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0083 THANKFUL LANE - Health
0 0-;g I Commonwealth of Massachusetts Title 5 Official Inspection Form cc Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Chad Hathaway a ,3 use the return Name of Inspector key. H.P.S. Company Name P.O.Box151 Company Address Forestdale _M_a 02644 _ City/Town State Zip Code 774-274-2581 12866 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this 44� ess and ftt the61-' information reported below is true, accurate and complete as of the time of thdDinspection`The irrgpection was performed based on my training and experience in the proper function antl aintenare of= site sewage disposal systems. I am a DEP approved system inspector pursuant o Section 15.3,4 of Title 5 (310 CMR 15.000).The system: Fa ® Passes ElConditionally Passes ❑ Fails ; ❑ Needs Further Evaluation by the Local Approving Authority , 7/12/13 I or's Signature-------- Date The system inspector shall mit a copy of this inspection report to the Approving Authority (Board of Health or DEP)witba 0 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. ****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. t5ins•11/10 Title 5 Official Inspection tFomSurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: Tank was pumped after inspection and reinspected tees in place Dox level and no carry overs leachin has no inspection ports Dbox shows no signs of ever being over full B) 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N FIND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 THankful Lane M Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 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 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 fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® 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 1/day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. ❑ ® Any portion of 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 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ 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 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑, the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone Il 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 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 accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. City/Town State Zip Code Date of Inspection C. Checklist 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? ❑ ® 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 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: ® ❑ Existing 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(5)] D. System Information Residential Flow Conditions: 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): 330 l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 83 THankful Lane Property Address Owner Owner's Name information is Cotult Ma 7/12/13 required for every —_ page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: house has been empty Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 THankful Lane M Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gal gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. City/Town State Zip Code Date of Inspection D. System Information cont. Approximate age of all components, date installed (if known) and source of information: Dbox and leaching 2009 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 24 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 0 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 THankful Lane Property Address Owner Owner's Name information is required for every Cotuit Ma 7/12/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 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? sludge judge tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank was pumped and reinspected Grease Trap(locate on site plan): Depth below grade: feet 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: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 Design Flow: gallons per day Alarm present: El Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): level no carry overs Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): t i Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: no inspection ports t5ins•11l1n Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 THankful Lane Property Address Owner Owner's Name information is Cotult Ma 7/12/13 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: _ ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 11.3x25 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.): Cesspools (cesspool must be pumped as part of inspection) (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 ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. Cityrrown State Zip Code. Date of Inspection D. System Information (cont.) 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,): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 I a 6 )k do Qo C) 2 a3) �9s' 93) G ,, Y) .2 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 83 THankful Lane Property Address Owner Owner's Name information is Cotuit Ma 7/12/13 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: N/A feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2009 Date ® 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: I You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 83 THankful Lane Property Address Owner Owner's Name information is C required for everyotuit Ma' 7/12/13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ooarwiio�>�ad�oLLdas\�a •2uluu►gaq of aopd Kaam(1)auo lsfaal ag uo!s!A!(l uouge: OSUOD alq>�suagg .8M 4inou lslg Ism noX'puBl;am 30 001 ulgl!A+pa;anpuoa aq 0191 Isal uolloloaaad 3I*** -----------)jovq uo pololduioD oq oZ ME(j aloH uotlen.lasgo uo!sin!Q glleaH a!Ignd. :lem8up (wx).popoom Supsay leuop!ppd :pal!va al!S passed ails 7ua ussassd Aig!galmS al!S lW g u1/ l a u b8g <Vol! Z Z > s aid poa OUILL 31909-OM itrelS dig IV amly axad;ogldaQ �6 lE sully #aloH uoi Ansgo I Par. i m laneZ ialentpgnaap (�� lolae3 (PV .�""tarsal!►ah1 XaPul� aleQ Bn?P2I #IIaM asps!, - - a ;ruucirlBn fps,ie3nmpu toa0- o� - :aioq•sq`o;o apes uiou-}Emdaanx of yldaQ - al :salllocu ll0s of gldaQ -ul :alog•sqo u!But puels panrasgp gidaQ :PasflPogl6w �•. . •'r' � ���`�¢i�' �LY1•�1��'��kY.V i� � SL1:J��1V:Q�ill:��1�.. D IalenIpunar0 112lH I?UOSWS palempsa gOgtl Ltd woa;8utdaaM �`^'- -ialoH u!laleb gut pdinS.:sajVmpnnarp of yldo(l sl o ! Xoo g of gld?CI (o!9oloag)Ieuplum lumM f' ro 1 (saloq rn 4lmilxoid nt spaellam al>oo['sisa3 o ad V satoy lsal;o suoueool loexa`lot}o suocsuauilP'aweu 122"s),H�Z► S tac{lo l; j�Z oul7,(uado�d l�/ ' �fBMaBea!eiQ g lla/A talent EuquuQ l; east+laM algissod l; ��fPofl ialeM uad0 wool saausls!Q �D sauols aoejtnS (%)sadolS via If asR PurlN . -� auoydalaZ; -- •mddazi: xol on�lSMOO MaI�I -f' ., ?Z✓-�1la�ameH s,iaau!Sug :lp�led�dey�l s,lossassb InS togn�! �. ■/�■� amaH s,�an//b0 � �++ ssa;PP1+uoneao7 Sg passawiM �H Pauuoilad �U • �uaussass z z ► zn' zo S � �.?.q •�. 51. �' z - L pdaa3_ story C� ~ PetoP9�oS a3uQ VIP i09Z0 dIN smneil; laa�1S u�ey(l OOZ: `�'����R�, polgi saa4I,las nsa: ao!uatnlBdaQ 7 f a. DEEP'0A'8ERVAtIM4 HOLD LOG I�TpXe# i s77 Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(In.) (USDA) (Mansell) :. Mottling (Structure,Stones;:Boulders. LL / s °`Y /2 L S 1,0 -ALA- �/� 2 cI 40. 5-Y E Sq%d 2i ORSERVATT Depth from: Soil Horizon Soil Texture Soil Color #p ale Surface(in:j Soil (USDA) (Mansell):: M9tthng (Structure,Stones,Boulders. . nsis en e. —roti° to Ya2 �1z - ia_3� . L N RV AT. ON ]ROLE.-L.OG I�nle# '. . Depth from Soil Horizon Soil Texture. Soil Color Soil ; Other 4 Surface(m:).:. . (USDA) (Murisell): Mottlin g (Structure,Stones,Boulders Consistency,%Gravel) j Dmp;O.USERVATION SOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Flood Insurance Rate May: Above 500 year flood;boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood.boundary:No < Yee Depth of Naturally Occurr%e Pervious-Material Does at least four>4eet of naturally occurring pervious material exist in all areas observed'throughout the area proposed for.the soil absorption system? �5 If not,what-is.ahe depth of:naturally occurring pervious material?. c: Certiftcatlon _ I certify that on I �dl� (date)I have passed'.the soil evaluator examination approved[iyFtkte,.,,.. - ---- Department of Environmental Protection and that the above analysis was_;performed by me consistent with the requ>ared':trainiz ` expertise anti'experience des,cribed?:in 310.CIvIR 15.017 b. Y Sigatitre Date.,. y , Q;!S1rPTIC11'E)CFORIvI DO so ofIME ro Town of Barnstable Regulatory Services * BARNSTABLE, * - v MASS. g Thomas F. Geiler, Director rEo 39. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 - Office: 508-862-4644 Fax: 508-790-6304 a t March 12, 2009 Mr. David G. Mugar 222 Berkeley St., Suite 1450 Boston, MA 02116 t NOTICE OF VIOLATIONS OF BARNSTABLE CODE CHAPTER 360 ARTICLE VII 4360-16 AND VIOLATION OF 310 CMR 15.351 STATE ENVIRONMENTAL CODE The property owned by you located at 83 Thankful Lane, Cotuit was inspected on March 11, 2009 by Donna Z. Miorandi, R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violation was observed : �360-16; Town of Barnstable Code: The septic system is in hydraulic failure. Raw .-- sewage was observed on the top of the ground immediately adjacent to the side of the leaching pit. You are ordered to correct the above listed violation by: 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. 3) You are further directed to contact and hire a professional engineer to design a replacement soil absorption system within 14 days. l 4) The soil absorption system shall be replaced within sixty (60) days, on or before May 12, 2009. 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 may result in the issuance of a $100.00 noh-criminal ticket citation. Each day's failure to comply with an order of the Board of Health shall constitute as a separate violation. Q:\Order letters\Sewage Violations\83 Thankful Lane,Cotuit.doc amas RDER OF T E BOARD OF HEALTH . McKean Director of Public Health CERTIFIED MAIL: #7008 1830 0002 0500 7966 QAOrder letters\Sewage Violations\83 Thankful Lane,Cotuit.doc f Parcel Detail Page 1 of 3 AM A d`ij t Logged In As: m.4 _ Parcel Detail Wednesday, Mari Parcel Lookup Parcel Info _ _.. .. _ Parcel ID 039-029 Developot LOT 8 e ..... ._ ..____._,.m,.. . ....... — .._ g ................�...m...•....._�, _-___- Location 83 THANKFUL LANE Pri Frontage:130 Sec Sec Road, ....... Frontage" Village COTUIT Fire District COTUIT Sewer Acct. Road Index 1704 a 3 ?N f€ Asbuilt Septic Scan: Interactive � , MA s 039029_1 MapMEN Owner Info _ .._ ... ...._._. ...._... .... _.. .... __....,_ owner MUGAR, DAVID G Co-Owner, Streets '222 BERKELEY ST, SUITE 1450 Street2 I _._•• ...... ......... ._ _... .... City BOSTON State iMA zip 02116 Country US ......... ......... Land Info Acres 10.71 use!Single Fam MDL-01 zoning RF Nghbd 0105 __... ._.r._ Topography(Level M Road ,Paved Utilities;Public Water,Gas,Septic Locations Construction Info BuildingI of E";." .w...__. . . .. .. Built Struct Wall = _,._ �... Year; Roof xt' 1980 Gable/Hip Vinyl Siding ._ _ ' ..... � Effect I. _.... Roof AC 1320 Asph/F GIs/Cmp Type None Area= Cover __. ..... . ti Style'Ranch wall`.Drywall nt Bed 3 Bedrooms Rooms Int�.... Bath - Model :Residential 2 Full Floor- Rooms . Grade;Average Type Hot Water Rooms 5 Rooms http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2480 3/11/2009 f Parcel Detail Page 2 of 3 ,..., qli 3 Stories � Heat f.._.._ �_,_.,�_.�...�.. ., ... Found-. 1 Story Fuel :Gas ation ;Typical 13111j�� �11. 3f N2v Permit History Issue Date Purpose Permit# Amount Insp Date Comments 06/01/1980 B22271 $0 CO 1 STOR Visit History Date Who Purpose 06/30/2005 00:00:00 Paul Talbot Meas/Est 06/26/1999 00:00:00 Frederick Stepanis Meas/Listed-Interior Access - Sales History ........ ......... . ....__.. ............................................. ......... ......... .................................................. .............. ......... Line Sale Date Owner Book/Page Sale P 1 09/10/2001 MUGAR, DAVID G C162733 2 MCKENZIE, JOHN R& MARJORIE C C83806 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Pare( 1 2009 $111,700 $4,500 $0 $155,000 2 2008 $130,100 $4,500 $0 $161,600 ; 4 2007 $129,300 $4,500 $0 $161,600 5 2006 $117,800 $4,500 - $0 $174,200 6 2005 $112,600 $4,500 $0 $158,300 7 2004 $91,500 $4,500 $0 $134,600 8 2003 $83,000 $4,500 $0 $55,600 9 2002 $83,000 $4,500 $0 $55,600 10 2001 $83,000 $4,500 $0 $55,600 11 2000 $65,700 $4,500 $0 $34,100 12 1999 $60,600 -. $5,800 $0 $34,100 13 1998 $60,600 $6,700 $0 $34,100 14 1997 $67,800 $0 $0 $25,600 15 1996 $67,800 $0 $0 $25,600 16 1995 $67,800 $0 $0 $25,600 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2480 3/11/2009 Parcel Detail Page 3 of 3 17 1994 $65,700 $0 $0 $30,700 18 1993 $65,700 $0 $0 $30,700 19 1992 $74,700 $0 $0 $34,100 ; 20 1991 $75,100 $0 $0 $55,400 ; 21 1990 $75,100 $0 $0 $55,400 22 1989 $75,100 $0 $0 $55,400 23 1988 $56,400 $0 $0 $25,600 24 1987 $56,400 $0 $0 $25,600 25 1986 $56,400 $0 $0 $25,600 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2480 3/11/2009 AsBuilt Page 1 of 1 TOWN OF BA.RNSTABLE LOCATION S2 )) L/ LL /f/!' SEWAGE #1 VILLAGE ASSESSOR'S MAP & INSTALLER'S NAME&PHONE NO._ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _ Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) _ Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ Furnished by 64C DeC� 9 o g � c, C R3 AID I http://issgl2/intranet/propdata/prebuilt.aspx?mappar=039029&seq=1 3/11/2009 Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ❑ El Zoom Out D D&D D fl fl fl QIn (kur R r y ] I N ks ® (3 JPG Map: 039 s oca L t ion: � .� s• r '' � � ey7 � �, � 039041 Owner: .p 72 Location In Map & Parce Location 4-1 Acreage Current Ow A r -•• ..� i, Mailing Addt 03902 r Appraised Extra Featur �„ "• _ # Out Building ` Land Buildings Total Apprai o39Dot h f 1 Assessed V po s '^► 4 }i�. f«, '` . ,�, Extra Featur 039031 . « ' Out Building Far 1 ., S p 55 Land Buildings p Total Assess Set Scale 1" = 5( Aril 2001 Hi Res III I MAP DISCLAIMER Copyright 2005-2008 Town of Barnstable,MA All rights reserved.Send questions or comm( BarnstableMA v1.2.3357 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=039029 3/11/2009 SuperPages.com Page 1 of 1- People I Reverse Lookup Area&ZIP Codes I + Add your listing Find Old High School Friends at Classmates.com RevENumber ne I Pho I 508- 1323 Search' I 1 Result matching "(508) 428-1323". David G Mugar PO Box 612 Cotuit, MA 02635-0612 (508)428-1323 I E Enlarge Map it http://www.whitepages.com/10866/search/ReversePhone?full_phone=508-428-1323&1oca... 3/11/2009 r °FWE T Town of Barnstable pep atory Services * BARNSTABLE, v MASS. $ Thomas F. Geiler, Director �A 03q. rEo,,,p�a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 " March 12, 2009 Mr. David G. Mugar 222 Berkeley St., Suite 1450 Boston, MA 02116 NOTICE OF VIOLATIONS OF BARNSTABLE CODE CHAPTER 360 ARTICLE VII §360-16 AND VIOLATION OF 310 CMR 15.351 STATE ENVIRONMENTAL. CODE. The property owned by you located at 83 Thankful Lane, Cotuit was inspected on March 11, 2009 by Donna Z. Miorandi, R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violation was observed $3.60-M Town of Barnstable Code: The septic system is in hydraulic failure. Raw sewage was observed on the top of the ground immediately adjacent to the side of the leaching pit. You are ordered to correct the above listed violation by: 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. 3) You are further directed to contact and hire a professional engineer to design a replacement soil absorption-system within 14 days. 4) The soil absorption.system shall be replaced within sixty (60) days, on or before May 12, 2009. 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 may result in the issuance of a$100.00 non-criminal ticket citation. Each day.'s failure to comply with an order of the Board of Health shall constitute as a separate violation. QAOrder letters\Sewage Violations\83 Thankful Lane,Cotuit.doc i PER ORDER OF T E BOARD OF HEALTH m4asMcKean Director of Public Health CERTIFIED MAIL: #7008 1830 0002 0500 7966 i QAOrder letters\Sewage Violations\83 Thankful Lane,Cotuit.doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION A F . r v �O .. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A sa f CERTIFICATION Property Address: 83 THANKFUL'L LANE COTUIT,MA 02635 Owner's Name: JOHN MCKENZIE Owner's Address: 661RVING STREET,SOMERVILLE,MA.02144 Date of Inspection: 8/2/01 ri Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O:`BOX 2119 TEATICKET,MA.02536 , Telephone Number: 508-564-6813 FAX7508-564-7270 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ 'Conditionally Passes _. Needs Furt valuation by the Local Approving Authority Fails . Inspector's Signature: Date: 8/2/01 The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspec ion. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shalI�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 ;. SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY TWO YEARS TO MAINTAIN SYSTEM. ****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. Tilly,; In+:ni'r'lifm Ritrt"" 6/1 S0(1M 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 83 THANKFULL LANE COTUIT,MA 02635 Owner: JOHN MCKENZIE * ` t, f Date of Inspection: 8/2/0I Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: , X 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 PASSES TITLE V RECOMMEND PUMPING EVERY TWO YEARS TO MAINTAIN SYSTEM. B. 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 for the following statements. If"not determined"please explain. n/a 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 exfiltratidA,or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *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. ND explain: n/a 4t aE n/a 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 inspection if(with approval of Board of Health): `t "_ _ broken pipe(s)are replaced _ obstruction is removed _ distributio'wbox is leveled or replaced ND explain: n/a n/a 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 cY +s 1' Page 3 of 11 .; a OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS i� SUBSURFACE;SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 83 THANKFULL LANE COTUIT, MA 02635 Owner: JOHN MCKENZIE 'i' Date of Inspection: 8/2/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. I 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 tfheRBoard 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 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 aiTd 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 n/a "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. u 3. Other: y.A n/a rs 1.9 , Page 4 of 1 1 OFFICIAL INSPECTION`FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ,. CERTIFICATION(continued) Property Address: 83 THANKFULL LANE COTUIT,MA 02635 Owner: 30HN MCKENZIE Date of Inspection: 8/2/01 i 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 X Discharge or ponding of effluent to,the surface of the ground or surface waters due town 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 X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow X Required pumping more than 4 times in the last year NDMdue to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X 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. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. 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 forma (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.T.he 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 now 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`'isystems in addition to the criteria above) yes no _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a'tributary to a surface drinking water supply X 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 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 the Inl'go system 1168' failed,The owner or operator of any largo System considered a signifcant throat 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. t Page 5 of I 1 t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 83 THANKFULL LANE COTUIT,MA 02635 Owner: JOHN MCKENZIE Date of Inspection: 8/2/01 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? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up X _ Was the site inspected for signs of break out`? ,E X _ Were all system components,excluding the SAS, located on site'? X _ 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'? 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 detennined based on: Yes no X Existing information. For example,a plan at the Board of Health. X _ 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)] P a - 5 Page 6 of 11 r' ssr r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM g. PART C SYSTEM INFORMATION Property Address: 83 THANKFULL LANE COTUIT,MA 02635 Owner: JOHN MCKENZIE Date of Inspection: 8/2/01 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):330 Number of current residents: 2 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): YES Water meter readings, if available(-last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203):;,n/agpd Basis of design flow(seats/persons/sgft,etc.):-n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a {+ Was system pumped as part of the inspection`(yes or no):NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a il Reason for pumping: n/a to TYPE OF SYSTEM X Septic tank,distribution box,soil`absor'ptior►system _Single cesspool _Overflow cesspool k k _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): n/a s Approximate age of all components,date installed(if known)and source of information: 20 Y EARS Were sewage odors detected when arriving at the site(yes or no): NO l Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 83 THANKFULL LANE COTUIT, MA 02635 Owner: JOHN MCKENZIE Date of Inspection: 8/2/01 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:—cast iron =40 PVC Xother(explain):20 PVC Distance from private water supply well or,suction•line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete—metal '.fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age.;confrmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: IOOOG L 8' 6" H 5' 7" W 4' 1 off" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: l" ; Distance from top of scum to top`of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS APPEAR TO BE STRUCTURALLY SOUND AND APPEAR TO BE FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. a� GREASE TRAP:_(locate on site plan)"' a Depth below grade: n/a Material of construction: concrete metal' fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of,outlet tee or baffle: n/a Date of last pumping: n/a ' Comments(on pumping recommendations;inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): n/a i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 1- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1 Property Address: 83 THANKFULL LANE COTUIT,MA 02635 Owner: JOHN MCKENZIE Date of Inspection: 8/2/01 ' TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into 1 or out of box,etc.): DISTRIBUTION BOX IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY. 'y PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO w. Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a a., • R Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 83 THANKFULL LANE COTUIT,MA 02635 Owner: JOHN MCKENZIE Date of Inspection: 8/2/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system .Type/name of technology: n/a Comments(note condition of soil,sins of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT APPEAR TO BE FUNCTIONING PROPERLY,NEVER MORE THAN 2 FOOT IN PIT.. PIT WAS EMPTY AT TIME OF INSPECTION CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert- n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or rib): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) 's Materials of construction: n/a ' Dimensions: n/a Depth of solids: n/a , Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a R Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 83 THANKFULL LANE COTUIT,MA 02635 Owner: JOHN MCKENZIE Date of Inspection: 8/2/01 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. 1 Dec(� j II A Id At �7 AC 39 FA t M Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P. Property Address: 83 THANKFULL LANE COTUIT,MA 02635 Owner: JOHN MCKENZIE Date of Inspection: 8/2/01 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells a, Estimated depth to ground water 12 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: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12 FEET 1,fse _ 4 TOWN OF BARNSTABLE / LOCATION 03 Aaykf yl twe SEWAGE# JQMs G VILLAGE COW1 ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 4�bdAj&-& , SEPTIC TANK CAPACITY rOCO /S1'1'd LEACHING FACILITY:(type) &M (size) //.3X ;, f NO.OF BEDROOMS OWNER t; PERMIT DATE: /j COMPLIANCE DATE: p G 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 i A TOWN OF BARNSTABLE Cc A'TION I-04,161L SEWAGE # %AGE (�irJ 'G 1 / ASSESSOR'S MAP &L o , INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY r.; LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE 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 k Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by c� ® o IR-)�� vd w�V- ��J .vv1S No. �� '(�o 3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mizpool 6p6tem Construction Permit Application for a Permit to Construct( ) Repair(✓rUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 8 1 {,l��Y. 01 Lt 4e Owner's Name,Address,and Tel.No. Z:P.)tV .lV(U%Gcr Assessor's Map/Parcel OZ9 _ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building KOJS V No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3�J7• gpd Plan Date G—2 'Zit( Number of sheets Revision Date Title Size of Septic Tank i= ISf VV Type of S.A.S. J(y H 90 X(AIS S, Description of Soil Nature of Repairs or Alterations(Answer when applicable) lojSfi oL j� N•Pc W C., A.6 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 this Board of Health. Signed n Date 61elo Application Approved by /` s Date OAQ Application Disapproved by: Date for the following reasons Permit No. 2o U el I(�3 _� Date Issued _ Z & �j �,�, r ..r No. Zoo t J / D Fee / V -THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: [l 'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes .:�4 . ` �rf ZIppYication for �Ngpooal *pgtem Cowaruction Permit Application for a Permit to Construct O Repair(v(Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. 8�J L l91 Vc+Nt� CO V+ Owner's Name,Address,and Tel.No. .Olo 1V(ua�at' Assessor's Map/Parcel Osci if Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Z',4G` 1�fc ANC, L-NS���,�/« c,��(ICS s -kcO-�/ 5 sb0-737- /7G Type of Building: ._ Dwelling No.of Bedrooms 3 Lot Size 3 0-2 V sq. ft. Garbage Grinder ( ) Other Type of Building, KoJS'p No.of Persons Showers( ) Cafeteria( ) Other Fixtures . ` a `r Design Flow(min.required) gpd Design flow provided y j,�j gpd Plan Date Number of sheets Revision Date _1 Title Size of Septic Tank. I C PX l S+y ` Type of S.A.S. 16 F1,2 Q 1,.��7Xc)5e*s, Description of Soil y� i Nature of Repairs or Alterations(Answer when applicable) I-Sfi C� >> NY'w S./�•S 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%een issued by this Board of Health. -, Signed Date G 8 oc/ Application Approved6 s Date _� D Application Disappr:.oved by: Date i for the following reasons 4,1Pertnit No. Zo O"( Date Issued Q THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by 7aJdQ S A :\ tco w w ):me at 9�) 7 Cr,4,J! t— has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 200cf— 1(03 dated (/B O Installer I ,)r� s *1 (caw ry Ini[' Designer � ��1, �—�0 g N t#bedrooms Approved design fl gpd The issuance of t is permit Zall not be construed as a guarantee that the system wi do as desig. ed. Date ' ' Inspector n � 1 1 No. L. oo 1 1 to3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS XDi!5poga[ A�pgtem Con!6truction Permit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) System located at t 3 f 1A„//C A// "e" (,O t-yi and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this pe rm. Date JU�v �' o C7 �( Approved by Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508462-4644 Fax: 508-790-6304 Installer&Designer Certifcation.Form Date: Sewage Permit# Qj =40 Assessor's Map\Parcel�9.6 Designer.-: 5:_�d Q"A (�t�°'/f'S._ Installer. Address: ) Z �` CCd�r Address: �are��a le r✓'►�9 ��,�..�l�, NL� on lam' ✓3r&_j 01 1 1I C. was issued a permit to install a te) II. (installer) septic system.at �� Tn a w ' Co `r based on a design drawn by (address) , _ eel A , L .. , x (designer) , . I cerafy',that the septic system.referenced above,was instahed substantially,according to the design, which may include minor approved changes:such as lateral relocation.of>the distribution box and/or septic tank. I certify that the septic:system referenced above was installed with major changes (i.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: Plan revision:or cerEfied a§=built by designer to follow. of U4,9. . 4, f2 PETE .T. GR, WENTEE staller'S Signature) ® CIVIL 9 No.35109 Q 2 `` �0 Fr G1 �Ss•/0N A (Designer's Signature) (Affix Designer's Stamp Here).: 'PLEASE RETURN, TO` BARNSTABLE- PUBLIC -,HEALTH DIVISION. CERTIFICATE OF COIVIPLLAI�ICE WILL NOT BE ISSUED.UNTIL BOTH THIS FORIYI AND AS-BUILT .CARD ARE RECEIVED W THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. i Q:HWth/SepticMesigner Certification Form 3-26-04.doe L LOCATION SEWAGE PERMIT NO• f. VItLAGE INSTALLER'S NAME i ADDRESS cd Z C R U I L 0 E R OR OWNER /0. i DA T E PERMIT ISSUED -3 Ab DATE COMPLIANCE ISSUED z�A?6 ---- ,, ��, �� �= ���_ � � � r ;� � .: No. ®.-a.��,� /�%0 u Fps...3... . Yr' :.. THE COM ONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH U-w�...... ...-.OF......- -... J........ ` < z Aliraiim fnria1 k C� Y� iY�sinri rxYrii# ,,. Application is hereby made for a Permit Co ( ) or Repair ( ) an Individual Sewage Disposal System at: g'l.• _ Location-Address or Lot No. Owner . Address a ---------------------------------------------- ......................4?4.P_ep �"!_r7 _ °! .o. ......... Installer / Address U Type of Building Size Lot___. %_ ®_ .....Sq. feet Dwelling—No. of Bedrooms____________________________________________Expansion Attic (4t}� Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Other fixtures ---------------------------:----------------------- -- W Design Flow.........5.�........................gallons per person per day. Total daily flow__o..........3;._o...................gallons. WSeptic Tank—Liquid capacity/v!?tO_gallons Length________________ Width................ Diameter.--------------- Depth................ x Disposal Trench—No_ ____________________ Width____f..__._._.._.._ Total Length__.__.____._________ Total leaching area______________..__..sq. ft. Seepage Pit No-----------/-------- Diameter__/__O___________ Depth below inlet-----:___......... Total leaching area_2 _C?_......sq. ft. Z Other Distribution box ( ) Dosing tank "4 Percolation Test Results Performed b ---_.L� -- --------------- Date---� ����-----------_.... a Y �. Test Pit No. 1_ :?-_____minutes per inch Depth of Test'Pit---- Depth to group water___.--^.c- ------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_____________._______- .. �-------------------------••-•---..._..... ........................................................ 0 ii Description of Soil ll'�° �.,. -------------------------------------------------------------------------- U .............................==....................................................................................................................................................................... W -•--------------•---------------------•---------------------------.-.....----------------------•----•------•------•--•-------•------------••-------•••--------------------------------------•• r U Nature of Repairs or Alterations—Answer when applicable________ ___________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with -. T R1-`. the provisions of f^i T i L , 5 of the State Sanitary Code—The undersigned further agrees not to place the system in x v` operation until a Certificate of Compliance has;beXissued by the board of hea . Si ned ----------� --••---'�-vim`--7 - ,�r Date Application Approved By...... ------ B l ✓l 5- ' Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- •......--......................................................................................................................................................--------------------------------------- Date „r PermitNo......................................................... Issued._ No.j� ........... Fmc... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --- -------------OF........ .................................................... ............ Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at lofVt7o` M19 9 I ............If.................... (et-Ujehei�...........1,.... .....rr........................ --------------------------I----------------- Location-Aldres§ r No LF..t.&s .......... ....... . ...................... 009 Owner Address _4000e------------------------------------------ .. .... . .... ... ........................... ....... I. ................................. Installer Address . ..Type of Building Size Lot....NO 00 C ......Sq. feet U Dwelling—No. of Bedrooms......................................___.___Expansion Attic #1 Garbage Grinder ( ) Other7.—Type of Building ............................. No. of persons......_._........._..__.___. Showers Cafeteria ( ) aOther fixtures -------------------------- --- ------------------------------------------------------------------------------------**--------------------- W Design Flow.....:X.1*107 ..... .. ........ -.gallons per person per day. Total daily flow-------------3.3.0...................gallons. .; .W Septic Tank ..t.. /A*- -0 —Liquid capaciv gallons Length................ Width... :,_.. Diameter______ ..._..... Depth....._.......__. Disposal Trench—No. . ....... Width... ............ Total Length.............P..... Total leaching area.._.. _._sq. ft. 1 Seepage Pit No----------10-I-------- Diameter.10------------ Depth below inlet—, ............ Total leaching areaPA*......sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by. ._..4 . Date.._ �04gjt!)................ Test Pit No. __minutes per inch Depth.of Test Pit....ZKl Depth to ground Test Pit No. 2................minutes per inch Depth'of Test Pit----- .............. Depth to ground water------------------------ ............ 0 Description of $oil....... ............................................................................................................. U -------------------------------------------*------I--------------- ----------------------- ----------- ................................................................................................................ --- ------------------------------------------------ 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 TITLE 5,of the State Sanitary Code— The undersigned further agrees not to place the system,in operation until a Certificate of Compliance has be issued by the board of healdi. . .. I Signed. ........... . ......... ... ......................... ........................ Date .. ..................... ........................................ Application Approved By....... Date Application Disapproved for the followin9 reasons:................................................................................................................ .............................................i..................................................................................................... .................................................... -pate PermitNo........................................ Issued---_-----------..................................... Date �A THE COMMONWEALTH OF MASSACHUSETTS A BOARD OFHHEALTH ....... ............... .......OF......... ..................................... Trdifiratr afTlImpliano- 0 'THtIV T TIFY, That the Individual Sewage Disposal System constructed or Repaired y--- ............b ....... ............................................................................................................................... I taller . .................................................... ............ ion of TIT at............moo ..e.......... -C has been installed in accordance With the r is ions 5 of The State Sanitary Code as described............. in the application for Disposal Works Construction Permit ---9>................ dated----- ---AJ- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... ............. 'LN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF . HEALTH .........OF......�4.. ...... .................................E N . ................ FEE.. 40............. Permission is hereby granted ..... .... ... ,."�..................................................................................... to Constru t or Repair I anlndividual Sewag is 2, S�Stem . . .... ..... . .. at No......... ._jg......... ......--- ----- . .... W,**1 1 ----------------- Street as shown on the application for -Disposal Works Constructigg--Reqnit No... ................. Dated---------17.7,?,r .......................... -------------------- DATE.__... 7 J/:n...t04,1!......................................... Bo*�ar�Foc Oth FORM 1255 HoBBS & WARREN. INC., PUBLISHERS fi8'-4�0„ 4 Loy 8 g ? J 5 F `9 G1i t 4 � Q U h} LA i1p iooc Gra_.Ca ►c. � F '��,��� y• Y� 4-'f:; `� SCPTiG .� t I r f ? ri'QuSF. 25 � � 00-__ tA '� `.v g 4 b s .4a' a •a' .. t - ` t ", �' i► ," l .,y ,fir',}a.✓, . . , •� 4*': i� f-�5+� t .r tYF. t;� '� rr "R � �.. tI' rt •,.� s�'4r r "` •r., +�� .. / r i.'-. ri ti�,D 'F„r-. ,�T'S"°,�. # s*,.,.- ��. 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EXISTING SEPTIC TANK �� i x 94�,71 TOP OF TANK, EL.=95.20 x 95..53(ry)J'�i� i x 95.65 1, i�X INV.(OUT), EL.=93.87E I II - x 93.70 Ben ch m ark Set f Top of conc. deck ft &�2 i �� `v EL.=94.58 (Assumed 1---) '\ 'J,�' SHED cc) x 96.8991 x 93 i / 97.60 y �� i DECK x �37.47 93.3696 EXISTING x 95.25 HOUSE (#83) pQ)� 93,49 TOF=102.0E o a J� /x 96,40 \ Paved Driveway x 99,66 x 98h x '97,67 a x 99.27\\ x 98.74 0' Grovel --- Porking x 99. 0 L=130.00' ' R=551 .20' edge of pavement 100 999 99sI THANKFUL. LANE OWNER OF RECORD DAVID G. MUGAR 222 BERKELEY ST, SUITE 1450 M4ss9� BOSTON, MA 02118 o PETER T. �G� PROPOSED SEPTIC SYSTEM UPGRADE PLAN LEGEND McE"TEE 83 THANKFUL LANE, COTU IT, MA o CIVIL --92-- EXISTING CONTOUR No. 35109 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 x 100.98 EXISTING SPOT GRADE o R£CI TFR �� Engineering by: SCALE DRAWN JOB. NO. W EXISTING WATER SERVICE FF EN Engineering Works, Inc. - 1"=20' P.T.M. 128-09 TEST PIT 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO- BENCHMARK s1 'LI 01� (508) 477-5313 5/2/09 P.T.M. 1 of 2 r NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:93.03 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE EXISTING F.G. EL.=96.2t F.G. EL: 96.0t F.G. EL 96.0(MAX.) MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 14' 8'(MAX) s INSPECTION ® S=1% (MIN.) ]74"�S�CH40 % (MIN.) PORT 4"SCH40 PVC PVC 6"10"1 11.3"14" INVERTEXISTING 48" LIQUID LEVEL ADDGAS BAFFLEINV.=92.97 PROPOSED . 2.80 f 4 ROWS W/4 UNITS AT 6.25'/UNIT = 25.0' I INV.=93.87t BO INV.=92.64 EXISTING (WATERTIGHT) SOIL ABSORPTION SYSTEM (PROFILE) Elt EXISTING SEPTIC TANK 4 OUTLETS (MIN.) ESTABLISH VEGETATIVE COVER BACKnLL WITH"1tEAN NAIIVE.OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT EL.=TOP EL. 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP ELEV.=93.03 FILTER FABRIC INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=92.64 OVER UNITS (RECOMMENDED) 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=91.70 ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 2.83' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF 3) INSTALL INLET & OUTLET TEES AS, REQUIRED. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3' EXISTING SUITABLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL=84.1 = MATERIAL AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 4 ROWS OF 16" (H-20) ADS BIODIFFUSER UNITS' WITH NO SEPARATION BETWEEN EACH ROW &- NO STONE SEPTIC SYSTEM -PROFILE TYPICAL sEcrloN N.T.S ' r N.T.S. SOIL' LOG DATE: APRIL 16, 2009 (REF#12,522) SOIL EVALUATOR: PETER McENTEE PE WITNESS: DAVID STANTON R.S. HEALTH AGENT ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH 96.2 0" 95.6 0.. FILL FILL 95.4 A 10" 95.1 A 6„ LOAMY /2D LOAMY 4/2D GENERAL NOTES: 95.0 14" 94.8 10' BAN B 1-ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL LOAMY SD LOAMY SAND tO 5AN 10YR SAND BOARD OF HEALTH AND THE DESIGN ENGINEER. 92.7 42" 92.6 36" 2•ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS C1 C1 PERC OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 48"/60" LOCAL RULES AND REGULATIONS. M-C SAND M-C SAND 3-THE SEWAGE DISPOSAL'SYSTEM SHALL NOT BE BACKFILLED PRIOR 2.5Y 6/4 2.5Y 6/4 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4.ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION, DIFFERING FROM THOSE SHOWN HEREON' SHALL BE REPORTED TO THE DESIGN 84.5 140" 84.1 138" ENGINEER BEFORE CONSTRUCTION CONTINUES. PERC RATE <2 MIN/IN. ("Cl" HORIZON) 5.ALL ELEVATIONS BASED ON ASSUMED DATUM. NO GROUNDWATER ENCOUNTERED 6-THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7'WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. &THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. DESIGN CRITERIA 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING NUMBER OF BEDROOMS: •3 BEDROOMS CONSTRUCTION. SOIL TEXTURAL CLASS: CLASS 1 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS DESIGN PERCOLATION RATE: <2 MIN/IN IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND DAILY FLOW: 330 G.P.D. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). DESIGN FLOW: 330 G.P.D. - 12 AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE GARBAGE GRINDER: NO INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. LEACHING AREA REQUIRED: (330) = 445.9 S.F. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 74 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), .H-10 RATED PROPOSED SEPTIC - SYSTEM UPGRADE PLAN USE 4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS 83 THANKFUL LANE, COTUIT, MA WZ NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25.0' Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 (HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED) SIDEWALL AREA: NOT APPLICABLE Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) Engineering Works, Inc. NTS P.T.M. 128-09 16 UNITS x 6.26 LF x 4.7 SF/LF = 470.0 SF 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD (508) 477-5313 5/2/09 P.T.M. 2 Of 2