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0035 WIANNO CIRCLE - Health
35 Wianno Circle osterville , �'� A= 139-008 .. Osterville i t i y �I i= i p i p 4 Illv:�:t` UPC 10247 or No__H163GN HASTINQS, LIN ■Ill ig 25 2016 19:59 Jim The Inspector Man 5085349919 page 1 ■ o® Commonwealth of Massachusetts Title 5 Official Inspection Fora. R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 35 Wianno Circle ° Property Address i Thomas Cullinan Owner Owner's Name information is / required for every osterville ✓ MA 02655 8-2-1'6 page. Cityi7own 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 A. General Information cI filling out forms on the computer, \```��� �t1 OF use only the tab 1. Inspector: 1 key to move your y G cursor-do not JamesD.Sears = .' JAMES =.m usy.e the return k.e Name of Inspector Capewide Enterprises, LLC A.% o o Q*: Company Name s F� 153 Commercial Street o„nN,INSPEt"�a� Hill-, Company Address ,r Mashpee MA 02649' Cityrrown " State Zip Code 508-477-8877 S1623 Telephone Number License Number. ! B. Certification 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).'The system: ` ® Passes ❑ Conditionally Passes ❑. Fails ❑ Needs Further Evaluation by the Local Approving Authority d��.y 8-25-16 t ;,p?e!ctVe,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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. . I ""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. . l5ins.doc•rev.6116 - - , - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 i Aug 25 2016 19:59 Jim The Inspector Man 5085349919 page 2 Commonwealth of.MaSuChuSetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 35 Wianno Circle Property Address Thomas Cullinan owner Owner's Name information is MA 02655 8-2-16 required for every Osterville page.. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ° Inspection Summary:.Check A,B,C;D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal Tank D Box and three 500 Gal. Chambers. 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 dr repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, Ni 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): t5insAcc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Aug 25 2016 19:59 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts r Title 5 Official i I Inspection Form t Subsurface Sewage Disposal System Form 7 Not for Voluntary Assessments yd 35 Wianno Circle Property Address Thomas Cullinan Owner Owner's Name information is required for every. Osterville MA 02655 8-2-16 . page. City/Town State Zip Code Date of Inspection b•. B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt.): ❑ 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 .❑y'ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health Ind 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 T 15 303(1)(b)that the system is not.functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Irupection Form:Svbsvrisce Sewage Disposal System•Page 3 of 17 i Aug 25 2016 19:59 .Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w ..' 35 Wianno Circle Property Address Thomas Cullinan Owner Owner's Name information is Osterville MA 02655 'B-2-16. required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) M 2. System will fail unless the Board of Health (and Public Water Supplier, if any). determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has'a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well, ❑ The system has a septic tank and SAS and.the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method.used to determine distance:. "* This system passes if the well water analysis, performed at a DEP.certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form: 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No � . ® Backup of sewage into facility or system component due to.overloaded or clogged SAS orces cesspool , . Discharge or ponding of effluent to the surface of the ground,.or surface waters ❑ ® due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded _ or clogged SAS or cesspool ® Liquid depth in III is less than 6" below invert or available volume is less than '/z day flow 4£AP/64 t5ins.doo rev.6116 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Aug 25 2016 19:59 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts . Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Wianno Circle Property Address { Thomas Cullinan Owner Owner's Name information is required for every MA 02655 8>2-16• �Stervllle page. CitylTown State Zip Code Date of Inspection. B. Certification (cont) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or ,obstructed pipe(s).Number of times pumped: ❑ Z Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within'a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This . system passes if the well water analysis, performed at a DER certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain.of custody must be attached to this form.] ®. The system,is a cesspool serving a facility with a design flow of 2000gpd- 10,0009pd. ❑ ® The system fails.I have determined that one or more of the above.failure' criteria exist as described in 310 CMR.15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. . For large systems, you must indicate either"yes' or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking.water supply ❑ ❑ the system is within 200 feet of a tributary to a surface'drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-1WPA) or a mapped Zone II of a public water supply well If you have answered "yes'to any question in Section E the system is considered a significant threat, I 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. t&ns.doc•rev.1116 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 5 or 17 Aug 25 2016 20:00 Jim The Inspector Man 5085349919 page 6 z: Commonwealth of Massachusetts F Title 5 Official Inspection° Fora Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments 35 Wianno Circle i Property Address Thomas Cullinansj Owner Owner's Name information is required for every OsteNille MA 02655 8-2-16. page. City/Town State Zip Code. Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No ❑ Pumping'information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has`the system received normal flows in the previous two week period? a El ® 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 ® 0 available note as NIA) ® ❑ Was the facility or dwelling inspected for-signs of sewage back up?, ® ❑ Was the site inspected.for signs of break out? . u` ® ❑ Were all system components, excluding the SAS, located on'site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption.System (SAS) on the site has been determined based on: ® •, ❑ Existing information. For example, a plan at the.Board of Health. Determined in the field (if any of the failure criteria-related to Part C is at issue ❑ , Z. i approximation of distance unacceptable) (310 CMR 15.302(5)] D-System Information - Residential Flow Conditions: k Number of bedrooms (design): . = 5 Number of bedrooms (actual) 5 ,DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): . 550 .t5ins.dm•rev..6/16 - Title 5 OKcial Inspection Form:Subsurface Sewage Disposal System•Page 6 or 17 Aug 25 2016 20:00 Jim The Inspector Man 5085349919 page 7 k Commonwealth of Massachusetts Title 5 Official Inspection Form.. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Wianno Circle - Property Address Thomas Cullinan Owner Owner's Name information is osterville MA, 02655.. 8-2-16 required for every State Zip Code Date of Inspection page. City/Town D. System Information Description: The system is a 1500 Gal Tank D Box and three 500 Gal. Chamber's. -1 i NA Number of current residents.- Does residence have a garbage grinder? _ ❑ Yes ® No . Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in-this report.) Laundry system inspected?' ❑ Yes ® No 1 Seasonal use?~ ® Yes ❑ No 2014-162,000Ga l Water meter readings,,if available (last 2 years usage (gpd)): 2015-168,000GaI's Detail: Sump pump? ❑. Yes ® No Present Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: •, ` Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seaWpersons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ .,-No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.dcc rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of W. Aug 25 2016 20:00 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 35 Wianno Circle Property Address A Thomas Cullinan e{ Owner Owner's Name information is • required for every Osterville MA 02655 8-2-16 . page. City/Town State Zip Code Date of Inspection y' D. System Information '(cont.) Last date of occupancyluse: Date Other(describe below): y General Information Pumping Records: Source of information: . NA Was system pumped as part of the inspection? ❑ Yes .® No .y If yes, volume pumped: gallons How was quantity pumped determined? ' Reason for pumping: . Type of System: ®. Septic tank, distribution box, soil absorption system El Single cesspool 4 Overflow cesspool i 0 Privy El 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 El Tight tank. Attach a copy of the DEP approval: Other(describe): 15ins,doc rev.6/16 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 8 of 17 Aug 25 2016 20:00 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Wianno Circle Property Address Thomas Cullinan Owner Owner's Name information is Osterville MA 02655 8-2-16 or every required f page. Cityfrown State Zip Code Date of Inspection D. System Information (cont;) } Approximate age of all components, date installed (if known)and source of information: 2010 Permit # 2010 -094. Were sewage odors detected when arriving at the site? : ❑ Yes ® No Building Sewer(locate on site plan): 22„ Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet 'Comments (on condition of joints, venting, evidence of leakage, etc): l Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): , Depth below grade: feet . N { Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) fi •l If tank is metal, list age: ; years Is age confirmed by a Certificate of Compliance? (attach'a copy of certificate) ❑ Yes ❑ No 1500 Gal.Precast H-10 s Dimensions: 4" Sludge depth: t5ins.doc•rev.6/16 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 ,I Aug 25 2016 20:00 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form .F Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments .'~ 35 Wianno Circle r Property Address Thomas Cullinan Owner Owner's Name e information is Ostervllle MA 02655 8-2-16 required for every A,j page. City/Town State Zip Code Date ofdnspection D. System Information (cont.)' Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle f Distance from bottom of scum to bottom of outlet tee or baffle 17" I How were dimensions determined? Asbuid_?Plan -Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and outlet cover at 1'w/inlet cover at 2". Two inlet tee's, outlet tee. No sign of leakage or over loading Grease7rap (locate on site plarl)i. Depth below grade: feet Material of construction: ❑ concrete. ❑ metal 0 fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness R Distance from top.of scum to topof outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5insAcc-rev.5/16 ' _ Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 10 o1 17 Aug 25 2016 20:00 Jim The Inspector Man 5085349919 page 11 k Commonwealth of Massachusetts i Title 5 Official Inspection Form : Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Wianno Circle Property Address Thomas Cullinan Owner Owner's Name information i e required for every Osteryille MA 02655 8-2-16 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, . liquid levels as related to outlet invert, evidence of leakage, etc.): a 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 5 Alarm present: ❑ Yes ❑ No Alarm level: _ Alarm in working order: ❑ Yes El No.,. Date of last pumping: bate Comments (condition of alarm and float switches,,etc,): Attach copy'of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 4 t5m,doc•rev.U16 Thle 5 Official Inspection Form:Subsurface Sewage Disposal System page',1 of 17 ' Aug 25 2016 20:01 Jim The Inspector- Man 5085349919 page .12 y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Wianno Circle Property Address , Thomas Cullinan ' Owner Owner's Name information is Osterville MA 02655 8-2-16' required for every — — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 ;a 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.): D Box is 16" x16"-20" below grade w/cover at 4". Box is clean and solid w/three dines out. No sign of over loading or solid carry over. ! Pump Chamber(locate on-site plan): Pumps in working order: ❑ .Yes F ..No* Alarms in working order: . ❑ Yes ❑ No* r , Comments (note condition of pump chamber,condition of pumps and appurtenances, etc.): r - " If pumps or alarms are not-in working order, system is a conditional pass. Soil Absorption System.(SAS) (locate on site plan, excavation not required):. ' If SAS not located,explain why: 04 mns.doc•rev.6/16 _ Title 5 Official Inspeciion Form:Subsurface Sewage Disposal Syslem-Page 12 of 17 - Aug 25 2016 20:01 Jim The Inspector. Man 5085349919 . page 13 Commonwealth of Massachusetts " Title 5 Official ,Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments r 0 35 Wianno Circle Property Address Thomas Cullinan Owner Owner's Name information is Osterville MA 02655 8-2-16 required for every page. Cltyl7own State Zip Code Date of inspection D. System Information (coat.) Type: ❑ leaching pits number: .3 ® leaching chambers' number: ` leaching galleries number: ❑ leaching trenches number, length` ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system - Type/name of technology; Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of Vegetation, etc.): Leaching is three 500 Gal. dry well chamber's13'x4l'x2'. Chamber's are 34"below grade w/cover at 8" Chamber's are clean and dry. Wall's like new. u Cesspools (cesspool imust be pumped as part of.inspection)(locate on site plan):.. Number and configuration Depth—top of liquid to inlet.inyert Depth of solids layer Depth:of scum layer ; Dimensions of cesspool r - , Materials of construction Indication of groundwater inflow ❑ Yes ❑ No tfiins.doc rev.8/19 title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Aug 25 2016 20:01 Jim The Inspector Man 5085349919 page 14 - Commonwealth of Massachusettts` Title 5 Official Inspection .Form f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Wianno Circle Property Address Thomas Cullinan Owner Owner's Name information is MA 02656 8-2-16 required for every Osteryille page. City/Town State Zip Code Date of Inspection D. System Information (cont:) Comments(note condition of soil,-signs-of hydraulic failure, level of ponding,,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of.vegetatior , etc.): t5ins.dcc•rev.6116 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Aug 25 2016 20:01 Jim The Inspector Man 5085349919 page. 15 Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Wianno Circle _ Property Address Thomas Cullinan Owner Owner's Name u information is Osterville MA 02655 &2-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately s-y� R EAR Y yEl A o 0 0 & { t5ins.clos•rev.sits Title 5 Official Inspecton Fort:Subsurface Sewage Disposal system•Page 15 of 17 Aug 25 2016 20:01 Jim The Inspector Man 5085349919 page, 16 Commonwealth of Massachusetts 4 Title 5 official Inspection I=orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Wianno Circle Property Address .Thomas Cullinan Owner Owner's Name information is required for every Osterville MA 02655 _ 8-2-16. page. City/Town State Zip Code Date of Inspection D. System Information (cont) Site Exam: Check Slope Surface.water ❑ 'Check cellar ` ❑ Shallow wells ND - Estimated depth to f igh ground water: 10. eet Please indicate all methods used to determine the high groundwater elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2-17-10 Date ❑ Observed site (abutting pro pertylobservation 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` T.H.on Design Plan 2-17-10 10' no G.W.. Bottom of chamber's at 5'below grade. Bottom of chamber's at 5' above T.H. Depth. 4 before filing this Inspection Report, please see Report Completeness Checklist on next page. tSins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Aug 25 2016 20;01 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Wianno Circle Property Address Thomas Cullinan Owner Owner's Name information is Osterville MA 02655 8-2-16 i required for every w page. Cityrrown State _ Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary' A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria.Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15'or attached in separate file i 15ins.doc•rev.6115 Title 5 Official Inspection Form:SubsWace Sewage Disposal System•Page 17 0117 TOWN OF BARNSTABLE LOCATION -7r�d!/lsy /C_ SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL / �I INSTALLER'S NAME&PHONE NO./Jps � C�1sJ�rar y-� SEPTIC TANK CAPACITY /J-2® C I LEACHING FACILITY:(type) Al Cat Y)(size) Q X y/�f'",c 2' NO.OF BEDROOMS OWNERr-- PERMIT DATE: 41-/.7-le COMPLIANCE DATE: IWO 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 Ac. " Awe7 ey, � y', i 7' y/s' No. 2 0 f V — (6 ! Y Fee l o o , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es ftphratlon for Bisposal *pStem Construttfon 13Crmit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon 211C100,Mplete System ❑Individual Components Locations Addrgs�,or of No. JT �//Q'!�/J�Gl/ e Owner's Name,Address, d Tel.No. As�so's Map/Parcel Installer's Name,Address,and Tel.No. Des, ner's Name,Address,and Tel.No. ell Type of Building: L Dwelling No.of Bedrooms Lot Size (1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _ gpd Design flow provided , :c gpd Plan Date Number of sheets y Revise n Date Title s vcjin/^G�"�' Size of Septic Tank /,S� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He S' ed Date� Z /.*,-7 Application Approved by av of v L Date J Application Disapproved by Date for the following reasons Permit No. ' o Date Issued L d t.M1 r^..,.r.�.,+-"5 A> .F�+.2"rsr�'m awn yrinay�Sj^• T+�qj.. - ' ,wr.,.s�i y3;>+'+v�•4 �rt�s ...�� f a No. 2 U 1 v _ (/ -(/ Fee ( 0 U /f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION-,TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftprication for ispo 16pstem Construction 3oertait Application for a Permit to Construct( ) Repair({Upgrade( ) Abandon( ) F-11 Complete System 0 Individual Components Location Address or Lot No. �e'"s W14Pew�f-J G', Owner's Name,,Address,and Tel.No. 4 + As�3�,s M�/P el �`J- `'lam!//��e /7 Are (.G�' �e� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: / Dwelling No.of Bedrooms ` Lot Size f✓, t'j�� sq.ft. Garbage Grinder( ) Other Type of Building eS/, ' '�'C Lo No.of Persons Showers( ) Cafeteria( °) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 21 Number of sheets Title ,5 5/ C�17 �✓ ��Q•/��!� (fl/e,Revision Date Size of Septic Tank Type of S.A.S. 3 Description of Soil ZZ,4e Y/,,-j"_.4.Z 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 Certificate of Compliance has been issued by this Board of Health. S'gned A Date �a Application Approved by & S. Date d Application Disapproved by Date for the following reasons s Permit No. -)U/0 Date Issued L / d THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by v,xe"qIg 4e/_ at 95 V)6?4,0, ' � j^�'�� �;` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0/0 w ! dated /3 'D. Installer Designer #bedrooms Approved design flow /��,573 d gP The issuance o this/permit shall not be construed as a guarantee that the system 'll 'nctii n as desi F'ed. Date lo Inspector lr! , S No. 2 U!U ._6GIZI Fee f>D THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Zisposal &pst em Construction J)ermit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at 3 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date L/ J /la Approved by l / 6V r r , cr �� Town of Barnstabie � /0 TFLEP iDepartMcnt of Regulatory Services Pub licHealthDflVll�Dol]i Date . - a HARNHTAHLE, o 200 Main Street,Hyanuis MA 02601 9 Date Scheduled Time L� Feell°d ( yQ ' `oil Suitability Assessipaent for Seuvage Disposal PcrYomcd By: ���►nCQ� �1i� _tjlilC Witnessed 13y: yr W• - ILOCAriON & GIEINT7 RAJL IlNFORN1LE51.7['1rON . Location Address r ►� C✓I D �.GtY.. Owner's Name Q /(jr V 1/ Gt✓1 r j� V) �1 Address Assessor's Map/Parcel: /3 / t) Cugiueer's Name LJ.t NEW CONSTRUCTION REPAIR X, Telephone It Land Use• n Slopes(%) 0-2 s Surface Stones Distances front: Open Water Body It Possible Wet.Area ��" ft Drinking Water Well ft Drainage Way .l�. rt Property Line � ' Yc Other —� ft Sk£IL,'TCH, (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands 4n protinuly to holes) Parent material(geologic) O&1W - Depth to Beclrock, Depth to Groundwater: Standing Water in 1-I01e; �ON > Weeping Irani Pit Rcp A1.9v C Estimated Seasonal High Groundwater . •• - �.- ". .m ri Yf WATER 7 9119Yrb ''lh 1LA 11� DE'J<'ERMINA'JCIO FOR SEASONAL HIGH yvr.�s:7l ER uAJ',(U,.)u Method Used: Depth Observed standing in obs.hole: ,�,,,,-_�,.._In, Depth 10 Soil 1pt(iitltst Depth to weeping from side of obs.hole: l!a, tJrotjiidwuler AdJushnent, Index Well i# Reading Date: Index Well level _ ALLI,factor Aaj.CJrpundwuter Leval PICRICOLAT IOR'�.'RST iLDut' / L 'Abie A�1 Observation Hole## Tinto it[9" _ Depth of Per'c 71,I111e at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak , _ Rate Min./Incl1 Site Suitability Assessment; Site I'assud SiI.G-Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Bacic --V-- ***IP percolation test is to lie conducted within 100' of Weiland, you must first UotiFy the. Barnstable Conservation Division at least one (I) Week prior to begiRmilrog. QASEPTICPERCI'ORM.DOC Depth from AT EROBSIERVATION T-I®1L + LOG Soil Hori2on Hole # ♦:a Surface(in.) Soil Texture Soil Color (USDA), i Soil (M Other unsell) Mottling ' .v (Structure,Stones;Boulders, Q' L.5 �o��y/� Con istene % ravel W ' i �'f�1 �T ray- �T y' �rl i .. DEEP ®p5_RR V'�11 JL®1� �®LJL� L®LP Depth from Soil Horizon I-role # Surface(in.) Soil Texture Soil Color (USDA) Soil (Munsell) er Mottling (Structure,iStones, Boulders. ConsiSrenc r %Qravei 3� A Y12 i� I i D -El-El P OBSERVATION 1-10 lL®� Depth from Soil Horizon ][LDlV if Surrace(in.) Soil Texture Soil Color i (USDA) soil (Munsell) Mottling (Structure,tStones,Bouldcm Cc siste e O vel I DE El P OBSERVATION ROLE ; Depth from Soil Horizon �'OG Bole;# Surrace(in.) Soil Texture Soil Color Soil (USDA) (Munsell Other Mottling (Structure,Stones;Boulders, Consi ten a I i it ]Flood Insnrance Mate Ma Above 500 year flood boundary No Yes—A _ I YA✓ithin 500 year boundary No Yes Within 100 year flood boundary No� yes ]Depth o[Naturally Oc, cnflrring Pelrwioljs Materi�➢ Does at lease four feet of naturally occurring pervious matarlal exist in all areas nbserved throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Ce¢•t��caQion •. I certify that on %© � (date)I have passed the soil evaluator examination approved by the Department of Environmental.Protection'and that the above analyt;js.was performed by me consistent with the required training, expertise and experience described in CIO CAdR 15.017. Signature Da !6 , Q:\SHPTIC\PERCEORM.DOC SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR Sou h APPROX. NGVD a n PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS �; �st• ACCESS COVERS TO WITHIN 6, OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE TOP FOUND. EL. 30.5' 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING \ FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o�ey 29.8' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE' REQUIRED OVER SYSTEM 0 MIN. 8" DIAM. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST BLOCKS OR PRECAST RISERS(na)o MORTAR ALL PRECAST RISERS UNITS TO BE AASHO H-]Z( � o��o IS0 4"0SCH40 PVC COMPONENTS a 9 ' PIPES LEVEL 1ST 2' �ENDS H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. 4' 4' (�P)INVS EL. 26.0' 4*28 3'f " .••Qo SIDES o0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10 14" • o 1500 GAL H-10 WITH R 0 TEE SEPTIC TANK TEE '�''�`'�`` 0 ° ° ° 310 CM 150 0 (TITLE 5.) I►Q,.S't o �, 27.0 ®a® o �0�® oo0gg ��(]0_0 �0�® °o°o°o° (BOTH) 6.75 s" MIN. SUMP ° ° ° ° ooaoaao�o 0000aoo�a�a 'o0a0a0o0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND ay 000000000010 ,000°0000 0 0 0 0 0 0 C = ° ° o 0 0 0 0 0 0 o o GAS BAFFLE.. °0000000000o t 2" MIN INT. DIM. O >00000°o° p0 p��ap ap�p p��p�p �p o0000o a000aaooaoo °o NOT TO BE USED FOR LOT LINE STAKING OR ANY Locu N ���aaoo®� ® 000aaa000a� :000o�o�o 00000000 °0 O00 0000O°O° , OTHER PURPOSE. 26.50 26.33 >°°°°°°°° . ° ° ° ° ° ° 24.0 4 LIQ. LEVEL (ACME OR EQUAL) 0 0 0 0 �9 ° 0 ° 0 ':,.• 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ,o,o 0_0_°_�_�_� 0 0 0 0 0 �_�_ _ _o_o.0 o H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. O > \ 3 UNITS REQUIRED 9• COMPONENTS NOT TO BE BACKFILLED OR " 3/4"-1-1/2" DOUBLE WASHED STONE CONCEALED WITHOUT INSPECTION BY BOARD OF 6 CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 41.5' X 12.8' HEALTH AND PERMISSION OBTAINED FROM BOARD COMPACTION. (15.221 [2]) 5.0' OF HEALTH. ( 6.1 % SLOPE) (6.2 % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION 21' SEPTIC TANK 4' D' BOX 12' LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE FACILITY 19.0' BOTTOM TH-1 & 2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF *THE INSTALLER SHAD_ VERIFY THE LOCATIONS OF ALL NO GROUNDWATER FOUND WORK. ASSESSORS MAP 139 PARCEL 8 U11UTIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED. LEGEN D 99- EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR SYSTEM DESIGN. E-99-1 PROPOSED SPOT EL.TH 1 W/ANNO CIRCLE GARBAGE DISPOSER IS NOT ALLOWED TEST HOLE -- �-2�21_ YYY �.80 28�- .61- �28.83 DESIGN FLOW: 5 BEDROOMS 0 110 GPD = 550 GPD 2� SLOPE OF GROUND DSO 9-52 125.00' X 37 7 USE A 550 GPD DESIGN FLOW �Qo UTILITY POLE 29. SEPTIC TANK: 550 GPD (2) = 1100 C.O. PROP. CLEAN OUT NOTE NOT ALL SYMBOLS MAY APPEAR IN t)RAtMNG ZE 29.66 /� USE A 1500 GAL. SEPTIC TANK LOT 105 ��Po LEACHING: 15,690t SF TEST HOLE LOGS 0, SIDES: 2 (41.5 + 12.8) 2 (.74) = 160 GPD � 29.80 / BOTTOM 41.5 x 12.8 (.74) = 393 GPD ARNE H. OJALA� PE, PLS 30.03 ENGINEER: � TOTAL: 747 S.F. 553 GPD 29.66 WITNESS: DAVID W. STANTON, RS USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) DATE: 2/17/10 BENCH MARK - TOP OF EXISTING DWELLING 29.64 WITH 4' STONE ALL AROUND AND BETWEEN UNITS CONC. STOOP EL. = 31.0 TOP FNDN. = 30.5' PAVED PERC. RATE _ < 2 MIN/INCH NOTE: 2 PIPES DRIVE 29.73 OUT CLASS I SOILS p# 12835 � •12 MA `�o .o 10 APPROVED DATE BOARD OF HEALTH cw X 0.23 30.04 2 .60 � ELEV. ELEV. x CONC. WAL x 30.08 L-•j 0.07 29.66 o„ 4 29.0' o„ Q 29.0' 30 . X 0 I 16" OAK 1% s S 29.09 000 O. " TITLE 5 SITE PLAN X X 8" 10YR 4/2 6" 10YR 4/2 0 29 X 67 �X .08 9 GARAGE OF B B I 12" P. PINE 1N 1 C 2 ° 35 WIANNO CIRCLE LS LS x X TH 2 22" OAK „ 10YR 5/8 , 10YR 5/8 .73 29 1s' OSTERVILLE 30 26.5 30 26.5 EDGE OF PLANT[ Gg 54 k 14" OA 28.46 r'9 29.43 PREPARED FOR 29.02 C C �9 N BORTOLOTTI CONSTRUCTION/ PERC 4 28 2� X 29.32 x 29.05 29.02 ALICE LAWLER MCS MCS 125.00' fMgss °F'�ss9c FEBRUARY 18, 2010 �o� DANtEL yes DANI> L A. a 2.5Y 6/6 2.5Y 6/6 OJ C OJALA �ZµoFM,� off 508-362-4541 fax 508-362-9880 downcape.com LA down cape engineering, inc. 4 120" 19.0' 120" 19.0' �No.46502 �� - 0. �� /STEM �' P civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' z a_20% p Fss� G\ �q a suRv� land surveyors 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 ' 0--030 0 10 20 30 40 50 FEET 10-030.DWG(SBO)