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HomeMy WebLinkAbout0422 OAK STREET (CENT./W.BARN) - Health C ' 422 OAK STREET CENTERVILLE A= 194 -005 -TOO S M EAD® KEEPING YOU ORGANIZED No. 12M 2-IMLOR too wmimi Posr�su� �aoENus�► WORGANIZEOATSYEA2=1 y a � Y � Q 0 0 00 00 cdlo� i 5 Commonwealth of Massachusetts F 7" 005 Too Title 5 Official Inspection Form 1; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments %'' 422 Oak Street Property Address Craig and Judith Wiegand -;', Owner Owner's Name information is MA 02668 10/05/2018bl t t Ba rnstable required for every W ' C>�1'lt• •`'""' 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. Important:When filling out forms A. Inspector Information 51,E- 13�1� on the computer, use only the tab Michael J. DeCosta, Jr. _ key to move your Name of Inspector cursor-do not Wind River Environmental _ use the return Company Name key. 46a Drive Company ny Address Marlborough MA 01752 Cityrrown State Zip Code (508)400-8083 SI 13230 Telephone Number License Number B, certlf cation I certify that:Lam a DEP approved system inspector in full campliance with Section 15.340 of Titte?; (31Q.CMR 15.000);1 have.personally inspected the sewage disp..osal System:af the property address fisted above;the information reported below is true;accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of o that the system: n-site>sewage disposal systems-Aftier conducting this inspection.I have determined 1. ( ] Passes' 2, Q Conditionaiiy.Passes I 3. Needs Further Evaluation by the Local Approving Authority 4. Q Faits. sp' toes Signa r Date The system spector shall submit.a :oft his in spec#ion report to the Approving Authority(Board of Heal#h qr YDEP)wtthin 30 days of completing this.nspection.. If the systern has a design flow of 10;OOt}gpd or greater,tFre inspector.and the system owner shall submi#the report to he appropriate regiouyer;,fice of the e The original form should be;sent to'the system owner and copies sent to the buyer;, applicable,and the.approving authority, Please note This r y eport onl describes conditions at the time of irispedtioli and under the coeditions 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. t5insp.doe-rev.712b12(}1s: Title 5 atfici�Irisped(on Fri:;Subsurface:Sewage 101sPosat System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 Oak Street Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: All covers are on risers to 6" below grade. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 Oak Street V Property Address Craig and Judith Wiegand Owner Owner's Name information is West Barnstable MA 02668 10/05/2018 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts yin Title 5 Official Inspection Form '= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 Oak Street Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: ' 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form �- r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 422 Oak Street v� Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 Y2 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 cam, Commonwealth of Massachusetts r Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 Oak Street Property Address Craig and Judith Wiegand Owner Owner's Name information is West Barnstable MA 02668 10/05/2018 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 422 Oak Street v— Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 Description: Number of current residents: N/A Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 331 GPD 9 ( Y 9 (gPd))� Detail: Usage data provided by Barnstable Fire District Water Department: 104,000 + 138,000 = 242,000 gallons/730 days = 331 GPD Sump pump? ❑ Yes ® No Last date of occupancy: Current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form I r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 422 Oak Street v Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Wind River Environmental -See attached record. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1,500 gallons How was quantity pumped determined? The quantity was measured by the pump truck. Reason for pumping: To check the structural integrity of the septic tank. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Work Order# 0217067959 Cust# 1994329 Customer Since: 2 017 Tax: 6 . 2 5 0 0 06 Job Comments Tech Comments 10/5/2018 CAT T5 inspection. Customer will have as Cover(s) secured. 10-3-18 11:001 am 2018-401-2309. built/design plan, water consumption report, pumping records and signed consent form. CC ON FILE (TS) System Owner System Location Craig & Judith Wiegand Primary Home 422 Oak Street 422 Oak Street West Barnstable, MA 02668 West Barnstable, MA 02668 (508) 591-8551 Craig & Judith Wiegand : (508) 591-8551 Service Date: FRI 10/05/2018 os:oo Am Frequency: Call to Confirm: Service Type: Standard Previous Service: 09/28/2018 Approx. Gals: o CCLS: Location Details: Depth Below Grade: Custom Clean:,.• .. ` Cost Home: No Filter _ - zQ/08/2018 Township: C Gunty Barnstable 7-Ut d lJp a .� w;s" y rn m ` jet w , y Inspection Title 5 (natndltid �7g umpg' 1 bE1� $ 365 0000 $ 365 OQ Inspection (Labor/Exposuze ees)ps&-t1r09 { 2 ® $ Cis4 9d990 $ 10o,, a Inspection Title 5 BOH Fees 1°Qa $ 25'"�Q00 $ 2'S OQz Pumping 1001 - 1500 r,��Mip e00 $�34:kQ0_$ .354oz12 Environmental Compliance Residential 1.00 $ 3.0000 $ 3.00 �3 .. Fuel / Energy Recovey a 1 ,00 $ 75 506 •$ 75 51 t' Zabel Filter 1 0(0 ��183=e52II0 $ 83�; 52 a a SubLoW! $ 13✓76.15 We suggest these 3 keys steps to keep your system healthy: • Regular servicing Tax $ 11.47 • Use CCLS bacteria additive Total $ 1387.62 . Use a filter Disposal Site: Disposal Volume: Payment Detail: V%'aste Code : 0.0000 Master ,ales Rep : NE_Repairs Installs CSR : Tiffany Sutton Due on Receipt rrUck : Technician : Michael Decosta Jr. On Site : 10:57 AM P 0 Number: Tech Notes : System Operating Fine. Normal water level. Moderate top solids. Moderate bottom ;:lodge. Both baffles are intact. Main line Not Applicable . No filter is present on the tank; current tank can be outfitted with a filter. Recommended Customer not on. site Installing a filter. Cover(s) secured. Title 5 inspection pass, full report will be emailed to customer, serviced system 1500gals, filter was installed X on outlet as per title 5 code, no one home could not do bedroom count, check interior piping or perform flush test. All set thank you. Customer Signature 0 EN VIR()I�IMENTAL Remit payment to 46 Lizotte Dr Suite 1000,Marlborough,MA 01752 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 422 Oak Street v Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 1998 per plan Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. 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: 0"/ N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Did not have permission to enter the building to check piping. I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 .. Commonwealth of Massachusetts �n Title 5 Official Inspection Form += P Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 422 Oak Street v Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2'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: 10'x5'x5' Sludge depth: 8.. Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): All covers are on risers to 6" below grade. The tees are OK, no filter installed. The liquid level is normal with moderate solids and sludge.The tank appears to be structurally sound and not leaking. A filter was installed on the outlet as part of the inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /; ............ 422 Oak Street v Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 422 Oak Street v- Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): The distribtution box is on a riser to 12" below grade. The box is 16"x 20". The liquid level is normal with equal flow to the outlets. The box is in good structural condition, watertight, and not leaking. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 Oak Street V� Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ..........c � 422 Oak Street v— Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The chambers have minimal liquid in them.There are no signs of ponding or hydraulic failure.The vegetation is normal. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 422 Oak Street Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments / 422 Oak Street Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 B C7 JD ku fvv�c5 .6 t5insp.doc.-rer.M6=18 TWO 6 Offidal Inspection Fam Subsurface. a Di Sewag sposa4$yatem=Page 16 of 18 cam, Commonwealth of Massachusetts lix Title 5 Official Inspection Form 'T Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 422 Oak Street v- Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 61+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: Dug small hole off the side of the leaching.The hole was approximately 6' below grade with no indication of ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 f c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 Oak Street v Property Address Craig and Judith Wiegand Owner Owner's Name information is required for every West Barnstable MA 02668 10/05/2018 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Certified mail#7006 2150 0002 1042 0460 -- -� Town of Barnstable Regulatory Services «� Thomas F. Geiler, Director lIARNSTi4Bl.E. 53 �$� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 13, 2008 Washington Mutual Bank 7255 Baymeadows Way Jacksonville, FL 32256 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you located at 422 Oak Street West Barnstable, MA was inspected on August 13, 2008 by Town of Barnstable Health Inspector Timothy B. O'Connell because of a complaint. The following violation of the Town of Barnstable Board Code was observed: § 353-1 Responsibilities of Owners: Garbage and rubbish observed though out property. Also large amount of brush and construction debris on Northern part of second lot. Some of this brush and debris seems to have been buried. You are directed to remove the garbage -and rubbish from your property and dispose of it properly within seven (7) days of your receipt of this notice. 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. Failure to comply with an order will result in a fine of$100,00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S.PCH ` Director of Public Health Town of Barnstable QAOrder letters\Refuse\422 oak street W Barn 2.doc 06-13-2403 Q 03 = 55P BASBLETCONYTRGISRYFRNTA COUNTY O DEEDS Date: 06-13-2008 D 03:55am Cal': 1382 Doc': 322F6 Fee: $593.11 Cons: $170Y35?.71 FORECLOSURE DEED and AFFIDAVIT WASHINGTON MUTUAL BANK, f/k/a WASHINGTON MUTUAL BANK, FA a corporation duly established under the laws of the United States of America and having a mailing address at 7255 Baymeadows Way, Jacksonville, FL 32256 present holder of a mortgage � /7 0 from Gleison Pimenta ?�I ?- 7070 to Washington Mutual Bank, FA dated March 31, 2004 recorded in the Barnstable County Registry of Deeds in Book 18392 Page 313 , by the power conferred by said mortgage and every power,other , for ONE HUNDRED SEVENTY THOUSAND THREE HUNDRED FIFTY N'.I:NE AND 71/100 ($170,359.71) DOLLARS paid, grants to WASHINGTON MUTUAL BANK, 7255 Baymeadows Way, Jacksonville, FL 32256 BARNSTABLE COUNTY EXCISE TAX. the premises conveyed by said mortgage. BAftPiFiTABLE COUNTY REGISTRY OF DEEDS Date: 06-13-2008 D 03:55am Q144 282 Doc': 32296 Fen: $388.74 Cons: $170P359.71 Property Address: 425 Oak Street, West Barnstable, MA 01905 Page 1 I r s Bk 22980 Pg 306 #32296 Witness the execution and the corporate seal of said corporation this - — day of Q 2008. WASHINGTON MUTUAL BANK, f/k/a WASHINGTON MUTUAL BANK, FA By: Name: Title: STATE OF �'L County of �uy0� `(YEA 2008 Then personally appeared the above named aa(\\ S and acknowledged the foregoing instrument to be the free act and deed of Washington Mutual Bank, f/k/a Washington Mutual Bank, FA before me, )Ck a_� �Sz� Notary Public My commission expires ... 20 LORA A. SATTLER Notary Public, State of Florida My comm.exp. Apr. 27, 2010 Comm.No. DD 545841 CHAPTER 183 SEC. 6 AS AMENDED BY CHAPTER 497 of 1969 Every deed presented for record shall contain or have endorsed upon it the full name, residence and post office address of the grantee and a recital of the amount of the ful.'. consideration thereof in dollars or the nature of the other consideration therefore, if not de7.:ivered for a specific monetary sum. The full consideration shall mean the total price for the conveyance without deduction for any liens or encumbrances assumed by the grantee or remaining thereon. All such endorsements and recitals shall be recorded as part of the deed. Failure to comply with this socti.on shall not affect the validity of any deed. No register of deeds shall accept a deed for recording unless it is in compliance with the requirements of this section. Page 2 Bk 22980 Pg 307 #32296 AFFIDAVIT I, 11 (A( `D�S of Washington Mutual Bank, f/k/a Washington Mutual Bank, FA named in the foregoing deed, make oath and say that the principal. and interest obligations mentioned in the mortgage above referred to were not; laid or tendered or performed when due or prior to the sale, and that Washington Mutual Bank, f/k/a Washington Mutual Bank, FA published on the 18`h and 25th days of April and 2Id day of May, 2008 in the Barnstable Patriot ! a newspaper published or by its title page purporting to be published in Barnstable, Massachusetts and having a circulation therein, a notice of which the following :is a true copy, FOR A TRUE COPY OF THE PUBLICATION SEE EXHIBIT A ATTACHED HERETO AND MADE A PART HEREOF (Insert Advertisement) I also complied with Mass. General Laws, Chapter 244, Section 14, as amended, by mailing the required notices by certified mail, return receipt requested. Pursuant to said notice at the time and place therein appointed, I sold the mortgage premises at pubJ:ic auction by Herbert N. Whiffen an auctioneer, to Washington Mutual Rank, f/k/a Washington Mutual Bank, FA above named, for ONE HUNDRED SEVENTY THOUSAND THREE HUNDRED Fi'WTY NINE AND 71/100 ($170,359.71) DOLLARS bid by Donna M. Freitas, duly authorized agent of Washington Mutual Bank, f/k/a Washington Mutual Bank, FA being the highest bid made therefore at said auction. Name and Title: U yC� �tC''S1 GPn,� Signed and sworn to by the said on , 2008, before me, LORA A. SATTLER Notary public expires Notary Public,State of Florida My commission - - - 20_ My comm.exp. Apr. 27, 2010 Page 3 Comm.No. DO 545841 Bk 22980 Pg 308 #32296 EXHIBIT A MORTGAGEE'S SALE OF REAL ESTATE MORTGAGEE'S SALE OF REAL Byviftwandinexecudon(rfihe.p"ae ofS;ale-containedin8ceitain mortgage givervby,Gielsga:P.pni*t DAashWglon Mutual Bank, FA dated March 31,2004,and recorded in the Barnstable County Registry of Deeds Iri Book 18392,Page30;bf which mortgage the undersigned:ig the present holder,for breach of the oonditions of said mortgage grid for the purpose of.foreclosing,the same will be sold4Publfc.`auction at 12.30 P.M.on Wednesdey the 14th_day,of May,2008,:on the-mortgaged premises lodged'-it 425 Oak Streak West Barnstable,Massachusetts,all and singular the real estate deacnlied in: id mortgage as follows; :...the foflcWng described pibperty laxlted1n.BARNSTABLE ,County,Massachusetts; LEGAL DESCRIPTION ATTACHED,HERETOIAND MADE A PART HEREOF, 42S.:0ak 5ticet; st:Batritt a MA 02888'<:'i�`:;: ile.andytogettterwilh the build�gs;sftuated therein•Bemstable. 09 4)BamstableCeurity,'Massadhiisetb;boundedanddescribed asfellowsi . Westerty:by,land nonror fotmerty'of Ruth H.Cofhnah,'as shown on saidrplah_herainaftsr_Ontioned,'one hundred twenty-six and 25/11.00'(126. 5)�*t. Northerly byrland now orfbAnedjr of Barbara R::Moon,as shown on saidpliinrooe hundieE ill -five and 01/100(05:01)feet. Eaa4etly liy fend�opw orfoiroerty o f Lillian M.Atwood et a 1,as sf ow cnsa p7en;orie:hundrednirlely-seven and 29/,100(197.29)feet Southeasterly by'bek'8tr9et,a Town Way,as shown on said plan one.hundiedawen(y fn[e'and D07100(12500)feet;.and.: Soudiwesterlyl?y,lanA riott!or forisrerly of Barbara R..Mom,as ehawn:or said ptan;;ohe;t Odred sb"fght and 91)100(186.91) The abov r descn'bed.premises are shown.as Lot 2 on a plan of Landengfled,'S'ybdnriajoriofLandini eWgamstable;Mass.propetty i of Barbara R.Moore;Scete,l Inds equals 40 feet,April 10,1981,Ed Kellogg CidEn_gineer',whkhsafdplani.dulyrecbrdWinBarnstable' Courdy.691s of Deeds in.Plan Book 182;Page 145:.• wtddYeumer hgtheaddressof4Z.OikStr ekWditBamstaK* MassadiuseCs 02688('P�opgAyAddresr<') TOGETHEft•VIfITHall tfielmprovements nowdrhereaftererected' on fire property,grid al(easements,appurtenances;and fixtures,now :orhereafter a P84 of Oe property:All replacements and additions aliatlaisobeoovered bythisSeW*.Instrument:Allofdieforeong .la relerrad to in this Security Instnnmerd as'the'Prope . Said.premfeei will be sokl subject to and/orwlth the:benefik of. any and ill.rastitWons;easements,4lmpigvemenis,'cbvenanta, oulatandigg taiitte,-murilcfpal or other public taxes,assemmerits, Ilene ori6ims'i tfie'natureoflieris,.andeJstlngencrimbrancesof record orealeg;pfldktothe,inortga' ifagylhere'be:-"::'": -Sold PAilikiii. 1 alp tra`sold t0le.0•to all leases aiid,tgnano(ea t n9 Pliority.ovor s,.mortgage;to2enandes oi;occnpation8 by. Pereonson the premises newer atthe,time ofthe said auction which tenandesot oCcupations.are_subject to,seid martgage,.lg rigMa or chime in personelpropertyinifalledbytenantaorformertenardarrow boetstlonthepremises andaisbtowilawsandordfna;i sindudIng, but nct lirfrited to;e9 building'anA-inning lawe?and oidinarces. TFIETERMSOFS. A THOUSANDand00/100($5,000.00) DOLLARS will beiequi{edtobe.paidDy.bankorcerGfiedcfiedconly bytirepurcliaseratth0 fims and p�ceofsale,endthe balenbeotthe purchase price:shall be paid.by bank or certified check in'oi within thb{y five:"(35)days thereci f6t%i thAttomeys Stantori,&Davis,1000 Plain Street;,Mars16e Massachrisetti Tlie siucessiulbidder at the sale of the premises shall be required to slgn:e Memorandum of.$ale of ReatPropertyByAuctionear:containing the above,herma ItlFreAgctioQsalei: •';�,.,,;' :-:'; `' Othertemts,;ifanW be:atnnounoed :thetime:andplaceof 'tlre sale. L.'. . FA8,1PGrNesEeDnE ldsldfeiS:a,t`'St0Ma0id0 t.al8ankfl.kaV inpM S halBank Mortgage,-By, T/NT0r4&DAVa AsireAomeyF:FMOFFICESUE; on S_DaE ,s; uire$TAQV&D�V AA• 2080Plain 5treet;Marshfield ' (2139-1435-1207F/Piment'a 04/18/08, 04/2$/08, .05/0�=X109292) The`Ban►stable Patriot April 18;*126fd May 2,,2008 ' ABLI REGISTRY OF DEEDS 'V .r Commonwealth of Massachusetts fC'Titie 5 UfficW inspection Form -Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information Important: ` $ ��L"ql/5 7 z5` c�I��CG �- When filling out 1. Property Information:/� /�¢ �Q/G� Gr�/O��U GU���•�S, forms pon the ��z (��� computer,use only the tab key Property Address i to move your cursor-do not use the return Owner's Name P7 key. T y ��( �" / Cyi- 0g,YUZ Owners Address City/T� State Zip de 3 Z: Date of Inspection: Date 2. Inspector: �-=l�l�t/•�r�� � cSj o�f o�pU��-��3fd�y Name of Inspector ��S Company Na�i,/�� Company Address City/Town State Zip Code Telephone Number f,.1 .B. Certification I certify that I have personally inspected the sewage disposal system at this address:and that tKb3 cp information reported below is true, accurate and complete as of the time of the inspection. The Inspec was performed based on my training and experience in the proper function and maintenance of= sit@ n sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.34&of y, Title 5 (310 CMR 15.000).The system: o� �. rr Passes to ❑ Conditionally Passes ❑ Fails ❑ Need u er Eval at' n th Local proving Authority Insp gnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '""'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in Vie future under the same or different conditions of use. �0 t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface SewaLeisposlally stem• YV Page 1 of 16 b. i Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'M B. Certification (cont.) Property Addres City/Town C4s 6 State Zip Code �C Owners Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated bb Comments: �� U� �C �PaY D'�ZO Aj B) System Con ionalll Passes: �c� �� /�U � 6c�� / dss:qeJ!io'6n?eAe7d4-to❑ O or more system components as described i the"Conditional be replac r repaired.The system, upon completion of the replacement or repair, as approved by the Board o alth, will pass. Answer yes, no or not ined (Y, N, ND)in the❑for the following statements. If"not determined," please explain. 0 The septic tank is metal and over 2 rs old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial I ation or exfiltration or tank failure is imminent. System will pass inspection if the existing tank I laced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally so not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is a 'table. ND Explain: t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (cont.) �zz '�--&k S/- Property Addres ��S — G ZC 3Z City/Town � State Zip Code�sv� 'e- Owner's Name Date of Inspection // B) System Conditionally Passes (cont.): 4 ❑ Observation of sewage backup or break out or high static water level in the distribution box due to Token or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pas inspection if(with approval of Board of Health): ❑ oken pipe(s)are replaced ❑ obst ction is removed ❑ distributio box is leveled or replaced ND Explain: ❑ The system required pumping more t n 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with appr al of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Furth valuation is Required by the Board of Health: A� ❑ Conditions exist require further evaluation by the Board of Health in order to determine if the system is failing top ublic health, safety or the environment. 1. System will pass unless Board ealth determines in accordance with 310 CMR 15.303(1)(b)that the system is not func ing in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface w ❑ Cesspool or privy is within 50 feet of a bordering vegetated nd or a salt marsh t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (cont.) Property Address z- Ci ifrown State /' -S,v / Zip Code Owner's Name Date of Inspection wl/f C) Further Evaluation is Required by the Board of Health (cont.): 2. Syste will fail unless the Board of Health (and Public Water Supplier, if any) determines at the system is functioning in a manner that protects the public health, safety and en . onment: ❑ The syste as a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a rface water supply or tributary to a surface water supply. ❑ The system has a sep ' tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank an AS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS an he 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 D P certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen an nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A opy of the analysis must be attached to this form. 3. Other: t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form N B. Certification (cont.) Q&2 6L� Property Address City/Town State ' ZipCode Owner's Name Date of Inspection D)System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ X1 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 ❑ Vq4j/4_ Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ [6 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 -l9- tributary to a surface water supply. ❑ ®N11 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- di}- 10,000gpd. Yes No ❑ T 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. t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 4, Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (cont.) �ZZ Ud1c f� Property Address Z y Y11 UZG�2— City/Town State� d9 Zip Code Owner's Name Date of Inspection N/ E) arge Systems: To be considered a large system the system must serve a facility with a /� des i flow of 10,000 gpd to 15,000 gpd. For large stems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in tion D. YES NO ❑ ❑ the syst is within 400 feet of a surface drinking water supply ❑ ❑ the system is wit 00 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a ' en sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zon of a public water supply well If you have answered"yes"to any question in Section E the sy is considered a significant threat, or answered"yes" in Section D above the large system has failed. owner or operator of any large system considered a significant threat under Section E or failed under Se ' n D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should conta a appropriate regional office of the Department. t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. Checklist ZP2 o0i s� Property Addr Z V"5 City/Town State Zip Code Owners Name Date of Inspection Check if the following have been done. You must indicate"yes"or"no"as to each of the following: YES NO ❑ ( 9] 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? ❑ /1 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 sy a bt ined and exa fined? (If they er no; v i able note as N/A) z / � dv�q n� 74 _ 7' Q/ ryv ❑ as e faci ity or dwe ling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? IMJLL Vn ❑ Were all system components, ie 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)] ST/-hc �170'Le t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Fora' Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Informatio '5�Zz Property Addre doze 32- City/Town State Zip Code Owners Name Date of Inspection Residential Flow Conditions: �. 2G✓yy�rta� Number of bedrooms(design): Number of bedrooms(actual): IF r� dSQ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: — Does residence have a garbage grinder? ❑ Yes J 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)): / Sump pump? ❑ Yes No Last date of occupancy: ZdOZ Date fv �/t6W41,vl^ E1I Co mercial/Industrial Flow Conditions: �viad A G�eryt-alii� Type of Es ishment: Design flow(based o 10 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/per /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: Last date of occupancy/use: Date Other(describe): t5insp.doc.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 472 d s� Property Address "e aY�Sj OZ-f� 3z- City/Town //�� State Zip Code L2d'y�� �—2 c" Owner's Name Date of Inspection General Information Pumping Records: A */-a�e 17Wev- C-)t-_4 (a, Source of information: ;� Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Ap roximat a e of all components, date installed (if known)and source of information: �d Q ►'j /�eGr/ �ZvT!✓arc✓ ��,S �� i.I spec r c�,,rcav/,ao,c2 Were sewage odors detected when arriving at the site? ❑ Yes No t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' M D. System Information (cont.) *z z D� S Property Address el,15 32 Cityrrown / State Zip Code s� � Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: feet Material of construction: Elcast iron 1�M-4 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): _ �7 1j tin1,t — �. �oV ►c /�i Septic Tank(locate on site plan): Depth below grade: V feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ NoNlt— certificate) --- - - --- ------ -------------------------------- Dimensionsi 4- C" /u=G"Xot1'1 y Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? ,>� -pil-etl k t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts up Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) Property Address DZG 3 z. City/Town State Zip Code Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition str t ral integrity, liquid levels as related to outlet invert, evide ce of leakage, etc.): f- a,ffP Sa c (/t- - 3f A v/IcOi I e;.•LC N1 Grease Trap(locate on site plan): Depth below ade: feet Material of constru ion: ❑concrete etal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee o affle Distance from bottom of scum to bottom of outlet tee baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or ffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 4- Tigh r Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below gr Material of construction: ❑ concrete ❑ metal ❑fiber ❑ polyethylene ❑other(explain): t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'M D. System Information (co ) �z o �- Property Address Cityfrown �r J�4 , State Zip Code e-2e 9 Owners Name Date of Inspection yJ�Tight or Holding Tank(cont.) Dimensio 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 Xzme Distribution Box(if present must be opened) (locate on site plan): ✓ Depth of liquid level above outlet inverti� a'vh 5 rac�o Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage intp or,out of b x etc.)• N/*- Pump cate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ No t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) Property Address .?ot_Vn S OZ� 3Z Cityrrown CO- State State Zip Code �o/ �" -�9 Owner's Name Date of Inspection omments (note con '' of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required)y � � '-SAS FgHbcated, explain why: � f � 3� �j / 11ze) 440-14pf- Type: Yhas S� �L s�,.•r a�-t ❑ leaching pits number: leaching chambers number: �3> e�- El leaching galleries number: ❑ leaching trenches number, length: Z' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil signs of hygfaulic failure, leyeI of ponding, dam!j�qoil' co dition of vegetation, etc )Vt�� �U J Imo/�l f 'i °� �c8�►?f-d�-Q� - 7 1✓��� (L v Q✓ T� S a ve✓ Q1j—A j l-04 o 45e d t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 • Commonwealth of Massachusetts Title 5 Official Inspection Form U Not for Voluntary Assessments Subsurface Sewage Disposal System Form I V D. System Information (cost.) Property Address City/Town State Zip Code Owner's Name Date of Inspection */1 sspools (cesspool must be pumped as part of inspection)(locate on site plan): Number d configuration Depth—top of li id to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failu level of ponding, condition of vegetation, etc.): Privy(locate on plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, leve onding, condition of vegetation, etc.): t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) .,;;�2z s7 Property Add.r�ess ao�Yns fyfz GL'G32 City/Town State Zip Code Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. V 410 Z ore., zl Imo- 6i,�,rns rr�s-{•�g�pv� ' /JP_ �IUvof2L �.� capped (`fOrtr lUU.O 7; 99.3 7,40 6,r-o Z 9 7. !.- �� FC, ove✓ tgs ice!• 9 t5insp.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 L/ • Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) lug .0ez y Al Property Address Cityr own State Zip Code ce- Owners Name Date of Inspection Site Exam: Slope �� �/�v SW S Surface water Check cellar Shallow wells T G✓.�? ✓.Sp✓v�cps ,ss�P C"?W 5vV/VUn c/r My �vec Estimated depth to ground water: 1'?' '�' "I'` ' /�,/ �vG 3 1n ���.��dBP.U ZL'- tau 3 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 6n Ale P-1601-1 ❑ 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) ,�� q 6 � SA y , . /0V / ❑ Accessed USGS database-explain: U/f " �iI`' Z-/2— 00¢ You must describe how ou established the high ground water elevation: E;G H�/U/, 9P let n e �iXeJ� Ce f) ry �s� o f" �T� —1717 t5insp.doc.doc•03/2006 �. Title 5 Official Inspection Form:Subsurface Sewage Disposal System /y���` Page 16 of 16 ov YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: Fill in lease: <APPLICANT'S YOUR NAME: 1 4G E I C 1 112A BUSINESS YOUR HOME ADDRESS: S 01W ST vZn,3,5� -7I/- 35 3 -- 6 '(3s- U) 34 s_a)S 1-413 LE� ,�4 n 24 6, T"'�,[,e, i - TELEPHONE #. Home Telephone Number Cel- -V� 14 -3 53-by / &UAW? NAME OF NEW BUSINESS (� 7" S fa f�i NTti V (s TYPE OF BUSINESS r ✓ IS THIS;A HOME OCCUPATIONS YES NO Have you beep given.approval from the:building diwson? YES NO � ADDRESS OF'BUSINESS ...... MAPfPARCEL WuM R. When starting a new business there are several things must d�in �rd�erto�beinomplian ith the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the ' ou MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has been i rm of t e permit requirements that pertain to this type of business. Aut orized Signature** COMMENTS: �° ' t d LY1621� 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: .Ir TOWN OF BARNSTABLE Date:( TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: S �- W N c N� BUSINESS LOCATION: '-lD_S OOK BAp ps t- INVENTORY MAILING ADDRESS: __ O. ! 0>C S�3 18/1 NP_j1 S + IX-14 6 TOTAL AMOUNT: TELEPHONE NUMBER: 3 93 — 6 4/-3 f CONTACTPERSON:Miy -Pey-, ,° EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Pmlh INFORMATION/RECOMMEND TIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division, LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor & furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers L m At (including bleach) Spot removers &cleaning fluids (dry cleaners) 94 Other cleaning solvents Bug and tar removers -L¢6 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS No. UU 3 r Fe$50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppricatton for Migool *paem Construction Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 3 9 4—1 1 1 7 W Barnstable Donna Hume 7 Crescent Ct S Yarmouth - Installer's Name,Address,and Tel.No.7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 5 4 8—0 7 9 6 Wm E Robinson Sr. Carmen E. Shay a PO Box 1089 .Centerville 34 Thatchers Lane E Falmouth Type of Building: i ,D U��Si 2 UC Dwelling No.of Bedrooms 2 `7 �`� �e 1��I,ot Size r�"'^'"'` �sq.ft. Garbage Grinder(nd Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank_ 1500 Type of S.A.S. Description of Soil, Nature of Repairs or Alterations(Answer when applicable) Install T i t-_1 P 5 S P=t-i r- to plans of Carmen Shay — #SD-390 Date last inspected: Agreement: The undersigned agrees to ensure the construcqon and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the vironmen 1-Code and not to place the system in operation until a Certifi- cate of Compliance has been issued.by. o of Health. r Signed a' Date Application Approved by Date Application Disapproved for th ollowing reasons Permit No._¢(�—i�3/ Date Issued 2 J t- 4 ``r,�No. ��Q Ll —�� � a 1 Fee$5�.00 � < THE COMMONWEALTH OF MASSACHUSETTS' Entered in cPmppter: Yes ;PUBLIC HEALTH_ DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3ppricat0n for Oigpool */pgtem Con5truction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon(:. ) O Complete System El Individual Components Locati Address or Lot No. Owner's Name,Address and Tel.No. 3 9 4—1 1 1 7 4 k� Stf W Barnstable Donna Hume Asdessor s ap azce 7 Crescent Ct S Yarinou'th 194-005 too r Installer's Name,Address,and Tel.No.7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 5 4 8 -0 7 9 6 'Wm E Robinson Sr. Carmen E. : liay -- a PO Box 1089 Centerville 34 Thatchers Lane E Falmcatath Type of Building: �}S, 2�'- ?11-1 a`1) ,I' Dwelling No.of Bedrooms 2 ��� `S��Lot Size 7a w✓wed,ft rsq.ft. Garbage Grinder,(nc) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date *N, Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install Title 5 septic system to plans of Carmen Shaft — #SD-390 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 o'f the,Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d bye, . Bo o .Health. � L) Signed � �� Date Application Approved by /�-� `V J, Date Application Disapproved for thWfollowing reasons Permit No. OO V—U 3 / Date Issued Hume THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Abandoned( )by Wm Robinson Septic Service at jl� Oalk Street W. Barnstable has been constru ted i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �Q 0'_ `y3 dated 1 a�o ",,Installer Designer n � The issuance of this pM shall not be construed as a guarantee that the sys'" mill function as de ned. Date '7 �1�-I Inspector �In/ � ' K-. I Q' No. �UUy--(�---------------==—=---------F fi50.00 Hume THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mfgpool *pgtem Conztruction Permit Permission is hereb ted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at W Oak Street W. Barnstable 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:Construc"on must be completed within three years of the date of this(' p Date: ?a G Approved by lz< I I J , J Y.2.2 otk S TOWN OF BARNSTABLE �L LOCATION SEWAGE# 0 VILLAG ASSESSOR'S MAP-& LOT 'dV S7!'T D INSTALLER'S NAME&P NO.��6 ' �" �''' 2 7 6' - SEPTIC TANK CAPACITY LEACHING FACILITY: (type) "' �l �� (size) J NO.OF BEDROOMSU BuiLbER OR OWNER PERMITDATE: . _COMPLIANCE DATE: I ' 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 ii H,1-U ��S 13�<, j l � L f r Town of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,-.Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 JAY PEREIRA May 20, 2004 P.O. BOX 253 HYANNIS, MA. 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS, NUISANCE CONTROL REGULATION NO 1 The property at 422 Oak St. West Barnstable was inspected on May 6, 2004 by Donald Desmarais, Health Inspector, because of a complaint. The following violations of the Town of Barnstable Board of Health Regulations, Nuisance Control Regulation No. 1 were observed: Nuisance Control Regulation No. 1, Part VU, Section 100: Massive pile of refuse must be disposed of properly. You are directed to correct the violations within seven days of receipt of this order letter. 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. Please be advised that failure to comply with an order could result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OtOARD OF HEALTH Thomas hcKean, R.S. Director of Public Health Town of Barnstable Q:Health/orderletters/refuse/274 South.doc '`� -� ',:; c. �.:-,.� <:'' ems. .'�, �: 0 � r I �.�f ,r � .. ' - ..,� J � j �. t w�' „ �� � �� i 'w: p�. �A •1 � a�1 n Y ��4 _� ���n ll���� 4R'.. � 1, r , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y�. 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E. PROP.SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 118/09 every page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your VANCE STEVE YOUNG cursor-do not Name of Inspector use the return key. Company Name VQ BOX 1592 Company Address MANOMET MA 02345 City/Town State Zip Code 508 759 5603 S1686 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 1/8/09 Inspector's Signature Date The system inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. tAj ' 01 422 OAK ST•08106 Title 5 Official Inspection Forth:Subsurface Sewage Dis System•Page 1 of 15 ,o Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 422 OAK ST. Property Address WASHINGTON MUTUAL Go N.E. PROP. SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W. BARNSTABLE MA 02668 1/8/09 every page. Ciityrrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Passe 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 exfittration 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 422 OAK ST-08.0) Me S O!bcid Inspechm Form:-Su bsurfa---Sewage D4s-al Sys+tpm-Page 2 of 1 S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E.PROP.SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W. BARNSTABLE MA 02668 1/8/09 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cunt.): ❑ 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: 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. 422 OAK ST•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •''p 422 OAK ST. Property Address WASHINGTON MUTUAL clo N.E. PROP.SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W. BARNSTABLE MA 02668 1/8109 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 ® 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. 422 OAK ST-08106 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal gSystem•Page 4 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y~ 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E. PROP. SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W. BARNSTABLE MA 02668 1/8/09 every page. C4/Town state Zip Code Date of Inspection B. Certification (cunt.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 east 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. 422 OAK ST•OaM6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E. PROP. SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 1/8/09 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 422 OAK ST-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts VTitle 3 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 422 OAK ST. Property Address WASHINGTON MUTUAL cto N.E. PROP.SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W. BARNSTABLE MA 02668 118/09 every page. City/rown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 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)): N/A Sump pump? ❑ Yes ❑ No Last date of occupancy: 1/1/08Date 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: Last date of occupancy/use: Date Other(describe): 422 OAK ST-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Jr< 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E. PROP. SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 1/8/09 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known) and source of information: 5 YRS PER AS BUILT DATED 1/22104 Were sewage odors detected when arriving at the site? ❑ Yes ® No 422 OAK ST-08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 OAK ST. Property Address WASHINGTON MUTUAL cto N.E. PROP. SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W. BARNSTABLE MA 02668 1/8/09 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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.): Septic Tank(locate on site plan): Depth below grade: 0 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: 10X5X5 Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? MEASURE STICK 422 OAK ST-f?&06 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E. PROP. SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 1/8/09 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) 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 INTEGRITY OK INLET AND OUTLET TEES OK .LIQUID IS ABOVE THE OUTLET INVERT. WHEN TRYING TO LOCATE THE D-BOX,A BREAK IN THE PIPE WAS FOUND,AFTER CLEANING THE DIRT FROM PIPE, EFFLUENT RAN BACK INTO THE PIPE FROM LEACH,PUTTING THE SYSTEM IN FAILURE 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 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): 422 OAK ST•OWN Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 422 OAK ST. Property Address WASHINGTON MUTUAL c!o N.E. PROP.SOL. 410 BRAIN. HILL OFF. PK BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 1/8/09 every page. Cityfrown state Zip Code Date of inspection D. System Information (cunt.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in worldng 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 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.): NOT EXPOSED DUE TO EXCESSIVE WATER IN TANK AND OUTLET PIPE Pump Chamber(locate on site plan): Pumps in working order ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No 422 OAK ST•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E. PROP.SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 1/8/09 every page. c4frowm state Zip Code Date of Inspection D. System Information (cunt.) 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: Type: ❑ leaching pits number: ❑ leaching chambers number. ® leaching galleries number 3 ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovative/aftemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): NOT EXPOSED DUE TO BACKFLOW OF EFFLUENT IN PIPE TO TANK 422 OAK ST•08/06 T(de 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 422 OAK ST. Property Address WASHINGTON MUTUAL Go N.E. PROP.SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 1/8/09 every page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) Cesspools(cesspool must be pumped as part of inspection)pocate 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 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.): 422'OAK ST-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 v Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E. PROP. SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 1/8/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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. , ,�e � 422 OAK ST•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 ,I h i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 422 OAK ST. Property Address WASHINGTON MUTUAL c/o N.E. PROP. SOL. 410 BRAIN. HILL OFF. PK. BRAINTREE, MA.02184 Owner Owner's Name information is required for W BARNSTABLE MA 02668 1/8/09 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: TB DETERMINEDfeet 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: SYSTEM IS IN FAILURE AND GW WILL BE DETERMINED BY OB HOLE DURING PERC TEST 422 OAK ST•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 �fJ L 0(4k S TOWN OF BARNSTABLE LOCATION 4- r SEWAGE* VILLAGE ASSESSOR'S MAP-&LOT= a �d S M r- .o- �s• INSTALLER'S NAME&PHO 0. ��6 F % � '�' 7 7 6�_ J SEPTIC TANK CAPACITY _ 5 LEACHING FACILITY: (type) �S ' G fdg� L- (size) `` I� '' NO.OF BEDROOMS q BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: , Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i I HY-o �yS 13A, 1 A OP TOWN OF BARNSTABLE LOCATION 6/,R O Q7 ;' % SEWAGE# ,7(3gvl-- 4✓1 VILLAGE - 3-7Aj5lF ASSESSOR'S MAP&PARCEL INSTALLER N E&PHONE NO. Z7�v SEPTIC TANK CAPACITY 1606 LEACHING FACILITY:(type) / O6 �/ G�/)1 /S(size) E���� NO.OF BEDROOMS ('0616 �J OWNER ICU Al o PERMIT DATE: �" 'e+�'�'ddf 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 13` r x July 9,2002 RECEIVED Barnstable Public Health Division 200 Main Street J U L 15 'ZOOZ Hyannis,MA 02601 TOWN OF BARNSTABLE HEALTH DEPT. ATTENTION: Mr.Thomas McKean, I am concerned about the health and well being of two children living at 425 Oak Street,West Barnstable, MA 02668. The children's names are Richard(age 10)and Helene(age 7)Thompson. As a concerned parent,a mandatory reporter and a Registered Nurse,I am obligated to inform you that: 1. The children have stated that"Their bedroom doors have been removed by the mother's male live-in friend to who the children refer to as Mark" 2. There has been more than one family living in the home since January 2002. (Two other adults,one other child and Mark). They have all been there for approximately 7 months. 3. There are anywhere from 11 to 14 cats(children's pets)living at this residence.They also have a rabbit in a cage outside the house that appears to be starving. 4. The children have stated that"the cats urinate and defecate throughout the house and in their bedrooms,on the carpets,under the beds,on the beds and in the dresser drawers." 5. At school the children are teased by other children because their clothing and back packs smell of urine and/or they have on dirty clothes. 6. Excessive refuse has been piling up for well over 1 year next to the house(at the south end)that smells and attracts vermin and bugs. Trash is being stored inside the house as well. 7. The children have complained that Mark has hit their mother in their presence. The children have complained that they too have been hit,pinched,kicked and thrown by Mark. The children have expressed concern for their mother's safety. 8. The female child(Helene)has stated"She is afraid to sleep at night because Mark comes into her room during the night and scares her."Over the past several months her behavior has drastically changed. I am truly concerned about the health and well being of Richard and Helene Thompson. Thank you for looking into this matter. Sincerely, A concerned parent Mandatory Reporter Registered Nurse Town of Barnstable B"'rlr�NSTA� ' Regulatory Services i639 ,$� p3ya Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 1, 2003 Richard & Catherine Thompson 425 Oak St. West Barnstable ,MA 02668 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property owned by you located at 425 Oak St., was inspected on May 27, 2003, by Donald Desmarais,Health Inspector,because of a complaint. The following violations of the Town of Barnstable Board of Health Regulations, Nuisance Control Regulation No. 1 were observed: Nuisance Control Regulation No. 1, Part VII, Section 1.00: Construction debris, ripped open bags of trash, carpet. You are directed to correct the violations within seven days of receipt of this order letter. 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. Please be advised that failure to comply with an order could result in a fine of$100.00. Each days failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Q:Health/orderletters/refuse/274 South.doc Ex,s,7.a r3io rwaYv t 2 v qto - 31 11 L.EV r C LE7VA-77o.J DID Imo - Q - exiS7. Ex,yT f�,.fD ru�an iiD r- F�EY�i Lffiffi L )T EcE-VA-nVnl i , RA-�UcN 2�Mo�� SCALE: • APPROVED BY: - DRAWN BYY �fml-D .. DATE: D-B-0 - - REVISED - y L �Sb 77Y o6 7SNARON NALT . - .. DRAWMG NUMBER ® New ,vaw v X ng+- AO NfO 7-u/ayy.'o1 ,VE107()�03.2 a$ 689L-r �Na3S ue -rw.2v3a RevsE FY-O-vS r-ixeD IR 1711�A kli --,� — a.y Of 73�lTN nlrw ' ~ Peo dv �w � K(TGH&A) + A}F+a � ! TO y`/.1 T ! �5T. $EDQ4Q0J4 - I 11 LJE9&N4EQ-5 FwAL Jis POCKET �X o7V G S L y PChN h . — Q•B,,t- L /ol a 4! -+ _ -13£P20CM Waif, 9-laU 5 E' Exist. 6 COAT' "I Gtdyx�Or- d NEW y i NEW NtCJ 1 i. O tW p3o `� ab I GOUNTl24 K.ITe+1&1J G a( I i NEW i 1)AUI,T G ' a T7o I �910 NEW-rzo..7 Yvj ro LU 3-��, 3as�o• � I ! Exi y T. Ex,S T• NEr 8© New 7WaYi/d- Z L Y a + 8_ „ U! 5! n Gt a/rJo t- 6 L o4xd0 +_ 3`k O D_I{ DN. xa !s T A Tu)dy310 _ Tway3lo-d �i oRoau 1 Q NEW rb lfl)dvva 1 � � jw3o3/o f"ixso IL1 i� i'x s-6 Si S - 3?-D" /( -O"Nr-hJ _ Ig-D, IV-Etc) (olo-D''A/EuJ OyrR�4L FLOOK PiA-N EXI:S7/NCB t ) IJ SCAU- Q(+�y 6r i " �W o 00 in —_�J — -- d m.0 sow. _ i wu.mwT f a�vae — -- EFiie3 — —.---------.-----.----- Wll 1�OM� Wtl�la�R-— —-—-—_ —_—-—-—_—.—_—_—_—.—-— —IWL l- - ® Lim, Imm[ ®E® ® s -�Jm NLH - -------- ----- o a -- . '- - ' U FRONT-ELEVATION RIGHT ELEVATION _ C/) SMOTEDE.-TECTORS REVIEWED U GQ �4 Zs/a T L BUIL NG DEPT. DATE w FIRE DEPARTMENT DATE LZ �+ Ul —. BOTH SIGNATURES ARE REQUIRED FOR PERMITTING O ^ saw — —WALL 10&ff ----------- --- maw lie ? r r — --------------------- ------ _ _ _ ___ ____ ___ _ _____ siei+- ip— i I E9 Effl ff] FFH I i I. T I _ 3 LEFT ELEVATION 4 REAR ELEVATION _ e n — — W N co IZ X 14 DECK A co) 00 ASPECT RATIO 2.75 --- .-- � W/D # ------ © WINDOW/DOOR SCHEDULE v I 6FEAR PANEL1• r s>n UADTH......R LL NE)CWT 6HEATWrNG 42i MIN. 7 nmoucr ccoe r. .`ate`• caxr CaAee enn rM sAcrow x Q • •40 s.• o.ss 8d COMMON 3 EDGE SPACNG. It FIELD 6PAGMG rr r.• x � e eor e'a yr x s'u rvssr) 1 30.. b OAo71 s••n 3'-0• i xw ov _ •c nnDsosue s'ox•'r � xw a p s s y LENGTH......FI LL HEIGHT SHEATHING� MIN. Q 5/8 FIRE X GYPSUM G � DINING AREA c>ss a'o yr x s'a sn es as os 5 s 6d COMMON 3'EDGE SPACING. If FIELD 6PAGMG a TAPED AND BANDED : • r • mu r+v� x s';w• e e w4+ o ss ; y 7 -sx ♦l ; ass MW LOW "vY x e'x MWe ) ( WA WA WA yY /� aw P R WATm r-w Vr x V4r(Vwsj I ti ti cAo = a � U n s w awa r4 vs•x t-s w• f rs uti os. 9 ppLd I v , ® • - T SW 7 sos Ya vs•x W-6 v.• r ass •os oJM m, r� w V d s ' , x r. . s s ss o� g 9 x = • LVL WEADER 19• & Iri' ram•I (o'O'oo_ 4 j _ GARAGE 7-sb' aob 7-4K' !.-0. ---------------=- N J usoDes.o-ss wd ea n. 516 SGLFT. ►- 6 �64h' DOOM•OJ( xA eo.II. V 22M•OAO fL eo.A. Sy 1 O V + i . O PL•. R.CHICK OIFV�'1tlLLATION WTALLmI 4 1 b , --------------"_"-- •yy Z+ BEDROOM sl , UVIr/Ca Roots Q a 6HEAR PANG. O O b•_!• O D + I8T FL GROSS FLOOR AREA s36 SQ FT. w 4 2ND.RL.GROSS FLOOR AREA 151 6aFT. r r -g A B A A na TOTAL GROSS FLOOR AREA 1693 SaFT. A•/ •'o• oo' i'o' ♦'o' s'o' •'-o' 6'-0' 1 •'-0• GARAGE AREA 5l6 Sa". 2W-O' 36'-0' FOOTPRINT 1545.8 SOFT. FIRST FLOOR PLAN s36 San. U (,Q O E-I D'ak• !'316• 4'-0• yp• pp• W o E H Az au stAn Fy ATTIC STORAGE 1O•-!r' D'u�' r 9 u y Q t L Y N 0 e'er' 'Y`0° BEDROOM 03 fl * + u 8 s• Y_2%' t'-4h•' t BEDROOM s! A 9 IL IL IL S 4-1 `AFT �.�. Q nu wm(r oain _ a — a ! Daeu ru4•nYml anoau 9 a 'o• �,+,rug s't awal 6 rs r� ♦ WAU 02j' Yam' YJ' ACLt1e K.G7D - � Y-0' a M.ru 1• Q D'O' FC-0• ILI D'-0• r I 0 i. 2.4.-0• WALLs3 6'-0• WALL04 Fi 0 to-0• � O ��cc I SECOND FLOOR PLAN isT paFT, — Q a Scb. of. F'ro ose d :E1 e v s fl _— pp 1 Ca ble vzsjon of` Mass, Inc, Ma 1 942# . .�Ol.5 Prop TGF Sill p 11 D 11 . T , Paroel 008�'02 � . �� 100.8 P Finish Grade ( House , / , t Prop Fnd 1a0 - Rt '� °A 110 89 7� n T i � � Cf `., : Js C.O.,LiI7 - 8 -1�oa�.,.•--' CB/DH 9007 k 99.3 Pro Invert out C�-House ------------- --- ' ------------ --- --- -_-- -----'-------!--- ____-__-__, _.- - 195:01 Y : Seb. of Exis tin :1 1e v s , - 100.OO F,G. o Ter S. T. was 99.t3 Top of S. T. 104 lL 617 a 98.2 In v :jn @ S T. r Sq 98.o Inv out @ s T � .—.. �./a ��, -��� 'LOCUS MAP 101.00 F.G. over D-Box \� X T S'. 97 40 Inv in (P D-Box 102 i t. `- 9715 Inv out @ D-Box 101.9 F. G. o ver SAS , 970 Top of Chambers �. 96,0 Inv in 0) Chambers �Y�; , -SAS - 11 sYt See C17a1 t � Zoned- RP 94. 0 Bo t of SAS - ---- -a. - \ x Assessors RefePenee. 1"Tr1j1e - � �fJO. i 13' x 33 5J 4 Bdr 'S stem .;> �. tsar w 3 500 Gal H2O C,hamber�-'. y ,, V '4ssessor, Ma 194 Parcel 005 T00 P 100 r9 0 r v© , ; '� .', -1" ,a, Assessors Ma 194 Parcel 006 WOO .,. , ^ J}r \ Deed Reference e� � ----y ( � Y t�hSerS �r,r ]'�]� ry �'g�j 7� Map 194 , j I `^L'��-.\ I S rX '''��( i `�� �� q1,L' L3.LS 2e.5 I f Pg 260 t- Parcel 006X01 r 0 ~ Cone &ce i .Plan Reference 76 EX1.S ling . .� . ' , .Flood Mafia Reference r. ` ` Zone C _- �, 18 Jx 04 JJ Cone A ', .ess a �_ r Comm un1 t V 50001 .-- T1 10 Q�tt Vj f CB,/DH E is t112� (97 07 1, 500 �'al ,s � r Map 194 Y o . H- 1 — Ta_rk - t5,3p !O PVC XlMeanouf t 1 "- :... i J� 60 m Car Prop'-­1 � �tr_xl.k r.i�a C.X / , -rf oo 0ar`Oge 3 for 1 �� 4 i 1 \ SILL - 01 CF/, , Flr� r �101 f _ - „A. �_� — , PTA IT Ej 4, a ns to bl , MDF A for EXISTING HO USE100 AND FO �ATA TI01 f j' HOUSE USE & T UNDO. TIC�N D/W and for .._ located Map 194 .._ -- Pareel 004 �, �; � rr;c, �"B%I3II -?k Street Water ,. ,,. ..- ,;' , 96 Curb /Plg li ,- Centerville, 71 P�� 1'e d For Ca.l T� c�S o 11 p, r �5 4q�ss L EDWARb9cti� l�.?Lr�P� RLJD L �"T N x _ f � STONE 20 EA� a ( �f f _ 7 T ( � 4✓ r ' < 1 N �{ No. 8 ct nco 4 t \ a1 i i'Y QF F ER F» ..f._/'1,./_x .1729 and cb, MA 02563 J'.IZ Ld 1 �d„� J .d �F$<. P�4✓L/ —l/V 8--P,../6 P� 0 10 20 40 B0 /f� 1 inch �IN F'EET 20 � ft. q D WG 6019 --/''f LOCKS MAF' VENTSche PIPE (O Least 24 inches toll) I1 10 in hnrn a o Schrdule 4 PVC w Charcoal Odor Filter 3-2,•DIAM. ACCESS MANHOLES I hUucrg fp Ae t1r tan1, NOrf ALL nr fS APt TO BE. A" C�IIWDULE 40 f-V.C. /� ng h. Exr"Gt1t.Fou1 3DOn P tin F,,0a) of rnishodttgoe4 � �:,,y ,, .� ".' ,.s.•..'::i'1; SQrViCg R Tpr - SECTION A -A F� -_- --'--' -�, ce I crole « s.ct,< Trs4 - u� ornn. 0.'" O-Bo, - 10300 --cr«+r oVrr s,s - vdr. From10200 to ,o,`oo iROFILE VIEW OF LEACHING SYSTEM 40� s - 002 ✓ a HALE INLET / t / / SIt TE ���. 0� p'Ta ! - S-0Ot (H-20) GIST l30x 3 Maximum Comer 1 tO' 3/4" to 1 1/2 ' washed Crushed Stone INLET / / `� / Ou ET NEW PIPE NEW 1.500 GAL ` 0t0" rr toot i 'r 3 of i/8" - 1/2" washed Peostone THE ACCESS COVERS FOR THE SEPTIC TANK, FPOH FOUNDAT1tRt to I 60 2'Etirctwr Depth to � � �• Y` rn c SEPTIC TANK --_ D `T - �-T^ DISTRIBUTION BOX AND LEACHING COMPONENT Q ad H-10 M 20 0 0 l \ SHALL BE RAISED TO WITHIN 6" OF Ca 9`j H w.a,en4 - pp t•., ... FINISHED GRADE. q o �Il uJ INSTALL TUF-TITE GAS BAFFLES OR EOUALS coNcRETE gull ra�NwT �, ? Jt at a' a- ! U ON ALL OUTLET TEE ENDS rn STEEL REINFORCED PRECAST CONCRETE I �n PLAN VIEW SYSTEM PROFILE m 12'-. 'lU �i o a I c� 1" =Not to Scale ch - I EFirctive Width t r Jk� C� L7 l= Ct O O [3 3-24' REMOVABLE COVERS - (3- � > L-30' STRIPOUT ALL AROUND ELEVATION 9c00 $ (� ° e` 3 U 2s 2 8.S` w/2' Separation = 29.5 6 not 3/4 -, ,/2" _- 3 \ ( ) ' -------z9.5'---� -.� ; , -� -� GENERAL NOTES compocted stone mo .7'5 2,7$ _min- aeoronce t3_ eaET.r � 1, Contractor is responsible for Digsafe notification 35' INLET 8• mn_ 2'-mn. inlet to outlet s'mrn �Eli _ and protection of all underground utilities and pipes. '� Bottom of Test Hole i Elev=88 00 � INLE L w w ie e1� -------------------------------- \ ! Effective Length ,o'mom.T� ,4- 2. The septic tank. and distribution box shall be set s -�' " --- i�Y t__ s -7- level on 6 of 3/4 -t 1/2 stone. k E ;,_o_min. 3. Bockfill should be clean sand or grovel with no ego.. Liquid depth stones over 3" in size. SOIL ABSORPTION SYSTEM (SAS) 4. This system is subject to inspection during installation r�r ,0 - C cH-20) LEACHING UNITS / WIGGINS PRECAST by Carmen E, Shay Environmental Services, Inc. _ � ___�i '• _ 5. The contractor shall install this system in accordance Note Pemove soil down to mad sand layer & reploce with G`r\i S e S Not to Scale 10'-0' with Title V of the Massachusetts state code, the approved plan NOTE. ALL COMPCvENTS MUST HAVE RISERS TO WITHIN 6 BELOW GRADE e + y� S 4 - -�- rote less than c equal to 2 min/n before attepplaacment 1I ff11 e� CROSS SECTION END-SECTION 6. If, Local Regulations. elegy 9A o0 � replace with clean coarse sona w erc ��.0 � and during installation the contractor encounters an C dl�r Jrs ' y soil conditions or site conditions that are different �� TYPICAL 1500 GALLON SEPTIC TANK from those shown on the sail log or in our design `" If Nrte r.ertl,icntion Of Fit! Materlol Required � installation must halt & immediate notification'be i ...,.,.,_ Before and After Placement by Seive Analyses: ( _ - ` NOT TO SCALE made to Carmen E. Shay - Environmental Services, Inc. SEPTIC TANK --80' D-BOX -*---�0----------.LEACHING FACILITY (H- 10 LOADING) 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. --- --- ---- - 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes- LOT 1 # r___._. .__.___,._ C3 i' PERCOLATION � /�i T 10. All 'solid piping, tees & fittings shall be 4" diameter f E R C O LAT I ON TEST ST Schedule 40.NSF PVC pipes with water tight joints. ry' ..__..__._Note: Remove soil down: tad; el. 94.00 & replace with 1 0 i 10 E 1 11. SITE and Surrounding Properties ore not Connected ___ L____S 89ct _ or equalto 2 sand wR/perc. rate less than or 40 j to Municipal water. _ 95.01' r + f i. before & after placementO 20 50 Date of Percolation Test: January 28, 2003 - Test .Performed B CARMEN E. SHAY- R.S., C. .E. 5 FOOT STRIPOUT AL�- AROUND AS SHOWN Y �.- \ � � Results Witnessed By Waiver - Barnstable BD Excavator: ARCH CONSTRUCTION 1 - Percolation Rate: Less Than 2 min./inch ® 8 FEET BELOW GRADE. NOTE: ATE AND 0 TEST HOLES #tI and #2 ONLY. COMPI THE LED FROM PERTY LITHE SURVENES ARE Y PLAN MGENERATED BY Test Hole �- YANKEE SURVEY CONSULTANTS OF MARSTONS MILLS, MA 4 1 `\ I Test Hol Test Hole ENTITLED " PLAN OF LAND OF LOT #2 OAK STREET", 102 a ` 53.5 ,' 1, WEST BARNSTABLE, MA", DATED APRIL 17, 1992 No. 1 No. 2 No. 3 L-DEPTH SOILS ELEV DEPTH SOILS ELEV. DEPTH SOILS ELEV AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN \ LOT. #2 -T I-- -� IT SHOULD BE USED FOR NO PURPOSE OTHER THAN C11) � \ 0 103.0 , 0 u 102.00 0 95.00 THE SEPTIC SYSTEM INSTALLATION. `� `� I Sandy loom i Sandy Loom Sandy Loom 40,210 S F. +/_ ` \ \ I i 10 YR 3/2 10 YR 3/2 ' 10 YR 3/4 0"-12" Ao 02. 0"-12" Ar 01.00 0"-12' As+ 94.00 THERE ARE NO WETLANDS LOCATED WITHIN A 200' RADIUS `\ \ Sandy Loom I Sandy Loon Sandy Loam OF THE .PROPERTY TEST HOLE #1 \ W `€LEV.= 103.00, �� ' 1 tOYR 5/6 I tOrtt s/6 I IOYR 5/6 VENT PIPE�''�� \ ,� ♦� L, \� 1 12"-36" B. 00,0 12--36" Bw 9900 12--36" B. 92.00 SCH 40 Med-Coarse SILT SILT NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE Z 00_ Sand LOAM LOAM FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED _ 25 Y 6/2 2 s r 6/2 2.5 r 6/2 OF AS PER BOARD OF HEALTH SPECIFICATIONS. 35 r 36"-96" C, 95.00 36'-96" Cr 9a.00 36"-264 C, 85.00 63, r, , ( �i \ \ Med-Coarse i Med-Coon EXISTING CESSPOOL TO BE PUMPED DRY & i� �t ` ial ,� �\ i Sand Sand FILLED WITH CLEAN FILL MATERIAL. �, LOCATION NOT 98-_ i ` ri \\\ \ 2 5 r 7/a 2-5 r 7/, SUITABLE D-Box \` `� 8800 1 36"-t 68 Cz 89.00 36"-168 C' t �\ J t TEST HOLE #2 �� I \ -C 1 , ' \ \ Q ASSESSORS MAP 194 PARCEL - 005-TOO I t ELEV = 102 00 ZONING _ _- (L FLOOD ZONEECDENTIAL Perc #1 S Depth to Pero ;f6 to 114" ® TEST HOLES 1 & 2 r f BOTTOM OGroundwatF NOS served THERE`ARE NO WETLANDS 'LOCATED WITHIN A 200' RADIUS ` `HOLE Elev. = 168" \ / l _ No Adjustment- uired-(118 OF THE PROPERTY } ADJUSTED H2O Eev. - Iu q 1500 al - I \\ \`` �. \ \ / II ��� / f 0 ALL OUTLET PIPES FROM THE r 9 ` 9 J i Sephc Tonle \i j/ QQ / ' -\ I " DISTRIBUTION BOX SHALL BE ,1 SET LEVEL FOR AT LEAST 2 FT. i2 CONCRETE COAR LEGEND r i TEST HOLE #3 �g 106 / r ._ \ I Jr Q, ELEV.= 100 50 i / a - 5. OUTLET : '.;� 2' \ , \ �'\ ,'t KNOCKOUTS I �� /�/ 8XD DENOTES PROPOSED _ A / -t55'• OUTLET ",r I l 12' INLET SPOT GRADE Foiled 1 Cesspool X 1 ' \: DENOTES EXISTING I \ ytss' 4" - SCH. a0 Te t.75 104.46 SPOT GRADE PROJECT BENCH MARK , '� EXISTING 2 TOP OF FOUNDATION BEDROOM /,,, `\ PLAN SECTION CROSS_.>ECTI N pL ELEV. = 100 (assumed) HOUSE PROPERTY LINE - 3 HOLE DISTRIBUTION BOX - H-1 C LOADING 97 PROPOSED CONTOUR 1 \\ TOF ELEV. 100 \ ,'� Q NOT To SCALE 97- - - - - -97 EXISTING CONTOUR � #425 '.1 �� j i DEEP TEST HOLE & Desicin Calculations PERCOLATION TEST LOCATION Number of Bedrooms: 2 Exist. - Equivalent to 2:0 Gal./Day (4 Bedroom Design - 440 GPD) Garbage Grinder: No ��---0 FENCE Leaching Capacity Required: 440 Gal./Day (MIN, PER TITLE V) \ \ Septic Tank 2 x 440 Gal. Da = 880 USE`1 500 GAL. Septic Tank. p / y !._' P PRIVATE DRINKING WATER WELL SOIL ABSORPTION AREA: Using percolation rate Ur <2 min./inch r Bottom Area: 0.74 gal/sq. ft. x 400 sq. f�. = 420 gallons ` S / Sidewoll Area: 0.74 gal./sq. ft. x 200 sq. it. 188 gollons REVISIONS ,� 4Q .� ? Providin`l: = 450 gallons NO. DATE. DEFINITION Use: (3) PRECAST 500-C UNITS, HAVING A EFFECTIVE DEPTH, -- ` TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND 2.75' OF WASHED STONE ON THE ENDS. { UNITS TO BE SEPARATELY PIPED AND TO BE SZPARATED 2' APART. \ r I r / I -9 _ r \ , LOT 3 \7 �. ------ A o� a PROPOSED\ PREPARED FOR . \ I SUBSURFACE SEWAGE DISPOSAL SYSTEM OF / r / ) OAK STREET JAIR C . PEREIRA WEST BARNSTABLE, MA P . O . BOX 253 - 9Z , .. � PREPARED BY: r L HYANNIS , MA 02601CAPHEY E. SHAY ��,�oFM�sc � 7 ENVIRONMENTAL SERVICES, INC. 9z Rio 34 THATCHERS LANE fSTE- -_� EAST FALMOUTH, MA 02536 r-- SANI TARSP� 9 r r / TEL/FAX 508-548-0796 90-''r SCALE: 1"=20' DRAWN BY: CES DATE: FEBRUARY 4, 2003 PROJECT#SD-390 FILENAME: SD39OPP.DWG SHEET 1 OF 1