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0015 HIDDEN LANE - Health
Hidde-Lo. a� e r� OsCerviil A — C II No. �► _ Fee a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[ppYtcattou for Mi5po5al *pgtem Con%trurttou Permit Application for a Permit to Construct(✓Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. IS Lyvti d �� G Owner's N e,Address;and Tel.No. y T l dl�-�Assessor's Nornhtt'Cro-�}— Map/Parcel A-07L t� ZbQ (a,S - 0 51 c rvA '� n1y�- O Z S.5_ Installers Name,Address,and Tel.No. De ipner's Namq,Addre`ssAndTel.No. S ���c / y ��q�\�iaax bSn�y�ne�r� � �l�(/�- OSkrv� OUo SOd-�IZ�-33Y Type of Building: Dwelling No.of Bedrooms S Lot Size ZSI Z,L{ sq.ft. Garbage Grinder P0) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S�n gpd Design flow provided S(o_0 and Plan Date kb(u�` 2.?j Z00 S Number of sheets l Revision Date Title,sl- ?V.I\ PCoQo�� �p�L Sy S�C IP' Size of Septic Tank 1 S00 (QAC. Type of S.A.S. 4"SOa (�/ C41aw� -,r\ke4i'nyZ 90 Description of Soil -,*_- IL, zZ o-8" L0 ftt" 8 Ch`tty- , MCI I 14 Lokft7 5►�n►�� TA-3�" 5L CAMr 161K a MED s"o �/ FCW�(�� 334 c (,*ram 4N r 'to sAkKD Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to onstructi and ai tena e of the afore described on-site sewage disposal system in accordance with the provi ' s of Tit 5 of e Envi nme al C e and t t e eAfern in oper ton u 1 a Certificate of Compliance has been issu th' of H -5- (�d Signe ��-ti^ 6'� A Date Application Approved by R Date Application Disapproved by: Date for the following reasons Permit No. Date Issued �r No. k `7vy-rY-� + Fee - MEntered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS _ 121"plication for Toizpoar *p!tem Construction Permit il{ Application for a Permit to Construct(�epair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. �`cacU t1 L4n 0 Owner's Name,Address;and Tel.No.1'r 1S F(', atoms , TkY"Ol-C NUM:hYC rtrd-�-- . Assessor'sMap/Parcel A-07Z. �A, i�Qn toy rJ5kr�At¢ ,v� of S.S 'i 'a Install Designer's Name,Address and Tel.No.. 't I�AN S�.'(�far�ur�Ay "7 �y) 8�6- SVI1�vn^ to 1 r s 11A u 4-4 Gaszj 3oX �S Hn A 05 �v�\ ot6 — ;ug-LIZ$ Type of Building: Dwelling No.of Bedrooms S r. ,`z"Lbt Size ZS Zit s ft. Garbage Grinder �0 _ _ t r q g . ( ) Other ,. Type of Building r'� No.o Persons Showers(Vr ) Cafeteria( ) f Other Fixtures r f y Design Flow(min.iequired) 5 5� gpd Design flow provided 5611 Z} gpd L Plan Date kof."r-7 Z's ZOO s Number of sheets ( r� Revision Date , r ITitle Slk i lG r\ BCuPO`aeek r,t A L !SN-,'`Vn Size of Septic Tank 1 SOU (ems, Type of S.A.S. 4-500 6A(. Ne.n,kra sfc `'•.� Description of Soil ?k, � 12.,IZG 0-8" WAn �ZC 3 CLIC`t 16`K II 16 I oAm) 4► !Zn k Z1-35 t3C (A'-ir& 16`lKVa MPD 4hNn v/ rw ti{NC� Nature of Repairs or Alterations(Answer when applicable) r Date last inspected: Agreement: The undersigned agrees tonsare th onstructi and ai: ena a of the afore described on-site sewage disposal system in accordance with the provisi -axis of Tit 5 of e Envi nme al C e and of to-pl• e t es tem in opera ion until a Certificate of Compliance has been issu thi of He Signe C_4_L ^ ® Date Application Approved'by Date , ApplicationDi-sap��v"e`d by:y \ Date for the following reasons 4 t; Permit No. "" Date Issued ————————————————6—L——————————--- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (�.�' Repaired ( ) Upgraded ( ) Abandoned( )by �/ ( S 11 Q"C(,DNS at 1 S f I 4cd . cAoG• os�r,, 1 C has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '� ! dated Zu- 45 Installer Cj pRAV_NAAyj Designer _Q u LL% yA �j r #bedrooms S Approved design flow SS��: gpd The issuance of thispen-nit shall not be construed as a guarantee that the system will function as design ed f F� Date �j /` 0 U Inspector iti �----------------------------------------------- r No. Fee, %_1 0 -a 7ZE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 4 ligool �&p!gtem Conkruction Permit Permission is hereby granted to Construct (--I Repair ( ) Upgrade ( ) Abandon ( ) System located at 1 S �i dc�e l V�� 011 rJALe 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 comple ed within three years of the date o this pe t r Date Approved by _ r Ile // TOWN OF BARNSTABLE' _ LOCATION ,/6 dc .r 1l Lrh 194, SEWAGE# � %'►5� VILLAGE �$����` ASSESSOR'S MAP&PARCEL _ IN*W7ttt-fRS NAME&PHONE NO SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ( Ve-rX l U w ? T, (size) NO.OF BEDROOMS 3 OWNER��'�-�"1' kLa-SCkUIVL PERMIT DATE: I EE DATE.-7 ®� .i/I S I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Front I M 9 9 31 34 4e 7 22 .20 TOWN OF BARNSTABLE LOCATION -,SEWAGE # Off°-o 77 11ILLAGE ��IC.G�' � ��'-t- ASSESSOR'S MAP & LOT I 'C_)7Z INSTALLER'S NAME&PHONE NO. � SR��fr � S�• � SEPTIC TANK CAPACITY /:500 fide LEACHING FACl1.rrY: (type) �� L..A&ZL<�&e) NO.OF BEDROOMS '1 BUILDER OR OWNER Ali PERMITDATE: �120/'�� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 2 Feet Private Water Supply Well and Leaching Facility (lf 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 /� ® 00, o ®, • 4 p 1' W r ti Zy( h f TOWN OF BARNSTABLE ► - LOCATION A(idde0 ,% 9�lox-c— SEWAGE # 1,gLLAGE 04 ASSESSOR'S MAP & LOT INSTALLER',S NAME&PHONE NO. .YZ/ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS -3 Bkffbf)S;�-e OWNER Oc� PERMUDATE: COMPLIANCE DATE: L-2 03 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 ss _age__oft, OFFICIAL INSPECTIONFORM:NOT FOR.VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM.INSPECTION FORM PART C ,(( SYSTEM INFORMATION(continued) Property Address: �N Owner: Date o nspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells.within_00 feet.Locate where public water supply enters the building. ' el- of 440yne ,fit ��• � c� KC ❑ { n ueeu', l f V 1 pale. . rn ❑ it 1.ST FLOOR PLAN BULL 0 > tl ,i 2ND FLOOR PLAN Town of-Barnstable Regulatory Services F16 Roa��� Thomas F. Geiler,Director Public Health Division . Thomas McKean,Director , 200 Main Street,Hyannis,MA 02601. Office:508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form s Date: f2) 6$ Sewage Permit# O� Assessor's Map\Parcel Desi g ne Installer:—�)w Address: ,7?it2K 6-R. 2��(D5-�-e2v-i c.L6, Address: . On 2/29 . was issued a permit to install a (date) IIll (installer) septic system at kS t�i��C � �- V I based on ofdesign drawn by , (address) g2-;FZS13LLk\JN" dated zlz3J� ', (designer) y I certify that the septic system referenced above was installed substantially tY according to the design,which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the,septic system referenced above was installed with major changes (i.e.greater than 10' lateral relocation of the SAS or'any vertical relocation of any component of the septic system)but in accordance with State&Local egulations vision or certified.as-built by designer to follow. 41M 'TER Js;er,s Signature) e� 4 SULLIVAN No. 29733 ,I °-IsTV A! (Designer s Signature), (Affix Designer's_ Stam p 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:Health/Septic/Desiper Certification Form 3-26-04.doc Town of Barnstable P# 114. Department of Regulatory Services. Public Health Division , ` Date tea. .eJa �� 200 Main Street,Hyannis MA 02601 a . Date.Scheduled .L! f ime a `16 Fee Pd. d 60 .O Soil Suitability Assessment for.Sewage.Disposal: PerfonmedBy: . �It�/a� L/{AI ryr\x # Witnessed By: d!1a4 Z; 1M�dt'4►1(�t FRS to CATION 0 -N��At.: �Ql�mt(�N Location Address `� , Owner's Name 0titi�C�� ei l t 1L-rr , Y t �) \ Address 15 Ni d R�'a► 'Fe rn lol L_)Vrvn To _ j I G� <0 &,i"" Assessor's Map/Parcel: I�� rC e� `� Engineer's Name1,i1 e S.o I I i�tGt,�. I=— c NEW CONSTRUCTION REPAIR Telephone# G�8'":.4 29 3 3 Land.Use Rey;d�n�,al Slopes(9b) 3"S/9 Surface Stones' /Ud fir; Distances from Open Water Bod ft Possible Wet Area• S `:ft Drinkin Water Well $OtT ft P Y g F- Drainage Way �4 ft` Property Line 10 ft Other ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) . 1 ® .. m if T. NMI 5.0 - � r6UzZt: rtt .I .. Al Parent material(geologic)60V�5 �' Depth to Bedrook Depth to Groundwater: Standing Water in Hole. d Weeping from Fit Facti Nd Estimated Seasonal High Groundwater �$L"ZZ Tm T,A� SoL fn9�J� 09TKNATI N " 11EA9� Gkt'W 'TA� `. Method Used:: Depth Observed standing in obs.hole: in, Depth to soil mottles In, Depth to weeping from side of obs.hole: _ in.: Groundwater Adjusts t ft P Index Well# heading Date: Index Well level„�,,. , •Act.factor's'Ao,.Groutldwater Level 1�E1 CU .A�`ION..T�ST.. »�tA� Observation Hole# 3 Time at 9" Depth of Peic S. 36 Time it 6" Start Pre=soak:Time @ . :�aAtirti Time(g"-V) End Pie-soak /rh Rate MinJlnch Site Suitability Assessment: Site Passed /. Site Failed: Additional Testing Needed(Y/N). \ C Original: Public Health Division Observation Hole Data To Be Completed on Back----------- X * esIf percolation testis to be conducted within 100' of wetland,you must first notify the -Barnstable Conservation Division at least one(1)week prior to beginning. J Q:\.SEPTICIPERCFORM.DOC' IEEE OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisteno Gravel) a-ZI Z 1 3. DrZo�, AEEP OBSRVT�01�1 P�OL .LOG ' 1T19 DepW from Soil Hot. zon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling g (Structure,Stones,Boulders. , Consistency, Gravel) 0 *P O0SERYATTON HOLE ,b Hine Depth from Soil Horizon. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) J . L. J. DEEP VjSERVAT 'ON HOLE LOG Hail # 4 . Depth from Soil Horizon Soil texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc.y. 0--7 Flood Insurance Rate.Maa: Above 500 year flood boundary No Yes F Within 500 year boundary No' Yes Within 100 year flood boundary.No. Yes Death of Naturally Occurrine PerviousMateriai Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system?. �\ If not,what is the depth of naturally occurring pervious material? - Certification I certify that on ''l (date)I have passed the soil evaluator examination:approved by the � Department of Envir4=-+— onmental Protection and that the above.analysis was performed by me consistent with the required training;expertise and experience described in 310 CIVIR 15.017.. Signature ACVDate Q:\SEPTl0PERCFORM.DOC (, Y\ i A • r V Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '- r _5 Hidden Lane, Osterville_MA 20655t-. .Pro a Address-- - 7-7- Jeff Property a Jeff Kaschuluk ti Owner Owner's Name information is PO Boil Osteryille77 . MA 02655 May 15, 2008 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information. ' -� �., When filling out ( ' . o r. forms on the _ 1 computer,use 1. Inspector: r only the tab key to move your Patrick M. O'Connell cursor-do not use the return Name of Inspector key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills _,-MA r 02648 Cityrrown t - State Zip Code 508-428-1779 .. S112855 Telephone Number License Number B. Certification ' 1�, Y ., is - i,_. `• I certify that I have personally inspected the sewage disposal system at this address`and that the information reported below is:true, accurate and complete as of the time.of the inspe tion. Thf:�inspection - © was performed based on my training and experience in the proper function and main enance5�,l on sfte sewage disposal systems. I am a DEP approved system inspector pursuant to Sction 15340 oaf Title 5(310 CMR 15.000).The system; CO NY ; . ® Passes ❑ Conditionally Passes ❑ Fat El Needs Further Ev uatiorr_by the Local-Approving.Authority'. tv Ur A May 15, 2008 Insp ctor's Signature Date The system inspector shall submit a copy of this inspection,report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design.flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies,sent to the!buyer, if applicable; and the approving authority. ****This report only describes conditions at the time of inspection andunder the conditions of.use f at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ' 08-116 Kaschuluk.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..'rt 15 Hidden Lane, Osterville MA20655 Property Address' Jeff Kaschuluk. Crooner Owner's Name information is PO Box 1026 MA 02655 May 15, 2008 , Osterville ' required for *.4 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) , Inspection Summary: Check A,B,C,D or.E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any,of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: - Cesspool and overflow were found empty overflow pit had never had more than 2'of standing water. . Passes: B System Conditionally •, Y . . ❑ One or more system components as described,in the"Conditional Pass_"section neeflo be replaced or repaired. The system, upon completion of the replacement or repair, as approved by , the Board of Health, will pass. y Answer yes, no or not determined (Y, N ND) in the ❑,for the following statements. If"not determined," please explain. ; ❑ The septic tank is metal and over 20 years old`or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank'is replaced with a_ complying septic tank as approved by the Board of Health. *A inetal'septic tank will pass inspection if it is,structurally sound, not leaking and•if a Certificate ' of Compliance indicating that the tank is less than 20 years old is available: ND Explain: t ❑ Observation of sewage backup or break out or.high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled"or.uneven distribution box. System will pass inspection,if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑. obstruction is removed. 08-116 Kaschuluk.doc•08/06. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -.Not for Voluntary.Assessments. "• 15 Hidden Lane, Osterville MA 20655 , Property Address Jeff Kaschuluk - Owner Owner's Name information is PO Box 1026,Osterville• MA 02655_. May 15, 2008 required for every page. CitylTown Y State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced.'* w ND Explain: The system required pumping more than.4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval,of the Board of Health): ❑ broken,pipe(s)are replaced ❑ obstruction is removed r ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment; 1. System will pass unless Board of Health rdetermines in accordance with 310 CMR " 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: - - Cesspool,or privy is within 50 feet of a surface water e .,❑ : 7Cesspool or privy is.within 50 feet of a bordering vegetated wetland or a salt marsh •2. System will fail unless the Board of Health (and Public Water Supplier,:if any), determines that the system is functioning in-a manner that protects the public health,- safety and environment: Y , El The system has aseptic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 1. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 08-116 Kaschuluk.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Mum Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Hidden Lane, Osterville.MA 20655 Property Address Jeff Kaschuluk Owner Owner's Name information is required for O Box 1026, Osterville MA 02655 May 15, 2008 • - State Zip Code Date of Inspection every page. City/Town P B. Certification (cont.) , C) Further Evaluation is Required by the Board of Health (cont.): ; ❑ 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 coliforrn bacteria indicates absent avid 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 [I ® Backup of sewage`into facility or system component due to overloaded or clogged SAS or cesspool 3 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool, ❑ ® Static liquid level in the distribution box above outlet invert due town_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. F ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 08-116 Kaschuluk.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title, 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 15 Hidden Lane, Osterville MA 20655 Property Address 'Jeff Kaschuluk Owner Owner's Name information is required for PO Box 1026, Osterville` MA 02655 May 15, 2008 . every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) - . D) System Failure Criteria Applicable to All Systems (cont.): Yes No A. El ® Any portion of a cesspool orprivy,is within a Zone 1 of a public well.- El ® Any portion of a cesspool or privy'is within 50 feet of a private water supply well. ® Any portion of a cesspool or privy is less than:100 feet but greater,than 50 feet from a private water supply well with no acceptable water quality analysis. [This system,passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system,is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be t 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 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ the system is within 200 feet of a tributary to a surface drinking water supply 0 - the system is located in a nitrogen sensitive area(Interim Wellhead.Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to anyquestion in Section E the system is considered a-significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the Y system in accordance with 310 C M R-15.304. The system owner should contact the appropriate . regional office of the Department. 08-116 Kaschuluk.doc'-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 f Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 15 Hidden Lane, Osterville MA 20655 Property Address Jeff Kaschuluk Owner Owner's Name information is required for PO Box 1026, Osterville MA 02655 May 15, 2008 , every page. City/town State Zip Code Date of Inspection C. Checklist ; Check if the following have been done. You.must'indicate"yes"or"no" as to each of the following: Yes No ® s ElPumping 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 flown in the previous two week period? ❑ ®- Have large volumes of water been introduced to the system recently or as'part of this inspection? ® El _ 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,jocated on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior.of the tank inspected for the condition of;the baffles or tees, material of construction; dimensions, depth of liquid, depth of sludge and depth of scum? Was the'facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption,System (SAS)on the site has been determined based on: ® ❑ Existing information. For,example, a plan at the Board of Health.' Determined in the field (if any of the failure criteria related to Part C is at issue ® approximation of distance is unacceptable) [310 CMR 15.302(5)] 08-116 Kaschuluk.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 f � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for.Voluntary Assessments 15 Hidden Lane, Osterville,MA 20655 Property Address Jeff Kaschuluk " Owner Owner's Name information is required for PO Box 1026, Osterville MA ' 02655 May 15, 2008 _ every page. Cityrrown y State Zip Code Date of Inspection D. System Information , Residential Flow Conditions: F Number of bedrooms (design):- = N/A Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.2.03 (for example: 110 gpd x#'of,bedrooms): Unknown. Number of current residents 0`. Does residence have a garbage grinder? - a ❑ Yes ® No Is laundry on a separate sewage system?{if yes separate inspection required} ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ ; No- Seasonal use?'' ❑ Yes ® No Water meter readings, if available(last 2 years usage.(gpd)): Sump pump? ❑ Yes.® No Unknown Last date of occupancy: Date Commercial/Industrial Flow Conditions: ` Type of Establishment: „ Design flow(based on 31.0 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.)`. - Grease trap present? ❑' Yes ❑ No Industrial waste holding tank present? ,❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? _ ❑ Yes ❑ No Water meter readings, ifavailable: Last date of occupancy/use: Date Other(describe): ` 08-116 Kaschuluk.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts{ , = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form--Not for Voluntary Assessments "t 15 Hidden Lane, Osterville MA 20655 Property Address Jeff Kaschuluk Owner Owner's Name information is required for PO Box 1026, Osterville MA'. _- 02655.": May 15, 2008; every page. Cityrrown State .Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Cesspool pumped March 2004 Source of information:" - _ - - s y r Was system-pumped as part of the inspection? .4 ❑' Yes ® `No If yes, volume pumped: gallons. How was quantity pumped determined? Reason for pumping: Type of System: y ❑ - Septic tanK, distribution box,soil absorption system ` Single cesspool' ® Overflow cesspool ❑ Privy a ❑ Shared system (yes o`r 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) El 'Tight tank. Attach a copy of the DEP approval. #, Other(describe): `Approximate age of all components, date installed (if known) and source,of information: Overflow pit installed in 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-116 Kaschuluk.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 �<L,N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Hidden Lane, Osterville MA 20655 Property Address . Jeff Kaschuluk . Owner Owner's Name information is PO Box 1026, Osterville MA 02655 May 15, 2008 required for every page. Cityrrown State Zip Code Date of Inspection, - D. System Information (cont.) Building Sewer(locate on site plan):',' Depth below grade: feet Material of construction: ®cast iron ❑40-PVC ❑ other(explain): Distance from private water supply well or suction line:`' feet, Comments (on condition of joints, venting, evidence of leakage,.etc.): Septic Tank(locate on site plan): Depth below grade: feet " Material of construction: ❑ concrete ❑ metal ❑ fiberglass -. ❑ polyethylene t ❑ other(explain) If tank is metal,list age; yearn Is age corifirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------- Dimensions: Sludge.depth: Distance from top of sludge to bottom of outlet tee or-baffle, Scum thickness Distance from top,of scum:to top of outlet tee or baffle r Distance from bottom of scum to bottom of outlet tee or baffle ' How were dimensions determined? 08-116 Kaschuluk.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts. Title 5 Official Inspection form Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments w y° 15 Hidden Lane, Osterville MA 20655 Property Address Jeff Kaschuluk - Owner Owner's Name information is x 1 26 Osterville MA 02655 May 15, 2008 required for PO Bo 0 Y everypage. y Cit /Town State Zip Code Date of Inspection D. System Information•(cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,' liquid levels as related to outlet invert,.evidence of leakage, etc.): Grease Trap,(locate on site plan): 7 Depth below grade: feet Material of construction: ❑concrete ❑ metal El 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.): 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): 08-116 Kaschuluk.doc°08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Hidden Lane, Osterville MA 20655 ' Property Address Jeff Kaschuluk Owner Owner's Name information is required for PO Box 1026, Osterville a MA 02655 May 15,2008 every page. City/rown State Zip Code Date of Inspection D. System Information:(cont.) Tight or Holding Tank(cont.) ' Dimensions: Capacity: gallons a , Design Flow: r gallons per day Alarm present: LL ❑ 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert ' Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working:order: ❑ Yes - ❑ No 08-116 Kaschuluk.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 4 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Hidden Lane, Osterville MA 20655 Property Address Jeff Kaschuluk Owner Owner's Name information is PO Box 1026, Osterville MA 02655 May 15, 2008 required for every page. C4rrown State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits,. number: " ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: Two 6x6:pits. ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): -. Old block overflow pit had previously failed, newer precast pit was found empty with a high stain line 2'from bottom of structure indicating pit has never had more than2'of standing water. 08-116 Keschuluk.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 15 Hidden Lane, Osterville MA 20655 Property Address Jeff Kaschuluk Owner Owner's Name information is required for req PO Box 1026, Osterville MA 02655 May 15, 2008 every page. City/Town State 'Zip Code Date of Inspection' D. System Information (cont.) Cesspools(cesspool,must be pumped as part of inspection) (locate on site plan): Number and configuration One with 2 overflow pits. 5. Depth-top of liquid to inlet invert Depth of solids layer f ` x 0„ Depth of-scum layer - Dimensions of cesspool i 6x6 Materials of construction Block s Indication of groundwater inflow ` 0 Yes No - Comments (note condition of soil; signs of hydraulic failure,'level of ponding, condition of vegetation, etc.): Cesspool was found empty at time of inspection.' Privy(locate on site plan): T Materials'of construction: Dimensions Depth of solids ` Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): q 08-116 Keschuluk.doc 08106' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts. Title 5 Official Inspfection Form Subsurface Sewage Disposal System Form - Not for'Voluntary Assessments 't 15 Hidden Lane, Osterville MA 20655 Property Address Jeff Kaschuluk Owner Owner's Name information is required for y PO Box 1026, Osterville MA -02655 May 15, 2008 - " every page. Cityfrown State Zip Code Date of Inspection Do System Information (cont.) r . Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties ` to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. a Front • - , r r r r.r r r. r r r r r r r r , r r „ r ' .. r.`r♦r♦r♦r�r�♦r♦r♦r♦r♦r,r,r,r,r,r,r,�♦�♦r♦r♦ � r r r r r.r r r r i r r r r r r i r r rrr rrrrr rrr r r r r r r r r r r r r r r r r r r r r r r . rrrr i r r r rrrr , rrrrrr rrr r r r r r , , , r r r r ' r r i r r r r i' rrrrr r r r r r r r r r r`r♦>♦r♦r`r♦r♦r♦ rrrrrrrr r i r r r r r r r r r �r r♦r♦r♦r♦r♦r♦r♦r♦ - r r r r r r r r r r r r i r r r r r r r r r r r r•r r r r , r r r r r r r i r rrrrrr rrrr r r r r r r r r r r r ♦r♦r♦r♦r♦r♦r♦r♦i ♦r♦i r♦r♦r♦i r♦rrr♦r♦r♦r♦rrr♦r♦r�r�r�r�r♦)fir♦r♦r♦r♦r♦ �♦r r r r r r rr r r r rrrrr r r r r r r r r r r r r r ♦/ t`l`� ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ r r r r r r r r r r r r r r r r r r rrr r r r r r r r r r-rrrrrr r r r r r r r r r r r r r r r v r r r r rrr r r r . ♦r♦rrr♦r♦r♦r♦i;♦ r r r r r i r r r r r r r r r r r r r♦i♦r♦i`r♦r♦r♦r` rrrrrrrr• ♦r♦c♦r♦r♦{♦r♦r♦ • ♦. ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ - _ -- .rrr-rr {-r ' • rrrrrrrr - � ♦ ♦ ♦ ♦ ♦,,♦ ♦ ♦ , 22 20 �. 46 7 - ` Old overflow Main New overflow - Comm9nwealth of Massachusetts Title 5 Official inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Hidden Lane, Osterville MA 20655 Property Address Jeff Kaschuluk` Owner Owner's Name w z information is PO Box 1026, Osterville -MA 02655 May 15,2008. required for every page. Cityrrown State. Zip Code Date of Inspection D. System Information (cont.) Site Exam: . . ® Check Slope ® Surface water ® -Check cellar w Shallow wells Estimated depth to ground water: 20 ` feet Please indicate all,methods used to determine the high ground water elevation:` ❑ Obtained from system design plans on record If checked, date of,design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) - ❑ Checked with local Board of Health,-explain: ❑ Checked with local excavators, installers (attach documentation) ® Accessed-USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el, 5 and topo map shows property at el. 30. 08-116 Ka schuluk.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable P��ptHE T�ti Regulatory Services BAENMBLE. ; Thomas F. Geiler, Director 9� �9 1�� ArForA Public Health Division Thomas McKean, Director 200 Main Street, Hyannis; MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who.is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division.received, the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic .System Inspector who conducted the inspection. i Q:ISEPTIC\Disclaimer Private Septic Inspections.DOC COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL'P:RO�TECTIO:NfAE.LE (il�tp.! ` 2 f ;i 3: c!l} v s� ,.�...__ ilxVz� TITLE 5 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: d/,t,� � Owner's Name: Owner's Addr s: /3.<-f,) jir 17.Py- /t-/A Date of Inspection.:%,LE l21/yX Name of Inspecto (please r t 70 bef`11 �1 1tC�n�I �a77 71 Company NamQ Mailin;Address: . k -�� Telephone Nurr, O e-, 7"]f , 25,3 g CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on in).- training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section.15.340 of•Title 5(310 CMR 15.000). The system: V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority .ils Inspector's Signature: Date: IOb'�. The system inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shaPd system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the,buyer,if applicable, and the approving authority. Notes'and Comments M ;`*",*This report only describes conditions at the time of inspection'and under the conditions of use at that" time.This inspection does not address how the system will perform in the future under the same or different' conditions of use. Title 5 Inspection Form 6/I5/2000 page I Page 2 of 11 (' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property:Address: 'Y Owner: Date o nspection: Inspection Summary: Check A,B;C;D or E./ALWAYS complete all of Section D A. S stem.Passes: I have not found an information y rm ton which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria.not evaluated are indicated below. Comments: B. System Conditionally Passes: One.or more:system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,-as approved by.the Board of Health,will pass. Answer yes,no or not determined(Y,NND) in the for the following statements.If"not determined"please explain. The septic tank is metal and'over 20 years old*:or the septic tank(whether metal or not) is structurally: unsound, exhibits substantial infiltration.or-exfiltration or tank failure is imminent:System will pass inspection if the existing tank is replaced with a.complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance. indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup w break out or high static water level in the distribution.box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with. approval of Board of Health): broken pipe(s)are,replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping.m.Dre than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection.if(with.approval of the Board of Health).: broken pipe(s)are replaced obstruction is removed ND explain: f _ r Page 3 of I 1 OFFICIAL, INSPECTION FORM -:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARfA CERTIFICATION(continued) Property Address:. /C o Owner: Ar Date of spection: C-Pt0 C. Further.Evaluation is Required by the Board.of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy.is-within 50 feet of a bordering.vegetated wetland or a salt marsh 2. System will fail unless the Board of.Health (and Public Water Supplier, if any):determines that the. system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of 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 aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. _.The system has aseptic"tank and SAS and the SNS�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 DAP certified laboratory, for coli form bacteria and volatile organic compounds indicates that the well is free from pollution from that.:facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered:A copy of the analysis must be attached to this form. 3. Other: 3. Page 4 of I 1 OFFICIAL.INSPECTION FORM—NOT FOR.VOLUNTARY-ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Owner: Date o. nspectio �(�« D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to each of the following for all inspections: . Yes No Backup of sewage into facility or system component due.to overloaded:or clogged SAS or cesspool Discharge,or ponding ofeffluent to the surface of the ground or surface waters due to an overloaded or clogged.SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded:or clogged SAS or cesspool V Liquid depth in cesspool is less.than 6"below invert or available volume is less than %z day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number ' Vof times pumped _ Any portion of the SAS, cesspool or.privy is below high ground water elevation. —V 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 I of a::public.well. ��TTTT Any portion of a cesspool er privy is within.50 feet of a.private water supply well. Any portion of a cesspool or privy is-less than 100 feet but greater than 50 feet.from a.private:water supply well with no acceptable water quality analysis. [This system:passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm;provided that no other failure criteria: are triggered. A copy of the analysis.mustbe attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria.exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. ` z E: Large Systems: To be considered a.large system the system must serve a facility with.a design flow of 10;000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems.in addition to the criteria above) yes . no the system is.within 400 feet of a.surface drinking water supply _ the system is within 200 feet of a tributary to a surface.drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes." in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner,should contact the appropriate regional office of the Department. Nee 5 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _ Owner: Date of nspectionc7 Check if the,following have-been done.You must indicate"yes"or"no"as to each of the followine: Yes N . Pumping.information was provided by the owner,occupant, or Board of Health r/ Were any,of the system components pumped out in the previous two weeks V 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 backup ) v Was the site inspected for signs'of breakout? V _ 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? V Was the facility owner(and occupants if different from.owne-)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System.(SAS):on the site has been determined based on: ... �. . Yes no 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 CMI 15.302(3)(b)] 5 r Page of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property.Address: s Owner: Date joP,nspection: FLO CONDITIONS RESIDENTIAL.. Number of bedrooms(.design):-_ Number of bedrooms(actual): 3 DESIGN flow based on 310•CM� 1.5.203 for example: 11.0 gpd x#of bedrooms) Number of current residents: i 4 , Does residence have.a garbage grinder(yes or.no): Is laundry on a separate sewage systemiyes or.no):/% .[if yes separate inspection required] Laundry system inspected(yt.or no), O Seasonal use: (yes or no):A/0 Water meter readings, if available(last 2 years usage(gpd)):0 Sump pump(yes or no) It Last.date of occupancy:J� / COMMERCIAL/INDUSTRIA414 Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft-,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the.Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use- OTHER(describe): GENERAL INFORMATION Pumping Records Source of.information: Was system pumped as Part of the inspection(yes or no): l If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single.cesspool _Overflow cesspool _Privy _Shared system(yes or.no)(if yes,attach previous inspection records, if any), _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank =Attach a copy of the DEP approval Other(describe): 7 A proximate aue�of all components,date installed(if known)and source of information: Were.sewage odor&detected when arriving at the site(yes or no) r Page 7 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM JNFORMATION(cor_tinued) Property Address: Own Datee �l d��. Inspection: - 4 BUILDING SEWER(locate on site plan) Depth below:grade: Materials of construction:_cast iron 40 PVC other(explain): Distance from private water supply well or suction line: t Comments(on condition ofjoints, venting, evidence of leakage, etc.): '{ 2 SEPTIC TANK:w(locate on-site plan) Depth below grade: Material of construction: . concrete_metal_fiberglass_polyethylene —other(explain) If tank is.metal list age: Is age confirmed by a Certificate of Compliance(yes or no) —(attach a copyof certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffler Distance from bottom ofscum to bottom of outlet tee or baffle: How were dimensions determined: Comments-.(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence,of leakage, etc.): GREASE TRAP%YSklocate on site plan) Depth below grade: Material of construction:_concrete metal_fiberglass .polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Page 8 of 1 I_ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) . l Property Address: Owner: Date o nspection: gi-)00 TIGHT or HOLDING TANK:Atank must be pumped at time of ins ection)(ocate on..site.plan) Depth below grade: Material of construction: concrete metal fiberglass. _polyetfiyl.ene other(explain);. Dimensions-' Capacity: gallons Design Flow: gallons/day . Alarm present.(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX (ipresent must be opened)(locate on site plan) Depth of liquid level above outlet inve_t: Comments(note if box is level and.disiribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER./. (locate on site plan). Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):, 'I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR-VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address.: n Alf Owner: Date o nspection: C900 - 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: Jt-aching fields,number, dimensions: overflow cesspool,number: innovative/alternative system., Type/name of technology: _ Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc a /, Cv P CESSPOOLS: V(cesspool must be pumped as part of inspection)(locate on site plan) v Number and configuration: - p' -' Depth'—top of liquid to inlet invert; Depth of solids layer: _ Depth of scum layer: Dimensions of cesspool: ' }c Materials of construction:. �,� Indication of.groundwater inflow(yes or no):/_ ' Comments(note condition-of soi', signs of hydraulic failure, level of pond'ng,conaition f vegeta i n,etc.): / � 4. - 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.): 'Ali Page 10 of 1.1 OFFICIAL INSPECTION:FORM:..-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ic Owner: Date o!!fnspection: -Ci ao SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within =00 feet.Locate where public water supply enters the building. eGr a - vy)e ' k C.v aJn 01 Page l 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) Property Address Owner: Date of Inspec ion: SITE EXAM Slope Surface water Check cellar Shallow wells Esiimated'depth to"groundwater feev A Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: t r - � { 11 Permit Number: Date: Completed by: _,:_•:, HIGH GROUND-WATER LEVEL COMPUTATION Site Location: // / ` / s /"lz Lot No. , Owner: W /� Address: Contractor: �� i�`�6/ > C `/ Address: f Notes: STEP 1 Measure depth to water table to nearest 1/1+7 f`. .............................................................................. Date month/day/year STEP 2 Using Water-.Level Range Zone and Index Well Map locate site and determine: OA Appropriate index well................... © Water-level range zone.........:............................................. STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to © f® •$' water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth. to water level for index well (STEP 3), and water-level zone (STEP 213) determine water level adjustment .................:............:..............:............................................ STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water ty x level at site (STEP 1) .... ......................................................................................................... /.G ✓ i e Figure 13.--Reproducible computation form. 15 i �if��l°��� ��� � � � - � � .� i I • � I ., - -__ _�. --_ _ Third 35' Wde 1 •- Prlvare way)A r' ASSESSORSREF.c - . .L.,. (. _ _ i ■,V116:Parcel 072 - /a f 3 3 i. OVERLAYDISTRICT: AP-Aqulrer Pmteetlon DlsMct - c ZONE: FLOOD ZONE _ ®. q RC Zane C f" .� u V 1 Area(min.)87,1200 SF(RPOD) Community Pond Na y,1. f OO U N� �.�..' 1 Frontay"(II 20'. 925000t om D f V te.,. 3 f - o off. } e% �)1b0 July$ 1992 + Front 2oSId ' ..L•.1// K�the Ine S. Horgan` .. No DESIGN DATA - eOr 70. Location Man: - 7998 side• 1'a z,oDo't - - .smyl.e.�-ssmu® !U84'lS pO wlmxoaae4a,meQ - - - . 158 00 - m o:erem.-uo.t-ssoaPo - _ �� - 3.. ✓i I�uoo ta-00.tmn-tiao�o SEMCNOTES . aWOrc' - .ram®mmmr�.,®mbe�.lm.4v�.araane.m. o Proposed 4 ! 42-f0 S.A.S. - [�ACEDAIG AR . tfemrwmawsmPmtvbllgmm,cm.msyosm. Min. 12' I - EA- -- 'sfoowtal.- - _. ��wbarmpyae0-maamf> - w�s.ya,e zneammba.smvems� O I. aaID;]T xGw Oee�J BiieN1.X110'fICQ�X99P, A(mciv PW fmOml®RHid�MH�mPmAiTmlLwn M-P f eeCmpAm-(rtA'=OEt�.p16P t.rb Wea ue.lmmbavwmati�mm' '1x- I - rse ePrminerml � - : eaaoewm.e,an.ubm.eemammmmaaamlm.rm ". - .. _ s.. 7BAC ■r�'omw�r� �o.emewee'x.am�. �y ) E�J 6CHAI�B$DESIGN ws+me.s a��� t.m awmaaumerm�ml¢emee�ieeuq� _ N 0 ' 3 O t� I i i 4fo0dt 1� Vdlalc'11/.�omb M1tO to.S�.9beel�gimdf J D.:B S'd'' /F•'_ 4_.. :. r m°" - - 6 mwu.n .Nma�mewat,00autma t'-t ,rao•=a'w�'Nbeam.nam Stone - ■ - - s—,!&gy Rwha— rl m-r e�.�aamrb.maream mm _bmdof ._ - - 0.IAre'r=m ebB Btlmr.■hd®afP - Dve I Goro9e _ i.• .• ,.: PHICTUST 12;126 fU:mEbhNb Sf:bm 82NbAem.ad.aNmdmeAbr brgf - - m Proposed � #15 I _ - 7c septic 1-112 Sty _ w a a,a a.es■am .aa. Tank / sn en ter} w1f Dwelling I �` m ExiSesting/I F.F. El. 32:2 I � a ptic I Deck p • as Not I m � w CROSS SF.CnON OF CHAMBER y ;a Nar TO seas PARCEL AREA 25,245 S.F. (cc%J 0.580 ACRES ., N784915�"(rn/cJ. o-zaw saw riw °■ - . a/amanN bull , -' a k l 1Ep p 155..97 aub N78•4500E 155.00.(deed) ••• ti...e .-. _ -IlEVBi.Op$p FROb1I8 BSE1iGSY81'FM 'ORFROPOSBp Tobin-- _ _ _. _ _ __114141210 717LE' PREPARED BY. yq ..� •.:. L � l.O i[ 'I Pro Site Plan EYC y'Yc• r8k 9 �tr7 7? 3nH/c PREPARED FOR ;y OTES structures Proposed Septic System S011 van ngmeering, Inc.. Ellen Valentgos Trus#ee °ono by _ At 5 Hidden Lane:Te'rn le Nomin 'Z) ctures shown were located on the g conventional survey methods by'HGO Enginee PO Box 659 The property infonnotlon shown-hereon was compited from Osterville, 14A 02655 p h ee TruSt .available record information by.Hayes Engineering, Inc. m 15 Hidden Lane f501i)<28-JJH(.10"We-MIS I- PO f-.OX TI l626 �)The location of the driveway an i trees are approximate - Mi4SS n: d :u� �c $c��_t�� QSterville :MA `02655 bused an held inspection. _ r •BARNSMME rnste�rilel .4.) The elevations shown were located on the ground by Draft: JOD con ven tiono('survey methods by Sullivan Engineering, Inc.DATE• :. SCALE:. .Review: PS a • 20 0' f0 20 4e _ aD'. -and ore b'tised o N G UD 29. February'23, 26o8 T n=2O - S) The intent of this plan Is for the Permitting of o septic SSS Prods 27002 .' - system only, and Is only val d 't' original stompo - I and signature. fI/ 'rl ones•'-.;i111� .... - ---- aII � ----- II alrl:i• ••;�II• p:"I IIIII.Ire IrW 61nI ilrl.ulr 1 'll.�l - -;.....dill��,:IIIL.I1111:,all : 9r..'III , III:pI - sons '�,' .... - - nene ■:28 „Onlu:'I,.�n'I I.1.11I.In .... .... '....,•,•II,•, ,,,•.' .... .... .■.. .... .... .... .... _ .meal IIIIIIIIIIIIIIII ;, .... .... ,.'.r..Ill,: I.11rI Noss .... .... ��:ni .... sell nesI ''�� sale III,.I,I• nu.'IrI.In IIII.' - - -- --- - - ��' - -'- —NINE som■ BM �:'."i_- —'.Ill_ --�911 UII ," I■rll.nlll.nn Lllll ,i Llu :I I.II'..rn11 II';.l i';rII'. .... .... .... 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I,.�l��.Il.nl.anl.tell._I,L.:II.a,11.11I.nl.rll�llln.Ill,.rll..n„alll ._• - NOTE: DOMVIE7 FIR011 OUTSIDE • - • • • WINDOW SCHEDULE 1 11 Tv IiIL•IC117_1.alS:<9:1eHfY171.:�/aP19:/71JaJGl9IJ1y31deLL` • /it�r,+ara�.r��■.'ri:�rJ-1,tu:r..e .ISERIES- - - DOUBLE WIND ll��19:I.y:✓,ia:�■.vnax��r:■re:r:w,e r[14.3:i1*i1LYG:2:j:Ins.:�llx:Pl:l•1:11:Li]"kiH.vaaa� Lt IUJ P.l L1JllN'/li L•1Vl I7il.1D::1�:1 s0UL17AEri•.:N111h:/1177iII:lQ IJ?Y131J/NL` LL", •+•*�:+�Y141.Ida.Itl:lq:Wal'IJ.b\:I Rdval\.NUbl:a .���N,m J:1 J:��ry ••. WINDOWS/DOORS r . I MASTER - 00, USE MR.FIRE RATED DOOR o�D _ b O'IATFORM AT SAME LEVEL _ _ AS FLOOR SYSTEM) « - N +�' REF .. 'rf' s•-I}' I CE N �1 USE TYPE-%IHR FIRALL RATED LLS/ _ Z C IUNGARD ON ALL WALLS/. _ .- L— ' a �, CEILINGS TOUCHING O - ® +.II I .L 2. -. LIVABLE SPACE. Iz'fUll CNINFIS lZ W T•-51 - LIVING r-o r-lo• •4 - ROOM 40 MASTER (1�I1 _ BEDROOM lul r 2...1.Z,.,L '"°' •'y'` 7'- U DINING- �- G LL FOYER - } � El � N 0 0 1 ST FLOOR PLAN a 1 14"_11-0II ALL WINDOWSMOORS NOT MARKED ARE EXISTING .. EXISTING WALLS NEW WALLS - I. e` BATH 2- INTERIOR WALLS TO BE REMOVED - NOTE:ALL DOORS VIEWED FROM OMIOE f ® - IT I�TNF RFBPDNBIBILITY OF THE CONTRACTOR ^ TO H K THE WINOOW H OO F BEFORE ORDERING ` ' '' WINDOWSCHEDULL • �� � / ^ w/� e ,. BEDROOM I L----------- - ANo Ham" -o BEDROOM 2 Z 2ND FLOOR PLAN 1/4"_ VCI Fi•l a s DATE 1/16/D7 A1 .1 I Wide Third ( ' ASSESSORS REF: y` •• '� � - 35 Private Wo) V :. Mop 116, Parcel 072 +•R : ,, ,� v r. ;^` Affr OVERLAY DISTRICT: • " AP - Aquifer Protection District � 2' ZONE: FLOOD ZONE: a ` - RC Zone C Area (min.) 87,1200 SF(RPOD) Community Panel NO. �x h • . . ' -� �° ��. V Fronts a (min) 20' # 250001 0016 D Cn �(cn Width min) 100' July 2, 1992 p ' Setbac s: 4 Fron t 20' Frank L. N/F r o, Side 10' Location Map: & Katherine o Rear 10' Scale: 1"-- 2,000't 19984 S Horgan n DESIGN DATA �317 n► Single Family-5 Bedrooms oWith NO Garbage Grinder N6475-00'E' �) Daily Flow=110 x 5 ec 550 GPD SEPTIC NOTES 158 Septic Tank:550 GPD x 200%=1100 GPD p .C �� Use 1500 Gallon Septic Tank 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Prior to Any Excavation For This Project the Contractor Shall Make Proposed LEACHING AREA the Required Notification to Dig Safe(1-888-344-7233). p - -�-_ 2.The Contractor is Required to Secure Appropriate Permits From Town 1 » 42 S.A.S. 550 GPD/0.74=743 SF Requirod Agencies For Construction Defined by This Plan. Min. 2 "'1 ' r I=3o.25' NGVD Sidewalk=2(12.83'+42')2'=219 SF 3.The Water Line Shall be Constructed n Coordination With n! 0 t of concrete bound Bottom Area=(12.83'x 42)=539 SF COMM Water,and Shall be in Accordance With 248 CMR 1.00-7.00 TH-2 758 SF Total Provided &310 CMR 15.00.The Water Line Shall be Slaved Whom RevirtA T!_1 ' 4.Install Risers to Within 6"ofFmishedGrade(4 Required). 0 LEACHING CHAMBER DESIGN 5.All Structures Buried Three Foes or More or Subject All Pipes to be Schedule 40.Use to Vehicular Traffic to be H-20 Loading.It is the Engineea's n Chambers am Leaching Gal. -4500 Gl.Lhing Chb i 30.6 � Recommendation that FI 20 Always be Usat 29.5 12-10"x 42Washed Stone Field as Shown. 6.Septic System to be Installed in Accordance Vrdh 310 CMR 15.00& Proposed 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable fli 3 D-BOX ' �r ■ Board of Health Regulations. �) < 30$ 7.All Piping to be Sch 40 PVC. Stone Drive , S.Inlet Tees Shall Extend a Minimum of 10 Below the Flow Line. t1 1 Car 9.An Outlet Tee Shall Extend 14"Below the Flow Line, C7 and Shall be Equiped with a Gas Bat11e. Garage 10.Existing Septic System Shall be Removed,or Abandoned by being r PERC TEST: 12,126 Pumped,Crushed,and Filled. y ,� "7 '`'✓ ''�`� PERFORNMIDY.J0W40WL%Err-SDLUVANFN(3OGEMM tV V WrrMSEDBY.DONNAZ.M10X01N,RS.-TOwNOFBATMA= w FFBRUARY22.2008 FmrshOmde O \ 1 r w ` TEST HOLE-1 TEST HOLE-2 TEST HOLE-3 TEST HOLE-4 w t EL 30A EL 30A EL 30A EL.30A 3, Mm t` O ..,.a LOAM LOAM jr LOAM LOAM as 9•� compacted FM 0 Ire iV 7�y[ j �� BLAYM 10YR 4/6 BLAYM r0YRa6 BLAYM I0YR4/6 .7 BLAYF7t,0YR4I6 Fabric Proposed ' C,,I DAUYELLOWISHBROWtt DARKYEt.LOWISHBROWN DARKYEI.LOWISHBROWN DARxVMLOWISTIBROWN 2, ,' '�,°2R. Septic i 1--112 Sty (/) ECrAYER OYR" 9 BCLAYER OYRM 7 SMAYERIOYRSIS r 7AAMYSANO V4S-�/Y Tank v YUMWISHBROWN YELLOWISHBROWN YELLOWISHBROWN TELLOWISHBROWN 3' Doubtewaahed 1- / �� (� MYA.SANDWIFEWFnWS 279 MM SANDWIFEWFM 9 KW.sANDW/FEWFM MED.SANDWIFMFM 2 LEACHING Same \(� W f Dwelling ti CLAYFR23Y676 32.2 CLMY11Y6/6 CLAY VEUDI6 CLIVEYE1j,0 6 CIL4MBER � El. � OLIVEYIISAW OLIVEYIIIAw OLiVETEI7AW OLtVEYELIAW �- wood f,F.F. © MED.SANo I • MED.sANO ,A MFD.SAND , b[M.SAM .7 ` 4r YERCTEST 269 NOOROUNDWATERIN000NTOFD 36" YPAC TEST 27A NOGROUNDWATERENCOUVITE FD _ tp EXi$ting_/ Deck �, O O 25GALLOMINaMMOSEc 2SQUIONSINSMiN Q Septic ✓ �, -� r • MCRATE<2MDM 6 1 PERCRATE<2MDM 4'-10• (See Note 10)' ' NOOROUMWAMM4C0r$nFrtFD NOOROMIDWATMEW"MIUM f Q IT 10' m CROSS SECTION OF CHAMBER ' NOT TO SCALE d Q F.F.EL 3220 ' 29.3 30.9 F.O.EL 3050 F.O.EL.30.50 Sae Note 4(tYP-) O PARCEL AREA ` Tb 251245 S.F. �ca/c� I5110 Gallen TopE42760 0.580 ACRES (ca/c) Septic Tank Flow Nizaa Daox As Ragaued EL266o Leaching Ur :;SS Chambc Fi T F. � Bat .z4so O SULLIVAN .. , „ ,o• asPcrTitle5 ItFamnmterzdRemowRReplaro Bedding,"T's,&Befiels N78 49 25 E (ca/c) op of c' cretNGV (See Notes g&9) Th� p�smf h cr C�,�`ri,L to of concrete bound ,aMm.-seb 5Tstem B No,z 7�3 155.97 (ca/c) DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM �4 e- ��_ N78'45'00IF 155.00 (deed) ° Y G NOT TO SCALE PQ TAH.CvwndaatetMap LLF .. , - Robert T. Tobin 114141210 TITLE: Site Plan PREPARED BY' PREPARED FOR: NOTES 1.) The structures shown were located on the ground by conventional survey methods by Hayes Engineering, inc. Proposed SnrlticSystem Sullivan Engineering, Inc. Ellen Val en tgcrs Trustee 2.) The property information shown hereon was compiled from Q PO Box 659 15 Hidden Lane Temple Nominee Trust available record information by Hayes Engineering, Inc. At Osterville, MA 02655 PO BOX 1026 3.) The location of the driveway and trees are approximate 15 Hidden Lane (508)428-3344 (508)428-3115 fax based on field inspection. Ostery lle, MA 02655 4.) The elevations shown were located on the ground by BARN,STABLE (Osterviile) MASS, conventional survey methods by Sullivan Engineering, Inc. Draft: JOD 20 0 10 20 40 80 and are based on N.G.V.D. 29. DATE: ]SCALE. „ Review: Ps 5.) The intent of this plan is for the permitting of a septic February 23, 2008 1 =20 Proj. # 27002 system only, and is only valid with an original stomp and signature.