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0034 ASPEN WAY - Health
135pen v %a: y .. Osterville A = 120 = 055 I a N SMEA No.2-153LGN UPC 12134 HASTINGS,MN • �P� „���� i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 . 10/24/12 page. Citylrown 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. General Information filling out forms , on the cossputer, 5qq . use only the tab 1. Inspector:key to move your cursor-do not Michael Kellett use the return key. Name of Inspector Aardvark Environmental Inspections Company Name PO Box 896 Company Address East Dennis - MA 02641 City/town State Zip Code 508-385-7608 SI 3742 Telephone Number Vicense Number ,-.,B. Certification I certify that I have personally inspected the sewage disposal system at this addre s and that th® 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 15.3.40 of- co Title 5(310 CMR 15.000).The system: ; ® Passes ❑ Conditionally Passes ❑ Fails t ❑ Needs Further Evaluation by the Local Approving Authority 1 J 10/25/12 Inspe or'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. t5ins•11/10 Title 5 iVloi.nm:Subsurface Sewage Disposal System-Page 1 of 17 ' i Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Citylrown 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: r ' B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass- inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The . system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y , ❑ N ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerwhich 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•51i50 Trffe 50ffrial 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 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. , ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis,performed at a.DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® 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'f2 day flow t5ins-11/10 Title 5Offclal Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is Osterville MA 02655 10l24/12 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: ❑ ® 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 coliforrn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no otherfailure 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. El ® 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"of"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 ❑ 11 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered `yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Cityfrown 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection?, ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑. Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information.For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form E Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Citylrown state Zip Code Date of Inspection D. System Information Description: 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)): Detail: Sump pump? ❑ Yes ® No r ' Last date of occupancy: Current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 316 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present?" ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): J L General Information Pumping Records: a Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins 11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 11/30/88 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1.9 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: 1.feett 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: 1,000 gal 3" Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) r Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" „ Scum thickness 3 f 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 16°' How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) - i Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day ,Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins 11/10InspectionTitle 5 Official Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Citylrown State Zip Code Date of Inspection D. System Information (cant.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order:. ❑ Yes ❑ No Alarms in working order: El Yes ❑ No Comments(note condition of pump.chamber,condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts ; Title 5 Official Inspection. Forme s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address r Thomas Deriemer Owner Owner's Name information is Osterville MA 02655- 10/24/12 required for every , page. Cityfrown State Zip Code - Date of Inspection D. System Information (cont.) Type: ® leaching pits` "numbera ,. . f ❑ leaching chambers number. ❑ leaching galleries number:, ❑ leaching trenches " number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: fr ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of,ponding,damp soil,condition of vegetation,etc.): This system has a 6'x6'precast pit surrounded by two feet.of stone.There was 36"between th inlet invert and the liquid. . . 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., f - Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 - Titleb Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of_17 • • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): , Privy(locate on site plan): Materials of construction: Dimensions Depth of solids - Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,. etc.): .4 t5ins•11/10 Titre 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 'i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is Osterville MA 02655 10/24/12 required for every 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 (mac 3 K a7 9-7 ❑ t5ins-11/10 Title 5 Official Inspection Form:Subsurrace Sewage Disposal System•Page 15 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Citylrown State Zip Code Date of Inspection D. System Information (cost.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells 20.0 Estimated depth to high ground water: feet 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 groundwater elevation: USGS maps show an elevation of over2O.0 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form E Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s� 24 Aspen Way Property Address Thomas Deriemer Owner Owner's Name information is required for every Osterville MA 02655 10/24/12 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 L Town of Barnstable pit_ ? Department of Regulatory Services j Public Health Division f 3 ( �-Z , l �� 200 Main Street,H*nisMA 02601 Date Scheduled /Oho 110L �` '►. "� r ,; Time _ Fpee Pd. 1 ' Soil Suitability Assessment for�Sewage Disposal Performed By: Witnessed By: LOCATION&:GENERAL INFORMATION Location Address Owner's Name f Y A'S� INbtir Ni a•�•��e�nl'`S� �rzt vlul j L sa-e/1�2 iLe z __Address �v y � ✓� e� Assessor's Map/Parcel: Engineer's Name/0�/�✓a � NEW CONSTRUUCTION REPAIR 4 Telephone# � 7 3-7 ` -7 6 Land Use ji, e44_ bu( Slopes(`�) 'L. L( s Surface Stones' All ok Distances from: Open Water Body�_ft Possible Wet Areaft Drinking Water Well >L� ft Drainage Way /" ft Property Line. `"'}� :Other ft SKETCH (Street name,dimensions of lot,exact locations of test°hol &perc tests,locate wetlands fn proximity to holes) UJ - w "Parent material(geologic) V Depth to Bedrock r-Depth to Groundwater. Standing Water in Hole: Weeping from Pit FGoe,, �,, �►_____r_�T c---) . . cEstimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _ in. Depth to soil mottles: In, Depth to weeping from side of obs.hole: ` in. Groundwater Adjustment ft. lndex,Weli# Reading Date: Index Welt level, ,, �„ Adj.Actor, , ®_ Adj..Otcar�dwater Level,,m PERCOLATION TEST bate�,._.�, 'IYme Observation Hole# 2 Time at 91, Depth of Pere2y Time at 6" Start Pre-soak Time® 2' t 'Time(9"•6")'_..- End Pre-soak L t Rate Min.11nch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division ;l;` Observation Hole Data T6 Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# L Depth from Soil Horizon Soil Texture Soil•Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure;Stones;Boulders. t .. w en �-3O 16 `f DEEP OBSERVATION HOLE LOG Hole# 't Depth from Soil Horizon Soil Texture Soil Color Soil - Other Surface(ih.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistena Wamyel), k DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil ' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) . 7 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling -(Structure,,Stones;Boulders. Flood Insurance Rate Man: Above 500 year flood boundary No— Yes , Within 500 year boundary No Yes Within 100 year flood boundary No_�L\ Yes Death of Naturally Occurring Pervious Material . Does at least four feet.of naturally occurring pervious material.exist in all areas observed throughout the. area proposed for the soil absorption system? �_terial? If not,what.is the depth of naturally occurring pervt Certification I certify that on. (date)I have passed the soil evaluator examination approved by the Department of Envtronmental Protection and the above analysis was performed by me consistent with .' the required train expertise and experience descnbed in '1U CIV1R 15.0.17 Signature ., Date """ /2 Q.\SBpT-CVERCFORM.DOC TOWN OF BARNSTABLE LOCATION A 5 a SEWAGE# Q,O t 2 7 � VILLAGE ASSESSOR'S MAP&PARCEL Zc2y ®5-5 INSTALLER'S NAME&PHONE NO._Dd,)��c-6. A 7r,,& JnI Z L SoP,-�IJn-ys3�. SEPTIC TANK CAPACITY E4,5 d r,�r� "' LEACHING FACILITY. (type) /tic 3 c (C (size)' co NO.OF BEDROOMS 2 OWNER ^4 4 r ti-e w S PERMIT DATE: ly 112 COMPLIANCE DATE: Separation Distance Between the: 8 rro+r/ rJc J S d� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,Uotor&4rapirt&)kJoI16et Private Water Supply Well and Leaching Facility(If any wells exist on pert tcSI' 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 FURNISHEDBv< lav�.J f OU:V I`3 C 14, Box - S'y I 33,1 r - 3`t s- o oo+- �,� iIc°ti+Io_77,y TOWN OF BARNSTABLE LOCATION 3A � SEWAGE# tJ 6 VI!�LAGE ASSESSOR'S 11MAP&PARCEL INSTALLERS NAME&PHONE NO. " \��tj SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (gX (Q LP— CG 4N Q\k (size) NO.OF BEDROOMS Z OWNER —�\C'WA P tt S PERMIT DATE: Yq�Q b COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility (0 Feet Private Water Supply Well and Leaching Facility(If any wells exist ••pp on site or within 200 feet of leaching facility) N (� Feet Edge of Wetland and Leaching Facility(If any wetlands exist i within 300 feet of leaching facility) -;I w ft" Feet FURNISHED BY W is No. J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: G PUBLIC HEALTH DIVISION - TOWN OFF BARNSTABLE, MASSACHUSETTS Yes Tipplit tion for Vspo8AY *pstrm ConstCUCtion Permit Application for a Permit to Construct( ) Repair(-�Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. '3 H A 5 i,,,j U-X y f_,Fer v0i* Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel ,;tU _ S Mc.F�kew15 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. i7®.9S S ��:A.rS �LtJG S08-if'LO yS9il Ln�Stve.wslNs (,04 S -y7 -5'3j^ Type of Building: Dwelling No.of Bedrooms 3 Lot Size L6*,)00 sq.ft. Garbage Grinder( ) Other Type of Building h V vs r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) p gpd Design flow provided 36 y y gpd Plan Date I 1 1 7 1 1 Number of sheets °�— Revision Date Title Size of Septic Tank 'E:trr9 I-►evS Type of S.A.S. A ec. N C_ Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign lam-- Date ! U / � Application Approved by Date f C Application Disapproved by Date for the following reasons Permit No. 2 f 1_ 7 J Date Issued LL 2- ` No. 0 I _ T? Feed THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -PUBLIC HEALTH DIVISION - TOWN-OF BARNSTABLE, MASSACHUSETTS Yes 21pplication for Disposal,6pstem Construction permit/y jJ F Application for a Permit to Construct( ) Repair(V�Upgrade( ) Abandon( ) El complete System n�div dual Components Location Address or Lot No. 3 a� q 5 paN.t�c�y C ,4�w v�))'P Owner's Name,Address,and Tel.No. Mk tlnevJ�S ti Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. i7o,75 S P��resvaN =fiJL SO�}'tl2.C?-�/S3ii LNSrNewejN (�l){LS S -1-/7 -S. 1 i Type of Building: Dwelling No.of Bedrooms 3 Lot Size 1.6,30c7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) !-y p gpd Design flow provided y fi gpd fi Plan Date 1 Number of sheets. -I— Revision Date � o Title Size of Septic Tank E x fiy F r Type of S.A.S. g!E -z ► _ Description of Soil Nature of Repairs or Alterations(Answer when applicable) -t „� �- 1� n11 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign�d- f2--- _ Date l 2011 Application Approved by Date / Application Disapproved by Date for the following reasons f Permit No. c {) - 7 7 1' Date Issued / TI-1 E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( v)--,-Upgraded( ) Abandoned( )by ` �M�c\a` A at 39 AT V2y- -�,- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o i - ,3i 75-dated 11 L I Installer, Designer � ✓� � #bedrooms Approved design flow lasdesil _ gpd The issuance of this permit shall notib�e const edhas�a guarantee that the system will functiogne Date •>�d" O' Inspector No. �� l 1 3 7) FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon System located at A S y0c, I-P f v,1�p 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. r Provided:Construction must be completed within three years of the date of this permit. n Date {I ' /��- Approved by V1 r K j i Town of Barnstable ' Regulatory Services' Sl, Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: �) Z Sewage Permit# J�o I-1- 37S Assessor's Map/Parcel Installer&Designer Certification Form Designer: Vva rlcs, Jr)c . Installer: ; • �! ��� I �c Address: I W, Crb S S ;e le,{ R4. Address: R-c y- T�� .1-4 t-e M A-, d z.b y y C�e�:4-e��, 1 l P V 1'111 O--Z-6 3Z. On // 2 G /'L 'P, iA yt_r_ was issued a permit to install a (date) (installer) septic system at 3` 1 � ��7 , Q S��`�`• l-Q based on a design drawn by (ad res ) dated /1 7 1 Z (designer) 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or. certified as-built by designer to follow. Stripout (if required) was ' cted and the soils were found satisfactory. OFMgssq PETER T. Gcn nstaller's Signature) cw LEE No,35109 e �dsP STE�� �Q4' esigner's Signature) (Affix Design re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc Barnstable Assessing Search Results Page 1 of 2 � zra 5 n Home: Departments:Assessors Division: Property Assessment Search Results New Search g wY New Interactive Maps >> Owner: 2006 Assessed Values: HYNES, RICHARD W&JANET T 34 ASPEN WAY Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $ 107,400 $ 107,400 120 /055/ Extra Features: $2,500 $2,500 Outbuildings: $0 $0 Mailing Address Land Value: $ 173,100 $ 173,100 HYNES, RICHARD W&JANET T Totals $283,000 $283,000 P 0 BOX 407 OSTERVILLE, MA. 02655 2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $34.62 Fire District Rates Town Barnstable-Residential $1.90 $6.31 Barnstable-Commercial $2.51 Commei C.O.M.M. FD Tax(Residential) $299.98 C.O.M.M.-All Classes $1.06 $6.54 Cotuit FD-All Classes $1.33 Persona Town Tax(Residential) $ 1,154.10 Hyannis-Residential $1.61 $6.49 Hyannis-Commercial $2.50 Other R; W Barnstable-Residential $1.60 Commur W Barnstable-Commercial $2.46 Total: $ 1,488.70 Construction Details Building Property Sketch Legend Building value $ 107,400 Interior Floors Carpet Style Ranch Interior Walls Drywall Model Residential Heat Fuel Gas Grade Average Heat Type Hot Water Stories 1 Story AC Type None Exterior Walls Wood Shingle Bedrooms 2 Bedrooms Roof Structure Gable/Hip Bathrooms 1 Full + 1 H http://www.town.bamstable.ma.us/assessing/assess06/displayparcelO6map.asp?mapparback... 9/6/2006 10/04/2006 10:51 FAX 428 4839 KINLIN GROVER GNAC cal 002 12/30/2016 23:24 FA)t 002i'UO2 Page 6ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 034 Aspen Way Ostcrville.MA Owner:_ Richard Hines Date of Inspection: 06/02/06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 _ DESIGN_.flotiw based on 310 C14R 15,203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents:_ l Does resideni;e have a garbage grinder(yes or no): No is laundry on a separate sewage,system(yes or no): No [if yes separate inspection required] Laundry syst m inspected(yes or no):— Seasonal use: (yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 68,Ooo gaillons-2003/64,000 gallons 2004 Stamp pump Eyes or no): Na Last date of occupancy: Currently eeupied COMMER(AAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CIVIR 15.203) gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes`or no): Water meter readings, if available: Last date of occupancy/use:_ OTHER(describe): _ GENERAL INFORMATION Pumping Records Source of in.::ormation: Ni;►ne on File Was system pumped as part of the inspection(yes or no):NO If yes,volunte pumped gallons--How was quantity pumped determined? Reason for y;umping: TYPE OF SYSTEM XX 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 die current operation and maintenance contract(to be obtained*o:n system owner) Tight ta'ik Attach a copy of the DEP approval Other(describe): Approxim,at,a age of all components,date installed(if known)and source of information: 1968-origin 1,-__.per Owner&BOH Records Were sewage odors detected when arriving at the site(yes or no): No T .. �+ �.....� ».........-r ri.i.c.a r r.r�♦ 1Ylltr 1".1LU/ UJJ/// Mpg 14ame: State Use:101U Vision ID:7333 Account#62256 Bldg#: 1 of 1 Sec#: 1 of 1 Card 1 of 1 Print Date:09/13/2006 08:22 CA . YNES,RICHARD W&JANET T 1 Level 2 Public Water 1 Paved Description Code Appraised Value Assessed Value O BOX 407 as ES LAND 1010 173,100 173,100 801 Septic ESIDNTL 1010 118,100 118,100 FIVE DATA-Barn.,MA STERVILLE,MA 02655 SUPPLEMEIV -AL�DATA "s : Additional Owners: Other ID: Plan Ref. Tax Dist. 300 Land Ct# Per.Prop. #SR Life Estate ♦`, ISION DL I Notes: DL 2 - GISID: 7333 AssocPID# Totall 291,2001 291,200 RECORD OF..:OWIVERSHIP„ "'., BK VOL/PAGE' SALE DATE "/u; vq;'.SA=LE PRICE TIC PRE[?IOZIS A "SSESSMENTS hTISTOR:Y YNES,RICHARD W&JANET T 1435/507 Q 0 Yr. I Code I Assessed Value Yr. Code I Assessed Value Yr. Code Assessed Value 006 1010 173,100 2005 1010 1 171,300 2004 1010 171,300 006 1010 109,900 2005 1010 1049100 2004.1010 85,000 Total: 283,000 Total: 275,460, Total: 256,306 r EXEMPTIONS" , , _ mOTHERA°SSESSMENTS , ;" _ This signature acknowledges a visit by a Data Collector or Assessor � . -Year Tvpe JQescription Amount Code- escri tion Number Amount I Comm.lnt. 0 5C ESIDENTIAL EXEMPTION 0 X ;9PPRAISED VALUE SUMMARY 4 ' Appraised Bldg.Value(Card) 115,600 'ASSESSIIVG7VLGHB©RIIOOD'k' .,_ ;Appraised XF(B),Value(Bldg) - 2,500 NBHD/SUB NBHD NAME STREET INDEX NAME TRACING BATCH Appraised OB(L)Value(Bldg) 0 0107/A Appraised Land Value(Bldg) 173,100 NOTES '' e '. Specialan e Land Value 0 Total Appraised Parcel Value 291,200 Valuation Method: C Adjustment: 0 et Total Appraised Parcel Value 291,200 BUILDING PERMIT RECORD.;E° # _ „� .. . V_SIT/:CHANGE HISTORY G -, •< _ Permit ID Issue Date Typ e Description Amount Insp.Date %Comp. Date Comp. Comments Date I Tvpe IS ID Cd. I Purpose/Result 9/12/2006 03 PT 00 eas/Listed a'- 11/4/1998 FS 07 Mea+Corrected Listing r " tr., R `-'� LAND.LANELUATIOVSECTON B Use Use ; �..� . Unit I. Acre C. ST. # Code Description Zone D Frontage Depth Units Price Factor S.A.I Disc Factor Idx Adi. I Notes-Ad• - S ecial Pricing df. Unit Price Land Value 1 1010 Single Fam MDL-01 RC 3 0.37 AC 170,000.00 2.18 5 1.0000 0.90 0107 1.40 ABUTS COMMERCIAL 467,874.00 '173,100 Total Card Land Units: 0.37 ACI Parcel Total Land Area: .37 AC Total Land Value: 173,100 Property Location: 34 ASPEN WAY MAP ID:120/055/ Bldg Name: State Use:1010 Vision ID: 7333 Account#62256 Bldg#. 1 of I Sec#: 1 of 1 Card 1 of 1 Print Date:09/13/2006 08:22 zCONS -TION — ;ot- TAILVZ- TAIL UC 'DE CONYT-VUCTION.-WE _CONTINUED Element Cd. Ch.Pescription Element Cd. Ch.Pescription Style 1 Ranch Model I Residential Foundation 00 ypical 14 Grade Average Stories 1 1 Story Bath Split it I Full+1H ccupancy - All XED 1�k PTO Exterior Wall 1 114 Wood Shingle Code Description Percents 3 13 Exterior Wall 2 11 Clapboard 1010 Single Fain MDL-01 100 Roof Structure 03 Gable/Hip 14 Roof Cover 03 Asph/F GIs/Cmp 44 Interior Wall 1 05 Drywall Interior Wall 2 'ZOSTIMARK-Et-VALU Interior Flr 1 12 Hardwood Adj.Base Rate: 107.71 Interior Flr 2 ' Section.RCN: 137,653 Heat Fuel 03 Gas Net Other Adj: 0.00 Replace Cost 137,653 BAS Heat Type 04 Hot Air AYB 1968 4 BMT 24 kC Type I one EYB 1991 Total Bedrooms 3 Bedrooms i ep Code A Total Bthrms I Remodel Rating Total Half Baths 1 Year Remodeled Total Xtra Fixtrs; Dep% 16 Total Rooms Rooms unctional Obslnc D 44 ath Style External Obslnc 14 30 FO Kitchen Style Cost Trend Factor 1 30 4 Condition %Complete Overall%Cond 94 Apprais Val 115,600 Dep%Ovr 9 Dep Ovr Comment Misc Imp Ovr Misc Imp Ovr Comment Cost to Cure Ovr ost to Cure Ovr Comment OB,OUTBUILDING FAP�-,DZ-T F-B UI -FEAT,�U L EX Code Description Sub IYub Descript LIB Units lUnit Price Yr 1Gde Qp Rt Cnd 1%Cnd FPLl Fireplace B 1 3,000.00 1991 1 100 2,500 -x,� 't,!-BUILDING$UB-ARE,4SUMMAR-Y-,:SECTION� Code escri tion LivinizArea Gross Area Eff.Area Unit Cost Undeprec. Value BAS First Floor 1,056 1,056 107.71 113,742 BMT Basement Area 0 1,056 18.36 19,388 FOP Open Porch 0 120 21.54 2,585 TO Patio 0 182 10.65 1,939 it. Barnstable Assessing Search Results Page 2 of 2 Roof Cover Asph/F GIs/Cmp living area 1056 Replacement Cost $127817 Year Built 1968 r� Depreciation 16 Total Rooms 5 Rooms Land CODE 1010 3y Lot Size(Acres) 0.37 Appraised Value $ 173,100 4 Assessed Value $ 173,100 » E3 View Interactive Maps > � imm Sales History: Owner: Sale Date Book/Page: Sale Price: HYNES, RICHARD W&JANET T 1435/507 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,500 $2,500 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) Second Story Living Area CAN Canopy FUS (Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story, (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) I http://www.town.bamstable.ma.us/assessing/assess06/displayparcelO6map.asp?mapparback... 9/6/2006 f - COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION M yyti O� � y\ i TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: #34 Aspen Wa Owner's Name: Richard Hines Owner's Address: 34 Aspen Way ?�,a'� V Osterville,MA 02635 Date of Inspection: 06-02-06 Cr Name of Inspector: (please print) Mr.Carmen E.Shay Company Name: Shav Environmental Services,Inc. _z ` w Mailing Address: P.O.Box 627 East Falmouth,MA 02536 t Telephone Number: (508)-539-7966 i. .• rt =. CERTIFICATION STATEMENT 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: XX Passes P�,SN�F�4Ss Conditional1 Passes Needs F her a uation by the Local Approving Authori o� CARMEN tiN Fails o E. SHAY 0 Inspector's Signature: Date:. 06/02/06 cFRTtF```cg' The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Healt DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments No evidence of hydraulic failure noted in leach pit. 2.5'effective depth available. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: .,.�,. 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 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. _ 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: l Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped XX Any portion of the SAS,cesspool or privy is below high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. XX Any portion of a cesspool or privy is within a Zone 1 of a public well. XX Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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. 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) 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 Page 5 of 11 15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Y N Yes o XX Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks? XX _ Has the system received normal flows in the previous two week period? XX Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up? XX _ Was the site inspected for signs of break out? XX _ Were all system components,excluding the SAS, located on site XX _ 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? XX _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no XX _ Existing information. For example,a plan at the Board of Health. XX _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2, DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 68,000 gallons—2003/64,000 gallons 2004 Sump pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd- Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None on File Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM XX 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: 1968-original,- per Owner&BOH Records Were sewage odors detected when arriving at the site(yes or no): No 6 f Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:j #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction: cast iron _40 PVC XX other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) t Depth below grade: 12"to Top of Tank Material of construction: XX concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 5' deep x 5'wide by 8' long (1,000 gallons) Sludge depth: 4.0' Distance from top of sludge to bottom of outlet tee or baffle: 2' Scum thickness: '/4 inch scum laver noted Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Structural integrity of tank was ok. No evidence of cracks,leaks,or water infiltration/exfiltration. Concrete Baffles present at inlet end. Outlet Baffle present and in hood condition. Liquid level equal with outlet invert. GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): . ., . . r .,..,. 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 434 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): NO D-Box Present PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type XX leaching pits,number: 1 6'x6' cement block leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions:_ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of hydraulic failure of septic tank or of leach either leach pit. Top of leach pit is 14" below ground. New Riser installed. 2.5' effective depth available. 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 or 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.): - I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 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. Swing Ties: ASPEN WAY A- Tank In— 19' B- Tank In—34' A—Tank-Out—20` B—Tank-Out—39.5' A—Leach Pit —26' Water;Line B—Leach Pit —52' Exist House A .13 O eeptick .) Leach Pit „�,, 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #34 Aspen Way Osterville,MA Owner: Richard Hines Date of Inspection: 06/02/06 SITE EXAM Slope Surface water -'/2 mile+/- Check cellar -Yes Shallow wells—None Estimated depth to ground water 20' feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: XX 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) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Ouadrangle of USGS Map. Per USGS MAP PLATE 2: Elev.of Ground=47 Feet Elev.Of Groundwater=17 Feet Elev.Of Bottom of Leach Pit 39 Feet Therefore: 39—17=22 feet separation between Bottom of Leach Pit and Groundwater. Groundwater Adjustment using Index Well MIW-29(C): 2.4 feet Adjusted Groundwater Separation=22'—2.4=19.60 feet between bottom of pit and adi.groundwater Grade=Elev.47 feet Pit#1 Septic Tank Bottom of Pit=Elev. 39 feet Adj.Groundwater=Elev. 19.40 r AsBuilt Page 1 of 1 TOWN OF BARNSTABLE ` LOCATION .-"A F15pex,� ( _ SEWAGE# N R VILLAGE ASSESSOR'S MAP&PARCEL Lea fT0 INSTALLERS NAME&PHONE NO. . 415T Ago: SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (s,x.tQ Leo�c�4.—Q\k (size) 1 �; NO.OF BEDROOMS OWNER PERMIT DATE: VR COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility (o Feet Private Water Supply Well and Leaching Facility(If any wells exist .1 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) N A' Feet FURNISHED BY - w - 1a�0 • Ig 3q- r `? C O . ;', CS http://issgl2/intranet/propdata/prebuilt.aspx?mappar=120055&seq=1 8/30/2012 10/04/2006 10:50 FAX 428 4839 RINLIN GROVER GMAC Z 001 ■■ KINLIN GROVER Home Buying Annual Sales Over 3.5 Billion Home Selling Over 1,200 Professional Sales Partners Mortgage Over 40 Sales Offices Relocation 22,000 GMAC Sales Partner Network Insu.-lance/Title 1.400 GMAC offices Nationwide 4 Wianno Avenue, Osterville, MA 02655 Phone: 508-420-1130 Fax: 508-428-4839 Websit:e: www.kinl!ngrover.com FAX COVER SHEET TO: � COMPANY/FAX #: & FROM: DATE/TIME: REGARDING: # Pages (Ind cover sheet) URGENT PLEASE CONFIRM RECEIPT Message: f 4) t-� .�� _ This facsimile contains privileged and confidential information only for the use of the address(es) noted above. If you are not the intended recipient ofthis facsimile or the employee or agent responsible for delivering it to the intended recipient,you are hereby notified that any review,dissemination or copying of this facsimile is strictly prohibited. If you have received this facsimile in error please immediately notify us by telephone at 508-420-1130. Thank you. Opt-Out Request: If this facsimile contains information considered to be advertising or solicitation.you may make a request to the sender not to send any further facsimiles related t:) advertising or solicitation. All such opt-out requests should be faxed to 508-428-4839 and the request must identify the telephone number(s)of the facsimile machine(s)to which the opt-out request applies. Opt-out requests may be faxed any time.24 hours a day and 7 days a week. The failure by the sander to comply with an opt-out request within the time frame to be determined by the FCC is unlawful. Rev 3-2006 Office Locathms: Barnstable,Brewster,Chatham,Harwich Port,Orleans,Osterville, Sandwich,South Yarmouth, Wellfleet, West Falmouth&Yarmouth Port < /''APRQX.LOCATION OF EXISTING SEPTIC TANK NOTES: T\ , / \ � 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS &DIMENSIONS IN THE FIELD / a's 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, / DETAILS,&FINISHES IN THE FIELD WITH OWNER 44'D (ADDITION) 3.).ROUGH OPENING HEAD HEIGHT OF WINDOWS AT (EXISTING) / FIRST FLOOR TO BE 8'-8"ABOVE SUBFLOOR / 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS STATE BUILDING CODE,BTH EDITION AMENDEMENT&IRC2009 / II / 5.) 110 MPH EXPOSURE B WIND ZONE,1.75 ASPECT RATIO / 8.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY, / OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/12"FIELD NAILING / 7.) ALL LVL LUMBERIBEAMS TO BE 1.9e U480 LOAD / 8.) SEE CERTIFIED PLOT PLAN DEVELOPED BY ENGINEERING WORKS,INC.FOR ALL . / PROPOSED&EXISTING DETAILS EXIST. IXI6T. EXIST. EXIST.. . 9.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL LE SIMPSON COMPONENTS REF10.)ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS IST. w-a TO BE 3000 PSI EXIST. 11.)VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE DURING FRAMING CONSTRUCTION L° -. EwsT. BEDROOM; 2 g,r 12.)TIMBER FRAMING TO BE SPRUCE/PINE/FIR NO.2 GRADE® REMODELED � �, "Q1 13.)ALL WINDOWS&DOORS TO HAVE SILL PANS&ICEIWATER SHIELD FLASHING SINK KITCHEN RANGE i CLOS. EXIST. EXIGT. A I --- N A " HALL ©© STACK M M%TER 4 m . BEDROOMJEW1111 3'M FOLDING � EXIST. I LIVINGIECC2009 RESIDENTIAL ENERGY EFFICIENCY D q 'EXIT. Z E FOLDING b - -- - ICLOS. a CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES Ui<i- II -` 'VBEDROOM#1 DO°R ;offEXIST. ! - TABLE 402.1.1(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) FENESTRATION SKYLIGHT CENNG WOODFRAMED WALL'FLOOR BASEMENT WALL BASEMENT SLAB CRAWL8PACEWU•FACTOR U-FACTOR R-VAUE R•VALUE R-VALUE R-VALE R-VAUER•VALUECL S. M SERp,36 O.W 3B ID W 10H3 10f2 FT.DEEP)BATH m L NOTES: 4 1. -VALUES ARE MINIMUMS 8 U-FACTORS ARE MAXIMUMS. ' EXIST, b ro 2.10/13 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR EXIST. q F THE HOME OR R-13 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL COVERED O PORCH x a•sa CONC. 3.REFER TO IECC 2OG8 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS APRON - ® WINDOW SCHEDULE (EXISTING) (Exl6 ) gbmnoM B MANUFACTURER'S UNIT ROUGH OPENING REMARKS A .ANDERSEN TW2446 2`8-1/8"x 4'6-7/8" i TILT-WASH DOUBLE-HUNG • F B TW3046 3'2-1/8"x 4'4-7/8" I TILT-WASH DOUBLE-HUNG auLL-Do m COVERED STAR NEWGARAGE 4 1.CONTRACTOR TO VERIFY Aty LL WINDOWS WITH OWNER AND ROUGH OPENINGS I I GAR " - WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS °c { PORCH L-———J 2.ANDERSEN'400 SERIES WINDOWS WHITE EXTERIOR. FIRST FLOOR PLAN g c LOW-E HP 4 GLAZING W/TRU SCENE SCREENS&ESTATE SATIN NICKEL HARDWARE B B 4 LEGEND: ° CONC.SLAB ¢ A C� EXISTING WALLS o C= B CONSTRUCTION TO BE REMOVED d I k ® NEW CONSTRUCTION © SMOKE DETECTOR I © CARBON DETECTOR N ® HEAT DETECTOR 1 F.T.POSTS TO MATCH EKST - S-w 24'd (ADDITION)I I THE DESIGNER SHALL BE NOTIFIED IF ANY NEW ADDITION/REM®DELI'NG FOR. - ERRORS OR OMISSIONS ARE ONSIBLE FOR THE ND ON CONTENT OTE .SCALE DRAWING NO. COTUIT BAY DESIGN, LLC THESE°BAWL"G6 PRIORTD START OF u CONSTRUCTION.THE BUILDING CONTRACTOR .1 WILL BE 43 BREWSTER ROAD COMMENCES WITHOUT NOTIFYING THEM 114.11 = 11-QII IN THESE DRAWINGS IF CONSTRUCTION MASHPEE,MA. 02649 DESIGNER OF ANY ERRORS OR OMISSIONS. PH.(508)274-1166 MATTHEWS RESIDENCE . OFTEOWNERNOTED. NYOTHE DRAWINGS ARE SOLELY RUSEOFE DATE : FAX 88 (� THESE THE OWNER NOTED.ANY OTHER USE OF FAX(5O 539-9402 THESE DRAWINGS REQUIRES THE WRITTEN 34 ASPEN WAY OSTERVILLE, MA CONSENT OF THE DESIGNER UNDER THE 10/22/2012 ARCHITECTURAL COPYRIGHT PROTECTION A 1 ACT OF 1959. i� d.1 LEGEND EXISTING LEACH PIT + BENCHMARK SET N —— 88 —— EXISTING~CONTOUR N c�WO°d o� TO BE PUMPED & FILLED OUTS/DE BULKHEAD CORNER ® ° ° x 100.98 EXISTING SPOT, GRADE W SAND AND ABANDONED � a . EL.= 106.15 (Assumed Datum) J —W EXISTING WATER SERVICE 7 EXISTING GAS SERVICE Q -�i O y y EXISTING SEPTIC TANK , A�� 103,37 11 H.W.— OVERHEAD WIRES m 2 c�O y�� GJc°yocy (TO REMAIN) \ �� x 105, 2 rri TEST PIT CD c TOP OF TANK, EL.=104.33 N 81.23 00 E \� x 1 \\ I BENCHMARK y °�/� INV.(OUT)=103.00E 19Ef,10 coo LOCUS O) (n o° 105.74 1 p 4.00 n \\ w' cad 82 �. Q p 1 S105,3 a -86,,03 _ TP-2 1 25' PO A, �x SHED k t O R°Oa INSPECTION CTION + -S , TFF 105,11 + LOCUS MAP x) 102.581 :o 5.49 1�C"` 1 '36 NOT TO SCALE .o I 0 x /� �\ x •104, x iIP14,7 105.50 I i 103,44 GENERAL NOTES: 0 4' �� i VEN T co, x \ �/x 105, 104,65 102,08 1. ALL CHANGES TO- THIS PLAN MUST BE APPROVED BY THE LOCAL =1- 1 6,10 N � BOARD OF HEALTH AND THE DESIGN ENGINEER.. 105,77 SHELL, { K TA i��J 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 106.3, 1 � LAMP G 103.0 OF LOCALERULESEAND ENVIRONMENTAL CODE,E CEPTTITLE ASVREQUESTED AND APPLICABLE 105,35 I 103,66 G� � � -310 CMR 15.405(1)(b): 106.FZ S > 1) 'A 3' variance' to the 3' maximum cover requirement for up 106.02 1 6 to 6' max. cover. S.A.S. shall be H-20 and vented.' 105J7 B �6 G -� O, 1 103,62 �• � � 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Z ��� fig. C� TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 105,70 106.11,-- /� + 10 ,7 SHELL G DESIGN ENGINEER. o t I catchbasin -PA' PROPOSED DRl1/EWAY C1,1 100,94 ~� 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING W m FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ADDITION. 104 22 I ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. cz ao EXISTING // x 105,0'2 ��, I ! 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �z HOUSE(#34) 101,96 100,66 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 12 O 105,43 T.O.F.=106.15 102.53/ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. •• t G� � ) �, ?0� n O� �i 39 �� 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. � A / g.� / l 100,40 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. x 104,9E`s 0� 9. ALL AREAS CLEARED.FOR CONSTRUCTION SHALL BE RESTORED AS 105,45 C) x 102,87 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 105.13 + x shrubs �� � (v 101,16 �� OF 44sS DIRECTED BY THE APPROVING AUTHORITIES. ��P� gcyG 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY shrubs �, 105,38. SEE1T0,00 a PETER T. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING LOT 2 R.,)i McENTEE CONSTRUCTION. '104,89 16,300fS.F "K f 'x 101 0 w CIVIL 11, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS STAKE&TAC 104,79 Q a� / No. 35109 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 0/ / Q REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). M�LU J�0—55�. �x 103,31 'bj'N % o�,OF G/S�� 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE rr1 /.'N SIONA INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. i� x 103,85 \' /�`� i 13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC x 10 3P� SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN. r 1�p, __�� 4.14 / � tj I2o I Z CB/seal �� ° L=76. 18' 102,78 / y 99,85 R=278 00' FLOOD PLAIN DATA PROPOSED SEPTIC SYSTEM UPGRADE SITE PLAN 0.00 ;. NON HAZARD-ZONE c 34 ASPEN WAY, OSTERVILL MA edge Of Pavement 101.54 100,93 ZONING CLASSIFICATION: ZONE RC 103,14 I SETBACKS: FRONT YARD=20' Prepared for: Frank & Lee Matthews, 34 Aspen Way, Osterville, MA 02655 OWNER OF RECORD L SIDE/REAR YARD=10' Engineering by: SCALE DRAWN Joe. NO. MATTHEWS, FRANK T & LEE E ASP�� �11 Y Engineering Works, Inc. 1„=20' P.T.M.. 260-12 34 ASPEN WAY MAXIMUM BUILDING- HEIGHT = 30' g g 34 ASPEN MA 02655 WIND EXPOSURE CATAGORY: Exposure B 12 West'Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. P (508) 477-5313 1 1/7/12 P.T.M. 1 of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.=101.8 " FOR A DISTANCE OF 15' AROUND THE PERIMETER; OF THE S.A.S. SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S. ) . INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT VENT. CHARCOAL C T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE .� EXISTING F.G. EL.=105.8(MAX.) o F.G. EL.=105.5f F.G. EL.=105.6t MAINTAIN 27. GRADE (MIN.) OVER S.A.S. I I L = 2' L = 5'(MAX) IKE ® S=1% (MIN.) ® S=1% (MIN.) INSPECTION PORT 05.49 6,r - 4"SCH40 PVC 4"SCH40 PVC 14 '1 EXISTING 48" LIQUID IN LEVEL INV.=101.40 �• GASABAFFLE INV.=101,67 PROPOSED INV.=101.50 1 TRENCH ,W/12 ADS Arc 36HC UNITS ® 5'/UNIT'= 60' INV.=103.00f D-BOX �� (FIELD VERIFY) SOIL ABSORPTION SYSTEM (,PROFILE) ' SHED EXISTING SEPTIC TANK UNITS MUST BE STAMPED H-20 �� �� 13.2 ESTABLISH VEGETATIVE COVER \� \ 13.6, PERC S NATIVEBACKFILL NTH CLEAN AND TO TOP OF CHAMBERS ERS 333, NOTES: 1) CONTRACTOR SHALL VERIFY ALLEXISTING PIPE INVERTS, PRIOR TO INSTALLATION. TOP .ELEV.=101.83 ' VHOUSE(#J4) XISTING 2) D—BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=101.40 `: GRADE ON A MECHANICALLY COMPACTED SIX INCH-CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=100.50 310 CMR 15.221(2). 2.-83' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE BOTTOM OF 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W. S.A.S. . LAYOUT AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL EXISTING SUITABLE BOTTOM OF TP, EL=95.4 MATERIAL SEPTIC SYSTEM PROFILE ADS Arc 36HC UNITS TO BE INSTALLED IN TRENCH CONFIGURATION WITH NO STONE s3.2s" N.T.S. TYPICAL SECTION 16" 34.5„ SOIL LOG DESIGN CRITERIA s r.�jv- DATE: OCTOBER 10, 2012 (REF#13,764) l9^ SOIL EVALUATOR: PETER McENTEE PE(SE#1542) TOP VIEW NUMBER OF BEDROOMS: . 3 BEDROOMS (NO INCREASE IN FLOW) WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT SOIL TEXTURAL CLASS: CLASS I ELEV. TP- 1 DEPTH ELEV., TP-2 DEPTH so" END CAP END CAP DESIGN PERCOLATION RATE: <2 MIN./INCH 105.5 q 0" 105.4 q 0" FRONT VIEW SIDE VIEW SANDY LOAM SANDY LOAM ENO CAP DAILY FLOW: 330 GPD 10YR 4/2 10YR 4/2 REAR/TOP VIEW 100.9 DESIGN FLOW: 330 GPD 8 g" 104,9 6„ B NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM TO CHANGE WITHOUT NOTICE, PRODUCT DETAIL MAY 10YR 5/8 10YR 5/8 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 103.0 Cl 30" 102.7 Cl 32" 1" 4640 TRUEMAN BLVD [1� PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLET (MIN.) SILT LOAM SILT LOAM ® HILLIARD, OHIO 43026 Arc 36HC DETAIL d LEACHING AREA REQUIRED: 330 GPD = 445.9 SF 10YR 5/3 10YR 5/3 ADVANCED DRAINAGE SYSTEMS, INC. UNITS MUST BE STAMPED H-20 ( ) 102.0 42" 101.9' 42" .74 GPD/SF C2 C2 PERC PROPOSED SEPTIC SYSTEM UPGRADE SITE PLAN SOIL ABSORPTION SYSTEM n�,��ll' M—C SAND 42"/54" 34 ASPEN WAY, OSTERVILLE, MA ' M—C SAND USE ADS Arc 36HC UNITS IN STOW TRENCH CONFIGURATION 2.5Y 6/6 2.5Y 6/s Prepared for: Frank & Lee Matthews, 34 Aspen Way, Osterville, MA 02655 (GENERAL USE APPROVAL FOR 7X SF/LF IN TRENCH CONFIGURATION) / Engineering by: SCALE DRAWN JOB. NO. 1 TRENCH WITH 12 UNITS @ 5.0' PER UNIT = 60.0' 95.5 120" 95.4 120" Engineering Works, Inc. NTS P.T.M. 260-12 60.0' x 7J9 SF/LF 467.4 SF PERC RATE <2- MIN ("C2" HORIZON) 12 West Cld d, Ftdole, MA 02644 DATE N0 GROUNDWATERER ENCOUNTERED rossfie Road, ores CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(467.4 SF) = 345.8 GPD (508) 477-5313 - 11/7/12 P.T.M. 2 Of 2