HomeMy WebLinkAbout0042 REBECCA LANE - Health 42 REBECCA ;,n OSTERVILLE
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TAE'COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipp ratton for aigoml *pgtem Con5trurtton Vermtt
Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No. 4 0 0—7 41 9
42 Rebecca Ln, Osterville Carlos Ferreira
Assessor'sMap/Parcel 146/45 1 42 Rebecca Ln, Osterville
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
Wm E Robinson Sr Septic Eco-Tech
PO Box 1089 Centerville 43 Triangle Cir, Sandwich
Type of Building: W ��c `76 , Y6 ( - -� Wn"
Dwelling No.of Bedrooms o►< J Lot Size sq.ft. Garbage Grinder (no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures !�
Design Flow(min.required) 31) gpd Design flow provided J��t �� gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach
system to pla s of Eco-Tech, ETE-2 5
V•Y
Li..
Date last i ected:
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 He
Signed,_______l✓!/` Date
Application Approved by ,, Date
Application Disapproved by. Date
for the following reasons
Permit No. QW-7 — ( Date Issued --�Y— 0 7
,o-y�. ., .-. r.,.....;.,,;,�.._. ..,�, 'a - _- - .. n .. yA.fi«6Ss` •-•✓" 'r'+`'•:.:._si✓-rs^ �+�:.�. �s- .- ... ..-t.. ..... .. _ _ w
2yq 4100.00
TAIMAMONWEALTH OF`MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
3pprication for 30iopozaf 6petem Conztructton Permit
Application for a Permit to Construct O Repair Upgrade O Abandon( j E�l Complete System I Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No. 4 O 0—7 41 9
42 Rebecca Ln, Osterville Carlos Ferreira
Assessor's Map/Parcel 146/45 r 42 Rebecca Ln, Osterville ti
' Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—O 8 9 4
Wm E Robinson Sr Septic Eco—Tech
PO Box 1089.. Centerville 43 Triangle Cir, Sandwich
Type of Building: j��qq 6(d jjr?�•c: -76 Y6 I 5p ooA19
Dwelling No.of Bedrooms W �� Lot Size sqt ft. Garbage Grinder (CIO)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures VN
Design Flow(min.required) 330 gpd Design flow provided - 33�, �� gpd
Plan Date ,. Number of sheets Revision Date
Title
Size of Septic Tank " Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Install a new :Title 5 leach "
system to plans of Eco—Tech,, ETE— �G �s
od d r
'v ti G1^
Date last i spected: --
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 off
Signe ��` Date
�MM
Application Approved by / Q Date
Application Disapproved b '\. Date
for the following reasons
4.
Permit No. Date Issued 0 7
---------------------------------------- - -----
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Ferreira Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( X ) Upgraded ( )
Abandoned( )by Wm E Robinson Sr Septic Service
at 42 Rebecca Lane, Osterville has been constructed in accordance
with the provi io s of Title 5 and the for Disposal System Construction Permit No. 0-00 7` dated O-U
Installer b Designers ,/�9o}.�J'�
#bedrooms x Approved design floe' l gpd _
The issuance of this ermit shall not be construed as a guarantee that the system will-functio aas designed.
Date � l� l Inspectors
No. �U� fe1e00.00
THE COMMONWEALTH OF MASSACHUSETTS
PU13LIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
Ferreira
=igpo.5al *p.5tem Construction Vermit
Permission is hereby granted to Construct ( ) Repair (X ) Upgrade ( ) Abandon ( )
System located at 42 Rebecca Lane, Osterville
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Con fsiruction must be completed within three years of the date of thi perm .
Date b!��y �, Approved by
- Town of Barnstable
Regulafory Services
• Thomas F.Geiler,Director .
9 '�: � Pubfic Health Division
Thomas-McKean Director
.. 200 Main Street;.Hyannis,MA 02601.
Office: 508-862=4644.. - Fax: 508-790-
b304.
-
Installer&Designer Certification.ForYn-
Date: 6 Sewage Perm it# j:n?-6?/(., Assessor's Map\Parcel
Designer: Eco-Tech Installer• Wm E Robinson Sr Septic
43-Triangle le Circle PO Box 1089
Address: g Address;
` .Sandwich Centerville
On v Wm E Robinson`.!Sr Septic Issued a ermit to::install a
(date):... (installer)-..
septic system at..42 Rebecca Ln, Osterville . based on a design drawn.by
(address)
EGo-Tech dated 06-05=07
1 '(designer
certify that the septic:.system referenced above was.installed substantially:according to
the design, which may:include minor-approved changes such.as-lateral relocation of the.:..
distribution.box and/orseptic tank:
ertify that the septic system referenced above was installed with major changes (i.e
eater than..10' lateral relocation of the SAS or any vertical relocation of any component
C/^ o the septic system)but in accordance with State-&Local Regulations. -Plan revision-or
certified.as-built by designer to follow.
SH OF Mgss
�a DAVID
o p �.
(Inst. 1
CO
e lJ
GHANO
No. 1093
SgNlT Aft P�
(Designer's Signature) (Affix Designer's Stamp Here)
I
PLEA:SE:.RETURN TO. :BARNSTABLE. PUBLIC :HEALTH DIVISION.... -CERTIFICATE OF
COMPLIANCE WILL .NOT:BE-ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION,THANK YOU.
Q:Health/Septic/Designer Certification Form 3-26-04.doc .
TOWN OF BARNSTABLE
V � �JPOCATION f PS SEWAGE #
kz VILLAGE C)1-,- (uk(I -ASSESSOR'S MAP & LOT d
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER 1.
PERMIT DATE: COMPLIANCE DATE: Iti���I/,OU
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 -
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TOWN OF BARNSTABLE
iL0CATION SEWAGE RY?
VILLAGE &*MXU1L(,6 ASSESSOR'S MAP&PARCEL
INSTALLERS NAME'&PHONE NO. %van 46rstS6w 57,^ 5&yct S E MM6
SEPTIC TANK CAPACITY 1006 Coa//a.4f
LEACHING FACILITY:(type) AA STb p'+fwt�fs (size) o2S.S A /y
NO..OF BEDROOMS 1
OWNER re it er<ti
PERMIT DATE: �1 O Tw "7 COMPLIANCE DATE
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility O��¢� Feet
Private Water Supply Well and Leaching Facility(If any wells exist T
ti
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
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Pi •m i
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Town of Barnstable P#
o> � Department of Regulatory Services G
• -Public Health Division Date Mp Zy 2W .
- - % auwerestE
MA88. .
200 Main Street,Hyannis MA 02601
Date Scheduled Time pyf\ Fee Pd._
Soil Suitability Assessment for Sewage Disposal
L l 5 t-cr OAS s Witnessed B
Performed By: + Y�
LOCATION& GENERAL INFORMATION
Location Address Owner's Name ��rI� Ferretti)
4 L to b ecc q Address ttC C
OSfe�vil�P . ,� je
Assessor's Map/Parcel: Engineer's Na
NEW CONSTRUCTION REPAIR Telephone#
_p 1 n �j
Land Use ` L / Gl e 1� 1�11 Slopes(�o) 4 (� Surface Stones t/ /1
Distances from: Open Water Body `D 0 + ft Possible Wet Area ( 00 + ft Drinking Water Well 'DV`r ft
Drainage Way S O '�[L ft .Property Line 7 + ft Other ft
SKETCH:(street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes)
! REBECCA LANE
4ti�
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GROUNDWATER ADJUSTMENT' <i
l EXISTING GROUNDWATER LEVEL
I BASED ON TOWN OF BARNSTABLE
I GIS DEPARTMENT RECORDS.
' INDICATED GW 22.00
® I INDEX WELL SDW-253
ZONE C `
READING DATE MAY. 2007
i twee Ft ' READING 47.1
------ --- --- - — ADJUSTMENT 1.7
I ADJUSTED GW 23.7 �
y���
Parent material(geologic)�oI � Dvf M47h Depth to Bedrock ,/�
Depth to Groundwater: Standing Water in Hole: Y 1 V eta Weeping from hit Fuce r f
Estimated Seasonal High Groundwater see above
ETERNIINATION FOR SEASONAL HIGH WATER TABLE
Method Used: ;,ee Q(00vtoi
Depth Observed standing in obs.hole: ,,,�. in, Depth to soil mottles:
Depth to weeping from side of obs.hole: __ _—In, Groundwater Adjustment ft• - I '
Index Well# Reading Date: Index Well level, :..� Adi.factor_ Adj.Oroundwater Level , 1
� 0
PERCOLATION TEST Datek/4107 Thne„r P►71 j
Observation i � ���
Hole Time at h" .,:.l.:,d... ��
Depth of Perc I V1 Time at 6"
Start Pre-soak Time @
V -o 0 Time(9"-6")
0 i
End Pre-soak V
2r17 i U
Rate Min./Inch
Site Suitability Assessment: Site Passed V Sitc.,Riled: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
'G 0 1 ` TEST'- L 0 G SOILE LISA LYONS,EVALUATOR: DUNE ONS. - '
R.S. �
i WITNESSED BY: DONNA MIORANDI. HEALTH DEPT.
R - -- - PERC NUMBER: 11813
; TEST PIT 1 . NO GROUNDWATER ENCOUNTERED ,
PARENT MATERIAL: PROGLACIAL OUTWASH
` PERC AT 55 in - 2 MIN/INCH IN-C SOILS
�ELEVATIOro-
SOIL USDA SOIL SOIL COLOR SOIL - ±
S) HORIZON TEXTURE (MUNSELL MOTTLING �1 OTHER
54.32
FILL I '
9-12 A/E - - - --- -. �-- -- - -
LOAMY SAND 10 YR 3/2 NONE FRIABLE
51.40 12-35 B LOAMY SAND 10 YR 4/6 NONE FRIABLE
35-124 C MEDUIM TO 10 YR 6/6 NONE
43.99
COARSE SAND LOOSE
TEST PIT 2
NO GROUNDWATER ENCOUNTERED
PARENT,MATERIAL: PROGLACIAL OUTWASH
2 MIN/INCH IN C SOILS
ELEVATION DEPTH SOIL -USDA SOIL Z(MU:NLSELL3
COLOR SOIL(INCHES) HORIZON TEXTURE MOTTLING OTHER -
54.19 -
0-11 A/E --•- LOAMY-SAND 10 YR 3/2 NONE FRIABLE
11-36 B, LOAMY SAND 10 YR 5/6 NONE FRIABLE
51.19 I
36-138 C. . MEDUIM TO _ 2.5 Y 4/6 NONE '_ . -LOOSE _
COARSE SAND
42.69 - • .,—.-
Surface(in.) (USDA) (Mansell er
) Mottling (Structure,Stones,Boulders.
C nsi to c o el
------------
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) Other
(USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consi ten
=� Flood Insurance Rate map:
Above 5W year flood boundary No_ Yes V
Within 500 year boundary No Yes
0
Within 100 year flood boundary No Az yes
Depth of Naturally Occurrin Pervious Material -
r lDoes at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? _ e5
If not,what is the depth of naturally occurring pervious material?
Certification
7 I certify that on 1 (date)I have passed the soil evaluator examination approved by the
Department of Environ ental Protection and that the above analysis was performed by me consistent with .
the required training,expertise and a erience described in 3I0 0&15.017.
Signature Date
Q:\$EPTIC\PERCFORM.DOC
is
• TOWN
�O,FBARNSTABLE
LOCATION .:. �?��'� a �i
SEWAGE #
VILLAGE_ S '0 SSESSOR'S MAP & LOT I
INSTALLER'S NAME&PHONE NO. '
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)_ (size)
NO. OF BEDROOMS
BUILDER O&;OWNER
j
PERMTTDATE: COMPLIANCE DATE: 60
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
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b es
v 4LO- �
LOC&TIOIjl ' 1..C�1 59\,NaC;E PERMIT UO. ., `
`VILLAGE
IWSTQLLER*S ww, AF- ADDRESS
BUILDER 'S S Q ONIE ll�DDRE 5S
DATE PERKA T 155UED
D ATE COMPLl b6KICE ISSUED :
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of I ,04
COMMONWEALTH OF MASSACHUSETTS .
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
s
DEPARTMENT OF ENVIRONMENTAL PROTECTION
A
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655 �- 0113
Owner's Name: HAVEN
Owner's Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Date of Inspection: 12/12/00
Name of Inspector:(please print) JOHN GRACI
Company Name: SEPTIC INSPECTIONS
Mailing Address: ;P.O.'B.OX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
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:
X Passes
_ Conditionally Passes
_ Needs Furt Evaluation by the Local Approving Authority
Fails
Inspector's Signature: I Date: 12/12/00
The system inspector shall submit 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
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING NOW AND EVERY ONE TO TWO YEARS
TO PROLONG THE SYSTEM'S USEFULL LIFE.
****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 [ncnPrtinn Fnrm 6/15000(1 1
�1+
Page 2 of 11
r
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
THE SYSTEM PASSES TITLE V.INPECTION.RECOMMEND PUMPING NOW AND EVERY ONE TO TWO
YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.
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.
i
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain.
n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits
substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced
with a complying septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating
that the tank is less than 20 years old is available.
ND explain: n/a
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of
Health):
_ broken pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping moA&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: n/a
I
Page 3 of 11
4
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic.tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water
supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank'and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic.tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water
supply well".Method used to determine distance n/a
"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.
f
3. Other:
n/a
iii..
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Page 4 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the'following for all-inspections:
Yes No
_ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the'distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped 1999 BY C'Awo.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool oc,privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet'bf a tributary to a surface drinking water supply
_ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
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'ghall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
a
Page 5 of I I
S
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
Check if the following have been done..You'must indicate"yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage backup?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS,located on site?
X _ 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?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems,.
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X Existing information.For example,a plan at the Board of Health.
X _ 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)]
• 5
1
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203'(for example: 110 gpd x#of bedrooms):330
Number of current residents:2
Does residence have a garbage grinder(yes'or no):NO
Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required]
Laundry system inspected(yes or no):NO
Seasonal use:(yes or no):NO
Water meter readings, if available(last 2 years usage(gpd)):n/a
Sump pump(yes or no):NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL '
Type of establishment: n/a
Design flow(based on 310 CMR 152Q3):n/agpd
Basis of design flow(seats/persons/sqft,etc.):n/a
Grease trap present(yes or no):NO
Industrial waste holding tank present(yes or no):NO
Non-sanitary waste discharged to the Title 5 system(yes or no):NO
Water meter readings,if available:n/a
Last date of occupancy/use: n/a
OTHER(describe):n/a
GENERAL INFORMATION
Pumping Records
Source of information: 1999 BY CANCO
Was system pumped as part of the inspection,(yes or no):NO
If yes,volume pumped:n/agallons--How was quantity pumped determined?n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X 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!bEP approval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source of information:
25 YEARS OLD
Were sewage odors detected when arriving at the site(yes or no): NO
Page 7 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
BUILDING SEWER(locate on site plan)
Depth below grade:9"
Materials of construction:_cast iron _40 PVC Xother(explain):20 PVC
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
THERE IS TOWN WATER
SEPTIC TANK:X(locate on site plan)
Depth below grade:3"
Material of construction:Xconcrete_metal fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no):NO(attach a copy of certificate)
Dimensions: 1000G L 8'6"H 5'7"W 41.10""
Sludge depth:2"
Distance from top of sludge to bottom of outlet tee or baffle:32"
Scum thickness: I" I1.
Distance from top of scum to top of outlet tee or baffle:6"
Distance from bottom of scum to bottom of outlet tee or baffle:n/a
How were dimensions determined:MEASURED
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related
to outlet invert,evidence of leakage,etc.):
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND•PUMPING
NOW AND EVERY ONE TO TWO`.YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.RECOMMEND
REPLACING COVER ON TANK.
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain):n/a
Dimensions:n/a
Scum thickness:n/a
Distance from top of scum to top of outlet tee or baffle:n/a
Distance from bottom of scum to bottom of outlet tee or baffle:n/a
Date of last pumping: n/a
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,Liquid levels as related
to outlet invert,evidence of leakage,etc:):
n/a
{
th:I 7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain):n/a
Dimensions:n/a
Capacity:n/a gallons
Design Flow:n/a gallons/day
Alarm present(yes or no): N/A
Alarm level:N/A Alarm in working order(yes or no):NO
Date of last pumping:n/a
Comments(condition of alarm and float switches,etc.):
n/a
F
DISTRIBUTION BOX:_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:n/a
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 DISTRIBUTION BOX
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no):NO `.
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
R
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6'X 6' leaching pits, number: 1
n/a leaching chambers, number: n/a
n/a leaching galleries, number: nla
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: nla
n/a overflow cesspool, number: n/a
n/a :.:innovative/alternative system
`type/name of technology: nla
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT
HAD 1' OF LEACHING LEFT AT THE TIME OF THE INSPECTION.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:n/a
Depth—top of liquid to inlet invert:n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool:n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no):NO
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
n/a
4
Page 10 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 REBECCA LANE OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
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.
6
B R
C
AC
Mal
in
f
Page 11 of I 1
A ,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 REBECCA LANE'OSTERVILLE,MA 02655
Owner: HAVEN
Date of Inspection: 12/12/00
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
NO Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavatdrs,.installers-(attach documentation)
YES Accessed USGS database-explain: n/a
You must describe how you established tie high ground water elevation:
USGS MAPS AND CHARTS- 12+FEET,•
a•: .4
tr,
y -
11
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
�v
Pfoperty Address
Ryan Danna
Owner Owner's Na
information is Ostervilleme/ Ma. 02655 April 26,2016
required for every
Satet Zip Code Date of Inspection
page. city/Town r
Inspection results must be submitted on this form.Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor do not Thomas Roux
use the return Name of Inspector
key.
Company Name
89 Mayflower Lane
tot Company Address
East Wareham Ma. 02538
city/Town State Zip Code
774-678-9066 S14531
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system of 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 ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP.The original should be sent to the system owner
and copies sent to the buyer,if applicable, and the approving authority.
***"This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3M3 Title 5 Official Inspection Forth:Subsurface Semage Disposal System•Page 1 of 17
A
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osterville Ma. 02655 April 26,2016
required for every p
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
9
Inspection Summary:Check A,B,C,D or E/ahvays complete all of Section D
A) 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:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes°,"no°or"not determined"(Y, N,ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5ins-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
o tvTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osterville Ma. 02655 April 26,2016
required for every p
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
r
❑ 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
❑ y q p p g y st cted pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(S)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Dsposal Systern•Page 3 of 17
. v
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
° 42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osterville Ma. 02655 A nl 26,2016
required for every p
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"N'o"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less
than Y2 day flow
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
v '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osterville Ma. 02655 Aril 26,2016
required for every P
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® 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.]
El ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,.
or answered"yes"in Section D above the large system has failed.The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304.The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
c
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is required for every Cisterville Ma. 02655 April 26,2016
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant,or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
• ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS,located on site?
® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid,depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information.For example,a plan at the Board of Health.
❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330.1 gpd
t5ins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
v
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osterville - Ma. 02655 April 26,2016
required for every
page. Cfty/Tow n State Zip Code Date of Inspection
D. System Information
Description:
4
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available Oast 2 years usage(gpd)):
Detail'
Sump pump? ❑ Yes ® No
current
Last date of occupancy: Date
Commercial/industrial Flow Conditions:
Type of Establishment:.
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osterville Ma. 02655 April 26,2016
required for every
page City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: owner
Was system pumped as part of the inspection? ❑ Yes ® No
If yes,volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank,distribution box,soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Altemative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
z1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is required for every Cisterville Ma. 02655 April 26,2016
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components,date installed (if known)and source of information:
9 years Design plan dated June 5 2007.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
1.3'
Depth below grade: feet
Material of construction:
❑cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: +10'
feet
Comments(on condition of joints,venting,evidence of leakage, etc.):
Septic Tank(locate on site plan):
3'
Depth below grade: feet
Material of construction:
®concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal,list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
8'Lx5.2'Wx5.3'H
Dimensions:
1"
Sludge depth:
t5ins•3M3 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r 42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is required for every Osterville Ma. 02655 April 26,2016
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cunt.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 29"
211
Scum thickness
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle 1610
How were dimensions determined? measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
The septic tank should be pumped out in about another year.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑metal ❑fiberglass E] polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's(dame
information is Osterville Ma. 02655 April 26,2016
required for every
ode Date of Inspection
page. Dityrro n State Zip C
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,evidence of leakage,etc.):
Tight or Holding Tank(tank must be pumped at time of inspection)pocate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level.' Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
kj
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osteryille Ma. 02655 April 26,2016
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
Distribution Box'(if present must be opened) (locate on site plan):
Oil
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.):
D-Box was clean and free of solids.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump Chamber,condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order,system is a conditional pass.
Soil Absorption System(SAS)(locate on site plan,excavation not required):
If SAS not located, explain why:
The septic tank and D-Box are functioning correctly.Therefore,the SAS is draining property.
t5ins-3/13 Ule 5Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'^ 42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is required for every Cistenrille Ma. 02655 April 26,2016
page Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number ,
® leaching chambers number: 2
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number,dimensions:
❑ overflow cesspool number:
❑ innovative/aftemative system
Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of
vegetation,etc.):
No evidence of hydraulic failure
Cesspools(cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater,inflow ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osterville Ma. 02655 April 26,2016
required for every page Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil;signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
t5ins•3113 Title 5 Official Inspection Force Subsurface Sewage Disposal System•Page 14 of 17
c
COMMO nwealth of Massachusetts
EREEM Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Ostenri8e Ma. 02655
page. Clty April 26,2016
required far every lrown state �Code Date oflnspeaion
D. System Information (cunt.) ,
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:
® hard-sketch in the area below
❑ drawing attached separately
j lkl- . -= (�
.� O O sr o }
1 �
TANK D- SAS
.44
45ins•Y13 Title 5 officM,InSpWftFOM Sum SM"s Deposal System•Page 15 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name
information is Osterville Ma. 02655 April 26,2016
required for every CByrrown State Zip Code Date of Inspection
page.
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check Cellar
® Shallow wells
below 11.5'
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
June 8,2007
If checked,date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
From the design plan on file.
Before filing this Inspection Report,please see Report Completeness Checklist on next page.
Tide 5 Official Inspection Form:Subsurface Sewage DisPosal system•Page 16 of 17
t5ins-3113
Commonwealth of Massachusetts ..
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
42 Rebecca Lane
Property Address
Ryan Danna
Owner Owner's Name 201E
information is Osterville Ma. 02655 April 26,
required for every Citylfown. State Zip Code Date of Inspection
page.
E. Report Completeness Checklist
® Inspection Summary:A, B, C, D,or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
a
Title 5 Official Inspection Form:Subsurface Sewage DiSposal system•Page 17 of 17
15ins•3113
•
• Commonwealth of Massachusetts
Title 5 official Inspection .Form
Subsurface Sewage Disposal System,Form-Not for Voluntary Assessments
yPropoeAddre s Owner ame
information is 9'A!` J/
�f Date of nspection
required for ----- . State' Zip Code
every page. cityrrown
d on this form.Inspection forms may not be altere d in any
Inspection results must be submitte
4 way.Please see completeness checklist at the end of the form.
Important: General neral Information
When filling out I I
forms on the
computer,use 1., Inspector:
only the tab key
to move your
cursor-do not I of nspector
use the return - R
key.
Company Name ,n
'tom IC b`
Company Ad es s Q a'S� d
L is /.�►0 -----
de Co
State p
aem f �p
b 0 License umber
:Te
ephone N mber
B. Certification
I certify that I have personally inspected the sewage.disposal system at this address and that the
information reported below is true,accurate and complete as of the time of the inspection.The inspection
was performed based on my training and experience in the proper function and maintenance of on site
EP approved system inspector pursuant to Section 15.340 of
sewage disposal systems.)am a D
Title 5(310 CMR 15.000).The system:
V Passes
❑ Conditionally Passes ❑ Fails
❑ Nee rther Evaluation by the local Approving Authority
� a
Ins s i "at
Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP.The original should be sent to the system owner
and copies sent to the buyer,if applicable,and the approving authority.
""This report only,describes conditions at the time,of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use. q (
Titles i' on Fom Subsata $ewage
I System•page f of f7
isins•OW8
ti
Y
Commonwealth of Massachusetts
Title, 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Prope Address_
Owner Owner's Name
information is
required for
every page. City/Town State _ Zip Code Date of Inspection
B. Certification (cost.)
Inspection Summary:Check A,B,C,D or E/always complete-all of Section D
A) System Passes:
I have not found any information which indicates that any of the failure criteria described
In 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
B) S stem Conditionally Passes:
❑ ne or more system components as described in the"Conditional Pam section need to be
re laced or repaired.The system,upon completion of the replace ent or repair,as approved by
the and of Health,will pass.
Check the b for"yes","no"or"not determined"(Y,N, ND)fo a following statements.If"not
determined,"p se explain.
The septic tank is me and over 20 years old*or septic tank(whether metal or not)is
structurally unsound,ex h ' substantial infiltrati or exfiltration or tank failure.is imminent.System
will pass inspection if the exis' tank is repi ed with a complying septic tank as approved by the
Board of Health.
A metal septic tank will pass insp on i ' structurally sound,not leaking and if a Certificate of
Compliance indicating that the is less than ears old is available.
❑ Y ❑ N [] NO(Explain below):,
Su•ON$ Title 5 Official Inspection form Subsurface Sewage Qisposat System•Page 2 of 17
I J ,
Commonwealth of Massachusetts
Title 5 Official Inspection ForM
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
i
P party Address
Owner rs Name
information is
required for
every page. City/Tkwn State Zip Code Date of Inspection
B. i tification (cont.)
B) yytem Conditionally Pa/replaced
t.): ,servation of sewage baeak t or high static water level in the distribution box due
to roken or obstructed pie t a broken,settled or uneven distribution box.System will
a s inspection if(with apo rd of Health):
❑ broken pipe(s)are ❑ Y ❑ N ❑ ND(Explain below):
obstruction is rem ❑ Y ❑ N ❑ ND(Explain below):
istribution box isrreplaced ❑ Y .❑ N ❑ NO(Explain below):
f
r
r
❑ The system r ired pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will p ss inspection if(with approval of the Board of Health):
❑ br en pi e(s)are replaced ❑ Y ❑ N ❑ NO(Explain below):
❑ bstruction's removed ❑ Y ❑ N ❑ NO(Explain below):
C) Further Evaluation is Req 'red 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 ublic health,safety or the environment.
1. System will pass unless Bo rd of Health determines in accordance with 310 CMR
15.3030)(b)that the system is t 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
t6ns•09/08 Title s Official Inspection Form:subsurface sewage olsposal system•Page 3 of 17
x,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address
Owner Qwners Name
information is _
required for City�o State Zip Code Date of Inspection
every page.
wn
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Suppli ,if any)
determines that the system is functioning in a manner tZa public health,
safety and environment:
The system has a septic tank and soil absorption syd the SAS is within
0 feet of a surface water supply or tributary to a surface w
❑ The system has a septic tank and SAS and the is within a Zone 1 of a public water
suppl
❑ e system has a septic tank and SAS an,0 he SAS is within 50 feet of a private water
supply well.
❑ The system ha septic tank and SAS and�Ke SAS is less than 100 feet but 50 feet or
more from a priva water supply well J,.r'
Method used to deter 'ne distance
"This system passes if the wed a analysis,performed at a DEP certified laboratory,for coliform
bacteria.indicates absent an¢ifhe prese of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm,provide�Aat no other failu criteria are triggered.A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes . No
Backup of sewage into facility or system component due to overloaded or
❑ clogged SAS or cesspool
❑ Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ Liquid depth in cesspool is less than 6"below invert or available volume is.less
than 1/2 day flow
Title 5 Official Inspection FOrm:W=rface Sewage Disposal system•Page 4 Of 17
t5ins-09r08
Commonwealth of Massachusetts
Title 5 Official Inspection Form-
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Propi!'d dress a
19 I,/
Owner Owner's Name information is J V.I ZCl�/
required for
every page. City/rown State Zip Code -• Me of Insp coon
B. Certification (cont.)
Yes No
❑ Required pumping more than 4 times in the last year.NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ -Any portion of the SAS,cesspool or,privy is below high ground water elevation.
❑ �, Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to'a surface water supply.
❑ [ Any portion of.a cesspool or privy is within a Zone 1 of a public well.
❑ (� . 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 2000gpd-
10,000gpd.
❑ gt 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 stems: To be considered a large system the system must serve a facility with a
design TI of 10,000 gpd to 15,000 gpd.
For large syste ,you must indicate either"yes",or"no"to each of the fo ing, in addition to the
questions in Secti D.
Yes No
❑ ❑ the system is wit eet of a surface drinking water supply
❑ ❑ the syst s within 200 feet of a tribu a surface drinking water supply
C ❑ system is located in a nitrogen sensitive area_DM<m Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water sup %asi
If ave answered"yes"to any question in Section E the system is considerficant 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 CM 15.304.The system owner should contact the appropriate
regional office of the Department.
t5ins•0QQ8 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
ME F
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Prop Address 44 ,
Owner O ets Name
information is
required for l)T//,2r//4(-e� - &a Z
every page. City/Town State Zip Code Date of InspecGon
C. Checklist
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
❑ - Pumping information was provided by the owner,occupant,or Board of Health
❑ Were any of the system components pumped out in the previous two weeks?
❑ Has the system received normal flows in the previous two week period?
❑ S Have large volumes of water been introduced to the system recently or as part of
this inspection?
g ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
J;4- ❑ 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:
0- ❑ Existing information. For example,a plan at the Board of Health.
El approximation
in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): .� Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): --' O
tUns-008 Me 5 Baal Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 official Inspection- Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Prope ress _
Owner Owne s Name j lecon—La—
required information is �c `
for State Zip Code DaA-9b,ins
every page. City own
D. System Information_
Description;
Number of current residents:
Does residence have a garbage grinder?
❑ Yes QNo
Is laundry on a separate sewage system?[if yes separate inspection required) ❑
Yes�No
❑ Yes 8�No
Laundry system inspected?
❑ Yes No
Seasonal use? A J —
Water meter readings,if available(last 2 years usage(gpd)):
Detail;
❑ Yes i2f—No
Sump pump?
Last date of occupancy: oate _
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(b on 310 CMR 15.203): Gallons per pd)
- __-
Basis of design flow(seats/pe A.,etc.): .
❑ Yes ❑ No
Grease trap present?
❑ Yes ❑ No
Industrial waste holding tan ent?
Non-sanita aste discharged to the Title 5 system?
Yes ❑ No
Water meter readings,if available:
Title 5 Official Inspection Form:Supeurfaoe Sexege Dispesal System Page 7 of 17
t5iins-090
K
Commonwealth of Massachusetts .
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
t/
Property"Address
Owner Owner's Name
information is
required for �' �-C��� � r
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancyluse: DAre
Other(describe below):
General Information
Pumping Records:
Source of information: /If
Was system pumped as part of the inspection? Yes ❑ No
If yes,volume pumped:
gallon
How was quantity pumped determined? '2 riot gWjJ4.�-2
Reason for pumping: l �� S J 4-10 C
Type of SysteM:
Septic tank,distribution box,soil absorption system
Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system(yes or no)(if yes,attach previous inspection records,if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
is ns 09108 Title 5 Official Inspection Forth;Subsurface Sewage Disposal System-Page 8 of 17
u
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1/
Property34dress
&
Owner Ome s Name
information Is `.— ! �. k /; /
required for s
every page. City/Town state Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components,date installed(if known)and source of information:
�067
Were sewage odors detected when arriving at the site? ❑ Yes JW No
Building Sewer(locate on site plan): 2 fi
Depth below grade: feet
Material of construction:
❑cast iron g40 PVC ❑other(explain):
Distance from private water supply well or suction line: feet/fit
Comments(on condition of joints,venting,evidence of leakage,etc.):
do
Septic Tank(locate on site plan): .
Depth below grade: feet
Material of construction:
concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain)
If tank is metal,list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
t5ins•008 Title 5 Official Inspegion Form:Subsuffaoe sewage Disposal system•Page 9 of 17
Commonwealth of Massachusetts
Fo
rm
Tale 5 Official Inspection
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
_doc c�J
Prope AdqEess _
owner Owner's Name �.
information is � ''
required for State Zip Code Date of Inspection
every page. City/iown
D. System Information (cont.)
Septic Tank(cunt.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
ZrAiDnp-
ir n P2 i 1� cd J� � f A 94ocirT st
e1*7 01:;� 1-4P-TrED TO Fa-I(),e� to
Grease Trap(locate on site plan):
Depth below grade: feet
Material nstruction:
concrete ❑fiberglass polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance fro p 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
tsirts-One Title s Ofricial Inspection Form:Subsurface Sewage Disposal system-Page 10 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Prope dress
I k o C
Owner owner's Name
information is 'T�k✓��� .` T Z
required for
every page. Cityrrown state Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert,evidence of leakage,etc.):
Tight or olding Tank(tank must be pumped at time of inspection)(locate on site plan)-
Depth belo grade:
Material of co truction:
❑concrete ❑metal ❑fiberglass ❑poly e ylene ❑other(explain):
Dimensions:
Capacity: aeons
Design Flow: gallons per day .
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition.of al m and floats 'ches,etc.):
Attach copy of current pumping contract(required). Is copy attac d? ❑ Yes ❑ No
t5ins-09108 Titles Of iipal Inspwtion Form:Subsu,ace sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Prope "Aiddress _
41
Owner owners Name
information is
required for State Zip Code Date of Inspection
every page. City own
D. System Information (cont.)
Distribution Box(if present trust 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(locate on site plan):
Pump . working order: ❑ Ye ❑ No
Alarms in working
Yes ❑ No
Comments(note condition of pump chamber, mps and appurtenances,etc.):
Soil Absorption System(SAS)(locate on site plan,excavation not required):
If SAS not located,explain why:
Title 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17
t5ins•09Me
Commonwealth of Massachusetts
Title 5 Official ,Inspection Form
Subsurface Sewage Disposal SSyyste/m!/Form-Not for Voluntary Assessments
r ;rope*Address
/"
Owner nets Name
information is �` ,r—
required for � �/ tl
every page. City State Zip Code Oate of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number: y
leaching chambers number: - - --�—"=�
❑ leaching galleries number:
❑ leaching trenches number,length:
❑ leaching fields number,dimensions:
❑ overflow cesspool number:
❑ innovative/altemative system
Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of
vegetation,etc.):
Dk
Cesspools(cesspool must be pumped as part of inspection)(locate on site plan):
Numb r and configuration
Depth—top o id to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspoo
Materials of ction
Indication of groundwater inflow ❑ Yes [] No
thins•QW8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sew%ge Disposal.System Form-Not for Voluntary Assessments
Property Address
Owner owner's Name
information is
required for Ci /Town to Zip Code Date of Inspection
every page. ty
D. System Inform tion (cont.)
Comments(note conditi of soil,signs hydraulic failure,level of ponding,condition of vegetation,
etc.):
Privy(locate on site pla
Materials of construc' n:
Dimensions
Depth of solids
Comments ote condition of soil,signs of hydraulic failu ,level of ponding, condition of vegetation,
etc.):
tsins-09108 Title 5 Official Inspection Form:Subsurfaoe sewage Disposal System•Page 14 of 17
• Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address.
Owner Owner's Name
information is
required for State Zi Code Date of Inspection
every page. City/Townp
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to
at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate
where public water supply enters the building.Check one of the boxes below:
❑ hand-sketch in the area below
❑ drawing attached separately
tsir*-008 Title 5 Official Inspection Forth:Suosurface Sewage Disposal System•Page 15 of 17
Assessing As-Built Cards Page 1 of 1
TOWN OF BARNSTABLE
I LOCATION ? &',MC-4 I-AN a SEWAGE#AD02 P l?
VILLAGE t kr7t IU-4[ ASSESSOR'S MAP&PARCEL
r INSTALLERS NAME&PHONE NO. Lv.n E kjsi.aa, Satz sco_,1 M7X$71
SEPTIC TANK CAPACITY /OAD 4ftu"A
LEACHING FACILtI•'Y:(type) d A Stu Ay...cd_ (size) g„4.S A N -
N0.OFBEDROOMS 3,
OWNER crlti
PERMIT DATE: 8 fd 7 COMPLIANCE DATE: a l/11 D 7 t
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility O�.S Feet
Private Water Supply Well and Leaching Facility(If any wells exist w
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) be
FURNISHED BY Orj r�=" P/�., d..�e� 6 S'o
i� _� 3C 1
, I
a
ao 00 o El
j 3
I TANK � * b.6t f SAS
-( 0�3
r
3a' 9-3` 33V 11-1` ',3
13 .
http://v ww.town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar—'146045&seq=1 8/22/2012
e
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
A42, If► B a�' CAS
Prophrty Address
Owner owner's Name
information is r�r
required for !
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
Check Slope tl .
[ Surface water d de,
[ Check cellar -P��
[ Shallow wells
Estimated depth to high ground water: feet
V
Please indicate all methods used to determine the high ground water elevation:
JZ Obtained from system design plans on record
. 2a0�
If checked,date of design plan reviewed: oats
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board`of Health-explain:
❑ Checked with local excavators,installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation: .
Before filing this:Inspection Report,please see Report Completeness Checklist on next page.
tans,09108 Title 6 official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Loc&TION - LC -1 SEW0,GE PERMIT MO.
VILLAGE '. — — — — — — — — —
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Y �oFSHE ra,. Town of Barnstable ,
Y Regulatory Services
• BABNSTABLE• '
MASS. Thomas F..Geiler, Director
1639• �0
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: January 21, 2011
Bar(s): 80340
Name of Offender: Carlos Ferrerira
Location of Violation: 42 Rebecca Lane
Date(s) of Violation: October 13, 2011
Violation(s): Town of Barnstable Board_ Code § 1704 Rental Ordinance
Facts:
As of October 1, 2006 a new rental registration ordinance was put into affect requiring all
property owners of rental units to register their rental units with the Town of Barnstable Health
Division.
This property has been inspected on numerous occasions by numerous town officials.. All.. '
inspections have divulged that property is being rented. Many of the inspections were due to
overcrowding complaints. The Town of Barnstable Health Division has received complaints
about this property on: 9/30/2010, 7/16/08, 5/29/07, 4/17/07, 4/3/07, 7/1-1/06, and 6/13/06.
Owner has registered property in 2007 and 2008. So said offender is aware he must register
on an annual basis. Due to recent complaints it was brought to said department's attention said
offender has not registered for 2009 or 2010. Due to lack of registration I issued a citation to
said offender.
Respectfully Submitted,
.Timothy B. O'Connell, RS
Health Inspector
Town of Barnstable t� '
200 Main Street V�
Hyannis, MA 02601
(508) 862-4644
l� "• .. NAME VF OFfENOER +`s n 5.� �'�' e�( ;t� -•'� .?� 4�'"' '� BA�RI ..
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REBY ACK WLEOGSRECEIPT OF"CITATIO.
���' r Date maned t!}Oa""i'+�w'l,�F .� , rr <z .� ; � �� � �• ,� �
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YOU;HAVE THE,FOLLOWING;ALTERNgTIVES WIT,HREGARD TO DISPOSITION OF THIS MA HER OPTION(1)'DR OPTION'(2)'WILLQPERATE AS A''FINAL s�a'x
cP OISP.USITION WITH NO RESULTING CRIMINAL RECORD T4 .i�"a' _ ��P ._k�,+,vl � � ,.� " "� .:, " 5rf� .�r�ew4r• ��$ �i� Lu';sj
REGULATION __
"� (t)'Y4u may elect to paye•above floe,either byappearJng in person'tietween,8:30 AM end 400 PM_.Mond thiough(ridgy,legal hblfd ezce y y =a
MMAA ey pled
s., afore The BartlstaWe Clerk 200 Main Street Hyannle 02G0t or hlfl I ga+check money order or ostel no4e',to BaniataWe Cle P Ebx Q4S0 +
Hyannis MA02t301 WITHIN TWENTY ONE(21):pAYSOFTHEDATEFTHISNOTICE �,•q r E? YLy ,: y
t(2:If qou ilesire;to contesf thtawmatte.['fii a noncTirtilnel p"roceedlr�gxyyoouu"rrieeyy do sd bytmaktngg,wiltten' nest to DISTRICT COURMAkFARTMENT FIRBTy r'•�
6�FiNSTABLE DIVISION COURT COME OUND MAIN STREET BARNSTABLE MA 02030"Attu 2 Nohorlminal Hearings and endoae a'cropy of thli s a
citattonrforahearing p4r� t .+ �.?;.t"'+... 7 w'�v r "tti} cri �C NY.> ; i `� x .. ,.f. 'ari✓Ef1 H.�`. •
(3)If:you fall to'pay the eUove offense or to request a hearing.withln 21 days or N you Tall to t y
f Y appear for the heaAng qr to pay any Rne determined at the
hearing to beadle crimin�lrcomplalnt may be issued a gloat u s `, a k { +
"'v 1 HEREBY ELECT the first option above confess to the offense charged and enclose payment m the amount.of S '
Search Requests Page 1 of 2
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TOWN?occnne€t Citizen t g u Requests t age t
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Search Request
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�t} [Road Name =Y
Road Name: rebecca
Status: Closed.
Date Range:
From Pan 07 2011
To Jan I 21 y- 2011 ;-
No Date.Range _ Return All
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Request Department Ass€pned Reguestor Request Date Request Text� Location 7ar
32180 Health Office O'Connell,Timothy Anonymous 9/30/2010 Requester states many cars in 42.REBECCA LANE
20973 Health Office Stanton,;David Anonymous 5/29/2007 COMM Fire,Lt.Burchill called 42_REBECCA LANE
20855. Health Office Desmarais,Donald Susan McGann 4/17/2007 Followup to complaints#s 2004 42 REBECCA LANE -s
20818 Health Office Desmarais, Donald Susan Unknown 4/3/2007 Over flowing septic system tha 42 REBECCALA_NE v
20124 Health Office Desmarais,Donald Joseph Pires 7/11/2006 Septic system pumped twice in 42._REBECCA._LANE
20046 Health Office Stanton,David Joseph Fires 6/13/2006 this address currently has no 42 REBECCA LANE
http://issgl2/internalwrs/Regs2.aspx 1/21/2011
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October 1, 2010
Mr Carlos Ferreira o 0
#1 -Lichen Lane o
Forrestdale,MA 02644 —+ o
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RE: 42 Rebecca Lane �O n
Cn
Dear Mr..Ferreira: —i
N : n
On behalf of the undersigned neighbors in Osterville Heights,a visit was made to th$� m
Barnstable Police station on September 29, 2010 to seek their help and guidance
regarding the fact that we are held hostage in our home due to the excessive.noise, .•
drinking and loud language that we are subjected to by the tenants at the above property
on a routine basis. We are unable to sit on our deck and enjoy our property: We must
keep our windows and doors closed so lessen the noise,which.frequently starts late
morning and goes into the evening.
Attached is a police report that I obtained during my visit
The Police Officer advised me to call the police each time the disturbance occurs and
suggested that I contact the owner in the hope that you could intervene on our behalf.
That next evening, screams for help were coming from your property and several
neighbors called the police.Multiple police cars arrived at 42 Rebecca Lane along with
other emergency vehicles.It is our understanding that someone at 42 Rebecca Lane was
severely beaten,two people arrested and a gun was found in the back of the property. It
appears that the disturbances we are subjected to appear to be escalating.
Mr. Ferreira, I am certain you would not like to be exposed to these types of disturbances
on an ongoing basis.
It is our hope that you understand how distressful the situation is for our neighborhood
and take appropriate action to eliminate these ongoing occurrences.
Sincerely,
V..
I
cc: Barnstabl olice Department
f 69
,-2410 Page: ,
42 REBECCA LANE
S 3
Apt# Year MM DD Time 'Reason Action Call# 'Vicinity
12010 09 26 1852 — _ 1 DISTURBANCE,NOISE 1ADVISED �10-31064 N
2010 09.26 1715 1 DISTURBANCE,PARTY 1ADVISED 110�-310-50 i N
2010 09 26 1614 DISTURBANCE, PARTY !ADVISED 1 04 0-314 N
'
I 12010 06 23 1359 FRAUD/FORG, FORGERY SERVICED 10-19230 1 N
j '2010 01 02 2204 HARASSMENT, UNWANTED I SERVICED 110-172_ i N
12009 05 312250 DISTURBANCE, NOISE !SERVICED 09-17162 I N
2009 04 26 1929 1 DISTURBANCE,PARTY ADVISED 1 09-12903 'N s
2008.1216 1029 B&E,RESIDENCE REPORT TAKEN 08-43195 N
1'2008 07 24 1726 !ASSIST,OTHER AGENCY ;SERVICED 08-26465 N
1 2008 07 12 0327 DISTURBANCE,PARTY =ADVISED 108-24617 N
1 j2007 05 26 0941 !ASSIST,OTHER AGENCY SERVICED 07-17772 N
2007 OS 10 1826 ;ORDINANCE TAKEWREFERRED TO OTHER AGENCY 07-15772 j N
BARNSTABLE PODUE DEPARTMENT
P.O.BOX B
1200 PHINNEY'S LANE
WANNIS, MA 02601
Message ' Page 1 of 1
O',Connell, Timothy
From: McKean, Thomas
Sent: Tuesday, July 15, 2008 8:31 AM
To: O'Connell, Timothy
Subject: FW: This Past Weekend (Two Nights) B.P.D.
Please check this property for compliance with Chapter 170 and all other Health Regulations.
-----Original Message-----
From: jkpires [mailto:jkpires@comcast.net]
Sent: Monday, July 14, 2008 9:30 PM
To: McKean,Thomas; Town Main Mailbox
Subject: This Past Weekend (Two Nights) B.P.D.
This past weekend the Barnstable Police Department was notified about a party that was
quite noisy at the following address: 42 Rebecca Lane in Osterville. The BPD had to visit.
the some location on two nights
I've been in the Osterville Heights development since 1976 (September). Everything
has been fine, up and until one Mr. Carlos Ferriera of I Lichen Lane, Sandwich, MA.
purchased this home from Vic Haven. Over the post few years, you've received more
than the necessary number of complaints concerning sewer, vehicles and numbers of
individuals residing in this home. How much longer must we, the residents within two or
three homes on all sides of this residence -put up with this crap? If it happened next
door to any of the three of you - the problem would be resolved in a matter of hours- if
not sooner............. If you're thinking, if your so upset, sell and move - come take a look
see for yourself. Would you buy next to this(slum house?) If I wanted to sell, I
couldn't......... I realize you personally can not do anything to make a homeowner improve
his property- but I promise you, I'll not put up with the noise of some 20 Brazilians(and
other nationalities)playing loud music, swearing and drinking in a public way after 10PM
nightly.......... I'll be notifying the police EVERY TIME it happens(or I'm made aware of
it)......... You can count on it! Furthermore, does Mr. Ferreira know of the activities at
this flop house? His "tenants"are back to their old ways/ Or could it be that another
group of illegals are now residing here?
Yes, I am quite.upset................
Sincerely d Respectfully submitted,
Joseph L. Pires
23 Rebecca Lane
Osterville, Massachusetts 02655
7/15/2008
. ...-. �'J �..
October 1, 2010
Mr. Carlos Ferreira o
#1 Lichen Lane CM
Forrestdale,MA 02644 —+ o
-n
s w
RE: 42 Rebecca Lane
3 z
Dear Mr...Ferreira: ---Ii
N>; a
03
On behalf of the undersigned neighbors in Osterville Heights,a visit was made to th m
Barnstable Police station on September 29,2010 to seek their help and guidance
regarding the fact that we are held hostage in our home due to the excessive noise,
drinking and loud language that we are subjected to by the tenants at the above property
on a routine basis. We are unable to sit on our deck and enjoy our property. We must
keep our windows and doors closed so lessen the noise,which frequently starts late
morning and goes into the evening.
Attached is a police report that I obtained during my visit
The Police Officer advised me to call the police each time the disturbance occurs and
suggested that I contact the owner in the hope that you could intervene on our behalf.
That next evening,screams for help were coming from your property and several
neighbors called the police.Multiple police cars arrived at 42 Rebecca Lane along with
other emergency vehicles.It is our understanding that someone at 42 Rebecca Lane was
severely beaten,two people arrested and a gun was found in the back of the property. It
appears that the disturbances we are subjected to appear to be escalating.
Mr. Ferreira,I am certain you would not like to be exposed to these types of disturbances
on an ongoing basis.
It is our hope that you understand how distressful the situation is for our neighborhood
and take appropriate action to eliminate these ongoing occurrences.
Sincerely,
n
cc: Barnstabl olice Department ;,�,
09-29-2010 Page: 1
42 REBECCA LANE
IApt# L!Year MM DD Time Reason - Action �Cail# - vicinity f
___..... . _ _ - -_
12010 09 26 1852 _ i DISTURBANCE,NOISE ADVISED _ ! —�1-0--31064 N _ I
2010 09 26 1715 DISTURBANCE,PARTY ADVISED 110-31050 N
2010 09 26 1614 DISTURBANCE,PARTY ADVISED 10-31044 I N
1 2010 06 23 1359 FRAUDYFORG,FORGERY SERVICED 10-19230 N
f 2010 01 02 2204 HARASSMENT,UNWANTED ;SERVICED j 10-172 %N
2009 05 31 2250 DISTURBANCE,NOISE SERVICED 109-17162I{N
09 04 26 1929 DISTURBANCE,PARTY ADVISED 09-12903 'N
-y
— 2008 12 16 1029 B&E,RESIDENCE REPORTTAKEN 08-43195 N
12008 07 241726 !ASSIST,OTHER AGENCY _ }SERVICED 108-26465 N
i 2008 07 12 0327 DISTURBANCE,PARTY !ADVISED i 08-24617 N
2007 05 26 0941 ASSIST,OTHER AGENCY SERVICED !07-17772 ;N
2007 05 10 1826 !ORDINANCE TAKENlREFERRED TO OTHER AGENCY 07-15772 N
BARNSTABLE POWE DEPARTMENT
P.O.BOX B
1200 PHINNEY'S LANE
HYANNIS,MA 02601
r
Certified Mail#7006 2150 0002 1041 8405
rt E r`
Town of Barnstable
Regulatory Services
BARN'aTAEi1$
"45 / Thomas F. Geiler, Director
Public Health Division
Thomas McKean, Director
W 200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
l
December 23, 2007
Carlos Ferreira
C/o Michael Pearson
5 Witherspoon Drive
Nantucket, MA 02554
NOTICE TO ABATE VIOLATIONS OF THE TOWN OF BARNSTABLE CODE
CHAPTER 170.
The property owned by you located at 42 Rebecca Lane, Osterville_was inspected
on December 16, 2008 by Timothy O'Connell, R.S., Health Inspector for the Town of
Barnstable. This inspection was conducted on the basis of the rental registration in
accordance with Chapter 170 of the Town of Barnstable Code.
The following violations of the Town of Barnstable Code were observed:
1§ 70-10—Smoke Detectors and Carbon Monoxide Alarms. No CO detectors
provided.
You are directed to correct the violations listed above within twenty-four (24) hours
of your receipt,of this notice by installing CO detector in accordance with Mass
State Fire Codes.
You may request.a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served. Non-compliance will
result in a fine of$100.00.per violation.. Each day's failure to comply with an order shall
constitute a separate violation. Should you have any questions regarding the above
violations, please contact the Town Health Division and ask to speak with the inspector
who performed the inspection.
i PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S_, CHO
Director of Public Health
i
Q:\Order letterMousing violations\Rental ordinance\42 rebecca ost.doc
Town of Barnstable
Regulatory Services
l: Thomas F. Geiler,Director
I t w BARN�t7'AOM + ,
�+ MAS&
t6g9. Public Health Division
Arfb MAC a,
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
December 16, 2007
Attn: COMM Fire
Health Inspector Timothy B. O'Connell conducted a rental inspection in accordance with
Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary
Code, 105 CMR 410.482, the Health Department is required to notify the Fire
Department if there is a smoke detector violation, or possible smoke detector violation.
The following property had possible smoke detector(and\or CO detector)violation(s):
42Rebecca Lane. Osterville Assessors Map-Parcel: (146-045):
No Co Detector within home.
Timothy B. onnel-Health Inspector
i -
}
Q:\Order.letters\Housing violations\Rental ordinance\\Fire ViolationsTIRE TEMPLATE.doc
FORM 30 H&W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
C BOARD OF HE H
If -
CITY/TOWN
DEPARTMENThL-
e
ADDRESS r1
�M yey`e
TELEPHONE
Address 1 Occupant ^
Floor Apartment No. No.of Occupants-
No. of Habitable Rooms No.Sleeping Rooms
No. dwelling or rooming uni s No.Stories
Name and address of owner
Remarks Reg. Vio.
YARD Out Bld s.: Fences: —C3
Garbage and Rubbish Approved: - -
Containers: MLQ Cert:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.: 461
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
Ej 110 ❑ 220 Fusing,Grnd.: ` •
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry `
Den
Living Room
Bedroom(1).
Bedroom 2 i
Bedroom(3)Ellk)ILt
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
S.faos, Flues,Vent afeties:
Kitchen Facilities ArA
e
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub.-
Infestation Rats, Mice, Roaches or Other:
Egress— Dual and Obst'n: C
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PE RY."
INSPECTOR TITLE
`O t5 A.M.
TIME P.M.
DATE4/
A.M.
THE NEXT SCHEDULED REINSPECTION I / P.M.
410.750: Condition.Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such 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 10 CMW0T0J 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 of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch,balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
i
f
Certified Mail#7006 0810 0000 3525 2827
Town of Barnstable
Regulatory Services
• snxrrsrnsL�.
vMAS& Thomas F. Geiler, Director
i6;q• ��
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Mr. Carlos Ferreria May 31, 2007
P O Box 1845
Hyannis, MA 026001
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 42 Rebecca Lane, Osterville, MA was inspected on
May 10, 2007 by Timothy B. O'Connell and the following violations were observed:
105 CMR 410.300 and 310 CMR 15.00: There were a total of four (4) bedrooms
observed in this dwelling; three were observed on the first floor and one was observed in
the basement. Septic was designed for three (3) and was in hydraulic failure.
§ 170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental
Unit(s).
§ 59-3 of the Town of Barnstable Code: Number of Occupants able to reside within
dwelling.
Tenant stated that (7) seven people live at this property.
You are directed to correct the violations listed above within fourteen (14) days of
your receipt of this notice by removing bedroom in basement this must be done by
removing mattresses and bedroom door and making opening into room 5' wide.
You also must register with town for rental ordinance. Furthermore, only five (5)
people are allowed to reside within this dwelling.
The unit is not currently registered with the Town of Barnstable Health Division
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Non-compliance will result in the issuance of a non-criminal ticket citation of $100.
Each days failure to comply with an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
Q:\Order letters\Septic\42 Rebecca Lane.doc.
as A. FcKean, CHO, RS
Director of Public Health
QAOrder letters\Septic\42 Rebecca Lane.doc
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Logged In As: Friday, May 4 2007
Parcel Detail
Parcel Lookup
Parcellnfo
_._.._.._ .__ ._... .. ................_. .__._ _. _..._.._.,...... ....,,. ..,,......._
Parcel ID:146-045 Developer LOT 28
Lot
Location 42 REBECCA LANE Pri Frontage'150
.... ........ .. ..........
Sec
Sec Road JANES WAY Frontage 90
village OSTERVILLE Fire DistrictC-O-MM
._..._............
Sewer Acct Road Index 11353
l �(� CC/lJ✓ 5 �� c r
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Owner Info d _
Owner FERREIRA, CARLOS Co-owner;
Streetl P O BOX 1845 Street2
City'HYANNIS State MA Zip�02601 Country
Land Info
Acres 0.35 use,Single Fam MDL 01 Zoning RC Nghbd 0105
. .............
Topography Level Road;Paved
........ .......
Utilities Public Water Gas,Septic Location
Construction Info
......... ._. ......... ......... ......... ......... _._......_ ............................... _ ............
Building of I
__..
Year 19r7 W9 Root Gable/Hip W Ext Wood Shingle
Built ---- _._.-__ Struct= -- Wall —_
Effect _ __�.__._.__. Roof AC`-_-_---'.
Cover p 3
Area 1743 . p Type Asph/F GIs/Cm =None
=
Int Bed
Style lRanch iD wall 3 Bedrooms
__.__ _..._._........ . Wall ry..... .11 Rooms
3
I !! Int I Bath i
8
Model rResldential 3 Floor'Parquet Rooms 12 Full
Heat€ Total
Grade!,Average Type�Hot Air 6 Rooms
,. _.._ Rooms I
Stories 1 Story Heat 1_Gas ""� "" Found-[Typical
Fuel ' ation
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Permit History
Date: May 10, 2007 Thursday 5 PM
Locations:
390 Route 149,MM
42 Rebecca Lane, Ost
47 Lewis Pond Rd, Cotuit
49 Bob-White Run, Cotuit
Inspectors: Tim O'Connell,Health, Paul Roma,Building&.
Robin Giangregorio, Zoning
Fire Dept: FPO Frank Pulsifer, COM Fire, Capt. David Pierce, Cotuit
Police: Officers Michael L. Riley
390 Route 149, MM
• This was a follow-up inspection.
• Owners, Giorgio &Nancy Lobue arrived on site.
• The owner has a building permit to restore the property to.a sf and remove a
kitchen.
• Found there to be new tenants,.a mother& 2 toddlers..
• Property is limited to 3 bedrooms.
• Team identified 5 bedrooms including two in the basement (apartment).
• The apartment first floor is kitchen, living area & loft.
• The apartment bedrooms were located in the basement.
• Found a mattress and TV in loft area accessible only by a ship's-type ladder.
• The apartment kitchen now contains.a front-end loading washing machine and
dryer.
• Owner argued that this is.not a kitchen but a laundry area.
• He claimed plastic sink is a laundry tub for soaking.
• Dirty dishes were noted to be in the sink.
• A full size refrigerator and built-in microwave were at the.end of the L-shaped
• configuration.
• Gave owner 2 weeks to remove kitchen and eliminate 1 bedroom in main house.
• Exit order issued for basement bedrooms.
• Owner decided to relocate washer& dryer to basement.
• Ordered the removal of the mattress and TV from loft area.
• Owner also has the option of upgrading septic system.
• He must advise accordingly by the end of 2 weeks.
• Property needed CO detector.
1
f
• Did not meet apartment tenant.
• Spoke to Jill Davis,tenant in primary unit.
• She agreed to allow the house to flow as a sf and share her kitchen.
42 Rebecca Lane, Osterville
• This is a 3 bedroom(RC/GP).
• A 2000 BOH septic inspection identifies this as a 2 bedroom.
• Admitted to property by Wallace Andrede, a tenant.
• Found un-permitted bedroom in basement lacking proper egress.
• Tenant advised 7 people live here.
• Language issues—Ricardo translated fro me by cell phone.
• Property lacking CO & smokes.
• BOH confirmed septic system in failure. As noted on 4/27/07 in file.
• List of occupants:
o Marcos, Carlos &Juno Tavares—reside in basement bedroom.
o Wallace &Florjsvaldo Andrede
o Geraldo Santos.
o Jose Geraldo Santos (?) tenant not sure about this last name.
• Advised Wallace to have three tenants in basement relocate.
• Obtained phone number for owner, Carlos Ferreira, -
UPDATE:
• Owner came in 5/28/07.
• New leeching field for septic system to be installed this week..
• Required owner to registered dwelling as a rental unit while at the counter.
• Advised owner to install CO & smoke detectors by Friday(6/l/07).
• Advised owner to reduce the num,ber of tenants.
• Required owner to ensure that no one is sleeping in basement.
47 Lewis Pond, Cotuit
• Property is located in RF/AP.
• BOH identifies 3 bedroom system.
• Record owner is Livia Freitas
• Tenants, Samatha&Jason Williams admitted the team to property.
• Two adults and two children reside here.
• Property is a SF.
• Cellar limited.to mechanical & storage uses.
• Contact info provided on site:
o Levia Freitas, Owner
o 1 Locust Street
2
' w '
o Falmouth, Ma 02540
o 5('
• Cotuit Fire noted a smoke detector was missing in basement.
• BOH advised that owner has not registered property as a rental.
UPDATE:
Livio Freitas came in to question why the zoning team made an unannounced visit
to 47 Lewis Pond Rd, Cotuit. Mr. Freitas accused us of intimidating our way into
the property and traumatizing the two young children in the household. He stated
that his rights were violated and we had no right to investigate this property
simply because a problem was identified at another of his properties. He
proclaimed that he knows his "rights"; he demanded copies of everything
including the complaint and report under the Freedom of Information Act.
Subsequently, he demanded that we immediately write a letter stating why we
were there. He declared that we were targeting him because he is an immigrant.
When I replied that we did not know that when we arranged to visit the site, he
accused us of lying and then loudly spelled his first name as if to prove that his
name indicated he was born elsewhere.
I advised him that the site visit in Cotuit was.largely based on what we found in
Osterville and we needed to confirm the use of the.Cotuit property especially as
we knew it was not owner occupied. I noted that the tenants were very
cooperative. They invited us in and we had a pleasant exchange. He blew up and
practically accused us of being storm troopers and forcing our way in the
property. It appears that he wrongly believes only the property owner can admit
an inspector. Also, he misrepresented himself as the owner. The assessing
records list only his.daughter, Livia. I was not sure if I misunderstood the
spelling or gender prior to this so as a courtesy I discussed the matter with him
and advised him to put his request in writing. I added that we have 10 days to
respond.
His demeanor was angry and accusatory. It was obvious he was not interested in
hearing our response (as Paul Roma pointed out)but only in venting and being
right. He left as angry as he started but he caught himself and then thanked us and
left in a huff.
Later, I had a conversation with Chief Fraser,who initially agreed to write a letter
and attempted to explain the mission of the zoning team to no avail. Mr. Freitas
left but returned later and was apparently so argumentative and agitated that the
Chief called me to discuss the matter. Ultimately, the Chief informed me that
with Mr. Freitas waving around papers and yelling about the Freedom of
Information Act, he reevaluated his decision to write a letter of explanation
without more careful consideration. When I pointed out that I doubted Livio to be
the record owner, the Chief decided to not respond at this time as investigative
matters may be limited to the record owner.
I
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49 Bob-White Run, Cotuit
• Received complaint regarding overcrowding& landscape business in RF zone on
4/3/07
• Caller reports 6 trucks, 2 SUVs and a boat, also stockpile of piping and pavers
• BOH records reflect a 3 bedroom septic.
• Found property to be occupied by 4 adults—two couples
• One husband &wife and their adult daughter&her husband.
• Daughter translated,husband and wife speak limited English.
• Mr. Ribeiro operates a landscape business—Jaycees.
• He agreed to relocate this business and advise this office by 6/18/07 with regards
to status of effort. His wife also indicated she wants business gone.
• We discussed the number of vehicles—mostly for business purposes.
• Found some construction was started in basement but has been abandoned for
now.
• Advised owner that a permit is necessary for this work.
• No evidence of overcrowding
UPDATE:
• Mr. Ribeiro's daughter called 5/2807>-_
• She stated that her father found rented a bay near Willow Street, Hyannis.
• He will use one pick up truck as transportation but is parking behind a fence.
• All equipment &material has been relocated to the shop..
4
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Regulatory Services
SAWSfAUU,
ft"& Thomas F. Geiler, Director
T x634• a.�Q' .
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Mr. Carlos Ferreria Apri130, 2007
P O Box 1845
Hyannis, MA 026001
NOTICE OF VIOLATIONS OF BARNSTABLE CODE CHAPTER#360-20.
The property owned by you located at 42 Rebecca Lane, Osterville, is failed and must
be replaced. The property was inspected on April 24,2007 by Donald Desmarais RS and
the following violation was observed:
V60-20(A);Town of Barnstable Code: Septic system is in hydraulic failure. Sewage r
flow was evident on the surface of the ground.
(1) You are directed to keep the on-site sewage disposal system pumped as many
times as necessary(daily if needed) to keep it from overflowing onto the ground.
(2) You are ordered to obtain a septic design engineer to design the repair plans for
the failed septic system at said location and apply for a septic p ermit with the
Health Division within thirty(30) days of your receipt of this letter.
(3) The septic system shall be installed -in -strict accordance with the approved
engineered plans within sixty (60) days of your receipt of this letter.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the.order is served.
Non-compliance will`result in the issuance of a non-criminal ticket citation of $100.
Each days failure to comply with an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
r L limas ViKean, CHO, RS
Director of Public Health
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SENDER: COMPLETE THIS SECTION
■ Complete items 1,2,and 3 Also complete A. Si ure l
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■ Print your name and address on the reverse. ❑Addressee
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Geiler, Tom
From: Geiler, Tom
Sent: Saturday, May 26, 2007 8:58 AM
To: McKean, Thomas
Subject: Fw: Open/overflowing Septic at 42 Rebecca Lane, Osterville
Tom, please see if you can get an inspector to go out and issue a citation if the system
has not been pumped. We may have to have an inspector visit the property each day until
the situation is resolved.
How long will it take before the system begins to overflow after it is pumped?
-----'Original Message-----
From: Geiler, Tom <Tom.Geiler@town.barnstable.ma.us>
To: Klimm, John <John.Klimm@town.barnstable.ma.us>
Sent: Sat May 26 08:50:33 2007
Subject: Re: Open/overflowing Septic at 42 Rebecca Lane, Osterville
We have done both and more. The owner has ben orderd to replace the current system and
PUMP the current system as often as needed , pending the installation of a new system. I
will ask McKean tosend an inspector out this weekend to issue a citation
-----Original Message-----
From: Klimm, John <John.Klimm@town.barnstable.ma.us>
To: Geiler, Tom <Tom.Geiler@town.barnstable.ma.us> _ II
CC: Niedzwiecki, Paul <Paul.Niedzwiecki@town.barnstable.ma.us>
Sent: Sat May 26 07:22 :59 2007
Subject: FW: Open/overflowing Septic at 42 Rebecca Lane, Osterville
Hi Tom-
Can we either send someone out to take a look or take some enforcement action?_.:
John
From: jkpires [mailto:jkpires@comcast.net]
Sent: Fri 5/25/2007 10 :24 PM
To: Klimm, John; Health; McKean, Thomas; Geiler, Tom;
Paul.Niedzwecki@town.barnstable.ma.us; Golden, Robert; bzba@town.barnstable.ma.us
Cc: jkpires@comcast.net; csicvs9l@aol.com; swmcgann@verizon.net
Subject: Open/overflowing Septic at 42 Rebecca Lane, Osterville
It would appear that the letter sent to Mr. Carlos Ferreria by the Town of Barnstable,
means nothing! As you can see from this photo taken but two days ago. . . . . . . He is not in
compliance w/ the Town of Barnstable's Code. As someone is always around to view whats
going on over at this residence - why hasn't it been pumped? Especially AFTER the Town
has ordered that this be done. I sincerely hope that no child or family pet wanders into
this open sewer. I would suggest that the Town and Mr. Ferreria are placing themselves in
a position I would not want to be in.
I hope you have a wonderful weekend with family & friends. As you can see from the photo
- my weekend will have to be spent behind closed doors. (thanks to the sweet smells coming
from this property)
Respectfully submitted,
Joseph L. Pires
23 Rebecca Lane
Osterville, Ma. 02655
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http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=146045&map... 5/26/2007
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Barnstable Assessing Search Results Page 1 of 2
Home: Departments: Assessors Division: Property Assessment Search Results
New Search � x 'New Interactive Maps.>>
Owner: 2007 Assessed
Values:
FERREIRA,CARLOS
42 REBECCA LANE Appraised Value Assessed Value
Map/Parcel/Parcel Extension Building Value: $157,.700 $ 157,700
146 /045/ Extra Features: $3,900 $3,900
Outbuildings: $0 $0
Mailing Address Land Value: $148,100 $ 148,100
FERREIRA,CARLOS
Totals $309,700 $309,700
P O BOX 1845
HYANNIS, MA. 02601
2007 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation)
Community Preservation Act Tax $38.73 Fire District Rates Town
Barnstable-All Classes $2.10 $6.32
C.O.M.M. -All Classes $1.03 Commei
C.O.M.M. FD Tax(Residential) $318.99 Cotuit FD-All Classes $1.34 $5.57
Hyannis- Residential $1.54 Persona
Town Tax(Residential) $ 1,291 Hyannis-Commercial $2.37 $5.57
Hyannis- Personal $2.37 Other R;
W Barnstable- Residential $2.02 Commur
W Barnstable-Commercial $1.69
W Barnstable- Personal $1.69
Total: $1,648.72
Construction Details
Building Property Sketch Property Sketch & ASI
end
Building value $ 157,700 Interior Floors Carpet
Style Ranch Interior Walls Drywall
Model Residential Heat Fuel Gas
Grade Average Heat Type Hot Air
Stories 1 Story AC Type None
http://www.town.bamstable.ma.us/assessing/assess06/displayparcelO7map.asp?mappar=14... 5/26/2007
Barnstable Assessing Search Results Page 2 of 2
Exterior Walls Wood Shingle Bedrooms 3 Bedrooms
Roof Structure Gable/Hip . Bathrooms -2 Full
y 4 i
Roof Cover Asph/F GIs/Cmp living area 1408 - V
Replacement Cost $181237 Year Built 1977 - 1, -
Depreciation 13 Total Rooms 6 Rooms
Land
CODE 1010 .44
Lot Size(Acres) 0.35
Appraised Value $ 148,100
AsBuilt Card N/A
Assessed Value $ 148,100
View Interactive Maps >
Sales History:
Owner: Sale Date Book/Page: Sale Price:
FERREIRA,CARLOS Mar 28 2001 12:OOAM C161034 $ 180,500
HAVEN, VICTOR E&JEANNETTE Jan 15 1982 12:OOAM C87753 $56,500
SALOME, Oct 15 1979 12:OOAM $46,250
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
FPL1 Fireplace 1 $2,600 $2,600
BRR Bsmt Rec Room 288 $ 1,300 $ 1,300
Property Sketch
Legend
BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area UST Utility Area(Unfinished)
(Finished)
FAT Attic Area(Finished) GAR Garage UTQ
Three Quarters Story
(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story
(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.barnstable.ma.us/assessing/assess06/displayparcelO7map.asp?mappar=14... 5/26/2007
j
April 23,2007
I _
Town of Barnstable
Department of Health
Hyannis,MA 02601
Re: Overflowing Septic System @ 42 Rebecca Lane Osterville,MA 02655
Dear Sirs:
It is my,understanding that the septic system permitting and inspection falls under the
Public Health Department. We reside next door to the above house and have noticed that
the septic system is overflowing and we are gravely concerned for our health and well
F
being.
Our two bedrooms face the septic system overflow which is approximately 25 feet from
the foundation f our house. 15 feet is our property and the septic system overflow is
approximately 10 feet from our property line.
We understand that this is not a new problem and has been reported on several occasions
by oihers in our neighborhood. We are concerned that with the warmer weather soon
upon us that we will be subject to insects,noxious odors and the overage spilling onto our
property.
Attached you will find a picture of the location of the septic system overflow taken from
our property line on April 20,2007. Additional pictures taken on April 23,2007 clearly
identify the sewerage overflow of the septic system.
F
Your prompt attention to this matter and a response to our letter of concern will'be
appreciated. According to your web site a health inspector will be dispatched to the above
Til
location in twenty-four(24)business hours to investigate the complaint. We-look :7 t
forward to your response to our complaint and what action will be taken to rectify the < ,
situation.
Sincerely,
Eleanor an u
14 Janes Way
Osterville,MA 02176
508-420-9741 cell:617-512-1884 email: csicvs9l@aol.com
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Susan K. and Wayne B. McGann
34 Rebecca Lane
Osterville, MA. 02655
April 20, 2007
Town of Barnstable
BOARD OF HEALTH
200 Main Street
Hyannis, MA. 02601
ATTENTION: DON DESMARAIS
Mr. Desmarais,
am responding to your phone message left on our answering machine 4/19/06.
In response, I left you a message on your answering machine on the same date.
As stated in my responding message left on your answering machine, I take
EXCEPTION to your suggestion that I call back, "when the ground has dried out".
I have a septic system in my back yard and inspite of the abundant rains and
dampness in the soil at this time, there is NO LARGE GREEN RING OF GRASS
growing around the top of my septic system, NOR IS THERE A HORRIFIC
STENCH OF RAW SEWAGE. Both of these are evident to anyone who walks
by the risk located at 42 Rebecca Lane, Osterville, Massachusetts.
The system at 42 Rebecca Lane is in FAILURE. The landlord was told in August
of 2006 by the Board of Health of the Town of Barnstable to REPLACE IT within
60 days. NOTHING HAS BEEN DONE IN THAT REGARD.
I am once again appealing to the Board of Health in the Town of Barnstable to
enforce the laws written concerning septic systems that are failed. Along with
other abutting residents to this property, we ask that this failed system be
replaced and the landlord for this rental property be brought into compliance with
the written rules and regulations in an immediate and responsible manner. - :
SSiincerel -
�: CU
Susan K. and Wayne B. McGann
CC: Tom McKeon
CC: Joseph Pires '
CC: Lawrence VanCleef
This letter was faxed on 4/20/07 to 508-790-6304
This letter was hand delivered to the Board of Health in the Town of Barnstable
at 200 Main Street Hyannis at noon on 4/20/07
•Map ' Page I of 1
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Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS
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http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=146045 4/20/2007
I04/17/2007 09:13 5087902344 F&C HYANNIS PAGE 01-w
Wayne B. and Susan K. McGann
34 Rebecca Lane
Osterville, MA, 02655
April 17, 2007 r
Town of Barnstable r;?
Department of Health �-3
(DI
Hyannis, MA. 02601
I
ATTENTION: Mr. McKeon '
RE: 42 Rebecca Lane, Osterville, MA,
Dear Mr. McKeon,
I have just spoken with a very kind lady, one Ellen Wadlington in your department
who was most kind in hearing out my SECOND complaint regarding the situation
with an overflowing septic system at 42 Rebecca Lane, Osterville, MA.
I would share with you that this is MOST DEFINITELY A RENTAL PROPERTY
with as many as 6 — 15 Brazilians at any given time - I understand that this
property has never been registered with the Town of Barnstable as a rental. A
clear violation.
The system at this home is an outrage to those of use who OWN OUR HOMES,
pay taxes to the Town of Barnstable, and maintain our properties in a responsible
manner. The slum landlord of 42 Rebecca Lane, Osterville, MA. has let this
property deteriorate and clearly makes no effort to maintain it. The overflowing
septic system is a total outrage and unacceptable.
I am appealing to you and your board to bring pressure on this man to take care
of this situation immediately. I was under the impression that last summer, the
landlord was told by The Board of Health of the Town of Barnstable, that his
septic system had failed ( having been pumped about 6 times in one month!!!!!)
and that he had 60 days to replace the system. This has never been done.
Nothing whatsoever has been done.
The stench over the weekend was beyond bad and I was unable on Monday
when we saw the sun briefly to open my front windows for the odor emanating
from this horrible situation.
f
04/17/2007 09: 13 5087902344 F&C HYANNIS PAGE 02
I look forward to hearing from you in this regard - with summer coming and
outdoor activities and gardening being done, to not be able to go out in the front
yard of our property is unacceptable.
trul yours,
Susan K. McGann
Wayne B. McGann
SKMlsdk
CC: Joseph Pires
Letter faxed to 508-790-6304 this date
i
Citizen Web Request Page 1 of 1
5 ' Citizen Request Management
a
y Request ID: 20856 Created: 4/17/2007 10:05:21 AM
Status: Assigned To Staff Assigned To:
Desmarais, Donald
Health Office
Title 5 : Section 353-7
MIN
Anonymous: No Category: Sewage
YE E.C. Date: 4/19/2007
Created By: Wadlington, Ellen Citations:
Health Office
" r Time Worked: 0 Response Time: 0
Request Location:
42 REBECCA LANE
Osterville, Ma 02655
Parcel Number: Map: 146 Block: 045 Lot: 000
Request:
Followup to complaints #s 20046, 20124, and 20124. The septic system has not been
repaired. The stench is so bad the neighbors cannot go into their yards or open windows of
their houses. Ms. McGann states the sewage is backing up in the yard.
Request Work History:
http://issgl/IntemalWRS/WRequestPrintPub.aspx?ID=20856 4/17/2007
Town of Barnstable
FTHE Tp�
do Regulatory Services
Srn6LE Thomas F. Geiler,Director
BAPN9�A MASS. ,�� Public Health Division
lF0 MA'S A
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
July 13, 2006
Mr. Carlos Perreria
P 0 Box 1845
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5
The septic system owned by you located 42 Rebecca Lane, Osterville, MA, is failed
and must be replaced.
The system was pumped on July I"by Patrick Sullivan, of Ready Rooter Company,
the system was pumped Julylst and again on July loth the leaching pit was
overfilling above the invert pipe
You have 60 days from the date of this Order Letter to bring the system into compliance.
If there are any questions about this reminder, please feel free to contact the Barnstable
Health Department.
BARNSTABLE HEALTH DEPARTMENT
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
fi
1
Town of Barnstable
Regulatory Services
nat�rrscna�, «
XAS& , Thomas F. Geiler,Director
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Mr. Carlos Perreria ~` July 12,2006
P 0 Box 1845
Hyannis, MA 026001
NOTICE OF VIOLATIONS OF BARNSTABLE CODE CHAPTER#360-20.
The property owned by you located at 42 Rebecca Lane, Osterville, is failed and must
be replaced. The system was pumped on July lst, 2006 and again on July loth 2006 by
Patrick Sullivan Ready Rooter, when the following violation was observed.
360-20;Town of Barnstable Code: Septic system is in hydraulic failure. The leaching
pit had overflowed above the invert pipe.
a
(1) You are directed to keep the on-site sewage disposal system pumped as many
times as necessary(daily if needed) to keep it from overflowing onto the ground.
(2) You are ordered to obtain a septic design engineer to design the repair plans for
the failed septic system at said location and apply for a septic permit with the
Health Division within thirty(30) days of your receipt of this letter.
(3) The septic system shall be installed in strict accordance with the approved
engineered plans within sixty (60) days of your receipt of this letter.
You may request a hearing before-the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Non-compliance will result in the issuance of a non-criminal ticket citation of $100.
Each day's failure to comply with an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, CHO, RS
Director of Public Health
Q:\Order letters\Septic\42 Rebecca Lane.doc
Message; Page 1 of 3
�plLAtl - 900yk
r Cp 1
McKean, Thomas
From: McKean, Thomas
Sent: Tuesday, June 13, 2006 8:51 AM
To: 'jkpires'
Subject: RE: Notification of what"appears"to be a problem..........
Dear Mr. Pires,
We will log your complaint into our computer database this morning and will dispatch a health inspection to that
location for investigation.
Sincerely,
Thomas McKean
-----Original Message-----
From:jkpires [mailto:jkpires@comcast.net]
Sent: Monday, June 12, 2006 6:14 PM
To: McKean, Thomas
Cc: Town Main Mailbox; cobra8@comcast.net;janeloakim@aol.com; Janice L. Barton
Subject: Re: Notification of what "appears" to be a problem..........
Mr. McKean...................
Each one of those vehicles "represents" an individual driver to that specific plate
number. This is a three bedroom home! How about the stress put on the septic
system by 7 individuals (or more)? As long as I've been a resident on the opposite
corner (1976) - I've seen the septic system pumped twice and that was with the
"original owner".......... You have apparently overlooked "total" number of individuals
residing at this location.
Respectfully'submitted,
Joseph L. Pires
McKean, Thomas wrote:
A Town Ordinance which addresses the maximum number of vehicles was recently adopted
by the Town Council. Your complaint was forwarded to the Building Division Office this
morning for action, as that is the enforcement agency for this type of complaint(i.e. number
of vehicles).
-----Original Message-----
From:jkpires [mailto:jkpires@comcast.net]
Sent: Saturday, June 10, 2006 5:34 PM
To: Town Main Mailbox; McKean,Thomas; cobra8@comcast.net;
janegoakim@aol.com; Janice L. Barton
Subject: Notification of what "appears" to be a problem..........
6/13/2006
f
Message Page 2 of 3
As I do not have the email addresses to the following named
individuals, please forward to them as well. (thank you)
Town Attorney, Robert Smith
Town Manager, John Klimm
Police Chief, John Finnegan
Osterville Fire Chief, John Farrington
Osterville Heights Development is a single family residential
dwelling neighborhood which is North of Route 28 directly behind
the 7th Day Adventist Church in what was formally known as East
Osterville.
Like many other areas throughout the Town of Barnstable, we are
presently experiencing problems with tconany individuals residing in
a single family dwelling. The property at 42 Rebecca Lane (corner
of Janes Way) which is owned by one Mr. Carlos Ferreira (mailing
address of P.O. Box 1845, Hyannis, Ma.) currently has no less than
five vehicles parked here on a daily basis (evening hours). At times,
there are seven vehicles parked on the property and along the
street (sidewalk area). Over the past six weeks, individuals come
and go but the upkeep of the property has been forgotten. It was
one of the pride's of the neighborhood at one time! It is now
bringing the neighborhood values down......... Unacceptable!
The following is a list of 7 Massachusetts Number Plates to vehicles
that can be seen here on a regular basis;
43 K - 568
49N - M50
54C - V61
59K - 068
69M - V36
71L - Y80
78E - V80
I'm hopeful that with the information provided above, that someone
can look into this matter ASAP and resolve this problem. (hopefully
this doesn't take as long as the Greenwood situation did
6/13/2006
Message, Page 3 of 3
(approximately three years to remove six horses that were illegally
housed on property within the same residential development).
Thank you in advance for you assistance with this matter.........
Respectfully submitted,
Joseph L. Pires
23 Rebecca Lane
Osterville, Ma. 02655
(opposite corner from where this is happening)
6/13/2006
FL O W - PROFILE ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS F �
EXPRESSED IN DECIMAL FEET NOT FEET AND INCHES.
TOP OF FOUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE ALL PIPE TO BE
EL = 58.50 +— INSTALL ONE INSPECTION RISER FOR LEACHING GALLERY SCHEDULE 40 PVC
TO WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT AND TO PITCH AT
AND INDICATE LOCATION ON AS BUILT. 1/6 in/Ft MIN.
54.50
D-BOX MAX
t
3" DROP
g -FLOW LINE I I i i 51.50 ~
iol - 14' -
PRECAST
46" GAS
DRYWELL
BAFFLE
54.75+— 6 in SOILBOTTOABSORPTION
EXISTING STONE 50.86 LEACHING SYSTEM'
EXISTING' BASE f
• EXISTING' S1.05, . 50.P5 GALLERY
48.'�5 �EXISTING 1 r (END VIEW) , 500 ft +
1000 GALLON SEE DETAIL ON REVERSE
EXISTING SEPTIC TANK 61 ft e) 5 ft
b) 12 17L
ADJUSTED = 1, 23.7
SEASONAL HIGH
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SOIL TEST L O G A `DSUILE EO VALUATOR: LLSPE LYONS R.S. DESIGN C A L.C.0 L A T I O N-S
WITNESSED~BY: DONNA, MIORANDI. HEALTH DEPT. n
PERC NUMBER: 11813 DESIGN FLOW: � BEDROOMS X UO GPD = 0 GPD ro[ -D`�
1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 220 GPD X. 2 DAYS = 440 GALLONS
1 TEST PIT PARENT MATERIAL: PROGLACIAL OUTWASH INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) D`
PERC AT 55 in - 2.MIN/INCH IN C SOILS DISTRIBUTION BOX: USE 3 OUTLET D-BOX. . 3f�T
SOIL ABSORBTION SYSTEM: THE LEACHING GALLERY DEPICTED BELOW CAN LEACH
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER AboL = ( 10.83 x 25.33 l +( 4 x 2.84 ) + 0.5 x ( 6.3 x 2.64 ) = 294.63 sf
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING `Asdw = ( 2 5.3 3 + 13.67 + 4 + 6.94 + 15 + 10.83 ) x 2 = 151.54 sf
54.32 Atot = 446.17 sf
0-9 FILL Vt_ 0.74 x 446.17 = 330.17 GPD
9-12 A/E LOAMY SAND 10 YR 3/2 NONE FRIABLE USE THE LEACHING GALLERY DEPICTED BELOW. Vt = 330.17 GPD L0 GPD REQUIRED
51.40
12-35 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 35-124 C MEDUIM TO 10 YR 6/6 NONE LOOSE 1000 GALLON SEPTIC TANK LEA CHI NG GA L L ER Y
COARSE SAND DIMENSIONS AND DETAIL NOT TO
43.99 A USE SHOREY PRECAST 500 GALLON NOT TO USE EXISTING H-10 UNIT SCALE
LEACHING DRYWELL (H-10 LOADING) SCALE
NO GROUNDWATER ENCOUNTERED CONSTRUCTION DETAIL EXISTING SEPTIC TANK IS TO BE PUMPED
TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH STONE DRY AT THE TIME OF INSTALLATION AND
2 MIN/INCH IN C SOILS DRYWELL UNIT IS TO BE EXAMINED FOR STRUCTURAL
15.0 f t 6.94 F}-4.0 ft INTEGRITY. INSTALL A NEW PVC OUTLET
TEE EQUIPPED WITH A GAS BAFFLE.
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER } m e4
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING
54.19 m m in,
0-11 A/E LOAMY SAND 10 YR 3/2 NONE FRIABLE m m` m 1 In
11-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE m �% TAPER I�
51.19 m
36-13B C MEDUIM TO 2.5 Y 4/6 NONE LOOSE 4.es o
O f t 8.5 Ft O f t Ft O FL[ 0
COARSE SAND o
5 FL-
8 In
42.69
• 25.33 FL
GROUNDWATER ADJUSTMENT - 500 GALLON DRYWELL
DIMENSIONS AND DETAIL 1
EXISTING GROUNDWATER LEVEL INSTALL ONE INSPECTION '1
BASED ON TOWN OF BARNSTABLE USE H-10 UNIT INCHES OOWITHIN I L GRADE 8 1,� A
GIS DEPARTMENT RECORDS. AND INDICATE LOCATION
ON AS-BUILT PLAN
INDICATED GW 22.00
INDEX WELL SDW-253 INLET
OUTLET
ZONE C
READING DATE MAY. 2007
READING 47.1 00 33 3 IN DROP
� 0oOpO Opp in -> �l FLOW LINE -�
ADJUSTMENT 1.7 a o 0 -Op _
ADJUSTED GW 23.7 o0000000000 �D00 BUILDING 101n - 14 TO
�ooa000000 00 D-BOX
NOTES 048
10� In LIQUID GAS
LEVEL BAFFLE
1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. CROSS SECTION VIEW INSTALLER MAY ELECT
2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED TO rurE AN
APPRROVEDOVED GEOTEXTILE
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. FABRIC IN PLACE OF
ONE
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS LAYER'SPECIFIED. CROSS SECTION VIEW
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15).
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 21n PEASTONE 21n PEASTONE
BEFORE EXCAVATING FOR .SYSTEM. � SEWAGE DISPOSAL SYSTEM PLAN
5) .EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND F-IDLED v' Zt- 2 3/41n TO EFFECTIVE 3141n To 2s
1n -1/2 1n GRAVEL DEPTH 1-1/2 1n GRAVEL to
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON;%J` INES. AND,:DUST IN PLACE. TO SERVE EXISTING DWELLING
7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLfA-TIO<N= ,OFi?;LO W"FLOW FIXTURES
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTICe;T;A.NK. 1 C/�RLOS EERREIRf�
' ' `�' 42 REBECCA LANE OSTERVILLE. MA
ED SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LfOAD'I-NG' NOT DO' N
. PARK OR DRIVE .VEHICLES OVER SEPTIC SYSTEM. '- EEO-TECH ENVIRONMENTAL
r.
9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE'iT0 GRADE ON A ,LEVEL
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON• TO`WHICH 43 TRIANGLE CIRCLE SANDWICH MA 02563
SIX INCHES OF CRUSHED STONE HAS- BEEN PLACED, TO. MINIMIZE 'U;NEVEN SETTLING.
' ETE-2651 I JUNE 5. 2007 1 1212