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HomeMy WebLinkAbout0085 COTTONWOOD LANE - Health 85 Cottonwood Lane 252-155 Centerville I I No. 4210 1/3 ORA 10 X0 &, A o 0 m ^.A a r �-, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 � Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 page. City/Town State Zip Code Date of Inspection 4" cn Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information / filling out forms s'4)L on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, IRS use the return Name of Inspector key. Eco-Tech Rapid Response Q Company Name 155 George Ryder Road South Company Address Chatham MA 02633 City/Town State Zip Code 508 364-0894 1328 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 Fu j 6a1, the Local Approving Authority AVID `NGs 0 �OWR N October 31, 2016 Inspector's Sign re o �p Date �IiTER The system ins - A, It a copy of this inspection report to the Approving Authority(Board of Health or DEP) ys 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White 'Owner Owner's Name required for is Centerville MA 02632 October 31, 2016 . required for every ;page. City/Town 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: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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 exfiltrationldFtank 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. <f *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): . ' L. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑- ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ 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: v ❑ 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: El Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31 2016 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 ❑ ® 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R.White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the-field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31 2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 283 gpd 9 ( Y 9 (gpd)) Detail: 2014: 97,000 gallons 2015: 110,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31 2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner's agent 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R.White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 7+ years. Certificate of Compliance for a new system was issued 6/11/2009 (Permit#2009-144 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Sewer line was not accessible for inspection. Septic Tank(locate on site plan): Depth below grade: 1feet 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: 8.5 x 5 x 6-1000 gallon Sludge depth: 8 in t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 page. City/Town 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 26 in Scum thickness 6 in Distance from top of scum to top of outlet tee or baffle 7 in Distance from bottom of scum to bottom of outlet tee or baffle 11 in How were dimensions determined? Design Plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping recommended at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 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 I ' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 page. Cityrrown 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 at outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No adverse conditions observed. 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system - M - Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. One cover was opened and unit was found to be empty. 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 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is Centerville MA 02632 October 31 2016 required for every 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 COTTONWOOD OoOoD LANE W THIS SKETCH IS ? DRIVEWAY BEST VIEWED INCt COLOR FORMAT Ui O F r§S T§NG 508 364-0894 DWELLING 0LOC� B GA�I K O ON OO DRIVEWAY A 1�DEPTIC TAN O 1 0_j D,BOX 1 LOOA ITIOnNIS -OF SEPTIC COMPONENTS � Q,3 � �- -DISTANCES IN DECIMAL FEET � � ' u +w.9dy J' t I� NOT A BrOAELEpY �p TO 1 27 27 LEACHIN SCALE 2 39 19 3 42 25 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31, 2016 page. City/Town 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: 25+ 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: 5/25/2009 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: Barnstable GIS Department records You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health a witnessed test pit in which no groundwater was encountered to a depth of 10 feet. Town of Barnstable GIS Department records indicate that the property is over 25 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Cottonwood Lane-Assessor's Map 252 Parcel 155 Property Address Deniz R. White Owner Owner's Name information is required for every Centerville MA 02632 October 31 2016 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 SEPTIC INFOJA� ECO GEOHYDROEOGICAL PROFICE . - NOT TO SCALE PRECAST DRYWELL BOTTOM OF LEACHING PER DESIGN PLAN LEACHING IS ABOVE HIGH GROUNDWATER O N GROUNDWATER ELEVATION PER GIS MAPS t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN O STABLE LOCATION a 7�'^ ��(�i__.�SEWAGE # _ VILLAGE— (J ;Oe ASSESSOR'S MAP& LOT 4 iI j NSTALP, R'S NAME&PHONE NO. SEP'1IC TANK CAPACM. 66 O Ca a I LEAt;I3]fNG 1FACIF.TI'Y: (type) ad G�S (size)__3 N0.OF BEDROOMS ..._. BUILDER OR OWNER PERMdITDA711:,.._._,. . .--—... -CO 4P[..IANCE DATE:— Separation Distance Betweep the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Pnility Itbee Private Water Supply Wepl and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wedand and Leaching Facility(if any wetlands exist within 300 feet of aching faci ty) O G D Q O d L' A -0- 3 5 ' / 5 ' i rjlessage Page 1 of 4 O'Connell, Timothy From: Lauzon, Jeffrey Sent: Monday, August 06, 2012 10:22 AM To: 'dwhite@acmebook.com' Cc: Anderson, Robin; O'Connell, Timothy Subject: RE: 85 Cottonwood Lane Centerville MA convert to single family Deniz White, Regarding permit application number 201203266 to restore to a single family home; I have approved the final inspection and have signed the building permit indicating such. Apy additional work needing permits would need to be addressed separately. Jeffrey Lauzon Local Inspector (508) 8624034 -----Original Message----- From: Anderson, Robin Sent: Monday, August 06, 2012 9:47 AM To: Lauzon, Jeffrey Subject: FW: 85 Cottonwood Lane Centerville MA convert to single family Please respond. Robin C.Anderson Zoning Enforcement Officer Town of Barnstable 200 Main Street Hyannis,MA 02601 508-862-4027 -----Original Message----- From: Deniz White [ma i Ito:dwhite@acmebook.com] Sent: Monday, August 06, 2012 9:38 AM To: Anderson, Robin; O'Connell, Timothy Subject: RE: 85 Cottonwood Lane Centerville MA convert to single family Hello: I was told all work was done and inspections passed, including some additional stuff that was needed to bring up to code but since this was not coming from your offices I wanted to make sure. I am going down to the Cape to settle up and wanted to confirm that we are all set and make sure there weren't any docs that I need to sign or receive. The builder said he had some docs from your services are these all that I need? Thanks: Deniz White From: Anderson, Robin [ma i Ito:Robin.Anderson@town.barnstable.ma.us] Sent: Friday, May 25, 2012 3:06 PM 8/7/2012 Message Page 2 of 4 To: Deniz White; O'Connell, Timothy Subject: RE: 85 Cottonwood Mr. White, You requested this early court date. Normally, it would take longer to obtain a date. I would suggest that all of the work be done by Weds. and I will go with Tim and close everything out. If it is satisfactory I will inform the court on Friday morning when I ma there for my other cases. The inspection must be on Weds. as I am unavailable on Thursday all day. Let me know what you would like to do. Robin Robin C.Anderson Zoning Enforcement Officer Town of Barnstable 200 Main Street Hyannis,MA 02601 508-862-4027 -----Original Message----- From: Deniz White [mailto:dwhite@acmebook.com] Sent: Friday, May 25, 2012 12:15 PM To: O'Connell, Timothy; Anderson, Robin Subject: RE: 85 Cottonwood Hello: That is fine for your required work. You gave me about another 40+ days from today to have it done, though it should be done late next week. I have a court date next Friday for Ms. Anderson's sink and cabinet issues. As mentioned I was told this required work has been completed. Ms Anderson are you willing to put on hold the court date if you want the dual inspection? I can't be sure the stuff Mr. O'Connell is concerned with will be done by next Thu and the hearing is Fri. Do it as separate inspections? Whatever you wish. Awaiting your reply. Thank You: Deniz White From: O'Connell,Timothy [ma ilto:Timothy.00onnelI@town.barnstable.ma.us] Sent: Friday, May 25, 2012 11:55 AM To: Deniz White; Anderson, Robin Subject: RE: 85 Cottonwood Once work is complete I due suggest a dual Inspection (health and zoning). Timot4!j N O'(lIonnrll, +R.S R-qFUU4 DnSPrrt0r Down of Tgarnstablr 200 , Rain _-,Nrrrt Uannis, AMA 02601 8/7/2012 Message Page 3 of 4 +,Email: timnt4!J.nrnnnrll@tVrWn.hurnstahlr.ma.us -----Original Message----- From: Deniz White [mailto:dwhite@acmebook.com] Sent: Friday, May 25, 2012 11:40 AM To: Anderson, Robin Cc: O'Connell, Timothy Subject: RE: 85 Cottonwood Hello: Fyi: Contactor(William Da Silva) said the work on the walls will still be going on at least thru Tuesday. The work you were concerned with in original tickets is done I was told yesterday. Would you want me there? I just want this resolved right as these are the last tenants before I sell, maybe I am an easy touch but I am beginning to believe tenant actually did not know sublet was wrong. Please give a time if so. The health dept gave 60 days as of a couple weeks back but we are doing it all in one go. I was told the current setup had 2 rooms (over the 4 allowed) that met the definition of bedrooms in your town, which was basically areas with privacy as I understood it. Which could be resolved by putting in 5+ft openings in certain walls where there are now doorways. I guess this is what you referred to as"flow" in our phone call. The health dept also said despite the 2 exits from the basement no one was allowed to sleep in basement room. Only Home office, game room etc... is an allowable use. That person (a relation of tenant will be moving upstairs when upstairs work is done. I am mentioning this to avoid having the Health people having to come out twice, it that is a problem. Thanks: Deniz White From: Anderson, Robin [mai Ito:Robin.Anderson@town.barnstable.ma.us] Sent: Friday, May 25, 2012 10:34 AM To: Deniz White Cc: O'Connell, Timothy Subject: 85 Cottonwood Dear Mr. White, A joint inspection with Health is recommended for next week. If the inspection satisfies us I will notify the court to dismiss the ticket otherwise the hearing will continue and you will be required to appear. 8/7/2012 Message Page 4 of 4 Robin I Robin C. Anderson Zoning Enforcement Officer Town of Barnstable 200 Main Street Hyannis,MA 02601 508-862-4027 8/7/2012 � oLjiiN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: �J Shawn Mcelroy Name of Inspector Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 Cityrrown State Zip Code 1-508-495-0905 S13971 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 Further Evaluation by the Local Approving Authority Z4 a 5-23-11 Inspector' ignature Date` The system inspector shall submit a copy of this inspection report to the Appro'ing Autf sty (Board of Health or DEP)within 30 days of completing this inspection. If the system is la sharedr,�aystern-dor has a design flow of 10,000 gpd or greater,the inspector and the system own shall sLkWit We- report to the appropriate regional office of the DEP.. The original should be sent to the sytem Meer 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. Lai,, co/fo), I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town 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: System is in good working order with no sign of 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. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ 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 i y q P p 9 y pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and.the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City(rown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has 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 ❑ ® 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 '/day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. Cityfrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'G M 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City[Town 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. 0 El Determined in the field (f 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 3 Number of bedroom 3 (design): s actual DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town 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? [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)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 4-2011 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A 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) (f 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2009 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12 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 gal Sludge depth: 12" t5ins-11/10 Titie 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 ;M 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. Cityfrown 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 20 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. 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•11/10 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 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town 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•11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town 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.): Good condition with water at working level and no sign of back-up from field. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500's ❑ 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.): Leach chambers in good condition and empty at inspection with no visible stain lines. 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•11/10 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 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. CitylTown 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. Cityrrown 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 1 r� 0 C o 00 L 19 -0- 3Y 6 -19- r5 • t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town 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: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Cottonwood Ln Property Address Deniz White Owner Owner's Name information is required for every Centerville MA 02632 5-23-11 page. City/Town 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ° �1,��� � � � � i , _. � �. I I �� r I � -,. SENDER' COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A Signatu _ item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X - i"T ❑Addressee so that we can return the card to you. B. R by(Printe N e) C. Date of Delivery ■ Attach this card to the back of the mailpiece, _ I or on the front if space permits. , D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No T WL 7 ( 4 3. Service Type 16-Certified Mall ❑Express Mall ❑Registered ❑Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. r 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number, (Transfer from service feb 1 #l 7 ,0 6; p 81 p #P 0 0 p 35 2 5;1 6 6 9j6 f i i I T PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 i UNITED STATES POSTAItt/+C ��` r°•f���-'i 6� {`r�� ,First-Class Mail Fees Paid 6 . .. •s:: ,:=a :;.;�.�. ,• t v-•a��" Permit No.Jb I • Sender: Please print your name, address, and ZIP+4 in this box • I I I I Town of Barnstable Health Division 200 Main Street I ' 1 Hyannis,MA 02601 I I �I Certified Mail#7006 0810 0000 3525 6696 Town of Barnstable Regulatory Services BARNsrABM ' "SAS g Thomas F. Geiler,Director fOMI►�A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office:508-862-4644 Fax: 508-790-6304 I � May 8, 2012 Deniz White 71 Allison Street " ✓" Newton, MA 02458 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION, THE STATE ENVIRONMENTAL CODE, TITLE 5. The property owned by you located at 85 Cottonwood Lane Centerville, MA was inspected on May 7, 2012 by Timothy O'Connell, R.S., Health Inspector for the Town Of Barnstable. This inspection was conducted on the basis of the rental registration of the Town of Barnstable. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of six (6) bedrooms observed in this dwelling; five (5) were observed on the first floor, (1) one was observed within the basement. However, the existing septic system (permit # 2009-144) was not designed for six bedrooms. It was designed for four (4) bedrooms. You are ordered to correct the violations listed above within sixty (60) days of your receipt of this notice by pulling any required building permits. You are ordered to remove any two bedrooms from this dwelling. This may be accomplished by removing entrance doors and by opening all door-way entrances to each room to minimum of five feet wide openings. This will bring the total bedroom count down from (6) six to the appropriate (4) four as designated by your septic permit. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. i QAOrder letterMousing violations\Rental ordinance\85 cottonwood In r PER ORDER OF T E BOARD OF HEALTH omas A. McKean, R.S., CHO Director of Public Health Town of Barnstable i QAOrder lettetAHousing violations\Rental ordinance\85 cottonwood In E SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign t S 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. B. Receiv by(��U 'Name) C. ate of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delive address different from item 1? ❑Yes 1. Article Addressed to: '-. If YES,a erli addres elgw: ❑ No 1 ' 3. Service Type I - C 6� 7 OLCertified Mail ❑Express Mall ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2 (lrans`ei Number `131,.p 0 0 0- 3 5 2 5; 6 6"4 i1 CJ PS Form 3811 February 2004 r Domestic Return Receipt' 102595-02-M-1540 UNITED STATES POSTAL SERV[GF .>Y,�.atr $ t^" I y: I • Sender: Please print your name, address, and ZIP+4 in this box • I I � i ' 4 Town of Barnstable Health Division 200 Main Street ' Hyannis, MA 02601 I Y ��.:,� l�l3t3iEil�?iii?11i3iF3?�fF�li�l.lFif�iiFiil�?l��:?!i1tF3iiF•�F� Town of Barnstable �FtHE t Regulatory Services Barnstable �p do Thomas F. Geiler, Director i erirajl/ Public Health Division ' 9 MASS. Thomas McKean, Director 2007 �Ar 1639. a`� 200 Main Street f0 Mp`l Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 15, 2012 Deniz R. White PO Box 1060 Centerville, MA 02632 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 85 Cottonwood Lane Centerville, MA. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications; they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2012 fees included. This must be 'completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your c)pperation. Timoth, O'Connell, R.S. Health Inspector Health Division Direct#508-862-4646 I • COMPLETECOMPLETE THIS SECTIONON • ELiYERY ■ 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 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 i or on the front if space permits. I D. Is delivery address different from item 1? ❑Yes I 1. Article Addressed to: If YES,enter delivery address below: ❑ No I `- I E? Deniz R. White Service T e 1 i 3' PO Box 1060 s Certified Mail Express Mail i Centerville, MA 02632 ❑ gls ere ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) — ❑Yes 2. Article Number 7326 �810 0p00 3524 5355 �� (Transfer from service label) Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 (1.1111(till(frl11 fit(tt fill ra1lfr Tiff(I M 1l1f11r(ifrr(III1 0120:V)T ;Q.�. 3�� N31<31N3. 01 NNrUMN ;. Z£9Z0 VW `aliinl;ajua0 I 090I xog Od i a�ttlrn •-d zivaQ SSE9 1125E 00 D0 0`190 90U. ZLOZ 96 21b'WSLbl9£6000 II ;y + o9L-9900 $ 6 09Z0Ml dIZZO I 109ZO VW`sluutAH aa�IS u�W �r��rT a 6{q r• 1 OOZ 'iP 'SStlW . '3'10Vi5NNVB oL•J� � ,T• I . aotsfnrQ galsaH a?Ignd S3M08 A3Nd�(��b1SOd S(1 a�QC jSU IEg 30[IMOZ I 1 �+ . I I � . • - Town of Barnstable Regulatory Services Barnstable do Thomas F. Geiler, Director AN."e icaCO Public Health Division snxxsrnBi.e, Mass. Thomas McKean, Director 2007 039. 3�a`` 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 15, 2012 Deniz R. White PO Box 1060 Centerville, MA 02632 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 85 Cottonwood Lane Centerville, MA. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.bamstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2012 fees included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your co eration. c Timoth . O'Connell, R.S. Health Inspector Health Division Direct#508-862-4646 k4lealth Master Detail Page 1 of 1 Logged In As: TOWN\oconnelt Health Master Detail. Wednesday, March 14 2012 Application Center Parcel Lookup Selection Items 1 Parcel Septic Perc Well Fuel Tank Parcel: 252-155 Location: 85 COTTONWOOD LANE, CENTERVILLE Owner: WHITE, DENIZ R Business name: Business phone: Rental property: C+ Deed restricted: r Number of bedrooms :�0 Contaminant released: F7 Fuel storage tank permit: r Save Parcel ChangesAReturnto Lookup � ', Parcel Info Parcel ID: 252-155 Developer lot:LOT 167 Location:85 COTTONWOOD LANE Primary frontage: 117 Secondary road:BEECHWOOD ROAD Secondary frontage: 105 Village:CENTERVILLE Fire district:C-O-MM Town sewer exists at this address:No Road index:0358 252155_1 Asbuilt Septic Scan: 252155_2 Interactive map w .. GP (Groundwater Protection Overlay Town zone of contribution:District) State zone of contribution:IN Owner Info Owner: WHITE, DENIZ R Co-Owner: Streetl:P 0 BOX 1060 Street2: a City:CENTERVILLE State:MA Zip: 02632 Country: Deed date:01/31/2003 Deed reference:C168104 Land Info Acres: 0.29 use: Single Fam MDL-01 Zoning:RD-1 Neighborhood: 0107 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info Building No ear Buil Gross Area Living Area Bedrooms Bathrooms 1 1981 13429 11769 15 Bedroom 3 Full Buildings value:)z129,100.00 Extra features: A41,800.00 Land value: A160,300.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=252155 3/14/2012 LjJ K^ 4Sitizen Web Request Page 1 of 1 a 0�\'iTAO 41435, 19- Citizen Request Management - Internal Use tip pAh� Request ID: 36694 Created: 3/9/2012 2:44:18 PM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Chapter 170 : Housing Overcrowding -Night Anonymous: No Category: Only Section 353-1 Garbage and Rubbish ., E.C. Date: 3/23/2012 Created By: Wadlington, EllenB Citations: Health Office Time Worked: 0 Response Time: 0 Requestor Details: Email: Z Request Location: 85 COTTONWOOD LANE Centerville, Ma 02632 Parcel Number: Map: 252 Block: 155 Lot: 000 Request: Neighbors have sent registered letters to owner, came back undeliverable.The property has at least six to seven cars; large work trucks; side apartment where the police have been there several times in the last two weeks; lots of trash and debris. Unregistered rental not side apartment as seen neighbors.This was put on the BIRST in 2009. Request Work History: r Internal Note History: System entry on 3/9/2012 2:44:18 PM: Assigned to O'Connell,Timothy. �f http://issgl2/InternalWRS/WRequestPrint.aspx?ID=36694 3/12/2012 I Message Page 1 of 1 Anderson, Robin To: Tamash Craig Subject: RE: 85 Cottonwood Lane, Centery Thank you Robin C. Anderson Zoning Enforcement Officer �Ibwn of BarnstabCe 200 Main Street Hyannis, JIA 026o1 .5o8-862-4027 -----Original Message----- From: Tamash, Craig [mailto:tamashc@barnstablepolice.com] Sent: Friday, March 16, 2012 3:14 PM To: Anderson, Robin Subject: RE: 85 Cottonwood Lane, Centery Sorry for the delay. Deniz R. White, 11/27/1964, shows an address of 71 Allison St. Newton, MA 02458. Sezen White,04/16/1935, shows an address of Box 1060 and 471 Shoot Flying Hill Rd, Apt 1. Craig Tamash Deputy Chief Barnstable Police Department PO Box B Hyannis, MA 02601 508-778-3801 508-790-6317,fFax)_� From: Anderson, Robin [ma ilto:Robi n.Anderson @town.barnsta ble.ma.us] Sent: Monday, March 12, 2012 2:48 PM To: Tamash, Craig h Cc: Chief Subject: 85 Cottonwood Lane, Centery Good Afternoon, I need to ticket the property owner of 85 Cottonwood Lane, Centerville. I am unable to determine where that party actually resides although I know he/she does not reside at the subject property. Can you provide me with a valid address and DOB for Deniz R White, please? I have a mailing address of PO Box 1060, Centerville and older reference to BOX 1600, Centerville. I am also seeing the name Susan/Sezen White with associated addresses including 471 Shootflying Hill, 940 West Main Street, & 1 Barn Board, West Yarmouth. Please advise: Thank you. !R96in Robin C Anderson Zoning Enforcement Officer Town of BarnstabCe zoo Main Street Hyannis, MA 02601 5o8-862-4027 3/16/2012 Postal ServiceTM - --- • RECEIPT ;- BAR 73935 (DFor delivery information visit our website at.wvvw.usps.corna omestic-!U--&-Qn-l�;No Insurance Coverage Provided) .D : ,, �. F rg ..L-._..: MV/MB REGISTRATION NUMBER Lrl fTI Postage $ Q p w - - p Certified Fee p Return Receipt.Fee /' ° _ P He] `r+I (���( f] I �� G 4�t 1� a Z(Endorsement Required) .7 - 61 �It/ „� ` L TION OF VIQLATION-•_„) LC Restricted Delivery Fee E /•,. i�v 20 I Z ', ��): ) ' )( /� J - C3 (Endorsement Required) �� Q - •� ENFORC G D T. BADGE NO. _ rW _ p Total Postage&Fees. � 1,: /f �� /� a o l3 sent To TAT ION X J ¢ - C3 street A t.No __"_"__ THE NONCRIMINAL FINE FOR THIS OFFENSE IS w or PO Box N------ L - --- Clry,State,Z/ 4 """" �� "-" """ """ """" ARO TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILCOPERATE AS A FINAL a aas� W rerse jearin in person between mailing02601,or by 8:30 A.M.and 4:00 P..M.,Monday through Friday,.legal holidays excepted, w Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS.OFTHE..DATE OFTHIS NOTIIC�Emoney order or postal note to Barnstable Clerk,P.O.Box 2430, � (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET 9ARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. - - (3)if you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be Issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense.charged,and enclose payment in the amount of$ ltl Signature x~ z NAME OF OFFEND �� k a BAR --r a �' �-r� +,�• rat ���z�,. -. L-cTOWN..OF ADDRESSOFOFFENDEfl r 1i ry '�i > �: ° t4 f.d-�.�} :§ ,BARNSTABLE 'Cm STATE,ZIP COOS 3 ti; z L y .k w r 60+6 MV/MB REGISTRATION NUMBER w - ,� 'R.� : q ..: a, 8 S -�-F��- 5�'x+t ::, d ;s+."�W.r'"!,l :N _ �,✓' \.�+.. l e.,,s rr a - �«. t. NAR\A7AalE. y {i t,�{ �: •+.'.�,j1' -F L 1 \{-w 1[ I- �y tq 'C.-r �.V'^.,+.4 .,r-;+..,• a I Ys �'AASS. "t i R. r '/`^ '`� NAME OF OFFEND 1 _h aM is '1 '�<a- x °�a�rs;u„v 'st >� y: �. - Il7-7 U•I y#'is.! Fr,; �:,.4 d :F !-4 fa -t-A"r-�'"y,• ,J ",+� 'L `mac' q"' 9-:'t'fh a.,� �l BAR, Mill :1 O ADDRESS OF OFFENDEtI. J. "jF' (r�• f LU �'-+4 z 'Cr� r�•�1ax'f..Y„ 4,y._n {t8 "'_ TY, `fi't M -fi ""� "rt'?,(}'Gx fi, ,,¢ wk' IaS i,�,taze xr,"! x * r •$ J r. _ Mil BAR STABLE CITY STATE ZIP CODE.... >" s�°s K.-_ s "e- 'g' 'Y. ,9 P-^-#. k�: ✓ t....z,.,,...�.w,, aN- lJJ x - MV/MB REGISTRATION NUMBS[ i , 5-$c_-.¢ .y5-",°ri�•T�-4esr: °r"'�s '` .7t:' IL puts FPS s # a - ,-F NAR\'l,TARIE ) -tom L fIld "OS AL d I a'"`'r`-x �"-. ` `fi' ° 5 """T I•* " r I '�. .Y,P + -t .a°v aq'`3t^i A`'^4r c xJ,. - Y, TLLJ IME AND DATE 0 VIOLAT N l a< : n r ? it aW to NOTICf:.OF rr de..�1 u a ` L 0 Inu N n § t r> Q EeW;: ' J SIGNATU .0 ENFQRCING t3f50 -., yam-sa3 ; +' -.' VIOLATION � �..I 10 u ,� C/' ksS ";G9'4=�"..,u sic? .�Y - - sAN', OFTOWN . . 1 F L my fi r n s. 3s IS r - HEREB ACKNOWLEDGE RECEIFT-.0t CITATION ORDINANCE t v, _ noble to obtain n�ata HEaNONCRiMINAL f off FINE F_ORTHIS OFFENSErIS = t ~h OW HAVE THE FOLLOWING ALTERNATIVES:WITH REGARD TO DISPOSITION OF;THIS MATTFA ERHLcH;OPTION(1)OR,OPTIONs 2 WILL:OPERA '" a M1t DISPOSI710N WITH NO`RESULTING':CRIMINAL:RECORD -saw *r - O TEAS A F REGULATION � _ - ``� ;�.�,�� ►%I�. (1)You.may elect to pay the above1nei7eiI;by appeanno In rson beMreen 8 30 A.M. nd 4.00 PM M ro FrI legal holid exce W before The Barnstable Clark;200 Main a pe day eys Hyannis MA 02601:„WITHIN- Hyanncr' 02601_or mailfrig a dteck money order or note Berttstable Clerk PO Bmr=430 _t TWENTY-0NE(21)DAYS:OF THE DATE iF THIS NOTICE ` { (2)If you desire to ooidest this matter m a noncriminal you m do so by makng wriflen ray�st m DIS RICT tIJRT DEPARTMENT FIRST BARNSTABLE DIVISION COURT COMPOUND MAI pD STRE aayy cda4on for a hearing.' r N BARNSTABLE MA 02630 Afln 21 D Norrcnminel Headnpa end enclose a copy of tlds K (3)If you.fall to pay the above offense or to request a head within 21 I youfall to } £ h hearing to be due,criminal Corti'taint d�H appear for the h�ring or to pay ary floe determ6red attlle P mey.be issued against you _ r ❑ I HEAEBY ELECT`the first option above confess to the offense.charged and enclose payment to the amount of$ - x � I _ - ATTORNEYS - March 30, 2012 300 Hyannis,MA 02601 Barnstable road Hy VIA FIRST CLASS & CERTIFIED MAIL o (508) 775-3665 Wesley Vlera Fax(508) 775-1244 3 1 (800)899-3003 85 Cottonwood Lane t http://www.wynnwynn.com Centerville, MA 02632 Jeni A.Landers Dear Mr. Viera, ) . Jeffrey L.Madison Richard A.Marton 3 Kevin P.D.Miller***Seth Please be advised that this office represents Deniz White, owne If 85-J S Robert F.Mills Cottonwood Lane and your landlord pursuant to the September 1, 2011 Lease Charles D.Mulcahy John J.O'Day,Jr. Agreement signed by you and Mr. White. Kevin J.O'Malley Anthony T.Panebianco**** Raymond C. * Thomas E.Porates It has come to Mr. White's attention that you may have impermissibly sublet ntes Michael J.Princi the property located at 85 Cottonwood Lane and that you may have installed a second Ryan E.Prophett Rebecca C.Richardson kitchen and/or second living unit. Please be advised that if in fact you have sublet Janice E.Robbins William Rosa* and/or created a second unit,you are in breach of the Lease Agreement and have Dina M.Swanson violated the zoning laws of the Town of Barnstable. Andrew A.Toldo Paul E Wynn Thomas J.Wynn Please immediately cease and desist any and all alleged.subletting of the Of Counsel property. Please also immediately remove any unauthorized appliances and Hon.Robert L.Steadman(Ret.) Hon.James F.McGillen,II(Ret.) return the property to move-in condition (i.e. single family). Failure to comply Keough&Sweeney may result in eviction proceedings. Mr. White also intends, as he is permitted to William E.O'Keefe Edward F.O'Brien,Jr. do_under the Lease Agreement,to hold you liable for the fines the Town of Barnstable,has lodged against him and for any and all fees and.costs related to Admitted alleged zoning violations caused by your actions. : - - , *Massachusetts and Rhode Island •"Massachusetts and New Hampshire - - - °**Massachusetts and Connecticut Please also be advised that you are not permitted to operate any business at •**•Massachusetts and New York this property and that your use is restricted to residential. Mr. White will be contacting you directly to schedule a walk-though inspection of the property in order to confirm that you and your family are the only ones occupying the property and that the property has not been altered in any way that would violate the Lease Agreement or the laws of the Town of Barnstable. If you, have any questions please contact my office. Very truly yours, en1 A: Landers �._.. cc: Client, Robin Anderson, Town of Barnstable TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date _ _ I Time: In Out T ' Owner l�Ci} Tenant Address -7 I ST- Address Compliance Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities �--> 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities -5 ��..- 7. Lighting and Electrical Facilities �Ve 8. Ventilation IiD 9. Installation and Maintenance of Facilities 10. Curtailment of Service Loo _ - 11. Space and Use 12. Exits vw 13. Installation and Maintenance of Structural _ Elements 14. Insects and Rodents 5 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width ►5fi NP o© 110 P-® 0 E 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; t9� Removal of Occupants; Demolition Number of Bedrooms ( Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here e' t r � No. � _ qq Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippricatiou for �Bigoml *pit m Couotruction Permit Application for a Permit to Construct( ) Repair(0111"Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No �� /W -J/VOMO`Q Owner's Na�n Address,and Tel.No. Asscli!5;aa /Pa�5� G ew X&/ 46I l/e- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size Z 6 sq. ft. Garbage Grinder ( ) Other Type of BuildingRLI-7 n Ge No.of Persons Showers( ) Cafeteria( ) Other Fixtures `, Design Flow(min.re uired) 7 gpd Design flow provided 1-11-141 gpd Plan Date / 0 Number of sheets Revision Date Title p it D 1V Size of Septic Tank QD© L°W /A' Type of S.A.S. '3--/5WO,)047 G 0*19 e&KS Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa of Health. Signed Date c�� < lam' Application Approved by G S Date S�ze e j Application Disapproved by: Date for the following reasons Permit No. 20,::�Pq —/e/4/ Date Issued s 2� 41 No. ` �. Fee APO r, 1 ' }' a � Entered in computer: ` -THE COMMONWEALTH OF MASSACHUSETTS� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE;'MASSAC;HUSETTS f appItratton for W6potal 6paem Confstructton -Vermtt Application for a Permit to Construct( ) Repair(i(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Vs- Owner s��N e,Address,and Tel.No. Asse o ap/Parc.®I [�i� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Q _ Dwelling No.of Bedrooms Lot Size , 6 sq. ft. Garbage Grinder ( ) Other Type of Building /•fie llce No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re u. d) 7 Q gpd Design flow provided gpd Plan Date /3 ` Number of sheets Revision Date Title c s S/ >i- /�!�/ d IG �✓ ce,ONwm /C7/l _- r g v Size of Septic Tank ��©df d ��'/S�/l1�i Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in. accordance with the provisions of Title 5 of the Environmental Code and not to P lace the system in operation until a Certificate of P Y Compliance has been issued by this Board of Health. Signed / Date Application Approved by ZZ, �r4 . S Date s 1 z4 d�J Application Disapproved by: -Date-- for the following reasons Permit No. 2 ot::>l —1 yG1 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certditcate of Compliance THIS IS TO CERT Y,that the O -site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )y at � C.Fi' �� Q��?• ��l� "�(,�/ _ as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 60 19 � 41 dated Installer go.(Z T p L o T T Designer Do w CApI� #bedrooms `"l Approved design flow LI QJ0 gpd The issuance of this ermi shall not be construed as a guarantee that the system w' 1 f �ti In as des' tied. Date W 1 t Inspector � ��1 / 0 No. 0"90 q Fee a/00 --- ~^ / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Dt5p0al 6pgtem Construction j9ermtt Permission is hereby granted to Construct ( ) Repair ( {.� Upgrade ( ) Abandon ( ) System located at 55 ,5 IGWMy9 e,,,&1 LJ11 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this pe it. Date 6- — 2,5 " 2O0 q Approved by i%` S , FROM :down cape engineering inc FAX NO. :15083629880 Jun.' 17 2009 11:57AM P2 Town n of Barnstable Regulatory Services R l T184B➢iim F. CaeRler,Director r BARNWARIas, Pugs Public l:lealth Division Thaanimm IV cKeaaim,gDiirectaar 200 IV➢obi,Street .i lymn➢oF.s,AILA►02601 Office: 508-962-4644 feeu: 509-790-6304 T➢➢gtaller &��gfl ➢ er C.er�tifcaLion Form te: Sewage Permit# �y y Assessor's Mapt4'arcel De%iguer. El\,Q' AU-vi Ingtaller: 44-�4/0 Address: 91 _..... _ Address: v0 Ax.... 6 .. On _._... 7. � wII.S issued a permit to install a date _ static sy";tem at �/ l,fU�.c.�ya based on a>.design drawn by (ad.dress) OA < ( D dated 0 - - ( -,signer) Zr certifytliat the septic system.referenced above was installral substaan.tially aeeorditig to the desilm., which may include minor approved changes such as lateral, relocatim). of the distribution box and/or wel-tic v nk. --_ 1 certify that the septic system referenced above was ilzstalled with major changes, (i_e. greater than. 10' late.ra.l reloeat.ion of(lie 5A,5 or any vertical relocation of atiy 001171pcmem of-the septic system) but in. accordance whl-i State& Local Regulations, Plan revision or certi Pied as-built by designer to follow. OANIFI..A. T _�_......... OJAtA n.staal s Signature..) � Civil No.46502 �c FSSfONAI. (T)es.igncr's Signature) l (MIN T-16i.g.ner's 5ttatnp Hete) P1,.IFASE RETURN TO _BAR 1_ST A&iI.JE FURLIC IEt:iFA.T,TH I)IVISIO.N. _. CS,i3TMx CA,TE Oi1e CO1Vd1'.LJrAIVLF 1'V11.i, NOT Fl1F 7SKYTE11 UNTIL BOTH TIES FORM A1jD AS-BUil.,T C:ARY) eAjgt,: RUi CEiYED i3Y TH,F.BAIRNSTA.TiF,T,P'(T LIC.LLEALTH T).."IISION. '11UNK YOU. Q;Hl-ilth/Scpuc/Designer C;ertilieminn Porm 3-26-OlAci. J ' � I TRANS. NO.: CITY/TOWN: APPLICANT: f 4--my 56&✓S ADDRESS: : 5 41Mo•w� DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OIL NO 'l %NF Legal boundaries denoted [310 CNM 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 ✓ CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CNR 15.220(4)] Easements shown [310 CNR 15.220(4)(b)] ✓ System located totally on lot served [310 CNR 15.405(1)(a) for f upgrades]- if not, a variance is required [310 CNR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CNR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CNR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CNR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CNR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CNR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.2421 Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 C1VM 15.220(4)(n)] Address 607TV c.�,�� � � Sheet 1 of 7 N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case / of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters.and wetlands located up to 100 ft. . beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction ✓ activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address Sheet 2 of 7 I N/A OK NO `�JLJ��.JLCTtiANK"7 '�+"/Fe�D.: Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR .� 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] ✓ Note regarding installation on stable compacted base [310 CMR 15.228(1)] f Separation between iizlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] �y-� � rm�'M��ra�r�ras ...,mac✓a .., 5ro i� r <- � r ;,�� R Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO ON Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[11) Cleanouts required/provided? [310 CMR 15.222(8)] f Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable f [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when / pressure sewer to d-box or steep pitch of gravity sewer) [310 ✓ CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] ]E�S r 'is Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR.15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, discomlects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating ill lead-lag mode. [310 CMR 15.231(6) and(e)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 N/A OK NO Calculations correct? �M 4 feet of naturally occurring material demonstrated? [310 CMR ✓' 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate s ecified as double washed 310 CMR 15.247 2 p [ ( )] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.2411 . Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] 1010 Aggregate 1'minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BEDS N a,inzeo "e 0' fief" 5000 g:Iad minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. 310 CMR 15.252 2 Bottom area used in calculations only [310 CMR 15.252(2)(i)] I Address Sheet 5 of 7 N/A OK NO Pressure Dosed Systein ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative / systems under remedial approval [310 CNIR 15.254(2) and UA ✓ Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to f scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CNIR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet / the specification of 310 CMR 15.255(3)? ✓ Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CUR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CNIR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CNIR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. / recommended) [310 CMR 15.255 (2)(e)] A Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface .J. .,... e��iu i eery x., Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance I ll11E'Ce '° Are the variances listed on the plan? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CNIR 15.414] Address Sheet 6 of 7 N/A OK NO Is the system in a Designated Nitrogen Sensitive Area(Zone lI for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 1310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] MUMry t IVlas`celPa7Ye®us wa; Y ` .,_ . <, W:��It Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.2901 Address Sheet 7 of 7 TOWN OF BARNSTABLE LOCATION �'��Gdr7�iw � .d t SEWAGE#A�& -1f/ 'VILLA� E ����+�✓� ASSESSOR'S2, / MAP&PARCEL. 2 INSTA�LER'S NAME&PHONE NO. 1�✓ j�i? ry/ v ��Z P9�� SEPTIC TANK CAPACITYOz/ LEACHING FACILITY:(type) (size) 147 r NO.OF BEDROOMS OWNER 4si t PERMIT DATE: -e T COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet. Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY. D,4,� 27' a7 f i z `�^^ '` ( Certified Mail Provides: ■ A mailing receipt 't ■ A unique identifier for your mailpiece 11 ■ A record of deivery kept by the Postal Service for two years Important Reminders: �� Certified•Nlail may ONLY be combined with First-Class Mail®or Priority Maile.` ■ Certified Mail is not available for any class of international mail. r p ■ NO INSURANCE COVERAGE IS PROVIDED'with Certified Mail. For valuables,please consider insured or Registered Mail. I ■ 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 i 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 i required, _ e 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". ■ 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. C 1 IMPORTANT:Save this receipt and present it when making an inquiry: PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 SENDER: CPMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete:rams 1,2,and 3.Also complete A. Signature IWA 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X d ❑Addressee I so that we can return the card to you. B. Received by(Printed Na e) Date of Delivery ■ Attach this card to the back of the mailpiece, r , or on the front if space permits. D. Is deliv r address different from item 17 ❑Yes 1. Article Addressed to: IV If YE enter delive ddre'ss below: ❑ No C.e.r)A--c-� vi( IQ MA- ( 3ye , Typeified Mail ❑Express Mail 2 6, ❑Registered El*�eturn Receipt for Merchandise I ❑Insured Mail ❑C.O.D. .; .W,k.�Ay2 tinV �4 ..x icyt re`F R� i�} �1 � ! ) ❑Yes 2 R�e CVe�be Sre�$B�Q9"faDe�t ,11 1»1.H, At PS Form ary 2004�`"" Ps" Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-I(Y C • Sender: Please print your name, address, and ZIP+4 in this box ° I Town of Barnstable CCED); Health Division 200 Main Street Hyannis,MA 02601 I I I I I „ t• t Town of Barnstable Barnstable" Regulatory Services Department SARNSPABLE I I 1639.. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO U/7;)(DfDDT May 8, 2009 Deniz White P.O. Box 1060 Centerville, MA 02632 Re: 85 Cottonwood Lane, Centerville, MA You are scheduled to appear before the Board of Health at their public meeting scheduled on June 16, 2009 at 3:00, to show-cause why your property or dwelling should not be condemned to continued use of a failed septic system. According to our records, your septic system failed on 08111105 and you were notified by certified mail to repair or replace your failed septic system on 03/13/09. However, to date, the system has not been repaired or replaced. The purpose of the hearing is to provide you the opportunity to provide testimony, documentary evidence, and/or witnesses pertaining to the repair or replacement of your septic system. The meeting will be held on June 16, 2009 at 3:00 PM at the Town Hall, 367Main Street, Hyannis in the second floor conference room. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health A.S.�Postal Service,. CERTIFIED MAILT. RECEIPT f1J (Domestic Mail Only; p r e CO OFF- ICIAL USE r� Postage $ S+� rq Certified Fee ru p Return Receipt Fee 6' Postma p (EndorsemeniRequired) C �QZBlHere p Restricted Delivery Fee N ad�i (Endorsement Required) p rr=1 Total Postage&Fees $ S1 N��T ill Sent To M No.; � p Street,Apt. or PO Box No. r' - -�-- City,State,ZIP+4 r1\f r i IY2 PS Form :r0 August 2006 Certified Mail Provides: r A mailing receipt ■ A unique identifier for your mailpiece ■ 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. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE_ IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ 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 USPS®postmark on your Certified Mail receipt is required. A i 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". n 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`:�COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ 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 ad ee so that we can return the card to you. B. Received by(Printed Name) of D ■ Attach this card to the back of the mailpiece, i\ or on the front if space permits. m 1. Article Addressed to: D. Is delivery address different 11 em 1? I5 Yes If YES,enter delivery addres w: gNo co 0. six i0�b 3. S rvice Type Certified Mail ❑Express Mail �/� ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number,11 1' 1 s {l;5 ELF a.4 s } (Transfer from serviceslabel)I c t7 0 0 6►c 2a15 0�'0 0.0 2 1`0 4�1 8 7`0 2 t t; PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATE�.,P.b T 9 illRli' �gsYa a&`FeL�S Paid • Sender: Please print your name, address, and ZIP+4 in this box • DLk)o v4Yl i OZ-&D i i �=..t_•� 011,,f�,Irl�.ils,�i,�����1i,1��f11„�Il�►»31�11i,l�Ils�,�1�1�i Town of Barnstable Barnstable Regulatory Services Department jmcacfiv snrerr�rasxae, 9HAS& ,� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 03/13/09 Deniz White r. Pro PO Box 1060. Centerville, MA 02632 FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at, 85 Cottonwood Lane, Centerville, was last inspected on 08/11/2005,by James M. Ford 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: "Single cesspool-automatic failure" "The original leach pit was full and backing up into the D-Box. The newer leach pit had 5.5" of liquid on the bottom. The scum line was up to the inlet pipe. There were signs of failure." The deadline for repair 08/31/07 has past. We, The Department of the Board of Health, have not been informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair or replace the septic system within 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. 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 I Town of Barnstable Barnstable ` Regulatory Services Department M�Ue;cacffy BARNS'TABI,E. 9�A 63 ,�� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 03/13/09 Deniz White P.O. BOX 1060 Centerville, MA 02632 FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at, 85 Cottonwood Lane, Centerville, was last inspected on 08/11/2005,by James M. Ford 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: "Single cesspool-automatic failure" "The original leach pit was full and backing up into the D-Box. The newer leach pit had 5.5" of liquid on the bottom. The scum line was up to the inlet pipe. There were signs of failure." The deadline for repair 08/31/07 has past. We, The Department of the Board of Health, have not been informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair or replace the septic system within 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. 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 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 85 Cottonwood Lane Centerville, MA 02632 Owner's Name: Susan White Owner's Address: 471 Shoot Flviniz Hill Road Centerville. MA 02632 ` = Date of Inspection: August 11. 2005 _ Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford �'' -w Mailing Address: P.O.Box 49 _ g' �F Osterville.MA 026554049 f Telephone Number: (508) 862-9400 W C—D CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the ' formation 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 CAM 15.000). The.system: Passes Conditionally Passes Needs urther Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: fz Date: Auust 13, 2005 The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This.report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: Auzust 11, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced.with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: Aueust 11, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "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 forma 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: August 11, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 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 (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: August 11, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 t Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: August 11, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 8+ Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): _2005- 76,000 gals.:2004- 122 000 gals:2003-99 000 als Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): spd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonnation: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Original system was-installed in 1981: a new pit was added in 1985-ver as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 Cottonwood Lane Centerville. MA Owner: Susan White Date of Inspection: August 11, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments (on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 14" Material of construction: ✓ concrete _metal _fiberglass _polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 ate._ Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels. as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs_ofleakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: August 11, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: -- Comments(note if box is level and distribution to outlets equal,any evidence.of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was broken down structurally and needs to be replaced. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments.(note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: August 11, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: _ 2-6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The original leach pit was full and backing up into the D-box. The newer leach nit had 5.5'of li uid on the bottom. The scum line was V to the inlet pipe. There were signs of failure CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: August 11, 2005 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 w—here public water supply enters the building. 701 I as aye y 3 a 3►` 3a. a L n`W`(. pad 3 ao C { 3� 10 page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 85 Cottonwood Lane Centerville, MA Owner: Susan White Date of Inspection: August 11, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/- feet 0 Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maw Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing ypproximately 30'+1-to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 COMMONWEALTH OF MASSACHUSETTS x EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION five TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVFp-, Property Address: — 85a ood Lane Owner's Name: Norma Atkinson JAN 1 _ 2003 Owner's Address:_85 Cottonwood Lane TOVVN Hyannis,Ma "'_ xr,-,,. Date of Inspection: January 9,2003 HEALTH OEPT. Name of Inspector: (please print)James Holler_ Company Name:_Holler& Son Construction Co.LLC_ MAP Z S 2. Mailing Address: P.O.Box 702 PARCELS S ^Marstons Mills,Ma Telephone Number: _508-420-0280 LOT I (p !CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: � 6-�-�-�- -= Date: ` 03 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. Notes and Comments it ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _85 Cottonwood Lane _Hyannis,Ma Owner:_Norma Atkinson Date of Inspection:_1/9/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 explaig: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: f Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_85 Cottonwood Lane _Hyannis,Ma Owner:_Norma Atkinson Date of Inspection: , 1/9/03 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 Z. 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 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_85 Cottonwood Lane _Hyannis,Ma Owner: Norma Atkinson Date of In_spection:_1/9/03 D. System Failure Criteria applicable to all systems; You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool N/A Liquid depth in cesspool is less than 6"below invert or available volume is less than'/�day flow N/A Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS, cesspool or privy is below high ground water elevation. X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no OCGeptable water quality analysis, [This system passes if the well water.analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ T 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART B CHECKLIST Property Address:_85 Cottonwood Lane _Hyannis,Ma Owner:_Norma Atkinson Date of Inspection: 1/9/03 Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No _X— — Pumping information was provided by the owner, occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks ? —X_ _ Has the system received normal flows in the previous two week period ? — —X- Have large-volumes of crater been introduced to the system rccently or as part of this inspection ? — _7X_ Were�,s built Plain 9f tiv bysmn 9btained and momined?(If they were n9t milable now-u.NL�') —X— — Was the facility or dwelling inspected for signs of sewage back up ? _X— — Was the site inspected for signs of break out? —X— — Were all system components, excluding the SAS, located on site? _ Were the septic tank manholes uiicovcr€d,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 ? p_t.... _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X_ Existing information. For example,a plan at the Board of Health. X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_85 Cottonwood Lane _Hyannis,Ma Owner: Norma Atkinson Date of Inspection:' 1/9/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design); _3_ Number of bedrooms(actual):_3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): _330 Number of current residents:_3 Does residence have a garbage grinder(yes or no):No_ Is laundry on a separate sewage system(yes or no): Yes_ [if yes separate inspection required] Laundry system inspected(yes or no):No_ Seasonal use: (yes or no): No_ r Water meter readings, if available(last 2 years usage(gpd)): ��J ����boo kv,:;, Sump pump(yes or no):No_ J Last date of occupancy; _12/27/02 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc:): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Owner Was system pumped as part of the inspection(yes or no):No If yes,volume pumped.: ___gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X Septic tank, distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology, Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank T Attach a copy of the DEP approval _Other(describe): Approximate age of all components, date installed(if known)and source of information: Owner, Approx. 20 Years Were sewage odors detected when arriving at the site(yes or no): No_ r Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_85 Cottonwood Lane _Hyannis,Ma Owner:_Norma Atkinson Date of Inspection: 1/9/03 BUILDING SEWER(locate on site plan) Depth below grade: _24 inches Materials of construction: —cast iron X_40 PVC_other(explain): Distance from private water supply well or suction line: _None Comments(on condition of joints, venting, evidence of leakage, etc.): Sound, no problems noted SEPTIC TANK:_X_(locate on site plan) Depth below grade: _12 inches Material of construction: _X_concrete_metal_fiberglass_polyethylene other{explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: 1000 Gal Sludge depth: 6 inches Distance from top of sludge to bottom of outlet tee or baffle: _32 inches Scum thickness:_1 inch Distance from top of scum to top of outlet tee or baffle: _2 inches Distance from bottom of scum to bottom of outlet tee or baffle: 14 inches How were dimensions determined: slurry stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc,), sound tank but recommend pumping GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:,concrete_metal_fiberglass,polyethylene—other (explain): Dimensions: Sgum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 Cottonwood Lane _Hyannis,Ma Owner:_Norma Atkinson Date of Inspection:_1/9/03 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_X_(if present must be opened)(locate on site plan) Depth of liquid,level above outlet invert: Zero Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): no solids carryover,D box is working well PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_85 Cottonwood Lane _Hyannis,Ma Owner:_Norma Atkinson Date of Inspection:_1/9/03 SOIL ABSORPTION SYSTEM(SAS):_X_(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number.- -leaching chambers, number: leaching galleries, number: X leaching trenches, number, length:_2, 45 feet long, 4 inch perf. pipe_ 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.): No hydraulic failure, presently working normally 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 or no): 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): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE .DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_85 Cottonwood Lane _Hyannis,Ma Owner:_Norma Atkinson Date of Inspection:_1/9/03 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. 1 z 2 z6 3 32 -o 61 z� --o 2- .Z,� 0 a 3 3�-0 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_85 Cottonwood Lane _Hyannis,Ma Owner:_Norma Atkinson Date of Inspection:_1/9/03 SITE EXAM Slope Surface water Check cellar Shallow wells Estim4ted depth to ground water_> 14�feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand Augered site to a depth of 15 feet, which is 14 feet below D box elevation. 1 E l,� c,�r TOWN OF BARNSTABLE uOCATION b J C 0-roo,\W 06G /Aouk, SEWAGE # VILLAGE CR^trvA- ASSESSOR'S MAP & LOT�,� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY / 0 b n LEACHING FACILITY: (type) a 1yX G+ Pi (size) QVQ NO.OF BEDROOMS y r �. BUILDER OR OWNER Lt/I'1►'Z w 4 PERIVIITDATE: CO I 911�� .5 Separation Distance Between the: P rN. 411 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ng facility) �" Feet Furnished by -rl 1,68Ak, t n a o a 3a `.-IJb S {'� �,� 4 No._..��....---._.....y Fps...... _ THE COMMONWEALTH OF MASSACHUSETTS { A aka BOAR® O� HE/�►Ll'H ....... OWN.....................::OF........BARNS.TABLE----------------------..._..__.......----...----- Appliratiun for Uiipus4l. Works Tomitrnrtiun Application is hereby made for a Permit to Construct ( ) or Repair ( ;'Individual Sewage Disposal System at: .....85.-C 9 t t Q ►oA s..I� xa.�.,._.C-POnt eX.Ville.... ..................La t..416_7.......................................................... Location-Address or Lot No. Thamas-..Le ana.r-d--------------------............................... .85...C.o.ttjouaaaad..L, jj ,...0 entem.;Llla........ Owner Address a .....Alf red..F'aler........................................................ .5995--Catuit..Ad.....Marston.8...Mill-&.............. Installer Address Type of Building -- Size Lot.......12.9-816_...Sq. feet U Dwelling—No. of Bedrooms...4......................................Expansion Attic (N) Garbage Grinder (N) 04 Other—Type of Building ..11 Q.Qd.............. No. of persons.........5.._........__.__.. Showers (1 ) — Cafeteria ( ) a Other fixtures ---2...Ls.Y.s.-2....toilets...1._tuh................................................................................... 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......................................... 1.4 Test -Pit No. 1................minutes per inch Depth of Test Pit----------.......... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---------------------------------------------------------------------------------------•--------•-.......................................................... 0 Description of Soil.....................................................................................................----------------•--------••-------------------------......._...._ x U W x ----•--- ----------------------••---•••---•--•----••-••-•-•-•--•----•----••-•---•---._...•-•-•--------•-------------------------•-••--•--------•---•------•-----•------------------••----...---•------- U Nature of Repairs or Alterations—Answer when applicable------Add_ ne.w...lei.c_h1ng...pit....1:ox..now....._.. -----•--•addit ion......................•---------------•--•-------•------------....------.....-------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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&# lie h. -- ------Signed - 1`24Z85..._.... " Daje Application Approved BY .....f.... ...! -•--•-... -----------i./zti/ iS:�------ Date Application Disapproved for the following reasons------------------------------------------------------------------------------------•......---•----•--........._ ............................................•------------•---------------•-••----•-----.........-----•---•----------•---------•-----•-•-•-----•-...---------••---•-------------------•--------•----..... Permit No. -���.r �-•----------------------- Issued.---..`... .�!... ....._..ate._._.. ,, D y No... :. FE� �-, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .. ..... ....................OF..........................-..-......... Appliration for Disposal Works Tonstrudiun rrmit Application is hereby made for a Permit to Construct ( ) or Repair &",, /an Individual Sewage Disposal System at: Location-Address or Lot No. ..K a Owner Address ----....-•---•--------------------•-------•-----•-----•----....------------------•---------_..... ......................................I.......-•-••••----..........-••••-............«q: -. Installer Address T Type of Building Size Lot............................S feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ... Design Flow............................................gallons per person per day. Total daily flow.......-...................._...............gallons. W ZFi 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 ( ) P-4 Percolation Test Results Performed by.......................................................................... Date........................................ W 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........................ W 1 -------------•------........------------------.....--------...-••-----...••-----•--•--------•-_.............................................................. 0 Description of Soil.....................................................................................--------------------------------...--------------------...----------•----•-_---_.. x V .-------------•----•--------------------._...-------------------•----•-------------•-------------------•-•-----------•---....------------•------••------------••----..._....--------.......--•••-•---.--- W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------------------------------------------------------•-••--• ------------------------------------------------- -------- Agreement: The. undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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...................................................................................... .......................... Da Application Approved B V e to Application Disapproved for the following reasons-----------------------------•-------•----------------------------------------------------------•--•---•--------- ..................................................................•------•-----------••--------•---------------------------------•------------------------•---••--•------------•---------------------••- 'ate Permit No........ _ `......7- ------------•-------..... Issued...... _�D�� ..................... ,. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Currtifiratr of flu t �i�anrr THIS IS TO CEPTITIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired e `) ,. Installer /r at. -----------L......--•---. e ll -----------------------••---•---------------- has been installed in accordance with the provisions of T UE r of The State Sanitary Code s des ibed in the application for Disposal Works Construction Permit No.___........ _ =---^�.G dated__.-------I_- _....�_-_`��............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUA ANT E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ... ._ ...........9..�--•.......................................... Inspector............. ...... --- ---•-•- -----•-••--- f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................OF..................................................................................... No.. ; FEE........•.''�`�..«C �ispos l rht T Intrnrtinn umit Permission is hereby granted -------` ;t' 4•------•--•-------------------•---------------•---•---------.__-.------.__-----_-_-_--_-___------- to Construct ( ) orkRepair K) an Individual Sewage Disposal System atNo. -c_"" �+> e;._,4 ,-._------------------------------- -------------------- ------ Street as shown on the application for Disposal Works Construction Permit �...............«.. ...-......-•---•----•---------------------------------------------------------••------..._...._........DATE « .-- Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON r �z n i 0 , G. �yr`'A� ITS w _ 777, .;LO' I: AT / SEWAGE P RMIT NO. VI L'CAG E Q� INSTA, LLE 'S N"�ME A ADDRESS i 'R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��.. ' Lz 6'0 a { fJ No....... _ THE COMMONWEALTH OF M.ASSACHUSETTS BOARD OF HEALTH - ..7Zv,/).--------_----OF....... r tat S L41. A a Appliration for Dhipati al Works Ton.6triirtion ramit Application is hereby made for a Permit to Construct V�or Repair ( ) an Individual Sewage Disposal System at • S- -C� ��U ��-tf.,� ....1 .............................� ---.................................................... cat;-Address v or Lot No. / �/wner { Address e a ............ r- 1 -._. �rl= '7.e.1/5-- .Zff�s ........... ... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_._.. t-: /zsc-_-_-Expansion Attic ( ) Garbage Grinder (NO) 0.4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------•--------. _ W Design Flow................... .gallons per person per day. Total daily flow_--_-- ___33.o........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....1{0-�.... Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (i-� Dosing tank ( ) 04 Percolation Test Results Performed by--........................................................................ Date........................................ aTest Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------••---•------------- --•--------•----•--••--•-•••--•---.........................---•--_...................• ..................................... 0 Description of Soil.......•... ...... x W -------------------------------------------------------------------------------------------------------------------- ------------------•---------------••-•-•-•--•---•------•----•-•••-•-•-•----•----••- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bin i d by tl,e bo rd,of health. X 1, �/�._ GAG /ia�,�tis /.vc, Si ned--may....- ------------------------ •- - r t Date Application Approved By-•--•- --------------------------- /Z--�r-------- Date Application Disapproved for the following reasons:--------•-----------------------------------------------------•--------------------------------••-•••-•---..._.. Date PermitNo--------------------------------------------------------- Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I. ,. -'................OF.............:.....:.._, /.• , pphration for Diipos al Works Tonotrurtion rrutit Application is hereby made for a Permit to Construct (f ) or Repair ( ) an Individual Sewage Disposal System at: .....� -•.............._..............---...:.. ====:::.::. -===--r..........-•--•---•••- •............•----•-••--••- - l Location J-Address _ or Lot No. .A�E.1=.C.�..._.... I l.. jC..:....=.c-:-_ ..^...................^^ .......................a ' ` � T............:L ..........___................................. Owner Address �...._... -.. _.._. / z . .:.: _.:,:. ......_...•----- ' .. ........ z L . /Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.........:..................... __:__-__-Expansion Attic ( ) Garbage Grinder (.,Vp) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pi Other fixtures ---------------------------•--•• . . —,—,:.:..gallons per person per day. Total daily flow___... _.__ _l�__._._.. Ions. W Design Flow....................... __ g P P P Y Y l 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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------------•---------------------........._.......---------.•----......................................................... of Soil •. ... - ------.............................. O � i ---------------------------•------------------------ W - -••------------------------------•-••-•-••-••----••------•••••--------••-•-----••-•-----•---------•---•••••--•-•-•----••-------••-•-•---------•••. UNature of Repairs or Alterations—Answer when applicable................................................................................................ ..........-••-••••••--••••--.......---•--••-•••-•--•••---•••--•-•--•----•----•-•••••-•-•••-•-•-•••-•••--•-•••--•••••-••-•••••-•-•••-••••••-•--•--•--••-•••••••••-••-•••......-•••-----....--•••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 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. ' � li_ i Slgned._ ..:...... ........'=' =-,...:......!.....:.:z,-'------••-•-••-•-•-••••• j- •• 1.._.... / Date Application Approved BY ==�•. -----.---::-.c ,. .��-.... ........................... ----- .............................. Date Application Disapproved for the following reasons______________________________________________� .......-•••................................... ----•------. •...............•--•-----............ •--•-•-•-•--. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r Trrtifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed l ) or Repaired ( ) b �--- y ice. --_.... •------•----••...••`••-------•••--••-•--•-•-•---•......................................................•--•---••-•----•----•---- Installer at................... r I . .... . - (- 1=/'/r has been installed in accordance with the provisions of TITL.F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._... ...._.._f-;?,/.............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION) SATISFACTORY. DATE................................. ---•------•--------•---- Inspector.............. ......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH %� O F......._.: / ,.................. Disposal Yorks Tonotrttrtion unfit Permission is hereby granted•......''__(.._.......•.... ::............. to Construct �(�) or Repair ( ) an Individual Sewage Disposal System atNo. ' -� `r ............................. 1................................... ............................................ Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Sri j. ---=- ---- ---- ---------- ••--t ---- = _ ------------------------ Boaid of Health DATE................ � � �.� FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 4. T:,dt Lam•( FIAw s 110 V. 't-As,tK - Ssov ISc % 56.P.0. 15•ao �y9 SP AL PIT - L-na (occo .,WC-WALL A2,G.A = V20 s P. 9t .¢ 97.7 .fo=' 49.t SD . A 1 •� - rl0 G.R D. �4Pes '4-7 TOTAL -VeS-16W = 425 m O a 12,8lG 7-oTQ tw a caw t t_�f r= Q , N �o o .• A . 0 PEf2GDL&T10U 0,&TE IIQ Sm Q,otz ASS. OL Ae I p \\\ OF AL ►eta!I I S UI; 9,� To? P%40 =ie>o..y F'6, 93 K o: C c 9� �r-�-ca .� JUVA —j LoQM ,d'F.Pe loon Iuv ' 4r�P� D}c,T Iw. GAL. SdBSo�G 'Box 9/•C Septic � f►4V' l to �: l -rANK tNv t►N '', . :• G4t-. S Le1 N ( 'A WfrN O2At 1. NAIASL1EL►L ^• SroNt � .�f4• � . ��2�c�Fil_E•. r . t0C.ATICO`I CE�Z 1uIus Sr Al 40 �--___- I Z t l o w . GGt7T11=`{. TL4A-r 112;r. PaW t--4A- X4 t-aF:1't_Zy1J tr�%PLVS WIT141 'f'1-lc �jID(=.t_i►-lam Lo7- A1.lU `;E'1"1;'��C1� tL•t:C�JI�EA�cl�lj';. D� T►•It= `I'o w w Or-9-MZ Py7TA eLt's _ ------- $AXTC9, 4. wsec RcGt�•rcrcU 1..ia1..►e� yuev�:.Ycr:�: TI-�t� t71_A►-1 tom, &JOT t;:.n;cca v� 1 A�.l 0aTr- -V%LtL- t•1Sr`:»..�l�iJ; �,c�;:.n=�{ .) "(•tat:. c�c=� : :("; iI•IcI A.ht?t_I4r.Ah-IT t// t•F�r c:r: u�>c�� rc► �'t�V� `l� r1S e a i0 'C TION u SEVIIiGE PERMIT NO. ,VILLAGE � s:S Cr F 4• YJ�/V � � INST A ll RjS,,ZZM,E i ADDRESS S UILDER OR *W*Vr DATE PERMIT ISSUED DAT E C0M ►LIANCE ISSUED _ _ _ -�,.: : '_ ;. r ,,� , a !� •, �! t � ,` �r Y -' �� �� S� I , � O' a � �' ' - --- �� � C�.� �, 2��� - ' ` � A -nc Builders w --- T �g� :t ¢ }Proposed Basement STA y 48 --------------- I I ;; J C y ' I J ---------------_--------------_------.------_------------- .: _i` _T ——————— - - - - ----------- I I BATH I d II I I 10'-11"x 5-0" ® I I UP I r l v M I I r I I I I Basement / storage / Gym 13,_6"x 21'_1" I b I m I I LOSET I I I II ,_51.x 3'_0" I I I 00 d -- —— —————— I I \ r I I I r- I � Z 0 CLOSET 6'-0"x 44" -- ————————————— I -------------- _ --- �� I Go I ———————————————————————————————— a LIVING AREA 0 2162 sq ft N M� 4) W U 'Z V_ 0 W C Q •_ �ADCI-Builders Proposed First Floor Q DECK DN � C y cc OFFICE \\, /STORAGE OFFICE 1 T-7"x 12'-8" DECK Z- 22'-1"x9'-7" BATH 5'-0"x 9'-6" ® ®• c� c4 0 II c CO) DINING KITCHEN MASTER BA 19'-2"x 2-9" 12'-2"x 6'-5" BEDROOM 1 a-2°x 1 ra" F-1 0 cd �f c BEDROOM J 13-6"x 21'-8" GARAGE 15_6"x 24'-0" C d r •� 0 i�..�00 ♦✓ MASTER BDRM LIVING 13'3"x 6'-1"1" 15'-9"x 11'-10" I I {Q I I 0 I I a I I N LIVING AREA m �d1 1746 sq ft Z •� /A W � Q ALL TE LL SYSTEM PROFILE MARK DS WITHC MAGNETIC TTAPEAOR BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE IF NEC., 20" MIN. DIAM WATERTIGHT WATERTIGHT 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. XX.X' FILTER FABRIC OVER STONE s'r 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 64.0 �� BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST RISERS UNITS TO BE AASHO H-10 c' 4"0SCH40 PVC MORTAR ALL Cm PIPES LEVEL 1ST 2' COMPONENTS (TYP j 5. PIPE JOINTS TO BE MADE WATERTIGHT. r INV'S EL. 60.17' L cus 10" 1000XISTINGGAL H-10 14^ o o 0 0 o EL. 61.0' �TMONSTRUCTION DETAILS TO BE IN ACCORDANCE we you -.. JEER] TEE SEPTIC TANK TEE 0��0 �0oo°oorRmR, �0(� - �000 o°o°o°o° Lake# o 0 1 o 0 0 0 0 0 > o 0 0 0 61 .49 f o 0 0 0 0�00��1�0� 0310 CMR 15.000 (TITLE V.) °o°°°°o°°°°° 6" MIN SUMP o >00000000 0 0 0 0 o 0 0 �o°o°o 0 0 0 0 o o 0 0 0°0°0(RE-USE)** GAS BAFFLE °o°0 12" MIN. INT. DIAM. c °°°°° 000a�aoo� o°000° oaaa�o�000 °o°°°°°° oaooaaaoo� o° aaoaaoaEl,Eml o°o°0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 60.48' 60.31' °°°°°°°° °O°° EL. 58.17' NOT TO BE USED FOR LOT LINE STAKING OR ANY t > o o ° ° o 0 0 0 ° ° OTHER PURPOSE. o� LH-10 500 CAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. DEPTH OF FLOW = '4' 3/4"-1-1/2" DOUBLE WASHED STONE (3) UNITS REQUIRED 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. o TEE SIZES: 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 40' X 10' 9. COMPONENTS NOT TO BE BACKFILLED OR INLET DEPTH = 10„ COMPACTION. (15.221 [2]) 4.2' CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OUTLET DEPTH = 14" 4'± OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP 54.0' BOTTOM TH-1 & 2 CALLING DIGSAFE (1-888-344-7233) AND (5•9% SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUND VERIFYING THE OVERHEAD UTILITIESLOCATION OF TO COMMENCEMENT O ALL UNDERGROUND FF NOT TO SCALE SCALE 1"=2000'f LEACHING NOTE: G-W EXPECTED AT WORK. FOUNDATION- EXIST. SEPTIC TANK 17' D' BOX 16' FACILITY ELEVATION 34.0'± PER ASSESSORS MAP 252 PARCEL 155 TOWN GROUNDWATER MAP 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE LOCUS IS WITHIN GP AND ESTUARINE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL PROPOSED LEACHING FACILITY. PROTECTION DISTRICTS UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 12. EXISTING LEACHING FACILITY SHALL BE PUMPED NO CONSTRUCTION PROPOSED (UPGRADE ONLY) AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT SAND. 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 99- EXISTING CONTOUR WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. X 99.1 EXIST. SPOT ELEV. ��// �6 x\70.46 99 PROPOSED CONTOUR �OP� L-39.2j x OO� OG�0F1/ R- 5.00 xNA 429 [98.4] PROPOSED SPOT EL. x TH1 TEST HOLE �w 1 48�0.09 N \\ c-� SYSTEM DESIGN: 22 SLOPE OF GROUND / \ ° \ O �� . LOT 167 / \\ A GARBAGE DISPOSER IS NOT ALLOWED CJTILITY POLE /C0.19 \ 12,695 SFt DESIGN ,FLOWN 4 BEDROOMS @ 110 GPD = 440 GPD DESIGN F GP FIRE HYDRANT \ / n E e a4,1GPDLOW yYo / 04 \ i P ED \ \ ..� NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING x'E 82 \•\ D IVEWAY 119.86 OO - o \tea / SEPTIC TANK: 440 GPD (2) 880 �o 71.00 / GARAGE / \� TEST HOLE LOGS �� **RE-USE EXISTING 1000 GAL. SEPTIC TANK \ \ i 0.15 z LEACHING: \L ARNE H. OJALA PE, SE \69 69.91 x/33 \'F SIDES: 2 (40 + 10) 2 (.74) = 148 GPD ENGINEER: ' 70.21 98 k�69.37 DAVID W. STANTON, RS 69.81 ,'\ \ BOTTOM 40 x 10 (.74) = 296 GPD WITNESS: DEC EXISTING DATE: MAY 13, 2009 g 24 DWELLING 70.61 0 \\ TOTAL: 600 S.F. 444 GPD PERC. RATE _ < 2 MIN/INCH C�><\1�98 6 \\ USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 66 66.81 CLASS SOILS p# 12563 �Q�° \ WITH 2.25' STONE AT ENDS 5' BETWEEN UNITS AND 2.6' - I \��a \ � \ �2 SILL 0 WALKOUT \ AT SIDES 66.86 DECK ELEV. = 62.7' ELEV. ELEV. x 66.47 \ 63.55 0" 64.0' 0,, 2 64.0' '? x 65.78 65..x7 / 3 A A 70 0.0 ISER \k 68.84 �d�- �Cp 5.2 64.06 GAS \ �' ; METER ucw E ?? 0 9 MA .33 EL HANDBox APPROVED DATE BOARD OF HEALTH SL SL x 6 .28 �� ��3.17 x 69.67� 99 10YR, 3/2 ,p 10YR 3/2 35' b , , TANN< // 18 B 18 B 69. ,� 1 x \ �, °° �� �P� TITLE 5 SITE PLAN ABUT. D LOCATION D 0 x .30 TF�2 4`'\P 6� �� /ABUT. DWELLING \ q x 65�44 3 L LS LS ,6 BENCHMARK OF 10YR 6/4 10YR 6/4 APPROX. LEACH PIT \\ T/ hj\ / NAIL 0 TOP PILING 50" 50" 51•0 (TIES UNCLEAR) /(� \ � \ s 65.23 ELEV. = 67.2' 85 COTTONWOOD LANE 8 x 6 .-7-2 11� 4 CENTERVILLE �%� 9 C C /N 6\ x' . PREPARED FOR PERC PERC x 61.40 62 5' REMOVAL OF UNSUITABLE SOIL REQUIRED BORTOLOTTI CONSTRUCTION/WHITE MCS MCS x 6 AROUND PERIMETER OF LEACHING FACILITY, DOWN TO SUITABLE SOIL LAYER. REPLACE WITH CLEAN MED. SAND, TO MEET MAY 13, 2009 2.5Y 6/4 2.5Y 6/4 x 60.82 SPECIFICATIONS OF 310 CMR 15.255(3) - -- . rv: F L<N o> M4 d9gSS off 508-362-4541 fax 508-362-9880 ITN{ELA 5G' '��� OANiE! ac re s.. r• downca e.com OJALA A. P CIVIL .�'aOJALA �I down cape en 09,0 gineering, inc. 120" 54.0' 120" 54.0' civil engineers Scale: 1"= 20' � ,.5� ST �' �t og �` � - K land surveyors NO GROUNDWATER ENCOUNTERED ' � �� 939 Main Street ( Rte 6A) mom- 09-091 0 10 20. 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 nQ-nQ1 nwr. CRn