Loading...
HomeMy WebLinkAbout0143 HICKORY HILL CIRCLE - Health 143 Hickory Hills10 Ostervillc ; A 121 - 038,. " y t i Commonwealth of Massachusetts 1 a aa8 iy Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessmentsv < / 143 Hickory Hill Circle t§ Property Address t. Matthew& Diane Gianatassio 3 Owner Owner's Name/ information is required for every Osterville ✓ MA 02655 03/29/2021 page. City/Town State Zip Code Date of Inspection k Inspection results must be submitted on this form:Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 51*-15307 on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key,.... 52 Rivers End Road r� Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 03/30/2021 In peck tor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 t Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This 4 bedroom home has an H-10 1500 gallon septic tank with an H-10 D-Box feeding a 40'x 20' x 2' leaching trench with 6 Cultec 330s and stone. At the time of the inspection no visible failure criteria was found. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Hickory Hill Circle V Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /n 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 - page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface.water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. j 6. You must indicate "yes" or"no"for each of the following for all inspections: 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. ® El approximation 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. 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 plus GPD Description: 'Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): town water Detail: In 2020- 173,000 gallons were used and in 2019-94,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e � 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 09/25/2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 32"feet Material of construction: ❑ cast iron ®40 PVC - ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is Osterville MA 02655 03/29/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"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: H-10 1500 gallon Sludge depth: 3' Distance from top of sludge to bottom of outlet tee or baffle 33" 1 Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 HickoryCircle Hill C c e Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts a = Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: El 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 9. Distribution Box(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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. 1 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (1)40'x10'x2'w/6 Cultec 330s ❑ .leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �e 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.)' Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �., 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 f c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 **As-Built from the installer attached on next page** i a t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Assessing As-Built Cards https://townofbamstable.us/Departments/Assessing/Proper y_Valu... TOWN OFBARNSTABLE LOCATION ZY2 ���� SEWAGE# Z2 0- GG VILLAGE Ofl{/VI 11e ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. 5 A 13 ,.J ' - SEPTIC TANK CAPACITY ($� _ _ •�" LEACHING FACILn-Y:(type)61Aec 3 50 —(size) y0,Y10X2 NO.OF.-BEDROOMS I/ OWNER PERMIT DATE 9,;?0 u Q COMPLIANCE DATE: 5 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 A) . % �e 9 36 r'(0'J' 4'JG 4 . S -GCS z 3 33 4 N8 LEY k 1 of 1 3/27/2021, l l:29 AM r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Matthew& Diane Gianatassio Owner Owner's Name information is required for every Osterville MA 02655 03/29/2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts: ti Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for,Voluntary Assessments 143 Hickory Hill Circle: Property Address Andrew and Jennifer Milk, Owner Owner's Name information is Osterville MA 02655 A rii 13, 2012 required for every p page. Cityrrown State -Zip Code Date of Inspection Inspection results must be submitted on ttis,form. Inspection forms may not be altered in any: Way. Please see completeness checklist at the end of the form: Important:When A. General Information filling out forms on the computer, use only the tab 1 Inspector: key to move,your . : i cursor-do not David_D. Coughanowr, R:S use the return` key. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City[Town State Zip Code 5.08 364-0.894 1328 Telephone Number License Number B. Certification LU ,f,,l certify that I have personally inspected the,-sewage disposal system at-this.address and that the c-anformation reported below is-true, accurate and completeas 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 trs sewage Fdisposal systems. 1 An!.a DEP approved system'ins pector pursuant Section 15 3.40 of -� Title.5(310.CMR 15.000).The system::; fys l ® IPasses` ❑ Condlttonally Passes ❑ Fails ❑ feeds Further Evaluation ythe.Local Appoving.Authority, �-s April 13,2012 Inspectoes Signature Date The system inspector shall:submit a copyof this inspection"report"tolhe Approving Authority(Board of Health or DEP)within 3'0 days of completing this'inspection'. If the:systerr is a shared system or has a designflow of 10,000 gpd.orgreat6 the inspector and the.system ownershall submit the report to the4ppropriate regional office of the DER The.original should be sent'to the system owner and copies:sent to-the:buyer, if applicable, and the.approvingrauthority. *'*This report only describes conditions-atthe.time of inspection and under the conditions.of use at,that time.'This:inspection does not address'how the system will performlirrthe future under the same or different conditions of use. 15ins,•141iQ Tillo$`Of6cial In ct Form;Subsurfabe)Sawage:Disposal System:e Fags l.of'17 Commornwealth of Massachusetts, _ - Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form-Not for Voluntary'Assessments 143 Hickory Hill Circle Property Address Andrew and Jennifer Milk Owner owner's Name information is required for every Osterville MA 02655 April 13, 2012 page: Cityrrown State Zip Code Date of inspection B. Certification (cont) Inspection Summary- Check A,B,C,D or.E1 always eo`mplete all of Section D Al System Passes: I have not found any,information which indicates that any of the failure criteria described. in 310.CMR 1.5.303 or in'310 CMR 1,5.304exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> 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 475. 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 lobe replaced or repaired: The system, upon completion of the replacement or repair, a&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,septictank.is metal and over 20 years old`or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration;orrexfiltr.ation 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): 15ins-11110 Title 5 0fficiel inspection Form:Subsurface Sewage Disposal System-Page 2'of 17 l Commonwealth of Massachusetts. Title 5 Official In pection Form Subsurface Sewage Disposal!System Form- Not for Voluntary Assessments 143 Hickory Hill Circle Property.Address j Andrew and Jennifer Milk- Owner Owner's Name information is required for,every 'Osterville MA 02655 April 13,:2012 page. City1rown State Zip Code Date:of Inspection. B. Certification '(cont.): B) System Conditionally Passes(cone.)! ❑ Observation of sewage backup or break out or high;static water level in the distribution box due to broken orobstructed pipe(s)�or du'e 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 s'removed ❑ Y` ❑.'N ❑ ND(Explain below): ❑ distribution box is.leveled o.r replacetl; ❑ Y '❑ N ❑ ND (Explain IoW)- El 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 be low): ❑ obstruction isxemoved ❑ Y ❑ N ❑ ND;(Explain below): C), Further Evaluation is Required by the Board of Health: El Conditions:exitt'Which require�furtherevoluation by the Board of Health in order,to deterrhine if the system is,failingAol protect'public:health; safety;o�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:6 surface water, Cesspool or privy is.within 50 feet of a bordering vegetated wetland.ora salt-marsh t5ms•-11170_ Tilie 5'OfGcial Inspeclion Form,.Subsurface Sewage Disposal,System•Page 3 6f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not.for Voluntary Assessments Y 143 Hickory Hill.Circle Property Address Andrew and Jennifer Milk Owner Owner's Nam& information.is required for every Osterville MA 02655 Aril 13, 2012, page:, City/,Town, We Zip Code Date of Inspection B... Certification 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.systern (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply: ❑ The system has a septic tank and SAS and the.SAS is.within a Zone 1 of a,public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from.a private water supply well**. Method used to determine distance:. ** This system passes if the well water analysis; performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent,and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure,criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to.All Systems,. You must indicate"Yes or "No"to,each of-the following for all inspections:. Yes- No ❑ Backup of sewage into-facility or system component due to overloaded or clogged SAS or cesspool 1:1_ Discharge orponding of effluent to the surface.of the ground or surfac-e vaters 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 ElLiquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins-111,10 Title 5 officiai ihspeclion Form:Subsurface:Sewage Disposal System Page 4 of'17, Commonwealth of Massachusetts _ Tide 5 official !n pection Form. Subsurface.Sewagee Disposal,System Form Not'for Voluntary Assessments. 143 Hickory Hill Circle Property Address Andrew and Jennifer Milk Owner Owner's Name information is required for every Osterville MA;_ 02655 April 13,2012 page. Citylrown State' Zip Code Date of Inspection. B. Certification (cont.) Yes No El Z Required pumping.more than 4 times in the last year.NOTdue tdclogged 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'10.0 feet of a surface'watersupply or tributary to a_:surface.'watbr.supply. ❑ 0 Any,portlon:of a cesspool.or privy is within a Zone71 of`a publicwetl. ❑ Any portion,:of.a cesspool or privy is within 50:feet°of'a private water supply well, ❑ 0 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'[hdicatcmabsent 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 S.a cesspool serving a facility with a design flow of 2000gpd 1.0,000gpd.- ❑ Z Tlie system fails..)have determined that one or more.of the abovo'failure criteria exist as described in 310 CMR 15.303; therefore the system fails. The System owner should contact the Board of Health to determinewhat.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 ❑_ ❑ thesystemjssWithinA00 feet of:a::surface drinking water supply ❑ ❑ the system is within_200 fleet of.a„tributary to a surface.drinking water supply El Elthe.system,is located in a. 'nitrogen sensitive area Interim Wellhead Protection. Area—IWPA)or a mapp6d.Zofie,ll,.of a public water supply well If you have answered_"yes'"ff 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 ordperatorof any large system considered a:significant th:reat.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 t5in3 17ff0 Tiflo 5Official Inspection form;:Subsurface Sewage Disposal System:Page,S of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Fi6rrh Not for Voluntary.Assessments 143,Hickory Hill Circle. Property Address, Andrew.and:-Jennifer jenhif6r Milk Owner Owner's Namia information is required for every Cisterville MA 02655 April 13, 2012 page. Cityrrown 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 E El Pump.in9 information was provided by the owner, occupant, or Board'of Health El 0 Were any,of thesystem components pumped..out in the previous two weeks? Z, Ell Hap.the system,received normal.flows"in the previous two week,period? El 0 Have large volumes',of water been introduced to the system recently oras part of this inspection*) M EJ Were as built plans.of,the system obtained.and,examined? (If they were not available note as N/A) 0 El Was the facility ordwelling inspected fcie:signs of sewage back up? Z F-1 Was the site inspected for signs of break out? • El Were all system components, excluding the SAS, located on site? • E] Were the septic,tank manholes uncovered, opened-, and the interior of the tank, insppc,ted for the condition of-the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Z' El' Was the facility owner(and occupants if different from owner.) provided with information on the proper maintenance.of,su bsu rface,sewage disposal systems? The site and location of'the,$oil Absorption System (SAS) on the site has been deterMinedtased on: z E] 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 C- Mk 15.302(5)] D. System Information Residential Flow Condit.],ons; Number of bedrooms,(design): 4 Numberof bedrooms (actual): 4 DESIGN flow based on 310 CMR'1 5.20.3(for xample.. 110.gpo,X#,ofbedrooms): 440 gpd t5ins-11410 title 661ficial Inspection Form:,Subsurface Sewage Disposal System-Page of 17 Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments: 143 Hickory Hill Circle Property Address Andrew and Jennifer Milk Owner Owners Name information is required for every Ostelville MA `02655 April 13, 2012: page. City/Town State Zip Code' Date of Inspection D. System Information Description:, Number of current residents: 2 Does residence have a garbage-grinder? ❑ Yes No Is laundry on,-a separate sewage system?[if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes M No Water meter readings, if available,(last 2 years,usage,(gpd));: 282 gpd Detail: 2010, 2011 Sump pump? ❑ Yes Z No current Last date of occupancy; Date Commercialllndustrial Flow Conditions:. Type of Btablish:menf; Design flow(base d'.on 3TO-GMR 15.203) Gallons per day(gpd) `Basis of design flow,(seafsLpersoris/sq.ft,, etc.) - Grease trap present? ❑ Yes ❑ No, Industrial.waste holding tank present? ❑ Yes ❑ No �Y 9 y ❑ 'Yes ❑ No: Non-sanita'; 'waste=dischar ed to the Title 5 s stem?:, Water meter readings,.,if available: --- t5ms•11I10 TH16 5'OKcial Inspection Form:Subsurface Sew ago,Disposal System Page 7:oi t7 Commonwealth of Massachusetts - Title 5 Official. Inspec ion Form _ Subsurface Sewage Disposal System Form-Not-for Voluntary Assessments 143 Hickory Hill Circle: Property Address Andrew, and Jennifer Milk Owner Owner's Marne information is Ostervllle. MA 02655`' April 13 20.12 required for every , 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 of the inspection?- E Yes E No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System:' Septic tank, distribution box,soil absorptionsystem EJ Single cesspool ❑ Overflow cesspool ❑ Privy El 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 IlA system by system operator under contract Tight tank.Attach a copy of the DEP approval. El Other(describe): 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-P..age.8 of 17 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary".Assessments 143 Hickory Hill Circle Property_Address Andrew and JenniferMilk, Owner Owners.Name information is required for every O'steryille MA, 02655 April 13, 2012 page. CityrTown. State Zip Code Date of'Impection D. System Information (cont) Approximate age.ofall components; date installed'(if known')-:and source of'infOrmation: Age:3+ years. Certificate of Compliance issued 9/25/2008. (permit#2008466). Were sewage,Odors:detected when arriving at.the Site, ❑ Yes; Z No. Building Sewer(locate on(site plan) 2 :Depth,"below grade; feet Material of construction:, ❑ cast iron 0 40 PVC ❑ other(explain):; Distance from private water sUppiyWell or suction line'; feet: Comments(on condition:of joints,,venting, evidence of;leakage; etc.;): Sewer line appears struoturaflysord with no evidence of leaka a or biackup into dwelling: Septic Tank.(locate On site,plan);' Depth below grade: 2.5feet Material of construction: concrete '❑,,metal ❑fiberglass ❑ polyethylene El other(.explain) If tank i"s.metal, list age: years: Is.age confirmetl by a Certificate,of-Compliance?`(attach a copy of certificate), ❑ Yes-❑ No 10.5 x.5:X 6= 1500 gallon tank Dimensions:; - , ,Sludge:,depth 2 in 15ins:•.11/10 Title,5Official Inspection Form;Subsurface Sewage'DisposalSyslern,•Page-9:of 19' Commonwealth of'.Massachusetts Title 5 Official Inspection Form Subsurtace Sewage,.Disposal System Form-Not-for Voluntary Assessinents f 143 Hickory Hill Circle Property Address ,Andrew and Jennifer Milk Owner Owner's Name information i e required for every Qsterville MA 02655- April 13, 2012 -. 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 32 in Scum thickness° trace Distance from top of-scum to top of outlet tee ors 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, structur Fintegrfy, liquid levels as,related to outlet invert, evidence of leakage, etc.): Liquid level at outlet invert. Pumping not required at this time, but maintenance pumping is recommended within and every 2 years. Tank'and tees;appear structurally sound.and functioning as intended. No evidence of leakage in or out was observed; 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 6f outlet tee or baffle Date of last pumping: Date l5ins-11110 Title S oKcial 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 143 Hickory Hill Circle Property Address Andrew and Jennifer Milk Owner Owner's Name information is required for every Osterville MA 02655 April 13, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 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 tMicial Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form -,Not for Voluntary,ASsessments �w— 143 Hickory�Hill Circle PropertyAddess Andrew and Jennifer Milk> Owner Owner's Name_' information is Osterville MA, 02655 Aril 13, 2012 required for every p page. Cityrrown State Zip Code: Date of Inspection D. System Information (cost.) Distribution Box.(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert atoutletinvert .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.) Distribution box appears structurally sound and function ingas intended. No evidence of leakage in or out was observed. Few solids in sump: A:bucket.of water was poured into the distribution box and was observed to pass.through in a rapid and unobstructed manner. No, staining above the normal operating level was observed. 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•9 V10 Ti11e 5 Official lnsr>edtion forms'Subsurface'Sewage,Disposal,System•Page i2 of'l7 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal'.System Form,-Not for Voluntary Assessments 143 Hickory Hill Circle Property Address Andrew and Jennifer Milk° Owner Owner's Name information is required for every Osterville MA 026,55 April 13, 2012 page. Cityrrown State Zip Code Date of°Inspection D. System Information (cant.) Type: ❑ leaching.pits number: El: .leaching chambers number. leaching galleries;. number: 1 ❑ leaching trenches number; length: leaching.fieldis. number, dimensions: El overflow cesspool number: innovative/altemative system Type/name of technology:: Comments(note condition of soil;;signs:of hydraulic failure, level of,ponding, damp soil;,condition of vegetation;etc.): ;Solis above,leaching gallery appear.unsaturated, No evidence of surface ponding, breakout, lush vegetation;or other evidence of hydraulic failure was observed. A-bucket..of 1waterwas poured into .the distribution box and was observed to pass.through in a.rapid and unobstructed manner. Cesspools (cesspool must be pumped as part'of inspection) (locate,on site plan) Number and configuration .Depth:-topof,llquld t`o Inlet;invert] _ — Depth,.of solids layer Depth-:of-.scum layer Dimensions of cesspool 'Materials f.construction -- Indication of;groundwater inflow ❑ Yes ❑ No 15ins•11/10 Tille S.OKcfat lnspec6on Form:Subsurface Sewage Disposal.System+Page 13'of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ — Subsurface Sewage Disposal`System Form-Notfor Voluntary,Assessments - 143 Hickory Hill Circle Property Address Andrew and Jennifer Milk Owner Owner's Name information is psterville MA; 026.55 _ April 13, 20.12 required for every — page. cltyrrown 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, 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•11110 Title 5 Offidal lnspegon Form".Subsurface Sewage Disposal System•Pago 14 of17. Commonwea"Itf of''Massachusettbv y ot�e 5 Off kJ 1 Qhszpe: Subsurface Sewage Disposal System;Form-Notfor Voluntary,Rssessments; - -- 143`Hickory'Hill'Circle a _ . _ . - Property Address Andrew and�;Jennifer Milk Owner - -- Owner?s Name. - infomiation is reguired'torevgry Osterville= MA. 0265`5 April.1'3, page. City.,Town State Zip Code; Dated inspection D: System Infiormafiion Sketch Of:Sewage Disposal:System Provide a view of._fhe.s.ewage disposal system, 'including ties to at least two permanent reference landrna�ks of benchmarks. Locate all wells:within 1'00 feet•.-Liocate' where:.public water,supply enters the`building.:Check one:of.the.boxes below: hand=sketch lh the,-area below El drawing attachedsepprat6ly t � 0 C � c L. t5urs; t/110' Tine,5.orrie al 4upacgon:Fo rat Su6siWka l.$o�tiage Disposbf Sydtem=Page 15 of 1Z Commonwealth of.MaSsachusetts `.i Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 143.Hickory.Hill Circle Property Address Andrew and Jennifer Milk Owner Owner's Name information is required for every Osterville MA 02655 April 13, 2:01 Z page. Cityrrown State .Zip,Code Date of Inspection D. System Information(cont:) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar El Shallow wells; 20'+' Estimated depth to high ground water;;: feet Please indicate all.methods used to determine the high.ground water elevation- Obtained from system design plans on record 1f checked, date of desi n _lan reviewed; 6/19/08 g p Date El Observed'site(abutting property/observation hole within 150 feet,of SAS) Checke'wit,K local Board of Health-explain: Barnstable GI.S Department-T-cords Checked with local excavators, installers-(attachAocumentation) ❑ Accessed USGS database_explain: You must describe how:you established the high ground water elevation: Approved design plan.on.file with the Board of Healthshows'bottorn of system to be 5.feet above'the bottom of a test pit in which no groundwater or groundwater molting was observed. Town of Barnstable GIS Department records-:indicate that'the.property,is over 20.feet above groundwater table: Before filing this Inspecti on Report, please see Report Completeness;Checklist on next page. t5ins-11/10 Tille.5 Official Inspection-Form;Subsurface'Sewage Disposal Syslem;Page 16 of 17 Commonwealth of Massachuset' _ = Title 5 Official In pection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Hickory Hill`Gircle Property Address Andrew and Jennifer.Milk Owner Owner's Name ro isrequired.fr:ev eryOsterville MA 62656 Anl"13, 2012 page. City/Town state Zip Code Date:of Inspection E. Report Completeness Checkiisf ® inspection Summary: A; B„ C; D, orE:checked, ® Inspection Summary D.(System Failure Criteria Applicable;to Al S' tems)completed System Information—Estimated':depfh to high groundwater ® Sketch,of-Sewage Disposal System either'drawn on'page 1:5 or:attached in separate file l5ins'r:;11l10 Titio'5 Official insooi JUbn Form;:'Subsurface Sewage,Disposol System' Page;:J7:of_:17 (/ Town of Barnstable P# Department of Regulatory Services ' Public Health Division Date' 200 Main Street,H yannb MA 02601 Date Scheduled O�AY Z/� ZOog Time // oa 'Fee.Pd. l04' Soil Suitability Assessment for Sewage Disposal Periormcd By._2161-1R20 d OW6;gl7 ," Witnessed By: "7` MC �<EAA/ LOCATION & GENERAL INFORMATION don Address — Owner's Name po/J•q[n 91t�07q4/ /4 3 N/LL C°/2CCF " �.QA/ wooer ' F72N_sTfil3[.F Address /cKarZ �. �h-' I EA?ti/s Map/ParaLMAP /Z/ f�/1CrG 038 Engineer's Name /CHARD D N .' NEW CONSTRUCTION ✓ REPAIR Telephone# 50 A 8 394 d Use /C,1 s/,qF_NT//-J L Slopes(96) Surface stones ^/ p stances from Open Water Body ZOOG f ft Posslble Wet Area 2000 f ft Drinking Water Well ft —!� Drainage Way ft Property Une ft Other ft KETCH:(Street name,dimensions of lot,exact locations of test boles&perc tots,locate wetlands fa proximity to holes) � 1 � sTK S yY Z 0 /5 Z Gi l0 7 Z SF h qz N M ® r/6 ® l4GD Off' M. N N N srv, -e I cKo�,� Hi�c Clrec PEfZ. so/<- 5 tv2\/E Y /?,2,!2/2/ sh/EF_ T 27 Cc Q ,zVFrz �aA�i�/'C oA25r _Sinn/D/ 32 To 8 Z scor-F Parent material(geologic)ZRO OUT)n/.45 H Depth to Bedrock V r Depth to Groundwater. Standing Water In Hole: Weeping hom Pit Paea K A Estimated Seasonal High Oroundwater )=2 Div r or-- L O 7- Z&Z0 ,L O 13 F 30 ' 43oV,�- G'/Z04//v o w i9 rE tZ DETPUvENATION FOR SEASONAL HIGH WATER TABLE Method Used. S In.19?5 Depth ed standing in obs.hole: In, NO to foil mottlaw 1p. Depth to weeping from side of obs.hole: in.`-0mundv+atst Adjustment Index Well N Reading Datr - hoex Well level Ad).factor Adj.Groundwater Level PERCOLATION TEST Data ;EZZ4 rime Observation Hok a # Z cast "[late at 9" Depth of Pere 5 Z," 5'¢" 'time at 6" Start Pre-soak Time® Tlma(9"-6") End Pm-soak At 2 Z.rn,�r ZZ sN r` Farr 3 oao� 'T 4 / i»/�✓ ¢O sFC Fore 3 .P?oP Rate'MinAnch L Z Z Site Suitability Assessment: Site Passed ✓ Site Paikd: Additional Testing Nailed(Y" 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:\SE nC F-RCPORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sal Texture .Soil Color Soil other Surface(in.) (USDA) (Munseu) Mottling (Structure,Stoa4 Boulders. 5 . G. /p '/./z 3/Z ^/p DEEP OBSERVATION HOLE LOG Hole# z Depth from Soil Horizon Sal Texture Soil Color Soil Other Surface(ice) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. .O - 9" 1:2 5 , G /p '/R 3z 9"- 31 13 C'oAl2 sOF DEEP OBSERVATION HOLE LOG Hole# 3 `l Depth from Sal Horizon Soil Texture Soil Color Sal Other Surface(in.) (USDA) (Mumsell) Moulins (Structure,Stones,Boulders. o - 9" 19 .s. L /G '/R 3 Z Al a 9 3/` 1i3 / , S. /p YR s. 3/ l23 C (20,4/Z5�v )O Y!1 DEEP OBSERVATION HOLE LOG Hole# 4 Depth from Sal Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseil) Mottling (Structure,Stones,Boulders, 0 -/2 19 S. L . /a YR 3 z No l2 - .33" 13 Z . S. /� Y2 . S� f � s. y. 33..- / zG.. C0,9/Zs 6 f e n'g�� s. 5. s¢,. Flood Insurance Rate Man: * T - Above 500 year flood boundary No T Yes Within 500 year boundary No_ Yes ' Within 100 year flood boundary No— Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas obserrved throughout the area proposed for the soil absorption system? ` 9 S If not, what is the depth of naturally occurring pervious material? Certification I certify that on 14 0 (date)I have passed the soil evaluator examination approved by the Department of En nmerltal Protection and that the above analysis was performed by me consistent with . the required training,ex 'se experience described in�10 CMR 15.017. Signature / '�—- Date ' II Q:1SP-P'T KVMCAORM.D0C J 8. There were four (4) bedrooms in the house as shown on the attached floor plan which I have drawn from my memory of the layout before the fire. Please see a copy of my floor plan attached hereto as Exhibit B. Signed under the pains and penalties of perjury on this day of November, 2007. CD -/-(r)7rn (SNfrrK Jani S. Barber, -A i Co dm nistratrix 602960 21148 We, DAVID J. CARVALHO and EMILIO R. CERCI, both of Brockton, Plymouth County, Measw:husetts in consideration of Twenty-eight Thousand five Hundred ($28,500.00) Dollars grant to DON AIKMAN and VIOLET AIKMAN, husband and wife, as tenants by the entirety, both of 143 Hickory Hill Circle, usterviiie, Barnstable County, Massachusetts, with gttltriaim roatnanta the land An with the buildings thereon situated on the easterly side of Hickory Hill Circle in that part of Barnstable known as Osterville, Barnstable County, Massachusetts, being shown as Lot 15 on "'Hickory Hill, Subdivision Plan of Land in Osterville, Barnstable, Mass., for John A. Lemos", dated September 29, 1965. I drawn by Charles N. Savery Co., Surveyors, which plan is recorded with Barnstable County Registry of Deeds in Plan Book 199, Page 31, said lot being bounded as follows:- Westerly by Hickory Hill Circle, one hundred eleven and 66/100 (111.66) feet; Northerly by Lot 14 on said plan, one hundred thirty-five and 96/100 (135.96) feet; Northeasterly by land of the estate of Ethel M. Scudder, as shown on said plan, one hundred sixty and 65/100 (16065) feet; and Southerly by Lot 16 on said plan, one hundred eighty-five and 01/106 (185.01) feet. Containing 20,420 square feet of land, more or less, according to said plan. Said premises are conveyed subject to and with the benefit of easements and restrictions of record, so far as now in force and applicable, and together with the right to use the streets and ways shown on said plan for all purposes for' which streets and ways are commonly used in the Town of Barnstable, and in common with others entitled thereto. For reference to title see deed of P.M.C. Home Builders, Inc. to the within Grantors, dated April 27, 1976, and recorded with_the Barnstable County Registry of Deeds in Book 2331 at Page 61. This conveyance is made subject to a mortgage held by the People's Savings Bank of Brockton with a balance of approximately $35,500.00, which the Grantees hereby assume and agree to pay. Executed as a sealed instrument this dayol tONWW^FAAL�LTH OF MAV ACHUSETT611WE w q C (>ibt(fammanmtaitl+of 9laae l;Mtte Plymouth Then personallyappeared the above named David J ;:Cai^Y;IhQ ;;ndi. 91i0 R. CerC1 gv IKI and ucknowledged the(orogoing instrument to be th i rX �� �n .11 Before me, 'Donna M.• SL t6e. y'' v.• Notary Public Mycom�nWslon4igitq rch 7, 1986 RECORDED AU& a 1979 ;" 1 n o So.mes Do nc-veA A km cam IW3 F41*c.kory W ►1I Circle 05ter ) Ill, Mkt VaAP5•5 Deck sa h ZeA 'coo m - i4 c6en ' era; ns { t3exi �o►a m 3 ed r no m Livin3 UP �Ct� LEVEE.. TN t t3 A�T4-F t k , y 5 C.ct r00 m. 44: } hoLiER LtvGL- 4 Btc 22975 Pz331 r06-12-200 aY 12 =370 im DEED RESTRICTION WHEREAS, DONNA JO-ANNE POLAK, individually, of 60 Burroughs Street, #32, Jamaica Plain, MA 02130 and JANIE SUSAN BARBER, individually of 10 Hyannis Avenue, Hyannis Port, MA 02647 and DONNA JO-ANNE POLAK, JOSEPH FRANCES POLAK AND JANIE SUSAN BARBER, TRUSTEES OF THE DONALD AIKMAN FILM TRUST, under a Declaration of Trust dated December 30, 1995, are the owners of 143 Hickory Hill Circle located LbC�CJ� in Osterville,Massachusetts 02655 (herein referred to as"Subject Property") and being shown as Lot 15 on "Hickory Hill, Subdivision Plan of Land in Osterville, Barnstable, Mass. for John A. Lemos, dated September 29, 1965, drawn by Charles N. Savery Co., Surveyors," which plan is recorded with Barnstable County Registry of Deeds in Plan Book 199, Page 31. WHEREAS,DONNA JO-ANNE POLAK,individually,JANIE SUSAN BARBER, individually, and DONNA JO-ANNE POLAK, JOSEPH FRANCES POLAK AND JANIE SUSAN BARBER, TRUSTEES OF THE DONALD AIKMAN FILM TRUST, as the owners of said lot have agreed with the Town. of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code,Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW, THEREFORE DONNA JO-ANNE PO LAK,OLAK individually, JANIE SUSAN USAN BARBER, individually, and DONNA JO-ANNE POLAK, JOSEPH FRANCES POLAK AND JANIE SUSAN BARBER, TRUSTEES OF THE DONALD AIKMAN FILM TRUST, do hereby place the following restriction on the above-referenced land in accordance with its agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. The Subject Property may have constructed upon the lot a house containing no more than four (4) bedrooms. The said owners, DONNA JO-ANNE POLAK, individually, JANIE SUSAN BARBER, individually, and DONNA JO-ANNE POLAK, JOSEPH FRANCES POLAK AND JANIE SUSAN BARBER, TRUSTEES OF THE DONALD AIKMAN FILM TRUST, agree that this shall be a permanent deed restriction affecting Lot 15, 143 Hickory Hill Circle, Osterville, MA, being shown on the plan recorded in Plan Book 199, Page 31. For title, see deed recorded in the Barnstable County Registry of Deeds in Book 2960, Page 156 and Barnstable County Probate and Family Court Docket No. 06P-0949-AA1. i f Bk 22975 Pg 332 #31889 m Executed as a sealed instrument this y - day of June,2008. V M Tv-A-0 r" P e l f DONNA JO-ANNE POLAK, INDIVIDUALLY THE DONALD AIKMAN FILM TRUST BY: DONNA JO-ANNE POLAK,TRUSTE COMMONWEALTH OF MASSACHUSETTS Suffolk,ss. On this 5 day of June, 2008, before me,the undersigned notary public,personally appeared Donna Jo-Anne Polak, individually and as trustee of The Donald Aikman Film Trust and proved to me through satisfactory evidence of identification, a Massachusetts driver's license,to be the person whose name is signed on the preceding or attached document and acknowled�e� Qme..., that she signed it voluntarilyfor its statedpurpose .+'' as . Notary Public ' d "+ z eo My commission expires: (��� ��,?a;AphQ04 `� Bk 22975 Pg 333 #31889 Executed as a sealed instrument this 5 day of June,2008. Ccivt�a. v S c�.n 3 4�✓�LSLI JAN SUSAN BARBER, INDIVIDUALLY THE DONALD AIKMAN FILM TRUST BY: Svs h Q c rbe frvs Fe-e- NIE SUSAN BARBER,TRUSTEE COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this day of June, 2008, before me, the undersigned notary y public,personally appeared Janie Susan Barber, individually and as trustee of The Donald Aikman Film Trust and proved to me through satisfactory evidence of identification, a Massachusetts driver's license,to be the person whose name is signed on the preceding or attached document and acknowledged to that she signed it voluntarily for its stated purpose otary Public i p,� r My commission expires; f Bk 22975 Pg 334 #31889 Executed as a sealed instrument this © dayof June, ,2008. THE DONALD AIKMAN FILM TRUST BY- JOSEPH F CES OLAK, TRUSTEE COMMONWEALTH OF MASSACHUSETTS Suffolk, ss. On this—/40 day of June, 2008, before me,the undersigned notary public, personally appeared Joseph Frances Polak,trustee of The Donald Aikman Film Trust and proved to me through . satisfactory evidence of identification, a Massachusetts driver's license, to be the pers:1 name is signed on the preceding or attached document and acknowledged to me that voluntarily for its stated purpose Notary Public t MY commission expires: .Q� RONALD E.TREMBLAY COMMOM b of mamcho t6s Mr Colmiae m lea March 18,2012 BARNSTABLE REGISTRY OF DEEDS MAY-05-2008 10:42 RUBINRUDMANCHRMBERLRIN@ 5083626060 P.02 r NO TES: 1.) THIS PLAN IS VALID ONLY IF IT IS STAMPED AND SIGNED IN RED. THIS OFFICE ASSUMES NO RESPONSIBILITY FOR INFORMA TION CONTAINED ON COPIES WHICH DO NOT HAVE ORIGINAL STAMPS AND SIGNATURES IN RED. LOT 74 \ 1 1.3ft �35 96 72.1 ft Zk W 2a.o' U _ 38.7f t o cfl u. 20,672 SQ. FT. i o 0.47 ACRES M it 01- 37.4ft 185.10' cq FND CB =149.61' LOT 76 FND R=313.20' \ LOT 96 d' R=313.20 Ci FND CB �1rj.00 FNa CB ASS,&'SSORS AMP 121 P.4,RC'--'L 15 FND -4S - BULL T IV 0T PLAN �1 J O' learn, P LOT /167 ,#143 XICffORY HILL CIRCLL' 35 Route 134, Swan Rzeve?- Rlaxa, ' llnft 0O.ST�'fZIfILL�; BARNS"T,4BL�; lYlA. South Dennis, rV4EZ. 0.2660 I CER77FY TO RUBIN, RUDMAN, CHAMBERLAIN AND MARSH doe No.: 1113R AND TO THE TOWN OF BARNSTABLE BUILDING INSPECTOR THAT TO THE BEST OF MY INFORMATION, KNOWLEDGE pySN OF DATE- SEPT. 19. 2007 AND BELIEF, THE STRUCTURE SHOWN ON THIS PLAN HAS BEEN LOCATED ON THE GROUND AS INDICATED RICHARD y AND THAT IT IS LOCATED IN FLOOD ZONE C PER J. CLIENT- R,R,C,M FL OOD-INSURANCE RATE MAP DATED O'HEARN No.27871 scare= I IN = 40 FT / G/S1E s� DR. BY.• R. O'H. Z J 07AL LAND D --REG. PR AL LAND SURVEYOR SHEET 1 OF 1 . b AFFIDAVIT OF JANIE S. BARBER ESTATE OF JAMES DONALD ALEXANDER AIKMAN, a/k/a DONALD AIKMAN 143 HICKORY HILL CIRCLE, OSTERVILLE, MASSACHUSETTS I, Janie S. Barber of 10 Hyannis Avenue, Hyannisport, Massachusetts 02647 on oath depose and say as follows: 1. 1 am an adult daughter of James Donald Alexander Aikman, a/k/a Donald Aikman, who died in a fire on June 21, 2006 at his residence, 143 Hickory Hill Circle, Osterville, Massachusetts. 2. On January 19, 2007, 1 was appointed together with my sister, Joanne Polak, as co-administratrix of our father's estate by the Barnstable County Probate and l Family Court. 3. 1 reside with my family on a year round basis in; Hyannisport, I Massachusetts. rn 4. My mother died before my father. 5. On July 31, 1979, my parents purchased their home a143 HickoryHill Circle, Osterville, Massachusetts 02655. Please see a copy of thei deed:attached hereto as Exhibit A. 6. Both of my parents lived at the Osterville house until their respective deaths. 7. During the twenty-seven years, my father lived at the house until the fire in June, 2006, 1 visited my parents there together with various family members on many occasions and was familiar with the floor plan of the house. i op- TOWN OF BARNSTABLE L`CATION SEWAGE# -2 VILLAGE al-rIVIt ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO.-� A SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /y�� �'(�_ (size) i1® (,�J0X2.- NO. OF BEDROOMS H OWNER ,f�vv►/ PERMIT DATE T, 6�J �,, ;7O 0? COMPLIANCE DATE:. o 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 h A I mac. 2 . 30. e, 3 '.3 co 3 22 3 -33 -I T- No. V l4 *" : Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS TippYication for Bigpogar *pg;tem Con5tructfon Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) Complete System ElIndividual Components Location Address or Lot No. 1 y S 014ory (f)) .C)r Owner's Name,Address andand Tel.No. 00CA411 e � kXO l e©LAJLI &tom .,l�r7vt�C Assessor'sMap/Parcel 1 I%1 O30 Xbrtj At kAuv Ft (fir I Kkx I, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4 s nh T1 row S —N AO— t l�.S ° 0 Hew-^) Type of Building: sp�m Dwelling No.of Bedrooms q Lot Si X 1— sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) qJO gpd Design flow provided H AlI gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 5G�dlcjJ Nature of Repairs or Alterations(Answer when applicable) W 16f- -11 Tjjr_ S orif Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved b Date for the following reasons Permit No.--)-O(!�i �b Date Issued a —————————————————— ———— — -=---gam -----�-- — _ 1 No. V � FJ�, r t Fee V t THE COMMONWEALTH OF MASSACHUSETTS _ \Enteredincomputer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication 5for igpo!9a`f 6P!5tem Cdn5truction Permit Application for a Permit to Construct O Repair( Upgrade( Abandon O Complete System ❑Individual'Components Location Address or Lot No. 1`+ Owner's Name,Address and Tel.No. c5fe(vill P t7o� wc�ot� -{gym-m�� Pjft&1b MI PC)(,/ c Assessor's Map/parcel Z 1 0 3 U7 ��1ltvkAr(�( 1NW T. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t b,)J ,S A TJ tow`J U nPG w Type of Building: fp�� ,Dwellin No.of Bedrooms q (DjkNp Lot Siz a O G- 2 s . ft., Garba a Grinder g _ q g ( ) Other Type of Building h o uS C No.of Persons 'Showers( ) Cafeteria,( ) r. Other Fixtures Design Flow(min.required) 1140 gpd Design flow provided �(`(� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. U 1 r C 30 R PF G(S f tl Description of Soil 5 e r �� Nature of Repairs or Alterations(Answer when applicable) t S P -T1 W r S 5 r 3 1 C Sy 5 ¢�•^n Date last inspected: Agreement: The undersigned agrees-to ensure the construction and maintenance of the afore described on-site sewage disposal system,in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of' Compliance has been issued by this Board of Health. Signed 1���:' (/ � � Date Application Approved by y r //]nl. r Date to ( 1/ o Application Disapproved by: Date for the following reasons §, z Permit No. 3 oo$- b Date Issued -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS \J� BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by at ( �(�a !f�lG'�y /7 N �i/C l� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Ood(f-.46 dated `` t Installer 'S 3((_o o Designer � H ec,✓/,3 #bedrooms �f " Approved design flow ��y gpd The issuance of this perm'j hall tot b construed as a guarantee that the system will on,as des e . Date ! _ r " C� Inspector L/ ——— —————No. ��O��b In Fee 6 y f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS - w L Mi5pool,6p!5tem Con,5truction Permit Y g ( ) p ) Upgrade ) Permission is hereby ranted to Construct Re pa ir rade U Abandon ( ) System located at !f G� )J/40/k/ p1 ) /rt p C? f-e--(V 1 N f " 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 t i perintit. Date I / �`J �� Approved by a 'I z °FINE� Town of Barnstable Regulatory Services • BARNSfABLE. « 9 Mnss, g Thomas F. Geiler,Director �p 2639. ♦0 Tfp 6. Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 December 19, 2006 Mrs. Janie Barber 10 Hvannis Avenue Hyannisport, MA 02601 RE: 143 Hickory Hill Road, Osterville MA Dear Mrs. Barber, I spoke with your brother, Jeff Aikman„ last week regarding your parents house located at 143 Hickory Hill Road, Osterville which burned last June. First we wish to express our condolences at the loss of your father. The reason for this letter is to inquire as to what are your intentions with this house and premises. What is left of the existing structure needs to be torn down and the premises cleaned up. There is debris and contents from the house littering the whole yard. Please contact this department and inform us what course of action you wish to take. Sincerely omas Perry, CBO Building Commissioner f �OFIKE► Town of Barnstable Regulatory Services ' SARNSTABU, 9 MAss g Thomas F. Geiler,Director 1639. �prEDMplA Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 February 12, 2007 Mrs. Janie Barber 10 Hyannis Avenue Hyannisport, MA 02647 RE: 143 Hickory Hill Road, Osterville MA Dear Mrs. Barber, Please update this office as to the status of this house. Sincerely, omas rry, CBO Building Commissioner STATE TAX FORM 290 Certificate N9 Al MUNICIPAL LIEN CERTIFICATE (Office of the Collector of Taxes) TOWN OF BARNSTABLE 9636 - CITY/TOWN BF:09410-02$5 94-I0-19 10:08 #61424 THE COMMONWEALTH OF MASSACHUSETTS i October 14 1994_ Richard S. Dubin, Esquire TITLE REF: 1645 Falmouth Road, Suite 4A Book #2960 - Page #156 Centerville, MA 02632 As recorded at the Barnstable County Registry of Deeds --------------------------------------------------------------------------------- ......... ------------------------•------ - I certify front aveilahle information that all taxes,assessments and charges now payable that constitute liens as of The date of this certificate on the parcel of real c,tatc specified in your application received on _ October 11 •1994 are listed below. DESCRIPTION OF PROPERTY Assessed owner; _ Don & Violet Aikman I.ocahon of Ptoperty: T is ory Hill Circe, Ostervi e, MA Lot _ Parcel Identification: R121-038 —Iand Area: .47 acres Valuation: 124, OW FISCAL YEAR 1994 'IAX *preliminary ------_-.--- - �_—_ - - AC,LIal—_--._-- _ 1342.92 DIS I RIC"I 'I AN '1reliminary Ac,ual COMM Fire District _ 239.32 _ ItF 1I P_RM FN-t S-SPFCIAI.ASS FSSMFNTS Committed Interest U-1I1.1IY 1.IF:NS Water Sewer -— — — Flectric — Commilied Interest Collection Charges - 0111FR LIENS Committed Interest — Collection Charges -- I O'I AI B11.1.F.n _.-__—_ 1582.24 _ Pavments __ 842.92 _ Ahatements Exemptions Clause 41C_ 739.32 Charges and Fecs Interest to —per diem BALANCEDUE PAID IN FULL - •['RE I.I M INARY'I AXE'S general represent no more than 50Si of prior year's tax. L'NI'AII)HFI-1 E'RMF.NTS;SPF.CIAI.ASSESSMENTS NO-I YI-I A[)IDFD TO TAX: Interest from to he added. IMPROVFMFN-IS VolFD FOR WHICH THERE WILL PROBABLY BE BFTTERMENTS/SPECIAI.ASSESSMENTS: UNPAID U-1II.ITY CHAROFS: _. OTHER UNPAID CHARGES: WATER CHARGES--428-6691 ❑ I his property i,in tax title.Contact the Treasurer for outstanding amounts. All of the•amounts listed above are to be paid to the Collector.I have no knowledge of any other outst n��a�stitu I HIS FORM APPROVED BY THE COMMISSIONER OF REVENUE. ' FORM 391 REV,11/92 A M SULHIN CO.BOSTON.MA BARNSTABLE REGISTRY OF DEEDS Collector of Taxes _ _____ _ -. �1 �.. F r i ,.2/10 07 XON 16:15 FAX 508 775 9974 BUSINESS CENTER CAPE COD I0.10U:! v r AFFIDAVIT OF JANIE S. BARBER ESTATE OF JAMES DONALD ALEXANDER AIKMAN; aik,,,t DONALD AIKMAN 143 HICKORY HILL CIRCLE, OSTERVILLE, MASSACHUS_ 1T I, Janie S. Barber of 10 Hyannis Avenue, Hyannisport, Massachusetts 02647 on o at h depose and say as follows: 1. .I am an adult daughter of James Donald Alexander Aikman, afk/a Donald Allman, who died in a fire on June 21, 2006 at his residence, 143 Hickory Hill Circle, Osterville, Massachusetts. 2. On January 19, 2007, 1 was appointed together with' my sister, Joanne Polak, as co-administratrix of our father's estate by the Barnstable County Probate and Family Court. 3. I reside with my family on a year -round , basis in' Hyannisport, l+tia.ssachusetts. 4, My mother died before my father, 5. On July 31, 1979, my parents purchased their home at 14:1 Hickory Mill Circle, Osterville, Massachusetts 02655. Please see a copy of their deed attached herato as Exhibit A. 6. Roth of my parents lived at the Osterville house until ft:!ir respective deaths. 7_ During the twenty-seven years, my father lived at the house until the fire in June, 2006, 1 visited my parents there together with various family m :rnl:►ers on many occasions and was familiar with the floor plan of the house. y c2 CN I d��JAEWUHDNbW0dN I and �tr:tr Z L00z—OT-:�_IcI If I D 07 'ON 16:16 FAX 508 775 9974 BUSINESS CENTER CAPE COD '00.1 �. There were four (4) bedrooms in the house as shown on the �Atached floor plan which I have drawn from my memory of.the layout before the fire. i3lease see a copy of my floor plan attached hereto as Exhibit B. Signed under the pains and penalties of perjury on this _ day of November, Jani S. Barber, Co-bdri ratrix v CNi1d-1N3E1WbH3NHWQr18NIEnH &7 tpT LOW-0_4-D'10 1ti;U7 40N 16:16 FAX 508 775 9974 BUSINESS CENTER CAPE COD II001 We, DAVID J. CARVALHO and EMILiO R, CbRCI, bout Plymouth County.M8aee96n3et of [3roekton, a in ennaidastion of Twenty-eight Thousand Five Hundred (528,500.00) Dollars , 0,,t to DON AIKMAN dhd VIOLET AIWAN, husband and wife, as tenants by the entirety, both of 143 Hickory Hill Circle, osterviiie, oernsiabie County: Mbssarhwith>iultcl let <ba,aartu tMe land AR with tho buildings thereon situated on the easterly side of Hickory Mill Circle in that part of Barnstable known as a5tervilie, earnstaDle County. Massachusetts, being shown as Lot 15 on "Hickory Hill, subdivision Plan of Lend s in MassacOstervhusetts, le. Barnstable, rye s., for John A. Lamas". dated September 29,1965. drawn by Charles N, Savery Co., Surveyors, which plan is recorded with Barnstable County Registry of Deeds in Plan Book 199, Page 31. said lot bcing bounded as follows:- Westerly by Hickory Hill Circle, one hundred eleven and 661100 96/100(111.56) feL-t; Northerly by Lot 14 cn said plan, one hundred thirty- tiortJweasterly by land of Lhe estate of Ethel K. Scudder, as shown on said plan, one hundred sixty, and 65/100 (16D.65) feet; and Southerly by Lot 16 Yard aft said Peet, one hundred eighty-five and 01/)00 O B9,01) feet. Containing square of land, more or less, according to said plan- 5aid premi303 arc conveyed svbJect to and with the benefit of and t toge it ettherher restrictions of record, so far as noW in force and applicable, og wit oh the right to use the streets and ways shown on said plan for all purposes far Which streets and ways are coeamonly used'in the Town of Barnstable, and in mown toith others entitled thereto, For reference to title see deed of P.H.B. Home builders, lng to the within Grantors, dated-Apr11 Z7, 1975, and recorded with the Barnstable county Registry of Deeds in book 2331 at Page 61 . This conveyance is made subject to a mortgage held by the People's Savings Bank of Brockton With a balance of apprbuimately $35,50D.00..which the Grantees hereby assume and 'agree to Pay, s° 19 Emaumted as ■ ,anted Inatrataent this day of _ Cr.i p14WEAlTH OF IAA1-',Ar-HU5FTTs ®4r milumlormmaltq df tom# Plymouth .AJ a/ 1 David J.%-CaP , �f�'1�4 i `jlia R. cerct 4c Tfion Duponen�vflPaa,ed die above nwmal �•"••,n 4. 0 4�, and ucknowladnd the(nrexucng luitrvmcnt t�be th 1?'�:(' ,� E,1nc.,fiB 8ei�r�,oie, nna M.,r N.,�4eT•Q��\,.•; 'Eopl.ry slu ',x lbir cam�ntYaiouaSt!�s4a" "f�arch 7, ja 86 RECORDED AU& 1 )97) Ir All t° "o �'309�9E80S CN I d-1i:133aw64oNdWanNN I EnH 617:VT L00E-0T ?'C r, l \ i.d�4' �J L'+'L-t 1 "'- J 4.i�r�l [� i.>C.i i��.t`�i �=4, 1 C a • � y o G :ID 'LV A C1Gco � • ro a � � 3 w _ m ® C4 room Liv ► r)� ti � . m I'i ;z 0 'J T p i o; I m l� i N O A Pam- OATS �- w ITU KAC75 m y CLMS C _ r0OC1A co CD w � to _.. - - - cn z o I-- 'y No TES: 1.) THIS PLAN IS VALID ONLY IF IT IS STAMPED AND SIGNED IN RED. THIS OFFICE ASSUMES NO RESPONSIBILITY FOR INFORMATION CONTAINED ON COPIES WHICH DO NOT HAVE ORIGINAL STAMPS AND SIGNATURES IN RED. LOT 14 ` 6 1 1.3ft 72.1 ft ' 24.0' a U v ; 38.7ft 20,672 SQ. FT. o 0.47 ACRES j (� 37.4ft / V 185.10' 0Ce \ FNO \ ce L=149.61 ' LOT . 16 FND R=313.20' LOT 96. i E L=20.01 R=313.20 j g5,00 �. CB RAID CB ��5.00 - ___ FND CB r�sccnnc cie ��> PAA/'k'/ 1.S Crocker, Sharon From: Stanton, David Sent: Thursda April-1.9,.2OO7 8:08 AM To: He eptMailbox Subject: R : 143 Hickory Hills Circle I'll give Janie a call today. Donna was running it by me when I stopped in briefly on Friday afternoon. I was trying to help her locate the owner, but we did not have much luck. Thanks, David -----Original Message----- From: Crocker,Sharon ' Sent: Wednesday,April 18, 2007 11:55 AM To: HeathDeptMailbox Subject: 143 Hickory Hills Circle Janie Barber, 508-775-0093, called to respond to Donna's notice to clean up property. She was just appointed executive of estate and was responding. I'm sending this out to everyone because I didn't know whether Donna had anyone following up on this while she's on vacation. If so, please let me know. Thank you. 1 r Barnstable Assessing Search Results Page 1 of 2 Homer Departments:Assessors Division: Property Assessment Search Results New Search "gs r New Interactive Maps >> Owner: 2007 Assessed Values: AIKMAN, J DONALD 143 HICKORY HILL CIRCLE Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $ 167,700 $ 167,700 121 /038/ Extra Features: $29,400 $29,400 Outbuildings: $0 $0 Mailing Address Land Value: $ 192,100 $ 192,100 AIKMAN,J DONALD Totals $389,200 $389,200 143 HICKORY HILL CIR OSTERVILLE, MA. 02655 Tax Information: Tax information is currently not available for 2007 Construction Details Building Property Sketc"o'grty Sketch & ASI Building value $ 167,700 Interior Floors Carpet Style Raised Ranch Interior Walls Drywall Model Residential Heat Fuel Gas Grade Average Heat Type Hot Water Stories 1 Story AC Type None , Exterior Walls Wood Shingle Bedrooms 4 Bedrooms Roof Structure Gable/Hip Bathrooms 2 Full + 1 H Roof Cover Asph/F GIs/Cmp living area 1400 Replacement Cost $192747 Year Built 1975 Depreciation 13 Total Rooms 8 Rooms Land http://www.town.bamstable.ma.us/assessing/assessO6/displayparcelO7map.asp?mappar=l2... 4/11/2007 Barnstable Assessing Search Results Page 2 of 2 CODE 1010 Lot Size (Acres) 0.47 AsBuilt Card N/A Appraised Value $ 192,100V� Wj, View Interactive Maps > Assessed Value $ 192,100 p Sales History: Owner: Sale Date Book/Page: Sale Price: AIKMAN,J DONALD 2960/156 $0 Extra wilding Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,600 $2,600 BLA Bsmt Liv-Aver 1232 $26,800 $26,800 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story (Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area(Unfinished) r (Finished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story (Finished) http://www.town.bamstable.ma.us/assessing/assessO6/displayparcelO7map.asp?mappar=l2... 4/11/2007 M.G.L. - Chapter 111, Section 122 Page 1 of 1 The General Laws of Massachusetts[ Search the�Laws Go To: Next Section Previous Section PART I. ADMINISTRATION OF THE GOVERNMENT Chapter Table of Contents MGL Search Page General Court Home TITLE XVL PUBLIC HEALTH L.Mass.gov CHAPTER 111. PUBLIC HEALTH NUISANCES Chapter 111: Section 122. Regulations relative to nuisances; examinations Section 122. The board of health shall examine into all nuisances, sources of filth and causes of sickness within its town, or on board of vessels within the harbor of such town, which may, in its opinion,be injurious to the public health, shall destroy, remove or prevent the same as the case may require, and shall make regulations for the public health and safety relative thereto and to articles capable of containing or conveying infection or contagion or of creating sickness brought into or conveyed from the town or into or from any vessel. Whoever violates any such regulation shall forfeit not more than one thousand dollars. http://www.mass.gov/legis/laws/mgl/l 11-122.htm 4/13/2007 Citizen Web Request Page 1 of 1 "! Al ' . K A zzsr , r, t q Citizen Request Management :. / Request ID: 20832 Created: 4/6/2007 12:14:11 PM f� I Status: Assigned To Staff Assigned To: Miorandi, Donna Health Office Chapter II : Housing Anonymous: Yes Category: Substandard Section 353-1 GarbagE and Rubbish E.C. Date: 4/10/2007 Created By: Fontaine, Tinai Citations: Health Office j Time Worked: 0 Response Time: 0 Request Location: 143 HICKORY HILL CIRCLE Oster✓ille, Ma 02655 Parcel Number: Map: 121 Block: 038 Lot: 000 Request: This house burnt down the spring of 2006. No clean up has taken place. There's garbage all over the lawn and the roof is caved in house is open so neighbors are afraid that kids will go in house and play. Also there are 3 abandoned cars that are parked at this site. Request Work History: http://issgl/IntemalWRS/WRequestPrintPub.aspx?ID=20832 4/11/2007 w l f �• - _ f - y.�. l J . - j4low At- .41 APR 12 20,07 - ONPM- low „ A dF ik x. � d? fir, '; :A r��•. .. _ _.�i�h jt -TJI'- _ . APR' lZI4 i _ _. �`J x_ s t IRL u vl A al Vol Al � � " i. swan 4� _ y � LIN i it low- =a r -•. � r n y + ..•� � , � � � a. fly_� �{+.��i� � i y r / { 'lip� PR 12 s . • . 44 V P ;-v - r - - IF OL ? k t 40 ' i 3/29/2021 ShowAsbuilt(1700x2800) TOWN OF BARNSTABLE LOCATION IyJ / U�/����/L�� SEWAGE# .2�0-•EGG. VILLAGE G r,-V! Y ASSESSOR'S MAP&PARCEL INSTALLERS NAME.&PHONE NO. - SEPTIC TANK CAPACITY WO LEACHING FACILITY:(type)6he,: 530 (size) y0X[9X'_ NO.OF.BEDROOMS / i OWNER PERMIT D._'� ��t!03 COMPLIANCE DATE: Separation Distance Between die: 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 Al .:Ayc �e 3'36 y s -G6 J R 1 -28G j l s 3 •33 4 .46 g 5-374 https://itsgIdb3own.barnstable.ma.us:8431/Home/ShowAsbuiIt?mp=121038&sq=1 1/1 a Town of Barnstable °pIHET � Regulatory Service's - - P Thomas F. Geiler,Director • BAR NSTABLE, ..Publie Health`Division 9 MASS. , 1639. �AIEpMpla Thomas McKean, Director" 200 Main Street, Hyannis, MA •02,601 Office: 508-862-4644 ----- Fax:` 508-790-6304 " AF wr Date: Sewage Permit#Zoo8 - Z G C Assessor's Map/Parcel Installer-& Designer Certification.Form _A1Z� Installer: /)oa c ���2 oi Designer: /L/G��.�•iro J--aH F U U Address: 3,>—IZ,—,= x /3¢ Address; u >� fo i . �lelCP S/laiu was issued a permit to install a (date) (installer) septic system at /¢3 iic��2y',L,/,��. C•zcc based on'a design drawn' by . (address),.. f�L S ,C 5 dated .5,• 27 ; o a (designer) I/ I certify that the septic system referenced above was installed substantially accordingto '. the design, which may include minor approved changes such.as lateral relocation o he ". distribution box and/or'septic tank., Stripout (if required) was inspected and the' soils were found satisfactory. : r I certify that theseptic-system referenced{above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS.or any vertical relocation of,any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer- to follow:_Stripo,ut (if required) was inspected and,the soils were found satisfactory. F RICHARD9�yc taper's Signature) 3 O'HEARN " y (Desi ` e ignature) (Affix Design- 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. q:'.office lormsldesiLnercerhfication form.doc s � RUBIN, RUDMAN, CHAMBERLAIN AND MARSH CAPE COD OFFICE OF RUBIN AND RUDMAN LLP COUNSELLORS AT LAW 99 WILLOW STREET • POST OFFICE BOX 40 • YARMOUTHPORT, MASSACHUSETTS 02675-0040 (508) 362-6262 • FACSIMILE: (508) 362-6060 ROBERT C. CHAMBERLAIN - PAMELA B. MARSH THOMAS I. PERRINO 50 ROWES WHARF JENNIFER N. LUCAS BOSTON, MASSACHUSETTS 021 10 April 25, 2007 (617) 3 3 0-7 0 0 0 OF COUNSEL BRUCE P. GILMORE Ms. Donna Z. Miorandi, Health Inspector Town of Barnstable Public Health Division 200 Main Street Hywnnis, .MA 02601 Re: Estate of James Donald Alexander Aikman, a/k/a Donald Aikman Barnstable Probate and Family Court Docket No. 06P-0949-AA1 Our File No. 10746-002 (922/11540) Dear Ms. Miorandi: Please be advised that I represent the Estate of James Donald Alexander Aikman, a/k/a Donald Aikman and the co-administratrices,Janie S. Barber and Donna J. Polak. Mr.Aikman died in a fire which occurred at 143 Hickory Hill Circle, Osterville, Massachusetts on June 21, 2006. My clients have forwarded to me the Warning Notice No. 3924 which was issued by your office on April 12, 2006 in connection with the condition of the property located at 143 Hickory Hill Circle, Osterville, Massachusetts. At this time, my clients are involved in a litigation pending in a Barnstable County Court. Until further Court order, we are presently prevented from demolishing the fire damaged residence or remaining personal property from the location until this suit has reached an amicable settlement and/or solution. We are working diligently to get this matter settled. I will keep you posted on the progress that we are making and hope to finalize this matter in the near future. Thank you for your cooperation in this matter. If you should have any questions as a result of this correspondence, please do not hesitate to contact my office. Very truly yours, RUBIN RUDMAN, CHAMBERLAIN AND MARSH amela B. Marsh _PBM/bgl. RUBIN, RUDMAN, CHAMBERLAIN AND MARSH CAPE COD OFFICE OF RUBIN AND RUDMAN LLP f,Pr COUNSELLORS AT LAW 99 WILLOW STREET apr `7 eP B 8e J 4 3-/ p POST OFFICE BOX 40 - ami g; 00..,390 APR. 25 0?. YARMOUTHPORT, MASSACHUSETTS 02675-0040 t - r Ms. Donna Z. Miorandi, Health Inspector Town-of Barnstable Public Health Division 200 Main Street Hyannis,'MA 02601 y ,. il'1 .,,,1=1Mt,iti,..l.ti,,li1l till!, s;1{E1t! 1sffit=,'I1s=,E11w v� \`\ _ �: at iij}t i j}� F i1i711� ° 1 � E° �1 1's i ii i �". ±� � t L i�t �i t! A S S t i�S S >i i t �� � i �t �{ •�•; t= 1 //+' f \ - — -- _ / i ��+ i J .,.�1 _.: �J'S+r'*+ ti-'',�:�. 1# w'�^'•'" .' �"""::. # 'S;tr -,�r`�"�rsy[,�°.'w� ,,;+07 � _����*� i. :s k'�ti�M�t ��f�� �t...., +.t� TOWN OF BARN TABLE ' BARB L f , �9 r l Ordinance or :Regulation WARNING NOTICE Name of Offender/Manager � �te" . Address of Offender 0 H UAL Nlg ` MV/MB Reg.# Village/State/Zip �IV / L1 '7 Business Name /1-N am/'pm; on 4h 20�J Business AddressX/ lj Signature .of E�nforcng-_..Officer Village/State/Zip Location of Offense Enforcing Dept/D`ivi'son Offeris.e �d ��"�,/11 � C.f7� (A �/!A., �( ;�Y�#' /r�P_ Facts i Lr VP rhos-i", d-je: CJ_4��,AA169 A j P"k ZL, q1). ZV 7 (If R'A k ?M/,_t I This will serve only as a warning/ .At" this time nb legal action has been taken. It is the goal of Town agencies to achieve .voluntary . compliance of Town Ordinances, Rules and Regulations. Education efforts, and warning notices are - attempts to gain voluntary compliance: Subsequent violations. will result- in appropriate legal action by- the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. M.G.L. - Chapter 111, Section 122 Page 1 of 1 The General Laws of Massachusetts]--,.............. Search the Laws =.. Go To: Next Section Previous Section PART I. ADMINISTRATION OF THE GOVERNMENT Chapter Table of Contents MGL Search Page General Court Home TITLE XVI. PUBLIC HEALTH Mass.gov CHAPTER 111. PUBLIC HEALTH NUISANCES Chapter 111: Section 122. Regulations relative to nuisances; examinations Section 122. The board of health shall examine into all nuisances, sources of filth and causes of sickness within its town, or on board of vessels within the harbor of such town, which may, in its opinion,be injurious to the public health, shall destroy, remove or prevent the same as the case may require, and shall make regulations for the public health and safety relative thereto and to articles capable of containing or conveying infection or contagion or of creating sickness brought into or conveyed from the town or into or from any vessel. Whoever violates any such regulation shall forfeit not more than one thousand dollars. http://www.mass.gov/legis/laws/mgl/111-122.htm 4/13/2007 r �..,t-..:. -. ,.,-,.,,......�•;....,,,,.,,.f,_.,_,R,.+v,�.�✓.v-.� � v,ctyrs`>-n.+.-, *;.q rzr+3".,>;w-r ....-a�cr'.-.'�+Y.m'�,,�,.; ^..,.,,.� rt'�.rt,a.-�...rr�Z,.»r+es°+..w.^.;a.r'v.:*+?w..+Tp �+,r�-n-----r-+`.�..,..�. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation 3924WARNING NOTICE Name of Offender/Manager V Address of Offender � �"" � MV/MB Reg.# a y y Village/State/Zip 1 MAt'.9 P% , /M OAh Business Name 7pd, on 200 r Business Address ;i' S7ignature of Enforcing-.Officer , Village/State/Zip . Location of Offense IT1J .�'!g ° lJ / �. I Enforcing Dept/Divi`sion' � Offense. 7 f l S 6G /F I? ,1A111). MA P7;_.P /I /,o Facts ftl i)c, TY, i ; " CI.ChAl 60 This will serve only as a warning/. At this time n"o legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain , voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. __. .•.:"�,,,r«-.�..a,r _ ..M .� .y.. _ - f?? � gs= - 27 TOWN OF BARNSTABLE BARS' w 3924 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager � -, ' �, ��'' �* , . . .`.� p� Address of Offender 4/ 1�ily�' ., A I ,5 MV/MB Reg.# Village/State/Zi Y w} li'4� IN (, '✓ -' Business Name �""`, . ,_Fam/p `2201'Q Y j Business Address ` . Axel ,.; r`�s f ; ("'V Signature of Enforcing Officer V Village/State/Zip , r/ Location of Offense `J 7 a d •� # lwl_l / �' (� , 2 ;'ire �r f x Enforcing Dept/D'ivisio`n 10* 81 Offense # w.' � "f;.1� r '� �• rif '': , f` •. Facts t s U ,'` I= , «�: "! ��;�� a t i � a` + �t ' fw klI.-✓+' .`_ G:e!- 1 -. This will serve only as a warning/' At this time no- legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. , WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Town of Barnstable Regulatory Services BARNSTABM ' Thomas F. Geiler,Director MAM i439' g a,�� Buildin Division � forur Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.t ow n.b a r n s t a bl e.m a.u s Office: 508-862-4038 Fax: 508-790-6230 r December 19, 2006 Mrs. Janie Barber 10 Hyannis Avenue Hyannisport, MA 02601 RE: 143 Hickory Hill Road, Osterville MA Dear Mrs. Barber, I spoke with your brother, Jeff Aikman„ last week regarding your parents house located at 143 Hickory Hill Road, Osterville which burned last June. First we wish to express our condolences at the loss of your father. i The reason for this letter is to inquire as to what are your intentions with this house and premises.. What is left of the existing structure needs to be torn down and the premises cleaned up. There is debris and contents from the house littering the whole yard. Please contact this department and inform us what course of action you wish to take. Sincerely �omas Perry, CBO Building Commissioner F —e' 'LOCATI SWAGE PERMIT NO.. y d VILLAGE R ` ` o TB INST LLER'S NAM i I�D RESS a � e• 4. R U I L D E R OR OWN ER .' DATE PERMIT ISSUED DATE COMPLIANCE ISSUED oa ``� ffr 14`I �A 1 1 j �. No....? 2 5 FE$. y. ... 3 THE COMMONWEALTH OF MASSACHUSETTS 6 BOARD OF HEA TH �✓ I ........,14�X.).............OF...� it!-------• .•............................. Appliration for Uiipotittl Workii Tontrar#ion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( X-Y"00an Individual Sewage Disposal Systt . --... . .----••-----•••-- ----------------- .--.....-.-------------------------------. ... -Addr � �l Q or Lot No. �� Owne B ' Address W !. :_ mod .......... . Installer Address U Type of Building// Size Lot............................Sq. feet Dwelling� o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) PaOther fixtures ...---------•-----------------------•-----•-•---•---------•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................•......................................•••_.. Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.......---.............. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P1' ..-• -- ------- i"j 0 Description of Soil......... ----•--- .K ......•---------------•--•-•------- ------.---. -----•.----------••-•-••-----•---- W -•--••------------------ •---.....•-••-----•------------------------------..........------------------------..----- -- .. .. UNature of Repairs or Alterations—Answer when applicable...... :... ........�w-.-.__.-.-•.1-J .�tl�,l�........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of AITLL 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued b, th o of health. Sig f % %' _. s.............. •-------•------------.. . n Date Application Approved BY /i� .._..... ....z .-- Date Application Disapproved for the l wing reasons------------------------------------•-------------------------.....-------------••-•-••••-•............••-••-.._ ....----•-•----------•--...-------•-•....................•---•--------.....------•---------•-------•-•----•----•••.......•••--•------•••-•-•---•...••••-••••--••-•••-•••---•••••-••-----•-••......•-•--• Date Permit No.......... � --•---...-r-------•--------•-•------------- Issued.--------•............................................. Date ..............� s �► W. } ...Y.. .....4...:I. FEB.. THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH u � .......oF...... .. ff7S: ------------------_.....----•----•----.... Applirativit f nr Disposal Marks Tonstrur#iru rrrmft Application is hereby made for'.`' Permit to Construct ( ) or Repair ( an Individual Sewage Disposal synths ............... .. .... .... ....._..........------.......... o a on Addr + .... -_--.or Lot.No. --_............... f nez - Address ... ..--�.�7 • -•----•...................••-••----•---•.....-••--•--•------••-••--••--•---•...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling o. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter......•....,.... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No............:........ Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank (. ) 0.0 Percolation Test Results Performed by........................... ----------=---------- ---...------------- Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit............_....... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----- ' >f` ... - ... ODescription of Soil......... ?�.. ... ` %C............................................................................................ ------------------------------------ ---------------------------------------------- •------- .---- --------- ••---- W ....-••---•--------•----••-------•...•--.....--•-•----•--------------•--•-------••--...••-••--••-•-----•-•••-•-•-• '` -----•- U Nature of Repairs or Alterations—Answer when applicable ''. ........................ r1w ... ------••--------•--••--------------------•-------..-•--- - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TIT IS 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b r th health. ` Sg ' .:.......... ..... ' 'f ............. .........................--.... Date Application Approved By 1Y. ---••-................. -•-•--•• ............ Date Application Disapproved for the f ll wing reasons:......................... ..............•---------•-------•---------•-••--•----....--•---•--------•-----.....---........-----........-----•------.....---•--•----••-------•-----.........--•---...----------••--••••......--...._. Date Permit No.......... ."". ...._... -._.... Issued........ .... _` .................... Date 4' THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALT ✓"�' % fir!........OF....... .!`. .... .....: (9rdif iratr Dorf Tout rlitturr TH,ZS.y14 0 TIF om, at the IndividuAl�`�Sewage Di System constructed or Repaired * by- -••-� ...........� .....A .... -i'.......... ... '` .-- . ( .........._•••--....... Iler at.. _... . ....:�. .. °sue " '. °° -, ...... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No................_..._..................... ::.:dated................................................. THE -ISS-,dANCE.OF THIS CERTIFICATE SHALL NOT 6E CONS RUED AS A GUARANTEE�THAT THE ' -STEM WILL FUNCTION SATISFACTORY. DATE.........................................I5----••-•••••• ------• Inspector--•---._..... •- - ........................ • THE COMMONWEALTH OF MASSACHUSETTS p BOARD' Ojf HEALT; No..�-�.............-�.. Fn.-I-------------------- Disposal parks (dun #rttr#tatt f rrmi# Permission is hereby granted..:.:` ; ems:......... "` ::... to Construq,,(, ) or epair�,( an Individual Sewage,DispgW;1System A lf:e� atNo ttJJ ... S . �. .... .....•-• .....- •... . ...... ............. as.shown on the application for street „� pp r Disposal Works Construction Per 't No. � ": Sated.._.......................................... . �_:. --•-••. _.v soara of x ....==•-•.............•---••--......._ ...........` .�.�_ ... ..:. •---••--- •.. FORM 1255 A. M. SULKIN, INC., BOSTON k I L0CAT1 ff WAG. E PERMIT NO. Uz VILLAGE o 3� I INST LLER'S NAME i kD RESS 6 U 1 DER OR OWNER DATE PERMIT AlSSUED DATE COMPLIANCE ISSUED , 7 r- 7 r No....`3� �-.------- -:................ THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEA ... OF. ...... ........."*' * .. ... ...................................... Appliration for Disposal Works (lonitrnrtion rnmit -Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal -yst at -- _ ••cc••-/•-•�---`---�---�"•�� .i�------ _ �---- ---- ation-Addr r of No. ...• ------------ Owner Addres Instal r Address Q Type of Bui Size Lot..../Y._.. _Sq. feet U Dwelling—No. of Bedrooms......... .......................Expansion Attic ( ) Gage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures --------•------------------------------•-------------------------------------------------------------- -------------- W Design Flow_ _____________ _ ___________ _ gallons per person per day. Total daily flow.......... .gallons. WSeptic Tank Liquid capacit _ - allons Length................ Width____ _.__. _.. Diameter____..__..._.... Depth__-.______.__... x Disposal Trench— o..................... Wi th.._........_. __ tal Le Total leaching area-_-.._ _____. _sq. tt. 3 Seepage Pit No..�....__..... Diameter�� .....�elo,, inlet....................Total leaching area_._ ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by ------------------------------------------------------------------- Date HTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--__-_-__--_-_-___-.---. fX4 Test Pit No. 2................minutes per inch Dep of Test Pit.. .___._____...,.. Dept to ground water___-____________----.--- O Description of Soil-------------------- �- ------ •. ---- ---•-- ------•--•---•------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W UNature of Repairs or Alterations—Answer when applicable...--------------------------------------------------------------------------------------------- ----------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe -------------•---------------------------- Date Application Approved By........ ----- ....._ ' ,� - ------------------- ate Application Disapproved for the following reasons:.-------- ----------------------------•----•----•-••- ---------•-----------------------------------------------------------------------•--••--------------•-....----------------------------------------------------------------------------------------••••-• Date PermitNo......................................................... Issued........................................................ Date No.-- ............ Fix.. ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAT;T+ Appliration for Mipoat Works Tonatrurtioat Prrutit Application is hereby made for a Permit to Construct ( �) or Repair ( ) an Individual Sewage Disposal 4 ratOr �F _ E� .. "' f_.�e j'••.� ••-�e.y,.-`Isr�' +`.'�-- y-------•_ -.. n L tion Addr f s. if 1 A 1}Y►°rdL°t NI� 9 V ----*'__�.Q t * s . ' a,e „w�4t ' ... :_ _st ?."t ar , � .. ......-•---- ---------- i r V j= � Owner Addres. Instal r% Address s " d Type of Burg' Size Lot____ _ _`_,_t ..Sq. feet Dwelling—No., of Bedrooms........ ...................•---_-_Expansion Attic ( ) Gae> age Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ._ W Design Flow, gallons per person per day. Total daily flow...._. __r-------tea--------------gallons. WSeptic Tank . Liquid capacit f " f�gallons Length___._ ... Width. jj a__ Diameter__________ ____ Depth---------------- Disposal Trench—No....................... Width..-� ,�.:,dotal Len, i- ,K_ i Total.leaching area___ sq. ft. Seepage Pit No _________________ Diameter x ,._. r._._..' th` eloinlet_=__-_ Total leaching area___,__ " ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---•....................................................................... Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit__-__.____-.__------ Depth to ground water__.._______-________._.. f1 Test Pit No. 2................minutes per inch DepAi of Test Pit._ Dept to ground water------------------------ ........................................................ O Description of Soil '".. _-ZIP ,: ... ---• --� .----- U --------------•---------------------------..------•---•-•-•---------•=----•--•.....•-----•----•------•-•----•---•-•-----•---......-•----•-••---•---------•-------------------------•------------------- W UNature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------•------------------------------------------------------------------•---- ------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article X1 of the.State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe -----------•--•------••- -- --- +r - s y /aate Application Approved By....... ' -: f-Ir# Application Disapproved for the following reasons------------------------ --••-•................................................................................. ----......•-••----••-------------•-••-••-••---------------•••--•-----------••--•--•-•---•••-•--•----•-------•------•---••---------------•-•-•--•------•-----........................................... Date PermitNo......................................................... Issued........................................................ E ate THE COMMONWEALTH OF MASSACHUSETTS , ` . g►`� �� BOARD F HEALT . ..............OF........ .�1°.¢J✓�..�.:. °' ......' ° r e Trr#ifir r af" TIMpliFattrr THIS ., TO CERTIF ,,That the Individual Sewage Disposal System constructed or Repaired ( ) e ' -------•---•- Of by......:::.! # r tall � }•• { at...-r 3' `Yp "''' _`J4� ......t_"e'i'j'4,. .......... - . has been installed in accordance with the prov',ions of Article of The State Sanitary Code as described in the application for Disposal V1�orlcs Construction Permit No_____________________ ______________ dated__.,�, :�.. ___��- -•-_-, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUN T'ON SATISFACTORY. ��;�" �� 1� DATE - ��' - �-�� - Inspector ��, --- - t`------------------- -- .......... } THE COMMONWEALTH. OF MASSACHUSETTS s ' BOARD OF HEALTH . ......... No.......... _. `._ �._.... ---------- FEE-- ,-•----._...... • aft f . , Permission is ereby granted.•____ "' to Gonst lCt (� qr.Rep ire-(. ) n IndividuSewage Dtsposa] stem ._.__" ..... f •' - t! """- M -F------' -- _----••---•-----_ Street a"s shown on the application for Disposa rks Construction Permit N _:1_= ;.:_ Dated__.., -_ a� Board,of Health f DATE---------•---------------------� ................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _O° T STAMP: per., . 'A! EC / rGJ3 -- --y O o O � POWDER f BAT o (T PININGRm O KITCHEN o Z .� t GARAGE N 10-O'C.O. " __ ___ ON a' TYPE X _ ______ U ao Z - ON WALLS t CLG. - -, ______ SQ BR. o i ry - m O Q 5" DIA. COL. - m r- _ 3a o� LIVING RM O J� f 120�0 ED OOM o .. OH DR. i O m - 1 T 5 3 STUD OCC.r ��.�. W. �i PKT, TYP. .(� vX _ - -_ . A O+ W BOXOUT. Q A _... BRICK ST A � � - J �6° - _ P - .. ._. 10" DIA. C J t J 9,_4° W Of16r_O" 42r_0n Lu Y W V) r - 12y_4. 13r_IO., 7-2<F> L .. - t •O B - O t ° Oo ' BATW I CL. n m O v . TM-E - _ - _ CL.I •w BEDROOM I N L NEN fr - BEDROOM 3 e FIRST o O O z'-ry O O _ SECOND UNFINISEIED p K FLOOR PLAN DN OPEN RAIL N N 1 . - - '-5 i' BEDROOM 2 DATE ISSUED: REVISIONS: CL. o I CL'O 15'_2" - soZ I e goo ` O E m Tv DRAWN BY: PROJECT#: DRAWNG NO.: SECOND FLOOR PLAN j f s - SCALE,/4' Ltl __ 1 • , I�A'SICN NOTES: CALCULATIONS NUMBER OF BEDROOMS .. 4 10. DESIGN OF S.A.S. ASSUMES A AND B SOIL LAYERS f. ALL Wt�RKMANSH/P AND MATERIALS SHALL CONFORM TO D.E.P. iTTLE 5 z 2 ..............................• AND THE TOWN OF BARNSTABLE RULES AND REGULA77ONS FOR THE GARBAGE DISPOSAL UNIT ................................ NO TOO UNSUITABLE, THEREFORE THEY MUST BE SUBSURFACE DISPOSAL OF SEWAGE. m REMOVED PER 771LE 5 TOTAL ESTIMATED FLOW 2. ALL COVERS TO SAN/TATY UNITS SHALL BE BROUGHT TO WITHIN 6 INCHES 3 ROUTE 28 ( 110 CAL/BR./bAY x 4 BR. ) ...... 440 GAL./DAY OF FINISH GRADE REQUIRED SEPTIC TANK CAPACITY.................... 880 GAL. J. EAIS77NC AND FINAL GRADES SHALL REMAINE ESSEN77ALLY THE SAME, EXCEPT ACTUAL SIZE OF SEPTIC TANK......................... 1500 GAL. AS INDICATED go 4. NO DETERM/NA 17ON HAS BEEN MADE BY THIS OFFICE AS TO COMPLIANCE c� SOIL CLASSIFICATION .................................... 1 W7TH 70M ZONING REGULA7701VS OWNER/APPLICANT SHALL OBTAIN SUCH EFFLUENT LOADING RATE......... ...................... 0.74 GAL/SF DET£RM/NA77ON FROM THE APPROPRIATE AUTHORITY N LEACHING AREA PROVIDED 5. THIS PLAN IS VALID /F IT/S STAMPED AND SIGNED IN RED. THIS OFFICE '1'9iy LOCUS o ASSUMES NO RESPONSIBILITY FOR INFORMA77ON CONTAINED ON COPIES � S/DEWALL + BOTTOM WHICH DO NOT HAVE ORIGINAL STAMPS AND SIGNA7URES ..... (40't 10') x 2x 2 t 40'x 10; 600 S.F. 6. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF LEACHING CAPACITY (S/DEWALL + BOTTOM) .. 444 GAL. WiTHSTAND/NG H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 9 600 SF x 0.74 GAL/SF FEET OF DRIVES OR WITH/N 10 FEET OF DRIVESNG H-20 LOADING OR PARKING AREAS ALL BE USED UNDER OR RESERVE LEACHING CAPACITY........................... 444 GAL. Z CONTRACTOR /S RESPONSIBLE FOR VERIFIC4770N OF ALL LOCATIONS AND RD. ELEVATIONS, INCLUDING EXISTING U77U77E$ PRIOR TO CONSTRUC770N. IF ' ANY DISCREPANCIES ARE FOUND, THIS OFFCE SHALL BE N077FIED IMMED/A TEL Y, a ALL UNSUITABLE MATERIAL SHALL BE REMOVED UNDER AND FOR 5 FT. r p/y,/ r/►rp�l r �,f,/p AROUND LEACHING FACILITY AND BE REPLACED WITH CLEAN GRANULAR L C�1`1 11 1 V 1�f ALL COVERS TO SANITARY SAND PER SEC77ON 11255(3) OF THE STATE ENVRONMENTAL CODE, UNITS SHALL BE BROUGHT 777.E 5 TO W/TH/N 6 INCHES OF 9. EXIS77NG SANITARY SYSTEM TO BE PUMPED, CRUSHED AND REMOVED LEGEND TO A SITE APROVED BY THE BARMSTABLE BOARD OF HEAL77.1. ALL 4 SCH 40 PVC EX/S77NG SPOT ELEVA77G1•I DOxO FINISH GRADE EXIS77NG CONTAM/NAMED SOIL TO BE REMOVED PER THE BARNSTABLE 10 FT. MIN. PIPE - MIN P/TCH BOARD OF HEALTH AND REPLACED W/7H CLEAN GRANULAR SAND EXIS77NG CONTOUR - -00 - - 118" PER FOOT PER SEC77ON 15.255(3) OF THE STATE ENVIRONMENTAL CODE. F/NAL``SPOT ELEVA77ON 00 TOP OF FOUND CONCRETE CULTEC 330 HO SOIL TEST LOCA77ON EL=50.25 I COVER 4" SCH 40 PVC RECHARGER TOWN WATER W MIN GRADE FIRST 2' TO PIPE;- MIN P/TCH CLEAN SAND S.T, TOP OVER S T, BE LEVEL 1/8 PER FOOT 2" LAYER OF EL=47.5 EL = 48.25 MIN, 2% MAX EL =48.6 GRADE. MIN EL =46.6 l/8"-1/?" DOUBLE WASHED STONE OR F/L TER FABRIC FLOW LINE CLEANOUT 9" MIN. SLAB EL = EL=46.50 43.1 10"7 MIN £L =45.8 O n EL=45.3 EL -45.3 ep h- co 4 EL=433 - EL =43.3 4" CAST IRON ( OR EQUAL ) PIPE - MIN. PITCH 114" PER FT, W 3/4" TO i 1/2" DOUBLE WASHED 5 FT MIN. STONE OUTLET TEE TEE DEPTH BOX' 40 FT x 10 FT-x 2 FT LIQUID DEPTH BELOW FLOW LINE 16 GAL 4 FT. 14 INCHES 5 FT. 19 INCHES BOTTOM OF TEST HOLE OR OBSERVED WATER TABLE EL 38.3 6 FT, 24 INCHES TANK ADJUSTED GROUND WATER TABLE ( / / ) EL = / 7 FT. 29 INCHES _ 121011216 8 FT. 34 INCHES P.ROFILA' OF 37,8 S1K SEXYACE DISPOSAL SYSTEff' SET NOT TO SCALD' 121105 #1 DEEP OBSERVATION HOLE LOG DATE OF TEST 5121108 W7INESSEO BY T. McKeon PERFORMED BY R. OH. DEPTH FROM SOIL SOIL SOIL SOH ►� fLEY SURFACE HORIZON TEXTURE COLOR MOTTLING OTHER 121011016 \ \ 48.3 0 - 6" A SAND LOAM IOYR 3/2 NO r m 47,8 LOT 6" 31" B LOAM SAND IOYR 5/6 loose, S.g. A� ` 1J` `'. 45.7 20,s�'z .$'/ti'f loose, S.31" - 120" C COARSE lOYR 7/6 � 42 0 47 .4C.f / 38.3 SAND � \ \ .• PERCOLA 77ON TEST DATE. DEP7H OF PERC 6 \ \ 77ME,• RATE MIN. PER INCH \ ao #2 DEEP OBSERVATION HOLE LOG ~ 54.8ft\ 40 DEP7H FROM SOIL SOIL SOIL SOIL £LEY DIHER SURFACE HORHORIZONTEXTURE COLOR MOTTLING40 48.6 .6ft ¢o ,� 0 - 9" A SAND LOAM IOYR 3/2 NO 57 \� \ 47.85 9" 31" B LOAM SAND IOYR 5/6 loose, s g. 4 , 0' \ 8 O 46.0 �2 Fx,'CX 121039 31" - 120" C COARSE IOYR 7/6 loose, s.g. a 38.6 SAND D _ Opp NO GWE _ PERCOLA T/ON TEST \ DA7E} 5121108 DEP7H OF PERC. 52" EL = 44.3 EXISTING PE pS TIME.• 11:10 RATE MIN. PER INCH < 2 I R Ci /l ANT CO M AN E S \ #3 DEEP OBSERVATION HOLE LOG T•0 OF 0 SEELI ELEY. DEPTH FROM SOIL SOIL SOIL SOIL OTHER [)ATE /11/ 5 9 4 4/ 3 1 M 0 I E SURFACE HORIZON TEXTURE COLOR MOTTLING rC # - -� o /// 33.4ft --� 44 �v NO 42.0 W = 48.8 0 - 9" A SAND LOAM IOYR 3/2 NO ` 16 0, 1 Oftt ; •a 2 481 9" - 31" B LOAM SAND IOYR 5/6 loose, S.g. 6�, _ $.0' V1500 _ _ 46.2 37.1ft SEPT/CAL -' 46 v W Z 31" - 123" C COARSE IOYR 7/6 loose, s.g. 38.45 SAND a 121076 NO GWE 6 � . ` a 29.3ft� �' TANK V 3 Q PERCOLATION TEST D-BOX 00 g Q DATE: DEPTH OF PERC• !� 4 18,5ft 77ME, RAT£ MIN. PER INCH ;�R �. R ,a4 J* -�- o #4 DEEP OBSERVATION HOLE LOG kg a o ELEYDEPTH FROM SOIL SOL SOIL SOIL Q SURFACE 01HER HORIZON 7EXTURE COLOR MOTTLING 49.4 n - 100% RESERVE 0 - 12" A SAND LOAM IOYR 3/2 NO L- 111 66 �L o 1'8.2ft ,o 48.4 � 30=, R= , 16 46.65 12" - 33" B LOAM SAND IOYR 5/6 loose, S.g. � z� N - ' 0 10.3ft SSTK E 33" - 120" C COARSE 10YR 6/6' loose, s.g. FNM 3 r Jr6. 8 39.4 SAND �*• GG � _ � -.... _. _. _„ NO OWE 50 ml _ o� - POLE EDGE OF '* r PAVEMENT I PERCOLA 77ON TEST B.M, TOP OF DATE? 5121108 DEPTH OF PERC. 54" EL - 44.9 • � 2 \ II STAKE SET 77ME, 11 40 RATE MIN. PER INCH < 2 POLE I 3 EL = 50.0 ASSUMED B.M. #2 TOP OF DA TUM I APPROVED: gOAR11 OA'.Sr�ALTIY ' W PK NAUL SET 48 REV. 6/19/08 - S.T. 10 FT TO FOUND. �.4T� acAwr ) ALSSUMEo91 HICKORY HILL CIRCLE "NO 1113R DATE 5127108 DA TUM 40 FT PRIVATE' #,4Y CLIENT. WOOD srcALE• AS NOTED ����'�"'� SITS' PLAN DR. 9r: I. O'H, SHEET 1 OF 1 MULE.- > IN = ,90 FT REGISTERED SANITARIAN s �� of ��5� LOCATION. LOT 15, j 143 HICKORY HILL CIRCLE' R. eJ. O Hearn, PROFESSIONAL � j q RICHARD ti� � 4�, J. a , � RICHARD �� 0,5"T�RVILLL; BARN,ST.ABLL; 1LlA. LAND SURVEYOR o allEAR�f ES 35 RO UTE 134, P. 0. BOX 237 s; " N0,2Ta71 N SWAN RIVER PLAZA, UNIT 2 R. L. S.,.tR. . , ASSESSORS MAP 1z> PARCEL 038 � AEG! �SOUTH DENNIS, MA. 02660S s�o L l FLOOD ZONE: C ELEVATION N A MAP DATE-. $Zaj%92 . a r• Irm���