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0944 SHOOTFLYING HILL RD - Health (3)
944 Shoot Flying Road Centerville A= 211-006 l k IA q . c O)mrford, NO. 152 1/3 ORA 1®°/�� F � kT J O 111 "�v � NNN v J6 V ti J 6 �— s a 2 �,. � .. h e', '� 1 s � \ .1 o I� a n f� 7 t h t - ! i I{ 1 { p� 1 i , I ! a I q P TOWN OF BARNSTABLE LOCATION' 1- o s SEWAGE # 10A 1-696 VILLAG ASSESSOR'S MAP & LOT A/ INSTALLER'S NAME&PHONE NO. e cas Keg g e&a ;g,2-?1 7� SEPTIC TANK CAPACITY ' J 14-2Q LEACHING FACIL=: (type) t.etas��f (size) *.' X 1 31 NO.OF BEDROOMS BUILDER OR OWNER f!"���S� DIlc� Vg-d1'LV-Q &TetUtr KALaa,� PERMTTDATE: lf�I�I COMPLIANCE DATE: �/7lii Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by M� -At m� '� �� CVwA _N� �qq/ �y ��,r, '� � �- I ENVIR 0 TECH LAB ORA TORIES, INC.. MA CERT. NO.: M-MA 063 8 Jan Sebastian Drive Unit 12 Sartthvich,AIA 02563 (508)888-6460 1-800-339-6460 r,4X(508)888-6446 Kirkland,Natalie Client Nome: Locution : 944 Shoot Flying Hill Rd -to Address: Y• 9 944 Shoot Flying Hill Rd ,�; Centerville,MA Centerville,MA -•• I:- Lab Number: DW-190273 si•Ct Collected By : Envirotech/ME Date Received: 02/06/19 Sample Type: Existing Well Well Specs: I �� �L�cat�n,�S.•ource�„ _�� ate��ollectgd� XTIme,�C�ollect�d��� ����� �� ��oertts� � °����� �� Analysis Regtieslerl Y 1 Units Recommended Limits Analysis Reeall Yfet/utrl Date Analp•>.ed A+rulyzed 13p i Total Coliform CFU/100mL 0 0 SM9222B 02/06/2019 MC pH pH units 6.5-8.5 5.65 SM 4500-H-B 02/06/2019 RL Specific Conductancert umhos/cm 500 128 EPA 120.1 02/06/2019 RL Nitrite-N mg/L 1.00 <0.006 EPA 300.0 02/06/2019 RL i Nitrate-N mg/L 10.0 4.28 EPA 300.0 02/06/2019 RL Sodium mg/L 20.0 17 EPA 200.7 02111/2019 MC Total Iron mg/L 0.3 <0.01 EPA 200.7 02/11/2019 MC Manganese mg/L 0.05 0.219 EPA 200.7 02/11/2019 MC Comments: I Low pH indicates high corrosive characteristics. Manganese is not a health hazard, but may cause staining and/or give water an odor or taste. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our Knowledge. Water meets EPA standards and is suitable for drinking for pararnet€rs tos ed, tt- Date 2/12/2019 Rnnnhl I.Sauri Lahoratorl,Director BRL=Llelorr Limits e ortabl7 R p See ftttached Page 1 of 1 ❑CertificaNaar is trot available for this analyle for potable ivarer samples.. I% i` o- €3r',TiLTJS'd'RSLE) r� KPISs. 2TiabIfe k e.af!ILh DivlieLrj)� T Domes MI e eau, :Duirerfo 200 Main Street,Hy auni'9, M 02601 Office: 508-862-4644 Fax: 508-740-6304 lustaner & Designer cCeT fiffeation Form Date: Sewne Permit I I-jp9'& AsSesso is M2p1PoiIl cell �e�igne�o 100A D M e G� C'A-7✓d y Address- � � "!fit 11 S 71 wtrJ A, 6- We:%T L yts(a I� On McasAllre_�� was issued a permit to install a (date) � (installer) Q c septic systems at / / JA Oo]V l l vw, �l� I based on a design drawn by (a dr ss) i Q.✓I i ell 6. 0 1'L/'� PE A-f dated � (design ) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the.SAS or any vertical relocation of any component of the septic system.) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ?�VjN OF MAssgcti DANIRLA. OJALA (Ins Pr's Signatu CIVIL Ne,46502 NAL (Deslgner's SignatLlre) (Affix�eslgriel''S Stamp Here) PLEASE RETURN TO BAP3NSTABLE. PUBLIC HEALTH _191VIlSION. CERTI'ICATE OF COYIPL dCE WILL NOT .'BE bSS ED uTN'b'z[ BOTH 'OHMS FORM A_ND AS-BST CARD ARE RECEIVED BY TBE BARNSTA LE PUBLIC HEALTH DMSI1ON. THAl'1K YOU. Q:Health/Septic/Desiguer Certification Fonin 3-26-04.doc No.--- -- -- - Fee----- - --- BOARD OF HEALTH TOWN OF BARNSTABLE Application,forWell Con5truct ion permit Application is hereby made Eor a permit to Construct (Alter ( ), or Repair ( )an individual Well at: Location — Ackress Assessors k1ap and Parcel —-----V 6-L' '-Ta 4-Q ------- - --- -- - _ _--- Owner �/ Address ^ Nl� i�Gll, �z.i u.c/J�= - 021 --------------- Installer — Driller Address Type of Building Dwelling---_------_�-�---- Other - Type of Building----__—__—_______. No. of Persons----.---------------- Type of Well — - L�7o 1DV� Capacity----1-al -------------- Purpose of Well- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate ,of %- 'ance has been issued by the Board of Health. Signed _—_ �' Wda Application Approved By. — ® - Application Disapproved for the following re ns: --- - A----- --------------- ----- --------------------- --------- date J Permit No. --- Issued N - --- --------- date e BOARD OF HEALTH TOWN OF BARNSTABLE (C'ertif irate ®f (tompriance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by-- - _ - ---—__ --__ -- -- ---- ------- ----____ -- -Installer at__ _»--—— - -- ------ -- --- ---has been installed in accordance with the provisions of the Town of Barnstable Bo r Health He l ' `ate Well Protection Regulation as described in the application for Well Construction Permit No. ted—_________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector-- ----- - '000, No. Fee--------------- BOARD OF HEALTH TOWN OF BARNSTABLE 2pptication-*rIVelt Cootruction3permit Application is hereby made for a permit to Construct (V�Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors ap and Parcel � �--LIL'r[ 21� _—_ —_-_ --- —— --------- Owner Address -------------- Installer — Driller r Address Type of Building Dwelling Other - Type of Building----___—__________ No. of Persons----.-__--.._-____.___—_____—___ Type of Well -�---. - PV G Capacity — - - -M-, ---- --_— Purpose of Well--- �. 1 _--___ I•Jt Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.of Co p'ante has been issued by the Board of Health. Signed _ __ , e date t Application Approved By ®-;� - -- date Application Disapproved for the following re ns: date Permit No. --- Issued dace-- -- -----_-------- BOARD OF HEALTH f _ t TOWN OF BARNSTABLE - '� Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) b Y______ --_ _----_.------_.__ --------------------- Installer r at-_— -- _—_ --- -- --- - ------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Bo r o He 1 �P ' ate Well Protection a ;- �lh Regulation as described in the application for Well Construction Permit No. ---- ---- ated—----- --_-________ F - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----= - — -- - - Inspector-- --—- ---------------------------------------------- --------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con$truction'ermit No. -,----- a Fee- . ------ Yf Permission is hereby granted N's W61j,=T to Con `u, t ( ), Ater ( ), or Repair (h an In -vidual Well `ah) tj No as shown do he ap lication �Well Construction Permit No.- --- Dated--- ---t — ---- --- - J DATE Board of'Health �— , f ., Town of Barusta.bk- 17;14 l i FEE lb DJepartmClnt of Regulatory ServicesPublic Health Divisioll Date (� IlAMUTA9(.G ° MASS,6 16y g 200 Main Street,Hyanuis MA 02601 q. ti� APED Date Scheduled Time ! D w Fee�°d ` Soil Suitability Assessment for SP ag� �b�pst� t'crYonned Dy V���L1- ,�' L"► ` �L� ��y��L" 1Vilnessed By: ls:V L �`''.✓ viJu it LOCATION Location Address /� �/^ v /L �L 4I Owner's Name /f Address { Assessor's Map/Parcel: Engineer's Namo (�Q k//V., e NP-W CONSTRUCTION REPAIR i p� Telephone it Land Use 7l Slopes(%) y I Surface Stones G 7 Distance's From: Open'4Valer Body J0D fe Possible Wet Areq fl Drinking Water Well tt Draihage Way Ft Property Line ft Other Yt SKI+TCJH: (street name,dimensions of lot,exact locations of test.holes&pert tests,locnte wetlunds'fn proxinuly to holes) f �fe-lc.1n 3 Tq �p VI co 71- > G131 re'rSYSv ni fh}�nJ 1� �W 1 2 C? Parent maLeriul(geologic)_ � Depth lq Detlrpelc Depth to Oroundwalcr. Standing Water in I-tole: / i Weephig I'I'ol)1 [Olt PRue _ Estimated Seasonal High Otoundwater ! J6—W c DID,TERImNATION]I,OR SEASONAL HIGH WATIC,R TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to s911 1)IUtlLS3: T III, Dcplh to weeping;from side of obs.hole: I!L ClrUulldwular Adf ustmetlta —fe. Index Well 0 Reading Dalc: Index Well level� Add,factm, A41,dt'mindwuter Uve.l 9 P]CRCOLATI0W7l'.1TS"1C - N1at� l( 'l'11I1#1 [DAM Observation � Hole# ��!� Tittle nt 9" _ Depth of Perc V D j� TIITte tit 6" Start Pre-soak Time @ � t/ ` _ Time(9"-V) ,`i 0 3�.2 c7 End Pre-soak 1�1� ell ` / Ratc Min./Incli �+Z 2 VYl""AH Site Suitability Assessment: Site Passed_ Silq'Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation 11o1e Data To Be Cotnpieted on Bat k----------- ***If percolation test is to be conldllctecl vvilllin 100' of weilland, you midst fit-sit uxo fy the. Barnstable Conservation Yjivlsi011 at least 011e (1) Week prior to bd±gtfl0.fldl[tg, Q:\SCPTIC\Pl3RCFORNd.DOC DREIROBSERVATIO ITT��OL , LOG Depth from Soil l-krrizon ]i�a7�E $� ce Surfa (in.) Soil Texture USDA Soil Color Soil• ( ) (Munselt) MottlingOther (Structure,Stones;Boulders. Con istenc %' ravel M- C? DEEP OBS]ERVA'�'I�1°d H®g,� LOG Depth from Soil Horizon ](gO'� Surface(in.) Soil Texture soil Color (USDA) Soil (Mansell) Other Mottling (Structu Stones, Boulders, Co si enc %C avel _ CZ z. N . D EIEP OB&EI VA7CION T-T®LE LOG Depth from Soil Ror�zon ][�®��# Sirrlice(in..) Soil Tex) Soil Color. (USDA) Soil (Muns411) her Mottling (Structure,Stones,Boulders. A L_ O\ Z Co siste eY.45 t7r rve17 C� MSG 5 !M% -S 2 c� .. _ ]I Soil Ho Oj?.zon ERVALTIONTIOL]E LOG Depth (In. Soil Horizon Hole`# '- Surface(in.,) Soil Texture Soil Color (USDA) •• Solt Cher (Munselt) Mottling (structure,Stones;Boul ers, Consi ten a I d ' 3 Cz �� S - � G"2 MS ][�Wd Insuva ice Rate A40 nos Above 500 year flood boundary No Yes Within 500 year boundary No Yes (� Within I00 year tood boundary No- Yes If�e tB>Iofl`�attnlr�99y� ��eua>r�in�]��tviouslV�ate 1aB Does at least four feet of naturally occurring pervious material exist in all areas observed area proposed for the soil absorption tiu'oughout the system? . .. Af not, what is the depth of naturally occurring per ions marel'ipl7 ce�tfflcatjon -.______, r l v 1 certify that on V (date)I have passed the soil evaluator examination approved by the Department of Environmental.d'ratection and that the above analysis was performed by me consistent with Ahe requited training, expertise and experience described in10 CMR 15.017. Signature r- Datb_ a�1 I rr ' Q:1SP_?TIC1PERCrORM.DOC No. "' Fee UY THE COMMONWEALTH OF MASSACHUSETTS Entered in co pater: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1 application for Bisposal 6pstem, Construction permit Application for a Permit to Construct 90 Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 9 y y SA coo r F I y�'n g /d f f/ Owner's Name,Address,and Tel.No. �1K1 /Ca 01,fropkcf velltvfa of Assessor's Map/Parcell D ty No.Ta e K/rKl�- <QATCt0/// mj4 g%7-2724% Installer's Name,Address,an Tel.No. Designer's Name,Address,and Tel.No. rOm 11eonnt C0*LGool-PcoNS o • Designer's dy vu, �r�c-. C-PC f l%0 a 4h;,5 ,L'a G 5:7 Er-3C Z-dt 550d 571 Wr(to t4 StrwT w.&,,,crxbts .MA 939noa}r+ Sr. ATKIA) or.rwc4A rs x Type of Building: Dwelling No.of Bedrooms Lot Size JB'°1 120 sq.ft. Garbage Grinder( ) Other Type of Building ►� a-r n No.of/ WA{^ A A, Showers( $ ) Cafeteria( ) Other Fixtures -T_ o;lef •_�^SA �;• �/V A, J >�/Il Design Flow(min.required)_'TS.gJ41.6 Ti 44- gpd Design flow provided 330 gpd Plan Date /13orck Zy. 7o it Number of sheets ,�( Revision Date Title 5 Fl ou Size of Septic T Tin a/ Type of S.A.S. Description of Soil I a nd +• N V medrvp+ „/ i Nature of Repairs or Alterations(Answer when applicable) Cr d Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ealth ig ed Date 1� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ,% ; Awn L v No. Fee �" '�� �� Entered in c_ puter: THE COMMONWEALTH'/OF MASSA�HUSETTS - PUBLIC HEALTH DIVISION -T'OWN OF BARNSTABLE, MASSACHUSETTS 01pplitation fdr 3pisposal 6pBtrut Construction Vertnit 3iM Application for a Permit to Construct(,") Repair( ') -Upgrade( ) Abandon( ) 'Complete System ❑Individual Components Location Address or Lot No: 9 yy S ti vo r F1%,,g M j lJ g d Owner's Name,Address,and Tel.No. vi .r..�4ovt Vt1lt,ryzs ciKY 5t,00i"fly.^y efrlt !rI Assessor's Map/Parcel �'1`"0`` /a'Mfs N�.Tgr ;�t;!��,� c j E ntc r e�/l f►+R $57- N56 Installer's Name,Address,ah'a Tel. o. Designer's Name,Address,and Tel.No. T'um cop(st-p �g gZ^090 pou.n C t r Y Voa ImAor-. n - (,A)4aee�,n< ,urlt :Itt' S71 L..it1eb4 rs'thtmV r,tir -.. cs<C!a aAtx 9 %Ytt'•n yi. i'i£a J.� Type of Building: , Dwelling No.of Bedrooms n Lot Size S2Q sq.ft. Garbage Grinder( ) Other' Type of Building 'jj„f n No.of Persons NIA ',, Showers( # ) Cafeteria( ) y 'Other Fixtures -7 ;,(� r` Design Flow(min.required)=IAA.!b T•^ =-3.;n4,. gpd Design flow provided ?�,p gpd Plan Date M a r rl ?..�1 l r�t I Number of sheets„ ,2. Revision Date Title 5 FJow Size of Septic T �( Type of S.A.S. Description of Soil I r ez Y, c,• h 1 t r.N+bdA, r A) / 1 i (� )) Nature of Repairs or Alterations(Answer when applicable) --� Date last inspected: ` _T)rp Agreement: / J The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance'has been issued by this Board o Health P ed Date Application Approved by Date i Application Disapproved b Date for the'following reasons Permit No. Date Issued ---------------------------------------------------------------------------------- -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE,MASSACHUSETTS Certificate of Compliance TIES IS TO C RTIFY,that the On-site Sewage Di}sp�saI system Constructed(�i)� Repaired( ) Upgraded( ) Abandoned( by 11 V- I ` at has-been const cted in accor ance �wv with the provisi ns of Title 5 and the for,Disposal Sy ter onstruction Permit No ated Installer 22,*,- Designer #bedrooms O Iry Approved design flow gpd The issuance of this permits all not be construed as a guarantee that the system willo nG i as designe . Date r/ Inspector ---------------------- ------ - - - - - - �--- No. ��J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 3pisposal *pstem Construction j3ermit -Permission is hereby granted to Const ct ) Repair( Upgrade( ) Aband /System located at ( and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Approved by i f _ r/0 ��� � T® ®f Ba>r1caSta table P# I 7-2/4 Departitnt it of Regulatory Services Public Health DiViSioll Date Public r ' S nnaNarestE, " . 200 Main Street,Hyannis MA 02601 . i Date Scheduled_ (� Tiime iJy : Fee Pd. Foil Suitability Assessirizentf for Seim e isp® al `,.,, ,� { QiL IJiJ���t-- Witnessed By: ^ 0` Perfanned-By. y �1 EL A.O) ,L- r p -1.fir0�7 - Location Address / S � /y �•/ Owner's Name C 111 Address Assessors Map/Parcel: 'a 1 0 O r� Cngineer•s Nanrc '0 0 VV V_ NEW CONSTRUCTION REPAIR Telephone 0 vd J cJ 6 G Land Use �4�a e-7-tA—A Slopes(%) i Surface Stones c/ 1 Distance's from: Open Water Body 70 r ft Possible Wet Area 7 V ft Drinking Water Well ft Drainage Way ft Property Line GjiC ft Other R SYXI TCH.(Street name,dimensions of lot,exact locations of lest holes&pert tests,locnte wetlands?n proximity to hales) 7 k/rA[14afl rn �b1 4TVfAy ti lit 4 2�21 19610\ 01�i vico 11�2p ) t;13 �V',�A5q �L Y) Depth to Bedrock Parent material(geologic)_ i e p • Depth to Groundwater: Standing Water in Hole: Weeping I'ronl Pit Fltcs _ 3 Estimated Seasonal High Groundwater "V_V/f DET MENA$ION FOR SEASONAL HIGH 9�V��'���TABLE Depth Observed standing in obs.hole: -A�' ` )n, Depth IU svll ntoUlss:_ - la, Depth ta_weeping from side of obs.hole: ,_ In. Ciroundwuter Adjustment _ ft. Index Well M Reading Date: Index Well level Acil,factor— ALU.CJroundwater Level ,. PERCOLATION T EST Date— � (( 'A'lulu_J0 AM Observation Holc# t t/ \ � Tinto at 9" Depth of Perc Tlmc at 6" j} ., Start Pre-soak Time @ v`00 0 , Time(9"-V) ++ End Pre-soak f Rate Min./Inch "'Z 2- Vh41 Site Suitability Assessment: Site Passed SiIS''Failed: Additional Testing Deeded(YIN) Original: Public hlealth Division Observation Hole Data To Be Cotnpleted on Back----------- *'k*If percolation test is to be conducted Within 100' of Weiland,you nitist first uotify the. Barnstable Conservation Division at least one (1) Weelc prior to beginuixtg. QAS EPTIC\PERCFORM.DOC J .l ERROBS l�'� ATION HOLE]LOG Depth from Soil Horizon Sail Texlure Surface(in.) Sdil Colar Soil• Other (USDA).. {Munsell} Mottlin g (Structure,Stones;Boulders, Q' Con iste c ravel M np 2 , • �--3 /VIA -SA ' lb 'Z sr, '7' L V-W DEIct P O Depth from BSIERVATION HOL,LOG Soil horizon Hole# G Surface(inJ Soil Texture Soil Color (USDA) SOtI Other (Munsell) Mottling (Structure,Stones,Boulders. Co sisteney % raven 2b ---?7. G M %© csi24v�) 2-1 / Depth from DEEP OBSERVATION HOLE LOG* • Sail Horizon •I�m,d~# • Surface(in.) Soil Texture Sail Color - Soi I • (USDA) (Munscli) Mottling Other _ g (gtructure,Stones,Boulders. (:0R istcacv-%Graven irs 10° --------------- 1..E --=�� CI M/c. 5 - DE IEP OBSERVATION HOLE,LO Soil Horizon Hole# � Depth from Surface(in.) Soil Tcxttre Soil Color . Soll (USDA) (Munsell) M011lln Cher g (Structure,Stones;Boulders, Con istency.96 t7rav Il ------3------- a Cz --- -- r� M Flood Insurance hate map. Above 500 year flood boundary No ycs Within 500 year boundary � Na Yes. Within 100 year hood boundary No yes` Depth of Naturally Occurrin Porvious Materfal -- ---- -- Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring per ious mar®rial? ceirtr— fication ? 1 certify that one . l (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analys-is•was performed by me consistent with the required training,expertise and experience described in CIO CMR 15.017, Signature Data—r?�a��� Q:\SEPTFWBPCFORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM ,.•''� 944 Shoot Flying Hill Road(aka 930 Shoot Fling Hill Rd.) Centerville Property Address — Alan Owner Owner's Name — require tifo is P.O. Box 897, Osterville MA 02655 June 8, 2010 required for 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. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, 31-R-u use only the tab 1. Inspector:key to move your �J cursor-do not Troy Williams use the return key. Name of Inspector — Troy Williams Septic Inspections _ Company Name 19 Hummel Drive Company Address South Dennis—------------- MA 02660 City/Town State Zip Code (508)385-1300_ _ — S1682 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 --a --- --- June 8, 2010 d " 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 thEE.79 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. w � + ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins 09/08 Title 5 Official Inspection For Subsurfa Sewage Disposal System•Page 1 of 17 • S Commonwealth of Massachusetts F - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 944 Shoot Flying Hill Road-(aka 930 Shoot Flying Hill Rd. Centerville Property Address — --y- ------ _ — ___— Alan Dalby Owner Owner's Name --- - ------- ---- information is -- -- -- required for every P.O. Box 897,_Osteryille MA _02655 June 8, 2010 page. Cityrrown - State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only. This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes or components, or the future structural integrity of system components and represents conditions found on the day of inspection only. B) System Conditionally Passes: —`--- ---�--'--------- ----- ❑ One or more system components as described in the "Conditional Pass'' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): N/A !Sins•09I08 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 944 Shoot Flying Hill Road (aka 930 Shoot Flying Hill Rd.) Centerville Property Address Alan Dalby _. -- - Owner ------ ------- —-- --.___-- Owner's Name information is P.O. Box 897, Osterville MA 02655 June 8, 2010 required for every _ —__—_ — page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): N/A ❑ 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): N/A C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �N 944 Shoot Flying Hill Road (aka 930 Shoot Flying Hill Rd.) Centerville Property Address --- Alan Dalb Owner �--------------- ------- ------------- ------- --Owner's Name information is required for every P.O. Box 897, Osterville MA _ 02655 June 8, 2010 _ page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is.within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: N/A 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 El ® 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 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 944 Shoot FIVinq Hill Road aka 930 Shoot Flying Hill Rd. Centerville Property Address Alan Dalb ry _ Owner Owner's Name ---_---------- --- --- -----information is P.O. Box 897, Osterville MA _02655 June 8, 2010 required for every _ _ _ — _ _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: N/A. ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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. 15ins•09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 944 Shoot Flying Hill Road (aka 930 Shoot FlyingHill II Rd.) Centerville _ Property Address Alan Dalby Owner Owner's Name information is P.O. Box 897, Osterville MA 02655 June 8, 2010 required for every -- -- _ _ page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank. inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 7------ Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 770 gpd per plan t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 L Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 944 Shoot Flying Hill Road aka 930 Shoot Flying Hill Rd.) Centerville— Property Address Alan Dalby - -- ---------- --------- — —=— -- Owner Owner's Name information is P.O. Box 897, Osterville MA 02655 June 8, 2010 required for every ----- _ _ —_ page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 09=39,000 gals. g ( y g (9p )) 08=46,000 gals. Detail Sump pump? ❑ Yes ® No Last date of occupancy: Auk. 09 — Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A N/A Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): N/A 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: N/A -- -- 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts . Title 5--Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 944 Shoot Flying Hill Road aka 930 Shoot Flyinq Hill Rd. Centerville Property Address Alan Dalby _ _ Owner Owner's Name information is required for every P.O_ Box 897, Osterville _- _ _ MA 02655 June 8, 2010 _ page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A _ Date Other(describe below): NIA General Information Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 944 Shoot_Flying Hill Road aka 930 Shoot Flyin Hill I Rd.) Centerville Property Address Alan Dalby Owner Owner's Name information is P.O. Box 897, Osteryille MA 02655 Jun_e_8, 2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank, d=box& leaching were installed on 5/10/99 per compliance_ Were sewage odors detected when arriving at the site? ❑ Yes ® No 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: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Flushed lines and found clear at the time of inspection. Septic Tank(locate on site plan): Depth below grade: 18 — feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/Ayears Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 gallon tank Sludge depth: 4„ t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Segv.age Disposal System Form - Not for Voluntary Assessments ^M 944 Shoot Flyinq Hill Road (aka 930 Shoot Fln� Hill Rd.).Centerville Property Address Alan Dalb r� Owner Owner's Name information is p_O. Box 897, Osterville MA 02655 June 8, 2010 required for every _. - _ —_ _ _ --- page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2 8-- -------- -- Scum thickness 2 — Distance from top of scum to top of outlet tee or baffle 6 - Distance from bottom of scum to bottom of outlet tee or baffle -12 -- ---------- --- How were dimensions determined? Probe/measured T _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pvc inlet and outlet tees were present. No evidence of leakage or damage was found at the time of inspection_- - ---- -- ---- -- --- -- - Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A ---- -- Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Officialildnspection Form SuW-urface Sewage Disposal System Form- Not for Voluntary Assessments ..yy< 944 Shoot Flying Hill Road (aka 930 Shoot Flying Hill Rd.) Centerville Property Address Alan Dalby _ Owner Owner's Name information is required for every P.O. Box 897, Osterville MA 02655 June 8, 2010 page. Cityrrown 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.): N/A Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A— - Capacity: N/A gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A ---- - Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A— Date Comments (condition of alarm and float switches, etc.): N/A Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System!Page 11 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form j Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments y _944 Shoot Flying Hill Road (aka 930 Shoot Flying Hill Rd.) Centerville Property Address Alan Dalby____ -- -- .--- _ -- _--- Owner Owner's Name information is P.O. Box 897, Osterville MA 02655 June 8_2010 required for every _- - --- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level with 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 was found level and in working order with equal distribution to outlet lines.. No evidence of solid carryover or backup in the past was found present at the time of inspection. 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.): N/A Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: N/A t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewag6 Disposal System Form -Not for Voluntary Assessments 944'Shoot Flying Hill Road Aaka 930 Shoot Flyin Hill ll Rd. Centerville Property Address Alan Dalby Owner Owner's Name information is required for every P.O. Box 897, Osterville MA 02655 June 8, 2010 .--- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: leaching chambers number: 11 infiltrators withstone 14" under ❑ leaching galleries number: 10' X 74.7'X 2' ❑ leaching trenches number, length: -- -- ❑ leaching fields number, dimensions: — ❑ overflow cesspool number: - ------- ❑ innovative/alternative system Type/name of technology: — Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Checked stone and found dry and clean with no evidence of hydraulic failure or problems in the past at the time of inspection. _ Cesspools (cesspool must be pumped as part of inspection) (locate on site plan).- Number and configuration N/A _ Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A_ Indication of groundwater inflow ❑ Yes ❑ No 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal Syst*em Form - Nc1t for Voluntary Assessments M 944 Shoot Flying Hill Road aka 930 Shoot Flying Hill Rd_) Centerville _ Property Address Alan Dalby_ Owner Owner's Name information is P.O. Box 897, Osterville MA 02655 June 8, 2010 _ required for every _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)". N/A Privy (locate.on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts F Title 5 Officialglnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _944 Shoot Flying Hill Roadjaka 930 Shoot Flying Hill Rd. C erville Property Address Alan Dalby Owner Owner's Name information is required for every P.O. Box 897, Osterville MA 02655 June 8, 2010 _ _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 944 Shoot Flyiin'q_Hill Road_(aka 930 Shoot_Flying Hill Rd.) Centerville Property Address Alan Dalb r� Owner Owner's Name information is P.O_ Box 897, Osterville _ MA 02655 June 8, 2010 required for every — —__ _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 15.0'+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: 3/18/97 _ — - Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: engineer letter on file saying sytem was installed to Ilan and code. _ ❑ Checked with local excavators, installers (attach documentation) ® Accessed USGS database-explain: AIW247_Zone C 20.6' no adjustment_ You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at a depth of 115. Groundwater adjustment at the time of inspection was .0'. Bottom of leaching at 4.0' was found not to be located in the high _groundwater level at the time of inspection. 10 ------- - h' c✓L . Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 944 Shoot Flying Hill Road aka 930 Shoot Flying Hill Rd.) Centerville Property Address Alan Dalby _ Owner Owners Name information is P.O. Box 897, Osterville MA 02655 June 8, 2010 required for every _ page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION:93o 5"de 4tiny to M IZJ SEWAGE # 99-G33 VILLAGE C Cr�t ASSESSOR'S MAP &LOT All 6 INSTALLER'S NAME&PHONE NO.An2ppNf GUALA1362�16Y1 L(iMA �) m4-1-ow SEPTIC TANK CAPACITY AM Vim`' LEACHING FACILITY: (type) t'2f�/c/f IAXI(IVW045 (size) 7'/'8�X 10'0 N X 2 c�ttp NO.OF BEDROOMS 7 BUILDER OR OWNER ALAN �h�£cfAl DAcB`/ PERMlTDATE:4/6l`f. COMPLIANCE DATE: tr 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 NoN�i 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 � a �oRt�S�VL �.' F'Cottut tL �U �� �• 100046L \ter' 1 p L gt.aj Cc (L(t{SL) d c p F .. fT g8-Orr (011:� Q�`Sr GZt�Sr l2?t b� '�-Ilt �i • t x u e ► r u t ar . � 56�� 53•'� qq,.8 7D''y 13s.,t 70.g _ s Now ck/k �OZ- Weq4faquet LEGEND \-�x WELCH, H/LLARD W & ✓OYCE T TRS 344 ANNABLE POINT RD OCA�ION �� �'-9,Q� CENTERVILLE, MA 026j2 348 t � � �. FOR (A G POND 99— — EXISTING CONTOUR BEAT X 99.1 \ AL \ PERM/TTED ) EXIST. SPOT ELEV. O 9 3 A / s,O� n E \� DOCK Lewis Point a od —[991---- PROPOSED CONTOUR P32 \�% �4•08'30 J �op� Wequaquet LC s N �, �` �'+ ------ ---,� ,Lake 198•41 PROPOSED SPOT EL: \moo CB/DH I ,i -- --- �; LOCUS rH 1 \ �w FOUND i ( 00 / �.. WOODS `` cn �,, KAYAK & BOAT I o �• TEST HOLE �� �'� \ WO i, v 1 �I `�' SAL TORAGE AREA 2� SLOPE OF GROUND \� /� `BOO �.`! +. UTILITY POLE \ �. 0 1 ' z 1' '`1 v' I BEACHAL I , 50RD WA -- -- ,` FIRE HYDRANT \ BENCHMARK: HYDRANT TAG BOLT 181 O W — WATER LINE <r s EXIS�NG ELEVATION = 65.83 NAVD88 Z 1 ,ice l \�� — �i�� BRUSH HAEL P ANT i' i {� ~r ` ---- r \ 5' PA TH — G — GAS LINE NEA TH, M/C f F y�F -vG, HYpR 900 SHOOTFL Y/NG HILL RD O��/ �Q� SNEp ,�y j I� ���00 = \ , — E — U.G. ELECTRIC LINE CENTERVILLE, MA 02632 \ \, PEBBLE .24�30„ E � F�oM P EAR � Q NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING '3 Rv\CC�' 0� ' ' N SE E / � � I� \� MOWED CLEARING � \�� BEACH LOCUS MAP UN NEW E PLANTING \ SNEp R � � ' ,' SCALE 1"=2000't PRODUCE OUSE NEW GAS LINE 10 CLEAR OF NEW ELEC. �,� GREENH \OD ` \ ASSESSORS MAP 211 PARCEL 6 CB/DH NEW ELECTRIC LINE 10 CLEAR OF GAS - GARD:N StiFO r North ;� `�;/ AL �\ #944 SHOOTFLYING HILL ROAD O FOUND covered manure G '4R 'Q \ II /� F WETLAND I i N ro//off durnpster & turning tee �,u, ���jUs ` �I Lily Pond ;' `! / 50 OF �,` LOCUS IS WITHIN FEMA FLOOD ZONES B& C I , - area- 6. stockade fence screening \ GRA VEL l i 1 � gravel to match existing _ ��• {, y l f ,^ _ -- ._ ��, AS SHOWN ON COMMUNITY PANEL FE �� Area--1 73,371 f Sq. AREA WETLAND /lWETLAND.. \ 2500010005C.DATED 8/19/1985 i BENCHMARK: SPIKE SET IN DRIVE ( \ I ,� /'' --•_ '. 1 \\ ELEVATION = 69.17 NAVD88 .Of A�Cresand� x, � wooD 4.5f Acres We Ian ) \ PLANTING �, h� I BED R0oF ZONING SUMMARY i I T LA WN DRAIN c� \- �' 13 70J �- rr' - l 1 / Z 4 ` ` GRAVEL / �\ �� c� - -- ZONING DISTRICT: RD-1 RESIDENTIAL DISTRICT CB DH / ISS1N ` i J EXISTING `,,� i ■ 1 / r i [71J \ TH2 \ \ ` SAS AREA \ , / I \ ,�' ` O / I fl MIN. LOT SIZE 87 120* S.F. FOUND WOODS / \ '6 0 „ / H4 �' �� \�sa "' �( S ' �_ --.- �,I� , �,' MIN. LOT FRONTAGE 20' 47.4' \ �°N Slab / o - - \ �\�- 6�� �� i > \`�'`,c` _ ' �N,y /'� �I MIN. LOT WIDTH 125' .� �) 71 1 ,/ s/T \ SAS I \ � . s \ �-9 BRUSH ` ,�' // �/ MIN. FRONT SETBACK 30' I I / \� LAA0 WG LAWN € ti0 !�l //' // // MIN. SIDE SETBACK 10� MOWED GROPE ,per - / ,/ MIN. REAR SETBACK 10 �o PROPOSED �,-r` ��/ / / / \ / ///62 / / / / / (NO UNDERS TOR Y) /,' MAX. BUILDING HEIGHT 30 WELL I / / , // / 61� / // �� h1 - 5' PA TH //, /,' ; �� / / /// - / 6�� / / / PLANT/NG , /,' �/ // *SITE IS LOCATED WITHIN THE R.P.0.D. BED � //��_- - -59; �/ I ,„ /� I' BRUSH OVERLAY DISTRICT South / p� ! ' �'''k �'' J a / , o ;/ Lily Pon /�b� - - - z n / I� y � OWNER OF RECORD v I / / / o l / I � �' I ; WO DOS / i / / l/ all I l _56- - - / 1 \ O o z WOODS /I { / CB H I I x 2 I/ o y' G , CHRISTOPHER VELLTURO I i FOUND \ \ / /i l l % J I ! I h� I h/ I WOODS Q Q I ' ,I � {� ,� /,� P 0 BOX 398 LU I / 6g_ =-et K: SPI}K'6 SET — / / h / i y 5' \ �` / / I / / / Q Q C,J / , , ,/ ,= 8.85 N �8— / CENTERVILLE, MA. 02632 - -66/ /l �J /ill l / /�- -s4� ^� IoJ IN, / �� / / � � / o // / �/ h r � / �� � � I I I 1I F ,� ' i I+ ,% A• Z WOODS �Y AL /i Q► REFERENCES LAND COURT CERTIFICATE 191898 FOUND LAND COURT DOC. 1 143 800 o1;$ LAND COURT PLAN 11611-A2 OBSERVA TION /' Q ---- I � ' /6 o' y \ �/ _ STAND AN WOODS z \ BRUSH /,. oIV WOODS NOTE. Q v i k 30 � EXISTING USE: RESIDENTIAL 11 00 ' 58311 W j,` PROPOSED USE: RESIDENTIAL WITH . �� 360.78' ACCESSORY -BARN FOR HORSES / APPROX. 10 HORSES PROPOSED 30 ACRES PROVIDED O.K. 10 Ov / / / r h THACHER, FRANK G Jl & STEWART, PRUDENCE ---------� / _ `� '` / /// \ ll l I // avk'/�C 220 ANNABLE POINT ROAD CENTERVILLE,' MA 02632 ------ i ; / 1 1 I / /// / / / I \ I I I F I / / / / /Wa0D. ' I /p / v / FLAN OF LAIN® 1A IN -----' �� 'it Fo No BARNSTABLE, (CENTERVILLE) MA PREPARED FOR WOODS FOUND W - `INS � `. CHRISTOPHER VELLTURO wr a & NATALIE KIRKLAND r h / E: APRIL 5, 2011 ' REVIS"D: MAY 31 ,...-201 1 (ADD WELL, ELIMINATE BARN TOWN WATER SERVICE) -` ---i I N '� Scale: 1"= 60' APPROX. 2500 LF HORSE FENCE SHOWN S FENCE 10 MIN. OFF LOT LINE 11 0 30 60 90 120 150 FEET OF ��NOFMA off 508-362-4541 "�ssq: .� ssgc fax 508-362-9880 DANIfiLA DANIEL �� A downcape.com OJALA -4 Q I A.LACIVIL ineefing, •���� b No.6502 �No.40950" down cape fpn Inc. _ N 8339'S0" W 513.02' �Fs Ntl�ss� � 5/3i /► civil engineers 85'43'40" W 202.72 land surveyors FERGUSON, GEORGE CB 939 Main Street ( R to 6A) FOUNDLN FOUND YARMOUTHPORT MA 02675 �. FOUND W U ON, LORE 24 SHEET. 1 O F 2 WESTON, MA 02493 10-277 KIRKLAND.DWG DICE JOB# 10-277 v BENCHMARK: SPIKE SET IN DRIVE ELEVATION = 69.17 NAVD88 ) OO 63' 8" AT 169 At 4�--- / 61 5 - TFla ed End Section inv. 52.0� . SOR, in I Provide stone swole 88 N as req.'d to bottom I PROVIDE GATES AS REQUIRED D R I of dry kettle hole FENCE PROV natural bioretention area APPROX. FEN 701 V V. 65 006 I in � \ �ake� of Wequaquet ° Lake LOCUS 35 ORAL I �� o - \ 68 \ I a mv.� � TH2 CD E� Cb / 0 \ 6 4 0 � � � P /7.2 \ 6 r ,O� a b inv \ ARN S 21 E I LOCUS MAP S 7 / RN� TH SCALE 1"=.200.0'f 2^ S` ` � ASSESSORS MAP 211 PARCEL 6 OFF BA � / SAS 42 6, #944 SHOOTFLYING HILL ROAD TH3 I � NOTES: . \ J LOCUS IS WITHIN FEMA FLOOD ZONES B& C / in 66 5 ' 1. THE LOCATION OF EXISTING UNDERGROUND UTILITIES SHOWN ON THIS PLAN IS AS SHOWN ON COMMUNITY PANEL / APPROXIMATE. PRIOR TO ANY EXCAVATION ON THIS SITE, THE EXCAVATING\ 250001 OOO5C DATED 8 1/ CONTRACTOR SHALL MAKE THE REQUIRED 72 HOUR NOTIFICATION TO DIG SAFE # / 9/1985 \�I / LINE I (1-888-344-7233) AND ANY OTHER UTILITIES WHICH MAY HAVE CABLE, PIPE OR RAIN / EQUIPMENT IN THE CONSTRUCTION AREA FOR VERIFICATION OF LOCATIONS. �'io R��FD 2. ALL CONSTRUCTION MATERIALS, COMPONENTS, AND METHODS EMPLOYED ON THIS 166' 6" % / PROJECT WORK SHALL CONFORM TO THE TOWN OF BARNSTABLE SUBDIVISION REGS. 0 1 2 AND ink' 68 A � SPECIFICATIONSO EMAF SR CHUSETTS DEPARTMENT OF PUBLIC WORKS STANDARD 7 / 0 BRIDGES AND HIGHWAYS AS AMENDED TO PRESENT. ZONING SUMMARY / ALL SEPTIC WORK AND MATERIALS TO CONFORM TO 310 CMR 15.00 TITLE 5. \ AND BARNSTABLE HEALTH REGULATIONS. ���� 3. VERTICAL DATUM IS NAVD88. ZONING DISTRICT: RD-1 RESIDENTIAL DISTRICT I 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHTO- H2O MIN. LOT SIZE 87,120* S.F. I / 5. THIS PLAN IS FOR PROPOSED WORK ONLY AND IS NOT TO MIN. LOT FRONTAGE 20' BE USED FOR PROPERTY LINE STAKING. MIN. LOT WIDTH ' 125 6. MUNICIPAL WATER IS AVAILABLE, WELL WATER PROPOSED FOR PROPOSED CONSTRUCTION, 0 CONTRACTOR TO COORDINATE ALL UTILITIES WITH APPROPRIATE VENDORS. MIN. FRONT SETBACK 30 , I 7. ALL SEPTIC PIPING 4"0 SCH-40 PVC AT 17. MIN. UNLESS NOTED. MIN. SIDE SETBACK 10' J/ 8. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT MIN. REAR SETBACK 10' INSPECTION BY BOARD OF HEALTH AND OWNERS ENGINEER AND PERMISSION OBTAINED MAX. BUILDING HEIGHT 30' FROM BOARD OF HEALTH AND OWNERS ENGINEER. 24 HR. NOTICE ON INSPECTIONS REQ. ' Cn b 9. INTERIOR PADDOCKS, FENCING, PER OWNER NOT INDICATED, PROVIDE GATES AND SECURITY J �J FOR HORSES AND GUESTS PER ALL STATE AND LOCAL CODES AND ORDINANCES. *SITE IS LOCATED WITHIN THE R.P.O.D. / OVERLAY DISTRICT BENCHMARK: OWNER OF RECORD ELEVATION 68.$5 NAVD88DETAIL SITE ' PLAN CHRISTOPHER VELLTURO Scale:1"= 20' P 0 BOX 398 CENTERVILLE, MA. 02632 0 10 20 30 40 50 FEET 6" LOAM AND SEED ALL DISTURBED AREAS EROSION CONTROL NETTING ON ALL SLOPES >10% (TYP.) EL. 70.5t CONCRETE COVER TO WITHIN CONCRETE H-20 TOP FOUND. EL. 71.76 H-20 CONC. COVERS (2) TO 6" OF GRADE COVER TO WITHIN 3" GRADE REFERENCES SLAB EL.71.1 ••' GND 71.0 � BLOCK UP D-BOX, RISER GRADE EL. 70.5 MAX. SI:OPE 29e PRECAST H-20 TO 6" OF GRADE, MORTAR ALL COMP NENTS MARK COMPONENTS WITH MAGNET TAPE OR EQUAL/ RISERS (TYP.) 2% SLOPE MIN. OVER SYSTEM V� VI/ LAND COURT CERTIFICATE 191898 9,0.' MORTAR ALL COMPONENTS P - BLOCKS OR LAND COURT DOC. #1,143,800 M MORTAR ALL PRECAST RISERS TOP CONC. EL. 67.5 FILTER FABRIC LAND COURT PLAN 11611-A2 COMPONENTS H-20 2-I.D. OVER STONE 67.66' 21' AT 2% 67.24' ' 10" 14" :' --7F _ NOTE: 4"OSCH40 PVC TEE 1500 GAL H-20 TEE ° ° ® r ° ° ® o°o°o°o° 4"SCH40 SEPTIC TANK 99 000000000°o°o 0 3=p V. 66.5 OO°O°O°0 . ®®®®®® ®® ®® ®® °°°°°°°° ° °0000000 > ° ° ° ° EXISTING USE: RESIDENTIAL 4' LIQ. LEVEL GAS BAFFLE 7' AT 2% o 0 0 0 0 0 °°°°°°°° 00000000°°°°°°° ° ° ° ° 00000000 ° ° ° ®®®®®®�®®®® ®�RM ®®®® ° ° ° PROPOSED USE: RESIDENTIAL WITH q SHOREY OR ACME OR EQUAL 4"0scH4o PVC °o°oACCESSORY BARN FOR HORSES PVC AT 27. °°°°°°°° °°°°°°°° ° ° ° ° 66.8 66.6 4"SCH 0 PVC EL. 64.5 APPROX. 1.0 HORSES PROPOSED •'' ''' ' �"' .. H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. `ZH OF,y 30 ACRES PROVIDED O.K. PIPES LEVEL 1ST 2' qs 6" GRAVEL & MECH. - _ " (2) UNITS REQUIRED ��� Sq� �`�HOFMASS COMPACTION TYP. ACME DB5 H-20 OR EQUAL DANIEL P#13216 3/4 -1-1/2" DOUBLE WASHED STONE 4' MIN. a A. m DANHELA. GN TH1 SOIL EVALUATOR: DANIEL A. OJALA SE SOIL EVALUATOR: DANIEL A. OJALA SE ALL AROUND PRECAST STRUCTURES `r OJALA CIVIL BOH: DAVID STANTON, IRS BOH: DAVID STANTON, IRS SEPTIC PROFILE OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.0' X 12.83' ^ No.40980� EXCV. TOM KENNEDY TH2 EXCV. TOM KENNEDY o No.CIVIL 6502 DATE: 3-22-11 10 AM DATE: 3-22-11 10 AM APPROX. SCALE: 1/4" = 1'-0" o� gg�d` Pp GAF r / EL. 69.4 011 EL. 69.4 0„ l 9N�8URV �d� � AL L L HORIZON SAND L OAMY SAND LHORIZON HORIZON LEGEND 57.1' BOTTOM TH1 L 10YR 3/2 10YR 3/2 6" 6" TITLE 5 FLOW: BARN ACCESSORY TO RESIDENTIAL SINGLE FAMILY DWELLING NO GROUNDWATER FOUND -B HORIZON B HORIZON CONVENIENCE BATHROOM, ACCESSORY TO HOUSE = 330 GPD DESIGN FLOW 99- EXISTING CONTOUR LOAMY SAND LOAMY SAND X 99� 10YR 6/8 10YR 6/8 NO GARBAGE DISPOSAL ALLOWED EXIST. SPOT ELEV. EL 66.4 C1 HORIZON 36" EL. 66.4 C1 HORIZON 36„ SEPTIC TANK : 330 GPD (200%) = 660 GALLON (1500 MIN.) -[991- PROPOSED CONTOUR PLAN OF LAND MEDIUM SAND MEDIUM SAND USE 1500 GALLON H-20 SEPTIC TANK BOT. PERC AT 68" 2.5Y 6/4 84" 2.5Y 6/4 72" 198.43 PROPOSED SPOT EL. IN � 24 GAL IN 3:40 C2 HORIZON C2 HORIZON TH1 PERC RATE: <2MIN/IN. SAND/40%GRAVEL 96, 84'SAND/40�GRAVEL USE C1 LAYER CLASS 1 SOILS FOR LEACHING <2 MPI = 0.74 GPM/SF LTAR � TEST HOLE BARNSTABLE, (CENTERVILLE) MA- C3 2.5Y 8 6 2.5Y 8 6 LEACHING: 330 GPD/0.74 GPD/SF =446 SF LEACHING AREA REQUIRED.HORIZON C3 HORIZON USE (2) 8.5'X4.83'X 2'EFF. DEPTH LEACHING GALLEYS W/ 4' STONE 2% SLOPE OF GROUND MEDIUM SAND MEDIUM SAND ALL AROUND (25.00' X 12.83' OVERALL DIMENSIONS) PREPARED FOR 2.5Y 7/4 2.5Y 7/4 BOTTOM CAPACITY = 25.0'X 12.83' = 321 SF X 0.74 = 237 GPD EL. 57.4 144' EL. 57.4 144" SIDEWALL = 2(25.0'+12.83') X 2.0'= 151 SF X 0.74 = 112 GPD �O� UTILITY POLE TH3 TH4 FIRE HYDRANT NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED 472 SF 349 GPD >330 O.K. C H R I S T 0 P H E R V E L L T U R 0 QQ EL. 69.1 A HORIZON 0' EL. 69.1 A HORIZON 0 - W --- WATER LINE APPROVED BY HEALTH DEPT. DATE NATALIE KIRKLAND 10YR 3/2 6" LOAMY SAND 1LOAMY 0YR 3/2ND 6 pC" SEPTIC SYSTEM DESIGN DATA - G GAS LINE B HORIZON B HORIZON - E U.G. ELECTRIC LINE LOAMY SAND LOAMY SAND NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING DATE: APRIL 5, 2011 EL. 66.43 1 H IZO 32„ EL. 66.43 1 H IZO 32" REVISED: MAY 31 , 2011 (ADD WELL, ELIMINATE BARN TOWN WATER SERVICE) C1 HORIZON C1 HORIZON MEDIUM SAND MEDIUM SAND Scale: 1"= 20' BOT. PERC AT 69": 2.5Y 6/4 2.5Y 6/4 24 GAL IN 3:20 C2 HORIZON 72r, C2 HORIZON 72" C1 PERC RATE: <2MIN/IN. SAND/407.GRAVEL SAND/407GRAVEL 0 10 20 30 40 50 FEET 2.5Y 8 6 84„ 28Y 8/6 84" C3 HORIZON C3 HORIZON Off 508-362-4541 MEDIUM.SAND MEDIUM SAND fax 508-362-9880 2.5Y 7/4 EL. 57.1 2.5Y 7/4 144" EL. 57.1 144" downcope.com NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED ��W� �� � � ' � �' � TEST HOLE LOGS p ng n rig, i*7c, civil engineers land surveyors 939 Main Street ( R to 6A) SHEET 2 OF 2 YARMOUTHPORT MA 02675 10-277 KIRKLAND.DWG DCE JOB# 10-277