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L. y }7J ��y.:r`•'K"" ,r Y''z ,tom *` �4 Jf. ," •,' +t4,;'.. ,Y :,.. ,r {: r} , . ill 'ill."r :� Y- �., '*" r 1' i :i7 � ;�•F-...... .:.4.,a .R,": 4r ar*',.._.,_ s, ..ker• �iJt Irxt.. y +h .9!f7!4'.k r{.�atr.��'.5... f z:^ .-. _. .. h'.!`t� U,+in , .'�', .•.� .';M(l,:. ,.: d�',,. ,.....�t�R„ � .. :.N,f, +Y�r .t.. _—. ��;�' .:' 1},,,'�!�;h a. t, [.1-,- Rd. 9ev 69 a� Ji E t OIAAQr- � a _ -� zv�l '� l rLt) 14 Y-t4laCb' 201c Q tor � � y 9 er CP rc S CQ.U►c orl S,n cP� �� - - �f . qw, dL4 201( CA IIAA4 drtr� .�' � s�a:l.� ��.�(oo.•F'�• 1 Z(Z3'so G; TOWN OF BARNSTABLE LOCATION 1 g� �=� " l�— SEWAGE# 1-7- zt6+ VILLAGE COS' ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. .1 > =G 1 SEPTIC TANK CAPACITY /—'72Z 4;At_ 171-01O e i LEACHING FACILITY.(type) (size) 33.-!f- X W--OX4 NO.OF BEDROOMS 3--1-6f � a� OWNER PERMIT DATE: It- 1*-i 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility $�� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) 14- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r 13, 1 ?ors ti 00 I �7� TOWN OF BARNSTABLE LOCATION 4 � 1—�-�T / #�nS� VILLAGE(f)5W(-t)tMZ ASSESSOR'S MAP&PARCEL S NAME&PHONE NO. SEPTIC TANK CAPACITY 000 LEACHING FACILITY: (size) NO.OF BEDROOMS OWNER (� PERMIT DATE: DATEN I I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands t within 300 feet of leaching facility) Feet FURNISHED BY f\F\f•F♦,tF4f♦F•f yi 7 56 \ \ \ \ \ \ \ \ I • 4 4 4 4 • • 4 \ /•/`f`f4r4/4F•f\r\f 18 37 51 for♦/4f•rtf♦f\f\/♦f % 4 4 4 4 E \ 4 \ • 4 4 4 4 4 4 4 4 4 \ 4 ! f f f f F F f f f F f r ! f f I r f ltff\ft 25 .. Y`y... % % ♦Fkf f•i4 ♦ \ \r F\f•f\F•ft \J\i\ • 4f4J4 4f4i4 4 •i• t \f\f . f f F • f f f f i r f f r f f r k 4 4 \ t t ♦ t \-4. 4 ♦ 4 \ ♦ t - 4 \ 4 ♦ \ \ 4 \ 4 ♦ ♦ ♦ • t \ 4 - Water Service Last Bay Road- No. r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co puler: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplitation for Misposal 6pstem Construction Permit Application for a Permit to Construct(K Repair( ) Upgrade( ) Abandon( < Complete System ❑Individual Components Location Address or Lot No. l(? rrR C4 Roca Owner's N e, dress d Tel.No. S�hCr dam" Assessor's Map/Parcel (Yd' Zm -•Acb Install is Name,Address,and Tel.LLo. �Q =-7 07 9 Designer's/ame,Address,and Tel.No. , Q jCitln�i W'io1 �N'i -%v SJ fi`�G7n �Aj41e@�� Type of Building: - 5,mo, ^ YZ v' ^ 3' y Dwelling No.of Bedrooms Lot Size f 5i 2'S sq.ft. Garbage Grinder( ) Other Type of Building Re5vy-"41a No.of Pers nos Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ��s G P gpd Plan Date I A //7 Number of sheets / Revision Date Title S IPIPA PCO,49&, _TMog'-o P'21"eA4 S Size of Septic Tank Type of S.A.S.2�"S®® 6,,&A C_ <44 CS i47 Ptea e Description of Soil ''T t4� 64 S c, Q /a G r 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 to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gned ' ¢ 9 Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued V.?..,,� NO. Fee ' THE COMMONWE LTH`OF'MASSACHUSETTS Entered in computer: �j PUBLIC.HEALTH DIVISION - TO,�N OF BARNSTABLE, MASSACHUSETTS Yes Zipplicatlon for bispos Y 6'psteut Construction j3erinit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( �)��Complete System ❑Individual Components Location Address or Lot No. 89 / fo- r O,wner's Name,Address d Tel.No. ' ' o� Assessor's Map/Parcel (,YQ/Z m -.0 Installer's Name,Address,land Tel.No. �"✓ '7 �(--- Designer's Name,Address,�and Tel.No. $ 73 (-Aa—1 ►4 'A q39 svll,'vgn ��,'heeP��g e s�J fl V "i 46 —F' �c��Strrl;.�g - Type of Building: Dwelling, No.of Bedrooms / Lot Size O 5' sq.ft. Garbage Grinder( ) Other. Type of Building e5�'d 4 r No.of Persons k 'Showers( ) Cafeteria( ) - Other Fixtures Design Flow.(min.required) d gpd Design flow provided J� Jt^ P gpd 1 fJ 3' 1'7 r Plan Date Nu/tuber of sheets ! 1 Revision Date 4 Title ' 1 .... P/�4 pceotPoS P.cf -T A p Ile Ale-04 5 Size of Septic Tank .E a+'�� Type of S.A.S. �� rs►(�Uh • n Description of Soil 'r4; 4 © Grr6e4 t-, — 3 �` l� C P y J'pGe, r'3 n!✓r1 , 3 S x /IfG Cfd(�hd MM��.r Sn... Nature.of Repairs or Alterations(Answer when applicable) y Date last inspected: Agreement: r 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 nd'not to place the system in operation until a Certificate of '!Compliance has been issued by this Board of Health. _ c 'gned ! AA/1 ¢ r, a Date Application Approved by i 1�J� _ _ i �� Date Application Disapproved by r Date r J for the following reasons t Permit No. / Date Issued - - - - -- -- /- - - - ---- - - - - --------------------- ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance ° THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( ) Upgraded( ) Abandoned( )byC1at f 4.1 S 4 4,-,Ll 4a r'l..l ds4'1den cons ' d m ac o d with the provisions of Title S-an'd for Disposal System Construction Permit No ��''� ate 3/ Installer l C-.�"" ... Designer 54r ll` I/q f ih .00-- ✓ 1 #bedrooms y Q� °gyp®iyt Approved desigrrflow�A y4/4, gpd The issuance of this pe iit s�hJall not be construed as a guarantee that the system will funchfor�as designed. Date f l -i-IN, Inspector / ( � n_, � i! � = Ni -- ------- ------- - ----. - - ---------------Fee ------- .. . �_ o. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS T Misposal *pstrm Construction j9ermit Permission is hereby granted to Construct Repair( ) Upgrade^ Abandon System located at 0 67 qS4g.96ZgOQ �fc i✓ „ '/t_,'� to n cvi r-1 s a " 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 !u)stfbeekLp�eted within..three.years of the date of this permit. Date I / r1 I/ r r, Approved by Y t Town of Barnstable Regulatory Services Richard V.Scali, Interim Director BARNSU A � Public'Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: k,Q 22U 1S Sewage Permit# 40 Assessor's Map\Parcel ly DV 00 1 Designer: ` 7 Installer: y�r `cA, Lr< Address: °U° cpt)t Iawry dress: `(S_T11_Jug ru Kd, L/, 1ty 1n I.(_I` I� 6iuss� On issued a permit to install a dat ) (installer) septic system at G° 0 V. W,l C based on a design drawn by (addre dStss) SCILUVAIJ no i D V I M (am.iLdated (d igner) 9rac. _ 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 s stem 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 tem referenced above was constructed ' liance with the terms a val letters (if applicable) P0"uF rV14 IVI (Installer's Signature) No asiss _ 9GFFSS/ANAL�N�'\� Designer's Signature) (Affix Designer'ss Stamp Here) 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 Fonn Rev 8-1441doc I Town of Barnstable P# 15 q Ve ' Department of Regulatory Servicese q Public Health Division. Date i p�� 200 Main Street,Hyannis MA 02601 i-4 Date Scheduled /� Time Fee Pd. lob Soil,Suitability Assessment for Se �e Disposal 8.,.:5 Performed By E/llll � Inew,n ? dl�f�tnessed By: LOCATION&GENERAL°INFORMATIONjjA_ , k Location Address r S.r �/ Owner's Name j)aflIe j �ar�uf�+ (�slt✓cvt t I C , PA A" 62_USS Address 73 Laj(v- 5+, ,She(I_vr()4rVO4 to Assessor's Map/Parcel:. I LA0 Zt V dd 1 Engineer's Name &,Ltj t\(4-N%q l nee(I 2 ava u NEW CONSTRUCTION REPAIR Telephone# (? -A- \� q?'a¢-a Vkz.'_ Land Use �e}iNf f C�� Slopes(%) , fJOf wtC-x Surface Stones /UA Distances from: Open Water Body S®�— ft Possible Wet Area _ft Drinking Water Well ft Drainage Way A/ ft Property Line ZS ft Other N A— ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 2. (\i . . V 740210007 7 0210 M Parent material(geologic)tt� Depth to Bedrock Depth to Groundwater. Standing Water in Hole:A W— Weeping from Pit Face 4j�r- ;f Estimated Seasonal High Groundwater DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: AfOc Depth Observed standing in obs.hole: in. Depth to soil mottles: in Depth to weeping from,side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date t v Z k7 Time t l Observation Hole# Z Time at 9" Xth of Perc Time at 6" Start Pre-soak Time @ 2�(„5�\e^S Time(9"-6") End Pre-soak Rate MmAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG'. Hole,# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Q w s O-k F I" U s DEEP OBSERVATION HOLE-LOG HOW#,�- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) U-lo'` Lu�►ir^ �, rneo rw 37-,i•Z3 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture ' Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Mao, Above 500 year flood boundary No Yes r Within 500 year boundary No/ Yes W Within100 year flood boundary No----. Yea Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area°proposed for the soil absorption system? M t5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on 1 6 Ll (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise.and experience described in 310 CMR 15.017. Signature 4Jse 1 Date IU Q:\SEPTIC\PERCFORM.DOC AFFIDAVIT Property Address: '467•East Bay Road, Osterville,Massachusetts We, Richardson-."S. Mumford and Janine'S'. Mumford; _Trustees 'of the Richardson and Janine Mumfordl Living Trust,-under Trust-Agreement dated November 18, 2005 state under oath depose and say as`follows: 1. f We`have owned the property at 167 East Bay Road, Osterville, Massachusetts since February 1, 2007. . 2.. We have utilized the property since that time as nfour bedroom residence. 3. The residence is serviced by a four bedroom Title.V septic system. r Signed under the penalties of perjury this 21St day of December,.2011. ichard ,son S. M ford Trustee J 'ne S. Mumf r S o d Trust :COMMONWEALTH OF MASSACHUSETTS i Barnstable, ss ;, y On this 2V day of December, 2011; .befor`e me, the undersigned Notary Public, personally appeared Richardson S. Mumford and.Janine S. Mumford, proved to me through satisfactory evidence of'identification'which were drivers' licenses, to be the persons whose name is signed on the preceding or attached document, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of their knowledge and belief. PETER L. O'KEEFFE Peter L. O'Keef tary Public Notary Public My;Commission x es: 4/2/15 'COMONNIEAtN1 MAb7AcifuSEm Cow►mk�an 8 iof lga�ft�.,"J1 6 - T I LY 10 Ll ; , :°, oxi Wv i' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �., 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is required for Osterville MA 02655 August 29, 2011 r every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way..Please.see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the I / computer,use 1. Inspector: (, only the tab key / 1 to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 S1 12855 Telephone Number License Number B. Certification I certify that I have�personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The;inspeetion was performed based on my training and experience in the proper function and maintenance of on s t sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15:�340 OV .— t _ Title 5(310 CMR 15.000). The system: , a f o ® Passes ❑ Conditionally Passes ❑ Fads -V_s T� ❑ Needs Further Evaluation by the Local Approving Authority w i v Ma-R-a i �f August 29, 2011 Job# 11-141 e w pector's Sign"�ture-- Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 6(1411 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is Osterville MA 02655 August 29, 2011 required for 9 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are 'indicated beiow. Comments: Tank is not in need of pumping at this time, leaching pits are functioning properly. Outlet baffle in septic tank is cracked, recommend replacing with a PVC tee. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. . *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth & Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments * 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is required for Osteryille MA 02655 August 29, 2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s) are replaced ❑ Y ' ❑ N ❑ ND (Explain below):_ ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The'system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is Osterville MA 02655 August 29, 2011 required for 9 every 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. (=1 The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: I, D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is Osterville MA 02655 August 29, 2011 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any, {portion of cesspool or privy is within 1.00 feet of a surface water supply or U tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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 considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is g required for Osterville MA 02655 August 29, 2011 every page. Cityffown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health 71u0 1"Vcre q;-y.o the syste^l components pumped CJiit'ii^ tf?e QreVl^vt S t1Rr0 weeks? ❑ 0 Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field cif any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-111110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is required for Osterville MA 02655 August 29, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description:' 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): N/A Irrigationsystem. Detail: Sump pump? ❑ Yes ® No Unknown Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: . Design flow (based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: (Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name . information is required for ery g Ostille MA 02655 Au ust.29, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information li Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: 1 ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is Osterville MA 02655 August 29, 2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate oil site plan): 2' 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.): i Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: �j 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: 8.5' long x 5.2'wide- 1000 gal. 0" Sludge depth: l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is required for Osterville MA 02655 August 29, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 0„ Scum thickness Distance from top of scum.io top of outlet tee 6r baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured 'I Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found slightly below outlet invert due to evaporation and vacancy. Outlet baffle had a small crack, recommend replacing with a PVC tee Tank is not in need of pumping at this time. Grease Trap(locate on site plan): Depth below grade: feet Material of construction* ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is g required for Osterville MA 02655 August 29, 2011 every page. Cityfrown 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): Dimensions: — Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is Osterville MA 02655 August 29 2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0,1 Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present, liquid level was.at bottom of both outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is required for Osterville MA 02655 August 29, 2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) f Type. ® leaching pits number: Two 6x6 pits. ❑ leaching chambers number: leaching tfaleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pit#1 located under landscape area and was not opened. Pit#2 was empty at time of inspection with a stain line 12-13" below inlet pipe Cesspools(cesspool must be pumpee as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is Osterville MA 02655 August 29, 2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•11/10 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 167 East Bay Road Property Address Owner Richard Mumford . —=--- ------....-- --------------- — — Owner's Name information is required for 9 Osterville. MA 02655 August 29, 2011 ___ — every page. City/Town 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_ 7 56 . . . . . . . . . . '•'•'•'•'�'•'•'•'•' 18 3 7 , 51 'NININ44 IN , , , / I , , , , , , , , , , , , , N. N N N Water Service East Bad Roar Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is required for Osterville MA 02655 August 29, 2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: 15 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database -explain: USGS topo map. You must describe hour you esOblished-the higi7 ground water elevation: Topo map shows property above el. 20. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 117 • . Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 167 East Bay Road Property Address Richard Mumford Owner Owner's Name information is required for Osterville MA 02655 August 29, 2011 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 • L DATE 8123106 PROPERTY ADDRESS 167 Eazt Bay Road '(110-A10 pa/ Uat eay.i.�.2e I Naas 02655 � I On the above date, the septic system at the address above was Inspected. This system consists of the following.: 1., 1-1000 gaiPon tank., 20 1-Dizta.itut.ion Box., 3o 2-1000 gaiion ieach.ing 12.it s.1 Based on inspection, i certify the following conditions: 4o 7h.i.z 1.6 a 7.it2e Five .6ept.ic zyztem (78Code) 5.1 Septic .system .ids .in pAopea wozk.ing o4dea at the paesent time., #1 ieach.ing pit .i s empty., pit #2 /2.it .i s not accezz ig ee unde2 daiveway. SIGNATUR Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc . _ C Address: P. O. Box 66 Centerville, Mass 02632 .;o Phone: 508-775-3338 or 508-775-6412 , JOSEPH P. .MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 t' COMMONWEALTH.OF MASSACHUSETTS EXEcuTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION a dr TITLE 5 OFFICIAL INSPECTION FORM—.NOT:FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART"A - CERTIFICATION - Property Address: : 16 7 Caz.t Bat/ Road O�steay.�.2.�e Owner's Name: Steahen Suzidko Owner's Address: Same Date of Inspection: 8122106 Name of Inspector: (please print) * Robert A Pao1ini Company Name: 7 % lea c o mIe 2 . .S'.on Mailing Address: Box- 66 Cen. e2vc e, abb.-02632 y Telephone Number: 5 0 8-7 7 5-3 3 3 8 CERTIFICATION STATEMENT I certify that I have personally inspected the;sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in:the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section.13:340 of Title 5(310 CMR 15:000). The system: XXXpasses Conditionally Passes Deeds Further Evaluation by the Local Approving Authority ails, Inspector's Signatures Date: 9'22"06 The system inspector shall submit a copy of this inspection report to the-Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system.is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall.submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This'report only describes conditions at the time of inspection and under the conditions of use at that '~. time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 ` OFFICIAL INSPECTION:.FORM—.NOT, FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DTSPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:16 7 Ea a t Bay' Road Owner:S.tel?hen Sr z idko Date of Inspection: 8122106 Inspection Summary: Cheek A,B,C,D or.E/A iWAYSVeompletetall of Stction:D A. System Passes: y6S NO I have not found any information which indieatalhat,any of the failure criteria described in 3 10 CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SeR;t.ic .sys"teM .i,6 .in /220/2e2 wo2k.in oade2 'at the /22ezent time I B. System Conditionally Passes: NO One or more system components.as described in the"Conditional-Pass".section'need to be.replaced:or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not-determined(Y,N,ND)in the for the following statements.If"not determined"please explain. NO The septic tank is metal and.over 20 years old*,or the septip tank(whether metal or:not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is.imminent. System will pass inspection if the existing tank is replaced with a complying septic tank,js approved.by the.Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: N-0 Observation of sewage backup'or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection,.if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distrilution box is leveled'or replaced ND explain: NO The system required pumping"more than 4 times a year due to broken or obstructed pipe(s),The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 167 Eazt., l~ay /toad Owner:. Stephen Su.6idko Date of Inspection: 8122106 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: n o Cesspool or privy is within.50 feet of a surface water no Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: no 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. no The system has a septic tank and SAS and the SAS is'within a Zone 1 of a public water supply. n o The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well. n o The system has a septic tank and SAS and the SAS is less than 100 feet but 50.feet or more froN a private water supply well". Method used to determine distance v.i s ua i "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page.4 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE_SEWAGE DISPOSAL SYSTEWINSPECTION FORM PART.A :. CERTIFICATION(continued) Property Address: 167 Eaz.t 'Bay' Road � eay.� .e • Owner:Stephen Suzidko Date of Inspection: 8122106 D. System Failure Criteria applicable to all systems:. You must indicate"yes".or"no to each of the following.fdr all inspections: Yes No X Backup of sewage into facility or system component due.to overloaded or clogged SAS.or cesspool X Discharge.or ponding of effluent to the surface of the.ground or.surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than.6"below invert or.availablv.volume is less than'/s day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ A .Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. i — X Any portion:of a cesspool or privy is within Zone 1.of&public well... r Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system:passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria.and volatile organic compounds indicates.that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forT.] . NO (Yes/No)The system fails.I have determined that one or.moreof 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 now of 1.0;00.0 gpd.to 15,000. gpd. You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — X the system is within 400 feet of a surface drinking water supply — X the system is within 200 feet of a tributary to a surface drinking water supply _ X the-system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above°the large system has failed.The owner or operator of.any large system considered a significant threat under Section E or failed.under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional.office of the Department. 4 .Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 167 E-azt. Bay Road O�ste2v.i.�.�e Owner: Stephen Suz idko Date of Inspection: 8122106 Check if the following have been done.You must.indicate"yes"or"no"asto each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available-note as N/A) X Was the facility or dwelling inspected for signs of sewage backup? X Was the site inspected for signs of break out X _ Were all system components,excluding the SAS,located on site? X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? — — The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes- no X Existing information.For example,a plan at the Board of-Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CNM 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM_TNSPECTION FORM PART C SYSTEM INFORMATION Property Address: 167 Eazt Bat/ /loud O�steay.�.2.2e . Owner:,UARhen Su iidko Date of.Inspection: 8122.106 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpo x# bedrooms): 4 4 0 of _ Number of current residents: 2 - Does residence have a garbage grinder(yes or no): yes Is laundry on a separate sewage.system(yes or no): no [.if..yes separate inspection required] Laundry system inspected(yes or no): n o Seasonal use-(yes orno):rzo 2004=125, 000 . ga.P$on.6 qP.D=342.i47 Water meter readings,if available(last 2 years usage(gpd)): 2005 204, 000 ga to o n s r%!D= 5 5 8 o 9 0 Sump pump(yes or no): no •ins P/tesent Last date of occupancy: R2 e z e n t COMMERCIAL/Il4buSTRIAL N/R Type of estabbshment: Design flow(ba ed on 310 CMR 15.203): gpd Basis of design'flow(seats/persons%sgft,etc.):., Grease trap present(yes or no):T Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: . OTHER(describe): GENERAL INFORMATION Pumping Records = 7/1/0 5 a Source of information: .� •� lyla e o in a a: Was system pumped as part of the inspection(yes or no):y e.6 . If yes,volume pumped: l0 0 0 gallons--How was quantity pumped determined? m e as u 2 e d Reason for pumping: m a.e n t TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system —Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: �. 11 yeaL3 Were sewage odors detected when arriving at the site(yes or no): n o 6 Page 7of11 OFFICIAL INSPECTION FORM—NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 167 fast Bay Road Owner: Stephen Suz idka' Date of Inspection: 8122106 BUILDING SEWER(locate on site plan) Depth below grade: 2 4" Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): o.ints aRpean t.ight.i No eve.idence oe iekagaoVented th4ough house vent SEPTIC TANK: tLa4locate on site plan) 1000 ga.e i o n s Depth below grade: 1 2" Material of construction: X concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ 'Is age confirmed by a Certificate of Compliance(yes or no):_.(attach a copy of certificate) Dimensions: 5' 8"X8' 6"X4' 10" Sludge depth: 1 n n r.n Distance from top of sludge to bottom of outlet tee.or baffle: t 2a ce Scum thickness: t bt a c e Distance from top of scum to top of outlet tee or baffle:1-2 a c e Distance from bottom of scum to bottom of outlet tee or baffle: tit a c e How were dimensions determined: m e a z u a e d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): PumI2 tank evelty yeaa gaagage dz oza.P is /22esenLi Inlet 9 out-&t i tees aae .in p eace.i 7ank. .ih ztauc ulta eiy o.6un .i GREASE TRAP:NO (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert:evidence of leakage,etc.): g2eaze. taa/? �h not /2aehent 7 Page 8 of 11_ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 167 East [ ay Road Oztezv.iiie Owner: S# Rhen Suz idk.o Date of Inspection: 8122106 TIGHT or HOLDING TANK: NO (tank must be pumped at time of inspection)(locate on-site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): tight oa ho id.ing tanks ate not 12aezen.t DISTRIBUTION BOX:cue 3 (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,.any evidence.of solids carryover,any evidence of leakage into or out of box;etc.): Box .is ievei., 11a6 2 .2ate.¢aX.6.i No zott'd caaayovea oz leakage .in oa out o.1 9ox.1 PUMP CHAMBER: NO (locate on site plan) - Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): P UmR chamgea .iz not 121te sent 8 Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 167 East - Ba a /toad Owner:Ste/zhen Suzidko. Date of Inspection: 8122106 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located zee page IN Type X leaching pits,number: 2 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): .� Loamy to medium zaado No zi nz o ai2u2e oa ondin .� Soii-3 ate d1ty vegetation .ins noamai.i CESSPOOLS: NO (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes br no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Cezzpooi.s aae not p/tesent PRIVY: N (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): l2.ivy i,6 not /22eZent 9 . v Page 100of 11 Of i IAL INSPECTION FORM NOT FOR VOLUNTARY.ASSESSMENTS SUBS ACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM i PART C i SYSTEM INFORMATION(continued) Property Address: 7 6 7 Eaz t Bd y Road CJ�steay.i.22e Owner: Stephen Susidko Date of Inspection: 8122106 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at Ieast two permanent referi'ice landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. j a� L`R, I 10. Page 1,1 of 11 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 7 £as.t ,Ba a Road O�steay.i.�.Pe Owner: Stephen Su.3.idko Date of Inspection: 8122106 SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: -NO Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) y e h Checked with local Board of Health-explain:n k /.i P# a 2 _ no Checked:with local excavators,installers-(attach documentation) �Lez Accessed USGS database-explainh.tt•/2:t o wn.-&liana t aCea.,ma.-u s You must describe how you established the high ground water elevation: 11.sed. : Cal2e Cod Comm.iz.ion Yatea 7aaie Coritoultz And l uktic ldatea SuI212Qy Ve.e.P head /2aotee.tioa ".aaeas mal2o Sept 1995 _ Uatea aezouacez o-l-lice cape cod commtzZon.' Tup of Ground Leaching 1 Pit / feet Groundwat�iD` Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical separation distance between the bottom Z, of the leaching pit and the adjusted groundwater table is feet. p 11 Vz��A r _ BOARD QF 11RAIT11 'TOWN OF A I? --- SUpBUttP'ACR tit;WJIgR ni81'USA4 t1Y8TEM I11grECTtoN FdR14 - PART D. CERT1F1CA�'dON +_ ».�„-r•.n.-r*+n.' **°^""'"'""" -TYPE 01 PAINT.01411,y- PnO.PERTY ,LN,SPI!OTRl1 .167 Waist l3ay Road STREET ADDt�ESS 140-210-001 . ASSESSORS MAP, BLOVK AND 'PARCEL OWNER's NAME PART:D 0S11rI4rr0ATrTON ..' F 'INSPECTOR Robert. A ':pao1in -NAME '0 .. . _ • COMPANY NAME S$ fC i3ox '6Ei.. crxr-x�i]3 'MA 'Q32-006� staL� L P COMPANY ADDS stsa k; Tour•or city. COMPANY TELEPHONE 508• Q7.5 - 33.38 FAX (' 508•,.190 � f 57$ . CER'r'hrICAT1.0N. STATEMENT if that I "hRva personai'lY .ins'pected ..tie Qewage digpopal. system at I 'Certify this address and that' ;t1i�e' information reported .is true,. aovUra•te•p an omplete aq of the time .aig�inapeoti0n.� The inno op'evti:*n was performed and any recommendationnt s regarding .upgrade. thing cperefutietionparid tnainteAdnceeof on- recommendation my trainip,9 and eXQ#rience i 6 site sewage disposal systems, . Check one: XXXX� SysteM PASS*D , • tion . s n•at' 'fou'nd an informw whic.h •I. have .•conducted ha ., .. y , . The in�peet io n - which indicates' tliat- .the system' Sails to •adequately.; protest .publi•c • t ro amhe as defined ill. CMR. 1'6*;30.3•1 -Ahy f4ijure t►eall.h or l;he eta i. criteria tit evaluated• are as stated in "the FAILUR CRI'1' RIA .sBation o;f this. form. System FAILED* . which I }rave ca�it ted 'lias found that the System fails to The inspectionStith Title protect the public lisa].t11 end the en�,i,ranment in acv ordance 6, tec CMR 15 + 303, and as !speei f lcally noted -on .PA•RT; C - . FAILURE of this inseatl.on .Ym. CRITERIA • ' G . Data ' - Inspector Signature.., Now OT No aerti,f i,o ar tnuat lie �;i`ovi'dec� to :the .QWf� I�, BUYER ni' copy of this t'i where aypl .awblg) ohd th!r I3QARD 08' HBAL'1'!I+ * If the inspection FAILLb,, 'thb .owne'�'.Ox 9Perator •s;hal�• upg•z':ade,•She system within one sear at the da't,e of the inepeation► unle$s ak'ldasd ctr regit#.,red ,/ TOWN OF BARNSTAB_LE LOCATION !& & SEWAGE # I � - I VILLAGE—'. . ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.—A % I qoo Z l o 0 6.2- SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR, OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: r A 5; .. I DATE:_ 7/21/95_ ; PROPERTY ADDRESS: 167 .Fast flay ..Go.a.d . Osterville ,Mass . 0sterville Mass . On the above date, 1 inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon septic tank . 2 . 1-distribution box . 3 . 2-1000 gallon leaching pits . Based on my instlon, I certify. the following conditions: R�CEAIEo l .This is a title five septic system. ( 78 Code ) JUL 2 . The septic system is in proper working order at 2 8 199 the present time . 3 The second leaching pit "in concrete driveway . We fumipz did cut up driveway -to loacate . f SIGNATl9Re-: Name: J. P.M'ac'omber Jr., i Company:' J•P.Mac.ogber -&_ Son', nc Address: Box 66 '< ---den Iry the Ma �' '_0263�2 Phone:_ 5084-77.5-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY s ,IOSEPH P. MACOMBER & SON, INC. Tan iks-Ceupoolls-Leachf lei ds Pumped & Ingttlle-,4 Town Sewer Cone: P.O. Box 66 Centerville, ,iA Q26 -0066 775-333Q 775-64' 12 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM Address of property 167 East Bay Road Osterville;Mass'. Owner' s name Donna Whitney Date of Inspection 7/19/95 PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. V None of the. system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _Z The facility or dwelling .was inspected for signs of sewage back—up. // 9 g P- ✓ The site was inspected for signs of breakout. All system components, excluding the SAS , have been located on the site. The septic tank 'manholes were uncovered opened, and the interior nterior of the se.ptic 'tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of .sludge, depth of scum. The size and location of the SAS on the site has been determined basest / on existing information or approximated by non-intrusive methods. ✓ The facility owner ("and occupants, if different from owner) were provided with information on the proper maintenance ,.of SSDS. Recommendations 1.. Raise cover on pit in lawn area . 2 . Install speed leveler in distribution box . Equal flow ) 3 . Second pit shoulbe located in driveway and cast iron ring and cover brought to, grade . Then pit can be serviced at a later date w 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B / SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms number of current residents garbage grinder, yes or no, laundry connected to system, yes or no Yet seasonal use, 'yes .or no If nonresidential, calculated flow: . Water meter readings, if available: 1993=109 , 000=GPD=298 . 63 1994=91 , 000= GPD=249 . 31 -Eesenth� Last date of occupancy GENERAL INFORMATION Pumping records and 'source of information: ` Pumped June 95 ] Nn System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type o sy stem Y stem XXXX Septic tank/distribution 'box/soil absorption system Single cesspool Overflow cesspool Privy NO Shared system (yes or no) (if yes, attach previous inspection records, if any) ' other (explain) Approximate age of all components. Date installed, if known. Source of information: 10 years ern Sewage odors detected when arriving at the site, yes or no I f 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATIOt; -- ntinued SEPTIC TANK: I-1000 gallon tank . * (locate on site plan) depth below grade: 12' material of construction: XXXX concrete metal FRP other(explain) dimensions: r.-8 ' 6" W=4 ' 10" H=5 ' 7." 0 sludge depth' Pumped 5 weeks ago 0 distance from top of sludge to bottom of outlet tee or baffle _0 scum thickness 0 distance from top of scum to top of outlet tee or baffle _ 0 distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet -invert, structural integrity, evidence of leakage, recommendations for r_ .'._d rs, etc. ) Pump tank yearly due to garbage disposal ;Tank structurally sound ; Inlet & outlet Lees Sch . . 40 4 PVC pipe _o . k . ; Inlet level of wateB 4 ' 6" outlet level of water 4 ' 3" . No repairs needed. for the septic tank . DISTRIBUTION BOX: XXXX (locate on site plan) is not depth of liquid level above c!. ' ,�t invert Comments: .(note if level and distribution is equal , � ' :?ence of solids carryover, evidence of leakage into or out of box, r._! . . . .!rnendation for repairs, etc. ) Box not level distribution is not equal..__ No carry ever of -sol ids or ' leakage in or out of box Repairs needed • Speed leye4r must be installed to establishteoual_ flow out of the box PUMP CHAMBER: NnNF (locate on site plan) NONE pumps in working order, yes or no Comments: (note condition of pump chamber, condition pumps and appurtenances, . recommendations for maintenance or repairi-- , - ) NONE _ 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : YPR ( locate on site plan , if possible ; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number leaching chambers and number Packed in stone . leaching galleries and number . leaching trenches , number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) Sand R gravel ;No hydraulic fail n normal Cover on leach pit must be raised . Did not cut up driveway to locate second leaching pit . CESSPOOLS ( locate on site plan) : number and configuration depth-top of liquid to inlet invert _ NONE depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments : (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) NONE PRIVY : ( locate on site plan) ' materials of construction NONE dimensions depth of solids Comments:. (ncve conditicil of soil , signs of. hydraulic failure, level of ponding, condition of ,;c!', ation, recommendations for- maintenance or repairs, etc. ) . . 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L_SPOSAL SYSTEM: include -ties to at least two permanent references landmarks or benchmarks locate all wells within 10o , Town Water DEPTH TO GROUNDWATER 2A_ depth to groundwater method of determination or approximation: stem Test hole 14 ' No water . Water, , Con' nervation SAVE Tips , ME! CHECK FOR LEAKS Water Loss in Gallons Due to Leaks Leak this Loss Per Day Loss Per Month Size 120 3,600 • 360 10,800 • 693 20,790 9 1,200 36,000 0 1,920 57,600 0 3,096• 92,880 0 4,296 128,980 ® 6,640 199,200. 6,9.84 '. 200,520 8,424 252,720 9,888 296,640 ® 11,324 339,720 12,720 381,600 14,952 448,560 TOWN-OF Barnstable BOARD OF HEALTH i Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION �Z::T.��:tZ,�:��T.:t�.�L3�SiT.�t-'r1�'-pr.+TST.SiR.'�t�T.T3�TiZ�iSt SZT:L�S�.��::.LS•'-�TT"L�t=�Tt:.:T..._.�T- -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRUS "�67 East Bay Iroad 0sterville ASSESSORS MAP, BLOCK AND PARCEL # — ",�D -9/0 OWNER' s NAME panna Why .t_uev- PART D - CERTIFICATION NAME OF INSPECTOR J P Macomber Jr COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville Mass . 02632-0066 . Street , Town or City State ZIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have, personally inspected the sewage disposal system at this address and that the 'information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems. Check one.: XI-UX System PASSED The inspection which ' I have conducted has not found any information which indicates that •the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature � Date 7/2T/95 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) . and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of. the date of the inspection, unless allo*.ed or required otherwise as provide! +n 310 Cpilz 15 . 305 . Partd.doa Ccmmenwearn cr Messcc^.aeTTs ExecuTve Office cr Envircnmema Atfc..s Department of Environmental Protection ' WaTer Pcllcnicn CcnTrol Tecnniccl Assomnce and ?raining Sec^ons W I= F.Weld Trudy Cox* Sww•ry.EOEA `!} Thomas & Powers � w 06/12/95 ATTN: Joseph P. Macomber, Jr Joseph Macomber and Soli PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr. , _ I am pleased to inform you that you have attended training, met the experience qualifications, and-have passed the Title 5 System Inspector exam, pursuant to 310 CMF. 15 . 340 . The passing grade for the exam was 39/52 or 75% . This is an official noti`fication that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15 . 340 . You will receive a .Systern Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D. E. P. Training Center 50 Route 20 Millbury, MA 01527 Thank you very much for your time and consideration in this matter. Sincerely, Kimball T. Simpson, DEP Trainl�a Center Director [2 4 0 5 J Row-a 20 • Millbury, MA 015Z7 • FAX 508-755 9253 • Telepnon• 508-756-7281 fi t; !>►`11<IICS �8 1�N 1 ---- r------ � — --- ----------- --- ---' � ,u .c,,.. . i I --- r------------------------------------- 'II 1PeMMR I I 'I I 1000mnmmwtlOAv<tim� �> Nwet our I I III z3i r---------- I 'MW61�7qM. .C. 8'X The L IBa—h sterSuite—[ L— Pool Area Sunderland Y riDk�altaa�r T�DF%N 18° 3oPna�arDss�PsDaaa.s Residence 'Ca b ana _lr..o..._.......__......_..........:.. ..........._..........._B'r:...._..............._.�� z........ ._2q...........:...._ -----------. I, -------- 167 East Bay Road CIO. CIO. y L1J---------------------------------------J Osterville,MA z zo —_J_ General Notes: [i�AL WNIHACIDH®IMLMA�AIL 1 I. slm-oox,HecroHse/msom�asweaaoP I T�aeQurel�rla oPTatrea NDlHa. 6 I � � N I � O�IdANCB WnHAIN T-e r (II moa A HDxiAu P88eRre3HAr re�9 seP NPLB 89-a• ! He �' T ._........ .__..._._ 'I W-S° 16-0° OOMDIACMO i�nS�ODOHOVi'1� t I O1W®lALOWTIHAOIOHHNAIlrAyO,TPWT y, COVERED PORCH PrerDTHHtHl1ID9H'OIIRTDBHP®OOHMtIDTO ----..........._._ .y........._ ..__..._....._...._._._ 'I_.._..._Living .....,•_ _ 2, CDNnWCn 7GA PART AMD9HAu.YIIlPir... .. ...... .I ._ ..._....._._... 't• ..... I � f Qi m Room Ifll .� ... ' Hmnea ROCsUM WOH wa I I A. IWOOD FLOOR _..........._ I _z t0- II - e•-s° POHH°>�MMIM HH scma�N ---- ..�............._............ ...................... I � `tlf : ! /' \ / ANY DreC9�ANClaBPWlID IN1'HBPWIa• ..._'-?!°.... '✓-,�° 44 ...._z-... z-11° a• ' VAPPAHWl[IW9pHIN—CLA38m .OR ..... ........._................._..............— -.....�a.....-.........................._........ D I ! aneramCVnONOPAPHODUOT•MA'IERMLOH a I L — — — — �uo�PA UTIMM K-ALCONMA TO PAat 1A8AT1@lOON OP TiID DIAL CON]%ACnp0. — N SNMecWavaAOHRYS roOHPWTNMaPMtwEPHG go COMTRAoBPOVmHHDN,eO+m�TuA•N,I.Dr,®a.malreo reHal w HrooD SX er lot — f PUNCISON OP AN IT®f ffiOWN oaHPHCm!®.H SHAM 4'-8" I gDm09M'r9Hfret�ALCONIHACNH� OP]lam : � ............._ I I Ea FO. � EGL.. E(l.- I HUQU@®f@nBPOH THB WOHH OP OIL \ : i i I I ` N �9OB�'Mf1W'IA�I.OP 6DIAL 0m POR WO&8_'�� -Jr ——— —I � srAarFi eraser :. %lam DR13c x Car _- ._...._ nNDIeAMwVWBreHW IoONs HsDAAMu O-MNUoSCrMH®a&AscTDAHvA�WDPMo aSB Y Garage DmP�NTIOMNDII@Y DRNWN EnC`pSed L. FooR Drawing Copyright: PAT POtch - Dining I I Tp W 7 "fi'- _ t m p�; AHaABN.AIA,rDYHBB9I.Y HPB�vH,9H Y HI( A'%HID NARCMMWT1ZC,ANDPAMIM BRICK ID Room PHO rMGMSI,i ,HM A9°L£0 a DHAWWM PBOPEM OF PATHILS lk d S> Mot)FLOOR AHH TNa I I — srra r , I i AATMOMA N.MND(D2 N�HO CBtDFmlWPnANAiHCOITYlT'YTU WHHDRY4EIB PHHD®APA99OTWtL®C1®RWAF®A6,ill 7 _ AWING IMPMINOH AUB OBT PEM%ffMONWPAM Hlre, ARCMTWr Roo ;` 1 r1C AND PATHICB AllBRN�A/@1 — —— — — 44 I Kit en N }--- I II a Drawing Title: o'-,O' I12-D�° I j I I 8•- [Di LAD GEILWG / 1 ....-.._%�-?j°_!!�. ::::..............._...._...............................................-..._...._._.. __...._..._..._...._.....__.._..._ N Proposed First ISI ———J N I Floor Plan : I � i H9PA4re N .- Erero6/BAS AAt - '-_e S rj 31 I i z-z' F' .......... �_Z_tl. ... i .. d a-roy a>l[ z a..... l Offic Reception .._ ... 6 * .... .' —'I -. ... —: _..._—.._..._._ f .. ti a ....- ''� ......... l.. ...... .........__... �� LOM g Den� ...�— ... ..........._-N.. 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The ........ Sunderland LEIRe{ OPEN TO \ / OPEN TO \-KING KOO/ \ / DEN BEYOND , sidence I BEYOND r it \ / X X 1 � X I i �\ \ � / �\! 167 East Bay Road o oo Osterville,MA General Notes. E:1 ! i GENERAL�NAN'1'NACTOR SHA�MAKE�L ♦ r / -' SW{q XOONTS FEHE ERSS. AREOF ' /J \ � I- e THE REQUIREA9iNT50P'1'FBiSE NO'IT:S. f ........ ' .. ALL WORK SHAILBEFRRFORDoHq "'"...""........ CONP 11—M III ALL APPLICABLE LOCAL, y .. ._... .. ....__._ .....— SAFE .._..._ ...._... ..._.... .......... ....—. ..._._.. ......... .................. ...._........... ._............... ............._.. .._....._.. STATEANDNANDFLU BUILDING,LIE'E SAFETY, AL T �� GENERAL CONTRPLUMI3INGCODES. tl 14 SFONSIB FOR SECURINGG ALL PERMITS NECESSARY FOR COMPLETION OF WORK-ROUG110UT THE . CONTRACT DOCUNRNTS. Reception/Entry Reception/Entry Reception/Entry Reception/Entry GENERAL CONTRACTOR SHALL LAYOUT IN THE FIELD InE ENTIRE WORK TO 13E PERFORMED TO 1F1-:11 Interior Elevation 2[1:11 Interior Elevation 3� Interior Elevation 4FE11 Interior Elevation ' COON TRU�GANY PART,AND SHAAL BEFORE Scale:1/2"=1'-0" Scale:1/2"=1'-0" Scale:1/2"=1'-0" Scale:1/2"=1'-0" ' ALL M PING CONDITIONS AND LOCATIUNIS BEFORE PROCEEDING WITH WORK, I GENERAL CONTRACTOR SHALL BE RESPONSIBLE 1 FOR THE CO-0RDMATION OF DIMENSIONAL I - RRQU1RIiNNMSBETWEENIIIE WORKOF REQUIRED TRADES/SUBCONTRACTORS. --VERTICAL CEILINDD-NG FLUSH BOARD DS—S,EXIS FOUND N ITION PLANS, FIREPLACE OVER MANTLE �� APPARENT ERROR NTHE CLASSIFYING OR e'WALLS, TYPICAL APPARENT OF A FRODUCL MATERIAL OR METHOD OF ASS-A Y IS TO BE BROUGHT TO j .........____.___......__....... THE ATTENTION OF ITR GENEEN,CONTRACTOR ' I ...._._.... ....... - IMI.IFDIABE Y. SHO-IOI REGARDIRSMUMED OFWEQ'naiR OR NOT ITEM IS CONTRACTOR SHALLPROV I)EE SNDITFT1IFITIS NECESSARY FOR THE PROPER INSTALLATION OR FINCITON OF AN ITEM SHOWN OR SPECIFnD. \\ / - SUPPLIERS AND SOBCI�NTRACTORS SHN,L 55"T.V. V INFO rNEGENERALCONTRACTOROFTHFJR ,. REQUIRENIE SFOR IHE WORK OF OTHER ! t:\ TRADES,WEBCI I MAY NOT BE INDICATED,PRIOR IO SUB M.OF FNAL BID FOR WORK. DRAWINGS SHALL NOT BE SCALED FOR ' ' OF N O j I DI—SIONSAND/ORSIZE.S.1) MEGSMAY TO ' ENO D HAVE BEEN REPRODUCED AT A SCALE I i DIFFERENT THAN ORIGINALLY DRAWN. EN�ED P SSE I II � P 7nIfp9T > j Drawing Copyright: PAIRICK/ .....BOARDSJ'TDKX FLUSH AHEARN,,GHTSRNTHE RESERVETHETHRE / \ ; `\ PROPERTY RIR IFNE PROF DRAT PAIRS.THESE y .._." DRAWINGS ARE IIIe IROPean of PAtwcK .. Mir. ARCIITECT LLC,AND PATRICK AHE:ARN, + ` / I AEA.ANDSHAILNOI'BE RIiPRODUCEDINANY ... ._...._ ....... ..... • . MANNER NOR SHALL THEY BE ASSIGNED FOR USE L'OLD BRICK THIN VENEER OBTAINING THE EXPRESSED WRIFTTEN SURROUND BS"GAS FIREPLACE OUMUNCTF9N VENEER � PER,wsS1ON OF EAM-AHEARN ARcmIEcr SURROUND WIHGAS FIREPLACE LI-C,AND PATW CK AHE—,AIA ..__......__......—..—_6_4°............................:.._.......... .. WMERRINHRE50GBONE 6'h' PATE MFIREW PATTERN FlREBOX ..............._.._....................................._...................._......_..............."' PATTf3W FlREBOX Den Drawing Title: - it 5 Interior Elevation 601 Dining Room Interior Elevation Interior Elevations Scale:1/2"=1'-0" Scale:1/2"=1'-0" ' 19 I Nov.7,2017 ISSUE DATES ❑B DOING PERMIT: 11/7/17 OPENTO! ( F�ONTENTRY HILL ❑CONSTRUCTION: \ / REVISION& I ❑Data / I .. ❑Data - ,. ❑Oat � I i ! � ! ❑Oat ' I I / \ i I � ❑Det iI I j ♦� ARCHITECTURAL STAMP 6 J013 NORTH 0 70Dining Room Interior Elevation D;nl lN5 Scale:1/2"=1'-0" t g� Vent - Charcoal r* F.F. El. 18.9 Filtered, to be field SEPTIC NOTES $ & Elev. 1.7.8 placed in least 1 LocationZONE. 6 • w; See Note 6 (typ.) conspicuous place or . ofUtilitiesShownonThisPlanAreApprox.AtLeast72Hours RC a «� See Plan View F.G. EL. 17.5f* - *Final Foundation Grading To Be F.G. EL. 17.85 Max, specified by Prior to Any Excavation For This Project the Contractor Shall Make designer e Coordinated With Landscape Plan landscape g the Required Notifications to Dig Safe(1-888-344-7233)and contact Area '(min.) 87,120 SF (RPOD) i n Sullivan Engineering&Consulting Inc.(508-428-3344). Fron toe (min) 20' " Width (min) 100' F1Flow Equalizers 2.The Contractor is Required to Secure Appropriate Permits From Town Setbacks: EL. 15.30 A s Required Agencies For Construction Defined by This Plan. Front 20' Installer To 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall r ' Con firm Prior EL. 14.70 1500 Gallon pp 3' Side 10' To Any Work Septic Tank EL. 14.45 Top EL. 14.85 Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to Rear 10' H-20 Required 14 H-20 Assure Watertightness. In General,Water Lines Shall be Constructed in (See Note 5) D-Box EL. 14.09 Coordination With COMM Water,and Shall be in Accordance 13.85 Leaching 0 With 248 CAM 1.00-7.00&310 CAM 15.00. FLOOD ZONE.R MY- To Be Installed On Chamber 4.AMinimum of 9"of Cover is Required for All Components. u stable Compacte ase Bot. EL. 11.85 5.AllStructuresBuriedThreeFeetorMoreorSubject Zones X (Min. Flood Hazard) a Community Panel No. Bedding,"T"s to Vehicular Traffic to be H-20 Loading.It is the Engineer's ' g, #250001 0757 J . Inspection Port, If..Efrtountereel Reppae & Replace Recommendation thatH-20Always be Used. July 16, 2014 -.._ . ;_ & Baffels all Vnsurtatale Soak tiY�thin ":cif t o 6.Install Watertight Risers and Covers to Within 6"ofFinished Grade as Per Title 5 The outer Perimeter of The Sys(am Over Septic Tank hilei;Outlet,D-Box,and One Leaching Chamber. . Location Map: ` All covers are to be maximum 18"for concrete or 24"Cast Iron. EL. 6.5 7.Septic System to be Installed in Accordance With 310 CAM 15.00& 1"=2,000±' No Groundwater 248 CMR 1.00-7.00 Latest Revision and the Town ofBarnstable Per Test Hole 1 DEVELOPED PROFILE OF SYSTEM Board ofHealthRegulations. �+�+ 8.All Piping to be Sch.40 PVC. ASSESSORS REF NOT TO SCALE 9.D-Box Shall Have a Minimum Inside Dimension of 12,and a Minimum Map 140 Parcels 210-001 Sump of 6". 10.The Separation Distance Between the septic Tank Inlets and OVERLAY DISTRICT.- Outlets .Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend a Minimum ofl0"Below the flow Line.Outlet Tees Shall Extend 14" AP - Aquifer Protection District PERC TEST: 15,486 Below the Flow Line,and Shall be Equipped With a Gas Baffle. PERFORMED BY:JOIN ODEA,PE- SULLIVAN ENGINEERING &CONSULTING,INC. SOIL EVALUATOR NO.2911 EiNt WITNESSED BY:DONNALD DESMARAIS,R.S.-TOWN OF BARNSTABLE i OCTOBER 2,2017 %iW SITE PASSED A ran d e av\ r` } r t TEST HOLE- 1 EL. 17.s TEST HOLE-2 EL.17.s u 1 Lawn ' OLAYER, .. . OLAYER... ................. ..... ..Proposed .... .... .... ... .. . LOAM . LOAM 1 ,1 r .. N4T 9„ ..... :. 16.8 10" . ... .. :°.. 16.7 1 Stone Wa Vent 97.07• B.LAYER.10YRsl8 BLAYER l0YR.518 �. fy f••.......... 6 Garden YELLOWISH BROWN YELLOWISH 17ROWN... . ; . . . . .. . ' 4tFf-� i� 35' M.SAND WITHSOME. ..... .. .14.6 32" M..SAND WITH SOW FM'S 14.8 ` � -g0.4 of 7 C LAYER 2.5Y 513 C LAYER 2.5Y 513 a� o ''• . c P op _ Lawn o 15,053±SF LIGHT OLIVE BROWN LIGHT OLIVE BROWNCL` W e tic o (} Setback Lawn l32' M.SAND 6.5 M.SAND E NO GROUNDWATER ENCOUNTERED 36" PERC TEST 14s l 6-- ` z s I -� 25 GALLONS IN 6 MIN 40 SEC. 1 Pro 120` PERC RATE<2M1N/IN(LIAR=0.74) 7s �' -Box Sep ti n1f 0 NO GROUNDWATER ENCOUNTERED .p Tank Patio Leah.R. Kesten w Proposed TH- ��:�� w Trustee - n�f i -D.rive \ tP Jones Family I / '`-Prop sed. Pro Pri. t I o Pied-A-Tree LLC i Court ar :� Lawn Ad tiQC► y Finish Grade 1 } Z 3 If Wat Pit 3' Max. ;ll 1 �� I , Il lil !ll - ll� 1 { �=111 =j i1 �11I�EI II► p o . Paved ro osed 167 Drive - o .� p 9" Min Compacted Fill Vent - Charcoal Filtered, to o Additions y Filter be field located in least e} "� r 2 St w f Fabric o i. . .l,. . . . . . . . . l conspicuous place or specified Dwelling And Or by landscape designer �' 2" 118" - 112" 3 b Pea Stone 1 1 Wa Existing Septic to r H-20 3/4" 1 112" 33.5 �+ t 1 be Removed !)� DESIGNDATA LEACHING Double Washed / f 1, � Patio Single Family �.._ CHAMBER Stone Cover to 6"'of 1 q)£ i/i Paved Drive Ys ' 23. 413edroom @ 110GPD )) �` � .•„ RR.Tie . . . . . . . . . Pro No Garbage Grinder Grade or Grade if ri ; to be ,� `Stairs / Total Daily Flow=440GPD �- 4' - 10' -1 Covered by Asphalt J Removed P� Addition❑ Use a 1500 Gal Septic Tank 12' - 10" 4' of 3�.. A i all Drive Under Crushed Stone it Proposed 1 (' 95 Garage ins ^ry LEACHING AREA Pro H-20 i� f Shed Pool i i .. P1ro 5\ob / to^ 90 GPD 10.74(LTAR)=595 SF Required CROSS SECTION OF CHAMBER 12.8 3-500 Gallo fI �r { SPa (j Sidewall=2(12.83'+33.5')2'=185.3SF Chambers 4.0 L .a .,_._ _ _, F = _ .mo/ G¢ Bottom Area (12 83'x 33 5) 429 8 SF Total Provided=615.1 SF(455.1 GPD) NOT TO SCALE :. i r� ,, , . . . .. . 0. ( `� LEACHING CHAMBER DESIGN Edge Setback' \` Lawn 4.0 r All Pipes to be Schedule 40. Use Brush ==-,x. . . D-Box S4 fi 3-500 Gal.Leaching Chambers in a OF SS 0� 51' 30'E 4' Chairr Proposed 12.83'x 33.5'Washed Stone Field as Shown. 9c 105 60 Link Bulkhead T. R®kl . Q �, Proposed SAS of Scale 1„=10, Michael D. Durand �Fc/sTER Slt� Plan �SS/ONAIE '�� Scale 1"=20' TI TLE. PREPARED BY. PREPARED FOR: NOTES: Site Plan 1) The property line information shown was Proposed Improvemenis En ij1ePrin Daniel G & Margret L. Sunderland compiled from available record information. m 73 Lake Street 2) The topographic information was obtained y AtU I n from an on the ground survey performed on -/ �+ } onsulting, hic. Sh erb orn, MA 01770 V 7 ESL �� R�C�d July 28, 2017. y (508)428.3344 • P.O.Box 659 • 7 Parker Road,Osterville,MA 02655 3) The datum used is NAVD '88. B M: seci@suilivanengin.com • wwwsuilivanengin.com al'nSta (Osterville) 5. Draft: CTR Field: WHKIIOD/CTR 20 p 10 20 40 80 L DATE: SCALE: Review: CTR Comp.: CTR November 13, 2017 1" = 20' Project: 370018 Project: Sunderland