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0034 HIDDEN VALLEY ROAD - Health
34 Hidden Valley Road Marstons Mills P A = 098 008008 t e ti 03 3 Fee /t/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpfiration for Misposal *pstem Construction Permit Application for a Permit to Construct(") Repair(' Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. 311 Ni 21 Vc✓ Rd Owner's Name,Address,and Tel.No. fl IYS-fcM�,AA MS `^ Assessor's Map/Parcel p/2 �O f iV V l 0 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �.A �JfO�tu 1 Nc. S -qOO -7/5-5 8-117 S"3j3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building (rSic_ b C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) - 35C) gpd Design flow provided 33© gpd Plan Date y-!7-20 Number of sheets_ Revision Date Title Size of Septic Tank 15-00 fa/0 2 Cl-1 Type of S.A.S. SOO �I4`)oN C6tbPrs 14- 3-o Description of Soil Nature of Repairs or Alterations(Answer when applicable) zfefl Ga <3-OG e14 -/U ✓LCO!r10GLA!?j VA 59yi( f�vJk- iS�(�1ot11 tc�J loQ( cAA30 a Too c,cRi�CV-3 4-X0 C(dn w�1 e!s 4 5 '�A0 V -o oti BIC'u Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si a Date Application Approved by Date r a J Application Disapproved by Date for the following reasons Permit No. Date Issued r..•..:s„3<+rwwm::+'* M"M.�.+_`+'..1' h.+f.:.rx�.,..rt,4,-'...J-.,.o .;n....� ..:w. +-�^tr" _ rx..y�J'^e.+,.iA:,�'�'-:. »,f^AS.;Y� _ i.:rs� .. p4 .. v+y'&t.^r ""� f`.^-R�...,rS.F°.�5"`w,,.f,;, .. r"1+-......,r^^��'°""c.-^-.li+T_• �F'""yt_.,�;,- a. No.c§ 0 t3,✓ ,} Fee 15 THE COMMONWEALTH OAF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TO N OF.BARNSTABLE, MASSACHUSETTS ftPlitatio'n. for.bisoosali OpBttm ConstrULtion 3PPrmit Application for a Permit to Construct( ) Repair(f/�Upg Faad (, Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 y /ai 12i or✓ Rc) bwner's Name,Address,and Tel.No. Assessor's Map/Parcel ©/ 2, CO ikh 0 , installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. V.A \J/C7W NSNC S Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building fr5la°r lf-t C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 1:3C) gpd Design flow provided 3 3(' 'gpd Plan Date N-17-20 Number of sheets 2 Revision Date Title ! ° Size of Septic Tank /,SOn /'//O 2 CotW Type of S.A.S. S'00 eiolloN rkmbe(S N Description of Soil of Nature of Repairs orAlterations(Answer when applicable) Too -/U fOMO lo WMAIV snallL. ' 11100t-1OeO leo)r MA)c) 2� *M0 CAMI C"� 1t-Xo e Graw IP/e, 4'5 560wn3. neu P On) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in, �'- accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. c Sigfied Date Application Approved by, Date Application Disapproved by Date for the following reasons Permit No. -_,�!� Date Issued '' THE COMMONWEALTH OF MASSACHUSETTS _ { BARNSTABLE,MASSACHUSETTS CertifitatP of CompliantP THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by 1 Rna,r-J `T A s r at- r/) has been constructed in accordance ,✓ with the provisions of Title 5 and -the for Disposal System Construction Permit Ncj *3dated -"1 � Installer /� 1� r ,J/O� A tur Designer ;-:IfrvPfY11, #'bedrooms' Approved design flow f(J gpd The issuance his permit shall no be construed as a guarantee that the systeEwill func 10.' . d�ed. Date j�/ ' Inspector \ No: �'" �/� ..:,.,_, Fee THE COMMONWEALTH OF MASSACHUSETTS F-PUBLIC HE°ACTH DIVISION-- BARNSTABLE;MASSACHUSETTS �I��O�ar �pstPm��OnBtCULtIDn �Prtnit.. :Permission is hereby granted to Construct( )) :.,Repair(. )., Upgrade( ) Abandon( ) System located at / 0r�id`YNf W/�� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5'and the following local provisions or special conditions: Provided:Construction in st be completed within three years of the date of this permit. Date ��j�� / Approved by t TOWN OF BARNSTABLE LOCATION l l I 4; VJV SEWAGE # VILLAGE It/lOd ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) l0 X G J P- t (size) d UD NO. OF BEDROOMS 3 BUILDER OR OWNER T ,460M on PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching.�aacility) �-- Feet Furnished by Se onv) �D�� � �r s • SV 1 roof^ . � Q i I 3 I ,. a as ash 3 qy s Desmarais, Donald From: Desmarais, Donald Sent: Wednesday, February 03, 2021 8:27 AM To: 'Douglas A Brown' Subject: RE: Barn layout If they ever want to finish that room above the garage I would need a deed restriction filed. They cannot have any more bedrooms. From: Douglas A Brown [mailto:dabrown5@comcast.net] Sent: Wednesday, February 03, 2021 8:21 AM To: Desmarais, Donald Subject: RE: Barn layout no its not finished wide open On 02/03/2021 8:12 AM Desmarais, Donald <donald.desmaraisgtown.bamstable.ma.us>wrote: didn't see the stairway to the second floor. Is the second floor finished? From: Douglas A Brown [mailto:dabrown5(g'bcomcast.net] Sent: Monday, February 01, 2021 5:15 PM To: Desmarais, Donald Subject: Fwd: Barn layout Hi Don , Attached is the barn layout for the septic on River Rd you were asking about. The bathroom is going on the first floor of the barn and the upstairs is going to be an open game / storage room. let me know if this works. Doug ---------- Original Message ---------- From: Kyle Condinho <kylecondinho mail.com> To: dabrown5na,comcast.net Date: 02/01/2021 11:10 AM Subject: Barn layout i TME 'own of Barnstable TpL_ Regulatory Services sAxxsrnsie Richard.V.Scali,Interim Director MASS9q, � Public Health Division Thomas -McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304. Installer& Designer Certification Form Date: �l 21 Sewage Permit# �o�l- 03� Assessor's MaplParcel !� d - 4 Z- Desi�ner: �� Mr, Installer: �; � � 3,f`d � b f r � 1 v`e i Address: j Z vvi /cf fZ,4 Address: C)• t3o-,r 1 VS >�res lalu�e G z�y y C�V,A--P,Y-,JZ i 4 y On -2- 3 .2 _ _ t-��,t,1 was issued a permit to install a (d te) (installer) Septic system at �z} .� �}, (`,,,� (� `� S' based on a design drawn by (address) AT 2 4eerl'f 6'1,'cs ri�sr l k( dated l-7 Z . (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system).but in accordance with.State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in with the terms of the 1\A approval.letters (if applicable) - P £ {Installer's Signature) �tvtt 140.35109 _ �L.� Rf015tE¢ ( esigner's Signature) (Affix Design e ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIV"ISION.. CERTIFICATE OF COMPLLANCE WILL NOT BE ISSUED UNTIL BOTH THIS 'FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:',Septi,;".vesigner Certification.Fonn Rev 8-1.4-13.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill.The engineer did not supemse construction of the system.The installer assumes responsibility for all materials,workmanship,backfilling to specified grades with proper compaction and setting nserslcovers as shown on the design plan. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is ®stett7itre �-���� r" vl f IJ Ma 02655 2/25/2013 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab key to move your 1. Inspector: cursor-do not Michael A DiBuono use the return Name of Inspector key.11 Company Name 31 Penobscot Ave Company Address Pocasset Ma 02559 Cityrrown State Zip Code 508-364-9587 S113522 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 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails - ❑ Needs Further Evaluatio the Local Approving Authority 2/25/2013 c,. 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•11110 Titte 5 Official&F'orm'Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. Cityfrown 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: Sytem is in Good working order. All tee's and baffles are in place 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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•11/10 Title 5 Official Inspection Forth: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 r 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. Cityfrown 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 '/day flow 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osteryille Ma 02655 2/25/2013 page. Cityrrown 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owners Name information is required for every Osterville Ma 02655 2/25/2013 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Straight forward 1000 Gal Tank, Distribution box, And Leach Pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ® Yes ❑ No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2011 5,000 Gal. g ( y g (gp ))' 2012 77,000 Gal Detail: Vacant in 2011 According to COMM Water Sump pump? ❑ Yes ® No Last date of occupancy: OccupiedDate 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: 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 - Commonwealth of Massachusetts-;-_ - - 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments. 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is Osterville Ma . 02655 2l25/2013 " required for every page: City/Town state Zip Code Date of Inspection D. System Information (cont.), s Currently occupied Last date of occupancy/use. Date t Other(describe below): General Information Pumping Records: Source of information: Home 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: : 1z 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): t5ins•11/10 "" "- M09 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ 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: 57' 57'x8,6" Sludge depth: No sludge t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. Cityrrown 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 na Scum thickness na Distance from top of scum to top of outlet tee or baffle na Distance from bottom of scum to bottom of outlet tee or baffle na How were dimensions determined? Scour Stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good shape. s Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts-- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 34 Hidden Valley Rd w Property Address Mark Harmon Owner Owner's Name information is Osterville Ma ' 02655 2/25/2013' required for every:. page: C,tylTown State Zip Code Date of Inspection D. System Information(cont.) Comments(on pumping recommendations, inlet and outlet tee br baffle condition; structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): System at time of inspection is working properly and handling design'flow` 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: ElYes ❑ 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•11110 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 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is Osterville Ma 02655 2/25/2013 required for every page. CitylTown 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 NA Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins-11110 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 y�. 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 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.): 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is Osterville Ma 02655 2/25/2013 required for every page. Cityrrown 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. Citylrown 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 attached separately t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. Citylrown 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: 60 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: Recorded at Health Dept ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Topographics and Health records. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11110 Title 5 Official Inspection 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 34 Hidden Valley Rd Property Address Mark Harmon Owner Owner's Name information is required for every Osterville Ma 02655 2/25/2013 page. Cityfrown 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 t5ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 17 of 17 AsBuilt Page 1 of 1 LOCATION SEWAGE PERMIT NO. VILLAGE H54 # 34- A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 1 BUILDER OR OWNER DATE PERMIT ISSUED 3 DATE COMPLIANCE ISSUED a•�K http://issgl2/intranet/propdata/prebuilt.aspx?mappar=098008008&seq=1 2/25/2013 10/23/2011 22:06 5088885925 BLANK AND SOLOMON PAGE 01/01 ,r JAINUF A. AUBUC 9en �1nHMARE)e A e 15g Marston Mi11s, MA 02848 Manaee�(�ichae1j.7100 A• Carman Got plans for . ing or sal ng'r -. Gat it done or stainl_ 4 �`-� • -�� * � w th Benjamin Hoore QC . Michael M ** �� Normal sa le 1,�' /• PO3 230 "I BAR & CHAIN GAL, . ENl;RG 43884304 7.AA8 10.99 tx Res Prc 7:99 Sale Prc 8.99 6,89 tx 00107O7g— , CO DFTECTOR 84tTERY ^~ _ Reg Prc 2$;59 Sale Prc 18.97 19-97 t') SA 54000 a0i3Si3 #522. 4.7a tx SUBTOTAL TAX i 158 8.28x ��•�` .• TOTAL 2,87 VISA 7554 45.41 ( � 047088 S 45.41 Involce #: 0030297822 SOU SAVED � 7 . 02 , HOhfE TEAS} �a int tote 1: 183 57 An fnt.9 any from Earn 1 Poi # for Ever + reward! $ Y .�. 1 you SAerld . WE VALUE YOUR FEE08ACK * - Please complete a short RatWolnt,com/tellussUrvay at: #**e ar /5950 STORE 14CURS Ron-Sat 7:30-6:00 Sun 8:00-5;00 Visit us.online at Nard"reStore cam Op 5 003029 81022 0159 003 230. 2978 10/22/11 10:41:47 1 TOWN OF BARNSTABLE BOARD OF HEALTH 1 ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date /®1?il Z� Time: In Out Owner3A %Mtl� VA1, tq ED NO �- LWSTTenant Address Iy11(.�— �� Address Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities vft- ri 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation ---� 9. Installation and Maintenance of Facilities Ljcog 10. Curtailment of Service 11. Space and Use 12. Exits ✓ 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal. 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 3 [��11 ® 16D ET Z 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 3 Number of Ve ' s Allo e rrtax` Number of Persons Allowed (max) Person(s) Interviewed yol\ke� Inspect If Public Building such as Store or Hotel/Motel specify here 1 COMMONWEALTH.OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS, SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 34 Hidden Valley Road Osterville, MA 02655 3 130 �t Owner's Name: John Harmon 'Y Owner's Address: f c ia7 C: gt; Date of Inspection: July 20, 2005 Name of Inspector: (Please Print) James M. Ford ' Company Name: James M. Ford x t Mailing Address: P.O.Box 49 Osterville.MA 02655-0049 r Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was perfonned 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 CAM 15.000). The system: Passes Conditionally Passes Needs her Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: July 31, 2005 The system inspector shall subm copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater;the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5-Inspection Form 6/15/2000 page 1 f Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Hidden Valley Road Osterville,MA Owner: John Harmon Date of Inspection: July 20 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping.more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Hidden Valley Road Osterville, MA Owner: John Harmon Date of Inspection: July 20, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detennine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Hidden Valley Road Osterville, MA Owner: John Harmon Date of Inspection: July 20, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must.indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 34 Hidden Valley Road Osterville, MA Owner: John Harmon Date of Inspection: July 20, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner, occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with infonnation on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS)on the site has been detennined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 34 Hidden Valley Road Osterville, MA Owner: John Harmon Date of Inspection: July 20, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAVINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped after the inspection for maintenance Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons--How was quantity pumped detennined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe). Approximate age of all components,date installed(if known)and source of information: Installed on Dec. 10184-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 Hidden Valley Road Osterville, MA Owner: John Harmon Date of Inspection: July 20, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 3" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 4" 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: 12" How were dimensions determined: Measuring stick Continents (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. The tank was pumped after the inspection for maintenance. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Hidden Valley Road Osterville, MA Owner: John Harmon Date of Inspection: July 20, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Coitunents (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) i Pumps in working order(yes or no): { Alarms in working order(yes or no) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 11 i" OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Hidden Valley Road Osterville, MA Owner: John Harmon Date of Inspection: July 20, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 dal.) 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.): The leach pit had 3'ofliauid on the bottom. The scum line was at the same level There did not appear to be any sips of failure. The cover was 16"below grade. The bottom to grade was 8'. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: —None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): i i 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 Hidden Valley Road Osterville, MA Owner: John Harmon Date of Inspection: July 20, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. .TU/1 roots e, 1 1 0 3 A C3 a I ao 31 a as a s6 10 E y' Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 Hidden Valley Road Osterville. MA Owner: John Harrison Date of Inspection: July 20, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: r Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours mans Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the reaps were showing gpproxirnately 30'+/ to Around water at this site. This report has been prepared and the system inspected and passed as of the.date of inspection. This report is not.a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection andlor this report. 11 N0r_y_._,31a �j �'" Fee----- -- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion-*r Vell Cootruct ion Permit Applica io hereby made for a perm Construct to Cuct (�, Alter ( ), or Repair ( )an individual Well at: �� .lam �Sd" -- Locatton — Address / Assessors Map and Parcel/ Ownerddress Installer — Driller -- Address Type of Building Dwelling ----- ----- ------ Other - Type of Building--- ------ No. of.Persons-- ---------------_--. �r Type of Well y — Capacity— --------------- Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .00fj�Compliance has been issued by the Board of Health. Sig-.A date l Application Approved By ----- , G - date Application Disapproved for the following reasons: -------- ------— — -- — date------ Permit No. {A� 3 —� �O — Issued --------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (✓), Altered ( ), or Repaired ( ) by _ t-u.14'/( Installer at—has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --- —Dated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- _ Inspector-----------______ —_—_--_—_ ---O JO No. ;=------- Fee----- -- ------ BOARD OF HEALTH TOWN OF BARNSTABLE 0(ppCicat ion-for Vell Cootructionpermit Application is hereby made for a permit to Construct ( ✓), Alter ( ), or Repair ( )an individual Well at: Locati n — Address Assessors Map and Parcel/ Owner Address L --��---'�-`�"----9�°_--��s� _.� �•N _off� �'�--------- Installer — Driller Address Type of Building f Dwelling - Other - Type of Building--- ------ No. of Persons-----------------__________ i Type of Well !t . -- — Capacity ——-- -- — Purpose of Well--L�'��° "-� _ o``l�-y — :t Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. sig bor date Application Approved B -7 date Application Disapproved for the following reasons: -------- ____ —_ 11 — date Permit No. l�� 1 —� � _— Issued - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (of Compliarice THIS IS TO CERTIFY, That the IndividualWell Constructed (✓), Altered ( ), or Repaired /� ( ) at— Installer 3 y , �� l t �4 �l, P d ------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. _—___—_ _Dated---- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- Inspector-------- ----- — —-- BOARD OF HEALTH TOWN OF BARNSTABLE V61 cootructiortpamit Fee----- Permission is hereby granted 6 A to Construct (A-1, Alt r ( ), or Re air ( ) an Individual Well at: Street —�---_—_ as shown on the application for a Well Construction Permit No._\4) '�Cac 3 Date`d=�-�-�� -_ ___------------------------- ——--- — -- -------------- DATE / 7 I U 3 — Board of Health — COMMONWEALTH OF MASSACHUSETTS 2j c O EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 34 Hidden Vallev Road �. fA Owner's Name: Daniel&Alice Chaplick Owner's Address: Box 434 Westbrook ME 04092 Date of Inspection: February 1, 2001 RECEIVED Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford FEB U 5 20 01 Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 _ TOWN OF BARNSTABLE Telephone Number: (508),.862-9400 HEALTH DEPT. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported' below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes N Further Evaluation by the Local Approving Authority Inspector's Signature: Date: February 2, 2001 The system inspector shall su a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. .... Notes and.Comments ****This report only describes conditions at the^time,of inspection and under the conditions of use at that time.,,;This-inspection does`not address how the system.will perform in the future under the same or different conditions of use. ` , " f °. _ ...._ Title 5,Inspection Form.,% 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Hidden Valley Road Osterville. MA Owner: Daniel&Alice Chaplick - Date of Inspection: February 1 2001 - - - a .• Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or .repaired. The system,upon completion of the replacement or repair,as approved by the,Board of Health,will pass. -Answer.yes,no,or not-determined(Y,N,ND).in the for the followmg statements, If"not determined",please explain. - The septic tank is metal and over 20 years old*or the,septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: .Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System,will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced . obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will -- - ---pass.inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 'CERTIFICATION (continued) Property Address: 34 Hidden Valley Road Osterville. MA Owner: Daniel&Alice Chgplick- ._ _ - --- Date of Inspection: February 1, 2001 _..._... ..,_ ._ v_ �• ;:" 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 r 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,iif 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`(S'AS)°and tlid iSAS isvithin j W,,feet.of a surface water supply or tributary to a surface water supply. -r The system has'a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence.of ammonia nitrogen and nitrate nitrogen is equal to or less-than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. .3. Other: ` .• r� ,fay .:-; :.. __.._.. 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Hidden Valley Road Osterville. MA Owner: Daniel&Alice Chaplick Date of Inspection: February 1, 2001 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: - Yes No _ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box abotie 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 'V2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of:a public well. _ ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is.less than,l 00.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 DER certified laboratory;for coliform bacteria and-volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve,a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well p PP Y If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B . -CHECKLIST Property Address: 34 Hidden Valley Road-_-.-'-.-.'T Osterville, AM Owner: Daniel&Alice Chapfick__ - ----- Date of Inspection: February 1, 2001 Check if the following have been done: You must indicate"Y&'or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health V Were any of the system c6niponeriis pumped out:in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or.dwelling inspected for'signs,.of sewage backup-?.-. T. Wis.the site inspected foi 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? ✓ W 6 f th Was the facility owner(and occupants if different from owner)provided with information on e proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)]. 5 Page 6 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION Property Address: 34 Hidden Valley Road - Osterville. MA Owner: Daniel&Alice Chaylick Date of Inspection: February 1, 2001 FLOW-CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2000-130,000 Qals.; 1999-200,000)Zals. Sump Pump(yes or no): No Last date of occupancy: Weekend use COMIKERCIAIJINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc)_ Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 1997-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: __gallons--How was quantity pumped determined? Reason for pumping: _ TYPE OF SYSTEM. ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other'(describe) a e-of.all.com onents,.date installed if known and source of information. Dec.-10184-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Hidden Valley Road osterville. MA Owner: Daniel&Alice Chaplick Date of Inspection: February], 2001 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): " SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 3" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: - Is age confirmed by a Certificate of..Compliance(yes or no).: (attach a copy.of certificate) ,. . . . . _ Dimensions: 1000Aa1. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: . 31 Scum thickness: 2" " Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tees were present The liquid level was even with the outlet invert There were no signs of leakage. Scum and sludge were minimal. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: D.isiance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: _ +` Comments(on pumpingrecommendations,_inlet and outlet tee baffle or bae condition,structural integrity;:liqu@ 16vels as related to outlet invert,evidence of leakage,etc.): Z,1..,..^!` .,3. ------------- 7 t ,. Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Hidden Valley Road - Osterville. MA ;t. Owner: Daniel&Alice Chaplick ti Date of Inspection: February 1 2001 , TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): Not found,jif present must be opened)�(locate on site.,plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address: 34 Hidden Valley Road__ Osterville, MA Owner: Daniel&Alice Chaplick. Date of Inspection: February 1 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type -. ✓ leaching pits,number: 6'x 6' leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: ... - Innovativelalternative system Typetname.of technology:. Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The pit had 2'ofwater on thibottoin The'ku' m'line was 3'up from the':bottoni There.were no�signs,offailure, -The cover was 16"below grade The bottom of the pit to grade was approximately 8' CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of.construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION (continued) Property Address: 34 Hidden Valley Road Osterville, MA Owner: Daniel&Alice Chaplick Date of Inspection: February 1, 2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. � C s 5 y O O 1 a 3 A - ao R1- 3 C 3- 51 10 Lao Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Hidden Valley Road. - ._ ..... Osterville. MA . Owner: Daniel&Alice Chaplick_._ f _ Date of Inspection: February 1 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high round wafe`� Y g g r elevation:..............v.....-...f The bottom of the pit to grade was approximately 8. Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 30'+/-to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. 11 3 } Commonwealth of Massachusetts x Executive Office of Environmental Affairs Te partment of Environmental Protettio M AF�E qR%WU EO Gom wa F.Weld 4 Trudy Co Gor�m A rmPaul Caliucal %OFF a r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FIG B PART A �Q `/ CERTIFICATION I f� Property Address- � drdss of Owner. Date of Inspection: g _ g —1 (If different) Name of Inspector. �0 J , Company Name,Address and Tilep one Number. CERTIFICATION STATEMENT'e� 'N 5�-�co g 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 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: �asse,V -.e-e 10 . - 'e(0" �lJ _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: L�rvG - /Date: The System Inspector shall bmit a copy of this inspection report tooth Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of110,000 gpd or greater,the inspector and the system owner shall submit the report to 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. I _ :axe SUMMARY: � �,, j c�'l- ,JCS � C�d� _ . Check A,B, C,or D: v A] SYSTEIy PASSES: C�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 Indicate yes,no,or not determined(Y.N,or 'be basis of hon in all instances. If"not determined",explain why not) The septic tank is metal,cracked,st Quad,shows substantial infiltration or exflt ration,.or tank failure is imminent. The system will inspection if the existing is replaced with a Conforming septic tank as approved by the Board of H • (revised 11/03/95) I i5ne VAnter Street. e, Boston,Massachusetts 02108 a FAX(611)556-1049 a Telephone(617)292-6500 i')Prmled on Recycled Paper j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property'Addreaa' ' Owner. Date'of Inspection: i I. B)SYSTEM CONDIT�I�Oy[M�_NALLY PASSES(continued) Se' S / Sewage bac or;breakout or high static water level observed in the distributio is due to broken or obstructed pipe(s) or due to a,bio viettled or uneven distribution box. The system will pass ' pection if(with approval of the Board of Health):'��" )� broken pipe(&)are replaced obstruction is removed distribution box is levelled or rep The system required pumping than four times a year to broken or obstructed pipe(*). The system will pass inspection if(with approval of the of Health): broken p (s)are repla obstruction • removed C) FURTHER EVALUATION IS REQUIRED BY THE ARD F HEALTH: Conditions exist which require further evaluati by the Board Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BO D OF HEALTH Dl, Er THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTEC THE PUBLIC HEALTH AND AFETY AND THE ENVIRONMENT: Cesspool or privy is wi ' 50 feet of a surface water Cesspool or privy is thin 50 feet of a bordering vegetated wetland a salt marsh. f,. Z) SYSTEM WILL FAIL S THE BOARD OF HEALTH (AND PUBLIC TER SUPPLIER,IF APPROPRIATE) DETERMINES THAT E SYSTEM 1S FUNCTIONING IN A MANNER THA PROTECT THE PUBLIC HEALTH AND SAFETY AND THE RONMENT: The m has a septic tank and soil absorption system and is within 100 feet to'a surface water supply or tributary to a surfs water supply. Th system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. e system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic is nk 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 ooliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen iad nitrate nitrogen is equal to or less than 5 ppm. 8) OTHER (revised 11/03/95) 2 f t i pg P"�:,Y. a.�u..:b. s, . 4 _ .. u r .. y .. ,. _ ... A ... c..:.�.s: s � ,•,..�.:� a-r ��� ra_.w a:�� :s �Y'. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. Date of Inspection: 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 ide%edbelow. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewy or system component due to an overloaded or dogged SAS or +Aaspool. Discharge or poadiag of efllue to the surface of the ground or surface waters due to an over or clogged SAS or cesspool. i Static liquid level in the distribution above outlet invert due to an overload dogged SAS or cesspool. Liquid depth in cesspool is less than 6' low invert or available volume,,idleas than 1/2 day flow. Required pumping more than 4 times in a last year NOT duertb clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,ce Yor privy is below the high groundwater elevation. r,. r' Any portion of a cesspool or privy is Kithira-400 f t of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy within a Zone I f a public well. i Any portion of a cesspool oyprivy is within 50 feet of a ivate water supply well. Any portion of a oesq}of or privy is less than 100 feet but ter than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyz to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitroge and nitrate nitrogen. i /FLS: El LARGE SYSTE The foll�stiagcriteria apply to large systems in addition to the criteria above: Th system serves a facility with a design flow of 10,000 gpd or greater(Large Syste\)-'and the system is a significant threat to public 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 suppb 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Anther information.. (revised 11/03/95), 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORTY{ PART B CHECKLIST Property Address: �e�C,c,�✓� v /„ �t.Ci�o Owner. Date of Inspection: Check if the following have been done: tf P,mping information was requested of the owner, occupant, and Board of Health. Ne 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. c� _As built plans have been obtained and examined. Note if they are not available with N/A. ✓_1'he facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow s The site was inspected for signs of breakout. vAll system components,excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank wax inspected for condition of baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. _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. _vThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. s (revised 11/03/95) 4 p SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: v�C�i L/ Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:_3_3.C)_.gallons Number of bedrooms: Number of current residents: `Z Garbage grinder(yes or no):�! ) , Laundry connected to system(yes or no): Seasonal use(yes or no): 141 Water meter readings, if e(vailable: 6 a 600 737 Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease tra or no) Industrial Waste Holding Tank present: Non-sanitary waste discharged to the Title 5 system: (yes _ Water meter readings,if available: Last date of occupancy: OTHER.(Describe Last date o panry: GENERAL INFORMATION PUMPING RECORDS ands of informat' n: lye — X 9!E System pumped as part of inspection: (yes or no)zk) If yes,volume pumped: gallons Reason for pumping: 4 TYPE OF SYSTEM �fSeptic tanWdistribution boxlsoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROJQMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no) vV (revised 11/03/95) 6 F _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORM�ATIION (continued) Property Adf" 3 f'C te�G�C�✓�' L' !�'� / "! /'` Owner. C./—L'&4'`. Date of Inspection: SEPTIC TANK (locate on site plan) l/ Depth below grader Material of construction: _metal_FRP_other(e:pLun) 77 Dimensions: S` Sludge depth: Distance from top of sledge to bottom of outlet tee or baffle: ';L6 Scum thickness: 6, ,i Distance from top of scum to top of outlet tee or baffle:_ t� Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: (recommendation for pumping, condition of inlet and outlet te9f or baffles, de th of liquid 1 1 in relation to outlet invert,stru integpSy evidence of ealsage etc.) GREASE TRAP:_ (locate on site plan) Depth below e: Material of donstruction: _con metal_FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or e: Distance from bottom of scum to bottom o et tee or baffle: Comments: (recommendation for ping,condition of inlet and outlet tees or baffles,depth of liqui in relation to outlet invert,structural integrity, evidence of etc.) (revised 11/03/95) 6 S 3 'M t'f Aj r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Date of Inspection: TIGHT OR HOLDING TANK_ (locate on site ) Depth below Bade: Material of construction:_con metal_FRP_other(explain) Dimensions: Capacity: sallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee,con ' ' n of alarm and float switches,etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if 1 and distri ion is equal, evidence o soli carryover,evidence of leafage into or out of box, ) nIZA PUMP CHAMBER:- (locate on site plan Pumps in working order:(yes or no) Comments: . (note condition of pump chamber, pumps and appurtenances,etc.) (revised 11/03/95) 7 Ai ill' A i II ifI I's114 1 1171 1 H II rUA 4 '1444itiaHiff SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Owner. Date of Inspection: —2-_ Is^ SOIL ABSORPTION SYSTEM (SAS):— (locate on mile plan,if possible:excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: ' L /GOB 0 leaching Pits, number: 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, levgl of ponding, con(Viyn of vegetation etc.)- - r IV CESSPOOLS:_ (bate 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: Mow(osspool must be ped as part of inspection) Comme : (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) t r PRIVY:_ (loeate on site plan) -- Materials of construction• : Depth of solids: Comments:(note condition of soil, hydraulic failure,Level of ponding,coaditio vegetation,etc.) (revised 11/03/95) 8 k L� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property.Addres 3L4 Owner: Mi Date of Inspection: (T- 9 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (2. -3o DEPTH TO GROUNDWATER Depth to groundwaterl��t method of determination or approximation: (revised 8/1S/9S) 9 t✓ TOWN OF BARNSTABLE LOCATION 3 y H tn VA I)e a4 SEWAGE # O p 3' C06'O VILLAGE O YrSev, Lk ASSESSOR'S MAP& LOT 09&LOO Cer INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYol I Uyb GPI LEACHING FACILITY: (type) (size)(ok'& NO. OF BEDROOMS BUILDER OR OWNER 04n)J AI CAL Ck PERMIT DATE: COMPLIANCE DATE: /a I l0/f 4/ 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 facili ) /F Feet Furnished by Sco t, 'rAJ2t%0) a!'/aOb/ -. FO.-J C Al- ao , Bi- 31 , �a Deck , ray- as /32- a 5. — � 63_ yy • O O 3 C3- s� • � � a -LOCATION y SEWAGE PERMIT NO. VILLAGE tl54 # 3�.. /A; A & B CESSPOOL SERVICE c• ,, r . 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER 'DATE PERMIT ISSUED 3 DATE COMPLIANCE ISSUED 4' t I /7 r � J A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T.QwI]...........0 F............Barnstable.................................................. Appliratiou for Diipniittl Warkii Tomitrnrtion ramit Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal System at ................. . . earl .. -•--------- -----•-----•........----_.... ----------• -----..............._... L. ion-Ad or t No. - ... ._ .......... ddrcas a ...................................... o ner , ` 128 Bishops Termce, Hyannis, MA 02601 •............................................... ----- ......................-• -----...---------------..........-•---•-------•----......•-----....--• Installer Address Type of Building Size Lot__ P 7�___.. .Sq.��f�e V Dwelling—No. of Bedrooms............�............................Expansion Attic ( ) Garbage Grinder 00) Other—Type of Building ............................ No. of persons..............2............ Showers (a) — Cafeteria ( ) Q' Other fixtures ------------------------------ W Design Flow...... jP..A. .......................gallons per person per day. Total daily flow...............MAQ...................gallons. WSeptic Tank—Liquid capacity.�00c)...gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------•----------•-•----------•--....-•------------•------..._.._.................................................................. 0 Description of Soil.......... a??d:._....•--------------•-•--•-------•--........_........_._....----••-••--•--•-••--•-••----••......-----•--•----- x ................................. x installation of a 1,000 1. septic tank, U Nature of Repairs or Alterations—Answer when applicable.--•-.--_•----------------------------•----.-•--.----------.�....._.....p__ _........__. distribution-•box•and•_a..1-,•000 gallon pry-cast, stone packed leach pit (_overflow . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLI� 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation unt' AO C tihcate of Compliance has been issued by the boa of h e g 9 3 ..._..._ Application Approved By... __.. -• .---••-••-----•-•----•-•-•-----•----------------•-----...............---•- .. -./ .. Date Application Disapproved or a following reasons:.......................................................................................... -•-•-._......------ .............................................._......-•••-•-•---------••-•-----•--------......................_...........--------•---•--•----•-------•••-----•----•---••......_............-•----•-----. Date PermitNo....... .............................................. Issued-.........49/0............................. Date ` l i ...... ! ----- FEs.....--_ ............ THE COMMONWEALTH OF MASSACHUSETTS �_ BOARD OF HEALTH ..................... ....................OF.............. < . _"'awn �aristal;l e Xpli iratiun for Dhi p s al Workii (Iunuitrnrtiun runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: X ---------••-•---------•--•--------------------------------------------••••----•-...-•-...._.-••_.. .............................................. ......----••__.....••••..............••--•- Location.Address or Lot No. ......................_............................. ....••--•--•••--••........_•........._.... ..............................................---••_..._._..........._...___.__........__......-_.. Owner Address .....-----•"----------------------------------------"--------._... ^_........... ..1�V 8 .�1�1•lbPn� �6re ;-•-I k....026,ft... Installer d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.....................--..... Showers ( ) — Cafeteria ( ) A4 Other fixtures ...................................................... 2 --•-•-"-•---""-•--"........--•.............................••-•-----•.-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..--........gallons Length.......... '::. Width................ Diameter..........--.... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------_-------- Diameter.................... Depth below inlet...............:.... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................r YlUke�er inch Depth of Test Pit.................... Depth to ground water........................ Test Pit.No 2 .. sntt e per inch Depth of Test Pit.................... Depth to ground water..--................---. OG r O . . Description of Soil------.... .. ............'-----••--•-•••-••--••••-----•••----•-•----••••---....•-•-••------•--•--...........---.......-•...... x Miff------------------------ U ------------------------------------"-------"-------------------------"--"-----------------•------------•---------------------------------------------"-------------------...-•---------•--•------•----- W U Nature of Repairs or Alterations—Answerrwhen applicable.-... iiTsa72ttsn tSf'" "f;IIOII"gm"1':'"septic'tank, Adgise1re ii Cori box aril a I;OOII gal]on'pr�l=C ; tt�ne" " ckeFd 1:0&01 --Sit f OVS-rfl-Gw`}:---------- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been.isssueed� bx the board of li ign ignf92 Application Approved By---- ---- Q.+`---- -------------------•-----.......-•---------------------•. ----8 f92/-83-------- Application Disapproved or a following reasons:..............................................---------------_---------------...---•---•-..-•-•---•--•--•--- ....-•--•-'---•-•""-----"----•-"....---•-•-"-•---------------------""---"-•"--"-------•--•-••------....-------•--•--.........-•-•-•-••-------..._•••--•--••••-•-•-•-•••-•••.-----••--•--•-•-•------_..._ Date Permit No. ------------------------------------------- Issued. -•---•--•---............-_... �3- .fo�,�t�3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH .................... ... ... ......................... �\ r ............O F..................Be sta b1.e.............. &rtif iratr u vaphunrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) __ X" by---------A-•&...B--Geaspcte1•--Sexwice;---i-28--tt9hay� +!� --------------- Y�n a�2r•�""YPY! al�,rin1.$f �.. .OGOV�......__.•............. 1 at........ ot.."..Hi.ddert.-ua;ller--Raa.-d.....MATston-s- 3ff p2 ------------- has been installed in accordance with the provisions of I 'LE TYie tate Sam ary"Zi�ae.° Sscrtbed in the application for Disposal Works Construction Permit No.........83_ 4V........... dated...............81t tt�./ _--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTE$ AT THE SYSTEM WILL FUNCTION SATISFACTORY. DATEZ=----�� ------------------ Inspector....... = -------•-----------------------•-------------------•-------•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / OF..........�.. .............................................. No..: 83--{O T cyarn....... r n s f ab7 aeFEE..... � ..... Dispoal Workn Tunotrnrtiun frrufit Permission is hereby granted........... .. .-$'f:e85pDi�T Se"ry C-------------•----------------------- ......... to Construct (X ) or Repair ( ) an Individual Sewage Dlspos System at No....Lot,--#8-.I+i-dden-Lot, -3:ey...Roadj--Marst-ons 31a�Stree4-----026F8-=-'aiic�----- Braun as shown on the application for Disposal Works Construction Pe/;11 Dated...._8/0-!$5.................... ................ {f. ......................................................... . L/�v� Board of Health DATE . --"------------------------•-------------------------....-- FORM 1255 A. M. SULKIN, INC., BOSTON V� SIG►,1 _C)ATA _ ��1►aG: FAMILY - 3 Bc OROoM i i wo GARBAGE• 6QAl JDE2- FLOW z 110 A PP � ,SEPT\G TA�JK = 33ox15�% = A9iG.P. � I, ;i u5� l000 GAt-. , ,� D15Po5AL PI'1- v5E tvo0 GAL. ' S %Dr-W,4LL i 150 5.F X 5 = 3'15 G.P D , BOTTOM A2EA- .. 50 5•r- -T oT A I- 17 1r 51 G N = .g 2 5 G.P D. ;I TOTAL. pA l LY t=�ovv = 33o G.Po PE2C0L4TI0N RATE: I''IN 2MIN oQ-LE55 I - I OF M /�N Q Al �J9.. q AIAN G1 �I RICHAFip w M. A. JONES ;, BAXTER V No. 24049 An .p No .'S 1110 C � 4O q TO '' - 0 SURq I — Top Vz�,ju �I INv. G ��; ,Y� 1000 lNq�'•1 ,Ca4M F DUST. INS. c,Epr�G /7.G3 SU$SosL x 9y� TANK GD.L. y�o LCAGl1 pIT INV. INV, WIT14 9y� yyy WASu6D 67vNfc _ G4B. O �Z CEQTIt=IGD PLOT PLA►.1 PRUFIL� I.DLAT.�oN /r(ll�STac�tS I�IILI_s NO SCALE SCALE ��._G4' DATE �IZlPa3 REFrc: Ca 1 G E QT I F Y T N AT T H E F24>?osZ5 1-Ul :!5 41ER Eot�1 GOMPLYS 1�ITN THE S I pEL1N �pr� A► P SI^T2,o.GK fL6Qv►R-EMENT� of -YNE- -TOWN O� 6,A�NST�.3L AND 1S N4el-- ` LOCEaTED WITNIIJ THE FLOOD F'L� ItiI DATE 8 2 C( C 1 BAXTEQ G t�I`(E I N C. REG I ST U'LAW 0,5 v�v E�oes -T1115 PLL\N1 15 NOT ar.��c D old A a3TEtZVILLE - ASS Iu5TR.UMEI.IT U2VE`( -rNE nl=1=SET5 5LI0UL3> n I.jr .�h'�GT c of2 n l ' Z m. i ESHT: y�•G _`99 yG•9 / 9S•3 3 9 3L i rls z�»:S p7 L 91.1 81'9 9y9 N B7•G 4:0 7 1 4/4 i bye 29y .9G J `N Of A(,�\!' P�1N Of RICHARO 'cyN c� ALANy� A. W. BAXTER y J JOKES No.24048 ,p No. Z5100 , 4 /ST¢� QQ• fF�C T �� suR�� 4 1 f i - -90 --EXISTING CONTOUR a =�,.F �: _.� ++ x 90.98 EXISTING SPOT GRADE `•�•�•11 WATERSURF9 92 PROPOSED CONTOUR ' • PROPOSED SPOT GRADE �- 92 NI EXISTING WATER SERVICEr W PROPOSED WATER SERVICE `•`• H.b!� (TO BE SLEEVED) OVERHEAD , RHEAD WIRES •�•�.IF- TEST PIT `��. ---•- WETLAND LINE & BUFFER 04 66 77.20 �.`• 6 e� WETLAND FLAG Q,R ,q 50' �4�. 6 ��� AL WETLAND SYMBOL e nr La ns•n `OFFER WF EXISTING SEPTIC TANK -�c4 OF -Tzq 88 BENCHMARK • TO BE PUMPED, FILLED Y CBNOELE� �!79\ �� `' _ _W/SAND & ABANDONED ��!t/Os AL LEGEND �` , RI TIER 37 1 LOCUS MAP O A NOT TO SCALE 73.73 84 EXISTING S.A.S. TO BE REMO VED . /e� \ \4.31 ` \• �. �'` `y 72.64Q1,�_. -_7 edge �' - 66 Of SPIKE7.02 1 -"2 � _ ` _ ' ` _ . Poveinen� 68 •�, \ 90.s9 x\3-i�- R VERFRON..ARE - g� •� `� -R .40 ��•'��\•It U\E.�- 84.03 �� ` �\ 72.15 \ \ 6 72.40 87.08 \- �98.60 �'��,,'`� � �� \ ` &8` ` \ \ _ X 85'�6\ \\ �:\p pp� 9 g0_B(�F/cE TO \ �•�9� � � � � e6.os \ � p � � 72.z1 \ 72.46 PA EL A 96.'3*�. �� 1 �RK MI _ __ 73.11 �. 27,5 7,,t 9 . 9423 9 62 R POSED RET. WALL BOTT. vARI 86 1 x e1.a1 \ \ P TOP=90.0, TAPER DOWN TO 8 eo.sa x \ \ �, •_. \ \ \ 9 EXISTING RET WA SHED `� 97.79 \ 0 36 91 �P=s6.0 (EXISTING) \ x x 77s2 ` _ •73�0�'•- iQ \ SH D \ TOP�84,0 (PROPOSED) 6.3 \ /EX/STING 97 02 % 95.38 ' ��PGARAGE�0 3 a � PARC�L 1 A +y I HOUSE(#34) x ` O.F.=92.0 M •`• "' 9z.'9 27,56y�f x 7a•9 \ 75.31 T.O.F.=101.5t x CELLAR�FL06R� 1 T. .S.=91.1 - ^ 100. \ K \ 1013s EZ.=sd.5fi TENT rn Sul 101,19 sgwE �PROPOEDEPTI T 91 a7 00 �� Ta B 81.19 eas EL.=95.6t 1 Z x V�j! r•`'"`'�' ` REL CATE SHELL I `ORVE' k x97.29 ��FfF� 10a. � �, 9y :• + 02.03 r..::.. , ~' VENT a .9a 3 LpF`x � GRAVEL ? 8279 o.9e \ '� o PETER T. ✓ 0.91 v x 6.33 �: :..' �r'. . I 106.76 wNE R 0� � McENTEE �. \ CIVIL G 1 `w'708 5 99.13 97.12 9 .0694 2 .29'., P 2 ' t PA !NG t e3.27 No. 35109 h.: 1 t; end _ 9$ f Povem \ D 82.01 �1 � / 10036 I 99.305 3O.52'DO„ E 97.91 S 4 OO E.,::' .. ,,,..,,:<".." PK edge \ PK SET ! / 88.31 87.22 101.81 I 96,17/ PK FND PK SET 90.10 95.08 91.90 4 � �� HI RIVER •ROAD PROPOSED GALLON CHAMBERS SURROUNDED W/STONE PARCEL ID: 060-012 + PROPOSED SEPTIC SYSTEM SITE PLAN PROPOSED WORK WITHIN THE 100' BUFFER ZONE 34 HI RIVER ROAD, MARSTONS MILLS, MA TOTAL AREA TO BE ALTERED WITHIN THE 100' BUFFER=1684 SF Prepared for; Kyle Condinho, 34 Hi River Road, Marstons Mills, MA 02648 AREA OF STRUCTURE (ONLY) WITHIN BUFFER ZONE=387 SF OWNER OF RECORD Engineering En meerin by SCALE DRAWN JOB. N0. NOTE: CERTIFIED PLOT PLAN FOR PROPOSED GARAGE SHALL BE SUBMITTED CONDINHO, KYLE & JULIE Engineering Works, Inc. 1"=30, P.T.M. 125-20 SEPARATELY TO ACCOMPANY BUILDING PERMIT APPLICATION. 34 HI RIVER ROAD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET.NO. MARSTONS MILLS, MA 02648 (508) 477-5313 4/17/20 P.T.M. 1 of 2 1 PROPOSED SEPTIC TANK NOTE: TO PREVENT BREAKOUT, THE PROPOSED PROVIDE RISER WITH FRAME & COVER OVER FINISH GRADE SHALL NOT BE < EL. 87.0 INLET & OUTLET MANHOLES AND SET OUTLET RISEf? FOR A DISTANCE OF 15' AROUND THE TO FINISH GRADE, OUTLET COVER SHALL BE SECURED o PROPOSED D-BOX PERIMETER OF THE S.A.S. TO PREVENT UNAUTHORIZED ACCESS. INSTALL RISER & COVER PROPOSED S.A.S. GARAGE SLAB=91.1 t SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=92.0%P SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT • F.G. EL.=91.0t -F.G. EL.=92.0f F.G. EL.=90.8f F.G. EL.=90.6f VENT MAINTAIN 2% SLOPE OVER S.A.S. L1 = 62' PROPOSED L2 = 11' '• L = 35' L = 16'f GARAGE O S=1% (MIN.) ® S=1% MIN. 4'SCH40 PVC 4"SCH40(PVC) S=1% (MIN*EFFECTIVE 2" LAYER OF 1 8 TO 1 2 p 4'SCH40 PVDOUBLE WASHED STONE "10, $ as (OR APPROVED FILTER FABRIC) t 4•' ta' s 2' EFF. a63 32. 0 INV.=89.00 48" LIQ. DEPTHaaaaa ^3/4" TO 1-1/2" DOUBLE - B' ^I INV.1=95.0f LEVEL PROPOSED 4.8' 2.6' WASHED STONE r-------- GAS GAS INV.=87.17 INV.=87.00 I PROP. S.A.S. ho (HOUSE) BAFFLE BAFFLE D-BOX WIDTH = 10' I r---JI INV.2=89.2f INV.=88.75 3 OUTLETS INV.=86.50 _29 (GARAGE) H-10 2-500 GALLON LEACHING CHAMBERS WITH STONE PROPOSED 1500 GALLON (H-10) SEPTIC TANK (2 COMPARTMENTS) AROUND AND BETWEEN CHAMBERS AS SHOWN INSTALL PIPE COMPARTMENT NO. 1 - 1000 GALLON MINIMUM STORAGE H-20 RATED BETWEEN CHAMBERS COMPARTMENT NO. 2 - 500 GALLON MINIMUM STORAGE TOP CONC. ELEV.= 87.6f BREAKOUT ELEV= 87.00 NOTES: INV. ELEV.= 86.50 ai aBaa B SEPTIC LAYOUT 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & aaaaa aaaaa aaaa INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. BOTTOM ELEV.= 84.50 4' ENDS 8.5' 1 1 4' 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 29.0' TRUE TO GRADE ON A MECHANICALLY COMPACTED STABLE PERVIOUS MATERIAL BASE OR 6" CRUSHED STONE BASE, AS SPECIFIED 5' ABOVE GROUNDWATER IN 310 CMR 15.221(2). LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO GROUNDWATER, EL.=77.0 - 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 3/4"W SHED STONE DOUBLE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. ®®®® 0 SEPTIC SYSTEM PROFILE r LAYER OF WASHED T ,E ® Ea DOUBLE WASHED STONE ►- 37" (OR APPROVED FILTER FABRIC) .t > ® Z ®i��®®®®®®®® DESIGN CRITERIA SOIL LOG 102" DATE: FEBRUARY 27, 2020' (REF#TPT-20-31) 4" KNOCKOUT NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE SE#1542 SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DAVID STANTON R.S. HEALTH AGENT 20" DIA. COVER DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH 4" KNOCKOUT / 4" KNOCKOUT 58" DAILY FLOW: 330 GPD 88.5 0" 88.9 0" DESIGN FLOW: 330 GPD FILL FILL 87.5 12" 88.4 6„ GARBAGE GRINDER: NO-not allowed with design A A 4" KNOCKOUT LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 10YR 4/2 10YR 4/2 .74 GPD/SF as.8 B 20" 87•8 B 131, 500 GALLON CAPACITY, H-20 LOADING PROPOSED SEPTIC TANK: 1500 GALLON-2 COMPARTMENT LOAMY SAND LOAMY SAND CHAMBERS COMPARTMENT N0. 1 - 1000 GALLON MIN. STORAGE 10YR 5/4 10YR 5/4 COMPARTMENT NO. 2 - 500 GALLON MIN. STORAGE 85.7 34" 86.1 34" C 18"/36" I C PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-10 RATED PERC PROPOSED SEPTIC SYSTEM SITE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES WITH 34 HI RIVER ROAD, MARSTONS MILLS, MA 0.0 x 29.0 M-C SAND M-C SAND STONE AROUND AND BETWEEN CHAMBERS 1 ' ' ( � 2.5Y 6/6 2.5Y 6/6 SIDEWALL AREA: 2(10.0' + 29.0') X 2 = 156.0 SF Prepared for: Kyle Condinho, 34 Hi River Road, Morstons Mills, MA 02648 BOTTOM AREA: 10.0' x 29.0' = 290.0 SF 1 Engineering by: SCALE DRAWN JOB. NO. TOTALAREA:............................................................ . PERC RATE < 446.0 SF 77.0 12 77.4 138" Engineering Works, Inc. N.T.S. P.T.M. 125-20 MIN/IN. HORIZONS 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(446.0 SF) = 330.0 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 4/17/20 P.T.M. 2 Of 2