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HomeMy WebLinkAbout0019 BLUE HERON DRIVE - Health Iu.e Heron. Drive Osterville� pA= 121-011-010 • Commonwealth of Massachusetts Title 5 Official; Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address Helen Herrlinger Owner Owner's Name information is Osterville MA 02655 11/21/14 required for every z page. City/Town State Zip Code Date of Inspection 1 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, �f use only the tab 1. Inspector: key to move your r cursor-do not James Ford c , use the return Name of Inspector key. Company Name ; ICI P.O. Box 49 r Company Address � Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 Telephone Number E; 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 Furthe valuation.by the Local Approving Authority 11/25/14 Inspe 's Signature Date The em inspe or shall s"ubmit 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 ypd 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 1--io.Inditions 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 cond'itions of use. (Ad I� l I t5ins•3/13 Title 5 Official(isp lion Form:Subsurface Sewage Disposal System•Page 1 of 17 I • Commonwealth of Massachusetts Title 5 Official'; Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 Of 2 Property Address Helen Herrlinger Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Checks A,B,C,D or E/always complete all of Section D A) System Passes: ri ® 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: S . 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'f&"not determined' (Y, N, ND)for the following statements. If"not determined," please explain.; The septic tank is metal andjover 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 i� 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. El Y ❑ N ❑ ND (Explain below): j F •s ,i r (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official] Inspection Form ytem Form Not for Voluntary Assessments Subsurface Sewage Disposal t y 19 Blue Heron Drive system 2 of 2 Property Address Helen Hen-linger Owner Owner's Name `. information is required for every Osterville MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): r ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed lllpe(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) re_'ireplaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is beveled 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) arb'replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 1, 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: s. r. ❑ Cesspool or privy is within 50 feet of a surface water r� ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t, ? l5ins•3113 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i d Commonwealth of Massa6husetts W Title 5 Official; Inspection Form Subsurface Sewage Disposal system Form Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address tf i� Helen Herrlinger Owner Owner's Name is information is required for every Osterville MA 02655 11/21/14 page. City/Town ' State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) 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. t ❑ 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 septicaank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determiAe 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: , 1 , i . . i i. ga I' fdd' .. if D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" of`iNo"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 ran 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 %day flow t5ins•3/13 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 :S to ; Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 19 Blue Heron Drive system 2 of,2 Property Address f ; Helen Herrlinger Owner Owner's Name information is required for every Osterville r'. MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No j ❑ ® 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. ❑ An® y p o},r.tion 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- 10,0009pd. ❑ ® The sysfem 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. I; For large systems, you must,indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 't Yes No T ❑ ❑ 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 El Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-1WPA)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'Q 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 3;10.CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 j Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 (1 . l: i Commonwealth of Massachusetts W Title 5 Officials Inspection Form Subsurface Sewage Disposal 9 ' tem Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address y Helen Hen-linger Owner Owner's Name ; ? information is Osterville ` MA 02655 11/21/14 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have bIeen 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? i ❑ ® Has thA .stern 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. ® ElWere as.built plans of the system obtained and examined? (If they were not available note as N/A) Ii ® ❑ 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? l; t ® ❑ 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 deitermined based on: ® ❑ Existinginformation. For example, a plan at the Board of Health. ® ❑ Determ6ed in the field (if any of the failure criteria related to Part C is at issue approxi7iation of distance is unacceptable) [310 CMR 15.302(5)] D. System Informatiohl Residential Flow Conditions: I � n/a ` Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 l� P i• t5ins•3/13 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i .. i j, a Commonwealth of Massachusetts v Title 5 Official., Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address Helen Herrlinger i Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. Cityrrown f `, State Zip Code Date of Inspection D. System Information. Description: �i r i t . i� Number of current residents t II Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? El Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: unavailable I� w Sump pump? ; ❑ Yes ® No 1, r Last date of occupancy: unknown is Date Commercial/Industrial Flow;Conditions: Type of Establishment: ) r. Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): a Grease trap present? F' El 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i . r r ! ff i. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 19 Blue Heron Drive system 2 of 2 Property Address Helen Hen-linger Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection D. System Informatiop' (cont.) Last date of occupancy/user; Date i Other(describe below): f9 Q ` Il � II General Information I Pumping Records: Source of information: Unknown I , . 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: l ® Septic tank,iidirtribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) i ❑ 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. i, ❑ Other(describe): , a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r; I Commonwealth of Massachusetts W Title 5 Officiat. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address Helen Herrlinger ' Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: installed on 6/8/93 -per as- built r, Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): r 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 plain): I i 101, Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) a. If tank is metal, list age: years. Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No I Dimensions: 1000 gal. Sludge depth: 2 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i E r Commonwealth of Massachusetts Title 5 Official'� Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 19 Blue Heron Drive system 2 of 2 Property Address Helen Herrlinger Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) F, c Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness ! 10 ! 6 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum'to bottom of outlet tee or baffle 15 z i How were dimensions determined? measure 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 tees were present and ter he was no sign of leakage. The covers were10" below. Recommend pumping the tank. � I c r I S Q I Grease Trap(locate on site': lan): l; Depth below grade: j feet Material of construction: A ❑ concrete ❑ metal ': ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum td top of outlet tee or baffle Distance from bottom of scup to bottom of outlet tee or baffle i; Date of last pumping: ' Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17- Commonwealth of Massachusetts . Title 5 Official:',: Inspection Form Subsurface Sewage Disposal gystem Form - Not for Voluntary Assessments tl °�M •'' 19 Blue Heron Drive system 2 of 2 Property Address ' Helen Herrlinger Owner Owner's Name ; information is required for every Osterville MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection D. System Information; (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): : 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): N/a Dimensions: Capacity: gallons : Design Flow: gallons per day Alarm present: ❑ Yes ❑ No if t Alarm level: ' Alarm in working order: ❑ Yes ❑ No s Date of last pumping: S Date Comments (condition of alarm.and float switches, etc.): i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No � t t5ins-3/13 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f ' Commonwealth of Massachusetts Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drives stem 2 of 2 Property Address Helen Herrlinger i Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present,�m.ust 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 ouf of box, etc.): The D- Box was normal ` d i• f } ti R ti l Pump Chamber(locate on site plan): Pumps in working order: r El Yes ❑ No Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/a r g' * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not Located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i I' I(� r, i - ' Commonwealth of Massachusetts Title 5 Official'. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address k Helen Herrlin9 er Owner Owner's Name information is Osterville !'� MA 02655 11/21/14 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 3� Type: ❑ leaching pits . number: 4 ® t`leaching charnb'ers number: 4 infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: ,I Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no sign of failure-The bottom to grade was 3' i r { Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): ,: I Number and configuration Depth—top of liquid to inlet invert f. Depth of solids layer ?` Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 E 4. ' Commonwealth of Massachusetts w Title 5 Official'; Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address Helen Herrlinger Owner Owner's Name information is Osterville ? MA 02655 11/21/14 required for every i page. CityrFown - State Zip Code Date of Inspection D. System Information (cont.) II Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): II P Privy(locate on site plan): Materials of construction: Dimensions t . Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a x> t. iyy t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official' Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 19 Blue Heron Drive system 2 of 2 Property Address Helen Herrlinger Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. CitylTown 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 ` i OAT I I, E i a-- S' 3 A Q S3 J;n 1 p Tt r 3 14o i 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ' Commonwealth of Massachusetts Title 5 Officials Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address Helen Hen-linger Owner Owner's Name information is required Osterville MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope t t� ® Surface water ❑ Check cellar ❑ Shallow wells li Estimated depth to high ground water: 5' per design plan + feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 1982-1 If checked, date•of design plan reviewed: Date Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Topo and water,'cgntours map ❑ Checked with local excavators, installers - (attach documentation) , t ❑ Accessed USGS database -explain: 1' -1 f You must describe how youliestablished the high ground water elevation: There is a 4"test hole observation pipe on site. Groundwater was found at 7' k ` a i Before filing this Inspection Report, please see Report Completeness Checklist on next page. i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ' Commonwealth of Massachusetts W Title 5 Official7, Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 2 of 2 Property Address s' Helen Herdinger Owner Owner's Name information is required for every Osterville i! o MA 02655 11/21/14 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 I A i 4 k: 1.1. 4 ii i 1 fl t 0 h, �1 t5ins•3/13 r ', Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 fl Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '�..A,.•'' 19 Blue Heron Drive system 1 of 2 Property Address H Helen Herrlinger I Owner Owners Name information is required for every Osteryille MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness bhecklist at the end of the form. Important:When filling out forms A. General Information on the computer, p 60 use only the tab 1. InS eCtOr: �' ' key to move your cursor-do not use the return James Ford r key. Name of Inspector a 'I tt! i r Company Name P.O. Box 49 ` Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S 12482 Telephone Number License Number B. Certification I certify that I have persona Ily inspected the sewage disposal system at this address and that the information reported below is'rue, accurate and complete as of the time of the inspection.The inspection was performed based on my t.aihing 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 valuation by the Local Approving Authority ° 11/25/14 Inspec Signature Date The Wern 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 describ�,s 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 co4d'itions of use. t5ins•3/13 Title 5 Official sp lion Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts t; Title 5 Official- Inspection Form Subsurface Sewage DisposalSystem Form - Not for Voluntary Assessments 19 Blue Heron Drive system i1 of 2 Property Address Helen Herrlinger Owner Owners Name information is required for every Osteryille MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection B. Certification (cone:) Inspection Summary: Check A,B,C,D or E/always complete all of Section D ;f A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 o in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 6 } t 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 11 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 substari'tiA infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing t"nk 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): ii 3 r: rr. ul it i+ !Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 fV 1 I� � i 1� F . Commonwealth of Massachusetts Title 5 Officia It It Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 19 Blue Heron Drive system�;1 of 2 Property Address a— Helen Hen-linger Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. Cityll own State Zip Code Date of Inspection B. Certification (conf) ❑ Pump Chamber pumps/61arms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): I ❑ broken pipe(s;)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is�:removed ❑ Y ❑ N ❑ ND (Explain below): f. ❑ distribution bcix'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 pipes)a're replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction isi>reMoved ❑ Y ❑ N ❑ ND (Explain below): e i I.. 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 uriless 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 r : ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t ' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i E' Commonwealth of Massa`.chusetts Title 5 Official'; Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ..a.•'' 19 Blue Heron Drive system;! of 2 Property Address R, Helen Herrlin er 4' Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. City/Town 4 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 aseptic 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 aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has al.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: F 4 **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. I. 3. Other: sl ; h , : r N i a is D) System Failure Criteria Applicable to All Systems: You must indicate "Yes';qr".No"to each of the following for all inspections: 'i Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than: day flow !Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i • r ,i u, Commonwealth of Massachusetts Title 5 Officiate inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I. } '�M 19 Blue Heron Drives stem 1 of 2 Property Address Helen Herdinger Owner Owners Name information is fa ; required for every Osterville i MA 02655 11/21/14 page. City/Town e State Zip Code Date of Inspection B. Certification (cont.!)� s i I; ;y Yes No ii h ❑ ® 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. E] ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ii El ® Any po�tipn 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 labo6tory,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- 1 o,00dgpd. ❑ ® The'system fails. I have determined that one or more of the above failure criteri�,exist as described in 310 CM 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 considdered a large system the system must serve a facility with a i.design flow of 10,000 gpd fo 15,000 gpd. For large systems, you mttst'indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. :. Yes No t�. ❑ ❑ the system is within 400 feet of a surface drinking water supply s. ❑ ❑ the aystem 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'11IIWPA)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 SectiorI,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,i 10 CMR 15:304. The system owner should contact the appropriate regional office of the Department. r t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 1 4 t A ili . a . Commonwealth of Massachusetts Title 5 Officiab Inspection Form Subsurface Sewage Disposal System 9 p y Form Not for Voluntary Assessments 19 Blue Heron Drive system 1 of 2 Property Address : Helen Herrlinger l Owner Owners Name information is required for every Osterville MA 02655 11/21/14 page. Clty[Town ( r. State Zip Code Date of Inspection C. Checklist Check if the following have fieen done. You must indicate"yes" or"no"as to each of the following: Yes No ,I ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were a6y of the system components pumped out in the previous two weeks? ❑ ® Has.tl &!system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recent) art of this in's eation? y or as p ® ❑ Were as;built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was d6t facilitydwelling or g inspected for signs of sewage back up? I, ® ❑ Was the'site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? l` ® ❑ Were 4he 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.sii�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)] V •' D. System Information , Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): n/a li ,t DESIGN flow based on 310 tMR 15.203 (for example: 110 gpd x#of bedrooms): 770 4 , ,r li i a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i i, A • �I it Commonwealth of Massachusetts Title 5 Official{; Inspection Form Subsurface Sewage Disposal system Form -Not for Voluntary Assessments l ,a. 19 Blue Heron Drive system 1,of 2 Property Address ' Helen Herrlinger is Owner Owners Name ,! required for is every Ostervllle required for eve MA 02655 11/21/14 page. CitylTown ! . State Zip Code Date of Inspection D. System Information Description: a, k f� i ii ;i Number of current residents a 0 �i Does residence.have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) i, `. ❑ Yes ® No Laundry system inspected? ` ❑ Yes ® No Seasonal use? El Yes ® No ,.. Water meter readings, if available(last 2 years usage (gpd)): Detail: unavailable 1' E• t, Sump pump? ❑ Yes ® No Last date of occupancy: k' unknown i; Date Commercial/Industrial Flew Conditions: Type of Establishment: Design flow(based on 316.CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/p.ersons/sq.ft., etc.): Grease trap present? , ❑ Yes ❑ No 4 Industrial waste holding tank,present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i 3 , Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal §ystem Form -Not for Voluntary Assessments I •'' 19 Blue Heron Drive system 1: of 2 Property Address Helen Herdinger Owner Owners Name G required for is every Osterville required for eve MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont. Last date of occupancy/user t Date Other(describe below): 1. f General Information I. Pumping Records: Source of information: Unknown Was system pumped as part;of the inspection?P ❑ Yes No If yes, volume pumped: gallons How was quantity pumped;determined? t Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system , t ❑ 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 maintenaAce 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. I ❑ Other(describe): f5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 `I f , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal system Form - Not for Voluntary Assessments °M A 19 Blue Heron Drives stem 1;of 2 Property Address Helen Herdin er Owner Owner's Name information is ` required for every Osterville MA page. City/Town 02655 11/21/14 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: installed in 1982 -per as- built r . Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on:site plan): P. t Depth below grade: k` ' feet Material of construction: G ❑ 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.): tiT Septic Tank (locate on site"' an): i' Depth below grade: (` 2" feet Material of construction: 1 . ® 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: 2000 gal. H-20 I: Sludge depth: + 2 l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 S` s' i E Commonwealth of Massachusetts I. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drive system 1 of 2 Property Address Helen Hen-linger Owner Owners Name information is Osterville ' required for every MA 02655 11/21/14 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) - i . Distance from top of sludge to bottom of outlet tee or baffle 30 Scum thickness 2 t Y 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 15 How were dimensions determined? measure a. Comments (on pumping ro'commendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees were present. There were no sign of leakage. The covers were 2" below. Recommend removing the H-20 covers and install steel covers to grade. . ill Y Grease Trap (locate on site plan): Depth below grade: feet Material of construction: i ❑ concrete ❑ metal ; ❑fiberglass ❑ polyethylene El 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: fi js Date t5ins•3/13 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i� t. Commonwealth of Mas"chusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal tystem Form - Not for Voluntary Assessments 1 19 Blue Heron Drive system 1 of 2 Property Address Helen Herrlin er Owner Owner's Name required for is every Osterville required for eve i. MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspection D. System Informatio(i (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.): I' Tight or g Iding Tank.(t nk must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: . l ❑ concrete ❑ mega,I El fiberglass El polyethylene El other(explain): N/a Dimensions: Capacity: gallons Design Flow: tt, gallons per day Alarm present: is ❑ Yes ElNo t, 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 1, . � ' u 'I I Commonwealth of Massachusetts Title 5 Official,; inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drives stem 1 of 2 Property Address , Helen Herrlin er Owner Owner's Name information is required for every Cisterville MA 02655 11/21/14 page. City/Town State 0 Code p Date of Inspection D. System InformatiOh (Cont.) Distribution Box(if presentm,ust be opened) (locate on site plan): l: Depth of liquid level above, a outlet invert even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D- Box was normal" .. R ; ]]rrx aj C . l; t 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.): N/a i..l t. Is � 1 * If pumps or alarms are not in working order, system is a conditional pass. q.. Soil Absorption System (SEAS)(locate on site plan, excavation not required): If SAS not located, explain why: l5ins-3113 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 E � t Commonwealth of Massachusetts Title 5 Official' inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drives stem 1 of 2 Property Address Helen Herrlin er Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number- ® leaching chambers number: 4 leach chambers ❑ leaching galleries number: ;! ❑ leaching trenches number, length: ❑ leaching fields. ; number, dimensions: ❑ overflow cesspool number: l.< ❑ innovative/alternative system I:. Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no sign of failure'JI dug up the leach field and there was no sign of failure. The bottom to grade was 3.5'The system has 4'of stone per design plan ii• C' i' i Cesspools (cesspool mustfbe pumped as part of inspection) (locate on site plan): F i; Number and configuration Depth—top of liquid to inletl,invert Depth of solids layer o Depth of scum layer I` Dimensions of cesspool Materials of construction is a` Indication of groundwater inflow ❑ Yes ❑ No l5ins-3/13 is Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i ' d \ I' ' Commonwealth of Massachusetts Title 5 Official; Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 19 Blue Heron Drive system 1:of 2 Property Address Helen Herrlin er Owner Owner's Name t information is required for every Osterville MA 02655 11/21/14 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.): i. ri Privy(locate on site plan): ; Materials of construction: Dimensions i Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a . i.. , . a. `t er t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments A,•'�• 19 Blue Heron Drives stem 1'of 2 Property Address Helen Herrlin er Owner information is Owner's Name ` required for every Osterville MA 02655 11/21/14 page. City/Town State Zi Code P 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: L: ® hand-sketch in the area below ❑ drawing attached separately is I a 1 ?� R , O O $` p y ie a3 `I'1 t 4 yy y SO 3Q- 6'. t5ins•3/13 I. I' t• Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 4: Commonwealth of Massachusetts Title 5 Official! Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Blue Heron Drives stem 1�of 2 Property Address Helen Herrlin er Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. City/Town State Zip Code Date of Inspect ion D. System Information (cont.) Site Exam: ❑ Check Slope f ® Surface water ❑ Check cellar E ❑ Shaliow wells f. it 4; Estimated depth to high ground water: 5' per desi n plan feet i 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: 1982 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Topo and water contours map ❑ Checked with local excavators,-installers-(attaoh documentation) r. ❑ Accessed USG:S database-explain: it : You must describe how you:established the high ground water elevation: There is a 4"test hole observation pipe on site. Groundwater was found at 7' r , I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 l Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 a t . ` Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Blue Heron Drives stem 1 of 2 Property Address Helen Herrlin er Owner Owner's Name information is required for every Osterville MA 02655 11/21/14 page. Cityfrown r State Zip Code Date of Inspection E. Report Completerss 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 0. L ' i` l r !I. k ii t t. t5ins•3/13 + Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 1; F iommonaveattt ro#"ilassachuset#s;: Title 5 Official Inspection For r ` ' Subsurface^ ewag [ tsposal SystQrrr 6_ ;CVatiar>Volu ttaryAss same is � 1 19 Blue M+�ryn Dstve system Heler�Herrltr�ger.. . C7mt�rs�tdarr�� . _. rr(C�,r r8u0r�a Ostervill�; MA f}265 1/121114 �egirlr ,a f sf av ty` _, .,...,... Gage. Crtyti rrvan .. t��t� ip, ode D3Oa of Inmp ctlprr. inspection results Must be sutirnittedn thh`farm Ins�ecton foim$ rrtay nc�t be alte"red rn any way:P..Isas :see Crnpleteiss checMist"at the end of the.forR , � . fititcg�,ut.tcrrns: A. st?Cf8'Ira Ill oFCElAi ion c.n.ie cq' 'uLar,' �tsr�only the t�ta,.. Eresrecor; k�Y to maxe:jvG.r: cursor-cio;::rant-: ,J��TiB� fiord v J" Use tsar rPtm - tJa;rrle of Iraspet�a�� t -- _ asterville �4 02655 . rt,sw" ' Cgtvfl`tsvm... ,• �ksye:� - `��'ip.C.o�#e` cos 6z-� ao> 512482 ,. Tr3t'pphtar?31umr. L�aers 'Naar beo I certify that i have", sona?;y inspectetl the sewage dt pawl systgm:at thrs ftiress°arid tit"at the mforn a>iart reported t�elflw'is t €�e acctar te;and c ir��a t as"of the time€'f the ir�spectaan T. ttlspectior :was perfarmed based on my tralning end.exper'rence inxthe_�pra r tur�ptt�sn Sri#trta� tenat� a of art; ite setiv ge dis.po a1 systems "atrt a 13EP a pr..oved m em inspector pursuant tc�8e6trfin l�34it cif T�tle.;a(310'Cfl11R 1 s:t)00}.The _. ._ P i�as"sus Condo ttana11 Pars"sea Need':s Furkt er vafiaa#tc�t by ttte l.oaal Appr vih, ,Auft tlty 111251,1�i Ift:�peC " Sr�rar�tu,� - h. I3aEs Tile errs inspector shalt s k rn:t a trcapy of fhrs mspecttoh rept�d to the pprav ng Au6harrty Bcaartl of;:Health or I EI? w�thira �days of cx�mpleti g th?s'it�spect on If tite system as a'shared.syMe'm or has a design Mary oaf 1 t3©fQ gpd oe. seeter,".the rnspctgrhd the stern owner sha{I stbcrttt tt3e rcpart to the apptQprtate regtortal srfficQ of tie QEP tn�cOr gtr,al should Ease"nt;to the"syster.er G?tid cc�pce5 sent'ilc #heyEuyer apitcfable artd te'apprvvrtg authai3rtty Thfs report Drily describes tondtttons at the ttm of inspecttort and tittder:fhe conclltloii ;of use tt that tune This rnspectjjbn does riot iii, ca s l ow t ie,:systern will per#drrt In tttt'future.under t#te sam or differentconc�tlorts of>use, : qnP 3"'�..; T'ItIE SrJtS' -01:`h3{T 'i'.1,Ftittn'Sub U43*eqff.VaPaunal.Ry,itt P,j9 t rt , Cohn' nonwealtf��1lasachu$ettTi le tiatinsPec 4: Subsurf ice Sewage DispasaI S;jrstem'Farm ='hloi€cat Uv i�r►# ry.7 s`s+rssrri nts Bl 'How qqv syste:rrm 1 cif 2 p _. - PrpR Y A jts,S. Helen:HA rHnr Uwncr .: ' ini?o€matioa�s e4�fr d r€we y, Osterville 41t,4 02655 1 t/291�4; Cwtylf _. State: �ri�' �teoflnpar#ion:; B...Cet�tiftvatin nspec#ion SirMMS'ry Check A B C,D yr�,t always complote ail of Sect A} System Passes'"- 1 1 have not faunrt ara inforrrracrarr hic} rstircates that eny of tie fa�trc criteria-descrit} i rn t9 t1t�R 15 3+33°or 1n 1i� M9R-1 .•3d4 eltist;;ar€y"f i.preacriterta riot eval`tiatect:are rnd�ca#et4 below,. . . . Cmrne�ts°` , B}- System`Candttianatty,'PAsses,. one i t mope system cornporier�ts;as described n:the''Conditlonal P'aW-see#ion need to'be, reel ce€i a 'refaifed Tla ,sys#em; upe rr. �impleticari of the�replacement orreeair, as'appraved b, the'�rd,of t-leaIt will pass Ct'eck the bpx for"yes or"not dotermaned° (1(, tJ Nd}for dhe follaw ng statements if"off determined fr(e�se ex�layn The septic#ark s m etal and ref 4 years BEd"or fhe septic tank(whet#ter metal of note,systr lc�turall} ugsqund,Fe' hrbits suns#antic{ irffitratidn"Qr exfiltrati�n car#aritC fia�lia�e is im�alnent 'Systerr+will pess inspection if it7e"existir g tarn is replaced.with,s ccarr ply�rtg septic:tsirtk as ppci v d by:tf a Boer.d:of f=tealth < A tt�et, F septic,Wk i+,rill pass'inspect an if t<rs stfu ttrraily°scurad. not teakirrg and tfa Certificate.;bf Cortplrance tniee#tngthat th ;:tank i5:less than 20',ye ;rs ez19 isvilable' I if j Ian # ?, iillw S C�'R :InSje flPr",9mt $l?`�3UP& sGN'*01�¢^ss 3y51em <atgP n'i ': 4 ` commonwealtl of Iassach use'fi, Title Officiai: nspecti+ n r r r Subsurface Se�nia l��s asal,5ystem,Fvrm s NOt far�aluntary t�sscssmerrts 19 Slue HerCitt Nve sys#erl 1 of Pro#serty Adds. Helen hlerrlrr�r�gsr __,.. .... ...,tr,r :G°v�stei f3vm�rN Namc` _, w_.;. Irrfr�rm�#tin is r[ u�ta�l[or evr ry` 4st�rvlile MA 0255 1'Iltd14 psg� GI r r 4�t n St rQ iP �d- bifa of it apt tkr�s_ F d ROMP Gh�m6' p�rgrpslalarms nit operatidnai System wr11 pass vvitt�Board cyf Health apprflvai if pursip8*arms are,re!'_ Wed.— „r BY "r CeC1i1di idn'Al Q,r�,,:.35 fJbservatir3r>'of sevte a b ck,up ter break gut pr"hrgh stetic Water level rrr the tf�strrbutron bo,x dd tm broken or'abstructec!prpe{s) r du ,tra'a E ruk+?r►, shied or;uneven t#Istrib�t.1 box.:System�niill.. pass°rnspeefimn rf,{rv�thi approval.of # f Haatth)' broken ereld ~ ® e.pipe [ Enlow obst uctaor rs r-e ivveu` ❑ ; ❑ N ❑ ND(EkpWin be16w)'. ❑ dr$tnbubon-bax is-:Eeveled rr rapl.aced ❑ Y' ❑ ❑-ND(E�,plarn blow); 44 The sy term"Tequ," d pump.rng.rnvre ttian 4 times•a„year due-to broke or okstructett prpe{:s) The: systgh�w111::j5ass ira�peci:tvr�.#{With,-appravai of the.Board.cif FJeaEth).; . " 3 a. broJeerr Pa are C am,d ❑ `!--` ❑ ✓ ].ND{ zplain b �awy: t�bstructr€�rt rs ramave'd'' ❑ Y'' JET N.. ❑: !D jr otin+); C) Iruler Eual. aticr is Ret#uiretl by;ttee 8ciard a#Wsalthr ❑ Condittvns-irX15t Which regaiire'fur#her�cv.alUatran by the Boa ;6f I lei!#tr rn e�rc4er to`�et�rm ner, Lhe systafn, failing tQ pr itec�pu ila hea..ith, safety ar ttre eiivironmert ysterr +y,ll bassnlss 13oard cif Heatth'defermirres rri eccirrdanoe.av�th 310 AMR'. 15 303� }(b}that the system is'not functror~ r g rn of manner whrchr vvili p otec#':pufa I'd; roealtL safaty arrd the envlror#rtiie'rtt:' M Y e 'I_or Is';-N.,I t iin $b feet of e�brfap w Re[ ❑: Cess of ar prsvyas wrth"in 5 feet,o a t otdertng Uegetateci watlarrd'or.a°sa1#-rrlars; > €erns ]s 61ti s i]f�rrai prr ; prm Ss�bstig48 5��� SaS�Sy<an -f?a�e 3 Qf S7> , arnt�cirtv�realtt4.af Massachtsett Y T'i le ffi i l ri pection Fora Subsurface.Sewa e�dteptasaL•Syst M ormfor Vplt�ri.t2iy A sessrrii tit5i �; 19 Sl%�s Fternn Qri+re system 1 of 2. Property A�is�����: Hetert Herrliner owner s turn c �.- ,- tr+'arrr�at+off as a'= r'equEre°fcit eery t35tenlille Mrt {2 It 4 Ctt !Tc at tt _' Zi Cy�de; aate ot`Ir spntpn,, B. c,Qrti#ication (c161,6� 2 RSysterh Will 141;1 unless th.e'Board of Health (arrd P'ubitrc Watof�Supp1:.,e. tf atty} determines that ttae'system is#ttC►cti€+r �n tri a mariner that protects this publrc health safe#y and ervironrrtent: C to sysfena ha s a scpfic tank>and soil a�ssoptic�nystern(SAS}and the SAS ss;wathi`n t {?.feet pf.a surfat a water s tppty ar tribal ry tp a surface water sa�ti ly Q TO�e systern l�"�a septtid tank and SAS and:the SAS,Is',within a Zeno. of a public Wafer: supply ❑ The system has a,sept�c tar k;and, AS ar d vo SAS is t+vlthtn'�O::f e€of .private water, supple well. ThP. ysterri has alsept�c tank and SASand tl1eA "isrless thrt �fl0 fact but 50, ©feet'or, m.orelfrom a,private�vater`eutaply well'*s: Me€.Od.used to deterralnae dista ce:a k3;; °F _!s sys#errs basses F#hs well water an t}t5ts performed at 6, L}EP mortified tat orator for Fecal cc laForrri Sao#aria tndic;3tas at�sent and the•pres2nce€�#ammonia n, roger and nitrate iiitmg r!, s`e aael tri`or Jess,:tlaan 5'ppm, prpvrr} that na otFier'failure;cater#a;are trtggeree :A conyf the anaislc o?us#` be attar he'd to.tlIts forrri. 3 Qthaar` ;Q) System"F iit er;�Ap�facabf a to A11 Syst6rna:;: Yota indicate``,`Yes"'.or:"NG"t each caf..thiz_faillrawing'for al! iihspecttons lf'es: No. Q backup OC si�wage tntv`fac�lity ar system corf,paribn dur5 tip overly rlad"or AS'er 005SDOO Qiscl�ar e Qr t3dtng Qt+afflue it tq tf surface O the gf p d gar surfs ce ;vater5 dtie to a overlQK O Qr clo d SAS or,CesSpaei Static 1 qujd level in#ire dtstr�tiution' !Q: ebciv�:€�utir�finvert dve:to an a`v+��laaded of clogged SAS or cesspgol L ctu, depth tai cesspaol.is:le$s fha> t3 below rnv6 tbr.Available vo9urr�e's less tftat 'r tl'ay Pw. t5(n9 �.i J I:�ile 5 CSf�disl�sptc#°ip7.Farrn fi r6 c�fCc"SC++t!$C sfl�Oskr S�SRtn I'p��9F 1�`; , t6 yi riwkl the df mdi hiusett's Title Offic al, Ins, eclion Form r era..Fm [ ASs%A :,Ce:aewage a � oo.te yss ssmer is 19 Blue Fferosi ar,ve syste ! vl -., !-teiQn hferri,rr�er t�vrr¢�r sf�ar�v mfvnMl., 9 is Osterviile MA, �2655 1 required fnre r®ryl21l14. 00flifOth h (car d `des.,- No R iu,re�i porn ing acre than 4 t,mes in the Oast yeas fVDT tlue taclogged or c taetr,cte f , e s N rrit r of t,mas;'LI ed . Ar%yor#ion of thi;E: 55;cesspoot orr,vy isbe�tu liiptt griurtd water eCesrttion A iy Rcrt�anycf Asspcol:Qr privy is,wit an.1 OQ`;fee#O c f a sutfa ra ter supply;cir trrbutary 6,0 sUrfao . Er s�3fipl,y,: Fx F#ry ptt>rrtipn crf acesspopt or pricy�sthlra a,Zort'e i of pupCic welt. ' - r,y i rt9mn c�i;e;cesspr al cir privy.,s with,n 5a feet of a privy#e.water supply well. ' Ain frQrticin cf a essp of pr pricy iS Ceps tfar 100 feet bir#greater'than 50 feet":, frarn a primate water s�ippCy+mall ittl"rie aa..cep abCe dater quattty ar+alysas'�(Thts, system,passes`if tha welC water S'no 11 ys,s,PlEl Wme at'e QEP`certlired 1"aborapry, fcirfecal c tafcsrr bacteria intli4�atee.aftsent' ,nd the presence'' of.arnt�c nfa rtltrogen,anrl n�tfate nitres en is equal to_or`Iaz s than:S pprrt prbvldedI at 6 other faure erg, rla are"'irr�gger py of th`a ariaiysis' And,chain',of cit.sody must tie attached t4 th,a f, rrn»j The systgrn As a:'cessOidbt sorvir,p a.fee,l,ty:-v+ritil a des7gri flog 0f,�Q t}gp The system faits.:C hpve determmned that cane or rn€re of tC .abpv faiiu6e; -erlt+?ri "exist as described in 31O.GCu1R 1 3 , therfcre Fhe system faals;,Tke sys#errs owner st Quidycor act ttie Board of Health to-deter me whet tiv,ll:tae necessary to rprre�tthe facture • - Ej Lre Sjrstems 'To becorasldercd a largE`systertt the system crust serve afacil�ty';w�th ra des:gn flaw of 1 Q,40{?.gpd t€s '15,0#�tt Fcr large'Systerris ycci.musttii ,cate etC�er 'fires"r��'''`na"to euCl� of the fal'Iovk�,ng,;ip.adrl�t�Qn t the; quest,cr�s�in Se�fiorG D Yes Nc the systerr3 is vdithin:406 feet clf.a,surfaCe drinic,ng,:water:Supply: [� [ the sy ierrs is.tirithiri� tl feet o a tribu#ai'y to a surface dnnO, W ier suppiy the eastern Js ioca e, in.ja ni rogeri,whstt,ve area(tn#erim"Vye111�o d Protectrari O x Area' ItdVi��4 c�'a ma d Zan+e 11,t�f'a ubl water`su I quell F ._ ,,,.. Ai}v o if ycu hive answered"yes t >anv ques o tin Iri S Ct�Qra E the syster is cdr%�derat a s,c�« fioarit thrOW'k or answered 'yes to Sect�ort 1?abave tCie Car'pe system has fa,ied='f#e elwi�er ear aperatc?r cifr,y lame system cons�der�d a slgn,f,ca> t tFrea#undei Sectic�i E or fted rcntlor Saet,ctn D.shal( itpgrd the, system inccar€ance wit? 310 GMfi 15,3D4,;The.sjsiem auvner stauld. itt""act the e"pprdpriiate cegtorial Off'rce ref the Q,epartrriant; �IUe` USItGc lPR8C60.FCtt l Suf�rtyc8 @ ti+�igr D �Sn �!23yslnm Fnc S 3f i ' yT6 - �� Com'mo6wV" th°af�a sac husetts` r Tile ,5. Sub$urfsae;Savage Qa ystem Form=Wt " V. luntsfy AsSessrrt�r#ts i 19:glue Heron ©rive Sys�rr! 1 of,2- <Prnpei;Ac!�ress Helen Herriar�ger �7wxlcrs-N2rt�e; .CinGcrrl';is regl�ued f�r;.every .Ostcrviii6 MA tD2f35�� 1'ti fil4 CI r�wn Zi ate S r . ... R.. dci _: Daie,Ai Iftspectiac� `C..Ch ORSt' f Check of Owl 'ii ve faun done.l'c� i°,r{tust inciscate yyes or no ass,to.each of the font tr rEg_, Yet Nei l:'urz��,trt�l rforrnbtion v as pro icJe db y tF�e oti ;er, bbr r,ar1#,,er 6r oar of Heaith Were er�y f the,systerrt: rapflnertls p mpedYoutAn the previou o wceks7, `` 1la'?the, y tern'reeeived rl4rmal flogs 'n.the,Previous,two w� .pro '> Heve far vC1lurT eS ofanrater t een".introduced to.t#he;syst6m-recentiy,,or<as part o �, this 1r�sp�xct�c�r1' Were.as swlt.plarfs of`the sysi m ata#aired and exam ned?i It they were nat' a aiiabfe:nolei as��11A , ] V+�'as the f ctlity o tivUtrllfn inspectedJ stgnsy of sewage lock up? 0'' Was the onspsc#ad for stgras;Qfi tweak aa�t'' Y® �iUerei� ystcm corrtparrits, excltada the;,S i€c"ate€f ons�t�?`' d, Utlere the septic tank rezihc�fes%lrrt � red;openedrerrd theriteior.of the tank inspected.orl,.he car dttton of ft*.baffle's or tees, mr Aena( of construction, dimensic�r�s, d P Ahlof 1i Old, ept of Mudge and oepth.of scumr'� , Wad the facii(ty owner(and oeoupants If different fr�rra owner)prpvided u fth Q tnformataor on tle,proper Main#enance of sbst�rfa�e sewage disposal syter€�s" The saz�ancf iocattart of #fie Sari AbSCrption 5y5tefti (S�►S}or�-tttP s:#e Fans:,: bin oeteinned bast�tt:on d Eisttng�ifornaatiQn Far'exarpi pl1l at tie Board of Nealth Determined in tt?€�field (if any o�`the fa's�ure criterra related to Parf G;g a#ai�s� pp axarn;atta i"of distanpe is unacce�labiei t31f}GPJiR D Sys�ern tnormattc h Rsrdfential Flow Conrtttons: tmberof hedrems tdsrgrW t�iuber cyf bdrovis��ctuaiy Ufa l E,SIGN flow based orr 31 Q NIR t 2€}3{for exern to 1 1<; x of be '77� � I Slns iss 1d1e Ol 61NitF+e� 'i�ei�€�t 3chc�S.iirrSrwA3"F-1A S't 58tt7 Carnmonwea[th bf.Msissaahusetts:. Title . Offic i n e- inn Form Substifface_Sew�t e'Q,s aaat "stern Fcrrrt:-col fi Valt�rttary�Assssmr�ts ` 9 ., . P..: Y. 19 Blue Heron anus:;stern Psap�riy;4�drgs Helen Heal nge Prrter_. t�tfatmah�n is � s " r ,tilcAd fcsr: ry VAf3265 t 1121194 p GityfCo vr5 Skate.... p tyde We of Inspection Q, ySt l<ri Inft rtb tier% Descnpttr+ ': Nurnbt:r Q-1. residents, Goes residence have.a°,gprbag ,grintfer? °4'es y No tq I � nrifyRQr�: s arat�a;sa a e sys€em'?. InolWe laun evsys'tem;inspiec,tion in€ rmet�n is�epct � e 0 Laundry systerrt inspected? Seasona'I;use ; Yes` a. V+lster rret r re clan , rf:R al's a blast. ye s u act (op } : I)etaal ' un �arlab Sump pump?;` C Yes !a -E unknov,±� Crum ercialllndustfla: low Gondlt"rans T raierrt €}esrgtrr flow{Eiese&.on 31 CMR 'l.fi_2(?3) .... ,.w. .: asls of des arc flaw.{seatsjpersons?sq Cruse trap presents L,"Yes, F No Industnal 'vaste,E ql' g tank g r sen#? Ye;;;°Q; Na lVon sanitary waste�schargeeR#o the Ti#le 5s} ter ' VVa#er rye:#er re dings if avaliaaie._ I5is•m �. lit matt 1R^ a 6 Fin Su liin o C@W8S1�CFiSRv4&y}9t�9 r'9.�k 7 g 17 E y Commonwealth"bf �;assach'ut tts .. = Title C f i 1 nspection Form J N 'Subsurfsce Sawa D,s c saI S"stem Fvrrr� dot fv�Vv votary Assessrnetrots p, y: _- ""y ;I-lel,wn H�rrlrr�g�r ; <4 Qavn 'S Narrao" irifrtlon {7stervrlle IAA' . f}2fi5 91123114 fegt�lred fcr"erery . ,. .. C#E �Tpwri Vi c�tdte' 2iai Date o!Ins ectinrl e„ Y P D yst r>r� lnfoe m tion`(r nt,) F Lss#dat®;of occupancyluse Data Other�dcscrrbeelaw)- j ,, •�erieral.lnfcrrma#vn Purapirtg`kecords:� source of in orm,ation 1Jnlsnovvn W. s sys purr7p$d, Kp rrtNt ih,a rri pec#rd �" Yes ®: No If yps,volume purrtped a • gariors ' Haw.wa5 quantity purt�p�d determrtted'?: d w R eorr'ftis ptrrn it ib Type t�f ysteni Septrc�.arrk ttMtribution box, strtl aF�S€�rpttotl 5ysterti, © Srnge cesspacl . �', av+rrflc�.w ce�spoo x Privy; Ell. Shated sysfQr y{ye5e rlo Of,ys att cl� pre ic�rr 'tnspeu>iott record 'if> rty) ®" Inr�ov2U 'Alternative teehrralagy Aktsch ,,' pt of the ce ment operat>on and, k:. r atnterrance onntraet;(to be:obt?In_ froli �yt em`o�vner) end�;cs�py.af latest.' speetian 8t tYie 64 system by aystirti aperatar tfr der Whitact .] "fight t6h �`Att�cl� copy caf.fhe AEI?za pr al; esC11,—e ' ^1.r'�S �t�. .. .. Mile�ONc.,L1:3i.�iwriura fgim Stm�Jti�,r k7 'L+t5L45�.S`{31�4F r'�ye" +vammarrwa[fh of tassa`ctiusetts` Title . 0 c� a ;lns ion , -orm pe 1 S � �, i�sabsrtace Serva a-C7i " osa9 . "ste� T 9.,, 5p,, y, . �n Form'-filot fc�r:"u`alunfary Ass�ssmer#s :11 8]Ue Heron Drtv_"e system.16f.2, .. Het n Herrl'nger Ost�rviUe � a�655 191'2�1'E4' p0c�e, ��ify/T6wn 'tote 7.>p.. ode �a. : y�#gym In�vrmatEan'����t.y __ Approximate age crf"all eompo�9cnts, date ii�stallod (if krrca�vn; as�d source of�rt0 it"stalled:rt i 982=per=as4 built '1+ere sevrage do ctetected,when arcs rin : t the 'Ito Yes':1 Via: �u�idrng Sews `{locate:fit�n site`plati� • D+ap#h.bol.awsae - .. . feet, Ntater�a(:".taf canstructi'n; Q rest it rr 4� C n:other:'explair . Dlster�ce-#rcrr prra#e tarter PY i+vll utcn take; test. Camment�(Qri ct��ditJt�ri of louts venting,QYsdenCc f loaka , EtC 50tic Tank(locate ort's#e plan) . Depth h de _ , NI2#eraal of canstPuct,onf, concrete met 1. 011bQrggas Q,p0.YO 1 09 e. ` t►lhe explain l3" If•#ink�s r�aetal Il$t age ' y��rs� Israqe c()rifirrrad;hy a Crt�fite of� t�tpl��ln;e '�(a;tat?h a; vpy ofer#Fca#e Yes. O N4 zap gal =20. C?irnensits ` ails t3 T ik 5 f)lfi4s�I insp n FvrT£xlbSc'fir 5e �e�isoasal'S%7 e� r�zs g�f#* i Com bnwealth.of Nla ssAdhus fts ' 'Ttle }fficiallrsectin Form Ia; ;Subsurfac6 Se+�vage C�isposaf Sys#em Four► <Nat fvr`Voltartt r}+Assessmentis � , < 40 Blue Heron Dave system U af.Z.. �. Prace. Address 'Helen F#errtingef 0*10v k _ _ iaFfor&n�'�r,:�� £}QfPr+rEtE� IVI�: 02855 111114: .. r�q�ilre�i for®very „ .� 1 page,. styli pviin: Th..' +'Gr�d� "Date.Gf Inspection ysterri Infcarma#loicait:}' Septic Tank fcont. ' ©ftance frorn:top of slisdge#o bottorrt a Nutlet tee tit tafte *.. Z: .... SG,tJ(Tt tttlCkneS�: Cl%stn ;frnfri tcp al aCurr tp tap a` `#fet te`Qr baffle`; I lstarce,rom bo o ct,scum �ta bottoc'�apvAlat tie ar baffle; vmeasyre IHerr were c��meits€vns:determined? _ .._ Gommerits(orr.ptira�ping recoMI Mends ionsF as let arty outlet tee ar'b f e°ct�rtdition,structur irttegrity i'rquiti'levels as:related o oi�ttP€ invert. auii ence of l ke e„stc:.i Tees ere present. There Tate' cavern were.''befrnv,Reo'6m iieno remnavingtt~e1-20 ear%erg and instil.ste1 covers#o ire. _. ,.Grease Trap (Tri to on"alte,pl fl _. .; L�ep#h below grade:: (uta#er�al�f const�uct�e�n . .cc�ncr # ` ;r et C]fiberglass:' :paljretbylt.:ne a#ker(ekp,]ain} ; �1MIOnsi ps.: Seam thickness; Dlstan ,frprtr.to caf soum #o<tr p of autiet.te c�r'b' fft i?istance from attain f sct m't -battam`a outtet tee&-taf e Date Ski+ "l1 7 rill$ (156,SSWCIT Papi 10 of 1,7 Corri`monweatth"of I ass �husetts IV .�F Tifle - ictal 1h.specti"OnForm, 3a ` Subs sutface Sewage©isposal System Form 'Wt for=Volur�tary R�issessrnerits z 4 Blue leron l rrre sys�e(rt 1 of W Propoft Add ass l-leien 9errl�nyeE aster."o e MA {12605 11121 M4 _ r�arlr�d far;�ry ., � _ �.' � . RgeF Grtydr4wrn - tatc Zrp: o+�e Da a ot;In§pgct on S,; em [n coon :_ �amrr�errts (arl:pclmping recp,mmend tons, itllet arid,oUtldt tee ter tiaffie,cflndltltrn4,structural trite li>a I"v a€s as`related tt}v�ttet;lr�vert,ew dence'af Ceaka-e,e c T ght.o ::# oldirtg Tartk ocate"on.ite.plan : Delith"berw firer e_ . Material of constfuc. on .c.Oricrste ;� metal floerlass [ " olyethylen ®tfher�eplajrs} _.. u. , Nl . �ft11er1510t15: _ , Capacity: ry gailcns Alarrr� Ksent> YE'S Nta Elterral leve:, Alarm vrk,ri arct�r' ba#e of( st pgmprrrg ..,. . .._ .: _._ Q nrRe i,t {rnrac{t{orT,of alarrri` {�9 fl at swit fees,etc l: "Attacks cP,Y of"currentum,pc?g tioiitact{regired ;ls_ca atac �d? �SIrsS ?,'13; glf.a��t::v7!l�rspew`Go�xcmn�tfasuri��e Se�wSpsD�pris��yslE9tr -PGg�tt nl.t,�, ` 06rr monwealth of,Mgsg sachirsetts Pr�� d � Title i+c el ns e+ ti n Fo ;Subsurface e�n►age Ltssposal System orrn IVot far Volnfary Ass, ssm�nts t9.Blue erd Dhve s stern af':2;`. >-lelen Merttrnger £3ur�ter sM1fsr�Te _T - lali�srRlBlrvrt 02655 1i4 , _. page", Cltyt own.: t E Zip Code D$Ee cif Airs ion InfdrfrhAtiv A.;);-' Distr►bu#is�n foxrf prse� rnrst besopenet }(!scats an,site plea};: . ,. f�e;pth of[�qurd bevel��ove r�ii�tfet r►��t�r.-' �everl'' � �. �,., � �... . ., ... . ..... Comments (naEe jf box"is 9euel"antl � trlb€� lora to au fats a ua],, riy esrsd ire f s rcfs. rry ay` r, nyrt evierrce of feaage rnt ,ar atrt.;of faux:etc y s.....r.. ,.,.:..: ::..:. Pump Ct !Mbdi (locate ors sits plan}: Pumps in°workii order. 0 �r1 No` Alarms r,1:work' g;nrder cornmertts(ncrte:carditrorr of pump ch mtier,con Itic�n ofMpumps Ord app�rteri€noes etc j: NTH. ....ri.. �.lf pumps anal" ms-ice not Sri"'ti�ark3r g order yst�n c :a c nc�rt�anat pass: Sr ) AP s+�rpt or�:System (S SA tlarate on�srte plar�;e.excauation r) t requi ed r . if SAS r�c�t Iac�t�e� s�tp[�rn� y 1�Et 3 1 S T t11e L* 1fS!17spe 1E Ftif t Suu9ufl t$ewny..lS^Ru Rjr frs Fagii's?nr 17 C.orr4niralt °a Iasachs+atts h� �'i +� 10ffi fa- n�p� �i+�r� Firm E . v S:UbS'Uiff-8ce,S Daa3pasal Sj%stesn l`vrera:-ttot fes�; fa€untary Asessnierts Btue Heron>Drive system 1 cf Pr�perfy:;Adslr�ss �_ ,.v �Neter� Hea'rht5ger . Q+rVr�r �" ,•.�u Ownerlemr antvrrraat+ar,�� - �egRd�rev#o :every { Stervi�l> T h+6A2f ,G&t rr 53ate: Dtak t i+t ,{,eti, - C}. Sy$tem In r nAfi (cOnt ) Type_= lechin ,pits riurrthe�r ' it�a�hang:^.�haraaaers, f�urrtb�r ": ieaeh` chaffers; leac�ang g�6lerie�, rti_amber �� t leaching rend es hurraW.length: Ie Chang a�1ri, ° number,.dimensions, overflrav�cesspoc�b �umber > �,.. � _ e irtt ov ttvel [tert otive:systc' Tyoariname p tciraralagy Cornmcnfs{note,cor�tlatn of soi3, sign pf hctriaii farlur ; level.ofitrt�ng, daanp soli cndititt of vc�o#atior`y etc }, _. , , .. Tel ra was nay 8€gri pi faa acre i dug up the leach field and there was no sign of fOl�lure"The`.t?gttosra.t grs 3 5 The sys4em had 4 taf 5torae. per design plre v . w Cesspools jac� i must be paarrapds:part cif irsoectiof) IocRe 0n,st lar} Number.as i confuratirt ._. Oth ,. top o,itq,uic to.J.nlet.invert -- }eptt.a ca"f=sbiidsaeyer �Qepth raf ISCU-M,B D�tilt:ra5iori5 of cuss ool I1t#enals'of s.vns€r�actiof 1nooafror�' faouriter rnflo :Yes :'Nc 15 3_.; T€, 'r{ c7�!mspacasr+Fcrcgi'8�tinU#8ceQtsp x it$ysarrn P�g-a Qt't1motlwea O$I assa,,c tfiS Tie O ici '! ;Inspection Fo.rm . L Subsurface SewaS®;C?rspcsa!System Fprm_llvt fQf 1lcylunt"dry Assessmehts, Blue N�rvtz Dfly systt:rti "af 2; � _ �'roperEy Address .< . Hete� hlerrll> ger, C1�rner s�Jarr1�_ -� �rliprtreati�ai�S � • reguere dcrevery P 5 �12 4 d�t?sterv�ile" R�q t r 3Tev S�t i mete' flt of€n ecUon System l0600ation .Cp.m pelt: (79:t vnditigrt'of.,soil,signs�f hy'd fic fatkure,I evel bt' d€rig, contl�tlon:Qf vegetatlor , v }ICI'Y(f i le 4�t:SItB 181} Materials of constr-uctlon:> oFvtrrtecjts f do dt#inn of sail, signs of hylta.., failure .levol of ooro i g, co dltiQn Q#ve et tlor .. _. tit f S i i I a laid J9S -,(jr n.F�,fn�utcss?itxSrrti� .:#7isnrd$yai¢n P?�a=S4nfi ' 4t 1mC1 1V E3a� �t:o . aSSaC tiseft a_ Title ..- . COffic ai , nsp cc icon Form - ' Subsp fsce Sew, Dispasal ysiem Farm Not ft�rrUvEaanf r A�5 S54�"Itdht' Pr'J BCt ➢4Lttf,E3S _ .,.. . .� Y._ , , Neien Hsfrlirler arifCytrYi2tlos4 9 '- � � - ., gyred icsrsva�+ 3sterville C S t 2 J�4 Glt from :.. State- Y, z!P f5ate of trisPectlan - D. System Ih orr»a�ii�n 5kef6 t3f-Sewage Disposal 5ystern Provide,a view 1�f th10 se re ciospvsal sy�#em,.inet�aciittg ties to >at ieast:iwo Perm anen`t.'W6f rence t�ndmark&or bang mork Lacatc�atl wets wttt in 1p4 feet;L;Qeate` where,ptsbk the:t xei be'faw . ......:.. [X =hrand=sketch=In the,area below. ,drativn ,attached separatciy a g I I = 4"1 J TideaCYliCial11_ddn rarh �nlprn PfirjoS54r,17 a i Corfimbnweai&.Of Massachusetts= :w✓ Tile O fictel I e fion orn .. 5ubsrtacc S�wg E3Esposal ystem Frrn- Nat for 1/alUr�try Assessrraert~ 19 Blue Heart ariv : systerii of Helen Herrlirt er Chvner - �nformatian.�s - - C�stery Nle EVIA {�26 requrr a"x;eu�r w v a ., _: 1 121/14 paw Gity(Tiv � a4a Zip Code dam of fnRr?rten ` Site tram: ope "Surface water` Sfiaallovr.Wells eE deli n Ear;, -Estimated.dep€h to I�rgh:ground water; ;� P 3 iradreate All methods csecl;ty determine the:fit gh ground v4+ ter elevatimt .4.,.x C1 f r er fr+ y8 em design`plang vn,reaard. I!check6d,ddte od d -SI I rt rc��cetived, C S rved =xrta(abetting pro per tyfobservatian'k Ee,within l5{?feet of-S "eeked+frith ion!Boar :a 9-lej§(Ih - Tra y arnd water caritoyrs map,... { Qa Cho i� : d wlth local excavat,=, it staCEecs {alt�crE�dorurr�ea�t�t�4r� Q Accessed USGStatabase eic iarn` YC9tJ C17LISt GSCP(be ft�1 ?Il`e.5tabllsh,d th'- h, h 'round water v t101 ;. Tflere ►s a 4"test gale�bservatrcr} ip an sgtertrnd�r,�aer.wa -o�rdFt 7' fj .. _ _ ...., .. „ e#ore filing#dais Ens edtlOn Report}'p6ease.se.e RepiDrt' mpleteness CEtiedk6is#an.nex page: jai R t:. Ti�li�a t�fFts',I pp , i�� T'8e 16 4�is f ?Cammonwealth,,of Massachusetts Tithe £�ffi ial" n pe on Roan Subsu. ce'Sewage.©espvsal System Fcsrm=N©t fpr Vr,6ElntryAssassllerffs 19 Blue fps€ors 16r sys en 1 cf 2 m `Preperty.fddr Neter� He rlinaer reOrc*3 tos av®ry QStervll�, � f�+aA, t32�5� 1 1��1�14 Gate at llis ection insolct►orn Svmrsa r}r A B; C , v t=checked frc ncctron Summery E} Sn sf rtt Failure; riter .Appl bye t WAtI Systems)c> millet 3; Systerp Intorrnat�on=E�bri?ated €:pth to=h�gh [dun mate ; ;;rSketcf7 t�f S w c e D{spt�s l $y ter» t, [er.i vvq vn ppge_T :0 at#acted m<se,ppriatefil+e:; I 1' I$r4 11: I 3Ilit 5 al 1 Sir®rjvt*Km;, osurr.9 5evra Dr4gria � -,Pa�� F 5r 17 y' - Ctsrr MOnwed.1t -bf assadh P T i d +cis n ct" n' Foe Subsurface Sewage®fposat SystQrn'Form.-Nt,fQr Vt}Puntar}r Asseseri#s •. � ` of Blve hteresn Qr,v Sys# m..2 RMgct y Addr#hs _ b Heiet Herrltnger` r�forrr'ailon tM� - - requ(r C}stery�lte MA t 111 atatc= rrr Cede tte tf liaspetlrxra Inspect!an.results`most.tre.submitted vn thls farm`trtspeetfnn frrns'inay not be alteredn any: way. Rlease see.compio`k@rsess.cMecklist`at the erid`i#theforrrt: Irnpvrtsr►� `�dheri' � , A. Gin rai n IfOrrhatiin �ilanc�out�grrr�s _ � ott r+a rc�mputer.,- p u�a onty.`he tab 1' lC]Sp2ctne:- ►?y o rntrt+e}6€rr 'Fltr�C3r a no3:� �se:1#a�r n�rn ar es Ford 1 MAI I, CQral�dr�yP,dtlre _. flPdY rstervaiie _.: CttylTov . _. > Z6 50;3 $C�2=9400" 824$2 1.icarte:fVun� r I certify that l have person Ely rr s ticked the s!RWag drsposnl syr to-l'at th-s attdress'artd that th& informatrar r nrie ;oe1ow51s true sccvrate and ccrrspfete as of the*taa ,g pt ,rtspe�t�vrr T`he inspertic�r wad periorrfred based are rrty I`raMing q. expetiertce 161he,proper function and maintert.nj e,ep 'On.site dlspasa3 syGterns`I ain a E?I`P appravctl systerin"irsspeCtor;pursuint toctfori l50"of Tale= {31® CMR SOt30) Thr� y5tem Ras es „ 0 Ceindkonally 'as es ` � Fart ., t l ecls.l=Crr#f a S�aluatrr�r�,by the Local Appro�fnc 1utl art, Inge s igrzture` ._:..,... i he? em rnspe or si7all �atamif a SPY o thls snspectlbnseport;fe#fie Apprvvtng Acrfl e�rrfy( 'oar of leai4N �El')Qthlri 3g days of s pleb g ttrrs.:nspec bn if#tie cyst rn is a,shared.`syste a gas a de �gnov of 1{?tQO 9Pd nr greater ,tte`lrrspsctcarad the'syste owner shall srE�mit khe re sodt to the app r�pnete regtonalot fca of the PEEP,'', he ar girral sl orald e sent tia t ie syste owner.. n ct�pir+s sent#t the t lfyer, it appl�eab ,. t d the pprovtrag authanty;: :;... �h.is report only describes tr►radOtiQns at the moo insp@ctpon.and and@r:Ihe Gonditions'of uSe at thak tfrne yThffs lnspectivn does"n�dt address hcw theyster�w€l� perfo irm in-tl :future rangier tY3i lama:or"r#i erent,.c h itions af'use , .5,n.,3,' _i",.11f,:�^"�ir"3a'1js3.,kchQr tclr t Su tau;dn Q v +Yt^4:h5P,aS�t S M . WGOW df I assacwsetts icial ins rm• , utsut'le6 Sege L}ispal:Sys#etti"Fc�riti'- Ic,t faroirMarySeSsrrtfit t ilue.Heron Drf...�e. r 2'6f 2, k iefen die=r!]ra Name «u. r� tnrti;f�r war &teClCe _ w. A "t'frown to � ��� Pate of tni p ifs I`r7specec or.Srnary r�h�ck AfPar E l atw.asr .pCttrfeGtrran }. A'); < Ystertt Passes:, t have ntat f, nei any tnf©rmat�cri v�trich'@ndca#es#heat eriy of ffte.faiture cri# rya descr@betJ' irs 3;1( t t 1 ,3Q ter Ire 3 G .t5.3t3 xist,.Arty:fs Lure otters' ot eya uetei pre.. Csnrrae@ts - 777777Z7_ . ,. ] r}e r more,system Cpmponen, as desc66Ptt in the"Conditional bass"se tien�n6a'c to'be, ropfaoed o repai d e,sy+s{eM,u.PMCOM elioil at the replacement 6r ri� a@r,a ap the C Ias _ egOw @nq sty#emenfs tf"rt box (Y , N�)fcrhc " cehe cOterrber e:ePair rt These t'C tanks metal anct ewer 2.years,old�or the septic tan ' vl thsrrnet I or r;etj is strtt.cfurat?y u @s4urid`, a hit�its subst�rtti l a lft�t�attora C,r exfittr $i431 tar t rek faiCWe is imrninen#;Systet _+, tt Piss ijrg�ps+eyctita tf tte:exisfjr{ #ank 'no!acd<w�it a. crrtiplyineptic tnk;as:-aRrrf 6,y!hsard i " metal sPPt@ 'tan11 'k t tC past;@rtapectl rt if it is strvcturatty srat@rid, not:te king,and if a tvertiftcate at tn. ar ce ar�dis}at@rtg that t ie tar@k.i5 tesS thiin W years old is"wailebte t5+;°„*•91,1�'� - _ `itie:StJYra,BI P�'ssts�rliCtr C'+Tt:" s+sal,il'mt.,-%�tS4 42 a i G«�titmorw��(th"tif�lass �hu�e>�#s" . Subsurac Sa+roge t)ispase ysterrti,Forr -htot"fir VQlur�tery Assesser� s' R ram' 1�Btue Ncrara l3nve s".sfem 2� Prr'perty Adrires , r" Herrltr� er. r+?ouEr Cw.evsry: c steryrRic: MA' C12655 St�teZp CrsdA Q�tf irssperttas�, . ertfllcatvr� (cant; 0 Furriplamber.punapstaiarms riot ape;rational, Syste wi3l Mass with Brxaid of IaEth apptoval`f pi,irttpsralarms.arc repaired M. g) System Cr�n¢tttortatlyr taa�ses,(t�3�t� F ( observebdfi of"sewage lockup ar brea.k att otih: tat�C-water i+ vel rr the^rf1gtrit`tltican fiX d , : tv'brokcr�or t�bstrt cted p p s)car dui t> a"dre�ken,,.sallled Of`,lrl'dlStrlb@1tj r box System vil a ss inspeOtt n.if"{�vlttt epprr 81" f Board of i IeaPth}: C' brz ken pipe{s}are rept e Z ❑;.r �^ N [, N-a iExplatrrLl f eCorrv., istructtdf is ree0ued °Y: :::N ( AiDExplair;betc�tn�� dist`;rbut.or box is'I veteCt er MP ps . y {�xptaan bafvwp 0 T}e syste3n requrd pumimg more#karC 4 tlms :;year due t0 hrsiien or c?bstr ote i pipes} Tte: system will p ss to CCivn rf'{va+ifh Rppro.,val of the>3oealti�� brpkera P ) ,.rep e s are tcnd5, Y,°< ❑ N NL�" Expiar belovu} ❑: of sttuction is removed Y; :� , Q.Y (E"I in t Fflvv):; e ^ C=' Fuijh0f Evaluati+ar't rs k--I-, db- the,Bpar ©f hleaEttt: . end'#runslst whichrqure func�r erluatcora by th ;Boa.d taf�l: tth iri order tQ,eterm"rrc".if the system is failing tt►p'rvteot pt biro health s fet y or,fhe env ir©nnien # System m l Mass uridess 13oard�f#oalth,ibterrrrtetes iR` CCOrdarice wtth 310 Ci R #5 30.3t1){b)thatt(7e system-is no functionin ►rr a;martn+er.Wvtrichwrll�p gfeCt,pt�bEic h alths salfetjr and-fh e.environ"mer5t: Ces pcanl;ar prrvyls wtthi't a0 feet df a urt ce;, fate"r' I�,: Cesot}i or prltiys valtflir Sa feek taf a.bord0ri ette wretland"or a sa[#`marfih`' ��"� �r:3 � I�:b 5 4")ilfrJrtd 1r,3�!�lipe'i�0n5 31hs=.'rf��${ y�`C11s¢"�9ty�ti^Ee�+ F'a#tr 3.4r 1:7 ; ommonweatfih of(Uls , ihusetts z �* Til mu ins +acti n. F+ r �55 sutsurtace sewag$ � �$�e t�n,...ivot. t,Vfltuntary'Asessrner,ts ,rt9 fJue ieron L9rrve• s S"tern 2 of . -- .. Pr�parsy dtl'.. �r e _ i Helen Retet gar. in# 'mfi4 t r. ;aqc,:refs:'Odeven. {7ste'rv,ile . MA:. t}266 11114 �agt:: �ityr?t�'rorl �t� CIQ_ t�: ^Zlp CaaA Dste aitri�p'e n .",System wilt.fall unle"ss the Bvard:af 1,Eea6th (ant! Public Water Supplier,if,•atj determines that the s�rstern dsunctlonm to a niiriner`that:pr efts the pc�Ialc ht (t;ii;. sa#ety.-and r,'avtrt nIrront:.' . b-The system has a septic tarn arad so�i ,starption cyst rra{SA ;ar',d tbo SA, a uv�thity EO(3 feet of; surface vs+atr ly Or trlG,�tar :;t a space:wter sipoiy, .._.: Cl The sysfem'f s a septicJan{c.ari S:ar d tt,e°SAS �s i lth�n vne i ;af a,lio the water suppler The systeM teas a septp%'tank and SAS-ancl ths'SAS is withan 50 fief c f.a prtvaf watt suppty we-ri 1`he systeri- has a sspt,c_tan a tc�SAS end tit :5;45 ts. tas :titan ti Q feat. vt fit} t:eat mt�ra fF'PM a private v�r8*r syppiY'WellY"; .., i�tethad rr d-to:deterrri'i distar Ce: M `*Th,s 5:yster pa$ses'if the well vveter araalys�s :prfrrnad at'a.LEP.certif�ed lahoratar-y, for fc ► cl�fofrr bactcrid and+cues aunt and #tie presence of a�t�mmnia rii#ragen�atf nitrate nitragsn is aqua!:: tei or tens than 5 pp iG rc vats #hat rs©o#her failu e,criteria are tr ggertd A topjr cif-the an ys s mb8E be attahed t this torn;: ., S:3 t : .a: S 4 , p� Systema�lute Crrt�ra^Appticable'to AlI.Sysfierrs Yost most rnclica�e"Yes"or`tNa"".to ea6h P. #6`ae fQ11Qwiiig#or; !! inspect�c�ns: Yes tacku setvcre an ` actt,tyr system cortpanerC trU0.1to mvrfocl '4r L �I aclvggedf'SASP cesspoot ,.. Q. `.. aischarg as pond�r�g dF efflueh#tc+ti c surface if#fie rcJr r sr dace tasters die to,,an,crrrerloaddr �tagti SAS er cespa ! Ste#it:Ilqu►d levi?( in the,-dlstribution qa aboire ot�tfet,nWart ciue fid'an.aver€jaded cc^to�ged SAS'o�ce��poo'I Liquid depth irs oes"q:1s ipss than iG .b tow.mver#<tar atr2lahla:ve lume 5 iEss ® tn'ld -- vn TiH a h rl t Rprra_on r Su4auriae x� r ru^a3e7 .... •.:... ..- 4- 5S'S@stl Fla^�4r�'1� S 9,: f C+3mmQrtutiiea fly:+af; assachusetts-. ti n Subsurfaca Sewe arposatystrr , orrit Nat.fdr,V�rluntary Assessen 19 Biue Heron Grave s s#e€ of 2` . _. _ Pro we.Tt At!dr ss _w Helen Fferrlih t�YfdrRl��Ori rs k,. • � .-.�...�.;,�,. reul�sU,for edam �s#ecvtile. k D65 Stets zr !r C4e at�r7spsCtiori B .C��ti�catc�r� {coot Li R Yes_ No.; r>' FieUrred prtanpfrtg more thin 4 tlRls in tiae:las#year €'Q- CJr3e tCl G1Qg { Ot e? PIP- Nuirnb i f#Imes p�rr7lpetf, ;Any pvrt3eri of ttre SA� .ces�poiaJ-,or.; riv ^rs'E�e[crw:.. y high gr iurd water elevatlori; Arly °retort taf:cessp €al or.privy,:is,w l}a€n 10Oj- "t of a surfa ce+ a'ter,s ply or` rabutry'tn a surfaal,OFustRPly f ?� Any port;Ong of'a ss,pcog:ar-privy�s?v+l#hirr:i� ine�I tic 2 p,�tjirc SIC .., .1� by ol Or privy iS;;rr€tl)rct 5Q fact of private water sarppy�vEl: C - Any portiere af°a cesspoat or,prrvey i5,les's uteri 1{3tl feel,but grea#e the- 50 f+rct fcarrt a pnva€e>ra#er supply v�t=il wit# na.aceeptabie'arater qualstr ar�alysrs �T ttis SyS'eM"'pas:3e5 rf ttte welt water analysis,performed at`a bEP;certified;; faboratary, f9r.f.. Gplrfr�ra7 bacteria rn sates absent`and tht prey ncd3. cif +rE9mt+nfa nitrogen"artd ri ir� a ni,rogen Is`equai,O war rovic#ar that rnoatFier.i`a flu { re cr€terra art trrO,§6red, A pY of the?rialysis ,and chJ of custody:must be attalFieci to;th9s f, rm system ls`assptsoi;s�rv�ng fclllty:ty€th', - srrnrwr dfl?DD�pd->' O.000gpd, ' @ S3f5$Grl1 faiES i have deter€nrned.thlat one or ryjor6 Of'th abra+to fallUr ' criteria exist as t�esc�r•i:,e irl 3 l0° 6 R 1 3D , thgrefvre tttc system fails The system vv ner ih'66lr�;contact-the Board of Ff alti iti.determorl 'what wilt rtOsary tc�°Core�t ti �,es e failure E) Lei;rye Systems: Tc> be car�sidere�<a taiga system the a"ystem"rxtust serve aic9tity With a d srgr€,fl'ow 010 Oo gpd t6>-°D5�Qt3{�gpd EOr Jarge,cyst r s,yarn mast indicate°eltt€er"yes or'"�o to�ach.i� Me.f6lEawcng, €n add�ticrrr tr;the: tta estlnrts €n Sec:.trora w:% ,1(es; 3Ji� ❑ tFe 5ysicm la rrr��hir€,4{}#}.fce#"pf e srfrfec drin.fnq,a er si:RpE + ' :` tJ}e sy+ te rs wvftt€rn: �(}feet t�f trrbatary to a sfrece dr€rikrrtig warPr supply #tt systeRi €s lacated in*.,a f�Itrt7 en sensIPve area intcnm W$Ilhead:F?rotect� rl C t Area fP, �,:crt'.a rnappa Zsr€e li,c�c_a pudic watersuppi ;-tiuef) If you haue answered yes tor€y> pe #rare rri'sectlt, the system I�Wit ridcrtl a slgsikfrGant}tEareel; 'or�rrs>�rered yes" rn S�ctlor:C`a�ove tie E;�cce syst�rr�I7as;faded.Theur,��ner o�.op�r�#ar of any lame"; sy tcm cz�sldered a S[ rnflcaErf three#=.tArtder" ectr€�n=E or failed under Sccfian fJ shall>r�prade:.th. systerrE lit accartiance Wlth.31{�;:CMR-1Y$3Q4 :litre s�sterra caner s9�vu6d c�-Itact:t#�e appropsiete; i re�tonal off,cp pfthe J�epartrn'�rrt. . . _ k15:a 3Js3• I-' Ti','�'�S?tlieael IRzp�rl�t91'prh' Ss7a5uK�ara^5+"'eBgE-C S"g,s�,".r'ys3h-rz ? �e`5,af 1�:; i , COma'nwe Ith crf`.CVlassahsett Title fii G i. Frm a Subsurfacesetw a I}�sposaC Sye#errs Firm NOt for VOlOntary"As ssrn r�# �; 19 C3lue C-ieHer:an�rCve sstem'2 cif 2 ..:. w.....— — '.,-.�,. Pr p art y Ad&ess777-7- oar's.7Helen t ferrlr_r,�er- t�wnc.'s'�lsme 'QUar�g S4t g„&ry.; Ostervaile N g , Ciiyfo�vn - 53' 1�ZifC4 Cs r , ctl�st hBG S r:the foClowIn ,ha � E3rb done YOr�''rnU6t-Bdi(if ACC: j�e5� {rr `r10rt as fo�'r3i�h r f C ff3iCt34 InC] No r'. C?ua pan =nformat,on wp5 ptavii pe �iy:#he�vvnor:occupant-,pr E#oard of F at Q1F Were any�f the-system'ei rnponents prrr p but r�r:tars prevro s ree sz :Has the system:receiued normal rlows<�rr tfo prev�oiis two�vek per,od ' nn I iave'tar uvlrsnes of::.wetsr been rntraifuced to theystt<rr:revr�t.y.ar.as part of. Were as b;tiit talat�s of tl'o syat tta,;rr7�d,ad"dicamns€t'�(:Cf they:wsre apt Waiia�l€ a alas the facirity o t#we.lling �r�spcted"fir sicns 0f. ewa�e'6ack up? Uyta s"tke"Site Ins eoCed ft�r s gr s of "yea o t3 1lt�ere�,li systerr� cvmparients, excfUdln #Cie SAS, Icrcatec vr?sCte? re#arc sep#� artk rnanhn es.unrgvered,,apened and heAnteNc'r�f she€artik irataected fnr the corrdit�on crf dFr , , ttteraffCes or:tees rrtatcrra!c�f`ronstrUc hosCUd dde tr�n, of cur ?4 uV s the elrCy owner{and ocMPMts, different f€off owners provit d +itl inferrrrae#ora.,on t.Cie prooe�maip onanbe of su surfs e;sewagc d�s;�q aC systcrt s2; the stze and4l�catConf the S`arl Af3sc>rptr'vt ;SyStem�S/S),on tie sife;.fes ee€�,deterrimiraert. ased'ot� ` Exr"strnq rrro3 matCar1 For;exrrjle, plr�et tCe C3oar c�C De ermChed the:fieid(Vt anv ofthe fa pre rritena relater o 'art G is at tss e �pproxlm #ion, rstane rs"Ot~acceptal t3.-S y"',sit'eim WdrTr !O - - Resaden�aC FCt>iir CvndatCQns Jutttt�er idf C'sdrooms,(clSiarn w.. ;Nur�r, Or caf bedre�a s'(acttspl� . . ' 1( Pm .'15.2(f3 Ifor; xar�ple 1 O f�P x of be oa �s.) 330 �.. twit%a 27y:� P oub a�a��Riresnge rnr16V Sys'I r p r Corrttn"owealth of as "acru : ts ffcE Form Subsurface Sewage Qi ►€isal SYst$rr# 4rm_t~l4tt Voitary Aessment '�� *s•' 9� FI'ue F�ercr�Dnv� ,sys�e�a�af 2 , .. t a C7vmp:'S tJart� every' t}Sterlril�� MLA 1 06�5 7121 Cit� ;rwrt n' S#ate'.. Zip od G)a4�fir(I�spe�:tlor� P. ySt£ 11 ICIOFClB ��tl.. tJ@S,�,FI '�IO:rB P , Nurr►t3er'r�f c�tre#�t,restdan# Cr00es're slde� a 3�ave a r'� TI Yes N Is:a,,V,n ry,on ge syste ,fauaI ir`y�;sy em �rispe ton #€farrrit.on wn'this'repark Yes RQ Laur etry,systeiTp.wnspected? Xes h)cs ��asnrr�l used.: J'. Yves ��y` Later mejer rec�n�s,`if awtablest 2 years usgs{gRd?3' - il�l�y�tfab�e g` '0—Y.eS No LsSt`[#ate cf 4 --unknown- L." , OrT4LY a I�f o- us CIF#,'Fitt Clt Etll�tp " Tips of EstabIjshrnent Lsan f�.e+used o 31{D SIR 1S 203} Bsls o#;d�ssgn fdc�urstsf�ersoraslse�ft, etc> trip present? �n �tstr#al4��ast�,f�tding;t�nP R�esottt?a , Ytrs too fVYbrt�san%naryste dtseharc3 to.thh ltle 5:sysPrri'?` `fey No V'J�ter meted rea�tn�s, fi avarl�b�e irir� 3 t? Tt S�,`AL i aoevJlVForm j BVISt2StKwa s_) z ©mmcwetth of Mas ; cfiuseit �' ' 5Official' 'i spec ion, c m Stabsurfce Sewage Disposal System►�orrn:-NQt`for Valuntary Asessrnents h Blue I-ferari "riV d f'Ie!Cn H r [� tilt, er �VPub?r,r� e for , asterwille a r Grfy(TOVOM >i°�129114 __ sp Gads i�atp�f It��s�icrr nfc�rrrigi h bast di�t��f d�cu�an:cy�use: t)ther .Wit a below ------------ n . : -- General inforrnat oh P;ump��g Recards.� _ So�rrce of infdf atiCri tJi ll7pvufl. Vayem-Pbmpdparf thespe r 'Cces yes,'vaWme,pumped H iw:eras quanfatY puff 'p 'd de rman V: Reaso for p rra:p�r�g ` Seprie-;t r t4, djstra�ut an t ox,::s �l absOrptic n s}tstcm s�rtgie cesspo0l 'C3verfl ow cesspo�s!` P�.iuy,. Sharett`syste Yes fir r_v}'cif yes, ttacl pi• vt�t� 3r�spectior�rdords, �t':ary: ° _ ... lraevaf�relAltrnatir�e technalay AttaC#1 a cep of the cirrt nperatCr aria. ma�nter�anGe,ct�ntract:4ty e.af�tairiei�fron�,systern.aw�c%aril a-�r�pyrtf latest nsp ttion of the la'A tecn'by sy #em op rat r.a er e4r Tract �' ght t hk A#face a Copy f the'DE approval: "::��i5 .::'3� _ fil(r'S f_14I�p1"k3$pBC.snati Farm$it�'klrf�„d 59awtt•t'['S�OgBI$'t5f�n fl29�b 8fi rj;; F Gommonweeith of Massa hit etts Tie: Official' I�tspecto ter Subsurface Sewage Drs;posal SYIS CM Form Not for Voluary Ass�s�rne�its PrOp®rty Addte§g': . Hefer hferrliner fnf3rart€��n[�- ... r$Gt�1,ed,ltr cur„y C]sfeey�ll8 M + t75 -11121114 N hu:. CityJTtacetr dip;�c�de . D t P tns:�e�ipri c�Et} System InfarmtJtc�n . Apfirgximate:age"ofall cpmppnBrktS,:date Utatied'f if kr�nv n}anal soirrc t�f ir�fvrmatiort: 'installed�on 6�S�g`�'-per as 4bii{t< , ... Vytere sOwage o c��s:detec#edwherirrrurn€ tr�e site` Ycs 17 ; B.uiltl�ng Sewer(looate tin site p[an) Pep "bcpw g10,tte,' KK €[ -Teel Mfe; (9f G9f§trl�Cgior cast,iErort 40 P�IC` ,t other'#expi � _ E} _. �ersu —terrGe'€rom prirateW-Rls su I 11 aotlon: n w.. ...- _ Comments(on condition nts, vesj�ing e+ritlencE �eptic Tank(�acat�on��te t�kan}° . 6 fvteteriai rif construction; concrrt [ rntal []'tbergls' © Qlyetnyfeer ^c�ther'(explatrS , ls;; r e t�,rifarm d by,a C:ertifioafP 6f"COmpf ia€ic 7{attach a copy of certific e ' l .Yes" :0 l 'I CtCI ai, S[udge.depth: 2 t5x T,%e. r Y 11 ,aij>Gim."k..,t 7A�eoaage:R scns�Sys�i E Gt CoMmonwezjlth:cif"N�as a hus tt5: Tel �iili Irspti dorm �I 5ufa$urf�€ce Sewage f�fspos�E SYstem Form;.:-foot fray Voluntary A55esstr► ts' . . �� '' 99Bfue,�ter�a� prase �� tertl2 of� . a :! dr s Own er: H hell Hcr�lf"h ,4r Owner s�dtne . ,"'. ,. _,�, .. ..�.� -_" rr�formaiapn rs' : _ --- ,On rairet!!'Pr 60ry. Ntervllfe . i1J1?14. SCaC� �i Ctn9� . Yte pf inspacNnn 17: yster�.lnforxrituirr;t:�; eptle Tank c n# : Q`�stence.frorn fop of Stud! eq botto .iu lit to r li ffte � :lckness: Distant'?:.� M, "tt}�}oo`strr�rr� t0 ,0�3 at"n�tl�t,":tee or..b ff1 his€arrc 'from i7ttvm o sCurrt tO attamrof outlet tee o;'tiaffle " . }how avert;rtr"eTIS10 A j.e#errr ed '. rr�eas r Con7me�'tS (on umptrig reCommsncfatranS, inlet"nd OUt3et:ter, sr b,ffle condition'structural rnt grrty; Jiq �rrl le+rels as r,. fa#eCl;[a v�atict tn�+ it;evadence aileakgo;etr 1`he tee. +ere present anct theeaFrt�srgr of I €ae"Tfae.coers werel .-below:.-.ReCorrarrtnd P = 9the:tky - Grease. ep ([oC te'drt.,060arng, T Deptf, allow cQrade: �ateraal:Qf cgn,sjruot€nr+e concrete mef [�,:fataerg as polyet,, le06 other< e*81til;, �?yPt'1 Cr1530n� b., S�ian`i #fiic_kness-- 3 5#ence"from tip cif ac m to,to .o1,.utle#teeter"ta f e Dstar7Crr�rn bra#tom of €urri" o Mottot outlet teeor baffle x. ... y�t o� orris:S,.h i,rt-sce�Eu��e GisPet,7i Rvs1.9r� 4��ge'4.W"i� I � Cotnrt�r�nv+v��"Ith.�ifi Massachusetts Titl O' S , fficilal Subsurfaceewge.Disosat ystett farm; fVct f€r U�iurtary,4sessrents, ' . , �w 19"gf�1e f-�eGorr Drive system 2 taf'�,. ?.r4e.rry 1�drasg: . .. Helen Herrling�r ... m. . regt�ireu. �s every. 4stecv�ll _ ! fa'1 77777 ._. �'f12 4 t7sle tsf Jr�ps:�t,uq . /S �' 1i. f3QCCx1C'1k3. i<CC}l1 )" Gvrrrrnents ®rt.plrttrrrg£ecome�rdatrorrse;inlet�rti c3�rtlet tee or;ble:eenditian s#ruct,rai lfegrrt+ c;;lerel5 a5eletei .#t t)Ut`rE#�rrverf ev�tSerrCe tsf Iakae, etc:: fight ter H �ciirtg Barak stank iTivs#,be,pum � ay.time';"Of'rnspect►t7 t)�Cci te,an"s to lar�3: Depth hilawrde;: �'3�#�rral;'raf'c:vr�5#�uctaQn. rt3etal frber lj ss lyeth ene :s ther f ez Wn 1 esign Ffu I Alarrrt presents: tVQ. Atarm, ee Alara�t it1 wrarkti rrrde:r` 'Y Na: ba#e of last hum. p Grate: , . .- . �orrrm�:pfs (ces tit:ora cif alarm:end fiat s +itched; tc;�: p of turrer t:purnp"n9 confr2ct(r erretl};;is Copy- attar#etl' . r _ Yes CI NQ lar x��: a ItEw«�QPsY;3lfisrnrrJh^r r' , _ �?»Suss,r;a�w5�rr,Ge�l�y�al.5ytireni �.age.,s1e�1T; C.or»rnar wealtkt Q'A ASSfthusettS T' st' 5 off K c al r�s foam. Fbr� surF ae ®wage 7i068 )Systerry:Farcr ;-:t t fcar.'Vrfur,3enyA es ergs' ue Heron t•}tiue "s++ MOW AddresF: i�lefera!-lartl�ri er; Q, ,ecs Name ir�fo raatidt as ` t, burr fir ev®rj:.' OsterVille Citya�ovm - _ �11 MA 02� 51f 4 S tZt{ pt�afi la�tspectior�; D Systerr� i farmatrar� �cc�rit } C7 strlbut EtQx fPi Serit ust.tae te site p146:}: C3e01h of Itl`OO, evelzabave.ciutiet Invert even Cornrreaits mote if x'is lava!ar d i tributiurl t©,€cutlets: qualA:anvevcd� ae af'sriirds carryaver, any: evld2r ce.Qf iealtage Ingo-vrou of:Eivx etc. : The€7..fax:wad;nv mil, y " Pump Changer�locat:g,orr site plan; f'Umps'in wcsrk�ng o d r. AlarmS work- card' C4mmer i${trot c4rtdif tarp of,pump rI amber°c nt l4er�n of p> rrlps no appurtcra aes }i .. _ .. "If=dumps or el an are'lot In wort rn o d r, y tsr is. ;Coraclitiartai pass: Sc Abao,rpt�or`.SystemS� ) 'skcte Qi site plan:exaavativr Ctttrp9paeea : Yl ifw:h 'H, fated expl rn wily;;. .77 to ra• +79' TRIP 5 r r aal 74js 4 c kp m:Riahst rr L wags n5 1 S gt rl r^87a 7 E f 77 . h Ca rr oriWO th cif as"s ctiu e s fficid ."Inspect'i on Orm i SubsurFae Sewage Q%s osC S stern Forrrt-Nnt for°1ft,l�rtaryts5esrfr!r1t5: �r Y k��, •� '��"E31ue Hcra� br,ve„s. �#ern �of 2_ . _. Y . P,rQpaIly,0k4drf.se b�urlei•:... ,, 7N C3WYiQ,..a-�rdi31e: r�°�ulrt�.+"fCrev�ry �ste�'°+1i1€e°._ t�H; a?65a 't�1f1T,°f4 reg G,tyli:ra" wn Y" - � DSyet Infrrna#itr� ctpn .Reading pats. . nurrabe`r; , { lBaGher7 G afS hers: ea rt� of `4 FF1flltret4fS . Within- gale ies.: rrurnl er:; Reaohrr trerrRs; number., tenth 1 i �Ch1;, fields; t1Ur11i *ilCltStDr4a : ;:,. �„! ycJU�Cf10'J4 C�SS��O� `ritrfr�bC1`: 'lnriova i:valet#emative.sysCerri' l`ye� arne ofs> hnology .. w. amments nr�t cofaditior� of D,3 sl scat-Yij+eira�r'CJtarltlr level:cif pond`ing camp so ditien a'' efattcsn,etc . 't'Iere ry ----------------- as n4 s n; ;:flare "The bot#gym to rae�ti 3`: CesSROo ie spoo, mast b "., j as;pa ft tsf'i�t pectro .(In Re n`s te•plan Number;prsd GrJr���tara#tan ; , -., s 1:3pth fE7f liquid to' ntet Dir�tertsi�O t�f cesspo�R� f (rtsdi atrp11n1, r:dwa&inflow, 'Yes, No tu;t?S .�P.�l` �dlf3«:fifS�gl:aS�si4iF Fern FuSat�rte9 S�vH`s� r�,al 5-;en -�" `. r Canl.niottvu (t(�.ci MaSS66 ausetfs-In F, r:"'�;m"' 7: 5ubsurf; c Sewage D�spos�Eytem'�orrri :-.htt for Vc�l�rrtary As,s�ssrrertts t - Ner0r�.a�ry sy #ern .cf > . h9eJe'i� Herrti flwncr; t��Br m. _ n'rs owner's sVame _. sl"fgrrr O 'r ulrsd;irr eggry' C Ste rl�; MAOZ S r R e Hatt��Ir�S¢3e�icrl D: System �r��ormatra�: (curt } G;ommerats�rEote.cartd t ora of;s it signs of 3:ydraul`i'c*failOre Eevel of`po"r7d��g..corditi?rr of veg�t�tipte, e# Jr. " c 7 _ rM terW bf ci nstfuctt0 n.` Drmenslons L?ept ids; Comrneat soil s€gns of ydr��,lic:falluro reu��'�tf pond€nq cnr�difis�rt*efvegefRtE�rn , • Y � lz 4 t:+i1b 3ft3 z: 'r:tiB's�3Pita9.lrtier...lr��'Pe+:• �t,'45U''2C9Seav3c,,C'r3AQ5al�ySrt''i r'e�A::hat1X ` 5- Commonuvealwof l�assachuse s w Title .5 ► lot pectsi Farms SS168LtTf�Ge S,:'1 O DIS�tQsaE'; y�tem.dorm..-N,of for V.dij tEary asses a nt5,; - .. 1ls�+e# eton dr¢ve sti sfesr� oft. i. - �lamei InSctYt4letior�ly •- . .' � qur�tl;for avary, 0 tE rvl!!� MA: {}2655 pdc�e Crt�r1'ar�n f,1(21/145ta�¢ Zip O4cJ� Date of°�nspectl4n �. "� S �te (n or rrt a ♦.. 41ra , 5ketch{ #S,swage Dispasa!SYstOn N oyi e cif the sewage disposes systerP tnclurig#ies to at feast tw ,ppernarscsst rfernccancItaa k5 4renl� arks 10� aEe elfve�ls'wit'hirt i' 0 feet. ocat 'h'hers?R;�'!�l�c water ss,ppfy�Briers tC�e bdinehekreof:'h besclt5w ff by �kech.sn tie area rbesv- D ��a,virac��#tach�d�;separaie�y ' 0 IP z 7-7 as << i `s cr r��r i;s3fa, crrr sin I ms�Mj Ccrrrtrrtnnwcalth,o N t� z chusetts Subsurface Suva a Qas.p�osat Syst9m:',, rr� dot far Volun ry As essr rrt l r ' t°9$Iue t letGn Drive sya [�f" telen H, 'I'r' er O9YfleS N9PhQ Cftytf pwn t 1 i 4 0 6S 11� Ss�� ZiP., Ode-:. Date�i in p�rtipn C?, y�#erg In ormat t ' �cont.� . CheckItp` thcck:belier } Sh�tlr�w vets - . ' a cies` t=5ttrnat d de" t "Rp hrph gro tod grater; .fear ... .. Please t dtcate all rt� hQdg":used to determ'he the t rgh ri bn �v "ter ele+ratron btarned from sy5te�.n des'ttn Ins o'i ec r i#checked°:date tyf des�gri plan' evtejwveei t , fJlaerreet 51#e(abutt�rg popertyt'obrvatron tote,eiltitan 150>feet of Cl�eoked with toot Boirc cf ttelttl-i?xikl>±ir Tcp�ar�ttv��ter�:�satc�urs map: a. Checked"va;ith i Ca`I excevators;.install rs �affaGtt ttOCumen on) Acessed.USGS database expi;arr w 1!au must esgribe hoer yo . rund dater elvatron.s Tti�re is 4`"test itch user atrotr 1 tTn,si e�,Gro4�ldWater MS.,, dund et 7' --------------- , p 6efare.fr['rng this Inspection Ftepc�rt,,ptease se .Repoit pletrtess Chi cktit°vn next page.. Wixom".zi+ j.j ac®Sewno P9 Fos 6}ycrr Fe 976r ,t2. 1 Cc�r rr�aPweal h'Ol: assach sett " Titl: : 5. Officialsped, ► n FlOrm • f i` Subsurface Sewage I tsposai t rr Form ,Not',.t ti�y A se�sr�er�t�:ro ``. ,. ����' "' 'E9 BEue E�ero�prive system �of 2 Pnerty Itdcatess. w ,. , E-�el�i'i !-ICrellnq�r "unftrr`m€S�an is _ , rewuire {pr erery.: OstprvtRe: MA I1 yJTivun Stag ZipCnde ., t1� � t�o�Irs�eCt°fir E: Re oft Com�Itr�esSeChecklist P . Ensp:otaon S6'MMary , etl Inpect!ortur�rary (Systemailt��e Cr�tri ,�ppEEabE tvEE: jSt ems�crrtplted System Erttarrnation Fi raundwtat r: ( Sketch r E Sewage ]>spa aE System ert r_drawn:on page 1 r a:s ct�e it aseparate file; t r E. I T;e_ t!fide(� Iv =ir,m;g 9U gtd$areas:�i�Pmsnl Ry earn a}a 9Yvf 9T ; TOWN OF BARNSTABLE LOCATION IC( SWe_ . iEiL0tj OC SEWAGE# a01 ]-3oco VILLAGE ASSESSOR'S MAP&PARCEL LI LI INSTALLER'S NAME&PHONE NO. U(jQ(-'f 9. au R C 6 . _ _r N L SEPTIC TANK CAPACITY XOOO a 4,L 15 bD G G L 01 MP C�noav►�x LEACHING FACILITY.(type) Rei > s'NO.OF BEDROOMS 9 OWNER NLX- rrb N LL C PERMIT DATE: q hcl l 1 COMPLIANCE DATE: 51b V4 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S 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 1 300 feet of leaching facility) {� j Do Feet FURNISHED BY "I' k J C� T �� v U� a F• I �I T A i cl r_ f � ply' .r► OL S No. ' THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Mispo8al 6pstrm Construction permit Application for a Permit to Construct(—.)r—Repair( ) Upgrade( ) Abandon( ) 2rComplete System ❑Individual Components Location Address or Lot No. he.-in.N O ner's Name,Address,and Tel.No. QiE, KCt"Ls) Assessor'sMap/Parcel Q� �O� yy P1ee, ZZ Installer's Name,Address,and Tel.No. S Designer's Name,Address and Tel.No. .�A �1/✓ 5'1V,Va Cm �hL /r'll��o�, �� Type of Building: Dwelling No.of Bedrooms Lot Size -sq-4- Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided Hz_ gpd Plan Date akx H, zcq\ r Number of sheets ( Revision Date Q 1 0711 I Title ��tL�� �t�00�[C� -Hw��vti►�e/1 rr Size of Septic Tank zck Type of S.A.S. I a I=Io�1_D'r r%i:a(s u I�.x 4 Description of Soil ?c( A)a i C Z�l C8 !2-Z�t� bi.f4y�(. tQyQs/G csrA�►�� 5�� 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 - -_:w`, Compliance has been issued by this Board of Health. Signed �i Date Cld4h Application Approved by ��,L f���"� �j�j Date Application Disapproved by Date for the following reasons Permit No. 1 Date Issued .`'No. Fee s THE COMMONWEALTH OF MASSACHUSEVia:TTS Entered in computer. \, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes �*p ication for MispoBAY �&pstrm (Construction penult T�-- Application f�a`Permit to Construct Repair(, ) Upgrade( ) Abandon( ) [.'Complete System ❑Individual Components ' <;'"i �rd�dress or Lot No. ave h 2N/1 17ra e Owner's Name,Address,and Tel.No. ghu¢. N� �•. t7C�Y� ,ALL Assessor's Map/ParcelNl y 49 plea�s� Sir 'ro Installer's Name,Address,and Tel.No.' CL of S Designer's Name,Address,and Tel.No. 0 5uj1;Vc e\ L nr' &F/u (_40,.. i ,or, � o c� off Ll Z}6-3 ,4 Type of Building r Dwelling No.of Bedrooms Lot Size 1((: .sch.A,_ Garbage Grinder Wh) Other Type of Building No.of Persons Showers( ) Cafeteria( Y, � Other Fixtures + Design Flow(min.required). gpd Design flow provided z_ gpd r. - �• Plan DateP (y Zot, Number of sheets_ 1 Revision Date Oil 0-/1 ' Title—'S,}S VIo-T?fod%ea lk,O wt n t ' Size of Septic Tank, , P �UOC) Type of S.A.S. (0 �IouT�.�ua,cs�^, r" Description of Soil Byc No «O 17�� t ok(� � J ►Z-7_1 Jb LAy to (-", G LON" 5ANO �.:. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: f Agreement: k 4 The undersned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the pAvisions 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. `ra ' � * `Signed Date Application Approved by Date Date � T_ Application Disapproved by Date for the following reasons t « Permit No. �� ��O7 Date Issued -------------------•------------------------------------------------------- - !- j (yVA1t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Q ,Id 514 P3, Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( ) Upgraded( ) Abandoned( )by �at `tjjyrw-, Mt,,,!C has been constructed in ac or�dance F with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer -�� 1 �� �n,. i j'��, ('>> � � Designer (� #bedrooms Approved desig _ ow ► ! and The issuance of this pe it sha IV,ot be construed as a guarantee that the system will nctio [as design Date �, 1 rr Inspector �� ; No. Fee S THE COMMONWEALTH OF MASSACHUSETTS -: PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *pstem-Construction pertnit -Plr,,:o^ Permission is hereby granted to Construct(1< Repair( ) Upgrade( ) Abandon( ) System located at I_buQ Htn,\ j'� 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. / c Date T f Approved by �,�Lla��/_ Town of Barnstable t HKEroy,o Regulatory Services Richard V. Scali,Interim Director + BARNSTABLE, « MASS. Public Health Division �� s639• 10� i °lEn►�+Ar°i Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# 11-30(o Assessor's Map\Parcel 099--00� Designer: s'A11dov\ h��.ee�,nn Installer: orb co C Address: �{.U. � �5 Address: Fp, Syi IISI'q On R-1 S-I was issued a permit to install a (date) (installer) septic system at based on a design drawn by (address) ( t 65VYt4rt1_'. dated (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. Strip out (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. Strip out (if required) was inspected and the soils - were found satisfactory. I certify that the system referenced above .was constructed in comp.l'ance with .the .terms of the IAA approval letters (if applicable) N OFIV,,4 r JOHN C. tiG O'DE o m ( nstaller's Signature) U No 168 90 PFG/STER�� /ON 1fDesrFe_es Signature) (Affix DesigneF's`,Stain ere) 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. QASeptic\Designer Certification Form Rev 8-14-13.doc Towle of Barnstable P# Department of Regulatory Services t g p Public e H alth Divis><on Date ?� 02 Illy p zoo Main sheet,Hyannis MA 02601 Date Scheduled l C l yTitrie ' ' '. Fee Pd. : d O. OO t Soil Sidtabil O Assessmer t,�for S e Disposal Performed :O6t-•L/J Van ...L`'�'J !:/�C'>"lJ Hy � Wnnesseil HY ]L ATIO GENERAL II�T'OR1V1fA�'ION , Location C Address p Owher's Nance .✓ .6/We �DY. d?'� ve c/ � d � A dress: 11.E I` s , 3a y AsseswesMap/ParMI: 0CtLJ��y - $ngineer'sNatrie ll`1/Qirt: l=.l id�CN1�' NEW CON$1RUGhON ... REPAIR; Telephone# Land,Use. Sir.�4n �.�. Slopes(%)'. of SurfacoStones t Distances ftomi Open Water Hody: S®:.•' ft Possible Wet Area�:7 -1t, Driniting Water Well Drainage Way ft Property Line ft Other IJIS ft SKETCH:(Sheet name,dunetrsions of lac,ejcact locations of test holes&pere tests,locate wetlands in proximity to holes). r �� .":'.' � i+�/" •"Y'�. �Y.r:`�.-> ,ram/•i� � �..�"fir.; i•.'`= r•• � .. ,����' ,, f Y .-/r/.'✓�-•'�J���.•�,�.jf�'���.• %�"��-`.e'er./'i'r^' �.�' r / i Parent material(geologic) .� � PA`N... Depth to Bedmck O� Depth to(koundwster. Standing Water m Hole: : Weeping from Pit Face Jl/tt./JtF7 Estimated Seasonal High Groundwater 5 J A�II'Yip �tt`SAS0I�TAL ffi( I WAT�R'TABEE Q ,\. M d Uaed• �f� r Depth.Observed standing in obs.hole. : -in De Ah.to soil mottles .° in. Depth to weeping from side bf obs.hole: in. Groundwater Adjustment 1 s7 i ft 't Ind Well#A W' N Reading Dete''5Zet In lei Well level AdI factor t4- Adj.Groundwater Level-S-13 Pl CO�ATION TES . lf>itte Time !D' Observation i Time at 9 Hole# Depth of Peie'` ZSI I a .'Ttme ate .�� .I Start Pre soak Time �� o n . l l Ttme(9.0 . End Pre-soak Rate i Ir Site Suttabtlity Assessmenx SttC Passed Site Failed Addtt►onal Testing Needed(Y/l� �. original: Public Health,Division Obsirvation Hole Data To Be Completed on Back ***If percolation test is to ble conducted within 100'of wetland,you must first notify the Barnstable Conservation Division atleast one(1)week prior to beginning. k RADOC Q:ISEPTICtPERCFO �- r DEEP OBSERVATION H011 LOB Depth from Soil Horizon > Sod Texhue: Soil Co16r Soil Other Surface(in.) + (USDA) (Munsell) Mottling (Structure Stones,Boulders.' �' Consrsiencv:%Gravelf Lo'\r' \ iZ-73- `r LO1Pim�1 Sip loll-T (a 2`t-12 C %n+v`TSnn 2sy.Gi l j -A1, ;DEEP CABS +It A�'f`IO1.1 Hb �,C�C* $ur cefrom Soil Horrzori Soi�I extrne Soil Color Sod Other (in.) ([j3DA) : (Mansell) Mottling. (Structu e,.Stones,Boulders. Consistency /°Gravel)_— 4-i ln�l L �ti^ Sa' a IdYrl`f f"Z - DEEP b$SRVATt01O .E LOCH : dole Depth from Soil Horrzrin Sbil.Texture. Sod Color Soil Omer Surface(in.) (USDA) (Mansell) Mottling (Structure;Stones,Boulders. Consistency."/o Gravel) t: DEI�bBSERVA'I'loN HOLE LO�ir I $ol # er Depth from Soil Horizon slid f�xtwe Soil Color. Soil Stones,Boulders. Surface(in.) �JSOA) (Munsell) Mottling (Structure;. Cans�atencv %Gravel_) �r Flood Insurance AbO4V 500 year flood l;otrn ';ld. Yes r ,o :i Yes C N f� a 5 trn � � .\ wrltad soo year bound.* ij Within 100 year flood lroun�ary No I .. Yes ' �1 a r i'�Sep L De th oiiNaturail iOccut Pehio(s Mate>�ial erved throu out the - Does at least four feet of na >`aly 6cc g p e ious material kis�in all areas obs area ro osedlfor the soil all o t►oii sys em7 _ I.' , :.. ' P P r orvious material? c¢ Ifncrt wfiat is;the depth o�n;t�illy;b g P1 _ CettiIIcatlon _ I certify that on .:I l9 i (dt}tej;, have p sed the soil eyalatol�e�xamhlatlon approved by he D artmeftt o Em�iro ell 1 piote�ta acid th t tale above ant ly,;is w performed by me consistent with ' Xp: t I�1fR`15.017 the required t ence d scnbed ii 310 C,j j aj p into e `ertise as ��1--`-L-- � Date Signature Q:\sEyncTERCFORM.DOC r a - - t, 1 T__•e •_--�_ �ccQc::2ccta �. � I 't I I':_ i I _ I LINE OF NEW a F ABOVE e.cxeae w>a NT a 50, I �-• Iy /, 1r: 1 'KI 9 Ir t o II } a µ:_i S I �r � 4 WETLAND:{• I I — $ BUFFER - _ A -1 9..�.j " 50' zI t NI II 1, I II WE $ _ BUFFER U Pp I II II i- I L 0 �. LLb 1 I_OPTONA, II SCREEN PORCH EXSTG FAtlLT RY>a, zy_.•.Ir.a' .I I"' { II CLERESTORY DORMER ABOVE I O �o NEw K -_ - _ ® > T�E ° �;R.eXI,T4� ,,...-.. - T ' ' ,-. ouxo I eunr-Ixwr 51TT NG R�I'I tlA9TE._— 71 El,-*- HALL L - ." w z w C Z • pc°wreK - -va U w LLl w'zI¢°�v[s Lei w 0;10 e�__-__ Q z O J I ---- ---- e� E ti w = to w 77'f — — — — - — •r 1:1 I I b I { I r 1., f ~Y i fly wA� C= J U HAIL ( i' 1 1. � '� NEW COVERED +,«J 3 NRFG HEYl eR y.'.'a."� Q O aS [O O Lij cn ugh ' I a eu �R� i ucv GLQSEC E 5. �® __ m [ •' I � �sTwee -. ._. � FIRST FLOOR �nL TT ex[I I U O PLAN V r E TOAEVSKM WE MUED: oarz4rmlo j$' I ' ?Y-O• DRAWN BY: SW - ' ' I U EXISTING I-FLOOR AREA(INC.GARAGC)9•I11 50 PT• EXISTING 1ND FLOOR AREA I. RXLECI 0' FROJECL NO. TOTAL—STING W.FT, L%N.FT. O DRAWING NO.: NEw]NND e I E FIR9T FLOOR RAN �� NEw FLCOR ADDITIONS )I4"q0.FT. I Ff.FN!] - j [Tvi rfTr.O� �_ PIIXJR ADDITONS TOTAL NEW W.T PT. 2•140 50.FT. TOPAL W.FT 6,5C0 W.IT. IX9T n4 wAu O A 1 e 1 a �_fie,� � �, .• � � } A ---- -------------------------- ------------------------------------- ----------------------------------------- ---- ------------------------------------ - -------------- -------------------- -------------------------------------------- ------------------------------------------ ----------- ----------- ------------------------ BEDROOM ROON US BEDROOM ROOM 92 11"10 -11 T, ------------ ------------r-T o CLQ22LEU csuu BEQR= 922a-BA i: z --------------- r------------ (D z -0 -------------------------------------------------------------------------- I—----------------------------------------------___----___--------------j -6 Lu 0: —--------------------------- -------- d z U w zz 0 LH It 0 LU Z M Lu uj Z: LU U LU -----------------T-i ¢o-b Z�o ---77777!7, n 7777-------------------T 0, CL iL ---------- ------------ iWE CLOSET SECOND RAINROOM H :L... FLOOR PLAN HALL CL CL i j -OTTE—MUEO 02J202010 REVOONS: -'E>ROQM ROOM a6 BEDROOM ROOM.7 li ORA"BY. SXM, H MoAm 1: PROJECT NO. ;LOOR PLAN 7 DRAYONGNO.; 21- A1 .2a BEDRODn iGARAGE / C 1-1 PWNDATIM 1WNDATIOI / $ F FAMILY ROOM fi p El BEDROOM ROOM P2 - MA5TER - BEDROCl-I \ If�-i SITTING R0011 HALL HALL / i w �Oz c cS w c Z La d Er I Eg J = c j VS o -= :N h a � m0 0 in Q LAUNDRY ROOM EXISTING I COMMONS . ' FIRST FLOOR PLAN DATE OWED:- DAM=ED REMON9: 7 LLI /• (�}�'� ._ DROWN BY: wl" / - PR EO N: MIOJEO NO, / EIA5EMNT PLAN DRAWING NO, n. AB-2 L• . BEDROOM ROOM a3 BEDROOM ROOM H-7 to - Z p LL z �0c c zZx p� w Z C �Oo m0 5 °` -- p l TT"7-; 1 CLOSET - 4 @ATHROOM EXISTING CONDITIONS a SECOND FLOOR HALL PLAN CL GL DATE 55 _ - DALE LBSJED __ BEDROOM ROOM at BEDROOM ROOM 94 - - O. "IF t%?9l:- DRAWN BY: R'Im .. ttt _ PROJECT PROJECT NO, I B .13'-3• �\ASEMENp PLAN ��� DRAWING NO.: AB-3 >_$ z j? Permit Number: Date: �# Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. Owner: Address: Contractor: Address: Notes: 7 — f STEP 1 Measure depth to water table a tonearest 1/10 ft. .............................................................................`.Date month/day/year STEP 2 Using Water-Level Range Zone and Index 'Nell Map locate site and determine: OA Appropriate index well....:........:......................:............... �"`�('✓ OBWater-level range zone ......................:.............................. STEP 3 Using monthly report"'Current Water Resources Conditions" determine current depth to �? water level for index well ........................... . month/year r STEP .4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ��2bS(�e1 • �1,°iI�9U11, �h�+? cod( U✓t, Ofbll / '���f , �i�� v; 3 1_,� 4o4 (urrt-i j rvuAh, clhk U , 0A11 o., 4� r{y� J,dt -�V w,+�a� S� �c 6111^141A +C1 yUJ �h USO Si* -6 _W , �. v � . Supplement Table.5._ Potential water-level rise,in feet,'for use'with index well Mashpe( MIW-2.9 WATER ZONE A ZONE B ZONE C. ZONE D LEVEL i 5.7 0.0 0.0 0.0 0.0 5.8, 0.1 0.1 0.1 0.2 5.9 0.1 0.2 . 0.3 03 .6.0 0.2 0.3 0.4 0.5 6.1 0.3 0.4 0.5 0,7 6.2 0.3 0.5 0.7 0.8 6.3 0.4 0.6 0 8 1':0 6.4 0.5 .0.7: 0.9 1.2 6.5 0.5 0.$ 1 .1 1_3 6.6 --0..6 0.9 1 ..2- 1 .5 6.7 0.7 1 .0 4.3 1 .7 6.8 0.7 1:1 .1.5 1.8 6.9 0.8 1 .2 1.6 2.0 7.02.2. 7.1 0.9 1 .4 1 .9 2.3 7.2 1.0 -1 .5 2.0 2.5 7..3 1.1 '1 .6. 2.1 2.7. 7.4 1.1 1 .7, : 2.3:` 2.8' .7:5 1.2 1 .8. 2.4' 3.0 7.6 1.3 1 .9 2..5 3.2 7.7 1.3 2.'0. 2.7 3.3 7.8 .1..4 2.1 2.8 3.5 7.9. 1.5 2.2 2.9 3.7 8.0 1.5 2.3 3.1 .3.8 8.1 1.8 2.4 3.2 - 4.0 8.2 .1 .7 2.51 3.3 4.2 8.3 1.7 2.6. 3.5 4.3 8.4 1 .8 217 3.6 4.5 8-.5 1 .9 2.8 3.7 4.7 8.6 � 1 .9 _ . 2.9 3 9 4.8 8.7 2.0 3.0 4.0 5.0 8.8 -2.1 3.1 4.1 5.2 8.9 : 2.1 3.2 4.3 5'.3 9.0 2.2 3.3 4.4 5.5 Table 2. Potential water-level rise,in feet,for use with index well Barnstable AlW--247-Continued u WATER ZONE A ZONE B ZONE C ZONE D. •LEVEL 30.7 6.7 10.0 13.3 16.7 30.8 6.7 10.1 13.5 16.8 30.9 - 6*1 10.2 13.6 17.0 31.0 6.9 10.3 13.7 17.2 31.1 6.9 10.4 13.9 17.3 31,2 7:0 10.5 14.0 17.5 31.3 7.1 10.6 14.1 17.7 31.4 7.1 10.7 14.3 17.8 31.5 7.2• 10.8 14.4 18.0 31.6 7.3 10.9 14.5 18.2 31.7 7.3 11.0. 14.7 18.3 31.8 7.4 11.1 14.8 18.5 31.9 7.5 11.7 14.9 18.7 32.0 7.5 11.3 15.1 18.8 32.1 7.6 11.4• 15.2' 19.0 32.2 7.7 11.5 15.3 19.2 32.3 7.7 11.6 15.5 19.3 32.4 7.8 11.•7 15.6 19.5 32.5 1.9 11.8 15.7 19.7 32.6 7.9 11.9 15.9 19.8 32.7 8.0 12.0 16.0 20.0 32.8 8.1 12.1 16.1 20.2 32.9 8.1 12.2 16.3 20.3 33.0 8:2 12.3 16.4 20.5 33.1 8.3 12.4 16.5 20.,7 33.2 8.3 12.5 16.7 20.8 33.3 8.4 12.6 16.8 21.0 33.4 8.5 12.7 16.9 21.2 33.5 8.5 12.8 17.1 21.3 33.6 8.6 12.9 17.2 21.5 TOWN OF BARNSTABLE LOCATION `q�1ve. ��e���j�,2 °` SEWAGE # 4�{ VILLAGE �S�P��, ��F ASSESSOR'S MAP & LOT &7,y. Doty INSTALLER'S NAME & PHONE NO. �O i2.pa v`�c�wow q ap -s°-6yo SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Z^r�-4 /,�112, (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER G'earre E, is �% DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: � VARIANCE GRANTED: Yes No �/ � o 2A6E } J - n J THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOAR® OF HEALTH tvAC �7 ��d � lion Department 4 namable Ccnserva TOWN OF BA R N STA B LE !� � J � � I Its#�9 �t�� 113it� E 1Qxlt,� �l�tt�#X1t.C#tlttt Pi`Ilit# plication is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal System at, �- .Loc-+b;on-Address r Lot o.. A......&J>�.,-1. ...-----••------------------------------------- �1 N d ......Os.. . vJal�. /� owner .4G®®0 1-4 A 'd ess ----_..... �- ----------.. .------ .......................... � In r Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms._--3-----------------------------------Expansion Attic Garbage Grinder aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. rx Septic Tank—Liquid capacity-gip 0..gallons Length---------------- Width---------------- Diameter....-.--_.-__-_- Depth................ Disposal Trench--No. ----_------------- Width.................... .Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter-----._-:_.-.-._---. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by--------- ---------------------------••--.._..--•------•••----•------- ••• Date......................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................................... 44 Test Pit No. 2................minutes,per inch r De h of Test Pit.................... Depth to ground water........................ a -------- - ass.....------ 0 Description of Soil........................................................................................................................................................................ V ....-•-•-•..._..-••-----•---...----••------•---••-•--•-••-•-•.....--•-•-•.............•-•••...•---...----.....-----------•-••---•-•-••---•-••----•-•-----•--••---•••-•-••-•-•••-••...._..........-----•-- W •-•---•------------------------------------------------------------------------------•----------------------------------- -: UNature of Repairs or Alterations—Answer when applicable----_--.-. R� _ � ._..__._.__ ... �^............................. .---•---•--------------------------••-----•-----•--•-------•------------------------•-•-•-•----...-•----------------------------------------------------•---------------------------•--...---........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compiia e has been issued b �.. .th�bboardotf h. Signed ....... .... ... .. ........... ...:...... Dare Application Approved By .................... a„ :.-� ................. .....3...-�1.^.�3.... Dare Application Disapproved for the fo lowing reafonf: ........................................................................................................................................ .......... ........... ..... . ...................................... ................................................. ......................- ---- ..................... ........................................ ecpp Dare PermitNo. ........ /... ......�. .Y........................... Issued .......................... . ............... ..... ....... Dare q � r No.._19 F�s....3.1:.9 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH giA BARNSTABLE O TOWN F 0 O ST BLE � y pplira on tor Diri.pniul Works (fouti#rnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual-5ewage Disposal Systemat:............................... --------------------- ------------------------------------.............................................................. Lot�io»-_\ddress or Lot No GIs 2 �,J� 1 , / N� 0 O�rJF ' J� ow" A 'dress . �i /7� �C1ri'Q!N /iafj�f �fslv�C Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._....3.............----------------------Expansion Attic ( ) Garbage Grinder ( ) a, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------- ----------------------------------------------------------- ----------------------------------•-----•-------------------- W Design Flow............................................gallons per person per day. Total daily flow..............__.___........................gallons. 1:4 Septic Tank—Liquid capa6ty_!/0_00_galIons Length---------------- Width---------------- Diameter................ Depth................ Disposal Trench—No. .................... Width'-_:,--___._-_-- Total Length_._..'......._.._._. Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................................ -----------------------•--•-- Date_..................................... Test Pit No. I.................minutes per inch Depth of Test Pit.............._..... Depth to ground water........................ 44 Test Pit No. 2................minutes er inch Depth of Test Pit.................... Depth to ground water........................ ................. ` - .-•-.•. a 0 Description of Soil......................................................................................................................................................................... W ........................................................ -----------------------------------------------------------• . U Nature of Repairs or Alterations--Answer when applicable............ A l_���__........ S N`............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed / - ---- -------------- ..._.. ?.. .... ................... . //97'� ....:...... ................. .. � �..._PP PP Y .. '....... -- ..- ._,. fi Application Approved B �. ...................... Application Disapproved for the following reasons: ...................... ............. . .. ................................................... ............................ � q Dare PermitNo. ............9.. ...... ........................... Issued .......................---.....................---.................. Dace ! THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CIler#ifira e of C�omplian e THI) IS TO CERTIFY, Tel a the Individual Sewage Disposal System constructed ( ) or Repaired by ......�0,0rC4. ....... , ur ._:.. ._�i�t..... ... --------------------------- ...... In�<r.Jlcr // at ....... ��........ / �..�Z. .N...._.... . ,� J �.5..� .1'.�.. ......_.. ........................................................ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _.......9...3_--_.�Vy............ dated ........_........._.......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------- ..`... _ 3............................................._ Inspector .................... . ..................... ...__----------------- -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ? FEE.J.�...'_' Disposal Works Tuns#rutuan urrnii# Permission is hereby granted--.&__ga&...... ............................................................ to Construct ( _) or Repair, ( ) an Individ al Sewage Disposal Sy�tem ^ -f .ct d1 0 ................................................ at No. - ��!! c r ° C -�:C_7-il�.-----------..� Street qq as shown on the application for Disposal Works Construction Permit No7'3.__1`V\\V___- Dated........................................... -------•-•-----------•----------- V S_ y-- ---------------------------•-•-•-•---•------------- _ Board of Health DATE.--•.............. .- ��------------••-•--------------•-- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS /zz ®'Owv/ _ ) 1 . . SUBJECT To APPROVAL OF r'ARNSTABLE CONSERVATION C-3MMISSION Fmc .......... '*ITHE`COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF... Appliratijan for U u gal Works Towitrurtion "amit Application is hereby made for a Permit Construct or Repair an Individual. Sewage Disposal SYA= at: XLocation-Address or U, .......lec'V,5�e... ZC!$` o!9F_A-W1D t 6 . CLk,<--1,1j LIA-fl 614 ............. -fffusn��,---------------------------------------- ............ ................................................................................... Own r Address ....................E.....:;;2!��,, ,,e- ----------------------------------- ------------------------------------*----------------------------------------------------------- Installe;...... Address Type of Building Size Lot..... t ........ .. ..... U geLl 1--Dwelling—No. of Bedrooms-_-.-- ...................................Expansion Attic (PO Garba Grinder- Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtgres ..................................... ............................ ...................................-2. ............................................ Design Flow..._..__.....................................gallons per person per day. Total daily flow.___.... 2.. . .................gajlons. P4 Septic uid capacity,XW1 ..gallons Length.A-C--t..i-'Width--L.'-.(*-', Diameter________________ Depth.A�'-(- W 1 4 Disposal 9L__f?1*No- ------- ........... Width....;�'+(...... Total Length..:?:-..._... Total leaching area...<L71.' s"q". �4 , Seepage Pit No_____________________ Diameter.._..........._..... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box (1--r Dosing-tank ( ) Percolation Test Results Performed by....b,-ft_ 36Z..1 .1 . ....4(.. ......... Date... A�k .... ...... Test Pit No. I------ -____minutes per inch Depth of Test lyit-----7-1.._........ Depth to ground water.._._______________ Test Pit No. 2................minutes per inch Depth of Test Pit.....I............ Depth to ground water-___- .............. ................................ ................... . ........ j(�........i. ...................Y.K .............................................. 0 Description of Soil....6.. 501 . ..... L �4 vl U ...................................................................................................................................................................................................... ......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T1Y 1— E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been)l ss u d e board of health, Signed........ ... ........................ ................... .............Ao�ajr_ ......... ................................ Application Approved . ................... ...... Date Le..... ;ate Application Disapproved for the following reasons:.............................................................................................................. .................................................................................................................................................................................----- ---------------- PermitNo.......................................................... Issued....................................................... Date F1as..... ..�. 9 THE COMMONWEALTH.OF MASSACHUSETTS BOARD nOF HEALTH jA-).............OF....%;.....1.../' ,../?'.....l k- ApplirFation for Disposal 19orks Tonstrurtinn ramit Application is hereby made for a Permit to Construct (��)\ or Repair ( ) an Individual Sewage Disposal System at: ..............1.:._...-__..._..... ...................... -•••..._J 1-7 ..... .. f- .... .................. ............ ...._..... ........ Location-Address or I�t �cp fC�,( � ;j lal'� 'r?fiJ l 4<7 . Ct a t rv•�.,Aj1- -•.......... .........................•--••- .-- •••-•............•••............. Owner Address - -• Installer Address Type of Building a Size Lot..... ?. ... 66 -#eet ......... . a: /--Dwelling—No. of Bedrooms.....D..................................Expansion Attic ( Garbage Grinder (j Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ............................ . W Design Flow.............:...........................gallons per person per day. Total : + da. flow......1....1..Q - Ions,, �ziuid capacity�. �.gallons Len th_A�._.k.1 Width.... .. Diameter................ Depth.. .�.R; Septic �t— _Disposal eh ._....... .......... ..... ..... g .._ .1..... Total leaching area..__' .::S-sq, ft. Seepage Pit No.................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( %-� Dosing tank ( ) Percolation Test Results Performed b ..n;_�! _._ . .ti.N.�........A....�_: . Date. _1. �l ;}c,vl y� ; CJ �. ,.� Test Pit No. I....:c__........mmutes per inch Depth of Test4it....n...l.......... Depth to grounA 4water..<,,--_,-------------- (i, Test Pit No. 2................minutes per inch Depth of Test Pit..:•`... Depth to ground water---_ —...f---......... 1 ►.._..1--------------•---........ -•••••------....... -'--a........................••••--••--•-••-•••-••......--'-•--•••••-•'••••••-•....-- O Description of Soil.. ' -`' .=�..... r!I ryn = ' �? ��`i �e •--' ------- W I �' ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---......................................... -•----•---------------•----•--------•-------•--•---.......----------------------------------------------------------------------......---....•--..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with TITLE ---' the provisions of I:t.?� 5 of the State Sanitary Code he rsigned further are of to place th ystem in operation until a Certificate of Compliancy,has been iss` r o he- th' iSigned........................................................ ................................ I Date 1 Application Approved BY-- ate Application Disapproved for the following reasons-------------------------------------------------------••------•-----------------.:............-••-----•......._ Date PermitNo.................'------......_..._........-•---........ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I �?�..............O F.... ..................................... Trrtifiratr of Toutplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Repaired ( ) by..................................................................................................-'---.................-•-•'-----•-...------..........•••••........-••'-•...........••----•'---••. Installer ,. +. �' ►\ *.... slew" has been installed in accordance with the provisions of TITL: 5 of The State Sanitary Code as described in the application for Disposal Worms Construction Permit No---- .............. dated-----........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � �y DATE........:...................•-.:.--•••-•-•--.... ............. Inspector.... k.............................................................. I{ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............OF...... ... W�e!1 ....................................... e� FEE.... ..... i� ,viiatl Works Toais#rt inn i Permissionis hereby g ted----•---•--...••------•-•-------••-'-----------------•-------•---•---------•---•-•----••--'--••. ............................................. to Construct (L--I�or Repair ( ) an Individual Sewage Disposal System atNo.........- ��.+t� _..... ._..-..._.. ` ' .r�- - - --- ---------------------------•---•----------------•-----------•----------------•-- 1 Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... o of Health � 1 DATE ............ .............. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - B A G 1 2 �•01 3 3.1 3.2 3.3 3.4 4 A3.o2 5 6 7 STAMP: GI'-21l2' G'O' B 10'-21/2' E^'-101/2' _ 2 15'-41/N' IG'-51/4- 1'-65/9, I I A201 DECK II I I w N m m c d) 40 b? P O E m O m A3.02 w ;' C 39 A3.02 rnP osP 'a I cn 61 05F rnP m cn m Z r 37 42 m CENTER IN U.R.O. N CENTER IN E%.R.O. AU•IN w1 CII.OF a O L L a WOR BELOW `1 _ - - - - - - - - - - - - - - - - - - - - - - - - - � -I - �"J = z g B EDROOM#6 csP DBP D3P D.1 z i6•-31/2• 1z-1P J oI Z , - w: D BEDROOM#4 TV SPACE SITTING AREA Ui � BEDROOM#6 O A3.oz c cl � (4)2X6 BUILT-UP 31l2"X51/4" a 31?%51/4' (4)2ST IN WALL m Qi E POST IN WALL PSL POST - POST POST IN WALLV.I.F. v I.r, r0 ROOP VE i0.A VE A5.03 r,PS1 O ROMP nDR TO F.Ofif nDR. ■o O BEAM ABOVE BEAM ABOVE BEAM ABOVE BEAM ABOVE 0�1 IN%ILL WALL OPENING III �ALIGN W/Ch fif TO MArJh fMSr. m ...... 'a N1NDGw eELGW 3 12•X 5 1/4- 4%4 POST 11 46 10 POLRPOST ro wrvE_ _— -- --- --- - HALL— E.3 BEAM 50'4: BEAM ABOVE X4 POST O rsf csP — — ro wa:E w - - - _ (1 .4 AM nBJVE-—-—-_- e _ - - - - _ CEMNR Oi'GDGf BEPM O }],\\ TER 0T GC�.,f BEAM E•1 „off o ABOVE O \4X4 POST POST \3 Ia.x 51/4• ABOVE Z W 20, w HALL f%IB rING CNIMNE�' iORCE.O DN FOR CEw NG CPT'1FCFJ.I.CEILING Of i O PSL POST Q . _ - 30 6'-I 5/9• O` 1O, h nOEi ABOVE I nDR ABOVE. DEN BELOW BEAM JVE TO ROGE W zm 4' w 3 s 1 ATTIC C C /z' FXISTG rue TO REMAI.As 0, 3 FX�sTING CHIMNEY r w 2 o SITTING AREA ______ P.EMOVATE,IG ruE r UI SUBSTRATE,INSTALL- -- ________________ N Z �� I ufw CEMENt fY1CRER BD 1 Z J c /206 Clog. CIOIL ® AND NEW TII O Q�LJJ I 3d�5C I A3.07 C 20'-I 2=0 i/2" 3'-2" 4'-V 5/B' 5n0 6'�4 /B' o- .03 8 CIOS. 8 A5.03 10 4)3/0' 3'-2 S/8' W Z _ qc = OLd RNEE WALL 3 ] E Fee LU z [2� J LLU Ly = C' 66 Q W _ — _ _ - - - z a'S EDO G Z H o Q Q ATTIC SPACE I Q 2 O A5.03 A2.03 \J CL , AZT TITLE: PROPOSED EXIBC,IUB 10 REMAN,I RfMJNE x,BrGNLf. SECOND SUBSrRAfE.iNSrALL NEW CEMENT Ba.RE BO ANDNEWi1IE � FLOOR PLAN A201 1/411 = 1 1-011 BATH , (��J1 CLOSET DATE ISSUED: V! 1 A5.02 13 O SHELL SET 11-6-14 14 HALL REVISIONS: �1 NO. DESCRIPTION DATE Clay. Cloy. LEGEND 31 O EXISTING PARTITION TO REMAIN BEDROOM#8 BEDROOM#7 PROPOSED NEW PARTITION DRAWN BY: Author PROJECT#: 32 - 33 DRAWING NO.: PROPOSED SECOND FLOOR PLAN A 1 - A3.oT a ' _ - - , I Finish Grade 1 , LEGEND: DIRECTIONS: - _ 1 Filter 24"r at.E .: . Fabric a * , ,' From HyannlS - Take Route 28 into Osterville; N Compacted Fill AND/OR 4Y 40 PVC 2s•rat. AP°°°dEwa r '•• At the lights b White Hen Pantry take a left _1/8' 1/2" R4ndCo"•r Deciduous TreeY Y o _ onto Osterville West Barnstable Road and follow a a e a a e Pea Stone -=*dtifiZel TaB. 8 m Pawed BY Separate to the end, Take a left onto Main Street; Take ��-� 3/4" - 1 1/2 L�'t �d r. a rl ht onto Parker Road, And an immediate Dabble Washed c ases ooar"�ea« , a"e,'. N I I Far Drain z F ..; righ onto Ba Street; Take a right onto Blue (`� 4' �I Stone I.D-Bax Coniferous Tree y sam s< t , T Heron Drive; Site is on the left, #19. ""I 1", �? f,.ri v_..4 12' MM.2 Co-r Light Post h Wetland Flag sa,r. T CROSS SECTION OF H-20 FLOW DIFFUSOR *0 • e:* � e * 't 2Y Sad.40 PVT; o am o e 1 4 H.P.M g Hydrant CB/DH NOT TO SCALE Batts n S26 . s �� ,� � ; �� �"cl, � C•l M M. $ 1 , ® Catch BasinTIT I U -a_ UtilityPole Karen A Mckenna 1500 GALLON H-20 Stone MM. LOCATION MAP: -°hw- overhead wires m, c157230 _:._-.'; Il PUMP CHAMBER SECTION DETAIL o- Picket Fence / N8758'4o'W D12 105.00' 1"=2,000±' N Post & Rail Fence / - ASSESSORS REF.: leayotb '�; / / ;;' -,5 SdeyadSethock ;- - I NOT ro SCALE ZONE. --- _------- I -- b ENSR T6/OCT DS --•-- •--•--- --�, { F1 For Float Support RF-1 Lome Map 94, Parcel 4 \ D'� / / ,='�� /OV 7 t {� DB { � Outside Of Tank r r 87,120 SF (RPOD) Ieta9ed In ccardarim Frontage (min) 20' �,/ - / ! �� r �1w Bldg. &.l=od '' '� rat Box '' J' , Billy.a t7.a cod.. MM.z Width (min) 125' --DS _ l l (^ ''- - ° .. Setbacks: D2 -. .D4 0�` Uf0 !f /J -l1w w Truk SM.MPYC Front 30' OVERLAY DISTRICT: \\R ��,, 1:\ // � ��: r t Side 15' Rear 15' AP � Aquifer Protection District f f '�f / ~`� - ' �!� / �,' Estuarine Watershed - 1500 GALLON H-20 \ t O<" ' As Shown on Plan Entitled ,, a - ' � r �. - '_- " °� -°� PUMP CHAMBER PLAN VIEW DETAIL Revised Groundwater Protection .' _ - FLOOD ZONE: Overlay Districts" - April, 1993 r f \ if �_ ,o `; �� NOT TO SCALE Zone A 13, All, B & C \ FEMA ZoneA11 e- / "' . I ¢ P,R�7POSED Community Panel No, �... GARAGE FO { .............. iitl. o #250001 0018 D �.•....... 1,e�� jj t .•..,.• ' T: m\ DRYWELLS :;:.:,::::. ` T VIDE OR Jul 2, 1992 -. .. ... Y f ...... ... �. d .......,,..,. ........... .... � 11r PRO & FA / f i. Z,.. 1I--11' rn ROOF, DRIVEWAY DRAWDOWN town v'/ RUNOFF ::.0.. EX I; r1t�G ;OBE'•. Flood Zone Lines ON O :O' •. 5>r 1M$' ED ` as Shown on FIRM F2£MC1�T 1Z AQ �. Panel 1250001 0018 D rrI l i PROPOSED \ Rev. Julyz, lssz PROPOSEDSEPTIC TANK PROPOSED D VEWA T t PROPOSED ENTRY,rrae _ ya _E�CTfiNSION PUMP CHAMBER / Shrub l! mo v - !~ \ PROPOSED \ Z5 O \ o #19 \ PR -� ��Ajpprox'Lkntt of wetlands / \ ` !J C7� l O i ` \\ 'LSty W�f �``` O 11 S.A.S. \ • Per SE3-221, / \ t \ \ Dwelling `� PROPOSED a 1 o D-BOX \ \ F �, \ N. rapt T ce \ \ 2� ; Lot Ariga - J AR° , ��\ E7.w 1..9 �SL, l �.•--'�"/ / � I 3 26+ Acres � �.\\ � ` BnDms ` \ \�\ N6 ,( PROPOSED �y 1s 1 D r, ......\....•.. .• t ITION REO IR 4 \ SLEEVE E \ � �\ ¢o s3 '�. - - / Shrub .. 5x6 t t 4 .. •, \' AS U O N89 39'40"W �rwe • ' PROPOSE str ,\� �' _ 96.22 a SED •'sn-•�;..........:................ VENT / sxz Shrub Po !! Shrub �� j_ ....... t ! \\ \ A D UII TI ON t F 1 W 9 \ t t I Lawn I t ���/' // < �� t l t,sxa BO•y \\ ^•.,~�''` .............. �.. ----t0---- -•-�' e Y _ _..._. ��'•••:,� \\ '1 .\� \� ;,\ 110 � NODE IN. TIP. 1 THRU S 'g O PR 4 s a gam ....... �� \ REO dt `L2�' _ �S E 1 LD 1 ---•-- Levi t 1-.axe _ r r t , l IN. _. ..- •T T _ _ __ ( ---r _ /, . _;- �, t -•-�---•--•--•--•--•-----•--._ _ B' .� t ... l�„IN• TH-3 I � �•_ ,_.. � - �, ; „�;... , B4 / srdeyard Se3Su9-'- B10 \ I I TH-4 _ If .��-' / It �7 1{ \ : \ t I / -,. lam- •� . �B„ BB / all \ --•- -- �,. L ES a \ N86 54'02 W \ B1z ' ------- • / t ✓ 1 1 7 �-_..._._..._..._... '.....'meted Wellandas Flagged . �... �� by ENSR 26/0CT/OS g ' • / fr f W/ f I/ fit'' I _9.3 I ♦ � � Virginia N ohas S85 A '15•E .-_,.. „� r4r W , N35091 - I ` --CD A2 / / t l 1r 5 I J B2 b1 ' Al ..-.''•"'"" ! t sh�N+f�+, ' f �f lsdoted Wetlmd as Flagged W3 Lawn ! / .,1� ' , �9� . \n by eNSR 24/Sw/o3 0� Meredith M Dale r\, C0 59296 J o c1 /rod // '\ B,tt►► ��P Lawn ! 4x I1 O 6x3 / € Shrub 9 - ! S Flood Zone Lines "------ �"�� I j as Shown on FIRM CW 1 Panel #250001 0018 D SEPTIC NOTES \ f Rev. July$ 1992 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Prior to Any Excavation For This Project the Contractor Shall Make _--5--- the Required Notification to Dig Safe(1-888-344-7233). I 2.The Contractor is Required to Secure Appropriate Permits From Town t Agencies For Construction Defined by This Plan. 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall l '� Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to Assure Watertightness. In General,Water Lines Shall be Constructed in ! �° Ven t Coordination With COMM Water,and Shall be in Accordance t Access Cover (typ.) ! F.F. E (See Note 6) With 248 CMR 1.00-7.00&310 CMR 15.00. i f os F.G. EL. 11.50 4.A Minimum of 9"of Cover is Required for All Components. I f lF �org1 GUEST HOUSE F.G. EL. 14.75 (MIN.) F.G. EL. 13.75 MIN. 5.All Structures Buried Three Feet or More or Subject i o<Dl P 6° DESIGN DATA to Vehicular Traffic to be H-20 Loading.It is the Engineer's 1t0° .PT9cG6T�,� Recommendation that H-20 Always be Used. I 5 �60 Single Family 6.Install Watertight Risers and Covers to Grade in Driveway,or j 8 Bedroom 880 GPD SEE NOTE 8 TYP. \ @ ( ) Provide'Inlet Tee Flow Equilizers to Within 6"of Finished Grade Outside of Driveway Over ( No Garbage Grinder Baffle, or Splash f As Required Septic Tank Inlet and Outlet,Pump Chamber Inlet and Outlet, ( Total Daily Flow=880 GPD Plate As Required D-Box,and Two Leaching Chambers. t t Use a 2000 Gal H-20 Septic Tank EL. 10.00 7.Septic System to be Installed in Accordance With 310 CMR 15.00& t /;.<' Installer To I EL Confirm Prior H-20 EL. 12.8 Top El. 13.0 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable 1 `% '' 2000 Gallon 1500 Gallon \ ! LEACHING AREA To An Work Board of Health Regulations. 1 / y H-20 EL S. H-20 a o 0 o a 8.All Piping to be Sch.40 PVC. \;'! ` / BOUYANCY CALCS 880 GPD/0.74(LTAR)=1,189 SF Required Septic Tank 8.25 Pump Chamber EL. 12.46 Flow Diffusor 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum ;' l ` ! 2,000 Gallon H-20 Septic Tank Sidewall=2(12'+84`)X0.96'=184 SF H-20 Sump of 6". ! Dry Dead Weight=25,080 LBS Bottom Area=(12'x 84)=1,008 SF to Beddin ,"T"s, & Baffels t 1 192 SF Total Provided 9 Inlet an - 10.The Separation Distance Between the Septic Tank e d _ _ eP eP Uplift 64 LBS/FT3(6'X 11) 4,224 LBS/FT P as Per Title 5 lf`. itiG25uifrtt i'eiriatir :'c `Ite : Outlet Shall be No Less than the Liquid Depth.An Inlet Tes Shall Extend ;'' ! 4.17 FT X 4,224 LBS/FT=17 614 LBS 6.5 uifals4 .ai ...%..........?.:.: Adjusted High Groundwater ! LEACHING CHAMBER DESIGN .............. / g a Minimum of 10"Below the Flow Line.An Outlet Tee Shall Extend 14" ! Checks 10' Tanks To Be f1l 3h 9:SyS+9R)' Below the Flow Line,and Shall be Equiped With a Gas Baffle Min. Factory Certified Water Tight t All Pipes to be Schedule 40. Use and Department Approved Effluent Filter. 1,500 Gallon H-20 Chamber & Waterproofed/Sealed Pump 10 Concrete H-20 Flow Diffusors in a jH OF w/2 Coats of Approved Sealant p\ MAS Dry Dead Weight=21,230 LBS F, Sq 12'x 84'Washed Stone Field as Shown. Uplift=64 LBS/FT3(6.17'X I Y)=4,343 LBS/FT 10' Min. - Slab JO#; !C. yG 3.25 FT X 4,343 LBS/FT=14,117 LBS 20 Min. - Foundation r m Checks Cn o C! DEVELOPED PROFILE OF GUEST HOUSE SYSTEM , PERC TEST: 13,368 NOT TO SCALE Fssio PERFORMED BY:JOHN ODEA,PE-SULLIVAN ENGINEERING NAL� SOIL EVALUATOR NO.2911 WITNESSED BY:DONALD DESMARAIS,R.S.-TOWN OF BARNSTABLE AUGUST 12,2011 TEST HOLE-1 la 2 TEST HOLE-2 13 8 TEST HOLE-3 11 s TEST HOLE-4 12 s Add Septic OA TE 09 O7 11 EL::;::;::•::•:s;;x;;;:;a:•:;•.. ::;: :;::;5; ;:;........... is?::::;r;i ;:;;iRfi•'.. ..,:.,::::::.:.::.::::.,:.::.:, mm :•.:•:..:..:•.:•:: :.::•::;:n::;::;::;;•a:•::•::•:x::•: R EVISION: Modify d Garage Footprint Per Conservation Approval DATE: 08122111 :..:;;.;::...:::::::::::. ............................::sit>rr.;:::<:::;:•::;:>::::;::;::: ................................... "......................................:..:.::...::::•::•::::::::•:::::::::::.::::::........ . " ;...:. 3 bfiS�dY,3ATfJ:::::::.:::::.::::::.-: :•.:.:::::.::.:::::.:,:.,:::.:::...:."...:.................................10.6 14 „_..:..::.:::::::.::::.::.:.:::::::::....::..,:. :.:::.::.:......::::::::.::.:11.3 12"•:::::::......,:.,:.::.::::•::•:::::::::::.:::::::::::::::::::::.::.,:.:.:.::.13.2 16 .................... .. 12.5 14 .: NOTES PREPARED FOR: PREPARED BY. TI TLE: . :.... •: .: .. ... :. .�::::::•:::::. :..,. •: .: ;::;.�,.;.�:••;>::�:.LkS .16:YR. .....................13..F.AYSR:LGYR:SG:.:: • -:. ills 1 .�fiYR. ...................... .IOXR. ..................... :•...:........................................................:.-::::::::::::.. .................................................................................. :ro;::;:x:•::•:•. . ;.... . Bittii:t:is r.:•:>:•::•::•::• :;•s:-:;:r:: ::.::..c.::::;•�3GA�1'IfSkk•�l�t.................. ;:::;isis ii:ii:'15 1E !tY#SI#' .. : :::� � ....... � �� ........... i PI n ..... . ::...... :: :: : :::: to a ::::.:. ". ...... " :: 24":::.::::.:::::::..:.::::.• :::::::::.:::•:•:::.,:•: "............................ :.:.:::.:.::.:.:: pA�,�,,•::.:.,::::::::::•:.:.8.7 p 3 ..:..:.::.._::............X�ll '. �k�11!.........................9.4 ..................�19,�.� .................:::...12.5 28 ........................�.ty. �.�,tS�:t1� 11.5 37 a a C LAYER 2.5Y 6/6 CLAYER 2.5Y6/6 C LAYER 2.5Y 6/6 �q� C LAYER 2.5Y 6/6 1.) The property line information shown was Blue Herron Drive LLCSullivaneSury OLIVE YELLOW OLIVE YELLOW OLIVE YELLOW `r' OLIVEYELLOW - 11 c �] eer -SAND SAND SAND . SAND compiled from available record Information. - , Sulll�an Engineering, Inc. Proposed ImprotV ements ADJUSTED G.W.-EL.6.5 5 PERC TEST 12.1 37' PERC TEST 8.7 •} �• PERMtw SERVE O.W. -- - 44 Pleasant Street PO.BOX 659 7 Parker Road At OBSERVED G.W.-EL.4.8 25 GALLONS IN<15 MIN. 25 GALLONS TE<15 MIN. 120" PERC RATE<2 MIN/IN(LTAR=0.74) 4.2 120" 3.8 120" PERC RATE<2MIN/IN(LTAR=o.7a> ,•a ]zo" 2s 2.) The topographic information was obtained Osterville, MA 02655 Osterville MA 02655 GROUNDWATER ENCOUNTERED GROUNDWATER ENCOUNTERED GROUNDWATER ENCOUNTERED GROUNDWATER ENCOUNTERED from an on the ground ,survey performed on Bridgewater, MA 02324 " '.. or between 41NOV102 and 14/SEP/05. (508)428-3344 (508)428-9617 fax (508) 420-399 (5 420-3995 fax cape sury 19 Blue Heron Drivue surCs�capecod.nef SITE PASSED 3.) The. datum used is based on NGVD 1929, Bamstable, (Osterville) M Wa fixed mean sea level datum. Draft: JOD Field: JPM WHK ass■30 0 15 30 60 120 I _ Review: PS Com WHK RRL DATE: SCALE: „ moms p June 14, 2011 1 = 30' Project: 22045 Drawin C566_1G1 I I LC ti 14 { ' 1Z.40 IZ-- 11 i '"l / � / t G� Vic ro�9 '�'• 7 _ I � � '.3 _ /,'?¢ � / •�,�y -ill--i/•� � / , c� FIST r 1. t3•Z� AvDI 1G�� 7- 7 eo lip 1 T-1 a'� _ �, No K,I Tc .� �� � _ — yIr r✓I;P C' „tom 1` i 4 N"" ; I Ci l N } �'�'� D 1`�T [4, 5VF yK k Y'- S^7 G G P D --- - -- -— -1 TV i�a�.. �L`..^,.,I/..�) G�, � 11 1, �' �`•`.\ ��� _�t- .:�.._�t.�, � ��.J�,�Jt�'"� ` LL tr .is c _ t�ts,► 1i: ,� N �ic:LIJk t Q `I f • i 4-4