HomeMy WebLinkAbout0040 FAIRWINDS DRIVE - Health 40 FAIRWINDS DRIVE, OSTERVILLE
A = 165 021
I
PROPERTY A o o R e S S: 4 0 Fairwinds Drive ----
' OstervilleL Mass J�
---- -----------
-------------
-
On the above data, I Inspoolod the eoptlo oyite'rh at the above address.
ThIl syatom consists of the following;
1 . 1 -1500 gallon septic tank.
2 . 1 -Distribution box.
38 'X1 3"X2'' IVED
3 . 4-Flow Pr? e u�RrAq Inspectlon,- V oortlfy the followlns oondltl nar
4 . This is a title five septic system. OCT 09 001
5. The septic system is in proper working order
at the present time. 1 HDESTPT'.
6 . ' Pumped septic tank at time of inspection. Heavy scu A
& solids layers are present. `
SIQNATURL7,
name : --------
Company; J_o, .�h_P _ H•comb@r_6 Son , Inc ,
Addreaa ; Box 66
_Concs.ry1!! L He_-02631-006.6
Phone: 508- 7.75 7738
-.... - rwwww ww
THIS CIATIFICATION OOE$ NOT CONSTITVTe A CVARANTY OR WARRANTY
C
P, MACOMBER & SON, INC,
Tnkl�Orlrpoolt'.l,�+chll"dPvmpfd 4 Inioll+dTown 5#w+r Cvnn+vlloni
66 CinllrYllli, MA 026JZ.0066
776
3
3
J8 7756412
_ �1
COMMONWEALTH OF MASSACHUgETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
i
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 40 Fairwinds Drive
Ostervil�le,Mass,
Owner's Name: Sandy Myrick
Owner's Address: Same
Date of Inspection: 9/5/01 r.
Name of Inspector: (please print) Joseph P.Macomber Jr.
Company Name:J.P.Macomber & Son Inc.
Mailing Address:Box 66
C'enteryil1P',Mass_ 02632
Telephone Number: RnR_77r;_-4338—
CERTIFICATION STATEMENT
I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP
approved system inspector pursuant to Section15.340 of Title 5(310 CMR 15.000). The system:
f 1/✓ Passes
_ Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:
The system inspector shal bmit 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
r ****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.
i
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: 40 Fairwinds Drive
s ervi e, a
Owner: Sandy Myrick
Date of Inspection: 975701
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
System Passes:
I have not found any informatio hich 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:
The septic system is in proper working order at' the "
present time.
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.
0 The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
416 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:
410 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
r
Page 3ofII 1 ,
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 40 Fairwinds Drive
ass.
Owner: Sandy Myrick
Date of Inspection: 9/5/01
C. Further Evaluation is Required by the Board of Health:
AjQ 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(i)(b) that the
system is not functioning in a manner which will protect public health,safety and the environment:
AM 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:
,JW 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.".
.Ud The 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 b t 50 feet or more from a
private water supply well**. Method used to determine distance r1Qlds ,
"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 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 40 Fairwnds Drive
Ostervi e,Mass.
Owner: Sandy Myrick
Date of Inspection: 9 5 01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
ackup 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
Zesspool #-Fkty 'Q^ ,
iquid depth in gosepool.is less than 6"be ow invert or available volume is less than"/2-day day flow
7Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped i.
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.
�y portion of a cesspool or privy is within a Zone 1 of a public well.
ny portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
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
il"the system is within 200 feet of a tributary to a surface drinking water supply
i /the system is located in a nitrogen sensitive area(Interim Wellhead Protection.Area—IWPA)or a mapped
Zone Il of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 1 1 7.
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 40 Fairwinds Drive
Osterville,Mass.
Owner:Sandy Myrick
Date of Inspection: 4/5/o 1
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
Zwere any of the system components pumped out in the previous two weeks ?
Has the system received normal flows in the previous two week period
ZHave 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, luding the SAS, located on site?
z— 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 ?
ZWas the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?'
M
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes noZ! 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 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 40 Fairwinds Drive f
Ostervil'le,Mass.
Owner: Sandy Myrick
Date of Inspection: 9/5/01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design); Number of bedrooms(actual): .�,vj�
DESIGN flow based on 3 10 CMR 15.203 (for example: 110 gpd x# of bedrooms): rG —7 �12
Number of current residents:
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system.(yes or.no):,U,6 [if yes separate inspection required]
Laundry system inspected(yes or no): &S
Seasonal use: (yes or no):,J&
Water meter readings, ifavailablle((1.ast2 years usage(gpd)):1999-143, 000 gal lons-391'.78 G.P.D.
Sump pump(yes orno):- — , gallons-369 .87—G.P.D.
Last date of occupancy: sprinkler system is present.
COMM ERCIAL4NDUSTRIAL
Type of establishment;
Design flow(based on 310 CMR 15.203): ,U gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no): fW '
Non-sanitary waste discharged to the Title 5 system (yes or no):Iw _
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped:,-- gall s-- How was ua tiryr
pump d determined?
Reason for pumping: y �vJ �'s
TT Y OF SYSTEM
Septic tank, distribution box, soil absorption system
Single cesspool
d 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
oOeatned from system owner)
Tight tank /L0 Attach a copy of the DEP approval
Other(describe):
Apt�"'o�xJimate ate of all components, date installed(if known)and source of information:
K16 !(,&,r olD.a.C"1^
Were sewage odors detected when arriving at the site(yes or no)/4)_
6
Page 7 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 40 Fairwinds Drive
Osterville,Mass.
Owner: Sandy Myrick
Date of Inspection: 9 5 01
BUILDING SEWER(locate on site plan)
,l
Depth below grade:
Materials of construction:"cast iron Z40 PVC II/G other(explain): AO
Distance from private water supply well or suction line: ld
Comments(on condition of joints, venting,evidence of leakage,etc.):
Joints appear tight.No evidence of leakage.The system
is vented through the house vents.
SEPTIC TANK: (locate on site plan)
Depth below grade: /d
Material of construction: concretelfl meta WQfiberglass,polyethylene
.(& other(explain) .t�A
If tank is metal list age:IP Is age confirmed by a Certificate of Compliance(yes or no)40(attach a copy of
certDimensions:
�nsions:
Sludge depth: '
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: o
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bott m of outlet tee or bale:
How were dimensions determined: A7—Tim
Comments(on pumping recommendations, inlet and outlet tee or baffle Indition, structural integrity, liquid levels
as related to outlet invert, evidence of.leakage, etc.):
Pump the septic tank annually.Garbage disposal is present.
Inlet & outlet tees are in place.The tank is stucturally
sound and shows no evidence of leakage.
GREASE TRA9'l�v�P(locate on site plan)
Depth below grade:4/i +
Material of construction:li concrete4*metaLW fiberglass4&polyethylenq,& 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:_ W
Date of last pumping: AM
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Grease trap is �not present
7 d!
r
Page 8 of I I ,
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
40 Fairwinds Drive
Property Address. ,
Os ervi e, ass.
Owner:Sandy Myrick "
Date of Inspection: 9/5/01
TIGHT or HOLDING TANKOkgfi(tank must be pumped at time of inspect ion)(]ocate on site plan)
Depth below grade:
Material of construct�on: concrete,94metal gAfibergiass/&A Polyethylene( other(explain):
1 Dimensions:
Capacity: Pallons
Design Flow: gallons/day,
Alarm present(yes or no):
Alarm level: _40 Alarm in working order(yes or no):&,
Date of last pumping:-AA
Comments(condition of alarm and float switches, etc.):
Tight or holding tanks are not present.
DISTRIBUTION BOX: (if present m��uyys��t 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.):
Distribution box has 4-laterals. Laterals are equalNo
evidence of solids carry cover.No evidence of leakage into
or out of the box.
PUMP CHAMBERrC2,1&(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.):
Pump chamber is not present
8
Page 9 of 1 1 ,
OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
. PART C
SYSTEM INFORMATION(continued)
Property Address: 40 Fairwinds Drive
s ervi e, .
Owner:Sandy Myrick
Date of Inspection: 9 5 01
SOIL ABSORPTION SYSTEM (SAS): (locate on site Ian,excavation not reqquired)
4—Flow Diffussors packed in 3 ' of 1 " stone. 1 ' of 12" l
stone under the tour ditfussors. 3g''��2 -
If SAS not located explain why:
Located.
Type
Z)leaching pits, number: 6
leaching chambers, number: �(p!(�
,11Q leaching galleries,number: 4
,dW leaching trenches,number, length:
leaching fields,number, dimensions: Q
AAD overflow cesspool,number:Q .
innovative/alternative system Type/name of technology: 2/�Z& Aj-&, gi5—, ��
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,
etc.):
Loamy sand to medium fine sand. No signs of hydraulic failure
or ponding.The SAS is drya e present ime. of s are ry.
Vegetation is normal.
CESSPOOL$ (cesspool must be pumped as part of inspection)(locate on site.plan)
Number and configuration: Q
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum laver.
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.):
Cesspools are not present.
PRIV (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.):.
Privy is not present.
9
Page 10 of 1 1
0.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C.
SYSTEM INFORMATION (continued)
Property Address: 40 Fairwinds Drive a
s ervi e,Mass.
Owner: Sandy M rick
Date of Inspection: 9 5/01 "
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
eirrv�rra�s Dr�a� Osr-rv,'Ilr
'F(,�,.F o� cA
Wren 1_D;mc
Ile
�.�
/ \ 3 .,
o _o
it
N O
3$'
10
Page 1 1 of 11 r•
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 40 Fairwinds Drive
s ervi e, ass.
Owner: Sandy Myr1ck
Date of Inspection:
SITE EXAM
Slope
Su-face water
,
Check cellar
Shallow wells
Estimated depth to ground water 48 feet ;
Please indicate (check)all methods used to determine the high groundwater elevation:
Allib Obtained from system design plans on record-If checked, date of design plan reviewed:
Observed site(a utting property bservation hole within 150 feet of SAS)
Checked with local Boar o ealth-explain: .
Checked with local excavators, instal ers- c documentation
Accessed USGS database-explain:Ira
�( � )
You must describe how you established the high ground water elevation:
Used; iISGR nhsPrva inn WP11 Data Pc)r 7mn 1992
nahroty & Miller Mndel
Survey Map. 92-0001 Plate #2
Cape Cod ommission Water resources office
Top of Ground
eet
Groundwater: et Below Bottom of High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the bottom
of the. A#t d i nd the adjus
ted groundw
ater table is
feet.
11
mare,-nrr�-r-ern:mr•nmas•�rrt.ne.r.rr.'r::�e•r-tmrlTnrr**mn nrniarra�rrer:1rsi .. �1
TOWN OF Barnstable BOARD OF HEALTH �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D •- CERTIFICATION I
•••r!'ter••.-•.fir-T. r.-..:rnrr.Tn'rt.7fn rn/r+vsIflTTf:1r{'T T1tnR1s'R1.►-9'CwA�Of 7RT�1.�l�Ip�7 7�n1 ..rrrr•r.--.,•�..A
-TYPE OR PRINT CLEARLY-
PROPERTY INSPECTED r .
STREET ADDRESS 40 Fair.wind Drive Osterville,Mass.
ASSESSORS MAP, BLOCK AND PARCEL #
OWNERRIs NAME Sandy Myrick
,mom.
PART D - -CERTIFICATION Y
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Son Ina: '
COMPANY ADDRESS Box 66 Centerville,Mass.02632
Street Town or City state LIP
COMPANY TELEPHONE ( 508 J 775 - 3338 FAX ( 508 ) 790 - 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate, and
omplete as of the time of.-inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems
Chec one :
J System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as -defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection ,which L. have con tcted has found that -the system fails to
protect the }iublic health and the environment in accordance with Title
5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE
CRITERIA . of . this inspection, form ,
Inspector Signature Date
copy ofthis rtification must be provided to the OWNER, the BUYER
One
Where applicable ) and the BOARD OF HEAL1'Ii.
* If the inspection FAILED, the owner or""o'perator shall u
within one ,year of the date of the inspection, unless allowed dortrequiredm
otherwise as provided in 3.10 CMR 16 . 305 .
partd .doc
No. �`—� Fee/L��
// TH COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
2pprfcation for igpozal *pttem Conotruction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. A0}q�YZU�INI�S 1 Z.1v r Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 1 S �-Lk �y � 7�c� T5`w%aD kv
ort-
Installer's Name,Address,and Tell.No. Designer's Name,Address and Tel.Zo.
�O �/1 �V U� WSiot_. SD6'S�0-2S 3
A-L LAME
MA 01,5-3�—
Type of Building:
Dwelling No.of Bedrooms Lot Size At,35'1sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 39W 4A 6 gallons per day. Calculated daily flow pia<, gallons.
Plan Date 10 - Q:�-'kkz�, Number of sheets -z Revision Date
Title 5%r►_ 1'"&a of LA.vz,, oa 0srsayo-t.c- k NkR Fog C�-�wn�FS o��►�t�
Size of Septic Tank ks 00 Type of S.A.S. �.Z�FUsort,�
Description of Soil 5s r-'_ SDx t_ 0.1 S-a-C= PLiw sv1GSZT- 7
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued I t 's and of Hje�I It
Signed (/r Date
Application Approved by Date
Application Disapproved for the following reasons
/� Permit No. Date Issued �'
No. f7 r Fee
TH COMMONWEALTH OF MASSACHUSETTS Entered in computers
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE 'MASSACHUSETTS"'
ZIpprication for Mioogar *pgtem Construction Permit
Application for a Permit to Construct( /Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
r
Location Address or Lot No. Owner's Name,Address and Tel.No.
Ao i-�►rtvl►Nl>S �t.►vr
Assessor's Map/Parcel 3�t s`a�►�D �v%�• DZ�' �bj'3 •
Installer's Name,Address,and Tel.No. Designer's Name,Address an%d Tel.No. 1
�p�v+ Igi�rl�ii �l����9S9S" s`sPr�t.► r. ��y�� E Assam. 5�0�a4o�z>3
i
Type of Building:
Dwelling No.of Bedrooms — Lot Size A3,5Tsq. ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
t Design Flow M 44 C, gallons per day. Calculated daily flow 4 gallons.
Plan Date of sheets Revision Date
Title _- EF._ -rcav -
Size of Septic Tank ids A Type of-S.A.S. _
Description of Soil �-�,-
i
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
i '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 b 's B and of Health. .
Signed Date IJ-- 41-' �'
Application Approved by - ,i Date
Application Disapproved oor the fo lowing 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( Repaired ( )Upgraded( )
Abandoned( )by _�
at11V has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated_, /i
Installer fj 4qq Designer
The issuance of this permit shall not be construed as a guarantee that the syste )function as designeE-
Date 1 -. Inspector
----------------------------------------
No. % Fee
i THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
xDi5po5ar *pgtem Construction Permit
Permission is herebyranted to Construct Re air Upgrade Abandon
g (� P ( ) Pg ( ) ( )
System located at i
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 must be completed within three years of the date of this petmi,. ('
Date: Approved b
f
1
TOWN OF BARNSTABLE Vol
LOCATION Zyo v w ram' s ,�rry SEWAGE # 9
VILLAGE D�«'��r�l� ASSESSOR'S MAP & LOTIX�o'62 L
dCl��
INSTALLER'S NAME&PHONE NO. J041A
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) ��/ �jO a �' C S�� (size) i X 3$ 'x 2'
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: U/ COMPLIANCE DATE: �`� L
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any well;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 leachin facility "; ,, Feet
Furnished by � � #
7> ' r
1cf'�, °�
(4 3 , zq 1
3 3? 0 -
DD 1rcv,.,7ds DI-1ve OSIrrv,Ile
-Frb4- Of
,e- I
o lo
3�,
��
-�
i
SOIL EVALUATOR& P �b'LATION TES.T`1FORMS
Page I.,of 4
Town of Barnst fle lid
= BA MASS. R De artment of Health, Safe � fTIA1T iy9fo
A88. $ I? Safety, and Envir�rrme Se�rv�+cc
�AlEO PAK�Aye ` `"
Public Health n>tvisb.>rii
367 Main Street, Hyannis MA 0260N O
OM": sos-79o-626s
rnx: 508•775-3344 -9 f
Soil Suilahib'ly Assessment for Sewage DmPoShc
ASSESSORS MAP Na \
PARCELMo- oZ\ - "T 3
NO. eat e2 Date:
Performed By: ST'r--p V->= 5 0!6l -25'3 . ':Date: \o- -gto
Witnessed By: Mom. -8a�4a
Location Address Owner's Name
A0 �/►1R.W�N�S`A"{L�VC-- G.1�AriL�S TAROhT�1t°
Lot a: Address,and
3� =5�.atuv AvE.
lYy 06Na't.�:f. W , �A A
Assessor's Map/Parcel: Telephone N
NEW CONSTRUCTION REPAIR
Office Review
Published Soil Survey Available: No� Yes
Year Published Ug,s _ Publication Scale t.�ooroo� Soil map unit C���---
Drainage Class r Soil Limitations
Surticial Geological Report Available: No Yes
Year Published :�-(y— Publication Scale
Geologic Material(Map Unit) ^ ,� `
Landform QL-1 ,P k z],j> - 1A,"
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Wetland Area: N/A
National Wetland Inventory Map(map unit)
Wetlands Conservancy Program Map(map unit) IA ZA
Current Water Resource Conditions(USGS): Month Ocr.
Range: Above Normal Normal 7 Below Normal
Other References Reviewed: c ar ,64rL
fir• N[ .. a
_, ,h DEP APPROVED FORM- 12/07/95
FORM 11 - SOIL EVALUATOR FORM
Page 2 ofORIGINAL
Location Address or Lot No.
On-site Review
Date:
Deep Hole Number t �•-t- 1 - \ ``��
Time: Nz'.3D Weather c,\ r.Aq_
. . . . ,.....
Location {identify on site plan) , .... e... .L/. Surface Stones �o
`�c-s•
Land Use . Slope e (/o)
Vegetationoo��:�
Landform
Position on landscape (sketch on the back)
Distances from: � A feet Drainage way VS'{ feet Sro'-rt VtLIWAS�
Open Water Body Property Line z3-ao' feet
Possible Wet Area s, I& feet ,
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOGS
Soil Other
Depth from Soil Horizon S it Texture
e Miunselll) Mottling (Structure,stones,G evlellrs, Consistency,
Surface(Inches)
c�V G 2Y
5Te\a� OtL�e1.1i.@Pc'�5
O 1B 30,E L S \c'Y R AI4 L
\o R � L Z�' 1.co5r•-Ffl-ertt+it.� �-ti-�u 5�+�•1.�
6 3011 - 67-01( C- MF..V.SANp !o \
SL 1o7&zitF4. '1A, �` - 3Q� B LS 10�tL llO Zj' �vua.R ti b�O St-eNCc trtL��suL�R>
30- \'L Ou C. MVo. 5t-4➢ 10YIt. Trb L Z�' `dose-t'vu iau3�C Za►t_wE1 SAP\)
DepthtoBedrock:
Parent Material(geologic) Weeping from Pit Face:
De th to Groundwater: Standing Water in the Hole:
E;;timated Seasonal High Ground Water: t
Et,• to'
DEP APPROVED FOI01•12107/95
LoT 3 '
o-
N 14
YN� -rN,O i
qol� i
gyp'
rl
7p,
Ito
I
A�R1G�� FORM 11 - SOIL 1:VAI,UATOR FORM
ORPage 3 of 4
Location Address or Lot No.
D Seasonal Hi h Water Table
Method Used:
El Depth observed standing in observation hole inches
❑ Depth weeping from side of observation hole ... ... inches
*[A Depth to soil mottles — inches t�*
❑ Ground water adjustment feet -
Index Well Number ....... ..... Reading Date .......... ..... Index well level .
Adjustment factor .... ... Adjusted ground water level ...
C.ApT C-OD cAMt�iss�ol�1 �aourl�v�l►C�-IZ CAN►TD�'(L aP - \RgSr
Dept of Naturally Occurring Pervious Material
F%v G.
Does at least fit feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on (date) I have passed the soil evaluator examination
approved by the Department of Environmental Protection and that the above analysis
was performed by meconsistent 017 with the required training, expertise and experience
described in 310 CIVIR
Signature -�1�-� = __ Date
DEP APPROVED FORTE-12/07/95
r
Y
FORM 12 - PERCOLATION TEST
Page 4 of 4
Location Address or Lot No. �� +���z ►��a5 ��� -
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test*
Date: Time:,
Observation Hole #
Depth of Perc 40
Start Pre-soak vz•.-3
End Pre-soak
Time at 12"
Time at 9"
Time at 6"'
Time (9"-6")
Rate Min./Inch tiu�.
Minimum of i percolation test must be performed in both the primary area AND
reserve area.
Site Passed Site Failed ❑
.....................................................................................................................................—
Performed By: _ a
Witnessed By:
Comments: . ��,•T��:c�.��...::...r-..,,�:sz-.,:.:....r-..�:�,���....>��.�,�.�.,�.�..�*��..:.�.M..-.......�,.�..�..:..�.��......,...
DEP APPROVED FORM•12/07H5
• l � 1 Y1 A
' .�zy � •• --rsf�vllle�TeaCho�__
-}�—JF—
' 4 ` p/� CraiRvil
.�• Co .nn� Public landing PeBCh
=' t
�• :I,i' •�. )yam}��'y � / / � I
Spindle
RocA,
»j
:•°J ' ; A �e� o e CFlh'ER ILLE
._
•��� �r v ,� / ry o
r
Sz
S 84'47'40. E 1
U SGS L-OCLJ S SCALE: 1 25, 0CD0
258.84'
W E
/ 1 \
ASSESSORS MAP: 48, 351 s q. f t.
165-21—LOT 3
ZONING DISTRICT: RC / N \
OVERLAY DISTRICT: AP
SETBACK REQUIREMENTS:
FRONT — 20'
SIDE — 10'
REAR — 10'
MUNICIPAL WATER IS AVAILABLE
NO WETLANDS WITHIN 150' OF LOCUS
' I
N / i
LOCUS DOES NOT LIE IN A SPECIAL i ��\ 36•
FLOOD HAZARD ZONE SEE BARNSTABLE i p
FIRM PANEL 250001 0016 D (ZONE -C•) 0 /
e i
REFERENCE PLAN:
LAND COURT 26824-841
•dh '� ,� '�
Co
-11
ti
o ,
1500 GRAPHIC SCALE
GAL/TANK
30 0 15 30 Eo 120
rv_s _. .....__.
LNFEET )
b'3.'7 r i
, 1 inch 30 ft•.
10 5
C z 84 WATER SERV. ,.
L=252
R=30p0
FAIRWINDS DRiVE
,
BENCH MARK: HYDRANT SPINDLE SHEET 1 OF 2
i l EL. 55.05' (DATUM—NGVD)
SITE PLAN OF LAND
IN
S�; T E fR \/ I L_ L_ E , NA �.
PREPARED FOR
OF—I AFR S; T .ni. fR CD /-:�. N 1. 00
SCALE: 1" = 30'
DATE: OCTOBER 8, 1996
STEPHEN J. DOYLE AND ASSOCIATES
42 CANREBURY LANE EAST FALMOUTH, MASSACHUSETTS 02536
TELEPHONE: 508 — 540 —2534
GENERAL CONSTRUCTION NOTES
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5
AND THE TOWN OF �L�-)LASS 4. RULES AND REGULATIONS FOR
PROFILE O F SEWAGE DISPOSAL SYSTEM THE SUBSURFACE DISPOSAL OF SEWAGE.
2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL .BE ACCESSIBLE
NOT TO SCALE WHITHIN SIX INCHES OF FINISH GRADE WITH ANY REMAINING ACCESS
PORTS BROUGHT TO WITHIN TWELVE INCHES OF FINISH GRADE.
." ALL COMPONENTS OF THE SANITARY SYSTEM SHALL .BE CAPABLE OF
TOP FOUND. EL. S','0,
WITHSTANDING'H--10 `LOADING UNLESS THEY ARE UNDER OR WITHIN 10'
OF DRIVES OR PARKING. H-20 LOADING SHALL BE USED -UNDER OR "WITHIN
10' OF :DRIVES OR PARKING UNLESS"NOTED.
4. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ALL
SITE UTILITIES PRIOR .TO ANYEXCAVATION.
-- �— -=}- 5. SEWER PIPES SHALL BE 4 SCHEDULE 40 'PVC LAID AT 0.02, SLOPE.
6, ANY MASONRY UNITS:USED 'TO BRING COVERS TO GRADE SHALL BE
INV.. EL. Sn.A ri MORTARED IN PLACE.
tL.S3±FLOW LINE WATER TIGHT COVER
'.•.
10- MIN. 10• l �-\ �L___
7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FEET PER FOOT.
INV. EL n \ _ `
. . _.fig_ �---- r Lrvn------� .
10' MIN.—
4! uCwo oTr{
ll
i ,
M{N. 6' ,
INV. EL. 50.-� w+p
t ,
2 -
INV. EL q9•'"1 '" ; Y r' "i'.. -
INV. EL qq•5''_ ac." -tAxx, coil-
2'MIN. - 1/8 TO 1/2' WASHED STONE
1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK 4' x 8' PRECAST'FLOW DIFFUSOR
MINIMUM CONSTRUCTION MATERIALS PER 310CMR 15.226(2) PRECAST REINFORCED CONCRETE
DISTRIBUTION BOX �.a
TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND >1
SHALL EXTEND A MINIMUM OF 6' ABOVE THE FLOW LINE INSTALL ON A LEVEL BASE mIN_
CEO
OF THE SEPTIC TANK AND BE ON THE CENTERLINE OF THE -o m
SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN-OUT MINIMUM WALL THICKNESS >a 2" -n
MANHOLE 3/4' - 1 1/2' WASHED STONE (2' MAX. DEPTH)
THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2' NOR MINIMUM INSIDE DIMENSION 12' ° r o t JV- 4
MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE OUTLET INVERTS SHALL BE "EQUAL TO EACH INV. EL ��ti o
a
OUTLET PIPE _._ OTHER AND AT 2" MINIMUM BELOW INLET INVERT. h-
SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE THE DISTRIBUTION UNES FROM THE DISTRIBUTION BOX
ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY SHALL ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING S.A S. m 3� LONG x �z WIDE x �- EFF. DEPTH
THE DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION+
COMPACTED AND.ON TO WHICH SIX INCHES OF CRUSHED STONE SEE PLAN VIEW FOR -DIFFUSOR LAYOUT
LINE INVERT AFTER=ALL LINES HAVE BEEN SEALED IN PLACE.
- HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT
SETTLING. INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE
AND NON-DEFORMABLE MATERIAL PERMANENTLY FASTEND TO .THE
SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9". LINE OR RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE Of
EQUAL ELEVATION.
THREE 20' MANHOLES WITH READILY REMOVABLE IMPERMEABLE �.•az.p'
COVERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS
FORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND
OUTLET TEESt �` -T'L_
- THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE.
8162.
�V
SOIL,OBSERVATION DATA: <A z:a.urav �I -ry-_q . vk-, {ca.o' + _ ��t U;�,u^
DESIGN DATA: g.csstf,t-L o�
sgE; can-y-e C-01* WA�cZ -r7.�C c-om'b"iAssn ° STEPH:N ,
D W�ts..Nt� � Plz� cTlc.N Hvi� J.
STRUCTURE 'TIES, t� l�ko :; I�tLtOARR % , c�3' bOYLE
L1f lflti
TEST DATE No. 37559
b►���� s������ ��9`• TYPE N0. BEDROOMS GARBAGE DISPOSAL a _
SOIL EVALUATOR �T 1w�.�tyc DESIGN FLOW 4 _
-� 1~ }I ri 1�t, = AAO C4P� lf�`.F�'Tr 90 FG r S EP` l ��,•P�4
B.O.H. AGENT 1�T; . $pW
`f yD SUR'�
ssttl�enl E�� j
EXCAVATOR �uU
PERC/RATE L Zt�l•� L�1
SEPTIC TANK
T.N.Z SHEET 2 OF 2
EL. 5-Z o it Ems. 5z,o LEACHING FACILITY t '38 i 'S _ L = zoo �
- f t.A �:� 1 o V R 2/1 �o.b•1�. to Y R t�i
lZ '
1 a R A/Cr
Ls 45G + ZOO O. 4 = 4 cArp 17>=Sy+1�Eb
40
lv _ SCALE: AS SHOWN DATE:
hn15a
STEP HEN J. DOYLE AND ASSOCIATES
+ _ { LANE. FALMOUTH MA. 02536
42 CANTERBURY
�.A, c {z•ca p TELEPHONE: 508/540-2534