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HomeMy WebLinkAbout0486 PARKER ROAD - Health _ r zr t. C , - ^;a'r �! � yr,.--' i�.� _ .:. i:r., `' 'R•t 1, �+` 1 a ^-�1.:. �, a, yg� All SPOT 2 x 1 WAR , t x : =, a irn;.,::: A• .: .ww , t : `� , J� 1i ' Est s- ll.Al w• , >f s „ r , not ' a , �w •�RdF . ten ,. i i. ;-. � }w wK ♦ .r skfix Zr r rOv now fi'� � r` �°a eR, ♦"�"}�Y ,.i,.�` "�:. r�.;; .amp;, � k�� 'su a .m , y�yy f t n r- ;�r s ' r I Sz , v , R" TOWN OF BARNSTABLE LOCATION SEWAGE# i VILLAGE ASSESSOR'S MAP kPARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Z LEACHING FACILITY. (type)/ (size) NO.OF BEDROOMS G OWNER PERMIT DATE: J I pgl lop _o 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 l � {�J, use. u . C No. OZ�^ ` /J-0 Q o I �, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation fir Disposal 6pstPm ConstrUttion 3PPrmit Application for a Permit to Construct �) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4,46 e-r 1 Owner's Name,Address,and Tel.No.`'�,,rV,,L r p_& Fc�a Assesso�Map/Parcel \ 47 G'�'�'^®� ���X� ►P'V(- g� tA Installer's) ame,Address,andr el.No. ILLS eb ��aAl- Designer's Name,Address,and Tel.No. 37,M @ 0" $��uL c,r�r•- 4 .n Srr`s u-el, 4^^ , �c33�C w�C ,�' 4"1$ f k,\ ,restRf '� ttb. f tidS�.. �' •- �� 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 ' Z�q Number of sheets 1 Revision Date ^`` Title Size of Septic Tank Z ( Z6,6© Type of S.A.S.( _�,k^Z� �ct rem�•��/ Description of Soil Nature of Repairs or Alterations(Answer when applicable) op 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 t�ce the system`in-operation until a Certificate of f Compliance has been issued by this Bo d o e Date 2 Application Approved by Date Application Disapproved b Date for the following reasons Permit No. �,Q — 3) 1 Date Issued 14 2.02_0 •=-- �^ 50 No. ,�l� '��� ° Fee ~ 'THE COMMONWEALTH OF MASSACHUSETTS Enteied in computer: Yes .,.� y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation f r bisposaf *pstem Construction Permit Application for a Permit to Constff.ct( Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4�(p Owner's Name,Address,and Tel.No.�4,N,r i;c R� r r Assessor's Map/Parcel S r` � ®� �'1 Conn-n�rc��n� i P.ic '�Jgo� M -, Installer's Name,Address,and Tel.No. iP L-j,, �e r.,A) Designer's Name,Address,and Tel.No. Teo,, O`kp- k. ��b. Ih r.c►'a n.: v. ���' : Z.ld=4 CCtvset. (SQg) &Jv- " Type of Building: Dwelling No.of Bedrooms Lot Size , � 4 sq.ft. Garbage Grinder( ) r Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ] ( Design Flow(min.required) gpd Design flow provided t9 gpd Plan Date O' L4k 1,101 ^ Number of sheets Revision Date Title " Size of Septic Tank Z 2-StQ d Type of S.A.S. ( 1 ")-n Soo Description of Soil 0 a Nature of Repairs or Alterations(Answer when applicable) �j A•, ,.! "!t_r e� Date last inspected: r 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 pAl pe-the-system in operation until a Certificate of Compliance has been issued by this Bo dd of a XS' Date Q o L Application Approved by ' Date O B1ZU7_J �i Application Disapproved b Date for the following reasons 4 Permit No.&)?o — 31 *1 Date Issued D 20 2 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 been constructed in accordance with the provi'ionssoffTiittlle 5 and-tki r Disposal System Construction Permit NOWO- 317 dated 817,07 d ,;�• Installe�� / Designer J E M • �, tip.. ,Ana Sn f ti�CJ' #bedrooms Approved design flow l G and The issuance of this permit shal of b c strued as a guarantee that the syste will function . de gne . Date Inspector �� - Fee No. �( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposat 6pstem Construction 3pPrmit Permission is hereby granted to onstruct( Repair( ) Upgrade( ) Abandon( ) System located at y 96 ( Wrif_ T D-,5 Tsui LLL 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:Con truction must be completed within three years of the date of this permit. Date ZQ"?,Q Approved by Town of Barnstable pF SHE 1ph Inspectional Services �O Public Health Division URNMBLE, MAS Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Selvage Permit# 20W' 3 0Assessor's Map\Parcel " Designer: fn�� %�'l, ,{ `its, CL+`'� f Installer: +c �o LC Address: *�ssos= iw1E; Address: �11r�' f-v aZ..co e On_ was issued a permit to install a (date)l :.. i s er septic system at � 'SJII-�G_based on a design drawn by (address) i -a64tA M• 0 ,�!LE., dated °� 28 2 vtS�D 1b I6 ZQ � (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 in compliance with the to rms of I1A pproval tters (if applicable) %�A . �P��\�O F MA& 9w ., JONN,M, (Installer's.Signature) ' p'R�ILtY + CIVIL v, -.. 4 NO.36200 gner's.Signature) i (Affix D 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. WoAdeptAHEAMASEWER connecASEPTICOesigner Certification corm Rev&14-1.3.DOC No. _ 7_ Fee BOARD OF HEALTH TOWN- OF BARNSTABLE ZIppYication -for Yell Cougtruction Permit Application is hereby made for a permit to Constructj, Alter( ), or Repair( ) an individual well at: 4gi Par Ker U 0s-re r V I IIt. t Location-Address Assessors Map and Parcel eve Lorenz 13,4 �ru_ � 20 Comy=v n Rk Owner Address f711(p �e�srnoh�l � .i l rI`i l noI L P�b� br. 2`�S f dr i�u,�S I Vim.P- Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well S C-h 40 f V6 Capacity Purpose of Well f rr((AQ-ham Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Application Approved B Date Application Disapproved for the following reasons: n / Date Permit No. \ � 00 Issued Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed 01 Altered( ), or Repaired( ) by c)r t YK-. Installer at q$I p1.r K-e-- ' P- Obte ry l.f(r, has been installed in accordance with the provisions of the Town of Barnstable,Board of Health Private We 1 Prot ction Regulation as described in the application for Well Construction Permit No. } o �Z( Dated�� A-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector *,No Fee HST 44 u 1 BOARD OF HEALTH } e,; ., TOWl`L �OF BARNSTABLE 01ppYicatiou ,for �eYY �ougtruction permit it Application is hereby made for a permit to Construct O, Alter( ), or Repair( ) an individual well at: 4 R 1e ear �_-q r Rr4 , r)ct E-r v I e, i n Z C; Location-Address Assessors Map and Parcel F.-v-e. Loy'enz I `t , C-sr 20 C car WAMU)fn H� K�IL BC�10Q , MN Owner r Address OY 11(p I no . �h( _ . P.0, f3r)y 2723 , 04- to n c- , M A 02-GS�3 k Installer Dnlle ±« k r y� _ ; t .. .`("`" a'b T.w �: ..1.- +Mf�. { x. 1J.:J. :. M t �:.,.��. ^^ t J` $'.�I! T +• •� � 4 F O $$ � . Type of Building i Dwelling V Other-Type of Building No. of Persons Type of Well Cw 1 4O IPVe-, Capacity ,f Purpose of Well 1 r 1 I Mf i r a rn i ¢ Agreement: ° ;. The undersigned agrees to install the afore described individual well in accordance with the provisions of the `3 4 t4g.` i 'Town of Barnstable Board of Health Private Well Protection Regulation The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. r, Signed Dates + 4 Application Approved By Date Application Disapproved for the following reasons: �..:.-::.=_as.+sK.�.-: -r.._:--'.r.,_-.._.:.,�-.,...�».,.�r-,-,e--'�..rs:r:=,s .�M�=aS-.#v_a+is•:�c:-c+G-::R�'...ae�-�5'=p;,:::v.�..:�.'�3::�,"�+mMy.`r'±i,��.c-r�e-cs--�.-�ats•r .. #at.•+t-+.r_s s:i�y... -".+� .-" �.�:.� Date�... Permit No. I 00r-.f Issued Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Aq Certificate of Compliance k; THIS IS TO CERTIFY,that the individual well Constructed(Y.), Altered( ), :,or Repaired( � by Installer at 436 P a fr k-P r P OCR d 0,)te.Y yr i t le- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well4Protection Regulation as described in the application for Well Construction Permit No. (j_J'WV,--CC,V Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH a TOWN OF BARNSTABLE \\ Vell Couotruction Permit No. At�Ac_o ) —co``l Fee J. Permission,is hereby granted to z->m0 l,(A we t v1C. . Installer #, to', Construct( -Alter( ), or. Repair O an individual well at: No. � �(4 eoxY P.Y Q�ACi, C J J t Cyr V•( I I 'i ` Street E�- e �/ as shown on the application for a Well Construction Permit No. A' : r~t �' ^1� Dated 9 �9_ Date ) 3 c9-CI Approved B��. o! a� 8� Ldeq d e1�EoWe X65/46 n 'b .eas _ o! LOT 12 Yd zaz f Vacant Land . � B» .EEb fisting c! rtIr SEE NOTE 16 o .p ed.a 1988a ate' 3 P mroSEp 1p8S� za. �,; LOT 11 ggNEWAR z ; .. Vacant Land . l Ml 9 VEM ` 24 Sg F Z �, ,..u� .. ._ \� •E39 \\ \\vv �. a 6.at LOT 10 Area=87,130 SF3 24. .23 t •as ab '`V' \lam .\ 1 ' ~SEE NOTE 16 / / VNOPOSED / WELL IOq •tab i ,:� z x2a pp n / PLAN -4 4. SCALE 1*=30' THIS AREA IS SERVED / TOPnf Wncm1E awnd EL=24.6311988 BY TOWN WATER. y LOT9 •zx. Vacant Land i / ems g typ 5 3 "29 9 cl O tlL 99 ■ CYO 9� R tlg S L a1.-,rt �i�aC 3. S^_ L L 4 a o `�; �g 9�� � 1�Q� � a�?���i�'g�•R° a R� ��Q� Q�"�R R#�S�#� g�B z �: z + ` � 5. 6P Q � �#9�& � F 5]f 9 � p B�Q•$S9Q�� g i ��P���py F 9 Cw R?�bp Q5 4p ��E F� Hill g�g• [� �� !■Ig o f BI m K a:i Q� 5ii # aa �9°#g 6g pp 'AR H# � RaI� 3 plf9 OR�� " � g 1 in 318 yRa b pj i K a @1R zp5a J o$°R@GCCIg & HIP # €� ga[[ @ go b gp€ �p5 gill', m a 11 @ 4�e�� Z pDo !a R �4R ga Q'�� 3RQQ " g_ 9; ,9:;:2Q D Q■ ° 999QQQ[[ #Q 1j6 aQ �d/ �� �� ai I t}§ 8 E do Y i �K �igad F Gl gR to r �4 o. i it i � /, e", •� � Parker Road Ilk ;• ar, e I g ., / q� �� e�,; � q-.;. ��� �I� a•� g �m Roo • \ / i I ,F, 1 6 @A I \ i ms; e 7 la t � �� D P.MIN IeMLan%M C L I � �' � �o i �•�� � � �� � � �a¢ r�9 f l I ®®a®� oboe."• R a� ¢22 gg pp� aeS I� f Commonwealth of Massachusetts 6 , U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 486 Parker Road.- lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name ' information is required for every Osterville MA 02655 11/3/2020 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 e A. Inspector Information ` filling out forms p on the computer, use only the tab James Ford key to move your Name of Inspector cursor-do not Ford Septic Services, LLC use the return key. Company Name P.O. Box 49 raa Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 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 11/11/2020 Inspec s Signature I Date The s em inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 1a r Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary D Assessments 486 Park L,. er Road lot 13 AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name information is required for every Osterville MA 02655 11/3/2020 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: ® 1 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: 2) System Conditionally Passes: ' I ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ...........�•, 486 Parker Road- lot 13 AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name information is required for every Osterville MA 02655 11/3/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): . ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 486 Parker Road -lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name information is required for every OSterville MA 02655 11/3/2020 page. Cityrrown 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 c Commonwealth of Masgachusetts I Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form _Not for Voluntary Assessments 486 Parker Roaq - lot 13, AKA 466 Parker Road property Address Parker Family Read LP Owner owner's Name information is required for every osterville MA 02655 page. City/Town 11/3/2020 State Zip Code Date of Inspeption C, Inspectit)n Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ _ Static,liquid level ir1 the distribution box above Outlet invert dNe to an overlgaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ Required pumping more than 4 times in the last year NOT dUe to clogged (Jr obstructed pipe(s). Number of tirfies pumped: _ ❑ Any portion of the $AS, 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 Zane 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 y'vith no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified( laboratory,for fegal coliform bacteria indicates absent and the presence of arnmonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no bther 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 10,000 gpd. a facility with a design flow of 2000 gpd- . . ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the¢ystem fails. The system ownershotald contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be cpnsidered a large system the system must serve a fecility with a design flow of 10,000 gpd to 15,000 ghd. For large syytems, you must indicate either"yes" or"na"to each of the following, in addition to the questions in Section CA. Yes No ❑ N the system is withih 400 feet of a surface drinking water supply ❑ the system is within 200 feet of a tributary to a surface drinking water supply Elthe 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 P Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 486 Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owner's Name information is required for every Osterville MA 02655 11/3/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (corn.) 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name information is OSterville required for every MA 02655 11/3/2020 page. Cltylrown 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road- lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner information is Owner's Name required for every Osterville MA 02655 11/3/2020 page. City/Town State 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: unavailable Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owner's Name information is 0 terville MA 02655 11/3/2020 required for every 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) i ❑ 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: installed 6/13/1977 per as -built 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: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 15insp.doc•rev.7/2612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owner's Name information is required for every Osterville MA 02655 11/3/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic.Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) n/a If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: I Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I ' I t5insp.cloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............ /% 486 Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name information is required for every Osterville MA 02655 11/3/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): N/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle 11 Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): N/a 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 Title 5 Official Inspection Form ,a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 486 Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owner's Name information is required for every Osterville MA 02655 11/3/2020 page. CltylTown 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.): N/a i *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 n/a 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 486 Parker Road-lot 13, AKA 466 Parker Road Property Address Parker Family Road LP - Owner Owner's Name information is Osterville MA 02655 11/3/2020 required for every page. CitylTown 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.): n/a * 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: 1- 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 486 Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name information is required for every Osterville MA 02655 11/3/2020 page. Cityfrown 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.): The pit was dry and clean. The scum line was 1' up from the bottom. There was no sign of failure. A camera was used 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 with overflow Depth—top of liquid to inlet invert Depth of solids layer - Depth of scum layer - Dimensions of cesspool 5'w x 5't x 6'bt Materials of construction block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure; level of ponding, condition of vegetation, etc.): The cesspool had 6"of water on the bottom The cover was 12" below t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 486 Parker Road - lot.,� 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name information is required for every Ostervill'e MA 02655 11/3/2020 f page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: N/a Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form S Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owner's Name information is r Osterville required for every MA 02655 11/3/2020 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.)' 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C3a�� A A 13 / 30 a I- � i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 • •, Commonwealth of Massachusetts Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road - lot 13, AKA 466 Parker Road V Property Address Parker Family Road LP Owner Owners Name information is Osterville required for every MA 02655 11/3/2020 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: 15 +/- feet Please indicate all methods used to determine the high ground water elevation: i ❑ 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: Topo 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: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. tsinsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 t k� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486.Parker Road - lot 13, AKA 466 Parker Road Property Address Parker Family Road LP Owner Owners Name information is OSterville required for every MA 02655 11/3/2020 page.e. CltylTown 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. f ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 �1KMIE t� Town of Barnstable " Inspectional Services Department ` eARNSTA1 MAS& ' Public Health Division 1639. 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8012 September 18, 2020 PARKER ROAD FAMILY LP 11 TEAWADDLE LANE AMHERST, MA 01002 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 486 Parker Road, Osterville was inspected on 08/13/2020 by James Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system `Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Single Cesspool. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF E BOARD OF HEALTH as Mc ean, R. ., O Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\486 Parker Road Osterville.doc f THE I'd Town of Barnstable • + BARNSfABM p 63 Inspectional Services Department rf0 MP'�A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). 2 YEAR DEADLINE CRITERIA Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER ❑ Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc f Commonwealth of Massachusetts llcS�� D02r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 486 Parker Road u— Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 - 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 SIB Nod-s­ on the computer, use only the tab James Ford key to move your Name of Inspector cursor-do not Ford Septic Services, LLC use the return Company Name key. P.O. Box 49 � Company Address Osterville MA 02655 Cityrrown State Zip Code � 508-862-9400 S 12482 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 valuation by the Local Approving Authority 4. ® Fails 8/17/2020 Inspec 's Signature Date The s s m inspector hall submit a copy of this inspection report to the Approving Authority(Board of Heal or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............ !% 486 Parker Road V� Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 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: ****The House has a single cesspool and is a automatic failure.**** 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health„ safety and the environment: I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. Cityrrown 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: - El 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 0 ® 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 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 486 Parker Road V Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osteryille MA 02655 8/13/2020 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 1/z day flow Required pumping more than 4 times in the last year NOT due to clogged or ❑ ® obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �^ ,`i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. Cityfrown 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? El ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? I ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): N/A Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A I Description: There is no design for cesspools 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 ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: unavailable Sump pump. ❑ Yes ® No Last date of occupancy: weekend use/summer M t5insp doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. City/Town State 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 i 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: Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 cam, Commonwealth of Massachusetts Itip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 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 I, 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: original date 1920 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: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: N/A 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: l Sludge depth: I Distance from top of sludge to bottom of outlet tee or baffle . Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- 'I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c� 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A 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 c � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. Cityrrown 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.): N/A "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 NA 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road V� Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 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.): N/A * 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: Single Cesspool Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is Osterville MA 02655 8/13/2020 required for every page. Cityfrown 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.): 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1-single Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool 5'w x 4't x 6' BTG Materials of construction block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): The cesspool had 6"of water on the bottom. The cover was 10" below. *** Note there is a pipe in the crawl space that goes to a bathroom and laundry. Could not find or trace were it goes out in the backyard? t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road t;- Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: N/A 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 c Commonwealth of Massachusetts Title 5 Official Inspection" Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 486 Parker Road Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. City/Town. State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where-public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately a3 . e Q�a�k I°I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 486 Parker Road u— Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 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: 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: Topo 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: See Above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments sec 486 Parker Road u Property Address Parker Road Family Limited Partnership Owner Owner's Name information is required for every Osterville MA 02655 8/13/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Z A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Massachusetts Department of Environmental Protection Bureau of Resource Protection + Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: C4861 ORKER-J 0.5T2.eV1 Ilet Please specify well type: Building Lot#: Assessor's Map#: Irrigation �� 115025 Assessor's Lot#: ZIP Code: Number Of Wells: 02655 City/Town: Well Location BARNSTABLE In public right-of-way: GPS (';,Yes f'No North: West: 41.61554 70.38345 Subdivision/Property/Description: Mailing Address: W click here if same as well location address Property Owner: Street Number: Street Name: EVELORENZ 486 PARKER City/Town: State: Engineering Finn; BARNSTABLE MASSACHUSETTS ZIP Code: 02655 Board of health permit obtained: Cs Yes Ct Not Required Permit Number: Date Issued: W2021004�) 01/20/2021 —� I Massachusetts Department of Environmental Protection y -^� Bureau of Resource Protection-Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRIWNG METHOD Overburden Bedrock uger -Choose Bedrock-- WELL LOG OVERBURDEN LITHOLOGY From(ft) TOM) Code Color Comment Drop In drill Extra fast or slow Loss or addition stem drill rate of fluid �� 20 Fine To Coarse S u� Brown �� _ r ( Fast( Slow1 } YES NO �.ITM.. _1 Loss Addition 20--- 25 Fine To Coarse S rown -- Fast�'Slow Los.— EYES NO C __� Addition .............. ....-.._ . _ .----------------- -.._._.-- _ ... _.... -- - - --------- - I_�� _.. 25 40 Medium Sand (• Brown • f Fast!' Slow YES NO ���_�_ � Loss Addition WELL LOG BEDROCK LITHOLOGY Drop in Extra fast or Loss or Visible Rust Extra From(ft) TOM) Code Comment addition of Large drill stem slow drill rate fluid Staining Chips Choose Code +' r Yes Yes; FYE;S Fast 51ow Loss Addition ADDITIONAL WELL INFORMATION Developed ( Yes i No Disinfected C Yes ! No Total Well Depth 40 Depth to Bedrock Surface Seal Type (Noneracture Enhancement ( 'Yes (7 No CASING r Is Casing above ground? ........ ....... ..... ..... ....._ ..... Diameter Driveshoe From To Type Thickness ......... ..... ..... ....... .... L36-_—� Polyvinyl Chloride ! Schedule 40rYes SCREEN rNo Screen From To Type Slot Size Diameter 38 40 _ Stainless Steel Well Point WATER-BEARING ZONES 11 :DRYWELLi From To Yield(gpm) 22 40 12 PERMANENT PUMP(IF AVAILABLE) 3 Wire Constant Speed E/2 Pump Description � Horsepower Submersible Pump Intake Depth(ft) 35 Nominal Pump Capacity(gpm) 25 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program ' Well Completion Reports(General) ANNULAR SEAL I FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement Choose Material Choose Material is C= —Choose One— WELL TEST DATA Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) __ -- - — .......... .....- ...... ............ ............................... - _. . . ....... -.-, . ..._.......... . .. 01/22/2021 Constant Rate Pump �12 01:30 24 1 00.01 22 r WATER LEVEL Date Measured Static Depth BGS(ft) Flowing Rate(gpm) 07/22/2021 22 — 7-7 112 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. WILLIAM Supervising Driller DESMOND, DrillerURQUHART Registration# 877 Monitoring[MJ Signature PATRICK, DESMOND WELL _ Firm DRILLING INC. Rig Permit# 0551 Date Job Complete �04/22/2021_ NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. k Jan Sebastion'Arlve,Unit 12 Vr ndtvicli,MA 62563 (508)888-6460 .1-800-339-6460 FAX(_08)88k-6446 Client Nftfne.» Desmond Well Drilling Location.: ,address.» PO Box 2.783 486.Parker Road Orleans, MA Osterville;MA 02653 Lab Number: DW-210267 Collected1il: WilliamU DateRecei.ved �. 01/22121\ Sample.Type: Well Specs. Irrigation Static 22 Depth 40 1 OClrtt0lt �Ot1rCe r, ' lute Collected l itfle Ci)llerted x M. 3Ct)fttfftd'ff15 q -_ s Atratrsrs:Regrde.sted 1lriits Recommended Limits Anajiw%sResult Method lbati,An&&y7d >€natyiedBy Total Coliform CFU/100mL 0 0 8M9222B 01/22/2021 KF @ 16:15 _...._... I ......_ _.:____. _ ..... ..__>.. pH pH units 6.5 8.5 , 5.9.7 SM 4500-H B 0 /22/2021 SSD1 Specific Conductancen umhos/cm 500 110 EPA 201 01/22/2021......... ._..... D...................._..-: Nitrite-N mg/L 1.00 <0.006 EPA 300.0 01/22/2021 SD tt Nitrate-N mg/L 10.0 0.49 EPA 300.0 01/22/2021 SD _.. -.._. ...... ..__.. _.. ... ... .. ..... _. ,._. _ Sodium mg/L 20.0 14 EPA 200.7 01/24/2021 KB _.....m. - ..__ . ..... ....._._ __---- ....... .............. -- ...._... ..... _. Total Iron mg/L. 0.3 6.02 EPA 200.7 01/24/202.1 KB _„ ..... _. ..___ ....._ . ._ -... ....... . . .__.._. ....._.. Manganese mg/L 0.05 0.025 EPA 200.7 01/24/2021 KB t(lfffJ7tL'tftS»...... _ Low pH.indicates high corrosive characteristics. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are,true and accurate to the best of our knowledge. Water meets EPA,standards and is suitable for drinking for paramete-rstested:7 Date 1/26/2021 - -W.._... .... -:_ _::._...... Ronald J..Saari Laboratory Director BRL=Below Reportable Limits *See.loathed Page,1 of 1 riCerlifrcation is nol available for this analylefor potable ivat&samples- Massachusetts Department of Environmental Protection L ,-r Bureau of Resource Protection. Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 39 MEADOW LANE Please specify well type: Building Lot#: Assessor's Map#: Domestic �� 133 Assessor's Lot#: ZIP Code: Number Of Wells: 005-003 02668 City/Town: Well Location BARNSTABLE In public right-of-way: GPS GYes C No North: West: 41.71743 70.38549 S ubdivision/Property/Descri ption: Mailing Address: click here if same as well location address Property Owner: Street Number: Street Name: BILL CHAPMAN 39 MEADOW LANE City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: 1e,Yes r�Not Required Permit Number: Date Issued: W2021 03/31/2021 Massachusetts Department of Environmental Protection Bureau of Resource Protection-Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD - Overburden Bedrock _ uger Choose Bedrock'- WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid �� 20 Silty Sand Brown ! �(`Fast C Slow rr (�% �j YES NO iiL_�__ Loss_-Addition _ ..................._....... 20 30 Fine Sand Brown I r,Fast t Slow =YESW �� Loss Addition - -- - --- —---- .. _ ....-..................... .......... ... 30 40 Medium Sand (+ I Brown �. i f�Fast Slow YES NO l_ Loss Addition WELL LOG BEDROCK LITHOLOGY Drop in Extra fast or Loss or _ Visible Rust Extra FFrom(ft) TOM) Code Comment addition of Large drill stem slow drill rate fluid Staining Chips Choose Code r r­] I _ Yes �Yes+ — — YES PIO Fast Slow Loss Addition ADDITIONAL WELL INFORMATION Developed ! Yes t`No Disinfected Total Well Depth 40 Depth to Bedrock Surface Seal Type None racture Enhancement Yes t N- I CASING r'Is Casing above ground? From: 1 To 0 [From To Type Thickness Diameter Driveshoe ....... --- _ _—_----- - - -- . .-- .- .............................................. {0 37 l Polyvinyl Chloride Schedule 40 ! � T'Yes SCREEN r No Screen From I To Type Slot Size Diameter 37 40 _ (Stainless Steel Well Point 0.012 �4---� WATER-BEARING ZONES �'DRY WELL From To Yield(gpm) 18 40 12 PERMANENT PUMP(IF AVAILABLE) Wire Constant Speed Pump Description Horsepower Submersible 1/ Pump Intake Depth(ft) 36 Nominal Pump Capacity(gpm) 10 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of E(gal) [(count) Placement 0 Choose Mate al__._._.____7* ( J Choose Material _ S _Choose One WELL TEST DATA Date Method Yield(gp m) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) _ _. ........... ... ..... -........._..,.............. ............... ........ 04/08/2021 Constant Rate Pump_—��1 �12 01.30� �27 00.01 18 WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured 04/06/2021 18 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. WILLIAM Supervising Driller DESMOND, DrillerURQUHART Registration# 877 Monitoring[M] Signature PATRICK, DESMOND WELL Firm DRILLING INC. Rig Permit# 0551 Date Job Complete 04/09/2021 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. ENVIROTECH LABORATORIES,INC. MA CERT. NO.:M-HA 063 8 Jan Sebastian Drive 11nit 12 Sandwich, MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name: Desmond Well Drilling Location Address: PO Box 2783 39 Meadow Ln Orleans, MA W Barnstable,MA 02653 Lab Number: DW-211212 Collected By: DWD Date Received: 04/06/21 Sample Type: Raw Well Specs: 40718' Ltictttttn�Scatrce�' a': LICsC(IIffCd TJIt3£,CQ'CtBII aM ' G .'M CtPt►ty7aa 5' Analysis Requested Units Recommended Limits Analysis Result Method jDateAnalyzedl Analyzed By PH pH units` 6.5-8.5 6.98 SM 4500-H-B 04/06/2021 SD ...._.._...._... ---._.._._.......-1--------- Specific Conductances umhos/cm 500 130 EPA 120.1 04/06/2021 SD Nitrite-N mg/L 1.00 <0.006 EPA 300.0 04/07/2021 SD ---------. .._...._.._--- -- —.._.._........ - -..._...--------- .....__.. -_------- ._._._._......_-._............--- ---- ................ ...----------------------- —. Nitrate-N mg/L 10.0 0.33 EPA 300.0 04/07/2021 SD _ -- -............................................ Sodium mg/L 20.0 11 EPA 200.7 04/08/2021 KB ----- -- --- - - _ . . ....-......... - Total Iron mg/L 0.3 2 74. EPA 200.71 04/08/2021 KB Manganese mg/L 0.05 0.254 EPA 200.7 04/08/2021 KB Total Coliform(Presence/Absence) Present/Absent Absent A SM9223B _ 04/06/2021 LL @ 18:45 Comments: Iron Level is not a health hazard,but may cause taste and staining problems. Over a lifetime,the EPA recommends that people drink water with manganese levels less than 0.3 mg/L and over the short term,EPA recommends that people limit their consumption of water with levels over 1.0 mg/L All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge. Water meets EPA standards and is suitable for drinking for parameters tested. Date 4/9/2021 Ronald J.Saari Laborator6 Director FURL=Below Reportable Limits *See Attached Page 1 of 1 oCertification is not available for this analyse for potable water samples.. f • y E]VP7WOTECH'L4..B0RATORIES,INC. MA CERT,NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name: Desmond Well.Drilling Location Address: PO Box 2783 39 Meadow Lane Orleans, MA West Barnstable,`MA 02653 Lab Number: DW-211273 Collected By: DWD Date Received: 04/09/21 Sample Type: Tank Well Specs: New Well 4VA 8' � Location Source Date Collected' , Tlme Collec7ed Cnmments r,. ___..._ -'t ,f� -. ..ems ,.,. 4.�. ., «.- ... ,+: or .'�., . � .. .... � u,. .. n.=�;•w'x�C, # ,,„�- .xa Analysis Requested Units Recommended Limits Analysis Result MethodDate Analyzed Analyzed By Volatile Organic Compounds` ug/L - See comment. `See Attached EPA 624.2 04/13/2021 NEC' Comments: *2-Butanone and acetone are found in the PVC glue used for well construction. 'Limits:2 Butanone 4000 ug/L,Acetone 6300 ug/L 'Levels should dissipate after use and flushing. 'Trace to low levels of chloroform are occasionally detected in groundwater in coastline areas. Toluene is used as a solvent,especially for paints,coatings,gums,oils and resins,and as raw material in the production of benzene,phenol and other organic solvents and in the production of polymers and rubbers. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge. Date 4/15/2021 Ronald J.Saari Laboratory Director BRL=Below Reportable Limits *See Attached Page 1 of 1 oCertification is not available for this analyse far potable water samples.. J New England Chromachem 6 Nichols Street Salem,MA 01970 978-744-6600 -Sample Information EPA Method 5242 Rev 4.1 Volatile Organic Compounds in Water Lab ID: 104215 Client: ... Envirofech Laboratory.,Inc. Client ID: DW-211273 _ State: Liquid Date Sampled: 04/09/21 Date Received: 04/13/21 Date Anal ed: 04/13/21 _ L Regulated VOC.'s_..,_ Results(uglL), _(uglL) Unregulated VOC's Results(ug/L) Benzene ND 5 Acetone" Carbon Tetrachloride ND 5 Bromobenzene ND 1,1-Dichl6roethene ND____. 7 Br6mothloromethane. ND 1.,2-Dichloroethane ND 5 Bromodichloromethane ND 1,2-Dichlorobenzene ND 600 Bromoform NO .1,4-Dichlorobenzene ND 5 Bromomethene ND Trichloroethene NO 5 2-Butanone .;697.04 1,1,1-Trichloroethane ".ND 200` N=6u Ibenzene ND Vin '.Chloride ND ` 2 Sec-Butylbenzene ND Chlorobenzene. ND 100 1 Tert-But benzene ND cis-1,2-dichloroethene ND 70 Chloroethane NO trans-12-dichioroethene ND 100 Chloroform _ 6.63 1,2-01chloropro ane NO 5 Chloromethane ND Ethylbenzene. ND _ 700 2-Chlorotoluene ND Styrene ND 100. 4-Chlorotoluene ND Tetrachloroethene ND 5 Dibromochioromethane ND-1.1111-11-4 ;Toluene 64.2 1000..` 1,2-Dibromo-3-Chlora ropane ND X enes otal) ND 10000 1,2-Dibromoethane ND Methylene Chloride ND 5 Dibromomethane NO 1,2,4-Trichlorobenzene ND 70 1,3-Dichlorobenzene NO I,1,2-Trichloroethane ND 5 { � jDichlorodifluoromethane. - ND I,7-Dichloroethane ND. Acetone Detection Limit=10 ug/L i:1,3-Dichloropro ane ND ND=<Method Detection Limit I 22-Dichloropropane ND NA=Not Analyzed i IJ-Dichloropro ne ND cis-1,3-Dichioropropene NO trans-1,3-Dichloro ro ene ND Hexachlorobutadiene ND j:Iso rop Ibenzene ND r'P-1sopropyltoluene ND I Methyl.4 "utyl ether ND- Naphthalene ND N-Pro benzene ND i1,1,1,2-Tetrachioroathane ND 1,1,2,2-Tetrachioroethane ND 1,2,3-Trichlorobenzene ND Trichlorofluoromethane ND 1,2,3-Thchloropropane NO :1,2,4-Trimeth Ibenzene ND i 11,3,5-Trimeth Ibenzene NO, Surrogate Standard Recoveries YO Benzene-d6 102 " MCL TTHM's=80 ug/L 4-Bromotluorobenzene .. 107 Method Detection Limit=0.5 ug/L 1,2-Dlchlorobenzene-d4 102 Analysis performed per 31 OCMR42 Electronically signed and approved by Mr.Bruce A.Bornstein,Lab Director Date: 4/14/2021 Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 F To: PARKER ROAD FAMILY LTD PRTNRSH Date Tuesday,February 20,2007 979 SEAVIEW AVE OSTERVILLE MA 02655 RE:Underground Storage Tank at: c 486 PARKER ROAD Map Parcel: 115025 Tank NO: 01 Tag NO: 00249 Our records indicate that your underground fuel(or chemical)storage tank is over 30 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 r Town of Barnstable �FVE tp� Regulatory Services Thomas F. Geiler,Director Public Health Division BA STABLE, + Thomas McKean,Director 9 MASS. QUA 1639. 10� 200 Main Street, Hyannis, MA. 02601 TFD�.t A Phone: 508-862-4644 Email: health@,town.barnstable.ma.us Fax: 508-790-6304 p Office Hours: M-F 8:00-4:30 Q September 17,2009 Parker Road Family LTD Partnership RE: Underground Storage Tank Removal ro klyn i Street B Order,486 Parker Road,Osterville,MA Brooklyn;N.Y. 11205 Map Parcel 115025 Tank#1 Tag#00249 Dear Sir/Madame: The Barnstable Public Health Division(BPHD)is in receipt of a copy of the"Application and Permit' for storage tank removal and transportation issued by the Centerville-Osterville-Marstons Mills Fire District demonstrating that the underground storage tank.was removed from the above referenced address on or about July 14;2009. 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. _Thomas A. cKean,RS, CHO Director of Public Health 10/JUL/2009/FRI 14: 04 C-0-MM FIAE DEPT FAX No, 5087902385 P, 001 . r e i f CENTERVILLE-OSTERVILLE—MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE &EMERGENCY SERVICES 1875 Falmouth Road, Rte. 28 Emergency Number: Centerville, MA 02632-3117 Business: (508)790-2375 John M. Farrington Facsimile: (508)790-2385 Fire Prevention/Administration Chief of Department Facsimile: (508)957-8239 Dispatch Center FAX COMMUNICATION MESSAGE DATE: cn- to-09 TO: (2(sib-t y­_1(/ULr10 PHONE: -495k--190- &301-1 ATTN: FROM: WE ARE SENDING '7�0 (�) PAGES, INCLUDING THIS COVER SHEET. PLEASE CALL (508) 790-2375 IF YOU DO NOT RECEIVE THE TOTAL NUMBER OF PAGES. CONFIDENTIALITY NOTICE: This fax transmission may contain confidential information belonging to the sender and such information is legally privileged and is intended only for the use of the individual or entity named above. Any copying. disclosure, distribution or dissemination of this information or the taking of any action based on the contents of this communication is strictly prohlbited. If you have received this transmission in error, please notify us immediately by telephone and return the original transmission to us by mall or delivery at our address above. 'We shall cover the cost of return mail. Thank you! 10/JUL/2009/FRI 14: 04 C-0—MM FIAE DEPT FAX No, 5087902385 P. 002 Make application to local Fire Department Fire Department retains original applidation and issues dupGrate as Permit. fimPintO�V UJrd L%0IC?1GC26— QO�V'G1� ?�9?l�l2G.OrlG APPLICATION and PERMIT I Fee: - for storage tank remcval and transportation to approved tank disposal yard in accordance with the provisions of M.G-L. Chapter 148,Section 38A, 527 CMR 9.00, application is hereby made by: Im ,c 1 Tank Owner Name(pi—a-w-e print) _r-1 L'l du-1 X rr - ygnaIre�ap g rpamm Address 2 �-C QS f2 V t �- O U 5 SUeer city stab Zip W;90"UN990 Min Company Namely 2�N ..1 SPIN `Co.or Individuals l^ p�+r Pant Address n I-S Address print Para Signature(if applying Signat lying scr::ermit) O 1FC1 Certtne; Other C 1FCI Certlfie = yam'n Other c� 1 ` Tank Location Co Pict r (fie rz-- •► -d � t I� /►-�Ifl sree(AM;/% r.5 Tank Capacity(gallcr (t�') Substance'Lasi Store`' �i Tank Dimensions(dia.�ewr x length) l� lr ' Remarks: (1 g Firm transporting waste 014A- 0 G State Lic.# racov Hazardous waste mar- CGlt 9 E.P.A.# R Approved tank disp �r_d 6YLQ4PA,ej... 'n.n/�c s Tank yard# _ Joao,I Co r Type of Inert gas Tank yard address es �`'•_ ko;-� S 4- d�YL9�k 2� City or Town Centerville FDID# 01920 Permit# Date of.issue July 9,•2009 Date of expiration' July 23, 2009 Dig safe approval nurr -_ Dig a To Number.-800-322-4844 Signature/Title of Officer_--ranting permit LIVA2M�­31 it P, a V WV After removal(s)send Fort 7-?-290R signed by Local Fire Dept to UST Regulatory Camp U it, O urton p�/ Room 1310;Boston, MA :u8-1618. , S O !` FP-292(revised 9/96) �P &v4�Q 710 i s UST Removal Permit Page 1 of 1 Pulsifer, Francis From: Martin, Cynthia [Cynthia.Martin@town.barnstable.ma.us] Sent: Thursday, April 23, 2009 1:50 PM To: Pulsifer, Francis Subject: UST Removal Permit Hey Frank, Thanks for refaxing the permit for 4 Jason's Lane.,Could you fax me a copy of the Removal Permit for Lisa Thomas at 31 Parker Rd, Ost? FYI you may be hearing from a David Plimpton regarding the removal of a UST at 468 Parker Rd as well. As always-enjoy! Cindy z 6/24/2009 Barnstable T' 1 � Town of Barnstable 9 SN SWIM MAS&� i639• ��+ Regulatory Services Department. A Public Health. Division 2007 200 Main Street, Hyannis MA 02601 Office:508-862-4644 __ _. _ .Thomas F.Geiler,Director Fax:508-790-6304 _ _ Thomas A.McKean,CHO To: Date: April 1, 2009 Parker Road Family LTD.Partnership 289 Adelphi Street Brooklyn,NY 11205 E/;:z�nnnD RE: Underground Storage Tank at: 486 Parker Road Osterville,MA Map Parcel: 115025 Tank NO: 1 Tag NO: 00249 Our records indicate that your underground fuel (or chemical) storage tank is over 30 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 (G . YT jr LR c i , CZ d �►• rq > level o � i , , I Osterville, MA GENERAL NOTES: SOIL TEST LOGS: SYSTEM DESIGN CALCULATIONS: A.)NEITHER DRIVEWAYS NOR PARKING AREAS ARE ALLOWED OVER SEPTIC SYSTEM TEST HOLE 1: EL=21.9t TEST HOLE 3: EL=23.7t SEWAGE DESIGN FLOWI UNLESS H-20 COMPONENTS ARE USED. DEPTH FROM SOIL SOIL SOIL SOIL OTHER DEPTH FROM SOIL SOIL SOIL SOIL OTHER BEDROOM DWnUW@ 110 GPD=660 GPD SURFACE HORIZON TEXTURE COLOR MOTTLING SURFACE HORIZON TEXTURE COLOR MOTTLING LEACHING CAPACITY REQUIREDi B.)THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UN- (INCHES) (USDA) (MUNSELL) (INCHES) (USDA) (MUNSELL) BEDR M (MAX.) =660 GPD REQUIRED LESS CONSTRUCTED AS SHOWN. ANY CHANGES SHALL BE APPROVED IN WRITING. 0-8" E loamy Fine Sand 10YR4 3 NONE Friable 0-8" E Loamy Fine Sand 0 2 NONE Friable 8-30 B Loam Fine Sand 10Y56.4 NONE Friable 8-32 B Loam Fine Sand 10YR6 4 NONE Friable SEPTIC TANK CAPACITY REQUIREDi C.)CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE LOCATION OF ALL -- - - DAILY FL =1,320 GAL.REQUIRED UNDERGROUNDAND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. 30-152 C1 Medium Sand 10YR7 6 NONE Loose Clean 32-154 Ci Medium Sand 10YR7 6 I NONE Loose Clean NONE SEPTIC TANK CAPACITY PROVIDEDi is LOCUS 2,500 SEPTIC TANK CONSTRUCTION NOTES. GALLON,TWO NT, 1000GALLO 1,500 GALLON,FIRST COMPARTMENT, 1000 GALLON SECOND COMPARTMENT TEST HOLE 2: EL=23.1t TEST HOLE 4: EL=23.8t LEACHING CAPACITY PROVIDEDi DEPTH FROM SOIL SOIL SOIL SOIL OTHER DEPTH FROM SOIL SOIL SOIL SOIL OTHER ONE 1 5 . EA HING CHAMBER CAN LEACH: tJ �` 1.)ALL CONSTRUCTION SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, SURFACE HORIZON TEXTURE COLOR MOTTLING SURFACE HORIZON TEXTURE COLOR MOTTLING Vt=[(50.5 X 12.83)+(50.5 X2.0)2+(12.83 X 2.0)2}X 0.74 GPD/5F=666:9 GPD 0D ° Sea View TITLE 5,AND THE REQUIREMENTS OF THE LOCAL BOARD OF HEALTH. (INCHES) (USDA) (MUNSELL) (INCHES) (USDA) (MUNSELL) r- 666 GPD>660 GPD REQUIRED 0-711 E Loam Fine Sand 10YR4 3 NONE Friable O-9" E Loam Fine Sand 10YR4 3 NONE Friable 2.)SEPTICTANK(5),GREASE TRAP{S),DOSING CHAMBER(5)AND DISTRIBUTION NOTE: A GARBAGE DISPOSAL IS NOT PERMITTED WITH THIS DESIGN. BOX(ES)SHALL BE SET ON A LEVEL STABLE BASE WHICH HAS BEEN MECHANICALLY 7-28 B Loamy Fine Sand 10YR69 NONE Friable 9-26 B Loamy Fine Sand 10YR§& NONE Friable INSTALU C COMPACTED,OR ON A 6 INCH CRUSHED STONE BASE. 28-120 C1 Medium Sand 10YR7 6 NONE Loose Clean 26-128 C1 Medium Sand 10YR7 6 NONE Loose Clean WE j-1500 GALLON SEPTIC TANK(H-20 Rated) C0 Nantucket Sound <2MINIIN I IPFRCt@70".R F<51MIN ONE(1)-6 OUTLET DISTRIBUTION BOX(H-20 Rated) CL 3.)SEPTICTANK(S)SHALL MEET ASTM STANDARD C1127-93 AND SHALL HAVE FIVE(5)-500 GALLON LEACH CHAMBERS WITH 4'OF STONE ALL AROUND AT LEASTTHREE 20"DIAMETER MANHOLES. THE MINIMUM DEPTH FROM THE BOT o NOT TO SCALE TOM OF THE SEPTIC TANK TO THE FLOW LINE SHALL BE 48". DATE OF TESTING: 8/20/20 CERTIFICATION U 4.)SCHEDULE 40 PVC INLET AND OUTLET TEES SHALL EXTEND A MINIMUM OF 6" PERCOLATION RATE: LESS THAN 2 MIN/INCH IN"C"LAYERS. I CERTIFY O11/25/1995(DATE)I HAVE PASSED THE SOIL EVALUATOR EXAMINATION APPROVED BY THE c ABOVE THE FLOW LINE OF THE SEPTIC TANK AND SHALL BE INSTALLED ON THE WITNESSED BY. MATTHEW T.FARRELL,EIT,J.M.O'REILLY&ASSOCIATES,INC. DEPARTMENT OF ENVIRONMENTAL PROTECTION AND THAT THE ABOVE ANALYSIS WAS PERFORMED BY ME CONSISTENT WITH .9 PLAN BOOK LANDCOURT PLAN 20678G CENTERLINE OF THE TANK DIRECTLY UNDER THE CLEANOUT MANHOLE. DAVID STANTON,AGENT,BARNSTABLE HEALTH DEPARTMENT THE REQUIRED TRAINING,EXPERTISE AND EXPERIENCE DESCRIBED IN 310 CMR 15.017. ao NO WATER ENCOUNTERED c NO BOOK: LANDCOURT DOC#1,406,798 5.)RAISE COVERS OF THE SEPTIC TANK AND DISTRIBUTION BOX WITH PRECAST USE A LOADING RATE OF 0.74 GPD/SF FOR SIZING OF SOIL ABSORPTION SYSTEM. Signature pate ASSESSORS' MAP 115 PARCEL 25 CONCRETE WATER TIGHT RISERS OVER IN LET AND OUTLET TEES TO WITHIN 6 OF a o. FINISH GRADE,OR AS APPROVED BY THE LOCAL BOARD OF HEALTH AGENT. 6.)PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL ! LEGEND BE LAID ON A MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 1%. LOW POINT FOR / 7.)DISTRIBUTION LINES FOR SOIL ABSORPTION SYSTEM(AS REQUIRED)SHALL BE STORM RUNOFF PROPOSED 12" HIGH m 32 EXISTING CONTOUR 4"DIAMETER SCHEDULE 40 PVC LAID AT 0.005 FT/FT. LINE SHALL BE CAPPED Existing Single Family Dwelling o -32 PROPOSED CONTOUR AT END OR As NOTED. TO BE REMOVED OWNER TO APPROVE MATERIALS '�I 2axs EXISTING SPOT GRADE j 8.)OUTLET PIPES FROM DISTRIBUTION BOX SHALL REMAIN LEVEL FOR AT LEAST Vent ry/ PROPOSED SPOT GRADE T BEFORE PITCHING TO SOIL ABSORPTION SYSTEM. WATER TEST DISTRIBUTION v/ - W-- WATER SERVICE LINE BOX TO ASSURE EVEN DISTRIBUTION. Utility m 2:e 1165/ 6 41 -o- OVERHEAD UTILITY SERVICE 9.)DISTRIBUTION BOX SHALL HAVE A MINIMUM SUMP OF 6"MEASURED BELOW 235 ' -U- UNDERGROUND UTILITY SERVICE THE OUTLET INVERT. 4 / 10.)BASE AGGREGATE FOR THE LEACHING FACILITY SHALL CONSIST OF 3/4"TO `�'o x 24 e h/a LOT 12 Tp- GAS SERVICE LI N E 1-1/2"DOUBLE WASHED STONE FREE OF IRON,FINES AND DUST AND SHALL BE F, x 2a2 '�� i5g Vacant Land TEST HOLE/BORING LOCATION INSTALLED BELOW THE CROWN OF THE DISTRIBUTION LINE TO THE BOTTOM OF THE Q 2 x 24.2 �o ST SEPTIC TANK SOILABSORPTION SYSTEM. BASE AGGREGATE SHALL BE COVERED WITH A 2" o m LAYER OF 1/8"TO 1/2"DOUBLE WASHED STONE FREE OF IRON,FINES AND DUST. DB DISTRIBUTION BOX y,. ` �p G X 24.3 x 22,6 Existing I SAS SOIL ABSORPTION SYSTEM Ces11.)VENT SOILABSORPTION SYSTEM WHEN DISTRIBUTION LINES EXCEED 50 FEET; Ln v �. �L SEE N NOTE al as `�, x 2.5 SEE NOTE 16 qj ti Reserve RESERVED FOR FUTURE WHEN LOCATED EITHER IN WHOLE OR IN PART UNDER DRIVEWAYS,PARKING AREAS, - � ,S• m s �o r'Q A TURNING AREAS OR OTHER IMPERVIOUS MATERIAL;OR WHEN PRESSURE DOSED. 0 �. 24.2 Q/o UTILITY POLE 11)SOIL ABSORPTION SYSTEM SHALL BE COVERED WITH A MINIMUM OF 9"OF 4- 23.3 x 2 ..- G 298.8p, y�/3 CATCH BASIN CLEAN MEDIUM SAND(EXCLUDING TOPSOIL). ,., ;, P w trl FIRE HYDRANT 13.)FINISH GRADE SHALL BE A MAXIMUM OF 36"OVER THE TOP OF ALL SYSTEM N �.� a� �'� x 208.si� x 23.4�� pROPOSEd�_ ® WELL DISTRIBUTION BOX DOSING CHAMBER "' L �D GO R1VEW ASPyALT "� a�� COMPONENTS,INCLUDING THE SEPTIC TANK, y� �: r Ay 3 3 i9 DRAINAGE MANHOLE OFDSOILABSORPTION SYSTEM. SEPTIC TANKS SHALL HAVE A MINIMUM COVER c ra 22. X X 24.1 ` 2 }' J3 CONCRETE BOUND,FOUND Q` Z X 23,9 .�c ry 22.a z3 X 22.0 0/ X 21.a LOT 11 - w - TOP OF BANK 14.)FROM THE DATE OF INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL n TWO H2O RATED RISERS Oi X 23.7 w�4,1 G �'�^+� RECEIPT OFACERTIFICATE OF COMPLIANCE,THE PERIMETER OF THE SOIL ABSORP- m �� p X L4 .rr'� �- +� s �' - Vacant Land -_-_- LIMIT OF WORK TION SYSTEM SHALL BE STAKED AND FLAGGED TO PREVENT THE USE OF SUCH 3 &COVERS WITHIN 3 FG "+ h�r2 t1G UG o UG AREA FOR ALL ACTIVITIES THAT MIGHT DAMAGE THE SYSTEM. r�o FENCE X 4.1 ' y w ,v ^ �� EDGE OF CLEARING 15.)SUBSURFACE COMPONENTS OF A SYSTEM SHALL NOT BE BACKFILLED OR UG •-�- UG UG x/¢ 9 x 23.4 OTHERWISE CONCEALED FROM VIEW UNTIL A FINAL INSPECTION HAS BEEN CONDUCTED Pole 431 x 23.5 fi� 4 o k ZONING TABLE BY THE APPROVING AUTHORITYAND PERMISSION HAS BEEN GRANTED BY THE APPROVING 1, AUTHORITYTO BACKFILL THE SYSTEM.THE DESIGNER SHALL INSPECT THE CONSTRUCTION Vent x 24, , AFTER THE INITIAL EXCAVATION,PRIOR TO BACKFILLING,AND DURING BACKFILLING. rr or 1'9 � 0o Zp C O x 23,9 AP-AQUIFER PROTECTION OVERLAY IN ADDITION,THE FINAL INSPECTION OF THE SYSTEM SHALL BE CONDUCTED BY THE v C/O X 22.4 RP-RESOURCE PROTECTION OVERLAY APPROVING AUTHORITY,THE SYSTEM INSTALLER AND DESIGNER PRIOR TO THE ISSUANCE �? x 24,a Q? OF A CERTIFICATE OF COMPLIANCE PURSUANT TO 310 CMR 15.021(3).ANY COMPONENT x 22,2 o OF THE SYSTEM WHICH HAS BEEN COVERED WITHOUT SUCH PERMISSION SHALL BE �2 N N LOT 10 ta RF 1-RESIDENTIAL UNCOVERED UPON REQUEST OF THE APPROVING AUTHORITY OR THE DEPARTMENT. au iw pt ee REQUIREMENTSi <� 2 CDN o g o Area=87,130 SFt Q x t.4 a 23, �� VO �� � oa `�19� LOT SIZE 87,120 SF 16.)EXISTING CESSPOOLS FOR EXISTING DWELLING SHALL BE PUMPED,AND REMOVED, a� N N 1 X 223 8, INCLUDING ANY CONTAMINATED SOILS. 21 Q� x ' o w X 24. X 24,0 FRONT SETBACK 20 FEET SIDE SETBACK 15 FEET 17.)ROOF RUNOFF FROM DWELLING SHALL BE PLUMBED TO UNDERGROUND DRY WELLS. 83 C/o 37.0 a Q x 225 REAR SETBACK 15 FEET 30 FEET SIX DRY WELLS:24"ADS PIPE WITH 2 FEET OF STONE AROUND P L 20 ;' x 23.4 -e FRONTAGE 20 FEET --12.83� �, 2 8 23 ��' `��' WIDTH 125 FEET 0 / x 20.9 O PROPOSED BUILDING COVERAGE Utility A 21,0 SAS PLAN VIEW W'" w P°°L � x 23.9 d Q I863p, �' 8LL' LOT AREA 87,130 SFt � '�� APRON x 2 SCALE: 1"= 10' Pole 0.9 LOW POINT FOR w X 23,2 ' '. N x 2;11 2, BUILDING COVERAGE: .225 �y3 22.7 HOUSE/GARAGE 5,250 SFt STORM RUNOFF �, x IX POOL&P.HOUSE 1,124 SFt Existing ,� C�0 �'.. / � 22.6 TOTAL 6,374SFt BENCHMARKI CessPool 'v 2� _ * :, x 23.3 / SEE NOTE 16 Top of Concrete Bound Cd to a x 23,8 x 231 / / COVERAGE=(6,374/87,130)X100%=7.3% EL=21.2t(1988 NAVD datum) "' ry �`L X 23.5 PROPOSE IRRIGATION WELL 23.5 X 24,6 25'PROTECTE RADIUS GRADE PLANE CALCULATION Otioi 25.0' I Al /22.a FLOW PROFILE: POOL CABANA: LINE C ti,���/ ` x24.8 ,�(10 X23.7 23.8 a /� NORTH:23.8+248/2=2435 NOT TO SCALE FOUR(4):4"PVC CLEAN OUTS,TO GRADE PLAN a""�/ / x 23,4 ���� v9 / / EAST:24.8+22.9/2=23,9 ONE(1)PROPOSED,EACH CLEAN OUT SHALL O \ O mot` / WEST:23.8+23.8/2=23,9 NX HAVE A 10"POLYLOCK COVER TO GRADE SCALE 1"=30' ��ac/ / QO x 23,5 / GRADE PLANE EL=23.7 FINISH FLOOR:POOL CABANA THIS AREA IS SERVED %oQ� Q x 23,7 / / MAX PEAK EL=30'+23.7 EL=53.7 EL=27.ot VENTED Ji;•y< MCP /22.V HEIGHT FROM TOF 21.0 FEET SEE PROFILE FOR ALL DETAILS BY TOWN WATER. X PROPOSED FINISH GRADE - &ELEVATIONS o%O' ti / / 22,4 PROPOSED HEIGHT z o`� x 24.6 sp0 x 3.2 / / TOF+21'= EL=47.0 dF inh ~ 2s9 x 23.1 //// HEIGHT EL=47.0<EL=53.7,HEIGHT OK ti� 98, �� atij 22.2t �r 14' 94' 98' 40' 5' ca� p, ` �O ,,/22.3/ a �4,%-4, x 22, // /22.1 SLOPE PROPOSED 1%,PIPE SHALL BE SET ON 6"BED OF 3 STONE 24.0 21.00 10 14" 14 sic u9 �� „ •�o � x 24,6 3"T TO DBOX,SEE PROFILE FOR a=o o x 23.4 x 2 "v MAIN HOUSE BELOW `� 22.0 / T ' ,� ti 251 GAS BAFFLE GAS BAFFLE �0 X22.1 1500 GAL. 1000 GAL X 23.0 2.0/ X 23.5 <§> 2500 GALLON,H2O RATED,TWO COMPARTMENT / // - SEPTIC TANK LOT 9 X 22.6 // ,121,e H-20 Vacant Land FLOW PROFILE. DWELLING, LINE A & B 2' x/21.y 22.0 NOT TO SCALE 4"PVC CLEAN OUT.TO GRADE 5!X(6)COVERS TOTAL ONE(1)PROPOSED W/10"POLYLOCK COVER TO GRADE THREE(3)SEPTIC TANK,ONE(1)DBOX 4"PVC VENT TOP OF FOUNDATION TWO(2):SAS,WITHIN 3" &CAP Y'SWEETAIR" A:EL=26.01 H2O COVERS&RISERS B:EL=26.0± RAISEDTO WITHIN 6"OF FINISH REVISED PLAN,10-21-20:REVISED BENCH MARK TO EL=21.2t. GRADE(OR AS NOTED) ENTED (SEE NOTE#5) Proposed EL=24.01 _.-Proposed EL=23.5t _,.,-Proposed EL=23.5t REVISED PLAN,10-16-20:REMOVED THE PROPOSED POTABLE DRINKING WATER WELL ADDED AN IRRIGATION WELL IN THE SAME PROPOSED LOCATION. LOT 8 a m 33"Proposed Vacant Land 22.2t (9"Min-36"Max) [ PARKER ROAD FAMILY LIMITED PARTNERSHIP t: 20.8± f - %Ty Gupta,Trustee, 267 Commonwealth Avenue, Boston, MA 02116 2"LAYER OF 1/8"-1/2"STONE A:2 .60 21.00 10" 14" 14" 20.75 19.80 3/4"-1-1/2"STONE - � ```` SITE & SEWAGE DISPOSAL SYSTEM DESIGN B:22.60 3" 20.47 20.30 "' ^' r "` °� 486 Parker Road, Osterville, MA 1 2"DROP GAS BAFFLE T GAS BAFFL 17.80 INSPECTION NOTE: 1500 GAL. 100 USE FIVE 5 SHOREY PRECAST PRIORTO FINAL INSPECTION BY THE ENGINEER,SYSTEM NEEDS TO J.M. O REILLY 8C AS S O CIATE S INC. . 0 GAL ( ) 500 GALLON LEACH CHAMBERS 8,6't BE COMPLETE INCLUDING BUILDUP FOR COVERS. Professional Engineering & Land Surveying. Services A:80_ Longest Run WITH 4'OF STONE AROUND B:40' 25W GALLON,H2O RATED,TWO COMPARTMEl10� - 25' (END VIEW) _ 0 30 60 90 1573 Main Street - Route 6A DB 6 EL=9.2 NO GROUNDWATER ENCOUNTERED,BOTTOM TEST HOLE 1 P.O. Box 1773 SEPTIC TANK D-BOX LEACHING CHAMBER (s06)696-a6o1 Office Brewster. MA 02631 (506)698-6602 Fax H-20 50.5'X 12.83'x 2.0' SCALE 1"=30' DATE: SCALE: BY: CHECK: JOB NUMBER: H-20 H-20 G:\AAlobs\PARKEROADLLC8926\Parker8926PRPOSEDSDS>DWG 9/28/20 As Noted MTF JMO JMO-8926