HomeMy WebLinkAbout0019 WOODWIND WAY - Health 19 Woodwind Way
A= 111 -017
W. Barnstable
I
L
Commonwealth of.Massachusetts
Title. :fflcll Ins ee®norm
Subsurface Sewage Disposal System Forni- Not for Voluntary Assessments
19 Woodwind Ways r
Property Address - - -
Richard Aittaniemi
Owner Owner's Name
information is
required for every W Barnstable -!/ -- - - 'Ma 02668' 6/11/1'6"
page. City/Town State Zip Code Date of Inspection
IV
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist -at the end of the form.
Important:When A. G&neral Infor-m-afu®n
Filling out forms
on the computer,
use only the tab 1. Inspector:
key tc move your
cursor-do not Michael DiBuono
use tl a return key. Name of Inspector
DiBuono Sewer and Drain
Company Name
8 Johns path
Company Address _
S Yarmouth Ma 02664
Cityrrown State Zip Code
508-364-9587 S103522
Telephone Number License Number
B.-Cer Vf6Cat9®n .
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
6/12/16
1 -pector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system 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.
r
t5ins•8413 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
v V
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,w..t
19-Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is required for ever,�y, W Barnstable Ma 02668 6/11/16
page. � Cityrrown - 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:
System contains a 1500 gallon septic tank as well as a Dbox and two H2O 1,000 GI pits. With T of
stone around. Pits have just 2ft of liquid in them. System is in great shape
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
I
Commonwealth of Massachusetts
N r Title 5 Official Inspection For
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
reform_ion is W Bamstable Ma 02668 6/11/16 required for every
page. City/Town State. Zip Code Date of Inspection
B. Certification (cont.) -
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (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):
t ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection _.Form
Subsurface Sewage Disposal System Forma - Not for Voluntary Assessments
19 Woodwind Way,
Property Address
Richard Aittaniemi
Owner Owner's Name
information is
required for every W Barnstable Ma 02668 6/11/16
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)
v 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 aseptic 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 This system" 1 ••- asse• p s 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
Ao 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
E ® Backup of sewage into facility or-system component due to overloaded or
clogged SAS or cesspool
0 Z- 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
99 p
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5-Official Inspection, Fr
Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments
a
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is required for every W Barnstable Ma 02668 6/11/16
page. City/Town 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.
0 ® 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 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts .
W Title 5 Official Ins ec i 'F r
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is
required for every W Barnstable Ma 02668 6/11/16
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
❑ ® 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 the w❑ ® ( y 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): 5 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Tit-le 5 Official Inspection rorm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
isrequired for every
W Barnstable
Ma 02668 6/11/16
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
System contains a 1500 gallon septic tank as well as a Dbox and two H2O 1,000 GI pits. With 3' of
stone around. Pits have just 2ft of liquid in them. System is in great shape
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes No
Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage Well
9 ( Y 9 (gPd))�
Detail
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:
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Ins ec i n Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
19 Woodwind Way -
Property Address
Richard Aittaniemi
Owner Owner's Name
information is required for every W Barnstable Ma 02668 6/11/16
page. City/Town State Zip Code Date of Inspection
Q. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Unknown
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
❑ 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 systemiol"In 'r) 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):
l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
2. W Tide 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
•' 19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is e W Barnstable Ma 02668 6/11/16
required for every ''
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
23 Years
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: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade: 2
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1500
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•3/1.3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 OfficialInspection r
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is
required for every W Barnstable Ma 02668 6/11/16
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 24
Scum thickness
3„
Distance from top of scum to top of outlet tee or baffle 42
Distance from"bottom of scum to bottom of outlet tee or baffle 1" Sludge stick
How were dimensions determined? Tape Measure
Comments (on pumping rec
ommendations,
mend atlons inl
et
t and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
No evidence of leakin Tees and or baffles in place at time of inspection `
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
i
. Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is
required for every W Barnstable Ma 02668 6/11/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tees are in place and levels are normal.
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 El 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
l
Commonwealth of Massachusetts
W Title-5 Official Inspection Form .
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a` 19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is required for every W Barnstable Ma 02668 6/11/16
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 Level and of normal level
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
II
Commonwealth of Massachusetts
=a W Title 5 Officia[ Inspection Form
'=1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
e
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is required for every W Barnstable Ma 02668 6/11/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 2 H2O 6' pitswith 3' stone
❑ 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.):
Soil is dry around pits.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer —
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts ~ "
Title 5 Official Inspection For
Subsurface Sewage Disposal SysterriForm - Not for Voluntary Assessments
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is
required for every W Barnstable Ma 02668 6/11/16
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.):
No pond in'g'no'break out
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.):
i
!Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
`1
I
Commonwealth of Massachusetts
File 5 Official Inspection--form
-
Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is required for every W Barnstable Ma 02668 6111%16
page. CitylTown State Zip Code Date of Inspection
D. System Wormatuon (cont.) :
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts ,
Title Official In Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
e 19 Woodwind Way _ ..
Property Address
Richard Aittaniemi
Owner Owner's Name
information is
required for every WBarnstable Ma 02668 6/11/16
page. __.Clty/Town State Zip.Code
Date.of,lnspection
D. System Wormation (cont.)
Site Exam:
a 01`Check Slope
❑ Surface water
El Check cellar
❑ Shallow wells
Estimated depth to high ground water: 15+ ft
feet
Please indicate all methods used tc determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 7/23/93
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:
Test hole data states NGE at 15'
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
i !l
I
Commonwealth of Massachusetts
W Title 5 Official Inspection For
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
19 Woodwind Way
Property Address
Richard Aittaniemi
Owner Owner's Name
information is
required for every W Barnstable Ma 02668 6/11/16
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
C)F BARNSTABLECLI
LOCATION+ t Tee- y SEWAGE # 5.3-y�6
VILLAGE n ASSESSOR'S MAP & LOT/Id-GODS
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY I
LEACHING FACILITY:(type) de"A,
A& (size) '� s
NO. OF BEDROOMS PRIVATE WEL OR PUBLIC WATER
B OR OWNER t I�f� a" 4/1F �
DATE PERMIT ISSUED: � �� � ,►
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
, � � � � ,
,. .�
6 � �
�.---
r
"[� � rrw.
i - __
J L • .rr�/ ./ ". �V jam_
FEs....../V.0 ..
......
THE COMM0IVWEILTH OF MASSACHUSETTS
BOAR® OF !—IEA_ 'H
y
�.W.LJ..............0 F.......$.P..�.Pl" .. I.k3:11.--•-----------..........
�J Appliration for Uispoii al Works-Tomitrurtion Vrrmit o
5�A'Jpcation is h b de f r a P it to Construct (�) or Repair ( ) an Individual Sewage Disposal
System at:
LOTy
LQ-
10
................_. ...
oc do -Address or Lot No.
.r6-L-=. .... ....-- . ------------------------
��� �o/w�ner �/
.... .... +�-'dre
--------------------
Installerp Address `.,
Type of Building Size I ot,_ .?*N77�'':_..Sq. feet
Dwelling—No. of Bedrooms___..___..............................Expansion Attic ( ) Garbage Grinder'
aOther—Type of Building ............................ No. of persons-------_____-•_-.-_--__--___ Showers ( ) — Cafeteria ( )
Q' Other fixtur s..___________________________
W Design Flow............... ...................gallons per person r day. Total daily %w.._.....5_ gal 9)
P ? to �.
Ra Septic Tank—Liquid ca.pacityjbb#gallons Length_0.1..-��.... Width.,5._..t.�.- Diameter................ Depth..�j.__.
Disposal Trench—No..................... Width_...._._...._._._ Total Length.................... Total leaching area_______._____._ sq. ft.
Seepage Pit No.--____Z........ Diameter..... .?.__..... Depth below inlet................ Total leaching area_�07._�...sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) I P
Percolation Test Results Performed by.S.A[G C...�L?Rl� _ _�?� _ +. Date....? ZQ Q, .........
as Test Pit No. 1................minutes per inch Depth of Test Pit-----A_5........ Depth to ground water----_-
f� Test Pit No. 2........Z..minutes per inch De th of Test Pit..... _........ De th to ground water..._ _0 °
............................. --------------- -
O Description of Soil....................... ------C.!..��?. f Z?- �v � .�L....g ti.L_� .------
W ----------- -------------- ...... �' ��-�-�'!? -'� � '_..._._....................
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of STILE y g g p y
5 of the State Sanitary Code—The undersigned furtl era agrees not to lace the system in
operation until a Certificate of Compliance has been i ued by the b rd of he
Signed ................ ............`--f......
__-
Application Approved By-------------�— ---------------------------------- -•----------
Date
Application Disapproved for the following reasons-----------------------------•-----------------------------------•-----------------------------------------••••--
--........••-•--•--------------•------------•-----•------•--•------•-•-•----•----._..........-•------•-•--------•------------••-----•-•------•--•-•-----------•-•--------•---------------•------......_.
gg - Date
Permit No...........l__ _ �................ Issued............. `�
Dste
No. �.2---...... Fzc$.-- •-i/� �.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliratiun for Disposal Workii Tonutratrtiun Prrutit
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at -
y M y ;
p y
:. j.. f�.....::�.a ......3+..,..'"...........-:.�.:5-. .}'�x�E& ....._ .... ...............................'� .l ..............Q..— .........................
Locdo -Address or Lot No.....� ....: .. .t�-- --------------------------- -------- -•---- .._.._...... .•••-........--------•-----------.....------------•---
Owner Addre
c' _'` -: ---------------
s
Installer Address
UType of Building � Size ....Sq. feet
Dwelling—No. of Bedrooms....... ................................Expansion Attic ,(., ) Garbage Grinder (�'DO
Other—T e of Building ............... No. of ersons__..-__......... ___ Showers —
a YP g ------------- P --------- ( ) Cafeteria ( )
OtherfixtuWs ...........................................---••--. •----- _--------••••-
d .�. , ...........-------------
W Design Flow..............a;, , ____ qgallons per person per day. Total daily flow.......; ......................gallo a:
WSeptic Tank—Ligmd capacity v4 gallons Length .. _... Width.:. . Diameter................ Depth_:,,z_..:' 7
x Disposal Trench—No..................... Width.................... Total Length ............... Total leaching area u sq. ft.
„-.
Seepage Pit No......._c2_,.�........ Diameter.... Depth below inlet I_°.:_......Total leaching area. .���._.sq. ft.
Z Other Distribution box ( , ) Dosing tank ( )
�. H* 9 tr.j r
'—' Percolation Test Results Performed by. l`e' �$ .._,, '.`'�" ti I � i u n �" '°
z ------. Date r�
Test Pit No. 1................minutes per inch Depth of Test Pit..... ..........Depth to ground water....... '. _s
f=, Test Pit,No. 2_..___ ' ..m per inch Depth of Test Pit.__..y.'Z..._._.. Depth to ground water....
r. ►;
inutes
i y
Description of Soil.................. ` ) C k ;O , , `
a
V 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 iiTL:
p S of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has 0* uy heboard of alth.Signed? ------------ • ••---••.....----••--....-•---------- /1-.'.hDate
Application Approved BY '_< -._.... --------F....�::?
Date
Application Disapproved for the following reasons---------------------•------••-------------------------------------------------------------......--••----•-......
.....................•----------------------•---------------•--------------••-----------.....------.........---.......---------------------------------------------------------.........................
Permit No........... `1��a.. ------...y.... ................. Issued.----------..��------------��._...au------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OnF- HEALTH
c...�r. LG %. O F.............ti ! :G:.G G•cc7 ....................................
C9rdifirab of TuutpliFanrr
THIS I TO CERTIFY, Tha_ the Individual Sewage Disposal System constructed (� or Repaired ( )
by------------------- ....._`........................ .....----•----------•----•---•-
I taller �t
at-------4.x-?7.--- --------14'.0 r� = "
�s ---------------------------------------------------------
has been installed in accordance with the provisions of TIT i of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No-------
_._./..: ......._ , ` .. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®'AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �
f
" . ........... ............................... Inspect _
DATE......... ��
THE COMMONWEALTH OF MASSACHUSETTSt
BOARD OF HEALTH .
!� z..............OF.... ..... /
No....J.: .._1_ FEE +0 ..
�iu�uuat Turku �unu iun rruti�
Permission is hereby granted • -•••----------•-•-•--•--•...--••••---.....-•••-•-•-...--•........................
to Construct (}I or Repair ( ) an Individual wage Disposal'System
at No....../- .�'-----A...........
r .�?- _e 6. ...
Street �-
as shown on the application for Disposal Works Construction Pe No y. '�f ated.... �..`...� =s._'.?
:._ .
y -
B rd o Health
DATE...... ,a / \:.7
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
. Department of Environmental Management/Division of Water Resources
WELL COMPLETION REPORT
V
WELL LQ�CA�TION r GEOGRAPHIC DESCRIPTION
. Addres, � 1` ��''/ NO E W of
�. p e8Y �/ (clrcfel
Clty/TOWn _ ,r�Aw./Glti./I a/i!>✓f,a/
Well owner Wit,/ /t ��,nQ� �r roe, � T
i /
Address! wrl.t+.n !�1 r/ N S E W of
Board of Health permit obtained: yes �' no Elurtersecr. w/ road/ C+$
WELL USE / WELL DATA
Domestic rr�,�Public[] Industrial ❑ Total well depthft.
Monitoring❑ Other Depth to bedrock
Water-bearing loc /unconsolid fta.t ed material:
Method drilled
Date drilled Description-
Water-bearing zones:
CASING / r/
I Type p��� 1) From�._rqnt To A
2) From To
Length —ft. Dia(.LD.)--6--in.
3) From To
Length into bedrock _ft.
/ Gravel pack well: dia.
Protective well seal: a/ Screen: dia.
Grout-E] Other Slotlength From to
STATIC WATER LEVEL(all wells)
Static water level below land surface—ft. Date
WELL TEST(production wells) kPI
�fkDrawdown ft. aftern`g"w Ilir. TnIn.at _gpm
How measured Recovery ft. after_hr. min.
0
LOG'of FORMATIONS COMMENTS
c
Materials From To -
�7 s
Driller
Firm
Address ,-.4, /
City/Town /�/ •,vr /'�9/it�i
C741/1/0` p Supervising Driller Reg.# --
-syffat re I supervis!g re istered wet!drlllB
Peso Prin(r;rm/y VA-RD',OF.'.HEALTH , COPY.
OFFICE LABORATORY
1498 HIGH STREET 176 PLYMOUTH STREET
BRIDGEWATER,MA 02324 BRIDGEWATER,MA 02324
OLIVEIRA ENVIRONMENTAL LABORATORIES, INC.
WATER-WASTEWATER-FOOD-DAIRY PRODUCTS
CHEMICAL&BACTERIOLOGICAL ANALYSES
Telephone(508)697-2650
FAX(508)697-0163 August 23, 1993
L. Wile & Son Drilling Co.
11 Annasnappitt Drive
Plympton, Mass. 02367
Source: Well Water - 6 inch PVC Well - 140 feet deep - producing 20 gal/smin.
Located on the property of Richard Aittaniemi - Lot 2 Aittaniemi Way - W. Barnstable,
MA
Analysis #93-08-3218
Coliform Count
/100 ml @ 35 C 0
Membrane Filter
S.P.C./ml
@ 35 C 2,000
Color (APC units) 55.0
Sediment slight
Turbidity (NTU) _25.0
Odor N.O.O.
Taste metallic
pH 7.20
Specific Conductance
micromhos/cm 103.
mg /liter
Total Alkalinity (CaCO,) 160.
Free CO, 1.95
Total Hardness (CACO,) 22.0
Y Calcium (Ca) 5.60
h Magnesium (Mg) 2 16
Sodium (Na) 8.10
Potassium (K) 1.61
Total Iron (Fe) 0.90
Manganese (Mn) -L DLL
O8
Silica.(SIO,) 13.5
Sulfate (SOO 10.0
Chloride (CI) 12.0
Nitrogen - Ammonia 0.16
Nitrogen - Nitrite 0.008
Nitrogen - Nitrate L 0.50
Copper (Cu)
L = less than
N.O.O. = No Odor Observed
Sample collected by L. Wile - 8/14/93 at 1700 hrs.
Sample relinquished to laboratory by L. Wile - 8/16/93 at 1000 hrs.
Bacteriologically, this well water is of a satisfactory sanitary standard and is suitable
for drinking and domestic purposes.
Chemically, this well water is high in iron and manganese content. The color, turbidity,
and taste are affected by the high iron content. All other chemicals tested meet the
standards.
Director
F83384-1
r
The Standard Plate Count indicated the general bacterial population of the well at the time of collection.
Coliform Group Bacteria:
Significance
The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay,
leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation.
Because the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful
organisms may be present, water containing one or more coliform group bacteria per 100 ml of sample should not be used for drinking or
cooking purposes unless boiled 5 minutes or disinfected by other means.
This bacteria is of animal origin(intestinal tract).and may be considered as closely associated with disease causing organisms.On this factor,
none should be present.
Color — APC Units- Ground water ought to be practically free from color. For attractive water- color should not exceed 15 units.
Turbidity — NT Units- Recommended limit not to exceed 5 units.
Odor£t Taste — For water to be of high quality, the water should be odor free and taste good.
pH — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or
very alkaline with 7.0 being neutral.
Specific Conductance — Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions
on chemical equilibria.
Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates.
Free Carbon Dioxide — Well water having a low pH and a Free CO2 level in excess of 50. mg/I will be corrosive to iron, bronze, brass and
copper tubing and fittings.
Total Hardness — Standard not to exceed 50. mg/l. Waters having a hardness level of 50 to 100 are in the medium hardness range, over
100 very hard.
Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale
in boilers, pipes and cooking utensils.
Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hay d-
ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action.
Sodium—Component of Salt.
Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/I.
Total Iron — Standard not to exceed 0.3 mg/l.
Manganese — Standard not to exceed 0.05 mg/I.The principal reason for limiting the concentration of manganese is to reduce esthetic and
economic problems.
Silica — Silica content of natural water is most commonly in the 1 to 30 mg/I. Silica in water is undesirable because it forms difficult to
remove silica scales.
Sulfates — Standard not to exceed 250 mg/l.
Chloride — Standard not to exceed 250 mg/I.
Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters. Its occurrence in ground water is generally a
result of natural reduction processes.
Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen -
nitrite concentration over 1 mg/I should not be used for infant feeding.
Nitrogen - Nitrate — Standard not to exceed 10. mg/I. Nitrate, in high concentrations can and do cause methemoglobinemia or so-cal'ed
nitrate poisoning in infants. Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook-
ing. It is especially dangerous to children and should never be used in infant formulas.
Copper — Standard not to exceed 1.0 mg/l.
Lead—Standard not to exceed 0.015 mg/1.
Arsenic—Standard not to exceed 0.05 mg/1.
Tannin—Tannin may enter the water supply through the process of vegetative degradation.
F83384-2
GENERAL NOTES.' T P 0
• SOIL TEST PIT DATA
!. THIS PLAN IS FOR THE DESIGN AND 80-SZ
CONSTRUCTION OF THE SEWAGE DISPOSAL YERT EL EYA TICN.S: GRNO-1 ELEY. �' b GRND-2
IN EL EV. j O D
FACILITY ONLY. 1 ,vo 6.W. ELEY. N 6.1✓. ELEY. NONE
INVERT AT BUILDING �I d,l?b �►L it #_____
2. ALL CONSTRUCTION METHODS AND MATERIALS INVERT IN A T SEPTIC T, hi ' 10 ,ra C7
FOR THE SEPTIC SYSTEM SHALL CONFORM , 8 SkNS� , SA?4 v i
TO MASS. D.E.G.E. TITLE 5 AND LOCAL INYERT CUT AT SEPTIC T.-",NK 104, 11 Z" ACCESS COVERS MUST BE WI THIN !2' OF FINISH GRADf". �7 L
BOARD OF HEAL TH REGULA TIONS. F )} op
INVERT IN A T DIST. BOX 1 b . � INDTES
ld. J = 11 O s 4 0 PERC. TEST ►
3. ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO INVERT OUT AT DIST. BOX 108. 00 r r 4 .pp r �a
VEHICLE LOADING (I.E. UNDER DRIYEWA YS, ETC.] INVERT IN AT LEACH PITS C 0`'S O D �. MIN. 2 Of: Rs
pyg e.
SHALL BE DESIGNED TO 1✓ITHSTAND H--20 LOADING. '
BOTTOM OF LEACH PITS _� 4' MIN. ' 'a D !/B -1/2 61A. $A l D
4. ALL SERER PIPE SHALL BE SCHEDULE 40 OR i LIQUID WASHED STONE INC t TES ► Sor
APPROVED EQUAL. - OBSERVED GROU,NDWA TER Oo3 DEPTH 1 Z OBVED �C
., � GRO A TER 6 tit YiC.L
ADJUSTED GROUNDWATER ►.S b�� 10 DIST. y 3/4'-1 !/2' Df,4. �' vg'L
5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE ��-.--)�j 150 0 GAL. BOX <<,p WASHED STONE = vd
l-800-322-4844 FOR L OCA TION OF )Y
,� min, SEPTIC TANK �-�L O `
UNDERGROUND UTILITIES. �,bt9 PIT 50�� SO�fC,
I
6. DATUM IS
$O vt�af.R+S
rH t 9 IF BURIED DEEPEREL
rotes _ AV ,6Rauwv W,A�k2 vgv'st.[ fvt -#� THAN 3 FEET, � � NSO WA-rZK {
-t��ry -Q��r'S o
'3Z ic. V T BY.• 5 U �) G fs 1 u
LEGEND _ �a �R6,l Rve �—� 6�.
50-•--= EXISTING CONTOUR YfoESSED BY
kwA Ph r. RATE Z MIN./ IN. I
r o L = ED CONTOU
�-- � PROPOS q
GCq +' UL
✓�0 = PROPOSED SPOT GRADE _
Feu L DESK G'RITERIA:
' 4,o b7lCHrdIEV.'► �•� HYLL a
No. 24' 6 F` �
DIRECTION OF STOR WA TE/
RUNOFF
DESK FLOW,'
BEDROOM DWELL I96. 110 GAL/Du Y PER BEDROOM
EGMfS 56 GALS. PER DAY. t
SEPW TANK REWIRED'
I
' DA TE PROFfSSIONAL NGINFER: C_TYl L) DA TE PROFESS OIVAL LANDS EY rR
E5D 6PD X 15OX = S 2 6 64L.
r
�
iCi p' 1�111.3 „�.b i �00
� SETW TANK PROYIDEa = GAL.
. t E1c�S`r)tsc'�
L SAGH l�..tG �,i �L�� SIE.ZF LEACHING FACILITY REQUIRED : r
d DEY' PERC. RATE = 2- MINUTES/INCH
L�
-- t
Y
SIE,9F L EACHING FACIL ITY PROVIDED.
�k�t
p o �9 t�'�`GA►`'-[' _ G " PIT W WITH 3 ' STONE
SIEVW L H 5 Z S.F. X T- 113O GPD
F 1 . 90TWY 2 2 6 S.F. X
23 �' � �,,,� TCALS S.F. l 5
GPO
o
BPFAIr CAL CULA TIONS•
DA TE REVISION
fib• , z `�o R o
v i t
� 410 .
55
h
10 T CATGH EAS VR l
47370f S. ►�r�, �� 1 �,��s`�'. PLAN SHOWiTi o 7f�
-
�- E .SIGN OF A PROPOSED
P p,10 F a ,7 5 c. Qoo L SUBSURFA(" SEP T L' DISPOSQ� S t
t I YSTEM
LOT P, f-r16/1" Se Rf? BARNSMBLE, M,4
212 99 no
� SCAL L- .' `' 40 ' JUL Y 15, 1993
EAGLE SURvE 7AIG ENGINEERING INC.
SANDWYC 1
4'� ROu 3 1, , CIA
- — ors 6—
vA GA rs i L Q T . 3 Pf?,9J-FCT 1r `—l? 93-085
L o