The URL can be used to link to this page

Home My WebLink About0080 INDIAN HILL ROAD - Health 1 1 ' HILL RD. , BARNSTABLE 031 i ■■�■■■�■■■■■■■■MEMO■■■■■■■■■NONE No ■■■■■■■■�■■M■■■■MM■■■■MM■ME■■OEM■■■■■■■■■■■■■■ No E■■EEO■■■■■MMM■eEMM■EEM■■MMM■■■■■OEM■■M■M■■s■ ME MEN OEM MEN ■■■■■■■■M■M■E■■■M■■■M■■■MM■e■■■■M■ME■■■■■■■E■ ■EM■EMMEEMEMM■■ _ �■■ _ ■■■M■M■E■■■■■■E■■■■■■■■ EMEMEMEMMENEM MEMEMEMEMMEMEM MEN MEMENNOMMEMMMMEME ■E■■■■■■■■■■■■■■■ ■■E■■■■■■■■■■■■■■M■■■■M■ .M ■■■■■E■■MMM■■■■■■ E■■■EOEM■■M■■■ _ ■■M�■■■M■ ■■■■■■■�■■■■■■■■■■■E■ m MMM�, Momljjp MMMMMMMMMEMMMMMMI ME m NMI MOMMMMMMMMMMMMMMMMMI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI iiiiiiiiiiiiiiiiiiiiiiiii■iiiiiiail iiiiiiiiiiiiiiiiiiiiiiii�■iiiiiiiiiI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm ................................... ::::::::::::::::::::::::::::::::::: ................................... ............ ...................... 1 � E Commonwealth of Massachusetts 33� -6,9q a . Title 5 official Inspection Form A s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable ✓ Ma. 02630 3/2/2017 page. City/Town State Zip Code Date of Inspection r„p -fa 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 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-2484850 smjonestitle5@gmail.com S14522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site. sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority !� 3/2/2017 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M .y 30 Indian Hill Road Property Address Walter& Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown 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: The dwelling located at 30 Indian Hill Rd Barnstable is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 18 Arc 3616 chambers The system was found to be in proper working condition at the time of inspection. ii s 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): t t5ins-3/13 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 M 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Indian Hill Road Property Address Walter& Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) l 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 Y rY 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: r 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 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonweaffh of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,> 30 Indian Hill Road Property Address Walter& Claire Peterson Owner -Owners Name information is required for every Barnstable Ma 02630 3/2/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. -❑ z Any portion of a cesspool or privy is within 5{?feet.of a private water supply wet ❑ ® 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 thef system must serve a f4tility'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-3/13 Title 5 Official Inspection Forth: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 30 Indian Hill Road Property Address Walter&Claire Peterson Owner 'Ownees-Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityfrown 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 gpd t5ins•M 3 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y. 30 Indian Hill Road Property Address Walter& Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include taundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 1/2017 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) -Basis`of-design flow(seats/personslsq'.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 avaltabtd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable = Ma 02630 3/2/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) i ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under,contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,e'yt 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 2/22/2011 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate Y N g y p ( copy ) ❑ es ❑ o Dimensions: 1500 gallons Sludge depth: 6" t5ins•3/13 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 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every .Barnstable Ma 02630 3/2/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness . 3 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle ` 10" How were dimensions determined? opened covers, tookmeasurements j Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank does not need to be cleaned now but should be done within 2 years and again every 2-3 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Outlet tee intact. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �y 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert oil Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was video inspected and found to be in good condition, no rot, water level was even with outlet invert. i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is'a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation.not required): If SAS not located, explain why: t5ins•3/13 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 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 18 Arc 3616 ❑ leaching galleries. number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system I Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of 18 Arc 3616 chambers in a 32'x8.5'field. No signs of past hydraulic failure. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts l W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s.'y< 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):, Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3113 Titles 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 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown 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 I R SAS 0 °2 iA tz Al z Li 9t V A Z 29" Gs (b'(: A 2 83 ro t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts .w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•''` 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown 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: 124 feet I Please indicate all methods used to determine the high ground water elevation: i ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: i You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts 'N r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y�. 30 Indian Hill Road Property Address Walter&Claire Peterson Owner Owner's Name information is required for every Barnstable Ma 02630 3/2/2017 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System information=Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Baknstable OFtHE Tp�� Barnstable o Regulatory Services Richard V. Scali, Interim Director M-AmefimCity &UMSTABLE. f Public Health Division 9�A ' �� Thomas McKean Director TFD MA'S s 2007 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 17, 2014 Mr. Walter Peterson and ' Mrs. Claire Peterson 30 Indian Hill Woad Barnstable, Massachusetts 02630 Dear Mr. and Mrs. Peterson: Thank you for your letter dated January 14, 2014. We concur that the system is a three bedroom system. Very truly yours, EZ�s McKean, R. ., Director of Public Health tm/ejw q:\septic\30.indian.hill.road.bamstable.01.17.2014 Itr.doc Jain 14t,h;2014 :Re gew, Title V Septic S yt a tem-Ca.pew.id.e Enterprises Barnstable Health Dept . �nw5�,i�1 t la in Street Hya.nnIs , Ma . U2601 ° 1s ,Attu : Supt. Tom PICKean Dear Sir, My wife Claire and. I have recently ap:pl.ied. for a Sr. Citiiens Apt. over on Rte 134 in Dennis and also applied to another Senior Aptl in 'dest 'ield , Jew Jersey where our daughter Gayle has her condo. I turn 92 on Feb. 14th this year and Claire will be 91 this coming June. We 1 ha.v6 great year living in Dennis nd now Bf course 17 years here in barnsta.ble When we purchased this house from Manya Coville the real ett�.te people advised us that it was a three bedroom house and. the , w septic system met the new Title V require- ments (Ha - Ha ) Turns out that rather than four 55U 961 septic tnaks there were only _ three cesspools-, with two in the back yard and one in the front yard hooxedup to a Leeching f ield . . that subsequently failed and the front yard cesspool abc�nda.ned and 'filled in with stone and and dirt. When Richard ana, Kana '\qlt this houF o years .ago the . used. the master bedroom. Their two sons occupied two small bedrooms on' soutsde of the house ( 10' by 10' . They Subsequently akid add two sections 8xiu _ cN making the rooims- for 'each son to now be 18 ft. by, 10 ft. When Ifr. Coville died and ww the two boys, lent , h1anya livel pra.cticallly all the" time in o F- of the boys rooms and turned off the radiators in the other two bedrooms in order to save on her heatit'ig bills . 4 We felt the need .to have a new ,bonof ide Title V liy stem insta .i.lel ,to. a.vold2l and ei 'in the closing once the house. here g on the market. At",-,ached are copies of tww of two documents issaed by your group de,00ti g of co rse that the new sy -tem will lepport the three. bedrooms . Your confirmation w will be appreciated . Tha.. k you Walter and Claire Peterson' 30 Ina ia.n Hill Road 508-375-0729 r � • TOWN OF BARNSTAIME LOCATION l 'Lc9 I 01 'av ail %I � SEWAGE# l VILLAGEn r \1 �e ASSESSOR'S MAP&PARCEL _ v v INSTALLER'S NAME&PHONE NO:' SEPTIC TANK CAPACITY 1Sdd \1 L� AC A ITY�type) _i$t3 cpls rc 3Qi(o 112d(size) _S•S x �Z. CNO.OF BEDROOMS j OWNER PERMIT DATE: ?f COMPLIANCE DATE: 1Z — ZC ►`1 I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 6 l Feet Private Water Supply Well and Leaching,Facility(If any wells'exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet a FURNISHED BY 1_arug14 Catewide rro�osq1 of Dec . 14 ,2010-, called . for a Design FLo ,' of 330 gals . ` ter day with ins'aI!ation cf. a 550 gal. concrete tank. Ti'E Lerticic9 -Le of Compli nse 1-24-11. gILQo_ 330' as I . r 5 ay i .with :earo4 i . yv r • I r31 Z 63 Ay AT 39 y 'I HE C:UMNIVIN W LALI H Ur NlAN6M_HU6L 1 13 BARNSTABLE, MASSACHUSETTS Certificate of <(;vtrp€lance THIS IS TO CER FY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by - ,t_e C, _C_ l� at 7j o I* I a e__ ha een constructe in ordance with the pyouisions of Tide 5 an the for Disposal System Construction Permit No.�0 _ dated 1 Installer Q Q{�,J?' p��) r 5 Designer ch,I Lt"' o L / _) bedrooms Approved desi n flow gpd Th'e-issuan� f this ermitshall not be co strued as a guarantee that the system wi fun io as designe �W, Date � -2 Inspector ��- -——————---------- ------------ - ---- --- --- - No.. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migofsar '*pztem construction permit Permission is hereby granted to Construct ( ) Repairs( ) Upgrade ( ) Abandon ( ) System located at .3O 7-vx,.L �'� t�-t a 1 t-u7C 'A't-)n-)rr+D[V and as described in the above Application for Dispo"sal.System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local.provisions or special conditions. Provided: Constru9tion Musfte completed within three years of the date of this pe it. Date Approved by r i Y F TOWN OF BARNSTABLE �LOCATION ,30 Thai go �4 �1 fZd SEWAGE# ��1 P OA� VILLAGE o i ►-o,t ki- ASSESSOR'S MAP&PARCEL S(oo y 9 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15O() \t y LEACHING FACILITY:(type) 6 t 3 epV, Arc re 3ij t(o ii id(size) NO.OF BEDROOMS _3 OWNER VW PERMIT DATE: COMPLIANCE DATE: of _ 1Z - Z®"" Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A$ 11 Feet Private Water Supply Well and Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ 1 , Feet FURNISHED BY � 0i 4w LAB:. 4 A3 zu As 31,y f3S a3,j d No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYtcatiou for Migpogal *p5tem (fougtructiou Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3o_T v,cA-" W 1 Q-r,-j Owner's Name,Address,and Tel.No. I)A 1 fi of Pe_-6>-. 1 Assessor's Map/Parcel -3 3(,p /C)09 Installer's Name,Address,and Tel.No.dvew,4 oikrwl�es Designer's Name,Address and Tel.No. /0o /3on DZL3Z ��1 rJf3 f2Cd. crc7gSt� C-0-ors t-D-►-(,.V31 ej Type of Building: + Dwelling No.of Bedrooms Lot Size DSO sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `JQ gpd Design flow provided 3�Ja• gpd Plan Date of I eg! :Xo l( ,Number of sheets � Revision Date Title "3 o &4n-k•Vt-v, 04( (La 4 Size of Septic Tank 5bo Type of S.A.S. 18 AQC- 3(o t-i a Cte 1-4-2,o rim / Description of Soil Nature of Repairs or Alterations(Answer when applicable) /j-Go l)_,�10 15 4 fib( b pti, to P C,4w l e,o o !-,<- 0 30-C. 71 Date last inspected: t.o Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b this Board of UValth. Signe 17P Date < Application Approved by Date Application Disapproved by: Date for the following reasons Permit No Date Issued - - ly Fe -8 No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y 2pprication for �Dioogar *raem Construction Permit Application for a Permit to Construct( ) Repair Y) Upgrade( ) Aban'dow(' ) El Complete System ❑Individual Components Cy Location Address or Lot No. 3G J-vt a-a-n FLU It Q.aq J Owner's Name,Address,and Tel.No. A I t r � e i�0✓1 Assessor's Map/Parcel 3 3(p /c)o(3 Installer's Name,Address,and Tel.No.C,.At"Ptr/�c�� ZJ,C��°�a�'.� Designer's Name,Address and Tel.No. Y7S ¢s tir'r W pn(C 1�p /j O JX 7 U3 — ' (t Type of Building: - Dwelling No.of Bedrooms 2, Lot Size ( aL 0 SO sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow(min.required) 3-3o gpd Design flow provided 3 3), - j gpd Plan Date p f f 191 �o I( Number of sheets 12. .Revision Date Title o CLoa,Vl,, 14-t (Ld, j Size of Septic Tank 5�� Type of S.A.S. I? A Q c 3 cr r, P`Lo %,e l Description of Soil wee Nature of Repairs or Alterations Answer when applicable) 111� P ( PP ) I�C.t.J 1`�I J n r/r_h, A -Z0 j)-3 o x- to C- 4 vov-d eat dl� 6l-'ZO 36 t, lqW - Date last inspected: -1,6 1 U ' `Agreement: t.rThe 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 nbthis Board of ealth. Signe 1AAp /d � Date I A,% 17- a Application Approved by Date Application Disapproved by: Date f for the following reasons 4 ay Permit Nod '77%� y Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER FY,that the On-site Sewage Disposal System Constructed ( ) Repaired O Upgraded ( ) Abandoned( )by ,JL- �v A r I („(—c- at 3 (-> 9*-a,V3,, -Wt (LP, �Ar-1 ( ha been onstructe in ordance f with the provisions of Title 5 an the for Disposal System Construction Permit No. � "` dated y 1 Installer C 5 L-Lt.- Designer Cott(t.t1Yt. J j o"c"t. #bedrooms Approved design flow �- gpd The issuance f thisr ermit shall not be co strued as a guarantee that the system will fun •tioon/as designe . Date ( .2 a1+"" ,� f Inspector � �- p 77 No `Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Di!gpo5al *p5tem Construction Permit Permission is hereby granted to Construct ( ),,,Repair (, ) Upgrade ( ) Abandon ( ) System located at 3 Q T,not%V� t. j �j P Tit 7 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construafion tipstibe completed within three years of the date of this pe Date Approved b a PP Y down cape engineering, inc. SIEVE SOILS ANALYSIS 30 Indian Hill Road Barnstable MA.xlsx DATE OF REPORT: 1-19-2011 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 30 Indian Hill Road, .Barnstable, MA LOCATION: 1-18-11 TP by P: McEntee- sampled at 144"C2 SIEVE ANALYSIS Weight Sample(Grams): 293.4 1SIZE :WEIGHT RETAINED °lo RETAINED % PASSED --------- __. .csurn _ _ ------ ... 3/4"' .. 1/2-1 __ 5: 9 2%,' 93.8% 3/8"------- ....................... ............ O.Q`� -------�0 ®r---------100,0% #10------- ��4' ------------ - --- .90 @l@ _-_------- \, d.______m_ -- a ee-a a #20 -%. .aa6,9` 22 @@� 7 5% .,_... % .....a..........a 1-------._ a.......e'd #40 151'.5; 51 %11 40.3% -_eC__-_-_--_---,..a_..............a .....(.�.. -------- - --^- -- 7..a........ ...a.p- -$Q------- ........ ........ .2.I.6a----------- -:5- e @ a.....a ..[4, ale #100 ----- ... 26 3a- _ --_.---- �2 Oele�- . fio ##200 ---- -`....,.... ..•.. 290 5- e9 f?e�o' ---- 1 0% -- - --- ......................... �. ��_---___- ---- -. .@- ------_------�- PAN: 293:4, 100.0 Vie, 0.0�"o SAMPLE- -`----"___-__ 293.4a --_-___--- ------ NOTE: TEST ON PASSING#4 ONLY, 4%RETAINED ON 94<45%OX RESULTS: SOIL CLASSIFIED AS AASHTO A-3(GRANULAR,SAND)(UNCOMPA:CTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE- #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100%. OK #100 0%c-20% OK #200 0%-S% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION RESULTS:PERMEABLE MATERIAL-CLASS 1<2 IfAINAN.MATERIAL NONCOMPACTED SOIL DESCRIPTION: MED SAND,TRACE SILT, 0.74 GPDGSF MATERIAL a, DAN1 A ,�; o 0'JE,LA t'IVIL un N6.46502 Ni YNAL �' arm 7 Engineering works*, inc. Civil Engin"ra e 12 West Crosofleld Rlmd, Foroetdslo,MA 02044 Teftx (M)477.5313 FAX QOffjt EAfi�i� To Barnstable Water Department ' No, of sheets: i Fax: (508) 362-9616 From: Peter McEntee PE (Tel/tax 08-477.5313) For the purpose of septic upgrade, please confirm the presence at Town Water, services at the fallowing locatlons: 9 (ndlan HIII Rd, Murray, Robert'. NO 12 Indian Hill Rd, Collins, Troy t NO .19 Indian Fills Rd, Richenburg,:Peter Y NO 29 Indian Hill Rd, Murray, Donald � NO 49 Indian Hill Rd, Hill, Lee YES NO 50 Indian Hill Rd, Haskell, Nency& WIddloombe, Sar~� )' NO Please Fax back to 508-477.5313 - - 01 e Town of Barnstable Regulatory Services St. Thomas F.Geiler,Director BAWMABM Public Health Division:. MAW .`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 ' Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit# Assessor's Map/Parcel 3 3 Installer&Designer Certification Form f' +.zf �• Mir=v. r e 4� C • (1 1` t n�z -°^y Wa<tkI, '\ C Installer: `mil("`c�`tee 'Designer: n fin. N`.s y Address: I' Wks r Crra ss Q�� Address: '� Q ` 7'6,3 'Fa—res r-4c,Le 1M►� ' a 2 �l U �L -Nl 62 2 On U'� was issued a permit to install a (date) (installer) septic system at ' based on a-design drawn by (address) dated (designer) vC 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Locaf Regulations. Plan,revision or. ' certified as-built by designer to follow. Stripout(if required) Rected and the soils were found satisfactory. '�1N OF n1, �4 PETER T. o WENTEE n taller s Si ature) v civtL ,o P No 35109 . /STE (Designer's Signature) (Affix Design ere) PLEASE RETURN TO-BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffrce formsWesignercertification form.doc Town of Barnstable $ Departinent of Regulatory Services . Public Health Division �ArfC A�� /' 200 Main Street-Hyanuis MA 02601 f Date ! I 7 l Date Scheduled k .11 ° Time .' Fes ' Soil Suitability Assessment or Se f wage asposal Performed By: Witnessed By: LOCATION& G NERALpItMATION . Location Address Owner's Name, Address 59rv`Q Assessor's Map/Parcel: 3 3 C Engineer's Name NEW CONSTRUCTION REPAIR' C WrCQ�. - t>< Telephone# Land Uses. ,,//' Slopes(%) 3 Surface Stones /t,/ -P Distances from: Open Water Bod �t . Y--___ft Possible Wet Area� 7�}t Drinking Water Well Drainage Way eft• Property Line . —Q: ft Other ft SKETCH:(Street name,dimensions of lot,.exact locations of test holes&perc tests,locate wetlands fn Proximity to holes) r t H LL ` 'Parent material(geologic) T Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL Method Used: .HIGH WATERTABLE Depth Observed standing in obs.hole: in. Depth to soil mottles: pth to weepin Deg from side of obs:hole: I ln, Groundwater Index Well ft. . Reading Date: Index Well level._ „ AdJ,faCtbr, ,- Adj.Groundwater Level,, Observation PERCOLATION TEST Batt: Time � - • Hole# ; . rA p� Time at Depth of Pero w P -3 Time at 6" --- _ Start Pre-soak Time -fps/ c�le Time(9"-61p) End Pre-soak Rate MinJlnchel G -C✓ S�-C✓`� ------------ Site Suitability Assessment: Site Passed� Site'Failed: " Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--------=-- R ***If percolation test is to be conducted within 100' of wetland,you must first"notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q\SEPTICIPERCFORM.DOC DEEP. • • OBSERVATIO Depth from soil Horizon N HOLE LOG Hole# l Surface(in.) Soil Texture .Sdil Color Soil �— (USDA) (Munselq Mottlln Other g (Structure,Stones;Boulders. 0_F o��L iLt;jn� t3rave1l 5 �Z-leg C-, �'➢ � -'�l a joydz5 -3 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture — Surface(in.) = Soil Color Soil Other (USDA) (Munsell Mottling (Structure,Stones,Boulders. ®=- A onsi ten 96 gavel . sue: � YAVz -3z Y g I•i- Lo a w. �Q� ,s/3 l Zo-l68 C Z fz hS-e Mo sow,.( Z,G-r fo _ DEEP OBSERVATION HOLE LOG Hole# 3 . Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 1) A 5i` .. `�, I��/ to e S Z� 2 3 f ------ Cu. a o , cv 2•. .6 C $ q DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,%Oravel Flood Insurance Rate Map: Above 500 year flood boundary No yes _- Within 500 year boundary No yes Within 100 year flood boundary No. Yes . Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? e If not,what is the depth-of naturally occurring p ious material? . Certification I certify that on 1 0,0 (dateI have passed the soil� evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature Date Q=PTiC1PERCFORM.DOC June 20t h, 2016 . . • Re' Recert.if Ica tion of i :-Title. V Approval • . , VeIter & Claire. Peterson . . +• � ,• Mail . 30 #Indian Hill Rd . r 1Bar.nstabl"e,' Ma . •02630 70. y Location '30 Indina Hill Rd. ..,� » ri:7Y. _ T��§_ i. J. Cummaquld ,Ma• ♦ .. - .S• 3 ' ' .•.., r 4 o f ~ 02637- - Town of Barnstable Dept .of"Public -Health .. ,, 200 Main Street H,ya:nnia , Ma,. 02601 Attn 1I r Donna E'. Miora.nd t, RS Dear Mrs. Uora.ndl, Attached Ss a. copy 'of the June ,1.6tr, 20I0 Inv._ No . 11185 from, the` Ca.pewide Enterprises' d LLC coverIng'the ,pulhpout of the (2) loots gal. tanks jh' -ourI,.rear4yar4 lHolding &Over- • flow) on' June 16tft,"201Qojn accordance with ' the" stSpula•ted approval of the revamped system to continue' to comply with the Title V kequirements. ., t As, stipulated this 'Ss in- compliance'''with the every (Two Year) requireftment 'done back Itj 2004by the then• Jos ; ' `P. Macomber '. f Son Iny+�. , once e,gair I 'a..m sure °your off Lee- will Qr should receive' a. -a, 'cop' ' of 4 receipt ` shOWing the, number ova gallone tYiat` were dr.op.ped off by ;Capeside a.t the Hyannis " dlspo l 'p• s the 'COPYwxI 'n area. 'If ;not erhA of their .b Ijing'would suffice.- <= r D) The garbage dispo"eat unit that wa.e .re moved: - beck in 2004 'is still removed and,, .1,. rusting away in the c$l.lar We will--advance our •f ile."and also •a:sk ' Ca.pewioe to a.avance1 the r, file for two x�..k y ears for the nest pumpout. We., trust ' that' if •we decide. to sell 'this yhouse that ' ,ymap Title V Approva:l' will . remain An fU. 1 force ano. ef.fec't'.. 4 , \ hahtk ou Walter -J Peter.eon � , ` s Attoltey a,t Law . cc : Mr. ..Robert smith, q 6l0 Main Street, De�?nSsport; Ma,. Capewide Enterprises, LLC Invoice J.P. Macomber& Son P.O. Box 763 Date Invoice No. Centerville, MA 02632 6/16/2010 11185 Name Walter Peterson 30 Indian Hill Road Barnstable,MA 02630 Job No. Terms 8186 Due on receipt Quantity Description Rate Amount 1 Septic Pumping:2000-gallons 360.00 360.00 `t Lb C. r �y r t.4."4 t crt'X's'.cC 'r ex �: h a Thank you for your business. Total $360.00 A finance charge of 1.5%per month will be charged to any outstanding balances that are not paid in full according the:payment terms above. Payments/Credits $0.00 Balance Due $360.00 i Phone# Fax# E-mail ; Web Site 1-508-428-4028 1-508-428-3928 Janine@CapewideEnterprises.com www.CapewideEnterprises.com Nov. 19th,2010 Re Recertification & Renewal of Title V Approval Walter & ClUre Peterson 30 Indian Hill Road Barnstable, Ma.. 02630 Town of Barnstable Dept . of Public Health 200. Main Street Hyannis , Ma. 02601 Attn : Mirs . Donna ..Dear Mrs . Yliorandi, Tbank you for returning my call yesterday In which I sought your advice as to the procedure for continuing our Title V approval should we be required to sell our home In the near future because of our declingng health situations and. of our ages (89 for me in Feb. and 88 for my I wife also Ip June 2011)1 vie ha,d' no idea that there had to be. an actual written recertification of our septic system every two years and assumed that the Title 5 Fart 'A certification of the David J . Burnie Septic Services app rova,l of 9/13/03 was suf- ficient as! ong as we had the (2 ) rear tanks (Ho ldinw, and overfl6w) pumped- out every two years which we have done falthfall y .with ()o_ probleMB whatsoever. In fact In that Burnie approval was a diagram Vhowins.. how they had used a, lazer level to shoot the grade from the top of our property down to the catch basin at the bottom of Indlaa Hill Rd . where it connects with Indian Trail. 5ecopdly , and perhaps more, Importantly after the front yao.I d tank was pumped out and filled In, we arranged to have the front copper piping removed and. a complete new PVC, piping ;all system installed by Bob Cleghorn, a Plaster plumber. This new arra,,n Fzmient has been workt-6 3 most satisfactorily for these past six years, I U-7 We had to have the wae- hing, machine in the front of the cellar moved to the rear side of the cellar and. connedted to the master piping leading out to. the rear system. 2 What we cannot understand Is why the lvddlacomber 10� did, not follow through on their promise that copies of tie amount of actual "effluent" that was pumped out over at the Ryannis merely showing that two 10O gal. tanks were pumped. I am almost sure that I may have dropped off copies of those Invoices at your office. In conclusion I �:alled the Burnie C3. the other day to have them recertify our system but learned that their company had been sold to "Blue :!'Water" Also that the 1,11acomber Co. that had all the date re the um outs ett was now part of the Capewide Epeterprise Co. I spoke with a gentleman down at Capewide yesterday and they said they would have "Bob" come by on Nov . 30th to re- inspect the system. Here agaI4 It was this sameBob who pumped. out the tigie tanks on June Loth of this year and in fact showed him the new PVC piping arrangement and said it was a good job. Once again thank you for your suggestiDe and assuming, the system will be re-approved , I will send you a. copy of the arproval . Is It possible that someone from the Health Dept. wholald be on hand Nov. 30th?? Have a. Hapriy Holiday Season , Claire Wa,lt,,zr -Peterson 508-375-0729 cc : Rooert Smith, Attorney at Law, 610,Za.-iln St. Denoisport MA 02679 JO EPH P. MACOMBER & SON, thy Tanks-Cesspaels-l_eachlields n b Pumped&installed VV Town Sever Connections P-0_ Box 66 Centerville,MA 02632-0066 775-3336 775-64 1 i 4 t INVOICE . } �:, It Qr�. ,►3 -0 -11611 v• .:_:: . :•- •: Fi i It stet L ,. tiiA 9�w95}aw- Job Address TER S , A-Indian Hill Poad 2637 NOW 1161 t006 Pumped ed t Cesspools '200 J f allons f Notes e CHARGES SUBT)TAL: $320.00 CREDITS 5UBTOTA.I- y, BALAj4CE DUE: $320.00 � � Capn*,vide Enterprises, LLC 4l.P. Macomber & Sons Invoice P.O. Box 763 Centerville, MA 02632 - Invoice No. T6/16/2008 5415 V Name Walter Peterson 30 Indian Hill Road Barnstable, MA 02630 EJob No. Terms 8186 Due on receipt Quantity Description Rate Amount 1 Septic pumping, 1000 gallons from(2)cesspo Is l6/08 210.00 210.00 i � CIC Thank you for your business. Total $210.O� A finance charge of 1.5%per month will be charged to any outstanding balances that are not paid in full according the payment terms above. BaIa11C@ Due $210.00 Phone# Fax# E-mail Web Site 1-508-428-4028 1-508-428-3928 Janinet CapewideEnterprises.com www.CapewideEnterprises.com I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ? • Certificate of Compliance *(( ,) TOC ETIFY, that the On-site Sewage isposal System Constructed( ) Repaired ( )UpgradedAbandoneTby $ CO 'E K' Or)at t. .l fYkgx as onstructed in accordance with the provisions_ of Title 5 and the for Disposal System Construction Permit No ated Installer Designer The issuance of thispe I s 1p t g� o trued as a guarantee that the sy4 wi �Jy�t�4p des n��!`� Date J 1Y� Inspector No.=- G�� -------------- --- _ Fee— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Migogaf 6pgtem Construction ermit Permission is hereby ranted to pnstruc ( )Re a•r( Upgrade b ndon P �pg ) ) System located at tQ}J(1 . 1�� —and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply w'p y with Title 5 and the following local provisions or special conditions. fj Provided:Cons do u t e mpleted within three years of the date of thi Date:_ Approved b r)? Y r F• jl �ttr� � � � l June 20, 2008' Re Recertification of Title V APprova:1 W461ter & Claire Fetersop Mail 30 Indian Hill Road. - Barnstable, Ma. 02630 Location 30 Indian Hill Road Cummaquid , Ma. 02631 Town of Barbstable Dept . of Public Health 200 Main Street Hyanols, MA 0260.1 Attp: Mrs. Donna E. Mlorapdl, RS Dear. Mrs. Miorandi, Atta.dLhed is a copy of the Invoice from the Capewide Enterprises LLC assumed control of Joe. F. Macomber & Son Inc) covering the pum out of the tanks In our rear. .yard( Holding & Overflow tanks )on June 16th, 2008 In accord4va-1 =1 ante with the stipulated approval of the re!E C=) vamped system to continue to comply with, th > Title requirements. X. All of the previous records that go back to 2003 are In your file and starting with firs NJ (every two year puapout requirement ) done back In 2004 by the then Joe . P. Macomber & Son Inc. Once again, I am sure your office will receive a receipt for the d-ror-off of the efflufent by Capewide. Also the garbage dis- posal unit is still re" moved from under the kitchen sink* The revamped system done in 20a by Master Plumber Robt . Cleg4orn Is still working per- fectly and no problem with the flow from the kitchen sink, dishwasher and washing machine in the cellar. The washing machine had to be changed from the front system, (abandoned) and hooked up to the backyard. system. A copy of this ltr. will go to our lawyer In Harwichport for his file. 2 I am now 86 yrs. of age and my wife Claire just turned 85 and. we therefore have been giving some serious thought to pertiapo- consider a chance to an assisted, living accorrim4ion so we want to make sure there would be no hangup with our pre- sent Title V Approval If and when we should -decide to sell our home. The Cai)ewidaj-�eople will advance our file for two yrs to June 2010 for the next pumpout re- requirement. Of courseshoild we set.l_, we trust the new owners would require an Insp6ection of the s ,yetem and that the present recertification could. continue for them under the same stipulations* Would your office please confirm that since we have adhered to all the Health Dept. Re- qJ.iremente that our Recertification is In still force and effect. Walter 30 Indian Hill Road ' Barnstable , M4. 02630 508-375-0729 y Capewide Enterprises, LLC Invoice J.P. Macomber & Sons Ce P.O. Box 763 Centerville, MA 02632 z Date Invoice No. 6/16/2008 5415 Name Walter Peterson 30 Indian Hill Road Barnstable,MA 02630 `.N .+• _ Ili Job No. Terms 8186 Due on receipt Quantity Description Rate Amount 1 Septic pumping, 1000 gallons from(2)cesspools 6/16/08 210.00 210.00 (J. Thank you for your business. Total._ $210.0 A finance charge of 1.5%per month will be charged to any outstanding balances that are not paid in full according the payment terms above. Balance Due $210.00 s Phone# Fax# E-mail Web Site 1-508-428-4028 1-508-428-3928 Janine@CapewideEnterprises.com www.CapewideEnterprises.com t" I_... . ._ _.30-Ind-ian ._H 13. -Road ;__.,Farn�ta.ble ,.._ xlk...--G2630-..-, Cummaouid....Secti_on ).. ( i ..._........... 1_..1- . .._.. _._ :.:_ _.s ._.re _a. ,.....f.i2. _.. _._. _. .._._. 1Q order. to ccnf orm. with Title V. requirements," the hoidJ. tank...fi)_led iri.�....in..June 200 ..._... he p3 pink-:eery_tag...the -kAt-c-tren--s--n:k....a,nd di4hwaRher were replumbed_._( both discharge 1i E .and ventins ] .ins to the rear of the .- ....... .house-, -n-Qrt.h- s.i-de } ar�:i�- wa:'Q her-and -dryer moved to rear system. co I Replumbing done by Rober Cleghorn, i !;,aster ?lumber of Centerville and rewiring of washer and dryer done y Bob Chaves electrician of Barnstable , Ma . 'e the Therefore , as Of this diconsistsnOf thetem ly is in the rear yard ar, hold it g tank and an overf low tapk and will both be pumped out eatery two years ° As of t�,is date the tanks were pumpedOut by ..Jos Macomber Co. in June 2006. Next pu...rout will; be in June_ 2008..by present owners or.. if... house sold by new hvnerQ to comtine Title. V conditional .aproval by the Burnie Co. of I Harwic h. _ t TOWN OF BARNSTABq) `4 Gov a� 1 LOCATION�� .��n'�. 1a i11 �®�i� �' SEWAGE iY VILLAGE ASSESSOR'S MAP & LOT I: �S NAME & PHONE NO • ��i��,�i� ��t 17 S Fp TANK CAPAC1TY*Qbo �4m7 �6� 'V3 , L FACILITY.(type) �`��(}��o' (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER'OR OWNER �FoC t4 `VJ•Ai<.-I'ctL, }� •,-Sa i( Ci, 91(e ) DATE PERMIT ISSUED• .�� S�p:SGd •1 icY 5 ��y DATE COLIPLIANCE ISSUED: iablC„ VARIANCE GRANTED, Yes No '� 0:�7e.c.�10•� 1, "1�a�cx.�o C�g��aA� S'�S� `'�� pst,�®x tea, 6�a�l�w b, U'lA V►is�1� tr �f �RaYineT�,� d (Ib 09 . 4 PISeep Boa RIUA, y 1�,`zii'H (.t�Na�`�:.�t �ialz'3, �v�ti;��oi�/eol �/2-5(�1 • . 13.az�a CV55 oWi �v;,,-�1wa P. A .. e TOWN OF BARNSTABLE LOCATION+ �. ,;�\a � ,�li 'R� �SEtiVAGE VILLAGE `fat-V pb1L, ASSESSOR'S MAP & LOT 33b �JQ I 'S NAME & PHONE NO. +�Cbrv: �v1JS �� ll SSE TANK CAPACITY ,•�ktw1T �� t� X L 'ram FACILITY:(type) Ct$%wl �►A�Kg X� (size) III, NO. OF BEDROOMS P.lT�-I-V-A-T—E��i:L—O-R PUBLIC WATER OWNER Nw-y4t-�, P - frroat- C+.�yUt,.0t DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: n r}cti 6�LQWII L VARIANCE GRANTED: Yes Nn i �bili•l ew py ,o e0.e��ottl� oo�.r�lo„► �� p �: 36 �,. �iYht�ery, AN `�PaLt (Cumma uid Section ) 1-15-07 S e,e re-Su la-r-f 1-1-e M In order-to conform with Title V.. requArements the f-r td�t=Y-a:r 3—s-y-L t e rri—wa-s—a-ba n-d-o-n e-d—a:n-d. the holding tank f i, ..led in. in June 2004. T he—pip-i n-g—s-e r v-'-nrg—the— i-t c cren—s n-1 a-n d dishwasher were replumbed ( both discharge _ line and venting line to the rear of the hau-se—(north—side-)a-n3 w�4,her and dryer I� moved to rear eystem. Replumbing done by Rober Clegh.orir,--- .. Master Plumber of Centerville and 'rewir"ing of washer and dryer done by Bob Chaves Electrician of- Bar.netable , Ma . Therefore , as ,of- this time the only system is in the rear yard and consists of the holding tank and an overflow tank and will both be pumped . out every two years . • As of this-date the tanks were- pumped - out by -Jos . Macomber Co . in June 2006.. Next pumpout will be In June._2008- by present owners or- if- house sold by new hcners to comtine Title conditional aproval by the Burnie Co. of Harwich. 'N June 26tEm 2006, Re Recertification of Title V Approval 30 Indian Hill Road Barnstable , MA 02630 Towp of Barnstable WINLi-2.e, Dept . of Public Health 200 Main Street Hyannis, MA 02601 Attn: Mrs. Do nna, F.. Yliorandi, RS Dear Mrs . Morandi Attached Is a cop y of the Invotedee- from the Joseph P. Macomber & Sop Inc . for the ammaunt of $320.00 covering their pumpout of (2) tanks located in the rear yard at 30 Indian Hill Road, , one belling the holding tank and, the other the overflow tank. This is In accordanwSwith the- stipulations as set forth by the David J. Burnie Septic Systems `Co. of E. Harwich, Ma. In their Certi- fication of Title V baZIK Ila Sept. 2003 (Copy also attached). One of the stipulations was that each of these two tanks must be pumped out every two years. T he first pumpout that -was made to con,form with this Title V approval was done by the Macomber Co. back In June 2004. It is my, understanding that a receipt for the; - i dropoff of the effluent will be sent to your office and a copy for my file. Your records should also show that the r.I Macomber Co. did fill in the cesspool that was in the front of the house and also installed a new tee in the holding tank In the rear yard. Also the file should show that we had the piping ,re va,mpt ed- so that all the piping now goes to the rear yard tanks. Eoclesed is an enV�ope that contains Actures of the new piping that now' conue4ito the cellar outlet pipe leading to the rear yard holding tank* The origlail garbage ddsposil unit was removed In 2004 by plumbber and is no longer in use. All Copies of the documents confirming the continued approval of our Title V system have been sent to our lawyer, for his file If and when we. should decide to sell.. 2 ?lease let us know if we must continue to obtain approval of our revamped Title V system or If we should just continue t.ohave the sytem pumped out every two years In accordance with the Burnie pro I of 2003?77 k yo Claire Claire & Walter Fetereo, 0 wners- ) 30 Indian Hill Road, Ba'rustable , MA 02638 508-375-0729 cc : Mr. Robert F. Smith, Esq. c/o LacK and Smith 610 M41p Street , Dennisptrt , Ma.. . Attachments : JA ) Copy of'June 20thj.. 2006 Billing from. Jos. P. Macomber .Co. for pumpout, of ( 2 ) tanks on 16-o6 - (B) Copy of Applic tiop for Disposal System Construction Permit No . 2004-285 approved. by Donna Morapd.1 Rs. dated 6-8-04. (C) Certifeate of Compliance and. Dosppsal System Construction Permit Spprovad also by Donna Xoilpndi R,, on 6-8-04. (D) TIt4T 5 Officalil Inspection Form- Not for Voluntary Assessments Subsurface Sewage, System Form Part A Certificaion (dantaining eleven sheets) by the- David J . Bfip4ie Septic Services of E. Harwich Ma. dated and, approved Sept . l9th, 2003* (E) envelope conaining two picturesof the revamped piping system hooked. up to rear cellar outlet leading to reard yard hold Ing -tank. TUk located 231 from house foundation to holding taiwO Flctures. of ",theNreva,m ed p stem eor b , ,ulster ;1:umber 14. 2004 t©-~" conform-witkl -Se :t . 2j0 T3tle 'V approval. x's,n s®S CLo-4,1re & llila,Iter Peterson 30 V ian Hill Road Bar:nstble , Ma. 02630 ' C _, • �__ _ - i'"� - .. f .�. ., �- ''� e m j y v AnothEx—v,i.ev-Of the -cal-lar showing the.-t.wo-uew,.PYC�P1Pe8, going, from. front., . --,a-ystem-.to:.back -y,etem,_,t-o. -co_nform.,with, ...r qu.iremw.nen'ts. of the.•Title.-V eoudisiona� p approval -also-shoing End of pipe .for r possible clea,nout orA for. us_e,_wit h"`sna,ke to open any .b.lo:c_kage,e s CAK 2004 Premises Ct. ;ire 2c �la;lter - Petersoq 30yt�1d ian `11111 ROa.3 B .r� sta.b ,e , Ma 02E30' z t�- Aa t i '=a�iiii11iI111{111Hf/ � � ?�IIII!if�lll'l. 0 e o• ..o,hot.l .showing anew .F .VC xpiping going .from,frobt yard .. system to rear 210 1 PVC pie fruns -water:-from kitchen si-nk. and. dishwas.her_'with-,a I*". pipe cQycj;R noew .hooke-I up Ito-°front veRL,,rp.ip ., (-coy.per )' a.nd now running to back cellar T-Itel V. a�, � pproved ,system`to rea.r yard cessp-ao.°l, a,nd overflow tans® July 2004 �. P'rEm'xses Claire & Walter F. eterson 3C I.Pd ian 'Hill-Road _ B x,rnstablef9-kA /102630 Two new PVC pipes now run f-romefront . y one from kitchen sink and dis asheand Other for vent to roof f JOSEPH P_ MACOMBER & SON) INC. Tanks-Cesspools-Leachfields Pumped Mnstall e d Town Sewer Connections P.O_ Box 66 Centerville,MA 02632-0066 775-3338 7754412 INVO IC E i VV::i ire. 06-115 11 rli:"0106. !ndliafi L4 I1 Fl11ia_ job Address �d Anc�s T�?I i 0 Indian Hill Fv E. ond. '- RF E:dJSb :•:•: $gq��1s� ...................... ....... ...... 6j l6 •`,00 �'�_!t7';�_:�ci ';2 C�:S„ilrl{_ai' '200i�u�,li�t'� $320.f;lj , Motes -".CHARGES CHAR ES SUBMTA1 .3%'17:t117 CREDITS SLTBTOMAI. .1 L1�JL•L 1 LU• L}17�JJ�•LJf�T.y• L.i No. Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes h PUBLIC HEALTH DIVISION„-TOWN OF BARNSTABLE MASSACHUSETTS 01pplitation for 0i5pootnbandon 5truction, Permit Application for a Permit to Construct( _ )Repair( )Upgrade( Complete System ❑Individual Components Locate A dress or t Np. O dd ss and Tel. Assessor's Map/Parcel Oct Installer's Name,Address,and Tel.No. C "`J Designer's Name,Address and Tel.No. ZA Type of Building: i Dwelling No.of Bedrooms Lot Size, sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated'daily flown- gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) !E � O,0 I -A Date last inspected: F Agreement: The undersigned agrees to ensure the construction and maintenarice of the afore described on-site sewage disposal system in accordance with the provisions of Title 5,of the Environmental Code and not to place the system in operation until a Certifi .cate of Compliance has been i Bo ^Health: Signed '�-: . Date"5O `d a Application Approved by Date Application Disapproved for the following reasons Permit No. . r Date Issued au + 4 1 ti,lr. THE COMMONWEALTH OF MASSACHUSETTS . BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance TH TO CTIFY, that the On-site Sewage isposal System yste Constructed( )`Repaired( )Upgraded ( ) Abandoned�by F 111 e-c - O n Tr G. at 40 4—r .I Kill (d fyux a� onstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ated Installer DesignerThe issuance of thisperrr�ft�sl ll�n t e o trued as a guarantee that the syst `vri unct' des^l n Date— Inspect' 0 r ,r .°r'r�y`' '_ (1 %.I!�J _ No. ' ---------- -.� — -------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS mi$pOnt bpgtem Con5trUction ermit Permission is hereby ranted to pnstruc ( )Repair( ).,,Upgrade b ndon 7 System located atfl �`� .. p �(� --and as described in the above Application for Disposal System Construction Permit. The applicant recognizes_his/her duty to comply with Title 5 and the following local provisions of special conditions. Provided: Cons do u [ e c mpleted within three years of the date of thi erni , Date:_ Approved by f s. a _ TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION"" 12 Property address: Owner's Name Owner's Address: Date of inspection: Name of inspector: (please print) ' Company Name: ��: � y �' ` � - Mailing Address: � <� r' Telephone Number: CERTIFICATI®1`1 STATEMENT I certifv that I have personally inspected the selvage disposal system at this address and thafthe°information reported below is true, accurate and complete as of the time of the inspection.The uispection 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'TitleS(310 " CM R 15.000). The system: . � •, a Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority r.Y Fails d Inspector's Signaiur .. �i/� ( .) 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 acid copies sent to the buyer, if applicable,and.the approving authority. , /1�� ;'?�!X-� Notes and.Comments J (37`2`�//` �l ti s� ,/ ,, �� r�i r�� 'n._'i' �j' C''(1; '�%,'✓fZ''�i'' �. F �,s r . �� + 7' i / 45 - ***This report only describes conditions at the thwof inspectio 'and u�,,? nder 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 i- t � � ✓ 1 . OFFICIAL. INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART A ? . CERTIFICATION (contu,tied) Property Address: G` ��-.✓ ✓ cam' Owner: Date of inspection:r Inspection Summary: Check A,B,C,D or 1E/ALWAYS coe➢tplete.ail of Section l A. System Passes: l have not found any information which indicates that any of.the failure criteria deIscribed in 310. . , CMR 15.303 or in 310 CMR 1 5.304 exists.Airy`failure criteria not evaluated are indicated below'.' . Comments: B. S Sten COndit'L IOnal I➢y ly asses: LZ one or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The sv tem,won completion of the replacement or repair,as,a" roved 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) s structurally unsound, exhibits substantial infiltration o�'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'Boardfof Health. *A metal septic,tank will pass inspection if it is structurally sound,'not leaking and it a Certlncate of ' Compliance indicating that the tank is less than 20 years old is available. NB explain: Observation of sewage backup or break out or high static water level in the disiribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution_box.System will,' ass 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 times a year due to broken or obstructed pipe($).,The system will pass inspection if(with approval of the Board of Health) broken pipe(s)are replaced w Obstruction is removed , ND explain: i��/�/ � j � OFFICIAL INSlPECTION PORiVI -NOT FOR VOLUNTARY ASSESSMENTS " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Ml u, dv"l x s < 4 Fyn��,.L'LI ny��.. fi 1 A CERTIFICATION (continued) A �J ✓ ) r, Property Address:,- -Owner: Date of Inspection: 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 aceordance'with 310 Cli R 15.303(1) •. (b)that the system is not functioning in a manner which will protect public iaealih,safety and the environment: k _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 sait marsh 2. System will fail unless the Board of Health land Public Water.Supplier,if any).deterrulnes 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 wfithitt 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"t001feet but 50 feet or more from a private water supply well ; Method used to deterrnine distance **This system passes:if the well water analysis, performed at a DEP certified laboratory,tor. 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 t' this form. 3. Other: OFFICIAL INSPECTION FORINI- NOT FOR V'OI:I1lNTARV ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT ION FORW PART: CERT'IFICATIQI -(continued) Property address: Owner: Date of Inspection: r, D. System Failure Criteria applicable to all systems: ' You must indicate`yes"or 'no"to each of the,following for all inspections Yes,--No/- -�� '�:'�o�?% `r '"'�' ✓% ; f;r %.- ,r J—"�'✓'';r > Back-up of sewage into facility or system component due to overloaded or clogged SAS or cesspool zLDischarge 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 invent due to an overloaded or clogged — SAS or cesspool- Liquid depth in cesspool is less than 6"below invert or available voiume'is less than !/2,fay flow Required pumping more than 4 times in the:last year NOT due to clogged or obstructed'pipe( ): . Number of times pumped ;any portion of the SAS, cesspool or privy is below hih ground water'wicvaiion. _ —/,rty portion of cesspool or privy.is,i itbiri 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. fny portion of a cesspool or privy is within 50 feet of a private water supply welt. ;. Any portion of a cesspool or privy is tess.than'100 feet but greater than 50 'feet from a private; water supply well with no acceptable water quality analysis.['Phis system passes if the well '- water analysis, performed at a DEP certified laboratory, for coliform bacteria and i volatile organic compounds indicates that the well is free from pollution from that facility y� and the`presence of ammonia titrogen 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.J. (Yes/No) the system fails. I have determined,that one'or more of the above failure criteria exist as described in 3 t0 CMR 15.303, therefore;the system fails. The system owner should contact the Jealth to dqtpunine what will bQ necessary to correct the failure, E. Large Systems: �"> -��;„�j J�Si"i' / � r� c •> - . 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 • x, accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office,of.the Department. OFFICIAL INSPECTION FORM -'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART CHECKLIST Property Address: T . Owner: Date of Inspection: Check if the following have been done. You must indicate``yes"or"no"as to each of tl-ie followinb. Yes ..No j _ 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? r ae been introduced to the system recently or,as art of ulis nispection? f water b Has lar volume o P :'�✓i r Were as built plans of the system obtained and examined? "if not available note as NA L Was the facility or dweltino inspected for signs of sewage back uD?"` _ '�— Was the site inspected for signs of break out'? i Were all system components, excluding the SAS,located'on site? " Were the septic tank manholes uncovered,opened,and the intersor of the tank uspected 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 th. proper maintenance of subsurface sewage disposal systems' - The size and location of the Soil Absorption System (SAS)on the site has been deiermined based on: w Yes No 4' Existing information.For example,a'plan at the Board of Health. Ai 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)fb)] A. f _ OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS, SUBSURFACE SEWAGE DISPOSAL. SYSTEM-INSPECTION FORM PART:C SYSTEM INFORMATION .. Property Address: Owner:_ / 1 ✓ �:'L a J`V Date of Inspection ) /Ll j FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design)��,' Number of bedrooms(actual). DESIGN flow based on 310 CMR 15.203 (for example:. 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder es r no �v Is laundry on a separate sewage system(yes or no)' yy :[if yes separate inspection requixd} � f ; Laundry system inspecte�es)or no):_ /�'t�/1 �r'p 7� -j9 •lam ``�� Seasonal use(yes or no):_ :� �/��YY/� /: /�' /C`te r :3/_ Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: /�r'• (� COMIVIIERCIALANDUSTRIAI Type of establishment: Design flow(based on 31.0 CMR 1 i.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 3 system(yes or no); Water meter readings, if available: Last date of occupancy/use: - OTHER(describe): GENERAL INFORMATION. Pumping Records ti Source of information: Was system pumped as part of the inspection•(yes or no): If yes,volume pumped: allons--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 _ ch a copy of the DEP approval F ? Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected w en arriving at the site(yes or no): . y OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM,INFORMATION(contanued).� Y Property Address: Owner: Date of Inspection:_ BUILDING SEWER(locate n site )Ian) y ;r �'�!✓'h. Depth below grade• i Materials of construction:4cast iron 40 PVC_other(explain):. ��T � Distance from private water supply well or suction line: Comments(on condition of join venting,evidence of leakage,etc.): , ` SEPTIC TANK:`vsite;Ian) Depth below grade: 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). e Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: . Scum thickness: Distance from top of scum to top of outlet tee or baffle; Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity;liquid levels as related to outlet invert,evidence of leakage,etc.): a=, GREASE TRAP:—(locate on site plan) Depth below grade: Material of construction: concreteF 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.): V 7D) J OFFICI:A-L .INSPECTION FORA = NOT FOR VOLUNTARY- ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION E0RM '" PART G SYSTEM INFORMAT'I®N(continued)-- Property Address: Owner: Date of Inspection: _ TIGHT or HOLDING TANK:� tank must be um�ed at time of ins i ( P P inspection) on-s�te pla►r? = . Depth below grade: Material of construction: concrete metal fiberglass _poly°ethylene__other(explain)'. Dimensions: r Y Capacity: hallons Design Flow:_ -allonsidav Alarm present(yes or no): Alarm level:' Alarm in working order'(yes or no.: F Date of last pumping:_ t, �.t' #y' Comments(condition of alarm and float switches, etc.): , / t1 DISTRIBUTION BOX: (if present must be opened)(locate on site plan) , Depth of liquid level above outlet invert: Comments(note if box is level and distribution toJ outlets equal, any evidence of solids carryover,a«y,r evidence of leakage into or out of box, etc.): ` t PUMP CHAMBER: (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.): r r ♦ a OFFICIAL. INSPECTION FORM -NOT FOA VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IN�FORINIATI/OIL(continued)' Property Address: Owner: Bate of Inspection: SOIL ABSORPTION SYSTEM(SAS):'/ "(➢orate on.site plan,excavation not required) If SAS not located explain why: ' Type —Leaching pits, number: Leaching chambers,number: Leaching galleries,number ' Leaching trenches, number, length: _Leaching fields, number, dimensions—Overflow cesspool, number: Innovative/alternative system'pe/name of teci»oloey: Cornmems(note condition of soil, signs of hydraulic•failiire,level of podding, damp soi); condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plait) Number and coati oration: f �%� �)C)/ .� .ry�i'� 'l z% f" Depth-top of liquid to inlet invert: 7. . Depth of solids layer: Depth of scum layer: Dimensions of cesspool k Materials of construction: Indication of groundwater inflow(yes or no); T ' Comments Qnote condition of soil,si is of hydraulic �failure, level o`fp/ondina, condition of'vegetatton,etc.): 67 PRIVY: (locate on site plan) v Materials of construction: Dimensions: Depth of solids: ° Comments(note condition of soil,signs of hydraulic failure, level of ponding,'condition of vegetation, etc.): F 'NIEN OFFICIAL, INSPECTION FORM -NOT FOR VOLUNTARY ASSESS FORM TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PART C SYSTEM INFORMATION(continued) /TAR. ' 1 Property :Address: •Owner Date of Inspection:- .' SKETCH OF SEWAGE DISPOSAL SYSTEM landmarks two Provide a sketch of the sewage disposal system including ties tout►easvater sue lan nters.�hle build ng.' or benchmarks. Locate all wells within 100 feet.Locate where public Pp, r f'i i z \ \' ' • ti �.: OFFICIAL, INSPECTION FORM - NOT FOR VOLUNTARY A-SSESSMENTS SUBSURFACE SEWAGE ISPOS L S F r .M. i SPE(„110 'ORm AIRT C Vroporty Address: Owner: i•8a of r - SITE E `lope S Surface water/V 0 3 Please 41dicate(check)all mahc4s used m,determine the high.groutsd wate€.elevatioU: btsa ntr d worn ,ystem de+essig�-s Yplais{hoc$ record-If c.hec,k,-d,date o design p1mi wvic,`i ,a.. Obse't vied Sitee l:.�butt.'Ing prop.•&t �43a v3 1jKEFV��.Cr.4�7.�4iJ j(.��i ,i✓V 4i•�%F°�! TI"�-.3 i Checkrcl Faith local Board of l-leaktta-explaird: Checked with local excavators, ua;;Wlers-(Attach ocazt ematroa,) Accessed USGS tie You must.describe:how you established ihii high gsta r—d w&Wr eleva 30 41" IA OIL j r iF y of / r l y i.•-:4�Yf 4�s,� 1 wit f No. f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mi5pO!6aY 6ndon 5truction i3Crmit Application for a Permit to Construct( )Repair( )Upgrade( Complete System ❑Individual Components Location A dress or i gtr�p. O dd ss�anndd7T1�e�l.I�o. i, bb (I ��ff Assessor's Map/Parcel Ooq r, � 1YdA6fl �+ f ��7.c�S'r{Ly`uv a 06 ��o 1 Installer's Name,Address,and Tel.No. j?5`? Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 57, __,5Q4. 1 of' Date last inspected: ;�hry Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ij�y th' Bo �Health. Signed � �' /l Date�L1 `� C7 ' Application Approved by Date Application Disapproved for the following reasons eQ Permit No. — Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migonl 9truction Permit Application fora Permit to Construct( . )Repair( )Upgrade( `� bandon( Complete System ❑Individual Components Locatign Address or Lot.N . Ow Is- d dress and Tel. o30 1+10 . Assessor's Map/Parcel •p 0 q 'Q m purL>Jl o c \ � lN� �'W . Installer's Name,Address,and Tel.Np 7�5 Designer's Name,Address and Tel.No. 0 5©►1 Inc Type of Building: - Dwelling No.of Bedrooms l !� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building t 't No. of Persons Showers( ) Cafeteria( ) Other Fixtures J .. Design Flow gallons per day. Calculated daily flow gallons. Plan Date 'f Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature o, epairs or Alterations(Answer when applicable) 1;7 61I !� e� 5�'�0U� ,f j'] rorl�- � hoL9,9- I• Date last inspected: Agreement: , The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is .0 •-)3y thi Bod-�f_tie alt R� Signed �!�'V'' AIM Date SVi j A// Application Approved by. Date / Application Disapproved for the following reasons Permit No. f Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS �< Certificate of Compliance THISUS TO CEgTIFY, that the On-site Sewage Pisposal System Constructed( )Repaired( )Upgraded( ) Abandoned(i/'1` by C0111,f�JQJt o n n G at 1'0 r , tQ��& fyVR1. ash constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ated $ Installer - I Designer • / '' / -/ - ;,/ fn 0 y The issuance of this permit sha<<ll��nfot/betconstrued as a guarantee that the syste'm'w,irlItfu�nction as designee n� t Date lJ�/2 �I Inspector No. Fee v i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migotal *pgtem Construction ermit Permission is herebyranted to C nstruct Re a r U rade b ndon 9 'J ,gnstr i,'(, ) p ( pg ( ) ) System located at :CY1, �`1�� --and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. �j Provided:Cons do/in t e c mpleted within three years of the date of th Approved by i erm t.// Date:_ �U / Health Master Detail Page 1 of 1 Logged In As: TOWN\miorandd Health Master Detail Monday,Sur Application Center Parcel Lookup Selection Items Parcel Septic /_ Perc Well Fuel Tank I a Parcel: 336-009 Location: 30 INDIAN HILL ROAD, BARNSTABLE Owner: PETERSON,-WALTER 3 &CLAIRE Septic 1, 6/8/2004 New Septic... I Permit number. 12004285 Permit type Select type Com le Issue date : 6/8/2004 Complete date : 6/8/2004 IM Septic tank size: Type/Size of SAS: Installer: ISelect Installer i 0 __ .. _... _ . ...""....__.W__.. _..._ I/A service type. Select service Innovative/Alternative Technology type: Select IA type Variance date : Abandon complete date : Abandon perm Repair deadline date : Repair notification date Comments: "Abandonment of system" and inspect outlet tee in main cesspool: Deli Inspection 9/19/2003 New Inspection... Number Date Inspector Result 1646 9/19/2003 David 3. Burnie, BLUEWATER/ D.J. Burnie&San Comments: v� Delete Inspe Save Septic Changes Return to Lookup F http://`issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=336009 6/30/2008 . a TITLE S - RECEIVED OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FOkW 4 2003 PART A TOWN OF BARNSTABLE CERTIFICATION HEALTH DEPT. Property Address:_ 36y/ /�'t Owner's Name:_ (/v ` � 2 ��• �� Owner's Address: MAPf Date of Inspection:_ ��1191/03 PARCEL ; �- j J f LOT Name of Inspector: (please print) ��3 Y� - Company Name: —_t1/1/, Mailing Address: Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes _Conditionally Passes Needs Further.Evaluation by the Local Approving,Authority - Fads , Inspector's Signatur . Date:' 3 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. Notes and Comments ..**This port only described cond�s at thetm)of inspectio an 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. X . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 'CERTIFICATION(continued) Property Address Owner: Date of Inspection: 103 ' Inspection Summary: Check A,B,C,D or E I 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 exists.Any failure criteria not evaluated are indicated below. Comments: , B. Syste onditionally Passes: ' One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,Won completion of the replacement or repair,as pproved by the Board of Health, , will pass. .s� /��' � J� �� •- -'r � 4 f 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. y ' •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): r 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 I/ ND explain:� D� ��`�" ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM = 7e F PART A CERTIFICATION(continued) Property Address•_�d1 Owner: (�/�! d T Date of Inspection:_ 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. L 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: r _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 aseptic 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: - a OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART A CERTIFICATIO (continued) Property Address:_ 3� I119/(J �` Owner:_ yfr' _ A—) Dateof Inspection: D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following c for al i Yes No te, ys+ r inspect �-��ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or poriding 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 ces spool Liquid depth in cesspool is less than 6"below invert or available'volume is less than day flow lZ Required pumping more than 4 times in the last year N T 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. . IZAny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. �y portion of a cesspool or privy is within 50 feet of a private water supply well. f Airy 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 %lQ✓,'r 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 y,6 /VO attached to this form.) (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- e to de�fine what will be n ssary�to^correc �fail ' E. Large Systems: 5 1`/, - ti� �$7� 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 15304.The system owner should contact the appropriate regional office of the Department. „ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST E , Property Address: Owner:_ ection Date of Ins P � > Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes o Pumping information was provided by the owner,occupant,or Board of Health _ -1.z`'here any of the system components pumped out in the previous two weeks? LZ— Has the system received normal flows in the previous two week period? , _ IHas large volume 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 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 breakout?.. �. Were all system components,excluding the SAS,located on site? , 4e the sbptic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and. depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _ Existing information.For example,'a plan at the Board of Health. A)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)]. L1 ! �/ I ¢ ,. .� • S • w OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORD PART C SYSTEM INFORMATION `L:T�d1 l6 ff Property Address:_ Owner: Date of I_nspection: I< �3 FLOW CONDITIONS, RESIDENTIAL Number of bedrooms(design),A—k Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: _ Does residence have a garbage grinder kes r no): Is laundry on a separate sewage system(yes or no): [if yes separate msppction req d] . �UsT Laundry system inspecte es r no): t 44 — � , S /l e� Seasonal use(yes or n() � �rast/2 1 / Water meter readings,if available( years usage(gpd)): - Sump pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd` Basis of design flow(seats/persons/sgft,etc.): ' Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION, Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM T Septic tank,distribution box,soil absorption system , Single cesspool 4 _Overflow cesspool t ; _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 _A,4ch a copy of the DEP approval _Other(describe): Approximate age of all components,date installed if known � and source of info tion: fit/ill �p Were sewage odors detected w en arriving at the site(yes or no): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection:_ Q�lg�03 w BUILDING SEWER(locate n site plan) ¢ �� /✓'j'a Depth below grade-p� �� Materials of construction: cast iron 1 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of*t�,venting,evidence of leakage,etc.): SEPTIC TANK:/U f Depth below grade: 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): r , GREASE TRAP:_(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.): . 13w OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFOR(MATION(continued) Property Address Owner: Date of Inspection: / v 4 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) r 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: (if 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 k evidence of leakage into or out of box,etc.): PUMP CHAMBER: (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.): a J, M OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ` Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type .. Leaching pits,number: , Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length; Leaching fields,number,dimensi ns: Overflow cesspool,number: Innovative/alternative system a/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): CESSPOOLS:/—wicesspool 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: - j�/��✓�---� Depth of scum layer: (/ Dimensions of cesspool: - Materials of construction: + Indication of groundwater inflow(yes or no): Comments note condit on of soil,si gns of hydraulic failure, level of p . din ,condition of vegetation,etc.): . s PRIVY: (1 cate 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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) f Property Address:_ Owner: tl{/ . Date of Inspection:_ p 11 �0 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. r OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFO TION*(continued) µ Property Address: _ 1_5� C�/�"8� Owner: Date of Inspection: �9 c �/Z �- /U d-3 : SITE E ,M Slope 5 Surface water/V D n Check.cellar 0�1Zc'f ! w Shallow wellsv ' -7 Estimated depth to ground watep?6 feet Please indicate(check)all methods used to determine the'high ground water elevation: btained from system design plans on record-if checked,date of design,plan reviewed. 4 T Observed site(abutting property/observation hole within 150 feet of SAS - Checked with local Board of Health-explain: } ' --Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain; You must describe how you established the high ground water elevation: 50 oil yj +� t & Claire Pete Waltla` p E• �� ",= <r; son ill `., 30 Ind -mA 02630 :.. �� . Barnstable, rV e `it �sn37 t G q a e Town Of Barnstable Pub-i.ic Health.-DI-vision 200 Main Street 6 rr— Hyannis , MA 02601 Attn: M.r DAvid Stanton.R.5 o -. � •� •i! iie .¢ii ! 1 if i iE i it: • I!�!°..?.!':lEl�te .,leas..74:4..v t1....3..... .t. .a..E t...'.i ..� � arts •�.*.`' w _ v� !.. :. - .. f I It'll III till tllil if t I !III fill; t hilt fill I { CC : DaviddJ . Burnie Septic. Services 3 Perry Wasy= : E. Harwich, MA . 02645 t CC; Briggs and Heino Pli''mingY,ana'-Hea.ting,:-Nyanni,s,MA —at '�h 'Re Conditional'`Pa.ss s wTitl`e V 6ystem y9 30 Indian Hill Road ; 'Barnstable ' (Curnma:quid ) 'MA `., , a _ Town of Barnstable Public Health Div,ison 200 Main Street j , F Hyannistn MA 02601 Attn: Mr. David W. Stanton , R.S:', . r Dear Da ve ' This will confirm: this mornings conversation g „ relative to .the conditions for "passing •our r -' septic system as submitted and approved .by the David J. Burnie Septic Services . I, nc. back on Sept. 19th, 2003. One of the, cond.i`tio'ns was that; the -Front•`5y- .w " stem is pumped outs and .then° cohlapsed +,and `k f illed' in with clean "f glla k. Relative to the 'remaind.er.' of °the conditions , ' :. we have already hired Briggs a.nd'.Heino �Inc'o to revamp all the, piping necessary4 to�'dhange ,, � e. y- plumbing to all` go to `the back rear, yard !--- system. Just when this';,wi'll .,be done , I do not know perhaps . not' untll: .this Spring. Ihave already. advised Mr.- Burnie than he can come at anytime ;and 'install a new -tee on. the rear yard �hold.ing tank a,nd even pumps ; out both of` the rear ,ya.rd systems "at, that-,- same a same time } { . ffi - -As I mentioned'.the ho�4se neit ,door at' #12 •Indian Hill' Road - was sold°arid ran, Title V "* Inspect'i&n made by' . anothe"r company whereby ti a thAd tank in the rear yard was to be , . eliminated Eby: brewing' it up and' f i ll,i ngthe space.fwith :dirt or,.sa.ndo Howver', 4 t mappears that' a 4new `concrete ca,p` has been ,put on that- third ,tank-°and'' r1ght now. •is .about .:half,. full -; ' of--water a.na I.�understand that-,"it will be P used -as atl drywell -tow ac'c'ommbdate the gutters , e i in the °rear 'of-'that - house. , ' TherEfre, :I . would' like "to. do the same with th nin our. . a front yard.. I am sure that the tank is of the honey-comb type and is strong enough to also serve now as a drywell. Once Briggs and Heinno Co., seal off the line from the cellar . to that cesspoll I could have someone ,in-. stall the pi inn from all three downspou9ts 41 -I will have he rout t nk inpsleetded -tca---- OK this change. Than s for yourWa`Relcy J Peterson `' WmffWalter'7.&Claire Peterson �O I'M s 30 Indian Hit!Rd„ O W • Ct� CD Barnstable MA 02630 � v I% fl J U L �� _ - ¢ usA37i oc:� o3arrlstable Dent. of health , Safety and Env. Serv. 200 Main Street Hyarn s , MA- 02601 Att" : Mr . David Stantton �,,;i,;,,,,,.�tY"�t .Lr•;?e�i,.�' tllltra!'�!l I��dlJt7!!!!1'�1�?!/.�JIL'!�ItdtlFdl�1/Y�1�1:!•�3(!/.Fl 1 �fm J r i r _ July' 18th. 2003., Re.: Title V Subsurface .Sewage N Dis-rosal System Requirements 30 Indian Hill Road _` Cumn;aqu id , Ma. Town _ of Barnstable Dept. of Health, Safety snd Environmental Services . : ., 200 Main Street Hyannis , Ma. 02601 Attn: Mr. David W. Sta.n to. n, Health Inspector Dear David , r I was just down to the Assessors office this morning and sadly this coming Monday they will . annonunce the new assessments. `hree years ago the land values in this area went up 60% for all owners on my block and now here again the total assessments for - land and buildings is . about to go up again but, they 'sa.y ., the taxing.. rate will go down somewhat. Hopefully , with my limited income from both my pension and. Social Security •.and. 'now being over 80 yrs . of age , I ( or I should sa.y we , my wif e and I) may qua.l4fy for the latest 1000 per, yr exemption on our propert-y taxes. In fact also this M,nday I will pick up the new application for this latest exemption apY'.roved. lkst March by the Town Council. I have had a couple -of., Title V , rerala:cernnt companies review the property, an,"' it is apparont that any :new system would or should . be pla.ced:'', In the front yard . My neighbor Lee Hill just ' had FKM put in a' new sy stem in his yard and. -it was necessary to dig a hollt 40' x 20l and 11' feet de:ept so undoubtedly if I have the same. clay sitaation ,I too would have to have the same hole and dispose of the cesspool system in the back yard which serves the two' bathrooms and also perhaps eliminate the cesspool with leeching field in the front yard that serves the- kitchen and cellar washing machine. Attached is .a cony of thet'oroposaI� of the Down'R¢ Cape -Engineering -Co. of'-Dec. 6th., 2002 :and does, not include the backhoe fee or the Town' perc Fee - My question therefore -would" ask if I have the perc test done on the front yard in Sept. and also pay for the Down Cane Engineering prop osal, gust how long would I have to wait ' before ha,vi.n, the actual work done. Is there ' a time limit, one Kr. 'two yrs , 3 yyrs Thank you for an,y help you ca.n gave us. . Regards , a:l e.rson i tel.(508)362 4541 t S s iax(508)362-9880 939 main street rt 6a outh mass 02675t Y e engineering d��n c�� civil engineers& land surveyors Arne H.Ojala P.E.,P.L.S. E.Daniel A.Ojala,P.L.S. tural design - Timothy H.Covell,P.L.S. 4 December 6, 2002 court eys w planning r. Walter Peterson 30 Indian Hill Road s N: Cumanaquid 026374. age system igns Dear Mr. Peterson: , and engineering services The following is a quote for surveying design for your home. Down involved with a proposed septic system spections the following: Cape Engineering, Inc. proposes cord re ermits _ Research for plans and deed of ,for designing Title 5 system nd control survey, ,. _ Topographic a T - Computations to produce working Plan s ecifications (an observation hole to Title 5 p Perc test/ holes in one-day) X allowance of 2 - Design and draft septic upgrade plan for installation-. Copies of plan for quoting purposes/apPlY1ng permit { " . the.; 1215.00, not including Any the above listed work is $ erc fee ($100.00} . our fee for 150.00) or the town p limited to - backhoe fee (usually $ such as but not additional work not listed above, corner stakings, revisions, additional Pero tests, lot line/ during installation-of the soil removal inspections ( etc. , would be. unsuitable l variance filing, If a Board of system) , Board of, Health forma 60.00 per person. rate of $ I would suggest billed out_ at our hourlYrocedureis necessary, variance filing P 350.00, to include the application Health one hearing. budgeting an additional $ fees. notification of abutters'and attendance at fling procedure, filing/certified ma The above quotes do not include any / �C,. ty our area, variable nature of-,the soils in Y as they the somewhat excavator instead of' a backhoe, Due to The cost would suggest the use of an 150.00 di deeper to search-for the suitable soils if need be. can g approximately $350.00, instead of the $ for the excavator is backhoe fee. the area to erc test procedure cannot restested to do so at Please note` that the p ecfically rem . We condition unless sP do fill in-the hole) : the pre-perc test condi erc test. excavator ac. ss, at the time of the p, additional costs from the contractor (the, would need backhoe/ J If you would like to proceed,.please sign a copy of this proposal., below and forward a retainer of $700.00. ' If you.have any questions, please do not hesitate to call me. If you wish to provide an interim fix for the failed system in the ' front of your house, I would suggest moving the laundry system to,the rear of the house and replumbing the kitchen sink to the rear system. , The rear system could,then be replaced when that system decides to f fail. (Obviously, the front system would be abandoned) .', Very truly yours (,y Arne H. Ojala, P ,P Engineering,PLS, r t Down Cape En ineerin Inc. e acknowledged and accepted date r + F z �f rt STATEMEN'T JOSEPH P. MACOMBER & SON, INC. 362-0729, Tanks - Cesspools - Leachfields ; Pumped & Installed Town Sewer Connections 4/1 1 P.O.-Box 66 Centerville, MA.02632-0066- g °ATE. /97. 775-3338' 775-6412 t t, • .f ....................... ......Walter Peterson ;- 30 India A ` n Hill y, -- Road t Fi z ., Cumma ud q ,-Mass ^ 0 2 6 3 et j3. c , ; TERMS ,Cash, 1 2%-;antlerrest 'ev e.r° _ _ - yk 3 0' ,days ' PLEASE DETACH AND RETURN WITH YOUR REMITTANCE DATE EN UMBER/DESCRIPT ONEI a > " CHARGES r r CREDIT BALANCE FORWARD l ) /97 Pumped two cesspools fi ` and.....l.. .cated. .. . 0o Raised(,�C 260 .,0 $ 260. 00over on cessppoof� • Power Snaked both over $ 3.3 0.^..5.6. fhow lines..... 3 n k from the " �,s _.... two main cesspools • 120 00 1..-new concrete K J fE qb'F cover. F 450 56 32 .... 52 50 $. 503 06 ............... ....................... . .. ................................... + } ti 1`k � - . •. z Y-- ..................... ................... n. ., _ 3 y -,t�2f � � •Vh t cov6r,4 ;: o they . g.y� f� ry�I� p,y .�. Q 1Q�l 4 c,10 e r> O ` I ", sf r,4s.[+& ,fit " l � '�" '�7. .......CL1Lf' CS' i t......41 G4 VJ.. JJ p, k `a°I,dfa" ab `+" ..t a -'is enbeen- it .may nece y r to',` out :f.q hETApx f w r t JOSEP .a, ?W�� H P, MACO Q.,.. MBER & SON, INC. . , PAY LAST AMOUNT IN Tlaic f r w TOWN OF BARNSTABLE LocATION �Qi 3U tam 4ilt cJ �`1Vi1(hA°�SE AGE# VILLAGE ASSESSOR'S MAP & LOT St�r�icCIV �. A� II�i&T�'S NAME & PHONE N.O. bYv��eJ., �vS b`t)V SSE TANK CAPACITY �Itc,,:�T ��6�n b X RLK yACLD � � FACILITY:(type) S�r3a� u�iiC'� b (U e) '. NO. OF BEDROOMS 3 PR4VATE �-�z--FOR PUBLIC WATER „s_r)o T ,.r._ O W N E R_d.mat 2 t \w L't T DATE PERMIT ISSUED: ��,�� ,+��,za„ar^i t-"L, `._�laoai< ' �rdpn} C)V C4 ow Ct' Ltr DATE COMPLIANCE ISSUED; 'b 1�� i� '��. �nc}t� �o—w-q�� ,y,x •�o VARIANCE GRANTED: Yes N� 1iaaY.''Sb ® tad i1�11u ON`f"4 w'k li NIL 4 U �X $ Cz��oe�'� °�c•r�lo� 6x $ Ca�S��l 3� '� y 4vu4 PvT, l�yi-F! �Bi10Jt i�� ,,,�A►� _�® �,�6�TC'� ��y A�� TOWN OIL BARNSTABwgI L Y LOCATIONN'.)_0 ta ;11 lRa�o �' SEWAGE I I VILLAGE Cyi,,r%.n: n rd ASSESSOR'S MAP & LOT Q,' I NAME,& PHONE NO.;• �C�jrn�tt► �'Sa1� ��5 �,'�.} {L Ce5 s q--O, C\ c,vO a P., 7 � •em s a S TANK. CAPAC1TY.Vb q�\,�s &B*49d&liS F'ACILITY:(type) � �'`��ol (size)_ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER Ptl"j)I BUILDER OR OWNER.r-'A%'Aq— ' cx �'l��o�,Sa� ` c- V C.t Sg redid OV \aw +{� t.G'v:rZ 9 DATE PERMIT ISSUED: L o Mvc ti I't Ate. 3 j- iv\ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No S�S loml J*WX 00'041 4% j `-lsc RUOL, BM W�. y'��F1 W INrl�i.`�vN� �►Kz`3 �O'}�i�3�E7Dtt✓e ct s h-6 ti4X VIA /"1? �vG►-�poi+ �� TOWN OF MMSTABLE LOCATIONO s �\ SEWAGE# VILLAGE ASSESSOR'S &LOT INSTALLER'S NAME&PHONE NO. :LOL14r,..- K—MAE 6e SEPTIC .TANK CAPACITY 9 6- LEACHING FACILITY: (type) .(size) 6 F 6(oGk NO.OF BEDROOMS _ �► BUILDER OR,OWNER PERMTTDATE: COMPLIANCE DATE: Separation"Distance.Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by LS If 1 _ _ . SUBSURFACE SEHAGE DISPOSAL SYSTEM INSPECTI ORM Address of property l,-l`11,)'�i1t.j Owner's name /11 r-: c' c �,t c:' S EP 2 Date of Inspection 1995. T0sr -` - PART A W CHECKLIST 8 ep Check if the following have been done: S Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. '�- As built plans have been obtained and examined.. Note if they are not available with N/A. %, The facility or dwelling was inspected for signs of sewage back—up. The site was inspected for signs of breakout. ., All system components, excluding the SAS, have been located on the site. V_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined base on existing information or approximated. by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance *of SSDS.' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION � FLOW CONDITIONS. If residential _ number of bedrooms number of current residents _ garbage grinder, yes or no, laundry connected to system, yes or no seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: k Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection yes or no if. yes, volume pumped Reason for pumping: Type of system Septic tank/distribution box/soil absorption system 77fL- - ingle cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: Sewage odors detected when arriving at the site, yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK PART 8 • SYSTEM INFORMATION continued SEPTIC TANK:.+ locate on site. plan) ( P ) I depth below grade: material of construction: concrete metal F'RP _other(explain) dimensions: sludge depth distance from top of sludge to bottom of outlet tee or baffle U scum thickness distance from top of scum to top of outlet tee or baffle T-O' distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) DISTRIBUTION BOX: (locate on site plan) depth of liquid level above outlet invert Comments: .(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of ,box, recommendation for repairs, etc.) PUMP CHAMBER: (locate on site plan) pumps in working order,, yes or no Comments:' (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or 'repairs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continua8 SOIL ABSORPTION SYSTEM (SAS) :_I� (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods If not determined to be present, explain: Type. leaching pits and number leaching chambers' and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : number and configuration -- y7�'�''^ ��f col( depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication -of groundwater inflow' (cesspool must be pumped as part of .inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommen ions for maintenance or repairs,etc.) 71 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, recommendations for maintenance or repairs,etc. ) . ; SUBSURFACE SEWAGE DISPOSAL SYSTEM INBPECTION ,FORM PART 8 SYSTEM INFORMATION continued SKETCH OF SEWAGE L:SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' DEPTH TO GROUNDWATER depth to c ccr� i5 el V;iV%, �-�rr� p groundwater � �reL, �� (,,e„��u,,J method of determination or approximation: I , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no,- or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) 14— Backup_ of sewage into facility? Discharge or ponding of effluent to the surface. of the ground or surface waters? Static liquid level in the distribution box above outlet invert? f� Liquid depth in cesspool <6" below invert or available volume< 1/2 d, flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked?structurally unsound? substantial, -infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? 21L within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? t` within . 50 feet .of a bordering vegetated wetland or salt marsh.- (cesspools and privie's only, "o the SAS)? within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? . If the well has been analyzed to be acceptable, attach copy of well water analy .for coliform bacteria, volatile organic. compounds, ammonia nitrogen and nitrate nitrogen. F SUBSURFACE SEWAOE DISPOSAL SYSTEM INSPECTION FORK PART D CERTIFICATION Name of Inspector �,c � J Company •Name Ltn Company Address �q-r ' Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Check . ne: • I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form I have determined that the system fails to protect public health and . the- environment as defined in 310 CMR 15.303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signaturze � � Date Original to system owner Copies to: , �• C` 1 Buyer (if applicable) Approving authority J. Walter J.Peterson 30 d7 lr►dian fIill Rd is —� < Bamstable,;MA 02630 Town of &wnstable. Dept. o% Helath, Safety and Environmental Services 200 Nair,) Street Hy a„.m p , eta 02601 Attn: Mr. Dattd Stanton Health Inspector :'i.L a 0 1.+40.r0`.?. "0 itli�ifl!l1111II11111Itt"Ild"I-.li:l7 III III 111111.1141.$1gill Ill �. �.,% -_� .>� J ��a � ... _ � , � y .. � '� /// �, ti � tt - i 1.tir- 1J , !i � P �j � i � � ii !7 � 1 t i � `( f !±� t M Hay 13 , 2002 He. Title V ubsurrfa.ce Sewage Disposal System Requirements ,30 Indian Hill Road CumTaquid , 19., Town of Barnstable Dept. of Health, Safety and Environmental Services r 200 Main Street HyaAnis , Ma. 02601 ,Attn , Mr. David. W. Stanton, Health Inspector Dear- ,.,4ir. Stanton, This is ;more or less a confirmation of our discussion of April , 16th in which I advised you that f.er a se in the very near future we intend to place our home on the market and : in fact 'already had an offer from a very good friend of ours who will be retiring T from the State' Dept. in Washington , .DX. shortly. With that in mind we of couree 'want to mare sure that WLsewage disposal system will meet the 310 C14R 15,303 requirements and/or if it will be necessary to have a new certification before the closing. Therefore, I wish�'to advise that. back on Sept. 23rd. , 1995 we executed a Purchase and .Sales Agreement with the former' owner, a Mrs. Manya. Coville, which stipu- lated thaton or before Oct. 7th, 1995 the offer was subject to a septic certification at the "Sellers" expense. Enclosed herewith is, a cony of the Certification of the XidCape Septic Co. (Rodger Roberts , owner) "' dated .Sept. 25t� , 1995. approving, the sewage disposal system at 30 Indian Hill Road , Cummaquid .. - S"up7nosedly a copy of this a,prroval was filed with your office back in 1995 however a Mr. Dunning advised me that he could not locate any such' copy . Therefore , you may wish to keep, this copy in the file under either our names or of the address. Having noticed many other oversights and shortcomings with this house made by a Mr. Jack Kelly Inspection Co. This_"compAg.y was recommended by a Via. Cathy McAbee U.M..,the Macabee Real Estate Co. and I r3aid for that.inepection (sa-d to say ) With this in wind I subsequently ha.d the Joseph :Macomber & Bob Co. check out the sewage system. Enclosed is. a copy of ttieir bill for 4503..06 and, as you can see included the cost of raising the covers on the . holding tank and the overflow tank in the rear `yard which controls the septic r removal from the two ba,throogsso that in the future it-would be easier to undercover the concrete covers, r I am also taking the libe-rty of enclosing,' a more recent bill of Arch Sertic System (Wayne Archanbeault) (owner) dated March 12th, 2002 for $200.00 covering the rum out of the front yard holdcflng tank and the rear ya.rd holding tank. Strange as it may seem Mr. Arch.ambeault said that the tanks truly did not need pumping but since I had personally orened the caws I sd6ld for him to do th.e.pumpouts even if h it meant to remove any sludge from the bottom of each pit. (preventive maintenance) . . As I also mentioned in our conversation, I said R that I . was considering another InDspetion by a bona-fide Plass. Inspector° to confirm again that out system would be approved . . , Before doing that however and in view of the various enclosures, I wonder if the Certift4ation of 9- 25-95 by the VlidCape Septic Co. would possibly elimitiate the necessity of having another Insnection If our property sale ibhould culminate within the next few months. I Uamt that there is always the possibility that any prospective purchaser might ask for a new intpection which we would have done at owr expense. I would appreciate your reply and advice and if any additional inf oaika.tion is required , just let us know* Tha`o. you Claire & Walter PE son Billing: 30 Indian Hill Road Barnstable , Via.' 02660 508-375-0729 .Home Address : 30 Indian Hill Road Pummaq,uid ,. Ala. (at onetime known as #6 India:n mill Fed . at whim of previous owner) June 27th, 2002 Re Title V-Subsurf a:ce Sewage Dis,,osta.l System Requirements ; v 1a Indian Hill Road Cummaquid , Ka. (at one time known as #6 Indian Hill .Road by f ormer, owners. Richard and aaya Coville) Town of Barnstable Dept. of, Health, Safety and Environmental Services 200 Plain Street Hyannis , Ma. 02601 Attn : Mr. David W. Sta.nton, •Health Inspector Dear David , Thank you for calling 'back yesterday. As I me4tioned ID Our 004verdatlou I have al,rea.dy spent 760.00 tryibg to locate the '.'overflow". tank In the front yard szeptia system. ( see copies .of A . & B Ca.aco statement that I j j.'u,st received yes- ter, for the 4575.00 and the copy of the COD Inv, of Play 24th, 2002. It Is quite obvious that there never was an over- flow tank connected to the holding tank, It is now further obvious that the overflow went, into a 50' long perforated Orangeburg pipe into a rather large 3eac4ing field: As I had also previously mentioned the± systems .both front and back have servedzus most satisfa.4brily for the six years we have owned this house andi also that the systems had served the only previous owners Richard and Tanya Covil.le since the house was built back in 1965. I have gust recently, learned from Richard. Coville , Jr. that his mother and ,father bought the property five .y ears . bef`ore the house was bu 11t and, the whole front area .of the land was filled in with sand and gravel and the area to the left of house was. also f i fled in with stone f ill: to make the necessary leaching field. .I am sorry that I did not have this information beforehand so I could truly contest the prior Sept. 1995 Title V IpPpection and approval showing the ,s�stem conplsted of tiao hold; tanks and two ovsrf l,ow � sTherfore I an n ies of the map p showing the Oresent front and back. systems and the rarious locations of the caps and the leaching field -in the front yard for tke. Town records acid •for further use by , any- new owners of this property. I guess the complete me.,s- will m°now go to y Attorney ,y , Bob Smith. , Thank you ,o Falter. & Calire �,Petersoh . y A FRONT YAM bE1jT1C lyyb ; - - � 30 Indian Hil Road , Cummaquid , Ra . r The front yard system is for the waters com;ng from the kitchen <` sink , the dishwasher and the washing machne in the cellar only It in n,o way connects with the rear yard system ( see seraate man) The front septic tank has ` an 18" concrete car with metal hook a.nd nowthiz car lays only 6" below grade the wa .ls having been raised t twice sine we bought house in Sept. . 1995. F P(a 93A ILK- owl A i While both the 1141dCane Settics Co. - ( certification done Sert. 25th, 1D95 and by the Jos . Macomber Co. A--ril 1997 contend there is an overflow tank it htis `now been determined : y A .& B Canco Co. that there never was such a tank ( see there bills of May and June 2002 but in actuality. there was and is only a 3 or diameter rerforated orangeburg ^ipe arprox . 57' long going from the holding tank to the lecching field comrrised -of sand and stone Copies of the -, revious maps shaving incorre t locations were given to the Health Dept. " To`.:n of Barnstable but now that we, have definitely determined that there is or never was an over- f low tank in. the front system , cosies will now, oe' given to the Health Dert. for their file. VERY IMOL ORTMENT - carefully note that when the front yard irrigation system was installed one of the lines ran over a portion of the front yard septic bank opening ,so when it may have to be re ;opende in the future make sure that the can is , removed c!=Irefully so the evade will not cut the cr_.rinkler line. W. J Peterson 6-9-2002 REAR YARD SEPTIC 5YbT1Uv► 1;_�,U �• 30 Indian Hill hoed , Cummaquid , Na . Rear yard septic system is for the two bathrooms only Toilets and sinks and tubs. Doe's not connect in any way with the front yard system. Both Sertic and overflow tanksy have 32' concret covers and were built uo in 1997 . and are ar,rox . 8 to 12 inches below level grade . (�� BI�Eck 1 ® Y V ! y�fA7 f4 P66� �� Q��w.►� . RSA Both connecting lines from tank to house , and tank to overlow to"nk rotor rooted in Arril 1997` by JoSerh P . Macomber & Son Inc. in Arri1 1997 ( see their bill r In this file folder. ) . Both tanks were pumred .out In Ar.,ril 1997 . When to King off the, cover of -the" , overflow tank in 1997 , the young man drorr..ed it and it had to be replaced at cost to us of 4,52 .50 which we complained about. We also comrlained a.baut the eoet of the rotor-rooting portion of the job and said we had heard that others were doing the 'rotor-rooting 4 much cheater. . We will think twice when it comes time to .have tanks r..umned" out a.ga in In fact when we lived in Dennis for 17 years we used the Ace Co. (now located on mary Dunn road } ., The father ran the business but it is now oFerate'd by his.; son. Here again this mar, showing -locations of tnake .etc were filed by us in 1997 ygo other record was ever _ found at the Tovan. hell and assume therefore that the former owners , Richard -'and Manya. CovlldL never filed such information . . Walter J . PetErson . 4 k ,350 Main Street West Yarmouth, MA 02673 , INVOICE f3 508 775-2800 Fax 508 778-9628 `ac.+ I I I PAG Terms - COD Complete Plumbing, Heating, FireSprinkler & Septic Pumping & Installation p Residential&Commercial Air Duct Cleaning WMA PETERSON WALTER 30 INDIAN HILL RD 30 INDIAN HILL RD CUMMAQU I D, MA -0:2 6 3 7 CUMMAQU I D :MA 0;2 6 3 7 ORPffTYPE C§ US §2 ic-0 8ERXNo SALES.REP. PURCHASE ORDER NO. M 13PTV02 Cal1TIOKEVA832 ITEM# ITEM/WORK DESCRIPTION EXTENDED PRICE ATTEMPT TO LOCATE LEACHING SYSTEM.` MAY 24TIl WITH LOCATOR. MAY 26TH ATTEMPT TO VIDEO, . HAND DIG. .MAY 30TH CUT DRIVEWAY. MAY 31ST EXCAVATE LEACH FIELD THREE HOURS . PUMP LEACH FIELD. ` *I, LABOR' CHARGES 575 . 00 Plue May 24th, 2002 Charge 0 COD 4185.00 to locate "overflow" tank to front yard eye tem that handles , eff uent. from kitchen si 3g, dishwae4er., and washy ng mach .ne 3n ..cellar enl.y- epee copy of COD Inv. attached) x . Total ooi to date to .try and ,loEa.ve :fro . yard ` 'overflow"tank and. lloe- - 760.00 575 . O,c,, TERMS:ALL INVOICES DUE UPON RECEIPT. SALESAMOUNT FINANCE CHARGE 1 1/2%MONTHLY OR AN A.P.R. OF 18010 ON MISC.CHARGES 0 . 00 BALANCES OWED 30 DAYS FROM INVOICE DATE. FREIGHT 5 7 5 . 0 0:, SALES TAX TOTAL 5 7 5 . 00 Visit us at: www.abcanco.com PAYMENT REC'D Questions or comments: E-Mail:.canco@gis.net BALANCE DUE . THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �CGL�"- IL DATA n M0 MAID STREET . , . . TEL: (508)775-2800 WEST YARMOUTH, MA 02673 .. (800)698-3993 ' t Fax(508)778-9628 Septic Service Mechanical Services Pumping& Installation Heating& Plumbing Duct-Work Cleaning cciffFire Sprinklers TMP T M SEPTIC SERVICES Since 1930 - 24832 SERVICE INFORMATION: �v►�yl # BILLING ACGT #: 13045 WALTER . 1 GOD PETER SON. WALTER `~' WALTER PETERSOPJ 30 '\INDIAN. IiII,L RD., 30 ' INDIAN HILL RD; 1 IUMMAQUID,. M.As 0207 . CUMMAQiJID, MA @:637 CONTACT: WALTER SITE PHONE: 508-375-0729 ' P :O. #: O I W 0 R h R E Q U E S -T E .D RING ARTIE LOC TE OVERFLOW OPEN DATE: 5/22/02 5/23/02 LTD _ . NOT RESPONSIBLE FOR DAIMME TO UNDERGROUND RINKLERS• OR UTILITIES WHEN DIGGING WORK PERFORMED AND EQUIPMENT NEI DF.D/USED t .._, \ .... . .�i IC SVC LABOR..:_ .UMPING%allT .. PuM PING CHG ALLONS PUMPED SEPTIC GREASE l' DI SPOS.AL CHG: ANK SIZE/TYPE/LOCATION - ADDL TNY./P I'1' `I2E/TYPE LEACHING : FIELD GALLEY �., 'PITa HOSE/LOCATE: RAZ'N' CLNG EQUIP: I DRN, CLEANING: ATL. USED: ------_-- _ __-- PRIORTY CHG: _°`l _ t ECH I DAT I TRVL. ( START ) E14D I CHRGD: TIME +e" MATERIALS:OP/11 o 0 _ J i __I �J I SUBTOTAL LESS PYMT. `a AMOUNT DUE:liereby accept the service., performed as satisfactory -and in working order . nt;erest will be chary¢•d at 1 1/2 per month on unpai balances . Btiypx 2greUUF' `V ,o pay all collection cas s . Credit Card' # Type: Emp :OMPLETE INCOMFL. SIGNATURE• -, DATE• ' 23 3 v NAME: d' -£�Tt It=sn :�✓ a. z 'ADDRESS < r CITY �� .}!, `"- 'A:- ✓ '�T ! ./<- /�� _ ,. ZIP 7 / i ORDER,NO� SOLD;B ,CASH COD t CHARGE ON ACCT. MDSE.RETD: PAID OUT QUAN: � '51yDE$Cf?IPTION ,. p; ` •C.i ;y-� ,r t PRICE :AMOUNT . Nt�'n 'c w clwe� {r I ca 06 S 10- i y sY uZ, _ 4 I , £i I 12 I I `15 -x .r c�•�A �.a, 16 UM-A 18 e �,.� •MyN, �..�.,1 .. . I . RECEIVED BY TAX TOTAL y FM 35805 REV. - a t SUBSURFACE. SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D r' CERTIFICATION Name of Inspector� Y -„-� •, ' Company Name ( O C Company pAddress P Y wnr�iPtivt Certification Statement I- certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed -and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and, maAitenance of on-site sewage disposal. systems.` Check ne: . . . I have not found any information which indicates that. the system fails - to adequately protect public -health or •the environment -as defined in *, 31 0 MR 15. 303. Anyp failure criteria not evaluated are.,as -stated in the FAILURE CRITERIA section of this form. I have determined that the`.'system. fails, to protect ,public health and the environment as defiried.` in 310 CMR 15:303. The basis for this determination, is provided `in the FAILURE CRITERIA section of this . form. Inspector's Signature r Date v[ Original to system owner 19 o. (4, Copies to: � too I Buyer (if applicable) Pin 0' Approving authority _ .. ti e r �,sr6: t�L al...� l.''S S.i �:�r• �3.^ .t+�i4' `� = x r k- .e... �x.3c n Kf. ♦ �w e, 3*0. «.n.F .'e P-r #w:1 Y•t'"1 7Y f ;•.,:,.F �'' ,3..,�.. �'F.q,? 34 '3 m'74{ .,'sv 'i �l �"w� 4�br `:� _ s. _ �, `",.�',;;i4 '?a#� s �•` � s'C r-'�. _ S. :! _, [.t., r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA , Indicate yes, no, . or not determined (Y, N or ND) Describe basis of = determination in all instances. , If '°no determined",,,explain why not) Backup_ of sewage into facility? Discharge or ponding of effluent to the surface. of the ground or' surface waters? _ / Static liquid level in the diestribution box `abov . fL qu ' e outlet invert? Liquid depth -in cesspool <6" below invert or available volume< 1/2 -day flow? s a k- Required pumping 4' times or more in the last .year? .� number of times pumpedJLL 3 Septic tank,:is metal? cracked? structurally unsound? substantial .infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS ;cesspool or privy:- below the high groundwater _elevation? w . i4 within 50 feet of a, surface water? within 100 feet of a. surface water supply _,or tributary to aesurface, water supply? i within a Zone I of a. public 'well? •~ f` within 50 feet of a bordering vegetated wetland or salt. marsh- (cesspools and privies only, not the SAS) ? within 50 `feet of 'a private`water supply well? less than 100 feet` but,. greatei' than 50 feet from'a private water supply well with no acceptable water quality analysis? If the well ; has been analyzed. to be acceptable, attach copy .of well water -analy_ , for coliform bacteria, volatile organic compounds, ammonia nitrogen: and nitrate nitrogen. SUBSURFACE SEEPAGE DISPOSAL SYSTEM INSPECTION FORK PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) :_Z (locate on site plan, if possible; excavation .not required, but- may be approximated by non-intrusive methods) If not determined to be present, explain: Type• leaching pits and number leaching chambers and number ' leaching galleries and number leaching trenches, number, length le fields, number, dimensions . overflow cess number t a lomw Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) ECEC SSPOO (locate on site plan) : number and configuration �� -- depth-top of liquid to inlet invert c� depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommend ions for maintenance or repairs,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,• recommendations for maintenance or repairs,etc. ) . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS. , If residential number of bedrooms number of current residents garbage grinder, or no, _ laundry connected o system, yes or no seasonal use, yes or(j!fW- If nonresidential, calculated flow: Water meter readings, if available: !-GS�M1k Last date of occupancy GENERAL INFORMATION Pumping records and source of information: 1 I -c.r System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system 77� Septic tank/distribution box/soil absorption system Ingle cesspool ,� � �► gA,,r- YAMS (:!� Overflow cesspool Privy - Shared system (yes or no) (if" yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: 3j i Jq Sewage odors detected when arriving at the site, yes or no - Cc SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .PORM Address of property cuvN,m)gom- t4p-, Owner's name Date of Inspection W K PART A R► CHECKLIST Check if the following have been done: y Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have .been pumped for at least two deeps 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. As built plans have been obtained and examined.. Note if they are not available with N/A. V/. The facility or dwelling was inspected for signs of sewage back-up. The site .was inspected for signs of breakout. All system components, ,excluding the SAS, have been located on the • site. The septic tan manholes were uncovered, o en , and the interior of P <'!s-�the septic tank was ected for conditio f baffles or tees, material of construction, dimensions, depth of, liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance •of SSDS.• i� a ' G b Lp o" r t IE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions: sludge depth distance from top of sludge to bottom of outlet tee or baffle © scum thickness 5y distance from top of scum to top. of outlet tee or baffle YY'` distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet. invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) Ajo lt�� DISTRIBUTION BOX:, (locate on site plan) depth of liquid level above outlet invert Comments: ,(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments (note condition of pump chamber, condition of pumps and appurtenances, - recommendations for maintenance or repairs,etc. ) - TYPICAL NOTES: _ — X11 1. THE ARCHITECT SHALL NOT BE RESPONSIBLE FOR THE VERIFICATION OF 2X8 WALL FRAM FO E "• CANTILEVERED OVER UNDATION WALL - v THE CONDITION OF ANY EXISTING STRUCTURE,EQUIPMENT OR - ® Q APPLIANCE AS PART OF BASIC SERVICES UNLESS IT IS PART OF ARCHITECTS SCOPE STATED IN THE AGREEMENT AND VERIFICATION IS MADE ONLY BY VISUAL OBSERVATION.IF THE ARCHITECTS DOCUMENTS a rr �� S �.c REQUIRE CHANGES DUE TO CONDITIONS NOT VISUALLY OBSERVABLE /l AT THE TIME OF PREPARATION CIF THESE DOCUMENTS,THE SERVICES ��WP�%I•j�TLu! �•ti WILL BE ADDITIONAL SERVICES. q q B tsm� 2 STRUCNRAL ENGINEER OR ARCHITECT SMALL PERFORM FRAMING INSPECTION '3 TIIERNATRU INSULATED I ,� •3 .3 •-g 7'_ orchitects interior designers builders �f°•'6 WHEN FRAMING IS COMPLETE AND PRIOR TO ENCLOSURE BY INTERIOR FIBERGLASS DOOR W/ I pE I WALL PLASTER BOARD/FINISH. INTEGRATED SIDE U IS in '-7• •-9• e ................_............ ...._...._.... 400 MAIN STREET = 3. CONTRACTOR SHALL SCHEDULE AND PROTECT FROM WEATHER ALL rt ............. ............. CHATHAM EXISTING HOUSE COMPONENTS AND INTERIORS DURING CONSTRUCTION MASSACHUSEIIS,02633 c. AND CONSTRUCT TEMPORARY STRUCTURES/ENCLOSURES AS MAY BE S NECESSARY TO INSURE SUCH PROTECTION. 'c, i i DESK NEVI TEL�608�241-1757 P,•1•,',Y _ EXISTING GARAGE WALLS AREA � HIp.I LIVING ;;�•/ MASTER 4. CONTRACTOR SHALL SITE INSPECT ALL EXISTING VS.PROPOSED 70 BE DEMOLISHED - ',' BULT—INS BEDROOM O1 299 WHRE'S PATH / e. CONDITONS PRIOR TO AND DURING CONSTRUCTION AND NOTIFY ARCHITECT "" ':.%. "ABOVE •,.,,,,•!I a SOUTH 7ARMOUTH. ... OF ANY DESCREPANCIES AND/OR CHANGES THAT MAY BE ENCOUNTERED. STAIR MA$$ACHUSET15.02664 I"""' .._........................... ./� ............ � n 5. CONTRACTOR SHALL CONSTRUCT AND MAINTAIN TEMPORARY WALLS/ - GARAGE �` ,:""�\ •"'••"••••• - i m ........ r tel(508{362-8883 SHORING ETC.TO MAINTAIN/PROTECT EXISTING HOUSE AND STRUCTURAL a - PITCH SI.ABE/\8 PER FT �S I TTI N G -g SHOWER 3• 1608{760-2800 ' INTEGRITY OF EXISTING HOUSE. r` - :. •' - :-' TOWARDS DOORS I fEIRTARCHRECO 6. DRAWINGS CONVEY DESIGN INTENT. WW,W CONTRACTOR SHALL SITE INSPECT/VERIFY ALL EXISTING VS.PROPOSED 3• CONDITIONS PRIOR TO AND DURING CONSTRUCTION AND MAKE ADJUSTMENTS PROVIDE 1 LAYER 5/8' HIGH WALL W/ AS NECESSARY,W/ARCHITECTS APPROVAL,TO ENSURE COMPLIANCE WITH TYPE•X•FlRECODE GWB �.` 'lj TitAN501M WINDOWS ABOVE C O CONNECTIONS W/LIVING SPACE 1. ___________ ___ ao DESIGN INTENT. 1 ,I m ,1 $S 7. DASHED LINES INDICATED EXISTING CONDITIONS TO BE REMOVED/ALTERED. T I Tg g T/E' -I S ... -. c J 8. WHERE AN ITEM IS REFERRED TO IN SINGULAR NUMBER IN THE CONTRACT i _-I _-_- { _,_ :I • AT Rip ii . ONDI 10 ... r.,,.,.. I... DOCUMENTS,PROVIDE AS MANY SUCH ITEMS AS ARE NECESSARY TO COMPLETE I i -- ---- -- ---- ---------THE WORK. •_. _ 4- TRACTOR ARCHITECT'S DRAWINGS DEMONSTRATE DESIGN INTENT. IT IS THE RESPONSIBILITY !!I 20 MIN..DOOR O° 11 O• `�,%'�,.,,, OF THE CONTRACTOR TO COMPLETE THE WORK IN A MANNER THAT ACHIEVES - DESIGN INTENT. i I �. , w )COATS 10.THE CONTRACTOR IS RESPONSIBLE FOR THE PERFORMANCE OF THE WORK IN ACCORDANCE ..I 9070 GARAGE DOOR 1 : - B A •H1WTH THE CONTRACT DOCUMENTS AND SHALL BE EXCLUSIVELY RESPONSIBLE FOR ITS CONSTRUCTION - � � "' WNW ' N D I A N MEANS,METHODS.SEQUENCES,WARRANTIES.AND PROCEDURES,AND FOR CONSTRUCTION SAFETY. - 1-' •i KITCHEN -\� `��'.ENTRY' " H I L L APRON { 1 t mea ` i { IC 0• ® zn 2-T 1 4• DINING O I4 • ,_. _ . or " t a t Y a ry 4 p ' 5,_ . i N C U A U I D m 3'- y 'Lpy�1. .. " 2X8 WALL FRAME. -, -•' y"" T� 00 CANTILEVERED OVER FOUNDATION W 1 f Y- 'S � p F I S 5 4 ,F.. s .,5 1 OM' BEDROOM N x h '. 1- 1 , - PC3RZCH Kan i x „ry1 it t i w + a �t r4 { _ t, ...•....�_.. �r.x•._,_. ,.. ....� .V .,�„ f,[tc..: s�:_ C X ._L.• �-� I IT I �,. •__.- 1-77 1.......... _...._ 0 O ml)Wr.WWrECrS P1C.,NE m..r6 Ab AZEK RAILING - .A�u1r•n m-•�r�rAW theme' a exrmr wwurms nc xo vw+r rsa¢s s�Mi. SQUARE WOOD FRAMED BASE unnm eY Atrr� ' wamAt� - • '-0• W/SPLIT FACED STONI;VENEER - �'vEm'� U OM ITrnWrTI'Aa�al rnN FINISHED WIDTH 1s X16• - 6•-0• I - - SPLIT FACED STONE VENEER PAD EXISTING WALL OUT W/ - //� PROJECT# ON FACE OF FOUNDATION WALL 2X8 FRAMING TO CREATE SECONO v, BLUESTONE STEPS W/STONE RISERS GABLE WALLDATE ISSUED: - - - - _ REVISIONS: PROPOSED FIRST FLOOR PLAN C- ---------------------------------— L -— PERMIT SET - ' - PROGRESS SET _ q _ PRICING SET PROGRESS SET STRUCT. ENG. SET ® OUTLINE OF - WALLS BELOW �StTPEO Aqa Qy,Y EATT •Cl CRICKET - d N0.10730�,•^ - .. ... of REGISTRATION 0 SCALE.- 0 1 2 4 8 UNLESS OTHERWISE NOTED. 8 y SHEET NO. A . 1 TOTAL NUMBER OF SHEETS IN SET: PROPOSED ROOF FRAMING PLAN 4THIS SHEET INVALID SCALE, 3/16•_1'-0• P R O P O S E D ROOF PLAN UNLESS ACCOMPANIED BY A COMPLETE SET OF SCALE:3/16• 1'-0' WORKING DRAWINGS I 5•_ t archi is TYPICAL NOTES:1. THE ARCHITECT SHALL NOT BE RESPONSIBLE FOR THE VERIFICATION OFTHE CONDITION OF ANY EXISTING STRUCTURE,EQUIPMENT OR ___---------------------- ----------------------- r orchilects inleriordesigners builders APPUANCE AS PART OF BASIC SERVICES UNLESS IT IS PART OF - - 1 I ' ARCHITECTS SCOPE STATED IN THE AGREEMENT AND VERIFICATION IS ______________________ _____________________ I 9 400 MAIN STREET MADE ONLY BY VISUAL OBSERVATION.IF THE ARCHITECTS DOCUMENTS A I A REQUIRE CHANGES DUE TO CONDITIONS NOT VISUALLY OBSERVABLE 3 I 3 .3 CHATHAM SERVICES AT THE TIME OF PREPARATION OF THESE DOCUMENTS,THE ! i - - MASSACHUSETTS,02633 WALL BE ADDITIONAL SERVICES. I 1O TEL(508(241-•1757 DRILL de GROUT I5 BRS O I 1 2. STRUCTURAL ENGINEER OR ARCHITECT SHALL PERFORM FRAMING INSPECTICIN 12 O.C.VERTICAL IN 70 299 WHARFS BATH WHEN FRAMING IS COMPLETE AND PRIOR TO ENCLOSURE BY INTERIOR EXISTING WALLS PRIOR WALL PLASTER BOARD/ETNISH. POUR TO TIE NEW WALLSSOUTH YARMOUTH, TO EXISTING.TYPI. MASSACHUSETTS,02664 3. CONTRACTOR SHALL SCHEDULE AND PROTECT FROM WEATHER ALLEXISTING _ tel 508 362-8883 AND CONSTRUCT COMPONENTS STRUC AND ITURE50/ENCLOSURESRS DURING OAS MAY BE I I NECESSARY TO INSURE SUCH PROTECTION. I508(760-2600 4. CONTRACTOR SHALL SITE INSPECT ALL EXISTING VS.PROPOSED GARAGE fax(508)760-58DO CONDITIONS PRIOR TO AND DURING CONSTRUCTION AND NOTIFY ARCHITECT I WWW,ERTARCHITECTS.COM OF ANY DESCREPANOES AND/OR CHANGES THAT MAY BE ENCOUNTERED. BACKFlLL W/CLEAR •I COMPACTED FILL FURN S. CONTRACTOR SHALL CONSTRUCT AND MAINTAIN TEMPORARY WALLS/ PITCH TO 1/8'PER FOOT CONTRACTOR SHALL TAKE CARE �p^E��OCE�C SHORING ETC. XI TINGMAINTAIN/PROTECT EXISTING HOUSE AND STRUCTURAL - TOWARDS DOORS NOT TO UNDERMINE STRUCTURAL (S,C_N�,JuS' �CrN4•JJ INTEGRITY OF EXISTING HOUSE. INTEGRITY OF EXISTING FOUNDATION -S. DRAWINGS CONVEY DESIGN INTENT. DURING EXCAVATION A CONTRACTOR SHALL SITE INSPECT/VERIFY ALL EXISTING VS.PROPOSED A DROP TOP OF WALL TO - CONOIT10 S PRIOR TO AND DURING CONSTRUCTION AND MAKE ADJUSTMENTS WITHIN 8'ABOVE FINISHED GRADE - AS NECESSARY,W/ARCHITECTS APPROVAL,TO ENSURE COMPLIANCE WITH I I DROP TOP OF WALL - - DESIGN INTENT. 12'AT DOOR OPENINGS - - .- - - 130 7. DASHED LINES INDICATED EXISTING CONDITIONS TO BE REMOVED/ALTERED. I - ——0 ———————0——————--0——-- ——-0————————0————————0——————— - 8. WHERE AN ITEM IS REFERRED TO IN SINGULAR NUMBER IN THE CONTRACT 2 ^ I N D I A N DOCUMENTS,PROVIDE AS MANY SUCH.ITEMS AS ARE NECESSARY TO COMPLETE- 0 - - ' ` THE WORK. - S. ARCHITECTS DRAWINGS DEMONSTRATE DESIGN INTENT. IT IS THE RESPOSTBIUTY - I - HILL ACHIEVES OF THE CONTRACTOR TO COMPLETE THE WORK IN A MANNER THAT ACHIEVES -----I--_----- ---------------- - - DESIGN INTENT. O 10.THE CONTRACTOR IS RESPONSIBLE FOR THE PERFORMANCE OF THE WORK IN ACCORDANCE NEW GARAGE WALL AT THIS SIDE OF DOOR - WITH THE CONTRACT DOCUMENTS AND SHALL BE EXCLUSIVELY RESPONSIBLE FOR ITS CONSTRUCTION _ TO BE AT PORCH WALL HEIGHT ^I /•1 MEANS,METHODS,SEQUENCES,WARRANTIES,AND PROCEDURES,AND FOR CONSTRUCTION SAFETY. CU M MAAQU I D OIL ELEC UCJ NEW PORCH ^I WASTE l V Tl,fg nim us nm ro ee uan PORCH FINISH MATERIAL SHALL • Frn rFmu as avrsmurnaN ri•angs ula—w srwpm s Roim BE HEIGHT TOTO ALLOW NEWSPORCH TOPWALL BE FLUSH - I\ a wµin a�•�iue u nr��Fn W/EXISTING INTERIOR.FLOOR As•rrmuT—OR•wrlsTRucmaN gt•. C O OF FART AR.s. rrC T1E oRAwBGs Arm L__----________________________________________ _ - w1A ��'nmwa�iFRTs. ;wto ' _ _ ___ _____________________________ ______ _______.____ •: - OR � *PMTTRTR-S�m1A'lry T m una—BY MY FFRSO4 F .m ca Om . DRILL h GROUT IS BRS O ______ Q __ _ 4 �Tm�T�� 12 O.C..VERTICAL IN TO I. ' EXISTING WALLS PRIOR TO LLJ POUR TO TIE NEW WALLS PROJECT TO EXISTING.TYPI. .. .. _ ,n v, DATE ISSUED: REVISIONS: ', I PERMIT SET �J•J PROGRESS SET .. PRICING SET, PROGRESS SET " STRUCT. ENG. SET 6 MIL POLY •,..u°°aa ry us w.'x' UNTIL CONC00 NOT RETE HAS IFILL ALL TYPICAL WALL NOTES I VAPOR RETARDER • - m.'m RmR ATTAINED 7 DAY STRENGTH AND BOTH TOP h BOTTOM 6'.COMPACTED FILL COORD.DIM.W/ OF WALL ARE PROPERLY 1111E1�111 d4•"OEpTir�,. 5/8'DAM.12'GALV.ANCHOR— l-' `\ 20 5 REBR l DOOR LOCATION SECURED. BOLT 0 4'-0'O.C. ,` 1 6'APRON.THICKEN TO e' I �J! W O DOOR OPENING 1 GARAGE DOOR a $No.in730 4 I f 8'POURED CONC.WALL 6'COMPACTED FILL 081.2X6 P.T.SILL— 4-CONC.SLR i 1 1 2'X1 1 2'%1 4' ,lf A Y I.,rt / / I/ f u 1 6 NIL POLY o SILL SEALER— N.T.S. I GALV.ANGLE W J/4 20R5 CONTINUOUS BARS TOP 8 jlf((I.plllll III < VAPOR RETARDER - -.I I i ANCHORS O 3'_O BOY.AND AROUND ALL OPENINGS d s' l i O.C.MAX. ,IIfI r'M OF. t F.O.F. I 1Nt Q, I FINISH//((##FF2TADE: FILL Aj TAMP N Y l CARRY DAMPROOFING 0(rolllllli Irt FF I-OUNDATION SLOPE,5 AROUND m 'l I F�OTNGOP OF I[11 19h�$1111 n . REGISTRATION III III7 nit`III p O 4 CONC ,SLAB III Illf Ir'9;1 O II _ S-• el Pllrl llrll!Illk ill lrlll II'Illul rf Iu II it. IL(II - n:url 11[ II '- ' y 2x4 KEYWAr ---- -- - - Il,lla IIItiI It... }II _ AI {I[!IIJ{JI +! II,I SCALE:1/4"-1'-0' dl(I AI{ Ik!ll j f Ok{{ III{ II UI i0f+ll t k u-y o 2x4 KEYWAY '• d i all[of lu.:rl!,:.ul I:I[:. !(I III Ill ll r::{ut III Illt a ilµ;> fk I(I 11( I 7u 9! 311 II ue-�lll::. b L'll 14 ;( t,d tl{I,li I lr{II a .pr;o! Ir p1•aqf Illy;P IP ;: 30/5 REBRS,CONT. ' O I r 0 1 2 4 6 . 1 111 ! {I IG a i..� Uhfk II II ,u!•<71!I !UI Jllf !I nIL;r11,. {ul:a!17 llll{94 111-,p III Ink luliul .; IPI !>.`(!II IIII Itln{Ilk-.II,I. Jnqu t1 ul 511j1,ln.,tlll,,II tl(I OIO p Ip:r IIIt nI IlI IL,kSq!ii: to c _allt alll lA a ,I l n II 1u ukh ]!il n IIG 14t x10 UNLESS OTHERWISE NOTED. R9 1 `II t I n1 t 1Iry 1 ell.,kJ a{I1 Iou,-:lrI JIC--:1,t,!j n.Ir:ti.If_;,I.t�-;I,n.;,f1:y•.0...i.:..!.:{_.. it....I.Ir-.n_,�:.i...- .I.I .I..::3.;,:I:I:fL-:FIDI.i 1.n:.:I::,:J9..l.I`:.I nI.IIIl[di.!t.l k{IIfu_t�..{.LI.IIt f.r:_l_n:l 1.I,.I In._I,.,i,.l..l,,-u,!n.I":,'bn,'. :6I{IIL1 1.1 11.C1 IOOk.M1:1.„a,IPlsc.I,'I...-I t'{_IFI:I,:IL:IfLL,,;I LO,I[U!.,II�E[I k-.I,L t!--:_l..r d.:a.1a.I_=..a.r 1_:1:[.,<L lI Il I...I.1{11.1r:.i.nn.....f.Iuti,,:.,.ll.11-Ita.I.�.t.;1lL:,t,rI.xn.s..t 4 i1 ru..fr dn:,I,i,a.,lulll!n.'I".Ih:I.I-.Ll:-u,i..I;!--I.t-U•:I-::.-..... .......-.,....:....-:.........:. lI�kq l IIS!It�IIa tI 1--A:L:-n.f,n..;.•-_�1_9If�f1.•11L:,.I e,nafi{;.:I_:z!I:Etv a,I;.l.-,I,. - IN..DO.F 48 OTINGNCM2X4 KEYWAY ,u NANTA 30/5 CONT.B FOOTING O ' AI:3-JILI-t,r1_-_u1"l1.l.,I:-!.I..1l-IlI.I6l:."Tk�{.II,..la't:l,:f;I::..-.{,l.t,::1::I!..lI.I.:.k',I IlIIt.tf4i'.-,u11'tII-.�[n ll I--I.lkdII.1-.,1u�U.l1a�.1..'1:l-�0fl a,a-s...nl!::.I.I.:::1l a]1--:.:Il.l;;:I1iyS;:!I l'.lI 1lI k:IUID I-I-.{,-iult,7r:...nI-I.II--,k5 I1.1(I.I,1IC41I 11I(1I:,.1k!I l_1'u6.k.:I:,,I.:.....�''•{I.!:I.u._lf:1k':e 1I:.�1 aIIII I.:1-I...�-I I.�.----_-:ktI,rI..,..+..I..I.l l Ik yk{i{..lI!�Irf:(.Cru.Ll.:.I:I,Il.If..{I,:.;:�l-In.;I.l:ikht{.:;.:.:O.I.:.f I la kt.al.'fr,IL.-II.I-I,a:i,,L--I.t..lIl-I l.:.-!In_.OL,L',t..1lII:1_I.k.tt.1l:l: .SF LL1p1 1..1.. 1lI.1 SHE ET NO. UF FOOTI70 BE BO O UNDSED L aW I O4 GRADE N T.BS OI A . O M VI MINIMU ELE le ., Iii I(I III} al III tlt i[I It dl II II .I Illk 14 UI 1I(I III a +G(!!F Y 6 6' . =Ilt{I[Illln lllfllill I.__u1 O Illr a�I {i IcIIL{I�I o01 IIr 1n-O Ilu Sq;p Ipf III tl1;:11, I TOTAL NUMBER OF SHEETS 1 IN SET: ,III, B Illilu111 e'UV�lu.l,,ui 6 ,IlPllligylltwl11iIIIIIIut,IlTii.rdllJ _ - -I•�-'Ifl.API alik,auE:,� - O GARAGE SILL DETAIL O GARAGE APRON DETAIL O TYPICAL FOUNDATION DETAIL THIS SHEET INVALID UNLESS ACCOMPANIED BY SOME i-1/x•-1'-p SONE 1-1/z'-1'-a- ��1-V�•-t'-0• A COMPLETE SET OF WORKING DRAWINGS LEGEND N k - LOCUS -- 98 -- EXISTING CONTOUR ' 48 J x 100.98 EXISTING SPOT GRADE ��`Ra Ho11y Ln o � C) S 86*44 20 W 1i a,°n N 0 107 EXISTING CONTOUR Vn% u, oCD C� 102.84 W EXISTING WATER SERVICE c s 7 e•H• � OVERHEAD WIRES °se Ln °o $ r� •'• r, 0 stonewall 100.00 _ a 100.39 �� . . . . . . . . 1d2:67 •+ 10 502:08 TEST PIT o ` s o #•101,52' _ + 02.28 �- BENCHMARK Route SA \� •1-00.04 edge of law. . .. • ' n o Y m (m 99:1�q `douse 100.59 + 01.71,\� a Q x CE L I �x \ 98,93 1' + . SHRUBS' SHRUBS'. (L T 5) \�� {EXISTING CESSPOOL LOCUS MAP APN 36-009 TO BE PUMPED, FILLED w/ / 100.45 ' - NOT TO SCALE lip 1 • 98--"-� � 12 050 S.F.f � wi SAND.AND ABANDONED DECK n Z GENERAL NOTES: 1 ' 1OL96 ci 4A. `D STP 1O1J1• • m Z 1 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL do 1 02:23 CONC. BOARD OF HEALTH AND THE DESIGN ENGINEER. ' 1 PATIO H RUBS O j �i 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 4� Cn �' LOCAL RULES AND REGULATIONS. ' rn o -310 CMR 15.405(1)(b): ' Ij GARAGE EXISTING s 1) A 3' variance, septic tank to cellar wall, for a 7' setback. HOUSEWO) `L ', 2) A 9' variance S.A.S. to crawl space, for on 11' setback. 100:15 _ T.O.F.=102.46t 0 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR fence (FULL CELLAR) 01 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE L DESIGN ENGINEER. 95.47 IM o 101.07 +`r x I 11M , 101A8 L' 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 100 I 101,10 PORCH I"' INSTALL 40 MILL POLY LINER FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN I STP 101:90 (CRAWL SPACE) r, TOP OF LINER, EL.=97.5 ENGINEER BEFORE CONSTRUCTION CONTINUES: / I (/) 101,47 10 :04 . 1` BOTTOM OF LINER, EL.=95.0 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. PAVED / 101,01 v 100, s 99.76 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 96,58 DRIVEWAY yY 101r42SHRUBS� f THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF x 11LID � 19 °IK '' 1Q0:3 HEALTH FOR '-PROPER INSPECTIONS DURING CONSTRUCTION. cn 1 PROPOSED 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. �� 1 r TP-3r-� Te�2 _ SEPTIC TANK 8. THERE ARE NO ACTIVE WELLS WITHIN 150' OF THE PROPOSED S.A.S. LI P 10+ J___ Lu--! 12' f; OLD LOT LINE 9. ALL AREAS- CLEARED, FOR .CONSTRUCTION SHALL. BE RESTORED AS 1� �"- OP SE_ _t- �_ TP-1� AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 3� �4 �_P� -� Jam. x 9 .85 to L J ;2, �� C ^i'r DIRECTED BY THE APPROVING .AUTHORITIES. r �X _f 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY x99` 99:27 _ 98 22 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 99.51 100 08 -A �(•W7-- CONSTRUCTION. / 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS N O.H. �� ' IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 9 JSSV/ <96:18 �� 'OF 44s�9� REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). A 2 9;2$ • AR BS Povernent P� yG 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE •H:W p. . . . . • of o PETER T. INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. UP edge g � McENTEE _._, 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND - o - 98:80 D v CIVIL- IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. R 0 A No. 35 109 99.35 H ILL �o PROPOSED SEPTIC SYSTEM UPGRADE PLAN. 99,64 STRIPOUT A��F �'£GISTER ��" SEE NOTE 11 FSSIONAL ENG\ 30 INDIAN HILL ROAD, BARNSTABLE, MA Benchmark No. 2 IN[)IAN Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632 • 99.63 OUTSIDE CORNER/BOTT STEP PK SET Engineering by: SCALE DRAWN JOB. N0. EL.=101.47 (Assumed datum) OWNER OF RECORD Engineering Works, Inc. 1"=20' P.T.M. 101-11 PETERSON, WALTER J & CLAIRE 30 INDIAN HILL ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. BARNSTABLE, MA 02630 (508) 477-5313 1/19/11 P.T.M. 1 of 2 i 4 ` NOTE: TO PREVENT BREAKOUT, THE PROPOSED EXISTING FINISH GRADE SHALL NOT BE < -EL.97.3 SEPTIC TANK PROPOSED D-BOX FOR A DISTANCE OF 15' AROUND THE HOUSE(#30) PERIMETER OF THE S.A.S. T.O.F.=102.46* PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT j OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL INSPECTION PORT OVER END UNIT T.O.F. PORCH EXISTING F.G. 00.3(MAX.) /- F.G. EL.=100.Ot F.G. EL: 102.Of I, f f MAINTAIN 2% GRADE (MIN.) OVER S.A.S. eu- L = 7' MAX INSPECTION �' Dc� �9 ® SL 1% (MIN.) SL N PORT 1% (MIN.) ® S=1%((MI .) r(, � 4CV "SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC CI5 t0"I ' • � 14„ , 6" 10.75" TO INV.=97.50 48" LIQUID INVERT LEVEL ADD INV.=97.14 PROPOSED INV.=96.97 I �31.2I GAS BAFFLE (3 ROWS OF 6 UNITS AT 5.0'/UNIT) + 1.2' (1 COUPLER) = 31.2' INV.=97.25D-BO� J SOIL ABSORPTION SYSTEM (PROFILE) INV.=96.90 � PROPOSED SEPTIC TANK j S.A.S.L.AYOUT PROVIDE NEW SEWER OUTLET FROM HOUSE ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR AT, OR ABOVE, INV.=97.65. MODIFY INTERIOR 16" PERC SAND TO TOP OF CHAMBERS 2" TYP. PLUMBING AS REQUIRED. BREAKOUT=TOP 1-4" POLYSEAL INLETS NOTES: TOP ELEV.=97.33 3-4" POLYSEAL OUTLETS . ..... INV. ELEV.=96.90 > s' 12" 1) CONTRACTOR SHALL VERIFY ALL EXISTING-PIPE •• `- ; INVERTS, PRIOR TO INSTALLATION. _ " g" 8" BOTTOM ELEV. 96.00 - - 1 2 SEPTIC TANK AND D-BOX SHALL BE SET LEVEL AND � MN ABOVE BOTTOM 0 2.83' 15.5 I F N TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX 5 0 I�- T.P. EXCAVATION OR G.W. - RATED H-10 2" EFFECTIVE WIDTH-8.5' INCH CRUSHED STONE BASE, AS SPECIFIED IN E E VE .22 1O 310 CMR 15.221(2). . j EXISTING SUITABLE DISTRIBUTION BOX 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W., EL=85.3 4 MATERIAL 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE USE 3 ROWS OF 6-ADS Arc "'36HC UNITS'`+ 1 COUPLER PER s3.25'= AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION 16" _ N.T.S. 34.5" - DESIGN CRITERIA . SOIL;; LOG LLJ DATE: JANUARY 18 2011 (REF#13,172) NUMBER OF BEDROOMS: 2 BEDROOMS SOIL EVALUATOR: PETER McENTEE (SE#1542) WITNESS: DAVID' STANTON R.S. HEALTH AGENT TOP VIEW SOIL TEXTURAL CLASS: CLASS I ! 60�• DESIGN PERCOLATION RATE: <2 MIN IN ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH ELEV. TP-3 DEPTH END CAP / END CAP ;l " " " FRONT VIEW I VIEW 0 0 0 SIDE E R 100.0 100.0 10 . DAILY FLOW: 220 G.P.D. A SANDY LOAM A SANDY LOAM 0 3 A I SANDY LOAM END CAP 10YR 4 2 - 1OYR 4 2 10YR 4 2 DESIGN FLOW: 330 G.P.D. 99.3 / 8" 99.3 / 8" 99 6 / 8" REAR/TOP VIEW GARBAGE GRINDER: NO B e B SANDY LOAM SANDY LOAM NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE WI VIEW , SANDY LOAM TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY II LEACHING AREA REQUIRED: (330) = 445.9 S.F. 10YR 5/6 10YR 5/6 10YR 5/6 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 97.3 32" 97.3 32" 97.6 32" 74 C1 C1 II C1 4640 TRUEMAN BLVD SILT e HILL ARD, OHIo 43026. Arc 36HC' DETAIL ak PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY LOAM sILT LOAM 10YR 5/3 10YR 5/3-.. ADVANCED DRAINAGE SYSTEMS.INC. PROPOSED D-BOX:: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED • SILT LOAM 90.0 120" 89.3 132" PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 3 ROWS OF 6-ADS Arc 36HC UNITS + 1 COUPLER PER 10YR 5/3 c2 °� c2 ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE MED.•SAND M-C SAND 30 INDIAN HILL ROAD, BARNSTABLE, MA BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) 2.5Y� 6/4 2.5Y 6/4 Prepared for: Capewide Enterprises, P.O. BOX 763, Centerville, MA 02632 Arc36HC Units) 18 UNITS x 5.0 LF x 4.80 SF/LF = 432.0 SF (SAMPLED) Engineering by: SCALE DRAWN JOB. N0. (COUPLERS) 3 COUPLERS x 1.2' x 4.80 SF/LF = 17.3 SF 86.0 168" 86.0 168" 85.3 180° Engineering Works, Inc. NTS P.T.M. 101-11 TOTAL AREA = 449.3 SF SIEVE ANALYSIS RESULTS:"CLASS I SOILS 0.74 LTAR 12 West Crossfield Road, Forestdale, MA 02644 DATE PERC RATE <2 MIN/IN. ("C" HORIZON) CHECKED SHEET NO. 0.74(449.3 S.F.) = 332.5 G.P.D. NO GROUNDWATER OBSERVED (508) 477-5313 1/19/11 P.T.M. 2 Of 2 fif REVISIONS: N0. DATE DESC. LOCUS INFORMATION 1 r ^ LOCUS �I` 1. 6/2/2017 N.H.E.S.P AREA N 2. 9/7/2017 REVISE ADDRION CURRENT OWNER: FRANCIS A. FACCHETTI,JR. OVERLAY DISTRICT' AP/O.K.H. \ L INDIAN a ANNE M. FACCHErn HILL RD. — = W TITLE REFERENCE: DEED BOOK 30375,PAGE 155 NITROGEN SENSITIVE. < z — ZONE NOT A ZONE II i � PLAN REFERENCE: PLAN BOOK 134/55 h 147/107 FEMA FLOOD r 1p .� ASSESSORS MAP: 336 ZONE DISTRICT. P ELL#25 TED1CO558 J .I 1 I BA J — PARCEL 009 MINIMUM LOT SIZE: 43,5603 S.F. 1 - \ ZONING DISTRICT: RF-1 SETBACKS: FROM ' EXI EXISTING LOT SIZE 12,0143 S.F. s SIDE 15STING BUILDING COVERAGE 15' REAR 15 (DWEWNC/PORCH/STOOP/DECK) 2,539f S.F. (21.1,5) ' PROPOSED BUILDING COVERAGE: _ LOCUS MAP I CERTIFY TO THE BEST OF MY (DWEWNG/PORCH/STOOP/DECK) 3,144f S.F. (26.25) [ ) ( _ _ A, �p .�� NOT TO SCALE PROFESSIONAL KNOWLEDGE, INFORMATION BELIEF THAT THE LOT,CORNERS, DIMENSIONS AND SETBACKS TO THE STRUCTURE AS DETERMINED BY INSTRUMENT SURVEY AND AS SHOWN ON THIS PLAN ARE CORRECT. . N88'4,V202 100.00' STONE WALL. 4 8> FIELD . N.38039 CONcjzvr BOUND FOUND L O l 5 11027 ,� i OFF UNE �TI•vA° x 101.6 17,0143SF. 102.3. • % 00.1 UNITS OF N.H.E.S.P. AREA. -- 9/7/17 PRCnSSIONAL LAND SURVEYOR DATE 100.6 x 102 %98.9 100.5 CERTIFIED PROPOSED PROPOSED PLOT PLAN '... EXISTING DECK PATIO DECK TO BE 103 WITH REPLACED e ty t °LKH 13.5 I PROPOSED - BULKHEAD e ADDITION PROPOSED GARAGE EXTENSION 71' AT fi F a' SAGE ISO J0 1 If INDIAN HILLH,-„ SLAB-101.4 RQ ROAD (TO BE REBUILT) EXISTING o BULKHEAD INDIAN HILL ROAD 8JJ'x6.JJ' TD�IOzs OF IN k FF 70.16 _ • BARNSTABLE INDI MASSACHUSETTS ROAD 85.5% PORcH (BARNSTABLE COUNTY) bC'1150.8 13sW X 99.8 EXISTING BITUMINOUS MAY 18, 2017 I.,. I I.. DRIVEWAY ...I W APPROX.LOCA71ON 98.8 X I.,. ...I Ell PROPOSED 4' ', gpTIC$ISTEMGG _ ____- PORCH EXTENSION __--_ a PREPARED FOR: 99.9 i I _ L: FRANK FACCHETTI OF DISCONTINUANCE CONCRETE CARVER STREET, UNIT 102 PLYMOUTH, MA 02360 \:Y 99.8 :. i // I BOUND FOUND 508 591 7580 Guy 'L� � frankfacchetti®comcast.net WIRE 979-4a621371 ADD RCC Rl/�, BENCHMARK �.; _ - IMTH95.7 DID( BOUND -�� 89.4:)♦ ' KITH DISK FOUND d HELD.E1EY-99.3 %� I.• ':I A _-_-_-_I��__a1.�-' � 97'1 349 Route 28,Unit D I' West Yarmouth, Massachusetts 02673 R _ 508 778 8919 INDIWlDA•'g5/��LL EtAyOUr OAS ---___-__- ©2017 Th.BSC G-P,Inc. PpgLIG- r SCALE 1'- 10' o 1.2.9 2.5 5 vvoe _ o 5 10 20 r¢r PROJ. MGR.: CRAIG FIELD FIELD: C. ARNOLD _ CALC./DESIGN: K. HEALY DRAWN: K. HEALY CHECK: CRAIG FIELD FILE 50117-CPP-2.DWG DWG. NO: 6448-02 JOB. NO: 50117-00 SHEET 1 OF 1 L