HomeMy WebLinkAbout0117 STURBRIDGE DRIVE - Health 117 STURBRIDGE Dl!t VCI
OSTERVILLE 1
A = 165 102
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TOWN OF BARNSTABLE
LOCATION 3`•b r �C,c� ZMEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) C_xz g=3, , (size) ►C-x► ��,
NO.OF BEDROOMS
OWNER �g�ln��
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) r Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY C.A � y�
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C33 3S
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,TOWN OF+BARNSTABLE \
LOCATION //-7V�Jrt ��j�' Nr SEWAGE #
VELLA.GE p STi✓rvt lle ASSESSOR'S MAP & LOT/&
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) V'iT �o��oJ (size)
NO.OF BEDROOMS—
,BUILDER,B:UILDER OR OWNER i�Jil 1 r Z-z �
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching cility) Feet
Furnished by r0/�
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No %/ a5_3 Fee < DD
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
applitation for ]Disposal 6pstem ConstCUttion permit
Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. ` Y( l��r;c5>� Owner's Name,Address,and Tel.No. �
Assessor'sMap/Parcel ((o — oz
'��L�" i1 JSrarV��b��1�. 3=► g_ `3?8 •�aQ�
Installer's Name,Address,and Tel.No.P,-C P���4-,'-5;N4'Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided 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 issuedLty this Board of Health. >
Si Date G
Application Approve Date %� f
Application Disapproved by Date
for the following reasons
Permit No. �� 3 Date Issued
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
I A ,
m / �C(�'J LI
DATA
No. E) - Fee /DV�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4plication for MispoBal *pstrm (Construction Permit
i
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System [ Individual Components
,5
Location Address or Lot No. ` l''� Sj v y i i e. Owner's Name,Address,and Tel.No.tcA
Assessor's Ma /Parcel ' 'L� \\� ��'�S"r �—fir' ` -,6
Installer's Name,Address,and Tel.No.p,-v ��p�tJ'��n� Designer's Name,Address,a`nd Tel.No.
Type of Building:
Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures + '`• ,
` ' r
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date ,\ 4 ' £
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
t Compliance has been issued by this Board of Health.
Sig Date C /
Application Approve Date J
Application Disapproved by Date
for the following reasons
Permit No. '— Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
p� BARNSTABLE,MASSACHUSETTS
1 (Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( )
Abandoned( )by . r
at ( �"� , rJ� �'. e/bnstructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit Noa, dated
Installer �� -'- �-�j_�.,r Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system wii.l�fiTnsti. si ed.
Date Inspector
No r // � ��5 Fee
l THE COMMONWEALTH OF MASSACHUSETTS
' PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
MispoBal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( )
-1-r G
System 16oated at�� "� � a, ` �� ` r `
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this p rmit.
Date , � � ) Approved
r
TOWN OF BAPI STABLE
�`' ' AUG 1 PH 3: 03
V u
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
-AAP 1 �� -
JARCEL
9
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TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A I
CERTIFICATION n a
Property Address: 1/7 Sturbridge Drive
Osterville, MA 02655 C:) _a
Owner's Name: Mike Ritzzo r D
Owner's Address: •• ca
o r—
a% M
Date of Inspection: May 6, 2004
Name of Inspector: (Please Print) James M Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49
Osterville,MA 02655-0049
Telephone Number: _(508)862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at.this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: May 12, 2004
The system inspector shall subra
copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall.submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: Mav 6, 2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined",please
explain.
The septic tank is,metal and over 20 years old*or the septic tank(whether 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:
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:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
i
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2004
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 wafer 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 coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2004
D. System Failure Criteria applicable to all systems: J
You must indicate either"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 '/z day now
✓ 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 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.)
No (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 System:
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
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- 1 WPA)or a mapped
Zone Il 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.
4
Page 5 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2004
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:
Yes No
✓ _ Existing information. For example,a plan at the Board of Health.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2004
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: 0
Does residence have a garbage grinder(yes or no): Yes
Is laundry on a separate sewage system(yes or no): n1a [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)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Unavailable
Was system pumped as part of the inspection(yes or no): No
If yes, volume pumped: _gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Installed 812178-per as built card
Were sewage odors detected when arriving at the site(yes or no), No
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2604
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: cast iron 40 PVC._other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 12"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1 S00 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: S"
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: 12"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert;evidence of leakage,etc.):
Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2004
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box appeared to be level and was clean. No solids were present.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or,no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2004
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 1 -6'x 6'(1000 Qal.)
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
The leach pit was dry. The scum line was approximately Y up from the bottom. There did not appear to be any signs offadure
The bottom to grade was 8'.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configurations
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 or no):
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
9
f
Page 10 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2004
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.
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10
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 117 Sturbridge Drive
Osterville, MA
Owner: Mike Ritzzo
Date of Inspection: May 6, 2004
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 40 +/- feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: Topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using a Barnstable topographic map and water contours map the maps were showing approximately 40'+/_ to Around water
at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
11
h ,
OA7e , 8/20/01 - -- -
sr
PROPERTY A O O R E S S 117 Sturbridge Lrive_+
—:_Osterville1Mass�,______
02655
On Iho aboYe data, I Inapootod the septlo oyite`rh at the aboYo addrass.
Thls iyslom consists o.l (he (ollowing
1 . 1 -1500 gallon septic tank.
2. 1 -Distribution box.
3 . 1 -1000 -the following oondltiona;
4 . This is a title five septic system. ( 78 Code :)
5. The septic system is in proper working order. at the present time.
6 . The system ho ever is in failure. The leaching pit is in the
neighbors yar&.New leaching area should be installed on your
property.There are no easements or variances on le for the
leaching pit being where it is nowV1QNATURf?
Law calls for 10 ' off the property ine.
r=
Name :_ i ,P...1{ssQa2tr-_U.J-----
Company;_Jo, •ph_P •__N•comb•r�b Son , rnc ,; f02,
Addreaa :_ 8oz_ 66---- ,----
_ CencerYilleL Ne , 02632-0066
Phone:__ 508 _775- 3338__
TroS CCRTIFICATIOH OOCS 'HO1 CONSTITVTC A CVARAKTY' OR WARRANTY
JOSEPH P, MACOMBER & SON,. INC.
Y,nkr�0�t�pooll�l �+chfl�idi
Pvmprd 4 In+lillod
Town Sowfr Conn#vUont
P,0, Box 66 Cintoryllk, MA 026JZ.0066
77s.3330 77s.6412
' RECEIVED
AUG 3- 1 2001
y TOWN OF BARNSTABLE
HEALTH DEPT.
b"�v
-\ COMMONWEALTH OF MASSACHUSETTS
T EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
r
Property Address: 1 1 7 Sturbridge Drive
Osterville,Mass.
Owner's Name: Victor Dinieola.
Owner's Address: 8/20/01
Date of Inspection:
Name of Inspector: (please print) Joseph P.Maeomber 'Jr.
Company Name: J.P.Macomber .Jr.
Mailing Address: Box 66j
en terville,Mass.02632
Telephone Number: 5 0 8—7 7 5—3 3 3 8
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 TitlSILRIO CMR 15.000). The system:
PAMD Pt� Mt�a T 9��%�
Passes
_ Conditionally Passes
'/Needs Further Evaluation by the Local Approving Authority
�. �y Fails
Inspector's Signature: - Date: ep�
The system inspector sha submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments rReaso_n for failure. The leaching is not on your,-
property.The law calls for the leaching pit to be 10 ' off
) the property line.It is not..No easements or variances are
-o
n file. If leaching area is not moved. A civil matter is
*�I�ftis�epoart onfyedesc
WAPe�s cdt2fti� t ?%el ilnte of€i s�p�c�ioR i tt�t�i f Q�tions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
i`
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)4
Property Address:117 Sturbridge Dr-ive
Os ervi e, ass.
Owner: Victor Dinico a
Date of Inspection: 8 2 0 01
A
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes: =J ^
I have not found an information which indicates that an of the fa'Y y failure criteria descri I bed-in 310 CMR
15.303 or m 310 C IvlR 15.30 exis A y failure criteria not evaluated are indicated below
Comments:
c
The leaching it is on the nemghbors property.Pit should be
;' removed or filled in. A new leaching area should en be
installed. If leaching is not replaced a civil matter will
occur lat&r- on down the line when the leaching pit fails. r B. System ConditioiiallyPassesgupposed to be 10 ' off the property line. /
A One or more system components as described in the"Conditional Pass section need to be replaced,or
repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined (Y,N,ND) in the for the following statements. If"not determined"please
explain.
_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 i
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:
�t!D 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:
The system required pumping more than 4 times a year due to broken or obstructed.pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1 17 Sturbridge Drive
Osterville Mass.
Owner: Victor inico a
Date of Inspection:
C. Further Evaluation Is Required by the Board of Health:
Conditions exist which require huther evaluation by the Board of Health in order to determine if the system
is failing to protect public health,.safety or the environment.
I. 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 wblch will protect public bealtb,safety and the environment:
A�8 Cesspool,or privy is within 50 feet of a surface water
ZQ Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh
2. System Vsill'fail unless the 13oard'of Health (and Public WaterSuppller, If any) determines that the
system is fuoctioning in a manner that protects,the public bealth,safety and environment:
Vb The system has a scptic'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.
if,oThe system has a septic tank and-SAS and the SAS is within'a,Zone I ore public water supply.
� The system has a septic tank and SAS and the SAS is within 50 feet ore private water supply well.
The system has a septic tank and SAS.and the SAS is less than 100 fee but 50 feet or more from a
private water supple well". Method used to determine distance ��J�,�
'This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of l l
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1 1 7 Sturbridge Drive
Osterville,Mass.
Owner:Victor Dinicola
Date of Inspection: 8 2 0 01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes Noi
Dackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
ischarge or pond ing of effluent to the surface of the ground or surface waters due to an overloaded or
/Static
clogged SAS or cesspool
liquid level in the distribution box above outletinvert due to an overloaded or clogged SAS or
cesspool elXks` 1S*4 `
Liquid depth'in.ccsspeal is less than 6"below invert or available volume is less than!h day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed i P P g y gg p pe(s).Number
of times um ed
P P �•
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
ater supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
_ y portion of a cesspool or privy is within 50 feet of a private water supply well.
y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water_analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammania
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.]
_AA(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. The leaching pit is !�
not on your property.A new leaching should be installed.
(-There are no easements or variances on file. Leaching pit isl v
E. Large Systems: supposed to be 1 0 ' off, the r ert 1 '
To be considered a large system the system must serve a 3acility witl a design fl�w of�$,�QO 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/
the system is within 400 feet of a surface drinking water supply
system is within 200 feet of a tributary.to a surface drinking water supply
Y
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 3 10 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
f
Page 5 of I 1
OFFICIAL INSPECTION FORM—NOT-FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:1 1 7 Sturbridge Drive
Osterville,Mass.
Owner: Victor Dinicola
Date of Inspection: 8/2 0/01
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No Pumping information information was provided by the owner,occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks
_
/1/ Has the system received normal flows in the previous two week period?
Have large volumes ofwater been introduced to the system recently or as part of this inspection ?
/Z 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,.'cluding the SAS,,locited 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:
Yes no l
dam Existing information.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)j u
5
Page 6 of 1 1
t
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
h SYSTEM INFORMATION
Property Address: 1 1 7 Sturbridge Road
Os ervi e,Mass.
Owner: Victor Dinico a
Date of Inspection: 8 20 01
FLOW CONDITIONS-
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMRA 15.203 (for example: 110 gpd x#of bedrooms): X - Q' �p
Number of current residents: GL J
Does residence have a garbage grinder(yes or no): l�
Is laundry on a separate sewage system yes or no):.JD [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or no):.&
Water meter readings, if av 'fable last 2 years usage(gpd)): p /"
Sump pump(yes or no): �� �iQ
Last date of occupancy: d
COMM ERCIALIINDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): ' gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system (yes or no):.4),4
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe): ,(
GENERAL INFORMATION
Pumping Records Not available
Source of information:
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: lions--Ho as ua i um ed det.n-n, ed?
Reason for pumping: V .Cww9 _i&` � ',IV d
� eptic
OF SYSTEM
tank,distribution box, soil absorption system
Single cesspool
4 Overflow cesspool
A Privy
2Shared 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)
4)d Tight tank A4'Attach a copy of the DEP approval
1510ther(describe): ,f_1W
ApPplIoximate ao of 1 co is d e installed(if known).and source of information:
11au�° 17`P Du4my'-
Were sewage odors detected when arriving of the site(yes or no):
6
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION.(continued)
Property Address:117 Sturbridge Drive
Osterville,Mass.
Owner: Victor Dinicola
Date of Inspection: 8/2 0/01
BUILDING SEWER(locate on site plan)
Depth below grade: AV ,k/
Materials of construction:,lpcast iron 1/40 PVCA/6other(explain):
Distance from private water supply well or suction line:-e"i'
Comments(on condition of joints,venting, evidence of leakage,etc.):
Joints appear tight.No- evidence of leakage.System ,is vented
through the house vents..
SEPTIC TANK: Y (locate on site plan) /6ZO QO&vs
Depth below grade:
Material of construction:_concreteM9metaltJ�fiberglass polyethylene
4�Dother(explain) W4
If tank is metal list age:4J0 Is age confirmed by a Certificate of Compliance(yes or no):A1W(attach a copy of
certificate)
Dimensions:
Sludge depth:
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: a
Distance from bottom of scum to bo of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendatio s, inlet and outlet tee or baffle con(ition, structural integrity, liquid levels
as related to outlet invert,evidence of.leakage, etc.):
Inlet & outlet tees are in.
place.T e tank is structurally sound and shows no evidence
of leakage.Pump septic.,.,tank at time .of inspection.', ` .
GREASE TRAR..14L%i�locate on site plan)
Depth below grade: r,
Material of construction:4�h- oncrete;WmetaW*iiberglass�IJ�/ po lye thyl ene6y_other
(explain): 110
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: l*f
Date of last pumping: Xly
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
Grease trap is not present.
7
Page 8 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1 1 7 Sturbridge Drive
Osterville,Mass.
Owner: Victor Dinicola
Date of Inspection: 8/21 /01
TIGHT or HOLDING TANK de, (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: AM
Material of construction: concrete metal..VLQ fiberglass Ay Polyethylene 4�f other(explain):
Dimensions: NiP
Capacity: Ah allons
Design Flow:_ AM gallons/day
Alarm present(yes or no): A
/
Alarm level: .4 Alarm in working order(yes or no):
Date of last pumping:_M
Comments(condition of alarm and float switches, etc.):
Tight or holding tanks are not present
DISTRIBUTION BOX: Zif present must be opened)(locate on site plan)
_
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,4any evidence of
leakage into or out of box,etc.):
Distribution box has one lateral There evidence of solids carry
over.No evidence of leakage into or out of the box
PUMP CHAMBER(locate on site plan)
Pumps in working order(yes or no): y
Alarms in working order(yes or no):-s
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Pimp chamber is not preGent _
8
Page 9 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:1 17 STURBRIDGE Drive
Ustervilie,Mass.
Owner:Victor Dinico a
Date of Inspection: 8 7 0 01
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
Le_achina nit appea-rs to be on he n iahbors property.
If SAS not located explain why:
Located_
TYP
leaching pits,number:_
VP leaching chambers,number:Q_
leaching galleries,number:_
leaching trenches,number, length: d' "
. leaching fields,number, dimensions: Q
overflow cesspool,number: �., .
d& innovative/altemative system Type/name of technology: -/ V& C ZF4le
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
Loamy sand to boney medium sand No signs of hydraulic
failure or ponding Waste water is within 14 of the invert
pipe.Soils are dry.Vegetation is normal.
CESSPOOLS M (cesspool must be pumped as part of inspect ion)(]ocate on site plan)
Number and configuration: -
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum laver:
Dimensions of cesspool: /9
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
CessnoolG arp not present
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.):
Privy is not present
r
9
Page 10 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1 1 7 Sturbridge Drive
Osterville,Mass.
Owner: Victor Dinicola
Date of Inspection: 8/2 0/01
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
to
Page 1 1 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued) -
Property Address' 1 1 7 Sturbridge Drive
s ervi e,Mass.
Owner: Victor Dinicola
Date of Inspection: 8 2 0 01
SITE EXAM -
Slope
Surface water _
Check cellar
Shallow wells ,
t
Estimated depth to ground water feet
Please indicate (check)all methods used to determine the high ground water elevation:
R/d Obtained from system design lans on record-If checked,date of design plan reviewed: 00
bserved sit�'ab ng property bservaion hole within 150 feet of SAS)
hece wit ealth-explain:
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain;
You must describe how you established the high ground water elevation;
Used; Cape Cod
Water Table Contours Map.
And: Public Water Supply
And; Wellhead Protection Areas Map.
September 1995
Water Resources Office
Cape Cod Commission
r
d
•wr.+.rw errs'^-rr-inn. mr•ntsnrnn rtnrrrm:-nt•-'rarr.�sr*srnrn rrsrtsJ na'tsrrsrt m's+ �'n'��tTn.-:..--.r...
TOWN OF Barnstable WARD OF IIEALTII
SI1I1SURFACR SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
•.•rn•T••.•:•1—�.11►^.T.Tf1SPTRT••1Tf TTIRlf fT':ti•T�:T'•.'I "1tR�771'7fivf•^TTRRVI♦�rl�.t�-,tT7 wre n
TYPE OR PRINT CLEARLY
PROPERTY INSPECTED
STREET ADDRESS 117 Sturbridge Drive Osterville,Mass.
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Victor Dinicola
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P:macomber Jr
COMPANY NAME J.P4Macomber & Son T.nc:'`
COMPANY ADDRESS Box 66 4414 Mass 02632
5 Ore T� or City State LIP
COMPANY TELEPHONE ( 508 ) 775- 1- 14 fAX, ( 508 1 790 _ 1 578
R
CERTIFICATION STATEMENT r
I certify that I have persan6l11y'"inspected the sewage disposal system at
this address and that thef-i-n7orrnat�l_g_.r•e�rted is true , accurate , and
omplete as of the time of ,inspection . The inspection was performed and any
recommendations regarding upgr.Rde ,.. maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one ;
System PASSED
The inspection which- I halve 'conducted has not found any information
which indicates that the' system fails to adequately protect public
health or the environment °as defined in 310 CMR 15 . 303 , Any failure
criteria not evaluated_ Are- as stated in the FAILURE CRITERIA section of
/ his form.
System FAILEll v _/Q / ,
The inspection which I have con Noted has found that the system fails to
Protect the jiublic health and the environment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CIZIT.ERIA of this inspection form ,
4 Inspector Signature Date
Iwhereopy of this rt.tfication must be provided to the OWNER, the 13UYER
applicable ) and the BOARD OF HICAL711.
* If the inspection FAILED, the owner or" perator ehal 1 upgrade ' the system
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 3.10 ChJR 16 , 305 .
partd.doc
I_
°FZHE rqk, Town of Barnstable
P�. {.
regulatory Services
4 1Y
• BAMSCABLE,
v MAss. $ Thomas F. Geiler,Director
i63q. �0
Public Health Division
Thomas McKean,Director
367 Main Street, :Hyannis,MA 02601
Office: 508-862-4644 - Fax: 508-790-6304,
September 13, 2001
Mr. Victor DiNicola
117 Sturbridge Drive
Osterville, MA 02655
RE: SEPTIC SYSTEM INSPECTION
Dear Mr. DiNicola,
Attached is a copy of the official computer record regarding the septic system inspection
conducted at 117 Sturbridge Drive Osterville.
Although I understand Mr. Macomber's concern about the location of the leaching pit on
the neighbor''s property, the State Environmental Code Title V Section 310 CMR 15.303,
does not list this as a criteria for failing the septic system inspection. Therefore, I
inputted this official computer record with a status of"P" meaning pass.
erely yours,
omas A. McKean, RS, CHO
cc: Mr. Joseph P. Macomber
Sever Information
'.f)ggER..::.: Gtg3 9/13/01
..
1102
............................:........ �� ..................
t`fu r f 0 i<tidcfr ss
1 1ICF :B OSTERVILLE
Etlspefi Joseph Macomber
< `sfr< fsfis P.
0
orrisrin3 The leaching pit is on the neighbor's property. Mr.
Macomber indicated on his report that the system"FAILS"
inspection due to it's location on the neighbors'property..
> gfijltE » epee
<��psrD?aacll€�FJc
05-07-1999 11:31AN CENT OST FIREDEPT 5087902385 P.02
Make application to local Fire Department-
Fire Department retains original application and issues dupfirate as Permit.
�p o�C�t''�fir,�e� ✓
UWS h� 01�074e
APPLICATION and PERMIT Fee: 10.00
for storage tank remcval and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 14$. Section 38A, 527 CMR 9.00, application is hereby mace by:
1" •
Tank Owner Name(piep—se print) Victor Dinicola X
B(V/6 , rPpgt,p
Address 117 Sturbridge Drive, Osterville, MA
Street 0&y Stara Ilp
Rmiovall Cordr t. • • "
Company Name Enviro-Safe Corp. Co,or Individual Enviro-Safe Corp.
Print Print
Address E.Q,')Box $10, E. Sandwich, MA Address
/ PAnI Prat /�
Signature ' plyi _e it) Signature(id ng' --e it)
IFCI C2rcnec Other 1FCl Certified = �P Other
Tanklocation____ 117 Sturbridge Drive, Osterville, MA
SOO(Addmss ri
Tank Capacity(gallcns 500 Substance Last Storms #2 Fuel Oil
Tank Dimensions(dia,—c-se x length)
Remarks:
V
Firm transporting waste Enviro-Safe Cor2 State Lic. # MA 329
Hazardous waste mars° E.P.A. # MAD985269323
Approved tank disposal yzed Turner Salvage Tank yard# 002
Type of inert gas _ Tank yard address 235 Commercial Street, Lynn, MA
Centerville 01920
City or Town FDIO# Permit#
Date of issue May 4, 1999 Date of expiration May 18 1999
Dig safe approval nurr s,: 19991806274 Dig Safe Tcll Tel, Number-806-322-4844
f
Pei U,
Signature/Title of OfS -:.'an- permit 1 r
After removal(s)send Fs--, FP•29OR signed by Local Fire Dept,to UST Regulatory Complies-A=Unit,One Ashburton Place,
Room 1310, Boston, MA. M.38-1618.
TOTAL P.02
No...... ?: ...... Fps.. . :. ..�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-----...... O F........ .!7.. ...........................................................
Appliration for Disposal Works Tonstrnrtinn Uprrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...T.0 RA R-UCF.---R. 1 VE.,.O.S_I.E.RV_1.LLE.................... ------------MA-P--1.65- :GT---4.92--•----------------------..................
Location-Address or Lot No.
MAR1 E P. RE I L L Y----------------------------------------•----------------- .......W_tRF-J RLD...L.AN.E-,-Q�TZ-R.V_J-LL---E......................
........... _._........
Owner Ad3ress
a JOHN...AALTQ....-------••---.----•.....................•--•---------------------- ....1.5Q..WALNUT---- Y-REE-T-yW. 8AIZS-TA-B-L•€;-MASS
Installer Address
Type of Building Size Lot............................Sq. feet
F RA ftwelling—No. of Bedrooms...........3..............................Expansion Attic ( ) Garbage Grinder (X )
Pk Other—Type of Building ---DWELLING_ No. of persons............................ Showers ( ) — Cafeteria ( )
w
Other fixtures .........z...BATHE...................................................................
W Design Flow............................................gallons per person per day. Total daily flow........45.............................gallons.
WSeptic Tank—Liquid capacity.1.50.0.gallons Length................ Width................ Diameter._._____--_.-.__ Depth................
x Disposal Trench—No..................... Width.................... Total Length................... Total leaching area....................sq. ft.
Seepage Pit No-J-000--GALDiameter.....U Depth below inlet_.6.!.............. Total leaching area....20..sq. ft.
Z Other Distribution box (1"I Dosing-tank
Percolation Test Results Performed by-_. ____YTS.Jy-r--__•_ ..... Date.....;-5/! ....................
aTest Pit No. 1......`L.....minutes per inch Depth of Test Pit...... Depth to ground water...-`-.............__.
tz, Test Pit No. 25".l ....minutes per inch Depth of Test Pit.................... Depth to ground water........................
..................................... ---------.-- -------------
O Description of Soil I F `S cd >Q t �� , 4 v`v_."2 !)D.>....................
x
V -----------------------
---.......
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UNature 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 iI'HE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has a u e d by the bo�ollth,
�_z0—��
Signed_... .. . ............................................... ................................
Date
Application Approved By------. ('-�L - elZrDate
Application Disapproved for the following reasons----------------------------------------•-----------------------......---------------------------------..........
---------------------------------•-•-------------------...---------------------------........------------......---....--------------------------------� - ate-----------•----•---- -------
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Permit No........r Q 5----....-•-------------••---•---....... Issued------® ....... ------------------.... ate•-----
Date
Lk
No... .. ....... A FlZ$..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF L-J[rA�LTH
......... . OF.....................................
16.,'4 Arrftratil�n for Di-spaiial larks Tongtrnrtion amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
r•I Ilntarfi mr^ _ nn -err nc-I r hie I I ► r X A A n -
J...:� ......................
,�: -•� +....."'............. 1 1:,! .f..l, r•r.-a i•_••_I v - r:`.v I....... ..._.-_..-........
i
v. Loca2iori A°ddres 4 or Lot No.
1RD1 (7 C, DV7 11 1 V t_I? e.t17I 01 f? !.Aar ne"1'c ►�!l I I 1
Owner _ Address
W r%Ll?l AA1 TA 7 rn t Inl tltt-r C'17nrr r t.t r"AntITAnt r k+At•`(`
'•"'_r_"'___•_' ...-----_^____________________________________ _�_r'v"-'s lu. _•a�•I'r'�::�:::... I'-C•FCu'J
Installer Address
Q Type of Building Size Lot............................Sq. feet
a 7,'j M_ g M ,r 4: Expansion Attic ( ) Garbage Grinder .(X )
Other Type BBuildioomsv____________...............................No. of persons............................ Showers ( ) — Cafeteria'.( )
►•+ F
a yP g : °=.
� Other fixtures .......?: ^^ r
-.:
W Design Flow............................................gallons per person per day. Total daily flow_--_._.49 __________.:__________._____gallons.
W Septic Tank—Liquid capacityl. nf?.gallons Length................ Width................ Diameter--.____.._______ Depth................
x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No 00n.__r-Al Diameter.....1n_l __..... Depth below inlet-!............... g � ..sq. ft.
....._. Total leaching area .__ __
Z Other Distribution box O Dosi �tank ( 1)
Percolation Test Result Performed by 1 )C1'a�t.4 ..
a `� '............. `t_����._ _.. Date___h _v-_--_----_-___-_---.
Test Pit No. IIw►tia ____.minutes per inch Depth of Test Pit-----I.?__.._.._._ Depth to ground water--"_________________
(z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil___.®._ _ '__....�"-° � ¢ �' �#t`"" " � !�MA �,A 4�
---•----••---•-------•--......---•--------------------------------------------------•---•------------------------------••-•-••---
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W -•--------------------•----•••--••-•-------•--•---------------•------------------...---•-•-•------------•-----••---••------•--•----------------------•--•----••-•--------------•----......----•---
UNature 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 TITI E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has iss d by the board of health.
�1 70 Signed------- ...-•--•--•-------2OS�--.......................................... ------
�-�c'�-'.•��"
Application Approved.By---- ---- ---- ----------------------------------------
Date
Application Disapproved for the following reasons:........................................•--•-------•-••----•----••-----•-•-••-••-----•-•-•--•-•-----•....•-----
-•-•----••••------•---•-•---•••---•--------•----••---•---•-----•-•-•-•---••••-••---•------•---•...._......----•-••-••------•---•-•-••--------------•---•-••-----------......-•••-•----•---•••---•--•-•--.
Date
PermitNo.......... ....•........................................ Issued..............................M.........................
Date
'THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. .....................O F.....................................................................................
�4 �rx#i it of fnntplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by........!.........-••��-47&-----•--'&'44 k.............. .._.:
f {+� Er ,#I& s alter
at ------•---• ---••--•••--......-- -••---•• ••----••... --------
has .been installed in accordance with the provisions of TITiE 5 o�The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.......... '.________________________ dated..------------------------•.....................
THE ISSUANCE OF THIS 'CERTIFICATE':SHAL!!'NOT BE CONSTRWED A GUARANTEE THAT THE
SYSTEM WILL F CTION S!%JIgACTORY.
Z --
DATE... ••-•----_._: _...-- ,.,.................................. Inspector... .. --•--•---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O,F 'HEALTH
,�.
fJThj,-� eel
'No....... ...11; .--..... Flu........................ 'y
Disposal Vorkg Twnnitrnrtion Virrmit
Permission is hereby granted....................`�`�'� "' '��`� ° '
........................................... =
to Construct ( )f,.�Rgpair ,#fir �*an Indi vl&A Se�� ��r9posal S'y'A G
atNo. --._----•------------------•-•------------.... - ---- ---�
' -Street ' r
as shown'
on the application for Disposal,Works Construction .Pe mit No..................... Dated.............................
(� Board of Health
` DATE_
FORM 1255 HOBBS & WARREN, INC., PUBLISHERSx;,
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: MAP NO. /" PARCEL NO.
OWNER NAME: VILLAGE:
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
� TANK INFORMATION
17
LOCATION OF TANK: -"�1 1^ rrv-
CAPACITY TYPE \ AGE FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS C I FAIL DATE
LEAK DETECTION C I CHECK IF N/A TYRE/BRAND
ZONE OF CONTRIBUTION C I YES C I NO DATE TO BE REMOVED �` 0y o
FIRE DEPT. PERMIT ISSUED C I YES C I NO DATE
CONSERVATION Cy] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. Y 97Z' 11 ]C ]C ] DATE 2 li l
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
ZL
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LO-C'A'.T10 1d� _ SEWAGE. PERMIT 0•
I—or 0
VILLAGE
16.E- /D
INSTALLER'S NAME & ADDRESS
1/06 N 6: D
BUILDER OR OWN
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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Ps t er ville,MA
Located At
117 Sturbridge Drive
NOTES: So. Dennis, MA
SCALE- I " = 20' DATE.• August 9, 2011
Owner of Record
Sturbridge Drive LLC Et AI
Deed Reference PREPARED BY
Cert 175349 A & M Land Services
618 Main Street Unit' 3
Plan Reference West Yarmouth, MA 02673
L C. Plan 31373E Ph. (508) 737-1777 Email- anmland®comcast.net
Lot 92
ASSESSORS MAP 165 PARCEL 102 GRAPHIC SCALE
20 0 10 20 40 80
( IN FEET )
1 inch = 20 ft. Dwg. 1160.dwg