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HomeMy WebLinkAbout0116 WINTERGREEN CIRCLE - Health 116 WINTERGREEN CIRCLE, OSTERVILLI A=119 046 ° G o ' I i t o t J COMMONWEALTH OF MASSACHUSETTS 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 Property Address: 116 Winieraeen Circle Osiervilk, MA 02655 Owner's-Name: Joe Amaral. Owner's Address: Date of Inspection: October 1. M07 # r-0 _4 1 Name of Inspector: (Please Print)J2nies M. Ford _ Company Name: t mes.M. Ford (i Mailing Address: P.O:-Box 49 Oster0e,MA 02655-0049 Telephone Number:- (508) a62-9400 7Z: CERTIFICATION STATEMENT' I certify that I have personally inspected the sewage disposal system at this address and that the infoination reportedr: below is true,accurate and complete as of the time of the inspection. The inspection was performed ased`on my training and experience in the proper function and maintenance of on site sewage disposal.systetns. am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes N d Further Evaluation by the Local`Approving Authority. F ils Inspector's Signature:' Date: October 14, 2:007 The system inspector shall subs ' 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,I'0,000 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 systein owner and copies sent to the buyer,if applicable,and the approving authority. - Notes and Coirunents ****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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) i Property Address% 116 Win`ergreen Circle Ostervil,e, MA Owner: Joe Arncral Date of Inspection: October]. 2007 Inspection Summary: Check A,B.C,D or E/ALWAYS complete allot Section D A. System Passes: ✓ I have not found any infonnetion 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 completiz)n 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 bac-cup 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 3bstruction 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 pipes)are replaced obstruction is removed ND explain: 2 1 Page 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _ 116 Winte kreen.Circle Osterville, MA Owner: Joe Amaral - Date of Inspection: October. 1. 2007 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 accord ance-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 systein has�a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surfacemater supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the'SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Metliod used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliforn bacteria and volatile organic compounds indicates that the well is free from pollution from.that facility_and the presence of aimnonia 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: 116 Wintergreen Circle Osterville, MA Owner: Joe Ainarab Date of Inspection: October 1, 2007 D. System Failure Criteria applicable to all systems: 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 flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 260 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: .116 Wintergreen Circle Osterville, MA Owner: Joe Anzaral ' Date of Inspection: October 1. 2007 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 infonnation 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 infonnation. For example,a plan at the Board of Health: ✓ Detennined in-the field(if any of the failure criteria related to Part C.is at issue approximation of distance is unacceptable.) [310 CMR 15302(3)(b)): 5 - page 6 of i 1 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:C SYSTEM INFORMATION Property Address: 116 Wintergreen Circle Osterville, MA " Owner: Joe Amaral Date of Inspection: October 1, 2007 FLOW CONDITIONS RESIDENTIAL " Number of bedrooms(design): n/a 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 z Does residence have a garbage grinder(yes or.no)`. n/a- Is laundry on a separate sewage system-(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): -No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 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/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): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infon-nation: Unavailable' Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped detennined?,.. ' 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: A 1000 gal leach pit was add on 4118179-per as built card Were sewage odors detected when arriving at the site(yes or no)-..'No Page 7 of 11 OFFICIAL INSPECTION FORM:-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE 'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued), Property Address: 116 Wintergreen Circle Osterville,MA Owner: Joe Amaral . Date of Inspection: October', 2007 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.):. a 4 SEPTIC TANK: ✓ (locate,on site plan) (Cesspool acting-as-a septic tank) Depth below grade: S" Material of construction: . concr--te _metal'_fiberglass _polyethylene ✓ other(explain) cesspool bloek . If tank is metal list age: Is age -.onfinned by a Certificate of Compliance(yes or no):. . (attach a.copy of certificate) Dimensions: 5'W x 5.'T x 8'bottom to,grade Sludge depth: 1' Distance from top of sludge to bottom of outlet tee or,baffle:w -- Scum thickness: - Distance from top of scum to top of outlet tee or baffle: - Distance from bottom of scum to bottom of outlet tee or baffle:. -- How were dimensions determined: 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.): The cesspool had F ofsludge on the bottom. An outlet tee was present. The cover was S"below Qrade. 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 baffler 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.): Page 8 of 11 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Wintergreen Circle_ Osierville, MA , Owner: Joe Ansaral Date of Inspection: October 1, 2007 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. Alann present(yes or no): Alarm level: Alarm in working order(yes or no); Date of last pumping: Comments(condition.of alarn and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:. Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Conunents(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: 116 Wintergreen Circle Osterville, MA Owner: Joe Amaral Date of Inspection: October 1. 2007 . SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 - 1000 Qal. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: ✓ overflow cesspool,number: 1 -5'W x 5'T x 8'bottom to grade 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 overflow cesspool had P ofliquid on the bottom. The cover was 5"below Qrade. The'leachpit was dry. The scur,r line was 2'up fi-om the bottom. The cover was P below grade. The bottom to-grade was 8.5'.,. There did not appear to be any sizns of failure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on,-site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer:. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes 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: .. . Continents(note condition of soil, signs of hydraulic failure,level of ponding,.condition of vegetation, etc.): • 9 Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 Wintergreen Circle Osterville..MA Owner: Joe Amaral Date of Inspection: October 1, 2007. 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 1-00 feet. Locate where public water supply enters the building. a Yq y. 8, 3 3 3S '�3 to - >, Page 11 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 Wintergreen Circle Osterville, MA Owner: Joe Amaral Date of Inspection: October 1, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells .Estimated depth to groundwater 35 +/. 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: a 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 Barnstable topographic and.water contours maps, the maps were showing approximately 35'+/-ground water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been 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 fixture. There'have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report andlor any components_of the septic systein which have not been located and inspected. . 11 • Town of Barnstable IME Regulatory Services sexxsrns Thomas F. Geiler,Director E.a•�� Public Health.Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Pen-nit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. + TOWN OF BARNSTABLE LOCATION Cinch— SEWAGE# VILLAGE 65' rvt1[L ASSESSOR'S MAP&PARCEL //q` OY(o INSTALLERS NAME&PHONE NO, SEPTIC TANK CAPACITY QI SP01 LEACHING FACILITY:(type) C2SrpdD I t PT (size) ICO �)�- NO.OF BEDROOMS 3 OWNER /AM4(A 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY S FOB t o I 01 W _ � - r W L.0 C A T ION ALW A C E PERMIT N0. VILLAGE P INST A LLER'S NAME ADDRESS c4, D UIL Ell OR OWNER DATE PERMIT ISSUED DATE C0MPLIANCE ISSUED 17Y i I 4i R 0 L` O 1-- No...........�..��..... Fxs.... ...._............. THE COMMONWEALTH OF MASSACHUSETTS BOA R DC�H E A� L 7OF............................... .....................-• . .......................... , pplira#ion for Disposal Works Tonfitrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair (4-T--an Individual Sewage Disposal System at: .. 1 .._... _..wr .......... ..�°' . - ems '------ ---- ----------------------------------------------------------------------------------- �y A Locati Address or Lot No. Q� Owner Address W a —•'•-'=.... .............................•...•. -•-•-•.............................. Ins iler Address Type of Building 3 Size Lot.................... Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria WOther fixtures .......................................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length...:............ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_------------------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ • -- w------------------------------------------ 4� Description of Soil '!'O< f ...................... x ...............................................--••••••-- ----------------.--------•--•••---------------- x ••-•-•--••-•---------•---•-•---------------•--•••-•••-•-•--------•-•-••-••--•-••-••......--•---•-•---•---••--•-••......•--------------• ------...........--•---•-• .......... . Nature of Repairs or Alterations—Answer when a licable.._ fl O ..... � '2 ___ Q ........... U P PP o... ` ' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I I E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of ComplAhasissue by the board of health. __Application Approved BY----•---� - �-l/�---.��-------------------------=------- ........................Date ............• Date Application Disapproved for the following reasons----------------------------------------------------------------------.................... ..........---- G� Date Permit No.}...:... ------...... ........... -------•--••...............Issued--- Date Y�. '� ,, ' .` � � ,: "�,"� � � � rry .��� �� �; ._. -� ; :.a ��.,,:. � did - - S� ��� ,_ t{} �� 7 �• �( ppy ' f I 4 � Y . i � � t "�i �..� ,� mil✓''� '.w .'`' �+.� No..•-•......f..�....... FEs................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH d{°"��..............................OF......": .. ........�.............---�.-....1 App iraation for Dhipos al Worko Towitrnrtiun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ~) an Individual Sewage Disposal System at f _ -.. - Locati "' Address or Lot No. y ...Y.f- -.......... ft ........................................................ Owner Address . .. I rns ----------------------------------------- ............................................._.__.-_-._........................................... ns ller Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms......* %.................................Expansion Attic ( ) Garbage Grinder ( ) a , Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------•--....--------.•------••-•--•--••••--••-•---•----•--•••-•--......-•---•--------••....----...............-•---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �_q Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - -- _.r _... r i Description of Soil....---? -_z_e_ .._...'.. . .... V .....••----•-•-•--•--••----•--•--•-•-•-•....-- ....................... .............................................................-.................................................................. UW •-•-••-••-•-... ..-----•-•••------•--••-•-•-•-•-•-•••----•---••-••......•---•-----••--------------------------- ------------ Nature of Repairs or Alterations—Answer when applicable...Z.- -------- 7 e.................r*. ............... ---------------•------•---------------------------...............--------•---......-•--•-•--••-------....----------------------'-------•--•-------•------......... ............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. f { Date Application Approved By...... . _ ---Ve '> !)•_---- -•,€- Date Application Disapproved for the following reasons:............................................................................................................._ ......................•--•-•••---------.....-•----•----------...-----------•--....------.....-•------•---•-------•---•------•-•------•--•-•••----•-----•-------••------•--•----•....------••••--•-----•. Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS • ...- BOARD OF HEALTH f . t/"Y'5...................OF...el ? :1 yea.,f� ............................... Trrtifiratr of Toutph anrr ,,,,THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (.4) by Installer ............................................................__C ____________ ______ _______ /teSSanitary has been installed in accordance with the provisions of T E5 of �he St Code as described in the application for Disposal Works Construction Permit No17_N;or'_____- --------------•---. dated__...-- "a� ." THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COLOTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........��.�.�,�f( ......... � -•-•----� Inspector------------------•----- ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N ?� ...... O F... .....................................� •� ..'"'' ... ... FEE ..��•✓ .............. Disposal Marko Tnnotra davit prrmft Permi Sion is hereby granted......'._'.....................................a "" 'r ' to Constr t ( r Repair ( 6" an Individu 1 Sev, p System f r at No.. ... f :( '4' t- ...............� r • ... • ,��• treet �,/��� �►y� as shown on'the application for Disposal Works Construction P tat No. _-: --- ._.._ Dated...._=1..:........:...!__....__.......... I� l� t s ........................... Board,of Healt-h DATE.----- .. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS T C r � e F i o ti 0 Y i a RUAALLrjr MLS Champion 011 1330 Phinney's Lane Hyannis,MA02601 Bus:800-244-1592 x 24 Fax:508-362-1313 Paul Gallagher Cell:508-280-9777 9 Email:PGallagher@RealtyExecutives.com www.PaulWGailagher.com MLS Report Flyer(218) - Page 1 of 2 Page 1 :g 4 116 Wintergreen Cir Osterville, MA 02655 $469,000 Already Gone!!Owners Have Moved to there New Home.Large Cape Waiting for Your Ambiance.Many Many Possibilities.Custom Built for Owners by Marney of Rogers&Mamey Building Company.Very Deceiving from Front.Must see Inside.Family Room with Full Bath and Slider Leading to a Patio.Generous Size 2nd Floor Bedroom with Half Bath and Bonus Room Plus Expansion Possibilities for Two More Rooms over Family Room&Garage.Sprinkler&Alarm Systems.In-Law Apartment was Started in Lower Level-Large Entertainment Room [kitchen never completed).Spacious Front&Rear Yard with Gorgeous Mature Plantings for Side Line Borders.Updates Include Roof= Septic-Gas Heating System.Stroll Down on Main Street or to Joshua's&Micah's Pond.Don't Miss Out-You Will be Amazed I! Directions:Pond Street to Wintergreen Circle Listing#:20705997 Year Built: 1971 Approx Square Feet 2104 Assessors Records Property Type Single Family Lot Sq Ft(approx) 23522 Property SubType Single Family Lot Acres(approx) 0.540 Ta 119-46-0-0-BARN County Barnstable e s: Baths FH :3 21 Presented By: Paul W Gallagher Realty Executives Primary:508-362-1300 x24 1330 Phinney's Lane Secondary:5087280-9777 Hyannis,MA 02601 Other: 508-362-1300 E-mail:pgallagher@realtyexecutives.com Fax:508-362-1313 Web Page:http://PaulWGallagher.com See our listings online: http://www.capecodschoice.com or see individual agent site August 2007 The above featured property may not be listed by the office/agent presenting this brochure. Information has not been verified,is not guaranteed,and is subject to change.Copyright 2006 Cape Cod&Islands Multiple Listing Service,Inc.All rights reserved R Copyright©2007 Rapattoni Corporation.All rights reserved. The listing contract has not yet been validated by MLS Staff. http://ccimis.rapmis.com/scripts/mgrgispi.dll 8/23/2007 Parcel Detail Page 1 of 3 Y x w" k i :. 004 � . Logged In As: Parcel e a 6 I Tuesday,August 28 2007 Parcel Lookup Parcel Info �_ .. ...... . Parcel ID 119-046 Developer e Lot Location 1116 WINTERGREEN CIRCLE Pri Frontage 150 Sec Sec Road .... Frontage -- - Village IOSTERVILLE Fire Distract C-O-MM Sewer Acct Road Index 1865 _. Interactive Map f . 5,1 Owner Info __. _ _._ ._. _.. owner AMARAL, JOSEPH F & MARIA A Co-owner i Streets 99 POND ST Street2 - UOSTERVILLE State�M zip02655Gtyi CountrySA Land Info Acres 0.54 use Single Fam�MD -01 Zoning Nghbd _ Topography fLevel Road?Paved utilities°Public Water Gas,Septic Location Construction Info Building I of i Years Roof Ext 1971 Gable/Hip Wood Shingle Built - Struct Wall - EArea of AC 12222 cover Asph/F GIs/Cm None p_. Type Style Cape Cod Int,Drywall Bed4 Bedrooms ' Wall -- Rooms Model Residential Floor R omsInt. Bath 12 Full + 1 W Heat T�.�,._.. Total Grade Average Plus Type IHot Water Rooms.1711 Rooms http://issql/intranet/propdata/ParcelDetail.aspx?ID=7222 8/28/2007 °Z 2-0-3 499 125 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent�tto , _ Stre Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee un Return Receipt Showing to Whom&Date Delivered a Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ - M Postmark or Date LL a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article n RETURN RECEIPT REQUESTED adjacent to the number. Q Ih 4. If you want delivery restricted to the addressee, or to an authorized agent of the C Iaddressee,endorse RESTRICTED DELIVERY on the front of the article. t O000 M i 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. 102595-97-B-01 a5 a Er Town of Barnstable o� • Department of Health, Safety, and Environmental Services MAS& Public Health Division iM6�9. ,�a pTFo3'�° P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health August 27,1998 Mr. Joseph Amaral 116 Wintergreen Circle, Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF THE TOWN OF BARNSTABLE REGULATION REGARDING FUEL AND CHEMICAL STORAGE SYSTEMS Our records indicate that you have an old underground fuel oil tank located at 116 Wintergreen Circle, Osterville,MA. This tank is listed on Parcel 119 on Assessor's Map 046 and registred as tank tag#260. This tank is located in a critical zone of contribution to our public drinking supply wells and is 20 years old or older. You must have your underground tank removed within 30 days from the receipt of this order letter. For the removal of the tank you must first obtain a removal permit from the Fire Department. I have enclosed tank removal information for you. Upon removal of your tank, please return valve tag#260 to the Health Department. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days of receipt of this notice. Sincerely yours, Thomas A. McKean Director of Public Health Enclosure: Tank Removal Information SENDER: Z',' ■Complete items 1 and/or 2 for additional services. I also wish to receive the ■Complete items 3,4a,and 4b. , following services(for an H ■Prict your name and address on the reverse of this form so that we can return this extra fee): card to you. a� j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address d ■Wn e'Return Receipt Requested'on the mailpisce below the article number. 2.❑ Restricted Delivery to mTMe Return Receipt will show to whom the article was delivered and the date .. delivered. Consult postmaster for fee. ° 3.Article Addressed to: 4a.Article Number c � �" Q� Z 20j (Z c E � i o,� �Od h s 4b.Service,Type «'� l Z] Registered . jpMrtified CC t» o� W / ❑ Express Mail ❑ Insured S GP (� ❑ Retum Receipt for Merchandise ❑ COD c 7.Date of Delivery w Q D 0 Z ih 5.Received By:(Print Name) , ,. 8.Addressee's Address(Only if requested c r~u and fee is paid) t g 6.Signature:("Addressee or Agent) a°, X zk Ps Form 3811 i Decem6er,1994'; 1;{ 102595-97-13-0179 Domestic Return Receipt i vi _ First-.Class Nfail _ UNITED STATES POSTAL SERVICE,'CJ r -"" . NA 01 __, Bostage&Fees_Pai JiSP_S k `. 10 ? =y___. Rermit�No.G-10_— _ • Print your naive, ddress, and ZIP'Code-in this-box-• ---• Mlic Health Division Town of Barnstable PO Box 534 Hyannis, Massachusetts 02601 Fax(508)775-3344 Phone(508)790-6265 THE TOWN OF BARNSTABLE TD�y bw o� OFFICE OF 13eBa9Tsffi i BOARD OF HEALTH NAM 1639' `em 367 MAIN STREET QED MPY k' HYANNIS, MASS.02601 , January 29, 1999 Paulina M. Reilly, Esquire 259 Great Marsh Road Centerville, MA 02632 RE: 116 Wintergreen Circle, Osterville and 99 Pond Street, Osterville Dear Ms. Reilly: You are granted extensions, on behalf of your parents, Joseph and Maria Amaral, until April 15, 1999 with respect to the removal of the underground fuel storage tanks located at the above referenced properties. Therefore, the underground fuel storage tanks shall be removed on or before April 15, 1999 and disposed of properly at a licensed facility. The extensions are granted because you testified that your father recently had double knee replacement surgery and is presently trying to recover, with the assistance and care of your mother. Thirty (30) days was not enough time to obtain bids, remove the tanks, and get alternative tanks installed. erely yo s, Ra > Acting hairman Board` Health Town of Barnstable RAM/bcs reilly 259 Great Marsh Road Centerville, MA 02632 (508) 778-8508 September 15, 1998 Mr. Thomas A. McKean Director of Public Health Town of Barnstable Public Health Division P.O. Box 534 Hyannis, MA 02601 RE: Removal of Old Underground Fuel Tanks�tl 16 Wintergreen Circle, Osterville and 97 Pond Street, Osterville Property Owners:-Joseph and-Maria Amaral - Dear Mr. McKean: I am writing in behalf of my parents,Joseph and Maria Amaral, of Osterville with respect to the removal of the underground fuel tanks located at their above-referencd properties. The purpose of this letter is to respectfully request that the Town grant my parents an extension of time to have their underground oil tanks removed. My father, Joseph Amaral, is presently in the hospital. He just had double knee replacement surgery (both knees) from which he is presently trying to recover. My mother, Maria Amaral,was recently served with letters from the Town on Saturday, September 12th, regarding the requirement that the oil tanks be removed. She has been caring for my father and assisting him with his recovery. She got very nervous when she received the letters as she knew she would be unable to handle this within 30 days. Given my father's present health, 30 days is not enough time for them to obtain bids, get the tanks removed, and get alternate fuel tanks installed. My parents have every intention of complying with the law and will certainly get the tanks removed as requested by the Town. However, they would like a six(6) month extension or whatever the Town deems appropriate in view of their present hardship circumstances. If my parents can get the tanks removed earlier than six(6) months from now, they certainly will. It is just unclear how quickly my father will recover and then the cold weather will be upon us. I spoke with Jerry Dunning today of your Department. He informed me that you were on vacation this week. I asked him about obtaining an extension, and he said it would not be a problem. However, he did advise that I put the request in writing. Should you require a hearing on this matter, please let me know. If you have any questions, please call me. I can be reached during the day at work at (781) 837-3600 or in the evenings at home at (508) 778- 8508. I appreciate the Town's,time, consideration and understanding in this matter. Very Truly Yours, ,, Paulina M. Reilly, Esq. Rid 1 TANKS] 31 FUEL STORAGE TANK RECORDS ] HELP [ ] FOR PA�,�CEL NBR: 1191 0461 ] ] MAIN ACTION C] . Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ ] [ 1] [ 2601 [0101721 [B ] Test ] Rem 0706931 ---- Test --- --Abandoned-- -- Removed -- -- Variance - [P] [0711911 [ ] [ ] [ ] [ ] [ ] [ ] Fuel Reason Capacity Constr Status Leak-Det Cath-Det [D ] [H ] [ 2751 [SS] [NT] [N] [N] Additional Details [ ] -------------------------------------------------------------------------------- Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ ] [ ] [ ] [ ] [ ] Test ] Rem ] ---- Test --- --Abandoned-- -- Removed -- -- Variance - Fuel Reason Capacity Constr Status Leak-Det Cath-Det [ ] [ l [ ] [ l [ ] [ ] [ ] Additional Details [ ] --------------------------------------------------------------------------------- Cancel [ ] END OF DATA NEXT SCREEN [HMENU] ACTION [ ] PARCEL NBR [ ] [ ] [ ] ] TANK NBR [ ] 04-12-1999 12: 19PM CENT OST FIREDEPT 5087902385 P.02 I..dr,C.�NNlw-auvn xo rocaf Tire uepartment. Fire Department retains original application and Issues duplicate as Permit. APPLICATION and PERMIT Fee: $/0,0a for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: • i Tank Owner Name(please print)_ Joseph Amaral X Address 116'Wintergreen Circle Osterville, MA r 3 Company Name Shoreline Construction -° Co. or Individual v PYtr . Address 87 .Pond Street Osterville, NA. Ptix Un 1 P�n,r Address . mf ig a applying for permit)- pp�� Signature(if applying for permit) VocO IFCI Certified Other ❑ IFCI Certified O LSP# Other 91THFIT.T111 Tank Location 116 Wintergreen Circ;a Osterville, MA .�QB owl S Stesraed�.aa cay Tank Capacity(gallons) Substance Last Stored #2 Oil Tank Dimension W�her7xength) Remarks: G� Firm transporting waste Envi ro=Safe State Uc.# 329 MA Hazardous waste manifest# MAK158936 E.P.A.# MAD985269323 Approved tank disposal yard Turner Salvage Tank yard# 002 Type of inert gas Tankyardaddress 235 Commercial Street Lynnr. MA City or Town Osterville FDID# 01 99n Permit# Date of issue —April 8. 1999 .Date of expiration AqQ '. 1 a a, \Sc.; Dig safe approval number. 19991500238 Dig Safe Toll Free Tel.Number-600-3224844 Signature/Title of Officer granting permit '� ��0 -- - a - fter removal(s)send Form FP-290R'signed by Local Fire Dept.to UST Regulato Compliance Unit, One Ashburton Place, loom 1310, Boston, MA 02108-1618. I(revised 9/96) TOWN OF BARNSTABLE MA VA V,6 UNDERGROUND FUEL AND CHEMICAL STORAGE SYS E S ASSESS ORS MAP NO. PARCEL NO. (9 Zlj ve ADDRESS: � � �,t�'„n-} r r,�i�,-� Cl,i r-C VILLAGE (0Qd:g_r-✓i I IP - M4 • Ca(oS5 14AME;_-. gla:,ck, Via_. arr) - r — CONTACT PERSON' 6o-na ca.t2c:� ✓e, PHONE NUMBER LOCATION OF TANKS:, CAPACITY: .TYPE. OF' FUEL. AGE: TYPE: LEAK OR-CHEMICAL: e DETECTION�()A dos ,�✓ aoo �. �e1 ol, i f�� SYSTEM! Sn DATE OF PURCHASE OF EACH: 1. 17 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: t,1Arc i y'7 2 TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION. OF TANKS ON THE BACK OF THIS CARD.