HomeMy WebLinkAbout0132 WINGFOOT DRIVE - Health °�1132 �Wingfo6t Drive
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TOWN OF BARNSTABLE L
LOCATION A-q SEWAGE # Od
�3 VILLAGE �5�_ASSESSOR'S MAP & LOT 3 Y I'OrLI
INSTALLER'S NAME&PHONE NO. �
SEPTIC TANK CAPACITY. x/ N toe
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LEACHING FACILITY: (type) . 1 �o'� (size) 14 3 X'.�
NO.OF BEDROO
BUILDER O OWNE
PERMITDATE: S U COMPLIANCE DATE: 3U G?•
Separation Distance Between the:
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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
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Commonwealth of Massachusetts
( Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is Cummaguid
required for every MA 02630 3-6-19
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. Please see completeness checklist at the end of the form.
Important:When A. Inspector Information filling out forms p `!zs '
on the computer, /# �--
use only the tab James D.Sears '��:` JAMES m'
key to move your Name of Inspector
cursor do not c
Jim The Inspector Man
use the return an ComP Y
Name
key. P.O.Box 784NISP�;'��``��\``\
4:1 Company Address
West Yarmouth MA 02673
City/Town State Zip Code
508-364-4398 S 1623
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system,!nspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
3-6-19
Spector'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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal sy.t'eM'P ge]of 18t.4f
f
y
Commonwealth of Massachusetts
,9 Title 5 Official Inspection Form
Ie Subsurface Sewage Disposal g p System Form Not for Voluntary Assessments
i yy/
132 Wing foot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is
required for every Cumma puid
MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
The system is a 1000 Gal. Tank D Box and six chamber's
I
2) 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):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is required for every Cummaguid MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.): -
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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):
3) 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.
a. 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�v
132 W ingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information isequired or every
Cummaquid
MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. 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.
c. Other:
4) 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
ti
Commonwealth of Massachusetts
x Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 Win foot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is Cummaquid MA 02630 3-6-19
required for every
State. Zip Code Date of Inspection
page. Cityfrown
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All-Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in is less than 6" below invert or available volume is less
than 1/2 day flow A9Ac'/N��vG .
❑ ® 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 water supply
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 2000 gpd-
10,000 gpd.
❑ ® 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.
5) 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 CA.
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
❑ 0 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
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is required for every Cummaquid MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes or"no"for each of the following for all inspections:
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)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 W ingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is required for every Cummaguid -MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 -
Description:
1000 Gal. Tank D Box and six chambers.
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes Z No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings,' if available last 2 ears usage NA
g _ ( Y 9 (gpd))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Present
Date
I
I
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
c Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 W ingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is Cummaguid MA 02630 3-6-19
required for every -
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. 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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
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 below):
3. Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
L 132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
required for
is every
Cumma uid
required for eve 4 MA 02630 - .3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. 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):
Approximate age of all components, date installed (if known)and source of information:
Tank NA D Box and chamber's 2002 Permit # 2002- 173.
Were sewage odors detected when arriving at the site? ❑ Yes ® No .
5. Building Sewer(locate on site plan):
Depth below grade: 32"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.):
Pipeing is 4" PVC SCH -40.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is
required for every Cumma Quid
MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 22"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: 1000 Gal. Precast H-10
Sludge depth: '
2n
Distance from top of sludge to bottom of outlet tee or baffle NA
Scum thickness Oil
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
How were dimensions determined? Asbuilt-Plan-Tape
Sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank at working level. Tank and covers at 22" below grade, Note: Outlet cover under large rock
wall. Inlet Tee. No Sim of leakage or over loading
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is required for every Cummaquid MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. 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.):.
8. 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
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Fl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 W ingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is Cumma uid MA 02630 3-6-19
required for every q
page. City/Town State Zip Code Date of Inspection
D. System Information (cost.)
8. Tight or Holding Tank(cont.)
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
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D Box is 16"x16"-28"_below grade. Box is clean and solid w/one line out. Note: Inlet line has a 4"
PVC Tee. No sign of over loading or solid carry over.
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 Wingfoot Drive
`f Property Address
Samantha Cambal
Owner Owner's Name
information is required for every Cummaquid MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. 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.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 6
'❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
<� Subsurface Sewage Disposal System Form Not for Voluntary Assessments
132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is required for every Cummaquid MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS)(cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching is six infiltrators w/3.5' stone. Chamber's at 30" below grade. Chamber's are clean w/no
sign of over loading or solid carry over. No sign of holding water.
12. 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
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'v
132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is required for every Cummaguid MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)"
13. 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.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 W ingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is required for every Cummaguid MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.).
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
s
r as-
/3- 3 s1
oc K C _
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 Wingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is
required for every Cummaguid MA 02630 3-6-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
wo
Estimated depth toFh ground water: 11'
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: 3-14-02
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:
T.H. on Design plan 3-14-02 11' no G.W.. Bottom of chamber's at 4' below grade. Bottom of
chamber's at T above T H depth.
r
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
�lo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 W ingfoot Drive
Property Address
Samantha Cambal
Owner Owner's Name
information is Cummaquid MA 02630 3-6-19
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist)completed
® D. System information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
C' 1414n1 a
Na
G IA!
!r
I
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
r � .
No. L� Fee
(/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for rhgool *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /✓O? 14 d} f Y e Owner's Name,Address and Tel.No.
Assessor's Map/Parcel �D �r'/►' 3R A//. i 've
say
Installer's Name,Address,and Tel.No. Desig Name,Address Na Address and Tel.No.
Jo6in C . 441f0 (s0f)`�a8 �OGtya f��r �..3,.ePr� �i T•,c
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 15�5 09 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil: '-'9/S"
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 Certifi-
cate of Compliance has been issu y t Ns Board of Health.
Signed 0 Date ?
Application Approved by 1 Date
Application Disapproved for the following reasons
Permit No. i Date Issued
,�� � ..... «..err,_.,-"s-•-• .N -. ., - J ._ � .. - /.-. .t ta,t" �e,.. r-^..;✓' .. ;.��, i
� o •� —/ �� k, Fee �.
E
fi s a THE COMMONWEAL-TH OF MASSACHUSETTS Entered in computer:+ yes,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS� -
. a--� 0(pprication for Miopogal *pttem Cottgtruction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components
Location Address or Lot No.
Owner's Name,Address and Tel.No.
/ 0 1aAssessor's Map/Parcel �
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�1
�o�s ,%/f O G 8 9 �y St y���o�7li ' o�C 7
Type of Building:
Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
'Description of Soil 1
?5
y
Nature of Repairs or Alterations(Answer when applicable)
Date fast inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue Ty t s Board of Health.
Signed v11 o Date -
Application Approved by .�� U ® r Date
I/Ir— V '—
Application Disapproved for the following reasons t
"
Permit No J Date Issued
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 T,26 , -. /-4 /7`:2
at ,Z zv,', (D. h b� constructed in accordance
with the provisions of Title and the for Disposal System Construction Permit No. - ated
Installer Designer
The issuancd of this permit shall not be construed as a guarantee that the system will fuliction as designed.
Date��� �►I (I Inspector
--- — ------------------------- —
97-117
No. Fee-
THE COMMONWEALTH OF MASSACHUSETTS
r ,4 PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Zi,�poe;ar *pgtem Construction Permit
Permission is hereby granted to Construct( ')_,Repair(�Upgra e( )A,bay do ( ) d
System located at /3�? /�!!'-y {ao'f �7r / 1
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Cons 'c ion r/t
�Ertpleted within three years of the date of this pe
Date: Approved by _
1/ // l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is required for CUMMAQUID MA 10/3/08
every page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
ImpoWhen
heen gout A. General Information JcZ�
forms on the « w
computer,use "4
1. Inspector: a
only the tab key
to move your DOUGLAS A BROWN " --
cursor-do not
use the return Name of Inspector w'
key. D.A. BROWN
Company Name � {
P.O. BOX 145 cj
Company Address Ul M
CENTERVILLE MA P2632
City/Town State Zip Code
508-420-4534 S 14297
Telephone Number License Number
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 ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
10/3/08
Inspector'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.
Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sawa a Disposal spe g System•Page�of
a
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID MA required for 10/3/08
every page. Cityfrown 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:
LEACHING SYSTEM IS DRY AT THIS TIME
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•O&W Title 5 Official Inspection Fond:Subsurface a Disp
osal posal System•Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'( 132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID
required for MA 10/3/08
every page. CdAwn 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
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 Inspection Form.doc•08106
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r( 132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID
required for MA 10/3/08
every page. City/Town 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 '/2 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 Form.doc•08106
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is required re wired for MA 10/3/08
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cunt.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ z 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.]
❑ IZ The system is a cesspool serving a facility with a design flow of 2000apd-
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.
Title V Inspection Fortn.doc•08/06
Title 5 Official Inspection Form:Subsurface Seerage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID
re wired for MA 10/3/08
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)]
Title V Inspection Forrn.doc•08106
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID required for MA 10/3/08
every page. tyRown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 2
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)): 06-127/07-154
Sump pump? ❑ Yes ® No
Last date of occupancy: CURRENT
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):
Tide V Inspection Form.doc-08/O6 Title 5 Official Inspection 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
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID
required for MA 10/3/08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
Flow 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)
❑ 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 4-02 BY J.C. AALTO ACCORDING TO AS BUILT CARD
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Title V Inspection Form.doc•08/38 Title 5 Official Inspection Form:Subsurface Sewage Disposai System•Page 8 of 15
Commonwealth
- � monwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner owner's Name
information is CUMMAQUID
required for MA 10/3/08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
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
El 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: 1000 GALLON
Sludge depth: TRACE
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness TRACE
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.doe•08/06 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
x` 132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID required for MA 10/3/08
every page. Crty/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•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disp
osal posal System•Page 10 of 115
Commonwealth of Massachusetts
. .. -U Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID
required for MA 10/3/08
every page. Clty/Town State Zip Code Date of Inspection
D. System Information (cunt.)
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.):
" 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 0
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.):
BOX LEVEL NO LEAKAGE
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
x< 132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID
re wired for MA 10/3/08
every page. Cityfrown 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: 6-
INFILTRATORS
❑ 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.):
OPENED OBS PORT CHAMBERS WERE DRY AT THIS TIME
Title V inspection Form.doc•08108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID MA required for 40/3/08
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
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.):
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.):
Title V Inspection Form.doc•0S/68
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
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is required for CUMMAQUID MA 10/3/08
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. c7S�
Neat
I
1'f u�
k
f
Title V Inspection Form.doc•0&06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
'Vot Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
132 WINGFOOT DR
Property Address
NESBIT
Owner Owner's Name
information is CUMMAQUID
required for MA 10/3/08
every page. City/Town State Zip Code Date of Inspection
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:
Title V Inspection Form.doc•08/08
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 or 15
e
TOWN OF BARNSTABLE L
LOCATION UJ �X . SEWAGE #. d� a " 17
VILLAGE—CO-a—NA !I�! u.10 ASSESSOR'S MAP & LOT 3 Y1'Dry
a
INSTALLER'S NAME&PHONE NO. �An r
SEPTIC TANK CAPACITY. FA I &+i h AOL U!
- �� w t ,(J
3 �C �. x
ff ""�� e
LEACHING FACILITY: (type) 1 c l �i`�, (size) �
NO. OF BEDROO
BUILDER 0 OWNE �L �d e cJl V L0('s
PERMITDATE: U COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
tEdge of Wetland and Leaching Facility (If any wetlands exist-
within 300 feet of leaching facility) Feet
Furnished by
Y
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9/2/99
DATE:-----------
PROPERTY ADDRESS:__132_Win_&f oat_Drive
—_—Cummaquid ,_ -- 9`
Mass _ 02637___________ !s,
t t, VE0 �=
On the above date, I inspected the septic system at above a9d1@9*.
This system consists of the following: NAL*�, a
ter, o
1 . 1-1000 gallon septic tank.
2 . 2-1000 gallon precast leaching pits . ti
Eased on my Inspection, I certify the following conditions:
3 . This is a title .five septic system. ( 78 Code )
4 . The septic system is in proper working order
at the present time .
5. Pumped septic tank as part of the inspection .
SIGNATURE:1 _
Name:_,. L Macomber _Jr�______
Company: Jose.ph_P. Macomber_& Son , Inc .
Address:— Box—66
--- ---------------
Centerville , Ma. 02632-0066
Phone: 508_775_3338_______
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPN P. MACOMBER & SON, INC.
Tan ks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775-3338 775-6412
.'
COMMONWEALTH OF MA.SSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500
TR UD Y
Sec
ARGEO PAUL CELLUCCI DAVID B. ST
Governor Co nuz=
SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM
PART A
CERTIFICATION
Property Address:132 . Wingfoot Drive Nam.of own.,Patricia Dimartile
Cummaquid ,Mass . Address of Owrw:
Date of tnapecdw: 9/1/99
Name of Inspector:(Please Print) Joseph P.Macomber J r .
1 am a DEP oved sy"m Inspector purw"to Section 15.340 of Tide 6 (310 CMR 16.000)
pa
Cornny Name: J.7.M a c o m b e r & Son I N c .
hl&1ngAddrssa: Box 66 Centerville .Mass , 02632
Telephone Number: �5 0 2-�7 5 2 2 2 E
CERTIFICATION STATEMENT
1 cartify that 1 have personally Inspected the sewage disposal system at this address and that the Information reported below is true, accurst
and complete as of the time of Uupection. The Inspection was performed based on my training and experience In the proper function and
maintenance of on-she sewage disposal systems. The system:
1 i
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fail
Uupectoes Sigrsrnue; Data:
The System Inspscto hall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)whhin thirty 130) day
completing this Inspacton. If the system Is a shared system or has a design flow of 10,000 gpd or greater, the Inspector and the system o
'shall submit the report to the appropriate regional office of the Deportment orEnvironmerttal Protection. The original should be sent to Trre
system owner and copies sent to the buyer, If applicable, and the approving authority.
NOTES AND COMMENTS
revised 9 2/98 Page I of 11
P,,? rmled on 9"kd riper
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (contirwed)
Propu yAddrass: 132 Wingfoot Drive Cummaquid ,Mass .
owner: Patricia Dimartile•
D'te of Inspection:9/2/9 9
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
I have not found any Information which Indicates that any of the failure conditions described In 310 CMR 16.303 exist. Any failure
.criterls 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.
Indicate yes,.no, or not determined(Y, N, or NO). Describe basis of datermination In all Instances. If "not determined', explain why not.
The septic tank Is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of
Compliance (attached)Indicating that the tank was installed within twenty(20)years prior to the date of the Inspection; or
the septic tank, whether or not metal,Is cracked,structurally unsound, shows substantial Infiltration or exfiltration. or tank
failure Is Imminent. The system will pass Inspection If the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
�( Sewage backup or breakout or high static water level observed in the box is due to broken or obstructed pipe(s)
r or due to a broken, settled or uneven distribution box. The system will pass Inspection if (with approval of the Board of
Health).
broken plpe(s) are replaced
obstruction Is removed
distribution box Is levelled or replaced
• The system required pumphig-rnorn than-four'timss wyeardus m broken or obstructed pipe(:). The ryrtrm wiltjran--•
Inspection If(with approval of the Board of Health):
broken pipe(:) are*replaced
obstruction is removed
e �
revised 9/2/98 Page 2ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropertyAddress:132 Wingfoot Drive.•Cummaquid ,Mass .
owner: Patricia Dimartile
Date of Uupecdw: 9/2/9 9
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 falling to protect the
public health, safety and 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.PRQTECT THE PUBLIC HEALTKAND SAFETY AND THE ENMONMENT:
Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presf nce of•ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance wJ/4 (approximation not vaUd).
3) OTHER
revised 9/2/98 Page 3or11
I
♦R �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A ;
CERTIFICATION(continued)
Pmp"Addr.: 132 Wingfoot Drive Cummaquid ,Mass .
Owner: Patricia Dimartile
Date of lnspection�/2/9 9
D. SYSTEM FAILS:
You must indicate either "Yes" or"No" to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of•sewage iMo4ecilityror-sTatem componer+t due%to en overloaded amleggedSiAS-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 thil distrib ion hax above outlet invert due to an overloaded or clogged SAS or cesspool.
1i Liquid depth in cacspeeI is less than 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
4Z Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
»coliform bacteria, volatile organic.compounds, ammonia nitrogen-and nitrate nitrogen. -
E. LARGE SYSTEM FAILS:
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:
�( The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
_ the system-is_witWn 200 4etof*4fibUtary4O-64ucf4004fW#kiwg•awteweupP4Y ~• - --•• - _ ._
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)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further infor natipn.
revised 9/2/98 Page 4orn
1-
I -
(- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 132 Wingfoot Drive- Cummaquid ,Mass .
Owner: Patricia Dimartile
Date of Inspection:9/2/9 9
Check if the followinghave been done:You must indicate either"Yes" or 'No" as to each of the following:
9
Yes No
41 Pumping information was provided by the owner,occupant,or Board of Health.
None of the system-compownts.hayabean pua►pad4o1=atJeast two-aweaks andthe'rystem hasbaaawceiaingwnemal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
Inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or Industrial waste flow.
_ The site was inspected for signs of breakout.
4 _ All system components, eluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered,opened, and the interior of the septic tank was Inspected for condition of baffles
or tees, material of construction,dimensions,depth of liquid,depth of sludge, depth of scum.
The size and location of the Soil Absorption System on•the site has been determined based on:
Existing information. For example, Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[15.302(3)(b))-
_ The facility owner.(and.nrmplunis,lf diflaraat fromawmar).were.prou ded.with Infnrmatioaan thA proper malritanaac of
SubSurface Disposal Systems.
I
revised 9/2/98 Page SofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C c l
SYSTEM INFORMATION
Property Address: 132 Wingfoot Drive Cu.mmaquid ,Mass .
Owner: Patricia Dimartile
Date of lnspectioo:9/2/9 9
FLOW CONDITIONS
RESIDENTIAL:
Design flow: //d g•p•d./bedroom.
Number of bedrooms(d -
esi991 Number of bedrooms(actual): 4
Total DESIGN flow u/, 6�
Number of current residents:
Garbage grinder(yes or not:
Laundry(separate system) ( s or ; If yes,separateJnspaction.required
Laundry system inspected l 6 no)
Seasonal use(yes or no): G A200 _ J� �1! �.
Water meter readings,if avJ� ble(last two year's usage(gpd): 7 / Vy�v c,(J
Sump Pump(yes or "v(lye no):�✓� ��!`'- �' j 0 '—
Last date of occupancy:
Ko
COMMERCIALMDUSTRIAL: Sprinkler System is present
Type of establishment:
Design flow: god ( Based on 15.2 0-3)
Basis of design flow f�
Grease trap present:(yes or no)_
Industrial Waste Holding Tank present:(yes or no)�jp
Non sanitary waste discharged to the Title 5 system:(yes or no)"
Water meter readings,if available: zo
Last date of occupancy:��
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
19
System pumped as part of ins action: (yes or no) s
If yes, volume pumped: Ilons / w
Reason for pumping: 'Z4,yez�
TYPE O"YSTEM
Y Septic tank/dis�b /soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records,if any)
I/A Technology et -Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
AP, MA G of all components, ate i taNed{if known1•end source of4mformation;
Sewage odors detected when arriving at the site: (yes or no)Alb
revised 9/2/98 Page 6of11
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 132 Wingfoot Drive Cummaquid ,Mass .
Owner: Patricia Dimartile .
Dace of Inspection:9/2/9 9
BUILDING SEWER:
(Locate on site plan)
Depth below grade:Ky
Material of construction:_cast iron J/40 PVC—other(explain)
Distance from private water supply well or suction line_V
Diameter
Comments: (condition of joints,venting,evidence of Jeakege;-etc.) -
Joints appear tight No evidpnre of leakage _
SEPTIC TANK: f4
(locate on site plan)
Depth below grade: ;
Material of construction:o concretemetal,e/r9FiberglassPolyethylenes'.�other(expla(n)
If tank is (petal,list age 1/&4 Js.age.confirmed by Certificate of Compliance I& (Yes/No)
Dimensions: PX '9"o
Sludge depth: 0
�j
Distance from top of Judge to bottom of outlet tee ortmffle:� -'
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bolt of outie tee or baffle:�
How dimensions were determined:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or-baffles, depth of liquid level In relation to outlet invert, structur64ntegrity,
evidence of leakage,etc.) Pump tank annually . Garbage disposal is present .
Tnl et R out-let tPp4 arp in i 1 are Thp tank i e ctrnrtnrn1 1 g eniinri
GREASE TRAP:
(locate on site plan)
Depth below grade/U14
Material of constru� �concrete)!YmetabVhFiberglassAW PolyethyleneAAother(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:N44
Distance from bottom of scum to bottom of outlet tee or baffle:,✓JO
Date of last pumping:—/
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level In relation to outlet Invert, structural integrity,
evidence of leakage,etc.)
Grease trap is not present _
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C �
SYSTEM INFORMATION(continued)
Prop"Address: 132 Wingfoot Drive Cummaquid ,Mass .
O" nw: Patricia Dimartile
Date of Inspection: 9/2/9 9
TIGHT OR HOLDING TANK• K (Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
I
Depth below grade: ll/p
Material of construction:,(concrete,Ametal VAFberglass,v�Polyethylene(Aother(explain)
AIA
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level:_Alarm in working order:Yes,&/ Noifl�
Date of previous pumping: AM
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
iQ t or holding tanks are not ;resent _
DISTRIBUTION BOX: (,
(locate on site plan)
Depth of liquid level above outlet invert: A,0 _
Comments:
(note-if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box, etc.) —
Distribution box is not present ,
PUMP CHAMBER:
(locate on site plan
Pumps in working order:(Yes or No)AS
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
Has sewagp Paprtor in haSPmant _ Handlpe nnp bath and nnp hpdrnnm
revised 9/2/98 Page 8of11
f
SUBSURFACE SEWAGE DISPOSAL SYSMM INSPECTION FORM
PART C
" SYSTEM WFORMA'nON(contnuod)
P,,p.MAddr.u: 132 Wingfoot Drive Cummaquid ,Mass .
Owner: Patricia Dimartile
Dan,of Inspection: 9/2/9 9
SOIL ASSORPTiON SYSTEM(SAS)• r
Im
(locate on site plan,if possible;excavation not required,location may be approximated by non-Intrusive methods)
If not located, explain:
Type:
Isaching pits,number:
leaching chambers,number:
leeching galleries,number:
leeching trenches,number,length:
laacNng fields, number, dime slops:
overflow cesspool,number
Alternative system: AMP
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.)
Loamy sand to mPrl; ,,m candy No s lgng 9L hydFaulle failure
CESSPOOLS:
(locate on site plan)
Number and configuration: 0 .
Depth-top of liquid to Inlet Invert: .4114
Depth of solids layer: 114
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of Inspection)
esspools are not nrPSPnt
Comments:
(note condition of soil, signs of hydraulic failura,.Ievel of ponding,condition of-vegetation, etc.)
_ es�sppJoo s are not present -
PRIVY:44t
(locate on site plan)
MatsrJals of construclJgn: Dimensions:
Depth of solids:,
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.)
rivy is not present -
revised 9/2/98 Pa¢e9of11
SUBSURFACE SEWAGE DISPOSA&SYSTEM tNSPE=ON FORM
PART C
^' SYSTEM INFORMATION(con*wod)
Proq*MAdd,su: 132 Win,gfoot Drive Cummaquid ,Mass .
Own0f: Patricia Dimartile
Dfu or Vapoc%a <+: 9/2/9 9
SI.ETCH OF SEWAGE DISPOSAL SYSTEM:
Include des to at Fast two permansnt reference landmarks or benchmarks
locate all wells within too'(Locals where public water supply comas Into house)
t4 ?
i mom===.
! l�
� 1
revised 9/2/98 Pear to of 11
I ,
' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
y PART C
SYSTEM INFORMATION(continued) a �'
Property Address: 132. Wingfoot Drive Cummaquid ,Mass .
Owrw: Patricia Dimart.il-e
Date of inspection: 9/2/9 9
NRCS Report name
` Soil Type_
Typical depth to groundwater
USGS Date website visited
Ob
servation Wells checked
Groundwater depth: Shallow Moderate Deep _
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
r
Estimated Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevatlon:
Obtained from Design Plans on record
Observed.Sits (Abutting property bservatlon hole, basement sump etc.)
Determined from local conditions
_Checked with local Board of health
Checked FEMA Maps
!> Cked pumping records
!/ Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevatlon. (Must be completed)
Used water contours map .
Gahrety & Miller Model
12/16/94
t �
revised 9/2/98 Page 11 of It
•nn.{sw rn rr�•rr arnrmn..r..r.r�+nrnrrnnn•..TR�i�e.nn{r.�rn�u ns-�.•.a.u�•. �'�.�.ur�r-4.T-.�.P'F
TOWN OF Barnstable WARD OF !HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I
•••rrt�••. *�rtn-�TT1.T.:'!11'.I.TCI TI/PIRA.fiRTT'1' —.{•iT'ItRT7t1'ROrTAI.AIAItt►fY11RI�lA'At7 VVM 1.1 •.+-irr'-•tr--.r�..A
-TYPE OR PA1HT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS 132 Wingfoot Drive Cummaquid ,Mass . '
ASSESSORS MAP, BLOCK AND PARCEL # SNI(D�S_q
OWNER' s NAME Patricia I)imartile
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr .
COMPANY NAME J.P.Macomber & 01'on Inc .
COMPANY ADDRESS * Bax 66 Centerville ,Mass . 02632
Street Tows, or City State LIP
COMPANY TELEPHONE ( 508) 775 - 3338 FAX ( 508 ) 790 - 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and
omplete as of the time of -inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check ne:
Systeui PASSED t
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection which I have con Octed has found that the system fails to
Protect the public health and the environment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspecteo f rm .
e
Inspector Signature Date e copy of this c tification must be provided to the OWNER, the BUYER
0(�n
where applicable) and the BOARD OF HEAL7111.
�...
* If the inspection FAILED, the owner or.gyp operator shall upgrade ' the system.
within o'ne year of the date of the inspection, unless allowed or required
otherwise as provided in 3.10 CMR 16 . 305 .
partd.doc
00
No. 73 FRa.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiuit fur Di-tipwial Wor1w Tnnitrur#inn remit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at• -
f� �'J '.. CDT 0 VO/I4,4 a U t
--... 0.
oc ti i�ss r---------•- � -------- w-,- ------ - Lot No. ��Mr4- -(..t,�----
W7 vlie�JV/ dZAJ( ,rt() Add r s
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..-.-.--....�_-----_................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons-----_---_----..._._---- Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- - -
W Design Flow................��............gallons per person per day. Total daily flow..........--.� ................gallons.
WSeptic Tank—Liquid capacity .®®..gallons Length---------------- Width---------------- Diameter................ Depth................
x Disposal Trench—No. .................... Width........_----------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........./........ Diameter....... ........ Depth below inlet......6.1....... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water................-
�i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
...........................................-.................................................................................................................
0 Description of Soil........................................................................................................................................................................
x
c, -- ----------------
W ••••------•......... .....................•----•-•----•-•---------•--.......---•-••-•-----•---•--•----•......----------.......-----•-•-----••--•......-••--•--•• .....................................
Nature f Repairs or Alterations—Answer when applicable__/40Q----- _4-------(.U��?.��'�...._. �`.:.._..----T
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Compliance s een issued t board of health.
Signed - ........A =
Date ...
.. ................ .. ---.e
................ Dace
Application Approved By ---------- �''� .. ....,...la?e...�.Q V..
Application Disapproved for the following reasons: .......... ...._........ ._.......... -- . .................................. .. .. .....
........... .............................. .. ............ .. . ............. ............ .... . -- ........._........... ..... .................................
QDate
PermitNo. ---------k..Y....... .7---- -------------------- Issued -----------........................................................
Date
No.._ `-/-. .�.� Fms............U............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Divjipwial Works Towitrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...----•----------------------------------------------------------------------------- -••--•-••---••----•-•-•••----•-•-----------•--••••-•--•------•---•---•-••--------...---•-••.....•.
Location-Address or Lot No.
-- ................................................... w ,..roc ��'-- 1 -C L)Vn'\MA 6 U!�..__
-•---•................ ......•-----
Owner Address
O��Ti'l b L'o it)S��U`TU —7(�a (�L4� `y I-Z.0 iM J ryl t�C S
------......•--•---------•-•.. .................•-•--•----•---•-• ---•--.••••-- ---------�......--------------------------•--_..._._--•---......-----•--.......--•-----•-•----
Installer Address
UType of Building Size Lot............................Sq. feet
., Dwelling— No. of Bedrooms......_..._...._7�.._-_--•.-___-___-__-.--Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ............................... . .
W ..�� __....__..__.gallons per person per day. Total daily flow-------------
Design Flow................
WSeptic Tank—Liquid capacity_/O'R.gallons Length................ Width---------------- Diameter------------------ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No---------- Diameter..-_._�G>-------- Depth below inlet------- .......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------_--- ------------•---•--•-•----•-------•-------------------••-•-• Date........................................
.�.a Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
P4 ------------------------------------------------------------------------•---------------•-----••---------------------------
•........
-...........
.........
...
0 Description of Soil................................................................................................................7---------------------------------------•-•-------------
x
U --•--•-----------------------------•-------------••-------------....._.....--------------•----•-----------•----•-----. --------...---••----------•---•-•---•-•---=•-•--•----......--•--•-••-•-•.......
UW Nature f Repairs or Alterations—Answer when applicable._.........A-,r-. _G �?. .�r�.........4, ........P/
f� P
�----------------7-J _711 r�y `-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
__Yihe provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance-has been issued/by/the board of health. 11 // �/�/
Signed <,�/.. .........................�' /Xs;l�
.................. . .
Date
Application Approved By .............C) �J ...-.- ----------------------------------------------.._...------------------------- -...::.�:...-.. -�-�..
Dare
Application Disapproved for the following reasons: .... .......................... . . ...................................................... .... ..
... . ............. . . . .... ....................... . ... .... .................. ........ ...................-- ---------------------------------------
n Date
Permit No. _d ..... .. ...3--------------------- Issued
Date
---------------------------------------- --------------- ------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C'ler#ifi atr of C�nmyliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � )
b / �/ �'c ---- -------------C- ..c>, .5", ial cr i '`�y .......................... ...... .... .. ..,........
Installer _
at .
__./3� C J✓``J� �.� c__v_� �./i�. .+-- -------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ......�,'�7/.----- '...7.. .. dated ....._.......................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
.......------------.------------------------------------
DATE...... .................. ........_1............'.....�------_--------------------------- Inspector .-------------. ...,
- --------�y-----------------------------�-- ---------------------------- ----
l V� ' O� THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?�_ y T) TOWN OF BARNSTABLE
No.. FEE........................
Mopmal Vorkii Tunitrurtion "Vrrntit
Permission is hereby granted.................WG " C .. ���-�='�.."l
---- - --
to Construct ( ) or Repair (X) an Individual Sewage Disposal System
at No.... / � �}1`- `-G--- ��L)f C' vta� rvt f+Gi-�l 0...............
?� L1
as shown on the application for Disposal Works Construction Permit No../_..___\_.., __ Dated-----l�.." 1�...-..f.��.......
c/ Aoard of Health
DATE..................
� �
FORM 36508 HOBBS&WARREN,INC..PUBLISHERS
No........... 1.3. Ftn$.-..L ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliratiutt -fur Uhipuiittl Works Tutt,strurtiutt Vautit
Application is hereby made for a Permit to Construct ( Z-For Repair ( ) an Individual Sewage Disposal
System at:
W l............................ R)V Z"
cation.Address or t No.
�G c ��------------------------- ..... -�'A U��z�--- .....�? ----------------------
�Wner� J11 / ...Addr /_S
119 R. .t. .. .>'- f -�
Installer Address
Q Type of Building Size Lot............................Sq. feet
V Dwelling No. of Bedrooms......................� -. _----Ex Expansion ttic Garbage Grinder
g— -- P ( g '
PA Other—Type of Building ---------------------------- No. of persons.......�.....--...---. Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------------------------- ---- --
W
Design Flow----.-_.....s� .._.--_.-... -gallons per person per day. Total daily flow........=�6.4---------------------gallons.
WSeptic Tank—Liquid capacity-'gallons Length---------------- Width----------- Diameter----------------- Depth-.-.-----_---_.
x Disposal Trench—No- --___-'----------_. �%idtl�-�-.----._.jTotal Length------------------- Total leaching area_-------:--.__-:---sq. ft.
z ( ) g ) leaching area------------------sq. ft.
Seepage P
Other Distribution box Diame sm tanD el�w ...... C Total e, �"7e
Percolation Test Results Performed bY.......................................................................... Date..-------------------------------------
a Test Pit No. 1----------------minutes per inch Depth of "lest Pit..................... Depth to ground water--.-_----------__-.___.
�14 Test Pit No. 2................minutes per inch Depth of Test Pit--..............---. Depth to ground water-------------------------
------------------------_e------• •----- ----••-----•---------•--• 0------I-- �_... --•---
O Description of Soil--------I--------- ------ �`. d� °'°� �
U '
VW •----------------------------------•-----------------------------------...-...-•---------------------------------------------------------••--------------------•--•---•------------•----........------
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issue by the boa/ f health.
Signe - C
------------------------------•••• -- ...
Q Date
Application Approved BY .. ---------------- --------•0-- �..-
Date
Application Disapproved for the following reasons---------------------------------•------•-------•--------•---------------•----•-•-------------------------------
•....•--•.........................•.....---•-------------•------------••-----------•--•---------......•-•-•-----...-------•--------•--•---------•----------.....-------------- ........................
Date
PermitNo......................................................... Issued...................... .................................
Date
No.-••••--•-•-?S"1?. Fna...../d..".........-
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
D..610.1V........OF...../3�}..r��./V 7r�1. L ��........................
Applirtttiun -fur 130pouttl Workii Totuitrnrtiun Prrutit
Application is hereby made for a Permit to Construct ( 4ror Repair ( ) an Individual Sewage Disposal
System at:
w iiv�; raoT- �R lvr` �� M___��..
17
cation-A dress or Lot No.
j,__!.G.......... ...-- -•-•--------------------- ----- - i..1 _ �.....M..1.S.. .............
owner J� Address n
a .............................................v t.. �- �........................... ......,�-�2.. � ------/...l..G l--
Installer Address
Q Type of Building c-� Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms........................Cam--------------Expansion Attic ( G� Garbage Grinder (�
a4 Other—Type of Building ............................ No. of persons.......' _____.______.__ Showers ( ) — Cafeteria ( )
a' Otlter fixtures --•--.----_-.-•. .............. . .
W Design Flow------------ 5�......................gallons per person per day. Total daily flow.......... iQA.................----gallons.
WSeptic Tank—Liquid capacity.] gallons Length---------------- Width.------ ........ Diameter._...__._--_ Depth----------------
x Disposal Trench—No- --------------------- Width.................... Total Length.................... Total leaching area_---..-----_._._____sq. ft.
Seepage Pit No------1------------ Diameters. � ./AlDe th Vow inlet.................... Total leaching area.._._.__.._._____sq. ft.
z Other Distribution box ( ) Dosing tankR «� DI ` /�� L
aPercolation Test Results Performed bY.......................................................................... Date---------------------------------------
,a Test Pit No. 1................minutes per inch Depth of "Pest Pit.-.-----..___--_---- Depth to ground water_-----.--.---.-..--._-
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.-------..-________- Depth to ground water-..--.---_-.----.-------
f� /,'
O Description of SU.j
_ _ ._.__
J
V •--
W
------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------•----------------
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 Article tI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b ens issued by the boar IV
health.
Signed__.._. .:..........................✓ -- `
Date
Application Approved B `P ! .. ...... f ..t... 64�= --•---•-------- ------._.. ...... SJ "7
Date
Application Disapproved for the following reasons:................................................................................................................
-•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
�-- BOARD OF HEALTH
...../...4.. ... ............. !`J1.34Z.............................
(11prrtifirttte of f11,ontplittnrr
THIS IS TO CERTIFY, That the I dividuaI Sewage Disposal System constructed or Repaired ( )
by At./ ......-.==-L- ......
Installer
at...W..�-Na D T '�� �� 11/'fJ�!'1 :.(?./l/ /�...---------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.(: /. _ -------------- da,ted------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL F NCTION/SATISFACTORY.
DATE r� 1 / ............. Inspector �
. -•- -r------------------
THE COMMONWEALTH OF MASSACHU S
BOARD OF HEALTH
/..U..�cJ . ......OF..., ............................
No. Ste••• FEE........................
�i��u�ttl urk� C�un�trnrtivat �rrntit
Permission is hereby granted--- C_� ._.=v_���-. ��
to Construct (/,,I-or Repair ) an Individual Sewage Disposal System l/
at No..Vl-��---�'--�`'-Q07......bX!...----. L 4 ........ =5----------- /.....Al 7
Street `
as shown on the application for Disposal Works Construction Permit' o----- __________________________--
DATE.........-------------------------------------------------------------------- l Board of xealt� j
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS /o f &d
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ATTENTION:
N Do not scale these drawings.Under no aramstanco
i - should these drawings be scaled for lengths,areas,
distances or for any other purposes to do arrome
quantities.If dimensions are in question,the contractor
shall be responsible for obtaining clarification.Wiles
- Architects is not responsible for inconsistences m
t recale due to printing,plotting and/or digital
vroduction.
C4 a 7%�' Drawings,sPeclfcations and oMerdocuments.
V //,/ prepared by Wiles Architects and Witt,Architects'
Consultants are Instruments of Service for use solely
E wfth respect to this Project:This includes documents in
E electronic form.Wiles Architects and their consultants
shall be deemed the authors and owners of their
re ,e:e Instruments of Service and shall retain all
an law,statutory and other reserved rights,
nduding copyrights.The Instruments of service shall
not be used by the Owner or General Contractor for
future additions,alterations to this Pro]—or for other
projects,without the prior written agreement of the
Design Professional th.Any unauorized use of the
- Instruments of Service shall be at the Owners or
` e yyy ryrymm�� General Contractors sole risk and Without liability to
Wiles Archilads and/or their consulhnta.
SEP 2 5 2013
z y�
LINE OF NEW DECK ABOVE T AT 1 own of
I Barnstable
---------=------------------------ ----, Old King's Highway
Committee
D D
3 A7
Dennis& Samantha
F-,
T Cambal Residence
REIER'NTO
ETAING WALL NEW 6X6 COLUMNS ON Nt�A/PIFJ25 J ° ° :
STRUCT DWGS -
0.
132 Wingfoot.Drive
REFER TO STRUCT FOR.
FOUNDATION INFOR02675
MATION. .. -
. :. � .. Yarmouth A
i Port, M
'
C
NEW UNIXCAVATED GARAGE. - -
... EXISTING UNIXCAVATED GARAGE EXIStln0625ement .
. - '.•. .. .., - ': ... essana Seal
NEW CRAWL SPACE. - � ' .
A6 / -.. _
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d.
...., ..
.'.'DRO,P WALL AT O.H.DOORS.
- _..
n
a �'I
I
les
cts,LLC
515 Broklawo Avenue
.:. ..
' NOTE.SHADED WALL I NDICATE
�l
EXISTING TO REMAIN I
_ Bridgeport,CT 06604
6003
p _ ________. .384.1751
r7 1. B www wilesarch com
�ph:
f.
' Architects
2'-6" 8'-0" Y-e+• •-tl' - ` No. ` Description Date
E
Basement Plan
N
L
�\Basement AS
114"_ „
- - - Project number 13-289
as Date September 25,2013
o A
Drawn by
U - A Checked by _
z �`J AO
.0 1 :2 _ I
^3 4 5 6
- (C)Copyright Wles Architects 2013
J Do not state these drawl g Under wmstanee
distameese drawings other
led f lengths, as
quar or for any oche minpup t n,the cna
g fides.enot..If ...are quesdan,thecontractor
'� / shah be responsible for obtaining aadmm�en.wiles
5 emle cis is not responsible for&,rdiiitancies:o
GENERAL NOTES - mprddue to pdndng,plotting and/or digital
reproduction.
1. REMOVE DUSTING SIDING.PREPARE FOR NEW Drawings,spetinca6as and abler Wiles
Ae hlte
prepared by Wiles Architecs and Wiles Architects'
GYPSUM BOARD FINISH.
2. REMOVE EXISTING WALL ASSEMBLY.SHORE EXISTING - Consultants are i s4uments of Service to'
use solely
E STRUCTURE r with respect to his Pmjetl.This Intludes comments in
3. SHADED WALLS INDICATE EXISTING TO REMAIN.PREP t electronic fans.Wiles Arrhiteela and their consonants
FOR NEW WORK. shall be deemed the authors and owners or their
4. 4'-0"HIGH KNEE WALL,CURVED,WITH HARDWOOD CAP APPROVED remspective Instruments a! other and shall retain all
6. REMOVE EXISTING CEILING AND INSTALL NEW GYPSUM on law,statutory and other reserved rights,
BOARD CEILING AND LIGHTING. not beng copyrights.The Instruments of Servlce shall
B. REMOVE EXISTING CEILING 8 CEILING JOISTS.PREP not re used by the Owner or General Contractor for
FOR NEW WORK future
adtll8ons,alterations to This Project or for other
]. REMOVE ALL GYPSUM BOARD AS REQUIRED FOR NEW projects,without the prior written agreement of the
WORK INSTALL NEW GYPSUM BOARD FINISHED WALL.. S C P 2 5 2O 13 Design Professional.Any hall
be at unauthorized use of the
J C r (>♦ D Instruments o1 Service shall be hors a Owners br
_ General Contractors sole risk and without liability to
Wiles Architects and/or their consultants.
NOTE: f
ALL DIMENSIONS ARE TO THAT REFERENCE EXISTING Town
CONDITIONS ARE TO THE FACE OF FINISH. I wn Os I Barnstable
Ulf
Old King's Highway
A4 Committee
3 2
HIGH RAILNNEW42 G
\ r EXISTING RAILING TO REMAIN
New Deck /
D .
D
Dennis & Samantha
24'-0"
Existina Deck Cambal Residence
4, N 8
DN NEW BAY WINDOW
7
, A r
- �� s
. . _
132 Wingfoot Drive
x.Kitchen
W1�' 1HR FIRE RATED WALL WITH ,. - cathedrel eeeling —E L
45 MIN RATED DOORS ',\, "6_ Yarmouth Port, MA
(E7(TEND UPTO UNDERSIDE OF �A 02675
, — — —
MUD ROOM ROOF SHEATHING) l
]
Ex.Breakfast
/r Ex.Den z Aa
Fab F—lace. 1 2
�fTTI y 2_
m I I111 I II C 0-
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r—FND WALI:I ��-
2 _ 2'-61/4• .6 Great Room--� -
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Ex.Clos
"A8 l CATHEDRAL CEILING
V1 �Ex:Fo er
X. Wiles+Arc hitects,LLC
1 �3' -7T_ Ex.Bath 155 Brooklawn Avenue
Bridgeport,CT 06604
u _ ph:203.366.6003
L cONC APRON - - 'v 2.wIesach.c
8 � '- www.ylnlesarch.com
B Architects
. .. - No. Description Data
,., 6'4T 5-31W F-31/4" ff-W 1. J
I
65-8 1/4"
F - n First Floor
E AS
First Floor Plan
t
m Door StItedute W ntlow schedule
NI Door Material Material Finish Finish Finish HEAD HEAD SILL SILL JAMB TRIM TRIM- SILL SILL Patted number 13-013
m Level Number Width Height Head Jamb Dow Frame '- Comments Mark Type WIDTH HEIGHT HEIGHT DETAIL HEIGHT DETAIL DETAIL MATL FINISH lMTL FINISH Comments
a Date September 25,2013
N First Floor 1 5'-t01/4"8'-2 3/8" Wood Wood Paint Point Owner Selected W1 Double Hung 2'4" T-10" - - - Vinyl Factory Finish Vinyl Factory Finish New Window Drawn
W
VI First Floor 2 Y-10' 6'-8" Wood Wood Paint Paint Owner Selected Window _ - A Checked by —
❑ A W3 Casement-3wide T-Q' 2'-/1" Vinyl Factory Finish Vnyl Factory Finish New Wlndaw
53 First Floor 3 78" 6'4" Weod Wood Paint Paint Owner Selected _ _ _
_ First Floor 7 2'-10' 6'41" Waod Woad Paint Paint Owner Selected WS CasamentmF ad/C 10-0" 4'-0" 12'6' i'• Vinyl Factory Finish Vinyl Factory Finish New Window
Basement 8 21b" 6'-0' Wood Woad Paint Paint Owner Selected - asement _
t First Floor 9 8'-0" fi'4T' Wood Wootl Paint Paint owner Selected W10 Oval Window 2'-0" 3'-0" 6'-10' = 3'-10" _ _ Vinyl Factory Finish Vinyl Factory Finish New Wineaw Al
First Roar 10 8'-0" 6'-0" Wood Wood Paint Paint Owner SelectedVinyl Factory Finish Vinyl Factory Finish New Window
u - Grand fatal:10
0 First Floor 11 Yam" 6'-8" Wood Waod Paint Paint Owner Selected
Basemen) 13 2'-1W 6'-8" Waod Waod Paint Paint Owner Selected -
'aI Basement 14 2 6 78"
, L
in
1 _ 'r� A CJ 6 some 114"_V-0"
ti G 't
(C)Copyright Wiles Architects 2013
I
I
�� T —
14
ATTENTION
Da not stale these drawings UrMer ne circumstance
should Mesa drawings be scaled for lengths are
f es to determine
qu-rites or for dimensither ons
an,in quest on,the contractor
aces If dimensions are c
shall be responsible for obtaining clarification Wiles
Arch tact;is not responsible for oiconsistenues'n
scale due to printing.plotting and/or digital
reproduction
Drawings,specifications and other document,s
prep d by Wiles Architects and Wiles Arch'teels
Consultants ara Instruments o/Semic,locus.solely
E with respect to this Protect This includes documents n
lecimnic form.Wiles Architects
and their cenhants
r shall be deemed the authors and owners of their
respeccve Instruments o/Service and shall retain all
common law,statutory and other reserved rights,
including copyrights.The Instruments of Service shall
not be used by the Owner or General Contractor for
1-"PROVED
�ppp �f�m�ppp �q,•� ��aaii per, future
add Mons,alterations to this Project or for other
., p p y h p Design
without Me pdor written agreement of the
t)�fb'1. � fp D sign Professional.Any unauMonzed use of the
-Ins m—ft of Service shall be at the O—cea or
- General Contractors sale nsk and without liability to
- Wiles Architects and/or their consultants.
2 A4 S EP 25 2013-
Town of Barnstable
Old King's Highway
Committee
•�A7
D D
Dennis & Samantha
Cambal Residence
I
.. ,.:. ROOF
ROOF E "'. .. ,. .,. ROOFt
I .
I7DDF o J Wingfoot Drive
N.. ... -. .. :; .. NEW 42"H.RAN 1 m I
—. z FL A4 Yarmouth Port, MA
..... ....: NEV OOR TO
</
ROOF CEILING OPG—� \ XIBY.-ICI Site 1 1� \\❑ ^
C 02675
GARAGE ATTIC AREA E O UP NEW
RIDGE C
l
UPP R GREAT R OM
97r
Y FINISH
ISt BEdf U
EXIST WALL W/
... ,. NEW G P IN
.. • ",.
�5 Prof anal Beal'
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- � --i ER TO
'\LEvanoNs • Exist Wardrobe -
01
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.. - • 6, , -.Up Per Foyer
ROOF
Wiles+Architects,LLC
155 Brooklawn Avenue
® it Bridgeport,
h:203.66 6003604
P 203.384.1751.,
U _ - - _ � �. www.wilesarch.com
U JArchitects
No. Description. Data
K
F
m
Second Floor Plan
ce
Project number 13-289
EDale September 25,2013 .
Orewn by --
C' A A Checked by --
2
1 2 3 l 4 C 6 Scale 1/4"_V_0:,
(C)Copyright Wiles Architects 2013
SYSTEM PROFILE TEST HOLE LOGS
TOP FNDN. AT EL. 44.7' (NOT TO SCALE)
. , ACCESS COVER TO WITHIN 6 OF FIN• GRADE
ARNE H. OJALA, PE
ACCESS COVER (WATERTIGHT) TO MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 28 O, - 29 O, ENGINEER: DAVID STANTON WITNESS CUM MAQU D GOLF COURSE
2' DOUBLE WASHED PEASTONE. 3/14/02 elev. 42.8' RUN PIPE LEVEL DATE:
FIRST 2' 27.0' PERC. RATE < 2 MIN/INCH
EXISTING 1_QQQ_
GALLON SEPTIC 4't I L/1_7FOR
I 10,194 Focus a DORAL DR.
TANK CH- 10 ) 4GAS TEE 0 25.5D' __ a 2' a ENDS CLASS SOILS P#
RE-USE BAFFLE 5• 7' 25.50 3.5° @SIDES 1"NGFOOT OR
2'
6' CRUSHED STONE OR MECHANICAL 8o ELEV.
COMPACTION. <15.221 [2J) � 0 o�g, 14" �� � 0-.-.. � 28.2' CYPRESS
DEPTH OF FLOW = 4' ( i 7 % SLOPE) A
TEE SIZES: 3/4 TO 1 1/2 DOUBLE WASHE) STONE LS
INLET DEPTH = 10" 7" 10YR 4/2
OUTLET DEPTH = 14 B
LOCATION MAP NTS
LEACI- 6.3'NG LS
---
FOUNDATION EXIST SEPTIC TANK 94' D' BOX 2' FACILIiTY 30 1OYR 5/6
(RE-USE) 257 ASSESSORS MAP 349 PARCEL 84
BOT. TH 1 = 17.2'
C1
M-F
10YR 6/6
_ 120" 18.2'
11.4 C2
8.2 1 FS
WETLAND 2.5Y 6/2
132" 17.2'
+ 1 �� 9 9•o NO WATER ENCOUNTERED
100 9.6
WETLAND 15 6`�A ! NOTES'
235•aa' la. � oo 10.3
�6 - + 3 _..%✓'' SEPTIC DESIGN! (GARBAGE DISPOSER IS NOT ALLOWED 1. .DATUM IS APPROXIMATED FROM QUAD MAP
DESIGN FLOW: g._ BEDROOMS ( 110 GPD) = 440 GPD 2. MUNICIPAL WATER IS .EXISTING
440 w
LOT 174 �g' �$ USE A GP.D -DESIGN FLOW 3. MINIMUM, PIPE PITCH TO BE 1/$ PER FOOT,
?� + i8• �° SEPTIC TANK: 440 GPD ( S) = 880 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 •
39,922t SQ. FT. 2�� 20.7
? 5. PIPE JOINTS TO BE MADE WATERTIGHT.
3 20 + 20.5 f�_T_ I US- A 1000 GALLON SEPTIC TANK (EXIST.) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS-
2� LEACHING: ENVIRONMENTAL CODE TITLE V.
4 + 3 3 33 22 22 SIDES: 2(41.5 + 9.83) 2 (.74) = 152 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
TO BE USED FOR ANY OTHER PURPOSE.
4 a 24.8 23 -''�- 23 BOTTOM: 41.5 x 9.83 (.74) 301 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC.
42-----, 4� 40 -�s ,�� 24
25 - TOTAL: 610 S.F. GPD 9, COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
A �3 `' 2,,?s 24 � '- INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
_. -- USE
�6) HIGH CAPACITY INFILTRATORS WITH 3.5
DECK 22 __ FROM- BOARD OF HEALTH.
'`D ---�,�_ STONE AT SIDES, 2' AT ENDS AND 14 UNDER 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PITS
� PAVED 37.4 .3 27.0 -25
43.5 44.4 DRIVE EXIST. DWELLING TH
\\ 4
\ 6.2
A 44J 6.58 �j LEGEND
r.- r-n ,
\\ a. \`""---r 28 _ TITLE 5 SITE PLAN
48.0 4 �- a �9 100,0 PROPOSED SPOT ELEVATION OF'
2.. oo _ 132 WINGFOOT DRIVE
10Ox0 EXISTING SPOT ELEVATION
�00 ,� 1 �3� IN THE TOWN OF:
\ ' ago ¢8 0 p _ 100 PROPOSED CONTOUR ( CUMMAQUID ) BARNSTABLE
a ,9 4y 4 .2 ° 100 EXISTING CONTOUR
s PREPARED FOR: RICHARD MORSE
\ .8 Q �6.7
\ � a
\ 0 2
+ 50.0 \ 4 .i 30 0 30 60 90
\
4 v BOARD OF HEALTH
DRAINAGE PIPE FROM
CATCH BASIN MA ,� MARCH 18, 2002
\ 'a9.i �' �AP�ROVED DATE SCALE:. 1 30 DATE:
\ s ,
RE-USE EXIST. 1000 GAL. \\ 3 BENCH MARK - HYDRANT ON TAG BOLT off 508-362-454t �,�tN OF
\ + #175. ELEV. = 50.7 fax 508 362-9m icy of o
SEPTIC TANK (CONFIRM \ '� o �• '��,� � ARNE H. s
SUITABLE TEES) \ 49.5 9.a q° aN E CIVIL
- d OJALA No.30792
9.2 own cape engineering, Inc. No.26348 9FC/STERN®
��
CIVIL ENGINEERS �® 01sTEe �,e.
-_ [A%
LAND SURVEYORS
939 vain st. armouth, Ma 02675 -
O2--039 Y RNE H. OJALA, F.E., F.L.S. DATE