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HomeMy WebLinkAbout0068 STURBRIDGE DRIVE - Health 68 Sturbridge Drive A= 165-043 Osterville 4 r _ Town of Barnstable Bar'iStab'e Epp SNE Tp�y v A&fte iea CRY Regulatory;,, egulatory Services Department I F i RARINTr BLE, • "ASS.1639. Public Health Division Om 0., . 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7008 3230 0002 5178 2770 December 14,2012 Mr. &Mrs. Thomas L. Barrette 68 Sturbridge Drive Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5' • The septic system.located at 68 Sturbridge Drive, Osterville, MA was last inspected on 11/20/2012,by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the.septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The Distribution-Box needs to be replaced. f You are ordered to repair/replace the above listed septic system components within Two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action: PER ORDER OF THE BOARD OF HEALTH mas McKean, R.S., CHO Agent of the Board of Health } Q:\SEPTIC\conditionally passed\68 Sturbridge Dr.Dec2012.doc f Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10736 u Logged In As: ^� r o _ Wednesday, December 12 parcel Deta '1• 2012 Parcel Lookup Parcel Info Parcel ID 166-023 ) Developer Lot'-LOT 63 Location 68 STURBRIDGE DRIVE I Pri Frontage,128 - I Sec Road OLD SALEM WAY I Frontage 91 age village OSTERVILLE ( Fire District C-O-MM Town sewer exists at this address No I Road Index 1550 f 'r Asbuilt Septic Scan: interactive 166023 1 Map — �<, Owner Info t. owner BARRETTE, THOMAS L& MARYALICE I co-owner %WHITE, CATHERINE D �) Streets 831 SEAVIEW AVENUE Street2, city I �'OSTERVILLE State MA ziP02655 Country Land Info Acres 0.31 I use Single Fam MDL-01 ,;I zoning RC Nghbd 0108 I Topography Above Street I: Road Paved I i Utilities Septic,Gas,Public Water Location r Construction Info Permit History Issue Date Purpose Permit# Amount Insp Date Comments 12/01/1988 B32499. $120,000 01/15/1990 00:00:00 OS 11/2 S Visit History Date Who Purpose a i 05/07/2008 00:00:00, Paul Talbot Cyclical inspection 10/15/1699 00:00:00 Paul Talbot Meas/Listed-InteriorAccess 03/15/1990 00:00:00 ML Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 01/03/1989 BARRETTE,THOMAS L&MARYALICE C116490 $76,000 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10736 1.2/12/2012 �� � i ��� Commonwealth of Massachusetts` Title 5 Official -Inspection form � k` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Sturbridge Dr. - Property Address �. i Barrette Family.Trust Owner Owner's Name x information is required for every, Osterville MA ' 02655 ' .11-20-12 page. Cityrrown State '° Zip Code q Date of Inspection = Inspection results must be submitted on this form. Inspection forms may not be altered in any. way. Please see completeness checklist at the end of the form: Important:When filling A. General Information o the computer, ; .p `````�����N OF�llygs use only the tab 1. Inspector: . `,_.' •.ti�,` key to move your o; cursor-do not r James D.Sears _ JAME.S m <. -t use the return " ,o' SPARS Name of Inspector, * , key. , ` . CapewideEnterprises LLC< _�•.�' °: � -Company Name • �5 I N Sp���`�' z 153 Commercial St. }. !��nfntiplunap�p Company Address Mashpee MA, 02649 Cityrrown State Zip-Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally iriipected,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 a� was performed based on my training and experience in the proper function and maintenance gf on s;te-y sewage-disposal systems. 1 am a,DEP approved system inspector pursuant to Section 1A:340W Title 5(310 CMR 16400). The system: E Passes ® Conditionally Passes ❑ Fails a '-n Needs Further Evaluation by the Local Approving Authority S x 11-23-12 pector's Signature i Date , The system ins ctor shall submit a co of this inspection report to the Approving Authority Board Y pe copy p P pp 9 tY( 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, a_ ***,*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•11/10 Title 5 Official in o orm:subsurface Sewage Disposal System•Page 1 of. 7p Commonwealth of Massachusetts; r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "•'< 68 Sturbridge Dr. Property Address Barrette Family Trust Owner Owner's Name t •; information is Osteryille ..MA 02655 11-20-12 required for every � -- page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ' Inspection Summary: Check A,B,C,D or E%always complete all.of Section D . A) System Passes: _ f Y ❑ 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 4 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. 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. ❑ Y ❑ N, ❑ ND (Explain below): t5ins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 i+ Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Sturbridge Dr. Property Address Barrette Family Trust' Owner Owner's Name information is Osterville MA 02655 11-20-12 required for every _ page. Cityrrown - State Zip Code Date of Inspection B. Certification (cont.) 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):' El broken,pipe(s)are replaced ❑ Y ❑ N ❑-ND(Explain below): El obstruction is removed ❑ Y ❑,,N ❑ ND(Explain below): ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): Need to replace D Box - i ❑ The system required pumping more than 4 times a year due to brokers or obstructed pipe(s).The system will pass inspection if(with approval'of the Board of Health):. El broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): i ❑ 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 El Cesspool or privy is within 50 feet of a bordering vegetated wetland or':a salt marsh t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments M , ''< 68 Sturbridge Dr. u " Property Address , Barrette Family Trust + Owner Owners Name information is Osterville MA `02655 11-20-12 required for every page. City(rown 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 aseptic 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 r more from a private water supply well". Method used to determine distance: . r y This system passes if the well water analysis, performed at a DEP certified'laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. } .3. Other. D) System Failure Criteria Applicable to All Systems: , You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. E] ® Liquid depth in eawipaW is less than 6" below invert or available volume is less than Y day flow /°>-/— t5ins.11/10 Title-5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts- Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M �( 68 Sturbridge Dr. Property Address Barrette Family Trust Owner Owner's Name information is required for every Osterville MA 02655 11-20-12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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. ❑ ® 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. y 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"ye`s"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 ❑ E 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Sturbridge Dr. Property Address Barrette Family Trust Owner Owner's Name " information is required for every Osteryille MA 02655. 11-20-12 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 El ® Were any of the system components pumped out in the previous two weeks? ❑ 0 Has the system received normal flows in the previous two week period? El Have large volumes of water been introduced to the system recently or as part of ® this inspection? ®. El Were as built plans of the system obtained and examined?(If they y 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 Boardof Health. ® Determined in the field(if any of the failure criteria related to Part C is at issue El 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. t5ins-11110 Title 5 Official Inspection Form: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 �l 68 Sturbridge Dr. ` Property Address Barrette Family Trust Owner Owners Name information is required for every Osterville MA 02655 11-20-12 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: k The system is a 1500 Gal Precast tank D Box and Pit Number of current residents: 0 Does residence have a.garbage grinder? ®' Yes [] • No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? , ' ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2010-26,000GaI g ( y 9 (gPd))' 2011-40,000Gal Detail: ,. Sump.pump? ❑ Yes ® No Last date of occupancy; NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Y. 4 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-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts. Title 5 Official! Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Sturbridge Dr. s Property Address Barrette Family Trust Owner owner's Name information is required for every Osterville MA 02655 11-20-12 page. City/Town '. State Zip Code Date of Inspection D. System Information (cont.) Last date of,occupancy/use: Date ` Other(describe below): , f General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,.volume pumped: gallons How was quantity pumped determined? Reason for pumping: ti Type of System: ® Septic tank,' distribution box,-soil absorption system ❑ Single cesspool ❑ Overflow cesspool El 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 1/A system by system operator under contract ❑ Tight tank. Attach'a copy of the DEP approval. ❑ Other(describe): T 4 F t5ins-11/10 Title 5 Official hisp action Form:Subsurface Sewage Disposal System Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form' a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Sturbridge Dr. Property Address Barrette Family Trust - Owner Owner's Name information is required for every Osterville ' MA 02655 11-20-12 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: 1988 Permit# 88-715 Were sewage odors detected when arriving.at the site? ❑ Yes M No Building Sewer(locate on site plan):' Depth below grade: 26„ e feet Material of construction: 0 cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction liner feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 1811 feet Material of construction: iM ` ®concrete ❑ metal 0 fiberglass ❑ polyethylene ❑other(explain) If tank is metai,'list age: years.. Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) Q Yes ❑ No' Dimensions: 1500 Gal Precast Sludge depth: t5ins•11I10 TrUe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Sturbridge Dr. Property Address Barrette Family Trust ' Owner Owner's Name information is required for every Osterville 'MA 02655 11-20-12 page. CitylTown State Zip Code Date of inspection D. System Information (cost.) - Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle' 30" 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' 18" How were dimensions determined?i Asbuilt-Tape- "Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank and outlet cover at 18"w[inlet cover at 4" in and outlet tees. No sign of leakage or,over loading ` , r Grease Trap,(locate on site plan): Depth below grade: feet Material of construction: ❑concrete Cl metal D fiberglass El polyethylene ❑other(explain): Dimensions: , Scum thickness.T Distance from top of scum to top of outlet tee or.baffle Distance from bottom of scum to bottom of outlet tee or baffle Y K i Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Sturbridge Dr. Property Address Barrette Family Trust Owner Owner's Name information is required for every Osterville ' MA 02655 11-20-12 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 Holdin • Tank tank must a um time f inspection) I t b pumped at t e o s ho ovate on site plan): g 9 ( P P P� )( Depth below grade: a 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i r M , ' 68 Sturbridge Dr. Property Address Barrette Family Trust f Owner Owner's Name information is required for every Osterville MA 02655 11-20.12 page. Cityfrown _ State Zip Code Date of Inspection D. System Information (cont.) - Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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 is 16"x 16"-29"below grade w/one line out, `No sign of over loading or solid carry over, ` Walls are gone on box, Need to replace D Box 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 arid appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation hat required); If SAS not located;explain why: : t5ins•11110. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 1 , s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Sturbridge Dr. Property Address , Barrette Family Trust Owner Owner's Name information is required for every Osterville MA - 02655 11-20-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) { Type: . ® leaching pits ' number:: ❑ leaching chambers number: ❑ leaching.galleries number: ❑ leaching trenches number,length' r❑ leaching fields. F number, dimensions: ❑ overflow cesspool ' number ❑ innovative/altematiye system - Type/name of technology;, Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): Leaching is one 1000 Gal Precast Pit w/3'stone, Pit and cover at 3' below grade, Pit is dry w/ stain line at 2, No sign of over loading or solid carry over Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to'inlet invert y Depth of solids layer _ Depth of scum layer k }. f Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13{of 17 ' Commonwealth.of Massachusetts Title 5 Official Inspection Fora y Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , y 68 Sturbridge Dr.i Property Address Barrette Family Trust Owner Owner's Name information is required for every Osterville MA. 02655- 11-20-12 - page- City/Town State Zip Code Date of Inspection D. System information (cont.)` . Comments(note condition of.soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc): Privy(locate on site plan): 4 Materials of construction: ` Dimensions 1 Depth of solids - Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):.. r . t ^4r ., t e � • * , .. ' �. • ,. ..t " . Y III R . t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 68 Sturbridge Dr. Property Address Barrette Family Trust - - Owner Owner's Name i e is required for every Osterville MA 02655 11-20-12 o page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.)= r 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 13-- - 3 - t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 17 f Commonwealth of Massachusetts b ` Title 5 Official Inspection Form _{ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ye 68 Sturbridge Dr. ` Property Address Barrette Family Trust Owner owner's Name information is required for every Osterville MA 02655 11-20-12- _ page. Cityrrown State Zip Code Date of Inspection D. System. Information (cost.) Site Exam: ❑ Check Slope , El Surface water ❑ Check cellar Shallow wells 1 f , Estimated depth t 12'high ground water: feet Please indicate all methods used to determine the high ground water elevation ® Obtained from system design plans on record If checked, date of design plan reviewed: Date. 8 ,F - 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) y ❑ Accessed USGS database explain: You must describe how you established the high groundwater elevation: - T.H.Per design 11-1-88 144" No G.W. Bottom of pit at 9% 3' Above T.H. Before filing this Inspection Report,please see Report Completeness Checklist'on next page. t5ins-11J10. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16'of 17 ` & Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 68 Sturbridge Dr. Property Address Barrette Family Trust Owner Owner's Name information is required for every Osterville MA 02655 11-20-12 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file a y t5ins-11110 Trtle 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 No. 3 7 Fee A)0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YeS 0(pplitation for Bisposal &pstem ConstCULtion permit Application for a Permit to Construct( ) Repair(K Upgrade( ) Abandon( ) ❑Complete System Winndividual Components Location Address or Lot No.� J \ .r v ACIZ,D r-, Owner's Na 1 rets,and Tel.No.X—Ir Mc Assessor's Map/Parcel14 ®�13 ���,�� �, �`�` Installer's Name Addreeslst altd Tel.No. Lf'7 77 Designer's Name,Address,and Tel.No. e r �s� Type of Building: Dwelling No.of Bedrooms Lot Size Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 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) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt igned Date ;L0I Application Approved by Date 1 Application Disapproved by Date for the following reasons Permit No. O� 3 Date Issued (U - No. O I / Fee 6 v y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes l PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2[pplication for Misposaf 6pstem CottstrUctioH 3perlttlt Application for a Permit to Construct( ) Repair(V�Upgrade( ) Abandon(') ❑Complete System Individual Components Location Address or Lot No.L,4'y S r r 5�- .�,� d 6' Owner's Name, and Tel.No. �b Assessor's Map/Parcel 1406 OA-3 � - r xc Installer's Name,Address,,ajid Tel No. ;O%;�-9977 Designer's Name,Address,and Tel.No. A +O� VAA Type of Building: ? J� Dwelling No.of Bedrooms Lot Size 3 7� sc�-ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd i Plan Date Number of sheets Revision Date Title I '{ Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) n t _ Date last inspected: - Agreement �tg 1 1. t y 1 under'Wed agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in abcddanc�Thle e with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of r"s: Compliance has been issued by,this Board of Health. igned Date Application Approved by, Date Application Disapproved by Date for the following reasons Permit No. :am Date Issued `�— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V�l Upgraded-) Abandoned( )by `��t?t_W 1 Ind' r" e5 • ^" � � at (� .�-�-cAG bK o AA#- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N.o dated - ,�' Installer Ca,�_cj,dy_ Designer #bedrooms *'� Approved design flow gpd The issuance of this;permit shall noflie construed as a guarantee that the system wi I f nction, des'iced. _ J J ) Date .t« �.r �//�� l l� Inspector..._._ No./a,,, -7 Fee / r) 0 THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6psteltt (Cons trUttiVi ermlt Permission is hereby granted to Construct( ) Repair(U11/ U grade( ) Abandon( ) System located at �p ��w _C�1 Os -*,NOV VP2-i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be comple te within three years of the date of this peimit. Date 'Z Approved bb -----�, f THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...............0F.... cirnstZtbh. 0 --------------------•--------.......................... Appliration for UhipugFal Vurkg C outitrurtion Prrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ea 7- �'Z ..: •• . ........................................... -••-..............••-•._...---•• _••••-••------•.......---•_----......•••--_-_••-•_--•------•- Locatio' Address or Lot No. i� x .. tw.......................................... SAt>rbrtcC� -Dctut E Icvr� 1�1 V.................... ........... .. ��•� �O _r I i Address �C .....�?- :. -•-------•------------------------------- C st r + ..----................. 1.4 Installer Address PQ Type of Building Size Lot....).:3T.l`1.0......Sq. feet 0­4U Dwelling—No. of Bedrooms....:.Mrncc..........................Expansion Attic WO) Garbage Grinder (X) a1.4 Other—T e of Building No. of persons.. Showers YP g ------•------•----••------•• P ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------•---------------- ---------------------------..------------......•----•-•-••- •-•--- W Design Flow....................................9 _gallons per person per day. Total daily flow-----------_------------- ........gallons. 9 Septic Tank—Liquid capacity..l4��!�=.gallons Length_1SY`-&y."... Width.J`-6>::_ Diameter-_.__---- Depths Disposal Trench—No. ___.•_..---.-----_- Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No...t�-------- Diameter....1Z ........... Depth below inlet....4;:, ?_`--_- Total leaching area.... 2....sq. ft. Z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed .................. ......_............ Date..Moj.:1S..rA18.@__.._..__.. a Test Pit No. I......2.......minutes per inch Depth of Test Pit----- Depth to ground water_-__— ----- fi Test Pit No. 2..... ......minutes per inch Depth of Test Pit....�� ��... Depth to ground wat 0+rtf4- 4 o i * ....O` .4----l-Q `�'1 : 1�� -----------•----- ----•-••--------•.................•-----------•--- . ...--•----- s��, Description of Soil............. s' _.�1!�c! -.. .etc+ e-.17!s� -.-= ?e1c�-tih�-1_�r.. hrxa h. te.c .........-..... ---------•--- - -- TE HEN __ `�• x _ a •.-----•-- N� ----1_`P----G.--. ?A---•,'$ C3i.� .. s_6x-.sxi.L X ALLYN U �. „ -ems ----- ----�------ v WILSOn W 7 ---i �321ecf. ri�Q `"sl�4ssc�u��.ai c knl�1t�.. -•................. tvo:3C�T5 U Nature of Repairs or Alterations—Answer when applicable.-._-------------- U Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i accordance with iz 8d� the provisions of'THE.s p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued y the board of health. Signed.......... ................4ca. .------. •-••----------------••----.----• --•--•----•••--....•-•_-•-- D t Application Approved By...........-�........................... Date Application Disapproved for the following reasons--------------------------------•---••---------------------------•-------------------------------------.......... --------------------------------•-...-••-....._....----------••----------...--•---------.....------.........---•--•------------------------------------......--------------------------------•------ ate —Permit No-' � . . Issued_ ......-- -----�................... ` Dsta F psz ............._._.._..-...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1uws... ................OF........ 1 -I?E� Applirtatiun for Dhipa,ial Works Towitratr#ioat Prrutit Application is hereby made for a Permit to Construct (k) or Repair ( ) an Individual Sewage Disposal System at: G Cif 7- (a-�i ----•---------------------••-------------...._....-•---.......----•-.._.....----.................. ...............................................---____.......------.._.._•-----•------•----------- Location-Address _ or Lot No. Ci' r^ `! � ._}+t' jru-^;eke-•C... S V <` .f_.:..s .. .1.ti.1..--••-----•.......................................... ...................... p.. .rr:-•---•--- 4r'..:tr:Y2S..�h_•-'4`- ..................... r�er Address ........................................ .... - +_:a_u. Installer, Address Type of Building Size Lot-----E _,_l_` !�------Sq. feet V Dwelling—No. of Bedrooms.__.:=t►�Y�=�_______________..........Expansion Attic (/VO) Garbage Grinder (; ) aOther—Type of Building ____________________________ No. of persons___-________________________ Showers ( ) — Cafeteria ( ) G 1 Other fixtures •--------------------------•••-• . Design Flow..................................... .gallons per person per day. Total daily Wx _ fl, ow_._.__._____.__________._az t________gallons. • WSePtic Tank—Liquid caPacity.1���gallons Length_l �":_ro`.`__ W Diameter----- � Depthr-_t-�r . .. Disposal Trench—No_ ___________________ Width_____.__....__._.___ Total Length-____._..___.______. Total leaching area....................sq. ft. Seepage Pit No.... alx--.______ Diameter....3_............ Depth below inlet____, . _?.'__. Total leaching area....;Z2_7____sq. ft. Z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed by--- tx• - .__.5 ,' saa_...................................... .......... aTest Pit No. I.__._.�2_..____minutes per inch Depth of Test Pit-----f2q.'k...... Depth to ground� �._��.____,--. If'Lz, Test Pit No. 2..............minutes per inch Depth of Test Pit....� Z...... Depth to groun . �1 1✓�� Q':i 1/---f S! Ir< �if I �+� ...............rt d.........................................^- - O Description of Soil .._ �R..':.l.�t�i''___�.�.__:e_.lrs:�:_.:�_�.s.�'_ '��_-._�____�I�:�_+�,"_d--------------------- ------.�,-n>.-._ x �1 N U :�laik--------------- ----- --•--•-•-------------------•-••---------------------- 1N ------ ;;P �. W ---• ---. _ � p'°''�" 'Y=3sd_..' a1 _..�? c2 � .a?�xt.F .cry J:a .i ------------------••-•----•------•-----•---•--- a .30216�Q ; - - NoMCP •,� U Nature of Repairs or Alterations—Answer when applicable----------_.............................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TT T IE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ued y the board of health. —Signed.......... _ .. Date Application Approved By....... ................ f /. _---x.._.................................... :---•-- Date Application Disapproved for the following reasons:................................................................................................................ -•-------•------•----------••-•--••-•--•--••-••-_•.................•-----••-------•------...---•------•-•--•----•---._...---•-••----•-•••-•••--•--•--------------_-••-••-•--•••-----•--...•------•------ ._....-. Date /7 Permit No.......�.�.......�..�.��. ....... Issued.. j L- S� Date THE COMMONWEALTH OF MASSACHUSETTS i ---'"""" BOARD OF HEALTH C .jam-r:� nJS~tic ` Turrfif irtttr of TootpliFattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.. -'v�_r-----� .. 1 i ..-------•------------------------------------------------------------------------ -- Lc Jl (1f Installer at..................................................................r......`�' I�Icl.:f-e---------:......................................................-......................... has been installed in accordance with'the provisions of T TIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ ___E,...... J_5�........ dated_--.._-,_. ./_ ______.____ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................� a'�-� f.......................... Inspector...............-------'z).---.._.._....._..--•----•--••----------..__..._. THE COMMONWEALTH OF MASSACHUSETTS-—. �!_��`... --y BOARD F HEALTH 05 Gs-5 /1 5 .............�......'^�.. �y,^-r'�C?rJ�(.i��.rr" No......................... FEE. ................. Disposal 02kii Toatutrudion rratai# Permission is hereby granted...... .----- _.1::1-:^?.........................................................................•................ to Construct ( ) or Repair ( ) an Individual S .v�Tage Disposal System at No----4__ �-- ....... ---- .. �.� _.:--.-_ _ r Street as shown on the application fo Disposal Works Construction Pe i Nc�`_ __.'7�1. __. Date ,.__ :2.._/2- /r A „>. Board of.Health DATE........................ -------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4 D1=5 tG-N DA rA TE5T PI T DgTA. - 3 S,n�ic , 1"ami ly i__3.. 13_cc9rooms , w� Ga�bu9G Grindar matt; av, D,e Flow:_3 lCj 1_ = 34 GP D Tcro- T3'A', g eu.�__ vl Scpt-tc. T-wmw =�3�5X :2D0-'Ie.-._=6(a0`G 1_I.ons l.t��tv�eg>i; unn�ha USE 11500 GALLON TANK �-p'A 1 TP�Z t-ae ch Pi t ,lo2c_- of 1 VC eLa 1p f{� w t , Si=at�C Stcicwc.1 214 SF X 2,5 6pol/SF = s34GP A 99,Z ��� 99, Do1+om 113. SFx I.O Gpd /SF = I'"13 GPI �,'� q�,Z 24" 97,3 -9z7 SP 447 GPD 1111 • � `.. ST�PE � .T i � 7 t1U - �L. , r t�y���`GJj'�•;-`j�lj-f���2�w_-- ('Tip 87.Z - ...._.........._...._..._.., To. o A��w+ �hlc� Gover Foundarl }o one 400+ below, FI 101.50 a', P-as s nc -finish g�adt J D�tt, V I SOo ►uv �r7 zl L3a7c 1w 97,SZ Ga//o.r �$Q0 I tJV = r 97,38 S50.0y;r. 97,77 T1 n k �♦� � h 96,87 730�,., aF 9z.00 ��t 31 G' 4 3 SYSTEM PROFILE (I.T +C ScRLe) L CERTIFY THAT THE -PR<:5 SEPTIC SYSTEM N- 5IGN SHOWN HSRSOW Co1APLYS WITH T'14L LOC-47740A/: Lor--3_ SIDELIWE AND SETMACK Rt3QUlrz6t1 MTS OF T1i E -MW PI F_$_AWN T_E3t3_Ll=-_ArN D Os slur , 15 N 0T I~ W-eb w ITH W ArL00UPLAIQ SCALE t c / / ,�_ APPL/c#%vT: chl. 4 41 _ U THI s tPL AkJ I S NOT BASED OW A}N 3 Ax-rGR 4 We, TNC, 10STRu► etsr SURVS`J AND THE Ot=FSETS iP���,E��c,4 Aar.! .Sv�.veyora -SHOWN HERCTON 54ovLp NOT ae useo / .4 r7C To CSTA©LI SH LOT L I N IES . d s rc�¢✓i�Lr$ /!1/!SS , SHEET / O F�? 881 Sb` ' Z-aT G/ .� GoT 4 0 Z-Q 7- 63 A � a / AT oe �� 0 8 CROP. n n N Gsra9e �+ewewAy u � c ` rP.2oPOSED DWELL//VG .a v h /0 7. Z,3 ' RL _ - - - --- - - O,Q� ..`f�l)rl'+1 J'�r LAr'Wf9"�`•4Y'r�h�r{��b$j M4lti,.'.'.7��3�d�1Gl.�� f � .. .. ,.i }�..•F `,�y�} S�7t lr y? e 1614 nrt.,m,l,�i•�a+?nr,'fs���i�fS4x..�li...r ,., ,. . - " �6�•u'5lA:i�.��,$i' ��..-,f r or ���. .r' ti ar. � �'���.r SC�9�G E•,/l �ZQF1,'D.—. .---- — F •��J/��� -- .,,,'- /�-- ,/ I /2.4 A Al .eE, 2E AleE Y F „ COT 6.3: 93,34 u s - Bi9XTE2 N Y41,AIC. t ����� .-:.::-«,;1-`' , :C�EG%S.T�",�E.j� L�9�t/l> SU•�t/EY�S iZ.i-a8 .�.e0.��SS/oNf�L ENG/N�E,eS: .QPPL �c-.9NT. CGi�,Co.PO IjOW O.STE�ts/GL E o MySS, - TOWN OF BARNSTABLE LOCATION SEWAGE -71 VILLAGE �y �vv�/�� ASSESSOR'S MAP & LOT O INSTALLER'S NAME & PHONE NO. j'j4ti I-?, Igo�f SEPTIC RANK CAPACITY II� L.EACIiING FACILITY:(Eype) NO. OIL BEDR00143 �3 PRIVATE WELL OR PUBLIC WATER BUILDER Olt OWNER /,{f 1�2'04z/ 6.�Iet�' V DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: I �r VARIANCE GRANTED: Yes No C� u✓u y� I -a