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HomeMy WebLinkAbout0031 PARKER ROAD - Health 31 PARKER ROAD OSTERVILLE Nl/P 117161 Commonwealth of Massachusetts (� =--, ,, Title 5 Official Inspection Form _ — I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ~= 31 PARKER RD _ :! r Property Address - — RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name —"— -- information is required for every PSTER_VILLE _ MA 02655 5/7/2021_ page. City/Town _ State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Trevor Kellett key to move your Name of Inspectorcur ---use the -do not Ca e Cod Se tic Services _ use the.return --�------�-- key. Company Name ,— — 350 Main St. -Comp__ .Company Adddress-- dress ---------------------- „d _ ---- W Yarmouth _ _ --------..._—_.:..— -- ---- ___ MA _ 02673 City/Town - State Zip Code z1u� 508-775-2825 _ SI-13744 _ Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3• ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5/11/2021 Inspector's Signature Date v The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5insp doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts �1!----- -_(r title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t� 31 PARKER RD Property Address --- — RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481. Owner Owner's Name information is OSTERVILLE _ __ required for every � MA 02655 5/7/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS IN WORKING CONDITION 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER RD _ Property Address RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is OSTERVILLE required for every _ _ _MA_ 02655 5/7/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑. Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): 1 ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further.Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 __ I Commonwealth of Massachusetts _- ---, Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �,�.. 31 PARKER RD _ Property Address RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is required for every OST_E_RVILLE ___ _ MA 02655 5/7/2021 — _ _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well", Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS_or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form lei Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER RD Property Address RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is OSTERVILLE required for every _ MA _02655 5/7/2021 _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation, ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure-criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts -= --- ;W Title 5 Official Inspection Form —�; � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ca 31 PARKER RD Property Address RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is required for every OSTERVILLE MA _02655 5/7/2021 � . page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site.inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) l5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 i Commonwealth of Massachusetts �)= `o Title 5 Official al Inspection Form �Nt— � Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments �� 31 PARKER RD L ' Property Address RIDGEBACK INVESTMENTS LLC - 15 LINC_OLN RD, WELLESLEY MA 02481 Owner Owner's Name ---' information is OSTERVILLE _ required for every — MA _02655 _ 5/7/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage '19 - 1128 GPD g ( y g (gpd)) '20-830 GPD Detail: LAWN IRRIGATION IS ONSITE Sump pump? ❑ Yes ® No Last date of occupancy: UNKNOWN Date f 15insp.doc-rev.7/20"/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form , �1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER RD_ _u., Property Address RIDGEBACK INVESTMENTS LLC - 15 LINCOLN_ RD, WELLESLEY MA 02481 Owner Owner's Name information is OSTERVILLE required for every —_ ___ MA _02655 _ 5/7/2021 page. City/Town — State y Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: — — Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — Last date of occupancy/use: Date Other (describe below): ` 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 GALLONS gallons How was quantity SITE GLASS q y pumped determined? Reason for pumping: MAINTENANCE 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts --_,__i Title 5 Official Inspection Form _ 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c �.� 31 PARKER RD Property Address RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is OSTERVILLE required for every _ _ __ MA 02655 5/7/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND PROPERLY PITCHED t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I Commonwealth of Massachusetts j1 -- ,'7 Title 5 Official Inspection Form Ii., Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER R_D Property Address �--------- ---------- —. RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is OSTERVILLE required for every _ _ _MA 02655 5/7/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): " ' Depth below grade: 21 - feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: ----- years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GALLONS Sludge depth: 2" -- Distance from top of sludge to bottom of outlet tee or baffle — 1" 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 -- How were dimensions determined? ESTIMATED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 GALLON TANK IN GOOD CONDITION. PVC TEES IN PLACE AND CLEAN. TANK AT NORMAL OPERATING LEVEL. COVERS 10" BELOW GRADE t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form',Subsurface Sewage Disposal System-Page 10 of 18 .� Commonwealth of Massachusetts f,--=--= Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments = 31 PARKER RD Property Address — RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name —"— information is OSTERVI_LLE __ required for every _ _ — MA 02655 5/7/2021 page. City/Town State Zip Code Date of inspection— D. System Information (cont.) r 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Scum thickness Distance from top of scum to top of outlet tee or baffle - Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): n Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: -- Capacity: gallons - Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts == --,7p Title 5 Official Inspection Form _ — I. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER RD Property Address - RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is required for every qSTERVILLE MA 02655 5/7/2021 __ ------- ------------ -------.......—.- — -------- — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date �— Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN 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 LEVEL AND WATERTIGHT t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts _WF Title 5 Official Inspection Fora .1y�0i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER RD Property Address ----- RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name — -- information is OSTERVILLE required for every _ ^.� MA 02655 _5/7/2021' page. City/Town State Zip Code Date.of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: — ® leaching chambers number: 3-CULTEC 330'S ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7126/2018 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection For 1' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31_PARKER RD Property Address RIDGEBACK INVESTMENTS LLC - 15 LINCO_LN RD, WELLESLEY MA 02481 Owner Owner's Name information is _ _ required OSTERVILLE for every _S __. MA 02655 _ 5/7/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 3-CULTEC 330'S WITH STONE FOUND IN OPERATING CONDITION DURING INSPECTION. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration — Depth —top of liquid to inlet invert ---- Depth of solids layer Depth of scum layer -- Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp,doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER RD _ Property Address -- RIDGEBACK INVESTMENTS LLC - 15 LIN_COLN RD_, WELLESLEY MA 02481 Owner Owner's Name —information is .—TE_RVILLE_ _ _ _ MA _02655 5/7/2021 required for every _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: -- ---- - Dimensions - --- -- Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 f Commonwealth of Massachusetts �1► _ Orp Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER RD Property Address RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner _ Owner's Name "--'-" - -- information is required for every OSTERVILLE MA _ 02655 5/7/2021 _ page. City/Town State Zip CodeA Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below; ® hand-sketch in the area below ❑ drawirig attached separately 6 � r I t5insp.doc•rev.7/26/2016 Title 5 Official Inspection'Form;Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .74 ti;� � — i, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 PARKER RD _ Property Address ^-- ——" RIDGEBACK INVESTM_ ENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is OSTERVILLE required for every _ _ MA_ 02655 5/7/2021 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar Shallow wells Estimated depth to high ground water: +9 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: I You must describe how you established the high ground water elevation: HAND AUGER PERFORMED ONSITE AT TIME OF INSPECTION TO 92" ENCOUNTERED NO GROUNDWATER. BOTTOM OF SAS AT 4' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3_1_P_ARK_E_R RD Property Address ---- --"----- _" — - RIDGEBACK INVESTMENTS LLC - 15 LINCOLN RD, WELLESLEY MA 02481 Owner Owner's Name information is required for every OSTER_VILLE _ _ MA_ 02655 __ 5/7/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: I 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Town of Barnstable P# 15 o��Z Department of Regulatory Services Public Health Division Hate MASS: t9 ze;q �� 200 Main Street,Hyannis MA 02601 Mla� I cr) Date Scheduled, Time � Fee Pd.. -o s Soil Suitability Assessment for Sew a Disposal Performed By:s 111191 Mb k n-C—f-1N& CN&j i j A j jitnessed By: .v^ W. 0751k_hw07r LOCATION-&'GENERAL INFORMATION Location Address Owner's Name L i scA timcS C)i I'art_eL- e_ck . Address LisA- MrZ}'TA 17�Glid �<► 0 5. te rVt U%17j!;)u r\lo&(1141 0\(', Assessor's Map/Parcel: 7 Engineer's Name #n.t 14 LI LJ Z3 it �Ilo9 Ufl v �!L' 1Vlet1" NEW CONSTRUCTION ®p REPAIR Telephone# Land Use L�e.S,�i 4 Aq Slopes(%) &) 5 Surface Stones Distances from: Open Water Body' ft Possible Wet Area ~' ft Drinking Water Well ft 1 .¢ Drainage Way `" ft Property Line JV ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �7' . for I Parent material(geologic) 0( Depth to Bedrock �i�eTY1 x Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION'TEST Date ,2 l Time Observation Hole# Time at 9" A << Depth of Pere 2- ly Time at 6" Start Pre-soak Time @ Time(9"-6') 3' End Pre-soak Rate Min./Inch � Site Suitability Assessment: Site Passed �� Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LUG`` Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other . Surface(in.) (USDA) "Y (Munsell) Mottling (Structure,Stones,Boulders. Consistenc ° Grave 0-3 4 , 11 3- y Nard t*dl �61'![ /� ' /S w Gs fG l0 A al s! 4 MR 2 e Anal DEEP OBSERVATION HOLE LOG' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.° Gravel Cl (G c0,9A , ro y fa^e. C CC-13 2 S4 h.�1 J41',o lG Y/? 7 2 So S-fa^,e S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency.%Graven Flood Insurance Rate May: I Above 500 year flood boundary No_ Yes Within 500 year boundary _ No Yes g Within 100 year flood boundary No V/1 Yes Deyth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious paterial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on 7 L (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 11017: d Signature (R � �/'C Date Q:\SEPTIC\PERCFORM.DOC I t Town of Barnstable oFtHe t Regulatory Services Thomas F. Geiler,Director . Public Health Division * -BARNSTABLE, * Thomas McKean,Director MASS. O �j 1039. 200 Main Street, Hyannis, MA 02601 Phone: 508-862-4644 .Email: health@town.barnstable.ma.us ��O��/] Fax: 508-790-6304 - U Office Hours: M-F 8:00—4:30 July 2,2009 Lisa M. Thomas Trust RE: Underground Storage.Tank Removal 6475 Dunbarton Drive Order,31 Parker Road,Osterville,MA Hudson, OH 44236 Map Parcel 117161 Tank#1 Tag#0239 Dear Sir/Madame: The Barnstable Public Health Division(BPHD)is in receipt of a copy of the"Application for Permit"for storage tank removal and transportation issued by Centervill-Osterville-Marstons Mills Fire District demonstrating that the above referenced underground storage tank was removed from the above referenced address on November 17, 1995. The Public Health Division appreciates your attention to this matter and has updated its data base to, reflect this fuel tank status change. Should you have any further questions please contact Cynthia Martin of this office at 508-826-4645: has A.McKean,RS, CHO Director of Public Health FORAM':P.P. 292 Department of Rubiic Safety Division of Fire Prevention and Regulation AppUCAT10N FOR P£;W—j, AM PEZI�, FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD FDIDI 01920 Permit Date November l7,lg 95 Osterville /7)/ J!� Ety,Town or Lli3w.c, t . 8 2 S . 4 0 N . G . L . DIG SAFE NUMBER :Fee Paid: S 10.00 954401353 star . �a _ 11/2/95 In accordance with the provisions cf Charter 140 , Sec. 2SA, M.G.L. , Shoreline Tank Service 527 C11,1R 9 . 00 cD:l herc}';T ;lar e bY.- 87 Pond Street, Osterville, MA Street Add_ -ss & Ci ar down S 17 n z t u r 2 O CC.L.X.._.,-� Applicants name printed: C.".r�5 m c� CC l� For per;,iission to %-:Move and trans.cr, cne underground' storace tank frcm. Ann Hall . 31 Parker Road, Osterville Owner. Stree* Address : Firm traZlSDcr _ng was - Enviro-Safe ^fate •LiC. 1 MA-329 T Hazardous west- manifest A. T Approved tank yard: Turner. Salvage 002 Commercial Street, Lynn, MA Wank yard Address : Type of -iner- gas: UZ tank 4T 275 Subs td C ! a5 t store-: #2 Fuel Oil. stor Tank c.�pacyty.. . November 17 Yi;ra icn: December 1 95 -Date of iss-ue : 19 Dai e of e Sianatsre/Tide oT officer grant rc per:�it: SHORELINE TANK SERVICE, INC. 87 Pond Street Osterville, MA 02655 508-428-5529 Storage Tank Removal Receipt aU.i i y Date:- ------ Type: Oil_ --------- Gas----------- Other—_-------- Own er:------------ Address------------ �-�Ar��_( --------- ------------=--- ------------------- fie .�1��r�'�---- -- - ------ -- --�;9�--------------------- Dig Safe#_SS� �l013S - - - - - Tank Transported To: 381 Old Falmouth Rd. Unit 6 (Temporary Destination) Final Tank Destination:__ Q-" -----------------Inspector:-_� Comments:_-�� _ - ------------- ------------- ----------------------------------------------------------- Fo Barnstable Town of Barnstable R Regulatory Services Department 2007 Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Date: April 1, 2009 TO: Lisa M. Thomas Trust 6475 Dunbarton Drive O D n/7 Hudson, OH 44236 PC �O p V RE: Underground Storage Tank at: 31 Parker Road Osterville, MA Map Parcel: 117161 Tank NO: 1. Tag NO: 0239 Our records indicate that your underground fuel (or chemical) storage tank is over 20 years old, and has not been removed as required by section 326-3:.subsection 2 of the Town of Barnstable Code regarding.fuel and chemical storage systems. You are directed to remove this tank within sixty(60) days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90) days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A. McKean, RS, CHO Health Agent TOWN OF B RNSTABLE LOCATION ` �( VAC J SEWAGE# VILLAGE d�,,&'C \J�\\SL ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY L ( &C� LEACHING FACILITY.(type) (size), NO..OF BEDROOMS \ADOV,i.:v `)0� ��"J C, OWNER M PERMIT DATE: COMPLIANCE DATE: WSW, 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 oaL - A-4-d P 4-0 � � r C�c�O�� nn� //0/�' T / ,56 No. .d`®y� ��I V �" "---5� ' Fee 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes OfPpYication for Bi5po5a[ 6psStent (Construction Vermtt Application for a Permit to Construct()Repair( Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. PQ1jkj2/k Owner's Name,Address;and Tel.No. C D esAssessor's Map/Parcel l t rl t 6 I Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ?— 33 L Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 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 111are th system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed V Date / Application Approved by Date '( 3 'd JT Application Disapproved by: -"'"'" Date for the following reasons 2 Permit No. Date Issued i t— 17 d l .�'.... Y,,..,*ti,.-.. 9.d.":tiSh'�'`.'*....:v♦ ^r T{'+,�� .y� �,.M.`.✓.#i ".'-,. ,••rrs.yfh.�..,� ,..*,.,r.,f-`r�1R,..,�t„: _ No. :pool ' 510 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes -.. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYicatton for -Migpoal 6p5tem ConsStruction permit Application for a Permit to Construct Repair Upgrade Abandon O D.Complete System ❑Individual Components Location Address or Lot No. �Q A" R Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 'l 9 1 (� i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4-1- 3 3 cl y f Type of Buildings`" Dwelling No.of Bedrooms > r Lot Size sq.ft. Garbage Grinder ( ) Other Type of Buildin No.of Persons Showers YP g�'� ( ) Cafeteria( ) Other Fixtures t Design Flow(min.required) gpd Design flow provided gpd i f Plan Date Number of sheets - �� Revision Date Title t Size of Septic Tank Type of S.A.S. 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 pjacQthe system in operation-until a Certificate of j f Compliance has been issued by this Board of Health. Y, Signed Date f Application Approved by Date 'a Application Disapproved by: Date for the following reasons F Permit No. 1 Date Issued l /3 ,d f } THE COMMONWEALTH OF MASSACHUSETTS Q� BARNSTABLE, MASSACHUSETTS �I Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage DisposalSystem Constructed ( ) Repaired ( ) Upgraded (�) Abandoned( )by % A :Q� / ) ►IJ9� at 31 �"� a-QX w v- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �L—37to dated ,,.,installer Designer #.bedrooms Approved design flow gpd The issuance of this permit hall of nstrued as a guarantee that the system w',(fu c io as d signed. r Date Inspector. - No.- — Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ` �Oigool �&pgtem CCow6truction 3permcit i Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) S stem located at � f and as described in the above Application for Disposal System Construction Permit.The applic ecognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thi�Dot Date /1( ` 'd Approved by r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes " PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS application for 30k;pool bpztem Cong1ruction Permit Application for a Permit to Construct( , )Repair( )Upgrade( Abandon( ) ❑Complete System ❑In 'vidual Components Location Address or Lot No. 3 1 PwE-K 1\A Owner's Name,Addres and Tel.No. i-.15 I�Ty am S Assessor's Map/Pazcel Installer's Name,Address,/la1nd17 U/Tel.No. Desig is N e,Address d Te1.�1o. E GpO�tT. tart✓ � /VA Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/nb) Other Type of Building E No.of Persons Showers(. ) Cafeteria( ) Other Fixtures Design.Flow lons per day. Calculated daily flow -gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 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 Certifi- cate of Compliance has been is "ed by t 's Board of lth. Signed AA Date - 01(14 Application Approved by Date Application Disapproved for the following reaso Permit No. a oil 57= 1 Ky Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS T Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded( ) Abandoned( )by at has constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ?dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector 11(?q No: ! Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - 7 Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Digpogal Opgtem Construction 30ermit Application for a Permit to Construct( )Repair( )Upgrade( /Abandon( ) ❑Complete System ❑In 'vidual Components Location Address or Lot No.3( P��Ki� 2d Owner's Name Addre and Tel.No. aM S Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Desig �r's Name,AddSP 1�No. All-�_ lv� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(No) Other 'Ilype of Building IF No. of Persons r Showers Cafeteria( ) Other Fixtures Design.Flow ions per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q t �``• ,. . Date<l,asi inspected:., Agreement: -'�r The undersigned agrees to ensure the construction and maintenance of thei�afore described n site sewage disposal system Jy in accordance with the provisions of Title 5 of the Environmental Code tad'notjto place the system in operation until a Certifi=-w•` Cate of Compliance has beAised byis Board of ealth.Sign Date S 6 Application Approved by _ Date Application Disapproved f the following reaso Permit No. Date Issued -------------------- ------THE COMMONWEALTH OF MASSACHUSETTS ,BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired( )Upgraded( ) Abandoned'( )by at has ba constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No � dated Installer Designer ` The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector-- - _ r t •- -.._. - ---- —.-----.------------------------- No. i Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ;Digpogaf *pgtem Construction permit Permission is h,�iehv vranterl to nair( R_l TlnorndH ( _l Ahar - - system located at • ' I r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be c mpl ed within three years of the date of thi Date: , Approved by V COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS UV DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE S OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 31 Parker Road "...,. :VED Osterville, MA 02655 Owner's Name: All Realty Trust F E B 6 2002 Owner's Address: 173 Lumbert Mill Road j Marston Mills. MA 02648 1 Tti r-N OF"'BARNSTABLE Date of Inspection: January 23, 2002 HEALTH DEPT• Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map: 117 Mailing Address: P.O. Box 49 f Parcel: 161 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs urther Evaluation by the Local Approving Authority Fails Inspector's Signature: \ Date: January 24, 2002 The system inspector shall subm a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 Parker Road Osterville, MA Owner: All Realty Trust Date of Inspection: January 23, 2002 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 distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 Parker Road Osterville, MA Owner: All Realty Trust Date of Inspection: January 23, 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: '31 Parker Road Osterville, MA Owner: All Realty Trust Date of Inspection: January 23, 2002 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 F. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST M - Property Address: 31 Parker Road Osterville, MA Owner: All Realty Trust Date of Inspection: January 23, 2002 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 Parker Road Osterville, AM Owner: All Realty Trust Date of Inspection: January 23, 2002 FLOW CONDITIONS RESIDENTIAL 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(yes or no): n/a 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 Water meter readings, if available(last 2 years usage(gpd)): 2001 -22,000,gals.; 2000-60,000,gals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None on file-per treatment plant Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Mar. 31, 1999-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Parker Road Osterville,MA Owner: All Realty Trust Date of Inspection: January 23, 2002 BUILDING SEWER(locate on site plan) T Depth below grade: Approx. 34" Materials of construction: _cast iron ✓ 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ locate on site plan) ( P ) Depth below grade: 24" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Parker Road Osterville, AM Owner: All Realty Trust Date of Inspection: January 23, 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: Qallons/day Alarm present(yes or no): Alarm level: Alarm'in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. There were no signs of leakage or solids. There were no signs of backup or failure in the leach field. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Parker Road Osterville, MA Owner: All Realty Trust Date of Inspection: January 23, 2002 , SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 3 Cultecs 330s with 3'6"stone 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.): The leach field was located, but not dug up. There were no signs offailure in the D-box. The bottom to grade was approximately S'.- CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 f Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Parker Road Osterville, MA Owner: All Realty Trust Date of Inspection: January 23, 2002 Map: 117 Parcel. 161 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. ,n AC9- 3�•� A a 3 O 10 f Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Parker Road Osterville, MA Owner: All Realty Trust Date of Inspection: January 23, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30' +/- feet (Adjusted High Ground Water Level:25.8') . Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach field to grade was approximately 5. Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 30'+1-to ground water at this site. Using the Cape Cod Commission Technical Bulletin, the high ground water adiustment for this site(Ml W 29, Zone B, 12101)was 4.2'. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. I - 11 GrA d e- as. 1-1 iq� GrovndWA?"ei leve �. tj -FM 3 a. o • �P('' G�ou��wATe I eve I i , TOWN OF BARNSTABLEPool ti n LOCATION PAK6; 2 SEWAGE # 9 Fr' (,O a a VILLAGE 6S tl✓<<� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3 CUl L 33b�s (size) 3 a STO•t� NO. OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (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 bySQec�'�ibn r ay c�'� `II a�-� 3$ � (33- S� a 3 O TOWN 05 BARNSTABLE LOCATION—-302PZfW— OU SEWAGE # VILLAGE `��PN 1 0 UL� ASSESSOR'S MA,P�&& LOT/—/? INSTALLER'S NAME&PHONE NO. ..�( SEPTIC TANK CAPACITY8 L� LEACHING FACILITY: (type)./ 3 HOC° �C' �, (size) JV NO.OF BEDROOMS S BUILDEROROWNER a lT PERMITDATE: COMPLIANCE DATE: �6///J 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 �_ _> �� v. ._._... � ut ,� �� Q Y � - - ,$. �- � -� _ _ � ' .:. 3 ��� �s�. No. 0�021 : Fee . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes �• PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for Migpozar p5tem Cottgtruction Permit Application for a Permit to Construct( )Repair( Upgrade( Abandon 11 Complete System O Individual Components //Location Address or Lot No.g/'�,*�f e/Z Owner's Name,Address and Tel.No. `Assessor/Map/Parcel S �QCJ"!1�`� �•t' Aw// Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 015 y0 � Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i 43 Nature of Repairs or Alterations�Ans er whepr►applicable) Vlcw _5 V f-4Y9( 0 i Rd a 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 Environ ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by-tbAffio Signed Date aZ Application Approved by Date Application Disapproved or the following reaso s Permit No. �X Date Issued } ,Eta "�. _ � .{ •�' t� � " No. +. aZ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: '" s Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETI TSB r ro, 2ppricatiou for Oi-4pooa`l"Opmem Congtruction Permit Application for a Permit to Construct( )Repair( 16pgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. ®Ass'8ssor's M/azcel r1rR 01' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. e2<� Type of Building: Dwelling No.of Bedrooms Lot Size ✓ sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures t r Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title ' Size of Septic Tank Type of S.A.S. Description of Soil . yF, Nature of Repairs or`Alterations Answer whe applicable) 010i:W V A41y� 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'Certifi- cate of Compliance has been issued by t ,Board-,o.-He MI. Signedr` 7 Date 3 Application Approved by 1Af Date Application Disapproved for the following reaso s d F Permit No. ^'' Date Issued THE COMMONWEALTH OF MASSACHUSETTS *,-BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,th4uh!he O. site Sewage isposal Syste Constructed( �)Repaired( ''graded Abandoned( )by at 09 A C ok 001 e'!P 4 fAOA--' C,.4 % l' s been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. .r.. ated Installer Designer n , n The issuance of this pe .' shal not a construed as a guarantee that the s*�,Vvn,�, tAf ill function as�'asignefd. Date t Inspector -----== --- --——---—————————————————— No. ("'Oper,4Z Fee�..r' 0 ( f � // tF✓ 111 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogar *pgtem Con.5tructio-n Permit Permission is hereby granted to Co truct( )Repair(�)Upgrade( Abandon( ) System located at ®' z � 0 g�-, d A--' and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. / Provided:Constructio must be comp eted within three years of the date of this p' it. e) C Date: "/ t'1 Approved by1l X 4 f NOTICE: This Form Is To Be__,LTsed For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, I 73�4Z A � S , hereby certify that the application for disposal works construction permit signed by me dated S�',] 3 �, concerning the property located at �� , �P/' �G( Q � meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation (according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED : DATE: 3� LICENSED SEPTIC SYSTEM INST LLER IN THE TOWN OF BARNSTABL NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert TOWW."TY OF BARNSTABLE ,tcn LOCATION �n - SEWAGE # VILLAGE �`� 11°✓ ? ; 4'�R ASSESSOR'S MAP & LOT G INSTALLER'S NAME&PHONE NO. '72 SEPTIC TANK CAPACITY .� 4 0 LEACHING FACILITY: (type)..— -o(:!J NO.OF BEDROOMS S BUILDER OR OWNfR CC PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t � i y , �.� TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS `—J . . ,VFA`�^.ESS ORS MAP NO. PARCEL NO. ' ADDRESS: �� �C �' �. C' ( e © (�L rl VILLAGE �— , i NAME:_ � - CONTACT PERSON )—y..) K PHONE NUMBER G - LOCATION OF TANK,:. CAPACITY: . .TYPE. OF FUEL. AGE: TYPE: LEAK OR CHEMICAL: DETECTION SYSTEM DATE ,OF PURCHASE .OF. EACH: 1. 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: 7p TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. oi .. f a � � . �� (� a �a S� � a.���i s+'r f ' `; 4 _ � � t T _,- �.� �_ ,.__ - _ _____ _____ - �. _ _..____ � � _ Q�` ��.r?�r � ` A � �4 u-u�, �,. .��.. r _ , i, 4� ., �,a • { ^^'`�-- i . � •T � �� t• � + + .4 x �- --�..��,_, _.�-.._____,.-,.�..y-�--_._.. ___. ._ - .. .. Op THE tp� ti�P� ti� Town of Barnstable Regulatory B,��AB,�, : g story Services y MASS. Thomas F. Geiler� Director ArFb MA'S A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 '' w W� � as� ��� ��^s... by �a d q� � ��.A"' '�° u� x• ^� r„� f t b"`4 ash`. ,S" �:�r." ,>a -�a•�.." "�i:G. .�' �` `I`Tn & +. �' '<� �'� f DATE: ti 3 e a . NUMBER OF PAGES TO FOLLOW: TO: FROM: A /y�,�� 91N bL ,7,J I i PHONE: PHONE: (508)862-4644 PAXONE: FAX PHONE: 508)790-6304 ( NOTES/COMMENTS: J f'� l Q:Tax Form.doc TOWN Or BARNSTABLE- vf UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS ORS MAP N0. PARCEL N0. ,WDRESS: r ?, r Q c'!.._ VILLAGE, NAME; �� -`.-1( l✓ e I &A L CONTACT PERSON �, PHONE NUMBER 4 R 9 LOCATION OF TANK„f:, CAPACITY: TYPE. OF FUEL. AGE: TYPE: LEAK OR CHEMICAL: DETECTION ' T t�� SYSTEi`1'�7 r DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: / !77 TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING TIIE LOCATION OF TANKS ON THE BACK OF THIS CARD. � I DO nLMon Q a m or LEGEND 0 Iron Pipe CD CB/DI-i {D Guy 4- Utility Pole q,N for 1. IP a O '•. K�j. `~' QP7io is lo��r .\ town NC0/DH fild w►- R / 1 Sly IV/P Qo F^4cr p O Q O J! ` coroge \ S r Er r ej SEbS^ �r � �MIN�k Y.)o� 9-1 4�,v t1 Ch S�' 0 TrrUace"' -z 86 ♦ {�1 s tt/F 7974 W•,� Q) `, ` l ` d 00 IS onno club.Inc �. !3 2 S( Frame JoCobso� homily T`Us! \ N f8.5�6, ) \ �"\►a,. . yr, . •F �� ' `, •. i PLAN VIEW Scare: l"-20, Title: PREPARED BY.• Sullivan Engineerin , Inc. car PROPOSED �POOL �`s Po Box 659 7 GARAGE ADDITION Osterville, MA 02555 Ostervn 31 PARKER ROAD (504r)428-•3344 (508)428-3115 fnx (508)•120-3994 (� OSTERVILLE , MASS. Draft: MJ o Field: WHK/rMOH Date: August 27t 2404 '� Scaler Review. pS Cornp/Draft: ml�/l As Shawn Proj. j 23022 Drawin g C51 D '2c ® Iron Pipet wvvlUlu Ll p CB/DH July 2, 1992 Guy f p Utility Pole ASSESS Map 11 OVERLA Lot 1 As Shown or \ ✓ \ 1 / / S 775320„ E \ osN/F - "Zoning Map _ 0 Barnstable, A �_ ..."�. 156 32. - \ men d � �,�� � W last a E 01 \ X7 2 sty WIF O 11.4• Dwelling I PIS r= A I- � ...". ........ 'R u C TR fO gC 1i P \ �\ `I? ��pW�j , ��D pw \ \ Lawn O Fnd N I Sty W/F `s 6\ I 03 O SX Lawn pp �' _ ! CB I Benchmark: ,r - O N) 0 Q \ \Fnd Top of CB/DH Fnd O O I I fl I d Q Z 1 .�. ! Post Ro// 13&35'(NCVD 29) L4.VN y,• \ Fenc0 S I (Ni Tt�. �Ry $�4c �A-f_l o� / ' 77'31'10" .CB/OH I t hJCk �Ro 1p' Ep 8'1J�� l \ 17.0' Fnd 1 ) �� I J n 1 2 ��• -a, , D- U.5S �l oc A b L T r� Trelloce \ 1 I AA c shove '�1. �r*Ok �} �LIoQpSCp SYSO� i�N l� A6 cenor — _ / M �0V 0 ohj -` k; \ O \ \ Line ���X S��r + 6 o v Q ' \ \ �'•q N I<C Patio h` #" Ig... 2 Story Wood 1 \ '—Fnd 3 Framed Dwelling a' wa Lawn o l \\ \ \ \ �Sf\ode once \ d G"c`• e 1586 \ a �1. LoL{. ry 'on FarAi/Y Trust 780520" 1y \ \ Lawn 17,980fSF /� h D4a — — —37— — — 8.7, .._._..._.... / of y IA OF&L.;,5 035 IV, ��N' Sack 2 sty W/F 8 Dwelling Russe//,g SN/F RICHARD ('JT Ison 'Jacob R. � son o- LHEUSEUX #34312 A� 36— T s w t7 5 PREPARED BY. PREPARED FOR: Notes/Revision: , Inc.Engineering, 1.) The property line. informal "Sullivan Eng g Cape$ury Lisa M. Thomas compiled from available rec 8f PO Box 659 7 Parker Road 31 Parker Road 2.) The topographic informot �N Osterville, MA 02655 Osterville MA �10265o OSterVlll e MA 0265�5 from an on the ground sL (508)420-3994 (508)420-j3995 fox; 17/FE8/04 (508)428-3344 (508)428-3115 fax I 30 The datum used is NC __ sea level datum. �•.. �� - - - - .... .................... .......-..... FYyy, 12 12 -71 Ll 11r �___ � � �i I •�I it lam. —1—_—�-- �'- —_I— — _- =J— iI s ,1tjI�, !1 7-7 — ' r-t F ADDTIUN IRETAIN ACKFI LANDSCAPETIES AT ACCZESS PATGN 4 ADE)' 2d(_�om1� r ;. _ DRAI^1N 8Y: Kri_ LATE: 10/15/07 L`t L' I — -- " "(46 C..OkGR�E WAIL '� O'xI&' CONTINUOUS FOOTING I a ICI "� I P ' U ROP WALL TO NAKF ENT I t I a. O Ub-FLOM EOUAL TO I C I 131 a in oP OF SLA5 450SITF'-BUILT I x ERI':Y IN HELD INSUL.ATEU I l c' 4 ACCESS NATC4 i VAPOR BAORIER I — j L_ r. 22'-✓" --- ------ �Gp FL f.. 2442 LITE 77B I I,-puGARAGE- o a MsTING 5A,14 r/, i4ALF I r - WALL jk UP UB 1 l l ill E]ii5Tllv:a -� EdiS''I1vG _ � • l GARAGE IC_)I] �"}i._f r"I GONG- SLAB n ADD Dc7OR SIb' CDi: 5I-IEA"'!!{, 13 z ASPI4ALT 914iNGLES L' \�\� f---' _ - MATCt•: EXISTING Rao F.G {� I \ $ ! $'eT fA I DCuiR I I B'Y.'P C44 DGOR r` Fc442 AM fkn Cf•I GAL \ - - Wf cam:1 _ WJTRANSQi1 I.U.1 f - CCVT. VENTI 41 DRIP EDGE' -. -- �.1 `yijf-'--- s 6i-'6 v�--'-- O Ix8 FASCIA 1x4 SECOND ;EM13=._R I------ j ynl-06 - 9 ALUMINUM GJTTER5$ DOWN SPOLT'S �' - MATCW EXISTING TRIM i Ic RIB F.G. iNSJL 2,4 ._ .. - ,¢� !•nA7Y.A,ansnW. 1J2" PLYWOOD 5F8ELTk�d'�fa _ py--- ---------------- -'� 5� .-�.. TYVEIC WRAP (OR Fa JAL, fl..49 � :-JI �a�'p�lb G_ —.JL_..— —'L�--�—1L--J I i // � A.C. �Ig;GLES 1 ,p 1 j Rsq F.G. INSUL. Z---(3i J015T UNDER WALL l k .- �S-FEET 2 Cyr ^ -VAPOR BARRIER tt - ..f 22' „u DRAWN Wr: KW DATE: 10/15/07 r t�t 48 Q J t ------------------------ ------------- tX r 8rX46�GONCR>:TE WALL !! -� ' I SVmtI' = CTDROP OO suls-F MAL TTTOOOTING I I Q it @ TOP OF SLAB 4"TE-EULT—ram ( �i R VERIFr IN FIIB.D INSULATED I '". I • ACCESs ITCH Iy1 CRAWL SPACE I 1 ; I VAPOR BARRIER I I a-O°` 22'-d --- { — — —— 2442 12442 LU A UTE \ I HATN co � j hfWNOl.iTa tlt WALF Zvi PATIO SLAB MOSTIM.. t WALL �/ I coNCRErE wr GARAGE 2� ° I 16"= INTBiRAL � T-OOrING � I I I SCCR�1EEE/-N�ED TBCISTIrtG EXISTING N L------- o GARAGE o CONC.SLAB CONC.sl 2 M ✓NDA+ 04 PLAN t ADD DOW SCALP-VW=T-G' 5/6°COX SHE LUATHING ° Ii I)A9PHAI.T oon .B f -z - -Q 1'7ATCH T9CISTIPIf. R30 FG. ADD WINDOW � O 4 c 9SFAWA NG DWPg M'`SMOND 24.0 o N Q aT�n DOWN spoors Z 0_4 Q AT M 4 _N 1 ADDITION LDS F9F?ST O to � - .y- - V SI oN r=V4 -r-C (Z Q r ,94 ( UD. .I 2t OfT. STUDS w t6° O.G. t rutG eiasn� -- 11V PLYWOOD SHEATHING 11 If II A II TYVEK WRAP(OR M AL) W.G. SHINGLES } �� w°t F.G. INWL. CRAWL SPACE SHEET 2 of 2 VAPOR BARRIER ff4 22'-Or } SEC71ON°A° SGOLM V4=T-a + JOB' 0334 DRAWN BY= KW ((r DATE. WIA/04 I ' 1� ' R r o / z» • Hi OWNER: a� o .• , Richard R & Lisa M Thomas id .' • ' i: 31 Parker Road Osterville MA 02655 ii h - '�, •• ° ZONE: \ o RC a •a �'' •b Area (min.) 87,120 SF (RPOD) •` ° u'= ? N Frontage (min) 20' •a. • • ° • Width (min) 100' ,u N t: • e•.• ;.. •`and `py p ••• Setbacks: ...' / _ 1 •�:'•. Fron t 20' w ga._ Parker Meek Side 10' / — Pond 6 � - a s$, 0. Rear 10' -- .' se o r la `1 4... oo . 00 FLOOD ZONE: ° LEGEND Zone C Location Plan: p Iron Pipe Community Panel No.#250001 0016 D Scale: 1"=2,000f' 0 CB/DH July 2, 1992 -O Guy -O- Utility Pole , ASSESSORS REF.: Map 117, Parcel 161 \ OVERLAY DISTRICT: o� \� \\ � \ \ \ > Lot 1 GP — Groundwater Protection District ;v N As Shown on Plan Entitled o N 1 \ � "Zoning Map of the Town of 2p A P Barnstable, Massachusetts" ' I ... .1..... W (last amended August 16, 2001) \ 7 o nd 6 0 ` 2 St tyW/F 11.4' O Dwelling r No 1-41 RO t'og E p \ 0 oK' ITtOIV Lown )Ul ,C91DH Fnd 3 u I 10, IV \ N 1 Sty W/F S Garage � s°• ,. OM ,Q� 1 I 1 I 10,.�+I ^ LL J Lown �' _ ^B/DH Benchmark: 3 IOo / I p' I a I Q 0 {Fnd Post 13d35'(NCVD '29)d O / m N �a a , ZQ'S 1 I Roil rice f y N III III sF 1�qc T1c L^'ORy a„mac pq pas �� / O S 773j 10" t? O o I CM 1 k o l E p , � CB/DN V a I I I 1 1\I 1 N•� Al Rod o' $ x 2 I \O t 17.(' P 06.55Fnd .o O sea S Sl9 p�0 Z O Trelloce � °yea' Orw c SyS 0 Tt aN TA gRac� M q,i O / J O f•ost Cr N7re Fence \ \ \ V N1O APRON Entry ..� Wionno Club Inc 79 NIF 14 °, 0 w 0=�0 _O \ _�_na_ ,.��\\SOX S�r..t O I \ \ \ . TQ N t<C Patio 6° I ' 1 l _ 2 Story Wood °hw '—Fnd Framed Dwelling B k walk Lown o J \ od once �QJ NIP \ 1 ' \ �— 15,6 .J Lot 2 CO ✓ocobs°� F°m1/y Trust \ \ \ �8 p5 \ \ \ G , 17,980t SF 3a — — —37— 2 p„ — — W Lown a0 ^ h o �O � \ ..� �"ow y35 ��tic ai ?x Dwelling suil,VA RiCHARD Sr\� ✓ocobson — _ / o Eafl•297e3 LHCUHEUX • J ClV 10 931'112 _ _ Title: _ PREPARED BY. PREPARED FOR: Notes/Revision: 1.) The property line information shown was compiled from available record information. Sullivan Engineering, Inc. CapeSury Lisa M Thomas PROPOSED POOL 81 PO Box 659 7 Parker Road 31 Parker Road 2.) The topographic information was obtained GARAGE ADDITION Osterville, MA 02655 Osterville MA 02655 from on on the ground survey performed on 31 PARKER ROAD (508)428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fox Osterville MA 02655 17IFEB104 �j OSTERVILLE , MASS. I 3.) Th•e datum used is NGVD '29, a fixed mean o Draft: MJD Field: WHK/MDH " 20 0 10 20 40 80 sea level datum. Date: August 27, 2004 Scale As Shown Review: PS Comp/Draft: WHK/RRL Proj. # 23022 Drawing # C510_2g1 23GaZ.. OWNER: Richard R & Lisa M Thomas id 1' P • • o 31 Parker Road i Osterville MA 02655 o - •• ' ZONE: RC Area (min.) 87,120 SF (RPOD) ". s ? •°' •.p• • ° U': •,_.• •• •• N Frontage (min) 20 ra `` '' . i' , • Width (min) 100' ,.\ a a v �� • r: o. �o u 4 Setbacks: Fron t 20' 3 � Side 10' a Rear 10 v, y .• �Se Q r is 00 LEGEND FLOOD ZONE: = Zane c Location Plan: p Iron Pipe Community Panel No. El #250001 0016 D Scale: 1"=2,000±' CB/DH July 2, 1992 -0 Guy o Utility Pole ASSESSORS REF.: \ / Map 117, Parcel 161 LLJ OVERLAY DISTRICT: CO N \ l \ \ \ \� \ \ Lot 1 GP — Groundwater Protection District h N I \ \ 1 s As Shown on Plan Entitled 1j $32pn E \ mOmosNq p "Zoning Map of the Town of IP Q 111 I \ �... .. -/ .../. �$632. , — \ \ o�,on W Barnstable, Massachusetts i Fnd I l 1 / I— . ... ^ \ \ r27 (last amended August 16, 2001) I a Sty `- ri� 11.4' .—0p 2 Dwelling WIF 16 Lawn Fnd 41 10 1 Sty W/F \ Is, _ 60 i0 1- - ?�. F z � \ I o�l M o a Lawn Q ° I a I :D HBench"''k TOP / Fn Find Fnd VO a a& 4- 38— 29) SEI S4 o " I/" Fence I I CMftAr IC °Ry pLc I'gT` os Q__ / o S 773j, Q%4 I 1 IN. k " �Ro Ia E� E,'.x \ c \ 17.0' 1�� dH '� O err 2 , � _/ q p sa L S T r a 2 ° Treuoce— � O°w $$.$ \ ° o�PTI S�rr^v�a �c° show °' OrJK+woy $ hoc I / q A Sy o oA, /� F - J Q PO=W4e rnce \ \ �I p/�O,V \ .EnUy i NIF �974'0- W °) lo .a \ \ \ _ p\ 00 °nK. Wianno Club Inc 11 \ \ e \ OX Tq IV ` "TQ_ ,,n /C patio #3 1 J Qo 1 Fnd .. 2 Story Wood ` °hw a° ¢N p I \ Brick D 4 o� Framed Dwelling KoJk Lawn \St\ :`Q I • �Qj 1586 Lot 2 Son FOmi/Y trusf \ l \ \ N 78 0 ., L J a 17,980t$F a — — \ $2o w \ Lawn ao ^ 3 —37— — — r7 // h �d�` W • ��Fi Gr P s 2S�p 135 r \ N - eZtiy Q 2StyW/F aark� gUgEppo/Zpp gg {� ©`a y Zl S43�LIS�7'i�::J Dwelling R N t n 2,9733�a O R. i N Susan 'JOcobson o lHe LsFdl. c C@'Jd9.� 934-312 ®mom tei'(^.firth 0 f° 3 6 ,�•,, �,,�, $, o Title: PREPARED BY.- PREPARED FOR: Notes/Revision: 1.) The property line information shown was compiled from available record information. Sullivan Engineering, Inc. CapeSury Lisa M Thomas PROPOSED POOL a PO Box 659 7 Parker Road 31 Parker Road 2.) The topographic information was obtained o Osterville, MA 02655 Osterville MA 02655 from an on the GARAGE ADDITION Osterville MA 02655 ground survey performed on 3 I PARKER ROAD (508)428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fox 171FEB104 j OSTERVILLE 9 MASS. 3.) The datum used is NGVD '29, a fixed mean o sea level datum. Draft: MJ D Field: WHK/MDH 20 0 10 20 40 80 •.y Date: Scale: Review: PS Comp/Draft: WHK/RRL August 27, 2004 As Shown Pro: 23022 J # Drawing # C510_2g 1 1 -3