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HomeMy WebLinkAbout0166 WEST WIND CIRCLE - Health rv' 166 WEST WIND CIR. , OSTERVILLE A 121 011 015 �kp�11 f I l4 I ,I o �1 i I i v Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 West Wind Cir r Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osteryille MA .02655 03/10/2020 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. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. Rivers End Road Co ,� Company Address to i Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 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 ia"i 03/13/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection.,If the system 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. City/Town 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: ® 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: y This 3 bedroom home has an H-10 1000 gallon septic tank and a D-Box feed three leaching trenches. At the time of the inspection the leaching was dry and no visible failure criteria was found. t 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 .03/10/2020 page. City/Town State Zip Code bate of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ 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): i 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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. ❑ 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 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in 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 system considered 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 all inspections: 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? ® 0 Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �- ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 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): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 33plus GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Does residence have a water treatment unit? ❑ 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 Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage town water 9 ( Y 9 (9Pd)): Detail: In 2019- 126,000 gallons were used and in 2018-84,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2019 Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts �n ►l� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. Cityrrown 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 flow(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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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: 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth.below grade: 24"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments(on condition of joints, venting, evidence of leakage, etc.): Water was flushed and it came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 16"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: H-10 1000 gallon Sludge depth: the septic tank was pumped in Jan Distance from top of sludge to bottom of outlet tee or baffle The home has not had much use Scum thickness so not much liquid in the tank 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.): I recommend the new owner put the septic tank on a maint..plan with a local septic pumping co. based on the future use of the home. At the time of inspection the tee's were in place. t5insp.doc•rev.7/26/2018 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 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. Cityrrown State Zip Code Date of Inspection. D. System Information (cont.) 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 (cn pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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: : gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 West Wind Cir V� Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cant.) 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): Depth of liquid level above outlet invert 0° Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ., 166 West Wind Cir j Property Address Allen and Resa Giles Owner Owner's Name information is required for every psteryille MA 02655 03/10/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 3-24'X 2' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osteryille MA 02655 03/10/2020 page. City/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.): At the time of the inspection the leaching was dry and no visible failure criteria was found. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 r Commonwealth of Massachusetts �n Title 5 Official Inspection Form ! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 166 West Wind Cir u Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. Cityrrown 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.): r f t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 i TOWN OF BARNSTABLE � jATION k/dSr tu.,.o (21 t VILLAGE GJ�tiv�,.`E SEWAGE# ASSESSOR'S MAP&PARCEL I Z l INSTALLERS N AME&PHONE NO. 1`A��ATCw�ro SEPTIC TANK CAPACITY /Oop !roc�o,J LEACHING FACILITY:(type) CFs�y,N, T� (size) NO.OF BEDROOMS 3 OWNER PERMIT DATE: /Z z Z o COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /6.o Private Water SupPly Well and Leaching Facility(If any wells e Feet on site or within 200 feet of leaching facility) xist Edge of Wetland and Leaching Facility(If any wetlands exist A/ Q Feet within 300 feet of leaching facility) FURNISHED BY Q� 1,J ( � N Y-' Feet C rtg..�►c aZ 30 a az' 6rs FYS f' ddsV• POn.T sap 53'Ln Cr (Val J21 C Q jR 21�/„ Spt,�f Commonwealth of Massachusetts �n ,9 Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V!% 166 West Wind Gir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 10 plus feet Estimated depth to high ground water. 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: 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) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with.a transit to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts (2� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 166 West Wind Cir Property Address Allen and Resa Giles Owner Owner's Name information is required for every Osterville MA 02655 03/10/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ' Complete all applicable sections of this form inclusive of: ® 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 Z 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Town of Barnstable Barnstable Of THE raw A�-SfIlE51C8CS'ly .�, Regulatory Services Department , y RARI SUABLE, ' "As5 q. Public Health Division. i63 �� O W �ArFD MAt A' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 6, 2008 Alan Giles � } oo't- 166 West Wind Circle Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTA TITLE 5 The septic system located at 166 West Wind Circle, Osterville MA was inspected on September 28, 2007, by James M. Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of I M TITLE V(310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to-overloaded or clogged SAS or cesspool. You are ordered to repair or replace the.septic system within Sixty (60) days from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORD THE ARD OF HEALTH t c ean, R.S., CHO Agent of the Board of Health: CERTIFIED MAIL# . lobU 9\50 booa io38 6'V44 Q'\SEPTIC\Letters Septic Inspection Failures\166 West Wind Circle.doc COMMONWEALTH:OF MASSACHUSETTS . EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 . OFFICIAL.INSPECTION'FORM-:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 166 West Wind Circle Osterville, MA 02655 .� Owner's Name: Alan Giles Owner's Address: w Date of Inspection September 28, 2007. Y, 0` ' y0 Name of Inspector: (Please Print)James M. Ford Company Name: : James M. Ford Mailing Address: P.O.Box 49= Osterville.M4'02655-0049 Telephone Number: (508) 862-9400 ` CV CERTIFICATION STATEMENT Y �n C > , I certify that l have personally inspected the sewage disposal system'at this address and that the i ormatiowreported below is true,accurate and complete as of the tune of the inspection,:;The inspection was perforine based n my ; training and experience in the proper function and maintenance of on site sewage disposal systems. I am a JREP CU approved system inspector pursuant to Section 15.340 of Title 5(310 CMR'15.000). The syste r- ' rn . Passes CgAditionally,Passes ee s Further Evaluation by the Local Approving Authority ail Inspector's 'Signature: -Date: December:l7,-2007 .' The system inspector shall`sub it a copy_of tl is inspection report to the Approving Authority.(Board of He'alth-or, DEP)within 30 days,of completing this inspection.. If the system•is a shared system or has a design flow of 10,000 gpd or greater,the inspector and.the system owner shall submit the report to.the appropriate regional office of the DEP. The original should be�sent to the system owner and copies sent'to the buyer, if applicable,and the approving authority. ; Notes and Comments ****This report only describes conditions,at the.time of inspection and under the conditions of use at that time. This inspection does,not address how the system will perform in the future under the same or different conditions of use. , Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION (continued) Property Address: 166 West Wind Circle Osteiville, MA . Owner: Alan Giles Date of Inspection: September 28, 2007 Inspection Summary: Check'A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any infonnation which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR-15.304 exist. Any failure criteria.not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to'be replaced or repaired.' The system,upon completion of the replacement or repair,as approved by the Board of Health,:will pass. Answer yes;no or not determined(Y,N,ND)'in the. for the following statements. If"not determined",please. explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally., unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal.septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of.Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation.of sewage backup or break out or high static water level_in the distribution.box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection.if (with approval of Board of Health): broken-pipe(s)are replaced obstruction is removed distribution box is:leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval-of the Board of Health):. broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 166 West Wind Circle Osterville, MA Owner: Alan Giles Date of Inspection: September 28, 2007 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 15303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2..- System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects.the public health,safety and environment: The system has aseptic 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 i of a public water supply. The system has a septic tank and SAS and the.SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet 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 coliforn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: . -« 3 Page 4 of I 1 k OFFICIAL INSPECTION FORM-•NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 166 West Wind Circle Osterville. MA Owner: Alan Giles Date of Inspection: September 28, 2007 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or`.`no"to each of the following for all inspections: Yes ` No ✓ Backup of sewage into-facility or system component due to overloaded or clogged SAS:or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due town 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 than6"below invert or available volume is.less than 'h day flow ✓. Required pumping more than 4 tunes 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-supplywell. ✓ Any portion of a cesspool or.privy is less than 100 feet but greater than 50 feet from a private•water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at.a DEP certified laboratory,for coliform bacteria and volatile organic.compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are.triggered; A copy of the analysis must be attached to this form.] Yes (Yes/No)The system fails.`I have determined that one or more of the above failure criteria exist as described in 310.CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system'must serve a facility with a design flow.of 10,000.gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following:' (The following criteria apply to large systems in.addition to the criteria above); Yes No . the system is within 400 feet of a surface drinking water supply the system is within 200 feet of.a tributary to a surface drinking water supply the system is located in a.nitrogen Sensitive area(Interim.Wellhead Protection Area-IWPA)or a mapped. Zone 11 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 underSection E or failed under Section D.shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regionaFoffice of the Department. Page 5 of 1:1 OFFICIAL INSPECTIONFORM NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 166 West=Wind Circle Osterville.:MA Owner: Alan Giles Date of Inspection: September 28, 2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: fi 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 twoweek 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 foraigns of sewage back up ✓ Was the site inspected for signs of break out a? 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 orxees,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: Yes No ✓ _ Existing infornation. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 . . OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 166 West Wind Circle Osterville; MA Owner: Alan Giles Date of Inspection: September 28, 2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on.310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 4 Does residence:have a garbage grinder(yes or no): n/a Is laundry on.a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system.inspected-(yes or no): No Seasonal use(yes or no): ' No. Water meter readings, if available(last 2 years usage(gpd)): = Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUS'TRIAL Type of establishment: Design flow(based'on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes_or no)`. Industrial waste.holding tank present(yes or.no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:` Pumped after inspection' t . Was system pumped as par,of the inspection(yes or no): If yes,volume pumped: gallons.—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box,soil absorption system Single cesspool Overflow cesspool. Privy Shared system(yes.or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract.(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 6126185 per as built card Were sewage odors detected"when arriving at the site(yes or no): No 6 , Page 7 of 11 OFFICIAL INSPECTION,FORM-NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: . 166 West Wind Circle. Osterville, MA Owner: Alan Giles Date of Inspection:. September 28, 2007 , BUILDING SEWER(locate on site plan) ; Depth below grade: 4: Materials of construction:--cast iron 40 PVC _other(explain): Distance from private water supply well or suction.line: Comments(on condition of joints,venting,evidence of leakage,etc.): } SEPTIC TANK: ✓ (locate on site plan)" Depth below grade`. IT' Material.of construction: ✓ concrete metal fiberglass _polyethylene other(explain) -lf tank-is metal:list age: Is age confinned by a Certificate of.Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 Qal. Sludge depth: _ Distance from top of sludge to bottom of outlet tee or baffle:` - Scum thickness: 8„ Distance from top of scum to top of,outlet tee or.baffle: - Distance from bottom of sewn to bottom of outlet tee or baffle: - How were dimensions determined: Aleasuring stick Comments(on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity,,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees Were present. The liquid level was above the inlet pipe. Backing up front the leach.pit. GREASE TRAP: None .(locate on site plan) Depth below grade: Material of construction: _concrete _metal fiberglass _polyethylene _other (explain): Dimensions: Scum thickness:. Distance from top of scum to top of outlet tee or baffle: Distance from bottoin of scum to bottom of outlet tee or baffle: Date of last pumping: I Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet.invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION(continued) Property Address: 166 West Wind Circle Osterville, MA Owner: Alan Giles Date of Inspection: September 28, 2007 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: .—concrete metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alann and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:. Above Conunents(note if box is level and distribution to outlets.equal;any evidence of solids carryover;any evidence of leakage into or out of box,etc.): The D-box was not dug up it was under rater from.the leach pit backing up. PUMP CHAMBER: —None. (locate on site plan) Pumps in working order(yes or no);: Alarms in working order(yes or no)' Comients(note.condition of pump chamber,condition of pumps and appurtenances,etc.):' 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 West Wind Circle Osterville, MA Owner: Alan Giles Date of Inspection: ;September 28, 2007 SOIL ABSORPTION.SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located,explain why: Type ✓ leaching pits;number: I -6x6 1000 gal. leaching chambers.,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The leach pit was full The liquid level was'up to the cover. The leach pit was in failure I CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on siteplan) Number and configuration: Depth-top of liquid to inlet invert: . Depth of solids layer: Depth.of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow{yes or no): Comments (note condition of soil,signs of,hydraulic.failure, level of ponding,condition of vegetation,etc.):. PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 i' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 166 West Wind Circle Osterville, AIA Owner:. Alan Giles Date of Inspection: September 28, 2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.' Locate all wells within 100 feet. Locate where public water supply enters the building:. a O 3 3 y7 .(o l 10 c> >;age l l of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION`(continued) Property Address: 166 West Wind Circle Osterville, MA Owner: Alan Giles Date of Inspection: September 28, 2007 SITE EXAM Slope 4 Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet . Please indicate(check)all methods used to determine the high ground water.elevation: Obtained from system design plans on record-If checked,date of design plan-reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Topogrgphic and water contours mans Checked with local excavators, installers-(attach documentation) 'Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the inaps were showing pproximately 25'+/-to ground water at this site. c This.report has been prepared only for the septic systein and components described herein. This*septic system has been inspected as of the date of inspection. This report is not a warranty or guarantee that the system will function properly , in the fiaure..There'have been no warranties or guarantees,either expressed,'.written or implied,'relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. t " . 11. - • • Town of Barnstable Op 1HE T� Regulatory Services h� o� BARMSTABLE , Thomas F. Geiler,Director MASS �$prFDyA`�g Public Health.Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862.4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. TOWN OFBARNSTABLE LrCATION 166 wdsT- bU„ 3 SEWAGE# SLR I VILLAGE G,tT�,`�.V1 �`�� ASSESSOR'S MAP&PARCEL I Z( �d(� -U INSTALLERS NAME&PHONE NO. 9A)1 64 C^1"'b //VOnTr+�'•� �► 39,9-9e*-7 Si SEPTIC TANK CAPACITY /0 0 0 C.4 L"-3 LEACHING FACILITY:(type) (size)(.? NO.OF BEDROOMS 3 /1 OWNER /1 PERMIT DATE: /Z/Z 0 /o'-1 COMPLIANCE DATE: /00 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �°+ u Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility)facili JV/� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N �� Feet FURNISHED BY (X...-.aC_ L4J C::&- J�/i7'w+r••o �/3�'�`n•••v 30181' 2j ' s C � A r No.` fj Fee _ THE cowq.NWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for ;h6pogal 6p5tem Cott.0tructiou Permit Application for a Permit to Construct pgrade( ) Abandon( ) Complete System [St Individual Components Location Address or Lot No. Owner's Name,Address;and Tel.No. 104?wE5TW1,AoQe. 4lt,Frk GtLkS Assessor's Map/Parcel WSAID'D O[S I�0 S ENV E C 9j 426 O O(o Ins•t�ller's Name,Address,and Tel. /���r J /� Designer's Name,Address and Tel.No..,,,,,., �oQ-rUEatk AVlh(ro �y l�J� �r✓ai,I,v I 2k�tnt(o AAILLCo4Su& Calloceivodg t-til 00 620T (9Fl?U RD Ur�t%' Q Type of Building: t Dwelling No.of Bedrooms ---✓ Lot Size Q 3,315 1 sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 O gpd Design flow provided 337. 4 gpd Plan Date l al 14 107 Number of sheets Revision Date Title iEpE0592 F_pTle DESI&.4 'PLAp4 Size of Septic Tank /I a)o Type of S.A.S. 1= g7 , 'PIT. Description of Soil "El'' SALT o a -4 5 l�--[¢E" Nature of Repairs or Alterations(Answer when applicable) PiT IcAtLvef- WuLLA-noel of IR>r.mr-4 545 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. / Signe Aj Date Application Approved by Date (� Application Disapproved by: Date for the following reasons Permit No.C=?" �t� Date Issued ..k r Fee Entered in computer: THE COMMONWEALTH ®F MASSACHUSETTS Yes PIOBLIC HEALTH DIVISION - TOWN OF BARMSTAM-E, MASSACHUSETTS J[pplication for 3i5pont *p9tev Congtruction Permit Application for a Permit to Construct O epairlW. +pgrade O Abandon O . 'Complete System ®Individual Components ! Location Address or Lot No. Owner's Name,Address; �o and Tel.No. IwEsri�j,,10Cle. o.5 -xv Ze 1,4 Ac�F„� (jtll;S Assessor's Map/Parcel I , Q I top S E1LV l L E CAN 51-0 a O(O i Installer's Name,Address,and Tel �° u / Designer's Name,Address and Tel.No. IjO TUEa+.I av�c��!J 7A @/ � Fi��ly "t"1ZV(Alo kt/cLCoMSvL�i4,tI7S ' 00 Q82 QZOTI tp$'TUPM1 f21D 0f4#T-1''3 4 Type of Building: �'y -�-- Dwelling No.of Bedrooms J Lot Size 151 sq. ft. Garbage Grinder Other Type of Buildiffg- ------ ' No.of Persons Showers( ) Cafeteria( ) Other Eixtures y Design Flow(min.required) 33 O gpd Design flow provided 337, 4 gpd -Plan Date 1,;k/ 1,4107 Number of sheets Revision Date 7� s Title T12op E'er �,�Fprte_ tk,c! Size of Septic Tank J oclo Type of S.A.S. EXIST - Description of Soil A.A E hV-1)5AL4 6,'e .4!&/,_tZ44I+ r r 1 Nature of Repairs or Alterations(Answer when applicable) 4' hT SA S ` 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. / %4 l i Signe v , Date / Application Approved by Date Application Disapproved by: Date ' for the following reasons Permit No. Date Issued ----------------- ------- -- _—� -,-------- THE COMMONWEALTH OF MASSACHUSETTS • BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewa a Di/s o�slal Syste a struct d ) Repairgd ) Upgraded ( ) Abandoned( )by 1/ (V ,1 at < has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "n dated Installer/1 (��X - 1 I l� )(�� Designer ✓� ) #bedrooms Approved design flow god The issuance of this .e its fall not be construed as a guarantee that the system wil,11u ction as des gned ✓L Date Inspector �� No.Z63 _56( Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwiopoar 6p.5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( J ) Abandon ( ) System located at i(o�� -4 ji)W I✓_ ����YU( I/ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Co struclon must be completed within three years of the date of th(s p rmitn Date 1 Approved by 1 Town of Barnstable ,BIKE o Regulatory Services r Thomas F. Geiler,Director BAMr CAB ' r Public Health Division Thomas McKean,Director . 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: i a001; Sewage Permit# 26a 7- YZ Assessor's.Map\Parcel i Q 1 0 i i-015 Designer: Installer: QoRMEtZ PA.VWG TAMES 'P• STROICE��E Address: (oSTvPPE2RD. SulTE413 Address: -gyp CAalDt.%rw00r L-A�.lE180Xgg5 SAMQwieN KU4 O Z5(a 3 1DF_" .1k5?0PtT 1 AAA 0Zfv39 Ca On Z- L°/u� /1/or�s» � ��- �- was issued a permit to install a (date) (installer) septic system at 166 AJL c sGil. ^+ �� 'L, OJ YeA. based on a design drawn by (address) - TyRhl,rtCoAaiuL C'o-4su�taturs dated ,a.lc9l0-IaOa`7 (designer) �I certify that the septic system referenced above was°installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. I"OF A14 c JA/6ES (Installer's Signature) o P STROKE No.20063 d s10r1NALE� esi 's i ature) (Affix Desig 's�`� p Here) PLEA RETU O BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE Whe NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc MOM ME No 0 ONE oloommom 0 MEN mommoom 0 MENEM 0 ommommomm9somm No moommom MEMO sommosom MEN No ■iIiM ■ ■■■0OMEN OEM mom No mom ii MEMO NOON mommommumm No No mom NEMENNEMMEMMEEM 0 0 somomm mom mom momomm immomommom OMEN EMENEMEMEMME mommom mom NEON ■ � a s mos� � N N■ O ■mmommomm � ■■ ■r � � 1NONE ONE 0 MEMMEMEMEM `A S m r� 3+ i 4 + �r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered id=computer' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pprication for Mi6pogal bpetem Construction Permit Application for a Permit to Construct( , )Repair X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �(p 6 (,tJT (,(71�o C►iL Owner's Name,Address and Tel.No. Assessor's Map/Parcel d 45- Z154A � C-"s 12.1 Cd 1 1 —Ur s Sa 0 fit'Z.` — O 1 0 (o Installer's Name,Address,and Tel.No. LSvL)3 9°-9 47 4 Designer's Name,Address and Tel.No.LS a co e B -4 ra,3 �9� l' 9T�i. �. //v IT,s-,;t'^-.� /��✓,�s. iuJt),.,a-b. J'7, l L 0A-4 vc.i��►-rt � O •��� �'!qJ � u`a....r��iw� 07-631 12—o J119^rnw11.H 0-2s6l Type of Building: Dwelling No.of Bedrooms Lot Size 2 3 3S sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 4"4' O gallons. Plan Date // i 9-/n 7 Number of sheets 1 Revision Date Title Pn Jap O J r,4- 7,&t 1 r- V cf-I cA­a Size of Septic Tank U O f- o a Type of S.A.S. C3 1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued bythis Board of Health. l Signed �) - Date Application Approved by Date A plication Disa prov for the following easons 1 /LGGM�' 1 c9h Z rah.r' Cr C. Jue b id �. / 'f Ti! r 'Permit Wo. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector �......_-- — ---------_-- --------- � --- -I No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ligooal *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by - 3 2s—, No. Fee _ / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for 30igpool bpgtem Construction Permit Application for a Permit to Construct(.,aepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. l 6 6 IA zit C�(` Owner's Name,Address and Tel.No. Assessor'sMap/Parcel c�S�efv��� r1 y98-066 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) F C ZDsZe 2)(tA-on EOX Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B oajdj4 Health. _ Signed V Date-s .31- CE� Application Approved by Date Application Disapproved for the following reasons Permit No. 'Zllbu — 3 Z Date Issued ,_- 3 �— No. - 3 Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes✓ PUBLIC HEALTH DIVISION -TOWOF BARNSTABLES MASSACHUSETTS 0(pprication for Mfopooar bpgtem Conotruction Permit Application for a Permit to Construct epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or,Lot No. 166 'We Sfi VY10 C C Owner's Name,Address and Tel.No. y �L AAA eonG rd KGPt 3n Assessor'sMap/Parcel o!Ivv, 111-oll-o/ 49f-066 / Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) c� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ce S�✓ v �'o� . O X Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B_QuA4 Health. _ Signed V Date Application Approved by Date Application Disapproved for the following reasons Permit No. `?�Ud U ' Z. Date Issued S'- 3 ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance is THIS IS TO CETIF ;that the On-site Sewage Disposal System Constructed( ) Repaired( )Upgraded( ) Abandoned( )by �— �� - at /(a G ' u d G"Z_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2e-�U Z dated S`3 Installer Designer _, f' max. .a AA rt The issuance of this permit shall not #e construed as a guarantee that the system will.function as de�sign4d: Date Inspector Z6rc) - 32-� �} — --------------------------Fee`-' '+ Z _olf— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miq;poai 6pote Canotruction Permit Permission is hereby granted to Cons ct( )Re air( )/1U r de( 1�'bandon( ) System located at ��6 �"� (,� v�r/(� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction ust be completed within three years of the date of thi t. Date: ��/�� Approved by �/—� _ COMNiONWEAL'I OF MASSACHUSETI'S - I;XECi1TiVE OFFICE OF rNV1RONMENTAL AFFNIRS DEPARTM-NT OF ENVI ZONMENTAL PROTECTION -, ONE WINTER STREET, BOSTON MA 02109 (617) 292-5500 �® 1 4 z_ _ JUN j Folyyo S 2D00 TR417Y COXE 350 MAIN STREET Secret,ary ARGEO PAUL CF,LLUCCI WEST YARMOUTH, MA IIS Governor 508-775-2800 r I3�C011 STRUner .�'1.0I1111lISSI011P1' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION MAP 121011015 PROPERTY ADDRESS: 166 WEST WIND CIRCLE, OSTERVILLE ADDRESS OF OWNER: DATE OF INSPECTION: MAY 30, 2000 LEONARD KAPLAN NAME OF INSPECTOR : JAMES.D. SEARS am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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 CONDITIONALLY PASSES NEEDS FURTHER,.EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: JUNE 1,2000 The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(80) 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: SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. revised 9/2/98 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION (continued) Property Address: 166 WEST WIND CIRCLE,OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30, 2000 INSPECTION SUMMARY: Check A, B, C, orD: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The System,upon completion of the replacement or repair,as approved by the Board of Health will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) 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 is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as.apprcved by the Board of Health. _ 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 pa pass inspection if(with approvali of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _ 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 revised 9/2/98 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 166 WEST WIND CIRCLE,OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30, 2000 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303 (1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER f . revised 9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 166 WEST WIND CIRCLE,OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30,2000 D]SYSTEM FAILS: N/A 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 16.303. 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 Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded 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%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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as 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 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 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 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 166 WEST WIND CIRCLE, OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30, 2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: 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. X The site was inspected for signs of breakout. X All system components,including 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.Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 166 WEST WIND CIRCLE,OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 3 Number of bedrooms(actual): 3 Total DESIGN flow Number of current residents: 2 Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): YES Seasonal use(yes or no) NO Water meter readings,if available(last two(2)year usage(gpd): N/A Sump Pump(yes or no): NO Last date of occupancy: N/A COM M ERCIAL/INDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 16.203) Basis of design flow Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: NOTE:SYSTEM PUMPED BY A&B CANCO DA AFTER INSPECTION. System pumped as part of inspection:(yes or no) If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM 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 APPROXIMATE AGE of all components, date installed(if known)and source of information: 1985 PERMIT#84-8/95 NEW D-BOX MAY 2000. Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 166 WEST WIND CIRCLE,OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30,2000 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction _ cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: X (Locate on site plan) Depth below grade: 101, 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) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 11" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How dimensions were determined ASBUILT AND TAPE 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.) MAIN TANK AT WORKING LEVEL,TANK AND COVERS 10"BELOW GRADE. OUTLET BAFFLE,NOTE TANK WAS PUMPED AFTER INSPECTION. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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.) revised 9/2/98 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 166 WEST WIND CIRCLE, OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30,2000 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction _ concrete metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order Yes; No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) NEW D-BOX MAY 2000.9"X15",ONE LINE IN,ONE LINE OUT.BOX IS 20"BELOW GRADE. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 166 WEST WIND CIRCLE, OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30, 2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type: Leaching pits,number: 1 Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) ONE(1)1,000 GALLON PRE CAST PIT.PIT AND COVER 16"BELOW GRADE.32"WATER IN PIT.NO HIGH WATER STAIN WALLS ARE CLEAN. CESSPOOLS: N/A (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(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure, ,level of ponding,condition of vegetation,etc.) PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) revised 9/2/98 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 WEST WIND CIRCLE, OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30, 2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house), y7- sa ' 3S- 0 revised 9/2/98 10 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 WEST WIND CIRCLE, OSTERVILLE Owner: KAPLAN, LEONARD Date of Inspection: MAY 30, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater 50.9 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) USGS WELL DATA: 3.200 SDW 25 3 50.9 ZONE C revised 9/2/98 11 �I SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sig atu item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Rec ed by PrQ d Nam , C. Date of Delivery ■ Attach this card to the back of the mailpiece, cc 7 or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Allen Giles 6 Fox Hill Road Blackstone,MA 01504 3. Service Type C®Certified Mail ❑Express Mali ❑ Registered Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 11 j I� ( 1 j(7 0 0 6 0 1011 0�0 0'0 l',3 5 2 51 613 O8 I �� j (Transfer from service labeq PS Fofm'3811,;February,2004 I Domestic Return;Recei{it° 102595-02-M-1540 �.,. G:'6~i��•a�:.�?`���`�?i':..�i t'; ;,:.. ;yea, , �+• UNITED STATES POSTAL RVICE • Sender: Please print your name, address, and ZIP+4 in this box • I I d4. Town of Barnstable I °�J) Health Division 200 Main Street Hyannis,MA 02601 N I I I}l�t�lli�1 littii„iII fill i,11111 IllIi��!!!li�l�!!}�,fifIll 4 J.5 kA HID Certified Mai14 7006 0810 0000 3525 6368 Town of Barnstable Regulatory Services wzxsrna x Thomas F. Geiler, Director MASS 1639. �� Public Health Division -- 7 i Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 s July 29, 2011 (0 60 Allen Giles 6 Fox Hill Road Blackstone, MA 01504if j NOTICE TO ABATE VIOLATIONS OF V CMR-4r0.060, SANITARY CODE 11 —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 166 West Wind Circle, Osterville was inspected on July 29, 2011 by Timothy B. O'Connell,R.S.;Health Inspector for the,Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 -Owner's Installation and Maintenance Responsibilities. Outside light located on back deck not working. 105 CMR 410.500- Owner's Responsibility to Maintain Structural Elements. Front step has loose and broken brick. A number of windows throughout dwelling do not work as intended to (i.e. do not stay open). Observed water stains on ceiling within bathroom which may be due to a faulty roof. 105 CMR 410.480—Locks. It was observed that windows within bathroom and bedroom do not lock. You are directed to correct the violations listed above within.twenty-four (24) hours of your receipt of this notice by insuring all windows within dwelling are capable of being locked. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by fixing or replacing above mentioned outside light; by repairing front step; by repairing or replacing windows so they work as intended to (stay open when opened); by curtailing all sources of chronic dampness observed within the bathroom. QA0rder letterMousing violations\166 W Wind circle Ost 7-29-11.doc You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH r T ma A McKean, R.S., CHp Director of Public Health Town of Barnstable Cc: Pam Shapiro, Tenant QAOrder letters\Housing violations\166 W Wind circle Ost 7-29-11.doc TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date — l ' Time: In Out /� e Owner A Tenant L • DQ Address 1 �`�`' Address f� Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities _ 10. Curtailment of Service vv- 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing nn r 18. Driveway Width ?j 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed - Inspector If Public Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date T� Time: In Out Owner Yl Tenant - /' lam- Address 10 Address Compliance Remarks or Regulation# Yes NO Recommendations i 2. Kitchen Facilities 3. Bathroom Facilities 6— / I 4. Water Supply r 2 5. Hot Water Facilities A � 6. Heating Facilities , 7. Lighting and Electrical Facilities ` f 8. Ventilation 0 9. Installation and Maintenance of Facilities "� F nl�j 10. Curtailment of Service vv- 11. Space and Use - 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 3 (L 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector 7 If Public Building such as Store or Hotel/Motel specify here e _ , �s Ell �a i24* io.a r 6i:aa iioz-si-aas z;ps d 1�ios IN-HOME SALE OR SERVICE NOTICE OF CANCELLATION: YOU MAY CANCEL THIS ENTIRE TRANSACTION,OR ANY INDIVIDUAL PROGRAM AS DEFINED BY.A SPEC SHEET, WITHOUT ANY PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS.{MONDAY- FRIDAY, EXCLUDING HOLIDAYS)'. OF`THE DATE OF THE HOME IMPROVEMENT CONTRACT ("SALES CONTRACT'). IF.YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS.MADE BY.YOU UNDER THE SALES.CONTRACT,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETI7RNED WITHIN 10 BUSINESS DAYS FOLLOWING RECEIPT BY SELLER OF YOUR CANCELLATION.NOTICE,AND ANY SECURITY INTEREST.ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. THERE WILL BE A SERVICE:CHARGE EQUAL-TO TEN PERCENT (10%) OF.THE TOTAL CONTRACT AMOUNT LF YOU- CANCEL THIS TRANSACTION AFTER THE THIRD BUSINESS DAY FOLLOWING THE DATE OUSALE,BUT BEFORE.MATERIALS,ARE ORDERED.THERE WILL BE A SERVICE CHARGE.EQUAL TO,TVQNTY-FIVE PERCENT (25%) OF THE TOTAL CONTRACT AMOUNT IF YOU CANCEL IIHS TRANSACTION AFTER MATERIALS ARE ORDERED. i' i . IF YOU CANCEL,YOU.MUST MAKE AVAILABLE TO.SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY j AS GOOD CONDITION: AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THE SALES CONTRACT,OR YOU MAY COMPLY WITH THE INSTRUCTIONS OF SELLER REGARDING THE RETURN OF THE GOODS AT SELLER'S,EXPENSE AND RISK; IF YOU MAKE THE GOODS AVAILABLE TO SELLER BUT SELLER DOES-NOT PICK THEM UP WITHIN 20. DAYS OF THE DATE.OF.YOUR NOTICE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE TH&GOODS AVAILABLE TO SELLER, OR IF YOU .AGREE TO RETURN THE`GOODS TO SELLER AND FAIL TO,DO SO,YOU; WILL REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER_THE SALES CONTRACT. TO .CANCEL .THIS, TRANSACTION, MAIL;. OR ..DELIVER A SIGNED. AND DATED COPY OF THIS CAN NOTICE.OR ANY OTHER WRITTEN NOTICE TO HOME DEPOT AT THE _ RESS AT THE TOP OF TIM SALES CONTRACT NO LATER TILAN MIDNIGHT OF* ( DATE 11IUST BE 977YIIN THREE BUSINESS DAYS OF DATE .CONTRACT IS.SIGNED; VONbAY FRIDAY, EXCL UDING HOLIDA Y. TO CANCEL EACH PRODUCT; CHECK APPROPRIATE PRODUCT(S) BLOCK BELOW; LIST EACH SPEC •SHEET_#AND CHECK CANCEL JOB BLOCK(YES) Job#: Cancel Job Internal Reference roducts. Sec Sheets # Ivers/no q ❑Roofing ❑.Sitling indows Insulation., t ❑Entry Doors ❑ 2C) b �. " ❑Gutters/Covers J � � ❑Yes EINo �. ❑Roofing ❑Siding ❑Windows, Insulation ❑Gutters/Covers []Entry:Doors ❑ ❑Yes ❑No ❑Roofing ❑Siding Windows Insulation ❑Gutters/Covers ❑Entry,Doors ❑ pYes ❑No, .. ❑Roofing FISiding El Windows ❑ Insulation ❑Gutters/Covers ❑EhtryDoors [] ❑Yes Elko ACKNOWLEDGEMENT.OF RECEIPT OF NOTICE.OF CANCELLATION Me hereby acknowledge receipt of two copies o the o et N j of Cancellation set forth above and that Seller has orally informed mews . our night cancel: Date .. Customer Sign e Date Customer Signature I HEREBY.CANCEL THIS TRANSACTION: Date Customer Signature R_S:nR CCC Z0"d OZ:OT T10Z-61-d21S l3 � it -15 L0CP T10 "Sf SEriACE PE0C31T C30• oT VILLA1GE I N S T A LLER'S M IRE A ADDRESS S e )-o. GUILDER OR OWNER cv� _DA+ � o� TP ERMIT ISSU E D G � s D A T E C0MPLIARICE ISSUED ZS �S Q o e (PlVj � 33' O �q�✓Q Lot � I �s-� NO._....- _.�....... y � FES.............................. 7 - THE 'COMMONWEALTH OF MASSACHUSETTS SOAR® HEALTH.OF..... ....................... ... . . ........ .. -- . Allp irFation for Dispoii al Workii Tutultrnrtiaatt Frrutit Application is hereby made for a Permit to Construct + or Repair ( ) an 'individual Sewage Disposal System at: Location-A�.drreess ........, No. y J� p r Owner a dress ...1 71/------------------- Installer Address Q Type of Building Size Lot_.---#_3.n...Sq. feet V Dwelling—No. of Bedroo ............ ..�.....................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building QLve,& No. of persons........... . Showers Cafeteria Otherfixtures --------------------------------------------------------------------------------------------------------- ..................... Design Flow............... ----------------gallons per person perldy. Total dail/flow-:------ ..............gaponsj., WSeptic Tank—Liquid capacity.I gallons Length...1,.Q4._.. Width.__,I ........ Diameter................ Depth..41r.�?... x Disposal Trench—No..................... Width........I........... Total Length............... Total leaching area-._...---- -- sq. ft. �Z Seepage Pit No-_-•_/-- - Diameter................ Depth)below inlet......-6--------- Total leachingar � ft. Other Distribution box Dosing tank Percolation Test Results Performed by....A-R-{ZAW..... Date... S.1/_`ge� ..0� aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.___ . ...... _ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_ . a !�j. ... Description of Soil_._..----•--_--_._ (r- _ �..:�------------ - ---/ �.Y__ ----- �.. p 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 iITi U 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 'S' .. ................................ Date ApplicationApproved By.................................... ........... ,..._ ................................. O---------- ---!/.............. Date Application Disapproved for the following reasons-------------------------------------------- ---------------------------------------------------------------:_... -------------------------------------------------------------------------------------------•------...----I-•--•-•-•--•......•-•--•••. Date PermitNo......................................................... Issued...................................................... Date i --- — - ----------__------------ _�To .................•- ........... THE'COMMONWEALTH OF MASSACHUSETTS �- ` BOARD OFHEALIr� Appliration for, Disposal Works Tonutratrtion Frrutit Application is hereby made.for.a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at ` ' -oAA caUon-Address ° 6M N_ o�, Owner Ad ress #�s •- Installer Address Type of Building Size Lot..___ 3_.��j...LSq. feet U ` a Dwelling—No. of,Bedrooms:.............3 ._...__. ._..._..__.Expansion Attic ( ) Garbage Grinder ( ) p-I Other—Type of Building 0 141'ag o. of persons..._..._._ __ Showers 5 ) — Cafeteria ( ) a' Other. fixtures ._ ........_ Design Flow_________________ ______ _ _____ gallons per person per/da Total dail flow_;_____..__ ............... onsf# w , " = WSeptic Tank—Liquid capacity../ gallons Length...�( __. Width.... Diameter................ Depth__ ... x Disposal Trench—No. ................. Width____ ....... Total Length...............I... Total leaching area.. __ sq. ft. Seepage Pit No----------I-_______--,Diameter........... _-- Depth below inlet...... ...... Total leaching area:: __ sq. ft. Z Other Distribution box ( Dosing tank ( ) '-' Percolation Test Results Performed by.....�•_�_�'-0-W.... "l _ 1`>✓� �1 _ Date._..T� C 414 04 ` Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water (z, Test•Pit No. 2...............nunutes per inch , Depth of Test Pit.................... Depth to ground water . , .._..__._ ac - .......... ............................... __. _. --••-•--- Description of Soil = �°... i ---------- -x• U -----------• --- w ` U Nature of Repairs or Alterations—Answer when applicable................................:.... ........... ........................................... Ze I Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code.— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..................-................................................................... ................................ Date Application Approved By.............................. Date Application Disapproved for the following reasons:........................................................................._...................................... .......................••••-•••••._._.........•••--••••••••••...-•••••••- .........._........................................................................................... ...................... -� Date PermitNo......................................................... Issued.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .. i�OF...... ... .. ' q rrtifira, of Toutpli anrr THIS IS TO CERTIFY, That the Individual Sewage Dis�osaI ;Istem constructed ( 4 or Repaired ( ) by-•••-••••..............�sf -,c -<. c? } � 7_.../V =-•--, _�: ..--••-- Q•------•---- �----./•----• . .....----- at_ { c' � ����a Ins ��`. •- ... _ ..{✓?!•_Clime.•-•-••----•••-- p "�has been installed i 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 CO TRUE® AS A GUARANTEE THAT THE - SYSTEM WILL FUNCTION SATISFACTORY. DATE.:.--•••••----- --7 �' . .CQ�......................... Inspector.-•------ ----- THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH r. OF....:. ...; .. 1 .._.� - FEE.--.................... Disposal ottik� �on�#�t ion rrZitit � - ti, Permission is hereby granted- :f.._ . •..... ........................... to to. Construct ( �; or.Repair ( ) an In •vidual-Sewage Disposal Systemat No - TI Street as shown.on the application for Disposal Works.Construction Permit No. :.:...........•Dated.._.: w__.. . DATE.....................Z4?__'//-.�..........:..................... ..........: Board o f Health FORM 1,255;A. M. SULK"IN, INC`,BOSTON - - - a Town of Barnstable „b P# Departitnent of Regulatory Services tu►twarnats, : Public Health Division" DateG r 2 �T, ZQ MAM 200 Main Street,Hyannis MA 02601 Date Scheduled iv� ime Fee Pd. ` Soil Suitability Assessment for Sewage Disposal Performed By: �J tl R 0 �C Witnessed By: 1��W W rl' ��t���'i )] LOCATION& GENERAL INFORMATION Location Address (66 wa I 1 J'1 N+ t_I JR Owner's Name I Ie� 0s i'L 2 L-Ll% I Address Assessor's Map/Parcel: f Z j 1„�1 s Engineer's Name A V)I) NEW CONSTRUCTION REPAIR i/ Telephone.# Land Use 041-5t cc �)�t�✓! Slopes('Yo) c, "Surface Stones, Distances from: Open Water Body I V�)` ft Possible Wet Area 100 ft Drinking Water Well ' �'it Drainage Way Sf� '�< ft Pro ert Line .� i P Y It: Other ft . SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) " 4� `/� h ........................ ............:::: ::.:::................ ...... ........::::::.: A .�P 094D b' . s s V Parent material(geologic) f 0(< o I f;� OLs�Wj�S k Depth to Bedrock, Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Woo, Estimated Seasonal High Groundwater. DETERMINATION FOR SEASONAL HIGH WATER TABLE' Y Method Used: !P-3_Nr V,\)<•I PrR[-C to i S •-�.G P,0 0 Q b W 4-TE-V.. j j —L v r E 1. ' Depth Observed standing in obs.hole: to©y e. in, Depth to soil mottles: i1 '1 in Depth to weeping from side of obs.hole: A U V►! In. ©roundwater Adjustment Index Well# Reading Date: Index Well level „.Adj.thetor _ Adj.Groundw ter level Ta PERCOLATION.TEST ''butpi q �' xttne. . Observation I Hole# // Time at 911. �•ei Depth of Perc 60 e h Time at 6" Start Pre-soak Time @ + -15me"(9"-6") bC c End Pre-soak Rate MinJlnch` Z iy ( : Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) V�P Original,"Public Health Division Observation Dole 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:\SEPT[CIPERCFORM.DOC 9: i DEEP.OBSERVATION HOLE LOG Hole# f Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. on istenc % ravel 0 -S � Cot�m� S�N� � (� i� ��z h➢fJN� ►)i U M swi 2 S.`t' 7/4.• W4J DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsi ten %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. Flood Insurance Rate Map: / Above 500 year flood boundary No— Yes _! -- `Within 500 year boundary No✓ Yes Within 100 year flood boundary No ZYes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ___. If not,what is the depth of naturally occurring pervious material? Certification * I certify that on ® � (date)I have passed the soil evaluator examination approved by the Depa ent of Environmental Protection and that the above analysis was performed by me consistent with therequir ling,expertise and experience described in 310 CMR 15.017. Signature Date 11 I L 07 Q:IS131"17I0PERC17ORM.DOC • f -�-7 '�-_ -. — � _;_- ___ _—_ ( � I �--Ai_.L EL�.`i. �>►.tc�,a,d�.; Ar<� MicAi�.P sE m. 1r..6s\d1E� i �}-. _ _ ----{f -� -j --=M � HA-SLa TJ �'e►1 �',� 5'r' E�S PINT l�►� P!._Jl r.LfE r I 2 Pl7r—W AL-L UWE', Mi jj L> 16 I ►' �,, l• + } C` 3 — ,AL PIPV 5 TtS A6,30 rd 74,k: SY S7 M S HA.t 1 !"aE CAg7 I 'G��rJ G� 'SC.w-�g tJt�� AO P J C 24 — --� ' _ ai � � ' ( ) ' � CO '� n 0 0 Cf•-- A.L L. �E sir Ic:�Teu.1 K s, ®��-r e�g Lrr�n,,.� �x, A►J O ` - ^ I�.E�CH,.JEa G rt SHALL ip_E 7E5tG,.�Eo r�� ! ---� - { N O IC1 O N - 2 C7 w►+E.Et _ ti �D .tGrS WHEN INSTALLEPUNAER PAVING -,, , ••t, � 1 I �LJ � 2E��0✓E A�i v.1S�J�T'A2S� MATEiZ1A� •p 1�'-`•yy i _ i li I } r O O OO - �E t�l✓ET� E:1-Et/Arto.�1S of LEp C. -41-jtl j P61 r •�J_ � •` I nT ----- I �� � ft �` 5 s....lO ♦.,,�S� E�2a.�1E� _ , �` . �E NCS1 1 F ED W H E�J T�+c 4 SrE M t5 ry Ems,2 V I Z' jr�•11"�-•- -r1 -iC.r �_II I \ J 1 J� �-- t��_1���5 Otl1f�.�rtSE T..SoTED, Ate �VS�>� 0 O O O � 'b�NJ SE►.1Y�� S/•�AL_l_. - ? 4 O 14CC CKZ DA. SCE. k/ITH -r cr E���co t^ T��rc MATE ( t ` CY O O C��U� Ar.1 Li A-nJ`t r`c5cn►. 12L�. ' 1 TV P iC 4L RlST2tC�lJTi 0" �c,X � UOT T*0 ScAL-1'c n,rc w ATFf T-gyp sc c ` �..! i3.�P��__ I r l.��u 'IT QEd� FOPl4-r> c MOT--rc �E Q�w,Q' ti.4T/G�t1 PITS 5��►r,� -rr...,r� �,y t��•-ti�t?�c,�.._J t'e�c_r.�T" ►.1c�T V ��ca�E. -� GW IE Q UA L. _: TPr.L K S 2ti(►d F"oC-GE V T�OUG�f pJ"r •.,. . ----- o,e,66,4,A r-/a Al OA7LF" �arl7a/✓ ar7�fl ©,53'E,' 'A7*/DNS 6X f - SEd�tC rA,.pC DNA L>=•.f�+,w�5. Pry• ada91a1<T IL/�/{r �30A,e o� ,•11. h TbF $OTCO►j. Co*c. 66 4000 rS.T. Y>;ST tLT Up TO t �n1e14c"i !iEG ;�.' f:..;, :#d f/ �OF' FOCN•t pA_ Ttbw� ,.l s,,7'a i7g =t.MLI'51J 6RADW r f..tdStd Gt?',a•.L•�C F i�.115►6 ���'D� CVtSC:. /F7,PUS.rI CsC�DE• '�6J�W 4/Ee 'T��•dlC�� <N�Q�Ci't3Cx •+ I�FA�GN•�lfi ��i + �l5 __ fir. 1 ►C le f - 44 AAA r t d �, ijcr /4: c.F ���+'+^^- !� 1 )NV�`r.�v.: , . 0 ® 0 '�• ? 'E O 6T0►.1& © ® -0 03 0 0 > - �EPI"IG. TA►.3K `� tyO-Trc �n_szr • ELF.V � y +! a}n 410, -GYP)CA L. r,E y.�,� 5 T�ram! �c^z��►L � c� C�:` XALE Jw l r - 4 Z,-, MAP SECTION PARCEL, LOT ADDRESS I i LL-6 AIP t PROPOSE© PAR.LINO �OCA T ION � DES/GN G@/TE4C/� it--- i°Je0/n�ceo CiavldGrC J r 6�y , o� afi"6� PROPOSED %3EN,Q D/SPOSQ �`Y B�1'/'f �"�qT ��,�ti 5y�,n\ G� _ � SYSTEM y "Ac o, .-crr 444V t 1S .�C©C�IJ�+y 6AL�aulS fC f�C�+N oEgP ei4 Y .�a .t O r - 1 1 �i4G�/a116 �e�QU/�f1�' ��..�..:i:� � D�$:i4� .lt'�C�T/G�ti �' Rr1YMOAli? `�'r � � .,".��-r``,l � ... 4,.- _ a.r l'-=t�i'���•^T'+� :�. .. ti", �ti ',rt ,✓ Nn 23563 l `•� l.�re c ar.vG Pao✓�oro �. , '� `PQOPo�r-D LEACH 1 t4c- P l'T ; b Ia ,�a'c- ��SPQSA•�... � �' �� JE a �� I���.t`_�"q'�'t'..� i�' ✓ �+�Gtt*I �WG 11�C.� IC70% EIIPAKt ►Oh! ' F,� .t ".: .�1� 7C.• �.a►�. JI.+1 �J'��Gj�� 'Q�.'��Gr P.� .,,r,,. , ,.,,.. ,,= �• - � •'�}��OS�E�'1:'� � � '€`��'y is';,tv�.�. .�5'1--l� ,,�.. �✓��..+i+n+c,�J�i�1 e•qv�'� r. (.,a5'�4AL.l, f» A = 2 x"1'i it °! x 2 5 a 37 i (1 PlT RAY V1 \t1 , QO T,ti 4*o I! � x � O C�P;a Vu.t3�7;x� rn 'iE`/i14ti: SAT 't . eiz �,a4.. F��c �vvs���,��� AS NOTED I . = S >` �e,,,•_..,. . ` ���1'�� ��.•aGl�."'1"t GL.� �''�Q, � .�;"�� W.�i.� `:�ts{wH �: ciK+ca ��; sa►. >� wo. - _- _ ... . . ---- -- _. --- - I VICINITY MAP N.T.S. Soli LOG SOIL LOG , TEST ES HOLE � I FORMULA: 1 ELEV.--37.5 TEST HOLE 2 E EV.--37. """�---- 0 EPrH �o� BOTTOM OTHER STRUCTURE, Ems' �oM BOTTOM OTHER STRUCTURE, F (No GARBAGE GRINDER ,�towED WITH THIS DESIGN) SOIL SOIL TEXTURE SOIL COLOR SOIL SOIL SOIL TEXTURE SOIL COLOR SOIL SURFACE OF LAYER STONES, BOULDERS, suracE OF LAYER STONES, BOULDERS, NCY, % GRAVEL) (INCHES) ELEV, H (USDA) (MUNSELL) MOTTLING CO _ = NCY, % GRAVEL) : (INCHES) ::- SYSTEM REQUIRED PROVIDED (�N„H „ ELEV. CONSISTENCY, CONSISTENCY, 0„� 8„ - - - ALLEN & S 0 --8 36 8 A LOAMY SAND 10 YR 3 2 NONE 37 1 A LOAMY SAND 10 YR 3/2 NONE L -_ -i- ` -, ". '. - DAILY FLOW: 3 BEDROOMS 110 GPD BEDROOM 330 GPD 8"-45" 33.8 B LOAMY SAND 10 YR 5/8 NONE - 8"-44" 34.1 B LOAMY SAND 10 YR 5/8 - s. 45" 120" 44" 1 GILES _ - .. - ; 27.5 C MEDIUM SAND Y 4 NONE 44 25.8 C MEDIUM SAND 2 5 YR 7 4 NONE _. 3 GPD x 00% 60 G 1,000 GAL. SEPTIC TANKS 2 6 AL SOIL EVALUATION BY: DARREN MEYER, R.S., CSE SOIL EVALUATION BY: DARREN MEYER, R.S., CSE ` WITNESSED BY: DONNA MIORANDI, HEALTH AGENT, BARNSTABLE BOARD OF HEALTH WITNESSED BY: DONNA MIORANDI, HEALTH AGENT, BARNSTABLE BOARD OF HEALTH ,BEACHING AREAS DATE:. NOVEMBER 9, 2007 DATE: NOVEMBER 9, 2007 24' LONG x 2' WIDE T: #120 PERIMIT: #12018 : 3� TRENCHES ® PERMIT 18 DEPTH PERCOLATION TEST: DARREN ME YER, R.S., CSE VET D TH MIORANDI, HEALTH AGENT, BARNSTABLE BOARD OF HEALTH I 2 EFFECTIVE N EN SIDEWALU- 24 +2 x 2 WALLS x WITNESSED Y• N E B DONNA 3 (/ 1 . .. \ � gym.: / < DATE. NOVEMBER 9, 2007 - 9 - ,.::: 2 DEPTH x 3 TRENCHES ._.. PERCOLATION RATE. 2 MIN INCH IN C SOILS 0 60 DEPTH NO GROUNDWATER' ENCOUNTERED w . ...: BOTTOM: (24'x2')x 3 TRENCHES 144.0 SF / TOTAL: 4 56.0 SF TOWN OF BARNSTABLE ADJUSTED HIGH` WATER LEVEL ELEV. 18.0' SITE s E LEACHING CAPACITY: ird _.' SIDEWALL: 312 SF x 0.74 GAL/SF 230.9 GAL 4" PERFORATED PVC, SCH 40 BOTTOM: 144 SF x 0.74 GAL/SF 106.5 GAL ® 0.5% SLOPE WITH 3/8" MIN. 166 WEST WIND CIRCLE TOTAL: 330 GAL 337.4 GAL AND 5/8" MAX. PERFORATIONS 3/4" - 1-1/2" DOUBLE MAGNETIC 2" OF 1/8"-1/2" DOUBLE WASHED CRUSHED STONE CSTERVILLE, MA EXISTING 1,000 GAL. MARKING TAPE WASHED PEA GRAVEL TANK AND RISERS TOP OF PEAST©NE EX. PARKING AREA !�/ES ELEVATION=35.017 SYSTEM VENT _ -------- ,� T s OUTLET D-Box WITH RISER TO WITHIN kko BSMT SLAB = 39.33 _ 9" OF FIN. GR. 2.0' LEVEL FINISHED GRADE FIN. GR. EX.=39,.00 F.G.= 37.8f MIN. 2% SLOPE EX. 10' WADE X nl CC� F.G.= 37.5t DRAINAGE CONSTRUCTION EASEMENT �� �% ,` , 2% 5.9%-+- 2%--.► A&E FIRM ' ° - BENCHMARK --- ; `�� INV. OUT INV. OUT INV. OUT OUTER CORNER -"-' �, .�� ► ; .. - ::- 35.75 35.29 INV. IN 33.96 INV. END INV. IN .:. . 35.46 �n 34.11 INV. IN 33.78 CONC PAD o , , .:: ::::: TURNING MILL EL.=39.8 ,� „ �:::::.: 33.8 .�'S ; EX. WATER LINE 1 MAP 12"i` �°c O i 14.4' 20.0' 8 2' MAx 24.0' CONSULTANTS, INC. PROPOSED 01 1 -014 ,�^��'• / i 3 DRIVE BOTTOM OF TRENCH LEVEL FOR ENTIRE LENGTH DEVELOPERS, ENGINEERS 6 OUTLET r' I �P�� ��l BOTTOM OF TRENCH ELEV.=32.54 AND CONSTRUCTION MANAGERS ' ` DISTRIBUTION BOX SHALL HAVE A DISTRIBUTION BOX � � � � ,:-::�. � p '' � ae TUPPER ROAD, UNIT 3 ; MARK WITH MAGNETIC TAPE ; , �, ; MINIMUM SUMP OF SIX INCHES Po BOX 1159, SANDWICH, MA-02563 PRIOR TO BACKFILL 36.8 I AS MEASURED BELOW THE PROM (om) -+ Fez: 8ft-4246 OUTLET INVERT ELEVATION EX. .. ' PATIO 44.8:. _ SEPTIC SYSTEM PROFILE 2 ` SITE ADDRESS SCALE: 1 8 PROPOSED SYSTEM • 6 _ , VENT PIPING I, 3i0.8' F4�F.J, _ SEPT--1 ` ► � 29.V' ' Srnt ,, 16.9' �� 14.14' S�Oc�` LANDSCAPE BEDS TYP q MAGNETIC MARKING 166 WEST WIND CIRCLE . 6 / i (PT ` ;fr i 'pq/ �C' _ PVC VENT TO ` LEACH TRENCHES TAPE x% ,r'; f' �' p �F�p�O :::: MATCH DIA. OF PROVIDE INSECT 0STERVILLLE, MA ►:::.. /,�,�, PIPE IN LEACHING SCREEN ON MAP 121 `.� •� `t j ! LOAM . ` ff'' ; ; r TRENCHES (SEE G - = - :. ::.-. OPENIN / ► ' PROFILE) 3 -0 r ti 4" DIA. PERFORATED j : :L-� FILL PROPOSED LOCATION ► _ 0 4 - �..�,�� „�_�_,.�';��_y�.�.: ,: _�.. 4 .. ... . - PVC INSPECTION PORT i. _ , ,._ _ �__ .z_ OF SYSTEM VENT � , ,��� �� � - t . . : . �_.. TO oOTTOM OF=SYSTEM MAP 121 I COLLECTOR /�//. ..,STONE AND THREADED ' D 11-015 i PIPE FINISHED GRADE PEASTONE ° CAP WITHIN 3" OF FINAL SUBMITTALS �• • 23,351 S.F. I A PROPOSED �` n x :.`..': DIST. LINE GRADE WRAPPED WITH ` __ .- Aco :: 2 ° PERMEABLE GEOTEXTILE INSPECTION PORT �, ` PFABRIC PROPOSED TRENCHES 2' WIDE %' ---- - -: Op:� I „ 24 'X LONG, 2 EFFECTIVE DEPTH :.:.. O i 2 2 MIN VENT ° PERFORATED 3 PLACES ; PVC PIPE SOLID- PVC SUPPORT VENT PIPE WITH COLLECTOR EX. DBOX ` ' 2 CF OF CONCRETE PIPE SYSTEM = 000= STONE D 12�/20/07 ADD VENT ♦ - - --- -�'� z ° ;� 0.9 - z W W C 12i/18/07 REV. FOR CONSTR. Ex. PIT tiFO -j f PLAN VIEW PLAN VIEW CRUSH AND FILL AFTER REPAIR IS OPERATIONAL ___------___ 011-016 o B 12i/14/07 REV. TO 3 BR EX. 1 ,000 GAL i/i ' SEPTIC TANK a5r �;0 TYPICAL VENT DETAIL 3 INSPECTION PORT DETAIL 4 A 11i/14/07 ISSUED FOR PERMIT EX. POOL / 9� co i SCALE. N.T.S. /, ,�♦ � + SEPT-1 SCALE: N.T.S.iA SEPT-1 PROFESSIONAL STAMP FILTER/PUMP y� ; EX. . ' `♦% TREEE LINE s - LEGEND i TH TEST HOLE. LOCATION � � I I�I I-4" LOAM AND SEED OR PAVING �� ►-►�� ►HT=III-,, GENERAL NOTES: .S EXISTING STOCKADE FENCE " 2 LAYER OF MAP 121 `� I CLEAN COMPACTED " 1. ALL DIMENSIONS ARE PERPENDICULAR TO THE PROPERTY LINES. 8cn X 62.5 EXISTING SPOT ELEVATION ` BACKFILL 9" 1/8 TO 1/2 ® �d� 038 �� ( DOUBLE WASHED 2•. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN COMPLIANCE WITH THE STATE SANITARY �� t MI{JIMIviM --------3$----------- EXISTING CONTOUR � �� � -.- ) � PEA. STONE CODE TITLE V AND THE BOARD OF HEALTH REQUIREMENTS. ---3$--- PROPOSED CONTOUR � ♦ - - - - -- 3. ANY CHANGE TO THIS PLAN MUST BE APPROVED BY .THE BOARD OF HEALTH AND .DESIGN ENGINEER. C� C� C7 4. BEFORE. BACKFILLING THIS. SYSTEM, THE CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER i LANDSCAPE BED .../ INV IN .. .. . . . .. . . .. . . .. . I .:. -' -.._: AND BOARD OF HEALTH TO INSPECT. 5. HEAVY EQUIPMENT SHALL NOT TRAVEL OVER DISPOSAL SYSTEM DURING OR AFTER CONSTRUCTION. UTILITY POLE \% i 4 PERFORATED 6. TIGHT JOINT T.J. PIPING SHALL CONSIST OF POLYVINYL CHLORIDE ' PVC PIPE, SCHEDULE 40. ♦ ( ) (PVC) EXISTING TREE LINE �♦ SCH 40 PVC ALL PIPES TO BE LAID ON FIRM BASE AND TO BE WATERTIGHT. ALL CONNECTIONS AND JOINTS O O 0 SHALL BE MECHANICALLY SOUND AND TIGHT. GRAPHIC SCALE � � 2.0' -.-� �' � � � � `.. -.' 3/4" TO 1-1/2" 7. PROPERTY LINES .FOR .LOT (MAP. 121, PARCEL -11-015 ) ON DEED` RECORDED IN DEED BOOK 14862 PG,165, DRAWN BY: SRS li PROPOSED SITE PLAN 1 20 0 10 20 0`♦ I MIN DOUBLE WASHED AND COMPILED FROM DEEDS ON RECORD AND PLAN RECORDED IN THE BARNSTABLE COUNTY REGISTRY © o 0 o STONE MAP PLAN BOOK 290 PAGE 55 „ _ CHECKED BY: M.F.J. SCALE. 1 30 SEPT-1 ♦ 8. THE DESIGN ENGINEER SHALL CERTIFY INSTALLATION. V 9. PARCEL SHOWN ON ASSESSORS MAP 121 LOT 11-015 AND IS ZONED RF (RESIDENTIAL DISTRICT) PER TOWN OF BARNSTABLE ZONING MAP. SHEET TITLE: 10. LOT 1S SERVED WITH TOWN WATER SERVICE. 3 MIN. 20" MIN. 1 I I 2.0'. 11. SUBJECT PROPERTY LIES WITHIN A TOWN OF BARNSTABLE WELL HEAD PROTECTION OVERLAY DISTRICT. 12. PROPERTY IS LOCATED IIN FLOOD ZONE C, PER FIRM MAP 25001 0015 C, DATED AUGUST 19, 1995. PROPOSED SEPTIC SEPTIC SETBACKS (MIN.1 s" MIN. 13. GARAGE FOUNDATION IS EXISTING. � E72" MIN. BOTTOM OF 5' MINIMUM SEPAR ATION 14. ALL DISTURBED AREAS SHALL BE LOAMED AND SEEDED IMMEDIATELY UPON COMPLETION OF CONSTRUCTION. LEACHING TRENCHES: TRENCH DISTANCE FROM 15. CONTRACTOR TO OBTAIN REQUIRED PERMITS. DESIGN PLAN 10' PROPERTY LINES --� " 19" GROUNDWATER 10 MIN. CONTRACTOR TO INSTALL CORROSION 16. IT IS THE CONTRACTORS RESPONSIBILITY TO NOTIFY DIG-SAFE AND ALL UTILITY COMPANIES PRIOR TO CONSTRUCTION 20' BUILDINGS MIN' RESISTANT GAS BAFFLES BY TUF-TITE, MAINTAIN 4.0 FEET FOR LOCATION OF ALL UNDERGROUND UTILITIES,AND UTILITY COMPANY APPROVALS. 100' WETLANDS OR EQUIVALENT APPROVED BY THE BETWEEN TRENCHES ENGINEER, ON OUTLET TEE 17. ALL EXISTING UTILITIES SHOWN ARE APPROXIMATE ONLY AND ARE NOT WARRANTED BY THE OWNER AND ENGINEER SEP11C TANKS: = TO BE CORRECT, NOR DO THE OWNER OR ENGINEER WARRANT THAT ALL UNDERGROUND UTILITIES ARE SHOWN. 10' PROPERTY LINES 18. CONTRACTOR TO PROTECT ANY UNDERGROUND UTILITIES FROM BEING DAMAGED. 10' BUILDINGS 19. PROPERTY LINE INFORMATION IS COMPILED FROM DEEDS AND PLANS OF RECORD AND IS NOT THE SHEET NUMBER: j 100' WETLANDS 5 TYPICAL LEACHING TRENCH DETAIL RESULT of A FULL BOUNDARY SURVEY. TYPICAL SEPTIC TANK PROFILE 6 20. CONTRACTOR TO COMPLY WITH ALL TOWN OF BARNSTABLE INSPECTION REQUIREMENTS. SCALE:. N.T.S. SEPT-, SCALE: N.T.S. SEPT-, SEPT=l TMC-7.16 I ,i