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HomeMy WebLinkAbout0141 THANKFUL LANE - Health 141 THANKFUL. LANE, COTUIT P�1 i i 1 I Ii h ii el TOWN OF BARNSTABLE kp 0 p01 1 LOCATION � % �/� �rl. SE E # 2 7nre,3 VILLAGE -MIr ASSESSOR'S MAP & LOT 1�9 INSTALLER'S NAME&PHONE NO. ��f��1�/ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO.OF BEDROOMS 3 j Do OR OWNER _ PERMPTDATE: /,=T-'a_COMPLIANCE DATE: 1 Separation,Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site.or within 200 feet.of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet.of leaching-facility) Feet Furnished by N O 4 Gt �, � � i t � 1�9' �__ . � > �. � �� � � � � � �' �`' �. ,. y ( i No._ ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for �Digozal *pgtem Cow6tructiou Permit Application for a Permit to Construct( d)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. %4j_N0-1Ak�V 4 Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0-�A — O Z.5 P.O• X 'ZO 2.t b2foS-S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rt<s�tcfti Eocco�tc tom �i C,Y,_V,tr sw"C-j i4<%kks1 "A �c-,ts uc 2(.5 Type of Building: Dwelli No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date 1?>1grl Number of sheets Revision Date gjzc.`(I Title Size of Septic Tank 1500 Type of S.A.S. Description of Soil h "'l2:7 i�Vle tQ.cl�.�Cc^tnt'Ct� �C;vtiQ Nature of Repairs or Alterations(Answer when applicable) DESIGNING RIM INS 1A ON N0 wEnTIN IN WRITING THE SYSTEM �AR INSTALI En IN STRICT Date last inspected: ACCORDANCE TO PLAN. 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed `iZ Date 1 b C� cti� Application Approved by Date Application Disapproved for t e o lowing reasons ��`t-elmit No. — Date Issued No. 3`. eeV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS ZIppYication for Digogal *p6tem Construction Permit Application for a Permit to Construct( �epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components 1, Location Address or Lot No. T� " k\ � � Owner's Name,Address and Tel.No. Assessor's Map/Parcel © _ O Zt X 'ZO Zt 02GZS Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. `e6rk-o% Svrvc-_JS yVV-*S4*"S ln�i 11s, lw lq 269 11MXSi�KS b:�\lS 1M OZfo�"$ Type of Building: Dwelli No.of Bedrooms Lot Size`'�sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) i Other Fixtures _ l Design Flow i 3r✓-Jr gallons per day. Calculated daily flow 3� gallons. a Plan Date Number of sheets Z Revision Date s 07_<a�5'1 r f Title Size of Septic Tank 1500 Type of S.A.S. Description of Soil O "rI S&66 w Nature of Repairs or Alterations(Answer when applicable) 5 Date last inspected: Agreement: - The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance w"�tth the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed 0- Date 1016k Glk Application Approved by Date /t] lG !2 Application Disapproved for the ollowing reasons Permit No. Date Issued ----------------------------------- ° THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(-0 )Repaired( )Upgraded( ) ° Abandoned( )by at k' LG dvs has been constructed in accordance with the provislons of Title 5 and the for Disposal System Construction Permit No. q 7—S&3 dated 164197 �-Installer 2S41V 40 Ile Designer ya..4 lCee The issuance of this permit shall not be construed_as a guarantee that the syst 11 fu ctio, asfdesign-ed. Date � ` G 'S 1- Inspector ,.,n i No. J_7— ----------------------------Fee �-7 — C THE COMMONWEALTH OF MASSACHUSETTS "UBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Mizposar 7)R;epair 5tem Con0truction Permit Permission is hereby granted to Construct ( )U7bandoonSystem located at 4 I 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 st be completed within three years of the date of thi Date: (// Approved b, r i _ .',.:• . TO/WN OF BARNSTABLE 2 LOCATION / '/Q'/1r/l/ /a, SEWAGE # �. <;VII:LAGE GG'tGfl'T ASSESSOR'S MAP & LOT,-I - 6LT : :INSTALLER'S NAME&PHONE NO. �o�fO�o I C���r 77/i'�32Y >;SEPTIC TANK CAPACITY .:LEACHING FACILITY: (type) BEDROOMS 3 ?: ,UILD OR OWNER PERMTTDATE: - "7 COMPLIANCE DATE: :;Separation Distance Between the: ... :Maiimum Adjusted Groundwater Table and Bottom of Leaching Facility Feet - - :::Private Water Supply Well and Leaching Facility (If any wells exist oti 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 F rr fished by `.. 2 - 34 �� 6 HSE. -- SEPTIC LOCATION 'I57__- "A" TO "1" = 28' "B" TO "1" = 14' "A" TO '2" = 35.6' w "B" TO ';2" = 29.6' a PAMELA CILMORE • A.M 39124 = 'a •3120 E �� b• N J AL %� r� AL AL 20 c- q.. >� 1 cl Cam=! o Vim' AL A g i AL �` L a �- � �` V\oN A.M. 39125 9�3 it o co_ AREA= 25,460 f S.F. 16 r+ Ir1 JAMES H. & JESSIE B. NYE \ ` \ AL ALA.M. 39126 C� AID \ sgl a 3911 \ �x AL HSE. \\ '� A =_ G � AL sV AL Aw►'ie FLOOD ZONE —'PC" SEPTIC CERTIFICA TION RES ZONE. "RF TO WN. COTUIT SCALE.•1"=40 PL.REF.• L C. 22824 D SHEET 2 I CERTIFY THAT THE ABO VE QF YANKEE SURVEY CONSULTANTS gM SEPTIC SYSTEM HAS BEEN P. 0. BOX 265 INSTALLED IN SUBSTANITAIL UCE BR �. COMPLIANCE WITH THE `�;• G. UNIT 1, 40B INDUSTRY ROAD APP 0 VED PLAN. '� ��� MARSTONS MILLS, MASS. 02648 TEL' 428—0055 Ire FAX 420—5553 �� ____ -- __ �___ _ JOB 51243S BRUCE C MURPH , S. DATE.• 215198 NUMBER______ qr �x la, �F y ?00, COMMONWEALTH OF MASACHUSETTS ' EXECUTIVE OFFICE OF ENVIRONME14TAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION "y�•�..... ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 141 THANKFUL LANE COTUIT, MA 02635 M339 P025 Name of Owner ROBERT BERKE Address of Owner: BOX 2021 COUTUIT MA.02635 Date of Inspection: 6/6/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tdle 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Passes _ Needs Further Evaluation the Local Approving Authority Fails Inspector's Signature: Date:617/00 The System Inspector shall su It"a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd w greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of Plow the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life" THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. , revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 141 THANKFUL LANE COTUIT, MA 02635 M339 P025 Name of Owner ROBERT BERKE Date of Inspection: 5/5/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any Information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. n 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.If"not determined",explain why not. DIA The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,Is cracked,structurally unsound,shows substantial infiltration or exriltration,or tank failure is imminent.The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. IlLa Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed distribution box is levelled or replaced Wa The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed V revised 9098 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 141 THANKFUL LANE COTUIT, MA 02635 M339 P025 Name of Owner ROBERT BERKE Date of Inspection: 6/6/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC TER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nla(approximation not valid). 3) OTHER n/a i revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 141 THANKFUL LANE COTUIT, MA 02635 M339 P026 Name of Owner ROBERT BERKE Date of Inspection: 6/6100 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)..Number of times pumped a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a 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 I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - 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-I'WPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 141 THANKFUL LANE COTUIT, MA 02636 M339 P025 Name of Owner: ROBERT BERKE Date of Inspection: 5/5100 Check if the following have been done:You must indicate either"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 - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X - As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing Information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)j X _ The facility owner(and occupants,If different from owner)were provided with Information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 141 THANKFUL LANE COTUIT, MA 02636 M339 P025 Name of Owner ROBERT BERKE Date of Inspection: 6/6100 FLOW CONDITIONS RESIDENTIAL: , Design now: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN now: 330 gpd Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate Inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM M ERCIALIINDUSTRIAL Type of establishment: n/a Design now: n/a gpd(Based on 15.203) Basis of design now:nla 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:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous Inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval. Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1997 Sewage odors detected when arriving at the site,(yea or no), NO revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 THANKFUL LANE COTUIT, MA 02636 M339 P025 Name of Owner ROBERT BERKE Date of Inspection: 6/6100 BUILDING SEWER:X (Locate on site plan) Depth below grade: 12" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: Na Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 6" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 160OG L 10'6"H 6'6"W 5'8 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 1" 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 dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:Na 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: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 THANKFUL LANE COTUIT, MA 02636 M339 P025 Name of Owner ROBERT BERKE Date of Inspection: 6/6/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or 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: NO Alarm level:NIA Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) n/a revised 9/2/98 Page 8 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 THANKFUL LANE COTUIT, MA 02635 M339 P025 Name of Owner ROBERT BERKE Date of Inspection: 616/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(0)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,dimensions: (1)40'X 12'X 6"STONE FIELD overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: _ (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: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a t Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a , K revised 9/2/96 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 THANKFUL LANE COTUIT, MA 02635 M339 P025 Name of Owner ROBERT BERKE Date of Inspection: 616/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) C D �I RJR O t Jy � revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 THANKFUL LANE COTUIT, MA 02635 M339 P025 Name of Owner ROBERT BERKE Date of Inspection: 6/6100 NRCS Report name: nla Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: nla Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used.to determine High Groundwater Elevation: _ Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET revised 912/98 Page 11 of 11 p- \ o JAI u= s A. i GC PLAN 22824 D 611 [6/z6 06 96 �� _ Npfl'1 rooms // i � 5N� ,(J—/'/' _86 .'7��' -�--e613, � oar �q }oc - d0A/ ------ O2 04 � DMZ n0O \\ \% m tb Of33ym a O \m otco g3yY y 1-31 a M Ott o� a o o PP rA v*�� NG9 wW1 ly.. .QR S113S�a, sil- 4 o � �zC n ks PO on lu f qj C � � WN . Z n1 ti O O WTO y o N c,i °" o NE 41 1 (? O O ANT IT Qz � Qom) C ,1 O\ co JL— f'U7NUfy A!'ENU y r , t =_102' TOP OF FO UNDATION 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. V.C. MIN. PITCH 1/8 PER FT. 2"LAYER OF VENT EL.= 100 1/8"-1/2" REQUIRED MAX. / i , CONCRETE CO VER WASHED STONE EL.=101 EL. =98 4'" CAST IRON PIPE (OR EQ PITCH 1/4 ' PER FT.MINIMUM M CLEAN SAND 9 ,77 MIN. FLO W LINE INVERT 1 10" EL laws*- MIN. 14» _ IN �2 O r6" ° °° ° O° ° O° O O ° °° ° ° °W 0 ° GAS _ 98 50' / b SUMP LEVEL ° ° 0 0 0 0 0 ° o p00 o® 0 0 0 0 0 0 0INVERT r BAFFLE EL.— INVERT INVERT o o ° o o ° 0 0 ® �' ° 0 0 0°o 98. 75' — 97 7 ° ° 0 ° 95.5 EL.---_ 5 EL._ .9_7_5' (TO BE PLACED ON FIRM BASE) DI�J Tl�IB UTION IN MECHANICALLY COMPACTED OR 6"" OF STONE BOX EL 96 1500 --GALLONS TO BE WATER TESTED 40' X 12' X 6" LEACH FIELD SEPTIC TANKTl IF MORE THAN ONE OUTLET PLACE ON 6" STONE 3/4" TO 1-1/2" ,SOIL ABSORPTION PROFILE OF WASHED STONE S STEM (SAS) SEWAGE DISPOSAL S YS T E IVI _BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV. =_9_0___ NOT TO SCALE ALE NO OBSERVED WATER TABLE (4/29/97) ELEV. =_90_ OBSER VA TION HOLE I ELEV. = 101 PERCOLATION RATE �5 _ MINI INCH AT _42'= INCHES OBSERVATION HOLE 2 ELEV. = 102.25 DEPTH HORIZ TEXTURE COLOR MOTT. ' OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 0"-7" A SANDY LOAM I0YR4-1 0"-7" A. SANDY LOAM I0YR4-1 7"-30" B LOAMY SAND IOYR5-6 7"-30" B LOAMY SAND I0YR5-6 GENERAL NO TES 30"-13 " Cl MEDIUM/ IO YR6—6 PERK 30"-13 " Cl MEDIUM/ IO YR6—6 COARSE SAND COARSE SAND 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TO ON OF _BARNSTABLE RULES AND NO WATER NO WATER REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO DATE OF SOIL TEST 4129197 WITHIN 6" -OF FINISHED GRADE, OTHERS WITHIN 12" WITNESSED BY: CHRIS KUCHINSKI 3) ALL COMPONENTS OF THE 'SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN SOIL TEST D 0 l E BY BR UCE G. MURPHY, R.S. 10 FT. OF DRIVES OR PARKING AREAS. H—20 LOADING SHALL BE DESIGN CA L C ULA PIONS: USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. - 4) ANY AIASONARY UNITS USED TO BRING COVERS TO GRADE SHALL NUMBER OF BEDROOMS . . 3 BE MORTERED IN PLACE. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH P 8920 GARBAGE DISPOSAL. . . . . . . . . . . NO DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO # TOTAL ESTIMATED FLOW OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. ( LJQ__GAL./BR./DAY x —3__ BR.) 330 GALIDA Y 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR REQUIRED SEPTIC TANK CAPACITY 1500 GAL DESIGNING ENGINEER MUST SUPERVISE IS TO CALL 'DIG— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS INSTALLATION AND CERTIFY IN,WRITING SOIL CLASSIFICATION . 1 PRIOR TO COMMENCING WORK ON SITE. THE SYSTEM WAS INSTALLED IN STRICT 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS ACCORUMCETpPL . DESIGN PERCOLATION RATE 5 MIN./IN. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. AN EFFLUENT LOADING RATE . . . . 74 GALIDA Y/S.F. 8) PARCEL IS IN FLOOD ZONE __"C LEACHING CAPACITY (AREA X RATE) 355 GALIDA Y ' 9) LOT IS SHOWN ON ASSESSORS MAP __39 AS PARCEL _25 RESERVE LEACHING CAPACITY . 355 GAL/DA Y (12X40X . 74 ) f SHEET 2 of 2 JOB NUMBER _ 51243