31, 2003. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health o' 00 �' \ 2 r ® CD 171 CO ° p � � •� / / gyp° . `�� I / v•Y\ le"�'` �� Ems' ,�, � d !I v 5 ep o pgo Op ! / —T I� bl Ou I N, -. NIL nI - yid^_ f•6u .I I LLL '-01- Id-OW ;11.'_2•n — I _ iiC b � "3ti I w I i I Isms top, I Na O NN b i. . F I N Z h 7A I p �; 3 / III gll�ar � o 1� s1 P n I I w 1 °a o C'= � O D N_ y. . 4,q° ( °It-'le It"y5Yy 1 ` ,al v\ n 13 ; — 3 .11 DON L. I -- - I __ ¢, m I ° p ®am � I - IryY o it -oa Ra .� v�$fix.` 19'•�%i' 55'la° 2' ^ .i 1 t^ z - i 'Y / 9 a �, .Wa•D DI4.-9ic._ G y . 13 40 \ Asp cees+n•°te svz \ �A 44 F9 \ i q \ C -¢1a�2'- - IA 4•aL.- ----- 3h_.. 4-3ys -- 4.8✓zz" avo \� -- — !1 Cam' ' SI• _ _ ter--� 'RFCN "at -:iW _ • 2 - / \\' , `. . / r+ � � �• �_SvmoDliv - i� �=WMVDW3LRT T--—.— - —^__"� I SLAT 3 �g � � I� - n - � I .•��b =.PrN \ -\ >6 D �TNRNI _ I -$6DROG4°2 ts ` dleYx yb- —..iw°yb Dh1 D DIlt �� a� \ �I A9YT0 t LYiAp _ yip A Mae O, \�` /• �\\ b[(a tLST '1•-1� 1`'IS�1'lr3' =� �f ��AFF• I9�9f ' �_ — - ��, b -I �c'_5 ( ... 11=•1y7.° $ta° I i 1-51° 1510'a't•' era ;I I a•kF• r d31 hW31 / I \� ——--— —— — —— `-y 1-- SYi-_ -— J —_ MD,.rASf .NtfAt_'H •"- _TW k i 2 " nj 3'- ° 3 4" 4=° ac+• ti•Po'h 3.1'/i' '�'-1 u ,IL{oai 3-0° ----- I'=o" 30° •IOIti, '1 1l2• , 3:/a° 110V • mae at aYs! 2.•D,• _ -0'o° 2,Du 3 D 14-Du 1 i SECOKD NL®OSi PL A K 1�� y&D ARCyr� /4%{ o' DLpD NDR7f4 \40 CA i O I No. 7718 cn p � FAL OUTH, Z7 S D Sa'f WILLIAMS HOUSE ROAD Al °°'•�`" "° "�° 'COTUIT, MA SYSTEM PROFILE TOP OF NOT TO SCALE .FOUNDATION FINISH GRADE EL. 16.8 FINISH GRADE FINISH GRADE OVER FINISH GRADE OVER OVER TRENCHES 16.0 EL. 16.0 SEPTIC TANK 16.0 DISTRIBUTION BOX 16.0 - ro- PRECAST CONCRETE _ o ! RISERS TO 6"`-0 500 GALLON DRYWELLS I F GRAD r ' H-10 REINFORCED LOADING :, � ail RISERS TO 611 '• oTRENCH LENGTH = 31'-611 3°MIN. - OUTLET PIPE(S) LEVEL1 1MIN.SLOPE i% OF FINISH GRADE o DRYWELL LENGTH - 8-63" FOR 2(MIN.1 /o SLOPE IMIN.SLOPE 1% o _ BEYOND r ,a• •/• O O '• • is 'y10;0:1• �t ;`i:.'•11Oa0:1• �i: 'N O;o•/ %�l ,.�i. 'q 0,o,a ,� i..'q �,0, 1.0 o_ ;� 13"MIN. 14" -� M1 4.00 13.80 16-SUMP o b ' 0_ 13.55 13.37 ,'�: ., 12.30 ; � .•;., 'off,;_ :,' •`�. a -< PVC OR CAST IRON TEE ''' �� �y 3/4"- 1-1/2" DOUBLE BOTTOM OF TRENCH ELEV.10.3 " ._ - � GAS BAFFLE 6 3/4 - 1-1/2 DOUBLE , DISTRIBUTION BOX WASHED CRUSHED 3 WASHED CRUSHED MINIMUM INSIDE DIMENSION 121, 3, STONE 7.T STONE �IJOO GALLON a A OUTLET INVERTS 2" BELOW INLET INVERT PRECAST CONCRETE '4 MINIMUM CONCRETE WALL THICKNESS 2" INSTALL ON COMPACTED LEVEL BASE BOTTOM OF TEST HOLE#2 EL.2.6 BSMT.FLR. H-10 REINFORCED a ELEV. 9.3 TRENCH SECTION '1 .�s�=~`�•- '• �' ;; - NOTE: EXCAVATE T0.=C= STRATUM IN ORDER TO '^ = �,-: •, , - 1 , • i REMOVE ALL =A=&=B= IMPERVIOUS M >TERIAL L` WITHIN 5 OF THE SAS. REPLACE WITH CLEAN, SEPTIC TANK "MIN. 3110E 1/8"- 1/2° If CLAY-FREE SAND N 4" DIAM. 6"MAX. DOUBLE WASHED INSTALL ON COMPACTED LEVEL BASE PEASTONE 3/4"- 1-1/2" DOUBLE " 51_2" 1 36" WASHED CRUSHED STONE TRENCHWDTH 11'-211 OBSERVATION PIT GENERAL NOTES: NUMBER OF TRENCHES 1 1. ELEVATIONS SHOWN ARE BASED ON NGVD P-10701 NUMBER OF DRYWELLS 3 2.ALL PIPES IN THE SYSTEM MUST BE CAST IRON OR SCHEDULE 40 PVC. PERCOLATION RATE: < 2 MINJIN 3. HEALTH AGENT/CAPE& ISLANDS ENGINEERING WITNESSED BY: DAVID STANTON MUST BE NOTIFIED WHEN CONSTRUCTION IS BARNSTABLE BOARD OF HEALTH COMPLETE PRIOR TO`BACKFILLING: DATE: MAY 11,2004 4.ANY CHANGES IN THIS PLAN MUST BE APPROVED BY CAPE & ISLANDS ENGINEERING AND THE BOARD OF HEALTH. 5. MATERIALS AND INSTALLATION SHALL BE IN DESIGN DATA COMPLIANCE WITH THE STATE SANITARY CODE on TEST HOLE#1 o„ TEST HOLE#2 EL13.6 [TITLE V]AND LOCAL APPLICABLE RULES AND REGULATIONS. AW LOAM AW LOAM 10 YR 2/2 NUMBER OF BEDROOMS 3 6. NORTH ARROW IS FROM RECORD PLANS AND IS 12" -E-SAND 12„ 10 YR 2/2 GARBAGE DISPOSAL AQ_ NOT INTENDED FOR SOLAR ENERGY PURPOSES. 10YR 6/1 =E=SAND DAILY FLOW 330 GPD, WATER SUPPLY: MUNICIPAL WATER ,24n 24" 10YR 6/1 SEPTIC TANK REQUIRED 1500 GAL. 8. FLOOD ZONE C [NON-HAZARD] =B=SANDY LOAM =B=SANDY LOAM SEPTIC TANK PROVIDED 1500 GAL, 10YR 5/4 1oYR 5/4 LEACHING REQUIRED 330 GPD. 48" 42" =C1=MEDIUM SAND PERC HOLE =C1=MEDIUM SAND SOIL ABSORPTION SYSTEM CALCULATIONS: 96" 10YR 7/4 g4" 10YR 7/�# EL.9.1 SIDEWALL AREA= 170 SF. 84" 170 SF. X .74 G/SF. = 125 GPD. =C2=FINE SAND =C2= FINE SAND BOTTOM AREA 53 1 SF. SEE SHEET I FOR SITE DETAILS 10YR 7/4 1oYR 714 351 SF. X 0.74 G/SF. = 259 GPD. 120111 NO GROUNDWATER 132"1 NO GROUNDWATER EL.2.6 LEACHING PROVIDED = 384 GPD. LEGEND SHEET 2 OF 2 52 PROPOSED CONTOUR SINGLE FAMILY RESIDENCE ---52- - EXISTING CONTOUR OBSERVATION PIT a��a o� �b yobs PROPOSED SEWAGE DISPOSAL SYSTEM bssszr PREPARED FOR ❑ DISTRIBUTION BOX °saaw e r ��y 08VHOIU �o JOHN WILLIAMS x �6ssdsr 0 0 o SEPTIC TANK ao ��1� HSE.NO. 682 POPPONESSET ROAD A COTUIT,MASS. p SOIL ABSORPTION SYSTEM A PLAN NO. 072204 SCALE:AS NOTED RESERVE RESERVE AREA DATE: JULY 22 2004 N ytN of MissSEPTIC FILE NO. 75 PCS FILE: popord 22.26 PIPE INVERT ELEVATION DAVID 9�y� .. AL .. cH�Aa�Es � �,� z z z CAPE & ISLANDS ENGINEERING 6 15 682 5 5 l sf , 800 FALMOUTH ROAD, SUITE 301C MAP SEC PCL LOT HSE 5 MASHPEE,MA 02649 (508)477-7272 � � � `�. s Al p v a ±� «\ �'�,,_•• .,r✓ �� Beach �1S Public cotuit a ' . 1, IC : k �•/ •.Qs .w 1N `d 1.% �!�• LAWN AREA TO BE REPLAC .� ._. �, A b • , ��� ,�•'' WITH BEARBERRY, YBERRbpl LOWBUSH BLUEBERR , EEP LAU L, ��,� moo, / 'a ' SH /- P �." 1. uiy.o�qn a• ,• i �I PENNSYLVANIA SE E & SWITCHGRA � •��- .� r � �' ° - _ ,' ' • �J 2 GALLON P S 3 ON CENTER Jk 01 J` // / (I iJwbl NS IMe R!arw Yeree.l ltl Nllb Ame lop:I.Sl,t MKS ,�- SALT / �'' �' EXISTING \1 ,,� CONC.BLOCK STE A 682 POPPONESSE T ROAD COT UIT 0000, TO W.NMAP 6 PARCEL 15 Vi .. ON 8,,, off' / JU.NE 23,2004 REVISIONS. - `� so, 1. EXTENDED HAYBALES/WORK LIMIT TO WEST PR to 2. NOTED PAVED DRIVEWAY 100010, / y JUKE 3 2004 REVISIONS _ _. ._. .- - " - - . i - - • ` �0 Q LREMOVE CIRCULAR WOODENSTEPSFROMREAR DECK& , 5� i} e •, ADDED TWO SMALLER STAIR WAYS ' SILL ESSPOOL ' 2.HOUSE DEPTHDD ENSIONS DECREASED � - , � •�•' �� •,•' 3.HOUSE LENGTHDIMENSIONS INCREASED e- -- o• 1 / - •.•� ,� / 4.17?ONT PORCH WID TH LESSENED & LABELED ~ CESSPOOL 5.SCREENED PORCH LABELED AS SUCH :N o p �`o•�•� �!' °o G A� - ' 6.DECK AREA DECREASED &LABELED AS COVERED DECK 7.EXISTING DWELLING REMOVED -- O J, �• � `` 8.EXISTING CESSPOOLS ADDED & NOTED TO BE FILLED \ •� � ��, . •'•% `I ;' �' 9.EXISTING LA WNHIGHLIGHTED SSPOOL 10.FORMER DRIVEWAY TO THE BACK YARD ADDED _ 11 DENOTED 50 FT BUFFER ALONG ENTIRE REAR OFBUILDING 12.EXISTIIVG CONCRETE BLOCK STEPS SHOWN ONPLAN 00 NO Off' - ti / ♦ �: f ' \ REV.SEPT.2,2004 REDUCED TO 3 BEDROOMS r , SHEET 1 OF 2 Q /I looms / �, 0 11 ,, �o SEE SHEET 2 F®R SEPTIC SYSTEM DETAILS •/ '�� 1 / ' 'f!� , ."'' Q 10 0 10 20 30 PROPOSED SITE PLAN / L OCA TED IN RICHF.RD AMES p Fk 94 CO TUIT,MA SS. I \ ✓ PREPARED -FOR JOHN WILLIAMS \� / DA TE.APR. 10 2004 SCALE:1 " = 10 , �� _� `� FILE: 162BA o Yd 682 p PP { CAPE & ISLANDS ENGINEERING NOTE: EXCAVATE TO =C1= STRATUM IN ORDER TO 800 EALMO UTH ROAD, S UITE 301 C REMOVE ALL =A= & =B= IMPERVIOUS MATERIAL MA SHPEE,MASS. 02649 [508]477- 7272 `' WITHIN 5' OF THE SAS. REPLACE WITH CLEAN, . CLAY-FREE SAND. EXCAVATION DEPTH = 48"