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Home My WebLink About0933 MAIN STREET (OST.) UNIT #I - Health 933 Main Street, Osterville A=117.187 _I t f i 0 TOWN N OF B w STABB L-E LOCATION -Z-SEWAGE M VILLAGE ayie, � ASSESSOR'S MAP do LOT INSTALLEWS NAME dt PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ''�X�%� (size) I NO.OF BEDROOMS BUILDER OR OWNERVA6/�L -X4 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 Leac ' g Facility(If any wetlands exist within 300 feet o e a=ty) Feet Furnished b a ' I ! Io __br, �� 1 xe�, 1 Os-E9,,tnl y(r (bj I)d1 .z. A Certified Mail#7015 1520 0000 1967 7603 of s KeEr Town of Barnstable BARN STABLE, ' Inspectional Services Public Health Division Thomas McKean, Director ;- 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ' July 26, 2018 John Giatrelis 648 Main Street ; Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 933 (I) Main Street Osterville, MA was inspected s on July 26, 2018 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection.was conducted on the basis of a complaint. The following violation(s) of the Town of Barnstable Code and State Sanitary Code were observed: Section 170-4 of the Town of Barnstable Code: Rental dwelling unit is not registered with the Board of Health. ' 105 CMR 410.500-Owner's Responsibility to,Maintain Structural Elements. ! Observed large hole in the ceiling within the living room. 105 CMR 410.500—Owner's Installation and Maintenance Responsibility's. Observed leaking water supply pipes within the basement., A105 CMR 410.550 (A).—Extermination of Insects, Rodents and Skunks. Observed �/ that the structural elements inside and outside of the garage does not keep rodents from entering the dwelling. ' j 105 CMR 410.482 - Smoke Detectors and Carbon-Monoxide Detectors. It was observed that there were NOT Carbon monoxide detectors within dwelling unit. 105 CMR 410.552- Screens for Doors. Screen doors missing on some doors within e-7 dwelling unit p X , P C QAOrder letters\Housing violations\Rental ordinance\933 I Main ost 7-26-I8.doc f 105CMR 410.552- Screens for Windows. Multiple windows in dwelling unit missing screens. 105 CMR.503- Protective Railings and Walls.s Observed that several balusters were missing on back deck andahe,railings were loose. You are directed to correct the violations of.105 CMR 410.482_ twenty four (24) ' hours by installing carbon monoxide detectors in,accordance to State Board of Fire,- Prevention (527 CMR). You are directed to correct the violations of 105 CMR 410.500, 105 CMR 410.550 (A) and 105 CMR.503,.listed above within fourteen (14),days of your receipt of this notice by registering dwelling unit with health division; by repairing all structural elements inside and outside of the garage so that it impedes/prevents rodents from entering any part of the dwelling unit; by repairing and or replacing balusters on the deck and repairing railings so they are safe and no longer loose; by repairing all leaking pipes and correcting all sources of chronic dampnessRwith_ in the basement and within the living room°ceiling area. You are directed to correct the violations-of 105 CMR 410.552 listed above within 4 i thirty (30) days of your receipt of this notice by replacing missing screens on doors ; and windows. 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 will 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 OF`ZOARDOF HEALTH tOk Thomas A. McKean, R.S., CHO ` Director of Public Health Town of Barnstable a` ' Cc: Claire Strauss, Occupant F t Q:\Order letters\Housing violations\Rental ordinance\933 I Main ost 7-26-18.doc TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date _ ;6— C& Time: In Out Owner 1� L�� Tenant Address 6�t� I """" Address ?✓ 3 Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply ,oL� 5. Hot Water Facilities 6. Heating Facilities n 7. Lighting and Electrical Facilities 8.Ventilation 9. Installation and Maintenance of Facilities N` 10. Curtailment of Service r �P 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural c Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal r 16. Sewage Disposal P 17. Temporary Housing C 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed , Inspector If Public Building such as Store or Hotel/Motel specify here i I ` Citizen Web Request Page 1 of 3 i,�'' f �' �!' 1+rf- *».�.k..,,.a•.�;..: ass ' N r Monday,July 23 2018 Application Center Logged In As: oconnelt Citizen Request Management Logoff Route to Users Search Requests Create Requests a L Request Information Request ID: 59619 Created: 7/19/2018 3:55:01 PM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 8/2/2018 Change Estimated Jul August 2018 Sei) Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 12 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 Created By: Soto, Kathryn Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request DETAILS:. 00 Unknown`'-`— LOCATION: 933 MAIN STREET(OST.) Unknown Ma 00000 I Osterville, Ma 02655 Request Parcel Number Map: 117 :Block: 187 ;Lot: 000 Caller reports following: there are --" - --' leaks in the ceiling and roof, holes in garage causing wall to fall down, holes in Parcel Lookup kitchen, mold in basement and laundry area. Unit is an unregistered rental. Email: ® Complete items 1, ' Print 2,and 3. name and address on the reverse A Signatu your so that we can return the card to you. m Attach this card to the back of the p X or on the front ifs mail iece, B. Agent • Article Addre pace permits. eceived by Pfin ed Name) 13 Addressee sled to: C. Date f D T �) livery . •�ri� . D• Is delivery address different d �) If YES,enter delivery from item 1? Ye '�� rY address below: KaZ, ❑No MA IIIIIIIIIIIIIItlIIIIillllillllll 'III IIIIIIIIII 3, Service Tyre 9590 9402 4116 ❑Adult Signature 8092 9365 pp ❑Adult Si ❑Priority Map I_xpress® ❑Certified nature Restricted Delivery ❑Registered Mail*M 2• Article Numtier Mal® �e91e erect (Transfer fro ❑Certifted Mail Resbt Registered Mail Restricted 7 5 2 0 /n service/abeB ❑Collect on Delivery cted Delivery ❑Return 1967 ❑Collect on Delive Merch Receipt for 7 6 0 3 Insured Mail ry Restricted Delive ❑ andise PS F lnsu 'very Signature Conrirrnation*n, $8 7,July 2015 P red Mail Restrict ❑Signature SN.753o- (over edDelivery Restrict Conrinnation 02-000-9053 t ed Delivery L Domestic Return Receipt t! F, TOWN OF B�ARN STAB LE ' SEWAGE M ASSESSOR'S MAP & LOT i NAME&PHONE NO. / K CAPACITY ACILIT'Y: (type) ,�� /`� (size) �)/ ,OWNER ebt-?2 '� E: COMPLIANCE DATE \ A ;ranee Between the: \ j usted Groundwater Table to the Bottom of Leaching Facility Feet Supply Well and Leaching Facility (If any wells exist _. 4thin 200 feet of leaching facility) Feet (�' ' end and Leaching Facility(If any wetlands exist Feet 9 \\ en1J feet o aci ag, ility) 7 V eat TOWN OF STABLE LOCATION ��`' T—-.--' SEWAGE N VILLAGE � ��'(�� -i-s.5—ASSESSOR'S MAP& LOT L'vSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) `�� (size)" NO.OF BEDROOMS BUILDER OR OWNERN.��112ged PERMIT DATE: 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 Leaclyng Facility(If any wetlands exist Feet within 300 feet o � lity) Furnished b� L , l / 1 / 1 1- i 10-19-199e 02:28PM CENT OST FIREDEPT 50e?902385 P.02 Fore Department retains original application and issues duplicate as Permit APPLICATION and PERMIT Fee:_,o_nD ' for storage tank removal and trans ortation to a r`p approved tank disposal yard in accord npTith fie p(o ls�ons of M.G.L. Chapter 148-Section 38A 527 CMR ('s 9.00, application is hereby mace by: "`• T � • f Tank Ownek Name(pix - print) McQueen x �ulre ao pwm Address�� I'��,�,ti`ee_t. _. octerville MA Snwt Cpy Srere Zip Company Name Advanced Environmental Advanced Environmental � Co.or Individual P.O. Box 472, S. Dennis, MA Address Address Pilnr Signature(it applyin , r rmit) Signature (if applying fcr=ermit) C C ' ec Ot r IFCI Certified _ =?' Other MR A i •LOU TankLocati4n 9 Gallery Place, Osterville, MA • Srsw acoreas G,y I Tank Capacity(galicns: .175 Substance Last Store^ #2 Fuel. 011 I Tank Dimensions(diar.ww. x length) Remarks: /C. o v ` k"' c-) ;j Firm transportingwasie Advanced Environmental State Lic.#_i�5083856100 j Hazardous waste marts E.P.A.# I Approved*k disposai vard J.G. C:rant Tank yard# 03501 Type of inert'gas Tank yard address _Readville. mA City or Town : Centerville FDID# 01920 Permit# i Date of issue: October 19, 1998 November 2, 1998 Date of expiration Dig safe approval number 984203178 11 a Dig Safe Toil Frae Tel. Number-800-322-4844 Signature/Title.of Officer.ganting permit After removal(s)send Ft=FP-29OR signed by Local Fire Dept.to UST Regulatory Compliance Unit,One Ashburton Place, f Room 1310, Sciston, MA FP-292(revised 9196) I TOTAL P.02 t i f s t s i i i i ' ,i i I j i i I 1 I i I l E �.�� d A _ r - - �-\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL,, PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM .PART A CERTIFICATION Property Address: 933 Main StrP,et Ostervillp' Mass. Owner's Name: Bu ' 1 rl i nn T Owner's Address: Joeanne Stuhhi us 943 Old Ea 1 WQU h Read Date of Inspection:Margtops M, � , .R-- RECEIVED 02648 Name of Inspector: (please print)) P. Macomberr___-J JUL5 Company Name: J.P. Macomber & Son Inc 2001 Mailing Address:P.O. Box 66 CPntPrvi 1 1 P Mn 09632 TOWN HEALTHDEPTOFl3ARNST. Telephone Number: Ana �?r,_333>� 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: Y Passes Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority jlFails. Inspector's Signature: V! Date: / `41 The system inspector shall bmit 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 authoriry. 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 I Nee 2 of I I , OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 993 Main Street Building I Os ervi e, ass. Owner: Joeanne Stubbins Date of lospectioo; 6 1 1 01 Inspection Summary; Check A,B,C,D or E/ALWAYS complete all of Section D A. S stem Passes: Gam_ I have not found y information which indicates that any of the failure criteria described in 310 CMR 15.303 or u, R 15.304 exist. Any failure criteria not evaluated are indicated below. Corn ments: This is s sewage s stem. Consisting of 4-6 'X8 ' block ` cacGpnn1G _mhe ov rflnwS are as good as new. The comp e e sys em is dry at this time. B. System Conditionally Passes: 426 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. iiismetal and over 20years old' or the septic tank(whether metal or not) is structurally unsound, 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 sepric 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: AIA(k_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, senled 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: AD 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); _brokenpipe(s)are replaced _obstruction is removed ,r• 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: 933 Main Street Building I Os ervi e,Mass. Owner. Joeanne Stubbins Date of Inspection: 6 1 1 01 C. Further Evaluation Is Required by the Board of Health: .,V0 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. S*N•stem 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: ,,Ifs 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. I6 The system has a septic tank and SAS and the SAS is within a Zone'I of a public water supply. 112& 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 fe or more from a private water supply well I'. 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: This is a sewage system. The system consists of two 6 X8block cesspoo s at tne rear or nouse. ( in series ) ',Two_6 'X8 ' block cesspools on the west side of house. Cesspools are in series. Overflows are as good as new. The ` _complete. system is .-present l dry._ 3 I Page 4 of I I OFFICIAL INSPECTION FORM — NOT FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A , CERTIFICATION(continued) Property Address: 933 Main Street Building I Osterville,Mass. . Owner: Joeanne Stubbing Date of lospectiom 6/1 1 /01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no" to each of the following for all inspections: Yes No ackup 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 lJk4vt Static liquid level in the distribution bo bove outlet invert due to an overloaded or clogged SAS or cesspool A� J4 uid depth in cesspool is less than b"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 6 . 4 _ 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. �y portion of a cesspool or privy is within 50 feet of a private water supply well. y 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 forma (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 Systems: To be considered a large system the system must serve a facility with a design now of io,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 nol the system is within 400 feet of a surface drinking water supply e system is within 200 feet of a tributary to a surface drinking water supply _ ' (Interim Wellhead Protection Area-IWPA mapped _ the system is located u1 a nitrogen sensitive area )or a PP.(, Zone 11 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 eves" in Section D above the large system has failed.Tlie 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 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECK,L,IST Property Address: 933 Main Street Building I s ervi e, ass. Owner: Joeanne Stubbins Date of Inspection: 1 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 Ywere 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 ? �/_ i Were as built plans of the system obtained and examined?(If they were not available note as /A 1 Was the facility or dwelling inspected for signs of sewage back up? �` Was the site inspected for signs of break out ? VV Were all system components',=Iuding the SAS, located on site? /►/�,� Were the a is tank anholes 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 CMR 15.302(3)(b)j 5 » Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 933 Main Street Building # I Os ervi e,Mass. Owner: Joeanne Stubbins Date of Inspection: 6 11 01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):_t DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms);0 X_//d -' Number of current residents: 0 t Does residence have a garbage grinder(yes or no):.ce Is laundry on a separate sewage system ( es or no):40 [if yes separate inspection required] Water comes from � Laundry system inspected(yes or no): water pit.Several houses are Seasonal use: (yes or no):�i51G' Cj� J� on the well pit.No readings,- - Water meter readings, if available(Fast 2 years usage(gpd)):' consumption can be Sump pump(yes or no): obtained. Last date of occupancy:L � COMM E RCIALINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): fU�9 gpd - Basis of design flow(seats/persons/sgft,etc.): X1.9 Grease trap present(yes or no): 9 Industrial waste holding tank present(yes or no):W.14 Non-sanitary waste discharged to the Title 5 system(yes or no): eo Water meter readings, if available: Last date of occupancy/use: yj¢ OTHER(describe): AAA GENERAL INFORMATION Pumping Records QQ _ Source of information: Was system pumped as part of the enspection(yes or no):,(2 If yes, volume pumped: gallons -- How was quantity pumped determined? eZ, Reason for pumping: fJ TYPE OF SYSTEM 416 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) ,0 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system.owner) �6Tight tank .fZ Attach a copy of the DEP approval Other(describe): �,Jf Approximate age of all components,.date installed(if known)and source of information Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of I I d OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 933 Main Street Building I s ervi e, ass. Owner:Joeanne Stubbins - Date of Inspection: BUILDING SEWER(locate on site plan)- Depth below grade: Materials of construction: cast iron Z0 PVC other explain)Orangrberg pipe runs from Distance from private water supply well or suction line: 'd house to the tw5main cesspools Comments(on condition of joints, venting, evidence of leakage,etc.): Seh40 '$'r Pve pipe runs from the main cesspools to the over, flow cesspools SEPTIC TAN}Gt ,"locate on site plan) Depth below grade: V,4 Material of construction:4Aconcrete metal4Afibergia.sgA Ll polyethylene •VAother(explain) If tan]: is metal list age:tM is age confirmed by a Certificate.of Compliance(yes or no)4) (attach a copy of certificate) Dimensions: AM Sludge depth: k Distance from top of sludge to bottom of outlet tee or baffle: rth4 Scum thickness: Distance from top of scum to top of outlet tee or baffle: AMDistance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: IVA Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage, etc.): , Septic tank is not present. Recc that two main . cesspools be pumped every 2-3 years. GREASE TRADIke(locate on site plan) Depth below grade: Material of construction:�0 concretete metal A1,4 fiberglass lepolyethyleneAlAother (explain): Dimensions: AR Scum thickness: y� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:'1LU9 Date of last pumping: A Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present. 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 933 Main Street Building I Ostervi e,Mass. ` Owner: Joeanne Stubbins Date of Inspection: 6/11 /01 TIGHT or HOLDING TANKdIWIC. (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: A✓R Material of construction: y,4 concrete 4metal 0 fiberglass polyethylene f&j other(explain): Dimensions: Capacity: gallons - Design Flow: gallons/day Alarm present(yes or no): 4M _ Alarm level: __&,I Alarm in working order(yes or no): Date of last pumping:A14 Comments(condition of alarm and float switches, etc.): Tight or holding tanks Are not bresent. DISTRIBUTION BO (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 01� 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 is not present. PUMP CHAMBER ACC-(locate on.site plan) Pumps in working order(yes or no):._Z2 Alarms in working order(yes or no): 0,1 Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present- 8 -� Page 9 of 1 I ' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 933 Main Street Building I Os ervl e,Mass. Owner: Joeanne Stubbins Date of Inspection: 6 1 1 01 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located. 4-6 ' X8 ' block cesspools 2 on west side. ( in series, ) 2-pools in rear. ( In series ) All pools are dry. Overflows are good as new. Type - leaching pits, number, leaching chambers, number: 0 leaching galleries,number: leaching trenches,number, length: 6 ` �, eaching fields, number,dimensions: Aiil overflow cesspool, number: y� innovative/alternative system Type/name of technology: rl,G,,' l9le Comments(note condition of soil, signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.): _Loamy sand to medium fine sand.No si ns of hydraulic failure or ponding.Veaetation is normal. CESSPOOLS:Zcesspool must be pumped as part of ction)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver. 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.): Same as above PRIv rAJZ� 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.): Privy is not_-present. a d 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: 933 Main Street Building I Osterville,Mass. Owner:Joeanne Stubbins Date of Inspection: 6/1 1 /01 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. \\ 10 Page 1 I of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 933 Main Street Building I Osterville,Mass. Owner:Joeanne Stubbins Date of Inspection: 6/11 /01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water/16�' feet Please indicate (check)all methods used to determine the high ground water elevation: ray fry*+ cvctem design plans on record- If checked,date of design plan reviewed: Obs_e'rved site(abutting roe observation hole within 150 feet of SAS) —Shecked 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: Used water contours map GahretX & Niller Model 12116194 11 '