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HomeMy WebLinkAbout0050 WEST WIND CIRCLE - Health 50 WESTWIND CIRCLE, OSTERVILLE i I. o 0 i i SOPHIA'S ROOM /� �- KITCHEN TV ROOM ..p 13'11' +)SMCiKE DETECTOR 0 / ..5 o ► bCAfV .. I1'0•r. - .. 7.8• -. SM 114E DE6'7— �Ei'T!�R � N ' iD A Cam( j SOPHIA'S ROOM c I MASTER BEDROOM/SUITE .I TV ROOM 1 14'4`x 9'3" 4'4'x 15 10" E j.. 4 E 4 � � 5 _ Y s m o All a �5 10 9 1"► o od•8.► a 43.6 ► 1 �., 14.0" 27'11" C . RZA-N cb .5-a vA (k es- 7-N i Alb C! jt4)4- Dad 5T _ 1 Commonwealth of Massachusetts /Rf_ 6�/_pp- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 WESTWIND CIRCLE _9 Property Address N COLMAN co Owner Owner's Name F-► information is 4> required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection U1 Inspection results must be submitted on this form. Inspection forms may not be altered in any'o way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the l lX U computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 IM Cityrrown State Zip Code 508-420-4534 S14297 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-12-16 In%je—cVs 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts M v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS ONLY 4 YRS OLD AND HAS NOT SEEN MUCH USE. 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber,pumps/alarms not operational. §ystem will pass with Board of Health approval if pumps/alarms are repaired. 8) System Corllitionally Passes(coat.); ❑ 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). El 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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: D) System Failure Criteria Applicable 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 Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. CityTTown State Zip Code Date of Inspection B. Certification (cont.) 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection 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 ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with 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. El ® 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(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M > 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. City/Town State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK D-BOX AND A 11.5X25 FT LEACH SYSTEM WITH ADS CHAMBERS Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: HOUSE VACANT NO ACURATE WATER READINGS, SYSTEM NOT DESIGNED FOR USE WITH GARBAGE GRINDER. Sump pump? ❑ Yes ❑ No 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: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2012 FOR CONSTRUCTION OF NEW SYSTEM 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: ® 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)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(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: S.A.S 2012 PER AS-BUILT Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: feet 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: LIGHT t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness LIGHT 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.): RECOMMEND PUMPING UPON TRANSFER AND EVERY 2-3 YRS THERE AFTER FOR MAINTENANCE. Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityfrown State Zip Code Date of Inspection 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.): 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: 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 i t5ins•3/13 Title 5 Official In spection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 01. 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.): BOX LEVEL NO LEAKAGE OR SIGNS OF SOLID CARRY OVER. 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.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO OBSERVATION PORTS LOCATED. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 11.5X25 ❑ 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.): Cesspools (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 ❑ No t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. Cityrrown State Zip Code Date of Inspection 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 landmarks 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ► Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: GREATER THAN 5.6 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: 6-2016 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) a ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 50 WESTWIND CIRCLE Property Address COLMAN Owner Owner's Name information is required for OSTERVILLE MA 6-12-16 every page. City/Town State Zip Code Date of Inspection 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOC 9TION_50 1,Je.1 u a CRJL SEWAGE# o9C/ -.0(o VILLAGE 0%kwA,:, ASSESSOR'S MAP&PARCEL ZI Jf INSTALLER'S NAME&PHONE NO.P9j W T Te.ak.ALJ[ &S4,,,LLt 774•Z37.7380' SEPTIC TANK CAPACITY jn0Qa c I{o LEACHING FACILITY.(type)Abs cJ L6e, M ee.j (size) NO.OF BEDROOMS 3 OWNER E11,,,, C.d TruJTtE I PERMIT DATE: -t 6- it COMPLIANCE DATE: �I a I� Separation Distance Between the: I. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ! 5.` Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Pt/]A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within � 300 feet of leaching facility) N/A Feet FURNI BM BY (`1,L a.l -r Ta�I Fou4 A,S4aK LLf. L 30' 2Q.5' 3 39, 3e 4 5 4 47.5' 40` 5 _ 64,5' Sz' a � 6 57, i Kz' 8 7 38' 213' 3 8 59' 4L.5� 6 A. 1-7 7 02 GS i MAC-IL O F Hnv-SE http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=121011005&seq=2 6/16/2016 TOWN OF BARNSTABLE `LOCATION�0 I�e: �e/i d Grde,. Osiory rA, SEWAGE# 6 `PILLAGE ASSESSOR'S MAP&PARCEL 12.1 Z 011. INSTALLER'S NAME&PHONE NO. 774-Z37-7380 SEPTIC TANK CAPACITY iO®O LEACHING FACILITY:(type) Abs rlam6ers 0� K0,J (size) NO.OF BEDROOMS OWNER Elk" C ., � -r,,J L PERMIT DATE: eZ.G 12. 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): N/A Feet FURNISHED BY 1 ri'e�.cert.� —Goo-1 GAL A, S4,0A.U.0 14,5� f 3 39, 3z, - 4 47,5' 40' 6 5'' 4y' 38' 42..5' 6 Oy OZ A ( mr. OF HVv§E No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: PUBLIC HEALTH DIVISION -TOWN OF'BARNSTABLE, MASSACHUSETTS VYes ftpl1tAtIDtt for MI8pD8AY *pBtP"ttY CDnStCULtIDYC P>Qrtll[t Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.0 We,, L f,r,j Ctrc,Q-- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel c3--4,X Qo- 1 ® " 140 ca Va��e Os may; � Installer's Name,Address and e1.No Designer's Name,Address,and Tel.No. l�„ i-I�c.nl, r�• o26tQs CS1N E:n,J)kin P.C�,f3ax Zc�30 `mac x'LIMA 02 59 Z -32So Type of Building: Dwelling No.of Bedrooms Lot Size S�r?�� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided � �j gpd Plan Date -Z'3 I Z Number of sheets Revision Date N/A' Title QlseosaJjel St s�en„ Size of Septic Tank (Q00 plJon Type of S.A.S. Description of Soil 9R g Nature of Repairs or Alterations(Answer when applicable) -XI\,c J ne,a SAS r,,,i 6 0JU 0--6% are 2c) AP-C. 3F, c�a )pys in SaJ 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. 170Date Application Approved by Date a" Application Disapproved by Date for the following reasons Permit No. Date Issued } No. '' THE COMMONWEALTH Entered in computer:OF MASSACHUSETTS << Yes PUBLIC HEALTH DIVISION- TQU#NwO RARNSTABLE, MASSACHUSETTS IpYIcatlOn for IB JDSa +pBtPltt Construction i3Prmit Application for a Permit to Construct( ) Repair( ) Upgrade ) Abandon'( ) ❑Complete System ❑Individual Components Location Address or Lot No.50 We.,4 Wr,d C irclo— Owner's Name,Address,and Tel.No. Lit., Assessor's Map/Parcel �s r v'�{� �Z I O 1 " (�� Zci--V,110 kj. Installer's Name,Address and�el.No. Designer's Name,Address,and Tel.No. 76:. �; S� LAC 508:7'7G.�3 7 —f ( j - CSN Ef1q If\C�J+A P�V.�Ok G.Q�O l��n.Fe M/� QZ gig QV�w Ackke- PJ I'kW[.(L MA oZ64 508-'Z49-3Zso Type of Building: Dwelling No.of Bedrooms 3 Lot Size S)555 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �J30 gpd Design flow provided 3 S gpd Plan Date Number of sheets Revision Date N//a 1 Title Pr0P0S.4 ..7evmljv_ �ispo a� 5: of n. M- Size of Septic Tank (C)DO �a�io" Type of S.AA.S./i PI(L4 c c�a, �jols r� Srnd� Description of Soil S-e�- A-0, kje Nature of Repairs or Alterations(Answer when applicable) Zn�f al.� new SAS �n �+ 6 OVQ (�-�ti ad( 20 /�QC 3C� c�aM�vs fn rSa,d t ,' s- i x z Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in E 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. r, ti S•gn/ t T; t Date Application Approved by 'dV � /1 ®fl Jt1s Date n� Application Disapproved by Date for the following reasons , Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance# THIS IS TO CERT,IE ,that the On-site Sewage Disposal system Constructed( ) Repaired , < Upgraded( ) Abandoned( )by Pn / at 50 bJ1P*67W))vjJ Cr. , n 7-has been cons with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer Designer t`YLC r. #bedrooms l Approved design flow gpd The issuance of this�ernnt shall n+t be construed'as a guarantee that the system will 5 ti�a des- d, v° � Date Inspector - --------------------- - No,? � j V Fee (1 V THE COMMONWEALTH OF MASSACHUSETTS PUBLI HEALTH DIVISION—BARNSTABLE,MASSACHUSETTS -Disposal 6pstem Construction Permit Permission is hereby granted t�o Constrruct( e�pafir�( ) Up ad/&(�)/'' Abandon System located at :1 lam! 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:Construc'o ` st a ted within three years of the date of this permit. Date � C/ Approved by a,. A ti Town of Barnstable �.f+E Regulatory Services Thomas)'. Geil'er,Director Kua Public Health Division .`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Z v Sewage Permit# Assessor's Map/Parcel 2. 0/1 // 00%, Installer&Designer Certification Form Designer: ZuVW4 Installer: Address: ��� /� Address: �,j,j r 4�,V_VA _407 On _ was issued a permit to install a (date) (installer) /� septic system at SCE �Ijed r �"/ drr,& based on a design drawn by (address) Aim �SrLg,� dated (designer) ✓117 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 and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' 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. Stripout(if required) inspected and the soils were found satisfactory. H OF A„ 4.11 LINDA J. �c�N l PINTO �' p (Installer's Signature) CIVIL 4WD No.46504 r (De ' er's Sign a e) (Affix De Here) PLEAS RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formAdesignercenification form.doc Town of Barnstable P# C�q_ 5 Department of Regulatory Services F Public Health Divisi O n Date / h u+nss jEO t ", 200 Main Street,Hyannis MA 02601 Date Scheduled l 1 1 - - d Ttme l_�_ Fee Pd. Soil Suitability Assessment fog- Sewage Disposal Performed-By: Witnessed By: LOC/AJTIO/JN&GENERAL INFORMATION Location Addre$s , 0 (�/P S W 1+ Li.v(� Owner's Name iz"J() r MA Address O!`�P�i/� r�e_ Assessor's Map/Parcel: Z d f - t"�j� - Engineer's Name it'd, , Csn/ C.✓�IANf-� NEW CONSTRUCTION REPAIR Telephone# Land Use y Slopes(96) 0 Surface Stones 0 Distances from: Open Water Body 7 0,0 ft Possible Wet Area—RLA—ft '-Drinking Water Well (� A ft Dra►nage Way 7 l0 0 ft Property Line S12 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test wilbs&perc tests locate wetlands'fn proximity to holes) -TP-Z 7P--I D e cL '-� � --a �tr.�aeP�wrs•�t--'-..�� :..-�-�..r..�'...�w.ctir+_�ldJ:'i.�S'-r�.� f�i: .'S•'�=Y+-. �-s.�.^ef^ ... � - "_ - . - - I 1✓O�r'!'Y•1 ��'c.-lilt v�' '�.: i^.3• � i .,. - Cl 2`t✓ Parent material(geologic)fQLacir,1 wvaSk Depth to Bedrock I Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to Soil mottles: In, Depth to weeping from side of obs.hole: In, Groundwater Adjustment f. .. Index Well# Reading Date: Index Well level- Adj,factor— Adj.CJroundwater Level PERCOLATION TEST Dille I l O- Tana I c» en Observation T^ Hole# M N I Time at 4" - (_�tl . Depth of Perc l9 Time at G" Start Pre-soak Time @ :DO Time(V-0) End Pre-soak :00ll Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q!\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# _ t Depth from Soil Horizon Soil Texture Sdil Color Soil Other \ Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.%Gravel) '40 C. 0 41y CZ M S"'d Io Sir DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis en %Grave o- 'k- sl(, C t to Ig- 01 -I23 Cl- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to c O r`r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consi t n e Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No V Yes Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us 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 AbV �-00a-- (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tr i g,expertise and experience described in 10 CMR 15.017. Date � �o I • Signature • �- - • Q:\S.EPTICTERCFORM.DOC Y. f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED ONE WINTER STREET BOSTON MA 02108,(617�)p 292-3500 4.Et S E P 2 2 2000 S E P 2 2 2000 TOWHEALTH DE PBARNSTAT.BLE 1 TOW'v OF BARPlSTiSL . ARGEO PAUL CELLUCCI jam° Governor ' SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART A CERTIFICATION P Property Address: 50 WESTWIND CIRCLE OSTERVILLE MA. 02655 Name of Owner MRS.COLE Address of Owner: SAME Date of Inspection: 9113/00 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tite 5(310 CMR 15.000) Company Name: TITLE V INSPECTIONS ' Mailing Address: BOX 2119 TEATICKET MA.02636 Telephone Number: 664-6813 CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is _ Needs Further Eval at n By the Local Approving Authority performing at the time of the inspection.My Inspection does Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:9114100 The System Inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this Inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS ; THE SYSTEM PASSES TITLE V INSPECTION'.RECOMMEND PUMPING THE SYSTEM FOR PROPER MAINTENANCE EVERY TWO YEARS. revised 9I2J98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 WESTWIND CIRCLE OSTERVILLE MA.02665 Owner: MRS.COLE Date of Inspection:9/13100 INSPECTION SUMMARY: Check A, B, C,.or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: r nta One or more system components'as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. n1a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank- failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank_as approved by the Board of Health. nla Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed _ distribution box is levelled or replaced 4 - n& The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _ _ broken pipe(s)are replaced _ obstruction is removed i' revised 9/2/98 Pine 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 WESTWIND CIRCLE OSTERVILLE MA.02655 Owner: MRS.COLE Date of Inspection:9/13100 ' D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. z X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n(a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. a X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system,shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. Yt* ;I t. 1. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 60 WESTWIND CIRCLE OSTERVILLE MA.02656 r Owner: MRS.COLE Date of Inspection:9/13/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: T Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced Into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow: '•tie - — X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)1 y X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. �tji; •s,: , ILI Y revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 60 WESTWIND CIRCLE OSTERVILLE MA.02666 Owner: MRS.COLE Date of Inspection:9/13100 FLOW CONDITIONS RESIDENTIAL: Design flow:—M g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): ' Total DESIGN flow: Q :a Number of current residents:l Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system Inspected(yes or no):1112 Seasonal use(yes or no): YES Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NQ Last date of occupancy: nLa COM MERCIALIINDUSTRIAL Type of establishment: nLa Design flow: WA gpd(Based on 15.203) Basis of design flow: n(a Grease trap present:(yes or no):JLQ Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:nLa Last date of occupancy: nLa OTHER: (Describe) nLa Last date of occupancy: nLa s3 ,GENERAL INFORMATION PUMPING RECORDS and source of information'' . nLa System pumped as part of inspection:(yes or no):N4 If yes,volume pumped nLa- gallons - Reason for pumping: n/A - TYPE OF SYSTEM s X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous Inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval '$ Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: 1984 PERMIT 84-390 Sewage odors detected when arriving at the site:(yes or no): NQ f,c , revised 9/2/98 Page 6 of 11 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued): Property Address: 50 WESTWIND CIRCLE OSTERVILLE MA.02665 Owner: MRS.COLE Date of Inspection:9/13/00 BUILDING SEWER: (Locate on site plan) Depth below grade: 18 Material of construction:_ cast iron 40 PVC X other(explain) Distance from private water supply well or suction line: Wa Diameter: n1a Comments: (condition of joints,venting,evidence of leakage,etc.)'- THERE IS TOWN WATER ° SEPTIC TANK: X (locate on site plan) Depth below grade: U Material of construction:X concrete_ metal Fiberglass _ Polyethylene"_ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ. _ g n(a Dimensions: L 8'6"H 5'7"W 4'10" " Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle: ,} 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'`nla ry How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND EVERY TWO YEARS r , GREASE TRAP: (locate on site plan) t . Depth below grade: A Material of construction:_concrete_ metal Fiberglass _ Polyethylene_other(explain) Dimensions: nl3 Scum thickness: nLa Distance from top of scum to top of outlet tee or baffle:1-nLa Distance from bottom of scum to bottom of outlet tee or baffle nia „ Date of last pumping: n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc) n1a. - k s .r - revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 WESTWIND CIRCLE OSTERVILLE MA.02666 Owner: MRS.COLE Date of Inspection:9/13/00 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n& Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene other(explain) Wa Dimensions: n/a Capacity: Wa gallons Design flow: n& gallons/day Alarm present: NQ Alarm level:jai& Alarm in working order:Yes_No—: ma Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/H F DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LEVEL WITH BOTTOM OF PIP Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.) DISTRIBUTION BOX IS STRI ICTURA I Y SOUND PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa revised 9/2198 * Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 WESTWIND CIRCLE OSTERVILLE MA.02666 M1_, Owner: MRS.COLE < Date of Inspection:9/13/00 SOIL ABSORPTION SYSTEM(SAS): x (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nta Type: leaching pits,number: 1000 GALLON L oruM leaching chambers,number: _n/a leaching galleries,number: _nLa leaching trenches,number,length: nLa - N' leaching fields,number,dimensions: nLiL ` overflow cesspool,number: n& Alternative system: n/a Name of Technology: n(a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTUR ALLY S D AND FUNCTIONI 9G PROPERLY PIT HAD 2'IN THAN 2 IT AT THE Tlh" OF TI,F INSPF(`Tlrly�ieven Deno CESSPOOLS: (locate on site plan) Number and configuration: nLa Depth-top of liquid to inlet Invert: n(a Depth of solids layer: n/a Depth of scum layer. nla Dimensions of cesspool: n/A Materials of construction: nla Indication of groundwater: nla inflow(cesspool must be pumped as part of Inspection)n& g• Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa PRIVY: (locate on site plan) Materials of construction:n& Dimensions:n& Depth of solids: n/A Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition rof vegetation,etc.) nLa revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 WESTWIND CIRCLE OSTERVILLE MA.02666 Owner: MRS.COLE Date of Inspection:9/13/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) , n/a , ov ►tb ' peck Qon � pq Iti� AP �t2� � Soy e t revised 9/2/98 Page 10 of 11 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 WESTWIND CIRCLE OSTERVILLE MA.02655 Owner: MRS.COLE Date of Inspection:9/13/00 NRCS Report name: nta Soil Type: n1a Typical depth to groundwater: nta USGS Date website visited: nLa Observation Wells checked: NQ - Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water u _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers. X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET revised 9/2198 Page 11 of 11 � V� LOCATION SEWA E PERMIT, N0. Lot ,�ra 4 y VILLAGE Cl add INSTALLER'Sff AM[ i ADDRESS 5 e1-o nCD BUILDER OR OWNER y� DATE PERMIT ISSUED �Vo DATE COMPLIANCE ISSUED t 4 Lot ............... THE COMMONWEALTH OF MASSACHUSETTS olAo BOARD OF HE)A _T . 0----------14-WIV.... Al ................. F.....6r. Appliration for Uispwial Workii Tomitrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sys at . .. ........ ........ ....j4. 5 T....je.. .......... i�..t� ...................... 0 or Lot No. 1011. ....................f ............... Address.e .... .................. ...V ------------------- Installer Address Type of Building Size Lot... ..7d'S__�rSq. feet U Dwelling—No. of Bedrooms ----------------------Expansion Garbage Grinder a Other—Type of Building No. of persons--------- ........ Showers (1, �� !ic. f) — Cafeteria Other fixtures ................. ...................................................................... Design Flow.................... ... ... ----gallons per person per/day. Total daily, --------------I...0... Liquid capacity/,�,44.gallons ----- Diameter_............. Depth............_._. 9 Septic Tank Length.... Width. -1 -4 Disposal Trench—No..................... Width._...._..______... To' gth................... Total leaching area....................sq. ft. Seepage Pit No........_!-____-,_-- Diameter--------�------- Depth below inlet...... ......... Total leaching area.//--f�.7.sq. ft. Other Distribution box q4 Dosing t nk ( ) C7/. 0-4 . Rua .... 14 Percolation Test Results Performed by-----A746k7_/Y) /A/46-1�A/k -- .- .. Date_..._.. �4 Test Pit No. I................minutes per inch Depth of Test Pit..................d Depth to ground water ---------------- rXq Test Pit No. 2................minutes per inch Depth of Test Pit...___t3l.. Depth to ground water.._______. ... ..... .... ------------•--­---------------*------------*--------------------- 0 Description of Soil........... ........ ........................................................................ W U ........................................................................................................................................................................................................ W 4 .......................................................... ............................................................................................................................................. �0 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 IT�11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Ce'rtificate of Compliance has been issued by the board health. Sined. - .. a. -------- k. ................................. D ApplicationApproved By------. - ----- ..... ..... .... ................................... ......................... ............ Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date Permit No........... ................ Issued..............!S.—tam,MR.......... Date ------------------------------------ —----------------- >, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LT « M .....OF.... pfiration for Disposal Works Tonstrur#inn famit Application is hereby made for a Permit to Construct°( or-.Repair ( ) an Individual Sewage Disposal f Sy ern a .. :_...._.l _...- ---- - •, w, L 'on-Address or Lot No -.-_-.--- - •-•- Address ...... ner ..c .. . . r '� � ) .................... i Installer Address ,,��++ U Type o Building Size Lot_. ,d..- e�Sq. feet Dwelling—No. of Bedrooms___.. ..____ ______________________Expansion ttic ( ') Garbage Grinder 94p) aOther—Type of Building # "t � No. of persons_._._.._ =_._ Showers ) — Cafeteria ('�) Other fixtures ------------- -4�•-•-•--------------- W Design Flow.................. __ ____gallons per person pel day. Total dailv Pqw________ gallons. WSeptic Tank—Liquid capacityf __gallons Length____........ Width___ • •--•- Diameter________________ Depth__.__.________.. x Disposal Trench No. Width____T To al Length_._______ Total.leaching area___ sq. ft. Total leachin area �( s . ft. Seepage Pit No __ ____. Diameter ._ _ ......... Depth below inlet_________ g •. q z Other Distribution box (, Dosing nk ( ) # Percolation Test Results Performed by._-. _:.J.&.4*6.04411_9141.6___ Date___ _ ""_a _ . Test Pit No. I................minutes per inch ,Depth of Test Pit t/ Depth to ground water fs, Test Pit No. 2................minut es per inch ''Depth of Test Pit . __ Depth to ground water �/ rE ' . O Description of Soil-------_•-- 1 .- _...1�:1' _�_ r...----- / - - - - .... x U 3 W --••-•-----•------•--...._..••---•-•---•----•-•••••---••••----•-•----------- U Nature of Repairs or.Alterations—Answer when applicable...................................... _________________________t__.._._.___.._..___._._._____________..____________.___.____._________ .e; ..................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with i' the provisions of TITLL 5 of the State Sanitary_Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board health. Signed__ '~ . --- .......................... Application Approved B D-e t F, s, Application Disapproved for the following reasons: Date----------------------------------•---• ---:....._......._ S ---•--•........-•---•--•••-----••-------=----•--•--•••---•--•--•-••-•----•----•--==•-•-----•---•--•-•-•-•---•- QADate Permit No.- ..._... --------• Issued_----- "......` ... t Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .r` Trrtifirtt#le of TontPh anrr THIS IS T,,O CERTIFY, That Ind v' ual Sewage isposal System constructed or Repaired bY..................... -Jot"' --- Jr_ c2--------------------------•-•-•---• ---• ---.._........------------••-- I a« Install ^ at7 - ... _. z' tr' ----------------------------- has been installed in accordance with the provisions of TIT F 5 of The State Sanitary Code desc ibed in the application for Disposal Works Construction Permit No._.. -_! '_ h_____________ dated-...... _ .. ................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUA ANT THAT THE SYSTEM WILL FUN TIO `SATISFACTORY. a DATE................... j• ,,..�.............................. Inspector................... - _••----- ................................................ THE COMMONWEALTH OF MASSACHUSET�S, BOARD OF HEALTH NJR I FEE ............... ` ioo �a for o#rnr$uan r anti# Permissio is herebyanted...... to Construct or=,,Repair ( ,,} n Individual �ewa a,Disposal ystem at No.. r� � � - -' ^8d �� r� -•-----:...... ._{gyp/�_ _ _ _ 'I --•& Street as shown on the application for Disposal Wor4construction Permit No..................... Dated............... .................... ........ ---- '� - ------------------- • ` `•- Board of Health ' DATE.................................................. . = � r` , FORM 1255' A. M. SULKIN, INC., BOSTON -ALL ELE�O. b Nc► �� uJ:.3 Ar2.F MEA.o,! SEr► LbV1EL ZaPl �G -V lc4� kLL L.I W A M'11U lMU"A OF — ~I i% _ _-_ Ut.tt_�55 CJT'NE��t'E S•F9EGa�lED. PIPES TO AND tal THE SYSTE►,'1 S NA.LL DE CAST 12,C)1.1 C*r- SC-*1,6DULE AO P./c 24' ALL SEPTOC TA►IK5, OIST-e%5LTT)O,. eoY-, A"O L.EJ6, �C"l JG P( SHALL $E N 2 DEStG�ED > c�� / - 0 v '++EE+✓ �U�D��1C�S T (� {� © �I I _--- - - -- -- - V-F-Ma✓E A.� uaSJlrAaL-E MATElZl4L l5e"EATLI e 0 ® C C) Q) - TltiE 1.1�1ESZT ELE�/ATIO.JS OF LEACF�I.lE� PETS Fc- -�- -- ' 0 A �.�QS ot= 1 C)' A,..►o Etc kt PILL_ w lT}A C�.y-FeZ7j!5 00 "AT U V �✓1 e-:- .o 01= t-iF. L-TVA "UST r>E EAf: ETInrJ La.�0 Pe oQ TO �t.GrCFiu.lu�a C �— Uc]►jL..E55 N2�<<SE OTE n1oTeC, A>� SySTE►� O COM�"VI+. EW-s SMAI� 4CGC Dn.JC� W tTN T�� 0 lY O E�:2Z F r1a STATE TY P i _4 L D15T�11!5UTI 61`t E'501L �' �' 0 `-�.• , y CjDv;7- 6."L) s�� ,y �ac�s>✓ sw��, UOT T® §GAL-E L_ { -- u1N1CN MAY A•P«-�/. .,_ ��f i7.�T�tt3vT,n...r e� AI.1� /Oda F.�o.>.. T P►Gr• :z'•C�uJ �Ya�i �e,P'T°�:• c^Jim ��-_��_ ►-1CT _P►� �_ .. _ _ OB,SE,C VAT/Oit/ V/7-5 S�V�T IC -T•�„. tsy A>�EI�Ic•. 1 �'E<_�.Sr �oT � SOCAI -L.- tioT to x,.�E Cam- �G7 UAL t TI+bKS ",,j Fo2C.ED Tµpn uC.NOVT ",e coo A ria x✓ 4A7� _ /rn.., /.•�c h QBiE'.CV•47*/0/5J5 Qy. --- ?.4 - �i.' reM8E00FD ST1�L (�Oa71 I.-1 a-� SCP'TIe Tr+.�eE3•s MAwtNolC� "'►"�_., 1 ANA t_E�CNl�lG+ P R�R•lira rR/F' Oo A eo OF );Z74 L 7-A,' �r r o-TTor✓t• Cb4,C. it, 4000 r-.1 TLml"-,T `- Ta fsrt BvILT OPTIC 1L!^4r-M'L'S, Tor FOV+lDAT1Gl.� aCLGw FrlllyN 61i'� �! ' PA S \ L- Lev _ A�,+o F!hl.tSK 6t[J►oti. � INtS�! 4Qi-.t�E F I�.11S1i E,eI► D! Gvttt.. Fipa,." GCI►M • - t W C IL TWd K. Q 1-t OI/Il2'60AMt! } IEACH!►tG t a 1. , - le f 1 LA- ZIP of 3� 7 cr 000 't t»-4- � '0 � • ,Rt4,I' 1E D bTIo+J*• t ! V `� Ce N trou e D C�►jC• pIStT IISO>rC _ 0 0 0m ..� � t g E PTtG Ta.►v . .. wLav —..r--► ��� 3$ � TVP1CAl. �¢�uAC�E SYSTEM t�IttTtF'1.L1� "� -_a _ z 4- 4 t�jdT Ta SCd►LtE L.E I►cN INf� P/r K)i � N — v Ar r MAP SECTION PARCEL(, GOT ADDRESS PIT 40— : _,_.._.._.- __. oils' ^V "`_.... . ... . l _._•-- _.._---. .-- ...... .-. M, .'` ��,sT p ro A%POSEP PAYR �,ING .LOCATION vE3/GN G!'/TES/� ," pib�o EaVladtG �'41 OF � s�; NAM p�,e aF AAo.4d;M s �',,, � PROPOSED SEWAGE RISPOSAI. SYSTEM Wb T y f�EitsaH/S t dfDreOvM -.. O sr4'DLi11h�/ �, E 1 `' L 6T t �•,flC , J i4.�` i....- "i,.. . gWLeW.5 � fad -iav UPON` Y _.fir._. NYC"O 3f1 � y ` ; I. fir. \ � ,�1ST>�:R�'i s.._ ►...k, � ���-�. � _, �.:� T,.=: � . , /�. l.�.4 cf/i,�l6 .:� ter•�;r �j P90POSILD LOCH INCs PIT - -. .. .... . r t >I 1: ,. �may. �. M1{ � ���'7u.•�� )�+, �{ > 'a�`►" `F r yr , ". .i_`'�:_" � >` TOP OF FOUNDATION 24'dameter concrete covers 05T L RV 1 LLL, EL=57.8 raised to within 6'of fim5h grade MA (or a5 noted) Inspection Port and cap with magnetic TWENTY(20)ADS ARC3G (3G I GBD2) LEACH marking tape to wthin 3'ofgrade CHAMBERS IN BED CONFIGURATION IN FOUR(4) ROWS OF FIVE(5) UNITS EACH 6n5tmg EL=49.9+ EL=49.5� EL=49.0-50.01'max) \A \ 3 6 5.0' 5.0' 5.0' 5.0' 5.0' o o 0 Zi W p 48.9+ Existing 46. 3 0 9 m x N Ln m Rte 28 m O f 47.7� + 0-BOX N � 5a5ting O Exstn 47./7 N 4700 46.53WMA 6� tf1 9 LOCUS 9 NLn > 1 Os ^ Gas Baffle 45.634 � IL lnspect/on Port(See Note 04) m O 3 Longest Run I TWENLEACti CD MBERS/N ED B02J 5.6+ o /2'+- ---##i Existing PLAN VIEW DB-6 CONE/GUR.4TlON W/Tl�FOUR(4)ROW5 °- EXIST/N6 /000 GALLON (H-20 Rated) OF FIVE(5)CHAMBERS fL SEPTIC TANK D-BOX LEACH CHAMDEieS -�O �rtomofTestfio% SCALE: I " = 10' SITE LOCUS NOT TO SCALE FLOW PROFILE INSPECTION NOTE: NOT TO SCALE I .) Assessor's Map 1 2 1 Parcel 0 1 1/005 PRIOR TO FINAL INSPECTION BY 2.) Deed Book 1 5414 Page 57 CONSTRUCTION NOTES THE ENGINEER, SYSTEM NEEDS 3.) Plan Book 290 Pa e 55 Lot 7 SYSTEM DE51GN CALCULATIONS Parcel 2 TOLD PF COMPLETE INCLUDINGg ' ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5(310 CMR Parcel 1 2 001 BUILDUP FOR COVERS. 4.) This property IS In a Zone II Of a Public 15.000): STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, Water Supply AND EXPANSION OF ON-51TE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE 5EWAGEDE5/6N FLOW REQL//REO:3 BEDROOM DWELLING(9 5.) Flood Zone: C TRANSPORT AND DISPOSAL OF 5EPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. //0 GPD/BEDROOM=330 GPO KEQU/RED : 2.j ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR SEWAGE DESIGN FLOW PROVIDED TWENTY(20)A05 UNIT5 IN BEDCONE/GURAT/ON/N FOUR(4J ROWS OFFfVE(5)UN/TS EAC/i. VEHICLES OR HEAVY EQUIPMENT TO PA55 OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 tX LEGEND- / LOADING. IF UNDER AN IMPERVIOUS,SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. Vt=L(330/0.74)/(4.B FTZ/FT)/5.0 LFJ = � 9 A05 UMT5 REQUIRED(20 PROVIDED) Cod QO 3.)TO MINIMIZE UNEVEN SETTLING, ALL SYSTEM COMPONENTS SHALL BE INSTALLED ON A STABLE EXISTING SPOT GRADE MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. 355 GPO PROVIDED>330 GPD REQUIRED Map 121 Z4x5 PROPOSED SPOT GRADE 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX, 5EPT/CTANKCAPAC/TYREQ111RED: 3306PDX200% =660GPDRE000RED Wooded Parcel 1 ! 004 EXISTING CONTOUR AND THE 501L ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING Map 121 `S 24- PROPOSED CONTOUR FIELDS,TRENCHES, AND OTHER 501L ABSORPTION 5Y5TEM5 WITHOUT ACCESS MANHOLES SHALL 5EPT/C TANKCAPAC/TYPROVIDED: EX15TINC 10006ALLONSEPT/C TANK Parcel 12 002 p�2 F w WATER SERVICE LINE HAVE AT LEAST ONE(1)INSPECTION PORT CONSISTING OF PERFORATED 4"PVC PIPE PLACED O OVERHEAD UTILITY LINES VERTICALLY TO THE BOTTOM OF THE 501L ABSORPTION SYSTEM WITH A CAP,TIED WITH A GARBAGEDOP05AL/5 NOT PERM/TTED W/T/I TH15 DES/GN FLOW MAGNETIC MARKING TAPE,ACCE55113LE TO WITHIN 3"OF FINAL GRADE. �`✓c oiled �dk ma's u UNDERGROUND UTILITY LINES 5.) PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A �6A - G GAS SERVICE LINE TOP OF BANK MINIMUM CONTINUOUS GRADE OF NOT LE55 THAN 2% FROM THE BUILDING TO THE SEPTIC TANK �• o-f-i- LIMIT OF WORK AND NOT LF-55 THAN I%IOTHERWISE. Existing D-Box to bye Removed a �_�� EDGE OF CLEARING G.) DISTRIBUTION LINES FOR THE 501L ABSORPTION SYSTEM SHALL BE 4"DIAMETER SCHEDULE (see Note A20) % 0" TP FENCE 40 PVC(OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE Exr5ting Leach Ptt(5)to he O I TEST HOLE LOCATION CAPPED AT END OR AS NOTED. Abandoned(See Note l�2D) sT SEPTIC TANK 7.)LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2)FEET BEFORE DB DISTRIBUTION BOX PITCHING TO THE 501L ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO Existing Septc Tank to be / / S SAS 501L A550RPTI ON SYSTEM ASSURE EVEN DISTRIBUTION,. Ublaed(See Note#/9) ��_�/ \/���\ �,6 Reserve RESERVED FO� _ R FUTURE USE 8.)GROUT TO B WH E USED AT ALL POINTS ERE PIPES ENTER OR LEAVE ALL CONCRETE �\\f^ �0 � / ` UTILITY POLE STRUCTURES IN ORDER TIO PROVIDE A WATERTIGHT SEAL. �� ® CATCH BASIN 0 FIRE HYDRANT 9.) HEAVY EQUIPMENT 5HIALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE C� BENCHMARK Wooded ` Fia roc i� DRINKING WATER WELL DISPOSAL FIELD DURING YHE COURSE OF CONSTRUCTION OF THE SYSTEM. TEST HOLE LOGS Top Corner Concrete p 0 2x `�� a�a° /� F ■ CONCRETE BOUND ACCORDANCE WITIH 310 CMR 1 5.22 1, ALL SYSTEM COMPONENTS SHALL BE MARKED I EL=50.00(Assumed Datum) �,c .�o g +, IO.)IN CC ��y4� y 09 WITH MAGNETIC MARKING TAPE. OR o a ZH Mq Test Hole#I (EL=50.3+) P#13529 OF 1 1.)THERE ARE NO KNOWN WEDS WITHIN 100'OF THE PROPOSED 501L ABSORPTION SYSTEM. O ��10 31q \ y Depth Layer Sod Class Sod Color Comments o LINDA J. G� 12.) FROM THE DATE OF THE INSTALLATION OF THE 501L ABSORPTION SYSTEM UNTIL RECEIPT OF PINTOCn -� THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT O"-8" A Medium Loamy Sand I OYR 3/Icl USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. 44"-G, B Medium Sandy Loam !OYR 5/G , \ 44"-G8" C I Medium Sand I OYR G/4 2 tJ \ '� 13.) THE DESIGNER WELL INOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS G6"-1 23" C2 Medium Sand I OYR 5/8 Perc @ G4" ��� `q 8 0 CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE �61 0 5 R ���� 0 g T DESIGNER. � n, �SS�iAL+� 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE Test Hole#2 (EL-50.2±) 2Co 0�,CJ BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE Depth Layer Soil Class Soil Color Comments Map 1 2 1 LOT 7 \2 �2\ \w Survey work b� SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED PLANES. 48 HOURS ADVANCE NOTICE 15 REQUESTED. 0"-G" A Medium Loamy Sand I OYR 3/1 Parcel I I DOG Area= 15,555 5.F.± lb1 A. 8 11r1 Land S Suite 3 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR G"-44" B Medium Sandy Loam I OYR 5/G `\� 618 Route 28, Suite 3 DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO 44"-1 2 C I Medium Sand I OYR 5/6 v�\_ \� 37- Yarmouth, MA 02673 COMMENCEMENT OF ANY'WORK.THIS INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO G4"-1 23" C2 Medium Sand OYR 5/8 QJ Pb- (50B) 737-1977 E}aail snmland®COIDCd9t.Ilet DIG5AFE, ANY PRIVATE UTTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. I TE PLAN � I G.)CONTRACTOR SHALL VERIFY THAT ALL WA5TEUNE5 ARE CONNECTED BY WATER TESTING DATE OF TESTING: 0!/19/1 2 v REVISION 03/1 3/1 2: Revised Profile Elevations, Contours: Added Water 1-me. WITHIN THE DWELLING PRIIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 501L EVALUATOR: LINDA J. PINTO, P.E., C51N ENGINEERING SCALE: I " = 20' Prepared for: BOARD OF HEALTH AGENT: DON DE5MARA15, BARN5TABLE HEALTH DEPARTMIENT P 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY PERCOLATION RATE: LESS THAN 2 MIN/INCH IN"C"LAYERS SEPTIC SYSTEM COMPONIENT5. Kinlln, Ellen C., Trustee 18.) INSTRUMENT SURVEY(CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT BE NO GROUNDWATER ENCOUNTERED 140 Ice Valley Pcl- Osterville, MA 02G55 USED FOR STAKING,OR ANY OTHER PURPOSES. Proposed Sewage Dlspo5al System 19.)THI5 PLAN DOES NOTF CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH ZONING I CERTIFY THAT I AM CURRENTLY APPROVED BY THE 50 West Wind Circle, Osterville, MA BYLAWS, SPECIFICALLY, DUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO Btu Kitchen Dmmg RESTRICTIONS. 31 O CMR 15.017 TO CONDUCT 501L EVALUATIONS AND THAT Bdrm THE ABOVE ANALY515 HAS BEEN PERFORMED BY ME Prepared by: o 20.) EXISTING 1000 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEE5 TO BE INSTALLED ON INLET CON515TENT WITH THE REQUIRED TRAINING, EXPERTISE, AND Garage , - AND OUTLET PIPES IF NECESSARY, AND A GAS BAFFLE INSTALLED IN THE OUTLET TEE. EXPERIENCE DESCRIBED IN 310 CMR 15.017. 1 FURTHER 9 CERTIFY THAT THE RESULTS OF MY SOIL EVALUATION AS hJ 2 1.)EXISTING SEPTIC COMPONENTS,TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND INDICATED ON THE ATTACHED 501L EVALUATION FORM, ARE Bd" Bth Bdrm Liv ng CSN �, AND ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. ACCURATE AND IN ACCORDANCE WITH 310 CMR 15.100 EC THROUGH 15.107 �ti;� Erg c�a��Qring 22.)EXISTING SEPTIC COIMPONENT5 TO BE REMOVED. ANY CONTAMINATED 501L SHALL BE REMOVED FOR A DISTANCE OF FIVE(5) FEET LATERALLY FROM THE 501L ABSORPTION SYSTEM (� AND REPLACED WITH CLEAN SAND. AREA TO BE COMPACTED TO MINIMIZE SETTLING. f LOOK\ P LAN 0 20 40 60 P.O.Box 2030 Phone:(508)299-3250 Teaticket,MCI 02536 Fax:(508)548-5478 23.) IF ANY FILTER IS INSTALLED IN THE SEPTIC TANK OUTLET TEE SHALL, IT SHALL BE INSPECTED4)�� J, 31141 NOT TO SCALE SCALE I =20' AND CLEANED ROUTINELY TO PREVENT CLOGGING AND BACKUP OF THE SEPTIC TANK. Linda J. Pinto, Certified Soil Evaluator C:\CSN\AM-We5t Wmd\AM-West Wmd SDS Plan.dwg Date:: OI trZ.4'2; Scaie A$ h " 'B LJP Check: MTA/I Project No. C5NO2 O 1 Ve bl s5