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Home My WebLink About0008 KING ARTHUR DRIVE - Health 8 King Arthur Drive Osterville A = 145 —034 I a T,,O�JWN OF�IBARNSTABLE LOCATION �� /yC, /�1}�'r A Ur A f, SEWAGE# VILLAGE �'ef V l Ile AS`SESSOR'S MAP&PARCEL !ys d3y INSTALLER'S NAME&PHONE NO. 5��7� Argk , k- SEPTIC TANK CAPACITY 142t)tj �fCGS�trrvc, LEACHING FACILITY: (type) -L C6 Qu �� h(size) �<A Y3 ")K �' O-ee p NO.OF BEDROOMS 3 0 � OWNER C-Gsey O V,n<P—n7— i PERMIT DATE: / COMPLIANCE DATE: Separation Distance Between the: I'r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on a site or within 200 feet of leaching facility) /1 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY S c c �-l1\ r A 13i qL/,S 03 .ors,a � A tvood Loft er TOWN OF BARNSTABLE LOCATION EWAGE# ��® - VILLAGE ASSESSOR'S MAP&PARCEL/'j� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: `/ (type) � - � (size) ,, NO.OF BEDROOMS 37 OWNER a c C o PERMIT DATE: ;L 3 COMPLIANCE DATE: 3 3 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 s k. C-;A . T10N SEWAGE PERMIT NO ' V I L L A C E - INSTALLER'S NAME & ADDRESS Py BUILDER OR OWNER -T DATE PERMIT ISSUED DATE COMPLIANCE ISSUED rlp �y06 / 009� 0,-( L � � t r �� TOWN OF BARNSTABLE LOCATION �EWAGE # VILLAGE ASSESSOR'S MAP LOTA- INSTALLER'S NAME PHONE NO ao SEPTIC TANK CAPAC171-Y 1000 LEACHING FACILITY:(type)— Ve-,,\, (size) 106 NO. OF BEDROOMS 3 PRIVATE WELL OR PUPILC WATER BUILDEROROWNER DATE PERMIT ISSUED: DATE C011PLIANCE ISSUED: "Z -a- 2- IF 2 VARIANCE GRANTED: Yes No I06 �? 3 C O o `� i ...Y.'2S- A Fss. .Q..:. .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH v �lTsea --.......OF........ ........ ..... ..................................... ApplirFa#inn for Disposal Works Toustrurtiun rnmi# Application is hereby made for Per it to Construct (l "for Repair ( ) an Individual Sewage Disposal System at* Lo. -Ad ress ) or Lot No. ._ . '\ ............. ...`� r s �.... _..C.t ..r......_........__._.... _............_.....�.........y.......V....•.�. :.......�.........42. ........ Owner Address a, �1 1.4 P 6Y1�SS� � Installer Address Type of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Q, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -----•-•---------------••-----•. . - W Design Flow............................................gallons per person per day. Total daily flow......................................._....gallons. 9 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter_______...__-_._ Depth................ 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.___-_____-_-_--_---__. 93:q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___--___-_-_-_•---____- 04 -•-•- ODescription of Soil...........................""._..._ .,_ __ _ __ _ U •-••--------•-----------•--••••••-••-•--••---••---•-------------•------------•---•••..........-•••••--._...-•-----------•---••-•---•-••--•••••----•-•-----------•----••••.......--------•-•-•-••---•---- V Nature of Rlepairs or NteratioA Ans ver when ap plicable __� -----`!'3_�_ ��___-____-__-___� !"= __. Pr Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT i'I:: 5 of the State SanitaL de— The undersigned further a es not to place the system in operation until a Certificate of Compliance has * sue y the b a d of h lth. Signed•- .••------------ ----�-- •---- :_... '------•-•-- `�12 r�l 97 ate Application Approved By............ - ------- _ Date Application Disapproved for the following reasons---------------------------------------------------------------•-------------•-------------------------........-- ............................................•---------------•-----------.....----•-----------•-----------------•--...---•----•--•--••---•--•---------••••-•-•-••---•-•••••-----------•--••----•......._. _ Date Permit No.------- -,�- -.. ..7 a� ----------- Issued....................................................... Date n THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �wu-: OF....... . . ............�.....4 (L�........ -.......... Applira#ion for Nipaaal Works Tnnstrnrtion rumit Application is hereby made for a Permit to Construct ('60ror Repair ( ) an Individual Sewage Disposal System ate: � :.,�� r* �!�_v- �� ... ---•-•----•-•_-•.�=--- -----------•---•: ........................ ............................. ................................................................. 1 Locat AJdress i F� } or Lot No. .._....... �..�..t.... .�"a^ ...Za+''--�.•...?.t +-......................... ...... ..............0°•._.. � ��..... e,..-•.....:..... ..... Own Address Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........................•.___ .__..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( j — Cafeteria ( ) a' Other fixtures ------•------------------- ---••-•-•••-•--••••-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. t� Septic Tank—Liquid capacity------------gallons Length,.............. Width................ Diameter__.__-__.._-_.-. Depth................ Disposal Trench—NTo. .................... 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.-__-----__.________-. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...-•._____-___-__ ---- 04 ....... ' ... ----------------------------•----.....--••-----.......---•------------•----.............---•-•---...-•-----••••-....._......•---.•••-- O Description of Soil......_......•..._��.....� .'" x U •--•----••••••-•••-•-••••-•----••-•--•-.....•--••-•-••--••----••-•--•-•-••-----•---•.............••--••-•--•-•••----•-•.....----•-•-••••--•-•--••-•--••---•--•-•---••-•---•-•-------------------------- W :..___..•.................•..._. ._..._...__ ._ J., U Nature of Repairs or Alteratio �` An wer when applicable.-.-__.____=0� �' ��:.............�.t��. ��.�� .._... .'- .-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i-_ 'of the State Sanitary"C,ode—The undersigned further Wjees not to place the system in operation until a Certificate of Compliance has een ssue ffy the b Ord of lipalth. ff - 7 Signed `._._. ... . ---- •-............••• . . ••.. Application Approved B ................................. Date ----•----------•................ Date Application Disapproved for the following reasons: = ----------------------------------•--------------------------------------------------•-•--. -•-•-•••-•••----•..............•--••---•-.....--•••••••------...-•--•••••---------...-----•••....-•••-•--._...........••-••-••----•-••-•-•-•••------------•---•••-••••---------•..........•........... Date Permit No.----- 7 ------------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........0F.........r0n 6 910 .................................. Trrfif iratr of Tumplittnrr Te17St TO ERTIFY - at the ndividual Sewage Disposal System constructed ( ) or Repaired (6.). ,.�-,_. -� Installer, � , ,. -_ has been installed..in.accordance W, h the provisions of '-[ iE j of The State Sanitary Code as described in the application for Disposal Works Construction-Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ s + ... Inspector.......... """"". _ , J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ) /..... ..................0 F....... ....................................... � Permission is hereby granted...... r.: _ :_-::..V..:;�`' - •---------- ...............•------....-----........•••.............-----•--_... to Construct ' ) or Repair an ndividual ewa a Disposal System----- ati�'o.._.__.._.__ `}_. �............ . � �C��._ .............................._....----.................... � Sueet �. as shown on the application for'Disposasl Works Construction Permit No.s.7.:.Y.�a'_._ Dated.......................................... Board of Eieal FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r 6o `( Fee / r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(/(Upgrade( ) Abandon( ) ❑Complete System [ Individual Components Location Address or Lot No. j/��,�c / � �, ,f-{J Owner's Name Address,and Tel.No. j f_e,,S� �2�(I d N Gwt Assessor's Map/Parcel ..� ' �j • _� fir. ®SC�i11 Installer's I�m e,Address,and Tel No. Des gner's N e,Ad ess,and Tel.No. S W�� cnY. 1�3 6W Ywr�a�✓ 1 eta j P-0 1'�5a% 1 5vv' 4enni5 � A sS 0 1(o; �t 3 Type of Building: Dwelling No.of Bedrooms �� Lot Size l_L( I I sq.ft. Garbage Grinder jJ0 Other Type of Building No.of Persons' Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) T 3® gpd Design flow provided sow gpd Plan Date , C a i Number of sheets Revision Date Title Size of Septic Tank e,)c�5 l C"to Type of S.A.S. ok a\ a 4 , C_ ci— Description of Soil �, _�� Nature of Repairs or Alterations(Answer when applicable) n e-1.> �.��,C�, 8.C`Ge. `r,, !P CSIk 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 b o Signe c/Date 7 J a Application Approved by Date 7 Application Disapproved by Date for the following reasons Permit No. �" �" Date Issued No: ` D (rvv/j]VVi/ :Fee / � x ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN.OF BARNSTABLE, MASSACHUSETTS Yes � x 2pplication for MispoSal 6pstem Construction j3erinit Application for a Permit to Construct( ) Repair(\/}/Upgrade( ) Abandon(_) ❑Complete System afndividual Components Location Address or,Lot No. �� l�C Owner's Name Address,and Tel.No. Assessor's Map/Parcel ' 0.3 �►` \�� G S c At Or. cs ir Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. V-c�� \\I 6S0 /C re"Ov�^'�'.k� � ��. l r.al g_rJ C3cx ,�. �� 9�n+�t� eA ®2 ,P6 �t h i 3� , A — r Type of.Building: Dwelling No.of Bedrooms t Lot Size sq.ft. Garbage Grinder(No Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required) Q gpd Design flow provided 7'? y' f M Plan Date V,, 1,L Number of sheets Revision Date Title Size of Septic Tank ' <,5�t N,It tO Ccr C,\- Type of S.A.S. C1,n>r t� a . 1„ I C Description of Soil f�� t.� d r.$ i Nature of Repairs or Alterations(Answer when applicable) c A e __-,� N,_P o i✓_L �'.f"'G�. �h Pr-c-%AA— 1 I 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,Boar_ of•ealth. ` Signe Date .-A pplication Api oved.by _ Dat€ Nt Application Disapproved by Date for the following reasons Permit No. l IKI ""P40 Date Issued ~ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( (;� Upgraded( ) Abandoned( )by at V k A 4 t Dr OS-WRY n Anaructed in accordance with the provisions of Title and the for Disposal System Construction Permit Nq /a"i%M6dated Installer (- ^t/ Designer S+9_1j I;'- I-A c r a #,bedrooms Approved design flow gpd The issuance of this permlit shall not bee construed as a guarantee that the systemwill function ' >d'�esiigned. Date �6 7 O Inspectorr _ -- No. . l _C,?'`�0 Fee A0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 4 Misposal *pstem Construction 3permit : Permission is hereby granted to Construct( ) Repair(e/) Upgrade( ) Abandon System located at i' r'k"l'� ,P 15� .I� Q;ZS A-cry r a. 1 and as described in the above Application for Disposal System Construction Permit..The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction'.mus t b�e^c�ompleted within three years of the date of this permit. Date I A Approved by`-- Town of Barnstalble Regulatory Services Richard V. Scali,Interim Director Public Health Division 163q �`rus+► Thomas McKean,Director 2Q0 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form DatA .2)LL Sewage Permit# 2(i 1 2(*assessor's Map\Parcel/ - a q Designer: S�Ek�i EIJ X. kA kS PC Installer: 15 1 A- Address: e, Address: DL-:�s �� o�� 4 A. � On j ! was issued.a permit to install a (date) (installer) septic system at y TA('%1,vr VC'. U4e_'y\11?based on a design drawn by (address) �"V=�p R`t.� 4AJA-S,RFdated ��Z (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system.referenced above was constructed ' 1 nce with the terms of the IAA approval letters (if applicable) (Installer's ignature) Willi To 19, AL (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8.14-13.doc Town. of Barnstable P# Departinent of Regulatory Services I ruuzr,ar,,nr�a F Public Health Division Date =�� X" Ti ia3t� 200t Main Street,Hyannis MA 02601 1 I • rFD AlK4� 14ad • ND Date Scheduled 4 Time l� 00 Fee Pd.— CD'�'� r Soil Suitability Assessment for e .Disposal F=` Performcd•By: e7 Witnessed By: LOCATION&.GENERAL,INFORMATION Location Address t J / R Oymer's Name d K,\n G A c-•� \p (' Address � Lki r\ A t�V C Or O S � S Assessor's Map/Parcel: ` v Engineer's Name 1� �-• �v NEW CONSTRUCTION REPAIR �/� —Telephone# Land Use• Ae7z>Z>,: - n�2 5lopas Surfhco 5tonas A�> Dletancoa ftnm: Open Water Body ft Posslblc%tArca ft Drinking VYatcr Well ft Dnrlhaga Way ft Property Line - o- ¢ ft Other {( SKETCH[(street name,dimensions of lot,exact locations of teat holes&para tests,locate wetlands-inn proximity, to holes) 101 4 101 Parent material(geologic) Depth t0 l3edroak 4-- r Depth to Groundwater. Standing Water In Hula: Weeping f In Fit FROG— A-)A Estimated Seasonal High Groundwater A-) A DETERMINATION FOR SEASONAL'EIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to sot)mottlert Delith to weeping from aide of obs,hole: ln, • Groundwater Adjustment tt, Index Welly Reading Date: Index Wall level.-._ Adj hator, ,,_.�_Adj.Croundwata1eval PERCOLATION TEST Data Time Observation 1 Hole# Time at 9" Depth of Para O 1 Time at 6" Start Pro-soak Time @ D U y Tima(911•6") End Pro-soak r/ Rate MlitAnch , LZ Site Suitablllty Assessment: Sltd Passed V Sitp Failed: Additional Testing Nodded(YIN) 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:\sBPTIC\PBRCFORM.DOC $", . Tr DEEP.OBSERVATION HOLE LOG Hole# Depth from Sell Horizon Soil Texture Shc1 Color Sall. Other Surface(In.) (USDA) (Munsell) Mottling (Stnucturo,Stones;Boulders, o iahlency.%Draval) �7 /./�"� ZZ DEEP OBSERVATION HOLEE LOG Hole# Z Depth from .Sell Horizon Soil Texture Sall Color Sall- Other Surface(In.) (USDA) (Munsoll) j Mottling (Structure,Stones,Boulders. �dS /vs,%� �� DEEP OBSERVATION HOLE LOG Hole# Depth from Sail horizon Soil Texture Soil Color Sall Other Surface(In.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders., Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Sall Texture Sall dolor Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Ca Flood Insurance Rate Map:_ Above 500 year Toad boundary No— Yes Within 500 year boundary No 1 Yes,:..:. Within 100 year flood boundary No. Yu ))egth of NaturaUv Occurring Pervious Ma erlal Does at least four feat of naturally occurring pervious mtiterlal exist in all areas observed thrpughout the area proposed for the soil absorpdbn syetam? Y&S If not,what Is the depth of naturally occurring pervious material?,._._._.._....... Codification ' I certify that on • {, (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tratnln p rdso and experience described In 410 CMR 15.017. Signature Datb 7 3 v Q;IaRFrrl 1PRRCPORM.DOC r - _ No. � Fee�,�v L THE COMMONWEALTH OF MASSACHUSETTS Entered in,computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplication for �Bi 5 Y &_ p5tem Con0truction Permit Application for a Permit to Construct( ) Repair( Upgrade( ),. Abandon( ) El-Complete System ❑Individual Components Location Address or Lot N P q Owner's Name,Address,and Tel.No�I�e Assessor's Map/Parcel Installer's Name,Address,and Tel.No.011h"211 9/N&r Designer's Name,Address and Tel.NoC96 � f�rv�'isT ��6'0� 8i 1119XE• v�cvoG, c� 3 o Type of Building: Dwelling No.of Bedrooms _7 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building < j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date a Number of sheets Revision Date Title Size of Septic Tank ��5�,00000, Type of S.A.S. 101 © 7C(7E Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system"in operation until a Certificate of Compliance has been issued by this Board of Heap Signed Date Application Approved by G Date Application Disapproved by: Date for the following reasons Permit No. o[.1007 ,_ Date Issued Fee k THE COMMONWEALTH OF MASSACHUSETTS., r l itered m computer: _ Yes PUBLIC HEALfA DIVISION - TOWN OF BARNSTABLE, MASSA�CH�USETTS` + Application for lDid--,og C *pgtem Cougtructiou'Vermcit Application for a Permit to Construct O Repair( Upgrade(( 4 Abandon( Complete System ❑Individual Components sr 1 Location Address or L,o.,tlNg � Owner's Name,Address;and Tel.Nolv�e Cj Assessori-'s Mapc/Parel � Installer's Name,Address,and Tel'.No.t If�l ��' � ` Designer's Name,Address and Tel.No. f '>• �`" d', r ':. .J' '' a ,! :Y ..n dt^ri ,Q O — 3 o.�.• ' Type of Building: f . _ Dwelling No.of Bedrooms Lot Size �/ �sq. ft. G bage Grinder(`' ) Other Type of Building ^ No.of Persons s , ' Showers( ) Cafeteria( ) Other Fixtures _ . Design Flow(min.required) ¢j�0 gpd Design flow provided l gpd Plan Date mber of sheets Revision Date Title Size of'Septic Tank Type of,S.A.S. 1t4r t H -Do Description of Soil - N•=,>` �ity 7 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in l 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. IAA Signed Date 0, 9 I Application Approved by Date Application Disapproved by: Date I' a for the following reasons s • d Per mit No. r} 9! � Date Issued �a -�� —————————————— °—————————————————————————-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired (fUPgraded ( ) Abandoned( )by at / ` U<' r R- ©5/ has been constructed in accordance :.. o � 7 �/ dated - with the provisions of Pitle.;jand the-for Disposal System Construction Permit No. Installer-, Designer #bedrooms r Approved design flow Z gpd P g Y i�i I , . The issuance of this it shall not be construed as a uarantee that"the s stem will flu ton/as de igne/ Date ( l J Inspector ( % [A J. ,[ ► �L - G / � No. 3 l Tee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1 1=igpo9;al 6pgtem Cow6truction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at a yk '- '/r �. f •i 1.e / � 1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. � � G Date ( � Approved by , �f �� ^ S Town of Barnstable '. '"E'a` .� Regulatory Services Thomas F. Geiler,Director • snnrtsreBLL MAMPublic Health Division Thomas McKean, Director 200 Main Street,Hyannis,ivt_A 02601 Office: 503-8624644 Fax: 503-790-6304 Installer & Designer Certification Form Date: (,� B Sewage Permit# — Assessor's ivlap\Parcel s / Designer: ��r�`� 'r Installer: / d:ew Address: b Address: G /7��;,77 37 was issued a permit to install a (date l (//installer) septic system at ht w based on a design drawn by (a7dated ) C7 f/p (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. V I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF {� o' DR, EN ' M (Installer's Signature) . NITAt0a oil (Designer's Signature) (Affix Designer's Stamp He PLEASE RETURN TO BARINS ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BAARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Heal th/Septic/Desiper Certification Form 3-26-ddoc Town of Bkmstable-. P# 5 S - °f � Department of Regulatory Services Public Health Division Date v s �s$ 20o Main Street,Hyannis MA 02601 Date Scheduled i Time - -'-- •ree Pd. a Soil Suitability Assessment for Se ge isposal Performed By,:a r Witnessed By: LOCATION & GENERAL INFORMATION Location Address' �� 7 Q j Z/vR D�v� 'I Owner's Name US 'am(, �� ' 34(,5 E. 1=061'14ILL- ILvD. OST�I2-V I�/L� W I Address 1 � G� 51!D Assessor's Map/Nrcel: 145/0•34 Engineer's Name T)Airf2,1 M eye NEW CONS' U0nON REPAIR I Telephone# So$ 36 2-29 Z Z ' Land Use i'`'��r r' C 4 h Gf � Slopes(`Yo) - Surface Stones _ 3t�U ` 5� f't Drinking Water Well ft Distances from: Open Water Body ft Possible Wet:Area g t ft. Property Line ! ft Other ft Drainage Way . SKETCH:(Street name,'dimensiodS%f lot,exact locations of t4t holes'&petc tests,locate wetlands in piozitnity to holes) • ?-- ,. ��% � � ,; `� ,- \ \ it ' '1 _� --l"�'� `\. �:•\\ \ter\. ;" `\ \ ,' • .. _ _ _ .,., !.: ......Y-"T}... \.1�`l++.w �, '�• 1 \. Exist. <� <<� Septi, �\\ \ ^��C. •'� \,✓� \\fie !i` 1 1 �B -Z g,c \ I 1 Existing Leach Pits 4'2, (Note 10) Depth to Bedrock Parent material(gedlogic I Weeping Depth to Groundwa(er. Standing Water in Hole:' f4 A ! P B from Pit Face Estimated Seasonal i jigh Groundwater 1 DtTERM N TION FOR SEASONAL HIGH WATEIr TALE Method Used: ln. Depth dbperved standing din obs.hole: _ , Depth to anll mottles: , i in. ©roundwnter AdJustment Depth tolwceping from side of obs.hole: I - A ,{aetor,,.,._�- Adj.Owundwater Level,,,,°, Index Well# Reading Date' Index Well level - I PERCOLATI�NTHST Date_._..._. -r e--�--" Observation Time at V N Hole# f A r/ Time at 6" ....-.------ Depth of Perc 'Time(9"•61�) Start Pre-soak Time.g ; End Pre-soak Rate MinAnch Site Failed: Additional Testing Nee Site Suitability Assessment: Site Passedded(Y/N).—�-- Original:.Public Health Division Observation Hole Data To Be Completed on Back ***If ercolalion test 1S to be conducted within 100' of wetland,.-You must first notify the P _ o-A..a,... watinn TH-w ision at least one(1)week prior to beginning- DEEP OBSERVATION HOLE LOG Hole# Soil * Other Depth from Soil Horizon Soil Texture Soil M ttling (Structure,Stones,Boulders. Surface(in.) (USDA) ( ) Consistency,%Gravel °! ? DEEP OBSERVATION HOLE LOG Hole# ?/ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.). (USDA) (Munsell), Mottling (Structure,.Stones,Boulders. risistenc %Gra 1 O' Av tU �6 DEEP OBSERVATION HOLE LOG. Hole# 14 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, QMvI Flood Insurance Rate Mai): Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No x Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist,in all areas observed throughout the area proposed for the soil absorption system? e If not,what is the depth of naturally occurring pervious material? Certification I certify that on (0 (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the,require '�expertise�a/n�d experience described in 3.10 CMR 15.017.. Signature Date • O:\SEPTICIPERCFORM.DOC ; f t a; _ _ } R ' ' - _ r VT _ Wa- :: y _ _ _ .. _ - M •�. C- D' Nam- _ -.{ .y1 _ _ - - E M - - fr C - ?- t. t- -' 6 "'; 3 d 3 } Y rroov,� t � i� _Etl "NAIRK Fr ^ +n.IC' J _ "} fr % 'c .k f - C - 3s -,{� c_Z 2 _ '"..� _ _ - 8 C�j t - _ ` FWWW -> x� .: �n^V .'fie I _ _ �31.i = S - }" .�a! _ _ T urt ; ,;, - � '�'�t *.'s �-- _ s ar. ^_'_ Div . s _ J li C v" _ - - ay 'a 3.: n.:'r E a•Ls zmc'sC A_.SS 170 - . , _ �- x s >f t' y y T Z y�s�� t1. X._14— .q RS -; �..'k I, - 1.L �,, y 'g z c40- _ 3 ! E . .X k_ - .x .' 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Qxa fit:N /�# _. � - , .,_ r .t`� x - - s . _ 1_ w. .: ' r .. _ . -r:::. _ _ Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, M 8 King Aurthur Dr Property Address - Indymac (contact David Holt @ Today Realty 1-800-966-2448) =a - Owner Owner's Name , information is required for Osterville MA 02655 9-15-08 every page. City/Town State 'Zip Code Date of,Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. _ - t t r f A. General Information 1. Inspector. �.�. .. 5 KZ Shawn McelroY w (��O.'4 Name of Inspector~ t s- DPPer Cape Septic Services Company Name . ..,J 29 Atwater Dr Company Address E. Falmouth _ MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number • r` .� psi, ;,a •�. � . 'e' i B. Certification I certify that I have personally inspected the sewage disposal system at this.address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience`in the proper`function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of w Title 5 310 CMR 15.000).The system: , _:r O r f •: leeds asses �_ ❑ -Conditionally,Passes. { ay• ® -Fails J. c Further Evaluation by the Local Approving Authority cry zz 9-15-08 frispector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board lof Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and-copies sent to-,the buyer, if applicable, and.the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that.time.This inspection does not address how the system will perform in the future under the same or different conditions of use. qlp t5insp•03/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 1 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty 1-800-966-2448) Owner Owner's Name information is required for Osterville MA 02655 9-15-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated 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, 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 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 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 t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts ;.. r Title 5 Official Inspection Form �< Subsurface Sewage Disposal System Form ,Not for Voluntary Assessments 8 King Aurthur Dr Property Address ,. $ ,s Indymac (contact David Holt @ Today Realty, 1-800-966-2448) Owner Owner's Name C, information is required for Osterville ' , MA 02655 9-15708 t " °- every page. City/Town State Zip Code Date of Inspection , B. Certification (cont.) B) System Conditionally Passes.(cont.):. , ❑ �:' distribution loz'is leveled or replaced „ il. . ,.•`r it .. s.,.t,=,e, i•' :at=l' ND Explain: ElThe system required pumping more than 4 times a year,due to broken or obstructed pipe(s). The system will pass inspection,if(with,approval of the Board.of Health):,--, ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 feetof a surface water 0 Cesspool or privy is Wit iin'50 feet of a bordering vegetated wetland or a salt marsh 2'.-Syst&ri will fail unless th'6 Board of Health'(and;Public Water Supplier,�if any) determines that the system is funciianing'in a manner that protects the public health, t : 'safety and.environment;. i ❑ The system has.a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of.a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water `supply. .�t ❑, The.system has.a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty 1-800-966-2448) Owner Owner's Name information is required for Osterville ' MA 02655 9-15-08 every page. City/Town State Zip Code Date of Inspection 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 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 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® _ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® 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. t5insp•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection .Form : Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments �.,ra; 8 King Aurthur Dr r , Property Address Indymac (contact David Holt@ Today Realty,_1-800-966-2448). Owner Owner's Name information is required for Osterville S- MA 02655 9-15-08+- every page. City/Town- ,, .: s,, State Zip Code Date of Inspection B. Certification (cont.) ,: D)' System Failure Criteria Applicable to_AII.Systems (cont.): . _ Yes' Nor ❑ S., Any.portion of a cesspool or,privy,is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or,privy is within 50 feet of a.private water supply well. ❑L '® Any portion of.a cesspool or privy is less thanA00 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 s 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 If 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._ r tkk The system fails. I have determined that one or more of the above failure ® El- ` criteria exist as described in 310 CM 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be ' s 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`fifes"or"non 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 1 ,❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area.-.IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question"in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed.The owner or operator of any large' system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty 1-800-966-2448) Owner Owner's Name information is required for Osterville MA 02655 9-15-08 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 ❑ ® 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•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts �. � - • : t Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4M 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty, 1-800-966-2448) 1-=, Owner Owner's Name A information is required for Osterville MA 02655 9-15-08 every page. City/Towne •State Zip Code Date of Inspection D. System Information Residential Flow Conditions:, ,,, Number of bedrooms(design): 3 Number of bedrooms,(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 330 Number of current residents: 0 • Does residence have a garbage grinder? , ., - =r, • , ° • ,� El Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required], ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? �, t; ❑ Yes ® No Water meter readings,-if available,(last,2 years usage,(gpd)): y-; Sump pump? ,:.a.�-_ ❑ Yes ® No . 8-08 Last date of occupancy: ,t.' Date r .r Date Commercial/industrial Flow Conditions: t,, . . , Type of Establishment:,— , , Design flow(based on 310,CMR 15.203). Gallons per day(gpd) Basis of design,flow(seats/persons/sq.ft.,,etc.): Grease trap present?, ,* ,, ,� ❑ Yes ❑ No Industrial waste holding tank present? a f`` ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑` No Water meter readings,,if;available:; : a • .p,�r Last date of occupancy/use: Date Other(describe): , t5insp-03/08 W Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty 1-800-966-2448) Owner Owner's Name information is required for Osterville MA 02655 9-15-08 every page. City/Town State Zip Code Date of Inspection D. System information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® 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: 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp-03/08 Tittle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 2 Commonwealth of Massachusetts Title 5 Official Inspection"Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,,-.-f: k •` ,M 8 King Aurthur Drf • +" Property Address Indymac (contact David Holt @ Today Realty '1-800-96612448) Owner Owner's Name information is required for Osteryille MA 02655 9-15-08{' - every page. City/Town 4, State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: } iY 1, 36" , feet` Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well,or suction line:,;, r Wit.- *- ' feet Comments(on condition of joints, venting, evidence of leakage, etc:): .• '. - Good condition. Septic Tank(locate on site plan): t1 Depth below grade: 30 feet Material of construction: . •� .,r;t1 `.° ® 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 ------------------ ----------------------------------------------------------------------------- ------------------------- J. Dimensions: 1000 Gal Sludge depth: . 20" t" Distance-from.top of.sludgeto bottom,of outlet tee or baffle a ; Scum thickness t 2"Y 5" Distance from top of scum to top of outlet tee or baffle 7 Distance from bottom of scum to bottom of outlet tee or baffle 14', How were dimensions determined? Tape t5insp•03108 '' _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not-for Voluntary Assessments U 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty 1-800-966-2448) Owner Owner's Name information is required for Osteryille MA 02655 9-15-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is in good condition with all baffles installed. 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.): 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): t5insp-03/08 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;,j� f wM 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty.1-800-966-2448) Owner Owner's Name information is required for Osterville i a. MA 02655 9-15-08 - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.)' Tight or Holding Tank(cont.) Dimensions: Capacity: "gallons Design Flow:. + gallons per days Alarm present: ❑,,,Yes .❑, No. Alarm level: Alarm in worldng order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): F "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 r3" F . , 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 in good condition with stain line above outlet invert. Pump Chambier(locateon site plan):= Pumps in working order: Tit j ❑ Yes : ❑ No Alarms in working order: . ❑ Yes ❑ No t5insp,•03/08 r r _ Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System.<Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty 1-800-966-2448) Owner Owner's Name information is Osterville MA 02655 9-15-08 required for every page. City/Town 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: 2-1000 Gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Both leach pits had stain lines above inlet inverts. t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments sit M 8 King Aurthur Dr Property Address r Indymac (contact David'Holt @ Today Realty 1-800-966-2448)R' Owner Owner's Name information is required for OSte(Vllle MA 02655 9-15-08 every page. City/Town. r State Zip Code - Date of Inspection r ..: .. D. System Information (cont.) #�' . Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration -�..� . ,t ,�a ., "41. A 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.): _ Privy(locate on site plan): Materials of construction: DimensionsV _ x Depth of solids Comments(note condition of soil; signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp•03/08 , Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts M u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty 1-800-966-2448) _ Owner Owner's Name information is required for Osterville MA 02655 9-15-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , 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 —� . o A a: 13-e- p A-F- 39G ° 9-r- or t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 8 King Aurthur Dr Property Address Indymac (contact David Holt @ Today Realty 1-800-966-2448) Owner Owner's Name information is Osterville MA 02655` 9-15-08 required for ` every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. 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: You must describe how you established the high ground water elevation: USGS maps show groundwater at greater than 20' t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 :NAMEOF..ENDER r P f BAR 6631 TOWN OF ADDRESS'OF OFFENDER D ' °I/'�t 8/!� M BARNSTABLE CITY,STAT,5 P CODE y E✓ I tJ�Jl J '0_ r r .. �1KE rq,. / `" ""' MVIMB REGISTRATION NUMBER OFFENS uAss. g. ,., rF0 MPS W TIME AND DATE OF v1 L TION LOGATION O F VIOL AT ION., ly NOTICE OF SSA M)i R,M,,t ON 20019 X SIGNATLrf E O WRCINGPEHSON ` �' C ,ENFORGI G t7EPT. BADGE N0. w VIOLATION I� ! ��f� �e o OF TOWN 14EREBY ACKNOWLEDGE/RECEIPT OF CITATION X a ORDINANCE Unable to obtain sign Ure of o ender. r► (}r THE NONCRIMINAL FINE FOR THIS OFFENSE IS S �� Date mailed ! ! w OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. Cn w REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, J before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. CL E2 If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST FINSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNS ABLE,MA 02630,Ann:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due criminal complaint may be issued a ainst ou. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature -- 7!'Y" y IY �-k w--t.a....A�.c?a+".�';^'}�."':"."''"n,n„r.' w4'1^r+c'�--•„c,�S-^...^w +� ,ft*,,-'*Pf-"5°".5,,".'.h.'1.+'A l'�.?�wt`E�.rcl+-�+,.cq+h.:,/' '-i �' "' e: TOWN OF BARNSTABLE BAR-WMO36 6 . Ordinance or Regulation ' WARNING NOTICE Name of Offender/Mansg e-r FEN,/ , j Address of Offender 2A � / f1 - MV/MB Reg.# y 0 _ Village/State/Zip c /a : -aLw`" , _ _ AV Business Name , /pm on �I 20 -02 Business Address '`` t -� i "�* . Signature ofeEhfoicing Off.icYer Village/State/Zip /I 4,, J Location of Offense i t RN 5G(A,1�r YAMal 4 / j x` '� Enforcing Dept/Division OffenseBL/T Facts3FJ #"tC.� This will serve 'only as a' warning. At this time no legal action h`as 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 viol at 1ons , will( result in appropriate legal action by the Town. a WHITE-.OFFENDER CANARY—ORD./REG.—PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ? TOWN &F,, BARNSTABLE 6 w 380 Ordinance or ,Regulation -Z WARNING NOTICE Name of Offender/Manage—r-I)/)AIA/A Z, — Address of Offender MV/MB Reg.# Village/State/Z ip Irv, 0 Business Name k 2.0 Ll�,Xlpm',. on' z 0 Business Address �11 At- Signature ofo"Ehforcing Officer Village/State/Zip A Location of Offense k Enforcing Dept/Division Offense Facts rp /z!3jx-I ac; iw�,, This will serveonly as a warning. At this time no legal action has been taken. It is the 'goal of Town agencies to achieve voluntary compliance 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. x..;. S .N;�.. 'Cat i•— - ----•yr�1^';,.ti�..,�,�^`'.,,n.'�d ,�f „•�r 'r+ .;r'7 g+�.nrw.,y'y. rm+; `eta^at:°rr.>en+C'Y"''' , •m'.', --":- � _. � TOWN OF BARNSTABLE BAR-WNOT 3683 rdinance or Regulation WARNING NOTICE Name of Offender/Manager 1� � IY r /V i Address of Offender � MV/MB Reg.# Village/State/Zip Business Name /pm; ,on 20= Business Address '' l . Signature of jEnfor`c ng' Officer Village/State/Zip E / Location of Offense f :�ar7, f• lf . { f/ j� /`�� / Enforcing Dept//t)ivisiori IOffense. !fit }/ 1 t i .�i"" ' 1 ON Facts - C41� `4 "kid-) A I 217 /100 ' d M & ► M ! &-��)A/ by / lo3 )/ r 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.. -� t 'r-=R .-:.. -. p-` r M--, t 'Cr`i'g'xl;T s^« ,. -;7 i. �, '"r 3 tF""-..--''aec,�3 rrgy✓x w^`ru° +r" -" . AT �. TOWN OF BARNSTABLE `Ordinance or Regulation . WARNING NOTICE y Name of Offender/Manager /41//, /1.4 _ r y € Address of Offender f i;' ; c l m� � .M MV/MB Reg.# Village/State/Zip x /�' I--�t :� ' ( Business Name w �am/pm,,.! on /120 a Business Address Signature of Enforcing Officer -" Village/State/Zip „,Location of Offense Enforcing Dept//Division Offense Facts ; iifi. :t,: jam^' 1 ' f - a r" tf� 5i' �aeeLia+�. V j� j , t t✓ +� t^i 1 s` f.� { r Ik.n 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. .a.....r^s,....`.-ti+w�?,-.^-tN.'•..-.t'✓p• M?'RT T' "..'f`.`-^'"' .etL„o^*"tc'-Am"'t*"'_.. ,>-„"' `rr .a ,�.y-.. .t«sF rmR �++,.wa;*+ -Sf 'X�T'.a.,rrmr-�-w.RvR�+,�_rr.f "'«,rT"'.."' 77 TOWN OF BARNSTABLE BAR-W✓ �`9 � Ordinance or. -Regulation WARNING NOTICE Name of Offender/Mans er (ITI N .� 600R f g a Address of Offender koJW s AkMik nk^ MV/MB Reg.#- to 4b , Business Name. . .&Y.pp; on , .� � � 2.00 y F, � Business Address /� ll•�� "� /T. Signature rEnfo'rcing O'ff� cer Village/State/Zipj1j JI)q Location of Offense j 1 A 1 /`I.t/(t�- , t "( {' /�(�` l � /o �l Enforcing Dept/DivBisi'on Offense. I� l�t /al�l �. - ` - N r / / lY ,' K Facts" 1f � � (_ � (_ K# 0 _h �1�f="I 11 eAX N hp_ r P()0' LS?" 6AO63 A LVCCA0yf ort%&V Floe This `will serve only 'as a warning. At this time, no le4al4action has been-' take"n. 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.i WHITE-OFFENDER CANARY ORD/REG R ROG PINK ENFORCING OFFICER GOLD ENFORCING DEPT. ". ",ti.,e4-..>+�.t'ti..+0��.�.�^r:.-r.^`.�..+s.. :!'..tw "..�s J`..�...�.,.r,,,�,ry.,.....rx`,�„Y:x.,,lt-.:r^r:w .t- --�^"*�.`r� ti+.mnr+T'y.^-..tam.q.,'�;w:i..,, �r.tr?.r'-�•.,•.:.�..^,r�-^:a'4 e-"v`-.r =•.r.-r :�7i ,0. � tt TOWN OF� BARNSTABLE BAR-W 39410 Ordinance or Regulation � . WARNING NOTICE ARM/1" Name of Offender/Manager �.,�� y` ,. Address of Offender ,{�S � ;- Sc ;�t;F' MV/MB Reg. 4 ` fc� 717 Village/State/Zip s f ' •I `., � � MA 67; , _ ..1 Business Name on / / 20 Business Address � t, ,. Signature of>"Enforcing Olf`icer Village/State/Zip Location of Offense f'� t (. Ir, :i- t,+, tw✓.3/ � r` /��r '/ ! �` 3 Enforcing I Division `Offense1 ! Facts` ! f Y ! :% l' t a' ' > IA( !rally Aa) /W lik- - This will serve -only 'as a -warning. At this time no ,14'gal/action has been! take"n.' 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.-FROG. PINK-ENFORCING OFFICER.' ' GOLD;'ENFORCING DEPT. + r , .4 TOWN OF BARNSTABLE BAR-W 3940 Ordinance or Regulation WARNING'NOTICE r. Name of Offender/Manager , f '" kill,° ► atJ K � Address of Offender R��Y :�^ r 1 r' %' MV/MB Reg.# Village/State/Zip t (� ,` /, ' , •;. '' x. �,° _.,� Business Name ,r m/.pm; on 200 Business Address ' tlh 1 Signature Enforcing Officer Village/State/Zip r Location of k ;� ,i Offense �� ,� `' � � :, '�,. 'r #�� °� `.,.�_ ,- }� ;4 ��,,�y �E`•F 3 � / Enforcing Dept[Di'vision Offense �. � t' r} ,t` "5 >f V Facts ! 4` .- .., + f �tt '1�11 # . If.. � ' �• `� � � ;j 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. Is .WHITE-OFFENDER CANARY-ORD/REG PROG. .PINK-ENFORCING OFFICER GOLD ENFORCING DEPT. a Barpstable Assessing Search Results Page 1 of 2 IRE y s y Home: Departments:Assessors Division: Property Assessment Search Results <<back to search 8 KING ART' UR DR IVE Owner: DONOVAN, KATHLEEN A Property Sketch Legend ; \ Map/Parcel/Parcel Extension 145 /034/ Mailing Address DONOVAN, KATHLEEN A 3, r � 1 8 KING ARTHUR DRIVE ' OSTERVILLE, MA.02655 r 3� 1333,, Assessed Values: Appraised Value Assessed Value Building Value: $100,100 $ 100,100 Extra Features: $2,600 $2,600 Outbuildings: $0 $0 Land Value: $41,900 $41,900 Interactive Property Map: ap requires Plug in: Totals:$ 144,600 $ 144,600 1 have visited the maps before y, Show Me The Man Sales History: Owner: Sale Date Book/Page: Sale Price: i DONOVAN, KATHLEEN A 12/15/1987 C112954 $ 1 v SICA,GLORIA J 9/1 511 9 84 C98073 $0 SICA, GLORIA J 1/15/1984 C95084 $10,000 -TO MCCLINTOCK, BRUCE B C76358 $0 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,359.24 Town Fire District Rates Other Rat 9.40 Barnstable 2.88 Land Bank %of Town Tax C.O.M.M. FD Tax $222.68 C.O.M.M. 1.54 Cotuit 1.88 Land Bank Tax $40.78 Hyannis 2.89 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 1/7/2003 Barnstable Assessing Search Results Page 2 of 2 West Barnstable 1.96 Total: $ 1,622.70 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.37 Year Built 1978 Appraised Value $41,900 Living Area 1316 Assessed Value $41,900 Replacement Cost$ 115,008 Depreciation 13 Building Value 100,100 Construction Details Style Ranch Interior Floors Carpet Model Residential Interior Walls Drywall Grade C Heat Fuel Oil Stories 1 Story Heat Type Hot Water Exterior Walls Vertical SidinClapboard AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms" Roof Cover Asph/F GIs/Cmp Bathrooms 2 1/2 Bathrms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,600 $2,600 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 (Finished) UST Utility Area(Unfinished) 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:Hwww.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 1/7/2003 Miorandi, Donna From: Lomba, Lois Sent: Friday, May 02, 2003 11:15 AM To: White, Samuel; Miorandi, Donna; Lavoie, Debbie; Stanton, David Cc: McKean, Thomas Subject: Request for Incident Reports At your earliest convenience please submit written incident reports for the following: John, Michael/BAR 66976: 66983; BAR 66985: 66992; Bar 44697/Health/White Baker, Donna/BAR 66312/Health/Miorandi Breen, Deborah/BAR 65311/Dog/Lewis Hercules, Gladys/BAR 66278/Health/Stanton Manley, Scott/BAR 65359/Dog/Everett Barnstable First District Court has received notice of these nonpayment violations and an arraignment date will be scheduled in the near future. Thank you, Lois Lomba 4672 1 i . .. . Health Complaints 05-May-03 �3 Time: 2:35:00 AM Date: 1/6/+563-Complaint Number: 3880 Referred To: DONNA MIORANDI Taken By: JOAN AGOSTINELLI Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 8 Street: KING ARTHUR'S DRIVE Village: OSTERVILLE Assessors Map_Parcel: Complaint Description: BEER BOTTLES AND TRASH ALL OVER THE YARD. PLASTIC BAGS TORN OPEN. TEENAGERS LIVING THERE AND ONE 21 YEAR OLD SUPPOSEDLY LIVING IN HOUSE, (RENTING FROM MOTHER). POLICE COME ALL THE TIME FOR PARTIES. UNDER-AGE. TRASH ALL PILED UP IN BACKYARD. ON CORNER. Actions Taken/Results: DZM investigated and there are several bags in front and in the rear along with open rubbish barrels. No answer at door-left a warning notice and also mailed them one stating it must be cleaned up by 1/8/03 or fines will be issued. DZM started issuing tickets on 1/21/2003 to owner, Donna Baker of 8 King Arthur Drive, Osterville. Investigation Date: 1/7/2002 Investigation Time: 11:30:00 AM ' 1 y2 .k COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION _ T t. uzl 1„t A • TITLE 5 s 1P OFFICIAL INSPECTION,FORM—NOT FOR VOLUNTARY ASSESSMENTS `r t SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM ; PART A .1 CERTIFICATION Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 1� J_ a Ni Owner's Name: MICHAEL WARD Owner's Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 ,; . f Date of Inspection: 11/5/01 ` v «, 3A, Name of Inspector: (please print) .r. JOHN GRACI Company Name: SEPTICINSPECTIONS P.O.BOX 2119 TEATICKET,MA.0253Mailing Address:Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT ¢ >;5 I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and ` experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system * p4 , •'t inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: , } X Passes _ Conditionally Passes Needs Furthe aluation by the Local Approving Authority 1 _ Fails ' Date: 11/5/01 Signature: Inspector's �(} �5 i. The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)withm ^ 30 days of completing this inspect on. If the system is a shared system or has a design flow of 10,000 gpd or greater,the �.x ins ector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be s: P °. sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. St sr Notes and Comments 44 ' THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG TIIEt i SYSTEM'S USEFULL LIFE';5 *** cribes conditions at the time of inspection and under the conditions of use at t1lat time.This { ****This report only des ill perform in the future under the same inspection does not address how the system w or different conditions o use r 5 haiel 1� S ({ct.rrtinn Form 611 5/ino n Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ., . . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .'r " PART A CERTIFICATION(continued) ' Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655tr Fr Owner: MICHAEL WARD i Date of Inspection: 11/5/01 Inspection Summary: Check A,B,C,D or E./ALWAYS complete all of Section D _ �9 A. System Passes: ,,. . X 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: ; THE SYSTEM PASSES TITLE.V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG ; , 5 THE SYSTEM'S USEFULL LIFE. 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. ) i Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. a , n/a 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: n/a n/a 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 ofi« F Health): r � _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a E n/a 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): h _broken pipes)are replaced . _obstruction is removed `z; ± vi 4�4 fi ! ND explain: n/a s .xtR Yly 01( tl f 4 d 7 Page 3 of 11 '�- • - YES�' _t$,� _. ;. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �� PART A ;y _ CERTIFICATION(continued) ¢ � is Property Address: 8 KING ARTHUR RD OSTERVILLE MA 02655 Owner: MICHAEL WARD 0, n Date of Inspection: 11/5/01 a' C. Further Evaluation is Required by the Board of Health: ;h> _ 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: i _ 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 ' Y 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that thef � 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 SASI 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 n/a **This system passes if the well water arialys►s 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 . m provided that no other failure criteria are triggered.A co pP �P gg cop of the analysis must be attached to this form ! i 3. Other: c' T VP a{ f 1:- a �3 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR;VOLUNTARY ASSESSMENTSTi SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM w , PART A r i CERTIFICATION(continued) Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 Owner: MICHAEL WARD Date of Inspection: 11/5/01 D. System Failure Criteria applicable to all systems: j ' �`. l You must indicate"yes"or"no"to each of the following for alLinspections: 1=' Y . i Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool { . _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ro, � 3 J y X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspools _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/Z day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. : + z _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ' _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. _l _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with c. .. no acceptable water quality analysis. [This system passes.if the well water analysis,performed at a DEP z � certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free , y 4 from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or r less than 5 ppm,provided that no other,failure criteria are triggered.A copy of the analysis must be ' t' » attached to this form.] tx + _ _ (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 . i CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be ro necessary to correct the failure. a � + 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: `F (The following criteria apply to large systems in addition to the criteria above) ; 1 yes no + - , X the system is within 400 feet,of a_surface drinking water supply _ } X the system is within 200 feet of a tributary to a surface drinking water supply t1 .+ _ X the system is located in a nitrogen'sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well x 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 't should contact the appropriate regional office of the Department. r �=� 1Zy.� tz n Page 5 of 11 {..F �. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMa PART B t c CHECKLIST Property Address: 8 KING ARTHUR RI)OSTERVILLE,MA 02655 Owner: MICHAEL WARD ' Date of Inspection: 11/5/01 Check if the following have been done.You must indicate"yes"or no as to each of the following: #t Yes No ,x } X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? ar j rk KKK X _ Has the system received normal flows in the previous two week period? S � ,l _ X Have large volumes of water been introduced to the system recently or as part of this inspection? 3 �x X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? _ nS.fke�. X _ Was the site inspected for signs of break out? { ` X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the kr ' baffles or tees,material of construction,dimensions,depth of liquid,depth of sludbe and depth of scum? X _ Was the facility owner.(and occupants if different from owner)provided with information on the proper maintenance " l g of subsurface sewage disposal systems? r The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no t X _ Existing information.For example,'a plan at the Board of Health. { X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J t 3w P, Page 6 of 11 _.;f� h OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ` ;. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM } PART C ' x` SYSTEM INFORMATION '� �._ Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 Owner: MICHAEL WARD Date of Inspection: 11/5/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 ¢ r. �x DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 u , Number of current residents:3 y1: Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):NO [if yes separate.inspection required] Laundry system inspected(yes or no):,NO Seasonal use:(yes or no): NO c E Water meter readings,if available(last 2 years usage(gpd)): n/a r Sump pump(yes or no):NO Last date of occupancy: n/a 1 COMMERCIALANDUSTRIAL , K Type of establishment: n/a Design flow(based on 310 CMR 15.203):,n/agpd F Basis of design flow(seats/persons/sqft,etc.): n/a is t t Grease trap present(yes or no): NO ,., Industrial waste holding tank present(yes or no): NO ; Non-sanitary waste discharged to the Title 5 system(yes or no): NO t Water meter readings,if available: n/a z " t Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records #. Source of information: n/a Was system pumped as part of the inspection(yes or no):NO , d If yes,volume pumped: n/agallons--How was,quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM ;: " X Septic tank,distribution box,soil absorption system z � _Single cesspool f _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 i -i urn system owner) 'L4 k� _Tight tank Attach a copy of the DEP approval t Other(describe): n/a " Approximate age of all components,date installed(if known)and source of information: y`. ORIGINAL 27-WITH NEW PIT IN 87 Were sewage odors detected when arriving at the site(yes or no NO Y" i P Page 7 of 11 s<"' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` t r � PARTCfs * SYSTEM INFORMATION(continued) Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 Owner: MICHAEL WARD ¢ Date of Inspection: 11/5/01 BUILDING SEWER(locate on site plan) Depth below grade:30" a p� Materials of construction:_cast iron _40 PVC Xother(explain):20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): " 9 j TOWN WATER . SEPTIC TANK: X(locate on site plan) ` 1 I Depth below grade:24" a r Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) , Dimensions: 1000G L 8' 6" H 5' 7"W 4' 101." ' Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" W Scum thickness:3" " Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of ouilet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related : . to outlet invert,evidence of leakage,etc.): }. MAIN SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING a;r EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ,='ls ' GREASE TRAP:_(locate on site plan),,,.) ' Depth below grade: n/a Material of construction: concrete metal fiberglass_polyethylene_other(explain): n/a Dimensions: n/a s . Scum thickness: n/a ;l A4-.dkt' q Distance from top of scum to top of outlet tee or baffle: n/a 1 Distance from bottom of scum to bottom of outlet tee or baffle: n/a Y� >. Date of last pumping: n/art, . Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related - f ' to outlet invert,evidence of leakage,etc.): • f; i �" x {a wo, n/a a C y 11 � s Page 8 of 11 fit'. : } OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C } SYSTEM INFORMATION(continued) : " i Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 � Owner: MICHAEL WARD Y' Date of Inspection: 11/5/01 a TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) An, i r: Depth below grade: n/a Material of construction: concrete metal_fiberglass polyethylene_other(explain): n/a F Dimensions: n/a �k xe Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A ?Y Alarm level:N/A Alarm in working order(yes or no): NO " '€ Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): loy DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) �. ,✓✓✓ i Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): k" BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no):NO Alarms in working order(yes or no):NOn ,. Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): , , n/ai�E ,s r A n r . re. Page 9 of 11 Zi 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS �4 "f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,; PART C SYSTEM INFORMATION(continued) �� i h> Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 Owner: MICHAEL WARD Date of Inspection: 11/5/01 ° SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type _ 1000 GAL 6' X 6' leaching pits, number: 2 � n/a leaching chambers, number: n/a °_: n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a1, ` overflow cesspool, number: nla n/a innovative/alternative system , R � Type/name of technology: n/aa 61 Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): : THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE SYSTEM SHOWS `W NO SIGNS OF FAILURE-THE NEW PIT HAD 2'OF LEACHING LEFT.-BOTTOM AT 9' � ;' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) £ ' Number and configuration: n/a � Depth—top of liquid to inlet invert: n/a 3 1 Depth of solids layer: n/a hg } Depth of scum layer: n/a {i Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no)! NO Comments(note condition of soil,signs of hydraulic failure,level.of ponding,condition of vegetation,etc.): ;:r n/a .,a PRIVY: (locate on site plan) ry Materials of construction: n/a Dimensions: n/a Depth of solids: n/ax Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a , 3 RC 9 ,! ", g i k`k q Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS w , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ='r PART C SYSTEM INFORMATION(continued) Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 Owner: MICHAEL WARD Date of Inspection: 11/5/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. t Locate all wells within 100 feet.Locate where public water supply enters the building. on t, YN Pelf . ID1 AD 6C � t k _{ r f s I Page 11 of 11 a OFFICIAL INSPECTION FORM-NOT FOR VOLUNT ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) Property Address: 8 KING ARTHUR RD OSTERVILLE,MA 02655 Owner: MICHAEL WARD Date of Inspection: 11/5/01 P SITE EXAM 1 _Slope - _Surface water _Check cellar _Shallow wells 1' Estimated depth to ground water 12 feet Please indicate(check)all methods used to determine the high ground water elevation: t NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a k YES Observed site(abutting property/observation hole within 150 feet of SAS) t , NO Checked with local Board of Health-explain: n/a NO Checked with local excavators;installers-(attach documentation) NO Accessed USGS database-explain: n/a 4y You must describe how you established the high ground water elevation: GROUNDWATER WAS DETERMINED BY AUGER-NO WATER AT 121-BOTTOM OF PITS AT 9' § F e ,r {k No. ................. Fps.............................. i THE COMMONWEALTH OF MASSACHUSETTS� BOARD OF HEALTH yGt^ ..................OF...... _ ....................... Appliration for Bigpnsal 10orkii Tanstrur#iun ramit Application is hereb made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst ��.. ? i. 2i�:-y .--. .............. .2 =�.... . ............... /•"�- .. ............ .. -. --- - ocation Address 4� / p�Lot/ o �� ..1. ... ` .. ... .. `. ...._ = �`.Y.........b ....0...__.t C!_Z2 _ O y rie %�S = Addres C............... W Z. ... �.. �.U <a' ........ ........ ... ........�----...... ................... Inst ler Address Type of Building Size Lot... ...Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures . ................................ Total 9 DSeptic Tank—Liquid capacity/"--n .gallon ss P Length person per day. ..f daily.fl.Diamete�_3...._. Depth___�lons: Wn Flow er I� W Disposal Trench—No..................... Width.•.•_............... Total Length.................... Total leaching area....................sq. ft. x !' bz°� Seepage Pit No__ _____________ �,�' Depth below inlet..__.__............. Total leaching area__._______..__....s . ft. __.. Diameter.._.... -- ..__._ p g q Z Other Distribution box (�' Dosing tank ( ) '-� Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No. 1...OA:_Z-.,minutes per inch Depth of Test Pit----- .._..... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... iDescription of Soil--- :.. ...... ...... ..: _ .. U ---------------------- -- ------ -----------------------------------------------------------•-------------------------------------- W ...---••••-•----------------••-••-•-••-•------••--•------••••--•-----•--•--••---••••-•---------••------•--••-•------------•--- --••----•-----••••••-----•--•-••••-----------•-•--•---••-•............... VNature 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 T IT 1.;.,. 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 by the board of health. / Date Application Approved BY-----� = l � Date Application Disapproved for the following reasons:-----•--------•----•-----------•------------------------------------------------•---........................... ....................•---....---------......--•-----------------...-----------•--•---------------......---------•----•-•-•--•-••••-•-••••-•--•-----•---••-•---••-•--•--••-•----•-•------•----••-••••..--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH y� ....... .............OF............ ... ............................. 1 r 'firatr of Tlamphaurr THI I S/ O CE..R FY, T h n ividual Se .agq Dispo 1 System c nst ructed or. epaired ( ) / Installer at_........'. .� � � .-=.=� (_�:!`� .L�� `=�t�`' = ------..0_7"` . -.--./- .----- has been installed in accordance with the provisions of T + 5 LL jj` of The State Sanitary Cod . as described in the application for Disposal Works Construction Permit No.. .7'�v................. dated...... - 7 �-f =.. THE ISSUANCE OF TINS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... 7f d '7- ......... Fizim............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CrL j ...................OF..... ... .............................................. Appliration for Dhiposal 10orkg Tonstrurtiou' ramit Application is hereby made for a Permit to Construct (�r Repair an Individual Sewage Disposal Sys at, trtm.................... .4 ........................j�n......... ....... .... ........ ............... .. ------------------------- ocatior 0 2Tj;re A.......J ... .... ............ ... .................I............... �M ............................ ... ------- --------------------- Addre-i ................ 0. ................. A..... .......................... 77 --------i----- -InstMer Address U Type of Building Size Lot.__ ,.Alln...Sq. feet 1Z Dwelling—No. of Bedrooms.............................................Expansion Attic Garbage Grinder.4 �11 44 Other—Type of Building .............................No. .110ersons............................ Showers Cafeteria Other fixtures ................................... .................................................................... ----------- ..............*.........Design Flow._.. . . ....G.-P-t...... .......gallons per person per ddy.. Total daily flow......... ..................gallons. W ------------------- 9 Septic Tank.—Li-qtqid'capa6ity./e>OV..gallons Length.....&........tvidth.... 'f• b` � . Depth................ iameter............... Disposal Tren6h No Width.................... Total Length........ .. Total leaching area ...................sq. ft. ------------- Seepage Pit No ---- Diameter A:54V..V Depth bef6w Total leaching area..................sq. ft. Z Other Distribution box (4- Dosing tank Percolation Test Results. Performed by....................................................... ................. Date.......................................... Test Pit No. I... n_minutes per inch Depth of Test Pit___-- �-...... Depth to grottfia water........................ 04 Test Pit No. 2.............._._minutes per inch Depth of Test Pit..................... Depth to'ground water..._._...............__. ILA 0 ... ... .... ............Description of Soil....0 12 _-Ly.........I............... 1 �w................. ... ..................................................................0. .............................................................................................. ------------------- .................................�y...... 1,19--------------------------------------------+�---------------------------------- -------------------------------------------------------------------- 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 TITJ 5 of the State Sanitary Code.—The unftX,§igned further agrees not to place the system in operation until a Certificate of Compliance has been issued by.tb;board of health. 77 S* ned_., . ............... . . .. .......... ............. ......... Date Application Approlv�ed By......;'14 .44, 4) ............ ..... VV---------------- Date • Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Pate PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH, OF MASSACHUSETTS BOARD OE HEALTH .......... ..OF.......... ........................... r -firate of (11intphatta THI 1 0 CER IFY, h nh idual age Disp I System ns tructed or epaired by........... ... .. . ....... ........ ... ................................ Installer at................ ... ... . ... . ...................... .........-----------(9... ................... ---------- ......................................... has been installed in accordance with the provisions of T 5 of The State Sanitary Cod described in the application for Disposal Works Construction Permit No ............... dated------ - ------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.............................................. ................................. THE COMMONWEALTH OF, MASSACHUSETTS BOAR F HEAL F. ...... ............................. .............**... � 3 No............Yfld..... . FE ........................ OA 0 .L _Ad i rd .1 L-Vermissi Z ..............V....................... .................................. is e ranted----"".... ...... ict or Rep an.;�idividuj rage D, �4D ;air to Constriqct 1. Sew Djff* P)Dsal ystem -2 A - A, at No... .......... ..... .................................................................. Street -;2 -nnl as shown on the application for Disposal Works Construction it No ......... .... Dated.._.................... ............ ................... DATE Bo of Healt 0� .... .. ------------- FORM 1255 HOSES & WARREN, INC., PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IM A\c� C DATA DC---S I Sl rw LE: FAM 1 V4, T Ito -4 P.P. 5 ey-r%C -r A W V- r7 X>kSVC>,SA.L PI CT 0 5 r,-- jcrr 'A L ,51VGD,.VALL A-EGA It5- BlaTTCMA AmeA L) ToTA-v- XUES%Gt-1 peZc,c -&-r(c>W 12ATr-- 1 IW I ftW AX 23�T-- rop ,Fwp joo,SV- AIZ F i 77r-'v 7770 C?ryM Pf- loop /Ps luv C*A.L. t000 GAL. rtc,.z 4- PiT 3/Z t i STD Lj rA. Q co P,I Wo Sc-ch"Lr-- V lch�.-r Q-- I i 4-o E-- t Cr--ICrtFY T"AT 'r k k I C' i I iJLp "Ee_S.Ar->j,4 C-0AA?L-'Y'5 \AjtrH -r"r,_- AWI> -.arBACV %ZeQL>jz-f—! AnE-L4-rS OF TWE OF- e V- V, T41r, ?L,&W IS UOT BA5F_I:> oLJ AU jjKTWmELAT 0e"Tjazvjl AAA-CoS. 5uE%-/9!,f 4 TWr- 0;=F5F-T; -y"DUL't> UOT 15r-- U-7er;l APPUC-A W"r To I I k •� 1 •tr `-- --- _\ - ��=' � � -;� � _ -� ; - LEGEND SITE ROUTE 28 PROPOSED CONTOUR ® PROPOSED SPOT GRADE- J/ „ 1l`l —— 98 —— EXISTING CONTOUR t'_._G + 96.52 EXISTING SPOT GRADE o 4 2 38 - \, \ _ 6 } / / W EXISTING WATER SERVICE. , THUR DR, TEST PIT �c K►NG �0 \\ \\ SSA 1 3 LOCUS MAP N.T.S. \ LOT \ \\ \\ I \\ i w GENERAL NOTES: AREA 1601 1\\S f .+— \� \\ \ 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL OF �q BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE 1 36 D LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: R - 310 CMR 15.405 (1) (8): O. 1140 1) A 0.61 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE 3.61 FT BELOW GRADE VS REQ'O 3 FT. (H20/VENT PROVIDED) . 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 44 Or `\ �\ \\ r\ \ �� EKL TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE \ \ NITAR\a DESIGN ENGINEER. 1 qqA TER �� \\ \� \ \ I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING J c.A E FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED, ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. \ \ I 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED /�i \I i N TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. Q jr l \• . jra I ` I h 9. IT. SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY \ 1 1 �,OOO THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING \\\ \ —Existing 9 CONSTRUCTION. OF k 6 \ \\\ Sep tic Ton 10. EXISTING LEACH PITS.TO BE PUMPED, CRUSHED AND REMOVED PER TITLE V. �Q� \ \\\ � I \ FILL WITH CLEAN MEDIUM SAND. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION f / - - 4 --6 J`-- •-� \\ , - 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY i I \ 'f 38 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY j \ \ 3. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT UNLESS SPEC. OTHERWISE \ I I \ 1 15. THE DESIGN 'OF-THIS SYSTEM DOES NOT ALLOW '�•. \ I �,� f j FOR THE USE_OF A GARBAGE GRINDER H-2 ! 16. NO WETLANDS- WITHIN 100 FT. OF PROPOSED LEACHING i 17. PROPERTY IS, IN ZONE II OR NITROGEN SENSITIVE AREA. w �., I I \ I 17. INSTALLER TO FIELD VERIFY H2O CERTIFICATION PRIOR TO INSTALLATION. H MARK 4-6 SENr4 0 1 PAINT SPOT ON �_ '4e',� WOOD DECK � 9 ELEVATION = 56- 22 __•;�^ i . ` �°^� \40 PROPOSED SEPTIC SYSTEM UPGRADE PLAN BA.RNSTABLE UIS DATUP.4 `�„ ' I '# 1 8 KING ARTHUR DRIVE, OSTERVILLE, MA 44 43 �.� TH-1 j Prepared for: Mike Dedecko I Existing Leach Pits MAP: �'..",,,......, LOT 034 1 SURVEY REFERENCE: (NO to 1 0) 42 L q.1 Engineering�by: Surveying by: SCALE DRAWN i LCP.•C165021,. DARRENM.MEYER,R.S. Eco-Tech !Environmental 1"�0' DMM PLAN. OF LAND BY BAXTER & NYE, INC. s� j _ �POeox881 1 DATED: JUNE 7, 1977 j (508) 364-0894 EAST SANDWICH,MA02537 DATE: CHECKED SHEET N0. 506-362-2922 12/01/09 DMM 1 of `2 = NOTE; TO- PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO, BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:37.39 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S. T.O.F. EL.=46.18 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION "PORT OVER t� OF S,S OUTLET AND SET TO 6 OF FINISH GRADE SET TO 6 OF GRADE ONE CHAMBER (MIN.) AND SET TO 3 OF F.G. . F.G. EL. F.G. EL=40.5t F.G. EL: 40.5f F.G. EL: 41.0-40.5(MAX.) VENT DAR�� No. 1140 L - IO'"t 9" MIN COVER/ ( 36" MAX COVER L - 15' L - 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) 0 S-176 MIN.) 0 S-Ix (MIN.) 0 S-1X (MINE.) NITAR 4"SCH40 PVC 4"SCH40 PVC .4"SCH40 PVC \Pa rl 14 INVERT \INV.=37.76 48"LIQUID INV.=37.51 - LEWL PROPOSED INV.=37.16- 4 ROWS OF 4 UNITS AT 6.25'/UNIT — 25'/ROW ! GAS BAFFLE D BOX SOIL ABSORPTION SYSTEM (PROFILE) INV.=37.36 DB-5 INV.=37.0 ' EXISTING 1,000 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND 75" TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ;'•' ' PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=37,39 ` f, :`<• 2) D—BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 37.00 ••'°. GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 36.06 INCH CRUSHED STONE BASE, AS SPECIFIED IN EXISTING SUITABLE 310 CMR 15.221(2) 2.83 MATERIAL ABOVE BOTTOM OF " ` 3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. • TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 4 x 2.83' m 11.32 f 76 IF FAILED, DAMAGED, OR UNDERSIZED. (7.56' PROVIDED) USE 4 ROWS .OF 4—HIGH CAPACITY ` PROFILE 4) INSTALL INLET & OUTLET TEES AS REQUIRED ADJ. GROUNDWATER EL.=28.5 = ADS BIODIFFUSER UNITS—NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION 16" - N.T.S. a. s.rs F 11,2 DESIGN CRITERIA SOIL LOG P#: 12556 +L� NUMBER OF BEDROOMS: 3 BEDROOMS DATE: MAY 8, 2009 i-� 34-0 SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR:L DARREN M. MEYER. R.S:, CSE. r sECTIoN END CAP WITNESS: DAVE STANTON, BARNS. BOH DESIGN PERCOLATION RATE: <2 MIN/IN 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT DAILY FLOW: 330 G.P.D. � Elev. TP—1 Depth Elev. TP=2 De _ _�� - - 41.0 -- 0". 40.0 0" DESIGN FLOW: 330 G.P.D. A LOAMY SAND A LOAMY SAND MODEL 16" HICAP 10YR 8 1 GARBAGE- GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 40.17 10, 39.37 tOYR 6 1 10" , ., B B LENGTH 76 NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY LOAMY SAND LOAMY SAND EFFECTIVE LENGTH 75" ' TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: 330 = 445.94 S.F. 10YR 8/6 10YR 6/6 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 37.92. 37" 37.0 36" SIDE WALL HEIGHT 11.2 .74 c c OVERALL HEIGHT 16" DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) OVERALL WIDTH 34" 4640 TRUEMAN BLVD PRIMARY S.A.S. MED. SAND PERC 0 36.75 MED. SAND m 13.6 CF .• —HILLIARD,-OHIO 43026- �1SE 4 ROWS OF 4 — 16" ADS BIODIFFUSER H-20 UNITS—NO STONE 2.5Y 6/4 2.5Y 6/4 CAPACITY (101.7 GAL) ADVANCED oRaNACE SYSTEMS. INC. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) 29•5 . 138" 28.5 138" _ PROPOSED SEPTIC SYSTEM SITE PLAN (BIOOIFFUSERS) 16 UNITS x 6.25 LF x 4.70 SF/LF = 470 SF DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 347.80 GPD > 330 GPD req'd PERC-RATE <2 MIN/IN. ("C" HORIZON)NO GROUNDWATER OBSERVED ,8 KING ARTHUR DRIVE OSTERVILLE MA Prepared for: Mike Dedecco Engineering` by: Surveying by: SCALE. DRAWN JOB. NO. DARRENM.MEYER,R.S. Boo—Tech Environmental NTS D.M.M. �. *'I, Darren M. Meyer, R.$., CSE; hereby certify that.I am currently approved by MADEP pursuant to 310 CMR 18.017 pO BOX 981 (508) 364-0894 to conduct soil evaluations dnd that the above analysis has been performed by me consistent with tha DATE T~ CHECKED SHEET NO. requirements of 310 CMR 15.017. I further certify that i have passed the Soil Eval. Exam in October. 1999. EAST 2-2922/CH,MA 02537 5oa,�szsszs 12/01/09 D.M.M. 2 . of 2 ACCESS COVERS MUST BE WITHIN 9" MINIMUM. I N VER T ELEVATIONS : DESIGN CR I TER I A : GENERAL NO TES : 6" OF FINISH GRADE 3' MAXIMUM COVER FIRST 2' TO INVERT OUT SEPTIC TANK: 95.0 DESIGN FLOW: BE LEVEL MIN 2" OF PEASTONE 'INVERT IN DI ST. BOX: 93.57 3 BEDROOMS AT I IO G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OR FILTER FABRIC INVERT OUT DIST. BOX: 93•4 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4" D/AM PIPE 94.o INVERT IN LEACH CHAMBER: 93.2 DO " - I !/E" D/A. NO GARBAGE GR 1 NDER 2. VER T I CAL DATUM I S ASSUMED. FOR BENCHMARKS % 95.0 93.4 � /2' �,o DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 92.2 `v OAS 93.57 $ SET. SEE 5/TE PLAN. BAFFLE 92.2 $ ADJUSTED GROUND WATER: N/A SEPTIC TANK REQUIRED: 3 OUTLET 6 LC-6 LEACHING CHAMBERS OBSERVED GROUND WATER: N/A 330 O.P.D. X 20OX - 660 GAL, 3. ALL CONSTRUCTION METHODS AND MA TER I AL S AND EXISTING D-BOX yy/2.5' STONE SIDES. 3.5' ENDS. 8'w x 43'1 x I2"d BOTTOM OF TEST HOLE #! : 85.6 SEPTIC TANK PROVIDED: /000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1000 GAL H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6" CRUSHED STONE OR 'COMPACTED BASE SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. DESIGN PERC RATE C 5 MIN/INCH N PROFILE : NOT TO SCALE SOIL TEXTURAL CLASS - 1 4, ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STAN0ING H-20 WHEEL LOADS. PROVIDED: 6 LC-6 LEACHING CHAMBERS �� W/2.5' STONE SIDES. 3.5' ENDS. A•446 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR �' G lW A c I 446 S.F. x 0.74 - 330 G.P.D. APPROVED EQUAL. is l l{/j/ l" RO U7-E SOIL TEST P l T 4A TAB 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED PRECAST CONCRETE OR APPROVED POLYETHYLENE. IERCOLArlWICArE'S �_ INDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER �- -� '- - " - - _ PERCOCATlON � OBSERVED r TEST - 6ROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE / - - - - - -- - - - - - - -- - - - - - - TP �i P�15634 TP #2 OUTLET. - -9S 0 - y ` - { 5�- - _ _ _ _ - _ - -. - _ - 0" HORIZON rEXruRI COLOR AS g 0. HORIZON TEXTURE COLOR 9s.8 7, BEFORE CONSTRUCTION CALL "DIG-SAFE'. �b +` � A LOAMY /OYR A LOAMY IOYR go / � / ' ' _ _ - - - ` SAW 2/2 SAW 212 1-888-DIG-SAFE AND THE LOCAL WA TER DEFT. // 6 LC-6 LEACHINd CHAMBERS 14' - - - - -- - - - - - - - - - - 94.4 12 - - - - - - - - - - - - - - - 94.8 FOR LOCATION OF UNDERGROUND UTILITIES. \ S 8Jc',�� w/2.s. srow sMrs. 3.s ENDS. LOAMY 7.5YR LOAMY 7,SYR ovEfFLo�r \ \ 1 72 52��.E B sANO 4/6 B SAND 4/6 g SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE ,/rig. \ PER\TOwN\RE6RDS\ \ 30" - - - - - - - - - - _ __ 93.3 24" - - _ _ _ _ 93.8 CATCH BASINS r 94,5 / �"""`�----- MEDI.um /OYR MEDI UM lOYR ® \ \ \ \ -F C C DES 1 GN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION I 1 \ 26`W 1 Dk DRA/)V sAn� 6/6 sAND 6/6 r ' � SOl2 EMOYAL � � -0F THE SYSTEM TO ALLOW FOR SCHEOUL 1 NG OF THE I � AGE EASEMENT CONSTRUCTION INSPECTIONS. 6.\ \ SEE N07f ID. " w TPe2 60" .: ALL UNSUITABLE MATERIAL (A B HORIZONS) } , ` ......... ..4.:.,,_:._..'; a ENCOUNTERED BELOW THE INVERT OF THE LEACHING " - ~�� "T"""" .• r tm� FACI L l TY TO BE REMOVED FOR A DISTANCE OF 5' 43 r D-BO \J \ '^ /gip• AV MATER 85.8 I20' W HATER Bs.$ AROUND AND REPLACED WITH SAND IN ACCORDANCE 1 97.4 e 16'oA \ W/TH TITLE 5. + \ ? 94.4 DATE: MARCH 30. 2018 TEST BY: STEPWN HAAS 101.7 I , \ / I +98.b �, \ \\ WITNESSED BY: DONALD DESMARAI$ PERC RATE: C 2 MIN/INCH / BM. CORAL-* 'OR I CX STEP { '�� 97 0 1 / EL 103.74/,,' I 2 / `11 \ \ 95.4 50 74 Ex�1TING \ \ d; SEPr(C TANK \ \ 0 N 94.7 \,✓1 ! 9917 \ �c VENT PIPE41 ID 90- r LOT 3z r IN LINK FENCE 16. 011{ S.F. up,l S EP T I C S YS TEM DE' S f ON 148.99• N 85°33 /Q-W 8 K / NG AR THUR DR l VE . MAP 145 . PARCEL 34 E3ARNSTA 8LE , ( OSTERVILLE ) M,4 . PREPARED FOR : LEGEND RourE as LOCUS A CASEY DE7V NCENT o a CB CONCRETE BOUND WATER LINE SCALE 1 - 20 " DUNE 1 2 , 2018 HYDRANT - 1 G GAS LINE STEPHEN A . HAAS OHW-- OVER HEAD W/RES, / LIGHT POST ENGINEERING c° --£-- UNDERGROUND ELECTRIC LINE P © . Box 1 6 �\w -T-- UNDERGROUND TELEPHONE L/NE /�� 1 1 �`�� Sou t h 0 e n n i s MA 02660 --CTV- UNDERGROUND CABLEVI SIGN LINE '' /�` 'l� ( 5 0 8 ) 3 6 2--8 1 3 2 +40.4 SPOT ELEVATION / / �,/ ...••40--•- EX/STING CONTOUR LOCUS S MAP 0 /0 20 40 41�10 PROPOSED CONTOUR JOB NO: 18-009