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Home My WebLink About0026 PRUDENCE LANE - Health 26 PRUDENCE LANE, COTUIT A= 040 054 y r a 'E i r U Commonwealth of Massachusetts Executive Office of Environmental Affairs MAY 3 1996rw OF Department ofe Environmental Protection � . ��`� 44 William F.Weld Governu 'Trudy.Coxe Argoo Paul Celluccl 8—*tWY tL Gowrnor David B.Struhs C.arnrrJsalor>.r • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ CERTIFICATION PropertyAddresa: 26 Prudence Lane Cotuit ,Mass . AddresaofOwner.Fred Pula Date of Inapeotlon /2 3/9 6 (If different) 7 Aqueduct Road Name ofInspecton Joseph P. Macomber Jr . South Natick,N4ass Company Narne,Address and Telephone Number. 01760 J.P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 CERTIFICATION STATEMENT 508-775-3338 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 my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: -Z Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signatur:Zbmit 1�� yW, 4Ls1 Date: The System Inspector a co f this PY o 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 copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: Z- 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 3 Any lure criteria not evaluated are indicated below. 10 CMR 15.303. B) SYSTEM CONDITIONALLY PASSES: 3 41' 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 sot) /l L3 The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltrationn,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston, Massachusetts 02108 a FAX(617) 556-1049 a Telephone(617)292-550o A f., Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) ProportyAddreaw 26 Prudence Lane Cotuit ,Mass . owner Fred Pula Date of Inspection:4/2 3/9 6 Bl 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 Health): broken pipe(&)are replaced obstruction is removed distribution box is levelled or replaced The m required pumping more than four times a year due to broken or obstructed i (s). The system will system�1 P P� 8 Y P�Pe � Pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION 19 REQUIRED BY THE BOARD OF HEALTH: 4,0_ 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: ,Q2, 7 Cesspool or privy is within 50 feet of a surface water VCesspool 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 or tributary 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 &oil absorption system and 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. 3) OTHER (revised 11/03/95) 2 U6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinuod) PropertyAddrau: 26 Prudence Lane Cotuit Mass . 02635 Owner. Fred Pula Date of Inspoo do n: 4/23/96 ° v ° D) SYSTEM FAILS: • ' • I haw detarminod that the system violates one or more of the following failure criteria as dafined in 310 CMR 16.303. The ba is'for this dat.armination is identified below. The Board of Health should be contacted to determins what will bo noeessary to correct the failure. ' P erg' Backup of ae into facility or system component due to an overloaded or clogged SAS or oosspooL �S- Discharge or ponding of effluent to the surface of the tround or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the d jtribution box above outlet invert due to an overloaded or clogged SAS or cesspool. ke'lti -1 - ti'1 Liquid depth in ce"fcal Is less than 6"below invert or available volume is lass than 1/2 day Dow. tiS1 Roquirod pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(:). Number of times pumpod , L.0 Any portion of the Soil Abzorption 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. N42 Any portion of a cesspool or privy is within 60 feet of a private water supply well. DLO Any portion of a cesspool or privy is lass than 100 feet but granter than 60 foot from a private water supply well with no acceptable water quality analysis. If the well has boon analyzed to W acceptable, attach copy of well water analysis for coliform bacteria,volatile orlu• c compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: ti'('1 The rystam servos a facility rzth 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 bocause one or more of the following condition.: exist: the system is within 400 foot o:a surface drinking water supply Lit the rystem is within 200 [At, of a tributary to a rurfaca drinking water supply the rystam is located in a rdzogen sensitive area (Intorim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply wall) The owner or operator of az�y such syst-9m sha.l bring the system and facility into Hill Compliance with the Voundw&Ur tr"trunt program requirements of 314 CMR 6.00 and 6.00. Plop_e consult the local regional office of the Department for tuxther information.. (revised 11IW95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddreas: 26 Prudence Lane Cotuit,Mass . 02635 Owner. Fred Pula Date of Inspeotion: 4/2 3/9 6 Check if the following have been done: Pumping information was requested of the owner, occupant, and 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 inspection. .L built plans have been obtained and examined. Note if they are not available with N/A ,�/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,ikeluding the Soil Absorption System, 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. -Tha size and location of the Soil Absorption System on the site has been determined based on existing information or I approximated by non-intrusive methods. f The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 26 Prudence Lane Cotuit,Mass . 02635 Owner. Fred Pula Date of Inspection: 4/23/96 FLOW CONDITIONS RESIDENTIAL.• Design flow: T L ns • Number of bedrooms: �_'� Number of current residents:041t Garbage grinder(yes or no):AZL) Laundry connected to system (yes or no):_5 Seasonal use (yes or no): Water meter readings, if available: cn - �I l'C�C ''� _ !l A y i4 Last date of occupancy:_ COMMERCIAL NDUSTRIAL: Type of establishment: Design flow: 1�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)d�D Water meter readings, if available: 4 F� Last date of occu Pancy:A�L— OTHER (Describe) Ai 11 Last date of occupancy: ►V 1' GENERAL INFORMATION PUMPING RECORD and so of formation: System pumped as part of inspection: (yes or no) � If yes,volume pumped: __gallons Reason for pumping: A TYPE OF SYSTEM _� Septic tank/disttsbutiaa-baz/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: r��`�;t L�•� -� Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT ION FORM PART C SYSTEM INFORMATION (continued) PropertyAddre" 26 Prudence Lane Cotuit ,Mass . 02635 Owner. Fred Pula Date of Inspection: 4/2 3/9 6 SEPTIC TANK4-an (pr %,v //l (locate on site plan) 1 Depth below grade:- Material of construction:L,�C/O ncrete_metal_FRP_other(ezplain) Dimensions: •; Sludge depth:___ Distance from top of fludge to bottom of outlet tee or baffle:. �� Scum thicImess: _ t� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:L_ Comments: (recommendation for pumping, condition of inlet and outlet Baas or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) P n in place , Septic ank shows no signs of leak -gP TrP epta_C--task -- structurall sound. No GREASE TRAP-q�niti-. (locate on site plan) Depth below grade:A Material of constructionfl tMooncret.e_metal_FRP _other(ezplain) Dimensions: I Scum thiclness: of Distance from top of scum to top of outlet tee or baffle: All N Distance from bottom of scum to bottom 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 o/f leakage, etc•) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) propertyAddreas: 26 Prudence Lane Cotuit ,Mass . 02635 Owner,. Fred Pula Date of Inspocti0n:4/2 3/9 6 TIGHT OR HOLDING TANK:jy!w`i (locate on sits plan) e Depth below grade: Al _ Material of construction:12concrete metal_FRP _other(explain) /U> Dimensions:_ r'+ Capacity: l�id gallons Design flow: LLj gallons/day Alarm level: )fir} Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOY:A !. E': (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if lewl and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,etc.) PUMP CHAMBER�G_`l,/ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc. iLt� C,v�Yi�f�'TS (revised 11/03/95) 7 U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 26 Prudence Lane Cotuit ,Mass . 02635 Owner. Fred Pula Date of Inspection: 4/2 3/9 6 14, SOIL ABSORPTION SYSTEM (SAS): /.: �J'! �'-u (locate on site plan, if pocaible;excavation not required, but may be apprwcirnated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number• leachin8 chambers,number: C Sea;ping galleries, number: C, leaching trenches, number,leagth:—� ------ leaching fields, number, dimensions: C i overflow cesspool, number: nts: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Sous; Loamy sand to fine sand•No Sl ns of h fraulis failure or n .ondi vege a Sion is norms No repairs are needed at the present time . CESSPOOLS:�:Z't_ (Locate on site plan) Humber and configuration: / Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer. A Dimensions of cesspool: Ails Materials of constriction:_ Ai 1j Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comment(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) A PRIVY: ti��, (locate on site plan) I Dimensions: Materials of construction: X / Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc- (revised 11/03/915) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddrera: 26 Prudence Lane Cotuit ,Mass . 02635 OwnOr Fred Pula Date of Inspection:4/2 3/9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: ' include tier to at least two permanent references landmarks or benchmarks locate all wells within 100' Cotuit Water Company 428-2687 T� y -7 d7r74/v/)J� `b 10i ' I 3p C� DEPTH TO GROUNDWATER Depth to groundwater. 16 1 + feet method of determination or approximation: c tuit No water encounters a (revised 11/03/95) 9 �1� V THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. .y Has satisfied the Departments qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ' ' •ion of Water Pollution Control ' L TOWNS OF BARNSTABLE LOCATION)4 e,Kie. SEWAGE # VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �6�� e E (size) NO.OF BEDROOMS BUILDER OR OWNER �1 / PERMTTDATE: #W'-E-2&�-,COMPLIANCE DATE: Separation Distance Between the: 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) Feet Edge of Wetland and Leaching Facility(If any well ds e t within 300 rfet of leachi g�� Feet Furnished b d P r No.... ., THE COMMONWEALTH OF MASSACHUSETTS BOA R® ror-717-0-Aln, ------......OF....:. .......... Application for Dispooal Works Tona:rution ywrmit Application is hereby made for a Permit to Construct or Repair ( ) an Ind• idual Sewage Disp)a, System at: ............Cf. P. ' .... str'l�a -' / ----- .. � ' . ocati - dress or I.ot a O -. wn Address � In er Address j,r- UType of Building ,� Size Lot_��.................Sq. feet Dwelling 7'!o. of Bedrooms_____________ ........_.............Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures --------------- -- W Design Flow..................1�.___.� allons per person per day. Total daily flow........... __________....................gallons. W Septic Tank l—Liquid capacity�.__..___gallons Length................ Width ��__�__/-____-____ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.... -__..__ --. 1 ____ otal leaching area....................sq. ft. Seepage Pit No______ __________ Diameter __. ep inlet______..__.... . . Total leac ng area..................sq. ft. Z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r3� Test Pit No. 2................minutes per inch Depth of T t Pit.................... Depth to ground water........................ -------------------- -• •-••-•---•-••-•.........---•-•-•----•••......................................................... 0 Description of Soil................................ G- =--••••--•-•----------------•---•--------•------ ................................................... x U ••-•--••---•--••••••-•-•--•-•-•._...-•---••-•-••-•--•-•-••-••••--••-••••--••••••-•-••••••-••••••--•-•-•-•-••-•-•-•-•--------•--------------•-••••-•---•--•-•••--••-•--•--•-•----•-••-•-•--•••••--------- W -----------------------------•--•••------•-••••-•--•----•---•-----------•-------------••--......-•-----••-•----------------•-----------------••----•••••-•--•-••--•-----•-•-•-•--•-•-•-•-•-._..._•••••- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has en ' l rd f hea Signed... _ •- --••• ••-•• = •• ••••.......................... •-•••••••••-•--•----•-•-•_----•- Application Approved By....... ,,c -----•-••- . D-ate Date Application Disapproved for the following reasons------------------------------------------------•--------------------------------._...•••....................... .........................•--------------•--...-----...-------------------•-----------•-------------------I-•-•-=•-•-••..._--•-••••...•-•--••--•••---••-•••-•-••...---•--••-•-•--•-•--••-•-•--••--•••••-•• Date PermitNo......................................................... Issued........................................................ _ Date No.... .,... FEE.... THE COMMONWEALTH OF MASSACHUSETTS BOA RR HEAL , pphration for Uhipvii l Works Tongtrurtion Urrmit 01 Application is hereby made.for a Permit to Construct (410 or Repair ,( . ) an In ' idual Sewage Disp al System at: -ocati dress or Lot ......�'�. - -....... .... ` "' _ ° .:: .. .............. Ow Address W ^ In t er Address UType of Buildin Size Lot-/ . R' . feet Dwelling No. of Bedrooms.::.. ........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of'Building No: of persons____________________________ Showers — Cafeteria a' Other fixtures W Design Flow...... :_cIt— :__ gallons per person per day. Total daily flow.___.._ __ ............gallons. 9 Septic Tank-Liquid`capacity gallons Length r________________Width................ Diameter................ Depth_______________- xDisposal Trench No.__.._:____ Width otal leaching area....................sq. ft. Seepage Pit No ___ ___________ Diameter ep1' inlet....... . Total leac ng 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........................ Test Pit No.,2................minutes per inch , Depth of,T ,t Pit .................. Depth to ground water........................ ODescription of Soil.............................. = i ----------•-•-------•------•------ . ... --------------._..........--- U ---------------------------•---------------------------------•-------------------------------•----•-----------------............................................ ................................ ------------ ----------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable----------------------------------............................................................... ----------------------------------------------•-•--•-------•-------------------------==----••------•---••-•--------------------------•--------•-------••----•--------------•--•--•-•-----•-----•--.._.._ Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary C de— The under ' ned fur her agrees not to place the system in operation until a Certificate of Compliance has rd f hea Signed-=N D to Application Approved By____,_ ' Date Application Disapproved for the following reasons:.____::_________________________........................................................... ------------------ ...-•--••---••--•-----•-•------------------•-••---•-•------------------------••-•-------.._...-•--------------------------------=-----------------------------------.--..---------------•-•------....... Date PermitNo.......................................................... Issued........................................................ \ Date - t y THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTHY; ....OF............ .°.1 ..................... (err tfiratr of To; finna THIS IS CERTIFY, h the I dividyal Sewage Disposal System constructed ( ) or Repaired ( ) by -. : .....---- " '' ' ------------------------------------------•----------....................................................... Installer r at...............i�..... has been installed in accordance with the provisions of Article of The State Sanitary Code as Id •bed in the application for Disposal Works Construction Permit No..___ __________________ dated------------ ` ........... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTR�D D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .:............ Inspector..... ............................ ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD QV HEALTH No. .. e!'.... FEE.... :' Permission is hereby grantedA4,4'� ............... ............................................... to Construct 4^ or pair ( ) an I di all Sewage D sp stem at No:.-•--•-- L .:..� '2�^rrxPt.I ._ ."'.......... ....................................................... Street i as shown on the application for Disposal Works Construction Permit No.__ Q_ Dated............ fa ---------•-------------------------------------------•---------------......_._...._..-•-•--••••........_ Board of Health . DATE.....................-.......................................................... FORM 1255 HOBBS & WARREN. 'INC.. PUBLISHERS *.` ��. �� 0� r •... • �' � � J .. a c-�• �"' � �� U �N��f C� � C�� r�� _ ��- � � �