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HomeMy WebLinkAbout0011 OAK RIDGE ROAD - Health 11 Oak Ridge Road Osterville F 11'8 116 . TOWN OF BARNSTABLE LOCATION 1 i o it���� � R SEWAGE# 0-61oB -4g e; VILLAGE 0 54E r v 111e -ASSESSOR'S MAP&PARCEL �`� /1 !!(o INSTALLER'S NAME&PHONE NO. M, I"6 d l f)7 4 « �D9-3�55- SEPTIC TANK CAPACITY f�UGG LEACHING FACILITY: (type)-Ireh<21i Cw �� 5�ne (size) 3 3-`5`x 10, 83' NO.OF BEDROOMS -4 OWNER &15_ c %C.l PERMIT DATE: / VV, 04. ZOOS COMPLIANCE DATE: T c, 5 Zb GS Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IIJ Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) AI L& Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet �FURNISHEDBY GVI �C /��L�l l'j�?Ire �a Qs (14-+ z y_ 40.6 I Commonwealth of Massachusetts Title 5 Official Inspection Form - �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' f 11 Oak Ridge Rd Property Address - THOMAS, RICHARD R TR MMLCOX; COURTNEY D , Owner Owners Name •� information is required for every Osterville Ma 02655 6/20/20 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information Lf'�� . on the computer, use only the tab Michael DiBuono > key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. �h35 Content Ln I�—V Company Address . Cotuit Ma 02635 ' Cityrrown State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title,5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes + 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 7/15/20 , Inspector's Signature Date The-system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. h t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Oak Ridge Rd Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is required for every Osterville Ma 02655 6/20/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: R System is functioning as designed 2) 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): i' t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M1 Subsurface Sewage Disposal System Form.-.Not for Voluntary Assessments YI. • 4 .. r M 11 Oak Ridge Rd . Property Address THOMAS, RICHARD R TR &WILCOX,COURTNEY D Owner Owner's Name information is required for every Osterville Ma 02655 6/20/20 ° page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ° 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if ' pumps/alarms are repaired. ❑ 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): s ❑ distribution box is leveled or replaced ❑ Y ❑ N' ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or•obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain,below): ❑ obstruction is removed ❑.Y ❑;N ❑ ND(Explain below): 3), 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. 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: t5insp.doc-rev.7f2812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments fi 11 Oak Ridge Rd Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is required for every Osterville Ma 02655 6/20/20 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier; if any) n determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and-the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: ; 4),'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 t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 r Commonwealth of Massachusetts r�100$ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Oak Ridge Rd j. Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is Osterville Ma 02655 6/20/20 required for every ' page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) " ' r Yes NoEl •, Static liquid level in the distribution box above outlet invert due to an overloaded ®. or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply. well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the"' questions in Section CA., 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 16 L c Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . M 11 Oak Ridge Rd Property Address „ THOMAS, RICHARD R TR&WILCOX, COURTNEY D Owner Owner's Name information is Osterville Ma 02655 6/20/20 required for every ' page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. A .. 6. You must indicate"yes"or"no"for each of the following for all inspections:` Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health- ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) - ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ❑ Were all system'components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ®' Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has ' been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health.El Z . 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)] ' t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 l , f c Commonwealth of Massachusetts . Title 5 Official Inspection Form I" Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 11 Oak Ridge Rd Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is Osterville Ma 02655 6/20/20 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: h Number of current residents: Does residence have a garbage grinder? ® Yes .❑ No Does residence have a water treatment unit? ❑' Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes,® No information in this report.) . Laundry system inspected? ® Yes ❑ No r , Seasonaluse? ❑ Yes ® No Water meter readings, if last 2 ears usage 41 263 GDP 9 ( Y g (gpd)): ` Detail: r Sump pump? ❑ Yes 0 No., Last date of occupancy: . c Date ' { t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . I- Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 11 Oak Ridge Rd Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is Osterville Ma 02655 6/20/20 required for every , page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) ' 2. Commercial/Industrial Flow Conditions: " Type of Establishment: Design flow(based on 310 CMR 15.203): t;auons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? r ❑ Yes ❑ No Water treatment unit present? '❑ Yes ❑ No If yes, discharges to: , Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: ' Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information:' Not provided Was system pumped as part of the inspection? 4 ❑ Yes Z No If yes, volume pumped: +' gallons + t F How was quantity primped determined? , Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts .- _ Title 5 Official Inspection Form - �- - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .°" 11 Oak Ridge Rd b Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name i information is Osterville Ma 02655 6/20/20 required for every " page. Cityr'rown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: t i i ® Septic tank, distribution box, soil absorption system - ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach'a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under'contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 1 j Approximate age of all components, date installed (if known)and source of information: 2008 0 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan):. Depth below grade: 1.5 ,. feet Material of construction: ' ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): - System is vented at the roof line " t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts UW Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments • ri.• 11 Oak Ridge Rd Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is Osterville Ma 02655 y 6/20/20 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) 1500 y If tank is metal, list age: years 4 , Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 e 1 . •Sludge depth: 3 . 2411 Distance from top of sludge to bottom of�outlet tee or baffle 3" Scum thickness .: .. ° 411 { Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined?' Tape Measure/Data On File Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as relate_d to outlet invert, evidence of leakage, etc.): 1500 .• Y its ,. ^: r - - - r• t5insp.doc°rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 11 Oak Ridge Rd - Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is required for every Osterville Ma 02655 6/20/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ; ❑concrete ❑ metal ❑fiberglass El 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must'be pumped at time of inspection) (locate on site plan): Depth below grader Material of construction: f ❑ concrete ❑ metal' ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v� 11 Oak Ridge Rd Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name , information is Osterville Ma 02655 6/20/20 required for every page. City/Town State Zip Code Date of Inspection , D. System Information (cont.) :s• 8. Tight or Holding Tank(cont.) r • 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)As copy attached? •❑ -Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and of Normal level 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.'): No sign of over loading } t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 11 Oak Ridge Rd Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is required for every Osterville Ma 02655 6/20/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation riot required): If SAS not located, explain why: ` . r Type: ❑ leaching pits , number:' ® leaching chambers number: } ❑ leaching galleries ' number: leaching trenches number, length: ❑ leaching fields r number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t6insp.doc•rev.7/26/2018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments r 11 Oak Ridge Rd " Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is required for every Osterville Ma 02655 6/20/20 page. Cityrrown State Zip Code. Date of Inspection D. System Information (cont.) ° 11. Soil Absorption System (SAS) (cont.) + Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Field was new in 2008. Field is functioning as designed 12. 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i r' 4 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 f ' Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 11 Oak Ridge Rd G Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name w information is required for every Osterville Ma 02655 6/20/20 page. Cityrrown State Zip Code Date of Inspection E D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions .i Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 6 ' f 1 • 4 F r Y � r f ' y' t5insp.doc Y rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Y Page 15 of 18 Assessing As-Built Cards https://www.townofbamstable.us/Departments/Assessing/Property_... TOWN OF BARNSTABLE LOCATION ! B�c� Ye �I SEWAGE# Z -0B VILLAGE ASSESSOR'S MAP&PARCEL 118 11 b. INSTALLER'S NAME&PHONE NO. .11,e Mc Inkre 508-39,5-W% , SEPTIC TANK CAPACITY /.gaaG y LEACHING FACILITY Or)4re/7 d?{i �l' stage. (size) 53.5'X;12,83 NO,OF BEDROOMS OWNER LT45fer r PERMITDATE: VVV.Z1-, 20116 COMPLIANCEDATE:• ec, 5 ZoGB'`` Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N Feet` Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) fit! F ky^ q Edge of Wetland and Leaching Facility(if any,wetlands exist within. i 300 feet of leaching facility), N Q. Feet , 'FURMSHED BY `!11 f'e A. a^ • r i deek ,X. s ` . 1. ^ ' is k .. <Z ZQ.O'. q •. t' .- € f� � ter• - - � fi .C-3�31:yr � � , a d ' • j . � , - ` .-0. t q•^ I.. • � F / r�' ,, r ..S T!q �' ft. • 1 '. r J { I 1 of 1 7/15/2020, 10:32 AM r 'Commonwealth of Massachusetts Title 5 official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,W1111 11 Oak Ridge Rd Property Address r THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is required for every OSteryille Ma 02655 6/20/20 1 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form -� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11,Oak Ridge Rd P Property Address THOMAS, RICHARD R TR &WILCOX, COURTNEY D Owner Owner's Name information is Osterville Ma 02655 6/20/20 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope , ❑ Surface water ❑ Check cellar ❑.Shallow wells i Estimated depth to high ground water:. feet Please indicate all methods used to determine the high ground water elevation: .. ' ® Obtained from system design plans on record .If checked, date of design plan reviewed: Daatete 20 D ❑ 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: r You must describe how you established the high ground water elevation: Test Hole Data on plan ' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I - 4 Commonwealth of Massachusetts r Title 5 Official Inspection Form - �� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 11 Oak Ridge Rd Property Address THOMAS, RICHARD R TR MALCOX, COURTNEY D Owner Owner's Name information is Osterville Ma' '02655 6/20/20 l required for every ' page. Citylrown State Zip Code Date of Inspection 3 E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A Inspector Information: Complete all fields in this section. ❑ B. Certification:.Signed & Dated and 1, 2, 3, or checked ❑ C. Inspection Summary: r 1, 2, 3, or 5 completed as appropriate ` 4 (Failure Criteria)and (Checklist)completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System,drawn on pg. 16 or attached.- For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. � Fee / Q0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALT.1i DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippfiratiou for 33isposal bpsttm Coustruttion ptrmit Application for a Permit to Construct( ) Repair( ) Upgrade(V) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /I oak-r idle- Owner's Name,Address,and Tel.No. o� �+� Assessor's Map/Parcel d f8 //`i c S -p�v;)� 7704 Mu/'i 3tf aS /v/lie MR 50:0^ Z6 - ZSZS Installer's Name Address and Tel.No, Designer's Name,Address and Tel No. manlyn M41=nfiy'r4e, /v3 r3�N Rc�!�'� Lbw, ��� 439 Mcc�K 5f oom R-OH At* pe of Building:. Dwelling No.of Bedrooms % Lot Size sq.ft, Garbage Grinder( ) Other Type of Building No.of Persons Showers( .) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 ga gpd Design flow provided 4 SS gpd Plan Date OG-f, 1 2,002_ �Na umber of sheets Revision Date Title TdL6 5 5 k� g� a- (5Q-C Ada e ®.5-,�--ry 1169 Size of Septic Tank I SDo !qa-1 Type of S.A.S.-fre-A lh 63 drz/A) 414 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Lh 516d[ /1 e-W `5,00G -5 T, , "3 ; Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f Health. Signe Ln Date Application Approve ` Date Application Disapproved by Date for the following reasons I Permit No. Date Issued i 1t1 - -- - --- --- - - i No. / J 7 .' �, = Fee /U Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC,HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppYicatcou for Misposal Opstertt`Construction 3perm it Application for a Permit to Construct( ) Repair( ) Upgrade:(V) Abandon(") ❑Complete System ❑Individual Components Location Address or Lot No. /I 0aJ-0c1le Fed Owner's Name,Address,and Tel.No.K05��/Cr cruel C.5 vo..1Q 77-04 /'Nal i 51f•1 U //C M A Assessor's Map/Parcel /�� / G• S/� Z — S•� Installer's' Nam eAddress,aed Tel.No Designer's���� Designer's Name,Address,and Tel.No. y +� . / 3 V ZOwn CAyoe 45:,1q 939 MCc LarmoyJ6 PortAt.1 ;Oe- 385--47ef07 1 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ) Design Flow(min_.required) gpd Design:flow provided - �Q S gpd Plan Date QG f 9 Zook Number of sheets / f Revision Date Title e- $ 5 L7� t'lr.N 9-p // G 5 /'i/ /e - Size of Septic Tank Type of S.A.S. wr-1 5 -4 �S7zv[e� Description of Soil Se_>r r< Nature of Repairs or Alterations(Answer when applicable) /A S' Q-�(� °(.J /6 oG c, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. /f Signe, Date //- 2G -Cr$ Application Approve 'y Date AT Application Disapproved by Date for the following reasons Permit No. r3o R Date Issued ' lV THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(X Abandoned( )by at O &q e �� ry//j(� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No-0 yQ9_dated /Q 6/G Installer ya.ri lqn /st c. 11{LJr Designer ►7 G/, #bedrooms Approved dZ14 gn flow qC�S �/ gpd The issuance of this peGGr��mit slhall not�'bee construed as a guarantee that the system v function as desi ed., Date ,L � �/! Inspector �� - - - - - . ._1 ---_-------F -------- ----- =---- . No. Fee THE-COMMONWEALTH OF MASSACHUSETTS T PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal Opstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(� Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permi` ICI 1 . Date , ✓" APpro\dyby . X" ,=F;4 ;:dawn cape engineering inc FAX N0, : 15083629880 Dec. 05 2008 04:03PM P1 Town of Barn. strible 3 Regulatory ServicesThomas Y. Geiler,N;rector y +: 1639. l; ���d� '�''kasy;a�q;�s 1'vl[e:��rz�tvit.,.�➢tt�-�;cbar'n r.: 200.10h in Ss reet,Ilyavrrnoa, ATLA 02601 Offica: 508-862-46V -790 I' , [ ' A�t99a1}aao- 1l.Des>i a�� �'ertala��saii® Form � P);ai±:e: �4L �.... sewn-e permlt## TOCAg3flttr: Aar 1 -- ...... dlres5. �— — — ,l _... .. as isstacd a pun—nit to install a 4 J +� 4 �J � septic systean.at i bawd on a design drawn by (�i.ddr. ss ZVI r nee�( sated 1 tie�3 1 designe ---- — ... cc=iil:y chat 'the septic System. re::lerea).ced above was i. stralled sabstantis.fl.y accordii-ig to ` . the design, which may inChLde minor approved chaciges SltCh as lateral rclocation of the distribution box acid/or selytic tank, ,. I ! ecrtif-�j that the septic system referenced above was h3stalled wi.tb major changes (i..c. greater than. 1.0' lateral rclocation of tho SAS or any-vertical relocati as t. 1 of any cora:iPonent of the septic system) but in accordance with c;tate c4 Local Peh;ulati.oais. Plan revision or. ce7.-ti_fied as-built by designer to follow, DANiFLA. zP E'r�ll (lilstaller's i a.ttlro — s OJAI..A + ji+ CIViL rn No, 4650?_ ( ECG f I, .•...(Lyesigner's rC.u.a.tZarc) (Affx.I.7csigrtur'S SL anll�I crc) � I s �ILtiI7r (�A��J @t-r 3 URN TO RIRNST'AB �; 7 U93MC' HEAL.111 DIVISION, _ qut'F-iFlc"' TJ' or, c I� i� ID T : (+)'VLPL,IAINC WILL NOT B1 ISSUED LiNE_11L IBOa'ft FORM AINI) .4,5-I3dJI9..TCARD ARF REC IVED Try 5' l.dll' BARNS r AIIL E 1PUBLIC HEAL 1 F��ti�5I�1°d. TB H INK.YOTT. o:(Te,Ifltll cpll.l.�)CSt!?RCt C.Cftiflcatiotl Forai 3-26-04.doc t c f� 004-- cz Town of Barnstable P# Department of Regulatory Services Public Health Division Hate /C�9 D04_ BARNSTABLK MAS& 200 Main Street,Hyannis MA 0260J,,,,, --` rf0 MA't \' '��((JJ� 00 Time 1 Fee a Date Scheduled -- Pd. — Soil Suitability .Assessment for.Sewa e Dis osal o a 4 0 ✓I - Witnessed B Performed By: y LOCATION & GENERAL INFORMATION Location Address /I 0 a K Owner's Name C rU e l J - Of Ile Address Assessor's Map/Parcel: _ Engineer's Name NEW CONSTRUCTION \ REPAIR Telephone# Land Use Slopes(9'0) i 'Surface Stones Distances from: Open Water Body ft 'Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft, Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands?n proximity to holes) ca en II Parent material(geologic) f Depth to Bedrock'`` Depth to Groundwater: Standing Water in Hole: r I Weeping from Pit Face Estimated Seasonal High Groundwater N/ —t ` DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _ In, Depth to soil mottles: in. Depth to weeping from side of obs.hole: _ In. Oroundwater Adjustment ft. Index Well# Reading.Date: Index Well level_ �w Adi.factor- Adj.(roundwnter L eve) PERCOLATION 'ITBS Date �� d 'Shoe Observation Time at 4" __.._. Hole# 1-- w/Depth of Perc � Time at 6" Start Pre-soak Time @ a _ Time(9"-G') �TL End Pre-soak_ Rate Min./inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) original: Public Health Division • , Observation Hole Data To Be Completed on Back-,- ------ . 4 A ***If percolation testis to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. .Q:\S EVr[C\PERCFORM.DOC i n� DEEP.OBSERVATION HOLE LOG Hole# i Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. S ' on i lency.%Gravel) DEEP OBSERVATION HOLE LOG Hole#_ Depth from .Soil Horizon Soil Texture Soil Color ; .Soil Surface(in.) Other (USDA) (Munsell) , Mottling (Structure,Stones,Boulders. -- Co se c %Grav I - Zo ell, S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other • (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co Si is erIcy Te Graven t Dept DEEP OBSERVATION HOLE LOG Hole# Surface(in.)from Soil Horizon R 'Soil Texture Soil Color Soil USDA Other (USDA). (Munsell) Mottling (Structure,Stones;Boulders. onsi t n c l I ------------------ Flood Insurance Rate Map.• Above 500 year flood boundary No Yes Within 500 year boundary No& Yes Within 100 year flood boundary No Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring per sous material?._ — Certr— ticstion I certify that on 5 (date)I have passed the soil evaluator examination approved-byTTW--.,, DPnarf�nr+nt of Rny;;^.�:rIT.B��tu1 rOtC�;un aTlu that the above analysis was performed by me consistent'witl pa •ne P t' the required training,expertise and experience described in 310 CMR 15.017. Signature fy Date ®� Q:6SEPTICVERCF0RM.DOC y . t��a ;s COMMONWEALTH OF MASSACHUSETTS 4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF EN MNMENTAL PROTFAMON ONE WINTER STREET,BOSTON MA 02108 (617)292-5600 WILLIAM F.WELD � � -a?��11 G?v 7's Tit coXE Governor ARGEO PAUL CELLUCCI DAVID B. STBUHS IA.Governor SUBSURFACE SEWAGE DLSPOSAL SYSTEM INSPECTION FORM Commisaiaaer PART A O _�ERTIF(CATION Property Address:l l DR-Krt Red co+cry � .i�la Address of ;Me at Inspection: IZ-Z -p 1 t Of different) a"ED or: S..�me . Inspect fY3fkS ! I am a DEP approved hstem inspector pursuant to Section 15.340 of Title S(310 CMRI 15.800) Company Name: 1 3 2 2 02 Marking Address: .. Icephone Number: b%) 3(a0—(-1(o09 ; _ALTH RNSTABLE EPT. CERTIFICATION STATEMENT I certify that 1 have personally inspwtft;the sewage disposal sys►ctn at this address and that the information reported below is true.accurate and complete as of the time of inspevion. The inspection was perforrvtd based on my,raining and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes • _ Conditionally.Passes Needs Further Evaluation By the Local'Approving Authority _ Fails Inspector's Signature: • Date: The System Igor shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY:, Check A, B, nl' or D: ,A) SYSTEM PASSES: I have not found%any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1.5.303. Any failure criteria not evaluated are indicated below. COMMENTS: Bl 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. Indicate yes, no,or not determined (Y,N,or ND). Describe basis of determination in all instances. If"not determined',explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tans as approved by the Board of Health. (revbW 04125/n Page 1 or 10 Plad ee heeded fjpy. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM s PART A -CERTIFICATION (continued) . Property Address: Owner: r Date of Inspection: B)SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or.high static water level observedin t14-distnbution box is'due..to broken or.obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will-pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Q 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DES THAT THE SYSTEM IS NOT FUNCTIONING IN A . MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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,APPROPRIATE) DETERMINES THAT.THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND s SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private r.• — water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER a k (reviced 04/25/97) t ase 2 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner Date of Inspection: D) SYSTEM FAILS: You must indicate either 'Yes' or'No' as to each of the following: :-:` I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified'below: The Board of Health should.be contacted to determine what will'be necessary.-to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 112 day flow. _ — Required pumping more than 4 times in the last year NOT due to clogged or obstructW pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater,elevation. Any portion of a 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.. 4 _ Any portion of a cesspool or privy is within 50 feet of a private water supply.well-. ; .. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the-well has been analyzed:to be acceptable..anach'copy:of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: You must indicate either 'Yes'or 'No'as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 13 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatmatt program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (re.bW 04/25/M rage 3 of.lo SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B .. CHECKOUT Prape"y Address: 11 o n Kr O 9e A c� OS+cCuI i le) "44 021—S, n'1 •:Fd Owner• L l(ice Ca)L x I £s+oA-r_ o- ivl arg red C, Crowe-((, Date of Inspection: Check if the following have been done: You must indicate either Yes or No as to each of the following: Yes No _ Pumping information was provided by the owner,of a"m or-Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. TJ/A As built plans have been obtained and examined. Note if they are not available with N/A, _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. Q� All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. , n' The size and location of the Soil Absorption System on the site has been determined based on:. �( The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. ' Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Pan C is at issue,approximation of distance is unacceptable) (15.302(3)(b)] Ireviced 04/2UM Pate 4 of 19 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Il Of�Kridt Rcl Osl ewi11� �1 G , oss— Owner. U-�F'U;-rtm CratXiq �dt e Of rye i.l Date of Inspection: -O FLOW CONDITIONS RESIDENTIAL: Design flow: t L d./bedroom for S.A.S. Number of bedrooms: Number of cement raidents `� Garbage grinder (yes or no):, t Laundry cormected to system(yes or noy1tL5 Seasonal use(yes or no): 1�0 Water meter readings, if available(last two(2)year usage(gpd): . Sump Pump(yes or no). NO Last date of occupancy: OL'2$'0 i art COMMERCIAL/INDUSTRIAL: Type of establishment: 9 Onn t- 5 Design flow: aal)ons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title S system: (yes or no)_ Water teeter readings, if available: Last date of occupancy: I"Z�ZS-61 �>resdlt JTHER: (Describe) ,. Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: ,/' System pumped as pan of inspection: (yes or no)_ If yes, volume pumped: ttallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system -� Single cesspool X Overflow cesspool Privy Shared system(yes or no) (if yes.attach previous inspection records, if any) UA e�lt�tology etc. Copy of to date contract? Other G1Gii Rancd LeccUna-:na Fi elci APPROXIMATE AGE of all components, date installed(if known)and source of information: 01-�I Mal C n ife -I9S0 Sewage odors detected when arriving at the site: (yes or no) 0- to 4+75/97) Page 5 of 19 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC 11ON FORM PART C SYSTEM BODRMATION(continued) Prop"y Address: 11 oFvKr(dode P0 cyS utkle Mca 6 s-s- Oww: Wi II(a,m UaAXA 1 ES4-cL. o F CA ar9 ve� Q-C-r6We t l Dole of inspection: (ZZ$- 1 111MMI SIG SEWER: (IA=on site plan) Depth below grade: Material of construction: _cast iron_40 PVC ._outer(explain) Distance from private water supply well or suction line Diameter t Co amens: (condition of joints.venting.evidence of leakage,etc.) 6 SEPnc TANK:_ (locate on site plan) �- Depth below grade: Material of conswction: ptincretc metal_Fiberglass Polyethylene outer(explain) x If tank is metal. list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dirrtetsions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distam from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:. How dimensions were determined: Comments: (reeorrtmandadon for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: concrete metal_Fiberglass _Polyethylene aher(wtplain) Dimensions: Scum thickness: Distance from top of staun to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: (rxonunendation for pumping,condition of inlet and outlet tenor baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) 097b d ttr/jM For f of to l - 6:a SUVISURFACZ SEWAGE DISPOS&L SYSTEM 24SPECTWN FORM SYSTEM DNFORMAIMN(endweed) PftwY Owner. Dde of Iapectiea: TIGHT OR)MOLDING TANK: (Teak must be pumped prior to.or at rime.of inspection) (loose on Bile Plan) •? r) >. ; Dq*below Snide: I of.00asunction _,00ncnae_trteral_ T,dyalgriene °d'p'{ } Dasnioas: Capacity:-gallons Design flow:.__paktasiday Alma level: Alarm in working order_Yes: No } Dare of PrVVIOUS potaft: Comments. r (aorrdkion of Wet me.conditioa of alarm and float pyke tes. etc.) xSPRI amw EORe_ 4`' (locate on sitt Plan) Deph of liquid level above owlet invest w........wr..$.r.�a. a � 1 .. -.P ..• tA':..... ...� ..... 'A .0 filf�. .. s y : tnote if level and disabution is equal.evidence of solids carryover, evidence of leak* * ui oiu of bate;etc.)`_ PUW Cam: (locate an site plan) Pumps in working order ()tes or No) Alamos in worm order(Yes or No) Comments: (hots CMMM of gimp dMd)er.cantloioa of P WVS and Wpwtataaea. etc.)' Ile ilea wis►m ftp 7 of Io 4 AI P•aeRi awmA mme (' ►JoMum'luTuod jo wl •amM xpniPAq yo Ev20'ions P uo(upuoo � suasuamrQ Moomasm Jo qatom (� 00MwU :AAlW sv�+s 'aogas� �I�AAq � . .. .. . Pam['>ep!y � 10 . p no!1,puoo .. :tea (�4 p ued se podumd aq.mm Imo)mM; Puma.W = P ,oqdscor� :no!nmfgaoo pw mquaN -a ( r o vs s ON a .4 .. ..(-�.� �• 'gym a�•� ��'�� .?��. :wm&amY . . . ' �. Wsm,mid t _ _.. (spoc�w aisnirw-uou 6q Youdde aq Am�aq•poumba�you -�-� .. . . -- . . . . 1`1•(SYSI iN3dSAS MOLidIi06aY IM . . ..-. a �aa�.,mv1� �o ��� Its'^¢-rJ um.�►�m:s+eNp . . _S50720 ++Rv�cwae a :ill..... ... . .WNW MCKEY Ld.SNQ j1Pd>YSfiSI[r9UM 30YAM X)VAWISVM c SLIBSLMFACE SEWAGE DISPOSAL SYSTEM V4SPEC-MION FORM ?ART C SYSTEM VUKW4ATMM(ao6oeM Phgwty Address: Owur: Dom of OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent referrnces landmarks or bendm�arks -. .._. loan all wdb wuhin 100' (Lucuc where public water supply comes imo boun) i 8 1 � nd A- Ai SMAGE DISPOSAL SYSTEM D4 SoilliCl70N FORM SYSTEM DWORMAnON(eaminued) Ilrepuly Addr�m- b(A Kr dOa2 RA os-�Cx-ul It, MCA- Date at loapeaion: . Tva Phase iodtcate all the methods used to High Grcttndwater Elevation Obtamed from Design Plaw on mcm Observation of Site(Abutting pr'oputy observation hole;I smap etc.) . ,-Downine it 5ium local conditions Check with local Board of health Check FEMA Maps Check pumping re&& Cheek local w avamrs. installers Use USES Data Desmbt m your own words how you establubed the High 0mund eater Elevation. (Mom be comVteted) Z �"`�''•4-�' ��l �'�.cc��,�--�-vac's �e� ��nS G-ASO GDP t4 M s . dwhw own" h '• D CyyVl"f ' —0 m a O Postage $ 6 E Ln Certified Fee —t CO �.' Postmarks Return Receipt Fee /, / Her m (Endorsement Required) M Restricted Delivery Fee (Endorsement Required) O Total Postage&Fees ,$ rt i -13 Se t To \ ^� -------- L7 Street,Apt.No.;or PO B x No. lII_ 2----------------------------=--------------r City State, +4 1 r 'S 6 ��'� Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A signature upon delivery o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. - o Certified Mail is not available for any class of international mail. o'NO INSURANCE COVERAGE IS PROVIDED.with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an.additional fee,a Return Receipt may be requested to provide proof of delivery:.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811�to the article and add applicable postage to cover the fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplicate returtr-'receipt,a USPS postmark on your Certified Mail receipt is required. o For`.an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,May 2000(Reverse) 102595-99-M-2087 Town of Barnstable 'THE rO� Regulatory Services Thomas F.Geiler,Director • snxxsTABLE, 9� ;� r Public Health Division Ar�p �A 39. Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. William Crowell 106 7TH Av. Hyannis Port, MA. 02647 Tenants: Charles Marino, Eric Gerson, Geoffrey Anderson 11 Oakridge Rd. Osterville, MA. 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at lila0akridge_Rd-Osterville;MA=was inspected on Oct. 12, 2001 by Edward Barry,Health Inspector for the Town of Barnstable,because of a complaint. The following violations of 105 CMR 410.00,State Sanitary Code II,Minimum Standards of Fitness for Human Habitation were observed: 410:351 Water on floor around furnace in the basement. Main water line into the house appears to be leaking. 410:201 Furnace inoperative therefore there is no heat or hot water. 410:253 Rear door exterior light inoperative,a number of face plates missing from electrical outlets, two ceiling lights in the kitchen are inoperative. 410:256 Using power strips for appliances. 410:480B No keys are supplied to tenants. 410:500 Kitchen windowsill retains water. 410:481 Building does not have 20 sq. inch sign bearing name, address, and telephone number of owner. 410:602 Debris in the rear yard. You are directed to correct the violations of within TWO WEEKS of receipt of this notice. You may request a hearing if written petition requesting the Board of Health receives it within seven (7)days after the date order is received. However,these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than$500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health COAtf3LETE THIS SECTION . • ON DELIVERY ki Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of D livery RG E� item 4 if Restricted Delivery is desired. CW19 M1)R (-A`�`,�c iDfe-7 ■ Print your name and address on the reverse so that we can return the card to you. C.rSia re ■ Attach this card to the back of the mailpiece, XN ❑Agent or on the front if space permits. ❑Addressee D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No T\()r d toor P-(-iCq G--eQsorz) ®:-:k_et���� �1 3. SSer ' eType rlCertified Mail ❑ Ex ress Mail ❑ Registered eturn Receipt for Merchandise d� ❑ Insured Mail ❑C.O.D. (QDO 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) i 'PS Form 3811,'July 1999 ' ' ' Domestic Return Receipt' 1 1 i 102595-00-M-0952 i UNITED STATES POSTAL SERVICE First-Class Mpil Postage&Fees Paid . LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • { Board of Health Town of Bamstibb P.O.Box 534 02601 ay�nn, Mamchucsft Town of Barnstable VE t°wti Regulatory Services „ Thomas F.Geiler,Director 9STAB � A Public Health Division 639. Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. William Crowell 106 7TH Av. Hyannis Port, MA. 02647 Tenants: Charles Marino, Eric Gerson, Geoffrey Anderson 11 Oakridge Rd. Osterville,MA. 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 11 Oakridge Rd. Osterville,MA was inspected on Oct. 12, 2001 by Edward Barry,Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00,State Sanitary Code H,Minimum Standards of Fitness for Human Habitation were observed: 410:351 Water on floor around furnace in the basement. Main water line into the house appears to be leaking. 410:201 Furnace inoperative therefore there is no heat or hot water. 410:253 Rear door exterior light inoperative,a number of face plates missing from electrical outlets, two ceiling lights in the kitchen are inoperative. 410:256 Using power strips for appliances. 410:480B No keys are supplied to tenants. 410:500 Kitchen windowsill retains water. 410:481 Building does not have 20 sq. inch sign bearing name, address, and telephone number of owner. 410:602 Debris in the rear yard. You are directed to correct the violations of within TWO WEEKS of receipt of this notice. You may request a hearing if written petition requesting the Board of Health receives it within seven (7) days after the date order is received. However,these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than$500. Each separate day's failure to comply with an order shall constitute a separate violation. s II ER O�TBOARD OF HEALTH Co7sAMc K� Director of Public Health 3 , ' M THE COMMONWEALTH OF MASSACHUSETTS FORM 30 ��W HOBBS&WARREN BOARD OF HEALTH CITY/TOWN DEPA TMENT ov ADDRESS TELEPHONE r � x Address__1_14'i _WW, v pant Floor _Apartment No. No. of Occupants__ No. of Habitable Rooms----- —No.Sleeping Rooms. ______ No.dwelling or rooming units__ _ No.Stories Name and address of owner_. __ __ Remarks Reg. Vio. YARD Out Bld s.: Fences: ' ,/�/„ dss3• ' Garbage and Rubbish P Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches:&& Dual Egress:and ❑ B ❑ F ❑ M Doors,Windows: ,. � ., ev - Roof Gutters, Drains:j?„jg -7 P , -, e . .. Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: ,,4 t. _ Dampness: ' " fil! - Stairs:- ...a ,� tAl—e 1jV Ze Li htin STRUCTURE INT. Hall,Stnirwa`- "" �' �sAl at R 4 p'7` , ,d .6 Obst'n. ` .t ew - Hall, Floor,Wall,Ceiliri Hall Lighting: Hall Windows: HEATING Chimneys: d 77'. Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: ,�... PLUMBING: Supply Line: ' ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.:/„ ,y ' , ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distri`b. oxi l-s, IVV _7 IV/1 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,Vents,Safeties: Kitchen Facilities i� .> , . �rri,t .> a'' ' Stove Bathing,Toilet Facil. Vent., Plumb.,SanitIn.: Wash Basin, Shower or Tub.- Infestation Rats, Mice, Roaches or Other Egress Dual and Obst'n: General Building Posted a`el'ge, ,! �Wlop 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 REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR °, ' , .!`Zof . ;TITLE_ "; A.M. DATE "' � TIME - Rcm A.M. THE NEXT SCHEDULED REINSPECTION _ P.M. 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 II, 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, 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 cf 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 to remedy said condition within the time so ordered by the Board of Health. Town of Barnstable ti Regulatory Services + BARNSTABLE, MASS. Thomas F. Geiler,Director qj i639• ♦0 Public Health Division Thomas McKean, Director 367 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 28, 2001 Mr. William Crowell. 11 Oakridge Rd. Osterville, MA 02655 Dear Mr.Crowell, We are returning the attached septic report to you dated December 28, 2001. Such a report cannot replace the previous report deeming the system "FAILED". Also, Chris Stephens is not a D.E.P. Certified septic system inspector nor is he registered with the Town of Barnstable. 12k �V as;cKea Director of Public Health CC Margrete C.Crowell <YL TOWN OF BARNSTABLE LOCATION �� Z�1)QAC 9-0 SEWAGE # VII.aQAGE ASSESSOR'S MAP & LOT 0 �� INSTALLER'S NAME&PHONE NO. � v�9` SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I a } i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL,PROTECTION '67 FAILED INSPECTION, LOT' TITLE_5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ` CERTIFICATION 1 ii 9 Property Address: J ,a Owner's Name:, -� � ' Owner's Address: C?P4S,7�;— ,D CM �- EC Date of Inspection: e9 10 C� ='' ` 2QOO ;b1 136'+F1QF ait Name of Inspector• please rint / �0 Company Nam 7 Mailing Address. - S� �p f�� Ak, Telephone Number: Dk `7 7/ � CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant'to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes . Nee s Fu r Evaluation by the Local Approving Authority,- Fail Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the-Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is.a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner.and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection,and.under the conditions of use at that time.This inspection'does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 ,y Page 2 of l 1 OFFICIAL INSPECTION FORM-NOT`FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A MORA CERTIFICATION,(continued) Property Address; z Owner• Date of-Inspe'dio rat Inspection Summary: Check A;B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that-any of the failure criteria described in 310 CMR ' 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic'tank is metal and over 20 years.old*or the septic tank(whether metator not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent: System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking,and if a Certificate.of Compliance indicating that the tank is less than 20 years,old is available. ND explain: Observation of sewage backup or break out or high static water`level in the distribution box due to broken or obstructed.pipe(s)or;due to a broken,settled or uneven distribution box. System will pass inspection if(with approval.of Board.of Health): broken pipe'(s)are replaced obstruction is removed distribution box is leveled or replaced 1 ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system Will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 i Page 3,of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUB-SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION(continued) . Property Address: 1 Owner: Date of Inspection. /� 12/0id C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the-Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: — Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the,Board of Health(and Public Water Supplier, if any)determines..that the system is functioning in a manner that protects the public health,safety and environment: _ The.system.has a septic tank.and soil'absorption system(SAS)and.the SAS is within 100 feet of a surface water supply.or tributary to:a surface water.supply. - The system has'a septic tank and SAS.and the SAS is-within a.Zone l of a publidwater.supply.. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or.more from a private water supply well". Method used to determine distance **This.system passes if the well water analysis;performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 t OFFICIAL:INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: � kot?", bt Owner 0 Date of Inspectio = 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 W Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than %.day flow Required pumping more than 4 times:in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. i� Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface / water supply. V Any portion of a cesspool or privy is within a Zone 1 of a public well. . /Any portion of a cesspool or privy is within 50 feet of a..private water supply well. _✓Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from.a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed,at a DEP certified laboratory,for coliform bacteria and volatile organic compounds .indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (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 flow of 10,000 gpd to 159000 gPd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone I1 of a public water supply well 'Q If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the.Department. 4 f Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE`SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: •p P 11,a4 Owner: ,�¢-_ . ZJ , .. Date of Inspection: Check if the following have been done You must indicate"yes"or"no"as to each_of the following: Yes No _ Pumpino'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? l Have large volumes of water been introduced to the system recently or as part of this inspection? _ Were as built plans of the system obtained and examined?(If they mere not available note as.N/A) _ Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out - — Were all system components,excluding the SAS,located on site Were the septic tank manholes uncovered,.opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and locatioq:of the:Soi!Ahsorotion System (SAS)on the site has been determined based on:. . Yes no xisting 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)) Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:C SYSTEM INFORMATION Property Address: - Owner: Date of Inspection.< 0 0 FLOW CONDITIONS RESIDENTIAL t� Number of bedrooms(design): Number of be"drooms(actual): .T. DESIGN flow based on 31 0 CMR 15.203.(for example: 1.10 gpd x#of bedrooms): Number of current residents:_ Does residence have a garbage grinder(yes or no); �1' Is laundry on a separate sewage system(yes or no)�f yes separate inspection required) Laundry system inspected(yes or no): 126— f Seasonal use:(yes or no)�,..9— Water meter readings,if available(last 2 years usage(gpd)):. Sump pump(yes or no)• Last date of occupancy- COMMERCIALANDUSTRIAL/,,X s Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste-discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: . OTHER(describe): " GENERAL INFORMATION. Pumping Records Source of information: Was system pumped as part of the inspecti (yes or no): If yes, volume pumped: gallons--How was quantity pumped,determined? Reason for pumping: - TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval �ther(describe): C�� ��. Approximate age of all compo ents,date installed(if wn)a source of information: L Were sewage odors detected when arriving at the site(yes or no�/ 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t. SYSTEM INFORMATION(continued) Property Address: _ Owne Date of Inspectib :_ /� /0 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comzrents(on,corditier.ef pints,venting,evidence of i.eakage,etc.): - SEPTIC TAN"-(locate on site plan) Depth below grade: Material of construction:_concrete—metal. fiberglass.—polyethylene _other(explain). — If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: ,. Distance from mtop of scum to top of outlet tee or baffle: , Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): GREASE TRaP,'� on s:te Depth below grade:Material of constructi— on:_concrete metal fiberglass—polyethylene_other (explain): — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):. 7 rA ' Page 8 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM' PART C t SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspectio J-0f 9/00 I TIGHT or HOLDING TANK__k k must be pumped at time of inspection)('locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__polyethylene__other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOXl'f present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal;any evidence of solids carryover,any evidence of leakage into or out of box,'etc.): PUMP CHAMBER;/ cate on site plan) Pumps.in working order(yes or no): Alarms in.working,order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: Owner. Date of Inspectio► SOIL ABSORPTION SYSTEM(SAS): �loca to on sit e plan ex egNat ioin not required) If SAS not located explain why: Type —7, leaching pits,number: . leaching chambers,number: leaching galleries,number: leaching trenches,number,length: ,leaching fields,number,dimensions: " overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation etc CESSPOOLS.: sspool 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: 'to// Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes.or no): � omments(note condition of soil,signs of hydraulic f ' ure,level of ponding,;condif on of vegetation,etc.): PRI�W- o_ to on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 ` : Page 10 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: v� Date of Inspection. �O 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. 1 4 0. I o 10 I OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �l Owner: Date of Inspectio / SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with_local Board of Health-explain: ---,,Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: a You must describe how you established the.high ground water elevation: 11 . i ° THE A Town of Barnstable Regulatory Services BARNSfASLE, * Thomas F. Geiler,Director MASS. 139. A.• Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 William K. Crowell Jr. March 1, 2005 11 Oak Ridge Rd.. Osterville, Ma. 02655 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The s eptic s ystem o wned b y you 1 ocated at 1 1 0 ak Ridge Rd. w as inspected on 12/9/2000 by Robert Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines_of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or registered sanitarian: to prepare a plan of proposed replacement septic system component(s). This plan is to be submitted to the Town:of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street,Hyannis);within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310.CMR 15.00, The State Environmental Code, Title V. You are a lso o rdered t o u pgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f your receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any c ourt o f competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. PER ORD T BOARD OF HEALTH Thomas A. McKean, BOARD C. . Agent of the Board of Health CC: Board of Health 1/tailed septic letters ffa MIR � g -nil 46-0' a '= I e'-7 114' b 1 p � � f N p X.i ' eoae i N 1i O t - N a W. 00 '1 j Z � III i I e I V 0 rr 01, RE I M is'-r CALLAHAN RESIDENCE ARGHITEGTURAL 11 OS KRIDCE STREET FI E LINE DESIG V A l N O TERVILLE MA 8 WE5T BAY ROAD OSTERVILLE, r-lA 02055 o IV W PLANS PHONE: 508-420-12�� m r. M SYSTEM PROFILE NOTES TOP FNDN. AT EL. 49.2' ACCESS COVERS TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) NGVD c ACCESS COVER TO WITHIN 3" OF FIN. GRADE 1. DATUM IS APPROX. (GIS SPOT ELEV.)ACCESS COVER (WATERTIGHT) TO rt WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING 46.9' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 47.0' 2" DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. v, otid RUN PIPE LEVEL OR GEOTEXTILE FABRIC 46.53'* FOR FIRST 2' PROPOSED 1500 3' MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 GALLON SEPTIC 44.50' 4a 0' " 44.75' TANK (H- 10 ) GAS 5. PIPE JOINTS TO BE MADE WATERTIGHT. ou h c o BAFFLE 43.53' �o0 43.36 0 0 0 O D 0 C7cr 0 43.17' p 0 p pr70 0 C7 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH ocus tn ( 7 % SLOPE) �_6" CRUSHED STONE OR MECHANICAL 0 0 0 o a a a a MASS. ENVIRONMENTAL CODE TITLE V. COMPACTION. (15.221 [21) $ 2' 0 1= 0 ED Q o00 41.17' DEPTH OF FLOW = 4 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. INLET DEPTH = 10„ OUTLET DEPTH = 1411 ( 3.5% SLOPE) ( 1 % SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. FOUNDATION 25' SEPTIC TANK 27' D' BOX 21' LEACHING 6•17' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION LOCUS MAP OBTAINED FROM BOARD OF HEALTH. NOT TO SCALE 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING ASSESSORS MAP 118 PARCEL 116 DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION BOTTOM TH 1 FL. 35.0' OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO LOCUS IS WITHIN FEMA FLOOD ZONE C COMMENCEMENT OF WORK. LOCUS IS WITHIN WP DISTRICT *THE THE 11. BE PUMPED LEGEND LOCATIONSALLER OF ALLHALL UTILT ESIFY AND ALL REMOVEDI LITY OR NG LPUMPED AND EACHING IFILLEDHALL WITH CLEAN SAND.ND BUILDING SEWER OUTLETS AND ELEVATIONS 100.0 PROPOSED SPOT ELEVATION PRIOR TO INSTALLING ANY PORTION OF 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE SEPTIC SYSTEM REMOVED 5' BENEATH AND AROUND THE PROPOSED +100.00 EXISTING SPOT ELEVATION LEACHING FACILITY. 100 EXISTING CONTOUR BENCH MARK - TOP OF CONC. 43.17 SYSTEM DESIGN: � � BOUND ELEVATION = 48.1 -- GARBAGE DISPOSER IS NOT ALLOWED 141 .78 O 5•� DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD N - 7 47.33 NEP � ' c9, USE A 440 GPD DESIGN FLOW 43.38 Q) SEPTIC TANK: 440 GPD (2) =880 co LOT AREA LISE A 1500 GAL. SEPTIC i ANK POSS. 46.92 CESSPOOL 14,744f SF 0 TEST HOLE LOGS LPG. 4 .91 LEACHING: MAPLES �DECK 9.19 SIDES:2 (33.5 + 12.83) 2 (.74) = 137 GPD EXIST. 4 BR 4 4 BOTTOM 33.5 x 12.83 (.74) = 318 GPD ENGINEER: A. H. OJALA, PE 0-) j. 7 0 DWELL. S TOTAL: 615 S.F. 455 GPD DONNA MIORANDI, RS TOP FNDN. _ amWITNESS: N - - 49.2' W�_W 6.65 DATE: OCTOBER 9, 2008 48 9 LRG. P.PINES I • 47.11 I �- USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) APPROX. r WITH 4 STONE ALL AROUND PERC. RATE _ < 2 MIN/INCH A , -- ----- I S EA I In I� 43 CLASS I SOILS p# 12393 N i 146.82 rn ELEV. ELEV. - - - - - - - - - - -- am , MA 1 ' r -- APPROVED DATE BOARD OF HEALTH D" " 47.0' D" 46.8' i 146.51 REMAINS OF PAVED DRIVE - - 43.95 46. I -a- - - - - - lJ� A A .4 - - - - TITLE 5 SITE PLAN • 4 .27 45.44��• 46.37 43.95 /LS LS 'n H 11" 10YR 4/2 11„ 1OYR 4/2 0 �S OF B 24, AS B � �, 1� _x�--x-x X 43. 3 11 OAK RIDGE ROAD 27„ 10YR 5/6 44.75' /LS ---4�. r-x °�,° 44.07 10YR 5/6 - ��- OSTERVILLE Cl 28 44.5 - 2 -----x 143.69 43.94 PERC MCS PREPARED FOR 67" 10YR 7/4 41.4' i2 5' REMOVAL OF UNSUITABLE SOIL REQUIRED ASSRD/CROWELL UND NORTHERLY PORTION OF PERIMETER FSLOAM C3 OFOLEACHING FACILITY (SEE TEST HOLE LOGS), 2.5Y 7/3 DOWN TO SUITABLE SOIL LAYER. REPLACE 96" 39.0' MS WITH CLEAN MED. SAND. ENGINEER TO 10YR 7/4 INSPECT AND CERTIFY REMOVAL. (NOTE: OCTOBER 9, 2008 APPROX. AREA OF REMOVAL SHOWN.) ��SN OF MgSS9C 11111� ZH OF s9c NS. C3 �° DANIEL tiGN off 508-362-4541 MS 0 A. �, °� DANIELA, yGm fax 508 362-9880 JALA10YR 7/4 q Noo..40980 �CIVIIL cn ©�� q No.46502 down cape en gin eerin g, inc. 144 35.0 120 36.8' �o �F �� Scale: 1 20' 0 OSURU �Fssc� aNG�P CIVIL ENGINEERS NO GROUNDWATER ENCOUNTERED "� LAND SURVEYORS 939 Main Street - YARMOUTHPORT, MASS. 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. 08-254