HomeMy WebLinkAbout0315 WINDSWEPT WAY - Health 315Vindswept=Way
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'.WI ,LAGS ASSESSOR`S MAP & LOT OSI' O-1
INSTALLER'S NAME&PHONE NO.
S 'MC TANK CAPACITY /fin
LEACHING FACILITY: (type) �a IOW bM`1"• (size)
%0. OF BEDROOIv'_S V
PBUILDER OR OWNER e, it
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted&oundwater 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 :)f leaching facility) Feet
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 315 Windswept Way
Osterville, MA 02655
Owner's Name: Peter Murray
Owner's Address:
Date of Inspection: March 22, 2004
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49
Osterville,MA 02655-0049
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
1 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 op my
training and experience in the proper function and maintenance of on site sewage disposal systems I am C=VEP n
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste ,,,
I -.D ,
✓ Passes
< N C,
Conditionally Passes n C W
Needs F Evaluation by the Local.Approving _Al hority --0 :x7
Fa' s tin
C D
Inspector's Signature: Date: March 27 2104 tV rCO--
rn
The system inspector shall su a copy of this inspection report to the Approving Authority(Bd 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.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PART A
CERTIFICATION (continued)
Property Address: 315 Windswept Way
Osterville, AM
Owner: Peter Murray
Date of Inspection: March 22, 2004
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 CM.R
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined", please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 315 Wiadswept Way
Ostervi'le, AM
Owner: Peter Murrav
Date of Inspection: March 22, 2004
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,satiety 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 ia a manner which will protect public health,safety and the environment:
_ Cesspool or privy i;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 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 se-)tic 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 and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. .A copy of the analysis must be attached to this form.
3. Other:
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Page 4 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 315 Windswept Way
Ostervilie, M4
Owner: Peter Murray
Date of Inspection: March 22, 2004
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due 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 'h day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000.
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
1 `
Yes No
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section.D above the large system has failed. The owner or operator of any large system considered a
significant threat 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.
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Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 315 Windswept Way
Osterviae, AM
Owner: Peter Murray
Date of Inspection: March 22, 2004
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 nspected 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 cons-ruction,dimensions,depth of liquid,depth of sludge and depth of scum ?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ Existing 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(3)(b)].
5
Page 6 of 11 '
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 315 Whidswept Way
Ostervi'le, MA
Owner: Peter Murray
Date of Inspection: March 22, 2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 6 Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550
Number of current residents: 0
Does residence have a garbage grinder(yes or no): n/a
Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no: No
Seasonal use(yes or no): No
Water meter readings, if available(lest 2 years usage(gpd)): Unavailable.
Sump Pump(yes or no): No
Last date of occupancy: Unknorrw
COMMERCLUJINDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): and
Basis of design flow(seats/persons/scft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system (yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Unavailable
Was system pumped as part of the inspection (yes or no): 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) (ifyes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Installed 618190-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 315 Windswept Way
Osterville, MA
Owner: Peter Murray
Date of Inspection: March 22, 2004
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: To grade
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 2000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 6"
Distance from top of scum to top of outlet tee or baffle: . 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage
NOTE: Roots were Prowinp inside the tank. The tank needs to be pumped and the roots must be cut out and removed
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 315 Windswept Way
Ostervilt?, MA
Owner: Peter Mvrrav
Date of Inspection: March 22, 2004
TIGHT or HOLDING TANK: Ncne-(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: izallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level. No solids were present.
PUMP CHAMBER: None locate on site plan)
( P )
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
8
a Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 315 Kndswept Way
Osterv`lle, AM
Owner: Peter Murray
Date of Inspection: March 22, 2004
SOIL.ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 12 flow diffusors(per as built card)
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.):
There did not appear to be any sijzw of failure. The bottom to fzrade was approximately 4.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
9
Page 10"of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
. PART C
SYSTEM INFORMATION (continued)
Property Address: 315 Windswept Way
Osterville, MA
Owner: Peter Murray
Date of Inspection: March 22, 2004
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 wit:-iin 100 feet. Locate where public water supply enters the building.
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Page I 1 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 31.5 Windswept Way
0.terville, MA
Owner: Peter Murray
Date of Inspection: March 22, 2004
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground wate_ 10 +/- feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)'
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using the Barnstable topographic-nap and the Cape Cod Commission water contours map the maps were showing approximately
10'+/-to ground water at this site.
This report has been prepared end the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee thet the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
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Far Y„r�� address coliespondence to:
124 Grove Street Suite 315
Franklin,MA 02038
Farr ply Phone: 1-800-430-0680
(508)553-9425
Glenmont,NY R (508)553 9420
TO: Building Commissioner or Board of Health or
.Inspector of Buil i gs and of Sele en
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----------------- ----------zr------------ t -t-Ila-Y.... . 6 O�
RE: Insured. l
Property Address:
q
Date of Loss:
Claim No.
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Claim has been made involving loss, damage or destruction of the above captioned)
property,which may either exceed$1 NO. Or cause Mass. Gen. Laws, Chapter 143,
Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section
313 is appropriate please direct it to the attention of the writer and include a reference to ;
the captioned insured, location,policy number, jature
and claim or fi um
'
1 ! c f va l
itle
On this date,I caused copies of this notice to be sent to the persons named above at the
addresses indicated above by first class mail''
`
Signature an date
❑ Farm Family Life Insurance Company ❑ Farm Family Casualty Insurance Company ❑ United Farm Family Insurance Company _ --
www.farmfamily.com
TOWN OF BARNSTABLE
t �� naSty� fi - �G.3
Z-OCATION—, „�:- Y� SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT C6I �M
INSTALLER'S NAME Fa PHONE NO.
'SET'TIC TANK CAPACITY 2600 ,
'LEACHING FACILITY:(t7pe) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: - /9 4O
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No. .......... Fua.........�.........®.THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
..................... ............ .....o F...............B,? NSTABLE
................
Appliration for Bhipoaal Worko Tonatrurtinn Prratit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
S te�n-a�:_.___
Inds��e t Wasterville Lot 189
Y.,. .................................................. -••••--------------••----•••-•--•-•-••----• -•-•-----------....._..----•-_........-•--
Location.Address or Lot No.
Paul Murray..
..... .....
Owner ress
a - : - . .............................. I--
-.__.r ........_; �-...................---...............------
Installer Address
PQ
UType of Bui ding Size Lot...52s266..........Sq. feet
Dwelling—No. of Bedrooms................7
............................ Attic ( ) Garbage Grinder ( x)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
� Other fixtures ---------------.....................- - Om
Design Flow......110............................gallons per er da Total°'Ail ow.... 770 GPD l0 5
wp - rs pac 200 g g �11-I_ '•Width 6.-=y6� ameter NSA p 5' 8�'
x 'V 1Liquid ca acrty-----..Width
dthns 16 en_t Total Length- 56 Total leaching area__D1034 sq. ft.
Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box (X ) Dosing tank ( )
'~ Percolation Test Results Performed by...._..5.__RUSQJ1............................................. Date....-_�?/15/u_.............
:..
Test Pit No. 1......2........minutes per inch Depth of Test Pit----- Depth to ground water-----7.1.-61-1___---.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Ix --••-------------------------------•---•.....-•----------...------........------------......•-------.........................................................
O Description of Soil Loam_and z,'-._--_Medium__Sand-_•-.--....__-
x - ----------•------------------------
v ---•----------------------•---------------••--•------------------------•-•-•--------............._
w
x --•--------------------------------------------------------------------••-----------•---•--------------••--•-----------------•----------....-------•-----------------------••-----------•--•......--••--
U Nature of Repairs or Alterations—Answer when applicable....._..........................................................................................
--------------------------•----------------•-------------------------•----•---------•-•-•-----.....•----•-----•---_...----------------------•-----•---------•---------------------------•.......--_-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TLl'i L� 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been d by the k@ffo ealth.
Signe ......... ....... -------_Y:........`................-••---------•-•-•-.
Date
ApplicationApproved By...........................----------••--------- ...................................... -•-------••-----•--------- .............
Date
Application Disapproved for the following reasons:-•----------•-------•-•--=---•------------------------•---•----•---------------•---•-------•---•-----....._.....
...................•--•-----••-•-------•-•----r.................................................. .............................. -----..................................
Permit No................` b -C; (p
--------------•----•--------•----_..... Issued..._..---•--•...�&W. -•-•--•------•----------••
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-----TC)iaiJ.........................OF...............B tNSTMU
Appliration for Disposal Works Tontrurtion umi#
Application is hereby made for a Permit to Construct (N ) or Repair ( ) an Individual Sewage Disposal
System at:
g icisvaePt_Wa ....Ostpr.;rill.e ...........................Lot 189
Location-Address or Lot No.
Paul P cull Viurra.Y......
x
�j ` owner �" "'� Q ress
a .. ....--- -f.�n-rc ...........................
. --••-•.--- 4;:...f:� (.. ! � ---------------------
Installer Address �� ���
Type of 3w ding Size Lot... _2'...............Sq. feet
Dwelling_—No. of Bedrooms................7
............................ Attic ( ) Garbage Grinder ( X)
a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ...._.... -----
Design Flow... M gallons per 7; jeejr da � 770 GPD
gg �""Total �jil ow -----------•. ---- .............01o11s.
W ti
c uid capacity 2�...gallons ��ength.__.11.'_-:L-�Vidth._ ......._. Diameter__-`t---A_____ Depth b
x No. ...1.........._... Width..., :`..._...... Total Length....5C)........... Total leaching area-----�`��.....sq. ft.
Seepage Pit No_____________________ Diameter.._................. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (X ) Dosing tank ( )
aPercolation Test Results Performed by.-___-_S,-•..17,I o11..•..............�____91...__.__._._.__.__ Date____--�115/8�_t..._•@�•_.....
Test Pit No. I-----2........minutes per inch Depth of Test Pit .7.."5.._... Depth to ground water_-___7...-6._........
4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P .-•- A ...S-U•b-...s o- -..--•••--5--.-.•--•-..�.F-3-...1-t-R-.....S-a---�------------
-------
------------------------------------
-...
----------
Ox Description ofSoil.....2' ._ ... --- - . .----------•-----•---------------------•-----------------------•---
W 4
UNature of Repairs or Alterations—Answer when applicable................................................................................................
............................,.........-.................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate df Compliance has been ' ed by the o iealth.
Signed:�2 .......... .................................. rk./?. .....
Date
Application Approved BY •-•-
Date
Application Disapproved for the following reasons:................................................................................................................
----------.•••••••-•...................•••-•-•--••-••••---•---•-••••....••----......_....._-•-•-•-••-----._......_....--••---•---••••-•-•-••••--•••---------•--••-••••--- ...............................
Date
PermitNo......................................................... Issued............qiEate ---u-•---•---•--......---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................` 41.�..............OF...............� .NST�cALE.........................._................
Tn#ifiratr of Tontplinnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( X) or Repaired ( )
bY------------------------------------------------------------------------------------------------------------------------------------------------'------------------------------------------•---•••-
at Lot 189 t�ivilb'�r.ept Way, Osteriri.11e Installer
has been installed in accordance with the provisions of 'l'-[Tj,is 5 of The State Sanitary Code as de,5cribed in the
application for Disposal Works Construction Permit No.;_....1 Q_____-j'Cj......_.. dated-..... /_.`--'.v......................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................................•--...---••----•--••---•......•-----•--•---- Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............
.......................................:::.OF.............WSTABI.._E......------..... ...........--..._ a
No...... >�....2�03 FEE........................
?deposal Works Ga otnuton "truth
Permission is hereby ranted................... .......
---------------------------------------------------------------------
to Construct (,X) or Repair ( an Individual ewage Disposal System
at No....- ..........�1.....lS�dc�---: �a�l ta�'.:S E' V11 e
T ------......•............Street G
/0 'G
as shown on the application for Disposal Works Construction Permit No............::.....�Dated....... � ��?._..._._._.._.
- �` _
r Board of Health
DATE ..........................................................
FORY1 1255 H2OBBS &^WARREN. INC.. PUBLISHERS
Vanasse Hangen Brustlin,Inc.
Consulting
Engineers
and
101 Walnut Street Planners
Post Office Box 9151
Watertown.
Massachusetts 02272
617 924 1770
FAX 617 924 2286
May 14, 1991
Ref: 2876.26
Mr. Paul Lander
Town of Barnstable
Health Department
367 Main Street
Hyannis, MA 02601
Re: Hyannis, Massachusetts
Dear Mr. Lander:
We have enclosed the April 25th percolation test results performed in your presence for the
subject parcel. The test results are provided for your approval and will be used for future septic
system design.
Please review the enclosed and confirm your approval. If you have any questions, please
contact me directly or Mike McNeice of my office.
Very truly yours,
VANASSE HANG:7 UST IN, INC.
/irector
s L. Fuda, P.E.
of Land Development Services
JLF/ne,m
Enclosures
cc: L. McIntosh-w/Enclosures
D. Sperber-w/enclosures
2876/Eng. File
2876/591/sil-MY3
ti
1
MANHOLE COVER BROUGHT TO FINISH GRADE NUMBER OF OUTLETS 5 Revisions:
T� 21• NOTES;
2'-3`• �" SLOTS
SOIL t EST PIT DATA 11'-1 ' 1)DISTRIBUTION BOX To WITHSTAND H-10 3•• --� �t- 8•• 21h 2" DATE ION
12- MIN
„ — LOADING UNLESS UNDER PAVEMENT, DRIVES 4 h 8.. 4 DIA. C
11'-5" J C0 4 OR TRAVELED WAYS WHEREBY H-20 LOADING ' _ -
-I--1- 6" 5 08 90 COWER NOTE
INDICATES INDICATES OBSERVE ———————————— r • r • t t t r -I SHALL APPLY. o c� _6 5-15-90 C TANK, D--BOX,
y r — �t� t r r r t • 4- IN � I 15- 2)PROVIDE INLET TEE AS SHO WHERE �, o ' �Q Q 1 1��•• Q
AM0 POOL WATER NOTE.
PERC GROUNDWATER I I 12- TEE I SLOPE OF INLET PIPE EXCEEDS 0.08 FT/FT I"� ' ' FLOW �(. 5-22-90 WE'T AND LOCATION
TEST I I L wo,��J OR 1N A• PUMPED SYSTEM. --) 1-2'/." 3"-1 I- 4'• LINE I 6-05-90 RtA11'�►TIf SE. RELOCATE SEPTIC,
12" 't IR - RECRADE,
PRECAST, STEEL — t; 14- �' S•_8• DISTRIBUTION BOX TO BE LAIIEVEl.. E SECTION A-A SECTION B-8 Cvr�/� O� �\ !kc REVISE
0 t C3 Ay �� ` /"- 0 REVISE FOOTPRINT
TP NO. _P_7324 TP N REINFORCED _ -o r 7-01-90 ROTATE N USE. R SE
s-o PLAN VIEW 4)RECOMMENDED MANUFACTURER- �`~� AND REVISE DRIV WAY.
0. E'L 10.0 GRD. EL — SEPTIC TANK 4. 6.
r t INLET 4'-0- MIN. OUTLET r, ROTUNDO OR APPROVED EQUAL
t GW. EL 2.4' GW. EL I I .. TEE LIQUID DEPTH TEE '
0 0 — I I F6- MIN. 3/4- TO 1-1/2-STONE ,: REMOVEABLE COVER
L -----------_J e, f' 2' B
1 LOAM CLEANOUT & INSPECTION L10
-1 r1 t r ' • t r{ • r • t r t f r • f �r - 5- DIA. OUTLETS) 5- DIA. INLET A ' A
SUBSOIL " v a. •O o 0 2 1/2-1 PROVIDE o
2 2 24 DIA. MANHOLE COVER "•• BOTTOM ON.LEVEL STABLE BASE e .• ..•.• • , .,., WATERTIGHT C�
• JOINTS (TYP) o
PLAN VIEW 40 INLET A ✓s
3 3 - 4' OUTLET ` J ll
i i � � •-J References:
4 MEDIUM 4 NOTES CROSS SECTION VIEW 15 9 1 2- • 2 7- I I - - -� - - - - - - - - - q. _ a.. send°� .
_ _
SAND 1) SEPTIC TANK TO WITHSTAND H-10 LOADING 3) INLET AND OUTLET TEES TO BE CAST IRON, y•. . •rj --J �' LAND �:rx1RT PLAN 1535�I1?,a
5 5 UNLESS UNDER PAVEMENT, DRIVES, OR TRAVELED SCHEDULE 40 PVC OR CAST-IN-PLACE CONCRETE. BOTTOM ON (PENDING)
' e o=.• e ''�--......
6 WAYS, WHERE BY H-20 LOADING SHALL APPLY. TEES TO BE CENTERED UNDER MANHOLE COVER. 20 i�� BASE
I '
6 6 MIN. 3/4 TO - - - -- - - - 1 , - - - - - - - - - r
2) ALL PIPE CONNECTIONS AND CONCRETE CON- CROSS SECTION VIEW 1-1/2 STONE
7 7 STRUCTION TO BE WATERTIGHT. B
8 OBSERVED $ DISTRIBUTION BOX DETAIL 8. a..
WA•� SEPTIC TANK DETAIL N o. OF GALLONS: 200o LOCUS M A P
g Q. 2.4' NOT TO SCALE NOT TO SCALE PLAN VIEW SCALE: 1"=2083'
10 10 / DESIGN ANALYSIS
LEACHING CHAMBER DETAIL DESIGN FLOW:
NOT. TO SCALE i
� � � 7 tER00l�S X 11® G.P.0.�77o G.P.D.
�� 12 � �' � 4' X 8' FLOW DIFFUSORS ® OR EQUAL
DATE: DATE:
l5-15--89 -�"
100 YEAR FLOOD PLAIN SEPTIC TANK REQUIREMENTS: Project Title:
TESTBY: TESTBY: 12 LINE FROM F.E.M.A. MAPS /
S 49•38'33 E
N�ITNE' SED BY: WITNESSED BY 11 96.00' "I \ /� / Z7DGP-® X 2 ',
10 E \\ USE 2000 G T LOT 189
PERC RATE PERC RATE: 5 6�•
_ 12 WINDSWEPT
<.2.. MIN.,ANCH --------- MIN./INCH \\ -- _____ 10' '
i
�
RESERVE LEACHING FACILITY REQUIREMENTS: WAY
W� �
D X 1 �,J �? ( OSTERVILLE
12 _____ 12j4'XB• FLO F>�asoRs W/4' STONNE1 )
NOTES (WX1C'X0.9V LEACHING AREA) BARNSTABLE
o PROPERTY LINES SHOWN HEREON WERE COMPILED
FROM A PLAN RECORDED AT THE BARNSTABLE A
.� A""_L AREA=�112'--1�-32')XQ_ = 1'. s S.F. Ivl A .
\ \ COUNTY REGISTRY OF DEEDS IN LAND COURT PLAN
\ \ POOL GRASS :4., .,.. r,n•• ' ., PROPOSED 2000 15354-126 AND DO NOT REPRESENT AN ACTUAL OT'T AREA-WX16' = 8 S F
\ ` GALLON SURVEY ON THE GROUND.
\ \\ BASEMENT TANK S TOPOGRAPHIC INFORMATION TAKEN FROM PLAN BY
BAXTER do NYE INC. DATED .DULY 12, 1989 LEACHING FACILITY PROVIDED
� O BE DISPERSED OVER LAWN UNIFORMLY � �l* O 'I�` L1 Z W 4'ST
T 4, S POOL WATER TO
\ � JACUZZI CONCRETE ��� 30 �- .
\ PATIO h' AT LOW FLOW TO ASSURE IT DOES NOT REACH WETLAND. AREA=138S.F.X2.SC.IP.R./S.F.=345u.P.D
w , -
\ D-BOX +�'�•_' +•• 'O =€39CS CC.P.D.LS.F.=B G.P.D.
\ • . . PROPOSED (12)4-4'X8' FLOW DIFFUSORS TOTAL a 1241 G.P.Q.
W/ ' OF STONE
\ �z PROPOSED . .
DWELLING
\ F.F.=13.6' . .
''�'• NOTES PREP FOR:
\ PROPOSED
`��5�"• GARAGE o •'' . O UNLESS OTHERWISE NOTE ALL CONSTRUCTION
'6°i9�' ` f; "� SLAB=10.6• °' \ \\ (17 +., '•:*., ,�0o METHODS AND MATERT.ALS MALL CONE TO D R. P A U L F. MURRAY
•c'� I �.'< CRAWL ;, \ •.', •, TITLE 5 OF THE STATE ENVIRONMENTAL CODE
SPACE PROPOSED STRIP \ \ '•'• AND ANY APPU LOCAL RfGUL�►TI'DNS.
STEP `'ORAIN EL @10.5 \ •'•;•, ,•,••� UNLESS O'THERV4SE NOTED, ALL CONSTRUCTION
CONC. -- _ ._ • � _ I�ETFfS AND MATEi^�ALS SMALL TO
GRASS WALK/ GRASS
TITLE 5 OF THE STATE ORIENTAL CODE
( \ '��� AND A14Y APPUCABLE LOCAL REGULATIONS.
3
" FENCE 3" FENCE— ._.� , —~i=ENCED PRECAST SEPTIC TANK„ UTION BOX.
— / —— ,
/ \ .ENCLOSURE AND IEACMG FACLLJTY TO WITHSTAND H-10 LOADL49
LIGHTS \ ` ,W/CONC. UNLE:r-Z UNDER PAVEMENT, PPJVES. LIEF TRAVELLED
\ WAY', 1 H-20 LO C SHALL APPLY.
PLAN VIEW I / PROPOSED DRIVEWAY 11
.� ALL 9?PLAP JOINTS IN�SEPTIC TANK SHALL BE
SCALE:1"=20' I // \ / \ SEALED WPI<"TH NEOPRENE GASKETS OR ASPHALT
CEMENT TO PROVIDE A WATERTIGHT SEAL A.M. Wilson
/ LOT 189 \ / 1 _ \ ALL PIPES IN THE SYSTEM SHALL BE SCHEDULE 40 Associates
l0 ft 52,264 sq. . \ i OR EO'.1AL Inc.
INVERT ELEVATIONS 1.19 acres 9
\ TP
LEGEND \\ $ / , --� , WASHED CRUSHED STONES SHALL BE FREE OF ALL
• �� � J� / I i \ DIRT. DUST, AND FINES.
PROPOSED CONTOURS � �� � I TEST� T � I 911 I�a�l street
EXISTING CONTOURS 11--•----------11 '�0 \ � �' / � HEAVEY EQUIPMENT SHALL NOT BE ALLOWED TO
4" INVERT AT BUILDING 11.05 10.8 0 _ -- 100 YEAR FLOOD PLAIN I OPERATE OVER THE LIMITS OF THE SEWAGE DISPOSAL 50 e%A ��
PROPOSED SPOT ELEVATIONS ( ) ,�h i PROPOSED STRIP DRAIN SYSTEM DURING .THE COURSE OF CONSTRUCTION. 50$-4213--1454
7
PROPOSED WATER LINE W LINE FROM F.EM.A. MAP \ AND DRYWELL
4" INVERT AT SEPTIC TANK (IN) 10_55 NO FIELD MODIFICATIONS TO THE SEWAGE DISPOSAL Drawing Title:
— — — — _�- SYSTEM SHALL BE MADE VATHOUT PRIOR WRITTEN
4" INVERT AT SEPTIC TANK (OUT) 10.38 PROPOSED
a •L'--''--`'r-�,�— — — — — — I APPROVALTHE ENG9 _ AND THE LOCI!-
DRYWELL L=258.28' I BOARD OF HEALIR
4" INVERT AT DIST. BOX (IN) 10.32 R=880.o0' I THIS SYSTEM SHALL BE INSPECTED AS REQUIRED SITE PLAN
P OPOSED \ 10 BY SECTION 2.10 OF TITLE 5.
4" INVERT AT DIST BOX (OUT) 10.15
S IP DRAIN EDGE OF PAVEMENT-1 A CERTIFICATE OF COMPLIANCE AS REQUIRED BY
SECTION 2.8 OF TITLE 5 MUST BE OBTAINED BY THE SUBSURFACE
CONTRACTOR UPON COMPLETION OF THE AROV€ WORK
INVERTS AT LEACHING FACILITY: \ IF AN "ASL1',IILT PLAN" IS RE DUE TO CONTRAc-EVII SEWAGE
TOR DATING FROM THESE PLANS. FOR SUCH
4" INVERT AT BEGINNING OF PLANS MALL BE C COMPENSATED BY THE 411 ACTOR.9.26 MANHOLE AND COVER BROUGHT MIN. 12" COVER THIS IS NOT DESIGNED FOR A GARDAGE DISPOSAL DESIGN
LEACHING FACILITY ° FINISH GRADE DIPOSAL UNIT.
5 S TO FINISHED GRADE7
4F�
°S MINIIIUN CONCRETE STRENGTH SHALL BE 3000 P.S.I. � s�
$" INVERT AT END OF FOUNDATION s " FIRST TWO FEET TO 4" PVC S=.015 FT./FT. MIN. 2" 1/8"-1/2" WASHED STONE AND "IVIMUl4 STEEL. IGTH SHALL PE 20.000 P.S.I. � �Aa�n��i ��,�
LEACHING FACILITY 9.26 4 PVC S=.015 FT./FT BE LAID LEVEL " " AYON�
'77 • ';.; 3 4 TO 1 1 2 FANTOZZ9
M.�a:� o �,
°S° �►° -4'X8' FLOWDIFFUSOR g.o�o DIA. WASHED STONE '� .
5 S o o " '
4" INVERT AT BOTTOM s — D—Bo 1111111111777
,1R,��°
OF LEACHING FACILITY 8.3 SEPTIC TANK BOTTOM ELEV.- R.3'/,!(
Scale: 1 = AS NOTED
TO BE INSTALLED ON A � FLOWDIFFUSORS
"
_----LEVEL do STABLE BASE.
OBSERVED GROUND WATER NOTE: GRADE TO MAINTAIN 2' 0 FEET
ELEVATION 2.4 COVER OVER 4" PVC
Date: 5-07-1990 Dwg No:
SYSTEM PROFILE Desi n: C.P.J.
ADJUSTED HIGH GROUNDWATER 4.3
- NOT TO SCALE - Dram: J.V.B.
Jab No: 2.0494.0 Sheet 1 of 1