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0056 ALDER BROOK LANE - Health
156 Alder Brook La)n�e'W t Barnstable " 1 { i I f t A 61 Qc t W o Jet r o i i e : ' • A s �r I f� , :i� � G� .. t =ip . p i f y ti c z r' c r Y - TOWN OF BARNSTABLE ,-� LOCATION e v C ; d SEWAGE VILLAGE LA4.j 1 � ASSESSORS MAP&PARCEL /33 D f ' � _ INSTALLER'S NAME&PHONE NO. - _ ✓•;�.�/ ���u 72y/-39,2-009S SEPTIC TANK CAPACITY LEACHING FACILITY:(type) %��� � ' ls, 4{size) 37 X .7,f 3f X-2 l NO.OF BEDROOMS O R ( c Ind f [o r.. P MI 1)A 43 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 - I r c s GARAGE a 2 O EXISTING 3 o 1 SWING TIES BEDROOM B DWELLING TOF=103.97 S. T. COVER IN 1 33.4' 21.80' S. T. COVER OUT 2 39.8' 15.9' t D—BOX COVER 3 25.4' 13.0' A SAS IN ® 4 19.0' 16.5 SAS IN ® 5 39.3' 24.5' `J SCHEDULE OF ELEVATIONS DESCRIPTION DESIGN AS—BUILT . ELEVATION ELEVATION SEPTIC TANK IN 1 99.55 99.45 SEPT. TANK OUT 2 99.30 99.20 D—BOX IN 97.37 97.81 r D—BOX OUT 97.20 97.64 gsl�arri 311 +r. TOP OF CHAMBER 97.25 97.15 wo.:acn7 SAS INV. IN 96.50 96.40 BOTT, OF SAS 94.50 94.40 ec m E/z4 1. SEPTIC SYSTEM SPINK DESIGN wa wctuen Loonc � ae AIDELtBR00E L1D. AS BUILT PUN ae C7A7 srnser •E31'BARNSTABLE.MA 20' Mm01YE0B0,MA clfu8E178 02868 0081E-1060, AS-BUB.T 77/-7EE-0EN ftP ogmwlcom AS-BUB.T PLAN o 1 4kr Jii-W �I sul u- FEE 100 tOMM WALTH OF MASSACHUSET Board of Health, fJll —11 !,41,0 , MA. APPLICATION FOR DISPOSAL SYSHM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repaii�radeO Abandon( - 061mplete System ❑Individual Components Location G Owner's Name h&✓ E ( Map/Parcel# M .3 c�C L Address S � Lot# b Telephone# Installer's Name Designer's Name i A J• .� Address Rtj Address g,7 y Telephone# 4) ') Telephone# ? _ 4/ Type of Building �`IA ! M` I Lot Size 4 � / !6 �� sq.ft. Dwelling-No.of Bedroo Garbage grinder ( ) Other-Type of Building No.of persons f Showers( ),Cafeteria( ) Other Fixtures Design Flow (min.required) 3 3 0 gpd Calculated deesign flow 3�7,. I Design flow provided 15�L- J_gpd Plan: Date Cel _ Number of sheets 1 Revision Date hm ff tire. Title k newer sci W14 [.AC or Ilecr• 1 Description of oils) -e J` 2. d.gk Soil Evaluator Form No. II I Z Name of Soil Evaluator kn v x Date of Evaluation "l e- DESCRIPTION OF REPAIRS OR ALTERATIONS R941&�P eX 6f_�1nG S�rQ C 4 V I-APILI R The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree t not to pla system in operation until a Certificate of Compliance has been issued by the Board of Health. �' i Signed r Date gDjf )' 0, Inspections -------------------------------_-•-_----- ��.... . .. .__-. .-.-...--._---.-..-.-----.-- -.-------------- -----i--------------- r °_..�?f R�"" -/ r, °!'3' r9 "4.. .t'• xI I_l� V !ti. ��,� f s,4' �.�.c ,J .• jj //..'�� ;. .r "4 SS x Board of Health, l/( S 1/ I ;MA. I APPLICATION FOR DISPOSAL, SYSTEM CONSTRUCTION PERMIT Application for a Permit to CnnstructO Repair Upgrade(, ) Aband ( }`f! IdJ�Corn�(lete,S tem ❑Individual Coin onents Location. S6 A'Gl 2j'jC Oa� �Q I•� G f i .'Owner's Name R%G k 6,/-C K t , i c- / � ► Map/Parcel# ,� /3 3 P�r'C 5�! Address' �'�n Q/-�p o ,tom• . Lot# ,+ Telephone# Installer's Name Cw o f,'v Designer's Name S n n Address 3 6 1`�1/e6 Q�n� Address 8` M,t Y WUr�h f 1 till Telephone# '7 7 3 12 OO 9 8 Telephone# Type of Building S lA q 4�M i I/ H 0hMF Lot Size /�i / �� t� sq.ft. Dwelling-No.of Bedroo s Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures u /� Design Flow (min.required) 3,3 gpd Calculated design flow 3 / 7, Design flow pro 'd d 3, 7- gpd Plan: Date T e_b//. �d�S Number of sheets Revision Date 10 j �o^f G r e Title — E0T1 S� M/ 'beI'Iq e wFt ,^cotlec4 , Description of oil(s) Soil Evaluator Form No. It /Z- Name of Soil Evaluator--rAJM A.S Rn v x Date of Evaluation DESCRIPTION OF;REPAIRS OR ALTERATIONS I C E i r e \--X n/ I C S P Tt S 1 PM f 1 C � The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree not to place system in operation until a Certificate of Compliance has been issued by the Board of Health: Signed / / Date a/ 2,// go If (. . ,,uJ 0, .2 Inspections 3 f}I .No. 7 O/� Y FEE /Uy- Board of Health, 4 /�f -( _ , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) atomplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned O by: LA% nA II "�� Ca, Va-� i OY\ - at 5-61dff ONA K41: Iy_ 5rr,has been installed in accordance with the pr nisi ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. S 17 , dated �' ? 3 /`1/ . Approved Design Flow ;1 6 (gpd) Installer II Designer: Inspector: Date: 0XI6 _ � I The issuance of this permit shall not be construed as a guarantee that the system function as designed. No. FEE, Ido COMMONWEALTH Of MASSACHUSETTS- n l r,,j� .` Health, i�r T/�J 1 r-1 f MA. CONS .�VIUCTION PFRMIT 'x♦ r r' err^2 i r ) fl.I;andon( ;an individl.'.c�Sewage disposal system as described in t1;e application for �? 6 'the date of thi-PC r�i,(nit. All Iola condidonss must be met. #Health TXown of Barnstable F n+e r Regulatory Services P " Richard V. Scali, Director 'A AB M Public Health Division v$ 1639. ,0m 10) Thomas iNlcKcan,Director 200 Main Street, Hyannis, ALA 02601 Office: 60S-362 64 Fix: 508-790-63,01 Date: A", Q. -Z Seti�abe Pet mitK Assessor's Map/Parcel Installer & Designer Certification Form G Designer: �Id //YJ l '�//?,,�' S �� ` Installer: F�/JF'� 60 ' ��--- � . � Address: �7 �• Zc,,. � Address: 4 ` dam/�,�e� -7 -76C On was issued a permit to install a (date) (installer) septic system at 14p P4W /V based on a design drawn by ` � (address) dated (designer) �I certify that the septic system referenced above \vas installed substantially according to the design, which may include minor approved changes such as lateral refocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certif.- that the septic system referenced above was installed with major changes (i.e. greater than I 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. Stripout (if required wa in ected and the soils were found satisfactory. I 5&tify that the system referenced above was con truct I,liance with the terms of the I/Approval le e (if applicable). �g CU r(l sfaller's Sja MIK 'ua 900� A& esi s Signature) (Affix Desi_ p Here) PLEAS RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CON[PLIAN'CE WILL NOT BE ISSUED UNTIL BOTH THIS .FORINI AND AS- BUILT CARD ARE RECEIVED BY THE BARNrSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gaofiice formsWesigncreenifieaiion form.doc Yy { Town ofBariastable �FZHE 1p�, Regulatory Services Richard V. Scali, Director '" MA Public Health Division � nss.MSS. �, 1639. �0 Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862- 644 � Fax: 508-790-6304 l Z Date: �(D Sewage Permit# � Assessor's Map/Parcel Installer & Designer Certification Form G !� . Designer: X P� Installer: Address: Address:. 3? BOA,. aNtA A4.4 On ?7/� w h QU n,h was issued a permit to install a (date) (installer) �' / septic system at 56 � ��kt��2a�(i ( based on a design drawn by 14 (address) dated c� (designer) ZI 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. Stripout (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. Stripout (if required) was inspected and the soils were found satisfactory. I rtify�t the system referenced above was constructed in compliance with the terms of t e I/A approval 1 e (if applicable). ( aller's Sign e) (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office fonns\designercerti5cation form.doc i' 1 I r i 0 C O '. GARAGE B 0 2 0 EXISTING 3 0 1 SWING TIES BEDROOM A_ $_ C_ TOFFELLING S. T. COVER IN 1 33.4' 21.80' =103.9S. T. COVER OUT 2 39.8' 15.9' D—BOX COVER 3 25.4' 13.0' A SAS IN ® 4 19.0, SAS IN ® 5 39.3' SCHEDULE OF ELEVATIONS DESIGN AS—BUILT DESCRIPTION ELEVATION ELEVATION SEPTIC TANK IN 1 99.55 99.45 SEPT. TANK OUT 2 99.30 99.20 D—BOX IN 97.37 97.81 D—BOX OUT 97.20 97.64 =cw TOP OF CHAMBER 97.25 97.15 «� SAS INV. IN 96.50 96.40 f . BOTT, OF SAS 94.50 94.40 PROJECT: PREPARED FOR: DACE 8/24/2016 SEPTIC SYSTEM SPINK DESIGN RICHARD EZOTIC =--. u�/JCS 56 ALDERBROOB RD. asEac AS—BUILT PLAN 59 CLAY STRUT NEST BARNSTABLE. MA. sckk 1" = 20' MiDDUMORO. MASSACAUSEM 02MB PROJECT 0 02M-1052 DRAMANG SHEET fa PUN SET: AS—BUILT 774—M-0544 Jsginld®gmaiLcom AS—BUILT PLAN 1 .e. �OpSHE Tp�y Barnstable C) Town of Barnstable ( A!AmedcacitY 03 + BARNS -LE, . Board of Health 9 MASS. ibgq. �0 AIF0 MAt a' 200 Main Street,Hyannis MA 02601 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Mr. Thomas Roux June 30, 2015 89 Mayflower Lane East Wareham, MA 02538 RE: 56 Alder Brook Road, West Barnstable A = 133-054 Dear Mr. Roux: You are granted variances on behalf of your client, Richard Kiotic, to install an onsite sewage disposal system at 56 Alder Brook Road, West Barnstable. The variances granted are as follows: 310 CMR 15.212: .To install a soil absorption system four feet above the estimated maximum adjusted groundwater table elevation, in lieu of the five feet minimum required. 310 CMR 15.240: To install a 3.75 feet of soil cover over the southern half of the soil absorption system, in lieu of the three feet soil cover maximum allowed. Section 397-8, Town of Barnstable Code: To install a septic tank 97.5 feet away from an onsite private well. Section 397-8, Town of Barnstable Code: To install a soil absorption system 122 feet away from an onsite private well. Section 397-8, Town of Barnstable Code: To install a soil absorption system 103 feet away from a neighbor's private well. Section 360-1, Town of Barnstable Code: To place a soil absorption system 91 feet away from a bordering vegetated wetland, in lieu of the 100 feet minimum separation distance required. Q:\WPFILES\RouxKiotic56AIderBrookWB.2015.doc y„ Section 360-1, Town of Barnstable Code: To place a pump chamber 54 feet away from a bordering vegetated wetland, in lieu of the 100 feet minimum separation distance required. These variances are granted with the following conditions: (1) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The engineering plans shall be revised to exclude the variance request in regards to a three bedroom design because it is not applicable and not needed. (3) The septic system shall be installed in substantial compliance with the revised engineered plans. (4) The professional engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised engineered plans. This variance is granted because, in the opinion of the Board, the revised plans would be designed to meet the "maximum feasible compliance" standards contained in the State Environmental Code, Title V. Sinc rely yours, W M. Ch firma Board of ealth Q:\WPFILES\RouxKiotic56AIderBrookWB.2015.doc Town of Barnstable Barnstable Board of Health • BARN srASL& • 200 Main Street,Hyannis MA 02601 III I KAM �ArEO/APr° 2007 Office: 508-862-4E44 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi _ BOARD OF HEALTH MEETING RESULTS Revised Tuesday,June 9, 2015 at 3:00 PM Formatted:Font:(Default)Arial Town Hall,Hall, Hearing Room, 2 ND Floor 367 Main Street, Hyannis, MA I. Hearing—Show Cause-Food: Jen Villa, Local Juice—Sale of bottled unpasteurized juice at farmer's markets and temporary food events, invalid or false documentation provided from applicant, product manufactured at unknown location. Warning Issued. Local Juice acknowledged wrong doing in producing their product. They did error in not meeting all the permits, etc. for their product. They did not have a food permit nor an inspection of the kitchen they were leasing and they did not obtain a wholesale license. Local Juice has stopped production until they are in a licensed facility and it is inspected and all requirements are met. II. Trash Issue: Attorney Daniel Rich representing Agnes Schobel, owner—100 Nyes Neck Road East, Centerville, trash has not been removed as stated. 100 Fine. The Board determined to issue$100 Fine and request the owner attend a show-cause hearing on July 14, 2015 unless they have cleaned the outside property to the inspector's satisfaction. III. Septic Variance(Cont.): Thomas Roux representing Richard Kiotic, owner—56 Alderbrook Road, West Barnstable, Map/Parcel 133-054, requesting septic variances. Granted With Conditions. The Board voted to grant the septic plan for a 3-bedroom septic with the following conditions: 1) submit a stamped revised plan, removing the wording mentioning variance for 3 bedroom. IV. Septic Variance: t Page 1 of 3 BOH 06/09/15 DATE: yVi O� ar UJ r`t FEE: * BARNSfABLE, MASS. �p 1639. ��� �;. UI 1' W"" . 7- REC. BY Town of Barnstable SCFIED. DATE: *115 w. Board of Health l `200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-760-6304 Yunichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION / Property Address 49 0 j IO�Q!'�Cj{�00 //� (\.1� W e_r 4- Assessor's Map and Parcel Number: 133 Size of Lot:_ Wetlands Within 300 Ft. Yes i/ Business Name: No Subdivision N,ame: APPLICANT'S NAME:�i C K&4 �\( O 1(�/c Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: R i C Gr� (o �� C Name: Address: root, "RA Address: � ci o",..?l_ Phone: Phone: o� VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) tf v e �DO��r�r. Qvw Far- 1� - NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System 16✓ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request l Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) A/A Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. �_. C:_\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC l A 5 r' February 25, 2015 Board of Health Town on Barnstable Barnstable, MA RE: 56 ALDERBROOK ROAD, WEST BARNSTABLE, MA 02668 Dear.Sir/Madam: i a I, Richard Kiotic, attest that this house located at 56 Alderbrook Road a has been a three bedroom house since 1985. Very trulyyour Y , Richard Kiotic i j 1 i i 7 A `., t EXCERPT FROM THE BOARD OF HEALTH MEETING RESULTS ON 4/14/2015: II. Septic Variance: Thomas Roux representing Richard Kiotic, owner— 56 Alderbrook Road, West Barnstable, Map/Parcel 133-054, requesting septic variances. CONTINUED TO MAY 12, 2015. The Board voted to continue. The Board requires a 150 feet radius to show neighboring wells, as well as multiple procedural items (i.e. list all code variances on the plan identifying state versus local, etc. I . EXCERPT FROMT F HEALTH MEETING RESULTS ON 4/14/201*5: HE BOARD O II. Septic Variance: Thomas Roux representing Richard Kiotic, owner— 56 Alderbrook Road, West Barnstable, Map/Parcel 133-054, requesting septic variances. CONTINUED TO MAY 12, 2015. The Board voted to continue. The Board requires a 150 feet radius to show neighboring wells, as well as multiple procedural items (i.e. list all code variances on the plan identifying state versus local, etc. IVO ��� °fs rowti Town of Barnstable Barnstable Board of Health AllftedcaCft �+ BARNSTABLE./• ' 9 MASS. $ 200 Main Street, Hyannis MA 02601 p D® 039• AlfO MA'I A, 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. Agreement to Extend Time Limit For Acting Upon a Variance Request In the Matter of a variance re nest form received on , the Petitioner(s), � regarding the property at -���o z 10 , the petitioner(s) and the Board of Health agree that the Board of Health has until V azn (insert date) to act upon the Petitioners' completed application for a variance. In executing this Agreement, the Petitioner(s) hereto specifically waive any claim for a constructive grant of relief based upon time limits applicable prior to the execution of this Agreement. Petitioner(s): Board of Health: Signature: Signature: Petitioner(s)or Petitioner's Represe ative Chairman Print: 1- 61� /�u..-Dl Print: Wayne Miller, M.D. Date: 51215 Date: Address of Petitioner(s)or Petitioner's Representative Town of Barnstable Board of Health Public Health Division 200 Main Street Hyannis, MA 02601 Phone: 508-862-4644 Fax: 508-790-6304 Q:\OFFICE FORMS\BOH Agreement to Extend Time Limit to Act on Variance.doc IMessage Page 1 of 1 a Crocker, Sharon From: McKean, Thomas Sent: Tuesday, April 14, 2015 2:12 PM To: Crocker, Sharon Subject: Fw: 56 (?)Alderbrook Road, Tom Roux plans for Board Sharon Will you please print this out and bring it over to the meeting at 3? From: Stanton, David <David.Stanton@town.barnstable.ma.us> Sent: Tuesday, April 14, 2015 1:20 PM To: McKean, Thomas Subject: 56 (?) Alderbrook Road, Tom Roux plans for Board Tom, I think it's number 56, Alderbrook Road, West Barnstable, soil evaluator,Tom Roux. No ground water adjustment done. (the adjustment is 1.2', which the engineer should show the work on how they get it. This will also create less then 5' below the bottom of the SAS to high groundwater) V ►" -Original Septic was for 2 bedrooms (in the file.) Original building permit aid 6 rooms Floor ! o Z plans submitted show 3 bedrooms and an "office" J -Need to list all variances (State an OB on the septic plans. (Note: there were incorrect variance requests and missing requests on the plans) (said septic tank to wetland 100', but they r met the requirement. They did not inclu e e septic tank less then 100'from a private well, SAS to private well less then 150'...) :/ -Show's h-10 septic tank and just after it has a note that all components to be h-20. � J — Thanks, Dave 4/14/2015 i Abutter's Notification Letter for the Upcoming Board of Health Meeting March 23, 2015 Dear Abutter: A public hearing has been scheduled for the Barnstable Board of Health to take action on a request for variances from Title 5 Regulations under CMR 15.000 and Town of Barnstable Regulations for the subsurface disposal of sewage for proposed septic system upgrade (To replace the entire septic system) at the Richard Kiotic residence, 56 Alderbrook Rd. West Barnstable, Assessor's Map 133 Parcel 054. The variances requested are as follows: Variance requested under Title V, Maximum Feasible Compliance 15.221(7): Max. Allowable cover over any portion of the septic system is 3 ft. Requesting a variance to have 4ft. +/- over one end of the Soil Absorption System. Variances requested under Town of Barnstable Board of Health Regulations: Art I: Section 360-1: SAS to be 91' from the edge of wetland (9' variance). Art VIII: Subsurface sewage disposal systems shall be located in an area where there is at least a J four-foot depth of naturally occurring pervious soil below the entire area of the leaching facility tJ� ' and the designated leaching reserve area. We are requesting a variance to not have a 100% �.k future reserve area. M . Section 397-8(f) Septic leaching facility is required to be 150' from well. We are requesting a variance for 103'. \ Said hearing will be held in the Hearing Room, Town Hall, 367 Main St. 2nd fl., Hyannis on April 14, 2015 at 3:00 P.M. Plans and the application describing the proposed activity are on file at the Board of Health office, 200 Main St. Hyannis. It is recommended to check with the Health Department to confirm date and time if you are interested in attending. Any Questions, we may be reached at: 508-862-4644. Sincerely yours, Thomas Roux, Civil Engineer. I can be reached at: 774-678-9066. I _ OCT 24116 PH 3:51 I _- --- -------- fit DER 8 ROOK Z /VE :.. �0C,9770 y: .WEST. . S clql E ao ATE LAN R 1=F:- .rd.� cam\ $K,•173-. . pG_sL..,..__... ........ ------- .�,,99! LLOYD - ,C. -. ,P FoR: KARL p XATJMEft - �� 0 < ffEPEay cERTIF HA 1' TT Ty1= fX�s7 �STE //Vs FaU1VDA710A1 40CA7/0/y /S CORRECT *° A S -S VOwN A.n/p DOES C 0 MFO R.Ff w rrA/ . aultDING- 9E7-8/9C RE<201RFlENn Gf T11, Taw) aF 8,4 p"T•1 5TA SL E, FAQ MouTH 17P,SS.. f 4 Nor r sZ *tf,ro, 1f c-^k � f ,1 Mhy s.br^,') ��w i�.,��I��,� did S,M,k lk/ry� �/��fiNn(e 2Gi✓t)/J 7 far'^" , _Vt.,r-N ( yr nu 6jJr46, t p "for- Town of Barnstable P# Department of Regulatory Services rtgnr�. Public Health Division Date NAM 200 Main Street,Hya�tns MA 02601 . ,� Date Scheduled Time Fee Pd. xm Soil Suitability A essment for Sewage Disposal Perfotmed8%, LOCATION&.GENERAL INFORMATION po'la X. Location Address - -- - Owner's Nane ��� / ✓ !"z S� A Ae- t,0o L.a,.>` �g lV �W- r#'11 Yt Address T` ] yp Assessor'sMap/Parcel: ] 1!�ll�� Ergrncer,sNarne7^�[ '�OA'►A^.S�Q�' gko%jX (/t U NEW CONSTRUCTION REPAIR aTa pbane# ( ! — 4 /p - Land Use l�SI J e vt V I Q( slopes(%) 3'O / Surface Stores o n e- Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft -_1F=e wav It Property Lit e ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&.Pere tests,locate wetlands in proximity to holes) parent mateuai(geologic) Depth tots^'.. /Y•�.ti2_ t t Depth to Groundwater. Standing Water in Hole: I cc) / Weepine from Pit Face J.v d A.Z Estunated Seasonal Hieh Gromdwater /0 c DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: • Depth Observed s-Landing in obs.hole: Z O {� in. Depth to soil mottles: rn Depth to weeping from side of obs.hole: in Groundwater Adjustment ft. Index Well# Reading Date: Index Well lekl Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time I o Ctl. Observation Hole# A Time at 9" Depth of Pere .fiC N Time at 6" Start Pre-soak Time @ Q✓IO�a M Time(9"-6') / End Pre-soak C Rate Min-finch M 7 8 ' (/� Ci Site Suitability Assesstnen[: Site Passed LZ Site Failed. Additional Testing Needed(YIN) Original:Public Health Division Observation Hole Data To Be Completed on Bach---------- ***If percolation testis to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning,. Q:\SE PTICIPERCFORM.DOC i DEEP OBSERVATION HOLE LOG Hole# , Depth from Soil Horizon Soil Texture Soil Color SCiI Other Surface 00 (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel V A 2 i� C S�tirG v ..� S Z LA- t 2 , G 6uU,rst, All"( /0 lk(A DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Torture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. n Consistency,%Gravel V I,^ Q 2 Z 3 S n 7 s� P DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in) (USDA) (Munsell) Mottling (Smicture,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No Yes Rrithin 500 year boundary No - Yes_ Within 100 year flood boundary No Yes- Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring perfious material? Certification i eertify that on D f OQ (date)I have passed&soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tram,a pertise and experience described in 310 CMR 15.017. Signature � K4 Date s /S Q:SEPfIMPERCFOPM.DOC DATE CASE NUMBER PREPARED BY - - 0610612015 Ricard B. Kiotic . David L. Dye LP0343A �/'1■f°C®�®P®` LOCATION LATITUDE LONGITUDE s � ® 56 Alder Brook Lane Barnstable MA 02668 DESCRIPTION - - - 1st Floor Plan David L. Dye Construction Supervisor License MA CS-033434 Garage ® Dining Room Kitchen / 1 E o V N 0 U J . n Bedroom 0 Not To Scale Page 1 of 1 t " - DATE CASE NUMBER PREPARED BY ' 0610712015 Richard B. Kiotic David L. Dye MA PI LP0343A G� A nn LOCATION LATITUDE LONGITUDE s�®09®p® 56 Alder Brook Lane Barnstable MA 02668 DESCRIPTION - 2nd Floor Plan David L. Dye Construction Supervisor License MA CS-033434 000 ��asat Bedroom Bedroom Lo \ Closet Closet Closet Closet Closet { Not To Scale- Page 1 of f Town of Barnstable Barn °* Regulatory Services Department 1 `S � Public Health Division � D .�i639 ,�p 39 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7014 1'200 0001 0358 0390 � February 17, 2015 Richard Kiotic 56 Alder Brook Lane West Barnstable, MA 02668 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 56 Alder Brook Lane, West Barnstable, MA was Inspected on 1/07/2015, by Thomas Roux, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "failed" under the guidelines of the 1995 TITLE 5 (310CMR 15.00) due to the following: • A distribution-box needs to be installed. • The SAS is a single pit structure; the structure is in the groundwater by one S (+1'). There is two (2') feet of standing water in the pit at time of inspection. You are ordered to repair or replace the septic system within sixty (60) days from the cz- .` date you receive this notification. , a Qp� Failure to repair/replace the septic system within the deadline period will result in future enforcement action. Per order of the board of health �-o Thomas McKean, R.S. CHO j Agent of the Board of Health G Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\56 Alder Brook Ln W.B.Feb 2015.doc \ �— JUN21 '16 010!35 v CPO* CL `� C �\ ti i{�F _ `$ 7T 5� A I coo ( AM 2116 mi SEc o�� Lob vow a -` ID C L , i Commonwealth of Massachusetts IS3 Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 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 A. General Information filling out forms I J I on the computer, V use only the tab 1. Inspector: key to move your cursor-do not Thomas Roux use the return Name of Inspector key. C Company Name 89 Mayflower Lane Company Address ——A East Wareham Ma. 02538 Cnyrrown State Zip Code 774-678-9066 S14531 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority Z4,e�� T- , :7 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection 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. t5ins-3M3 VTitleition Form Subsu ce Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts Title 5 .Oficial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. ' 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 l_ Commonwealth of Massachusetts Title 5 Official Inspection Fora a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every west Barnstable Ma. 02668 Jan. 7 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they'were not available note as N/A) Z ❑ 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. I ❑ ® 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): +330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No 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: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ® Other(describe): septic tank and single pit with no d-box. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 40 years. As-Built plan dated Jan. 2, 1975. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.5' 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: 81x5.2'Wx5.33'H Sludge depth: 1" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every west Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet t Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle ` Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert NIA 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.): No d-box present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: II The SAS is a single pit structure. The pit was excavated and inspected. The pit structure is in the groundwater by+1'. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): No evidence of hydraulic failure. There was 2'of standing water in the pit structure at the time of the inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGWAL (S) m ^ C DATA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every West Barnstable Ma. 02668 Jan. 7, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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 attaphed separately va : - `•-»-�,��-,,.�-:��� -.. -.: �-�` s.opt e- � ..�-� _�_._____ -- L p Wo//T I /SS' \� ., http://issgl2/'intranet/propdata/ptehuilt.aspx?mappar=133054&seq=1 12/31/2014 t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal� 9 �System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage!Disposal System Form -Not for Voluntary Assessments 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every west Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7' +/ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: It was determined with a surveyors level. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 56 Alderbrook Lane Property Address Richard Kiotic Owner Owner's Name information is required for every west Barnstable Ma. 02668 Jan. 7, 2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts FB 1 Executive Office of Environmental Affairs �qr 199 J Department of 01 Environmental Protection William F.Weld Governor retary Argeo Paul Cellucci SUBSURFACE SEWAGE DISPOSAL SYSTEM INFORMATION FORM David B.Struhs U.Governor � , PART A Commissioner CERTIFICATION Property Address: 56 ALDER BROOK LANE WEST BAPATSTABLE Address of Owner: Date of Inspection: FEBRUARY 10. 1997 (if different) Name of Inspector: JAMES A.ORPHANOS Company Name,Address and Telephone number: CERTIFIED INSPECTION ASSOCIATES 1 47 CAMERON ROAD N.F i MOUTH MA. 02556 (508) 564-5653 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority �. Fails Inspector's SignCt Date: FEBRUARY 11. 1997 I The system Inspmit a copy of this inspection report to the Approving Authority within(30)days of completing this inspection. s a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall subto the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: '. A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: , One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston, Massachusetts 02108 • FAX(617)556-1049. • Telephone(617)292-5500 i0 Printed on Recycled Paper n , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Q PART A «at CERTIFICATION (continued) y perty Address: 56 ALDER BROOK LANE @ wner: LORRAINE K.LENOIRE TRUST Da a ofiInspection: FEBRUARY 10, 1997 4 �� B] SYS M`. -ODITIOIALLY PASSES (continued) - Sewage backup or breakout or'ligh static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with the approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection(with the approval of the Board of Health): broken pipe(s)are replaced obstruction is removed c] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH, Conditions exist which require further evaluation by the Board-of Health in order to determine if the system is failing to protect the public health,safety and the environment.. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANN_F.R I AT PROTECT TILE.PUBLIC IiFALTH,AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50'of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER I,,f. r - •,y., r. (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 56 ALDER BROOK LANE Owner: LORRAINE K. LENOIRE TRUST Date of Inspection: FEBRUARY 10, 1997 D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is outlined below. The Board of Health should be contacted to determine what will be necessary to correct the failure.. Backup of sewage into the facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or the surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times Dumped----- Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any,portion of a cesspool or privy is within 100 feet,of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist:: ___ 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 (PATA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 3IL4 CI 1R 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 56 ALDER BROOK LANE Owner: LORRAINE K. LENOIRE TRUST Date of Inspection: FEBRUARY 10, 1997 Check if the following have been done: X Pumping information was requested of the owner,occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system- recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected or signs of breakout. T X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of- scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner) were provided with information on the proper maintenance of Sub=Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 56 ALDER BROOK LANE Owner: L ORRAINE K.LENOIRE TRUST Date of Inspection: FEBRUARY 10, 1997 FLOW CONDITIONS R SIDENTLk' Design flow: 200 alions Number of bedrooms: 2 Ivuenoer of current residents: 2' Garbage • der(yes ):—c Laundry.connected to system (_yes or no): YES. Seasonal use (yes or no): NO Water meter readings,if available: HOME IS SERVED BY A PRIVATE WELL. Last date of occupancy: HOME IS CURRENTLY OCCUPIED. COMMERCIAL/INDUSTRIAL: N/A Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no): Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings,if available: Last date of occupancy OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: SEPTIC TANK WAS PUMPED IN TUNE OF 1996 ACCORDING TO THE OWNER NO System pumped as part of inspection: (yes or no) If yes,volume pumped:�allons Reason for pumping: TYPE OF SYSTEM X Septic tank/distribution box/soil absorption.system Single cesspool Overflow cesspool -- Privy Shared system (yes-or no) (if yes,attach previous inspection records,R any) Other(explain) --- — ------ -------------------------------- APPROXIMATE AGE of all components,date installed (if known)and source of information: 1975.ACCORDING TO BOARD OF HEALTH RECORDS. Sewage odors detected when arriving at the site: (yes or no) NO revised 11/03/95 5 C: SUBSURFACE SEE":AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 ALDER BROOK LANE Owner: LORRAINE K.LENOIRE TRUST Date of Inspection: FEBRUARY 10, 1997 SEPTIC TANK: X (locate on site plan) Depth below grade: 14" Material of construction: X concrete metal FRP other (explain) Dimensions: 4' WIDE X 8' LONG X 4' DEEP Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 12" Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) LIQUID LEVEL IS 49"AND CONCRETE OUTLET TEE IS IN GOOD CONDITION. NO ADVERSE INDICATORS NO RECOMMENDATIONS. GREASE TRAP: N/A locate on siteplan) Depth below grade: Material of construction: concrete metal FRO other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) (revised 11/03/95) 6 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 ALDER BROOK LANE Owner: LORRAINE K. LENOIRE REALTY TRUST Date of Inspection: FEBRUARY 10, 1997 TIGHT OR HOLDING TANK: N/A (locate on site plan) Depth below grade: Material of constructio..n: concrete metal FRP ether(explain) Dimensions: ------------------------------------------ �.ayauty.-------- gat Design flow: . __.. gallons/dav Alarm level: ConiluentS: (condition of inlet tee,condition of alarm and float switches,etc.) -------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- DISTRIBUTION BOX: N/A (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) ---------------------- PUMP CHAMBER: N/A (locate on site plan) Pumps in working order: (yes or no) ------ Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- (revised 11/03/95 7 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 ALDER BROOK LANE Owner: LORRAINE K. LENOIRE TRUST Date of Inspection: FEBRUARY 10, 1997 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non--intrusive methods) If not determined to be present,explain: ---------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- Type: X leaching pits,number: ONE: 6' DIAM.X 5' DEEP (INLET INVERT) leaching chambers,number: -------------------------- leaching galleries,number: ----------------------------- leaching trenches,number,length: ---------------------- leaching fields,number,dimensions: ____________________ overflow cesspool,number: ----------------------------- Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.) COVER IS AT 10" AND THE LIQUID LEVEL WAS 29" AT THE TIME OF THE INSPECTION THE BOTTOM OF THE SAS IS 92" BELOW THE GRADE AND THERE WERE NO ADVERSE INDICATORS. CESSPOOLS: N/A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.) ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- PRIVY: N/A (locate on site plan) Materials of construction: --------------------------------------------------------- Dimensions: ---- __ Depth of solids: --------- Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- (revised 11/03/95 8 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 ALDER BROOK LANE Owner: LORRAINE K. LENOIRE TRUST Date of Inspection: FEBRUARY 10. 1997 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 56 ALDER BROOK LANE N 3 .A' 20.7' APPROXIMATELY 160' 81.5' 60.0' TO BVW BROOK NOT TO SCALE DEPTH TO GROUNDWATER Depth to groundwater: 9_5 feet method of determination or approximation: THE BOTTOM OF THE LEACHING PIT IS 92" BELOW GRADE. THE RESULTS OF A HAND LEVEL SURVEY INDICATE THAT THE ELEVATION OF A NEARBY BROOK IS 114 BELOW THE SURFACE GRADE AT THE LEACHING PIT P114" -92" EQUALS A 22" SEPARATION BETWEEN THE BOTTOM OF THE PIT AND GROUNDWATER revised 11/03/95 9 LOCATION W // __ ' '-```- /5E4,C;E PERMIT- M.O. 'VILLAGE —�-���ft_ orbris /F !33 A ESS-MMAM- - PARCELNO:.—� - IhlSTQLLER�S-IJ�►NIE--� -ADDRESS _ _ _-.-. _ -____ _ _ .__ Thy s 41 e ._—BUILDER 5_ L1.I�NIE-- __ADDRESS _-- M►TE-PER"%T__.155UED 3_>>__—_—_— -.D ATE -COMPLI-WACE JSSUED : _ _� ,�,�o- �. P Wo// % ��= /SS' i � ��. \b '�' ��� f ter a !� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....../~_ 1/...........OF.../,�AIWG ..................................a ..........._..... Appliration -for Uhiposal Workii Towitrurtinn Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Loc ti n-Ad ress or o �! ,L.................................... ...1N 'ST >/I............................................................ W Owner Addr s ,a ---•--•------- Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms----- Expansi Attic =JjlVlsjarbage Grinder ( ) aOther—Type of Building ------------------_------- No. of persons....7-------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ........................................... Q •- --------�r -----------------------•------•----••••-•--•---•----------------------•-------•---------.------ W Design Flow.__._ �_____________________________gallons per person per day. Total daily flow...._ �-.-_____-______...__._-.gallons. WSeptic Tank l Liquid capacity/Qo-a_gallons Length---------------- Width................ Diameter---------------- Depth................ x Disposal Trench—No. ..................... Width.................... Total Length-------------------- Total leaching are a____._______..._____sq. ft. Seepage Pit No------I------------ DiameterfBl�GA1._S��fh below in t........... .... Tot 1 leaching area....._.----------sq. ft. z Other Distribution box ( ) Dosing tank �) "A!'"! _ y� ------ Test W Percolation Test Results Performed by.___3..__ � _ ._ e__ _-. r..`s`f �ate............... ....__.__.______.. Pit No. 1................minutes per inch Depth of "Pest Pit._.----------------- Depth to ground water...___-_._____.__.__.._. GZ-, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water__.__._____.________.._. ----------- - - ------ Description of Soil-----: -•--•----......... Cl' " .._P.1 .-------------------- ------ -- .14 U ----------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------- W -------------- -------- ------------------------------------------------------------------------•------------------------------ -------------------------.-------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by tthhep�boar y health. Signe .. . ••..1�".`.=._._VG �s�_�_r' G...�.. ------• A, — ---�`-�--- ate .v Application Approved By--------- :� �� ��� F ------------------- Date . ?.Dat 7`� e Application Disapproved for the following reasons:--a-----------•----- --___4-_611--- ---------------------------------------------------------------- v � - -------------------------•------------------------------------ ----------------------- �N�►./y� � Gf1/•�"' !�""�.. � ,� '"''� � ".•� S Date PermitNo----------------------..........-=----••--••------�` I ,,.- Issued.......n...-------- ......J.......................... V i j ' i Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH //9..'f.<//I/...........OF..... off/ % r3......._ Application -fur Bi,gpuottl Works Tonofrurtiun Vrruift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 141 z>r-f 3 do/ .... ............i ?/vS96 d7 ------- -------•-•---•-•---•---•----•••--•••-----•---•-•-•••--•--. Location•Ad ress or Lot N . 11�9 ==. u 1 io ..-�..................................... ....�iNC s •--•• ........................................................... ,.� Owner _ � � Addre es,� w 1 ...../�N---•A.i� =-T d................................................ fN La_�`...-•---/3/� r?/v,� / .4(3-G...........---•------•--- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms...... _ __ ____Ex ansio- Attic �' g ( )a g— p (FY/t✓/j/yc Garba e Grinder p, Other—Type of Building ____________________________ No. of persons----- Showers ( ) — Cafeteria ( ) dOther fixtures --•--------------------•---------------------------------------------•---•------------------••---•--------------------------------------•------------ W Design Flow-------- ................................gallons per person per day. Total daily flow_______ U_Q__-____--____...-------gallons. WSeptic Tank / Liquid capacity_/4"gallons Length________________ Width................ Diameter...... Deptli.__:............ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........------------ Diameter)!W!� 4__tjlD th below inlet____y_____________ Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank '( ) C)4X- d �1'(4 -ly" /� ` ` --- a .Percolation Test Results Performed by._.•_ -.._ r_ ---____ ..----!.s._--. ....f`..''/Date.______-----------------------_----- Test Pit No. 1----------------minutes per inch Depth of Test Pit.... ____...._.... Depth to ground water-------------._-_.-____. (7. Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water__.____..___________.__ O Description of Soil----------v' -� Lr�_ ���c t! - 3 1 --�`��_-N'u- i 1�, v U -----•-•------------------•---...._..--------------------------•••••-•-•-------'...-------------------------------•-----•-• -------------------------•---•----••----.....-•--•---•----•------- W ---------------------------------------------- ----------------------------------------------------------------------- --------------------------------------------------- .......................... U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------._1---------.................. . ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been}issued by the board-of health. Signed. -----70�.._.tlt! rG.�'�*G'1-.....----- .. r l! ✓ / /f / � D-a�te Application Approved BY ` = �' `t f'----_,-1'�._l..G�-!.-�-�..�' ---- 1/ �v -- �J --------•---------------•-------.-_------•----------------- Date ---.-- Application Disapproved for the following reasons__________________________ ._.... .....................•-•••-•••--------••----------------•--•-••--------....••-•--------------------.........---•--••-•--•••--------•..-•---•---•-------------•-------•---......._•----------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... �'%..�W.........OF.... i9 .......................................................... Q.,rrtifirate of fDeompliatirr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (2,)�or Repaired ( ) bY-•.....!:.�UH�'y.------.�--'�L-� •-----•-------------•-----•---. .. ---------•-•----••---------•--•-----------------...%.--•-•---•-•-------------.........------------ Lnst Ile, — T has been installed in accordance with the provisions of Ar-ticl'e XI pf The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-_'S___._...... _..-:......... dated.... !.... .:............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No........... �.. ... ----•........ FEE..1J.-- ... Bi-riVmittl Workii Tontitrurfion Vrrmft Permission is hereby granted___ _` Id........:�.�_�-��....................... . to Construct (�-)—or Repair �(/ ) an Individual Sewage")Disposal Syste/tmJ / • /y/^} /fl at No..ki?'7�'---_l9_..._..A!-. 6-R._....��_.'-?U.''V'e _./_..4 to�"-... A. 14, C.=.T._S_7__._ /r A ' NL- ----------------•-------•...--- Street t as shown on the application for Disposal Works Construction Permit No::_............?____ Dated..-. /._'-V_' 7_} _-._�- --- -://_- 1 s:�!rl D /� Board of Health ATE. . ... �J FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS r 50 w C 1 _ } i vas 6Z - . D BROOK ANL / C,/� r/nay/ • 11)ECT _ S C A c = `L -. " ro A4 T� j7 /o/1i S /b� soya, PLA,�I REF:' g K. 173 - -`I LLOYD s�L +o •: FoR: KART LuaH.CKF- A ;1-, M Eft 7 fir, 4, 1 HEF, EBY CERT.iFr THAT THE zKis-r- ' igT£� 0' 2 S .ij,R4 �, //V6 cd UNDA7/0/J 40CA7'/O/y /S CoR,R6CT StrOw:Nl AND _ DOES . CoMFORr-i wrFH TNT �u/t t�/NG- 0E7-8,QC. RF-aUl R HEN 7-S Of T!/E 7-ocj,N OF �A�11 57A.IIL ,E. REG �LAiVn SuRVEyoI� —" —' FA MO uTH l7F5S. Fi 6AR FIT 34' gBMT� �Z : ;lfi - 11 26 26 4: . eas S C K (00 TO ` s�;cs 34: http://www.town.bamstable.ma.us/sketchesl5/8440_8776.jpg 3/18/2015 I i RE: 56 Alderbrook RD.West Barnstable,Ma.02668 I,Thomas Roux will be representing Richard Kiotic at the meeting scheduled for March 10, 201S. Thomas Roux I r February 25, 2015 Board of Health Town on Barnstable Barnstable, MA f RE 56 ALDERBROOK ROAD, WEST BARNSTABLE, MA 02668 Dear.Sir/Madam: 1, Richard Kiotic, attest that this house located at 56 Alderbrook Road has been a three bedroom house since 1985. Very truly yours, xf Richard Kiotic i 's S 1 l f Health Master Detail Page 1 of 1 It Logged In As: T0'wN\Flynnj Health Master Detail Monday,January 11 2016 Application Center Parcel Lookup Selection Items Reports Parcel Septic Perc Well Fuel Tank Parcel: 133-054 Location: 56 ALDER BROOK LANE,WEST BARNSTABLE Owner: KIOTIC,RICHARD B Septic 1 I New Septic... Permit number: 2015-243 Permit type Select type V Complete system: ❑ Issue date :�� Complete date : Septic tank size: Type/Size of SAS: Installer: Select Installer V Card on file: ❑ I/A service type: Select service Innovative/Alternative Technology type: Select IA type V Variance date : 6/09/2015 @i Abandon complete date : Abandon permit number: Repair deadline date : 4/17/2015 Repair notification date : 2/17/2015 Keyword: Comments: *,+ISSUED NUMBER ONLY, NOT A PERMIT, .PLANS NO GOOD, r'Delete Septic SCALE INCORRECT. SEE DS (TM SAID TO CASH CHECK, STILL WAITING ON ENGINEER TO SUBMIT ACCEPTABLE PLANS** (6/19-septic plans denied, w/b revised) V Inspection 1/7/2015 Inspection 2/10/1997 New Inspection... Number Inspection Date Inspector Result 9042 1/7/2015 Roux,Thomas V F(Fail) V The following condition(s)are occurring: ❑ 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 facility or system component due to an overloaded or clogged SAS or cesspool ❑ static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Q any portion cf the SAS,cesspool,or privy below high groundwater elevation ❑ any portion of the cesspool within a Zone 1 to a public well ❑ any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis Received Date Comments �4/14/2015 - BOH,mtg'_-_requested septic-variances- r Delete Inspection ,Board voted to a continuence to May 12 2015. Board requires a 150 foot radius to show neighboring wells; as well as multiple procedural items (i.e. list all M, code variances on the plan identifying state versus F1—/9/2015 local, etc.jmf 5/12/2015 Septic Variance - Continued to 6/9/2015. BOH granted with conditions: The Board voted to grant the septic'plan for a 3-bedroom septic with the following conditions. l) submit a stamped V revised plan, removing the wording mentioning Save Septic Changes= Return to Lookup http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=133054 1/11/2016 \ r j Town of Barnstable Barnstable Board of Health a , BARNNSTAABLE 200 Main Street,Hyannis MA 02601 1639.►,�� 2007 MAy Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING RESULTS Revised Tuesday,June 9, 2015 at 3:00 PM, Formatted:Font:(Default)Aria] Town Hall, Hearing Room,2N1 Floor -------------------------------------- 367 Main Street, Hyannis, MA I. Hearing -Show Cause- Food: Jen Villa, Local Juice-Sale of bottled unpasteurized juice at farmer's markets and temporary food events, invalid or false documentation provided from applicant, product manufactured at unknown location. Warning Issued. Local Juice acknowledged wrong doing in producing their product. They did error in not meeting all the permits, etc. for their product. They did not have a food permit nor an inspection of the kitchen they were leasing and they did not obtain a wholesale license. Local Juice has stopped production until they are in a licensed facility and it is inspected and all requirements are met. II. Trash Issue: L.• Attorney Daniel Rich representing Agnes Schobel, owner- 100 Nyes Neck Road East; Centerville, trash has not been removed as stated. 100 Fine. The Board determined to issue$100 Fine and request the owner attend a show-cause hearing on July 14, 2015 unless they have cleaned the outside property to the inspector's satisfaction. III. Septic Variance (Cont.): Thomas Roux representing Richard Kiotic, owner 2-66-Alderbrook Road,- West Barnstable, Map/Parcel 133-054, requesting septic.variances. Granted With Conditions. The Board voted to grant the septic plan for a 3-bedroom septic with the following conditions: 1) submit a stamped revised plan, removing the wording mentioning variance for 3 bedroom. IV. Septic Variance: Page 1 of 3 BOH 06/09/15 t i r Town of Barnstable fit` VKQE� Barnstable Board of Health AFAmaltaft sARNSTABM 200 Main Street, Hyannis MA 02601 ' y XAS& .� s63q 1��39 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING RESULTS Tuesday, May 12, 2015 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA I. Hearing — Tobacco: Tobacco violations as reported by Bob Collette of Barnstable County Tobacco Control. A. Sav-On Gas , 326 (a.k.a. 300) West Main Street, Hyannis — First Offense, tobacco products sold to a minor. B. Sav-On Gas , 590 lyannough Road, Hyannis — First Offense, tobacco products sold to a minor. WARNINGS Both locations of Sav-On Gas will be issued written warnings. II. Hearing — Hazardous Materials: Shaun Breau, owner, The Pool Man —40 Industry Road, Unit# 15, Marstons Mills, storage of hazardous materials. WITHDRAWN: Issue resolved. III. Septic Variance (Cont.): Thomas Roux representing Richard Kiotic, owner 256 Alderbrook Road;,, West Barnstable, Map/Parcel 133-054, requesting septic variances. CONTINUED TO JUNE 9, 2015: The owner is interested in a two bedroom. Thomas Roux will prepare a plan for a two bedroom with the following additions to the plan: 1) groundwater adjustment increased 1.2 feet, 2) list all variances and codes on plan 3) show all well setbacks within 150 feet, 4) will clarify whether tank is H10 or H2O (and correct second notation), and 5) will do new floor plans. Page 1 of 5 BOH 05/12/15 FINE TO BE ISSUED. `-- The Board voted to issue a $100 fine as this is the second offense. III. Septic Variance: Thomas Roux representing Richard Kiotic, owner—456 Alderbrook Road; West Barnstable, Map/Parcel 133-054, requesting septic variances. CONTINUED TO MAY 12, 2015. The Board voted to continue. The Board requires a 150 feet radius to show neighboring wells, as well as multiple procedural items (i.e. list all code variances on the plan identifying state versus local, etc. IV. I/A Monitoring Plan: A. Winston Steadman, representing Oyster Harbors Club = 170 Grand Island Drive, Osterville, test results of I/A Monitoring results. DISCUSSION. Winston Steadman discussed difficulty the current system has with BOD count. The owners are good about pumping every year. The Board requested water flow numbers and the full testing to be done mid-June and mid-July. Mr. Steadman will return to the Board in the Fall and the results will be discussed with George Heufelder, Barnstable County, for suggestions. RESOLVED B. James Teegan, owner - 195 Route 149, Unit#A, Marstons Mills, no I/A monitoring contract. V. Informal Discussion — Sewer Connection (Cont.): POSTPONED UNTIL May 12, 2015 Gilbert Wood, owner— 730 and 740 Bearses Way, Hyannis VI. Food (Cont.): A. James Surprenant, Crisp Flatbread — 791 Main Street, Osterville, septic capacity, seating. CONTINUED TO MAY 12, 2015. No one was present. B. Joann Lucas and Panagis Kappatos, owners, Egg & I Restaurant— 521 Main Street, Hyannis, follow-up of correction of procedure to recurring food violations (both critical and non-critical) during inspections on June 17, July 23, and August 28, 2014. DISCUSSION. The owner suffered a serious illness and has not be able to install the new floor yet. Once this is done, the owners will meet with Mr. McKean, the new inspector for the restaurant, and Mr. Sawayanagi to review the established protocol of operations. This must be done at least 7 days prior to opening. If satisfied, they will be allowed to open without returning to the Board. Page 2 of 4 BOH 04/14/15 I Health Master Detail Page 1 of 1 it . Logged In As: TOWN\flynnj Health Master Detail Tuesday,November 24 2015 Application Center Parcel Lookup Selection Items Reports Parcel I Septic Perc Well I Fuel Tank Parcel: 133-054 Location: 56 ALDER BROOK LANE,WEST BARNSTABLE Owner: KIOTIC,RICHARD B Septic 1 New Septic... Permit number:*2015-243. 1\f Permit type: Select type Complete system: ,❑ Issue date: �91 Complete date : Septic tank size: Type/Size of SAS: Installer:I Select Installer v Card on file: ❑ I/A service type:I Select service v Innovative/Alternative Technology type: ISelectlAtype v Variance date : 4/15/2015 Eff.Abandon complete date Abandon permit number: F Repair deadline date : 4/17/2015 12 Repair notification date : 2/17/2015 Keyword: Comments: ***ISSUED NUMBER ONLY,NOT PERMIT,,PLANS NO GOOD,SCALE Delete Septic Inspection 1/7/2015 I Inspection 2/10/1997 New Inspection... Number Inspection Date Inspector Result 9042 1/7/2015 Roux,Thomas v F(Fail) v The following conclition(s)are occurring: ❑ 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 facility or system component due to an overloaded or clogged SAS or cesspool ❑ static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑� any portion of the SAS,cesspool,or privy below high groundwater elevation ❑ any portion of the cesspool within a Zone 1 to a public well ❑ any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis Received Date Comments 1/9/2015 4/14/2015-BOH mtg'-requested septic variances-4/14/2015 Board voted 0 Delete Inspection r Save Septic Changes I Return to Lookup I http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=133054 11/24/2015 Property Location:56 ALDER BROOK LANE MAP ID:133/054/// Bldg Name: State Use:1010 . Account# Bldg# ' `1'of 1 Sec#: 1 of 1 Card 1 of 1 Prmt Date:06/05/2015 14:35 Vision ID:8440 .1,., a,V'.�.�::C, SF�^, ,?; „ s4`..' OTIC,RICHARD B 1 4eve1 Peptic 1 raved Description Code Appraised Value Assessed Value ESIDNTL 1010 164,400 164,400 801 6 ALDER BROOK LANE asl ES LAND 1010 154,100 154,100 r201 S BARNSTABLE,A EST BARNSTABLE,MA 02668 ,:" " SUPEIEMEN=TAZ DATAI dditional Owners: ther ID: Plan Ref. plit Zoning Land Ct# esExpt. #SR VISION esExpt Qual YES Life Estate DL 1 LOT 6 Notes: JDL 2 318 500 318 500 IS ID 8440 ASSOC PID# Total , r « AS ESSMEIVTS.. STOR' ._ .._.._ ,. . r.._„ u RECORD,OF QW1hERSSIPU x:,,_;.. "c"., BS.I'O�AGE SALE DATE. /u.:vA SALE�PRICE^_"L'C . ?.. . . :.: .....::_..._._.,.;r PRE f�IQUS.. S OTIC,RICHARD B 10619/152 02/21/1997 Q I 160,000 00 Yr. Code I Assessed Value Yr. I Code Assessed Value Yr. Code I Assessed Value ENOIR,THOMAS&LORRAINE 10127114 04/15/1996 U I 1 A 2014 1010 155,600 2013 1010 155,600 2012 1010 157,700 ENOIR,THOMAS&LORRAINE 2706/ 69 05/15/1978 Q 64,000 2014 1010 154,100 2013 1010 160,200 2012 1010 154,100 Total: 309,7001 Total:1 315,800 Total: 311,800 — r �£ 7 r x 7 This signature acknowledges a visit b a Data Collector or Assessor ,.�.. . s: �.,.,�s,r�.. Fk. :,�..;."J �,,., ::�« O.THER�ASSESSMENT,S. , � r:,,' g g Y Year I Tvve I Description Amount Code Description Number I Amount Comm.Int. 2011 5C SlDENTIAL EXEMPTION 0.00 0-00 Appraised Bldg.Value(Card) 129,700 ASSESSING NEIGHBORHOOp° .,_`" . r'.:,, ' ._.-" ..,,. r ,. :...><`Appraised XF(B)Value(Bldg) 34,700 NBHD/SUB I NBHD Name Street Index Name Tracing Batch Appraised OB(L)Value(Bldg) 0 0106/A WBARNS Appraised Land Value(Bldg) 154,100 6R.Igp P.. ...,,,!,aaR rx ... .,. ,;r....,. , : ., h Special Land Value 1 Total Appraised Parcel Value 318,500 Valuation Method: C Adjustment: 0 Net Total Appraised Parcel Value 318,500 �.,..... >. ¢.. w z , fIANGR,HISTORY ab : VISIT/C �v ,:.: r:. _ - ,. .• r� a' .. ,.: , �• �, UILDINGPRRMIT'RECORD .�.. a.+. ? s Permit ID Issue Date Type Description Amount I .Date %Comp. Date Comp. Comments Date Type IS ID Cd. Pur ose/Result 4/07/2014 03 JR 16 In Office Review 1/25/2011 03 MA 16 In Office Review 3/19/2007 02 PT 14 CyclicalInspection 3/08/2000 01 DD 00 eas/Listed-Interior Ace( 5_ ,.. ....: ,.. ..... s .'. ... .. ', r :kw ...... ., .. _. e_. �.. is ,!k _ - EGTION ., ,•i!"¢i:"' t �;.:.S,vs.`��•,,"';.,�:a,..��` k���4...na,...r.r�n.^l.re 'n!n:�n�.�,,h��... _ B Use' Use Unit L Acre C. ST. S ecial Pricin S Adj # Code Description Zone D Front De th Units Price Factor F.A. 'Disc Factor Idx Ad'. Notes-Ad' Sec Use Sec Calc Fact 4di. Unit Price Land Value 1 1010 Single Fam MDIr01 RF 5 1 0.94 AC 124,000.00 1.0574 5 1.0600 1.00 0106 1.25 1.00 154,100 Total Card Land Units: 0.94I ACI Parcel Total Land Area: .94 AC Total Land Value: 1549100 a•yc•y tiva.rrrrvr. ✓V a�uaiva�uawva�LAa,L a•a�aa ta+.a✓✓• v✓�, ., ✓r•s6 •uurc.• _ urMtc VJG.Aviv Vision ID:8440 Account# Bldg#r 1 of 1 Sec#: 1 of 1 Card 1 of I Print Date.06/05/2015 14:35 Element Cd Ch. Description Element Cd Ch. Description tyle 4 Cape Cod odel 1 Residential Foundation 01 Poured Conc. 16 rade Average tories 1.5 1 1/2 Stories ath"Split 20 2 Full Exterior Wall 1 14 Wood Shingle Code Description Percentage Exterior Wall 2 1010 Single Fam MDL-01 100 11 34 Roof Structure 03 able/Hip GAR Roof Cover 3 sph/F GIs/Cmp 4 terior Wall 1 03 Plastered 2 terior Wall 2 r 4 _zC.OS,T/M.9'RSE2'V�4LU'ATIONc O ,N .= 14 BMT 1 _t- terior Fir 1 12 Hardwood Adj.Base Rate: 3.47 terior Fir 2 50,767 BAS eat Fuel 2 Oil et Other Adj: 1.00 16 1 11 Replace Cost 50,767 6 TQg 2 Heat Type 5 Hot Water yg 975 C Type 1 None EYB 999 Total Bedrooms 3 3 Bedrooms Dep Code Total Bthrms I Remodel Rating Total Half Baths Year Remodeled otal Xtra Fixtrs Dep,% 14 34 otal Rooms 7 Rooms Functional Obslnc Bath Style External Obslnc Kitchen Style Cost Trend Factor Condition /V Complete erall%Cond 6 pprais Val 29,700 ep%Ovr ep Ovr Comment isc Imp Ovr isc Imp Ovr Comment ost to Cure Ovr Accessory Apt ost to Cure Ovr Comment u;t OBOUeBU1ING`AUf1RD°ITEMS(L)/XFBVILDYG EXTRA FE�I TTTRES(B) x Code Descri tion Sub I Sub Descri t LIB Units Unit Price Yr Gde DD Rt Cnd VoCnd Apr Value PL2 Fireplace 1.5 st B 1 4,575.00 1999 1 100 3,900 AR Attached Garal B 384 30.00 1999 C 1 100 10,100 MTBasement-Unfit B 1,038 3.00 1999 1 100 20,700 Code Description Liviniz Area Gross Area E .Area Unit Cost Unde rec. Value AS first Floor 1,038 1,038 1,038 93.47 97,022 MT asement Area 0 1,038 0 0.00 0 AR ttached Garage 0 384 0 -0.00 0 QS hree Quarter Story 575 884 575 60.80 53,745 � co IL Gross LivILeav-Arva:l 1,6131 3 44-. 1613 - I50 767 r Bill Inquiry-Munis [TOWN OF 133ARNSTABLEJ W Die Edit Tools Help Year/Type/Bill No, Customer Account Information History _ . 2015 390264 Detail Property Information KIOTIC,RICHARD 8 Parcel ID 133-054 56 ALDER BROOK LANE Ong Bill _..... - _. _... WEST BARNSTABLE, MA 02668 Alt Parc Effective Date Prop Loc 56 ALDER BROOK LANE Special Conditions/Notes I Lien/Sale I . Scan Bill Installment Information _ int Dt Billed AbtJAdj PmtJCrd Inheres# Unpaid ball 1 Quick Entry 08J02J14 „± 7Z4 54 100 ` 7.24 54: -y .00 z r 00 t 11J04J14 724 54 i .00 724.54, 00 00 Utility Acct —_.O____. �__._ ___- w._____...�________ ___. _ ___ _ _ _____._ _....._ ____ 02J03J15.. _ 806.91 00 00 38.06 ' 844.97' Customer 05J02115. 80691 _..._. ,00.., .....__. 00 _..1083 �81774' Name Fees/Pen 00 .00 .00 .00 .00 Totals 3,062A0 ,00 ,449.08 48.89 • 1,662.71 Parcel _.... _1 _ .. _ r Notes Alerts - r Prop Code / Due 06f,)5,2015 1,662.71 Bill Dates )AN 1 Owner KIOTIC,RICHARD B Per Diem 61 Int Paid 57 26 ': Bill Audits Total Paid 1,506.34 i VL-'v`priC=f, unpaid bills fI Bill Events j Reprint Preferences Diagnostics 21 Attachments fM LM Display transaction history for the current bill, —=J III , Bill InquiryOF My Fle Edit Tools Help Year/TypefOill No, Customer Account Information History 2014 RE-R F 15356 390264 (e3 Detail Property Information KIOTIC,RICHARD B 56 ALDER BROOK LANE Parcel ID 133-054 WEST BARNSTABLE,MA 02668 Orig Bill Alt Parc Effective Date Prop Loc 56 ALDER BROOK LANE _ Special Conditions/Notes Lien/Sale _... .... Scan Bill Installment Information Int Dt (Billed Abt/Adj Pmt/Crd Interest Unpaid bal E Quick Entr+f 08/02/13 . I 68795 ; �r - _.00 687.95 0-0 00 lA� 11�02J13 687 94", 00 687 94 00 00 r Utility Acd --.� _ ... ! 02/04J14„ 761.13 00. 1.,... .,._..__... .761 13w 00 I 00. . _....... _.. .. .. . J Customer 05�02/14 1 761 13 N r 00 : 761.13 00 r i Name Fees/Pen 00 15.00 15.00 00 00 .... - _ _ _ _ . ... Totals 2,898 15 j I 15,00 . ..__._Z,913.15 . I _..- 00 ; ,00 Parcel Notes Alerts ;! r Prop Code / Due 00,�5,2015F. ,00 I Per Diem 00 Bill Dates )AN i Owner: KICMC,RICHARD B Int Paid 45,87 Bill Audits Total Paid 2,959,02 o3-oc-n.pri F ur7p��lEl Bill Events Reprint Preferences Diagnostics ` os 21 i 1 -...._►� Attachments(0) Display transaction history for the current bill. 7 l � 3Z t OF Nam!r Fle Edit Tools Help - Year/Type/Bill No. Customer Account Information Historr y 2 113; RE-R 15430E 390Z64? Detail Property Information KIOTIC,RICHARD B 56 ALDER BROOK LANE -- � Parcel ID 133-054 i Ong Bill _...._.... WEST BARNSTABLE, MA O2668 Alt Parc Effective Date Prop Loc 56 ALDER BROOK LANE E�;Special Conditions/Notes Lien/Sale _ .. Scan Bill Installment Information Int Dt Billed Abt/Adj Pmt/Crd Interest Unpaid bal -Quick Entry 08f'OZ f 1Z 642 17; 00 —642.17 00 .00 Utility Acct TJ1Z .. _....._. .__ _64Z 16' ___..... _ ._,._.-.00 !. ._...... 642..16_ 00 .00 11rOZ OZ/OZ f 13 733.72 _ '00 733 72 , . 00 00 Customer 05/O2113 .. '�. 733 71 .. .. 00 73331, 00 ... ... ...00 _.. Name Fees/pen 00 00 00 00 : ,00 Totals 2,751.76 .00 ; 2,751.,76 ` '00 00 Parcel - - - ---- - ..._ ...._ - - - -- _. _. Notesl Aerts . _.-.. - Prop Code 1 Due 061�J5,2015 00 I Per Diem Bill Dates ]AN I Owner: KICITIC,RICHARD B Int Paid 19,70 .Bill Audits _ _ _.-,.... Total Paid 2,771.46 %A& 'pU-iyr unpaid blI i Bill Events i Reprint Preferences Diagnostics 3 of -21 .. __ .. . . _.. .. Attachments(0) Display transaction history for the current bill REQUESTED TITLE 5 VARIANCES: 2» X 2» X 60 » PLANc PROFILE HARDWOOD POST. T.O.F. „ 103.97t i 15.212: T s• MIN. COVER NOTE: ALL COMPONENTS WILL BE H-20 LOADING, EXCEPT FOR THE SEPTICE! DEPTH TO GROUNDWATER s FIVE FOOT SEPARATION DISTANCE FROM THE BOTTOM OF THE SAS TO HIGH G.W. IN SOILS WITH 4' W MAX. COVER TANK, WHICH WILL BE H-10 LOADING R TE. 6 A A RECORDED PERCOLATION RATE OF TWO MIN./IN. OR LESS. a\//\\� /\ \ \ FINISHED GRADE , REQUESTING A VARIANCE FROM 5 FEET TO 4 FEET. � /\�\� , 15.240: SOIL ABSORPTION SYSTEMS �� /�\ I / \ \�/�\// �,\\ \\ \\ \ \ \j FINISHED GRADE 27i MIN. SLOPE / \ o A MAXIMUM OF THREE FEET OF COVER OVER ALL COMPONENTS. // \ ' \�/�// // //j//\ /\//�//�/ \/\/\/\/ / 77 REQUESTING A VARIANCE TO HAVE 3.75 OF COVER OVER THE SOUTHERN HALF OF THE SAS. 3 MIN 3 MIN ADD 2 - 1 RISERS \/\/\/\' \/\/\/\/\/\/\• w; SILT FENCE F d' / a SANITARY TEE ° 4• PVC PIPE >i /�// /77 �/ Aft ///`� z Y REQUESTED LOCAL VARIANCES: FILTER FABRIC�-- 34" MAX, o o L ! t0'f' r o \.\\, 3 MIN W GAS (SCH. 40) 97.88f ry LOCUS ' Z B 8 a SLOPE OF .05 NOTE: ONE ACCESS PORT r 397-8 E(e): WELL LOCATION 16 MIN. t P L _ 2" MIN 4" P1A� PIP r 1.5' SHALL BE WITHIN 3 OF SEPTIC TANK IS TO BE 100' FROM ANY WELL. Z ? o ° • z a 99.30 6" MI ° (SCku. 40) FREE OF FINS AND IRONS FINISH GRADE. MIN. 2 OF 1�8 1/2 WASHED PEASTONE a 'e o- 14 �' I 97.25t Q w REQUESTING A VARIANCE TO HAVE A SETBACK OF 97.5 FOR PARCEL 054. C3 0 4 PVC PIPE �� s7.37 1.5' 1.5' o Z a (SCH. 40) ' " d' '97.2 z w 397-8 E(f): WELL LOCATION d F s7.25t Q SEPTIC LEACHING FACILITY IS TO BE 150' FROM ANY WELL. o , SLOPE of .02 REQUESTING A VARIANCE TO HAVE A SETBACK OF 103' FOR PARCEL 053. FLOW-►- w a _ O O 0 �s. a 'a SANITARY TEE REQUESTING A VARIANCE TO HAVE A SETBACK OF 122 FOR PARCEL 054. o OUTLETS a 0 0 O Q Q 360-1 LOCATION OF COMPONENTS WITH RESPECT TO WATER BODIES: �7/�r%�7/ / / .°' / / ,''� a , _ �, -,- . o, _ a . ; PLUGGED 1 96.5 A VARIANCE TO HAVE THE PROPOSED SAS O BE 91' FROM THE BVW. �\ /\/\ ,� 4 0 0 0 �k REQUESTINGSTIN A VARIANCE TO NOT HAVE A 100% FUTURE 'RESERVE AREA. '\ �\ ` `\�` ° '\° °° o LQ 20 ' o 0 6 0 �° �° v° 00 00 REQUESTING EMBED FILTER FABRIC // �\,/ ''/�\\'� �\'/ \ 10' MIN o °0 0 0 0 ° o 0 0 0 0 °0 0 gy0v oLQ°o 0 °0 0 O r O °Oo Q 0 MIN. 4 INTO GROUND 94.5 3/4 - 1-1/2 fop 0 1,500 GALLONS DOUBLE WASHED STONE (1.5' OF STONE ALL AROUND) 0 14 MIN. 94.5 . r 3 4 - 1-1/2' / LOCUS MA / „ - DOUBLE WASHED STONE 12" MIN. H 20 LOAD ING /� / T 4 , MIN. » D85 D BOX 4.2 I H-20 LOADING Scale. l V l S 6 CRUSHED STONE 310 CMR 15.232 37.0' I----- 4s3' WIDE ----� S y ( EE LAYOUT) 7.83 H 20 LOADING 4 500 GAL CHAMBERS H-10 LOADING GROUND WATER AT 90.3 4 - 500 GAL CHAMBERS INSTALL POLY BARRIER FROM THE FRIMPTER METHOD �5 FOR BREAKOUT SIDE VIEW H-20 LOADING H-20 LOADING (SEE LAYOUT) N F (SEE DETAIL) NO SCALE OPTIONAL KNOCKOUTS DB5 D- BOX wEL BARBARA MCDONALD 4 - 500 GAL LEACHING GALLEYS N WITH 1.5' OF STONE ALL AROUND SEE PLAN VIEW FOR CHAMBER AND PARCEL 053 I PWF1 '00 -� STONE CONFIGURATION _ MAP 133 I100 OFFSET FROM THE WETLAN I `" EACH CHAMBER IS a51 x 4.8'W x 2.75'H 1.83' L J , IT-, 250 E . - MAN HOLE COVER L z a 24 DIAMETER MIN. TYP. ( ) ._. � � •.. '�` .`' :. .'-::: w I USE WIGGIN .PRECAST COMPONENTS OR SIMILAR. :.• w ''' I ALL COMPONENTS WILL BE INSTALLED ON A STABLE COMPACTED BASE VEN J o I h ' [SEE 310 CMR 15.228(1)] ST `` 10.5 O 1 -i L A RIS R TO WITHIN W PWF2 - c LEGEND sa qy 1 0 .»d 6 0 FI ISH D GR DE I ( SOIL IL TEST' D AT� ' 000000 SW STONE WALL ® CB CATCH BASIN o \ \ I o GARAGE O E ISTIN PI TP No. 1 DEEP HOLE TL TREE LINET. 1 BM BENCH MARK , 4�7 ( > GRD. _ 99.Of THOMAS ROUX ® SMH SEWER MANHOLE $ UP UTILITY POLE 91 t D SOIL EVALUATOR: _ �, GW. EL s ® DMH DRAIN MANHOLE HYD FIRE HYDRANT O , I APPROVING AUTHORITY: DONALD DESMARAIS ® W WELL O PRC PERC TEST z 4 PI SURFACE SOIL SOIL SOIL SOIL DH DEEP HOLE _ I ' I ( (� FEBRUARY 6, 2015 © EC EROSION CONTROL ' ' DEPTH HORIZON TEXTURE COLOR MOTTLING OTHER DATE PIERFORMED: Q O , I Crl � PROPOSED CONTOUR PROPOSED SPOT ELEV. I\I i o N O• - 9• A SANDY LOAM 1OYR2/2 -90--- x99.9 EXISTING SPOT ELEV. __.► � I I EXISTING .CONTOUR W I I O ' 9•-42• B SANDY LOAM 7.5YR5/8 PERC TEST w o » p U I I XISTING SEP •TANK I WF3 z o o 118 OAK o o 42•-128• c COARSE THOMAS ROUX EXISTING 3 7 1oYR8/6 SOIL EVALUATOR. .� D SAND C) BEDROOM _ . . _ .AT Q � �. OM C, DONALD,DESMARAIS. n T ..�i.LL \ non s .,. �:n.► peTv _ t' . .. DWELLING ..may :,: .. __- �. JL LL , <7 _. z _10F=103 NCHIvI/�xr�. ,' 1 FEBRUARY 6 2015 z ) I 97 t� DATE PERFORMED. _ ' ,g 1 ALL ELEVATIONS REFER TO T.O.F. OF EXISTING HOUSE, SEE PLAN FOR BENCHMARK LOCATION / w � Tf .F. 03 f 1 �l , - _ 2, ,411, ON C STRUCTION SHALL CONFORM TO 310 CMR 15.00, TITLE V AND THE REGULATION OF THE TOWNS BOARD OF � �J SOIL EVALUATION PERFORMED BY. THOMAS ROIJX HEALTH. F-- / <, SOIL EVALUATOR LICENSE NUMBER. SE2703 N S, ESTIMATED SEASONAL GROUND WATER ELEV. .. o / / I CERTIFY THAT I HAVE TAKEN AND PASSED THE 3. THIS PLAN DOES NOT WARRANT OR IMPLY ANY SUBSURFACE SOIL CONDITIONS OTHER THAN THOSE O �-- ' / � � STANDING WATER AT EL. 88.9 121 SE OBSERVED AT - I ( ) THE IMMEDIATE TEST PIT LOCATIONS. IF UNSUITABLE MATERIAL IS ENCOUNTERED. �J SOIL EVALUATOR CLASS ON OCTOBER OF 2000 Au1 CONSTRUCTION SHALL CEASE, AND THE DESIGN ENGINEER SHALL BE CONTACTED IMMEDIATELY. 0 i F \rWF4 4. ALL TANKS D BO AN/ XES, D CHAMBERS SHALL BE SET LEVEL AND TRUE TO FADED ON A MECHANICALLY - 2�� s� � TP N0. COMPACTED STABLE,BASE. R I C H A R D K I TIC � �- c, cRD. EI 99.o PT No. A w > C gg-1 5. AREAS DISTURBED DURING CONSTRUCTION SHALL BE STABILIZED TO MINIMIZE EROSION. THE AREA OVER THE M A 133 P C E 0 5 � GW. EL GRD. EL. 95.5t -' \ ` O ( Ss- » SYSTEM SHALL BE GRADED TO A MINIMUM OF 2% SLOPE TO PROVIDE POSITION SURFACE DRAINAGE. SURFACE SOIL SOIL SOIL SOIL PERC DEPTH 55 DEPTH HORIZON TEXTURE COLOR MOTTLING OTHER 6. THE ORIGINAL TOPOGRAPHIC SURVEY AND PLAN WERE DONE BY GATEWAY SURVEY ASSOCIATE LLC . 0 0 WOULD NOT HOLD PRESOAK U) w r J _ 0 2� V7 0 8 A SANDY LOAM 1 YR2/ ASSUME A (PERC RATE LESS THAN 2 M.P.I. 7. THIS PLAN SHALL NOT BE USED FOR THE REPRODUCTION OF PROPERTY LINES, NOR SHALL IT BE USED AS A WELL \ 8 -38 B SANDY LOAM 7.5YR5 8 MORTGAGE PLOT PLAN OR TITLE SURVEY. CONFORMANCE TO LOCAL BYLAWS SHALL BE DETERMINED BY THE OWNER 100 OFFSET FROM THE WETLAND CC / PRIOR To. CONSTRUCTION. 150 TO WELL B. R COARSE THE OWNER IS RESPONSIBLE FOR THE DETERMINATION OF THE LOCATIONS OF ALL BURIED UTILITIES. I • 38"-131 C 10YR8/6 SAND 9. FOR PROPER PERFORMANCE, THE SEPTIC TANK SHOULD BE INSPECTED AT LEAST ONCE A YEAR AND PUMPED WHEN THE TOTAL DEPTH OF SOLIDS EXCEEDS 1 4 THE LIQUID DEPTH OF THE TANK. I / _ _ 10. ANY ALTERATIONS MUST BE REPORTED TO THE DESIGN ENGINEER PRIOR TO PROCEEDING WITH CONSTRUCTION. � 2so -� 11. THE SYSTEM MUST BE INSPECTED DURING CONSTRUCTION BY THE BOARD OF HEALTH OR ITS AGENT AND THE DESIGN ENGINEER ESTIMATED SEASONAL GROUND WATER ELEV. a EER AND BE CERTIFIED BY THE DESIGN ENGINEER. I » STANDING WATER AT EL. 89.1 119 N F I ) 12. NO STRUCTURE MAY BE CONSTRUCTED OVER A RESERVE AREA. STEPHEN ROSE M A R Y 8C 13. A SPLASH PAD WALL BE USED ON THE azouND WHERE THE WATER ENTERS THE 4 CHAMBERS. MAP 133 PARCEL 044 14. ALL STONE USED IS TO BE DOUBLE WASHED STONE. 15. SEE 310 CMR 15.255 FOR FIL L SPECIFICATIONS. SEE 310 CMR 15.247 FRIMPTER METHOD FOR AGGREGATE SPECIFICATION. • .Ion. S C - 9.9 2 t[2 tvw 16. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING TAPE OR A COMPARABLE MEANS IN ORDER II S.D� . SPINY � TO LOCATE THEM ONCE BURIED. 9 w OWc = 21 .9 .5 : SILT FENCE � . 9� 17. THERE ARE WELLS WITHIN 150 OF THE SYSTEM. O = �w . 97.25 ROLL END OWmaX 20.51 (n fS I� f v/ I , 5.0 - 0� 18. AN EFFLUENT FILTER IS TO USED AT THE OUTLET END OF THE TANK. SILT FENCE . SAN O FILTER FABRIC Sr 4.2 C p - 19. THE EXISTING SEPTIC TANK AND PIT WILL BE PUMPED DRY AND ABANDONED ACCORDING TO TITLE 5 REGULATIONS . I OVER - OWr 4.82 . , DIG O ® 0� 2 . SLOPES MUST BE STABILIZED POST CONSTRUCTION. O i _ - 21. EXISTING 3 BEDROOM HOUSE WAS DESIGNED FOR 3 BEDROOMS. �I 94.5::] Sh - Sc - Sr OWr X OWC - OWMAX )MUE > > 22. THE SYSTEM IS NOT ESIRN END OF ROW _ - D GNED FOR A GARBAGE GRINDER, Tu Sh - 9.92 _ 1 .2 - 8.72 » SLIGHTLY UPHILL 23. THE BUILDING PERMIT INDICATES THAT THE HOUSE F. 30 LONG 40 MIL. RUFCO 4000E 2 X 2 X 60 SE WAS DESIGNED INITIALLY AS A 3 BEDROOM DESIGN. LINEAR LOW DENSITY POLYETHYLENE 10 FT., MAX. HARDWOOD , O POST., TYP. THE GROUNDWATER ELEVATION WAS ADJUSTED SUP BY `1 .2 BARRIER O WELL COMPACTED DETAIL USING THE FRIMPTER METHOD. AN BACKFILL SILT FENCE END y. SEPTIC SYSTEM DESIGN PLAN CLEAN r�.Ts. CLIENT. LOCATION. POLY BARRIER. DETAIL 56 Alderbrook Rd. P Richard Klotic D ESIGN DATA. N.Ta West Barnstable, Ma SINGLE FAMILY DWELLING NO GARBAGE GRINDER ALLOWED. 02668 E 0 o o TYPE OF BUILDING. , , � SEPTIC TANK VOLUME: 1500 GAL a ,� TOTAL NUMBER OF EXISTING BEDROOMS. 3 DATE. FEB. 19, 2015'` SCALE. 1 - 20 DESIGNED BY. TCR 0 a � S P(N K DESIGN PERC RATE: < 2 MIN/INCH Fn .. DESIGN FLOW. 110 GAL/BEDROOM/DAY _ Richard Kiotic _ LTAR _74 GPD/SF DRAWING NO.. JOB NO: DESIGN DESIGN FLOW. 3 BEDROOMS X 110 GAL. EDROOM - 330 GAL. AY CHECKED BY. JCS 56 Alderbrook Rd. _ ,� BOTTOM AREA. 37.0 X 7.83 - 289.71 S.F. # DATE REVISION DESCRIPTION BEET MASSACHUSETTS �'. S.F. C TION DRAWN CHK 59 CLAY STREET SEPTIC SYSTEM DESIGN PLAN WEST BARNSTABLE, SIDE AREA. 2[2(37.0) + 2(7.83)] 179.32 ►� 3 TOTAL LEACHING AREA. 289.71 S.F. + 179.32 S.F. - 469.03 S.F. 1 � MIDDLEBORo, MASSACHUSETTs 02668 - 25 1 ADD NOTES AND REVISE PLAN TCR JCS --1 469.03 S.F. x .74GPD/SF 347.1 GPD 02346-1052 2 u N SINCE 347.1 GPD > 330 GPD O.K. 28 1 ADD NOTES AND REVISE PLAN TCR JCS N 774=766-0544 s mkiO mail.com 3 l P 8 6/8/15 ADD NOTES AND REVISE PLAN -:TCR JCS I