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HomeMy WebLinkAbout0092 FALLING LEAF LANE - Health 92 Falling, Leaf Lane, Osterville 2 Bed A = 144 003007 y r I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments f 9 p Y ry, . wM 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is ill terve required for every Os MA 02655 ` Octobee-,t, 2016 page. City/Town State Zip Code Date of Ir%tection - C77 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information c filling out forms J 1 4P /1 9/3 ' on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, IRS use the return Name of Inspector key. Eco-Tech Rapid Response r� Company Name 155 George Ryder Road South Company Address Chatham • MA 02633 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails qN OF M ❑ Needs Furt he Local Approving Authority DAVID ( o U ANOWR % S October 3, 2016 Inspector's Sign I re � O Date C'/STERN r, The system ins t a copy of this inspection report to the Approving Authority (Board of Health or DEP) w • 0 ays 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. f - , t5ins,-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Propii y Address eon Eu ene L. and Frances C. Tur 9 9 Owner Owner`s Name information is =, required for every Osterville MA 02655 October 3, 2016 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 below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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.domplying septic tank as approved by the Board of Health. a' *A metal septic tank will pass inspection if it isf 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): f. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments ,M 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 4 Property Address 4 r Eugene L. and Frances C.Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3 2016 page. Citylrown 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. F ` ' 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): _ r ❑ 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: r, El Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 e Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is Osterville MA` 02655 October 3, 2016 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence,of.am Mon ia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: . D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 r , Commonwealth-of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 - Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is Osterville MA 02655 October 3 2016 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. 0 ® Any.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. • t ' ❑ ® 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: t. ❑ ' ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ f 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. l t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 5 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments o°�M 92 Falling Leaf Lane -Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2016 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 gpd t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 w S a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M •''v 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osteryille MA 02655 October 3 2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: A system sized for two bedrooms was installed by McShane Construction in 2000. Number of current residents:' Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? s ❑ Yes °Z No, Water meter readings, if available last 2 ears usage d 329 gpd 9 ( Y 9 (gpd)): , Detail: 2014: 101,000 gallons 2015:139,000 gallons(Irrigation system in use). Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? '❑ Yes ❑ No'. Industrial waste holding tank present? ❑, Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 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 wM 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner Was system pumped as part ofthe inspection? ;•,. - -❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Tur eon Owner Owner's Name information is Osterville MA 02655 October 3 2016 required for every , page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 16+ years. Certificate of Compliance for a new system was issued 9/22/2000 (Permit#98-15 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 . 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.):- Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): 0.5 Depth below grade: , feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ -Yes ❑ No _ Dimensions: 10.5 x 5 x 6-1500 gallon Sludge depth: 6 in t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 a , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances'C. Turgeon Owner Owner's Name information is Osteryille MA 02655 October 3, 2016 required for 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 28 in Scum thickness 0 in Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design Plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site Ian): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 ti Commonwealth of Massachusetts w Title 5 Official• Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 92 Failing Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2016 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): Dimensions: Capacity: gallons Design Flow: _ gallons per day Alarm present: a ❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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 adverse conditions observed. Pump Chamber(locate on site plan): working in Pumps Yes No* 9 order: ❑ ❑ Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 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 .. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: t ❑ leaching trenches ,number, length: ® leaching fields number, dimensions: 1 = 12 ft x 40 ft ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments,(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A hole was dug into leaching field stone and,no effluent contact staining was observed in the stone or overlying soils;.No standing effluent was observed to a depth of 6 inches below the.top of the peastone layer. i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer - Depth of scum layer Dimensions of cesspool ` Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 92 Falling Leaf Lane-Assessor's Map 144-Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2016 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.): { 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 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2016 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 M1; LEACHING L OC A T§O S NOT FIELD —OF SEPTIC COMPONENTS TO —DISTANCES IN DECIMAL FEET SCALE A 8 " l 40 32. [. DISTRIBUTION BOX 2 41.5 39 I 1500 GALLON SEPTIC TANK A THIS SKETCH IS 8 BEST VIEWED IN COLOR FORMAT EMS T#NG DW LUNG 92 W or .. PAVED w DRIVEWAY t 508 364-0894 FQLUNG LEAF LANE t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M .' 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+ 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: 1/8/1998 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 9.5 feet above the bottom of a witnessed test pit in which no groundwater or groundwater mottling was encountered. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 92 Falling Leaf Lane-Assessor's Map 144 Parcel 3-7 Property Address Eugene L. and Frances C. Turgeon Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2016 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 .. f Q - a 2 BOTTOM OF o LEA° C rMi NG MELD LEACHING PER DESIGN Z 0 U) PLAN I_ o a W t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 o� L' TOWN OF BA�jRNSTABLE LOCATION LsO� � �I lil c L Nail.. SEWAGE # VILLAGE OS6yAR �A �+ ASSESSOR'S MAP & LOT 'agg� INSTALLER'S NAME&PHONE NO. �►�\AL_'.P_ GIN-A, 47-7-Z�f3C% SEPTIC TANK CAPACITY f LEACHING FACILITY: (type) Tc_ r (size) L Xq0 NO.OF BEDROOMS BUILDER OR OWNER , - PERMITDATE: Nr COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 141 , AL q, r � ► z= M t � 78 4ci .. No. --,� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Migaaf *pgtem Congtruction Permit Applicatio or a Pe t Construct( Repair( )Upgrade( )Abandon( ) Xomplete System ❑Individual Components _ Lgcati dress or Lot o. 11� Owner's Name, ddress and Tel.No. �'�`/''! ssesso e , as1Z �lI eye G lk-A S WAcKf �e Assessor's Map/Parcel � l� b_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ' Dwelling 1—M.of Bedrooms L �` Lot Size, LWsq. ft. Garbage Grinder( C� Other Type of Building WNo cf'Persons Showers( ) Cafeteria( ) Other Fixtures ~"" Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets / Revision on Date c' Title — Size of Septic Tank szo C ox Type of S.A.S. 52 X40 U Description oaf Soil __- d �� �� 5p f .._�_r— �S VVl `�t�l d I I✓I/, -- X & —10-1 74[�10"N4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: DESIGNING ENGINEER MAST SUPERVISE INSTALLATION AND CERTIFY IN WRITING Agreement: THE SYSTEM WAS INSTALLED IN STRICT The undersigned agrees to ensure the construction and maMM1090 W B ribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue Bar of alth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued '� '- ! `j4 d +'' Fee d i E THE COMMONWEALTH OF MASSACHUSETTS Entered computer: r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPrication for )Diopooar *pgtem Con0truction Permit Application for a Permit to Construct( -Repair( )Upgrade( )Abandon( ) kCompl'to System ❑Individual Components L ati ddress or Lot No. Owner's Name, Address and Te.No. — Assessor'sMap/Pazcel /, L� W f P!7 U5 /L Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: -- bjrW Dwelling L'•`15o.of Bedrooms Lot Size t 5 sq. ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow s 5 gallons per day. Calculated daily flow <3 gallons. Plan Date / Number of sheets / Revision Date -7- 'Title 71- 1. - 05 Size of Septic Tank 1 `�� �P L.L 4 D Type of S.A.S. c`3' U -C Description q Soil 0 o'Z f `5V �yG[�. s�- - VVl a l U-w d rt-kj o, Nature of Repairs or Alterations(Answer when applicable) .Date last inspected: , J Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y tins Boar of ealth.(� Signed AOt, _ c Date y Application Approved by Date Application Disapproved for the following reasons ,A f . Permit No, �" "' Date Issued "® ---------------------------- LTHE,COMMONWEALTH OF MASSACHUSETTS r ,BARNSTABLE, MASSACHUSETTS :* er-tificate of tompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired,(' )Upgraded( ), Abandoned( )by at - ✓ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �' ' dated Installer Designer i The issuance of this p t Pall of be construed as a guarantee that th s will functio> de Date Inspector ` r ——— —J——— —— — ———————————— No. ""° �, -- � ----- —_-- — Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS loiopooal *pztem Congtruction Permit Permission is hereby grantee to Construct.( )Repair( )Upgrade( )Abandon( ) System located at InvL 7 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this-Termit. Date: Approved b .� w9V13 e:..:: ""'r-o' -o- t-�• ,•-a' T-r V-{ 3^ Y-r ) 7-r ♦-t Vr D r I TM IIT TO 1 � I � sic`=4•x n•-r I � O i 1 'i •bra - ItiG101Aly �� i. I 1 1 ®1 r I �♦ i�I p1�t•L � o r r-r u'-. a n p I �••� I O � E ABOVE , I , O 11 ' 0 CWWT , ,. ----------_ -----; > GRIM-AT ROOM �! wuuaAo ■ I x u t Q t x I{•-r _ ____ {Ar_ues.►_Z-q_!R�_ o r aQ i CAF$MCRAL 9-0- x - >, c I I i MCC AL �Cavf 7 OO U/ p O '. E ABOVE �T --- ' z.� nc Il ALL rA71t.t w „ � ' OffICE o 4 GA01- - T-� yr O Co, cr OASOVE T i cr +• r-o Vr \ 0 N - - . A I ,_ , BAXTER, NYE & HO'LMGREN, INC. Registered Professional Engineers and Land Surveyors 812 Main Street,Osterville,MA 02655 (508)428-9131 FAX:(508)428-3750 August 22nd,2000 Board of Health Town Hall 367 Main Street Hyannis,MA. 02601 Re: Lot 7 Falling Leaf Lane . Members of the Board; This letter is to inform you that the above noted septic system was installed in substantial compliance with the plan dated January 71h, 1998 If you have any questions or comments please call me. Very ly yours, phen A.Wilson,P.E. cc:McShane Construction 98023-7 Land Surveys Subdivisions • Septic Design • Wetland Filings Site Design farrFT " �:tp GA05ALQ �Ml�v mz' .5( 17AAl-`j FLOW = 3 x Ito =3ao ` ►o �' 1 .�--.-- tdo a Or ^sZMc rnN� - 3bv x2co'/.=GGo r t2� :-- US� 15D0 Gay. /' �+���• ,&pruG ATEoN AzzEA <o 5EPnc. AppP jet-nog-1 AVE& T>t<S16N io. PR..vPv�� Lj 51tx---w,&LL 5� r �� �TToM a>z 12 s 48 ry 7upv- s � PE:ZGOLATID4I I?dTE L• c,title/II,IGG1 t ( Ty • WILLIAM 3 C. N Y E •p Nc. 19334 (3�STE l4a� SUS`` - r-j'z AV TA-A1,O i • lug INt ;. .3 z lu Z. � TA►s� ;� S , T A j , �l�il_C3F" L.t-�1?sCL1 ..F11� PIPE TV 5E KEA 3' tic Ii,S( yEI�OPFDOFIt.� c (�J c. Sc I+ty�n 1Fi 5vu me OT PLASI Nd I�i R- 3I�t � -V l`/-Z, r 1r�GATtr 1 p Gt Dom Z.�-86o VW 5 H LED s7z'UC S6AL r-- : ( e � =s l0 .3v tl: F`f '["NAT T14 rr E 51�wN P11�1,1 IZ Yet tip A► z 4�N CAti1PL`IS 1d1IT1'•t T>� SIDELINt= .>D U�- � -7 nL PSG-3f38 P� z -fBAGtc. zEQVIZFM&I-T OF 1-146 TO Wa OF MAP 1414 - FAp1.>=L 3 $A4zVJST�h�A►1ti {5'poi LLtG.�T W 1 T►�I tJ /a -17 N`/E I NG 5?6�1 d 1. FlsbD HAZAZ.Z> -LO �AJJD SUQVEYr�S • SJ 16 t►16E�, W JJ,OL4A G 1J 1,002 I-Lf� oST�ev1:�..� MASS. oFFSer'S V:=OAn 8V u-t)I -'5 SNDtNt;, NOT 13� Q('fJ(�G4NT: G�E�.ysGct ATZ* i USt:D �b I6TY>5C..I•S%A FZOPE>ZT`� LIIJE°S. f STEPHEN` • , f ALj.YN The dwelling shall be limited2 be limited to drooms unless_the-septtc1system�is-moth '� "''�c, - - fed toe, . ! — a, VO �Oc1• ,in enhanc __-Mutrient removal as approved by the Board of Health in which ease a dwelling served by a modified system may be permitted to have not more than 3 bedrooms. G ;�u► REVISED:, :p. WLAJAM >ta a a TOWN OF BARNSTABLE ' LOCATION fiI�(�a LJ' IN- SEWAGE # VILLAGE �"Z Je YIN ASSESSOR'S MAP & LOTAN INSTALLER'S NAME&PHONE NO. ! 1'1rSC e_� ytiS C4ZY-IMCi SEPTIC TANK CAPACITY LEACHING FACIL-IT_Y ('rYpe) Irl (size) [7 qO NO.OF BEDRUi� IS � N BUILDER OR OWNER s' j PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f r _ � BL =. -Z/ =�� t2�iZ� , 1� TOWN OF BARNSTABLE LOCATION Lt3A 7` �II�►,e IP2� �rt�_ SEWAGE # VILLAGE L�P\f��W ASSESSOR'S MAP & LOT +���/' 44 INSTALLER'S NAME&PHONE NO. 1 �1Ct� _ �5 SEPTIC TANK CAPACITY i LEACHING FACILITY(type) _ (size) Z X q0 NO. OF BFDROOMMS " BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (H any wells exist i on site or within 200 feet of leaching facility) Feet jEdge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet i. Furnished by ------------- r � BL = ` w Lf72 r Town of Barnstable + iARNSTABLE. 16 9. ,• Board of Health lfDMpYA , 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Brian R.Grady,R.S. Ralph A.Murphy,M.D. Decision of the Board of Health Regarding Lots 1 •Through 14 and Lots 16 Through 25 Falling Leaf Lane, Osterville, Shown on Subdivision Plan dated February 11, 1984, revised April 23, 1984 and Identified as Parcels 3.001 Through 3.014 on Assessor's Map 144, and Parcels 3.016 Through 3.025 on Assessor's Map 144. PROCEDURAL HISTORY On November 18, 1996, the Board of Health agent, Thomas McKean, R.S., C.H.O., received twenty-four (24) disposal system permit applications along with two checks totaling $2,400.00 from Peter Sullivan, P.E., of Baxter and Nye Incorporated, who was representing O.R.E. Associates Incorporated and Osterville Highlands Trust pertaining to proposed construction. along Falling Leaf Lane, Osterville. The lots are located off of Acorn Drive, Osterville Massachusetts, and are identified as parcels 3.001 through parcels 3.014 on Assessors Map 144, and parcels 3.016 through 3-.025 on Assessor's Map 144. The disposal system construction applications indicated that parcels 2, 4, 6, 8, 10, 12, 14,` 16, 18, 20, 22, and 24 (all the even numbered lots) were owned by Osterville Highlands Trust. The remaining applications i indicated that parcels 1, 3, 5, 7, 9, 11, 13, 17, 19, 21, 23, and 25 (all the odd numbered lots) were owned by O.R.E. Associates. l On or about November 21, 1996, Mr. McKean disapproved all twenty-four disposal construction permit applications due to the fact that the plans lacked maximum feasible compliance with the State Environmental Code, Title 5. He also returned the checks totaling $2,400.00 to Peter Sullivan, P.E., of Baxter and Nye, Incorporated, and invited him to attend a Board of Health hearing scheduled on Tuesday December 17, 1996 in order to provide Mr. Sullivan the opportunity show why he, and the owners of the parcels,. believed it would be feasible to construct septic systems on these 24 lots which would meet the provisions of Title 5, the State Environmental Code. During the first hearing which was held on December 17, 1996, the applicant requested a continuance. Then the Board members voted to continue this matter to the February 4, 1997 ' public meeting. On February 4, 1997, the applicant again requested a continuance; then the Board members voted to continue this matter to the March 4, 1997 public meeting. Continuation hearings'were also held on the following dates during 1997: June 17th, July 1st, and August 19th. Many documents were submitted into the record by'both the applicants) and the Board of Health. The Board members rendered a decision on September 3, 1997 during a special public faring. FINDINGS OF THE BOARD OF HEALTH After discussion and based upon the evidence submitted, the Board of Health made the following findings: I. All 25 lots in the subdivision fall within a DEP approved Zone II of a public water supply: the Centerville-Osterville-Marstons Mills Water district wells CO# 10, CO AR#3,4, and CO MC#2. The Zone II for these wells was approved by DEP May 3, 1994. Further, these wells are showing nitrate levels in the range of 1-3"mg/L; these levels clearly exceed background nitrate levels (generally <0.5 mg/L)'and are indicative that nitrogen from human sources is reaching these wells. Septic systems are known to be the largest source of nitrogen to groundwater on Cape Cod. 2. All lots in the subdivision are within a DEP-defined nitrogen sensitive area as defined in 310 CMR 15.215(1). 3. Further, the majority of lots in the subdivision (lots 1-10 and 16-25) fall,within the town of Barnstable defined WP zone, the five year time of travel contribution zone to a public water supply. 4. Septic system effluent is a known source of nitrate and other possible contaminants to the public water supply. 5. Increasing density of housing is associated with increased levels of nitrate and other ntaminants in groundwater. M In recognition of 4 and 5 above, DEP has determined per 310 CMR 15.214(I), that no serving new construction in a nitrogen sensitive area designated in 31.0 CMR 15.215 shall 3 be designed to receive or shall receive more than 440 gallons of design flow per:day per acre except as set forth at 310 CMR 15.216 (aggregate flows) or 15.217 (enhanced nitrogen removal). 7. All lots in the subdivision are less than an acre in size. Further, all lots, except lots 23 and 21, are less than one-half acre (20,000 sf).. Under the nitrogen loading requirements of 310 CMR 15.214, the half-acre lots would be entitled to a 220 design flow, the lots less than one-half acre would be entitled to a 110 gpd design flow. 8. Under the Title 5 transition rules, 310 CMR 15.005, the owner of a lot on which construction of a septic system in full-compliance with 310 CMR 15.000 is not feasible-is entitled to construct a system with a cumulative design flow of up to 330 gpd provided that the system is constructed in compliance with 310 CMR 15.000 to the maximum extent feasible as determined by the local approving authority`pursuant to 310 CMR 15.404 and 15.405. 9. 310 CMR 15.404 (maximum feasible compliance) states that a non-conforming system may be brought into compliance through the installation of an alternative system (i.e. a nitrogen removal system with associated design flow credit may be used to bring.a system into compliance with the requirements of 310 CMR 15.214). 10. The Board is in receipt of a letter from DEP to William Nye (one of the applicants)dated February 4, 1997 stating that"the department interprets compliance with the requirements of 310 CMR 15.005 (3)(a) through (c) to require, pursuant to 310 CMR 15.005(c), a considered assessment by the proponent of approved nitrogen removal technologies when site limitations prevent attainment of the 440 gallon per acre design flow standard set for new construction,under 310 CMR 15.215(1)...", 4 11. The applicant is entitled to pursue an aggregate determination of nitrogen loading per 310 CMR 15.216 and DEP guidelines. It is this board's belief that the cumulative acreage in the subdivision, minus the acreage devoted to roads, when considered in the aggregate is sufficient to allow the construction of 2-bedroom homes (220 gpd.design flow) on twenty of the lots and this will be in general compliance with the nitrogen loading requirements of 310 CMR 15.214. 12. The applicant has acknowledged that lot 15 will be used for.drainage and is not to be considered buildable. , 13. At the hearings held on August 19, 1997 and September 3, 1997, the applicants proposed to the Board that dwellings located on 20.of the lots, which specific lots they identified, would be limited to 2 bedrooms unless the system(s) are modified to include enhanced nutrient removal as approved by the Board of Health in which case.a dwelling served by a modified system may be permitted to have not more than 3 bedrooms. The remaining four lots would be limited to not more than 3 bedrooms and said system(s) must be modified to'include enhanced nutrient removal as approved by the Board of Health. 14. Based upon the evidence presented, the Board finds that the applicants can achieve maximum feasible compliance with 310 CMR 15.000 through either 1) the construction,of 2- bedroom homes on twenty of the lots with the remaining four lots provided with nitrogen removal technology; the twenty lots must have appropriate restrictions placed upon their deeds to indicate that only 2 bedrooms are allowed, or 2) the installation of nitrogen removal technology on any lot will entitle the owner to a design flow of 330 gpd. 5 15. The applicant may choose in the future to present to this board an ' aggregate nitrogen loading which complies with 310 CMR 15.216;,this plan, if approved by the board, will negate the restrictions in 14 above. ACTION TAKEN BY BOARD OF HEALTH Based upon the Board's unanimous approval of the proposed u, findings, the Board of.Health voted to take the following action regarding the pending twenty-four applications for..disposal system construction permits submitted by the applicants, Osterville Highland Trust, John Alger,Trustee and ORE Associates, Inc.: A) Disposal System.Construction Permits shall issue to ORE Associates, Inc. for lots 3, 5, 7, 9, 11, 13, 17, 191 21, 25 and to Osterville Highland Trust, John Alger, Trustee for-lots 2, 4, 6, 8, 10, 14, 16, 18, 20, 24, as designed, said issuance subject to compliance with the following conditions: 1. All dwellings shall be limited to 2 bedrooms unless the system(s) is modified to include enhanced nutrient removal as approved by the Board of Health in which case a dwelling served by a modified system may be permitted to have not more than 3 bedrooms. 2. Each plan shall be modified by the applicants to include a notation containing the full text of the language recited in paragraph (A)(1) above. 3. Deed restrictions, approved as to form by the Town Attorney, limiting-the use of the 'ellings to two bedrooms on each of the above-referenced lots shall be recorded at the stable Registry of Deeds. A copy of the recorded deed restriction for the particular lot for 6 which a Disposal System Construction Permit is sought shall be provided to the Barnstable Board of Health prior to the issuance of a Disposal System Construction Permit. (B) Disposal System Construction_Permits shall issue to ORE Associates, Inc. for lots I and 23 and to Osterville Highland Trust, John Alger, Trustee for lots 12 and 22, as designed, subject to compliance with the following conditions: 1. All dwellings shall be limited to not more than 3 bedrooms and said system(s) must be modified to include enhanced nutrient removal as approved by the Board of Health. 2. Each plan shall be modified by the applicants to include a notation containing the full text of the language recited in paragraph (B)(1) above. (C) No permit shall issue for lot 15 which has been designated; pursuant to the initial subdivision approval by the Planning Board, as a lot reserved for drainage. (D) The issuance of the permits, as restricted, shall not prejudice or otherwise limit the right of both applicants, jointly or severally, to file with the Board of Health and the DEP a plan pursuant to the provisions of 310 CMR 15.216(2);nor shall the mere filing of such a plan obligate the.Board of Health to approve same. , VOTE: IN FAVOR OF DECISION RASK, GRADY, MURPHY OPPOSED: NONE Dated: October 7, 1997i Susan Rask, Chair Barnstable Board of Health +' M c � a� Eacc4E oana E 77777777 0 3. ca - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -, /3 ;tNs Y (UNFINISHED) 43 • O "i x • I wl o r- �^` i - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ — _ _ — _ _ _ _ _ _ i A f boxed-in beam depth 9" width 31" T _ O• _ 43 - new 2x6 CD v NOTES: 20'-0" I install owner-supplied bookcases(2); N location T.B.D. build shelf under rn ' existing windows xl c Y a remove and reinstall existing - r — . rn wl ceiling panels around perimeter (finished)as needed I I V °�' in GRAFT ROOM existing ceiling fixtures to remain.' o CARPET x �l73 J3 F • �T box-in existing pipes I �j �S (unfinished interior) = ai (UNFINISHED) ;34 add 18"wide b panel door I I � Z _ r d - N G w m B • F'� �� 2 b/6 anel abs ~ F J - - - - - - - - - - - - - - - - - - - - - — — — - - - - - - - - - - - - - - - -. I 1 Date: • 4-30-11 _• Revisions: BASEMENT PLAN scale: 1/4=1-0 Final Plans: 4 1 Lx BUILDER TO CONFIRM ALL CONDITIONS , AND DIMENSIONS ON SITE Accepted by: Date: Note:These plans are for the sole purpose and Q ,1 ` use of Capizzi Home Improvement and are not to be distributed or used for construction other o Accepted by: Date: than by Capizzi Home Improvement.