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0022 FINGER LANE - Health
L'07sfe inger`bLane>P 04800 n f i r e p �i 379— I 161 10111— 7'2 - 7'11- �,•� 2 f1r, 1-7 d 2 Concrete Foundation With 2 Change to Egress Window Wall Above(Existing) 7rl - -- � 2x4 KneeElec Panel&Water Meter N Wall Framing wl 5'-0"Bi-Fold Door T R-13 Kraft Faced 2x4 Framing Insulation. I w/R-13 Kraft Faced r• Insulation.. Pro used Liven Area Concrete Block Wall(Existing)/ f L ^ 2x4 Knee L1 �/( t 1 �/ �.v U or, 3'-0"Door(Existing) Wall r 1 � Framing w/ 3-2x8 Beam(Existing) R-13 Kraft Insulation.skulladtion. Existing rn (- — _ i I 3'-O"LH Door,Swing into utili Y M N z 2x4 Wall(New) — N ao tD s CD 04 a Utility Roorn,(Existing Area) Concrete Foundation With 2x4 Wall Above(Existing) N - <O CH V� i 411 _ 919 18'1 32'9 Daly Floor Plan ,r 'Right Side of louse (old Mill) 1/2"Sheetrock. 2x4(existing) -..� 2x8(Existing) TE3/2x8 (Existing) 4"Lally Column ° (Existing) �` Change Existing Window To Meet Egress(Casement Winow Replacement) ' 6'-3 6-10 V2" 41 3/4" 44" -- Concrete(Existing) 3/4 T&G 4 Mil.Poly — 2x4(New) sure Treated on Front of House (Finger Lary o.c.,w/1"Pink . ----_.___ _ and Between Daly Cross Section Basement �;k Above 1/2 Wall Above 1/2 Wall TV - - I Electric Baseboard Heat wP , 100 amp Entrance 0 ve 1/2 Wall- -Recess Lighting � f Baseboard Heat-, Up \ / 1 1 sow uc� so Top Of Stairs ( "d3.uiz Fix-Nn Electrical Plan t l� a 6 0c) k r Add Dishwasher — - Change Kitchen Cabinets to Sam , as Current rom Basem nt l ADD CcuKYMRror y Remove Top 1/2 of wall.[Truss Old Mill Rc Roof Framing Above e Finger. Lar en AndWall Chan es� aly ditch . 100" 30" 30" 1" V 9" 36„ 6" 24' 121. 3 3 30" ' r, 221"' �14A" m W1236 W3018 W3036 Cq CM M 0 GAS i2ANGE_ 830 2FWT I N m � ------- -----' OD 0 N SS Home Depot is not installing theses cabinets.Customer takes 100% O ' respong ility for proper Install. l0 ➢ A Oy Y � J � N N N V :i N N m ', .` 0 CO b ID d (a N - j _ _____ ________ _ r� X m WD GAS RANGE B30 2F1MT r N M �. -,WS2436RWD1236R W3018 W3036� 22, 21 36" 3 30" 24" 14 es� 9" 38 s' 24" 12" 30" 30" All dimensions_size desi a' ns This is an original design and must Designed: 1/6/2009 given are subject to verification on not be released or copied unless Printed:1/6/2009 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. s� cl40df62.kit All Drawing#: 1 M1 • � 0 -10 C ®® F-1 (Dm o } F Note:This drawing is an artistic Designed: 1/6/2009 interpretation of the general Printed:1/6/2009 appearance of the design.It is not meant to be an exact rendition. cI40df62.kit All Drawing#- 1 El Note:This drawing is an artistic Designed: 1/6/2009 interpretation ofthe general Printed: 1/6/2009 appearance of the design.It is not meant to be an exact rendition. cl40df62.kit All Drawing#: 1 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: ,2A/40 Finger Lane Osterville,MA 02655 Owner's Name: Andre Lebel Owner's Address: 143 Shire Road Leominster,AM.01453 Date of Inspection: April 6, 2007 Name of Inspector:(Please Print)James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 OsteryXe,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system,at this address and that the information reported below is true,accurate and complete as;of the time of the inspection, The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP , approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syst1gm: - c ✓ 'Passes .: Conditionally Passes m- Needs Further Evaluation by.the Local Approving ku4iority co 5 Fail Inspector's Signature: Date: A ri18 200 N The system inspector shall sub a copy of this inspection report to the Approving Authority(13oar of Heal;;or DEP)within 30 days of completing this inspection. If the system is a shared system or has'a design w of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that . time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 4 Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20140 Finger Lane Osterville,MA Owner: Andre Lebel Date of Inspection: April 6, 2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20140 Finger Lane Osterville,M,4 Owner: Andre Lebel Date of Inspection: April 6. 2007, Y C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a.Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a.DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20140 Finger Lane Osterville,AM Owner: Andre Lebel Date of Inspection: April 6,2007 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in�cesspool is less than 6"below invert or available volume is less than'h day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from'a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is,equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone H of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 20140 Finger Lane Osterville,MA Owner: Andre Lebel Date of Inspection: April 6. 2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on-the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on Yes No ✓ — Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CNM 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20140 Finger Lane Osterville,MA Owner: Andre Lebel Date of Inspection: April 6,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 ' DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currendy occupied COMMERCIALM41DUSTRIXL Type'of establishment: Design flow(based on 310 CMR 15.203): god Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped on April 6,2007 Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology: Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: . March 16101-per as built card Were sewage odors detected when arriving at the site(yes or no): No . 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20140 Finger Lane Osterville.MA Owner: Andre Lebel Date of Inspection: April 6.2007 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) ) Depth below grade: Approx. 3' Material of construction: ✓ concrete metal _fiberglass _,polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 al. Sludge depth: 2„ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 7" 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: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. There did not appear to be any signs of leakage The tank was pumped after the insyection GREASE TRAP: None (locate on site'Ian) Depth below grade: Material of construction: _concrete:_metal _fiberglass polyethylene _other (explain): Dimensions Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 f Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20140 Finger Lane Osterville,MA Owner: Andre Lebel Date of Inspection: April 6,2007 TIGHT or HOLDING TANK: None (tank must be pumped at time'of inspection)(locate on site plan). Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: --lions 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: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. There were no signs ofsolids There did not appear to be any signs offailure PUMP CHAMBER: None,(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20140 Finger Lane Osterville,MA Owner: Andre Lebel Date of Inspection: April 6, 2007 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,dimensions: 21'x 42' overflow cesspool,number: 1 Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): There did not appear lobe anv signs offailure A video camera was used for the inspection The bottom to grade was 4.5. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool:. Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan). Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20140 Finger Lane Osterville,MA Owner: Andre Lebel Date of Inspection: April6.;2007 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 buildinglk dM � 12 10 f Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20140 Finger Lane Osterville.MA Owner: Andre Lebel Date of Inspection: April 6,2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain:_ topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the mans were showing approximately 15'+% -around water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection- This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 c E R FJ 1. UNITED STATES POSTAL SER o M �G sta e 29 SEP6-4A---•- ., I • Sender: Please print your name, address, and ZIP+4 in this box • Public Haft OWN Town of BwnsWft 200 Main$t Hyannis,.Massachusetts 02601 I I i i i I�It2!!lSl�i��i-iS�lI1!lil�{1111��34lFI!!i!!illillll��!!.lEii�l� ' SENDER: COMPLETE THIS SECTION MPLETE THIS SECTION ON DFLIVERY ■ Complete items 1,2,and 3.Also complete A.M;:7 item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Pri ted Nme , �GG Dat�Delivery ■ Attach this card to the back of the mailpiece, — V or on the front if space permits.. D. Is delivery addre diffe�f�jtf//rom item 1? ❑des. 1. Article Addressed to: If YES,enter deli ery aac7r8ss below: ❑h1:d' C 5 C.X� S-4' 1 � 3. Service Type u Avertified Mail ❑Express Mail ''�.� i �e�t �� ❑Registered tVrReturn Receipt for Merchandise v 1 ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7pp1 194� 0�04 9�42 17�9 (transfer from service label) I PS Form 3811,August 2001 Domestic Return Receipt 102595-02-rot-1540 F F I C .,F ra ru Postage $ J 3 , GENTEgL�` � Certified Fee D Postmde� Retum Receipt Fee y; W Here (Endorsement Required) p C3 N p Restricted Delivery Fee t3 (Endorsement Required) Total Postage&Fees • �6� p— Sent To Street Apt No.; c; - b or PO Box No. °° C"!�VZ/ Clty,State,ZIP+4 l ,/,� ,�y�* i Certified Mail Provides: a A mailing receipt o A unique identifier for your mailpiece a A signature upon delivery a A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. a Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. 1 a For an additional fee, delivery may be restricted to the addressee or I! addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. j IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,January 2001 (Reverse) 102595-M-01-2425 �1 � � g � � � EYE _ � �� � Y Town of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 508-790-6304 { September 23, 2003 ANDRE LEBEL 35 GROVE ST. CLINTON, MA 01510 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND ARTICLE 51 OF THE TOWN RENTAL ORDINANCE. The property owned by you located at 20 Finger Lane, Osterville was inspected on Septemberl9, 2003 by_ Donald Desmarais R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. (Free from chronic dampness) Mold was observed in several locations throughout the dwelling. There was a strong musty odor present in the dwelling. Mold was observed at the following locations: The window frames, the bedroom closet doors, bathroom ceiling, and on the front of the refridgerator. 105 CMR 410.480(E): Some windows were missing locks You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice, by removing the mold and the source of chronic dampness causing the mold to grow in the dwelling, and installing window locks. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance could result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER F THE BOARD OF HEALTH v Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Q:Health/Order letters/Housing violations/245 Lincoln.doc 09-29-03 13:47 From-CLINTON SAVINGS BANK 9783653718 T-876 P.02/02 F-925 September 25, 2003 To: Ian& Emily Crowell 20 Finger Lane Osterville, MA 02655 This letter is a response to your verbal request on September 18, 2003 in which Emily Crowell indicated that there was.a problem with the ceiling in the bathroom and the front bedroom and that the dryer vent had a water leak. On September 18, 2003 at approximately 4:15 pm, Paul Label, a civil engineer with over forty years experience in the construction industry,as well as the builder of the duplex, met with Ian Crowell to assess the problems. With regards to the dryer vent According to Mr.Label,the area surrounding the dryer vent was dry and covered with saw dust Mr. Label indicated there was no evidence of a leak around or near the dryer vent.Additionally, according to the signed lease by Ian&Emily Crowell on 12/1/02, a washer and dryer hook-up were not a condition of said lease. Please refer to the first paragraph of lease which states "....do hereby*ease,demise,and let unto Ian and Emily Crowell,the apartment located at 20 Finger Land, Ostervilte,MIA consW ug of two bedrooms,living room,kitchen/dining room,bathroom,and lower level storage room...., Therefore, this problem is considered resolved With rag@s to the bathroom: Mr. Label advised that the ceiling should be cleaned/stripped and repainted to prevent mold build-up. On September 21,2003. 1 arrived with a contractor who clean the ceiling and window frame;primed both and applied three cots of mildew-resistant Perma-White paint. Additionally,l noticed the soap dish in the tub,which not mentioned previously as a problem,was resealed and Me tub was re-caulked.You were notified to keep the tub and soap dish area dry for 24 hours in order to allow the caulking and sealant to dry. This problem is considered rawhred. With regards to the ceiling in the front bedroom: Mr. Label advised to scrap and paint the ceiling due to a small spot that was originally present prior to your original move-in on 12/31101. When you originally wowed the apartment, Ian agreed to point the room because t diet not have time due to your request to move in the same day the prior tenant moved out. I had agreed to take$100.00 dollars off the rent once the room was painted.This was never done. Additionatly, Mir.Lebet sUded there is no current leak from the rod,molding or any area that caused the stains on the reft. Ttme stains were present from a roof Iesve approximately five years before you moved in,however the roof was redone fourerrs ago and the prior tenant never asked Mr Label to repaint the ceiling in that room. On September 21,2003, my contractor and t dean the waft,baseboard,doors and ceiling in the front bedroom. The ceiling was repainted as well as the frames on the windows that were replaced in January 2003. This pn*fom is considered to be wed. Please note,that I was at the property on May 31,2003 and July 19,2003 taking care of other tenants and each time I .asked you if evmyhng was afthtwft the apartment to include asking you if the appliances needed to be replaced, On both occasions you sbftd everything was fine&-A you did not need new appliances. I apologize for invorwenience of having to Move the apartm&t for the day,however, it was necessWfor thug safety of your chiidr ank you Since ebel s PO ox 204 , Clinton,IM 01510 508-8 .7-2008 09-29-03 13:47 From-CLINTON SAVINGS BANK 9783653718 T-876 P-01/02 F-925 e To: Donald Desmarais Fax: 508-790-6304 From: Andree Lebel Date: 9/29/2003 Re: 20 Finger Lane Osterville Pages: 2 CC: ❑Urgent ❑For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle 0k T 9f • • • • • • • Ye agi•79 P. ��t is a copy of the letter sent to the Crowell after the problems were corrected.I will be 1t roperty this weekend to fix the lock and vent the bathroom fan to the outside,which N'015 A be the problem for the moisture in the house.I will fax the letter after this corrected IPice' �,�-n , ! �� records. Thank you for your help with this matter. Tr I can be reached at 508-667-2008(cell)or 978-466-1169(home)at any time.My mailing address is PO Box 204 Clinton MA 01510,but my home address is 143 Shire Road Leominster,MA.I have not be at 35 Grove Street since March 2003. Thank you again. Andree Lebel Y • • • • • Health Complaints 01-Oct-03 Time: 3:45:00 PM Date: 9/18/2003 Complaint Number: 17089 ' Referred To: DONALD DESMARAIS Taken By: RITA Complaint Type: MOLD Article X Detail: Business Name: Number: 20 Street: FINGER LANE Village: OSTERVILLE Assessors Map_Parcel: Complaint Description: MOLD IN APARTMENT AND LANDLORD IS IGNORING HIS COMPLAINT. LANDLORD'S NAME IS ANDRE LEBEL. PLEASE CALL HIS WIFE BEFORE GOING OUT TO BE SURE SHE'S HOME. Actions Taken/Results: SPOKE WITH TENANT, SAW MOLD ON BATHROOM CEILING, CHILDRENS CEILING -CLOSET DOORS, REFRIDGERATOR AND WINDOWSILLS. MISSING LOCKS ON WINDOWS. BAD SCREEN. WILL CONTACT LANDLORD TO ARRANGE CORRECTION. 35 GROVE ST. CLINTON, MA. 01510. Waiting for tenant to get me information on landlord. SHE FIXED EVERYTHING. } Investigation Date: 9/19/2003 Investigation Time: 11:00:00 AM 10-06-03 08:28 From-CLINTON SAVINGS BANK 9783653718 T-986 P-01/02 F-160 • r [�i�ai -�s�g;�•-: -n. ••• �i�-� .,, :n -`h ... ��Aj!-�_�!y�"ry..��� - �p �.w°�-�� °�� .�il°Jkj �_ _ . To: Donald Desmarais Fax: 508-790-6304 From: Andree Lebel Date: 10/6/2003 Re: 20 Finger Lane,Osterville Pages: 2 CC: ❑ Urgent ❑For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle 12 J. • la c• • ...,,y.x Mi-1E J i• • • •. • • • • � rt lu+'� a'1a �?�'^+e.18 iAa• ',�i, i ` •1 ri ''•�,- b"'.`-'.:-�ci �i'� ;_ yea.`+i.'..;—i 'a" �rah.•, .: � ._ IN"jiMI.��p11""`n'n �= `use `g you a copy of the letter I have sent to Ian&Emily Crowell who reside at 20 Finger 11 ,+s a . Z. tsterville. I believe I have corrected all the problems you indicated in the letter sent to me 9/23/03. Please contact me at 508-667-2008 or 978-466-1169 after you have inspected the property and let me know if there is anything else 1 need to do.I appreciate you assistance with this matter. t 9 Thank agai . Andree Lebel 10-06-03 08:28 From—CLINTON SAVINGS BANK 9783653718 T-986 P.02/02 F-160 October 6, 2003 TO: Ian &Emily Crowell 20 Finger Lane Osterville,MA 02655 This letter is in response to the remaining corrections required by,the Public Health Division in a letter dated 9/23/03, On Sunday October 5, 2003, I was present on the property with a contractor who corrected all problems indicated by you and the Public Health Division. 1. After speaking with Donald Desmarais R.S,Health Inspector,I was advised that the three new windows in the two bedrooms needed locks. As of October 5, 2003, all windows have locks. 2. The contractor vented the bathroom vent to the outside of the house which is believed to be the primary cause for the added moisture in the house. 3. The windows in the rear bedroom were cleaned and painted. 4. The windows in both the kitchen and living room were cleaned and disinfected as were the bedroom closet doors. 5. The refrigerator was cleaned as well as the floor underneath. As of this time, I believe all problems,as indicated by the Public Health Division,have been corrected. I apologize for the inconvenience on Sunday, October 5, 2003 and I appreciate your cooperation. Please feel free to call me with any questions or concerns. Additionally, I left a copy of two letters I had sent to you certified mail,which have not been signed for at the post office: one letter notifying you I will be fixing the problems on 10/5/03, confirming our telephone conversation to such and another letter notifying you to vacate the apartment when your lease is expires 12/31/03 for I will not be renting the apartment on a year round basis any e. Thank you again for your cooperation. Sincerel Andree Lebel 508-667-2008 978-466-1169 a , I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTE"CTl'ON_ �'I�l.l�l�/E® �t OCT 2 4 2002 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION �� . Property Address: 20140 Finger Lane Osterville, MA 02655 - Owner's Name: Andre Lebel Owner's Address: Same Date of inspection: September 20 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map: 141 Osterville,MA 02655-0049 Parcel: 048 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs rther Evaluation by the Local Approving Authority Fa 11s Inspector's Signature: Date: September 23, 2002 The system inspector shall su ritapy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20140 Finger Lane Osterville, MA Owner: Andre Lebel Date of Inspection: September 20, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N',ND)in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20140 Finger Lane Osterville, AM Owner: Andre Lebel Date of Inspection: September 20, 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20140 Finger Lane Osterville, MA Owner: Andre Lebel Date of Inspection: September 20, 2002 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or.clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than ''/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I of a public well. _ ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to.the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone 11 of a public water supply well 1f 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.. 3 4 Page 5 of 1 I -1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 20140 Finger Lane Osterville, AM Owner: Andre Lebel Date of tospection• September 20, 2002 Check if the following have been done: You must indicate"yes"or`no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage.back up ? ✓ Was the site inspected for signs of break out ? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example, a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related io Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of I l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20140 Finger Lane Osterville, MA Owner: Andre Lebel Date of Inspection: September 20, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2001 - 65,000 gals.; 2000- 47,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCLUJINDUSTRIAL 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 nb): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed(if known)and source of information: Xfur. 16/01 -per as built Curd Were sewage odors detected when arriving at the.site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20140 Finger Lane Osterville, AM Owner: Andre Lebel . Date of Inspection: September 20, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 3' Material of construction: ✓ concrete _metal _fiberglass polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 5" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 9" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage Recommend pumping GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass z 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 outlei tee or baffle condition, structural integrity;liquid levels as related to outlet invert, evidence of leakage,etc.): r 7 I t Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20140 Finger Lane Osterville, AM Owner: Andre Lebel Date of Inspection: September 20, 2002 y TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day. Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. There were no signs of solids. There were no signs of failure or backup from the leach field PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20140 Finger Lane Osterville, AM Owner: Andre Lebel Date of Inspection: September 20, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches, number, length: ✓ leaching fields, number, dimensions: 21'x 42' overflow cesspool,number: Inn ovative/alternative system Type/name of technology: ` Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The leach filed was located, but not dug up. There were no signs of failure in the D-box. The bottom to grade was approximately 4'6" CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 ' Page 10 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20140 Finger Lane Osterville, MA Owner: Andre Lebel Date of Inspection: September 20, 2002 ` 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. co 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20/40 Finger Lane Osterville, MA Owner: Andre Lebel Date of Inspection: September 20, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15' +/- feet 1 Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach field to grade was approximately 4'6". Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 1 S'+/-to ground water at this site. t This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 /� WN OF BARNSTABLE I ":A ON +A e/ IAIW, SEWAGE # VILLAGE S�Z/t/�l ASSESSOR'S MAP & LOT PIl ay INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �Ut7 LEACHING FACILITY: (type) 1 J (size) X / r,• NO.OF BEDROOMS BUII.DER OR OWNER A/1 drlc LAG d PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If.any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facility) J Feet Furnished by n �QrG it 0 Oa 3 1 a� r3 TOWN OF BARNSTABLE / p LO ATION �J 4A1uF SEWAGE # �,gLLAGE 0 12 V II F ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. V-O*JOW �u mpo s Sla�"S�y6 SEPTIC TANK CAPACITY 1606 LEACHING FACILITY: (type) t F- ZJJi Ja (size) NO:OF BEDROOMS ' BUILDER OR OWNER PAD] Lf$C' PERMIT DATE: �� " DO COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 009 - , .i ' I� �� Ihl,, �° w No. .�" �^ Fee8��� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIPPrtcation for 30iqual *pgtem Cow5tructiou Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location �s`o��ot No. Ja, � £a f�dlv� Ow 's N��� r�sus�ndTel.No���2 /��� �D�A (�S R� Ori/ 3 y/o /r/� 11; Assessor's Map/Parcel 4/07 61 s ©q ` J IZI Installer's ame,Address,and Tel.No. A1oZ `���U Designer's Name,,Address and GTel.No. 61tloxi 8t>MAQJs � s oY,w.BARIN�``�A— If, 'Rd OS oases 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 (,10 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /I Type of S.A.S. Description of Soil S A tJ y o)IS Nature of Repairs or Alterations(Answer when applicable) 2ZPAPS 0 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of ealth. Signed Date Application Approved b Date Z 0 D.ry f Application Disapproved for the following reasons Permit No. 8_0 Date Issued 1 h .1Y.,�. . •- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS r! 2pplication for Diopool *pgtem Construction i3ermit �O Application for a Permit to Construct( )Repair(>, )Upgrade( )Abandon( ) ❑Complete System El Individual Components � w� Location Address o�j.Lot No. S I f A Own e ' Name,Address and Tel.No. ,D C15�'� if o 4, 1<'1, �� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. h/a.4-5617'J Designer's:Name,Address and Tel.No. s 1C�p.�l L)m }j ` I 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 6d gallons per day. Calculated daily flow �j 41.6 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ,. Description of Soil S y So 144 Nature of Repairs or Alterations(Answer when applicable) �A/.13 a lc�( ��s � ✓l;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- r cate of Compliance has been issued by this Board o,,,$ealth. ' SignedGLG '7I'11116o Date v Application Approved b q Date 'o_ ` Application Disapproved for the following reasons Permit No.7,!g l'/--Ll Y.? Date Issued ----------------------------------------- f THE COMMONWEALTH OF"MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate-of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal S'�y�s-�tein Constructed( )Repa.i�ed ( )Upgraded( ) Abandoned( )by �J%di`il�d�i�� CPA s rl 0ALP � ) at D �d; J. & OS Gf i� has been constructed in accordance 1 with the provis'ons of Title 5 and th for Disposal System Construction Perm dated ^' / � �?l S Installer u� i Designer The issuance of this pe 't sha not be onstrued as a guarantee that the syste ill fu des' n Date 3 6 V Inspector y No.,�'�AGl�.� ��� --------------�.'�,-- ------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS . 1=igpo!9a1 *pgtem Construction Vermt.t Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( �� System located at //U(,j�� ,d/U ,� C�S Ui F v and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this Pe it. Date: �' d� Approved b +�1 �« U6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH .A'+-D APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PE1ZtiIlT (WZ-I- 01IT"DESIGNED PLANS) -US hereby certify that the application for disposal works construction pe.= signed by the dated oncerning the propery located a't meets all of the following criteria: • The failed system is con `e ed to a residential dwelling only. i fie:e are no commercial or business uses associated with the dwellins. • Tne soil is classified as CLASS 1 and the oercolacton rate is Less than or equal co 5 minutes per.inch. • There are no wetlands within 100 fee;of die oropesed seodc s;stem • T-here are no private wells within 1J70 fert of the proposed septic system • T'nere is no increase in dow and/or change in use proposed • There are ao variances requested or needed- • Tine bosom of the proposed leacain;faclity wi l not be located(ess than Five fe_;above the ma..,dmurn adjured undwater cable-Ievadon_ (Adjust the goundwater table usin-the Frimotor method when anolicablel • If the S.A.S. ,grill be tocated with 250 fe_;of any vegetaced wetlands, the bortom of dhe pr000sed leaching faciliry will not be located!ess chart fcurteen(1 Y) i= above dhe m-Lamum adjusted a*oundwater table e!evacion, Please complete the rollowiag: A) Too of Ground Surface =1e•iadon(using GiS inzarmation) ` B) G.'N. 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Ia TOWN OF BARNSTABLE e LOCATION SEWAGE # I d V� VILLAGE OsT R V j IIF ASSESSOR'S MAP & LOT v �� INSTALLER'S NAME& PHONE NO. 00RJO ly IL I SEPTIC TANK CAPACITY 1606 LEACHING FACILITY: (type) kEk-� SJ�E1 (size) CA NO. OF BEDROOMS BUILDER OR OWNEg 1 's(0 PERMITDATE: ,2 2601 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet tdds Furnished by yy 7. ..c..,u: .,�"` ,' ^l 3 • r. 1 — n O "- �=w, W ( 1� o