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HomeMy WebLinkAbout0021 WEST WIND CIRCLE - Health 21 West .Wind.°Circle Osterville. P. ` 1 A.= 121 ..`011029 e d d f 1. K i 1 k e k: �I I t i Cf a jl TOWN OF BARNSTABLE LOCATION , VK�� W i Al &,,C te_ SEWAGE#,;�®45 VILLAGE QG}ex-Ale_ ASSESSOR'S MAP.&PARCEL /.2 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I TOO Oti k LEACHINGrFACILITY:(type) a� f'��+ 0- (size)Hec NO.OF BEDROOMS Z . re OWNER �4,C�' PERMIT DATE: /' COMPLIANCE DATE: I// 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 ori` 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 /�•G�;�C�°► } A i WWI of PH C AS 38'3" Ga ®ec.\C, A �- C31 �S1,3u 03 Vk' Qy 31,`V No. CTIJ 1 t Fee rc)o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for aisposaf *pstem Construction 3dErmit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a I Wic/1" (AA CILI C, rj Owner's Name,Address,and Tel.No. c C� Assessor's Map/Parcel 12-1, � — �� l7 —�l/�—0 Installer's Name,Address,and Tel.No.PO 6 6 72 !� Designer's Name,Address,and Tel.No. Type of Building: 7 Dwelling No.of Bedrooms Lot Size DOv sq.ft. Garbage Grinder( ) Other Type of Building S! No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided 2j�j gpd Plan Dater Number of sheets - Revision Date Title Size of Septic Tank 14Q Type of S.A.S. Description of Soil A$ Nature of Repairs or Alterations(Answer when applicable) T P1 94-0(1 fV,&,kJ 16670 4/,1[ � �. h vx w l _a_D_AY-1, ?i, Ff G ut cn 5 y� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed,," /A _ — Date Application Approved by '/7h��J J y`I �ZC� _ Date ,7 s Application Disapproved by Date for the following reasons Permit No. a 0 I Date Issued 7, /,__� Fee /c)o. x l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: z Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Aj, 2pplicatlon for ]Disposal *pstrm Construction Permit Application o a Permit to Construct( ),;"Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.c�r � Gihv� (�/G I{,- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel '?3,o h/w I i r �(7 -c/1p Z-d�IT Installer's Name,Address,and Tel.No.PO 6 67,2! f� Designer's Name,Address,and Tel.No. �� )C,-�✓I CaSfivfi u, �- 7 nK �� Type of Building: 5/b,G ` -7 / -Dwelling No.of Bedrooms ? Lot Size f7 ago sq.ft. Garbage Grinder( ) Other Type of Building S/vv�,��i No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 Design Flow(min.required) 3 � gpd Design flow provided ]0 gpd Plan Date 1-3 Number of sheets oZ- Revision Date, Title ` Size of Septic Tank—rn Type of S.A.S. /(, Description of Soil hT i�j [✓4' A( / /1✓� ' y Nature of Repairs or Alterations(Answer when applicable) 'T-h T,a f l 6j&i xJ 15 670 G1 a/lGh '� 0 h rix r✓/ n H4 3i, Date last inspected: Agreement: ; The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed �..�° - '"v..°''�' •o% ..w Date -7 N ®13 Application Approved by �yY1 j'Y\,� Z(.� G 5 Date f ft (3 Application Disapproved by Date i for the following reasons 1 Permit No. D 0 1 Date Issued 7- TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by R;Xer L4. 4 CQnS��C 4.�/� at 3 ] ��GS4 Q t,d C�le k has been cofls`t i t, in a or e with the provisions of Title 5 and the for Disposal System Construction Permit N d edrr Aft, 4,,,,,,N Installer ,/A- /`� K�� Designer M!!�gAs X.0. #bedrooms --rk ec C Approved design flow 330 /` gpd a The issuance of this permit all not 'e construed as a guarantee that the system fun do as desi d. Date Inspector ----------------- - - _ _ .No. D _ - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ye.e' ' Disposal .pste Construction Permit "'+ `j Permiis o is hereby granted to Construct( ) /Repair( ) U grade( ) Abandon( ;1// y ' _System located at o2 1l/ 4 "1 (tell�'1� /rL � �/(L.-_� and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permit. Date 7- Approved by i�� 08/28/2013 09:32AM 17744139468 MEYER AND SONS PAGE 01/01 Town of Barnstable Regulatory Services Thomas F.Geller, Director �n�systs, x " y Public Health Division Thomas McKean,Director 200 plain Street,.Hyannis,NLA 02601 Ot'Bce: 5U.362 46 Fax; 508-790 6304 Installer& Designer Certification Form Date: 7 r !3 Sewage Permit#&, ' 445 l assessor's N[ap\Parcel 61l 42-1 Designer. � s�S E AC, Installer- i f el Address: SO 9W. q v Address: d 'V*, P1jrwfj 7Ji On XG( &yn/�- ` was issued permit to install a (date) (i�nsrall{{er) septic system at _-W-6 �fV1 CCti; CA� based on a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design. which May include minor approved changes such as lateral relocation of the distribution box an&or septic tank. l certify that the septic system referenced above was installed with major changes (i.e. greater than l 0' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. plan revision or certified as-built by designer to follow. OF DAR � M (Insiallez's Signature) o. 1140 ANITAR\a� _17, 43 (Designer's Signature) (AfRt.Y Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE-__PVSLIC HEALTH DIVISION. CE_ RTIFICATE OF CO,rIPLIk CE WILL NOT BE ISSUED UNTIL BM Tk(JS FQRtr( A�iD A.S-0u1LT CARD AU RECEIVI;T)BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YQU_ Q: HealdVSeptielDesigner Certification Form 3-264.doe ea-\,J i TOWN OF BP PN TAg E t)4.31 ab rya ►2 °� 2 �-� 2013 JUL -I AM 9: 25 of MvbamM a, ,,n To Mcit`e I n f Jlui-stable r r ow o # �' Departrnent ofR1•alatory Services w. AIWBiABLB, : Public ilea:h Division ]'date a63¢ tee$ 200 Main Street,Hyannis MA 02601 Date Scheduled r . . "Time, Fee Pd. , oil' �5 iiability Asse�srrie ct,for Sewa e �posal Performed B}rsl0 il ( ✓� ►"l e Vl e"�• Witnessed By 1 LOCATION & GENLRAI,INFORMATION Location Address'. 21 ' Wt5T 1w l �� G( Owner's Name We(' k: 05 1(v 1 I It yl/I,A i. Address T'S�� Assessor's Mapfi feel: I2 ) 02� I Engineer's Name DaY-fe -. Ae*�� NEW CONSIRUtON REPAIR Telephone Sog 'j(o0''33 Land Use 1`C�� � Slopes(50) Surface Stones +e- Distances from: Open Water Body Zvi ft Possible Wee Area ft Drinking Water Well t / brainage Way ft. `Property Line '=` ft ° Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) r ; - Parent material(gedlogic) �• &A r15"1 I Depth to Bedrock , Depth to Groundwatdr. Standing Water in Hole:';111 �1 I' Weeping from Pit Face ' Estimated Seasonal Nigh Groundwater s„ :? DtTERMINATION FOR SEASONAL ffiCH WATER'TADL tom.. Method Used: Depth obperved standing in obs.hole: _ in. . Depth to sail mottles: le ' f in. `©roundwnter AdJuetment , Depth tojweeping from side of obs.hole: A {1@fO ,.._ - Al drqundwutex l eVcl:,.,,e Index Well# _ Reading Date: Index Well level - 4J C s j PERCOL,ATION'X'L+'s'i'.. : Date...,.._ �cinie_____ " Observation 91k N Time at Hole# �� , Time it6 Depth of Perc J - -- y0-0 Time(9,1_601) Start Pre-soak Time.@ ` End Pre-soak Rate MinJlnch " Site Suitability Assessment Site Passed Site Failed: " Testing Needed(YM) Original:.Public le$tth Division - Observation Hole Data To Be ComQleted on Back-- - oU must f1Tst notify the ***If ercolation test is to be conducted within 10 p 0' of wetland,y Barnstable C6riservation Division at least one(1)wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# C Depth from Soil Horizon. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel oil t4. tPA*A Sk14 (-v N . d �F f �ll ID jt 0 t) tl M eA DEEP OBSERVATION HOLE LOG Hole# ` Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gra el 041- (fit 3f • lit(- �°` �..� c �� °io '��� Sa vv d DEEP OBSERVATION HOLE LOG Hole# Al Depth from Soil Horizon, Soil Texture Soil Color, Soul - Other Surface(in.) (USDA) (Munsell) - Mottling (Structure,Stones,Boulders. Consistency,%Gravel ' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA)" (Munsell) Mottling (Structure,Stones.Boulders. Consistency, ra I Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No Yes LL Depth of Naturally Occurring Pervious Material` Does at least four 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 p rvious material? Certification I certify that on JUJ (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the require traini expertise and experience described in 310 CMR 15.017. Signature V L Date Q:\SEPTIMERCFORM.DOC � ° ,,, TOWN OF BARNSTABLE LOCATION , Vvtr,��" �,1J j(�� Lr-e`p SEWAGE# VILLAGE c S}erV�1I� ASSESSOR'S MAP.&PARCEL /�J INSTALLER'S NAME&PHONE NO. 1Zk k e r SEPTIC TANK CAPACITY LEAeG FACILITY: (type) �� C'�C�+.�r S (size) L X I�j�v z lU•/�b !� 3G c ac,-bvy CmcCve/ems 5ys74e-1 NO OF BEDROOMS r//�2 OWNER �r,,�.�- PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom ofLeaching 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 PH r A5 35,.3 Li ' r is Town of Barnstable Barnstable Regulatory Services Department AFAmeficaCft `E, Public Health Division BARNSTAB �. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 9118 I May 16, 2013„ 2013 Elaine Bower 21 West Wind Circle Osterville, MA 02655 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 21 West Wind Circle. Osterville MA was last inspected on 5/01/2013 by Mark L. White, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. - Failure to repair/replace the septic system within the deadline period will result in future enforcement.action. PER ORDER OF THE BOARD OF HEALTH. • Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\21 West Wind Cir Ost May 2013.doc Parcel Detail _ http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=7476 ` x"ASS .� . ion y Logged In As: Parcel Detail Wednesday, May 15 2013 Parcel Lookul) Parcel Info Developer€ Parcel ID f 121-011-029 I Lot(LOT 36 Location[21 WEST WIND CIRCLE Pri Frontagel120 I Sec Sec Road Frontage I Village JOSTERVILLE I Fire District Town sewer exists at this address No I Road Index 1821 I Asbuilt Septic Scars: Interactive Map 121011029 1 rZ Owner Info Owner BOWER, STANLEY L&ELAINE Co-owner _ Streets _1 WEST WIND CIRCLE City JOSTERVILLE State(A I Zip 02655 Country Land Info Acres i0.35 use Single Fam MDL-01 I zoning RC Nghbd 0106 Topography i I Road�—-_ -- Utilities �A I Location I Construction Info Building i of 1 Year Roof -" Ext Built 1985 Struct[Gable/Hip I Wall Wood Shingle I Living Roof AC 1364 �Asph/F GIs/Cmp Central Area_ Cover_ Type K a�w Style Ranch Int D wall Bed 2 Bedrooms I147 �� I Wall ry Rooms '24 m l a Int Bath , + s ' Model Residential Floor Carpet Rooms 2 Full ,e43 ms x Grade Average I Heat Hot Water ( Total 5 Rooms Type eat Found Rooms �" � 1r:rto H ` 41 Stories 1 Story Fuel Gas ation[Poured Gross Are3564 Area Permit History _. http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=7476 5/15/2013 A�ykv 9� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "M 21 WEST WIND CIRCLE Property Add Owner ELAINE BOWER _.........--._._.._.......-- - ------ ------- - -- - information is Owner's Name - required for LE OSTERVIL every page. ----._T I _. ---- - -- -...-. MA -- 02655 .:--- MAY 1, 2013 --------....._---- - ..---- =---- City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: henfili A. General Information When filling out forms on the computer, 1. Inspector: 0use only the I V tab key to MARK L WHITE "Id moveyour - -- -------- -- - ..__.._..:- ---- ---= ------- ----_.... ---- ----------— ------- -------- — - cursor-do not Name of Inspector use the return BOUSE HOUSE ENTERPRISE key. Company Name 14C JAN SEBASTIAN DR e Company Address -— ---- SANDWICH MA e(um City/Town State ---..--- Zip Code 508-962-0819 S113381 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: CZ7 ? o ❑ Passes ❑ Conditionally Passes ® Fails ' ❑ Needs Further Evaluation by the Local Approving Authority °�' MARK OM No=ao: WL4TE .5 381t s 6 -- MAY 1, 2013 - Rrf`�o F - -- - - - -1 -E '' Inspector's Signature Date The system inspector shall submit 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. ****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. LtWp l5ins•11/10Title 5 Official Insurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined"(Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): B. Certification (cont.) B) System Conditionally Passes (cont.): t51ns 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh B. Certification (cont.) t5ins•11/10 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2. System will fail unless the Board of Health (and Public Water Supplier, if,any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: . - — ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: c D) System Failure Criteria Applicable Y pp to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow B. Certification (cont.) t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Yes 'No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the.presence of ammonia nitrogen and nitrate nitrogen is equal.to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone 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. C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G t ' ❑ ® 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)N/A ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms 3 (design): - -- -- Number of bedrooms (actual):3 DESIGN flow based on 310 CMR 330 _..._...__.-- -- -- - - -- ... _ 15.203 (for _._ __ . _ .----.._---..._ . example: 110 gpd x# of bedrooms): t5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments D. System Information Description: Number of 2 current residents: Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection ® Yes ❑ required] No Laundry system inspected? ❑ Yes ❑ No Seasonal use? E Yes ❑ No Water meter readings, if available (last 2-years usage (gpd)): -------- Sump pump? ® Yes ❑ No tsins-11110 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: __.----_.------------------------------------- --- Design flow(based on 310 CMR 15.203): --- ---- ..-----_---.-_------------------_.—_-_ Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): -- - -- - - --- --- ----------------_. Grease trap present?. ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — --- — D. System Information (cont.) Last date of occupancy/use: ------ Date , Other(describe below): General Information Pumping Records: PUMPED IN SEPTEMBER 2012 i 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Source of information HOME OWNER Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: ------ -- - --------- ------- gallons How was quantity pumped determined? ------------__------------------------- Reason for pumping: ---- -- - — --- ------ ----------- Type of System: { r ® 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 y maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval ❑ Other(descrilie)': D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1986 PERMIT#84-386 - - - -- ------................ ...-...- - .- - Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: ------ ----------------- feet Comments (on condition of joints, venting, evidence of leakage, etc.): INLET & OUTLET BAFFLES IN PLACE AND LINE IS CLEAR Septic Tank (locate on site plan): Depth below grade 20" Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Level in tank is too high. Approximately '/z of the tank is under the foundation of an addition._ If tank is metal, list age: -- - ------ ----- ------- years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: -------- Sludge depth: 2„ D. System Information (cont.) Septic Tank (cont.) t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 3 Distance from top of scum to top of outlet tee or baffle - — - - ------------ - - Distance from bottom of scum to bottom of outlet tee or baffle -- -- How were dimensions determined? - ------------.---- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.) INLET TEE & OUTLET BAFFLE IN PLACE AND TANK SEEMS TO BE STRUCTURALLY IN GOOD SHAPE, 1000 GALLON TANK Grease Trap (locate on site plan): Depth below grade: — --- -- -- ---- ----- feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene or (explain): Dimensions: ---- --- — ---.._ Scum thickness __.__-..___..----------__—.-- Distance from top of scum to top of outlet tee or baffle --- --- -- ---.-----------___ Distance from bottom of scum to bottom of outlet tee or baffle ------------------- -- Date of last pumping: ___..-__.-------.___-..._____—_ Date D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.):. t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: ----._.:_-----------___-- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: ___ _ - .. -- ----- -- - ...- --------------- Capacity: —-- ------ -- ----- —-- gallons Design Flow: ----------------------- ------..-- ---- __.. gallons per day Alarm present: ❑ Yes ❑ No Alarm level: - -- f- - Alarm in working order: ❑ Yes ❑ No Date of last pumping: _____._.___ _..__ .____----..-----..__.----..__----_------___--- Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): t5ins•11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Depth of liquid level above outlet invert 8 i 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 WAS REPLACED IN 2002, BUT IS HOLDING LIQUID 8" ABOVE OUTLET INVERT DUE TO A FAILED LEACH PIT Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 i Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments D. System Information (cont.) Type: ® leaching pits number: 1-6X6 PIT ❑ leaching chambers number: -- - ❑ leaching galleries number: ❑ leaching trenches number, length: - - - ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ----------- ❑ innovative/alternative system Type/name of technology: ----.. - -..... - --- --.—. -------- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc. LIQUID LEVEL IS AT THE TOP OF THE TANK, SYSTEM IS IN FAILURE Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Depth -top of liquid to inlet invert - - --=-------- 1 Depth of solids layer _----------------=---_--....-----------_—._-- Depth of scum layer ---------- Dimensions of cesspool ---------.----- -- Materials of construction Indication of groundwater inflow ❑ Yes ❑ No D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: ------ ---------- Dimensions ----- - ---- — -------------------- Depth of solids .......... - --- -- ------- -- ---------- Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): (Sins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmark's or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately J 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20 FEET feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: PRIOR REPORT DATED 10/23/02 STATES G.W. AT 20+ FEET ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database—explain: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a You must describe how you established the high ground water elevation: FROM PRIOR REPORT DATED 10/23/02 Before filing this Inspection Report, please see Report Completeness Checklist on next page. E. Report Completeness Checklist ® Inspection Summary: A, B, C, D,-or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t,ins•11M0 � Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�'J IL DATA _ NAME&PHONE'N = s F.u SEPTIC TANK CAPACITY Jl £OLD C LEACHING FACILITY: (type) (siu) NO.OF BEDROOMS BUE-DER OR OWNER A C GU 1,ez PERMYrDATE:_.��.�3 "a^ COMPLIANCE DATE: d 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 _....: O S"1 37 n 30 y_s• as' � - ' R£AR C GARA��. Z � 3<a� . COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION , m O,,M Ste 350 MAIN STREET ♦`� WEST YARMOUTH,MA 508-775-2800 O�y y2 T TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 121 PAR 011-029 Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner's Name: MCGUIRE,MARGUERITE Owner's Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Date of Inspection OCTOBER 23,2002 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street I West Yannouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date: /Dfl o The system inspector shall submit 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 tot he 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any infonnation 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: N/A 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 imminent. System will pass inspection if the existing tank is replaced with 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 C. Further Evaluation is Required by the Board of Health: N/A 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 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 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pit 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone I of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this fonn.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303,therefore the system fails. The system owner should contact the Board of Health to detennine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service 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 is 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. Title 5 Inspection Form 6/15/2000 4 L Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 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? J Has the system received nonnal flows in the previous two week period? J 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) J Was the facility or dwelling inspected for signs of sewage back up? J Was the site inspected for signs of break out? J Were all system components,excluding the SAS,located on site? J Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No J Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of Distance is unacceptable)[310 CM 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2000 63,000/2001 112,000/2002 26,000 Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): 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 infonmation: N/A - 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: AROUND 1986.PERMIT#84-386.NEW DISTRIBUTION BOX 10-23-02 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 24" 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 onsite plan): ✓ Depth below grade: 20" 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: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions detennined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL.TANK AND COVERS 20"BELOW GRADE.INLET BAFFLE.OUTLET BAFFLE.NO SIGN OF OVERLOADING SEEN IN TANK. GREASE TRAP(located on site plan) N/A 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.): Title 5 Inspection Form 6/15/2000 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: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alann level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ./ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS NEW-OCTOBER 23,2002. BOX IS 16"X16".ONE LINE IN,ONE LINE OUT. BOX IS 18"BELOW GRADE. PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type J leaching pits,number: 1 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS ONE 1,000 GALLON PRE CAST PIT.6"WATER IN PIT.WALLS ARE CLEAN,NO SIGN OF OVERLOADING SEEN. CESSPOOLS: N/A (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: N/A (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.) Title 5 Inspection Form 6/15/2000 9 J Page 9 of I I f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 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. O 30, 0 ys, AS� Title 5 Inspection Form 6/15/2000 10 Page I 1 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 21 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: MCGUIRE,MARGUERITE Date of Inspection: OCTOBER 23,2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 20+ feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: G.I.S. 20+' TO GROUND WATER. reed Z Z -------------------- A? ,•t P17 .Title 5 Inspection Form 6/15/2000 11 i 4' TOWN OF BARNSTABLE . � I..',DCATION Lcs £S% �c /tip c�. SE'� GE # ILLAGE �� )� ASSESSOR'S MAP & LOT cI rag 9 INSTALLER'S NAME&PHONE NO. /7 l /QA.1 SEPTIC TANK CAPACITY 1FIr A4W C£ 3 lea* LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 3UILDER OR OWNER ✓h C �U I�£ PERMITDATE: /0;.3_--.!P, 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 O � ly e� 30 No. Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migooal bpgtem Con!truction Permit Application fora Permit to Construct( )Repair(pf Vpgrade( )Abandon( ) ❑Complete System eS<dividual Components i /�►/ Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Q S T I D Installer's Name,Address,and Tel.No. Sa 8 7 S' kOT Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow . gallons. Plan Date 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) 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 isspy by this Board of Heal Signed Date Application Approved by Date IT Application Disapproved for the following reaso4j, Permit No. ?S 3 8_6 Q,& _ Date Issued a t oo S O d O 'No. .. Fee p —/� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � Yes r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2p prication for nigogal *pgtem Conotruction Permit Application for a Permit to Construct( )Repair(PfUpgrade( )Abandon( ) O Complete System E! `l dividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. N 1) 0,1 k' Assessor's Map/Parcel Gv rS T lcrilt✓t9 N�,C a sr Installer's Name,Address,and Tel.No. d 8 • 9 f-i2,PO's Designer's Name,Address and Tel.No. t1,8 (►�N�v 4 Type of Building; Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date 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) £ ,04f' C F 2) 6o 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 by this Board of Heal Signed _ p Date Application Approved by Date Application Disapproved for the following reaso So- Permit No. zr L/ - -3 8l0 D,1!21;. Date Issued a. f THE COMMONWEALTH OF MASSACHUSETTS r ', BARNSTABLE, MASSACHUSETTS Q Certificate of Compliance THIS IS TO-CERTIFY,,that the On-site Sewage Disposal System Constructed( )Repaired( 4`Upgraded/'9 ( ) Abandoned( )by 174NC G 03S0 10,41A' II- LAO- ?"OeV at d)` !N F S T G4olA,.3l P/,f o S T has - constructed in accordance p with the r7vi sions of Title 5 and the Lor Disposal Sy stem Construction Permit No. dated Installer SX-44WA-P" A.�. r Designer The issuance.of this permit shall not a construed as guarantee that the system will function as,de igned. Date �. r� ' !�� Inspector V/�t4 A Af� � �4 ,r�� x), l 1/9 IV I VV-- p i/IT" v L"M 1 ! r No. � --� �7" _ ---------------------Fee�r--- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS ligpogar *pgtem Conaruction Permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at T 4. 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 �mu t be co �lete 'within three years of the date of this pe t. Date: C/ Approved b PP Y TOWN OF BARNSTABLE LOCATION ES 7 4-;'Al Di C""f SE(dAGE # VILLAG ASSESSOR'S MAP & LOT c// a;-S INSTALLER'S NAME&PHONE NO. d� 7' �i9 o® SEPTIC WANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: e� 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 G O -37 30f I Y1. 0 _C A ; 10 L / SEWAGE PERMIT NO. Ile VILLAOE c INSTA LLER'S NA PAZ A 0 0 A E S S f M Vic► ����-/�,��t� 8 U i L D E R OR OWNER DATE PERMIT 15SUEO //�b7 ' f f OAT C0MPLIAMCE ISSUiD 18 .6 I' 4 �- LA A. A No.......Q.J.—M.- .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALLT. " ........ OF.... ................... Appliration for Disposal Workii Tomitrurtion ramit Application is hereby made for a Permit to Construct */—)-or Repair an Individual Sewage Disposal System at: ..................... .......................................... ....... ................ ......... ............ ....... S or Lot NNo. �.. ........................ er Address ....... .. . ............d-----ya a . ............................. Installer Address Type o Building SizeLot... feet U oms.......... ............................Expansion Attic Garbage Grinder Dwelling—No. of Bedrooms.....__.._ P4 Other—Type of Building No. of persons--------- Showers — Cafeteria -OW- --------------- P4Other fixtures, ..............................ft..................................................................................................................... Design Flow............. .....................gallons per person per �ay. Total daily �?w..........3.3.17.....................gallons. 1:4 Septic Tank—Liquid capacity..[$00allons Length------Y..... Width_,_r._ ... Diameter________________ Depth................ Disposal Trench—No..................... Width.......1p........... Total Length.............../... Total leaching area....................sq. ft. Seepage Pit No.___----/--------- Diameter.........}._..... Depth below inlet........._..... Total leaching area...�_4_7_sq. ft. z Other Distribution box (J.1 Dosing tank Percolation Test Results 'I Performed by_,�l'PZi)(..IAdC-13erlA?J.11.41............... Date.._.... Test Pit No. I................minutes per inch Depth of Test Pit................... Depth to ground water rZ4 Test Pit No. 2----------------minutes per inch Depth of Test Pit----------......... Depth,to ground water................it-e_ � .................. . ........... ---------- ------- /V........................................... ..................... -------------- 0 Description of Soil...........64, ..... .. U ......................................................................................................................................................................................................... .................................................................................................... ................................................................................................... U Nature of Repairs or Alterations—Answer when applicable--------------------------------__............................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I Ti U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' sued by the board, of,�bealth. . Signed.... .... . ....... ................................ Di%'f Application Approved By.........._16Z----- ---- ----- - -------------------------------- ...�� ---------------- Date . Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date -----------—---------------------------------------------------- - y No.......R'51'�B� - 'ti Fps..........................._ THE COMMONWEALTH OF MASSACHUSETTS B®A R® F H EALT Appliration for Uiopowd Works Towitnution Errant Application is hereby made for a Permit to Constructor Repair ( ) an Individual Sewage Disposal System at V-7 -• ---- ` oca ion-.A r ss t No. -- ----- -------- -•--` ` ';, .......... .: s' ......................... ` we AOf ddress Installer Address Type of Building Size Lot__ ...Sq. feet ' Dwelling—No. of Bedrooms.....________________________________Expansion Attic ( ) Garbage Grinder ( ) Other.—T e of Building No. of persons Showers P I Other—Type g P ) — Cafeteria aI An Other fixt ................................................................__ Design Flow_____- :--- :_-____--- _. gallons per person peg jay. Total daily, �pw.--.---- -�?-- ----..................gallons. W r Septisc!Tank—Liquid capacity_- all Length._._:.-_....... Width__� !__ Diameter________________ Depth................ x Disposal Trench No..................... Width___ _4............ Total Length..............!.____ Total leaching F. • area Sq ft SeeP�e Pit -- -- Diameter -----• --- De Depth below inlet____._�.......: Total Leaching area_- 7sq. . ft. ` Z Other Distribution box ( Dosing tank ( ) '-' Percolation Test Results Performed by. _ .�� _! �!1 _ _._._______ j Date_____ _:_ _ - Test Pit No. 1----- =minutes per inch Depth of Test Pit.................... Depth to ground water �,f 4A Test Pit No. 2........ ._minutes per inch Depth of Test Pit____________________ Depth to ground water.............. Description of Soil--------- Z ...................................' 3 W U Nature of Repairs or Alterations—Answer when applicable............... ..............................................._................................ -------------••------•-----•--•-------------•------------------•---•---------•--....-•-------•••---•---•------------------•--------•-•-•------•---•-----------------------------...--------••_-•--- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place-the system in operation until a Certificate of Compliance has been sued by the boar of ealth.f 4 Si ned _.... r_ ' Application Approved BY -- --•• -•-= r Date Application Disapproved for the following reasons:................................................................................................................ { --•---------------------------------------------------------••----•------.....-------•-----•----....--•--'---•----•------------•----------------------•----------------•-•--------•----•••------••------- i Date '�. Permit'No---------------••------------.._..---•---•--------------• Issued_.........----------•--••----•------ ^ --------••_ •-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H ._.... . ` > , .??.....oF...... ...... Trrtif iratr of Tontplinnrr _ THIS S TO CERTIFY, T rthe Ind v al Sew i;;posal System constructed or Repaired ( ) by �'�"` � -- ... --------------------------•------- Install has been installed in accordance with the provisions of TIT F,e���of Is Mate Sanitary Code as described in the application for Disposal Works Construction Permit No....... lJ____C__.____ dated-...................... __________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUVCTIIPN SATISFACTORY. ' DATE................ /.�� .�%' ................................... Inspector............. -4✓_.--••---------- . - --........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD _OF HEALT16 c e.......... X-4 g FEE........................ MOV0,0 1 IV 0.6 no#r ' n p „ it Permission •s hereby granted-•-••- --=•-••••-` ._���✓._l.-. � ��w.. . �� c .. ............ . 1 to Construct ( or\Repair ( an Individual Sewage Disposal Sys em . Street i as shown on the application for Disposal Works Construction Per o_______________ _)Dated.......................................... R ...................................... Board of Health DATE................................................................................ t 1255 A. M. SULKIN, INC_ BOSTON '� 1 , p OSTER VIILLE _ LEGEND ,. • 4 y PROPOSED CONTOUR ' ® PROPOSED SPOT GRADE UPOLEROU `� - v g EXISTING CONTOUR $' 9 y + 96.52 EXISTING SPOT GRADE 21 G _ LOCUS• 28r � WEST •o „ W— EXISTING WATER SERVICE - ♦ ``` �, S LOT 37 W; WIND CIR. ra _ TEST,PIT O G 4 N ' • . �\_ \ \\' `«.,,:• 9SA' `�sr \' .� Ro Ride �+ - - . • . W `.♦°tip �` ;, �y9�� �, oQ r • a ° y a T t\ �`. t • ;. . I --. - � �\�'; .' , 7. c \ t c. •a. . -.LOCUS MAP .f a , • i �- .— � .. n. era" % .. ',.•. r:% F. - ♦ h' ' �} x x t V. 'INFORMATION :z r .. ry .� . A 5 ,. 550 5118 . 1 y= t. a. `O ,w.r • „ f e EI • 2MAP 21 PAR'.`011-029 O PLAN ,R _ a , _ .. ` WINOD ONE 3 EXPOSURE "B"21, �s g- -� a - SEPTIC SYSTEM n _ `off' '' � �♦` N REPAIR PLA GENERAL. NOTES: . � y � FLowER;. 'LOCATED AT: - 1 ALL CHANGES TO THIS PLAN MUST BE APPROVED=BY. THE LOCAL " ` " n GAR ENS 2 1 t , WE S T� WIND '-CIRCLE BOARD OF HEALTH AND THE'DESIGN ENGINEER. G G� � � ••• 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OSTER;VILLE, MA. OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ' BASEMENT LOCAL RULES AND REGULATIONS. ' EL—41.0 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFiLLED PRIOR' R .. a, • TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. t •S ANLEY L. &=�- EL NE 4. ANY CONDITIONS ENCOUNTERED MAY 26; 2013 DURING CONSTRUCTION DIFFERING ." �' .... ," �� �' T\ , FROM THOSE SHOWN HEREON SHALL BE REPORTED-TO 'THE DESIGN. �''• - .` 10"P A } O' T- ENGINEER BEFORE CONSTRUCTION CONTINUES. F TBM• •" 0 38 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. GONG. COR.= j1P r O \ ��, � 41.0 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF _ �' !�, ��'� �F �qSS• HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. - AL 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. +' ',;' _— b DA t �N M 9G 10-P I - DC15T.. : I_;000 GALLON j(8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND'CONTRACTOR., 10"� 4' 5EPTIG TANK (NOTE If7), o. 1140 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY LOT 35 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO.BEGINNING CONSTRUCTION. 10" '!;� c� PROP. I ,500 GALLON AN tTR 10. EXISTING LEACHING PIT TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. x :' 'n SEPTIC -TANK l r.'. 3 = REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. 10" €r` 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION LOT 39 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY S1 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING S` �v MEYER & SONS, INC--`4 14. ALL PIPING TO BE 4" SC H 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) L_/t I STI N G CESSPOOL✓ 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW <, FOR THE USE OF A GARBAGE GRINDER f - (5ee note I. 0) P.O. BOX 9 81 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING EAST SANDWICH, M A. 02537 17. EXISTING 1,000 GALLON SEPTIC TANK TO BE ABANDONED IN PLACE AND . - - - - - - STRUCTURALLY STABILIZED (DET. BY OTHERS) TO SUPPORT EXISTING DWELLING. S O 8>3 F)2-2 9 2 2 18. PROPERTY IS WITHIN THE ESTUARIES PROTECTION DISTRICT. , , = # '' n — OF 2 v SHEET 1 J#154 2 ,. » .... •. _ SCALE:- 1" 20' } -NOTE. TO PREVENT BREAKOUT, THE•PROPOSED " NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:38.76 `- FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. jrSEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S: INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL` A'.4" DIAMETER INSPECTION PORT OVER _ 14" ` OUTLET AND SET .TO 6' OF FINISH GRADE SET TO 6" OF GRADE ONE:,CHAMBER (MIN.) AND SET TO 3" OF F.G. I LEr STALLED F.G. EL.=42.Ot x �N �F Mq �F.G. EL.=41.80 t F.G. EL:41.60t - F.G. EL: 41.50(MAX.) _ •. - ��� `S`S9 r X 9.45" o� DA E G SLAB 9" MIN COVER/ L 25't 36" MAX COVER L = 10' L 15'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) - 12.37" - o • .N��o�Y11. 1140 EL. 41.0 0 S=1% (MIN.) EL.=40.00 0 S=1% (MIN.) 0 S=1% (MIN.) s ry 4"SCH40 PVC -• 4"SCH40 PVC 4"SCH40 PVC w , , 1TI 0- 14- s" 10 75" TO _ S4NI TAR\V\ INV 39.00 48" LIQUID INVER LEVEL INV.=38.75 INV.= 38.30T COUPLERz DETAIL '" • ) PROPOSED � ® NIT - - ` 'Z(D GAS BAFFLE ` 4 ROWS,OF 'S UNITS 5'/U - 25%ROW - D-BOX .''' l� „..: .,. . INV. SOIL' 3 8.45 DB-5 . . y •. - F� ABSORPTION- SYSTEM .(PROFILE) v =38.65 _ • PROPOSED 1,500 GALLON SEPTIC TANK , EXISTING OUTLET :. . . , RESTORE VEGETATIVE COVER ti- • Y - a , CHAMBERS BACKFILL WITH'CLEAN PERC AND ' TO TOP OF 60"= NOTES: 1) CONTRACTOR•SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=38.76 2)-TANK AND D-BOX SHALL BE SET LEVEL AND ,. . " •- - - TRUE TO GRADE ON A MECHANICALLY COMPACTED INV.• ELEV.= .38.30 - SIX INCH CRUSHED STONE BASE, AS SPECIFIED 1N E EV = TA BOTTOM L 37 43 310 CMR 15.221(2) �. EXISTING SUITABLE,_ MATERIAL- , 3) INSTALL INLET & OUTLET TEES W/ 5' MIN. ABOVE BOTTOM• OF - _ y ' EFFECTIVE WIDTH* 4 x 2.88'_-p11.52 ` GAS BAFFLE AS REQUIRED • T.P. EXCAVATION OR G.W.: - . - . : . (6.73' PROVIDED) USE 4 ROWS.OF 5-ADS ARC 36HC ' `BOTTOM OF TESTHOLE EL,` 30.70 - (H2 UNITS'-"'NO STONE" = " • SEPTIC SYSTEM PROFILE a _ TYPICAL SECTION e N.T.S. • N.T.S `" :1 6 • - - - , T r , .- DESIGN CRITERIA -- _ - SOIL .LOG TP#:�40 4� DATE: MAY 24, 2013 :. i ECTION . 10.'INVERT NUMBER OF BEDROOMS: 2 BEDROOM ACTUAL/3 BEDROOM DESIGN, (NO INCREASE PROP.) y` m SOIL EVALUATOR: DARREN M. MEYER;_R.S., CSE #1'614 HE/crlT . END`CAP SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: .<2 MIN/IN WITNESS: DONNA`MIORANDI, BARNSTABLE HEALTH, DAILY FLOW: 220 G.P.D/BR. DESIGN FLOW: - 330 G.P.D. • ry ,t ' Elev. TP- Depth'' ;Elev. • TP-2 Depth ' f ADS - - ARC- 36HC CHAMBER (H20 LOAD • • o GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 41.80 0", 41.70 0" MODEL ARC 36HC ` A LOAMY SAND A LOAMY SAND SEPTIC TANK: 220 gpd x 200% = 440 gpd USE PROP. 1,500 GALLON SEPTIC TANK 10YR 3/2 1OYR 3/2 LENGTH 63" 41.00 10" 40.90 10'; NOTE: UNIT CONFIGURATION AND,AVAILABILITY SUBJECT DISTRIBUTION BOX: 4 OUTLETS (MINIMUM) B LOAMY SAND B LOAMY SAND EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE.`-PRODUCT DETAIL MAY 10YR 5/8 1OYR 5/8' DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. TEST' C 3.V, 38.53 C 38" SIDE WALL HEIGHT ' 10.75" PERc TEST OVERALL HEIGHT 16" ® 37.50 OVERALL WIDTH 34.5" 4640 TRUEMAN BLVD PRIMARY S.A.S. 10.7 CF ® HILLIARD, OHIO 43026 USE 4 ROWS OF 5 - ADS ARCHC 3616 H2O UNITS-NO STONE MEDIUM-COARSE MEDIUM-COARSE CAPACITY GAL ADVANCED DRAINAGE SYSTEMS, INC. SAND SAND (80.0 ) BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) 2.5Y 7/3' . 2.5Y 7/3 (CHAMBERS: 5/ROW)20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF _ PROPOSED SEPTIC SYSTEM/SITE PLAN 30.80 132" 30.70 132"' 21 WEST WIND CIRCLE, OSTERVILLE, MA TOTAL AREA = 480.0 SF - � „ DESIGN FLOW PROVIDED: 0.74GPD/SF(480.OSF) = 355.20 GPD > 330 GPD req'd PERC RATE <2 MIN/IN IN C" HORIZON) Bower {� -Prepared for: NO GROUNDWATER OBSERVED Engineering and Surveying by: SCALE DRAWN ws :- MEYER&SONS, INC. NTS D.M.M. " I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX981 to conduct soil evaluations and that the above analysis has been performed b me consistent with the DATE: CHECKED. y P Y° EAST SANDWICH,MA 02537 SHEET NO requirements of 310 CMR 15.017.' 1 further certify that I,hove passed:_the Soil.Eval. Exam in October,`1999. 508-362-29V 05/26/13 D.M.M. 2 OF 2: OSTERVILLE LEGEND PROPOSED CONTOUR PROPOSED SPOT GRADE UPOLE ® �l —— 98 —— EXISTING CONTOUR LOCUS: ROUTE 28 + 96.52 EXISTING SPOT GRADE \ G /• 21 WEST LOT 37 WIND CIR:''</ o W — EXISTING WATER SERVICE TEST PIT O `x G _ - �� N � q R CD .� LOCUS MAP ks " �tK LOCUS INFORMATION PLAN REF: 290/55 TITLE REF: 25550/118 v /, PARCEL ID: MAP 121 PAR. 011-029 % ZONING: "RC" FLOOD ZONE: WIND ZONE 3, EXPOSURE "B" LOT 36 AREA=15,000 S.F. #21 SEPTIC SYSTEM S . REPAIR PLAN GENERAL NOTES: FLOWER LOCATED AT: 1 ALL BOARD OF CHANGES TOTHTHIS PLAN THE MUST B ENGINEER. BY,THE LOCAL "GpJG� GARDEN 21 WEST WIND CIRCLE 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 1F�'� '" �� OSTER VI LLE, MA. OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE BASEMENT 1� LOCAL RULES AND REGULATIONS. 4� -- EL=41.0 �' PREPARED FOR 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SQ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH.AND THE �. ' / + • , S TA N LE Y L. ,-& E L A i N E DESIGN ENGINEER. LOT 38 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING ` h r B O WE R FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10"P TBM: '.'� O / \\\\��OO MAY 26, 2013 ENGINEER BEFORE CONSTRUCTION CONTINUES. F �' (I(i� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. CONIC. COR. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 41.0 TH- THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. �/ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 10 -- 0J EXIST. I OOO GALLON o o RE 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED f ' TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. LOT 35 10* I / �p 5EPTIC TANK (NOTE.. 17) �—N' . 1140 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ��` �� , THE CONS CATIOON N.OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 0� 10„ �� f. �' ;; �1� S PROP. ) ,500 GALLON cist NITA 10. EXISTING LEACHING PIT TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. x 5EPTIC TANK �?'�' REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. 10"f � 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION ��' _ LOT 39 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING d MEYER & SONS, INC. 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. OTHERWISE) EXISTING_ CE55POOL5 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER (see note I O) P.O. BOX 981 } 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING �. EAST SANDWICH, MA. 02537 17. EXISTING 1,600 GALLON SEPTIC TANK TO BE ABANDONED IN PLACE.AND _ STRUCTURALLY STABILIZED (DET. BY OTHERS) TO SUPPORT EXISTING DWELLING. - t (5 0 8)3 6 2—2 9 2 2 18. PROPERTY IS WITHIN THE ESTUARIES PROTECTION DISTRICT. - ' SCALE: 1"=20' SHEET 1 OF 2 J#1542 a _ .w • .. '., .... a a ; NOTE: TO PREVENT BREAKOUT, THE PROPOSED. NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS °, « ' FINISH GRADE SHALL NOT BE < EL:38.76 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S. ` INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER. INSTALL''A 4" .DIAMETER INSPECTION PORT OVER 14" OUTLET AND SET TO 6' OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) -AND SET TO 3" OF F.G. INSTALLED LENGF.G. EL.=42.0t F.G. EL.=41.80 t F.G. EL:41.60t F.G. EL: 41:'50 MAX. ��� OF .MgsS' > - � DAPRE M. 9 45" SLAB 9" MIN COVER/ o • ,L = 25't 36" MAX COVER L 10' ,L = 15'(MAX) ,INSTALL TWO.INSPECTION_PORTS (MIN.) _ 12 37" No. EL. 41.0� ® S=1% (MIN.) EL=40.00 ® S=1% (MIN,) ® S=1% (MIN.). • ` 4"SCH40 PVC 4"SCH40'PVC 4"SCH40 PVC 3- rill S1E ML 14, A s" 10.75" TO SgNITAR�a ' \INV-� 39.00 4a"LIQUID INVERT a INV.=38.75 COUPLER DETAIL [ LEVEL - : - INV.= .38.30 :. .. PROPOSED `4.ROWS OF I5 UNITS ® 5'/UNIT = 25'/ROW GAS BAFFLE , D—BOX ... �=5 3 .45 INV.=38.65 #T SOIL ABSORPTION' SYSTEM (PROFILE) ' PROPOSED 1.500 GALLON SEPTIC TANK xi EXISTING . OUTLET a RESTORE VEGETATIVE COVER A . . BACKFILL' NnTH'CLEAN"PERC SAND TO TOP OF CHAMBERS,' 60 •, NOTES:. 1) CONTRACTOR SHALL VERIFY ALL EXISTING a :� yr PIP PRIOR TCONSTRUCTION• E INVERTS P O 0 - 2) TANK AND D—BOX SHALL BE SET LEVEL AND 'BREAKOUT=TOP ELEV.=38.76 TRUE TO GRADE ON A MECHANICALLY COMPACTED y INV. ELEV. 38.30 SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV..-- 37.43 ' _ .. _ EXISTING SUITABLE - 310 CMR 15.221(2) 2.88' - MATERIAL t 3) INSTALL INLET & OUTLET TEES' W/ 5' MIN. ABOVE BOTTOM OF — , GAS BAFFLE AS REQUIRED »" T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 4 x 2.88' 11..52 _ (6.73 PROVIDED) USE 4 ROWS. OF;S —ADS ARC 36HC ' BOTTOM OF TESTHOLE EL 30.70 _ (H20) UNITS,— 'NO STONE' r C _ , x- •,.E y w r ♦ Y SEPTIC -SYSTEM • PROFILE — f " TYPICAL SECTION E a s N.T.S N.T.S. � '� �. ° • 16 n., SOIL -,:LOG-. #. 014 DESIGN CRITERIA _ e z 9 _ , DATE: MAY 24, 2013' ' . � �. > SECTION '•10.75' , NUMBER OF BEDROOMS: 2 BEDROOM ACTUAL 3 BEDROOM--DESIGN NO INCREASE PROP. r ln/vERT- ` / ( ) - ,' , SOIL EVALUATOR: ;, DARREN ,M.: MEYER, 'R.S., CSE 41614 HEIGHT. END CAP SOIL TEXTURAL CLASS: CLASS •1 DESIGN' PERCOLATION RATE: <2 MIN/IN >` WITNESS:, DONNA MIORANDI,, BARNSTABLE HEALTH �` '. _ " DAILY FLOW: 220 G.P.D/BR. DESIGN FLOW: 330 G.P.D.- TP- 1 T — h Y Elev. Depth' E�ev. P 2 Dept �� a` ADS ARC 36HC J. m CHAMBER(20 LOADS GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) _ 4Y,80 _ 0 41.70''A LOAMY sANo 0 MODEL- -ARC 36HC SEPTIC TANK: 220 d x 200% = 440 A LOAMY SANO � gp gpd USE PROP. 1,500 GALLON SEPTIC TANK = 10YR 3/2 1oYR 3/2 LENGTH 63°' , 41.00 10"i 40.90 - 10� � • NOTE: UNIT CONFIGURATION'�AND AVAILABILITY.'SUBJECTp DISTRIBUTION BOX: 4 OUTLETS (MINIMUM) B:LOAMY SAND B -LOAMY SAND EFFECTIVE.LENGTH 60" TO CHANGE WITHOUT NOTICE, :PRODUCT DETAIL MAY IOYR 5/8 10YR'5/8 - S D DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (330)/0.74 = �445.94 S.F. 38:55 " . 99° NI 38.53 C 38' 10.75" I E' WALL 'HEIGHT ' PERC TEST ti_ "OVERALL` HEIGHT 16" ' ®.37.50 a CJ OVERALL WIDTH 34.5" _ 4640 �UEM�AN BL VD PRIMARY S.A.S. USE 4 ROWS OF 5 — ADS ARCHC 3616 H2O UNITS—NO STONE MEDIUM—'COARSE MEDIUM—COARSE CAPACITY SAND 'SAND' ',,- (80.0 GAL) ADVANCED DRAINAGE SYSTEMS,'INC. 2.5Y 7/3 2.5Y 7/3 M BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) p PROPOSED SEPTIC SYSTEM/SITE PLAN " (CHAMBERS: 5/ROW)20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF ` 132" 132' 21 *WEST WIND CIRCLE OSTERVILLE, MA TOTAL AREA = 480.0 SF 30.80 i 30.70 B - . - --, "r b? PERC RATE <2 MIN IN -- "C" HORIZON) e m •b Prepared SCALE DRAWN .* DESIGN FLOW PROVIDED: -0.74GPD/SF(480.OSF) = 355.20 GPD > 330 GPD req-d �- d for: E � ^ NO GROUNDWATER OBSERVED Engineeringand Sury y g. y • I _ . MEYER&SONS, INC. NTS * 1, Darren M. Meyer, R.S., CSE, hereby certify that l am currently approved by MADEP pursuant to 310,CMR 15.017 { to conduct soil evoluotions'and that the above analysis has been DATE: y performed by me.consistent with the CHECKED EAST SANDWICH,MA 02537 SHEET NO. requirements`of 310 CMR 15.017. 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