Loading...
HomeMy WebLinkAbout0225 WIANNO CIRCLE - Health 225 Wianno Circle Ostervilie A= 140-188 Lj W%L—ji. o ° 0 m , , n • a < < P 0 e t n a d a , r a a � n ° 0 o y 5i ^ s ° o : ° P r ° 0 �_ �_:._ ,.s. .. .. _ .. a+.�w�, .:. ...a s �1-.-....�.°..,._4 .,as.-. .,...m ..a^•..�.., or_.. ..++r...�n c..�,.. ten.........._ ..x..___ _ — - ° 1 vg �" 7 x' � 9a�u i .= •s,'r3 ',`2.jt _ t�.,.to ./ n �t,' f'� ,' •, .p t� e .�5' .s z r t ,G,.�p'� 8 M+A.^,�tyu. L g �7r •` ry Pry rM}. 'zO A`R14,4 , r 4 Ws r"b �#�' w ,rtx '� Lfi s LA �� tJ ^['•a�g ��}?,` '" /%j •'/ /����'�,�.��,•1-'1 t ik!'� 5P c a '" Mn.;,g',yS e��' 54 �,y; Y 'k�"•'�•.P-.�"'t� �y ,����' �`�i�/���`�—/V fV``'rF�kYa'��sSY�"#,+nuG,�+'+�r F'�'M�j '*''�y 4 ..a s� gs Fat e_t aS ; `�1 s 17a' •�„'' t• "�' v 'q �' _ ' Popp 'c 1?�ir 3 s, :t :1¢e` Pp'`z 2.nCv ..t'#d•+ •axa.�. NZ jj �y F.: ✓ �,,,.. y ys. ; y re�SitiAr y,�t;• � . -3#� ��'ll`,.�e , #��Y( I ^,,7�.�•�� �� `/ - ✓ •rrry�y>�`�fi+R.+.�r'�F.d•^' ��"t*c ,r�.��. 1" j ff�F,(C 09 `�3t33Y �i t `lb47 \ /n/ .,,,[/^/ `"fir 1a {��.'e��j'f TFq''� d �`MtJ4'!) 1�1 5 "R•s i} 'a�i}tph Y Y' / V' �ti 4u ' s�,tht> 'S" s' i'{xA � S e �,#S.'. J VV 't �n' rye a�` `7 ,- s r,}. 'w'g;TC�."i"'t :g{ $,3bK4'cGry�" q�" •jM1�_ fA}• + Y '! T ,�"*n �, 'j .i" Y'S" } 4' '�.'�i•�`t S tiP-` 3 /�� t r Y+R"'�N y4 Lam`^' �'��•�P� s^.+ t>reC`."`.��^ �G,. F §i . ;4y 3 c ro t iduv. ri y * s�3�p t " a° x"s. t�.���. � - - s a"v \ / '`���I%'� ,�R1��,.'�'� 'sc c wF ',emu"" .•'ti 'sp`ea•�R,q-��r, RYY T x:r�P ��;r7. y §� ///''���� itass'#y�✓[. �.yj���v, 1 ,'+.��'P�"�^6�-..r,i5- ���9 �' . " f XX y G ,�g'nw Ll E, ' � s: 3y ;.t a =,'� .. „: �f kcx '.:_ �, t.:. ,.� v rse F::=.s• �.,:, 4�-y; ug rF �,.s ;S. •�P�*,. .# r k 5h •; k• c i d fiT} 5,"' *� .:"a i•F vi x�f 117 �'• `k"e,,t «F i>.' % '-��txt •::�?: �#.; � fi.,,•L x �" yZr ya ���, �' r T3^ �° �{* "3 -+� ,,.:. r f. w�.�fi^4, •j+.*G �`^ .*°�,�..�'.; -.. ' da. :e +mac - kd.- *a�' rt '.� tir y x' >'""•'`..�,x s ' �€`a `�, . 7' w, ,' t t r S. :�cr "r 'F'�- J .,SQY� ,✓r" 7,xY �.="v .4 yh Ys ^s 9 Lam' 9 't�.*�• $ ht 1C a t 'W�i ,�}, 1 .T.�''�a��A . x" , lv 4 u ?, � c �a aa�yam ". gP` x c'P sue.. ��sat ,<< sh «fi. r �� t v� �tna�o .h i�'�`i'�,p ,�, .. a ;�= x t ��-� � a r 2t `r ra, .Y` ?� r' ri�� �.x`; ,y^ z -+°ti�3� 7 ay.:•4'sa .,rt_ z-tM1 c v.+ctY}f »t'a;s. y-ni�z,¢h C .y; 4hy'r- ":wk A,y tR•"�. ". ,i,. .•+- n. Y ,ki ,# r § � !-• '-f .e-yn{4'.:.f rt > M:'+`,a"C'6,d-. -4� y a> '��P =7 `x',4. ,$4.0 P t',-". ):.' ?'�Y' 'iR:`y+sY M�✓�,•ii. riiSi yO�cF'3 ���,�� r�, a` y°+• .; x kayo ¢�€'",,y � `y`�? .y ..#.qla*xa# w "''.:MF's '&' fha 'ram 'r'r,:; s• �.vF",#,.. 3F yw e'm ^,5.,. la��Fa fd�k 4t� t _ €- ' 7 'a'" o� "-r":v '+R r y° ° a "r,3 �� :' .,.4��-" k p� :� �'> sa, iso v a �' '3t t Ga Mry '� ai.»i� •ct k i J� �s?„ _¢i�v t^�''.�rr'••`k a�r�.'..�a.,v.h:s'�a�'rx k�B�w�3et4-„T�.�..�i�.".•.,:�k.��c' 74e'e�`"r ty'"C�a`°`•s•�e'�T r>;"#Y.•:a:S=.�'�t�'�t'v�'a#t�;�y;Lr'"��g'-v 4's."';:'r'�a�""'''��P"f is s7 1�'''l�;•_.:.eas-f..=`,s5,.'yYr*s'at+5��`a`�#14e`0 a�a�„a...."•t-".::.s:.i,:;:•�'zin w+''.�'�^�a ..f'F°'�de•z'?.'�-{�7-da}`P+�ra..a_ .s.3^�'�ia r r"�u34-1'•-a..t Y`n_a�`r s��•Pt k':�����.k.5,`�'� ,e••a��.,H+a.;.•.re.��f,:'�-;.w�#i"Aa�',q fi.S tr,R�t,'n.�.x�#,`.a�a°,2d�•+.,^y'i�5t"k�•'�Pe.`xt-r-+.#,�+,,.,,a�c,' A—t`kr'� , i f: d dt;h m♦''�sY r."��'y`t��5 aa�f:,.t�-,rs�:-;v�.,.:,,.='+.�a. 7'7 ` .; .--„ ,�m�.,3�� ��. ,aa as ay,, xY,:x �+,'. e+' � y7,� g` : k'i z5 '��`t60 iq' s 'ti1, 11{ iyyC s'"„` n '�S*�-in`'e• :d7::rr<,.fir: '�t �'J�' ���•C'S' "..f� ��` a ^-'� ` Vic. rr,,� x. ��Fsr��! a'��A'�A'�r� M;., "�N F �' � � �+E;1" �'�_. "�'` st -M ^�_: 9� '' as°'7""'w`£`'m+• caa4 �- �� �`i< >•T T:. n:. -: t ':s s T y. `*t, + .� ,'„3 ,^i '� p .n•�a24. `$T',. '.P rr:.' '�°r 4• r�S .l .,g !r F" +: r 'a .,fit"} +, �. d•. '�vs'� S-.:i ,.in.,, �r§`�" :' '>< " ' i "" t r3r: .•,i"'r' ,' `.�Jr t'�. "tr i .Pti n �x'i4,`'� �' tn, «`4• s `..'3"uM .. ,xs... "�, ,,r. ,�,b q .:a �r�'S •ie < "� �i'.r`�n $+- nr "sf ..�a'�.t" � `�_,�r' "„ �-!. s•'v '� 1�� i a:,t �' $- s&« •p`. �fi?`' Pa4Pt .` r^y, ,�� `tt ,' ,� .,+ , .Y -.✓ :�,:;.:. ''.Q , ,ex ` "t'` '�`* rl s,k.:'�' `'`r a�`�w"`>r+ .` '' dn'r#.' ;..u'' 'r (1_:s �.'#`�, r` Fae3 ` >'_',' �p3SS._. n ��P rx x v 4 •'+�' c`2,..a ti.`+w a':,. 'nTSS,ac. t `z 3P•i r,,_ 1 3 x j a - f"{ r a „ y� z;r+ -A � � e , i 1;y ' M g "•nC .` q +r•.Y.g�y� ina^ ,ts, - ..�-,• � ;# .� srt5�'�" #r*' '��a* r � ` , �x t±.: L '� Y 'z:,Y. c k A i� ;'.• q i'3'•s ,r*',.o i tS §, '.r ,�S i a'` r. '�a�gt7 °��wt t, �.' t � .`• ,q,. • St _•�' c-�' r-- .'a'se's ?c�Y"' zt a r,P" '` �:: �„.A a?¢S++ '' s �.t?,� t•;;�"`�"�`w s. a C.'�� ,n>5,'�.7,�r. A° � '4�� t.., •� � €`y ��,s'�'"¢a,;,. �Y'�'a ka,} y�_•r_ ai'y �a 4.�'�'� '�,�. w,:#�� �, a� -.�.�. �" *n �<,,�, rt r� ,-c. `�` '� t s�' k 6�f: •�. �. -�•„« 5 ram' r�.h" 4r 6�.A .' �j� � � ;r, � X ,� � R� � a '-°'+, ..>'� -s *. ✓. .,�. �.." �:�,�: TOWN OF BARNSTABLE LOCATION 2 2- CX,[C 1'e SEWAGE# a®12.-C)OG VILLAGE c�yy�I p ASSESSOR'S MAP&PARCEL 14 0, J f3 INSTALLER'S NAME&PHONE NO. ,, I��.e Ac lea(cX0rJ J AX_' s % SEPTIC TANK CAPACITY i S C00 LEACHING FACILITY: (type) dtc.1 f C kr✓w hie (size) NO.OF BEDROOMS 5_bet,1rrJ OWNER PERMIT DATE: ` COMPLIANCE DATE: y ✓/p y Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Ct �4 T��c-�- 3 r —43 2- ai a --sr) �G T isov-LP3 S 1 No. � Fee d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppiitation for Misposal 6ysrlm Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. -2-25'LO i uar4© C) orC Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /t f 5 In ller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Zia L Type of Building: Dwelling No.of Bedrooms Lot Size / ,XO sq.ft. Garbage Grinder( ) Other Type of Building ./, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) j gpd Design flow provided gpd Plan Date %) ;3/)-L Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. `j N 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 Health. igned ' - Date G l Application Approved by Date Application Disapproved by Date for the following reasons Permit No. c� Date Issued f c91 No. � Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes M Zipplitation for Misposat °�'PBI M ConetrUction permit Application for a Permit to Construct( ) Repair( �Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2.2 5`W r r.�a N O C, I C r. Owner's Name,Address,and Tel.No. s Assessor's Map/Parcel /y �� - 1�` i Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �VGUS1co Uole S /4>t � Type of Building: Dwelling No.of Bedrooms 5 Lot Size / sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria R Other Fixtures Design Flow(min.required) 5 50 gpd% Design flow provided gpd Plan Date 3 /-7 Number of sheets / Revision Date Title i 1 Size of Septic Tank /!;i(Do � � Type of S.A.S. 5-GO C.P(Q Description of Soil Nature of Repairs or Alterations(Answer when applicable) //JS i G ll A)r(,.L) 5P•r01'/r a 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. 'igned ` Date Application Approved by Date t/ Application Disapproved by Date 1 for the following reasons f Permit No. 0 / �` 40 Date Issued t 5, t 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 r r r.c A 1�ou) rat -1. Nr at 2 r S" Vy ,r�. i J< ,(C 1 110 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nor9�79-C) dated Installer .�� �`c /� (�)"i ro Z ry r Designer �j Yl �,,� �py I1---"" #bedrooms �J, Approved design flow $ (p('> gpd The issuance of this permit s/I)a11 not b construed as a guarantee that the system functio ig,ed. Date G�/ ja� Inspector No. / (S b Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( kr­, Upgrade( ) Abandon( ) System located at 7 7 S' lc/i ct .n..iil/G Y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with r Title 5 and the following local provisions or special conditions. Provided:Construction must e//completed within three years of the date of this p�it. Date �') C� Approved by�-- r; Town of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division �`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 i Office: 508-862-4644 Fax: 508-790-6304 Date: o4-->a- rZ__•. Sewage Permit#20/2-0g3C2 Assessor's Map/Parcel kayo -i a Installer&Designer Certification Form Designer: Installer: �� /�, _� _UJ Address: 4-r— Address: On was issued a permit to install a (date) (installer) septic system at 2.2.��`, HAS C.ccr_ _ based on a design drawn by (address) dated -0 3_t Z (desi ner) 33 I certify that the septic system referenced above was installed substantially according to e design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component• of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required)was inspected Boils were found satisfactory. ttiss�® �k OF pHEN DAVID� � Qs� oY E nstaller s Signature) B. �\ F MASON M NO.1066 __r ®® � �F- �yo�, \ c� � co, ® qND SUF� �® Desig er's Signature) f amp Here vv'f PLEASE RETURN TO BARNSTABLE PUBLIC HEAL IVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • .''p� 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Cisterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection 6 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. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Robert Paolini 65 use the return Name of Inspector key. Robert Paolini Septic Service t� Company Name 17 Playground Ln. a a Company Address Yarmouthport Ma. 02675 City/Town State Zip Code 508 362-3555 S14454 Telephone Number License Number I' B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes 0 Fails 4 :er0n ❑ Needs Further Evaluation by the Local Approving Authority F 4= 2/10/2012 22 Inspec or's Signa ure Date H The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. ti la t5ins•11/10 Title 5 Official Inspectlon F :Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • ,M Vey' 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yrY 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No I] 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 ❑ n Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ M Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑x 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. ❑ ❑x Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified • laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑x ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, • or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • 'Y o 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 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 0 ❑ 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? ❑ 0 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? ❑ 0 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? ❑ ❑ 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? N ❑ 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: ❑ ❑x 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • 225 Wianno Cir. Property Address John Fawcett Owner owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: NA Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? 0 Yes ❑ No • Seasonaluse? 0 Yes ❑ No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes 0 No NA Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No • Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑X No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. • ❑ Other(describe): t5ins-11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ❑x 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1 e+ p pp y feet • Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts 19 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 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.): • Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle • Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: • ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): • *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 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 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.): • 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: • t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: 0 overflow cesspool number: 1 ❑ 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.): Sandy soil.System shows signs of hydraulic failure.Heavy staining in overflow cesspool. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Main and 1 Overflow Depth—top of liquid to inlet invert 6' Depth of solids layer 3" Depth of scum layer 1" Dimensions of cesspool 61x6' Materials of construction Concrete Block Indication of groundwater inflow ❑ Yes EXI No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • 225 Wianno Cir. M Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 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 vegetation, etc.): • t5ins•11/10 \ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information Sjrstee Parcel Viewer Custom Map Abutters Map Size Zoom Out 1111111JIn 5 777777 777777Oil s Yam;,'"'- a , „s R EMU t Y5 i � NIEE r 3K r �a x rN rp 9 - 2 YF� '1 3a { Set Scale i" 120 1 Aerial Photos W1 I MAP DISCLAIMER • rnr vrinht'1mr—oni0 T^AAfM of Gnrnetnhie hfl6 till 6M to rceorin - http://66:203.95.236/arcims/appgeoapp/map.aspx?propertylD=140188&mapp... 2/13/2012 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water 0 Check cellar ❑ Shallow wells Bottom of CP 18' 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. • Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 225 Wianno Cir. Property Address John Fawcett Owner Owner's Name information is required for every Osterville Ma. 02655 2/10/2012 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file • t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ii LqWMMJADrY V:ViI Er •. • .- .n ul 171- � OFFICIAL C3 Postage $ is Certified Fee o � Postmark� p Retum Receipt Fee ' Here O C3 (Endorsement Required) �O JUL 2 L�lUB --` O Restricted Delivery Fee (Endorsement Required) O � rrzi Total Postage&Fees $, il�p . rll o plc :. c ��S -- --- ---- --------------- ------ meet, pt.No.,./� /, M or PO Box No.I'V a !�� aG UJA— tat,ZIP+�4!' • � ,n A^�� Certified Wail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail& n Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking...If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Flynn, Judith From: Crocker, Sharon Sent: Tuesday, March 27, 2012 1:25 PM To: Flynn, Judith Cc: Crocker, Sharon Subject: 225 Wianno Circle, Ost- update Update on failed septic: Caitlin Fawcett's father was in trying to track down progress on septic permit. They have hired Stephen Doyle to do the engineered plans. Mr: Doyle has already done the perc test. I explained the process to them. They must track down Stephen Doyle, get two copies of plan and have an installer come in with plans and take out a permit. They will do! - Sharon 1 61 \-1 - •� mot•�. W, ��� _ � � .. - �,��. 9,r•r.k' �� xr '0 :r'.t,a"r r ,$" ' '• ` s," ,•r."-a.riF,a�°s` sn AkO z„mr.�^., , _ C 5 t £ � i_ L'{"✓d' J,N .� .❑,,...M ..0:4. .�:� t� k':' .� :C�� •`t �.-v �1 4 ,V - � Lf r _ eft? L.w� `:.\- ,t,q "•;v-:r . - •• � = a•>"-'te.a.6N."�"yri-a:'Y-+v+c� -___i"i� a an'!ri-,,S'rrY�";_ '^"- '¢4 rg`�y�_ ,�Y.xwt..: - Z�o }.. >v� r1 5F 21 V Y aaa'ah t w i f 4- t1:�. ,.F ye .r .-:« a �rcwn,..�.=..�..= ...- G�, zP �r a,..�! -��i-: r" tt �' roY �.:r?R� xT#.p•`'�+� �`-"`•:"_v,m..,E,. '�i �` 1,, n1 W���, � at r1`•.�fs,�. - uw. td.-�,,c�i�'r,,��x,'lT�y,3a •'�s'3,k�-,Y ,w�-r �'�� t.''^I:<t� � '.x""&' {•�e�.•*t:.,sa ��` .'�,x'k '�i;: ,,Lwt' - ��" a4, 'x_.. 'ce .�'L, kt'•ti fx t _'€ �' a 3"�3 t- d�..ya'Ii'q# 'fin;^' i'`,T t4tY mi '�i Board of Health . ' S( .. < =," Town of Banlstable 'rr' 200 Main Street t,""�'` e 3 af,. .z'v w�, '4+ .�:. a,,•' t.. .,..n wt'�, Y ,a'� .•- Esc Y i':: k.,`.-'�' x xr zj Hyannis,MA 02601 "`q''' a,�n ry a*<.,.;,,+,r "t,Lar•C .t, }•A, r-'tt- "y :,a,:e+R`t"� o_w-ta'*'2�;p. xi +,.. ...".. Nc'ti.. <T-^v- -- --.�- s , •, �.-.• --,.t» :::v">t '•.c ° '.:« 1;,,,: r a`as:.. _.r. .! „+ ,;.,. .;3v - ...A ya' - t!-�i#-rL .l' �."S.s Pe .• sR.. �•Y-Y � i� � .�. :�.,,,>... 'L`` ',_ '6:+. .t�. .R.,,: ".'�»,d •1 .. -., ..: ,-.: s .x >- 4r:x: _- ... :xs.� r -e .. _.,,t •,`�:;..�'.- :.a.+ x...a .?f` $+' g ,...r i-,..,- _ts'.s. -.-�*...:,, 3:.. ..- '"e ,..._..,. .._: � Q ._.:.. •.,,.. ... a .-, ......�� ..,. . ,- .es.-r.... _-,�;.,+,^,.-�. ,. 9 �.,1:�:... •#'. h � - :. mm ;�-'. a� - �-::..-4r�asR.ti- �--• �., x .C".5 _..Fa - :v-�g{ M'.✓� k'.:� .-p.` a:.-. :>L.' {,, ..__,. ,.- :zt- .... _. ;�, -2.a,... ...._. , �-;_ - � -.K:. r•'.'aTc. 4�,y+{ �"' ,�,:-.. :.,,.c ,..... c. - ,.. a -_a..: .-.-- :t • � cr+, .. . f ,1-t`:- -.d'a�>� ,t. .. f. ...,..: ... .:.,. <t". r..�' „,.r• _..•gym'-,";F .�..<t ..s+... :..,... ��-.t .� ,xx. .. _ .,*: ;,ry:: a-�. nr "^'�•,'�'>rF^i,.iw•a. ��Et `6 `,�'te `��,� . k..�..,i '.-.,..:yma-.S=3 K.,._ ,� .. • ... .r s.'..,." ... �_ _., ,..., '. :' -. .-, ,� ��.fi& .,:. ._.'7+` r�. ' �•t F-- .. -..... ,. ....>:, ..,... : .. _ ^x > .. ;.. a -�Na. xs .,a .•.� ,...., r ,_. '- ,v". r,:: x.ro2.'x > ..� ,.,,.. .- .. -. �y •_.�,:., _''� ...,_. ,'j,..._ s"a �. �'.,�,.,�4.V -,.. .�.: ' .##t!rr#�' ,...... - �,... ... ..L v:.,;•i.,ik�- at4✓�'i. R'. "'rye �i.- 1.� vC: ar f^.. x.,: �-:Y� :.-6".. .rT•': emu.}..Yi- -/i-'S�v`�. :+ rW.t.<. 'r✓i�•g+5.-r. $; .�$� �Y3.a:-e� r_ r-;fi,Y; -- '.:< �.._. ....G- n 1..,. �x.. � ..,. i_4F! " ,,. .3;.: - F•• ?�4% `_ ..-T„' ,'lj` - y,.'a.". .0 Y"c�' _�i,.. b ,5:::. ..+F-•-"R;,.. .... :{•,.. 1.,.. .- _ ,--.�..9 ..2. N a P'.�. :•/�S'fi' ... `:"<S � r f, h * Y s. }�1� ,*w: .- �a s•... v ......... ...... a,- .�.._."}:_. ". :n"-:•. <"�€.. - .,i%..�jt'�°. -�k. ;.fi- �L MZ'� f, �7 -'ct is7'L e ( .Y;a,. '. .ems 't« .r,.•. e� ..,�.. > ... c-_'� .� - ,.�,4.. '}:. , 4 >a-.,: .'�. .?,. . -.,,. !�. _ r•+i' >� .•. R- ..�"' u,,�•• .C„. #�"•` - �".,}` �M .'�k .,..SS 5 •5:S -% .. -n " ...... .,.... _ _ „a: ,.,. . ,.-�.•'t 1 '-td :�trP`A... R X3'. k ,5 .,.t� .'f',"l• ^. .'I', ,1`. at' 6.. .a:. y i,.. « 9.:` ate,,.r ,.4, ^.' .. �,. ,,. a yf, .-Yy��_u.t; }kn,, .. .a...ti. - ?*'i< •.� �>. «",e`��-tf��_ ,' ��.'..,, .-. ..: .. -,,.- u? . n -. .•.u.,:,,. •w .- � ... .,-aa.�.wy,.t-�q. '`�:, br 'ts..:�'" c ,.,.. -- .. t � _ ,�' '- .:�` - .....y: -., .,:... v _+„,.�q�'..:Y r.._ � •- � t+' t' y'3..._ "fit '.�,'� t...- yvt.a '�' i'1 .u .. E, ,. 'ae a.„_--,::.�;; , .T v -';y: poi'- .M1v .rtYe:L'. 'Ci 3'--,_i". >w .." .R; '»tt' '' _ ;>.. -.'+usa',. C. -�-'�-,ta''"$, .; ,....3 .- >g. . Yr... -... _o. .'.'+ ..f...... h- ..4a.�� s•s.`.-. r .. ,,..,,a'^=:esx'- :,, ...•£:.. -a 3 " ,, a, S ....... .•wc, ''> ..' . .- tiT": -- a...."Kv e,'" ';:.. A.`i" .,n!i ,m_ N. ...,.. =s:-.5.:.- .' '._ ks.+f'... _,,.., -:..w n.- ,. _. ." - ., '.,ut{��� .:•d''". .Y.,,. ,.;. 'C..:..✓�,.. a "w� dr -rr ...�i:r �. btr.. ,.R-�" .v ,_ ^...: •,x.,tt... - 4 ,5.. _ ..,. w ...r„r. ,: „ 5.=z,. .r„_.... 41, s.y., i. -�..�ry., r »..,. .x_ �.��,— ,:a _y—,"4 _ ,. ,lrb�. : .,' ..,�"« w .t .,"m. yi} m't`c ;.,�^'ti.u:,-.r`" :'t•':r :,*".y.."f•:s• m. ..r=-.-c. . ;..- :, .: ,' ,-...__ r.x. '' ...,t... ram` �,: ,. ': - i' ..�. ... a a,... ):-:'>,�_ .. �-.. .. �. � i7:... .,. ..... -.:4'. �.. :� r.� 'wAP',. -Y�. j:!': .4,'}�+ t _ , , .x x .w a -.5 �F mom• ,.-�` >.r .: "�' ., - _ ,....,'C,.< :.._. _. _ . . /... J. ..v?.•. "a 'S, , ..s _ _ "+.cr ...... :: f s„ :r' �,,.: - l es.M -�iru.. 4 .....---... -•.:.. r t. _. ,. .., .:•.-+.,.m --AT,. r .._..._ t.,3' . .,rat. - C t .w. �1'drM.;.. ... - .- ,,,"N a, °, ', y -__, ..'•a'Tl:•...k1tY � �->.°�.. _. ... .. .. ..a...;t.��sa r".s',�" •.� t.:,2`b. Pw.�.u, 7 . .,! �K .�'e ,.c r. .�n_.., :w.: ...s. .,. .. .�-_ w..;. -"v .'.L..�c. %, ., ,.._. 'e»..+,�:a F... - t ,.�. yl'1k:,t t` x 4 'c '• t +:'^• wra ' ,.:'.r` S x+:'� "., ..s .c� •, zw-'•e;n ....,s. tr» .. a:.- !•r ..�,2 .-.�.a ..�,.,.. h..y- ., -+.n. }...}.LL. - 4f" .. " a. �. y� -::. Y.,a..... .:..; ,. --0..r:2 rfia;,.. ...., n #JL "-,< +: _ y�,;v.,-, .. •T„>t._,._ r. -_ v_,�iqr .�qr r+•`' : ;-",N._ �' �?r^, -4*"k" rfi � ,#7"D.:. { d "._t .�,._.. 1. �..: "-�`.y.,n -,..r -,a ._ ,A'", >b., 7w. _. A._.t. -'.,'-R' 'S7 i*�' ,:... '� - :: a �. - '_.'t„ .'y�•:-.,.. T` _n t..� .,x::. , �- .:.,.., ..w...% ..... _,:.sx -fry, �..... 1.w... -. '.'�-`5'' m4.:+ .: ���_�.,£,�. F-,� •+ig::=`ws - - 'r{: �„ .sy.+-; ; tr .. "_,+... ,.H- .-., ,.".. +ar�'..:..•..�. a ..`-sue .,:.a� .�•+, `_.:,�>, ,.,. -„ .�?'. k -x ea,,.•,€,.; .y fP%" _ p. ; :•s �,��� ,�„ `# { -�`^-. .,i.,......:...-;..k.r....:e.-._....-a:.'r..._:�._H�.+...:..-_r..,>.,•:.y.,........:.:......_._..:,.:"._-.h.....�,yh.a...:,W,+4..-tK-...-.,.:.,._.a..,u..-..,-..�,c.,,-,..1.-.{t.',,..:-:,R:ar.r,,:,t:a.i.!:.+..✓.:..S',r-.,ixn...�..'.>a�.._�,.".....�m...�,..,..,,. +...:k... .::.�-,-a.?..LK..s...x.s:.".Fu.,....-.Ev,v..a:.�,..,z�r.-ac r:e k.i$e'��"w.."3,�y..phXc•tu«�t-^,�...:.h..,-L.t.'��.k,.n,-.,.'-,1 r;'Y..a.. t.a7.x,..A•..;...,n..a�'.,-,a..:',S M.."ys>«v.-4-',r w+..+�..::_r'G..'.>,�.--`-'Ta-;,A_..:>a,y.:,,:..tr..R.._4ea:.._.,,-�-:.-'.<x.;..e:,om::^a'.33'ft,.„_r r�.r�,..a.,�t.e.i-s�.�a'.d`a�,t k1'r,�x c"--,...":.:...'4.r,.t::d.S.�:a_. .%'.{:,..9 a,,i.pcdt"."e+��',-,�:.T w`w;,.��,.R.,k.".r 3.'1'..s.,-,-;o•,y -'...s1`'°`r:,' m,„an,:av.3,..w+F,,'�att�i?t4'•.._ '.-•Ag wY1 w`��$te ' , C ' - � '^ �.�r- $'"7��.'t.M•'S':._E'` {•.h,.t^��.e1-^'.,`..-°,�r=".�E.'!�kr.y I iffy m ah 1q�t•�. 'N r �,.,k: - ::....- :.;"' u'>_., y, dl, t !rt s .tyw_ ,:: .;A.✓ -,: .yra•:iv._'dl._ - :. -v ,.`awry .. ,._ . - - '?C;mt �,'':ns.. z:: e..�.:...:. -.-_ .. �...-_--: �.:-4:.� t. '., t .' t.d•`_t,�'. ,,:,. -e.� �'�'fP.,- -..�"', 't*ax-ra.� - �. :ate : e•. � ..' "iE�V c. .'.:.s^ - a_3>.:. -.�v,r_s�• _....a. ,'f-r".F a,.. R!. Ss ,' < °' :: r 'ti kP. nn_'F.. f «F - .: r�:.�t k ,�• S. F re .... ..,. ,.,. .. ,. «.-` ..' ,. .:..•a'" .• .,,, :... .: .i-:.. «.:- r � �R.. x ._ "-.R• ,.5 Y 'i,{, �„ :$' k'$ ..,p���w 4 a' :. � -., ,titek y.. ,...SL. '3{. '.. •. .:b.. n _ ..p't"-a. °:.}s«T~� <t,"k- - a.r R... ,��� ,-�.,:R :�... '+ 8• -. x: _..:. .:_- ..-.w .. -:-- ,..r. _. ate._-._ r _ ,4" ':-}, ..<;t: ,y;�• 3.-r ..: ... ...-. .: :-E,. ;'�. a� r• :.. �. , ... -,*,,.sa ,a.att.... �• ,,. „, w;. ,., '.. _ .,.. ,a,, ,,. h^`, -,t'�res. ..- mi * aar «w'u P «:r x„ A. . '. .f.. - �jy� ;,. ',. -�.,..:; ,,:# .Rp .d •-t4. �''S ,k,`.'.Z'i_R+a` - �,�; Mr. John Fawcett 400 Hutton Road Dover MA 02030 � 5 �'ri " k p4 y r .,g yu5` w pv�xY3 ry� { .z y� t u �1 ' pi AF '"'Ke S.R az - - p4 w ' � � -<3} Yv :'r w - .., pia.+ . ::...:�� t.�. �.« p:;x; " ,`'; � ; ' <✓ _ c � '�"1 x�, S,C, a k :t cex`l:'. # x,p i � '° �+s`. tr•Ss: �}a-. ra� � ar;;st,,a xu-:r �t k,..,,.y- � t„tF"' -t$� } .Ti - T f. 3 *--• ,r ° .•+- [5. :,,: .. : s;, R 4 , .i„e�' ,.�' +. #�� �'• k-.y_..asPr' r§ y+ -51 s f, �s: ��.• ,i :- a..4..:aY.#. A 5+.¢. `�, Y.,-;,,,+,, ,. .^ `,'�.. f •}'3 'v'f" ,n-`�'td. • .y +,$ ,,. d�iv ;; q1 p:.k `3'- .-:s `t..' _4t ,,• y, F' '�, �� Yy�v a. .,a � '� 1 r,s" r ;r. ,yr, _ k fi P� °k��'•.m:, .., �:,.r -., �y gt � :.+� �t t y ,.. t a'•.,'. .n 5 1 c., y, r •7 Y 1-�f E yEs'r :< z `. „tX'. � ,v .�>t �•, .,�FL"" ' c�,„b +..,,,_.q,ry t ..,,,.a w .,;' J .r 3„ s .. ^N �. aa< { ,.y ;:v .. ,,.y5m rJX'a ,•t,�,•. t i €' M:ti. k R-Var`i "t 'a L� a d .��;. "4 ,;�::s �..- -r to r,a. •� ,x ,. � x v:� a a +-_,�,# t :.;, t aa'"a$' 4,t.-�S R+A» r; � •.t. "�' y, t„'"�" 5 _:-r ,y+.�_.'. ."5 &, t .�+ a � +,'�'f 4;';: Y s>�. x i � ! *"L t a}.a `•'# "�.,;f 4 :5 ,f->F� ,..Y �` .-t '�"'.AY W d '�.'„ {. yrt"p^4r,A G GA ,gyp P'.•d, I'�SV� �.i,;:W,t W Y'� S C' au �N ��i, _':� .. •a ;s?': r' ba"�'ia�,, a,µ- ;:� en ,.,,..-,, ek.,rw�:„e ..;:...,.;tia .,Rca+•.+r',�;` '' ,x. -`� i � � .�'"_..' a•W. 'x .1,.. a, -l;„ �� ;k:.-r "3d"'g nf•� „� .�,:_z`-,}'., . a,: i `.�+'ier' # ,£.. <a <:t: .•.�r ,.;<s '°{ -'�:?,_x; `.. *Y.,''-.:: ,.,•�' .._:t �. ,�,is.. '� ...ar,�,,w t �r.� ;..f...-a ...a c� .w ]:-� ,, ,.4 #t t* .�._"+;,a� r' .n >f#>.,- u.. :,c �F x.. .s.>e: *:t' x ,.:".. ram#. ,..s.. i;... ,"w,•X� r - 'a'*t :+` i -" .,t. r ,a „�`. s x; ., -;,,,n kt �.... -xr-;.-., .t M:.. .., < : '1' .,. �='_ :.r.... r.,.raa.:, fi t, �. a ry::k.: ,,r4,:;R••,�`A.:c,.. rr.,: ,.•,wt. `,., :":. „A :".`' ,..«... u?r"k�'.t-:'h°Q" ',`�'•' x ..y,; ,p m:g y .i"< <afi� ,y.vr�. "�'- ,."P,' .�$qiG*' �• :,„ ,a;a.w .-„�'•�°° .w� rr, <� .i. ,s- ,xr.. ,� .�; ,..�t.3.v�' ,..a:-, „,.;<�. ;,r�-�sa+.. w .,, :,a <.."Yc ... . ,: ,..': -,' .r,.tw�, -��.�a'-.`«�'+•• c�m�" r -.�; �'# "�r"a•,a'.,,, ,..e•. <a,�,:, '-�' Fir''-.. :,,;.°` _tom";4. w,.er.�..a_.:.x .� ,.,: .« ,�.t,..:. J a� :w.. .�'q..e,.,. :,. y„s.w * „ .x. 4 n .�.t -,.�'a�Tr'.°, �'-•!« -':t -�°iNir`Ay�py�'���u�,•�„,�ii *.•� `���, ��- � gip,.... .�,r- � :r.,A-3 i N ...n-� - _ _ UNITED STATES POSTAL SERVICEId a A,xwr First } .Mfill W. it G-1� 4�111-1 . .. . 31.424. ....... O Sender: Please print your name, address,a' i +4irt tt3t �- Town of Barnstable Public Health Division 200 Main Street Hyannis; MA 02601 . �siEr a r '.FF FF��'F!, s FF s:r lal�FF F F;rl' F;FF s ! SENDER- COMPLETE • COMPLETF THIS SECTION ON DELIVERY ■ Complete items 1,.2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired. ❑Agent a Print your name and address on the reverse X ` ❑Addressee so that we can return the Card to you. B. R e' ed by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, .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 41 �Mr,'&Mrs John H. Fawcett 4 Hutton Road Dover,MA 02030 3. Service Type ❑Certified Mail ❑Express Mail I ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ,t ;t t 4 i ;t7�r11y i 47 �,�14 4t 5 2 5 5 5 0 1 c (transfer from service labeQ PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 ur- �_ o � Ln Ln Ln ru rn Postage, $ CerBfled Fee �Q 0 Postmark C3 Return Receipt Fee O M (Endorsement Required) a JAh'. Hre^rti2 p. Restricted Delivery Fee 1� Cu (Endorsement Required) O Total Postage&Fees Is vSPS rl d Mr>& Mrs-John H. Fawcett , �4 Hutt0:n Road Dover, MA_ 02030. p ' Certified Mail Provides: m A mailing receipt o A unique identifier for your mailpiece - o A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Maila or Priority Maile. o Certified Mail is not available for any class of international mail. to NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested'.To receive a fee waiver for a duplicate return receipt,a USPSS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted-Delivery. i a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. ` IMPORTANT.Save this receipt and present it when making an inquiry. ' PS Forth 3800,August 2006(Reverse)PSN 7530-02-000-9047 I Barnstable of-TKWE r Town of Bainstable , regulatory Services`Department,W ;m;caC {* BARNSrABLE, _ ..� "A5• Public Health Division r m �AlFO MA'I A. r _ 200 Main'Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler„Director` FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7006 0810 0000 3524 5501. .December 28, 2011 Mr& Mrs JohnH. Fawcett . r x. 4 Hutton Road Dover, MA 02030 .. a _ YOU ARE SCHEDULED TO APPEAR BEFORE THEBOARD on Tuesday; February 14th at 3 pm in:the Town Hall, Hearing Room, 2nd Floor 367 Main,Street,, Hyannis,MA due to your failure to repair or_replace the Tailed (7/26/2009) septic system at 225 Wianno Circle, Osterville,MA The State Environmental Code Title-V Requires.altfailed septic`systems3to be repaired or replaced within two years. The Town-of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified.`Iri this.case, the septic system. has been in failure beyond the established deadline., You will be given the opportunity to testify;present witnesses,,documentary,evdence,.and other official information regarding this case. k ' PER ORDER OF THE BOARD OF HEALTH e` ' i Wayne Miller, M:D. . ., Chairman a . rw n . P. Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\225 Wianno Circle,Ost.,:doc w I, Town of Barnstable Barnstable Regulatory Services Department ;e'ca�j .ARtvsrnaLL MAM Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7006 0810 0000 3524 5501 December 28, 2011 Mr& Mrs John H. Fawcett '01 -` 4 Hutton Road Dover, MA 02030 Y ,U A SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday, Feb ar .'14th at 3 pm in the Town Hall, Hearin Room;2°a Floor 367 Main Street, i►�" g Hya MA due to your failure to repair�,or replace the failed (7/26/2009) septic system at 2 Wi no Circle, Osterville, MA -' The State Environmental Code Title V Requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the septic system D� has been in failure beyond the established deadline. / You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. c'^ PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman •Y Q:\SEPTIC\Letters Septic Inspection Failures\225 Wianno Circle,Ost..doc `� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments p 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Osterville MA 02655 S-29-09 every page. Cityfrown State Zip Code Date of Inspet on t Dion results must be submitted on this form. Inspection forms may not be altered in any av P-tease see completeness checklist at the end of the form. Important:When filling out A General Information fortes on the computer,use 1. Inspector: only the tab key to move your Joseph R. Smith cursor-do not Name of inspector use the return key. 'E. Stevens Construction, Inc. Company Name v P.O. Box 71 Company Address Marstons Mills MA 02648 rim Cityrrown 1 State Zip Code 508-776-9054 SI 4994 Telephone Number License Number B. Certification:'-`-'-- I certify that I have personally inspected the sewage disposal system at this address dad thafthe O information reported below is true, accurate and complete as of the time of the inspects'..The insoectioA 1 was performed based on my training and experience in the proper function and maintea ce of ori.,gite o sewage disposal systems. I am a DEP approved system inspector pursuant to Secfi 15.34"f Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority , v 8-29-09 Insp is Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions.at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use.. t5ins-OW08 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is Osterville MA 02655 required for $-29-09 every page. City/rown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are. indicated below. Comments: System is in good working condition, None of the failure criteria were present at the time of inspection. Overflow cesspool configuration is structurally sound and system was in good working condition at time of inspection. Both cesspools contained no standing water. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to'be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•09108 Title 6 O(Adal Inspection Forth:Subsurface sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts 4 x 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley : Owner Owner's Name information is Osterville MA . 02655 2r29-09 required for . every page. City/Town State Zip Code Date of Inspection B. Certification (cost.) .System Conditionally Passes (cunt.): Observation of sewage backup or breakout 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): p 4 . ❑ 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): b 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 rl Cesspool'or privy is within.50 feet of a bordering vegetated wetland or'a salt marsh. t5ins•OW08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pop 3 of 17 `_ a i, i Commonwealth of Massachusetts , Title 5 Official Inspection Form -Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner owner's Name information is required for Osterville MA 02655 2,29-09 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 trust indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6°below invert or available volume is less than Y2 day flow t5ins•00108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts lopTitle 5 Official Inspection Form -Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Osterville MA 02655 ^$-29-09 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence , of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails,I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone If of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•0908 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts :Tale 5 official Inspection Form e --Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Osterville MA 02655 $-29-09 _ every 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-W08 Tide 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 - s Commonwealth of Massachusetts 'ie 5 Official Inspection Form -:Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Osterville MA 02655 2-29-09 every page. CitylTuwn State Zip Code Date of Inspection D.-System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-29-08 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts ur Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is'squired for Osterville MA 02655 S-29-09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: 6-15-09 Date Other(describe below): General Information 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: Pumping was not conducted because both of.the cesspools had no standing water in them Type of System: El Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ 'Other(describe): t5ins-09M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Osterville MA 02655 8-29-09 every page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source'of information: 1971 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5' feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 150'+ feet Comments(on condition of joints, venting, evidence of leakage, etc.)- Joints and Venting all in good shape and in good working order, no evidence of leakage found during inspection. Septic Tank(locate on site plan): Depth below grade: 2.0 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) 1,000 gallon primary cesspool, cover is within 6"of final grade. Cesspool is structurally sound and in good working order. Primary Septic tank was inspected and treated as it was the septic tank of the system, and the overflow cesspool was inspected and treated as the soil absorption system. If tank is metal, list age: years .. Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: &Diameter, 8'depth Sludge depth: 311 t8ins-DWO8 Title 5 Official Inspection Form:subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Clsterville MA 02655 8-29-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) 71511 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness oil- Distance from top of scum to top of outlet tee or baffle NA-No standing Water in cesspool Distance from bottom of scum to bottom of outlet tee or baffle NA-No standing water in cesspool v How were dimensions determined? Sludge Judge, Tape Measure, Probe Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump system every 24 years as needed for regularly scheduled maintenance of septic tank for solids removal. Both inlet and outlet Tee's are in good working condition.The cesspool itself is in good structural condition and there is no standing water in it. The liquid levels could not be related to the inlettoutlet Tee's because the system primary cesspool contains no standing water. 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: e . Date t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts fTftle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Osterville MA 02655 2-29-09 every page. CityfTown State 'Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle_ condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons , Design Flow; gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Data Comments(condition of alarm and float switches, etc.): *Attach copy,of current pumping contract(required). Is copy attached? ❑' Yes ❑ No t5ins•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts T .e 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle 'Property'Address Thomas P. Foley Owner Owner's Name information is required for Osterville MA 02655 U-29-09 every page. CW own State Zip Code Date of Inspection q...System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No D-Box Present 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.): No D-Box Present 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurlaos Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts :, e 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owners Name Information is Osterville MA 02655 $-29-09 required for ' every page. Cityrrown State Zip Code Date of Inspection D..:System Information (cont.) -Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number. 1 primary, 2 overflow ❑ 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.): Soil was dry and in good condition, No signs of hydraulic failure present. No standing water found in overflow cesspool at time of inspection. Soil at the bottom of the overflow cesspool was dry. Overflow cesspool was not pumped out because there was no water to pump out of it. There was no indication of groundwater infiltration as the soil was dry at the bottom of the overflow cesspool. Vegetation consisted of grass landscaping, Oaks and Pines in surrounding lasndscapes. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration 2 Cesspools(total)Overflow Configuration Depth—top of liquid to inlet invert No standing liquid in both Cesspools Depth of solids layer 3„ Depth of scum layer Off Dimensions of cesspool 6'diameter, 8'depth Materials of construction Concrete Block Indication of groundwater inflow ❑ Yes ® No t5ins-09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 r Commonwealth of Massachusetts Ti e 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Cisterville MA 02655 29-09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts r Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 Wianno Circle Property Address „ Thomas P. Foley Owner Owner's Name " information is required for Osterville MA 02655 5-29-09 every page. Citymown -St-ate' Zip.Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate, where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System.•Page 15 of 17 Commonwealth of Massachusetts -Tile 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 225 Wianno Circle Property Address Thomas P. Foley Owner Owner's Name information is required for Osterville MA °02655 8-29-09 every page. Cityrrown State Zip Code Date of Inspection D.-System Information (cunt.) :3ite Exam: Check Slope Surface water Check cellar ` ® Shallow wells Estimated depth to high ground water: 20' 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: Obtained Mean sea level datum information from USGS site You must describe how you established the high ground water elevation: Obtained Mean sea level datum information from USGS site and related the elevation to the property in which the title V inspection was conducted on. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•OWN Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 225 Wianno Circle Property Address Thomas P. Foley Owner owner's Name information is required for Osterville MA 02655 $29-09 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked v.® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed D System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection F •� - orm . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 225 WIANNO CIR d Property'Address i, MEDEIROS r Owner Owner's Name information is ' required for OSTERVILLE every page. CRW I own MA 7/21/08 State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposals s tout least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. system including ties Title V Inspection Form.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System Page 14 of.15 331 UNITED STATES PQ§T SE VIP.11 M • Sender: Please print your name, address, and ZIP+4 In'Ns'o box • """ 5 . —To O Q --)?Z�n I i VNC i Jjjff }j{ ii t t i (fp j i ��J�:l� IliFf'ffl�F�l.�1i.:f�!!!lit�Ii�iflllFFF1,l.'�lFlli111lIi'1ttf.d�lf SENDEIN: COMPLETE THIS SECTION COMPLETE THIS SEC hON ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature Item 4 If Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by rioted am) C. Date of Deliv ■ Attach this card to the back of the mailpiece, -, .-3 6 or on the front If space permits. va D. Is delivery address different from item ? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑Wo 3. Service Type A6QWied-Mail ❑Express Mail ❑Registered ❑Return Receipt for Merch indiSell ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee); 'p>Yes 2. Article Number —''_ f! i —� (Transfer from service label) 7 0 0 6 215 0 0' 2 10 41 7 5F6 9 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540' ;FiE Tp�� Town of Barnstable' Barnstable Regulatory Services- Department ,m;cacr aARNb"rABM tbM" Public Health Division �639, ♦$ m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508=790-6304 Thomas A.McKean,CHO July 21, 2008 Geraldine Medeiros 225 Wianno Circle Osterville, MA'02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 225 Wianno'Circle, Osterville, MA was last inspected on July 21, 2008,by Douglas A. Brown, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Two cesspools both show signs of Hydraulic failure, with staining to the top of both pools. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action: PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL#7006 2150 0002 1041 7569 0:\SEPTIC\Letters Septic Inspection Failures\225 Wianno Circle.doc • r . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 't .225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is OSTERVILLE required for MA 7/21/08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. henta filling out W A. General Information When forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN cursor-do not Name of Inspector use the return key. D.A.-BROWN Company Name PO.BOX 145 Company Address CENTERVILLE MA 02632 BO'D City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification w I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority -z 7/21/08 :z Insp Signature Date -� oard e system inspector shall submit a copy of this inspection report to the Appr ving A104orit��ll of Health or DEP)within 30 days of completing this inspection. If the system i 'a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The'Original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 • I • Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 225.WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is required for OSTERVILLE MA 7/21/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is required for OSTERVILLE MA 7/21/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ 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: 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 ❑ Y p P Y (SAS) 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. Title V Inspectlon Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is required for OSTERVILLE MA 7/21/08 every page. C4 own State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑. ® -Discharge or,ponding of.effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool, ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than'/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. Title V Inspection Fonn.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is OSTERVILLE required for MA 7/21/08 every page. Cityfrown State Zip-Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 jThis system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails.I have determined that one or�more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a. design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the . questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply , ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to`any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. a Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 ~ Commonwealth of Massachusetts maim, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is OSTERVILLE MA required for 7/21/08 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ E Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ❑ Were all-system components, excluding the SAS, located on site? ❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ❑ Existing information. For example, a plan at the Board of Health. ® ❑ -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)] Title V Inspection Form.doc•08106 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is required for OSTERVILLE MA 7/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 06-175/07-90 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Fonn.doc•08106 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'r 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is OSTERVILLE MA 7/21/08 required for ' every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , General Information 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: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ` ❑ Privy k ❑ 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: APPEARS TO BE ORIGINAL FROM 1970 Were sewage odors detected when arriving at the site? ❑ Yes ® No Tide V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page a of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information isequired for OSTERVILLE MA every page. Ctyfrown 7/21/08 State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------- -----------------=------------------------------------------------------------------ Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title V Inspection Form.doc•0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is OSTERVILLE required for MA 7/21/08 every 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.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): Title V Inspection Form.doc•011106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M �< 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is OSTERVILLE required for ity/Town MA 7/21/08 every page. C State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): f " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No ' Alarms in working order: ❑+Yes ❑ No Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is OSTERVILLE required for MA 7/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 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: ❑ 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.): 2 CESSPOOLS BOTH SHOW SIGNS OF HYDRAULIC FAILURE, WITH STAINING TO THE TOP OF BOTH POOLS Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 L Commonwealth of Massachusetts Title 5 Official Inspection Forrn Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .•'` 225.WIANNO CIR Property Address MEDEIROS Owner Owner's Name information equired for is OSTERVILLE required for MA 7/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2- IN LINE 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.): HEAVY STAINING IN BOTH POOLS,OBVIOUS HYDRAULIC FAILURE 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.): , Tale V Inspection Form.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments = '( 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name information is OSTERVILLE required for MA 7/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. 3$ y t ' r y Title V Inspection Form.doc•08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 225 WIANNO CIR Property Address MEDEIROS Owner Owner's Name informationefire for is OSTERVILLE required for MA 7/21/08 every page. City/Town State Zip Code Date of Inspection t D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to 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: Tide V inspection Forrn.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 :d Town of Barnstable OF tHE Tp� Regulatory Services BARNSPABM : Thomas F. Geiler, Director 9$ M •1 10g ATEo �A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER , 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 or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations 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 Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASFP]IC\Disclairner Private Septic Inspections.DOC �,.--� �-r°w- R°�' �� �� bFr �� Y�� � ���,.� T' �� a h,cG- �.."`.� ' G�v�A had v�� Use i� N-d J._QfY►_. _ A.M. FOR OATETIME P.M. l • - PHi�N1"Ci . OF.. FAX fiUE1NEG1 PHONE ❑MOBILE Y011R<CA L ���QRE NUMBER XTENSION �`Ji t'L)ASI CALL•MESSAGE-amt I� e r WAIi41N r VifANT T 61 OT 7M 0g�. ...SEE,YOII SIGNEDryri. FORM 4003 agbTEs z z y ; f ' Town of Barnstable Barnstable Regulatory Services Department m4medcac'ty BARNSTABLE. y MASS. g 039. ., - Public Health Division 200 Main Street, Hyannis MA 02601 ' 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7006 0810 0000 3524 5501 `r ' December 28, 2011 Mr& Mrs John H. Fawcett . 4 Hutton Road Doveb,MA 02030 ',�� YOU ARE SCHED TO APPE BEFORE THE BOARD on Tuesday, February 14th at 3 pm in th own H , Hearing-, earing Room, 2nd Floor 367 Main Street, �J Hyannis, MA due to your failur o epair or replace the failed (7/26/2009) septic system., at 225 Wianno Circle, Ostervil t. The State Environmental Co e Title V Regui all failed septic systems to be repaired or replaced within two years The Town of Barnsta oard of Health has more stringent deadlines dependent up the type of failure identifie this case, the septic system has been in failure beyond the established deadline. You will be given e opportunity to testify,present witnesses, documenta evidence, and other official�i}4formation regarding this case. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman Q:\SEPTIC\Letters Septic Inspection Failures\225 Wianno Circle;Ost..doc Health Master Detail Page 1 of 1 Logged In As: TOWN\crockersh - Health Master Detail - Tuesday,January 102012 Application Center Parcel Lookup. Selection Items Reports Parcel Septic Perc . Well I Fuel Tank Parcel: 140-188 Location: 225 WIANNO CIRCLE,OSTERVILLE Owner: FAWCETT,JOHN H JR&CAITLIN Septic 1 New Septic... Permit number: �_ Permit type: Select type _ Complete system: Issue date :F Complete date :�} Septic tank size: F Type/Size of SAS: ?cesspools^ Installer: Select Installer Card on file: [7_: I/A service type: Select service Innovative/Alternative Technology type: Select IA type ri Variance date : Abandon complete date : Abandon permit number: Repair deadline date: 09/?6/2009 Repair notification date : (T7/26/2009 ; Keyword: Comments: Spoke with Tom Foley on the phone will have it reinspected and repaired in Delete Septic ..I Inspection 08%29/2009 Inspection 0 7/211 200 8 New Inspection... Number Inspection Date Inspector Result 5642 08/29/2009 Smith,Joseph R.,Bennett Environmental Associates P(Pass) Received Date Comments An inspection done 7/21/08 (Failed) .-Sixty (60 ) day rDelete Inspection ltr sent 7/21/2008 no record of repair. On 8/26/2009 inspection of system by Joseph R. Smith - that. passes. 1/10/12 TM said to have the new owner get 09/03/2009 another inspection and if it also passes then the owner will want to go to the BOH for determination of possibly reversing initial failure. (New owner was only aware of the passing report.- TM cancelling our . request to come to BOH until after new owner has opportunity to clarify with another inspection. - J` Save Septic Changes I Return to Lookup z http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=140188 1/10/2012 Town of Barnstable P# 3 5 -7 S Department of Regulatory Services t►arvar�at� i Public Health Division Date 7. NAM lED GtKt a1 200 Main Street,Hyannis MA 02601 Date Scheduled _ /"` /. Time Fee Pd. l o o. Moil Suitability Assessment fog- Sewage Disposal Performcd By: 5 Witnessed By: LOCATION& GENERAL INFORMATION � Location Address VL 1 *k►sa"A-A B C�t¢, Owner's Name - �� ">o ol► i 0 5►r�rLd t►.t►• Address 4 1�t1 tto ,GTE. Assessor's Map/Parcel: 1 46) kQ E Engineer's Name cr "r>o�►rt6 �srsoC. NEW CONSTRUCTION —/— REPAIR Telephone# Land Use: _ Slopes(%) a `�/ Surface Stones I4-1) Distances from: Open Water Body y t 4'10 ft Possible Wet Area ft Drinking Water Well 7 Q e ft Drainage Way ' ft Property Line 1 t3 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test ales&perc tests,locate wetlands in proximity to holes) co 41, 9 `tea' f L 74,, 1PkreL �Q ._.. - g 1 1 N 4" r A � I Parent material(geologic) w.n Depth to Bedrock Depth to Groundwater. Standing Water in Hole: o Weeping from Pit Face Estimated Seasonal High Groundwater ` DETERMINATION FOR SEASONAL HIGH WATER TABLE Ivleili«TUsed: _ Depth Obser ed standing in obs.hole: _____In, Depth to soil mottles: !n. Dcpth to weeping from side of obs.hole: In, Groundwater Adjustment f. Index Well# Reading Date: Index Well level— Adj.fhetor— Adj.Groundwater Level;,,,e, PERCOLATION TEST bate 3 . tn Time Observation Hole# Time at 9"• - Depth of Pere Z'r Time at 6" Start Pre-soak Time @ i t -- � — Time(9"-6" End Pre-soak t 1 ' 13 11:I �-4l_t-�►�►5 - l t a!�w� Rate MIn./Inch Site Suitability Assessment: S'e P sed_� Sitc Failed: Additional Testing Needed(Y/N) Original: Public Health Divisi Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:SEPTICIPERCFORM.DOC DEEROBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Ottrcr Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,,Boulders. / Consistew ravel) -3 Cp d 4- Ce 0 GO-1-7 C_ �+.sCr,•sat-6<? z_�t� re „�, l♦ LooStt�, DEEP OBSERVATION HOLE LOG Hole+# Depth from Soil Horizon Soil Texture Soil Color Soil Cher Surface(in.) . - (USDA) (Munsell)- }Mottling (Structure,Stones,Boulders. ' C,onsistenev.%Grave n Lj^'T%4�e'9r 15 o-`'�G '�` 'l'ri�.Y...= adr«ss �i�L, m tG 3� �t� td ✓. , Lcr DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%a e o l fifiCG�Ga � . A ^"V, rr z �rJ, l esati a Y IL trL ]DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil they Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency, Lk ZY� 1-7, 3r .sPq41-'- -Z,V e Flood Insurance Rate Map: / Above 500 year flood boundary No— Yes ! __ Within 500 year boundary No Yes ' Within 100 year flood boundary No._ Yes - 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 3 S� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,experds, and experience described in 310 CMR 15.017. Signature Datb a3 'l —I Z Q:1$EPTICTERCFORM.DOC Town of]Barnstable P# 3 L - S Department of Regulatory Services Public Health Division Date O -0 ,7. MAW rfo A, 4 200 Main Street,Hyannis MA 02601 Date Scheduled iJ l . / Time Fee Pd. �a,9 Soil Suitability Assessmentfor Sewa e Disposal Performed By:_ Witnessed By: �. LOCATION& GENERAL INFORMATION Location Address -L•L r� N41 uawA-k/ C—.-11%,• Owner's Name Address `f 14 Ll<ot Assessor's Map/Parcel: 1 46) l Engineer's Name S �4fo4. NEW CONSTRUCTION REPAIR Telephone# Land Use 5t r>r A Slopes(%) G Surface Stones 1,40 Distances from: Open Water Body T I�;6� ft Possible Wet Area 1>1G� ft Drinking Water Well t S ft Drainage Way %^sra ft Property Line ,� t to ft Other ft SIKETCH:(Street name,dimensions of lot,exact locations of test ales&pere tests,locate wetlands in proximity to holes) W co z; � � • �,,o•C t-L3 1� ,y c l a W±' + 1-0 41 G ALP Xi Parent material(geologic) w.» Depth to Bedrock Depth to Groundwater. Standing Water in Hole: o �.e.n.�tj ' Weeping from Pit FOce _SL"Tz Estimated Seasonal High Groundwater i VA DETERMINATION FOR SEASONAL HIGH WATER TABLE Method'Used: --- Depth Obse ed standing in obs.hole: In, Depth to soil mottles: in, Depth to weeping from side of obs.hole: In, Groundwater Adjustment ft- Index Well# Reading Date: Index Well level__,_ _._,• Adj,factor- Adj.Groundwater Level, PERCOLATION TEST , bale 34 tj T me Observation Hole# r _3 Time at 9" .—._. Depth of Pero t. Time at 6" Start Pre-soak Time @ It -- �(�, Time(9"-6" - End Pre-soak I ' 13 11 11 �s�s �-`t C.YaL AJ5— K Z-rui-t Rate Min./Inch �r���r� s�rtGt�•r`�, Site Suitability Assessment: S'a Passed, Site Failed: Additional Testing Needed(Y/N) Original: Public Health Divisi Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, o i tenSL� v.96 Grave[) 0-3fo A �F.�e_ `(� ��'L h e ' C'rs�+ �o 'B� �s �o•gz r/� tt c1nu)�o.Tt, GO-1-t'z C. F+.+tE1s•Sat-6�7 z_��� to 4 t L o o s��.. DEEP OBSERVATION HOLE LOG Hole+# Depth from Soil Horizon Soil Texture Soil Color Soil ther Surface(im) _ (USDA) (Muriseli) Mottling (Structure,Stones,Boulders. o sis en %Grave • mot- . o L�tL��"� � c9G jFi%j— ko.4 tG-3/7t.se r,t i. �e37Z. G Y-1P--y.4--,u37 4 . ©1 DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravell A Sea.-L A" t`� �• C al i..s4rTL. / Lb 13 Z (✓ `>-�1c�.TJ. i►t� z.�°t 6�I` ' )4 I ooS,t L�1� ' • f '� `s F -t° r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil ther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Cwo�sitn 4att`R P rre, Flood Insurance Rate Map: • Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No._ Yes 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? .119 If not,what is the depth of naturally occurring pervious material? Certification I certify that on 3 SS (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertis� and experience described in 310 CMR 15.017. Signature Date Q:15,EPTIC�PERCFORM.DOC TOWN OF BARNSTABLE t`? LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL 1q6 1,6% INSTALLERS NAME&PHONE NO. mb� � ( � SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 2 C@;5 .� (size) (� NO.OF BEDROOMS OWNER ede , % DATE: a4110 00MPLIANCE 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 if . , -� `��� . . 2 �� S Nj_Tx<_3/ 1 -,E -.PH 11 F1_LH V 1 1iE W IV. T. S. SYSTEM DESIGN DATA: FIVE BEDROOMS = 5 x 110 GPD = 550 GPD REQ. FLOW �e 0 USE CHAMBER TRENCH 12.83'W x 42'L x 2' EFF. DEPTHo� w o TOP DWELLING FOUNDATION EL 52.9't 4" PVC IP WITH SCREW TYPE CAP SIDE WALL: [42+42+12.83+12.83] x''2.0 = 219 SF L CUS �° East Q N Q WITHIN 3" OF FIN. GRADE FINISHED GRADE EL. 52.2"f BOTTOM: 12.83 x 42 = 538 SF Bay Rd v o 757 x 0.74 = 560 GPD TOTAL DESIGN FLOW PROVIDED eck O 8" 8" 1/8" TO 1/2" DOUBLE WASHED STONE 0 3" THICK OR GEOTEXTILE FABRIC V1 EXISTING NO GARBAGE DISPOSAL ALLOWED PO �, C al Z N TO RISER FINISHED GRADE EL. 52.2 t Lake <_ REMAIN FINISHED GRADE EL. 52.2'f 50.6' 20" 20" RISER s 1 11lllllillllllllllllllllllllllllit IIIJIII/illull llllll/Illl I r b �' Q ''" MIN. DIA. MIN. DIA. r----- 8.5' -•-1 RISE 4 I `°r G�� 3 J� tea 2 m V)n 9.2 15 NO BRK/OUT II °c�`� o�`e•� �oJ J Q N INV. EL �T� INV. EL Yin. 6" INV. EL. Qa. . ."mom .. m ®®o d . I 46.3T I , e o�c INV. EL INV. Ei. 12.83 ,`JG� p Q � 49.60' BAFFLE 49.35' 49.20' S'� 49.0' 48.3T 3/4" - 1 1/2" $" t� U Liquid Level 48" 6" BED OF 3 4" STONE DOUBLE WASHED STONE 34" �d'• „ dk - N 24 -' too 42' c 4s =''n „ PROPOSED DIST. BOX �; 58" w <�;; 6 BED OF 3 4' STONE PROPOSED CHAMBER TRENCW N rEC� CL_J � NAP t _ � z NUMBER OF TRENCHES = ONE 0- cn PROPOSED 1500 GALLON TANK I NUMBER of UNITS FOUR W d PRECAST DISTRIBUTION BOX NOTES: BOTTOM OF TEST PIT EL. 41.2' PROPOSED LEACH TRENCH-END VIEW to w INSTALL ON A LEVEL BASE NO GROUND WATER OR REDOXAMORPHIC INSTALL THREE 500 GALLON UNITS ,A, +- MINIMUM WALL THICKNESS = Z" FEATURES ENCOUNTERED WITH FOUR FEET OF DOUBLE WASHED STONE VV SEPTIC TANK NOTES: MINIMUM INSIDE DIM. = 12" REMOVE ALL UNSUITABLE MATERIAL FIVE FEET AT SIDES AND AT EACH END OUTLET INVERTS SHALL BE EQUAL TO EACH AROUND THE S.A.S. DOWN TO THE C HORIZON TANK CAPACITY: OTHER AND AT 2" MINIMUM BELOW INLET INVERT. AND REPLACE WITH CLEAN COURSE SAND PER REQUIRED-550 @ 200% 310 CMR 15.255 - AS REQUIRED. I PROVIDED-1500 GALLONS `-f BM; CB RIM INSTALL ON A LEVEL, STABLE AND COMPACTED BASE EL. 50.9' ` I TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND SHALL EXTEND ! DATUM: ASSIGNED ; U ASSESSORS MAP 140 PARCEL 188 I A MINIMUM OF 6" ABOVE THE FLOW LINE OF THE SEPTIC TANK AND BE ON PROPOSED SAS CHAMBER TRENCH ; CJ REFERENCE CERTIFICATE: 190636 THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLY UNDER THE 421 x 12.83'W X 2'EFF. DEPTH (•� REFERENCE PLAN: LC 2664-83 CLEAN-OUT MANHOLE. THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR MORE �-- I4 1 U ZONING DISTRICT: RC THAN 3" ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. N84• 470 50"E 118.45' OVERLAY DISTRICT: AP o - -51. +51.3 + THE TANK OUTLET TEE SHALL BE EQUIPPED WITH A GAS BAFFLE. U LOCUS NOT IN A FLOOD HAZARD ZONE a E -r1 1 + ti C ALL AT GRADE COVERS SHALL BE SECURED TO UNAUTHORIZED ACCESS �N � � to + • - � F N + --� 0 EXIST. SEPTIC SHOWN PER AS-BUILT DATA 50. -�-51.8 3rn +n 52V2 4 -f�-52.1 �- 1 + /� ,Y ! - 52.4 + + Q STONE f 1 + 1 `�CRUSHED Y _-� ` + 1 > �'' VEIN A + 'o 1 . + `� 'i' `� PLAN LEGEND .!--- DR1 1,"+1 20' �� 51.4 + z DECK 5 .6 cot + o w 35.0 EXISTING SPOT GRADE ,./ G1 ► 0 p Z EXISTING CESSPOOL TO -�-50.6 G� 20 DA-k-... + `tIM1T-OF-STRIPOUT BE ABANDONED + Q t `r. , -�-51.6 -W -- BURIED WATER 1, ' 1 LOT 123 -- G -- BURIED GAS 11,000±S.F. C' + W B N� OF SOILS TEST PIT W ' 20 2 i 1,-o i DAVID Sy 0 -r _ , tv B c +51.4 HRa EENCE �� -�-52.3 i� i � p MASON No.1066 01 I �' 51.5 1 fiC�sT� ►►►► of etas aaa p +52.0 +52.0 1 s ��P�G\STcR�90// +51.9 ; o STEPHEN ® � DOS J +51'4'4 76, PROPOSE 1500 GALLON TANK ►�4 GENERAL NOTES: '6. 5g, ► suF'�a� N �- ' 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO DEP AND a-o-S ►Z. THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE SUBSURFACE 0 20' 40' DISPOSAL OF SEWAGE. 2. ACCESS PORTS OVER TANK TEES SHALL BE ACCESSIBLE WITHIN 6" OF FINISHED GRADE. SOIL DATA: PLAN 1" = 20' 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL; BE CAPABLE OF - TEST DATE: MARCH 19, 2012 WITHSTANDING H-10 LOADING UNLESS OTHERWISE NOTED. SOIL EVALUATOR: STEPHEN OOYLE APPROVAL DATE 03-95 4. THE EXCAVATOR/CONTRACTOR SHALL CALL "DIG SAFE" AND VERIFY THE LOCATION WITNESSED BY: DON DESMARAIS RS OF SITE UTILITIES PRIOR TO ANY EXCAVATION, AND SHALL BE RESPONSIBLE FOR PERC RATE <5 MIN/INCH ALL MATTERS RELATING TO ELECTRIC AND/OR GAS EASEMENTS. P# 13575 b 5. SEWER PIPES SHALL BE SCHEDULE 40 PVC. (4" DIA. UNLESS OTHERWISE NOTED) TP 1 TP 2 TP 3 TP 4 04 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE PERC RATE M/I PERC RATE <5 M/I PERC RATE <5 M/I PERC RATE <5 M/I II MORTARED IN PLACE. 0" EL. 52.2' o„ EL 52.2' 0„ EL 52.2' - O" EL 52.2' O W 7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FT. PER FOOT. A SL 1OYR 3/2 A SL 1oYR 3/2 A SL 10YR 3/2 A SL 1OYR 3/2 `` 0 ,;J 8. THIS PLAN HAS BEEN PREPARED FOR SEPTIC SYSTEM DESIGN 6" 6" 6" 6" o AND NOT INTENDED FOR ANY OTHER PURPOSE FILL 10YR 5j6 FILL 10YR 5/6 FILL 10YR 5/6 FILL 10YR 5/6 a O U 9. THE EXCAVATOR/CONTRACTOR SHALL BE RESPONSIBLE TO CONTACT DOYLE �' w O w AND ASSOCIATES 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS. 36" EL 49.2' 36" EL 49.2' 36" EL. 49.2' 36" EL. 49.2' a. Z -J� N 10. ALL COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR Q o COMPARABLE MEANS IN ORDER TO LOCATE THEM ONCE BURIED. BW LS 10YR 5/6 Bw LS 10YR 5/6 BW LS 1OYR 5/6 B z W LS 1OYR 5/6 c�I 11. WHERE WATER SERVICE IS LOCATED CLOSER THAN 10 FEET FROM 60" EL"47.2' 60" EL 47.2' 60" EL."47.2' 60" EL. 47.2' n.0 to o K i PERC � 62 PERC � 64 U N -► SEWAGE COMPONENTS, SERVICE LINE SHALL BE SLEEVED IN PVC. a N cr 12. EXISTING SYSTEM COMPONENTS - IF ANY - SHALL BE ABANDONED PER C MED. 2 5Y 6 4 C MED. 2 5Y 6/4 C SAND 2.5Y 6/4 C SAND 2.5Y 6/4 V' Q TITLE 5 REQUIREMENTS. SAND / SAND a 0 132" EL 41.2' 132" EL. 41.2' 132" EL 41.2' 132" EL 41.2' No GROUND WATER OR REDOXAMORPHIC NO GROUND WATER OR REDOXAMORPHIC NO GROUND WATER OR REDOXAMORPHIC NO GROUND WATER OR REDOXAMORPHIC FEATURES ENCOUNTERED FEATURES ENCOUNTERED FEATURES ENCOUNTERED FEATURES ENCOUNTERED