HomeMy WebLinkAbout0057 WEST WIND CIRCLE - Health 57 Westwind Circle
Osterville
A = 121-011-032
Fr...
TOWN OF BARNSTABLE
LOCATION 5 / W C\ 4- W i h Q i K SEWAGE#
VILLAGE a vC J Z \ ASSESSOR'S MAP&PARCEL k7Z k
INSTALLER'S NAME&PHONE NO. T d V,0_5 e-X C ?
SEPTIC TANK CAPACITY ` U 0 0
LEACHING FACILITY:(type(3 500 (size) IS
X 3 3
NO.OF BEDROOMS LL
,
OWNER `V/C) Q
PERMIT DATE: �J Z Z — ZC/LO COMPLIANCE DATE: "y
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) .met
Edge of Wetland and Leaching Facility(If any wetlands exist viihin
300 feet of leaching facility) Feet
FURNISHED BY
100
zA
A
q.
I.jO
No. � Zed Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppUtation for Disposal *pStpm Construttion 3permit
Application for a Permit to Construct( ) Repair ) Upgrade( )`Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.5? was—, W c 1 K Owner's N e Address,and Tel No
Assessor's Map/Parcel j-Zl v i i (J 2 ICID 1~40& 106L VI
Installer's Name,Address,and Tel.No., rrdyj Designer's Name,Address,and Tel.No.
Q a �c� 89-0 S�GPFn" 7 A�r1 I Ma%(6R-- -L Saga: 04,
0- h5S 1 C CO P 0 9QX is i E• SKr V0igH rvtA JW -n
Type of Building:
Dwelling No.of Bedrooms Lot Size J.� 000 sq.ft. Garbage Grinder( )
Other Type of Building J No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) _3 3 D gpd Design flow provided K✓ gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank QO Type of S.A.S.
Description of Soil A
Nature of Repairs or Alterations(Answer when applicable) Cj
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 0d#0 of/ e!alth:
OiledfiV - .� .__..� Date
Application Approved by Date '
Application Disapproved Date
for the following reasons
Permit No. Date Issued LI 17-g l?ozc
-
No. -ozo — Fee# loo
Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
� Yes
PUBLIC HEALTH DIVISION - TOWN OFIBARNSTABLE, MASSACHUSETTS
2pptic tlon for ]Disposal OpBtem Construction Permit
l
Application for a Permit to Construct'(, ) Repair ) Upgrade( ) Abandon(. ) ❑Complete System ❑Individual Components
Location Address or Lot No. � W ST W IUD, CIA, Owner's Name Address,and Tel.No.
p���•VILt..-6+1 Wlfi 1~Sif��� � X��3EfZf t.. lUfleD+a�
Assessor's Map/Parcel 47_1 1 4 V .032. Rio(! WE 144 101 iGAlub
Installer's Name,Address,and Tel.No.7oNES » iv1J Designer's Name,Address,and Tel.No.
�+• f� 1�sox 8;�� �£,A����1, �'� �01��t;p2,.. �, S�,�tS fP�,
rjJP'�. 6 p 0 R 981 fy . Sl+r�roe�ct� wiA SW 3 0 .33I1
Type of Building:
Dwelling No.of Bedrooms Lot Size ?, 1000 sq.ft. Garbage Grinder( )
a
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) -3 3 Q gpd Design flow provided f� gpd
Plan Date Number of sheets Revision Date
Title
j Size of Septic Tank X t 000 Type of S.A.S. i.
Description of Soil /.r�4 Oovl �.9 'V!o .15-A A
Nature of Repairs orAlterations(Answer when applicable) C%
Date last inspected: r
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 Booarrd�ofHealth:- _-•
Signed/ \l,r-� Date
Application Approved by "'� Date y t M0: -•y
Application Disapproved by Date r y
for the following reasons
Permit No. 7 0 "` t z Date Issued t� 79/00-7o
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( )
Abandoned( )by '��(V E S E,XCpiQA-Tipt
at Wr�S i W+(%lt> CI f?. T)SIV,11 V I Lt-V has been constructed in accordance4.
with the provisions of Title 5 and the for Disposal System Construction Permit No, /X_5 dated
y - -
Installer Designer
#bedrooms Approved design flow gpd
��T�
The issuance of this permit s wi
shall not be construed as a guarantee that the system ll function as�designed'—"---_.-
Date ( �� ! l * •Cx' Inspector ' ` .
--
No. W Fee �p
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Bispos :Rgai!r
* em Construction Permit
Permission is hereby granted to Construct( ) ( Upgrade( ) Abandon( )
System located at /h 3vS 1 !�' ('.,i12,
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.
i
Provided:Construction must be completed within three years of the date of this permit;/"" -- ----°------
Date 41 a t z,O 2-D Approved by
E
Town of Barnstable
Regulatory Services
Richard V. Scali, Interim Director
anxtvern�,
Public Health Division
1639.
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
-Installer & Designer Certification Form
Date: Z� II� Sewage Permit# �����'' 'Z., Assessor's Map�Parcel 12_1 It
Designer: -2,f, V�✓�L Installer: �6 CU .
Address: P0 Address: "C' S /Qr
On Z� 64� A/ was issued a permit to install a
dat (installer)
septic system at S� W ) y14 C' based on a design drawn by
(address) z
t `C M ..0-4 �dated T_)—J-2
(design r)
I certthat the seotic 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. Strip out (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. Strip out (if required).was inspected and the soils
were found satisfactory.
I ce that the system referenced above was constructed in compliance with the terms
the IAA roval letters (if applicable),
ler s Signature)
METER
esigner's Signature) (Affix ere)
PLEASE RETURN TO BARNST LE PUBLIG_IHEALTH`D ON. 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. :r T
QASepticTesigner Certification Form Rev 8-14-13.doc
�L\' �j&^-- Ali y, t�` •1V! `
Town of Barnstable
' BARNSfAHLE,
MASS
,p 1639, Inspectional Services Department
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An "x" marked in the ❑ is the failure criteria and associated repair deadline ti
60 DAY DEADLINE CRITERIA"
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool,.or privy below high-groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
W(eaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
J . Commonwealth of Massachusetts 1°al- D//- OSLL
Title 5 Official Inspection Form -
i� Subsurface Sewage Disposal stem For - o S S m Not for Voluntary Assessments
- 9 p Y rY
57 West Wind Cir.
Property Address
Kevin Noddin '
Owner Owner's Name
information is Osterville ✓ MA 02655 3/22/20
required for every ,
page. 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.
i'
Important:When filling out forms A. Inspector Information on the computer,
use only the tab Robert Paolini
key to move your Name of Inspector
cursor-do not Robert Paolini
use the return
key. Company Name
67 Tanbark Rd.
Company Address
Marstons Mills MA 02648
City/Town State Zip Code
(508)280-9499 S14454
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title
5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true,,accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3.' ❑ Needs Further Evaluation by the Local Approving Authority
4. ® Fails
J
3/22/20
Inspe is ig re 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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc•rev.7/26/2018 Titie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin 1
Owner Owner's Name
information is required for every Osterville MA 02655 3/22/20
page. Cityfrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete,1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
El I have not found any information which indicates that any of the failure criteria described
in 31.0 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) 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):
4
t
r
t5insp.doc•rev.7/2a'2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
57 West Wind Cir.
Property Address „
Kevin Noddin
Owner Owner's Name
information is required for every,, Osterville MA 02655 3/22/20
page. Cityffown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cunt.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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):
3) 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.
a. 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:
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is Osterville MA 02655 3/22/26 .
required for every "
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
1,
❑ 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. 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.
O 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.
c. Other:
4) 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection, Form
Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is required for every Osterville MA 02655 3/22/20
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® 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 1/2 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.
E ® 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 water supply
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 2000 gpd-
10,000 gpd.
® ❑ 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.
5) 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 CA.
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 If of a public water supply well
Snsp.doe•rev-7l28l2018 We 5 Official hrspaofsorr Form.Subsurface Savrage Usposal System•Page 5 of 18
Commonwealth of Massachusetts
j Title 5 Official Insp ection'Form
w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is required for every Osterville MA 02655 3/22/20
.
page. CitylTown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to ariV questionJn Section C.5 the system is considered a significant
threat, or answered"yes" to any question in Section CA above the large system has failed. The
owner or operator of any large systemconsidered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department., '
6. You must indicate"yes"or"no"for each of the following for aff inspections:*` J
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ R 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 ofsubsurface 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)]
L
Y
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18'
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is Osterville MA 02655 3/22/20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms (actual.): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
Number of current residents: 1
Does residence have a garbage grinder? S ❑ Yes ® No
Does residence have awater treatment unit? 1❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: NA
Date
t5insp.doc•rev.7/26/2018 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
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is 1Osterville MA 02655 3/22/20
required for every
page. Citylrown State Zip Code< Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions: `
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd) '
Basis of design flown(seats/persons/sq,ft,etc.):
Grease trap present? ❑ Yes. ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: `Date
Other(describe below): ,
3. Pumping Records:
Source of information: -
Was system,pumped as part of the inspection? ; ❑ Yes ® No
If yes, volume pumped gallons
How was quantity pumped determined?
Reason for pumping: ,
t5insp.doc•rev.7/26/2018 Y 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
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is Osteryille MA 02655 3/22/20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
4. 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):
Approximate age of all components, date installed (if known)and source of information.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. 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.):
Joints appear tight. No evidence of leakage.System vented through house vents.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
1
Commonwealth of Massachusetts
Title 5 Official Insp ecti®n' Form
w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is required for every Osterville MA 02655 3/22/20
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. - Septic Tank(locate on,site plan):
3'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
F
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?.(attach a copy of certificate) ❑ Yes ❑ 'No
Dimensions:
1000 GI.
Sludge depth:
3"
Distance from top of sludge to bottom of,outlet tee or baffle 44"
i
n '
1»
Scum thickness
Distance from top of scum to top of outlet tee or baffle
7"
Distance from bottom of scum to bottom of outlet tee or baffle 11"
How were dimensions determined? Measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump every two years.Inlet and outlet tees in place.No signs of leakage.
t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form!-.Not for Voluntary Assessments
u
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is required for every Osterville MA 02655 3/22/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
7. 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
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
i
8. 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: J
gallons per day
t5insp.doc•rev.7/26/2018 Tole 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owners Name
information is required for every Osterville MA 02655 3122/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
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
9. Distribution Box(if present must be opened)(locate on site plan):
1 No
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Box is level.Box has one outlet laterals with equal distribution.No signs of leakage.
I
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form i
lip Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
Al
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is required for every Osterville' MA 02655 3/22/20
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
.10. 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.
11. Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type;
® leaching pits number:
6'x6` 2' stone
❑ leaching chambers number:.
❑ leaching galleries number:
❑ leaching trenches number, length:
11 leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
r Subsurface Sewage Disposal System Form Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is
required for every Osterville MA 02655 3/22/20
page. Cityf town State Zip Code Date of Inspection
D. System Information�(cont.)
11. Soil Absorption.System(SAS) (cont.),-
Comments(note condition of soil, signs of hydraulic failure, level of ponding;damp soil, condition of
vegetation, etc.):
Sandy soil.Leaching Pit was full at time of inspection.
1
l
12. 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
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,.
etc.):
i
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is required for every Osterville MA. 02655 3/22/20
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealths of Massachusetts
Title 5 Official-Inspection Form
Subsurtace Sewage Disposal S NotfoVol .- ments-i Assess
57 West Wind Cir.
Property Address::
Kevin Noddin
Owner
Owners Name:
information is )
required:f.r every .Qsternite MA _ 02655: 3/22/2t3
page:. Cityffown State: Zip Code. Date of►rspectior
Q. System Infolrmatllon;(cont:)
14,.Sketch of Sewage Disposal System:
Provide a,view;of the sewage disposal systern,.including ties to at feast ti. permanent reference
landmarks or benchmarks. Locate ail welts within.100 feet. Locate where public watersupply enters
the building Check one of the:boxes below:..
01 hand-sketch in.the area below
Q drawing attached; eparatefy
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
All
57 West Wind Cir.. .
Property Address
Kevin Noddin
Owner Owner's Name
information is required for every Osterville MA 02655 3/22/20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
l
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 15,
feet
r
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: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health explain:
As-Built
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Used USGS observation well data.Used technical bulletin 92-0001
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
57 West Wind Cir.
Property Address
Kevin Noddin
Owner Owner's Name
information is Osterville MA 02655 3/22/20
required for every
page. Citylrown State . Zip Code Date of Inspection
E. Report Completeness Checklist r
Complete all applicable sections of this form inclusive of:
R . A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6(Checklist)completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
II
r:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
LOC TION SEWAGE PERMIT N0.
Ld 33 8`�- 3 ��
VILLAGE
Dsf rv'd
INSTA LLER'S AME i ADDRESS
,
eroT c'a
�� �'
L=so .
BUILDER OR //OWNER
0ed4a ,' ►CJPS pea& ?k&5
, DATE PERMIT ISSUED $C/
DATE COMPLIANCE ISSUED
Q I,
� aG
o
3'1 ay
57 UV e1 W d j clrc�
U4
' 1
i
PIR,,se Ml,lb -:1 AId-ptr.
Vtz „
F�S.............................
THE COMMONWEALTH OF MASSACHUSETTS
✓'f BOARD OF HEALTH
YI .....O F...... -- --- --- ...........
Appliration for Dhipati al Works Tomitrurtivat ramit
Application is hereby made for a Permit to Construct 4t or Repair ( ) an Individual Sewage Disposal
Systenj at
e
ocatig-Address/f�� r/,Lot
�N,o.�
" ff "VA4
Owner Address
Wr
a -------- . . .... ...................
Instal er Address
U Type of Building Size Lot... ....Sq. feet
., Dwelling—No. of Bedrooms------------------- ----------------------Expansion Attic ( ) Garbage Grinder (w�
aOther—Type
of BuildingV�! No. of persons........ Showers ( ) — Cafeteria ( )
-----•----•--
(00
Other fixt e -----------------------•--• -•-----•-------------------------------------------------------------
--------------------------------------
W Design Flow................I ..................gallons per person per duly. Totally fw........ --- _.t�...................gallons.
WSeptic Tank—Liquid*capacity .�aallons Length.......-'..... Width... _.4... Diameter________________ Depth.....__..._.....
x Disposal Trench—No..................... Width•-----. Total Length..............
--- Total leaching area....._..._._-------sq. ft.
Seepage Pit No.......... ...... .. Diameter........ .__..... Depth below inlet..... Total leaching area.'/--- �.sq. ft.
Z Other Distribution box (-f} Dosing to ( )
W
Percolation Test Results Performed by._.... 1kP. ._.1.1��j.. ,l ��Q�,/i �'. Date........ .....:. ___. 1�
Test Pit No. 1................minutes per inch Depth of -Test Pit......._............ Depth to ground water-.-�/
fS, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water/! .Gl�..... :. �
W .--..........
. ---------
•------------
Description of Soil........... .-6=�. .... .....�.?fl..�"r ----- �7...... --------- /-I--
x
W
UNature 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 TLNU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the be r f h h.
ed..... ---------•--- ................................
Date
Application Approved By. ------------------------------------- ----- .............
Date
Application Disapproved for the following reasons:-- --••••••--•---••-----•-•----•-•------•••-------•---•---•-----•••••-•••--•------•------•••-•-•-------------
--•-------•-----•-------------------------------•----••---•...-----•-----...---------...--•--•-----...................-•--•-••---•-•-••••------•-------•--•-•-----•--•--••-••-••------••••••-------------
Date
PermitNo......................................................... Issued---------•----•-----------------------------------r.._
Date
`---
............._............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA ,TH
,� r�ir tine foci Disposal Works Tons rurtiun rumit
Application is hereby made for a Permit to Construct (+ "') or Repair ( ) an Individual Sewage Disposal
Syst at
•--
Locati Address
j.J-
Own Address
W + A
r Insta erAddress /
Type of Building -t------Sq. feet
V YP g Size Lot._,F .:
�-� Dwelling—No. of Bedrooms...............................___._..ExpansionAttic ( ) Garbage Grinder f+je)
a Other—T e of Building
p .............. Showers ) — Cafeteria ( )
a —Type g -LM' No. of ersons..__...
Other fi r -
W Design Flow................ .... ...... .........gallons per person pe�rY y. Total dail 9p.......
WSeptic Tank—Liquid capacity/ :Qgallons Length------- .._... Width._ .._. Diameter-------- - Depth................
x Disposal Trench N :_ Width...... Total Length ... Total leaching area.._.. ...........Sq. ft.
Seepage Pit No Diameter ._..... Depth below inlet �/'Total leaching area. . 7 ft.
Z Other Distribution Iiox ( Dosing rank )
.. Percolation Test Results Performed b .. +� _ *^"
y -�... ------....�� ,�..t�l,/�`�-- Date.._
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water
w. Test Pit No. 2................minutes per inch Depth of,Test Pit__..........._..._.. Depth to ground water.`. .
Description of Soil ._ _ _ /� f- .... : "�. -� ---- -
c.� -------------------••-------------.....----•---------------------------•---......-•------------•---------------.... =
.'.;
W
UNature of Repairs or Alterations—Answer when applicable..........................................................................:.....................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforede'scribed 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 bee ` issued by the b ar of h th., �.
✓ Date
Application Approved BY e.. =---•- --•- ....................................... ...rn�v"-ja..............
Date
Application Disapproved for the following reasons--------------------•----•-----------•--•-------------------•-----------------------------------....----••.......
...... A.
...............................................................................•--_-.....---_..._._..........__..._..._._.._....•.._•__-......._.....__......---._...•...------.....__._......._...._..--
Date
PermitNo......................................................... Issued--•-------------•----------•--•-•-•------••••--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
10
Trtifiia-d6 of Tunt#lia, urr:
THIS IS 0 CERTIFY, That
...tth^e�lndividual ewage Dis o IsSystem constructed or Repaired ( )
by.... --•- . -�------------ ..' . "ir.. .. ....-•------ --•---............................. ...........................
I taller F
........./I............
......
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in.the
application for Disposal Works Construction Permit No....... .......... dated_.---_--- '......................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIOM SATISFACTORY.
DATE................•---•--� --- ---.-----
---------------=--------•--..._.. Inspector-------•------ •----- ------- -•--- -- - - --... ..---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
FEE........................
,
Permission 's hereby granted------ `= --- ----- . ........ �
to Constru t ) orNRepair ( ) an Individual Se rage Disposal Sy em
at
, 3 ..
Street
as shown on the application for Disposal Works Construction Permit N�o........ .........:. Dated............................,.............
1.._ �.. ..............................................................._
DATE- d of Health
---................................................................. Boar
FORM 1255 A. M. SULKIN, INC., BOSTON -
LEGEND OSTERVILLE
PROPOSED CONTOUR o
® PROPOSED SPOT GRADE
98 =— EXISTING CONTOUR m
h� WEST . WIND CIRCLE
+ 96.52 EXISTING SPOT -GP„ADE
"� W= EXISTING WATER SERVICE Q FAUNOU7ii ROAD
EDGE OF PAVEMENT
® ® TEST PIT R o
32 34 - 5� ♦ 0
..,
LOCUS -
�/ N
€f I , S
I
W \� LOCUS MAP o
3
8 LOCUS INFORMATION
1 ..
\ ; �' 11 I _ PLAN REF: 290/055
I i > _ 1 TITLE REF: 5250/170
a 11 I _ PARCEL.ID MAP 121 PAR. 011/032
I 1C, I I PROPERTY IS WITHIN ZONE II/ESTUARIES PROT. DISTRICT
I FLOOD ZONE: "X"
COMMUNITY PANEL 25001CO544J DATED:07/16/14
I _
SEPTIC SYSTEM
\ EXISTING
20 ft DWELLING N G REPAIR PLAN
- I a ! I
I LOCATED AT: .
Y ; o - TOP OF FNDN_ I - - - 57 WEST WIND - CIRCLE
o ,\ EL = 41 .41 { -138 1 OSTERVILLE, MA
1 vnt o �\ 1 .0 PREPARED FOR
12.50 PATIO , �. NODDIN
\ 36
` - �' APRIL 10, 2020 REV: APRIL 22. 2020
i
C ��\ LOT 33 ����� ofss9�
�� \\ AREA = 15000 sf+- 1 ft o� DAR E
10 ft \� PLAN BOOK 290 PAGE 55 MEY ,.
\� `\ AssR MAP 121 PCL1 1-32 ` / ..�1140
TP-2 \
30: T -1
o �NITmwt
"11
30 -32 34 T'
MEYER & SONS, INC.
P.O. BOX 981
BENCH MARK P LA N EAST SANDWICH, MA. 02537
TOP OF FOUNDATION PH: 508 360-3311
41 .41 SCALE:' 1 in 20 ft '. FAX: ((774)413-9468
BARNSTABLE cis DATU 0 20 40 meyerandsonstitle50gmail.com
O • 1 O #' 20 40 I
SHEET 1 OF 2 J 2076
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, .THE PROPOSED FINISH GENERAL NOTES'
TOP OF FND SEPTIC TANK y GRADE SHALL NOT BE < EL:28.70 FOR A DISTANCE '
INSTALL RISERS & COVERS OVER INLET & 15' AROUND THE PERIMETER OF THE S.A.S.
EL=41.41 f » PROPOSED D-BOX 1. ALL cwwcES To THIS PLAN MUST BE APPROVED BY THE LOCAL '
OUTLET AND SET TO 6 OF FINISH GRADE PROPOSED S.A.S. BOARD OF HEALTH AND THE DESIGN ENGINEER.
INSTALL RISER &'COVER •
INSTALL LOCKING COVERS IF AT FINISH GRADE " INSTALL A RISER OVER ONE CHAMBER (MIIN) 2, ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
F.G. EL.=36.Ot SET TO 6 OF GRADE AND SET TO 3" OF F.G. OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
F.G. EL.=34.58t F.G. EL:'33.5f
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
;. F.G. EL 33.50-34.0(MAX.) - 310 CMR 15.405 (1) (B):
1) A 2.30 Fr. VARIANCE FROM 310CMR15.221M TO ALLOW LEACI'IING
9" MIN COVER/ TO EE 5 30 FT(MAX) BELOW GRADE VS REO'D 3 FT. (H20/VENr PROVIDED)
O S-IX (MIN.) 36" MAX COVER L 50' L = 25'(MAX) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
4"SCH40 PVC EL-32.98 O S-1% (MIN.) O S-Ix (MIN.) s TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
4"SCH40 PVC 4"SCH40 PVC 2 OF 3/8 .DOUBLE WASHED / » _ / DESIGN ENGINEER.
STONE OR FILTER FABRIC DOUBLE WASHED"STONE 4• ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
\INV.=31.951:
10' t4 6 / FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
�`VEL INV.=31.70 ®®a®. ® ®a®® 5. ALL ELEVATIONS BASED 'ON ASSUMED DATUM.
LEVEL PROPOSED ®®®®® aaaaa 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
GAS BAFFLE _ a a a a a a a a a a a THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
INV.=30.0 �� ��-29.80 aaaaaaaaaaa HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
1 DB 5 _T
7. DWELLING IS SERVICED BY TOWN WATER.
EXISTING 1,000 GALLON SEPTIC TANK 20) 4 3 X 8.5 4 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
EXIST. SEWER oUTLET EFFECTIVE LENGTH = 33.5' 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK.
INV. ELEV.= 27.70 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5.
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
PIPE INVERTS PRIOR TO CONSTRUCTION TOP CONC. - EL, 28.70 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
2) D-BOX SHALL BE SET LEVEL AND TRUE TO ELEV. Z8.7O AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
'w
GRADE ON A MECHANICALLY COMPACTED SIX INV. ELEV.= 27.70 as 13. NO KNOWN ABUTTING PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING
INCH CRUSHED STONE BASE, AS SPECIFIED IN
:' aaa 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. )
- _ aaaaaaa
mamma aa 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
310 CMR 15.221(2) BOTTOM EL.= 25.70 as a as
3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK 3.75' 5 FT. 3.75' FOR THE USE WI A GARBAGE GRINDER.
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING WITH 1500 GALLON SEPTIC TANK IF FAILED, •• '
DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPARATION 5.30 FT. - EFFECTIVE WIDTH = 12.5' • 17. NO PROPOSED INCREASE IN FLOW.
4) INSTALL INLET & OUTLET TEES W/ SOIL ABSORPTION SYSTEM (SEON •
GAS BAFFLE AS REQUIRED CTIBOTTOM OF TESTHOLE EL: 20.40 (500 GALLON H-20 LEACH CHAMBER)
SEPTIC SYSTEM PROFILE
N.T.S.
SOIL LOGS TPT: 20-53
DATE: APRIL 6, 2020 -
" OF "iff. SOIL EVALUATOR: DARREN MEYER, CSE 1614
WITNESS: DAVID STANTON, BARNSTABLE HEALTH' -
o DARRE,;dM Mi '
Elev. TP-1 Depth .Elev. -T P-2 Depth
" N 1140 "' 31.40 0" 31.60 0"
�pp A A _
' • �/ tF`" LOAMY SAND „ LOAMY SAND.
U 10YR 3/2 2" %10YR 3/2
DESIGN CRITERIA **NO PROPOSED INCREASE IN FLOW ALLOWED** NI TAR�a� 30.40 B 1 -30.60 12»
B `
NUMBER OF BEDROOMS: 3 BEDROOM EXIST./4 BEDROOM DESIGN** LOAMY SAND LOAMY SAND ,
L� tOYR 5/6 � _ . 10YR 5/6
SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) ,
n» DESIGN PERCOLATION RATE: <2 MIN/IN 27.73 C 45" 27.77 C 46"
DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D: PERc TEST MEDIUM MEDIUM
GARBAGE GRINDER: NO (not designed for garbage grinder) p OEL, 26.2 2.5Y D SAND 2.
SEPTIC TANK: 330 gpd x 2007o = 660 gpd RE-USE EXIST. 1,000G SEPTIC TANK 20.40 132" 20.60 132"
LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. PERC RATE <2 MINAN^ (-Cl- HORIZON)
NO GROUNDWATER OBSERVED
USE THREE (3) 500 GALLON H-20 PRECAST LEACH CHAMBERS PROPOSED SITE AND SEPTIC UPGRADE PLAN
W/ 4' STONE ON ENDS AND 3.75' ON SIDES: 33.5' L x 12.5' W' x. 2' D i
- 57 WEST WIND CIRCLE, OSTERVILLE, MA
BOTTOM AREA: 33.5 x 12.5 = 418.75 SF Prepared for: Noddin
SIDE AREA: (33.5 + 12.5) X 2 X 2 = 184 SF System Design and Topography Plan by: SCALE DRAWN DATE
MEYER&SONS,INC. N.T.S. DMM 04/10/20
TOTAL SQUARE FEET PROVIDED 602 vs. 445.94 REQ'D ' 1, Damen M. Meyer,,R.S., Cst, hereby certify that l-am currently approved by MADEP pursuant to 310 CMR 15.017 POBOX981
to conduct soil evoluations_and that the above anaWw.has been performed by me consistent with the EAST SANDWICH,MA02537 REV DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74(602 S.F.) = 446 G.P.D. vs. 330 G.P.D. req d requirements of 310 CMR 15.017. 1 further certify than I have passed the Soil Eval. Exam in October, 1999. 508.3622822 04/22/20 DMM 2 Of 2
1
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