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0170 CONCORD LANE - Health
170 Concord Lane Marstons Mills; A= 122-127 e • I i i 1 rr V®170 Concord Ln,Ostervil,I X. ' T tt F 4 ' l u www.zillow.com�omedet ils/170-Concord-Ln-Osterville-MA-0IL655/108611351_zpid/ Apps ®http--www,town.barn... Application Center ®suggested Sites C]Imported From IE E Parcel Lookup i Cape Cod Healthy Co... New Tab Q SAVE @ HIDE GET UPDATES REPORT HOME MORE City,State,or Zip 170 Concord Ln o--------------------------- PRE-FORECLOSURE Foreclosure Estimate: Osterville, VIA 02655 $222,040 similar Homes for Sale i Below Zesnmate .$42K 2 beds-2 baths-1,440 sqft 06%) 0 FOR SALE This 1440 square foot single family home has 2 bedrooms 1247,900 and 2.0 bathrooms.It is located at 170 Concord Ln Osterville, Action View Help Massachusetts, - _ v"Public Contacts(TOB) • v AirportDept-775-2020 fax:775-0453 I Bell,Joshua.778-7771 li FACTS Breault,Bud-775-3033 Lot:0.38 acres Built In 1982 Cain,Jeremy-508-778.7770 Single Family Heating:Other __ Everson,Brad-508.77E-7770 Gaye,Lisa-508-718-7773 - Holzman,Robert-778-7771 y More v See data sources -.- Jenner,Arthur Kennedy,Suzanne-778-7762 KondracH,Michael-778-7771 Lounsbury,Christina-778-7765 L McDonald,Mary-718-7761 I SeelisjMurphy,]oseph 1752020 Foreclosure Information Norkus,Nick-778-7774 Plikaitis,William SEPT 4 Home in The owner of this property has been served a Notice r., Rios,Hildie-778-7770 , j Ruhr,Jay-778-7771 2013 default of Lis Pendens. ................. Sanchez,Frank 778 77fi4(Idle) ; Sears,Donald-508-778-7772 Loan issued A loan was issued by WELLS FARGO BANK NA, Soldatov,Leonid t .....p pssessingDept-862-4022 fax;862-4722 o Benjamin,Robin-4013 s More v learn more at Zillow Foreclosure Center t Clark,Geraldine 4019(Idle) Finch,Nancy-4012 ,Henderson Lisa.4017(Idle)kf Leonelli,Anne-4018 W It i _ �I�s `V^ �► Zestimate Details ;jOnline• s Ad (wnpr iodimatp LVSt $170 Concord Ln,OsterviL., Ipswitch IM 12:54 PM Computer name : HEALTH899JF User name : flvnni Operatinq Svstem : Windows NT (5.1) 00 � Diart, Orenberg in'Nernk x ..� Y ax-y.. a f..�,r a .i-r. ar- n� ., a tir5_f' .a5-� rr, rY",td'4(51ti�' °P^Yb':_ ..aogas ®"fir• S.ilr= '?' , r „'. : �X�Mwwo i ism a N i� � ' r _ 7 sort By: Charles Orenberg 94 Dedham MA Diana Orenberg Abases: Osterville,MA James Orenberg Barnstable,MA Kimberly Orenberg W C Orenberg Canton,MA Chas Orenberg Charles Orenbeg Charles H. 50 Mansfield MA David Ehrenberg Ehrenberg Sharon,MA Eliza Ehrenberg Foxboro,MA Elizabeth Ehrenberg ' Aliases: Allston,MA Charles L Ehrenberg Norwood,MA Chuck Ehrenberg Chas Ehrenberg Chuck H Eherinburg Charles E. 72 West Wareham MA Charles Arenburg Arenburg Wareham,MA Eldridge Arenburg Stoughton,MA Lillian Arenburg RIM Brockton,MA Virginia Connell Kathleen Downie Charles R. 8o Attleboro MA Charles Arenburg Arenburg Simone Arenburg MN Abases: Joan Dupre Charles 0 Arenberg H@0 i � www,peoplef inders,comrrp/james+orenbeng/1-794876584 fida or�,a W Sign up for a membership>> PeopleFinders>People Directory>0 i Your Search is Confidential James will not be notified of your purchase. James Orenberg - 3 Records Found in the United States People Search results for James Orenberg in the PeopleFinders Directory Click on a person belovvto viewtheir address,phone,email address,and more.PeopleFinders also provides r detailed background checks and criminal records checks. Search Again mom Ifto WE James B Orenberg 70 Menlo Park,CA (660)-864-w Jacob Orenberg James Portola Valley,CA (660)-864-)w Jane Orenberg rr e (660)-864-m Joshua M Orenberg (660)-864-m Of Beck Orenberg i Orenberg ames M Orenberg 48 Cranston,RI (401)-821-wx Kimberly E Crossley James Orenbe oventry (401)-413-tea Charles Orenberg Cif Jinn Orenberg Osterville,MA (401)-821-)= Diana Orenberg y North Kingstown,RI (401)-463-w, Kim Orenberg Debary,FL (407)-321-;cxxx State James Orenberg (707)-785-w, (707)-785-m I � UM Parcel )etail , http:His sgl2/intranet/propdata/ParcelDetaia.aspx?ID,=7755 4110 2 r , Logged In As: Parcel Detail Tuesday, July 15 2014 Parcel Lookup Parcel Info Parcel Developer'ID�122 127 1 LOT 10 _.__ __.w .. _r....._ Pri Location,170 CONCORD LANE Frontage 47 Sec Sec F RoadEAST OSTERVILLE ROADL"LL �� Frontage _�. Village MARSTONS MILLS DistrictC-O-MM Town sewer exists at this Road'0343 addressiNo ( Index' Asbuilt Septic Scan: Interactive 1221271 Map a x,: �� Owner Info Owner ORENBERG, CHARLES& DIANA ° F— T Owner' Street[1170 CONCORD LANE Street2l City[_O�TERVILLE State tMA Zip j02655 Country Land Info _ _ ........ _ Acres 10.38 Use[Single Fam MDL-01 I Zoning jSPLIT RC;RF I Nghbd i0105 TopographylLevel Road Paved Utilities`Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year 1198r-2"--- Roof iGable/Hip Ext Clapboard Built Struct lGa Wall Living(1490 Roof Asph/F GIs/Cmp AC None Area Cover TypeInt — - Style Cape Cod Wall Drywall Rooms Bed 2 Bedrooms Floor° Rooms �------- Int p � Bath�_.__ Model Residential ECer et 2 Full r 1 Heat Total — Grade!Average Type IElec Baseboard 5 Rooms Rooms _— Heat - :_ Found-r-_ ___ ____ ___ � .. ._.,a°, P Stories 11.4 Fuel Electric ation[Poured Conc. Gross http://issgl2/intranet/propdata/ParceiDetail'.aspx?ID=7755 7/15/2014 P� z.? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 170 ConCord Ln. r M U S Property Address ,; j Mir Realty Group Owner Owner's Name P: information is required for every 9stei�i#fe M MA 02655 1/26/18 /-� page. City/Town State Zip Code Date of Inspection {z.. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When 83S filling out forms A. General Information 670 14! J on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. Excavation Company ,� Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 CitylTown State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs urther Evalua ' n by the Local Approving Authority 1/26/18 InspectorV,ifignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �0jj1d VS i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I_ i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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. p System will ass unless Board of Health determines in accordance with 310 CMR Y 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"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 99 P ❑ ® 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 '/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 170 ConCord Ln. Property Address Mir Realty Group Owner Owners Name information is required for every Osterville MA 02655 1/26/18 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is Osterville MA 02655 1/26118 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gp ))� Detail Sump pump? ❑ Yes ® No Last date of occupancy: fall of 2017 Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1,y , 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 170 ConCord Ln. Property Address Mir Realty Group Owner Owners Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: tank original to dwelling leaching upgraded 2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order with no sign of leakage. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon 5.. Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order,baffles present with no sign of back- up.Liquid level equal with outlet invert. Tank is not in need of pumping at this time but should.be pumped every 2 years for maintenance. Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in working order with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-3050s infiltrators ❑ 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.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Leaching was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ,.•''r 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal.System Form -Not for Voluntary Assessments 170 ConCord Ln. Property.Address Mir Realty Group Owner Owners-Name information is required for every Osterville MA 02655 1/26/18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System:Provide a.view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply.enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately s- .. .. . .... ...... 03 �S 3 Li t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ' 170 Concord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No Gw 144" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2/10/13 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file at BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. f17 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 0 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 170 ConCord Ln. Property Address Mir Realty Group Owner Owner's Name information is required for every Osterville MA 02655 1/26/18 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 l tX TOWN OF BARNSTABLE x *1�OCATION aft) C,2"1e4fJ 0Aht , SEWAGE# 00,-?j� c� VILLAGE /Vl)►iS ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY L000 LEACHING FACILITY:(type) 'S �S�,� (size) NO.OF BEDROOMS OWNER Ili/ PERMIT DATE: 2 C23 �i Z COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �•a'1 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 a wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Ll 1. t No. Fee Od THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplitation for Disposal 6pBtem Construction Per]�rvidual i Application for a Permit to Construct Nj Repair( ) Upgrade( ) Abandon( ) ❑Complete System Components Location `r,�ot No. 1--7(o Go�COYp1 LQhQ_ Owner's Name,Address,and Tel.No. �t"w, f MtA \JlGAim.r S�ro},r_, )lj6$ VFI Qo%,-Lv1"Sv t ?3 Assessor's Map/Parcer In o as o" 1; 1 -0 Y'%ain A MAR oaiza Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.otG r) A S t. YN \AC,Y-w\Z ►.A\q b aE Mq D*k5 5b - C7E S ' e Type of Building: Sb� �13a _SSt;S ' Dwelling No.of Bedrooms Lot Size �f d�0 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 370 gpd Design flow provided .37!� gpd Plan Date F,oa. �b, a o 1 j Number of sheets -1 Revision Date it- N rip TitleSOlan 0� pr� 0_=S+ojd,13V1 i10 ConC6Yc�i Size of Septic Tank I 'D GO C�CO, � mcV _s Type of S.A.S. Description of Soil Icne d o')TYn Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this d of 41th. e� 9 Si e � Date D- Application Approved by Date ..- Application Disapproved b Date for the following reasons Permit No. � i Date Issued .2— -1 -gYN' u f + Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r. PUBLIC HEALTH DIVISION - TOWN OF�BARNSTABLE, MASSACHUSETTS Yes 0(pplication for 33isposal*stem Construction Permit J i Application for a Permit to Construct 4 Repair'( ) Upgrade( ) Abandon( ) ❑Complete System U l �Mdual Components Location Address or ,of No. 1`7(3 L otK or 01 Lah L Owner's Name,Address,and Tel.No. -- fv-cj- ,-, M,III �s -- �n- Vlo,dim,r s�ro+ r, �a�g v po,r�v Sv,kl 3 - Assessor's Map/Parcef Ln 1 o1a a,Cst l: 1 a S� o x1),,v k M I (0 1 - 1 -- Installer's Name,Address,and Tel. 1J No. Designer's Name,Address,and Tel.No. CG r1 q SPML rY�q►� � G�cc ,c-lv, 1 LLC 15SWPb,`C W" \Aoorw\c M\q oaE 5 lS S �w\C MA 0X45 50 -4 - b ,/f JV G4 J 1^ Type of Building: s0'-`l3a-SS+,S Dwelling No.of Bedrooms J Lot Size /5 (D\'l 0 sq.ft. Garbage Grinder( ) a Other Type of Building 1, No.of Persons Showers( j Cafeteria( ) Other Fixtures Design Flow(min.required) y gpd Design flow provided 7 gpd Plan Date Feb. �() a.o\5 Number of sheets .1. Revision Date h1�K1 Title Sloe plan 3� Pr0p02jjd consfv-j613h �16 C,3v,\C oYd LQr\k 0%"i'\1 o` ,M) Size of Septic Tank I O O y (�O.I�'J h Type of S.A.S. Description of Soil W d k%o m SC�n d U x. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ,Agreement: a 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-55 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this'Board of HedIth. o Signer Date 0� ` 1 S c� r Application Approved by , Date * Application Disapproved by v ._."Date for the following reasons Permit No. �'c/ _� 1,?f Date Issued Z --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CI TIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( `�' Upgraded( ) Abandoned u n P "/(A" at (� n r 1,��l �1 11/)i I&has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No..Z o/) dated Installer Designer r #bedrooms Approved de ' n flout �3U gpd The issuance o his ermit shall not be construed as a guarantee that the system Dill fu bU� n as des4ned. c Date _ � ) Inspector �V" J --------------------------/------------------------------------------------------------------------------------------------------------- No. )-u! Fee lot) THE COMMONWEALTH OF MASSACHUSETTS k PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( /) Repair Zgrade ( ) ) Abandon(System located at )70 r o f o ter/ �n P M�f1mot) /1/1 /l 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:Constru tion m st be completed within three years of the date of this permit. P , Date �2 Approved by u 1A f ` 1 . Town of Barnstable of,HEti Regulatory Services � t Richard V.Scali,Interims Director y g Public Health Division 6 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:. 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems ddress:Property A t�n U tJl n Q. C)��`e Assessor's MaplParcel:! 1 Property Owners.Name: K'd le C"\T_ ��pJ� Co C In accordance.with Massachusetts DEP alternative system.approval letters, the following certification information is required.by the Owner of record. ' The Owner of record .must place an "x" in the applicable box next to each line.certifying the information. Yes N1A l�S I have been provided a copy of the Title.5 UA technology Approval letters. �(15-page S tanda rd.Conditions letter and the specific technology letter-) I have been provided with the Owner's Manual lf/J ❑ I have been provided with the.Operation and Maintenance Manual ❑ For Systems'installed under'a Remedial.Use Approval,l agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval L�l ❑ For Systems installed under a Remedial Use Approval,I agree to.fulfill my responsibilities to provide written notification of the Approval to any new Owner,as required by 310 CMR 15.287(5) ❑ if the design does not provide.for the use of garbage grinders,the restriction is understood and accepted l�1 ❑ Whether or not covered-by a warranty,T understand the'requitement to repair,replace,modify or take any other action as required by the Department or the LAA,if the Department or the LAA determines the System to be failing to protect public health and safety and the environment,as defined in 310 CMR 15.303 agree to comply with all terms and conditions above. Pro printed e Property Owners ignature Date Note: This .form must be submitted along with, the sgLtiL systern disposal works pexnait application .for all RA systems including new construction, reMairs lungrades,- with and without aggregate (stone) and with conventional design criteria or credited design criteria. . 'QASeptic\1A homeowner certification.doc DA iN A. SPEAKMAN, CONSTRUCTION LAND SURVEYING & TITLE ENGINEERING DIVISION 15 SPFAK WAY NORTH HARWICH, MASSACHUSETrS 02645 I • Phone: (S08) 432-5565 / FAX: (508) 432-5099 i i JCERTTHCATION OF SUBS�FzSFWAGE SPOSAL SYSTEM I LOCATION OF SYSTEM: 170 Concord Lane, Marstons Mills i JOB#: Permit # 2015-36 I DATE(S)OFPTYPE OF INSPECTIONS: Final May 7, 2015 I, �y i s M a c n n ,Civil EngineerAtegistered-Sanitarian,duly licensed as such in the commonwealth of Massachusetts,do hereby certify that this firm'has visually inspected the constructed subsurface sewage disposal system shown on the referenced approved plan,and further certify that the system, as constructed,Sawally conforms within acceptable tolerance to the regulations,as varied,set forth in 310 CMR 15.000 and the Town of R4xngjaft@rd of Health Regulations. I i i i I I I i May 11 , 2015 Date ► I i Town of Barnstable °FtHE 1ph, Regulatory Services ti Richard V. Scali, Director MRNSTABLE. MASS. Public Health Division 1639. ArFp39.is Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Cr, VAS Sewage Permit#'10( S- O? { Assessor's Map/Parcel Installer & Designer Certification Form Designer: n' C7y-e— �A wS-f Installer: Address: Address: "CW On D O^7 was issued a permit to install a (date) (installer) septic system at\_1 0 &3n1 G d Ujht, based on a design drawn by (address) ' � dated (designer) I certify that the septic system referenced above was. installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. ,ZN OF o� DAVID 0 g a. U (Installer's Signature) MASON No.1066 Co F <) '•. G/ST6¢ S�All AQ\ (Design ! na ) (Affix De mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc 05/18/2015 09:20AM 5084325099 SPEAKMAN PAGE 01/01 ry". 0� Mlh Ll J THE Town cif Barnstable P 0, Department of Regulatory Services �' Public Health Division Date MA&& �A 1.639. �a� 200 Main Street,Hyannis MA 02601 • rfl)hgd'I h ,� i Date Scheduled Time f Fee Pd.` f �d //,a(p' — c� a5a suitability A�se.ssment f®�° Sew e I)is ®,sal �� Performed By:. I. •J� Witnessed By: r LOCATION & GENERAL INFORMATION Location Address V' oA Owner's Name r, 1 �l c,,yya b Q`ohC OYd ` Y� a rt J Address t, C O y�C_ i`G t1SL Assessor's Map/Parcel: O� ( a a lPcxyc_t,` o `a Engineer's Name ! t3Y\� 5 may.r1lk Y- NEW CONSTRUCTION REPAIR REPAIR Telephone 5 U' Land Use r. ra�a�+(�akrnq�'l�V1l�fAt� Slopes(nv Surface Stones .. C O-V1 Distances from: Open Water Body ft Possible Wet_Area ft Drinking Water Well ft Drainage Viray ft Property Line ft Other ft SIM,TCII:(Street name;dimensions of lot,exact locations-if test holes&perc tests,locate wetlands fn proximity to holes) II Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping fa•oin Pit FAce Estimated Seasonal High Groundwater DETERMINATION FOR SEASONALMIGII WATER TABLE Method Used: Depth Observed standing in obs.hole: . In. Dept1110 loll mottles: lot, Dcpth to weeping from side of obs.hole: ln. Groundwater AdjuJatment f[. Index Well# Reading Date:. Index Well level w Adj.factor AdJ,druundwater Level PERCOLATION TEST ST Date_ Inme Observation Hole# Time at 9" Depth of Pere r/U Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak / !' Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) , Original: Public Health Division Observ'dtion Hole Data To Be Completed on Back---------- ***If percolatioh-testis to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTfCkPERCFORM.DOC DIE EP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsistency,%Gravel) DEEP OBSERVATION HOLE'LOG Dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistengy,% a DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to c O ]DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Man: Above 500 year flood boundary No_ "Yes Z Within 500 year boundary No u es Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material_ Does at least four feat of naturally occurring pervi us wa erial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pert/ous material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro menta Protection and that the above analysis was performed by me consistent with . the required training,expertis xp rience described in 10 CNM 15.017. ) Signature Date �d f Q:\SLPTIC\PBRCPORM.DOC • Town of Barnstable Barn Regulatory Services Department AllAnsicaft # BARNSUBM Division I Public Health - 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1852 January 27, 2014 i Mr. &Mrs. Charles Orenberg j 170 Concord Lane Osterville,MA 02655 The septic system located at 170 Concord, Marstons Mills, MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following • Backup of sewage into the house due to an overloaded or clogged SAS. You were ordered to repair the septic system within sixty (60) days from the date of the system failure, However, as of this date May 21"2013, we have not received any notice that the repair of the septic system has been done. Therefore you are again ordered to repair or replace the septic system.within sixty,(60) days from the date you receive this notification.. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter,within seven (7) days after the day this order was received. PER ORDER OF THE BOARD OF HEALTH Qsel�" R.S. CH0 Y Agent of the Board of Health = o - �� f 0 Q:\SEPTIC\Letters Septic Inspection Failures or Future Evahl70 Concord Ln.Final Notice.docFinal Notice 0 Er .. u') CO Postage $ R! IZM -- Certified Fee 00 Retum Receipt Fee 0 (Endorsement Required) 0 Restricted Delivery Fee0 (Endorsement Required) rq0 Total Postage&Fees rL - - - Mr. & Mrs. Charles Orenberg 170 Concord Lane Osterville, MA 02656 Certified Mail Provides{ o A mailing receipt a A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. a Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mtailpiece"ReturM Receipt Requested".To receive a fee waiver for a duplicate return•receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". , e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save•this receipt and present it when making an inquiry.- ; PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 s Town of Barnstable Barnstable �SHF Tp� Regulatory Services Department `n i BARMABSN Public Health Division I. i659. a�� 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2850 9071 May 21, 2013 Mr. & Mrs. Charles Orenberg 170 Concord Lane Osterville, MA 02655 • �N, The septic'system located at 170 Concord,Marstons Mills, MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following e Backup of sewage into the house due to an overloaded or clogged SAS. You were ordered to repair the septic system within sixty (60) days from the date of the system failure, However, as of this date May 21"2013, we have not received any notice that the repair of the septic system has been done. Therefore you are again ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification.. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter,within seven (7) days after the day this order was received. PER ORDER OF THE B ARD OF HEALTH • T omas cKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\170 Concord Ln.Final Notice.docFinal Notice 4 I i Town of Barnstable Barnstable Regulatory_ Services Department 1 • saRNST"M +039. D MASS Public Health Division 8, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V. Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 4266 August 19, 2014 Charles & Diana Orenberg % James M Orenberg 28 Hunters Crossing Drive Coventry, Rhode Island 02816 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday, September 9,2014 at 3:00 pm in the Town Hall, Hearing Room, 2❑d Floor at 367 Main Street, Hyannis, MA due to your failure to repair or replace the septic system which failed inspection on 6/20/2011 at 170 Concord Road, Marstons Mills, MA. The State Environmental Code Title V requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the septic system has been in failure beyond the deadline established by both the Town of Barnstable and the state of Massachusetts. You will be given the opportunity to testify,present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH e5a�sMcZn, R. S. CHO Agent of the Board of Health Q:\SEPTIC\BOARD\170 Concord Rd MM Aug 2014.doc 6 ' U.S.POSTAGE>>PITNEY BOWES oF'"E'wsti Town of Barnstable / ;PI �� _ � Public Health Division " 1 BARN_:LE. ` 200 Main Street A � 02 0�601 � ��6.4�80 1 MASS. pJFD N1P�°0� Hyannis,MA 02601 - '�. 02 1VV 424 AUG. 21. 2014. i 7012 1010 0000 2851 4266 Charles & Diana Orenberg % James M Orenberg 28 Hunters Crossing Drive Q Coventry, RI' ,.q y., . . .. . - - �.���Ni'l 1V'.i I V�=S�iV�•��7C 7:,":.. .. ... UNCLAIMED _.... LINABLE TO F 0 R WAR D 3C: 62601403200 *03G2- 0907 0-21-41 rrt&: : ' , gbtitit ►� r � �j3�.� �1�s �e�s ��� ,I�,,:9��;s>� �# �� ��.jz 1 ..,, ___,;.fir"" • �,,,,•A In Complete items 1,2,and 3.Also complete A. Signature I ha t I item 4 if Restricted Delivery is desired. ❑Agent j R Print your name and address on the reverse X ❑Addressee l so that we can return the card to you.. B. Received by(Printed Name) C. Date of Delivery 1 i ® Attach this card to the backof the mailpece, I or on the front.if permits. l D. Is delivery'address different from item 1? ❑Yes 1 Article Ad If YES,enter delivery address below, ❑No Cha Diana Orenberg I % 1 Orenberg 28 H?rr ers Crossing Drive 1 service Type Covenlr ; Rhode'Island 02816 ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise I \mot -T Insured Mail El C.O.D. 1 v. 4. Restricted Delivery?(Extra Fee) E3 Yes I 2. Article Number � (Transfer from:senVice label) 7012 1010 0000 2851 4266 CY PS.Form 8811 February 2OOa Domestic 02595 02 M 154 �- Dom Return t R n Receipt ' e 4 3. Town of Barnstable Barnstable Regulatory Services Department B' � Public Health Division 1639. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2850 9071 May 21, 2013 Mr. & Mrs. Charles Orenberg 170 Concord Lane Osterville, MA 0265,5 The septic system located at 170 Concord, Marstons Mills, MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following • Backup of sewage into the house due to an overloaded or clogged SAS. You were ordered to repair the septic system within sixty (60) days from the date of the system failure, However, as of this date May 21St 2013, we have not received any notice that the repair of the septic system has been done. Therefore you are again ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification.. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter,within seven (7) days after the day this order was received. PER ORDER OF THE B ARD OF HEALTH T omas cKean, R.S. CHO. Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\170 Concord Ln.Final Notice.docFinal Notice .�:. 14 ..: �`•'"E Town of Barnstable U.S.POSTAGE>>PITNEY sOWEs Town Public Health Division eARMpRLe. ' 200 Main Street •v ��O`_^ 6�9 •� ZIP 02601 $ 6 00 .q 10 ptEp tA{CGp Hyannis,MA 02601 02 IVY 1 000138.3424 MAY. 22. 2013, 7012 1010 0000 2850 9071 1 Mr. & Mrs. Charles Orenberg 170 Concord Lane Osterville, MA_02655 X '015 N?=E 1 212,1 00 05 %--13 /'13 !, ORWAR[3 T ,t*7c c } ? RTN Tti ScivD RE'e4;9ERG IDE131-i .M MA 02026-3515 RETURN TO SENDER � 0 2 6 o i @4 o D Z lil ltillill11,1111}3111°i�l�ll�l lllt�falJ9.�l 1�111��}111�111� . COMPLETE .N COMPLETE THIS SECTIONON DELIVERY 1 ■ Complete items 1,2,,and 3.Also complete A. Signature i item 4 If Restricted Delivery is desired. ❑Agent I ■ Print your name and address on the reverse X ❑Addressee , so that we can return the card to you.( y B. Received by(Printed Name) C. Date of Delivery I I ■ Attach this card to the back of the mailpiece, or on the front if space permits. .a ca 1 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes r-4 If YES,enter delivery address below: ❑No O 0 i fV ao rn r E Mr. & Mrs., Charles Orenberg m i 170 Concord Lane 3. Service Type = O 8 M I OsterviJ:le; MA 02656 ❑cernfi�Man ❑1=xpress Mau I tv C 4 j ❑Registered ❑Return Receipt for Merchandise I C'D r I -— ❑Insured Mail ❑C.O.D. a, 7 O I 4. Restricted Delivery?(Ettha Fee) ❑Yes I w p � j 2. Article Number 's}. (Transfer from service labeq 7 7 012 1010 0000 2850 9071 l i e s s I Ps For,3811,February 2004 Domestic Return Receipt 102595-024 VI-IM • OFFICIAL I Y S Ln C Postage $ J Certified Fee p C3 Return Receipt Receipt Fee Here t I p (Endorsement Required) N O v1j + a p Restricted Delivery Fee �2! y p (Endorsement Required) �� x p p Total Postage&Fees �/ ra Mr. & Mrs Charlse Orenburg 170 Concord Lane Marstons, MA 02648 Certified Mail Provides: o A mailing receipt a A unique identifier for your tr ilpiecg, o A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. a Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a JSPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed;detach and affix label with postage and mail. IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 i a .l t �WE r� Town of Barnstable Barnstable Regulatory Services Department OfteftCh Y I I I I Y M M`ter Public Health Division �iOtFp 39. a 200 Main Street, Hyannis MA 02601 2007 SECOND NOTICE Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 1166 November 20, 2013 Mr. & Mrs. Charles Orenburg 170 Concord Lane Marstons Mills MA 02648 The septic system located at 170 Concord, Marstons Mills, MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following • Backup of sewage into the house due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action. PER ORDER OF T BOARD OF HEALTH T c ean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\170 concord cent Jun 2013.docFinal Notice i VE Town of Barnstable Barnstable Regulatory Services Department ;edcaC P BAJW9rAB# ^ Public Health Division 2007 200 Main Street, Hyannis MA 02601 SECOND NOTICE y Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 4.7012 1010 0000 2851 1166 f November 20, 2013 Mr. &Mrs. Charles Orenburg 170 Concord Lane Marstons Mills MA 02648 The septic system located at 170 Concord, Marstons Mills, MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following • Backup of sewage into the house due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action. PER ORDER OF T BOARD OF HEALTH T c ean, R.S. CHO Agent of the Board of Health Q\SEPTIC\Letters Septic Inspection Failures or.Future Eval 170 concord ce nt Jun 2013.docFinal Notice Town of Barnst#bte Y U.S.POSTAGETNEv Public Health Division-. BARNS ABLE. 200 Main Street MASS. �plEp�Ap+°0� Hyannis,-MA 02601 l `"' {; ZIP 02601 $ 006.110 02 10 0001383424 NOV. 20. 2013, 7012 1010 0000 2851 1166_ JO vF p . ` Mr. & Mrs. Charles Orenburg mac. ® 170 Concord Lane 9 1st NOTICE o . ..` Znd NOTICE ET- r µ ,.d '4 NED E ,' F_._ ' ' ter �• — �."'". ti+,"r__ ,t_...tip". •�Ty ` .o Complete items 1,2,and 3.Also complete A. Signature I, item 4 if Restricted Delivery is desired. ❑Agent I v ® Print your`name and address on the reverse X ❑Addressee I so that we can return the card to you. B. Received by(Printed Name) C Date of Delivery ® Attach this card to the back of the mailpiece, or on the front-if space permits. D Is delivery address different from item 1? ❑Yes I 1 Article Addressed-to: If YES,enter delivery address below: ❑ No Mr. & M ;:Char! "-Orenburg I 4 0 Cc�tacor:,d Lan�tt�= 3. Service Type, ❑Certified Mail ❑Express Mail 0 Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I 12. Article Number r y 1010 ' 0000 2851 1166 ' I S 'i i S i ._,�:. _ - "• ?�P _ __.___ 11002595-02-M-1540 I a � ..-_..�_�.�.•'---------- urn ec Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=7755 ti yti 4LlSS it � t t a '� 9 Logged In As: Parcel Detail Wednesday, November 13 2013 Parcel Lookup Parcel Info ...... ........ .. ......... Parcel 122 127 Developer LOT I D Lot Pri Location F170 CONCORD LANE �I Frontage 47 Sec _) Sec Road 1EAST OSTERVILLE ROAD Frontage r —_ I Village;MARSTONS MILLS -- I Fire C-O-MM._ .._. ----._ District Town sewer exists at this Road(�— ---------_____ address INo Index i0343 Asbuilt Septic Scan: �teractive 122127_1 d- Map Owner Info Owner-ORENBERG, CHARLES&DIANA Co- Owner Street111170 CONCORD LANE i Street2 CityAtOSTERVILLE State MA Zip 02655 Country Land Info z. Acres 10.38 Use ISingle Fam MDL-01—I Zoning ISPLIT RC;RF Nghbd 10105 Topography FLevel ( Road Paved Utilities JPublic Water,Gas,Septic ( Location Construction Info ---___-- ---._.........._...-- .. .__._ __ ........ _._---____..__.. .....__. .......... ......... Building 1 of 1 Year 1982 Roof Gable/Hip I Ext Clapboard Built Struct Wall Living 1440 Roof Asp F GIs/Cmp AC tNon�e � q- Area Cover Type 7 _ _ D 1 Style Cape Cod I Int.Drywall I Bed 2 Bedrooms Wall l Rooms Int Bath — __ Model Residential Floor Carpet ) Rooms 2 Full � s Heat " Total Grade Average Type Elec Baseboard) Rooms E5 Rooms Stories�1 Story w/FAT_ Heat IElectric Found- Poured Cone Fuel ation Gross http://issgl2/intranet/propdata/ParceiDetail..aspx?ID=7755 11/13/2013 y .njD • co 0 .• t. ,q OFFICIAL Ln ti Postage $ S d S` Certified Fee rP \ ostmark \J) O Return Receipt Fee C) O` Here O (Endorsement Required) 100 O Restricted Delivery Fee CO T � (EndorsementRequired) t_ 'a �1 tv sIN O Total Postage&Fees rLI c3 Mr. & Mrs. Charles Orenburg 170 Concord Lane Osterville, MA 02655 1 Certified Mail Provides: a A mailing receipt w IN A unique identifier for your mailpieceA 0 A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mail(& a Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 ' Town of Barnstable Barnstable Regulatory Services Department AMnalnM B, S& Public Health Division �Ajfo µp'i 0.`0 2007 200 Main Street, Hyannis MA 02601 SECOND NOTICE Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 0862 October 15, 2013 Mr. & Mrs. Charles Orenburg 170 Concord Lane Osterville, MA 02655 The septic system located at 170 Concord, Marstons Mills, MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following • Backup of sewage into the house due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action. PER ORDER OF T BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\170 concord cent,Jun 2013.docFinal Notice Mom• � '.� `ofi"Er 'Town of,Barnstable U.S,'POSTAGE>>PIT'NEYBOWES Public Health Division �� `�'� .C7 e C� �"MA S LE. ' 200 Main Street f MASS. � C� °jq' .� Hyannis,MA 02601 �r: ZIP 02601 02 1VV I$ 00b'� A 0 �'prfD MM° i . 0001383424 OCT. 16. 2013. I 2 7012 1010 0000 2851, n8kr OA r P. G 9 t� 1 TI Mr. & Mrs. Charles Orenburg 2nd w.��,�� : CE 1`70.Concord-Lane x "3`7.`:txJ x?kalrF;^4a 1.� n 3..�}I•�Pv' ...e.....^^" - s i ® Complete items 1,2,and 3.Also complete A. signature { item 4 if Restricted Delivery is desired. X [I Agent { { © Print your name and address on the reverse ❑Addressee I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ® Attach this card to the back of the mailpiece, I or on the front if space permits. G 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: '❑ No Mr. &-Mrs:.'Chiles Orenburg 3. Service Type I ❑Certified Mail ❑ Express Mail I ❑ Registered ❑ Return Receipt for Merchandise 1 ❑,Insured Mail ❑C.O.D. I Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7012 1010 0000 2851 0862 l { (Transfer from service label) Form nl 1 February 2004 D ipt ,_ ?_o2sss o2-M __ - http://www.whitepages.com/name/Diana-Orenberooxboro-MA/2fDrz6f WhitePages Diana Orenberg 65+ years old i. Phone number 508-428-7918 Addresses 172A East St Foxboro, MA 02035-2253 170 Concord Ln Osterville,MA 02655-1264 People Diana may know Samuel S Savage Debra J Savage D Orenberg Alexandra Savage Ali Savage Previous locations Canton, MA Dedham, MA West Newton, MA © 2013 WhitePages Inc. - Privacy Policy and Terms of Use 11/20/2013 �� ,�., �. I �� L_ Town of Barnstable Barnstable Regulatory Services Department edeaC'1 TRMA AESM MASS, s63q. Public Health Division Qjp �� TfDUAAtA 200 Main Street, Hyannis MA 02601 2007 SECOND NOTICE Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 1166 November 20, 2013 Mr. & Mrs. Charles Orenberg 170 Concord Lane Osterville, MA 02655 The septic system located at 170 Concord, Marstons Mills,MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following • Backup of sewage into the house due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evahl70 concord cent Jun 2013.docFinal Notice Town of Barnstable Barnstable Regulatory Services Department ca y &UMS[ABLE, MAS& Public Health Division s6sq. 10� m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 - Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1326 December 2, 2013 The Pearl Williams Trust 77 Milne Road Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 77 Milne Road, Osterville, MA was last inspected on 10/25/2013 by Mark Polselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The cesspool structure is unsound; roots have caused the structure's blocks to loosen and bulge.. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\20 County Seat St HY Nov 2013.doc Town of Barnstable Barnstable Regulatory Services Department �``�� SrAHM Public Health Division16. 2007 QED"AAA 200 Main Street, Hyannis MA 02601 SECOND NOTICE Office: 508-862-4644 Thomas F. Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 0862 October 15, 2013 Mr. & Mrs. Charles Orenburg 170 Concord Lane Osterville, MA 02655 -�-- • The septic system located at 170 Concord, , MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following C Backup of sewage into the house due to an overloaded or clogged SAS. You are ordered to septic the lace or repair re stem within six 60) days from the P P p Y sixty � date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action. PER ORDER OF T BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\170 concord cent Jun 2013.docFinal Notice http://www.whitepages.com/name/Mr-Charles-Orenberg-Sr/Osterville-MA/ake8zcz WhitePages.com MR Charles Orenberg SR 65+ years old Address 170 Concord Ln Osterville, MA 02655-1264 People Charles may know Diana Orenberg More results at InstantCheckmate.com Simpler inves -in i waiting for 0 © 2013 WhitePages Inc. - Privacy Policy and Terms of Use http://www.whitepages.com/name/Mr-Charles-Orenberg-Sr/Osterville-MA/ake8zcz 11/27/2013 a n, N , ti OFFICIAL , ..ice tti �•. ,- Postago $ Ln N Cartifled Fee . l7 Return Receipt �� Receipt Fee � � Here p (Endorsement Required) � fj M Restricted Delivery Fee a (Endorsement Required) rU Total Postage&Fees $ m /�1V cc o Mr. & Mrs. Charles Orenburg 170 Concord Lane Marstons Mills, MA 02655 r Certified Mail Provides:' c Amailing receipt n A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Maile or Priority Mail& in Certified Mail is not available for any clasff of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. d For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Retum Receipt service,please complete and attach a Return Receipt(PS Form 38111 to the article and add applicable postage to cover the fee.Endorse'mailpiece Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047 SENDER:�COIWPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY s Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X —'-'� ❑Addressee so that we can return the card to you. 13•Rece' (Printed Name) C. Date Delivery ■ Attach this card to the back of the mailpiece, L V YY or on the front if space permits. D. Is delivery address different from item'11 13 Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Mr. & Mrs. Cha4es Orenburg 170 Concord Lane Marstons Mills, MA 02655 3. Service Type I ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. ` I r" _ 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. Article Number 7008 3230 0002 5178 2794 (Transfer from service label) Ps Form 3811,February,2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS I Permit No.G-10 � I f • Sender: Please print your name, address, and ZIP+4 in this box' j i I I Town of Barnstable Public Health Division 200 Main Streety Hyannis, MA 02601 I i I i i e �< < }�arnstable Town ®f Barnstable Regulatory Services Department adcaft 0 Public Health Division 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FINAL ORDER Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7008 3230 0002 5178 2794 December 18, 2012 Mr. &Mrs. Charles Orenburg 170 Concord Lane ! Marstons Mills,MA 02655 The septic system located at 170 Concord, Marstons Mills, MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following • Backup of sewage into the house due to an overloaded or clogged SAS. . You were ordered to repair the septic system within sixty (60) days from the date of the system failure, However,.as of this date December 14th 2012, we have not received any notice that the repair of the septic system has been done. Therefore you are again ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification.. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven (7) days after the day this order was received. - I PER ORDER OF THE BOARD OF HEALTH omas McKean, R:S. CHO Agent of the Board of Health I l -QASEPTICUtters Septic Inspection Failures or Future Evahl70 Concord Ln.Final Notice.doeFinal Notice h Health Master Detail http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=122127 Health Master Logged In As: Towr!\flynnj 4 Health Master Detail Monday,December 16 2012 Aonlication Center Parcel Lookup Selection Items Reports Parcel Septic Perc I Well I Fuel Tank Parcel: 122-127 Location: 170 CONCORD LANE,MARSTONS MILLS Owner:ORENBERG,CHARLES&DIANA Septic 1 New Septic... Permit number: F— Permit type: Select type Complete system: F Issue date :F AlComplete date : Septic tank size: F Type/Size of SAS: Installer: I Select Installer Card on file: F I/A service type: Select service -:1 Innovative/Alternative Technology type: (Select IA type Variance date :F— 4 Abandon complete date: F Abandon permit number: I — Repair deadline date: 09/27/2012 Repair notification date : 09/27/2011 Keyword:I Comments: «created for septic inspection Delete Septic Inspection 06/20/2011 New Inspection... Number Inspection Date Inspector Result 6845 06/20/2011 Childs,Matthew L.,Stocchetti Road Construction IF(Fail) The following condition(s)are occurring: r discharge or ponding of effluent to the surface of the ground f pumping more than 4 times during the last year NOT due to clogged or obstructed pipe F7 backup of sewage into facility or system component 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 F any portion of the SAS,cesspool,or privy below high groundwater elevation * any portion of the cesspool within a Zone 1 to a public well any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis Received Date Comments 09/22/2011 lone(1)year Itr sent Delete Inspection Save Septic Changes I Return to Lookup I� http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=122127 12/10/2012 Town of Barnstable Barnstable Regulatory Services Department 1 � ABMWMCN ' NAW Public Health Division 0 D. 1639. 1 0N1�c4p 200 Main Street, Hyannis MA 02601 200? Office: 508-862-4644 FINAL.0"ER Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7008 3230.0002 51178 2794 December 18, 2012 Mr. &Mrs. Charles Orenburg 170 Concord Lane Marstons Mills,MA 02655 The septic system located at 170 Concord, Marstons Mills, MA was last inspected on 9/09/2011 by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following Backup of sewage into the house due to an overloaded or clogged SAS. You were ordered to repair the septic system within sixty (60) days from the date of the' system failure, However, as of this date December 14th 2012, we have not received any notice that the repair of the septic system has been done. Therefore you are again ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification:. You may request a hearing before the Board of Health,a written petition requesting a hearing on the matter, within seven(7) days after the day this order was received. PER ORDER OF THE BOARD OF HEALTH } omas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTICUxtters Septic Inspection Failures or Future Eval\170 Concord Ln.Final Notice.docFinal Notice Fly —WIN 0 "�' U.S.POSTAGE>>PITNEY60WES Town of Barnstable o Public Health Division • BARM 95BLEg 200 Main Street I �� °e Hyannis,MA 02601 OZI2P 0601 $ 005.15' {. 0001361475 DEC. 20. 2012 I k /7008, 3230 0002 5178 2794 \ /' F '� Charles Orenb • � , J�\` , Mr.%'& Mrs. gFrg Z{ 170 Concord Lane J \ � \ / � fMarstons Mills, MA 02655 V r r i,`. k.... '.R E �,T'i.3 R 7 TO E!q!�i.7 C.M UNCLAIMCD 11NAR) F TO FORWARD — - — BC: OZ—' G31400200 ib —li e:5'u— Ei3—=a0-n ' >��"�� �`'�'' � riill�►1li11r�1IIf1i1S��liill�iili�lE#1'I1.{lliid��911e[ai3s�}� . I \ FF i x TN 'Ili e Barnstable OF SHE Tp� Town of Barnstable e;caC I BARNSTABLE, regulatory Services Department I> e Public Health Division -t7 i639.gq �0 m ATF0 MAC a, 200 Main Street, Hyannis MA 02601 2007 r Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7011 0470 0001 4525 5303 September 27, 2011 Mr. Charles Orenberg 170 Concord Lane Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The,septic system located at 170 Concord Lane, Osterville, MA was last inspected on 9/9/2011,by Matthew L. Childs, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup oM sewage into the house due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within one (1) year from the Date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH T,- cKean, R.S., CHO Agent of the Board of Health J:\170 Concord Ln.,Ost..doc 1 t a. t � Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments s Subsurface Sewage Disposal System Form Inspection resultsamust be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. 1 A. Certification 4 1. Property Information: 170 Concord Ln. Property Address Charles Orenberg Owner's Name same ' Owner's Address 9etefadt w f�f f k MA 02655 City/Town State Zip Code Date of Inspection: Date 1 Date 2. Inspector: Matthew L. Childs Name of Inspector same Company Name 4 Orchid Ln. Company Address W. Yarmouth MA 02673 City/Town State Zip Code 508-989-1479 Telephone Number G� v �r Certification Statement: „� I certify that I have personally inspected the sewage disposal system at this add ress and th�•tthe 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 maintenancee zf or site sewage disposal systems. I am a DEP approved system inspector pursuant to Section t5.340;gf Title 5 (310 CMR 15.000). The system., ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/20/11 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System "`' Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form y s+ey`e A. Certification (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection 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: N/A , SAS in total hydraulic failure. 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: N/A orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG M See e Subsurface Sewage Disposal System Form A. Certification (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: N/A ❑ 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: N/A 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 orenberg.doc 11/2004: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form o Not for Voluntary Assessments i4^M SV � Subsurface Sewage Disposal System Form A. Certification (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. i ❑ 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: N/A orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments o Subsurface Sewage Disposal System Form M A. Certification (cont.) 170 Concord In. Property Address Osterville MA 02655 City/Town State ZipCode Charles Orenberg 6/20/11 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h 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.] 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. orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 170 Concord Ln. Property Address Osterville MA 02655 CityFrown State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth, of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments G^M SV Subsurface Sewage Disposal System Form B. Checklist 170 Concord Ln. Property Address Osterville MA 02655 City/Town ° State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection 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? ® El available 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 ® ET information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): N/A Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A Last date of occupancy/use: N/A Date Other(describe): N/A orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 L f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments s Subsurface Sewage Disposal System Form C. System Information (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection General Information Pumping Records: p 9 Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A 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 1982 per permit issue. Were sewage odors detected when arriving at the site? ❑ Yes ® No orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal S ystem Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form C. System Information (cont.) 170 Concord Ln. Property Address Osterville MA 02655 Cityrrown State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): i Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): All working at time of inspection. Septic Tank(locate on site plan): 1.5' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) Dimensions: 8'x5'x5' outside 1000 gal. Sludge depth: '6 Distance from top of sludge to bottom of outlet tee or baffle 2.1 Scum thickness .5 Distance from top of scum to top of outlet tee or baffle .3' Distance from bottom of scum to bottom of outlet tee or baffle .5' How were dimensions determined? sludge judge orenberg.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank shows no leakage at time of inspection. Grease Trap (locate on site plan): Depth below grade: N/A p g feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A N/A Dimensions: Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last N/A pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 l Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes❑ No Date of last pumping: N/A Date Comments (condition of alarm and.float switches, etc.): N/A Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 5 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was not leaking but backed up due to overfull sas. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes '❑ No Alarms in working order: ❑ Yes ❑ No orenberg.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments �^M Subsurface Sewage Disposal System Form C. System Information (cont.) 170 Concord Ln. Property Address Osterville MA 02655 Cityrrown State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System SAS locate on site Ian excavation not required): p Y ( ) ( p If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ 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.): 1 6'x6' pit full to top and in failure. orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts F Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A I Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form aS Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection 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. ®ll71c®II° n. /S #170 r R 0.6 � o orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 ' y Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form '4M C. System Information (cont.) 170 Concord Ln. Property Address Osterville MA 02655 City/Town State Zip Code Charles Orenberg 6/20/11 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: i ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: i ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Observed site shows no sign of high groundwater. orenberg.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 LA CATION * 110 SEWAGE PERMIT NO. VILLAGE I.NSTA LLER'S NAME 6 AD.DRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED /�� �z I 1 m P p No.`t.2n del:.. r ✓ i FEs... �5.................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ZZ - I ZI c.v. ..............._0F....2#IR�TI.E L,0..-------------- AV� Apparatiou for Uiipngtal Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SystemT ..... �......�l.../ZL .OZ4 ..... ocation-Address or Lot-No. C� Ts...r .Ty._..1. -..........�. .��>�1 .....p Owner ddress a ...................... .. .04 Installer Address dType of Building ,y Size Lot............................Sq. feet 4 U Dwelling—No. of Bedrooms_____________ ............... Expansion Attic ( Garbage Grinder ( ) P4 Other—Type of Buildingf.C� r _ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------•-•-- . w Design Flow......... -_...............................gallons per person�er.1day. Total daily flow............ �?._Q.........___.....gallons. WSeptic Tank—Liquid capacitylODQ._gallons Length.__----•..._._.. Width.......... Diameter----"'........ Depth... ........ x Disposal Trench—No. -----l............ Width.................... Total Length.................... Total leaching area----jv^o....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosin ank ( ) aPercolation Test Results 2 Performed by._. / X7r!'-Y..I'-.1-��/-_L.......................... Date........................................ .-- Test Pit No. 1./ ._______.minutes per inch Depth of Test Pit.................... Depth to ground water.*6.7.---..j=ira*-;h (x, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___•______--__.••..____ a •-•-•-......-•••------------•-•--•••-----••-------•-----__-_ 7.............;1............................................................................ ODescription of Soil---. -SA..M...................: ... ........ �g V .................................. x �., --•------------------------- w -•----------- -----------•---------•-------•-----•-------------------------------•-••---••---------------------------•----------------•-----•---•--•----------•-----•............_...-----.....--------- UNature of Repairs or Alterations—Answe when applicable.___............................................................................................ --------••-•---------------------------------------------------•--• -------------•-----------------------------------------------------------------------------------•--------------•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code The undersigned further agrees n place the system in operation until a Certificate of Compliance has been i e le b d�2 Ith. Sig ........ Z ned ._ -------•------ -• ----- ------ -------•--•- Date Application Approved By.......... 'i,�.._._,. � ..._.1/�. � ._ _ ...................................... .........Date Application Disapproved for the following reasons-----------------------•--------•----------------------••---•---------------------------------...-----•.......__ ---•-------------------------•----...----••-•------•-----................------------......._..--•---------....._......__-•-•-•-•--------•••-•--••------•---------•-•--•••-----•---••--•-•••-------•---- Date PermitNo......................................................... Issued....................................................... Date t- s - i .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•..... .. ..........................OF...........................--.-......... Appliratilan for Diiplau al Works Toustrartinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ' ----------------- -................. -...............-------------------- .--..--------- -•--•-------------••---------- •---------••--------------- •--•-----------------.--. ------------ Location-Address or Lot No. .........._...---•----.....................•--•--•--•-•-•-•-.....----•-.._......................_ ..........--...................................................................................... Owner Address W Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------r----•----•••--•-••---••••--•-••---••••-•-••---••------------------•-------•-•-•-•--•-••-•--••..............--•----••-•---- 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Descriptionof Soil................................................................................................................. ...................................................... U VW --•-••••---•--------------------•--------•---•-•-•-•-----•---------•------------•-•-•-•••••-•-••-••-----••----•••••...._.....-----••---•---•---•----•••••••-•••-••---•--••-----••-•......-•-------...... Nature of Repairs or Alterations—Answer when applicable._..___......................................................................................... .....................................-.................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.L 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. Signed...................................................................................... ................................ Date a. -6L Application Approved By..... ''' : ............................. tr •--•-••-- Date Application Disapproved for the following reasons___________________________________________________________ .........................•............................................................................................................................... Date PermitNo.......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................I.........OF..............................................................I.................... TWrtifirdr aaf Tantlrliaatrr THIS IS TO CER IFY, That the Individual' Sewage Disposal System constructed ( ) or Repaired ( ) by..................... .-. .....�....-•--•--•------•---•--•---•-----•----••-- Installer at .......-• ------- .................... '= has been installed in accordance with the provisions of TIT" 5 of The State SanitaryCode as described in the application for Disposal Works Construction Permit No------- � .✓ ..__.._..._. dated .............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C N RISE AS A GUARANTEE THAT THE SYSTEM WIUNCTION SATISFACTORY. DATE....i1= .........-•----•........:..............•--------•------- Inspecto THE COMMONWEALT ASSACHUSETTS BOARD OF HEALTH ..........................................OF..........................................................._.........._............ f/ No... .z.'.. . . FEE.....of Disposal IV k TnntrndUan rrmi# Permissionis hereby granted.............. ...........I............................................................................................... to Construct ( r Repair ( ) an Individual Sewage Disposal System at No------------- -- ^�-,Ao-•---•-•--c2:� ....�- .,_.i... � ? Street as shown on the app ' do or Disposal Works Construction Permit No..................... Dayd.......................................... --- 7 •----•----- _ - ---------- /f B rd of Health DATE.---•••• .• --z-------------••-----•--•-------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS S/TE PL A N T YPICAL PROFIL E SCALE — / . 30 ` �L, �L, 48 . 5 NOT TO SCALE IB"STD. LT. WGT. C. MH COVER 47. 5 4w•00 ` 4"JIZ 4"BIT. FIBER PIPE TIGHT JOINTS FLOW L/NE OUTLET LEVEL TO FIRST JOINT - OWEL L/NG " I4 o O4 2 SoEC/ TEENDARD PRECAST 3 Q — �� p1 CONCRETEI��GALLON 4/•�9 - SEPTIC TANK D/S TRIBU T/ON BOX B TO BE INSTALLED ON LEVEL , STABLE BASE, SEPTIC TANK TO BE INSTALLED ON LEVEL , STABLE BASE Opp 5f� - I L I ,L I, 00 2"- //B" TO 1/2" WASHED PEA STONE L EA CHI NG PI T ALL AROUND FREE OF IRONS FINES E� , �✓ � � � BASE TO BE LEVEL C' AND DUST IN PLACE l 40 ° BRICKS MORTAR COURES 3/4" TO /-l/2" WASHED CRUSHED AS REOU/RED TO BRING STONE ALL AROUND FREE OF F - / N L o COVER TO GRADE 2AND /FRAMECOVER 7 IRONS, FINES AND DUST IN PLACE. C__ �8 . O7- I0 � 16,411 4jp q S T,D P.eEC,rl,$�'•�,oi1�G� � ' / Z L. EACLl B A 5 /4/ 46 ��, 4" —FLOW LINE LEACHING PIT SECTION— INL ET __ - - ,,, TD. P,eECsll„S/- CD.UG. 8 - _ �`aOiZ `"!P ♦ r � �'4 t/,t� P/Pf 1. CONCRETE TO BE 4000 PSI 28 DAYS I Gvy — _ �_ a[ Ep /G - — 2. REINFORCED WITH 6" x 6" NO. 6 GA. W.W.M. 6 cc� ¢`/ 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS. 9 46Y9 OI OPENING WITH 4-//8" 4. NUMBER OF PITS REQUIRED / `� ZQ OUTER DIAMETER B NOTE: EXCAVATE TO ELEVATION o a 0R LOWER AS 3 P,C. DUJL. _ _ e 1-3/4 INSIDE DIAMETER , ��GL• el-. 46.5 N - ' 3 REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN A- GRAVEL TO DESIGNED GRADE . 4 G I \ v �' 42 MIN. EFFECTIVE DIAMETER (NOT TO EXCEED 3/ TIMES EFFECT!V£ DEPTH) �' Ot ► �� �-v WATER TABLE AlOA14 38 `4 4x9 , A` SOIL AND PERC. DATA GENERAL NOTES c43 r �7 �7' �'15e' \VIC PERC. RATE : Z MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. 44 ,u c�2lo'$(o'Gc/ �TK f3A TEe l/� E - s( L a cJ JO/tJE$ p. E . SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD -�- -- - TEST BY: _ _ .__. PRECAST REINFORCED CONCRETE UNITS. EDdiE Exisr. /ovinr.l y ____ WITNESSED BY: 6q1�'GG_'e_D 8 �_ _ ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE tiC O,C Q L A k/ � — z6/8/ TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , 4 p " t; ! E J TEST PIT GR. EL.: DATE ' MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF TEST PIT NO. 1 TEST PIT NO. 2 SANITARY SEWAGE EFFECTIVE I JULY 1977. 0 ". '/350 0" ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE S� �� Z96 - ---- BOARD OF HEALTH. AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE ED, 5 4 1)D 5 A /4 2� BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED 144" OTHERWISE. _ DESIGN DA TA BEDROOMS 2 DISPOSAL /./otiE EST. TOTAL DAILY EFF. 3-30 GALS. L EGEND — $E'TIC TANK /DD 12 GAL. SIDEWALL AREA Z' S GAL./SQ. FT. BOTTOM AREA /' GAL./SQ. FT, SEWAGE DISPOSAL SYSTEM Oxop EXISTING GRADE LEACHING REQUIRED 10 . 90 SOFT. ZONE �o. 3 oo FINISHED GRADE ACTUAL LEACHING AREA J'7. 5o SQ.FT. FOR O. 00� INVERT ELEVATION �jf/fi) �,L-` ���-�` Lr_ 0 T�Z��L LE ��E� C� NTS DOMESTIC WATER SOURCE: 7"0`4o xJ eat A T E,e �o c1Co eD L q .cJ -- --- --- PROPERTY LINE A�No�l�irsw • �5rE2�/ /LLE A',eAjS57 a � E MASS PLAN REFERENCE: � c T /O a � T Ee 11 iL L E 'i c- A4 rT 5 �r —" - MEAN HIGH WATER r ; ,�" j �t s_ SCALE: AS INDICATED DATE : BENCH MARK DATUM: A 5 5 4`A4 ED MARSH WM, M. W.4RWlCK B ASSOC/AYES BOX BO/ - NORTH FALMOUTH .mot, oo,D za,c%� ,va.v- IVA zA ,et� `C � AQ .UEL �C1a, z5'000l oo�S�# 4�3�78 - MASSACHUSETTS 02556 i fop o f -j'o /off 70 Cove r-s 4" cas f iron or o 4 o P v c pipe. wlmin. pi-t-CA7 V4-per f J .��!/-T._.._.,,,, OOf 1 -4" SG/7. yo P V G TT "�1 � m/n. p,yGh ��8"/per ff. cl J lr / . e ,rrp;•C1;JJSI7ed�• -./ e°° e: s• • �y a` D e s /l7V Se - c / cLr7K t 1 /��z - i ;._. . •• '. , .:_ •.' -. . .•... ' -/ y o°s °• ° • �.,i �_. -fir/ ..._„_....d.L� —.L. 6 r ° J j �(O.;crcishe°cl•�J`'f'o/7�a LL.$e.r'a • • Q/J' l.!/ inV. el. 6 o G` Z € ) / 9rour,d wafer �-a6/e e/ev. _ ,, i4 boffom f esf hole e/ev. _ iSEWf-� GE- SYSTE ,f" PJ2GF/LE- S G N L-) Iq T/9 A/U r�B E R O� B E o/e O o/�s : 7' S 7- H _ L CD G GF pj3,9GE DISPOS/9L UN/T : / l`J1 LGC7I / y. TEST OATS �1 ( T07-/9L E' STlMJ9TED FLOW � - -.- GAL PE/P_COLATION ,eHTE : - ~� M//v /Ivc Eck• SEPT-/C TANK CflPAc/TY: GAL. /-/oL E1 HOLE Z m J9cTUAL SEP7-lC 7TANK. SIZE : GAL. e/.= �s/n+ 807_ /,vA L� z GAL. 1 ? / � �./, TOT,gL [-EACHIAJG C/gPRC'ITY - R GP L. � RE- SC-)P-VC- LEACHING C H P7 lTY c.?J// - �e c �! " ?J r ALL Wo,ekM a 1 ? 7 RNSH/P AN MATEJ2/!-BLS TO O. .P. T/T � 5 j O § P ND THE- TOWN ©F F- ULES l9 "D /2EGULPT/OR.IS FD/2 j SUBSU/eFACE 4D,/S'PoSFg4_ OF - S A Ill I T fl l@ Y S E W R G E. job 2) GOMPL/AI\IG E !�//TH ZON//VG /2 E G[JL/9T/ONS _J _ SHALL BE DETEPMINED BY BUILDING I1`1SPE C7-0 C0fv7M/SS /O/VE,E?. L-XISTIIVG /9IV0 F//VAL G1E'1q0ES SHHLL. "7 2EM gIAJ ESSENTIALLY THE Sf9 MC—. 'q) 7HE ?7YE ,G-OG.r}"770 J d�" 0 /9 T E /3 P P Fz o v E O . B n. o F H E ,q L T H 7D Eli i Ti l /- GENT S / TE- PL G 0AJS -F EIUC7-/0 &J L O C /9 7-! O IL/ . (D ok 12 Go /e S / T PLAN E-FE )eE l\/C E- : � P /z ? 6� 1 ` / #71 J E P/9 /k=-' E=- D F O)P I'/� J i / i a 5 y0W a ScAL E � DATE r ISO . l cL.I� L EGE,v LD / • [ ' p• e'Xistin Spot elev. - D•OF���C 3 9 c o rn �o u rL,21/E' /G� � � fyP. prop. fin. sPo t e/ev_ - o. o ►� I TL � . �/� �I�� �l 1/• G;41 ,° Z /Drop. -Pir/. confout o o-- �S E is- -f-est ho/e /oca7`-ion w Loc /yT/oN MRP _� -S Z S c A L E: