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HomeMy WebLinkAbout0050 WEST STREET - Health 5.0 West Street -� Cotuit 036-0511 i i i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A' CERTIFICATION Property Address: 50 West Street G'v( Cotuit. MA 02635 Owner's Name: Paul Grover Owner's Address: Date.of Inspection: February 10, 2006 Name of Inspector: (Please Print) James M. Ford 4 Company Name: James M. Ford Mailing Address: P.O.Box 49 _ _ Osterville.MA 02655-0049 a Telephone Number: (508)862-9400 CERTIFICATION STATEMENT eei .ii;N I certify that I have personally inspected the sewage disposal system at this address and that the in onnation�'reported below is.true,accurate and complete as of the time of the inspection. The inspection was perform d based`on my�� training and experience in the proper function and maintenance of on site sewage disposal system . I am-a-DEP+— approved system inspector.pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sys em: ' ✓ Passes Conditionally Passes Need urther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: February 16, 2006 The system inspector shall sub i a copy of this inspection report to the.Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under'the same or different conditions of use. Title 5 Inspection Form 6/15/2000 . page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 West Street _ Cotuit. MA Owner: Paul Grover Date of Inspection: February 10, 2006 Inspection Summary: . Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or 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. 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 inuninent. 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: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 ND explain: 2 Page.3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 West Street Cotuit,MA Owner: Paul Grover Date of Inspection: February 10 2006 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 West Street Cotuit. MA Owner: Paul Grover Date of Inspection: February 10. 2006 D. System Failure Criteria applicable to all systems: You must indicate either"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 or available volume is less than ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ ✓ 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 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.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15:303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow 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 systems in addition to the criteria above) 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes in Section D above 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. 4 Page 5 of I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 West Street Cotuit, MA Owner: Paul Grover Date of Inspection: February 10 2006 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 infonnation 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 ✓ _ 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(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: 30 West Street Cotuit. MA Owner: Paul Grover Date of Inspection: February 10 2006 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 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): . No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc* Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _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) - Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 10/10103-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 i Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: SO West Street Cotuit MA Owner: Paul Grover Date of Inspection: February 10 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 101, Distance from bottom of scum to bottom of outlet tee or baffle: 6" How were dimensions determined: _Measurin stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any s_ lgnS of Ieaka .e GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: SO West Street Cotuit MA Owner: Paul Grover. Date of Inspection: February 10 2006 TIGHT or HOLDING TANK: None (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: orallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): D - ISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Coimnents(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.): The D-box was level and clean. No solids were resent. The cover was 1 S"below PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Connnents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 West Street Cotuit MA Owner: Paul Grover Date of Inspection: February 10 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: _2-500 Qal. chambers 25'x12'(ner as built) leaching galleries,number: leaching trenches,number, length: leaching fields,number,.dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Commments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The chambers were dry. There did not appear to be any si ns o ailure.A video camera was used for the inspection. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): it 9 f Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 West Street Cotuit, MA Owner: Paul Grover Date of Inspection: February 10, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM . Provide a sketch of the sewage disposal system including ties to at least two permanent reference1andmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. a a y - i is� ay a 19 a(o 3 O 3 3° 3 s y yo a9 S y� 3-7 } 10 f Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: SO West Street Cotuit, MA Owner: Paul Grover Date of Inspection: February 10, 2006 SITE EXAM_ Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/- 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 property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain:_ topographic and water contours tnap _ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours ntap Maps are showing approximately 30'to groundwater at this site This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,,relating to the system, the inspection and/or this report. 11 r _ _ TOWN OF BARNSTABLE LOCATION 5b (A)L51 Y/- SEWAGE # 03 �qa'` `VILLA,3E C�V i I - ASSESSOR'S MAP & LOT GS NSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /OO D LEACHING FACIL=: (type)a'S rUO CAA % tpf t (size). aS X ��- NO. OF BEDROOMS 3 BUILDER OR OWNER Grover PERMITDATE: 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 Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by -. Ejr� A 6AGk 6 � s I _ O� a y o a iq a(o %-33 0 3 31 35 n _ TOWN OF BARNSTABLE i UPCATI.ON �� W ca-5-k- 5 SEWAGE # 'VILLAGE �0 u t ASSESSOR'S MAP & LOT 36 ,r RiSTALLER'S NAME&PHONE NO. �t N\.d�Cauu�J6 -R SEPTIC TANK CAPACITY 1,000 i LEACHING FACII.ITY: (type) Z- 56 0 S (size) of S l Z NO.OF BEDROOMS _ BUILDER OR OWNER ' C- PERMUDATE: 0 ` 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 Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility), i"' Feet Furnished by Q G' �- All fi � �d No. �-- Fe�5 0. 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pphration for Mie;po.5ar *pgtem Construction Permit Application for a Permit to Construct( )RepairXX)Upgrade( )Abandon( ) ❑Complete System XMdividual Components Location Address or Lot No. a o h n 13. B u t t/L i c k Owner's Name,Address and Tel.Noa o h n B. B u t t 2-i.c k 50 lde,t S.t2ce.t .t��- 50 oe,6t S.t2ePat Cotuii-, (7a,3.3. 02635 Assessor's Map/Parcel 3 6—5 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3 0 3 7 7 a. P. Nacomge2 & Son Inc. JC, Cng.ineezing 2854 CaantRe22y K.igh Jay R o x 66 Cente2v.iite, Ma.6.6. 02632 1 Cant 1da1zeham, Na.66. 02538 Type of Building: DwellingXXXNo.of Bedrooms 3 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 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) )m i.t.t i g IPanhina n.i i s 2-500 gaieon chamgezz Packed .in 4 ' olf 14" stone (25 'Xi3 'X2' 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 Certifi- cate of Compliance has been "bytof Heal L Signed Date 1016103 Application Approved by Date C, A G Application Disapproved or�th following reasons Permit No. 3 ^ Date Issued O $5 0. 00 4. Fee-, t �, _ THE�.COMMONWEALTH OF n �MASSACHUSETTS A U Etered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS es 0[ppfication for �Dfgpogar *pgtem Congtruction Verinit Application for a Permit to Construct( )RepairXX)Upgrade( )Abandon( ) El Complete System X.Mdividual Components Location Address or Lot No. ;o h n 13. Butt t-i c k Owner's Name,Address and Tel.N-�?,o h n B. 13 a.t t a i c k 50 Ye.-At StItee-t 50 est Staeet Co1_u.it, Nas.e. 02632 Assessor's Map/Parcel 3 6-5 1 CC�d V i 1 Installer's Name,Address,and Tel.No. 5 0 8-7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3-0 3 7 7 a. P. Nacomke/z 9- Son Inc. ;C, Fng.ineea.iny 2854 Cz 2 K.i an&e2y yh ay l3ox 66 Cen't:e2v.ii e, P?a.6-6. 02632 Cast Yaltek`am, Ma,3...,,. 02538 Type of Building: 3 j - t DwellingXXXNo.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 Number of sheets Revision Date Title E Size of Septic Tank Type of S.A.S. Description of Soil r Nature of Repairs or Alterations(Answer when applicable) 0m.i t t.i n y Z e a c h.i n g 2.i t.s. I n e t a Le i n g { 1- 2-500 gaiion cham9e2.s packed .in 4 ' o,l 14" .etone. (25'X13"X2" ' .Date last inspected: ,c' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system - 1 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 isseed"fs . of Heal� !Signed Date 1016103 Application Approved by Date 0 Application Disapproved for the following reasons t Permit No. e';L�75 Date Issued O g THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )RepairedX(XX)KUpgraded( ) Abandoned( )by 1. P. Nacomgea 9 Son Inc. W, at 50 Ye st St feet Cotu.it, Nae•s. has been constructed 'n a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No.SLV 3- 2 dated /D -� Installer .7. !. Macomgea 9 Son Inc. Designer John Au2e i.t :.� The issuance of this flzrt, hall not be construed as a guarantee that the system A 1 A-n a e gne . Date � Inspector No. '��' � 3 -'41k7 3""'"'` Fee $5 0. 00 THE COMMONWEALTH OF MASSACHUSETTS vPUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigpogar *pgtem Congtruction permit Permission is hereby granted to Construct( )Repair 4 X�f Upgrade( ).Abandon( ) 1 Systemlocatedat 50 G/eet .Staeet Cotuit Plana. 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. _r Provided:Construction must be completed within three years of the date o this pp Date:_ /O IU 3 Approved by COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS • b DEPARTMENT OF ENVIRONMENTAL PROTECTION FAILED INSPECTION TITLE 5 OFFICUL INSPECTION FORINI — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORNI PART A CERTIFICATION ; CEIVED Property Address: 0 t✓e 4- ,S- - i MAY 0 6 2003 Owner's Name: `/p -� �c Owner's Address: p P FUvvN OF BARNSTABI,E HEALTH DEPT, Date of Inspection: ` Name of Inspector: ( lease print) X Company None: /U!✓! — "c C Mailing Address• O MAP X • 9I l Telephone Number: Sv LOT CERTIFICATION STATENIENT 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 =fining and experience in the proper function and maintenance of on site swage disposal systems. I am a DEP approved system inspector pursuant to section 153-t0 of Title 5(310 CivIR 15.000). The system: Passes Conditionally Passes eels Further Evaluation by the Local Approving Authority !/ Fail Inspector's Signature: cat 3� Date: 'the system inspector shall submit a copy of this inspection report to the ApproNing Authoritv(Board of Health or DEP)«iteatt 30 days of completing this inspection. If the system is a shared system or has a design flow of t0,0i)U Dpd 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, ilappticable,and the approving authority. Notes and Comments _ C G1 /Ce5�/44 ""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 conditions of use the future under the same or different Page 2 of 1 I OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORT PART A CERTIFICATION (continued) Property Address: t,/PS� S Owner: ri Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Pauses: f// I have not found anv information which indicates that any of the failure trite ria jo_.303 or in 310 CN R 15.304 exist. Any failure criteria not evaluated are indicated below. s�ribed in 310 CiviR Comments: B. System Conditionally Passes: 4V One or more system components as described in the"Conditional or repaired.The system,upon completion of the replacement or rcpair,as approved-by the Board of eallth, will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined" please ^r The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound,exhibits substantial inMEMdon or ex filtration or tank failure is inin inent. System«ill 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 irupection 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: 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 inspe ction if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed i s . Thc system will pass inspection if(with approval of the Board of Health): p�( ) broken pipe(s)are replaced obstruction is removed ND explain: OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertjAddrcss: �Q / - Wc� � S� Owner: „ r Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board a is failing to protect public health safety or the environment. f Health in order to determine if the system 1. System will pass unless Board of Health determines in accordance with 310 CNIR 15.303(1)(b) that the System is not functioninb in a manner which wi11 protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the 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 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 pprn, provided that no'other failure criteria are triggered. A copy of the analysis must be attached to this form. 3• Other: OFFICL•kL L ISPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: � 6 Owner: Date of Inspection: 3 D. System Failure Criteria applicable to all systems: You must indicate-"yes"or"no" to each of the following for all inspections: Backup of sewage into facility-or system co,tponent due to overloaded or clogged SAS or cesspool Discharge or pondin0 of cifluent 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 clo cesspool gged SAS or Liquid depth in cesspool is less than 6"below invert or available volume is less than V-day flow _Z Required pumping more than •t times in the last year NOT due to clogged or obstructed i Of times pumped P pe(s). Number /Any portion of the SAS,cesspool or privy is below him v Any portion of cesspool or privy is within 100 feet of a surfagroce%e`ater sud water pply or tributary to a surface water supply. /may portion of a cesspool or privy is within a Zone 1 of a public well. y ponion of a cesspool or privy is within 50 feet of a _ JC Any portion of a cesspool private water supply well. po or privy vy is less than 100 feet but greater than 50 feet from a private water supply well «ith no acceptable water quality analysis. (This system passes if the well water analysis, pCrfo rm.e DEP certified laboratory,for coliform bacteria and volatile o Danic compounds indicates t::... :ne 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 arc triggered.A copy of the analysis must be attached to this form.) ��Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as (/ described in 3 10 dKIR 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 la s`s'cm gPd- the$vstem must ser-ye a facility with a design now Of 10,0)4)gpd to 15.04)4) You must indicate either"yes" or"no" to each of the following: (The following criteria apph to large systems in addition to the criteria above) yes no _ the system is within 400 fen of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water suppiv _ — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes to any question in Section E the system is considered a significant threat. or answered "yes" in Section D above the system has failed The owner or operator significant threat under Section E or failed under Section D shall u of any large Gorda considered a 15.304. The system owner should contact the appropriate regional office o f thesystem to accordance with 310 ChIIt Department. OFFICL-kL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEIJ INSPECTION FORM. PART B CHECKLIST Property Address: Q /��� S* p 63�Owner: �� /r cry I Date of Inspection: Check if the folloMnz have been done. You must indicate`�•es" or"no" as to each of the followiniz: Ye No ; Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped Ped out in the previous two weeks Has the system received normal flows in the previo us us two week period Ha a ve large volumes of water been to troduced to the s<•stem 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 backup Was the site inspected for signs of break out F Were all system components,excluding the SAS, located on site V Were the septic tank manholes uncovered opened. and the of the es or tees, material of construction, dimensions,depth of liquid, interior de the tank inspected for the condition , goid 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 - E fisting information. For example,a plan at the Board of Health Determined in the field(if anv of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CNIR 15.302(3)(b)1 . OFFICIAL hi ISPECTION F ti _ . ORI I NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL. SYSTE IMSPECTION FORM iNTS PART C SYSTEM INFORMATION Property Address: Gvc�s� Owner: � Date of Inspection: RESIDENTIAL, FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on.310 CNIR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents:�_ Does residence have a garbage grinder(yes or no): /VG Is laundry on a separate sewage system yes or no :_O tf yes se Laundry system inspected(ye or no):/kV ) slate inspection rcquiredj Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage ( )): SAP PAP(Yes or no):/j/'Q Last date of occupancy: � C O NDIERCIAULND USTRUL Type of establishment: Design flow(based on 310 C1v1R1-5-2-0 3�Y: gpd Basis of design flow(seats/persons/sgft,etc.); Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of ec upancy/use: OTHER be): Pumping Records GENERAL IINFOPUMATION Source c f information: /'<-r e. d Was system pumped as part of the inspection(yes or no):_ If yes, volume pumped:--___gallons —How was quantity Reason for ping: q ry Pumped determined'.' TYP F SYSTEM eptic tat distribution box, soil absorption system _Single cesspool _Overflow cesspobi -Pricy _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 hom system owner)* Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date insta ed(if known)and source of information: FJ✓r i•'Ig ( " .. .-. Qc-vLe Sf> Svc. G l0 S � � Were sewage odors detected when arriving at'he site(yes or no):" OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM LYFORINIATION (continued) Property Address: JrQ0 4't�5 Owner: &1 Date of Inspection BUMDLYG SEWER Oocat¢ptt site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): S EPTIC TAINK:—(1 c to on site plan) Depth below grade: / Material of construction: concrete_metal—fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no :certificate) (attach a copy of Dimensions: Sludge depth: Distance from top of slu a to bottom of outlet tee or bade: A7 Scum thickness: Distance from top of scum to top of outlet tee or batEle: Distance from bottom of scum to bottom�f outlet ten baffle: _ `f How were dimensions determined: e �e—mac c Comments(on pumping recommendations, inlet and o tlet tee or baffle condition, structural integrity, liquid levels a�latcd,to outlet inven., evidence of ge,etc.): �, /,� s �,�� � ��� CPG n,.� /vo GPI �• GREASE TRAP./// (locate on site plan) Depth below grade:— Material of construction: concrete metal fiberglass_polvethviene other (explain): — — _ Dimensions: Scum thickness: Distance from top Of top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): ragc a u< <i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM II ISPECTION FORM PART C SYSTEM L 1FORINIATION(continued) Property Address: Wes Sj Owner: Date of Inspection: TIGHT or HOLDii(G TANh:4E/(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: Material of construction: concrete metal : fiberglass_polyethylene other(explain): Dimensions: Capacity: Design Flow: gallons gallons day Alarm present(yes or no): Alarm level: Alarm in worlds order Date of last Pumping: g (Yes or no): Comments(condition of alarm and float switches, etc.): D15TR1B(MI k1lImo`;; / Id (if present must be opened)(locate on site plan) Depth of liquid level abo%-_ .. invert Comments(note if box is lc'.Cl =;d distribution to outlets leakage into or out off any evidence of solids carryover,any evidence of h� PUMP CELMNMER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances.etc.): OF'FICLA-L INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORI-vt PART C SYSTEM LNFOILMATION(continued) Property Address• J Owner: Date of Inspection: SOIL ABSORPT'OY SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Typ p / leaching pits,number: leaching chambers, number: I ' � leaching galleries,number: ��e leaching trenches, number, length: leaching fields, number, dimensions overflow cesspool, number- innovative/alternaLve system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ndin� etc.): // _ Po ,,damp soil,condition of vegetation in � w U/G� �TCil.7$ �O /hVe.�� ` CESSPOOLS: cesspool must be pumped as of i' ! n�u Wocate on site plan) I�lumbcr and configuration: _ s Depth �— —top of liquid to inlet invert: Leptn of solids layer: Depth of sewn layer: Dimensions of cesspool: Materials of construction: Indication of groundwater intl (yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation e(c.): 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.): OFFICIAL INSPECTION FO&NI' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM LNFORINLATION(continued) Property Address: 0 Owner: Date of Inspet-tion: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including tics to at least two F'crn=cnt referentc landmarks or benchmarks. Locate all%•ells within 100 feet. Locate Where public water supply enters the building. 67Z 3y rage L i v► t t OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM " PART C SYSTEM LYFOPUN ATION(continued) Property Address: Owner. 12 H li Date of Inspection: �^ l SITE EXAM Scope 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 sv stem design laps�p on record-If checked.date of dent Plan re., w Observed > P ze cd: site abut ( �,Pro rtv/observati Pe on holc within ISO feet of SAS) Checked with local Board of Health—explain: Checked with local excavators, installers-(attach documentation) Accessed USGS da tabasc-explain: -. You st describe 'ow you established the high ground water elevation: Ole a ©a� 000 d 0 CO0 QaQ f / 1 If / j � J A-0 TOWN OF BARNSTABLE LOCATION �® t,'c y SEWAGE # Zg Ai 2 VII.LAGE C0 O, ASSESSOR'S MAP & LOT—!— INSTALLER'S NAME&`PHO TANK CAPACITY o C) SEPTIC , LEACHING FACILITY: (type) 'Z ��05 (size) S l NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: D 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) l Furnished by I , ��\�: -35-.® - <Avolno;v� Law Q �re z E C7 F"m°»ti 4 PEW W � IQo 46 U v. {EXISfQY.J . NEW AKWM NEW ARVEMN Mi AIMN FWG 6068 L 1 W 24MO - G 4:-6 . . T------------ ____D . ------------------------- 3iAI 1N ------ NEW L -- 00 KItCN�N(KWANW5ENb I& W2446-2 VEPFY KIf(HN Oo '1I1 - LAYMM/OLNV,) i t II n0 s PANfRY F=-===-� r.FWAd\TcR9EN N 1 I DOG1? t700 1 11 x ----_-�_-- R` - —--- - N NEW r-+ ----------------- PECK DIVING OrMOI E19 wG o 6 N II A �GiENIJPWPIL f?INING - Q �-• fO RMAf&,1Ff I onul 9M OF SfAPS 1 � W (71 I ✓ �^y 11 l n v`NEWANVMN .MWANVEMN WWAIMP.`.EN NEWAWEP.`N I (W2446 IW2446 fw2446 . 1W2446 I NEW. I _ o raw 2-2.aG';f AE'OVE ---- ---- ---- ___— __ SCALE: A r4wa.4 P.fFo5f5w/ t.5/r.(7 CAso G 6'-10" 6'e _ DATE: 7/9/2004 I /� I (APO") (MU nUJ) I If\5T PROOF\ PAN JOB NO.:G E �G�Nbc EST 6EME AL NOTE5: I.) CONt�ACTOR IS t0 VERIFY EXISTING CONt7iT10N5 MR7 DIMENSIONS DRAWING NO.: EXI5TING WA-1,5 ,_ _ IN TIC FIELD FRIW TO TIC 5TVf OF WORK - CON5VUCTION TO It MMOVU9 L--J 2.) CONfRALTOR TO RE-MOVE EXISTIIzDOORS,WINDOWS, • - - ^_," NEW CON5f MCfIOM WALL5,&ROOFING A5 MQUIRED FOR MW CON5fUfI0N. -5.) ALL NEW C01J5TRI.ICTION TO MATCH U1571NG IN MATERIAL, DETAL.AJD FIt\I5N i a NEWG5FhTWWIJWN MWAWMN I �EWCA A€NfNJ3J70A tY] Pw s P1EnBvau�e rw2442 w>�.EVBvatm Z Li zp� b'o"Ord n EXIST. Q W 16'a'BIFan Q N R j PATH I o QOS. j Q'05' n�wG,�nr�Nrwlw)oW . Q Ew- MwN c�N FXG C 0 M2442 6�(7r00M I I I 5tMePOYMNE'R Z co W; F Wa.ti EXIST. oM¢00 2.411VOO-1 -I' 2,6,.tXKk Z 9WAP N n VtJ b N _ � w iw 2442 _- ;r w ENLAU12 few a%MeNr Way 0 MINOOM ( ( amEvBYaoP.M - - - - - --- -- -- -. .. _ - - - - - --- - - - - - - - - - - -- -- - --- -- - -- - - - - - - 6,0"Blfan 16'O"BVan ENLAI?M2 - - A a05. I ( a05. C3MOOM i ( ' rl tt - tt __ _______ _ (__-L----------- c NEW FOOF CON5Tf3.1CTION �- •i :: .� •- t.2x8P.PffERS@I6"o.c. NEWATnEF. N N I�INAM7E1', tJl NEWAWEP.�N t.�WMIDEP,�N t�W` N 2.112CPXMMOOP9fAlHWA, - tW 24NO rW 24510 M 24510 TW 24VO 1W 24:10 5.A5PrKf POOF 5{•A11E5 12 - ' TAW5'-6" 7'-I" b'-5" 5'-b"' 2'-10" - 4.15 4 KVPA-TP MAfCN� 5.9"(R-�O)CAM IN%AfIOV@ FLAT aLW,6 EXIST. l 2'Cp' O zb 6.8"<R-50)MGfiniNS.W5AATION@SLGrEnCEILP 5 ►--� (IEWSEDPGRJ9J G (O - `P02Gi!?CYvF- - CG1f.&MAPA O BELOW 50FF If vrw5 I/Z"aP ON I:5 S1R*FItT?PPIIJ NEW WAf. CON5T. 16"o.G A 2 1%2'PLMOOP HAM114 6f f2t?OOM 5.5- I/2"(P D)Mr.M11.ATION 54'-O"s 5.WIC. NQE SIDf1rl e g t 1 6.rMK VAPOR BATEP, 2.8 ~� 5FCONn F�OOV PLAN r 2-2x8•z V KW 4 x 4 P.f.PO5f5 W/ t� tt��GG w ` 1.9/1.6CASWG C f�117 r\LM012. ►—+ � PGVCN LIVING W 2-P.T.2.10's SCALE 1/4"= 1._0.. DATE: 7/9/2004 NEW 12"PIA 50tJOM5 rO4'O"ffLaVC AM JOB NO.: Y� WEST f-A--\6UI�PINCA SIG C It 1 ION @ NFW rOVCH DRAWING NO.: A2b - r9w Kfftf ROOF S ZW5' z rQrOF�i.ArE � Z p� C7 � FM IFIDIf� Ioo r, IFFHI ® ® ro auCrwseorms Q q Q FM FM cD LLLI Z C/)w— WW FASQA&F 9 t�W WC.si�a E 1r11AY — F LJ N S�i_�Ef0 P0A°D5f0MAfQiEXISt foMAfO1EXI5fWG Ems-m U pp W d o x D ❑ tW 4 x 9 P.f.PO5f5W/ H-HI_+ w 1x5/116CASM TP IFM IFFFI --- -- =- --- -- - - - -- - - - Fr5fFLOGK - - - - --- - --- - - - --- - --- -- -- ---- - - - - - -- - - - - - _ 9irf CLP. _..... _. . ommm MONT UVA110N nEWLAffILE nW P.ACE S iP.W GOP�'VS 12 - 12 O � 10MAfQiDa5f. MArOi� �EXISf. EX15f. rO�� i07OF FLAtE � V 0-4 w W a. > w Q c) 12 4t ToP Of RATE tr T.J z r l CD x ` Fv rF�Oci? SCALE: v �ooUlll 1/4"= 1'-0" DATE: 7/9/2004 mmP.f.6x6 Posrs JOB NO.: WEST FICK 51PF UVA-flON . DRAWING NO.: e IOW ASf•Wd.f --- zoo (no C> JM max¢ s W �U)W.—. E—w=N --- - (U) E--m¢a EM IF I Urn IFF — -------- - r - ❑ ❑ - . MA ��FVAT10N I2 IZ o D u%.12 IMAsr.roH MEW ME S iRUA DOAMi Ew ro MA"Exi5r. roP of roan o tfw CORNER COAM5 ® ® ro rowrctl Ex�sr, w w IOW W.C.%MQ.E 5Q M6 G - ro tmroi"6TIN6FM x o r LEIQ cn i2 �--� 5ECOW FLOCK w ' new 4 z 4 P.r.P05t5 W/ F—/Iz5/Iz6CA5Cde So 1 -------- SCALE: 1/4"= F-Q" FP.5r FLocr wEF�ooP_ DATE: 7/9/2004 w P.r.b bw�nrn� JOB NO.: Fosrs EST DRAWING NO.: } (PMSICTll NEW P.f.6 x 6 PO%50N IT t0.`0MOM5f0 0 MLOWCPD0 { { { { { 8 LP ( { { { NEW P.L 2 a 12's 0 * Z mew KW P.r.7.10's ei'16"O.C. � � �Cz7 x N iv g a w F-ooQC> p ExtSr.��:wvu.s>3 EONW6 rO MMAJN m G o c N N - ii fl. (V . - tV ssxi �XISt. ID O A o P.f.2zIOLED6-Fk'VOl-)EOLIfPfO ^ O 5av 6 OCKMG IN 5/A"55.LP6 Ml5 TO"oc.5fAG&MV.5M Oaf FEAR I� LEM 5V rLA5f%,OVEP hG_W P.f.2 z$s @ I6"oc. O ✓ ` P.f.2 z 10's @ 16'oc. 1 z 4 NfAl106kJY 60f1i ENVS OF,7615 .f.6.6 POSfS i > - PL500&16 d 9"of 55��qqrr SfFf.LEREDd 2,6 fO O&V POSt _1JISt5 A S l SCALE: d IdEW ff.2 z IO's - - 7 ' A I W P,t.6 z 6 PO5f50N 1/4"= F-0" i2"D A 50N0fm5 f0 4'0"PELOW6M 6'-6� DATE . _ _ 7/9/2004 <A�it0v) AVV f 12'M.CC- qso o JOB NO.. FOUNPA11ON PLAN MAM WEST �C�UI�nING 5�CWN @ NEW PECK DRAWING NO.: A5 .. 1 4; �s 's u r, �. TOP OF FOUNDATION ELEV. = 56.1 4' PROVIDE PRECAST CONCRETE 5"DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS= 46.85'-48•83' EXTENSION RISER WITH GENERAL�1 E p /� I NOTES c+ CONCRETE COVER TO WITHIN 6" REMOVABLE COVER SLOPE @ 2%MIN. OVER SYSTEM V N RAL S FINISH GRADE FINISH GRADE OF FINISHED GRADE ABOVE 4"SCHEDULE 40 PVC MIN SLOPE 1 /o DOUBLE WASHED STONE TO CROWN OF PIPE FINISH GRADE OVER D-BOX=47.80' � 3/4"TO 1-1/2" DOUBLE r OUTLET COVER 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION . @ FND. EL.= OVER TANK EL.= 47•80-48.60 2"OF 1/8"TO 1/2"DOUBLE WASHED STONE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. SLAB EL.= 48.81' 20"MIN.ACCESS COVER TOP OF SAS= 45.83' PLACE RISERS ON ALL CHAMBERS 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD (TYPICAL FOR 2) 36 MAX. TO 6 OF FINISHED GRADE 45•001 36"MIS , OF HEALTH AND THE DESIGN ENGINEER. - . ,,,• EXISTING 4" BREAKOUT EL = 45.50 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL PVC PIPE BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 6" 3° " 3" 9° PROVIDE WATERTIGHT- 4. TO PREVENT BREAKOUT,THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN ;•.:.,. 2 DROP MIN. JOINTS(TYP.) ELEVATION =45.50'FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS 3"DROP MAX. 4"PVC IN FROM 1cp _ 0 0 0 o000 0 O 0 0 0 •''�' *CONTRACTOR TO o A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF '�'•' 14" SEPTIC TANK 4"PVC OUT TO THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. •it T .. f VERIFY ' LEACHING FACILITY � 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. w F_: 48.40'± 46.54 ± 12" 21 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. *CONTRACTOR TO CONTRACTOR SHALL VERIFY SIZE 48" 45.54' MIN. 45.3T 00 0 00 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN VERIFY AND CONDITION OF TANK AND TEES OUTLET TEE " c 0 0 o SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO 6 CRUSHED STONE BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. AND REPLACE AS NECESSARY " GAS BAFFLE OVER MECHANICALLY 0 0 0 6.63' COMPACTED BASE 4' 8 5' - 8. ELEVATIONS BASED ON ASSUMED DATUM OF 50.00'MSL OBTAINED 5 OUTLET DISTRIBUTION BOX 25 0' 3.55' 4 9' 3.55' FROM A NAIL IN OAK TREE AS SHOWN ON PLAN. TO BE INSTALLED ON A LEVEL STABLE APPROX. 5.O' /USGS (TYP.) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION BASE. FIRST TWO FEET OF OUTLET 43.00' GROUND WATER ELEV.- l � 12.0' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE EXISTING 1 000 GALLON CONCRETE SEPTIC TANK AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY PIPES TO BE LAID LEVEL. 2- 500 GAL. CHAMBERS 5 MIN. DISCREPANCIES TO THE DESIGN ENGINEER. LENGTH 8'-6" WIDTH �- �� DEPTH sr?�� 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE CROSS SECTION VIEW SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR NOT TO SCALE NOT TO SCALE NOT TO SCALE ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH TEST PIT DATA DETERMINATION FROM APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS * Coffin LOCATED UNDER PAVEMENT DRIVES OR TRAVELED WAYS IN WHICH CASE INSPECTOR: Cynthia , DESCRIPTION HC 1 HC 2 * �" � SOIL EVALUATOR: Samuel Philos Jensen THEY SHALL WITHSTAND H-20 LOADING. •"" x * II D-BOX (1) 40.1' 34.1' ' { "� DATE: July 17,2003 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. CHAMBER COVER 2 41.8' 28.3' 11 TEST PIT#: 1 O , i/ 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND �. ELEV TOP= 45.33' UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF - CHAMBER COVER(3) 47.9' 36.T � �' e ' "' � � ,a ' _ �.ar s LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN • '• , +• ELEV WATER= APPROX. 15.0'(USGS) COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN u ` ACCORDANCE WITH 310 CMR 15.255(3). MAP 21 PERC RATE_ <2 MIN/IN W a •�, .k �.►o 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PARCEL 114 c i r II DEPTH OF PERC= 39"-57" SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. TEXTURAL CLASS: 1 o 16 PROPOSED PROJECT IS LOCATED WITHIN: ci • ' �� � ASSESSORS MAP 36 PARCEL 51 • . ` ' ... . . �,.: if 0 45.33' to + ■ , 17. OWNER OF RECORD: JOHN B. BUTTRICK O o POST - �; } O Sandy Loam W FND " " ' �" � 10YR 2/2 ADDRESS: 50 WEST STREET CB N88036'40"E 240.02' g • COTUIT, MA 02635 x * " 4" 45.00' 1 • �, r Ob1� Med.Sand FEMA FLOOD ZONE ZONE C FND,, E 10YR 7/2 AS SHOWN ON COMMUNITY PANEL# 250001 0021 D 10" 44.50' 18 PLAN REFERENCE: • �� „ �, .• Loamy Sand BOOK 153 PAGE 7 AS RECORDED AT THE BARNSTABLE COUNTY REGISTRY OF DEEDS. 56 / / . " • . • B 10YR 4/6 S MAP 36 r:, ' • 37" 42.25' 19. DEED REFERENCE: MAP 36 �5 _- ,,, . , . . • BOOK 3345, PAGE 287,AS RECORDED AT THE BARNSTABLE COUNTY REGISTRY OF DEEDS. / PARCEL 51 PARCEL 17 . .*a.• • 1 ACRE± * � +C C-1 M-C Sand 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. EXISTING 1000-GAL �►` " "". 10Y 6/6 ' \ r' ' 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY SEPTIC TANK FOR SEPTIC SYSTEM UPGRADE.--JC ENGINEERING WILL NOT ASSUME ANY LIABILITY MAP 21 37.33' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. PARCEL 9 / , • ` * Ur G2 Med. Sand 2.5Y 6/4 LOCUS PLAN 132" 34.33' / / \ NO WEEPING,WATER OR -'� SCALE: 1"= 1000' MOTTLING OBSERVED. LEGEND DESIGN DATA �OO \ �\ \ - - 50 - - EXISTING CONTOUR ���0 �^ HC �' \ �°, MAP 36 NUMBER OF BEDROOMS(ASSESSORS) 3 50 PROPOSED SPOT GRADES ��Q � �� \ \ w NUMBER OF BEDROOMS(DESIGN) 3 GRAVEL DRIVE ' o��0 �� \ SID ro PARCEL 16 NUMBER OF PERSONS 2 E PROPOSED CONTOUR W W W W - W' - W -- h`�� 2p0• DESIGN FLOW 110 GAUDAY/BEDROOM - w} Sp \� TOTAL DESIGN FLOW 330 GAL/DAY E/T/C EXISTING OVERHEAD UTILITIES / \ Z ` OD 6.6' C'' �}/ EXISTING WATERLINE �, , O� HC 1 CO '� DESIGN FLOW X 200% = 660 GAL/DAY o �� . EXISTING GASLINE �`"---2-500 GALLON USE EXISTING 1000 GALLON SEPTIC TANK GAS LP 1 \ LEACHING CHAMBERS TEST PIT LOCATION WEST STREET W S '� (3) \� , INSTALL 2- 500 GAL. CHAMBERS (UNDEFINED LAYOUT) � � ((( / ` \o, \ Q Q Q EXISTING 1000 GALLON SEPTIC TANK LP • SIDEWALL CAPACITY / ' ( 30"PINE 5 4"SOLID SCHEDULE 40 PVC PIPE f ' ` TP#1 Ik \ \\ (L+W)(2 SIDES)(2 HIGH)(.74 GPD/S.F.) = GAUDAY 1 ' ` rn ' � � ISTRIBUTION BOX (25'+ 12')(2) (2') ( .74 GPD/S.F.) = 109.5 GAUDAY ❑ DISTRIBUTION BOX o \45.33' m r 1 \ 500 GAL. LEACHING CHAMBER \ \ � ' \ �j EXISTING BOTTOM CAPACITY o DISTRIBUTION BOX (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY \ \ S sr o, p (25 x 12) (.74 GPD/S.F.) = 222.0 GAUDAY 2 t V, Ira 10/8/03 DS JLC LEACHING FACILITY PLACEMENT ' I 1 10/7/03 DS JLC SLAB ELEVATION o o � � I `� TOTALS: REV. DATE BY APP'D. DESCRIPTION CB TOTAL NUMBER OF CHAMBERS 2 s88036134"W 239.54' ! / O FND PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING AREA 448.0 SQ. FT. TOTAL LEACHING CAPACITY 331.5 GAL./DAY PREPARED FOR: B.M. EXISTING LEACHING PIT / / ! 1 MAP 36 JOHN B. BUTTRICK MAP 36 Nail in Oak TO BE PUMPED AND FILLED / / l PARCEL 2 Elev. =50.00' WITH CLEAN SAND(TYP.) / I ' PARCEL 15 Assumed � LOCATED AT n I 50 WEST STREET / I � COTU IT, MA 02635 RESERVED FOR BOARD OF HEALTH USE MAP 36 SCALE: 1 INCH = 20 FT. DATE: JULY 28, 2003 0 10 20 40 80 FEET PARCEL 14 TH OF AQ� O� cCS goy"L. w PREPARED BY: CHURCtiILL m-` R. JC ENGINEERING, INC. CiV;L No 4180' 2854 CRANBERRY HIGHWAY 4 EAST WAR HAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1"=20' Drawn By: SJZ Designed By:SJZ Checked By:JLC JOB No.494