HomeMy WebLinkAbout0021 OAK LANE - Health 21 OAK LANE, OSTERVILLE
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Commonwealth of Massachusetts
53
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--� Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
\ a 21 Oak Lane
Property Address h•
Werber Adelh_eid _ x
3
,,Owner Owner's Name -- ------------ �
information is . //
required for every Ostervilie-_V MA 02655 _ 3/30/17
page. City/Town State Zip Code Date of Inspection i
• r�;t
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information /
filling out forms �f a o1y
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Mik_e_DeCosta Jr.
use the return Name of Inspector
key.
And.River Environmental _ ----__.—__—
r� Company Name
46 Lizotte Drive Suite 1000 _
Company Address
Marlborough_ _ -
_
MA 01752 -------- ._._.__.._
- City/Town — -- State ------------ Zip Code
800-499-1682 . SI 13230
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection.The inspection
was performed based on my training and experience in the proper function and:maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
e
Passes ❑ Conditionally Passes El Fails
0 Needs Further Evaluation by the Local Approving Authority
spector's Signature T Date
The system inspec r 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 ashared 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
�-/Page 1 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System(Form -Not for Voluntary Assessments
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
A build up will be installed on outlet cover as part of inspection.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of-'
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins.doc-rev.6/16 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
w a 21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken; settled or.uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y. ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipes) 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. A
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage,Disposal System Form - Not for Voluntary Assessments
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
page.e. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from m a private water supply well'"*.
Method used to determine distance:
"This system passes if the well water analysis, performed at a.DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen,is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® . Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
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:
❑ Z Any portion of the SAS, cesspool,or privy is below high ground water.elevation.
El ® 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.
❑ Z. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system-is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes" to any question,in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
JN
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the.system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
[AWere as built plans of the system obtained and examined? (If they were not
El 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?
® ElWas 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 15.263(for example: 110 gpd x#of bedrooms): 330
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
7
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
i= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is Osterville MA 02655 3/30/17
required for every
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 laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 127 gpd
9 ( Y 9 (gpd)):
Detail
See attached
Sump pump? ❑ Yes ® No
Last date of occupancy: Feb 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/persons/sq.ft., etc.):
Grease trap present?. ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
\a 21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is Osterville MA 02655 3/30/17
required for every
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)
❑ 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
❑ light tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is Osterville MA 02655 3/30/17
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
2007 per plans
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
18
Depth below grade:
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.):
All joints sealed, no leaks, vent on roof.
Septic Tank(locate on site plan):
1'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 8'x5'x4'
,
Sludge depth: -4"
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of,Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
N- 21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
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
32"
Scum thickness 2
Distance from•top of scum to top of outlet tee or baffle 6 --
Distance from bottom of scum to bottom of outlet tee or baffle 15"
How were dimensions determined? The dimensions were determined
by sludge judge, rod, and ruler.
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
All covers 1' below grade, tees in good condition, liquid level normal, light solids and sludge. Tank
appears to be structurally sound, not leaking, a build up will be installed on outlet cover as part of
inspection, recommend pumping annually.
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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
s
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
a 21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is Osterville MA 02655 3/30/17
required for every "
page. City/Town State Zip Code Date of Inspection
D. System Information Cont.
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,.evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes. ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
page. City/Town 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
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.):
Box is 2' below grade, box size 16"x20", box has one outlet, liquid level normal. minimal carryover,
box in good condition, not leaking.
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage bisposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.w a 21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)-
Type:
❑_ leaching pits number:
® leaching.chambers number: 3-30'x10'x2'
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology: -
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Chambers are dry, no evidence of.hydraulic failure,vegetation normal.
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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is required for every Osterville MA 02655 3/30/17
page. City/Town State Zip Code. Date of Inspection
D. System Information (cont)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
drawing attached separately
t5ins.doc•rev.6/16 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^N e 21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is Osterville MA 02655 3/30/17
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 7
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
2007
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers -(attach.documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
Obtained from copy of design plans on file at the BOH.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17.
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System !Form - Not for Voluntary Assessments
M 21 Oak Lane
Property Address
Werber Adelheid
Owner Owner's Name
information is Osterville MA 02655 3/30/17
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:-A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
L—
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SURVEY REFERENCE: NI
PLAN OF LAND-BY BEARSE & KELLOGG, ENGS.
DATED: DECEMBER-22, 1947
1
g TOW , R
LEGEND TOwn
D
PROPOSED CONTOUR n �..
®, PROPOSED SPOT GRADE Zo Hi
--98 -- EXISTING CONTOUR SAE Z v c A 2 ON HO
ON'� E �
+ 96.52 EXISTING SPOT GRADE p�Rp S E R n Oa
W— EXISTING WATER SERVICE S� o` FINGER v�
TEST PIT
flsierwlle
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3 ST Bay.'fS o 0
LOCUS MAP N.T.S.
BENCH MARK GENERAL NOTES:
PAINT SPOT ON STEP 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY-THE LOCAL
ELEVATION = 60.33 BOARD OF HEALTH AND.THE DESIGN ENGINEER.
ALLE REQUIREMENTS
BARNSTABLE GIS DATUM 2. OF THERSTATEDENVIRONMENTAMATERIALS SH�CODE,NTIOTLE RM V�AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS,
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
5. ALL ELEVATIONS BASED OW ASSUMED DATUM.
6. THE DESIGN ENGINEER 'IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
.7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
.8.ALL AREAS DISTURBED.DURING CONSTRUCTION SHALL BE RESTORED
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
\ 9. IT SHALL BE,THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
\ THE LOCATION OF ALL .UNDERGROUND UTILITIES, PRIOR TO BEGINNING
\ CONSTRUCTION.
\\ 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND REMOVED
\ 11. 48 HOUR NOTICE:FOR ENGINEER CERTIFICATION
\ 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM.PURPOSES ONLY
\` AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
\ 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING
\ 14. 'ALL PIPING TO BE,\\ 4- SCH 40 ® 1/8-/FT (UNLESS-SPECIFIED OTHERWISE)15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
FOR THE USE. OF A GARBAGE GRINDER
16. NO WETLANDS_'WITHIN 100 FT: OF'PROPOSED LEACHING
'Existing Leach Pit
(See.-Note 10)
a
4lgss .
' M `r . , PROPOSED SEPTIC SYSTEM UPGRADE PLAN
1 H -
21 OAK LANE, OSTERVILLE, 'MA
Prepared for: Heidi Weber
g1a� MAP. 141 Engineering bY: Surveying by: SCALE DRAWN
LOT.025 DARRE"..MEYER RS. fco—Tech E'nvisonmentod JOB. NO.
I .1 Z� �� DEED BOOK 17615 POBOx9si 1 =20' DMM
�. DEED PAGE.091
EASTSANDWIClt mA02537 (508) 364-0894 DATE: CHECKED SHEET NO.
5O M62--2922 07/23/07 DMM 1 of 2
No. ( ( � �=- Fee G
THE COMMONWEALTH OF MAS&ACHU•SETTS - Entered in computer. ✓
Yes
..PUBLIC HEALTH DIVISION 7. TOWN OF BARNSTABLE, MASSACHUSETTS
01pplication for �i$ponf i§p2temc CoTC�trUCtion permct
Application for a Permit to Construct O Repair O Upgradlk Abandon O ❑Complete System , Individual Components
Location Address or Lot No.a �i(, n C 0 'er's Name;Ad re s,and Tel.No.
Assessor's Map/parcel AA QQ p�J
—
Installer's Name,AddASJr ,WIAANCO Designer's Name,Address and Tel.No.
350 Main Street lit CV4z rl /t
W. Yarmouth, MA 02673 /
Type of Building:
Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2 U
Design Flow(min.re tiired) J3� gpd Design flow provided 37(D ;�t gpd
Plan Date 7 0 Number of sheets Revision Date
Title v
Size of Septic Tank Ty a of S.A.S.
Description of Soil e J<`
Nature of Repairs or Alterations(Answer when applicable) `
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 Co e and not to place the system iri operation until a Certificate of
Compliance has been issued by this Board of Heal h.
Signed C C LL Date
Application Approved by Date*2�E_
Application Disapproved by: Date
for the following reasons
Permit No. 2.c1�— Date Issued U
_ _._.__..�__�•________.r- -- -i-�--------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS i
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded
Abandoned( )fbyC
at � ( ! �/4 k A 01'r— O SIr`Q41)// has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. w "I dated —7
Installer Designer
#bedrooms 3 Approved de/sign ow 3° gpd
The issuance of this permit shall.not b constru rd as a uarantee that the system 414 r p
'on desi ed.
Inspector jif
Date 1 i —
———— ---------------------t �-----d————-----
Fee 1 v
C-O-mm-, WATER DEPT
CUSTOMER STATEMENT
ACCT NO 1,533, 3/30/2017
WEBER,ADELHEID
LOCATION:
21 OAK IN
OST
LOT:
MAP&PARCEL: 141025
Consumption History
DATE READ
12/31/16 448 20 l r
06/30/16 428 37 ��`
12/31/15a 391 10
06/30/15 381 12 � rf
12/31/14 369 13 _ :' �i.�ce`a rf`s`` 3 �J=� A \
06/30/14 356 �12 -
12/31/13 344 13 Sc'D
06/30/13 331 8i
TRANSACTION HISTORY
DATE DESCRIPTION 0 to 30 31 to 60 61 to 90 Over 90
10/02/2000 MINIMUM BILL 0.00 0.00 0.00 15.00
11/03/2000 PAYMENT 0.00-1' 0.00 0.00 -15.00
01/01/2001 MIN EX 0.00 0.00 0.00 116.50
01/26/2001 PAYMENT 0.00 0.00 0.00 116.50
04/02/2001 MIN 0.00 0.00 0.00 15.00
06/25/2001 PAYMENT 0.00 -0:00 0.00 15.00
07/02/2001 MIN EX 0.00 0.00 0.00 75.90
07/24/2001 PAYMENT 0.00 0.00 0.00 -75.90
10/01/2001 MIN 0.00 0.00 0.00 15.00
10/22/2001 PAYMENT 0.00 0.00 0.00 -15.00
01/01/2002 MIN EX 0.00 0.00 0.00 104.90
01/23/2002 PAYMENT 0.00 0.00 0.00 -104.90
04/0I/M02 MIN 0.00 0.00 0.00 15.00
04/16/2002 PAYMENT 0.00 0.00 0.00 -15.00
07/01/2002 MIN EX 0.00 0.00 0.00 90.10
07/22/2002 PAYMENT 0.00 0.00- 0.00 -90.10
01/01/2003 MIN EX 0.00 0.00 0.00 127.80
Balance Due: 0.00
a_ C-O-MlId WATER DEPT
CUSTOMER STATEMENT
01/01/2012 MIN EX 0.00 0.00 0.00 37.90
01/12/2012 PAYMENT 0.00 0.00 0.00 37.90
07/01/2012 MIN 0.00 0.00 0.00 35.00,
07/23/2012 PAYMENT 0.00 0.00 . 0.00 -35.00
01/16/2013 MIN 0.00 0,00 0.00 35.00
01/23/2013 PAYMENT 0.00 0.00 _ 0:06 -35.00
07/01/2013 MIN 0.00 0.00 0.00 35.00
- t
07/15/2013 PAYMENT 0.00 0.00 0.00 -35.00
01/01/2014 MIN 0.00 0.00 0.00 35.00
01/16/2014 'PAYMENT 0.00 0:00 0.00 -35.00
07/01/2014 MIN 0.00 0.00 0.00 30.00
07/21/2014 PAYMENT 0.00 0:00 0.00 -30.00
01/01/2015 SERV EX 0.00 0.00 0.00 43.00
02/09/2015 PAYMENT 0.00 0.00 0.00 -43.00
07/01/2015 SERV EX 0.00 a 0.00 0.00 42.00.
07/29/2015 PAYMENT 0.00 0.00 0.00 -42.00
01/01/2016 SERV EX s 0.00 0.00. 0.00 40.00
01/12/2016 PAYMENT 0.00 0.00 0.00 40.00
07/01/2016 SERV EX 0.00 0.00 0.00 99:30.
07/20/2016 PAYMENT 0.00 0.00 0.00 -99.30
01/01/2017 SERV EX 0.00 0.00 50.00 0.00
01/20/2017 PAYMENT 0.00 0.00 -50.00 0.00
1
Balance Due: . 0.00
t �
= Town of Barnstable Barnstable
F THE Taw
Pao. °I� Regulatory Services Department Al-At11ECIC8 C11y
. I � p
"A55.6;9 Public Health Division
\9oO�1 /m
\\fD MABiA`�' 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
March 18, 2008
Adelheid Weber .
23 Sunset Lane
Osterville, MA 02655
Dear Mrs. Weber,
Enclosed is the Certificate of Registration* for the property located at 21 Oak
Lane, Osterville. Please post the certificate in a conspicuous area located within the
rental unit. ,
*Note: Permit is only valid on the condition that smoke detectors are installed in
accordance with Mass State Fire Codes as well as Mass State Sanitary Code Chapter 105
CMR 410.482.
Thank you for your cooperation.
Respectfully,
p Y,
Caitie Barrett
Health Division Assistant/Rental Program Coordinator
Direct Line#508-862-4072
JACertificate Letter.doc
FORM30 C&w HOBBS&WARREN TM THE COMMIONWEALTH OF MASSACHUSETTS
BOARD O
CITY/ OWN
on
ADDRESS
M sey`0
/L TELEPHONE
Address — Occupant � '�
Floor Apartment N No.of Occupants
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units-----
nits �No S ries_
Name and address of owner
2-3 Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway: 57�4_
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
Stacks, Flues,V Safeties:
Kitchen Facilities in
ove St
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub.-
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION RE - T IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PER Y.'
INSPECTOR TITLE
176
DATE -3— O TIME D P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
A
V.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
` occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violatioR(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide"a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar,place as
required by 105 CMR 410.503(A)and 410.503(B). Z
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
Certified Mail#7006 2150 0002 1038 7015
%/P��F Tow Town of Barnstable
L�Q,,
Regulatory Services
IIA
�1
MASS. q/' i
•,\90\16 �0%� Thomas I'. eiler, Director
po 3 9:
IFDMAt�� Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
March 18, 2008
Adelheid Weber
23 Sunset Lane
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 21 Oak Lane Osterville, was inspected
on March 17, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable.
This inspection was conducted on the basis of the xental registration in accordance with
Chapter 170 of the Town of Barnstable Code.
The following violations of the Town of Barnstable Code were observed:
170-10 — Smoke Detectors and Carbon Monoxide Alarms. No smoke detector.
You are directed to correct the violations listed above within twenty-four (24) hours
of your receipt of this notice by installing smoke detectors in dwelling in accordance
with Mass State Fire Codes.
You may request a Hearin before the Board of Health if written petition requesting same
Y q g p n g
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. W
QAOrder letters\Housing violations\Rental ordinance\21 Oak Lane.doc
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed'the inspection.
PER ORDER O THE BOARD OF HEALTH
oma A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Timothy O'Connell, Health Inspector
r
QAOrder letters\Housing violations\Rental ordinance\21 Oak Lane.doc
TOWN OF BARNSTABLE
OCATION_ � 0AX LA)C SEWAGE# �009 3
VILLAGE C S re/Z V(U 6 ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO. 14116 (?JqNC O
SEPTIC TANK CAPACITY l-x �t an-b 941
LEACHING FACILITY:(type( 31 Wf i 8O 6—Z> (size) f)(10, K
NO.OF BEDROOMS U
BUILDER OR OWNER LA3 2b 2 CZ
PERMIT DATE: R/810 7 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 63
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) I til Feet
Furnished by
j- J3 w Li1
6
®3. 3
..a t �`mot,'• .pt 1 �. �''e'�
No. ( 3 l ! Fee 6
THE COMMONWEALTH OF MAS&ACHllSETTS — Entered in computer: ✓
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIPPlication for �Digo!gaY fpwe YY Comaruction PerT1jt
Application for a Permit to Construct( ) Repair( ) Upgrade Q Abandon( ) ❑ Complete System Individual Components
Location Address or Lot No. a C(, n e 0 ner's Name,Ad re s,and Tel.No.
Assessor's Map/Parcel -� ll J " '"�r CZ/�-�a y�F f
AA @/ ��►►eeo c t
Installer's Name,AddrdS�, d4e1 !NCO Designer's Name,Address and Tel.No.
350 Main Street /* eyG1 J•1
W. Yarrnoutri, MA 02673 3�
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2
Design Flow(min.re uired) 330 gpd Design flow provided 3 (0 gpd
Plan Date 7 6 Number of sheets ( Revision Date
Title 1'd o C.-_
Size of Septic Tank �al,Yj -c�c%r4 h Ty e of S.A.S. `S D rX/o
Description of Soil e(� h
Nature of Repairs or Alterations(Answer when applicable)
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 Co e and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Heal h.
Signed ) C(.Lj�__ Date 8A)./0
Application Approved by ° Date d
Application Disapproved by: Date
for the following reasons
Permit No. 2[��— Date Issued o 7
No.. W.7 J 1f (='' � c Fee
"THE COMMONWEALTH OF MASSAC.,HUS"ET, Entered in computer:
x e w .,J` Yes
hUBLIC HEALTH DIVISION,- TOWN OF BARNSTABLE, MASSACHUSETTS
Z(Pprtcatton for �Dtgpo!gal 9pp5teut Con5tructton Permit
T
Application for of Perniit to Construct O Repair O UpgradeA, Abandon')( ) ❑ Complete System Individual Components
et
Location Address or Lot No. �� LK 1A 0 e Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel ✓�Jt C/v f ( G
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
P/C I -3 6 1 - o�`lc�
c�
Type of Building:
Dwelling No.of Bedrooms -3 Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.r?(j3(
,uired) �30 gpd, Design flow provided 1 7 "( gpd
Plan Date 7 0 Number of sheeef's (2 6 r 9--4 Revision Date
Title C-V7
Size of Septic Tank /(� +� 'J I '^5 TyEpe.,of S.A.S. 3/ 3o sa s 3 d x/0 f X.;2
'Description of Soil
tom`
Nature of Repairs or Alterations(Answer when applicable) P ��
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 Co a and not to place the system in operation until i'Certificate of
Compliance has been issued by this Board of Health. -•
Signed �\ L C C t" DateAl
� U
Application Approved by Date 8 0
Application Disapproved by: Date
for the following reasons
i ,� - y -� Date Issued Permit No. U
———————————————————————————— ————————————THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
x Certificate of Compliance
THIS IS TO CERTIFY,that the On-site ag Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (�
Abandoned( )by �$ Cf ,0!�
at 66 K •4 Ale C�,rfi�fv�� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 Od - "l a- dated P/jk/7
Installer Designer
#bedrooms 3 Approved desig—n fly .7 d J gpd
The issuance of this permit shall.-not-beoj construed as a/guarantee that the system Kidd-fu tion�S designed.
Date �`>`� 1 l l t I 1 Inspector ��)44 d c:✓lr0
---------tJ------------ --(y----/--/'----
No. •C)17 7 .� Fee / w
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
1=igpoga[:*pgtem Con5truction Permit
Permission is hereby granted to Constructs ) /Repair ( ) Upgrade (-), Abandon ( )
System located at d
;N
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: Construction must be completed within three years of the date of this
pe
Date is;,Z-2 "" Approved by "W
Town of Barnstable
�'ME
' •� Regulatory Services
Thomas F. Geiler, Director
" IABNSfABLL
Public Health Division
^" Thomas McKean, Director
200 Main Street,Hyannis,NIA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form i
Date: 1 Sewage Permit#07_ 3 assessor's Map\Parcel_ J
Designer: I y-"-e,'A Installer:
�o x>x �l/ A& B CANco
Address: Address: 350 MaiR Street
1 , S��JOVV � A O2X37 W. Yarmouth, MA 02673
On 8 07 /�1 fC"(V was issued a permit to install a
(date) (installer)
septic system at �L OA-IL LSE based on-a design drawn by
1 A (address) L
• dated 3 U
�( (designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation or the
distribution boX and/or septic tank.
I certify that the septic system referenced abode was installed with major changes (i.e.
heater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Ptan revision or
certified as-built by designer to follow.
OF Mqs
o R N s .
a(Designer's
aller's Signature) ` o. 1140
N d 0ADI
SOITA Signature) (affix Designer's Stamp Here)
PLEASE RETURN TO BARNS BLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q: Health/Septic/Designer Certification Form 3-267a.ldoc
i
Town of B (arnstable.
P.#
,ttE •
Department of Regulatory Services
Z�A
• Public Health Division Hate
+.�AF?Ia7AB(Sv
t �e$ 200 Main Stree4 Hyannis MA 02601
RFD MAT' ;
Date Scheduled w Time
Fee Pd.
Soil uitahility Assessment for,Sewage Disposal '� ,
� � �I
Performed By: Witnessed 11 c_
LOCATION & GENERkL INFORMATION .
I Owner's Name YW P;
Location Address 1 OAK 1.,/ f4e
L4AIE
rr i
d�IZV l Lt,G I Address 05�VI e
to
02 S I. Engineer's Name��r re,_r`• M � co
Assessor's Map/PNrcel: �'4 t7r7
NEW CONSTRU(t TION REPAIR X j Telephone* 3 G 2 Z9
Land Use Slopes Surface Stones ,(lldryW--�y�
Distances from: Open Water Body, 'C O® ft ' Possible Wee Area a ft Drinking Water Well eft
I
Drainage Way 5 / p ft. Property Line 7 /y ft Other ft
i
SKETCH:($treet name,dimcnsiods'of 104 exact locations of tot holes&perc tests,locate wetlands in proximity to holes)
�ee
S I S
0 -0 .7lZ3l07
-
� Ott J '��Y�+�F':� .. .. "'e" ^"t s+•`� z �i
i
I .
Parent material(geologic) =Waw
14a,141 " �J� Depth to Bedrock
y.�I�t I' m Plt Face N
Depth to GroundwaWr- Stan /V i ! Weeping from
Estimated Seasonal;ogh Groundwater
�TIONF()RSEAS61AL HIGH WATER'T"L,E C=.P
Method Used: i
Depth c1bperved standing in obs.hole: in, Depth to soil mottles;
In, Groundwater Adjustment ft. I
?
Depth toiweeping from side of obs.hole: r,,, Adj.Groundwater Level.,..,°• r
Index Well# Reading Date Index Well level A -i'actor,
PERCOLATION TES ' Date 7 23 �rl �
Observation �� -•...- `. -.i '
Time at 9
Hole#
Time at 6" ....._---
Depth of Pere i
I�03
t Time(9"-6„)
Start Pre-soak Time.0
End Pre-soak _ r
Bate MinJInch
I:
Site Suitability Assessment Site Passed _ Site Failed:
Additional Testing Needed(YIN)
Observation Hole Data To Be Completed on Back--
Original:.Public Haith Division ------
***If percolalliiOn test is to be conducted within 100' of wetland,you must first notify the
Barnstable 6 servation Division at least one(1)week prior to beginning.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil''Color Soil Other
.Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsistenc %Gravel)
and I /Z
" 3 V Loam "ej /Q R 6
33 -132 �t�e_ Od .S l
- � Sakd
DEEP OBSERVATION HOLE-LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other'
Surface(in) (USDA) (Munsell) M_ottling (Structure,Stones,Boulders.
'Consistency.%Gra el
0 (0rr=
38'r- 12b`r
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consiste c o Gravel
DEEP OBSERVATION HOLE LOG L Hole#.Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
nsist n m
Flood Insurance Rate Map: No Yes'x .
}�pp __�^^ "wd L�uttilary _
Yig '. ,d--�✓i ��vYy:rvv Cur1 •'
Within 500 year boundary No/,( Yes
�Qe t� Within 100 year flood boundary No x Yes
In Depth of Naturally Occurring Pervious Material
Does at least four feet'of naturally occurring pervio s material exist in all areas observed throughout the
-�-1 area proposed for the soil absorption system?
-F If not,what is the depth of naturally occurring pervious material?
�tt
9
`.'
Certification
I certify that on A0 � (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by_rie consistent with
1 r the requi -ni g,expertise and experience described in all CMR 15:017.
Signature Date
Q:\,SEPTICVERCFORM.DOC
Certified Mail#7006 0810 0000 3524 8707
�oFztro�� Town of Barnstable
Regulatory Services
x s
x
AARNSCA6LE,.i
p MASS. Thomas F. Geiler, Director
�p 1639.
""A��,
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
March 5, 2007
Adelheid Weber �f
23 Sunset Lane
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 21 Oak Lane, Osterville was inspected
on March 5, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable.
This inspection was conducted on the basis of the rental registration in accordance with
Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.190—Hot Water. Hot water only reaching 100°F when required to be
between 110°F - 130°F.
You are directed to correct the violations listed above within thirty (30) days
of your receipt of this notice by supplying hot running water reaching a minimum
temperature of 110°F but not exceeding 130°F.
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 $1.00.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
QAOrder letters\Housing violations\Rental ordinance\21 Oak Lane.doc
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF THE BOARD OF HEALTH
C
Thomas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Ginger& Michael Doak ,
Cc: Timothy O'Connell, Health Inspector
QAOrder letters\Housing violations\Rental ordinance\21 Oak Lane.doc
Certified Mail#0000 0000 0000 0000 0000
z HE r Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Alfi° � Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
date
S (lZ
oa5
i ,
NOTICE TO ABATE VIOLATIONS OF 105 CMR 41 0.0001 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 `
—T � was inspected
y (Address)
on / / � b U
Health Inspector for the Town
(date) (Inspector's name)
of Barnstable,
(Reason for inspection)
The following violation(s) of the State Sanitary Code were observed:
State code violation number-violation description)
105 CMR 410. 1/ V C °
105 CMR 410.
105 CMR 410.
105 CMR 410.
QAOrder letters\Housing violations\Rental ordinance\template.doc
Y
J-0,5.-G' IIR 410.
The following violation(s) of the Town of Barnstable Code were observed:
(Town code violation number-violation description)
§170-_ -
§170-_-
You are directed to correct the violations listed above within i r ) days„
(written# (#)
of your receipt of this notice by k y
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.
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S.,!CHO
Director of Public Health
Town of Barnstable
��Cc: Q
(Name,tt t,owner,Fire Dept.,Building Dept....)
CC: (_
(Health inspector's name) -
(Generic codes-located at Q:\Order letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC
Q:\Order letters\Flousing violations\Rental ordinance\template.doc
FORM30 Ilhw HORBSBWARREN M THE COMMONWEALTH OF MASSACHUSETTS
C�
BOARD___Qf EALTH
CITYlTO
W I
` o DEPA MENT
ADDRESS
M sey`0 (� o r0 I
TELEPHONE
Address Occupant
Floor Apartment No. No. of Occupants 2
No. of Habitable Rooms 5 No.Sleeping Rooms _2?—__
No.dwelling or rooming units_ - No.S ries
Name and address f owne �-. __ L
Remarks Reg. Vio.
YARD Out Bld s.: Fences: _5
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains.-
Walls:
Foundation:
Chimney:
BASEMENT Gen. Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
—Pantry
Den
—Living Room
Bedroom 1
Bedroom 2 1
Bedroom 3 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
St cks, Flues,Vents, afeties:-
Kitchen Facilities 41nk f= ( (�
ve
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other.-
Egress Dual and Obst'n:
General BuildingPosted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORTjq SIGNED AND CERTIFIED UNDEAI.THE PAINS AND
PENALTIES OF P JU Y.
140�m
INSPECTOR 1 1 1 d
TITLE—
DATE� TIME v v M.
A.M.
THE NEXT SCHEDULED REINSPECTION � P.M.
•},.. . .. a iJ 5. �ry 1 � ..( ~t'�' ...i T.�n a t`►t]eY+"'!W�,i�l. .:14 H ,4✓M":"rTi�'F ri.ltW 1 C..:�',.. 't'9Y �}... �lj' rvr. r.i�
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or
impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burs, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner i
to remedy said condition within the time so ordered by the Board of Health.
7�
'i0CAT10N SEWAGE PERMIT NO.
VILLAGE
of Z /� 41w C. ostrr--ull ) hl4
I N S T A LLER'S NAME L ADDRESS
B U I L D E R OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED ' ..
Wfit" �
'Y
Ear: ve l ®.R e
i
- 1
/0 0 0
v
..........
N-1
Fmc..,r.........................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR HEALT
...........I.............F ........
.........OF... ........... .... ........
Appliration for Di"oiial Works Tonstrurtion run fit
Application is hereby made for a Permit to Construct or Repair (e_)--aff-Individual Sewage Disposal
System at:
.......... ...........
.2. ........................
... .. ..... .012A .... Itr I--------L
L n-Addi or Lot K'o'
_------ ........................................... ...................................
...............in_0..L. . ...7.................... ............ Addres
.......
.�rer
.................... f----------
.... .. ... .... ... ............................................. . ...........05 .. I ...................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.... ....................................Expansion. Attic Garbage Grinder
Other—Type of Building ............................. No. of persons............................ Showers Cafeteria
Other fixtures ......................................................................................
---------------*..........*----------------*-----------
Design Flow............................................gallons per person per day. Total daily flow...........................................gallons:
Septic Tank—Liquid,capacity............gallons Length................ Width..............._ Diameter__._............ Depth.................
Disposal Trench—No. .................... Width.....__.:........... Total Length.............._..... Total leaching area....................sq, ft.
Seepage Pit No..................... Diameter.............__..._. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) I
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch. Depth of Test Pit....._.....__....... Depth to ground water.._....._...............
;-14 Test Pit No. 2................minutes per inch Depth of Test Pit...__.'_...-__.._... Depth to ground water--_--._____-.___.__.____
9 ...........................................................*...............**"*....-----------------------------------------------**...*...*----*.....
0 Description of Soil........................................................................................................................................................................
-------------------------------*-------------------*--------------- ------------------*----------------------------**-------------------*---------------*----------------*-----------
............................................................................................................................ ... ..............................-/,F;"
Nature of Repairs or Alterations—Answer h pplicable----41;17.SV� --- -------- .........
U when a �-Oe-.zK- -----
-- - --------
..............q..i............5.
Agreement:
The undersigneragrees to install the aforedescribed Individual Se age Disposal System in accordance with
the provisions of'L ILT 1-2 5 of the State Sanitary Code— Th undersigned rther agrees not to place the system in
operation until a Certificate of Compliance has be and iealth.
......... fec
.. ........... ..... ..............................
D le
Application Approved By.........11....... .. ........................ ............................................ 1a
/ Dae
Application Disapproved for the following reasons:.............................................................=-----------------------------•......----•......
....................................................................................................................................................:----------------------------------------*-----------
Date
PermitNo................ .........._. ........ IssuedL.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD---QF HEALTH
1 q -
Appliration for Uhipmta1 Works Tonstrnrtion thrmit
Application is hereby made for a Permit to Construct ( ) or Repair (C --3n` Individual Sewage Disposal
System at: �/Igr
f /............ .... __. ----•-----
Lo.. _�.,'71 rbn-.Addr ss or Lot No.
�� �..................•.
�! y Oynerf < _�) Address
arc. _'tl.l......af .. ..... �. -.f....••••..................•--
Installer Address
d TypeDwellinNo. of Bedrooms.............. Size Lot.._.._.._...._.._..____.._._Sq. feet
Building of
g— ..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures --------------------------------------------------------•-••••----•--•----•••--•••••-•••-•-•••••-••-••••••-••••••••-•••••--••---•-•-•---•••......•----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 Septic Tank—Liquid capacity............gallons . Length................ Width................ Diameter---------------- Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
---------•------•-----•--•------------------------------------------------------------------•--......---•---------•---...........------•---.............---..
0 Description of Soil........................................................................................................................................................................
V
W -•-••------•----------------•--••--------•--•••••••---••--•••---•--•••-••••••...--•--•••-••••-••••-•----•---------•••-•-••-•- t
_—
Nature of Repairs or Alteration s—Answ r when. --- -------
_,/� ...----_.--------
1'`' -/------
C,< ................ .ft '•L°' ''f' t ;= ems.- >._. T
Agreement:
The undersigne agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T I T IE 5 of the State Sanitary Code—Th jidersigned rther agrees not to place the system in
operation until a Certificate of Compliance has been,.istued' , e b and health.
rSt ned to d F ....... . - /
to J 7-
Application Approved By....................................� � r1�"_.-.-•�-
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------•--•----------------••......•...._..
-------------------------------------------------------•-•_
..........................................................................................................................
_ Date
Permit No............. 5 Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,
�F HEALTH
ell� r
........ ..... . ...............................
THIS I OCRTIFY, TaTrtifirttte of Tnntplianr
� t e Individual Sewage Disposal System constructed ( ) or Repaired ( ~)
by � _ i --------------------------------------------------------•...
-----------
7b-2,
at................. .t'.............._ ............ ---- -_-------------- ---•----
-------------------
has been installed in accordance with the provisions of TI 5 of The State Sanitary Cade as 'e-ccribed in the
application for Disposal Works Construction Permit �'o.._" `:_ .__7.. .. -..... dated__....-_ ��t `<a...................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME
SYSTEM "NCTION SATISFACTORY. 5 _7
DATE.... .......................................................................... Inspector....................................................................................
�I
/ THE COMMONWEALTH OF MASSACHUSETTS
BOARD 3DF HEALTH
..........OF.... ...�.A........ T.......................
................ FEE...... .....:..........
�1 .�rk� �nr� ,tra�rtuart pr�ttt
Permission is hereby,granted•••• - . ° '" - ----------------•------------------...........•.....................
to Construct ( ) or Repair ( an Individual Sewage Disposal System
at No...
. .. -1--•-------------.-------Street------- -•---------..---•--•----------.- ---.----.-.--------
as shown on the application for Disposal Works Construction Permit Na ?....:_,. JDaW.._.�` _ LA---------
f t ,j Bard of Health
< / - ....•-••.
DATE........ = -'�===-= - ........y...................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
_l
I ,
Y
. R
LEGEND p TOw-
PROPOSED CONTOUR
® PROPOSED SPOT GRADE :o HIB�S d .
� TON H01
DEMENT EXISTING CONTOUR ►RE \Y z c p z
OF P A E ER "
EOGE 581, � + 96.52 EXISTING SPOT GRADE
�oo.00 ft - W— EXISTING WATER SERVICE NST: o FINGER �n P
C� TEST PIT
GATE WATER _CC R C% 25 \\ ' Q a o OsterVdle
AREA _ '�,448\3, Sf
r
\\ \\\ \\ \\ ! LOCUS MAP N.T.S.
BENCH MARK GENERAL NOTES:
\ N G I PAINT SPOT ON STEP 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY.THE LOCAL
�L S. ELEVATION 60. 33 1 I I - BOARD OF HEALTH AND THE DESIGN ENGINEER. . -
\ I � =I 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
BARNSTA9LE CIS DATUM OF THE STATE ENVIRONMENTAL 'CODE, TITLE V. AND ANY APPLICABLE
\ D V v C I I LOCAL RULES AND.REGULATIONS.
3. THE SEWAGE\ DISPOSAL SYSTEM SHALL NOT BE,BACKFILLED PRIOR FNDN I I TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
L OP OF G 4 I I �' DESIGN ENGINEER.
�� E� 62 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
I FROM THOSE SHOWN:HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
/ 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
62 I 56 6. THE DESIGN-ENGINEER. IS NOT RESPONSIBLE FOR THE FAILURE OF
lol THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
\ \ ✓ I �5 it / [ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
o \� o I I 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
-THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
\\ .7 I I \ CONSTRUCTION.
\ I \ 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND REMOVED
\\ 1 I \\ 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
12. THIS PLAN IS TO BE USED FOR .SEPTIC SYSTEM_PURPOSES ONLY
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
\I CCJ{ I \ 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING
I C I I \ 14. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED OTHERWISE)
X�
I o
OG 15. THE DESIGN OF THIS SYSTEM DOES ,NOT ALLOW
0 D / I (\\ FOR THE USE OF A GARBAGE GRINDER
EN \
15 16., NO WETLANDS WITHIN 100 fT. OF PROPOSED LEACHING
ft i of TH-2 P Existing Leach Pit
I o j I (See No to 10)
01 56 ..
-5 it .S8OF
r
/ �1a
60 Io ° R Z EP` M' �, PROPOSED SEPTIC SYSTEM UPGRADE PLAN
62 0. 11y" 21 , OAK LANE, OSTERVILLE, MA
SEC/SiEtI Prepared for: Heidi Weber
SURVEY REFERENCE: MAP,' 141 Engineering by: Surveying by: SCALE DRAWN JOB. N0.
` N.ITAQ'\P L0T.•025 DARRENM.MEYER,R.S. Eco-Tech 1�nvironmental
PLAN OF LAND BY BEARSE & KELLOGG, ENGS. 1"=20' DMM
{ -7 DEED BOOK. 17615 PO BOX 981 (508) 364-0894
DATED: DECEMBER 22, 1947 1 1. E4STSANDWICH A4A 02537 DATE: CHECKED SHEET NO.
DEED PAGE.091 506-3622922 07/23/07 DMM 1 of 2
- 9
ELEV. TOP r,
FOUNDATION
(Existing)
= 62.04 F.G.EL: 61.0 F.G.EL: 60.0 F.G. EL:.60.0 FINISH GRADE= 60.0 - 59.5
a MAINTAIN 29;;,•, MIN SLOPE OVER LEACHING AREA
COVERS TO WITHIN 6 OF 'GRACIE
6" INSPECTION PORT
= W/IN 6" OF FINISH GRADE
`
A 35 6„ 1 " 4" SCH 40 P
4 3" VC 9 L _ 5, r
1D"I ° ° ° ° ° ° ° ° ° ° ° °
14'(MIN. ° :INV.57.55
S= 1% (MIN.) e•
" ) TEE'S ARE TO BE @ S= 1 (MIN.)
n. 4' SCH 40 PVC
En
INV.57.1'01
INV.56.90 °
EXISTING OUTLET BAF LE PROPOSED DB-3
� '. . . :. . H-110 DISTRIBUTION BOX 30'
{
INV. 57.80 EXISTING 1000 GALLON SEPTIC TANK
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
PIPE INVERTS PRIOR TO CONSTRUCTION RL0?FaBR � 9" MIN.
2) D-BOX SHALL BE.SET LEVEL AND TRUE TO
OF Mq GRADE ON A MECHANICALL 'COMPACTED SIX
PER T1 TLE 5
INCH CRUSHED STONE BASE, AS SPECIFIED IN J BREAKOUT EL. - 57.50
3` 310 CMR 15.221(2) INV. ELEV.=56.80
ME
DAR E M 3) REPLACE EXISTING 1,000 GALLON SEPTIC t�ve ��
R TANK WITH 1500 GALLON SEPTIC TANK J14•- li 24 30 5"
r N . 140 "' IF FAILED, DAMAGED, OR UNDERSIZED. MUMS WAS'=S 1/ERT
\ SEPTIC SYSTEM PROFILE 4) INSTALL INLET & 1N
OUTLET TEES AS REQUIRED BOTTOM EL.= 54.80 T
S4NITAR\P� -35" 50" 35"
a7
23� SEPARATION 5.30 FT. I 120"
INFILTRATOR 3050 SPECIFICATIONS BorroM of rH-1 EL: 49.5 SOIL ABSORPTION SYSTEM (SECTION)
SOIL LOGS DESIGN CRITERIA
}
NUMBER OF BEDROOMS: 3 BEDROOMM
DATE: JULY 20, 2007 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF)
DESIGN PERCOLATION RATE: <2 MIN/IN
SOIL EVALUATOR:, DARREN MEYER, R.S., CSE
° WITNESS: DONNA ,MIORANDI DAILY FLOW: . 110 G.P.D.
HEALTH AGENT DESIGN FLOW: 330 G.P.D.
INLET END GARBAGE GRINDER: NO (not designed for garbage grinder)
(OPEN) Elev. TH-1 Depth Elev. TH-2 De th SEPTIC TANK: 330
60.50 �_ gpd x 2 = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK
A LOAMY AND 0" 59.50 A LOAAYMRY A D 0" LEACHING AREA REQUIRED: (��) 445.94 S.F.
1OYR 3 2
4.5"Dt4 ACCESS PORT FOR INSPECAON. 59•83 B 8" 5s.o a 6" USE THREE (3) INFILTRATOR 3050 UNITS WITH 2.92 FT. STONE
LOAMY SAND LOAMY.SAND ON THE SIDES, & 3.83 FT. STONE ON ENDS: 30' L x 10' W x 2'D
,.� 10YR 6/6. 10YR 6/6 .
BOTTOM AREA: 30 x 10 = 300 SF
57.34 C1 38" 56.34 38" SIDE AREA:
Cl (30 + 10) X 2 X 2 = 160 SF
TOTAL SQUARE FEET PROVIDED = 466 vs. 445.94 REQ'D
° ° ° DESIGN FLOW PROVIDED: 0.74(460 S.F.) = 340.4 G.P.D. vs. 330 G.P.D. req'd
° PERC 055.17
FINE - MEDIUM PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SAND FINE- MEDIUM
INFILTRATOR 3050 z.SYs/s 2.sY6/6 " 21 OAK LANE, .OSTERVILLE, MA
NOMINAL CHAMBER SPECIFICATIONS Prepared for: Heidi Weber
Engineering by: Surveying by: SCALE DRAWN JOB, NO.
SIZE (W X H x L) 51" X 30 X 85.4 49.50 132" 49.5 120 DARRENM.MEYER,R.S. Roo-TecA Emvhvnmenlel N.T.S. DMM
WEIGHT 80.0 LBS. PERC RATE <2 MIN/IN. (C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) EAS ox981 CH,MAo253� (508) 364-0894 DATE CHECKED SHEET NO.
NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED 508-362-2922 07/23/07 DMM 2 Of 2