HomeMy WebLinkAbout0286 WEST WIND CIRCLE - Health 286 West Wind Circle,
sterville F/R
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Health Complaints
20-Sep-04
Time: 9/16/2004 Date: Complaint Number: 17727
Referred To: DAVID STANTON Taken By: DAVID STANTON
Complaint Type: TITLE V SEWAGE
Article X Detail:
Business Name:
Number: 286 Street: West Wind Circle
concerned about water in basement during past
two heavy rains, thinks it is from the new septic
installation and the finished grade.
Actions Taken/Results: DS WENT TO SAID LOCATION AND TOOK
SOME PHOTOS. IT DOES NOT APPEAR
THAT THE NEW SEPTIC SYSTEM IS
CAUSING THE WATER TO GO INTO THE
BASEMENT. THERE IS A LARGE SLOPE
ALONG THE BACK OF THE HOUSE. THERE
HAVE BEEN TWO RAIN STORMS THIS
SUMMER (REMNANTS OF HURRICANES)
THAT EACH DROPPED MORE THAN 3" OF
RAIN IN A SHORT PERIOD OF TIME. THIS
IS MOST LIKELY THE CAUSE OF THE RAIN
WATER IN THE BASEMENT. IF YOU RE-
GRADE OVER THE SEPTIC, IT MAY CAUSE
THE RAIN WATER TO COLLECT ON THE
LEACHING AREA,WHICH YOU DO NOT
WANT TO DO. IF THIS CONTINUES, THE
OWNER MAY WANT TO INSTALL A CATCH
BASIN TO MOVE THE WATER AWAY FROM
THE HOUSE. NO FURTHER ACTION
REQUIRED.
1
I
Health Complaints
20-Sep-04
Investigation Date: 9/17/2004 Investigation Time: 3:55:00 PM
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TOWN OF BARNSTABLE L
286 WEST WIND CIRCLE 2004-306
LOCATION SEWAGE #
VILLAGE O S T E R V I L L E ASSESSOR'S MAP & LOT1 21 - 1 1 -2 7
INSTALLER'S NAME&PHONE NO.ELLIS BROTHERS CONST _ CO 362-hp-17
SEPTIC TANK CAPACITY M 0
LEACHING FACILITY: (type) _/4z;,./Zd 7e/1 C (size)
NO.OF BEDROOMS
BUILDER OR O WNER E V E R E T T WRIGHT
PERMIT DAA/ 18/0 4 COMPLIANCE DATE: , - (�L
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
/3 3
Town of Barnstable
S-ETgy, Regulatory Services
Thomas F. Geiler,Director
BARNSrABM '
MASS. Public Health Division
zG�.q• ��
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date:
Designer: IASA Installer: 1�,L 5 vpao S
to
Address:
62 VtI• v1,t5 ` ar,- 'Address: 22-?
n�►�.s �2bD f
On (o e5 6`r- 15 �S was issued a permit to install a
( ate) . (installer)
septic system at `Z-� V h�' VV l r ) a; _�"` 'based on a design drawn by
(address)
(—1 SOr l�y�r iS , as. dated b/34
(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. ,�g11�11NIt
C.
(histal er s Signature) LOC.�r =
f11�3 �r
�**$ate,
esigner' e) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE .
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form - `
TOWN OF BARNSTABLE L.
LQTION 286 WEST WIND CIRCLE SEWAGE
V,;
OSTERVILLE
VILLAGE ASSESSOR'S MAP & LO'Ia 21 - 11 -27
INSTALLER'S NAME&PHONE NOEL L IS BROTHERS CONST _ CO 362-623,7
SEPTIC TANK CAPACITY 4,106 0
' LEACHING FACILITY: (type) ,44 &/Z"A4A S' (size)
NO. OF BEDROOMS
BUII.DER OR OWNER E V ERETT WRIGHT
PERMIT DAT ! 1 8/0 4 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by i
r .
i
13 r .
,43
133
. f.>
No. W., L? ^30` Fee 5' p�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
s
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZIppYication for Mizpoga pgtem Conotruction Permit
Application for a.Permit to Construct( )Repair( pgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. t j eS -k4-11 d C i�C)Vcwner's Name,Address and Tel.No.
Assessor's Map/Parcel X o L v
Installer's Name,
Address,and Tel.No. 69 3 2 KSoh' ]Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
y
Design Flow t gallons per day. Calculated daily flow gallons.
Plan Date !o l0)d N Number of sheets ( Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil S f-e &ci L C
Nature of Repairs or Alterations(Answer when applicable) P E-e v-i,'� S J
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 i s ed byt B ealt .
��S ne Date 0 Application Approved Date )-
Application Disapproved for the following reasons
Permit No. 30 Date Issued
"
J
No. W ,� •'P•• -tl � Fee �� ^�
# THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS
Application-for Migpoga ,,*pgtem Congtruction..Permit
Application for a Permit to Construct( . )Repair( Upgrade(} )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. p�.c'rl CO Lt/P,Sd-k)h D1 C!f(/ Owner's Name,Address and Tel.No. �- .p LL✓
GSje,�� t ff vs� tti ! c�> t ,.
Assessor's Map/Parcel C �� ��`l6 n�.
Installer's Name,
Address,and Tel.No. .3&a �7'3 7 •S`'e ]Designer's Name,Address and W.No.
' (.. �1 � J VJ�cf�'�°i� �c.-7 S'j• L 6 S I �.�Cy�� � �l
Type of Building: v
Dwelling 9 g No.of Bedrooms 3 Lot Size s .ft. Garbage Grinder —�—.-
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Ifox 3 U
Design Flow t gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title t
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) " S-Pf)j 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 Certifi-
cate of Compliance has been i spied-b p is,B afa- f ,ea
d
Slgn� k 0 �"" ` Date
ApplicationApprovedby Date—��V O
Appliction Disapproved for the following reasons30 '
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
t (Certificate of compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded ( )
Abandoned( )by l I 1 g f r!r r 5- Cc- ?S ( c
at 04 � IN?S� 4,1 h G� C 1 r C �f ) C.S J-0"V, i/ � has been constructed/in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. DU • 30� dated G/19l O
Installer : - A r r Designer
The issuance of this Permit shall not be construed as a guarantee that the s s�r will funck-on as dell dd. (J
Date Inspector
--- — '— "-- -- _--- ------ ---- —
No. �-^� — —— Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
li5po5al *pgtem (Elon5truction Permit
Permission is hereby granted to Construct( )Repair,(v)Upgrade( )Aban on
System located at C (o P�d �,t n W r �� '' / h
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 conditio
Provided: Cons ction musst/be completed within three years of the da e of this pe{�ir►b.
Date:_ � T Approved by - \
Z2i (DI
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
R
d RECEIVED
FAILED INSPECTION SUN. 2 12004
i�M See
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 286 WESTWIND CIRCLE OSTERVILLE;MA 02655
Owner's Name: WRIGHT
Owner's Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655COP
Date of Inspection: 6/3/04
Name of Inspector: (please print) JOHN GRACI,INC. .
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 MAP'
Telephone Number: 508-564-6813 FAX 508-564-7270PARCEL
CERTIFICATION STATEMENT ® a_ —
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
_ Passes h
_ Conditionally asses
_ Needs Further# 'valuation by the Local Approving Authority
X Fails
Inspector's Signature: !!,Im Date: 6/3/04
The system inspector shall submit a cop of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspection. If �e 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
SYSTEM FAILED TITLE V INSPECTION. LIQUID LEVEL IS FULL OVER ALL PIPES. SYSTEM IS IN HYDRAULIC
FAILURE.
****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.
Titla 5 Imnartinn Fnn-n A/I V1000 1
f
Page 2 of 11
OFFICIAL INSPECTION FORM`NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655
Owner: WRIGHT
Date of Inspection: 6/3/04
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments: ,
SYSTEM FAILED TITLE V INSPECTION. LIQUID LEVEL IS FULL OVER ALL PIPES.SYSTEM IS IN.
HYDRAULIC FAILURE.
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.
n/a 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: n/a '
n/a 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: n/a
n/a 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:n/a
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655 .
Owner: WRIGHT p y
Date of Inspection: 6/3/04
i
C. Further Evaluation is Required by the Board of Health
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the.environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering'vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 160 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 n/a
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and
volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy
of the analysis must be attached to this form.
3. Other:
n/a
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655 4
Owner: WRIGHT
Date of Inspection: 6/3/04
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No v
X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
_ X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped n1a.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. [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. 1
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet of a surface drinking water supply .
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone,11 of a public water supply well
If you have ariswered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat
under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
r
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655
Owner: WRIGHT
Date of Inspection: 6/3/04 t
Check if the following have been done.You must indicate "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 Were any of the system components pumped out in the previous two weeks
X _ Has'the system received normal flows in the previous two week period
X Have large volumes of water been introduced to the system recently or as part of this inspection'?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out'?
X _ Were all system components,excluding the SAS, located on site?
X _ 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?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems
i
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation tof distance is
unacceptable) [310 CMR 15.302(3)(b)]
`e
r
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655
Owner: WRIGHT
Date of Inspection: 6/3/04
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: 2.
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use:(yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)):w
Sump pump(yes or no)`. NO ' p
Last date of occupancy: n/a "1 000
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a -
Reason for pumping: n/a
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)
_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): n/a
Approximate age of all components,date installed(if known)and source of information:
1984 PER OWNER
Were sewage odors detected when arriving at the site(yes or no): NO
i
Page 7 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655
Owner: WRIGHT
Date of Inspection: 6/3/,04
BUILDING SEWER(locate on site plan)
Depth below grade:30"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 24" '
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: L 8' 6" H 5' 7" W 4' 10""
Sludge depth:2"
Distance from top of sludge to bottom of outlet tee or baffle:32"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 0"
Distance from bottom of scum to bottom of outlet tee or baffle: 0"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels,as related
to outlet invert,evidence of leakage,etc.):
LIQUID LEVEL IS FULL THE TEE IN THE SEPTIC TANK-SEPTIC TANK IS STRUCTURALLY SOUND-
RECOMMEND PUMPING EVERY TWO YEARS.
GREASE TRAP:_(locate on site plan),
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to•bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
Page 8of11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY'ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655
Owner: WRIGHT
Date of Inspection: 6/3/04
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day '
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a ,
DISTRIBUTION BOX:X(if present must be opened)(locate;on site plan)
Depth of liquid level above outlet invert: OVER PIPES
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.):
DID NOT EXPOSE D-BOX
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO ~
Alarms in working order(yes or no):NO -
Comments(note condition of pump chamber,,condition of pumps and appurtenances,etc.):
n/a
f
Pap9ofII
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655
Owner: WRIGHT
Date of Inspection: 6/3/04
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 1
n/a leaching chambers, number: , n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
J
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
LIQUID LEVEL IS OVER ALL PIPES IN THE SYSTEM-THE LEACH PIT.HAS NO EFFECTIVE LEACHING
LEFT AND IS IN HYDRAULIC FAILURE. BOTTOM IS AT 10 FT. -
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a-
Depth of scum layer: n/a .
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan) '
Materials of construction: n/a .
Dimensions: n/a
Depth of solids: n/a Y
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a 4 n.
i
Paga 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,MA 02655 "
Owner: WRIGHT
Date of Inspection: 6/3/04
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties tout least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet.Locate where public water supply enters the building.
7
y0
AL 2�
a in
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 286 WESTWIND CIRCLE OSTERVILLE,,MA 02655
Owner: WRIGHT
Date of Inspection: 6/3/04
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 10+feet ,
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
HAND AUGER-10+FT.
a .
LO CATION � i� SEW & E PERMIT NO.
Lof yT
VILLAGE ++ (1
a INSTA LLER'S NA E i ADDRESS
eko �1eo ►141l S
7
R U I L D E R OR OWNER
S�4�- c f
�vIAMIUVY4
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
�_� 8!S
'F
. - a
qLl— S '
-- d
No................._...... FF$ ........................
THE COMMONWEALTH OF MASS�CHUSETTS �—
i�� Q BOARD OF HEA1 -_r"
�6_/L_'r/...O F.............. ... ------••---
A lirFatiun for Uhi uua1 Works Toustrurtiun Frrutit
Application is hereby made for a Permit to Construct ( } or Repair ( ) an Individual Sewage Disposal
System at: '
LocatiQ-n-Address /J ,�]- j Lott�No.
1
.... /••. `.��... --6-•l-/-- ..._..i +�•+;-�i�F-a..9.-b✓ca.rNf'!__________________ ...C. .....................
Owner Add ess
Installer Address //
d Type of Building Size Lot-___1_&7 7_._..Sq. feet
U Dwelling—No. of Bedrooms--------------3------------------------Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building Dytl No. of persons..........6
a ............. Showers � — Cafeteria ( )
Other fixture
W Design Flow.............. ...................gallons per person pert dap Total daily Pow..........P .. '0................gallons.,,/
WSeptic Tank—Liquid capacity./oagallons Length--/. --- Width....45..-.__ Diameter---------------- Depth...... -.
x Disposal Trench—No..................... Width..... ------------ Total Length............... ... Total leaching area....................sq. ft.
Seepage Pit No------I............. Diameter.......6......... Depth below inlet...... .......... Total leaching area.f�/-X.7..sq. ft.
Z Other Distribution box Dosing a ) p
`" Percolation Test Results Performed bylv� /Y /�,!/tE_�o Date _
a •• f{
Test Pit No. 1................minutes per inch Depth of Test Pit.---f___ _�!. Depth to ground water.--- /
/ ..-.--..y�
fX, Test Pit No. 2................minutes per inch Depth of Test Pit--- -11.. ..._._. Depth to ground water _---- >"T i
Pr' •-•------- ----- - ..... - •------...
_.... ._
0 Description of Soil..............
—e....-- �_...1'!l._ --�----------- --� ........................................
x
U •••••-••-•---•-••-•--•-•-•-•••••-•••-••-••-•-•-••--••••••-••---••••...............••-•-••----•-•----.....•••-••-•••••••-••-••••-•-•••-•-•--••---•-----•-•--•--•-•-•-•••-••--•-•--•----••-•-•---••-••--•-
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 TI'i U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has4bbeen ' dby the board o ealth.Signed- -••-•• � ..................••-••...---•--
DateApplication Approved By--••••-•--••-••-----•----•-•••-•••• = --- ................................ .....
Date
Application Disapproved for the following reasons---------------••--------•-----------••-----------------•------------------------•---------.........•---•••....
--•••-•-••••••••-•-•-••••-•...-••-......................................................................................................................
-- -------- ............................
Permit No...... 0 ... Issued......I..--- g .C......Date............................
• Date
.r
No................_....... .........................
~THE COMMONWEALTH CIF MASSACHUSETTS ,
BOARD OF HEA TM
Appliratinn for 35iipns al Works Tonstrnrtiun 'Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
... Location-Address o Lot No.
r', :�� �.. .7 :----- .Y.%`: , .... ...... ..... .....................
�,.p- Owner�} / ( f� Ad
W ' R_c? 1_�aj. "�C?h� } .1. 1. ._.: :ft .�!�i-A�°/.�tr�fl_.._�[t.....
Installer
� Address
UType of Building Size Lot_.. .�ZZ.7-----Sq. feet
Dwelling—No. of Bedrooms.............. ................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—Type of Building _ p
yp g ,,.�,t,. =f _ No. of ersons....___...r ............. Showers (�) — Cafeteria ( )
Otherfixtures -----------------------------t-t------------------------.-----------------------------------------------�----
W Design Flow.............. ....____._..____._gallons per person per day. Total dail `.flow__._._...}.,, .-0.................gallons/-,�
WSeptic Tank—Liquid capaclty`_& Qgallons Length.J'V.. ___ Width......... Diameter................ Depth...3.. ...
x Disposal Trench—No..................... Width.....f............. Total Length.............. Total leaching area....................sq. ft.
Seepage Pit No------I------------- Diameter......6.......... Depth below inlet...... /_......._.. Total leaching area , _- -._sq. ft.
Z Other Distribution box (/ ) Dosing tank ( ) /
'-' Percolation Test Results Performed by._.,W. _ T/vet-'/N :_f [_<S!•(,• Date......
Test Pit No. I...........:....minutes per inch Depth of Test Pit...
_ _.. / Depth to ground water.._:.____. _
PN Test Pit No. 2................minutes per inch Depth of Test Pit.. . ...... Depth to ground water:_ .
Ix .................................................... .� . .---.. !� .-------------------
--------
•-----------
D Description of Soil............. .......�.. . ��f�.� � -------S.. /���.d---------------------------•-------...---
W
V •-•---------------------•-•---......-----------......-------------------------•--•-------......------....------------------------------------------------------------------..._..-•-•--...•--••--•--••-
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 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 ' ued by the board of-health. r;
r f
40.
Signed...... ...: - �f� '; t -
-
Date
ApplicationApproved By---••-••-••••-•••••--•-•••----•••-••••-j.........................................................
Date
Application Disapproved for the following reasons-------------------------------------------------------•-------•---------------------------------...-•-••-....._
..............................................------------...------------•----------•----------....-------•••••••••--•-•••••••••-•--••......----•----••-•-•-- .....................................
� tc
Permit No.........: _.�.. ...--•-••-----•---•----•---. Issued........... ( -••...I 1•....- ----......
D e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... ...
Qurrtifiratr of TompliFanrr
THIS IS
�TO CERTIFY, That the IndivdduaT Sewage Disposal System constructed or Repaired ( )
by---------------- j� �._..__. ''r..: / ' c"% :.� „� zete. ---- -------------- --------•---
1 Installer
at.... ' ------•-----
has been installed in accordance with the provisions of TITIF 5 f Te State Sanitary Co ea scribed in the
application for Disposal Works Construction Permit No..__�'5—...)0.(-)----------- dated-.-..�.�.__(_�_. �'.____................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU R TEE THAT THE
SYSTEM WILL FUNPTION SATISFACTORY.
DATE................--....... ................................ Inspector...........................
.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i
........ .Vl...OF.--•-• $ '
No....................... FEE........................
Disposal Works Tonsiruction rrntit
Permission s hereby granted----- ....... ...-----....��. ....._._..
to Construct (-rf or\,Repair ( ) an I dividual Sewage Disposal System
at
Street
as shown on the application for Disposal Works Construction Permit No.. .................. Dated..........................................I
AI e�
.........................................................................................................
Board of Health
DATE-------------••••ZU Z/. -f-s-5-f.................................
FORM 1255 A. M. SULKIN, INC.. BOSTON '
---- ,'°
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I
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ln1 L..E^Cr i"C:q PR's: SHALL 8E DE`S}G,AJEC� F-0-
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MAP SECTION PAR4'E64 1-0T ADDRESS
iwj
1r •` ,
v ;.-.
PROPOSED OARUING LOCATION
�,. �,', PBs/�N G!'/TEE'/.+► :f r� 'i� �a� c`�vlQlut
t ,II:IF�l�e7-►!NS L' �O,Pdrs,t-! _'ir,4 ' PROPOSED SE&4GE P!sPOSd� %5 EM
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Y✓
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V
EXISTING 1000 GALLON' TANK PISTRIBU'TION BOX HIGH CAPACITY INFILTRATOR DETAIL- CROSS SECTION LOCUS PLAN
NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE
MIN 2% SLOPE---> 44.7
I COVERS TO THIN 6"OF GRAD ROUTE 28
14
4"SCH.40 P.V.C. 3"MINIMUM _ MIN. 12" COVER
4"SC10. .V.0 j� � 4"SCH.4 MIN.
MAX. 36" COVER 3 1/8 1/2 WASHED ST ,r-L, WEST WIND
S=0,02 IN. 13'-r � 3 S=0.01 MIN. .�k '„ =0.01 MIN. � 11 �� - i� � � O
tt
EXISTING tl �„ I CIRCLE W
4 .2
. 5
EXISTIN
42.5
4.0' 42.33. \ / / 0' .92' ` \
10.0' 417 \ \ H LOC o
MIN 3/4"-.1 1./2.!'.D0UBLE WASHED. STONt- 1.08' / o p
\ / O
6":OF;STONE d;F.ND1�..T�NI�: ::::: :::::::::: ::� I � 5.00'
10.5' 1.5-r- 25.0' ij I. ' 4. 2.8 4.
28.o BOTTOM OBS# o 10.83'
33 7
FLOOR PLAN DESIGN CALCULATIONS GENERAL NOTES
NOT TO SCALE ALL PIPING TO BE SCHEDULE 40 P.V.C.
EXISTING BEDROOMS 3 ALL LOCATIONS OF UTILITIES SHOWN'ARE AS
PROPOSED BEDROOMS 3 @ 110 G•P.D.= 33o G.F.D. MARKED BY DIG-SAFE AND ARE TO BE VERIFIED
BY INSTALLER PRIOR TO CONSTRUCTION.
NO.OF UNITS 4 THERE ARE NO KNOWN WETLANDS WITHIN
DEPTH BELOW INV. 2' 150'OF THE PROPOSED LEACHING FACILITY
FIRST FLOOR
UNLESS SHOWN.
WIDTH 10.83' THERE ARE NO KNOWN POTABLE WELLS WITHIN
LENGTH 28' 150'OF THE PROPOSED LEACHING FACILITY.
SIDEWALL AREA 155.32 SF THERE ARE NO KNOWN IRRIGATION WELLS WITH
100'OF THE PROPOSED LEACHING FACILITY.
i ! BOTTOM AREA 303.24 SF
TOTAL SQUARE FEET 6o6.86 SF THIS PROPERTY DOES NOT FALL WITHIN A
� ZONE I I OF A WELLHEAD PROTECTION AREA
CAPACITY SIDEWALL @ 0.74 114.94 G.P.D.
CAPACITY BOTTOM @ 0.74 224•4 G.P.D. THIS PROPERTY DOES NOT FALL WITHIN A
DECK CAPACITY TOTAL FLOOD ZONE AS SHOWN ON FIRM MAP
339.34 G.P.D.
THIS DESIGN DOES NOT REQUIRE VARIANCES
BATH TO TITLE 5 (310 C.M.R. 15.00)OR BARNSTABLE
DIN ING ROOM KITCHEN BEDROOM SUPPLEMENTAL REGULATIONS.
THIS SEPTIC SYSTEM IS NOT DESIGNED ALL CONSTRUCTION SHALL BE IN ACCORDANCE
LOT I-2 1-11-2 7 TO ACCOMODATE A GARBAGE DISPOSAL WITH TITLE 5 AND BARNSTABLE SUPPLEMENTAL
REGULATIONS.
16,17�' SF
IN-LINE ELEVATIONS PROPOSED AS-BUILT
LIVING ROOMBEDROOMBEDROOM SURVEY INFORMATION
AT INV. @ HSE 46.2-EXISTING PROPERTY LINE DATA TAKEN FROM
INV INTO TANK 45.5-EXISTING PLANS DRAWN BY
INV OUT OF TANK 45.25 ARROW ENGINEERING
INV INTO D-BOX 42.5 JUNE 11, 1984
INV OUT OF D-BOX 42.33
INV INTO INFILTRATOR. . 41.7 PLAN TO BE USED FOR INSTALLATION
OF SEPTIC•SYSTEM ONLY
BOTTOM OF INFILTRATOR 40•78 NOT TO BE USED TO DETERMINE PROPERTY LINE
BOTTOM OF STONE 39.7
EI�AAnT.I,�„>xP.,� 6 BENCH MARK-
WATER TABLE NONE ENCOUNTERED
BOTTOM OF OB S HOLE
33.7 S/W CORNER OF FOUNDATION EL. 44.7
DATE; OBSERVED BY: WITNESSED BY:
SOIL LOGS JUNE g,2004 LISA C. LYONS EMERGENCY
WESTWIND CIRCLE SOIL EVALUATOR UNWITNESSED
- 'I OB 5. HOLE #1 OB S HOLE #2
ELEV. DEPTH ELEV. DEPTH
44 7 A SANDY LOAM 0 0 0��
A
ioYR 2/2
l 44.28 B LOAMY SAND 5t B
loYR 5/6
FINE SAND - FIRM
42.53 2.5Y 6/3 26,E
FINE SAND ® s2"
4 7 2.5�'5/4 74'6
�. f,
II CZ C2
NO GROUND WATER ENCOUNTERED
(v) 33.70
32�� C3
DECK � C4
pj -
EXISTING l000 GAL TANK
( INS-rALLr CAS 1_AFFL,
p EXISTING LEACHING PIT
TO BE CAVED AND FILLED
All
PROPOShD
INFILTRATOR
IN A
TRENCH
���TIAOF off
PLAN SHOWING:
a # �, PROPOSED SEPTIC SYSTEM REPAIR IN BARNSTABLE
tr .�
✓'Q ���+. �' �$ FOR: DRAWN BY: LISA C.LYONS
!r r
.y��,�fC/ E rM�.��� 'V EVERETT WRIGHT DESIGNED&CHECKED BY:
c� LISA C.LYONS
j,��i , LOCATION: REVISIONS: DESCRIPTION: DATE:
286 WEST WIND CIRCLE, OSTERVILLE
LOT#121-11-27 DATE: 06/10/04
SCALE 1 r'r`�O 4 LISA C. LYON , R.S.
: I CERTIFY THAT THIS PLAN CONFORMS T LIQA C. LYONS RS .
TITLE 5 ANI� BARNSTABLE B.O.H. RIGU TIONS
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