HomeMy WebLinkAbout0122 SCHOOL STREET - Health 122 School Street:
I Cotuit
A= 020 037
I
TOWN OF BARNSTABLE
LOCATION c�,, I Y-+• SEWAGE # �a04
E O�
VILLAGE t A I IM.� M ASSESSOR'S, AP & LOTc 16 _3--2"
INSTALLER'S NAME&PHONE NO.� S.
SEPTIC TANK CAPACITY I SyaG�-i4(Plt,. — 1{1
LEACHING FACILITY: (type) �-fjLL t (size) Iy o t y 4-7.5
NO. OF BEDROOMS S
BUILDER O OWNER 11Ck,4�Gk Cz W k,1 e,
PERMITDATE: 2 2310-1— COMPLIANCE DATE: 1a U �
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 lea 'ng facility) Feet
Furnished
e
r
1 13 '-8 u 2 C�
1 L341 -6"
30-1
� �3� -® � ►-3� oa
N � � �o
_. - _.. 1. r ...O..ti..�...a•'^Yr'�'""'�''^ ra.w.. ,.�"........rlw...w'+.,�°wV+61•+^.'�.w�`. ^...,�wx. �w s'Y-�'a'8.. -. a - .
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEAL H DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for �Di!6pozar 6p6tem Con.5truction Permit
Application for a Permit to Construct( ) Repair Upgrade( Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. � �j2i 1Qa 5 Owner's Nome,Adidress, Tel.No.
Assessor's Map/Parcel
77Y �6
v Installer's Name,Address,and Tel.No. _ 1 If Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (
Other Type of Building No.of Persons Showers(Z) Cafeteria( )
Other Fixtures —
-
Design Flow(min.required) jp Design flow provided gpd
Plan Date ZVO j/ Number of sheets Revision Date �—
Title
Size of Septic Tank— � Type of S.A.S.
Description of Soil /ZtfO'
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by%4.ais Board of He .
Sig Date
Application Approved by Date
a!,.Application Disapproved.,by: .Date
.,for the'following reasons
7
Permit No. Date Issued
�....,�-..-.,.�. •. �. . :sv ,. y.^i. -.., yC .-� +.....'t-v,;.r'�".y.J'�'r.�+'....`�(yP•'�.y1..'°ao.+t.'.-^... _nW ti•'4.rni" -. -«° •�-••.:�
1 No. �� .., _ �'°, ti _ M1 Fee VYes
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpplicatton for �h6pozal �§p5tem CCon5trUction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
%SS; Owner's Name,A ress,a Tel.No,Location Address or Lot No. .5e I
Assessor's Map/Parcel aO
�7Y—
^ Installer's Name,Address,and Teel..No. j`' _ 7 4f Designer's Name,Address and Tel.No.
Type of Building: ` y01
Dwelling No.of Bedrooms Lot Size` sq.ft. Garbage Grinder (k�)
1
Other Type of Building �/� �- No.of Persons Showers Cafeteria( );
Other Fixtures �—
Design Flow(mina.r/ 7 pequired) _/�d Design flow provided >� gpd
Plan Date /yOl/ L�l� Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
r-
a ✓ i
Description of Soil __:5
u`
1
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal`system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
A Compliance has been issued by'this Board of Hea th.
Sig e _ —Date �,�
Application Approved by U � _�`.!� ++ /, � .A� Date /,�2 �?
Application Disapproved by: / U r l �`� Date
for the following reasons
Permit No. /a'�:j �/ Date Issued �ix /
' THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage{�Disposal System Constructed ( ) Repaired ( /S Upgraded ( )
U Abandoned( )by d 5✓h - J ,-V Z
at h been co/nstruct accordance
10
with the provisions of Title 5 and the for Disposal System Construction Permit NQ' �D/ dated
Installer ArY\V•^r-t C.0 A MQ� Designer "�-
#bedrooms 5 Approved design flow^ �.� gpd
The issuance of this permitshall of be/construed as a guarantee that the system will f�unctib`n as�d��sig\r d.
Date �/ / �' � Inspector
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
1 1=i.5po!6al �&p.5tem Con5trUction Permit
Permission is hereby ,r��j t a)to Construct ( )1 Reppaiir�-(_ ) Upgrade,(>j ) bandon ( )
System located atn(
a
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must becompl ted within three years of the date this permit.
Date ���7 Approved by
FROM :down cape engineering inc FAX NO. :150836213880 Mar. 27 2007 12:29PM P2
Town of]Barnstable
Regulatory Services
Thomas F. Geiler,Director
Public Health Division
ua" Thomas McKean,Director
2.o0 Maio Street,Ryaanis,MA 02601
Office: 509-862-464A Far,: 509-790-63M
Installer & Desivlaer Certification Form
Date: Sewage Permitft Assessor's MaplParcel.203
li? igro
es' er: U W ri carec, Installer:
Address: � jAl
R� V Address:
on was issued a permit to iz=11 a
{date) (installer) �
septic system at - ls� " / ' based on a design drawn by
(address)
dated
(des er}
I certify that the septic system referenced above w2s installed substantially according to
the design, which tnay include minor approved changes such as lateral relocation of the
distribution box andlor septic tank.
I certify that the septic system referenced above was installed with major eh2ixagesLL_( ,e.
-- greater than 10' lateral relocation of the SAS or any vertical relocation of any, component
of the septic system)but in accordance with State &Local Regulations. PI_an revision or
?er"
by designer to follow_ ARNE H.OJALACIVIL
re) No.3�79�
N A L _
(Designer's Signature) (A.f ix DesiCmer's Stamp here)
TtI,EARE ItETtJRN TC1 BARNSTABLE PUBLIC HtALTH DIVISION. CERTIFICATE OF
COMPIrIANCI: WILL NOT BE ISSUED Uh'TIL BOTH THIS DORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TI4ANK YOU.
0,Health/Scotic/Desiva Certification Farm 3.26-04.doc
I --
DATE 8t/9/06
PROPERTY ADDRESS 122 school street
Cotuit
MA 02635
On the above date, the septic system at the address above was t5��V
Inspected.
This system consists of the following:
1., 2-6X8 cezz/2ooiz.1
2.i 2-6'X90' c.e.6ZI?oo.2z
Based on inspection, I certify the following conditions:
3.1 7h.iz .iz not a 7.it. e ;rive ze/2t.ic zy.tem.iIt .ins a zewage -5yztem.,
4., 7h.iz zewage zyztem .i.6 .in p1tope2 woak.ing oadez at the /2aeaent t.ime.1
7h.iz .ib a z/z&t zyztem:l
SIGNATURE
Name: Robert A. Paolini
Company: Joseph P. Macomber & Son Inc. a
1
Address: P. 0. Box 66
Centerville. Mass 02632
Phone: 508-775-3338 or 508-775-6412 C"
JOSEPH P. MACOMBER & SON, INC. .
Tanks-Cesspools-Leachfields
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775-3338 775.6412
•
COMMONWEALTH.OF MASSACHUSETTS
EXECUTWE OFFICE:OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVII'ONMENTAL PROTECTION
Y
C
TITLE 5
OFFICIAL INSPECTION FORM- NOTIORVOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART•A
CERTIFICATION
Property Address.. 122 School street"
o uit MA 02635
Owner's Name: Richard White
Owner's Address:
Date of Inspection: /T(9
Name of Inspector:(please print Rub rt
Company Name: E S:o.n In a.
Mailing Address: a,3,6,•02632
en pltv.c a,
Telephone Number: 5 0 8-7 7 5-�3 3
CERTIFICATION STATEMENT
I certify that I have personally inspected the.sewage disposal system at this address and thatthe 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•proper function and maintenance of on-site sewage disposal systems.I am a DEP
approved system inspector Pursuant to;Section 15340 of-Title 5(310 CMR 15A00). The system:
XXXPasses _
Conditionally Passes
Needs Further Evaluation by the Local Approving,Authority
Fail
Inspector's'Signatures
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 a is 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
DEP.The original should be sent to-the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This•report only describes conditions at the time of inspection and under the conditions of use at that
how the system will perform in the future under the game or different
time.This inspection does not address
conditions of use.
6/15/2000 page 1
I
Page 2 of I I
OFFICIAL INSPECTIONYORM—,NOT FOR.VOLUNTAR3t ASSESSIVI['- NTS.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION—FORM.
PART A
CERTIFICATION(continued)
Property Address: 122 School Street
Cotuit MAC -0263 5
Owner: Rich
Date of Inspection: %CJ 6 K
Inspection Summary: .Check :A B,C,D or.B•/ALW,AYINoomplete•,all of Section:D .
A. System Passes: YES
NO I have not found any information which indicatesffiat•any of the failure criteria desciibed'b 310 CMR
15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indidated below.
Comments:
Sewage 6us.t8m &3 .in /2ao/2ea wozk.ing oadea at .the 12,2eaent
f�mo_
B. System Conditionally Passes:
NO One or more system components-as described in the"Condition6Pess"A ection..need toibe.teplaced:or
repaired.The system,upon completion of the replacement or repair,as approved by thtr Board of Health,will pass.
Answer yes,no or not-determined(Y,N,ND)in-the for-the following statements.If"not determined"please
explain.
NO The septic tank is metal and.avcr20 years olds'or the septic-tank.(whether'metal or.not)is tsstrxucturally
unsound,exhibits substantial infiltration or exfiltration or tank failure-is.imminent.System will pass inspection if the
existing tank is replaced with a complying septic tanlc;#,s�a•,pp oved by.the. and of Health.
*A metal septic tank will pass inspection-if it is striieturaliy sound,not-leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is.available.
ND explain:
NQ Observation of sewage backup'or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken;settled-or uneven distribution box.System will pass inspectionif(with
approval of Board of Health):
'broken pipe(s)are replaced
obstmetion is removed '
T distribution box is levelM'dr ieplact d
ND explain;
NO The system required pumping.more than 4 times a year due tobioken 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
ND explairr;
i
Page 3 crf 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
CERTIFICATION(continued)
Property Address: 1 22 School Street
o ui
Owner:. Richar i e.
Date of Inspection. f 9/0 6
C. Further Evaluation-is Required by the Board of Health:
NO Conditions.exist which•require further evaluation by the Board of Health:in order to determine ifthe system
is failing to protect public health,.safety or the environment. -
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(I)(b)that the
system is not functioning in a manner.which.will protect public health,safety and the environment:
no Cesspool or privy is within,50 feet of a'surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(andPublic Water Supplier,if any)determines that the p
system is functioning in a manner that protects the public health,safety and environment:
n o 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. ,
SAS and the SAS is'within a Zone 1 of a public water supply
n o The system has a septic tank and
.
n o The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well.
noo .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 v,i.6uai
**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 froom that facilno other
ity and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided
failure criteria are triggered.A copy of the analysis must be attached to this form. .
3. Other:
3
Page.4 of 11
OFFICIAL INSPECTION FORM--NOT FOR:YOLUNTARY ASSESSMENTS
SUBSURRFACE SEWAGE DISPOSAL:-SYSTEM.INSPECTION:F.ORM
PART A ...
CERTIFICATION(continued)
Property Address: 122 Scholl Street
Cotuit KA 02635
Owner: Richard Whi tP
Date of Inspection:
D. System Failure Criteria applicable to all 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
_ Discharge.or ponding of effluent to the surface o€theground 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
X Liquid depth in-cesspool is less than.6"below.invert or available?volume is less than'%.day flow
_ Required pumping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ r .Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion.of a cesspool-or privy is within a:Zone 1,of a-public well..,
y Any portion of a cesspool or privy is within.50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.{This system:passes if the well water•analysis,
performed at a DEP certified laboratory,for 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 nwst be attached to this forT.l'
NO (Yes/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 fails,.The system owner.should contact the Board of
Health to determine what will.be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve.a facility with a design flow of 1.0,00.0 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
_ y the system is within 200 feet of a tributary to a surface drinking water supply
— _ the system is located in a nitrogen sensitive area()nterim Wellhead Protection Area-IWPA)or a mapped
Zone II 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
"yes"in Section D above We 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 accordance with 310 CMR
15.304.The system owner should contact the appropriate regional.office of the Department.
4
Page S of.I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL SYS.'TEM.INSPECTION FORM
PART B
CHECKLIST
Property Address: 122 .School Street '
o ui
Owner: Richard- White
Date of Inspection:
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 _.Has the system received normal flows in the.previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?
— Were as built plans of the system obtained and examined?(If they were not available hole as N/A)
_ 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 system components,excluding the SAS,located on site?.
. _ Were the septic tank manholes uncovered,,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
. _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems? _
The size and location of the Soil Absorption-System(SAS)on the site has been determined based on:
Yes no
X Existing information.For example,a plan at bite Board ofliealth.
_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b))
' I
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISP,OSAL.SYSTEM-INSPECTION FORM �
PART C
SYSTEM INFORMATION
Property Address- 122 School Street
Cotuit MA 02635
Owner: Richard Whit_ e
Date of.Inspection:_
FLOW CONDITI.ONS
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): 3 3 0
Number of current residents: 5
Does residence have a garbage grinder(yes or no): n o
Is laundry on a separate sewage system(yes or no):_,a w[ifyes separate inspection required]
Laundry system inspected(yes or no):•U_E,s _ '73, 97
o
Seasonal use: no. f'r•P•
): gQll6ns(yes or
Water.meter readings,if available(last 2 years usage(gpd)): 00S=0g6 �//(a►i,5 C.P D= 7/•a3
Sump pump(yes or no): n o
Last date of occupancy: u rtkn o wn
COMMERCIAL/IIISTRIAL
Type of esta '.ant: -NIA
Design flowed on 310 CMR 15.203): gpd
Basis of d.bsign`'flow(seats/persons/sgft,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):_
Water-meter readings,if available:
Last date of occupancy/use: .
OTHER(describe):
GENERAL INFORMATION
Pumping Records _
Source of information: N/A
Was system pumped as part of the inspection(yes or no):_UZ,5
If yes,volume pumped: 1000aallons--How was quantity pumped determined?22ea-suzed
Reason for pumping: c e s s,?o o.2.3
TYPE OF SYSTEM
_Septic tank,distribution box,soil absorption.system
X Single cesspool
X Overflow cesspool
—Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
—Tight tank _Attach a copy of the DEP approval
X Other(describe): .sptit S e-Rt i s
Approximate age of all components,date installed(if known)and source of information:
5n 1=4 4
Were sewage odors detected when arriving at the site(yes or no):n 00
6
Page 7 pf I I
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL'S.XS.TEM INSPECTION FORM
f PART C
SYSTEM INFORMATION.(continued)
Property Address: 122 School Street
Cotuit MA 02635
Owner: Richard White
Date of Inspection:
BUILDING SEWER(locate on.site plan)
Depth below grade: 10
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.):
lo.int s apReaa t.i4ht no .2eakageo l/ented thaouah house uanto
SEPTIC TANK:, ; locate on site plan)
Depth below grade:
Material of construction:—concrete—metal—fiberglass—polyethylene
—othe-(explain)
If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_,._.(attach.a copy of
certificate)
Dimensions:
Sludge depth:_
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,structural integrity,liquid levels'
as related to outlet invert,evidence of leakage,etc.):
GREASE TRAP: Nalocate 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.):
Gaeaze taaR ins not aae sent
7
Page 8 of 11
OFFICIAL INSPECTION FORM.--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSALS INSPECTION FORM .
PART C
SYSTEM INFORMAT)<ON(continued)
Property Address: 122 School Street
Cotuit MA 02635
Owner: Richard
Date of Inspection:
TIGHT or HOLDING TANK: yin (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene otheir(explaft*
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes.or no):.
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
Tight on _h6-0dg,nry fnnkA ase not Rae�sent
DISTRIBUTION BOX: NO (if present must be opened)(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.):
Dizta.igut.ion Sox .ins not Raesent
PUMP CHAMBER: NO (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.):
13uMR chamlea .i4 not paezenIt
8
Page.9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION.FORM
PART C
SYSTEM INFORMATION(continued):
Property Address: 122 School Street
Cotuit MA- 02635
Owner: Richard White
Date of Inspection: ;
SOIL ABSORPTION SYSTEM(SAS): ,(locate on.site plan,excavation not,required)
If SAS not located explain why:
Located .see Rage 10.1 ,
Type
teaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
,_overflow cesspool,number:__2 612-tit .sy-stem 1 oh 1 .s.ide I. on. othe4.1
umovative/alternative system Type/name of technology:
Commenits(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
.so•its aae day ! Vegeta .ion L6 nb/thaai
CESSPOOLS: (cesspool must be.pumped as part.of inspection)(locate on site plan)
Number and configuration:Z- 2-
Depth—top of liquid to inlet invert:
Depth of solids layer: -Wt
Depth of scum layer: SWB" —
Dimensions of cesspool: 2—&X St' ?_ CO�L`01
Materials of construction:46)O[
Indication of groundwater inflow(yes tor no):.
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Loamy to .sandy zoii., No zigns o, ,1a.iivae__o2 Rond.ingo- Soi.2,3 aae
d2yo Vegetatation i.6 noama�o
PRIVY: NO (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.):
l a•ivy .iz not pnesent
9
Page 10 of 11 Y
OFFICIAL: INSPECTION CORM.-NOT FOR VOLUNTARY.ASSESSMENTS
� S ,,SURFACE,-gEWAGE:DISPOSAI:SYSTEM INSPECTION FARM
: . PART C.`
SYSTEM INFORMATION(continued)
Property Address: 122 School: Street
Cotuit MA 02635
Owner: Richard White
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch ofthe sewage disposal system including ties to at least two permanent reference landmarks or
benclai narks.Locate all wells within 100 feet.Locate where public water supply enters the building. .
f
i
x
r ^
10
Page l Lof 11 .
OFFICIAL INSPECTION-FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION.(continued)
Property Address: . 122 School Street
Cotuit MA *02635
Owner: Richard White"
Date of Inspection: _
SUE EXAM
Slope
Surface water
Check cellar -
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed-
y e s Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain: u. .ft n2ad -
no Checked`with local excavators,installers-(attach documentation)
1�ehAccessed USGS database=explainAttR:t own.,&a to stgCea.,ma..uz
You must describe how you established the high ground water elevation: .
Used : Cape Cod Commizi:on Oaten 7at ee CoAtouaz And P ul2.te Uatea SUPP4
Veii head paoteet-io•n aaeas ogl2o Sent 1995 -
Glate2 aezomeeh o, tice cape cad eomm.is:ion.,
Top of Oround
CetwAl
feet ./0
�� c6QC
Groundwater: Feet Below Bottom Pit High
. g Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore,the vertical.separation distance between the bottom
of the leaching pit and the adjusted groundwater table is
feet.
x10
. 11 .
•„»,.,,.rw ., B STABLE . .. .�`�'•-•'Y
'FU�iN OF . DOAAD QF 11$AIT11
-BuBSURFACR SEWAGE 0I01684 Sys'l` m INSrRCTtON FORM - PART D.•' CEitTIFICATION .�
".'"''''`'"^"•"""'""'�'�"� -TYPE on PRINT.01,301"Y"
PROPERTY rN,SPL07FJ7
STREET ADD93SS 1 22- ;School .Street Cotuit 02635
A•SS•ESSORS MAP, DLWK AND 'PARCa 4
OWNSW's NAME Rich arrl...,�Ih .Ce
PART°'D 08)?t IFICATION
NAME bF 'INSPECTOR Robert A- Pao3i ; ;.�, - - •
LT
COMPANY NAMEos'r-nx i �. n t��, ,' •. ''p' �'r3 iErr.+`++Fr+r.>r
Y
COMPANY ApDEiESS ox?"6s: -O� . r�°il�.� M "° 32-006� w
sire k: _ Yown�•or 01ty.. .att P
COMPANY TM&PHONE t'508. ):�73 " 3838 VAX 1' 508•,$1'90 f57$ ,
CEng-I•FICATION. STATEMENT .
v ersonall .inn p to p A y
z certify that I •ha; e p Y a• sated the Qewa 'dig o a�. system at
this Ilddress -and that.-ttia' information rep6rted ,is 'true#.. noogra•te•, Arid
oms addete es of the time .gf,ei nspsation.,• The in;Feotiorn was performed and any*
recommendations regarding upgrade-1 .mainte.nanoe I'. and repair ,are• aongistent
witD my trainip,9 and experience in the .ppoper function- acid tnaintenanoe of on.
site sewage disposal systems
Cheek ones
System P•ASD _�•
The inspection which J. have .00ndugted has ,,nat- toiind any infOrmation .
which indicate$' that• :the system' Sails to ' adequately.. protect .publi4
health or the env i.ropmen t as defined io- .310 CMR. 1 g$80.3•, -Apy f4iture
criteria nbt ••evaluas'fed' are as stated in tthp .FAILUIM -OR.I.MA .seation e•f
this. form. '
System FAILED* ;
The inspectioh which I have oo�dtRSted 'haS found that the 1#yatem fails to
protect the public stealth and thq engrortment ' in aaooVdanc1e with title
' 61 310 CMR 16 4Q0 j and as•speoif ioaliy noted -on .PAR.T.' C -. FAILURE
CRITERIA of this insPectiq ;
Inspector 6ignature' Date'
s ro46d -to the QWH99.1 unit
necopy ofthis oeitific ia'n nu HEAD
'•
where appli•oable) ALnd thV I3QARD OF 118A �'ll� ..
* if the inspection FAIL•L- .1 'th** .own*1,',ox Qperator a ia],I. upga?ade,•the system.
within one year of the da'to of the inspection, unless: a];'lctascl Qr regiaired
as provided iT1 WO CHR 15 ,305.k . .
#'P COMMONWEALTH OF MASSACHUSETTS
OREM EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
t
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
122 School St. rF
Property Address: RECEIVED
Cott i t f MA
Owner's Name: Richard White
Owner's Address: Box 366 N1AF� 0 7 2001
De r byline.,nee VT 05830 '
Date of Inspection: % 3 to i TOWN OF BARNSTABLE
HEALTH DEPT.
Name of Inspector:(please print) Wi 11 i am E_ . Robinson Sr.
Company Name: William E. Robinson Septic Service,
Mailing Address: P O Box 1089 .
Centerville, MA
Telephone Number: ( 5 0 8) 7 7 5-8 7 7 6
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 proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant toSection 15.340 of Title 5(310 CMR 15.000). The system:
+/ Passes
Conditionally Passes a
Needs Further Evaluation by the Local Approving Authority
Flails ,
Inspector's Signature:[fsyL;U'� ..�-, � Date: i -3 o
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaRhor
DEP)within 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
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of l l 1.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 122 Seheel= St.
Owner: White
Date of Inspection: -,44 0/
Inspection Summary: Check A,B,C,D or E/ALWAYS complete,all of Section D
t:
A. Syste 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:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
rep Ared.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
An wer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
ex lain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
un und,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
exr tmg tank is replaced with a complying septic tank as approved by the Board of Health.
tcted
tal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
ting that the tank is less than 20 years old is available.
pla'm:
Observation of sewage backup or break out or high static water level in the distribution box due to-broken or
pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
val of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
ass inspection if(with approval of the Board of Health):
i
broken pipe(s)are replaced
obstruction is removed
ND explain:
lPage 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 122 School St
Cotuit
Owner: White
Date of Inspection: i^3--0 1
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 fa i _ng to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
s stem 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 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank 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 front 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 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.
3. Other:
3 .
Page 4 of l 1 '
Y
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1 22 School St.
+-
Owner: white
Date of Inspection: /e 3e—o
D. ystem Failure Criteria applicable to all systems:
You ust indicate"yes"or"no"to each of the following for all inspections:
Yes o
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
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''/z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
-T Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
4 water supply.
Any portion of a cesspool or privy is within a Zone 1 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. [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/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 fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. 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
gP
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 o
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 11 of a public water supply.well a
If yo have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes 'n Section D above the large system has fafled.The owner or operator of any large system considered a
signifi ant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304 The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 122 School St_
Cotuit
Owner: White
Date of Inspection: 6 3 0
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No ,
Pumping information was provided by the owner,occupant,or Board of Health
_ Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
e system recently or as art of this inspection?
water-been introduced to the P
Have large volumes ofY Y P
-0 Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Were all system components,excluding the SAS, located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ,
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes
Y.0
xisting information.For example,a plan at the Board,of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]
5
Page 6 of l l F
. d
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 122 School St.
Cotuit
Owner: White
Date of Inspection: y-319-0 I
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):q Number of bedrooms(actual): q
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): '2 oZ 0
Number of current residents: 0
Does residence have a garbage grinder(yes or no):k 0
Is laundry on a separate sewage system(yes or no):" [if yes separate inspection required]
Laundry system inspected(yes or no): 4-0
Seasonal use:(yes or no):
Water meter readings,if available(last 2 years usage(gpd)): 2000 21 ,000 gal.
Sump pump(yes or no): J 1999 27 ,000 gal.
Last date of occupancy:-�
CO_ MERCIAL/INDUSTRIAL
Type f establishment:
Desig flow(based on 310 CMR 15.203): RDd
Basis f design flow(seats/persons/sqft,etc.):
Greas trap present(yes or no):
Indus ial waste holding tank present(yes or no):_
Non- anitary waste discharged to the Title 5 system(yes or no):
I meter readings,if available:
Las date of occupancy/use:
O ER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of4he inspection(yes or no):_4,v
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping: h A-
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
Agle cesspool
_jZOverflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all.components,date installed(if known)and source of information:
- S 11YZ, 3
Were sewage odors detected when arriving at the site(yes or no): %1i D
6
'Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) _
Property Address: 1� 2,z SG-h--Pe 1 St.
CotLit
Owner: Whi tP
Date of Inspection: i —3,R
UILDING SEWER(locate on site plan)
De th below grade:
Ma erials of construction:—cast iron 40 PVC other(explain):
Dis ce from private water supply well or suction line:
Co ents(on condition of joints,venting,evidence of leakage,etc.):
SEP IC TANK:—(locate on site plan)
Dept below grade:
Mate ial of construction:—concrete metal—fiberglass polyethylene
_oher(explain)
If tan<is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certi cate)
Dim nsions:
Slud a depth:
Dis nce from top of sludge to bottom of outlet tee or baffle:
Sc thickness:
Dis ance from top of scum to top of outlet tee or baffle:
Di tance from bottom of scum to bottom of outlet tee or baffle: .
H w were dimensions determined:
mments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
related to outlet invert,evidence of.leakage,etc.):
I
G EASE TRAP:—(locate on site plan) < `
Dep below grade:
Mat rial of construction: concrete metal—fiberglass polyethylene_other
(eXP ); F
Dim nsions: '
Scu thickness:
Dis ce from top of scum to top of outlet tee or baffle:
Dis ce from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
c` Co ents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as r lated to outlet invert,evidence of leakage,etc.): . - w
7
Page 8 of 11'
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 122 School St.
Cotuit
Owner: White
Date of Inspection: / ..3 o e t
TH HT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Dept below grade:
Mater al of construction: concrete metal fiberglass polyethylene other(explain):
Dimen ions:
Capaci gallons
Design low: gallons/day
Alarm p esent(yes or no):
Alarm 1 vel: Alarm in working order(yes or no):
Date of ast pumping:
Comme is(condition of alarm and float switches,etc.):
DIST BUTION BOX: (if present must be opened)(locate on site plan)
De of liquid level above outlet invert:
Co ents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leak ge into or out of box,etc.):
PUM CHAMBER: (locate on site plan)
Pump;in working order(yes or no):
Al s in working order(yes or no):
Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
'Page 9 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 122 School St. .
Cotuit
Owner: White
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): a/ {locate on site plan,excavation not required)
If SAS not located explain why:
Ty�leaching pits,number:
leaching chambers,num er:
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 ponding,damp soil,condition of vegetation,
etc.):
r
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: t/- k -6' `
Depth—top of liquid to inlet invert:
Depth of solids layer: /=3
Depth of scum layer:
Dimensions of cesspool: K
Materials of construction: hu G 1 s
Indication of groundwater inflow(yes or no): �
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
A,o '11iv,;r Ti ,P—j
PR (locate on site plan)
Mate ials of construction:
Dim nsions:
Dep of solids:
Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
:
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 122 School St.
Cotuit
Owner: White
Date of Inspection: 1 y3
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 the building.
r
t
36
'N
71
10
I
P2ge l l of 1 i
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 122 School St.
Cotuit
Owner: White
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
i
Estimated depth to ground water�ZS .feet
Please indicate(check)all methods used to determine the high ground water elevation:
design plans on record-If checked date of design Obtained from system d gn p gnlan reviewed:P
served 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:
11
LEGEND TOP FNDN. AT EL. 50.0' (HOUSE) SEPTIC PROFILE NOTES O
TOP FNDN. AT EL. 50.3 (BARN)
a ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 1. DATUM IS APPROXIMATE NGVD
100.0 PROPOSED SPOT ELEVATION ACCESS COVER TO WITHIN 3" OF FIN. GRADE
ACCESS COVER (WATERTIGHT) TO
100X0 EXISTING SPOT ELEVATION 49.0' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE
2. MUNICIPAL WATER IS EXISTING LOCUS
2% SLOPE REQUIRED OVER SYSTEM 49 0'
3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o a
F1001 PROPOSED CONTOUR RUN PIPE LEVEL- 2" DOUBLE WASHED PEASTONE a
* OR GEOTIaCTILE FABRIC
. 47.3 FOR FIRST 2 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO
15oD
100 EXISTING CONTOUR *B=48.67' PROPOSED 3' MAX. H- 10 4schoo i
(PROPOST62
GALLON SEPTIC146 -37. ' " st.
' TANK (H- 1DAS X 46.3 5. PIPE JOINTS TO BE MADE WATERTIGHT. g cotu t
45.6'
AFFLE 45.77 0 m 0 0 m = = 0 ,
0 45.5' p p p O O 0 ED � 06. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH Ba
�6" CRUSHED STONE OR MECHANICAL [] 1 0 m p p p p p MASS. ENVIRONMENTAL CODE TITLE V.
COMPACTION. (15.221 [2]) 2' = � 0 a 0 0 1:1 0 O 43.5'
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO
DEPTH of FI_ow = 4'
TEE SIZES: 3/4" TO 1 1/2 DOUBLE WASHED STONE BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE.
INLET DEPTH 1'0"
8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
ourLEr DEPTH = 14 ( 3.8 q SLOPE) ( 1 % SLOPE) ( 1 % SLOPE)
A=18' LEACHING 5' WITHOUTONENTS INSP INSPECTION BY9. NOT TO BOARD OFILLED E HEALTH AND C PERMISSION LOCUS MAP
OR CONEALED
FOUNDATION B=82' SEPTIC TANK 60 D BOX 12
FACILITY OBTAINED FROM BOARD OF HEALTH.
MIN.( 2.5 % SLOPE) NOT TO SCALE
10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING
DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION ASSESSORS MAP 20 PARCEL 37
BOTTOM TH-1 EL. 38.5' OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO
COMMENCEMENT OF WORK. LOCUS IS WITHIN AP OVERLAY DISTRICT
11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND
REMOVED OR PUMPED AND FILLED WITH CLEAN SAND.
12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE
TEST HOLE LOGS
REMOVED 5' BENEATH AND AROUND THE PROPOSED
LEACHING FACILITY. ENGINEER: DAVID FLAHERTY, R.S.
13. INSTALLER TO VERIFY FEASABILITY OF NEW SEWER LINE WITNESS: DON DESMARAIS, R.S.
FROM BARN PRIOR TO INSTALLING ANY COMPONENT. DATE: OCTOBER 31, 2006
PERC. RATE _ < 2 MIN/INCH
CLASS 1 SOILS P# 11488
53.59'
50.92' ELEV. ELEV.
LOT AREA SYSTEM DESIGN.
A A
28,346 SF f GARBAGE DISPOSER IS NOT ALLOWED LS LS
10YR 4/2 10YR 4/2
DESIGN FLOW. 5 BEDROOMS 0 110 GPD = 550 GPD 10 48.2 12 48.0,
SO USE A 550 GPD DESIGN FLOW B B
LS LS
50
SEPTIC .TANK: 550 GPD (2) = 1100
32" 10YR 5/8 46.3 33" 10YR 5/8 46.2
USE A 1500 GAL. SEPTIC TANK '
EXISTING BARN
1 BR PROPOSED LEACHING:
(NO KITCHEN)
SIDES: 2 47.5 + 10.83) 2 (.74) = 172 GPD C C
ABUTTER'S SHED BOTTOM 47.5 x 10.83 (.74) = 380 GPD PERC
TOTAL: 747 S.F. 552 GPD MS MS
USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 2.5Y 6%4 2.SY 6 4
GRAVEL DRIVE
�9 WITH 2.5' STONE AT ENDS AND 3' AT SIDES /
MA 126" 38.5' 126" 38.5'
APPROVED DATE BOARD OF HEALTH
NO GROUNDWATER ENCOUNTERED
N
49
N
. 8 N
55.4'
s �
' r P
�- TITLE 5 SITE PLAN
4g h 10
�2.0. ��, fi•" OF
CID
122 SCHOOL ST.
AREA OF PINES BENCH MARK - CORNER OF
AND OAKS
BULK HEAD (ON WOOD) (COTUIT) BARNSTABLE, MA
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EXISTING D NG EL. 50.1
PROPOSED 4 BR CID CP PREPARED FOR
OF FNDN =50.0'
ROVER . BUILDING REMODELING/
RICH 'D C. WHITE
J�� 3 CO DATE: NOVEMBER 7, 2006
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ASp A 17189, I
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\\\\ T S/DEwACK Scale: 1"= 20'
T\\ O 0 10 20 30 40 50 FEET
off 508-362-4541
fax 508 362-9880
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o ALA ti�N� ���� ARNE 9cyG� Cl VIL ENGINEERS
Civil o LAND SUR VEYORS
fo. 307 N ,2 348
DA °� �G/ST oJAL s a 939 Main Street
- YARMOU THPOR T, MASS.
DICE #06-244 suRv�
ss�o,�a� . quo 1�
06-244 GROVER.DWG (DDF)