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HomeMy WebLinkAbout0024 TRACEY ROAD - Health 24 Tracey Road J Cotuit P r A _ Y005 052 r COMMONWEALTH OF MASSACHUSETTS � I 2 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION 'RECEIVED FAQ 0 " 2004. TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION . -� .. Pro pertyAddress: 24 Tracey Road MAP Cotuit, MA PARCCL `.._. .--- Owner's Name: Mark ('_ann i e a rn LOT ' Owner's Address: Date of Inspection: Name of Inspector:(please print) W i 1 1 tam ,E_ . Rob i nson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1 089 Centerville MA Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT 1 certify that l have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Se on 15.340 of Title 5(310 C11 1115.000). The system: . Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fail � y Inspector's Signature: Date:/ �P— The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heaithvr, DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office ofthe DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) . Property Address: 24 Tracey Road Catu i t ., MA Owner-. mark L C'anni Date of Inspections.;—,, / a Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. S stem passes: 1 have not found an information which indicates y m icates that an 'y of the failure criteria described e in 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Ans er yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please expla . The septic"is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unso d,ekhibits substantial infiltration or exfiltration or tank failure is imminent System will pass inspection if the existin tank is replaced with a complying septic tank as approved by the Board of Health. `A meal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indica ng that the tank is less than 20 years old is available. NDlexpl in: bservation of sewage backup or break out or high static water level in the distribution box due to-broken or obs pipe(s)or due to a broken,settled or uneven distribution box..System will pass inspection if(with appof Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced NDIin; 'Ihe system required pumping more than 4 times a year date to broken or obsmxted Pam( )s .The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rt:wwd ( ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 24 Tracey Road _ Cotuit, MA Owner. Mark Cannizpago Date of Inspection: . s :::Q 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. ,stem will pass unless Board of Health determines in accordance with.310 CMR 15.303(1)(b)that the. tem is not functioning in a manner which will protect public health,safety.and the environment: is Cesspool or privy is within 50 feet of a surface P P �'Y water Cesspool or.privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that(he , system is functioning in a manner that protects the public health,safety and environment: IThe system has aseptic 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. LThe system has a septic tank and SAS and the SAS is within a Zone_i 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 Gonl a private water supply well•• Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform -bacteria and volatile organic compounds indicates that the well is Gee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: 24 Tracey Road Cotuit, MA Owner: Mark Cannizzaro Date of Inspection:, D. S,•stem Failure Criteria applicable to all systems: You mist indicate"yes"or"no"to each of the following for all inspections: Yes No _ 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 oc available volume is less than%day-flow Re uired pumping more than 4 times in the last year NOT due to clogged or obstructed i e s .Number _ — q P P g Y gg PP ( ) tof times pumped A�ny portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within I00.feet of a surface water supply or tributary to a surface water supply. _ Any portion of.a cesspool orprivy is within a Zone 1 of a.public'well. _ .Any portion of a cesspool or privy is within 56 feet of a private water supply well. y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private Kala 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(he analysis must be attached to this forma (YeslNo)The system fails.I have determined that one or more ofthe 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. La a Systems:. . To be co sidered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• You must dicate either"yes"or"no"to each of the following: 1, (The following criteria apply to large systems in addition to the criteria above) yes no _ th system is within 400 feet of a surface drinking water supply — _ thi system is within 200 feet of a tributary to a surface drinking water supply — _ th system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-1WPA)or a mapped ne 11 of a public water supply well If you hav answered"yes"to any question in Section E the system is considered a significant threat,cr answered "yes"in Se lion D above the large system has failed.The owner or operator of any large system considered a significant eat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate.regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST. Property Address:- 24 Tracey Road Cotuit, MA Owner. Mark C'anni z,arp Date of Inspection: 7r- /—(3 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? 1/ _ Has the system received normal flows in the previous two week period? V Nave large volumes of water been introduced to the system recently or as part of this inspection? p. i _ 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? v Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?. "Was the facility owner(and occupants if different from owner)provided with information on the.proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes ..no j ✓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 CUR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 24 Tracey Road Cotuit, MA Owner: Mark Cannizzaro Date of Inspection: 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/1 of bedrooms): z Number of current residents: ¢� Does residence have a garbage grinder(Yes or no). " d Is laundry on a separate sewage system(yes or no):60[if yes separate inspection required] Laundry system inspected(yes or no);A/0 Seasonal use:(yes or no):�✓ Water meter readings,if available(last 2 years usage(god)).`'`'`2.1003 5 0, 0 0 0 Sump pump(yes or no):0! 2002 — TF,70 0 Last date of occupancy. COMME CIALMIDUSTRIAL Type of esta lishment: Design flow tbased on 310 CMR 15.203): gpd Basis of desi flow(seats/persons/sgft,etc.): Grease trap p esent(yes or no): Industrial waktc holding tank present(yes or no): Non-sani waste discharged to the Title 5 system(yes or no): Water mete readings,if available: Last date o occupancy/use: OTHER escribe): GENERAL INFORMATION Pumping Records Source of information: lCiZ7- 1 Was system pumped as part of the inspection(yes or no): &L,0 If yes,volume pumped:_gallons How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM - Sep tic 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all compon is date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):_ 6 I'agc 7 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C SYSTEM INFORMATION(continued) Property Address:- 24 Tracey Road Cotuit. MA Owner: Mark Cannizzaro Dale of Inspection: .4.2-1—p✓r BUILD G SEWER(locate on site plan) Depth b ow grade: Material of construction:_cast'iron _40 PVC_other(explain): Distance from private water supply weU,or suction line: Comme is(on condition of joints,venting,evidcncc of IcAagc;'etc.): SEPTIC TANK: V locate,..,_( on site plan) ) Depth below grade: 101-6/concrete Material of construction: metal fiberglass e -- —. g _polyethylene. o th e x la•m If tank is metal list age:— Is age confumed-by a Certificate of Compliance(yes or no):_(attach a copy of certificate) ► 1 Dimensions:— /' r' LA )(� Sludge depth:_ Distance Gom top of sludge to bottom of outlet tee or baffle: o� Scum thickness. �✓Q'-- r Distance from top of scum to top of outlet tee or baffle: Distance Gom bottom of scum to bottom of gjutlet tee or baffle: 1 How were dimensions determined: 01'e V Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,.): / > i GREASE TRAP:_(1 cane on site plan) Depth below grade:— Material of construction: concrete._metal fiberglass_�molyethylene_other (explain): _. Dimensions: Scum thickness: Distance from top of sc m to top of outlet tee or baffle: Distance from bottom f scum to bottom of outlet tee or baffle: Dale of last pumping Comments(on punt tng reconunendationS.inlet and outlet tee or baffle conditio:,structural integrity,liquid levels as related to outlet Vert,evidence of leakage,etc.): 7 Page 8 of I I OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(continued) Property Address: 24 Tracey Road C-c)tiii t., MA Owner: MArk CAnniZZaro Date or Inspection: r i—G TIGHT or plan) OLDING TANK: (tank must be pumped at time of inspection)(locate on site P ) Depth below de: Material of con traction: concrete metal fiberglass_polyethylene olher(explain): Dimensions: Capacity: I gallons Design Flow: allons/day Alarm present es or no): Alarm level: Alarm in working order(yes or no): Date of last p ping: Comments(c ndition of alarm and float switches,.etc.): DISTRIBU TION BOX:Z(ifresent must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): p PUMP CHA IBER: (locate on site plan) Pumps in w king order(yes or no): Alarms in rking order(yes or no): Comments note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM"INSPECTION FORM PART C' SYSTEM INFORMATION(continued) Property Address: 24 Tracey Road Cotuit, MA Owner: Mark Cannizzaro Date of Inspection: SOIL ABSORPTION SYSTEM(SAS)::V�(Iote on site plan,excavatiodnot required). If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): / )� CESS OLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number nd configuration: Depth—t p of liquid to inlet invert: Depth of s lids layer. Depth of s um layer: Dimension of cesspool: Materials o construction: Indication f groundwater in[low.(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): s PRIVY: (locate on site plan) Materials o construction: Dimension Depth of s ids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Tracey Road Cotuit, MA Owner: Mark Cannizzaro Date of inspection: 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.. ti y l L) 10 Pale 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Tracey Road Cotuit, MA Owner. Mark Cannizzaro Date:of Inspection: SITE EXAM ..Slope Surface water Check cellar. Shallow wells Estimated depth to ground water feet Please indicate(check)all methods.used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting propeity/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: tthecked with local excavators,installers-(attach-documentation) Accessed USGS database-explain: -� You must describe how you established the high ground water elevation: it TOWN.OF BARNSTABLE LOCATION ,�® �"� �°- l��:. SEWAGE # � VILLAGE ASSESSOR'S MAP 6z LOT0196 O 1 INSTALLER'S NAME & PHONE NO. D t j, A_ SEPTIC TANK CAPACITY /�� • . LEACHING FACILITY:(type) Z(�--,/aClre j0 T-S (size) NO. OF BEDROOMS l RIVATE WELL O BUILDER OR OWNER PX>--Yj /CC& DATE PERMIT ISSUED: jT Z, Af DATE COMPLIANCE ISSUED: ,, VARIANCE GRANTED: Yes No �— -� .Z • � C � N d� �� `J. � 2 �� a a L s--, �1 � `. �� a N .��. ......M�� FiS....767._ THE COMMONWEALTH OF MASSACHUSETTS EbAeR® O HEALTH ..............oF....... T Appliration for Disposal Works ..CTnntrnrtiun ramit Application is hereby made for a Permit to Construct"(�r Repair ( ) an Individual Sewage Disposal System' G.r. ..................... .�0..7' 11.�1__.'.. ................................. ..............--. Loc ddr s or Lot No. Owner Address W Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............ ..............................Expansion,Attic ( ) Garbage Grinder Other—Type of Building .... No. of persons.......:.................... Showers — Cafeteria a' Other fixtures -------------------------------------------•------•----------- •---------------- W Design Flow..............��..._.................gallons per person per day. Total daily flow..... J___________._ gallons. WSeptic Tank—Liquid'capacity/.�.S;Q_gallons Length..lQ°..._.. Width...�_�..... Diameter------- Depth, �.., x Disposal Trench—No. .................... Width........_.._._..._ Total Length......._.___..___. Total leaching area... __.__.._...sq. ft. Seepage Pit No......_�____---- Diameter.._.._......... Depth below inlet..... Total leaching area..G.M ....sq. ft. Z Other Distribution box ( ) Dosing tank // r� aPercolation Test Results Performed by tll�._!...Cr,,_________________ Date...__��..- zfx/-_--•---•---.. Test Pit No. 1...� ....minutes per inch Depth of Test Pit_, ���.__ Depth to ground water........................ f=, Test Pit No. 2e�� ..minutesper inch Depth of 'I t. , /--�--_. P�� _.. De th to round water________________________ :; ... Q" - J✓ at�.l.. ------------------- o ,� Description of.Soil...... — �,. 2 of 1_ � x �vo - 'TtDt�'-AN®-- TtFY-i1V-l�rf�lTllvG-- U Nature of Repairs or Alteration —AAWY1 when applicable_.____..T�__SYSTEM -WAS-INSTALLED-IN-STRICT-. ...............•--------•---•--................--------------------..A00t A1-=-T0- ----------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL 1Z 5 of the State Sanitary Code, he and sign t rees not to place the system in operation until a Certificate of Compliance has been is ed b boar .�. Date Application Approved By............... --_- - -- Date Application Disapproved for the following reasons:.............................................................................................................. .......----••-•-•---••--••--....---•-----•......................•--------................-•--------...................---•-•------...-------•----•--•--•--------...----------------------------••••-••--- Date Permit Na........... r.`.��__...'13 Issued....................................................•... Date g S' lio ................. --� FE's.. , ' ...... THE COMMONWEALTH OF MASSACHUSETTS ` BOARD�9 F• HEALTH ,/ ,( 4..GcJ ................OF.....//. ✓-��T� .2�......................................... Appliratinn for Disposal nrk� Toustrudinn Farm# Application is hereby made for a Permit to Construct K-5-or Repair ( ) an Individual Sewage Disposal System.-a't. f /f ..............11.�._ :.'"...., / ..................-----.....•--....... .r r.T.�1_..... -- ............. Lo on-Address or Lot No. G .............. - ........................................ 1 Owner Address 3 W Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......... ................................Expansion Attic ( ) Garbage Grinder-f—k4q `4 Other—T e of Building No. of persons............................ Showers — Cafeteria dOther fixtures .._....-•----------------------•-----..............---.--------•-----...............-••--••--•••-•-- ��5....................gallons per person per day. Total daily flow..... .: ..G....__._........._.._...._..gallons. r W Design Flow.... = g P P P� Y �Y � it { W Septic Tank—Liquid*capacit/Z��Q.gallons Lengthy........... Width.�.......... Diameter-----..-...... DepthS_';.1 1..O_¢ x Disposal Trench—No..................... Width.... ....... Total Length........... Total leaching area..... .............sq. ft. Seepage Pit No__ ............ Diameter.._..F.......... Depth below inlet._.K.._.._....._. Total leaching area7'e<o ...sq. ft. i Z Other Distribution box ( ) Dosing tank ( )� Percolation Test Results Performed by.Z. _li.. 'N..y�t-'.7................... Date...�r:.9:Z�.._...._..... Test Pit No. 1. ......minutes per inch Depth of Test Pit. V_ Depth to ground water______ ______________ f=, Test Pit No. e�.' .minutes�per inch Depth of .' it/&....... Depth to ground water........................ D Description of Soil f3 _.... Jf'. 50�G = !' /.G..a= I S� / - U --•------------------------•---- � - ! "�9(/_ �f"� s_.!�`�7ry- L r�C1..yJ�Z?= t/ :�A C_ ......... ' Nature of Re airs or Alteration s. when r when applicable...__.._. y �% A��_..... _! 2V------------------------------------------------------------------------ ...----•----•-.._...-•-----•----------------------------------------------------------------------------------------------------------------------•---•----------........................--------------- 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 a un rsig r grees not to place the system in operation until a Certificate of Compliance has been i ued e boa g h _Signed_.. c.-• lB�c-t------------------ ----?�1-_ ../-.4:.7-•-- . -- - 7 Date Application Approved By.............. .�:.. �_ :__ .< —.. ...........................••-•--- ------.. Date Application Disapproved for the following reasons------------------------•---•---•----------•------------------•---------------------------•----•---............_ ---•-•--.......--•....................•....--•--....------.....-------•----------•------•--_•---•---•-•--•.....--------•-------------•-------------•••------•----••--•-----•-------•--•-•-••------------ Date PermitNo............ ......................................... Issued-.................. ................................ Date \ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF... ' ................................ (Inrfif iratr of Tnutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed K)'-or Repaired ( ) by w Pu .... Installer .....--•----- ��� y at.. ..�2'...1_...... T f �i{/.................... - •--•----------- ---------•.------------...--•--........._...................--------•---•-----. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit dated----�'``� -__z_0.` . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA-//__ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r / - /- Inspector.......... ------------------------------------------- THEv / DATE - ._ ... .._�..�:...---• -1f� 4w. C��' "`1 =�-• NCB C v��f��•f�l'NGL P c�.�tt c�L .deft i� `,� COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH lx� FEE.. .....'j............ 19ispnsal Works Cannotrurtion frrmft Permissionis hereby granted.............................................................................................................................................. to Construct (lj�or Repair ( ) an Individual Sewage Disposal System atNo..Zlc�' -� �'.� � �. .....-----•--.----------- -----------------••-----------....-----•--••------•--•----•-------•-----------..... Street c­_ as shown on the application for Disposal Works Construction Permit N'o�... Dated. 1._` :'7---------------- . _. _.-. Board of Heah�h�`- DATE------.... ............................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS sssr ssrsqp:pssss:sss:::sssrss:ss::sssstsss:::setsr s:srt:ssrtsttnst:sttt:r:s............ts:stttssssss::ss:rt tststssssssssrssssrsrs:sss:s:sst:tstsssstsststttssss s s:sssssssss:s:s:s:::s sss...ssrss::a�stst4 sttstsst::s:sstsss::::s::::r ENVIROTECH LABORATORIES - 449 Rte. 130• Sandwich,MA 02563• (617) 888-6460 - CLIENT: Egan Constuction LOCATION: N: Lot 5 Tra cy Lane ADDRESS: Box 1240 Cotuit,MA - Dennisport,MA 02639 COLLECTED BY: Desmond Well SAMPLE DATE: 8/4/87 TIME: 1:00 PM DATE RECEIVED: 8 4 .87 SAMPLE ID: ET 41A JOB #: New Wall WELL DEPTH: RESULTS OF ANALYSIS: - • Parameter Units Recommended limit Result - Coliform bacteria/100 ml (MF Method) 0 0 E= H - H unit- p s 6.0 8.5 p 5.80 Conductance umhos/cm 500 52 - Sodium mg/L 20.0 7.3 wI Nitrate-N mg/L 10.0 <,05 Iron mg/L 0.3 <.05 Manganese mg/L 0.05 Hardness mg/L as CaCO 3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride. mg/L 250 COMMENT: YES NO XXX ❑ WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TE TED DATE � - ; :::::.:: ...::..... ::::::::::: :::: ...:::::: ti `fsiiiiii:s:sssssssssss:::ssssss:::ss:s:s:ssus:ssssuss:s::s:ss:ssss:::::sssssiiiiiEiiiiiiiiiissssssissssssssl sills iiiiEiiiiiiiiiiiiissssss::ssssssss:ss:s:s:sss:.sss:us:sss:uss:ssss:::::sssssss:sssssssssssss:.....iiiiiiiii..W. �\ r Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION Address Za7 ZZ le i/ ,4/"' City/Town d)7Z!/r AIA_-3S G.S.Quadrangle Map Grid Location /�,, Owner E"G/l/>/ �,/Y.S?)'A C.f/O,U F7� �iJ.� l/�/Zf7l�!) Address / .sl�a ✓ ,�/n/iCSPJ,Pr' u3s WELL USE CONSOLIDATED WELL Domestic©"'Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones' Method Drilled !�f/6 EIS 1) From To 2) From To Date Drilled, k/y 3) From Tc 4) From To CASING Depth to Bedrock Length el Diameter _ Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface t Sand: fine❑' medium coarse 0� Date measured /4 Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: If 76 r Yes No Slot*16 length & from to ❑ Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Sloth length from to Chemical 12" Biological Depth To Bedrock PUMP TEST Drawdown /1 feet after pumping-days / hours at h9 GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 I FAA&A 93 41 A//6'tt'SNNo S � `D DRILLER cb Firm J611716 i a Address JX/i�'X ` City , e,.it lhTP/ Registration No. iA-, sevE/z1a perator s Signature Please print firm y BOARD OF HEALTH COPY 25M-10-85•807101 20 FT MIN. 1C ri `. SOIL TEST TOP OF FOUND EL = �'�_. 10 FT. MIN. OBSERVATION HOLE I OBSERVATION HOLE 2 OBSERVATION HOLE 3 CONCRETE ---- N 4 SCH 40 PVC DATE OF TEST 7- 9 - e7 DATE OF TEST 7- 9 " 7 DATE OF TEST COVERS PIPE- MIN. PITCH CLEAN SAND WITNESSED BY G WITNESSED BY J D• WITNESSED BY -CONCRETE I/ 8 PER FT PERC. RATE L 2 MIN./ INCH PERC. RATE <2 MIN./INCH PERC. RATE MIN /INCH COVERS F �� 4 CAST IRON (OR ELEV = �dO"3 ELEV. _ 2 ELEV. = EQUAL) PIPE- MIN. �12"MAX E/. =/Gr%.3 C E/ =/gZl.2 O PITCH I/4 PER FT o o c� /00� 71`o1 /00/77 r / e.., o ° ° ". 2-0 �/ 2 /o MIN51, 5- aub �� 5c�b 5ai/ o FLOW LINE a . LEVEL f I o� U C/eUn meo! C�evr1 /I' MIN. EL:: -' / ° �` ° - ° --EL = `�8' 7 Po © / - P/'r3� ' 97 i fo E L= � E L= '/_/-=' c� {inc 5aOd __ _ EL n 0 Inc`o E L -E Ll DIST o o BOX �9 LOCATION MAP WATER AT EL = — WATER AT - EL = - WATER AT EL = No !✓o r`e i- En co u n �e r�ec� /2 50 o J GAL ' PRECAST LEACHING a SEPTIC —� EL - yZ'2 LEGEND: TAN K BASIN OR EQUIV./ EXISTING SPOT ELEVATION OOXO .D 40 EXISTING CONTOUR - -- 00 - - - - -- - - FINAL SPAT ELEVATION O0.0 FINAL CONTOUR 1001 /� PROFILE OF BOTTOM TEST HOLE OR OBSERVED WAT -_Z&2LE . EL = 96,2 SOIL TEST LOCATION Jf�, 6n7-1 47 SEWAGE DISPOSAL SYSTEM ADJUSTED GROUND WATER TABLE ( / / ) EL = TELEPHONE POLE ^/ NOT TO SCALE HYDRANT TOWN WATER VV = _ �A _ CATCH BASIN ®� FRAME & COVER SHALL BE / _ - SET WITH MASONRY UNITS 98 CLEAN SAND-� i WHICH ARE TO BE MORTARED, ; - IN PLACE GENERAL NOTES / //__ \ �� ( liOCQn 71-� 2 LAYER OF L.L�f n p ! I/8 - I/2' WASHED I ALL WORKMANSHIP AND MATERIALS SHALL !a� \ ./� STONE � ,t - - CONFORM TO D E Q E TITLE 5 AND THE� �� '• ` 9 � _ 6 _� �a I! TOWN OF '�"_ RULES & REGULATIONS 9, _ _ _ _ _ _ i ----- FOR THE SUBSURFACE DISPOSAL OF SEWAGE 2.ALL COVERS TO SANITARY UNITS SHALL BE P Posc-d We/'-� ! — _ ,I- - BROUGHT TO WITHIN 12 OF FINISHED GRADE w 3/4 1 1/2 3 EXISTING AND FINAL GRADES SHALL REMAIN �' I 'r—Enistn9 Well I I � F F- �I p �� >= v p WASHED STONE ESSENTIALLY THE SAME I a U G 4 NO DETERMINATION HAS BEEN MADE BY THIS -'" _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ I �o OFFICE AS TO COMPLIANCE WITH TOWN N _ _ - - Li- --- PRECAST LEACHING ZONING REGULATIONS OWNER / APPLICANT ` w BASIN OR EQUIV D,A COVERS —/ TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY PLAN VIEW 5. THIS PLAN IS VALID ONLY IF IT IS STAMPED � =o' AND SIGNED IN RED. THIS OFFICE ASSUMES NO RESPONSIBILITY FOR INFORMATION CONTAINED r-FRAMES & COVERS SHALL ON COPIES WHICH DO NOT HA VE AVE ORIGINAL _- - "+ STAMPS AND SIGNATURES BE SET WITH MASONRY UNITS 8=0" WHICH ARE TO BE MORTARED PL ACE 6 ALL COMPONENTS OF THE SANITARY SYSTEM iOo o - n ___^ INLET - _- SHALL BE CAPABLE OF WITHSTANDING H-10 _ _ LEACHING PIT DETAIL LOADING UNLESS THEY ARE UNDER OR WITHIN c MIN. OUTLET NOT TO SCALE 10 FT OF DRIVES OR PARKING AREAS H- 2( 6 MIN. FLOW LINE -- LOADING SHALL BE USED UNDER OR WITHIN 2 MIN. OUTLET PIPES REMOVEABLE COVER zoo �� �- OUTLET TEE /— IO FT OF DRIVES OR PARKING AREAS CAE �o �IO MIN. AS REQUIRED her u 5nQlI LIQUID DEPTH TEE , DEPTH �U� Qnn .� �- If BELOW FLOW LINE 1�4 �ef U'�eo 4 FT 14 INCHES INLET - D MIN FRONT SETBACK 30 b'C ,gym c�''�g / '� y�, i I J �} 5 FT. 19 INCHES _ �, ° OUTLET MIN REAR SETBACK 5 ,4 ff �tft a� 'G, f k , �_,, f} 4 FT MIN 6 FT. 24 INCHES —� FLOW MIN MIN SIDE SETBACK /5 ,)p VO o h Cie ' `' `et< -/ r t ,n LIQUID ( -- t� -LINE —�1 — pit e,cC� Orov �,f ell DEPTH 7 FT. 29 INCHES —� ��; n v� '�`_%' t'r + 8 FT 34 INCHES f' 2' 6' �. APPROVED : BOARD OF HEALTH s-' o r --- 4 . ` Z ! c' DATE AGENT r _ 2 10� r - PER I TEE NLET PROVIDED "yid °• - TITLE 5 PROJECT LOCATION - } 99 Lot 5 ?r�ocey 4.1 N0. OF OUTLETS CROSS SECTION VIEW DIST BOX DETAIL APPLICANT ;. �• SEPTIC TANK DETAIL NOT To SCALE �/9T��� � EG�/v' NOT TO SCALE Ht-A finch MMork_ R. J. O ANC Re Land Surveyors - Re So itoris on /(fJ.o DESIGN CALCULATIONS 9 y 35 ROUTE 134 - UNIT 2 - P 0. BOX 237 NUMBER OF BEDROOMS `*- ► SOUTH DENNIS, MA . / GARBAGE DISPOSAL UNIT /20 TOTAL ESTIMATED FLOW z -Y.4' < iQd ' .', IV4 ,81 tWK-64/7'' ( /iD GAL/BR /DAY x 4 BR ) 440 GAL / DAY REQUIRED SEPTIC TANK CAPACITY &(00 GAL. ACTUAL SIZE OF SEPTIC TANK i250 GAL — - - - - LEACHING AREA REQUIREMENTS - -- — SIDEWALL AREA e r GAL./SF -- - --- BOTTOM AREA o GAL./S.F. 8 ¢ r `u OF REVISIONS — • LE CHING CAPACITY ( BOTTOM -t' SIDEWALL) -�- - _ GAL. 2�2 5 x �- r. � X �;) •- (/O x Tr' x 4 x 41 � � � �, — ------- M � SCALE DATE RESERVE LEACHING CAPACITY4. GAL. o UM Y o. 5 • .p DR BY APPD QX IsrE sAll TAR�P� gN1) SU JOB No SHEET OF / FORM II/6/ 85