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0110 PHINNEY'S LANE - Health (2)
a110 Phinny's Lane Centerville A=209-098 I i I ,YcOOcgy� UPC 10259 No. H_ 1_OR HASTINGS.YN Town of Barnstable �� Barnstable .� Regulatory Services Department Q p tARNSfASM O Public Health Division 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7015 1730 0001 4990 4872 June 07, 2016 JKM Holdings LLC % Timothy J. Conners 30 Dean Street Braintree, MA 02184 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 110 Phinneys,Lane, Centerville,MA was last inspected on • 3/23/2016,by John P Graci Sr, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Corroded distribution-box and collapsed pipes.need to be replaced. You are ordered to replace the above listed septic system components within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOA OF HEALTH omas Mc ean, R. ., CHO 6' Agent of the Board of Health Z� Q:\SEPTIC\Conditionally Passes Ltr\110 Phinney's Ln Cent Apr2016.mht.doc Postal o . I'ru Domestic Mail,• cc For delivery information,Nisit our website at vvvvvv.UsPs.coMID. r- jr Certified Mail Fee 10 $ � �0� Extra Services&Fees(check box,add tee as appropriate) O I"I ❑Return Recelpt(hardcopy) $ - E(N P16 --' O ❑Return Receipt(electronic) $ PDSA atalel' r3 []Certified Mail Restricted Delivery $ Here 0 ❑Adult signature Required $ ❑Adult Signature Restricted Delivery$ O Postage U$P S m $ Total Postage and Fees � � �3 $ Iri JKM Holdings LLC I'r %Timothy J. Conners 30 Dean Street Braintree, MA 02184 ICertifiedMail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. s associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this , delivery. `, USPS®-postmarked Certified Mail receipt to the. ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides _ for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age, international mail. and provides delivery to the addressee specified a ■Insurance coverage is notavallable for purchase by name,or to the addressee's authorized agent j with Certified Mail service.However,the purchase (not available at retail). _ of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a, certain Priority Mail items. USPS postmark.If you would like a postmark on -n ■For an additional fee,and with a proper this Certified Mail receipt,please present your .rn endorsement on the mailpiece,you may request Certified Mail Item at a Post Office"for F, the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.Fora hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02.00043047 Parcel Detail Pagel of 3 f sl —Alak 'w ` 1� ' ,"" 'v�'�' i � -=--� ticAala. � L1it8S, 1 � z �.. 1 a x Logged In As: Parcel Detail Tuesday,June 7 2016 Parcel Lookup Parcel Info Parcel ID i209-098 .__, _. , _ _�.__.._. ._- ��. _-._ .• I Developer Lot Location110 PHINNEY S LANE - �I Pri Frontage#198 Sec Road�_ .�....�..�.. .,.�..,��..�. ,.,�... . ...-�...,.,. <� Sec Frontage Village Centerville M Fire District Town sewer exists at this address No I Road Index f1242 __ I Interactive ° `e Map , z ww s Owner Info owner+JKM HOLDINGS LLC ( Co-owner i%CONNORS,TIMOTHY J& DEGRAAN, M Streetl 1ROBERT& DONNA f& CEFAIL, S&E Street2 30 DEAN STREET I city f BRAINTREE � �) state MA zip 02184 Country J - Land Info _ Acres i0.90 I Use ISin Fw;- DL-01 ,I Zoning 'RD-1 Nghbd [0106 gle Topography IAbove Street I Road 'Paved Utilities 'Public Water,Gas,Septic Location t Construction Info Building 1 of 1 Year 1984 '� Roof;Gable/HipI Ext Wood Shingle Built' Struct Wall Living i 1648� I Root Wood Shingle�I .0 None 20. Area' Cover Type 6 r- 1BWDK � _ _ � .�._.._... Int __ ®���.. Bed , Style;Cape Cod I. Wall�rywall.�... I Rooms 4 Bedrooms _�.�,__.. .�_ . - -• Int - "• � Bath�—_._�_J ._.. r4 24 17 Model IResidential I Floor'Pne/Soft Wood I Rooms 12 Full-0 Half I 10• - iQS - BAS BAS. BAS Grade iAverage I T Heat e Mot Water �I Rooms Total s Rooms �I IT 2 0RT 2 2EMT7 Yp tit7;, Stories a 1 3/4 Stories I Huei OII � I Foation Poured Conc. I k_ 14 24= Gross"3776�. _., .-....-_..I Area Permit History Issue Date Purpose Permit# Amount insp Date Comments 5/15/2014 insulation 201422746 $1.682 6/30/2014 12:00:00 AM INSULATE ATTIC;KNEEWALL http:Hiss gl2/intranet/propdata/Parcel Detail.aspx?ID=149 5 5 60/2016 Postal nJ Domestic r` nJ For delivery information,visit our website at www.usps.comO. m r' Certified Mail Fee nJ $ ru EXtra SeNICeS&Fees(check box,add lee as appropriate) rj ❑Return Receipt QwAoop» $ - 4q O ❑Return Receipt(electronic) $ 14POStR1�8IIE ❑Certified Mall Restricted Delivery $ '� Here`F' )3 ❑Adult Signature Required $ d Q ❑Adult Signature Restricted Delhrery$ ��C N Postage �F L r) ra Total Postage and Fees $ y� a JKM Holdings LLc '^ N Joseph Martore 110 Phinney's Lane Centerville, MA 02632 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. .j associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(Including the recipients retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Servicee, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified. ■Insurance coverage is notavallable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipients signature). of this label,affix It to the mailpiece,apply i You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.t electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return i Receipt attach PS Form 3811 to your mailpiece; IMPORTAIfC Save this receipt for your records. Ps Form 38009 April 2015(Reverse)PSN 7530.02-000•9047 .'� U.S.POSTAGE4PITNEYBOWES Town of Barnstable Public Health Division 200 Main Street 0 ( # = ZIP 2601 $ oos,73° 02 M 55. Hyannis,MA 02601 # r. f 0000336455 APR. 26. 2016. 7015 1520 0001 2273 2725 (� JKM Holdings LLC Joseph Martore 110 Phinne rye _- Centerville - !Y L7FT(dRN TO CFYtiDER UNCLAIMED UNABLE TO FORWARD {,� B C; tOZ6++01 t400200 *2722?-G5 •491.-Z7`4Z 0 Z 6 � . 1'(�4 0O:Z .3 �77.�1.Itiij.�9:� �91��� 1 �11911iz,iiJl,l1.1,9�91Il117$:i,.�1;i11,: ,9 _?,.`'is•._9w''�.."'` 3s''•'••'� .� is-—-- -----�--_- ----- --( / COMPLETEo . . . . _- ■ Complete items 1,2,and I A. Signature ❑Agent ■ Print your name and address on the reverse X so that we can return the card to you. ❑Addressee B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article_Addressed.to:_-- D. Is delivery address different from item 1? ❑Yes =�.fJKM Holdings LLC If YES,enter delivery address below: ❑No I Joseph Martore .110 Phinney's Lane Centerville, MA 02.632 it I IIIIII Illl III l I I I I II I lil l II I II I l(III I I I I'll 3. Service Type ❑Priority Mail Express® ❑Adult Signature ❑Registered MaiIM ❑Adult Signature Restricted Delivery ❑Registered Mail Restrictedi 9590 9403 0521 5173 2829 51 ❑Certified Mail® :Delivery ❑Certified Mail Restricted Delivery ❑Retum Receipt for ❑Collect on Delivery Merchandise 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfiirationTM - ^-- �❑Insured Mail ❑Signature Confirmation 7 015` 15 2 0 0001 2273 27 2 5 ❑Insured Mail Restricted Delivery Restricted Delivery (over$500) PS Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt ............... 1' Town of Barnstable Barnstable �.. ° Regulatory Services Department p AB� D 9 MA . Public Health Division 200 Main Street,Hyannis MA.02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0001 2273 2725 April 26, 2016 JKM Holdings LLC Joseph Martore 110 Phinney's Lane Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 110 Phinneys,Lane, Centerville,MA was last inspected on 3/23/2016,by John P Graci Sr, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Corroded distribution-bog and collapsed pipes need to be replaced. You are ordered to replace the above listed septic system components within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Q Thoma - c ean,R.S., CHO Agent of the Board of Health • l Q:\SEPTIC\Conditionally Passes Ltr\110 Phinney's Ln Cent Apr2016.mht.doe Town of Barnstable Barnstable kuniftyl Regulatory Services Department 1 i Cft �, ` Public Health Division 200 Main Street,Hyannis MA.02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1520 0001 2273 2725 _ F. April 26,2016 JKM Holdings LLC Joseph Martore 110 Phinney's Lane Centerville,MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 �r • The septic system located at 110 Phinneys,Lane, Centerville,MA was last inspected on 3/2312016,by John P Graci Sr, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Corroded distribution-box and collapsed pipes need to be replaced. You are ordered to replace the above listed septic system components within one(1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Qom— Thoma - c can,R.S., CHO Agent of the Board of Health • .O Q:\SEPTIC\Conditionally Passes Ltr\110 Phinney's Ln Cent Apr2016.mht.doc Town of Barnstable ' ; s►xxarAscc, p "0 9. ,d$ Regulatory Services Department TEa n+�►'t" • Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6,'2007 Rev. 7/6/15 DEADLINES TO REPAIR-FAMED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA. ❑ Static liquid level in distribution box above outlet invert due to an overloaded or clogged SAS of cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within*a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water.quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components; etc) ❑.Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code §3 60-9.1) O THER Repair deadline: WSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc I _ Commonwealth of Massachusetts w Title 5 official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 PHINNEYS LANE Property Address t ,. JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name iTf information is required for every CENTERVILLE '/ MA 02632 03/23/46 page. Cityrrown State Zip Code Date of Iloection Inspection results must be submitted on this form. Inspection forms may not4ie altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information # on the computer, //619-1-- use only the tab 1. Inspector: key to move your cursor-do not JOHN P GRACI SR use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS LLC Company Name PO BOX 2119 Company Address r TEATICKET MA 02536 CitylTown State Zip Code 508-641-6694 S 1468 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 Evail on by the Local Approving Authority 56 03/23/2016 Inspector's Signature Date The system inspectorssubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)withi days of completing this inspection. If the system is a shared system or has a design flow of 10 00 gpd or greater, the inspector and the system owner shall submit the report to the appropriat regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 -- X ona VS Commonwealth of Massachusetts � W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: NA B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ® broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): PIPE FROM SEPTIC TANK TO DISTRIBUTION BOX IS COLLAPSED. PIPE FROM DISTRUBITION BOX TO BOTH LEACH PITS ARE COLLAPSED . DISTRIBUTION BOX IS CORRIDING. ❑ 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): NA C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M •' 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet,of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: NA **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: NA 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 Y day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 44 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. CitylTown State Zip Code Date of Inspection D. System Information Description: 1500 GALLON SEPTIC TANK DISTRIBUTION BOX AND (2) 1000 GALLON LEACH PITS Number of current residents: ZERO Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d TOWN 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 03/14/2016Date Commercial/industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): NA cations per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA 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: NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts -- W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: NA Date Other(describe below): NA General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: NA gallons How was quantity pumped determined? NA Reason for pumping: NA Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1984 Were sewage odors detected when arriving at the site? Yes No 9 9 ❑ Building Sewer(locate on site plan): Depth below grade: (12)TWELVE INCHESfeet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ FEET feet Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTUARLLY SOUND AT TIME OF INSPECTION Septic Tank(locate on site plan): Depth below grade: 1'6"tee" Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GALLON Sludge depth: (8) EIGHT INCHE6 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle (23)TWENTY SIX INCHES Scum thickness (2)TWO INCHES Distance from top of scum to top of outlet tee or baffle (6) SIX INCHES Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? MEASURED/VIEWED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION . RECOMMEND PUMPING EVERY TWO YEARS. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NA Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NA Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: NA Capacity: NA gallons Design Flow: NAgallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA — Alarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments(condition of alarm and float switches, etc.): NA Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert BOTTOM OF PIPE 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.): DISTRIBUTION BOX AT TIME OF INSPECTION IS APPERS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NA t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE _ Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: NA ❑ leaching galleries number: NA ❑ leaching trenches number, length: NA ❑ leaching fields number, dimensions: NA ❑ overflow cesspool number: NA ❑ innovative/alternative system Type/name of technology: NA Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACH PIT(A) AND LEACH PIT (B) APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION. LEACH PIT (A) NEVER MORE THAN 1/2 FULL. (1) ONE FOOT OF LIQUID IN PIT AT TIME OF INSPECTION. LEACH PIT (B) NEVER MORE THAN (2) FEET AND PIT WAS EMPTY AT TIME OF INSPECTION. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA Privy(locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1�2- a32 V- 2)5 5 b5- co8 D� BACk A g \o�tiQ ®r=ctL �lr —°� �5rao CaII�n sT, 3 O O —.W rma aa[(on LP 4 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 110 PHINNEYS LANE Property Address ' JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 11+FEET 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: HAND AUGER Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 PHINNEYS LANE Property Address JKM HOLDINGS LLC JOSEPH MARTORE Owner Owner's Name information is required for every CENTERVILLE MA 02632 03/23/2016 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE. LOCATIf.."I I/0 �j1el'/���'5 Li9�v� SEWAGE # `'13 LAGEC �t/07 4. itV ASSESSOR'S MAP , OT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 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 um D o es B A AA �� AE 3ci ' o 6� 35.6 14 � 6E �3 e0 I No. 0 I ` I Fee 7-51 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�u/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplifation for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.I 10 0 nrtq L n Owner's Name,Address,and Tel.No. Assessor's Map/Parcel (—r-n W\ 1 d1en KM Old U—C. Installer's Name,Address,and Tel.No. Designer's Name,Address, d Tel.No. An s+ Type of Building: Dwelling No.of Bedrooms 'F*Ou r Lot Size 3q 1000 sq.ft. Garbage Grinder( ) Other Type of Building &j 16k 15AA10L.A No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `gpd Design flow provided gpd Plan Date ' Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) n s$-a 9 @ n2vg D-ecK eln-4a 91 new 4o N G P 1 pw-p M b—RA Av C 23 4-Y4I0 leach n►�-s Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f al Signed Date .. Application Approved by t 5- Date Application Disapproved by Date for the following reasons Permit No. Date Issued i No. jib ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . , PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal *patent Con4truction 3perritit ± Application for a Permit to Construct( ) Repair A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ' !Q 1 ylrtq t-n Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ACen krvl ►le % m Hold +n s t,.-C I`nsstaller's Name,Address,and Tel.No. Designer's Name,Address, Tel.No. YV S �Qan Type of Building: Dwelling No.of Bedrooms A r OU Lot Size 39 Oot/J sq.ft. Garbage Grinder( ) Other Type of Building qPS, iA eV)A1pL 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date *x_. Title r Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) n s�a I I nevi krlf)+a 11 n:ew 4D pV C. P 10-e m Date lasf inspected: 3/2—'j/.0!(o Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f 1ealt . - )<Signed 3 ,� — Date Application Approved by ` Date /1' Application Disapproved by Date for the following reasons Permit No. Date Issued �- ---------------------------------------------------------------------------------------------------------------------------------------- w � �n THE COMMONWEALTH OF MASSACHUSETTS i►/0 X BARNSTABLE,MASSACHUSETTS - i Q 5Compliance Certificate of r �� THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by at 11 Ph;N nJ Ptl j has been constry�t;i acco dce r with the provisions of Title 5 and the for Disposal System Construction Permit No. �oL�V �b �d�ated Installer " �� Designer #bedrooms _ Approved design flow 1 gpd The issuance of is pe it shall not be co�nstru'ed as a guarantee that the system wil func'Was!esigned. Date H inspector _ r/ [j N A-D ------------------- ----- - f Fee----- ------:7 -- ---------------------------------------------------- No. U 0 t/ I , -7 5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEAL-T,H DIVISION-BARNSTABLE,MASSACHUSETTS -Misposar ft,8terit Construction 3derinit Permission is hereby granted to Construct( ) Repair27, Upgrade( ) Abandon( ) System located at Q �l�l I and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 'I— t� Approved by l0of11 to y OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:. 110PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1. P LN AR X5 AC qE �ti 35� 13 Pj< MI6 6� b� e ss CD3� to SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign t re Item 4 if Restricted Delivery is desired. gent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. R e e y(Printed ame) C. Date of very ■ Attach this card to the back of the mailpiece, �� f I or on the front if space permits. 1. Article Addressed to: D. Is delivery ddress different from kem 1? ❑Yes N YES,enter delivery address below: ❑ No a Le -7�� 3 3. Service Type IXicertwied Mail ❑Express Mail 2-0 6 t0 0 Registered X3-Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra:Fee) ❑Yes 2. Article Number 70 (Transfer from service(abeq ' :7 0 0'6 215 0 0 0 0 2 1 a 4117 8 8 0 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE s'Pgr i.vmxY.a`�a4�:2M.. ,tI�JJjL+b{�i♦�•�,�'.�4.•�lv �....w..•d� Irl �.- •1:.{c': .,1!: ry G!::.i+1Ly^:��'.�.��. '.Y: _.�f' T.. �•rif<fYi, alC .. ,.�ydae rrplil',^. ar�larrrao�s�. • Sender: Please print your name, address, and ZIP+4 in this box • I �5 Town of Barnstable Health Division 200 Main Street I Hyannis, NIA 02601 w I I � I .. I - I I I i I I I I � - Health Master Detail Page 1 of 1 s: i ..wawae_..««au.._?ja't�w. M' aastec.$'�D,. ..rf, a,l A o,D,k'a'`on Censer Parcel Lookup Selection Items Parcel; Septic PerC M etr Feet Teak L Parcel: 209-0 Location: 110 PHINNEY'S LANE, CENTERVILLE Owner: MARTORE, JO EPH 4CIA) Business name: Business phone Rental property: C Deed restricted: F—! Number of bedrooms 0 Contaminant released: F Fuel storage tank permit: "Save Parcel Changes Return to Lookup ' Parcel Infra Parcel ID: 209-098 Developer lot:LOT 1 Location: 110 PHINN Y'S LANE Primary frontage: 198 Secondary road: Secondary frontage: Village:CEN i ERVILLE Fire district:C O-MM Sewer acct: Road index: 1242 Interactive map P� Town zone of contribution:AP (AgUifer Protection Overlay District:) State zone of contribution:OUT Ovvner Info Owner: MARC ORE, JOSEPH &GRACIA Co-Owner: Streetl:728 SPRINGVALE RD Street2: City:GREAT FALLS State:VA Zip: 22066 Countr Deed date: 11,/15/1984 Deed reference:4305/285 Lard Info Acres: 0.89 Use: Single Fam MDL-01 Zoning: RtD-1 Neighborhood: 01 Topography:Above Street Road: Paved Utilities:Public Water,Gas,Septic Location: Construction Infra 5i.'O €n.i Noy r u,4 ffe, E f ,a r3C: C7t^.; z ?=t ( ?'l.z 1 1984 1851 Bedrooms2 Full Buildings value:'g184,300,00 Extra features: )x3,400.00 Land value: ai211,600.00 http://Issgl/intranet/healthMaster/HealthMasterDetail.aspx?ID=209098 10/8/2008 'Cape Cod real estate, Cape Cod vacation rentals, homes for sale Page 1 of 2 Cape Cod Real Estate&Rentals Home #ls , , p ' o r K a lo, rtl' TCape Cod Real Estate for Sale Home Cape Cod Real Estate, Properties for Sale, Vacation Rentals: Search Seaport Village Vacation Rental Property Featured Properties Search All Cape Cod MLS Properties Centerville, MA 110 Phinneys Lane Centerville, MA Make Reservation Request Search our Non MILS View Availability Calendar Properties Search Cape Cod Yearly/ Village Setting! Vacation Rentals Pro ert No.#810 Phinne s Property Management About Seaport Village Realty a Buyers and Sellers Cape Cod Area Information f Mortgage Information I .. Relocation Information What's My Home Worth e' a Cape Cod Find an Agent 10311031 Exchange_j Contact Us Login MIL ; ,t11ck- ell cl1f .� Choose a location Lovely,south side 3 bedroom,2 bath cape with c F path to Long Pond for swimming,small boating Choose a price range fishing.This charming home has a country flair% Minimum Ej "southern yellow pine foors thoughout. First floor pretty year round sunroom with french door to d, Maximum f country kitchen with separate dining area and its - French door to the deck. Living room has large fi MLS# ` with "see-thru"to dining.There is 1st floor bedre spacious bath with claw foot tub and pedistal sin Second floor has 2 bedrooms connecting to an c Search bath.One bedroom has vaulted ceiling,ceiling fe skylight!!This home is perfect for those who take in their surroundings and location!With or witho furnishings.Oil HW heat. Full basement with washer/dryer.Just a short side-walk stroll to 4 Si Cream, Library and Craigville Beach.$1700 Mont http://www.seaportvillagerealty.com/cape-cod-vacation-rentals-listing.asp?Id=60l 9/25/2008 'Cape Cod real estate, Cape Cod vacation rentals, homes for sale Page 2 of 2 last and security please.No smoking. Bedrooms: 3 Bathrooms: 2 +iir Half Bathrooms: n/a REIBItlTX Square Feet: 1601 PROGR" Heat: Oil Interior Features: Dishwasher,Washer/Dryer, Batl Cathedral Ceilings, Fireplace, H Floors Exterior Features: Deck/Patio,Wooded Lot Amenities: Water Rights View Map Make Reservation Request Rate Schedule Rates Available Start Day End Day Monthly N/A N/A Start End Date Date Monthly All Other Dates 1,700.00 Fine real estate listings and vacation rentals in Massachusetts,Cape Cod,Barnstable, Chatham,Cotuit, Dennis, Eastham, Falmouth, Harwich, Hyannis, Marstons Mills, ME Sandwich,Truro,Wellfleet,Woods Hole,Yarrr I i Cape Cod Real Estate Home I Cape Cod rentals Home I Cape Cod homes fo Search Featured Properties I Cape Cod Real Estate MLS Listings I Cape Cod Vacation Rentals I About SE Cape Cod Area Information Mortgage Information I What is Your Home Worth I Property Management Copyright©2007 Seaport Village Realty 128 Main Street, Hyannis, MA 02601 • (508)771-1994-Fax: (508)771-15 Email:judy@seaportvillagerealty.com Licensed in Massachusetts Real Estate Web Design by Webfodder http://www.seaportvillagerealty.com/cape-cod-vacation-rentals-listing.asp?Id=601 9/25/2008 Town of Barnstable oF1HE ro Regulatory Services Barnstabie v� o Thomas F. Geiler, Director ' -F = Public Health Division * BARNSTABLE, * - 9 MASS. Thomas McKean,Director 200 " 1639. s`� 200 Main Street ED MAy Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 8, 2008 Joseph Martore 728 Springvale Road Great Falls, VA 22066 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 110 Phinney's Lane, Centerville. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2008 fees included. This must be completed within (7) seven days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Timothy B. O'Connell Health Inspector Health Division Direct#508-862-4646 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION = Y � d a Y ti C OW In Vsy TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 110 PHINNY'S LANE CENTERVILLE,MA 02632 �� O 2 Owner's-Name: JOSEPH MATORE Owner's Address: 728 SPRINVALLE ROAD,GREAT FALLS VA.22066 Date of Inspection: 9/4/01 Name of inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was p i-formed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs Further luation by the Local Approving Authority Fails Inspector's Signature: Date: 9/4/01 The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM USEFUL LIFE. ****This report only deseribes coutliflons at(lie thue of Inspeetion find under the conditlons of use of tint finte.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 In mPctinn rnrm Fil snnnn I I Rage 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: l 10 PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. if"not determined"please explain. n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or'break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed NI)explain: n/a ,i Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 110 PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for colifonn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a z Pdge 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 110 PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 D. System Failure Criteria applicable to all systems: You mint indicate"yes"or"no"to each of the following for all-inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _ Yes/No The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails'.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. F' E. Large Systems: To be considered a large system thelsystem must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)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 I✓or failed under Section D shall upgrade the system in accordance with 310 C:MR 15.304. The system owner should contact the appropriate regional office of the Department. 4 i. Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 110 PHINNY'S LANE CENTERVILLE, MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 Check if the following have been done.You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection '? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For example,a plan at the Board of Health. X _ Determined in the field*(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] S Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 110 PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available last 2 ears usage d : n/a g � ( Y g (gP )) Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 19$4 Were sewage odors detected when arriving at the site(yes or no): NO r, Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction:_cast iron __40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,.venting,evidence of leakage,etc.): TOWN WATER. SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc): n/a 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 TIGHT.or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): DISTRIBUTION BOX APPEARS TO BE STRUCTURALLY SOUND AND IS TO BE FUNCTIONING PROPERLY. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: nla Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PITS APPEARS TO BE FUNCTIONING PROPERLY.FIRST PIT WAS NOT EXPOSED.AND THE SECOND PIT HAS NEVER HAD MORE THAN 4 INCHES IN IT CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) , Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:. IIQPHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. l.. �lecl� n AB X5 AC a) q �3 �`a fiA 3ois 3S 13 Pj� L16 gC C: O.')S in Page I I of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 PHINNY'S LANE CENTERVILLE,MA 02632 Owner: JOSEPH MATORE Date of Inspection: 9/4/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 13+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You.must describe how you established the high ground water elevation: GROUNDWATER DETETEMINED BY AUGER HOLE DUG 4' BELOW BOTTOM OF SYSTEM- 13+FEET NO WATER ENCOUNTERED t � i TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date b Time: In Out Owner CIn'`-- Tenant Address O t I Address S V Complian Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities hoproved'. 4 � O 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use _ 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed 15 v 1 5 0 1 ,20 PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms L Number of Vehicles Allowed (max) Number of Persons Allowed (max) b- Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here to . : .. Heys 1.cco Main Level l 1 ,�Zoq'OFF- 1 _LL _ t7 h a r-.s d2 2 --1 e+5 2 IL - 1, KrFCHEN 1 J —L—4 10 -----14 9Mu 12 2 r I RAT - 4 710, 21 - PaoNt Bonn r" oAG1LOQ8C 26.6- 1/29/2010 Page: ? 10010050 2nd Floor '2'10 12 2* 6 4 6 4' 6 2 6 4 2'--I ATTIC'121 t �' r/ � � �I nL 1� �1/��"`�(�-�+) ee-4ce�e-k (k)Aere- reftlo ��o ;;Cj) .2 6..-f Door-5 r. I RATH Walls oefe -4 8 CX 0,5e al OLA --4 4-- NIL AID /V u U c p) rad 4.4'-- CLOSET M 2-2 F-)) ATIICI III An-c SIDE SDRM 16 6 26 6 1/29/2010 Page: 9 10010050 ✓ Basement n e- 10 Rep C(1fS -jv 1h G ( 5b.Jr ffift - F )erj i-►cu ( Afet'lCJ 6 2., J- nS('t �GC 'vr) 1-3 J-- T 2 6 b 1 l swxeneKr 12 10/ j — T 1 z9,,4 12'6' 5'6" _m o — Basement 10010050 1/29/2010 Page:6 l0'CATION // / SEWAGE PERMIT NO. VILLAGE ce I N S T A LLER'S NA E i ADDRESS d BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 7� O .F _ Z 7 ?s 3a �3 �3 ,� �Z y° � s� ... r ., _. �.. No....... YmR.2c,................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH VO-W!. ...............OF... ................................. Appliration for Dispasal Works Tumitrurtion Frratit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 17_1% I ............................ .......................................LVT .... . ... ...................................... or Lot No. ................................ -------Cof __Q) ................. ..............&.............................................. ................................................M---------------------------------- ..............5;4�.............es.s........................................... Installer Address Type of Building Size Lot------3.qtk�K�..Sq. feet Dwelling—No. of Bedrooms.............. ........................Expansion Attic Garbage Grinder P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4 Other fixtures .......................................................................................................................... . -------------------- Design Flow............. ......' ----gallons per person per day. Total daily flow......................11�f�..........gallons. -l" 9 Septic Tank—Liquid capacity '�Q.gallons Length................ Width....__...._..... Diameter__._____.._..... Depth................ Disposal Trench—No. .................... Width.......j............ Total Length.............. Total leaching area.______ ........sq. ft. ea.d ....sq. ft. Seepage Pit No. X Diameter.._______..... Depth below inlet.......&........ Total leaching ar ------------ ---- Z Other Distribution box (I Dosip tank Percolation Test Results Performed bYW"_4Xj,1,t_fAj.ZT......pt-L& 4..At_ Date.... . ................................ Test Pit No. I....:Mn....minutes per inch Depth of Test Pit......./Z------ Depth to ground water--_- '__-__I Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..._-_.............._._. P4 .............................................................................................................................................................. 0 Description of Soil............................ . ................................. ................. S ...................... ........................................................�.A_1111_ ....... . ......... U i*ai� .............L----*------------------------------------- ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. ............................................................................................................................................................--------------------------......----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'L I Ti U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed------------------------- ........................................ ................................ Date Application Approved By......... ........ Date Application Disapproved for the following reasons• -e�.................................................................................................. ............................................................................................................................................... ........................................................ Date PermitNo--------------------------------------------------------- Issued....................................................... Date ----------- -------- ----------------------------------- 1 No......................... FEs............. ............._ THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH Q-w lJ ----------------OF..! ......2.rJ.-7.T Appliration fox 'llisposttf Works Tatt xnr#ion Famit Application is hereby made for a Permit to Construct (0/) or Repair ( ) an Individual Sewage Disposal System at: Location.Address. or Lot No. `'� W wner ddress 1 �-� V/ �., -------'-•-----------------................... = .-•-•--------------•.••.---.......••. ------....•----.---.-•---`�=......-------- -•-•....----••------.........•.....--•'--••-----•-.. Installer Address q d Type of Building Size Lot.... ./.j ....Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow.............S .............. gallons per person per day. Total daily flow....................._.. ............gallons. WSeptic Tank—Liquid capacityf �_gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width. 4............. Total Length........- ._P_...._ Total leaching area... ........sq. ft. Seepage Pit No......... -_____ Diameter........ ....... Depth below inlet..... r ......... Total leaching are�oo_....sq. ft. Z Other Distribution box ( Dos' g tank ( ) Percolation Test Results Performed b} ,4_? .��-_�.f4j4?v...---_ ���Li.c1 A ' 1 Z-0 ,-a �° Date •••-_. . Test Pit No. 1----74�----minutes per inch Depth of Test Pit...... . „__.._ Depth to ground water..._.-7" ......... 44 Test Pit No. 2--_-.___-_••-•minutes per inch Depth of Test Pit.................... Depth to ground water........................ D Description of Soil..........:....:.:... x --•�----••-----••--- ------------------------- W UNature of Repairs or Alterations—Answer when applicable._.............................................................................................. -------••-----------------------•--------------------------•-------------------••-------'•••-•-------------•----------------------------------------------------------------------------•-•----......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.I 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..................... ... --------------•-------...---------•-------------- ....-.......----..........-.... Date Application Approved BY---••-----" -- --. ,._,; -- • -- ........................................ Date Application Disapproved for the following reasons ......................................... ...................................................._...... ....-•--------.•...-•------------------------•-•---•----••---....-••-••--.....••.._...------....--------••-•--•---...•••-••-••••---------•••••-•--•-------••••----•----•••-----•--•-•-•-----••-•--_..... Date PermitNo............................................•---'•--••-.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS +/� BOARD OF HEALTH ......../...0.W.4...........OF.........B.✓'l it iJS 7-,4 "(3�............................. Tntifirtt#r of Tontlifiattrr �ZHIS IS TOgERTIFY That tke Individual Sewage Disposal System constructed () or Repaired ( ) by..t y±ZC U... (.._.._' .Y?L C�'7.Q!1-•-•-•--•-------•----... _.. f lA�� has been installed in accordance with the provisions of TIME 5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit No----- ........i........._.____ dated--------------------_........................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WII;X FU/ACTION SATISFACTORY. DATE.....Z...G�..../..__ .................................................. Inspector--••- ---- .................................................................... ti THE COMMONWEALTH OF MASSACHUSETTS t. BOARD O HEALTH ( �``�....... 1� 0F........... ...... �_� ...••-••....................... .-•-.- FEE. ''... �i��ro.� ork� �on�#� ion rrntit � Permission is hereby granted................... ......................................................................................................................... to Construct (Il) Rep�°ir ( a Individual S wa a isposal. stem at No. { , Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... U -------- -- ------ a Board of Health DATE----------------- FORM 1255 A. M. SULKIN, INC., BOSTON Q- Z- � P A W L-Y - p6 GA¢ AG CA NDE2 AAZ> G.P. R '5EPTIG TANK = 44cxi5c>% :&4,06.P0 UsE l5@o GAL. LOT6 I D1'5PDSAL P1T U5E2.- tooO GAL. Pirs TAIIAwka-f'5j LA 5+DG•WALL_ AP-SA. - 15o S.F BOTTOM AZEA- • �0 S.F. �O 5.1= K I• o - 5.0 GPp.. -T oT A I_ D E 51 GN G.P o. K 2'o 050 G 1� -TOTAL DA 1 Ll( 1=o-OW = 61Qd G.PD, i PE2Cot_ATIoN RATE : l"IN 2MIN oP- LE55 •` I !,Jif fit, 7C' -rti'' :7!CI�IAf"917� •.. ;:�. , o� D AVIDC. yGs THULIN J Na z9_9Zb H e• t��,t l y 1ST/E-��o �~ ,' �•`•, `,f.., _ +� •,.� 77-� � f-G= �' S TOP FNu r/v' ,Coate/ E ISoo 1Nv. D►ST. INS. SEPTIC /`6 �r/ {Doo IN�l. w•G TANK LEacu y-'G (i PITS INV.. INV. t w,Yu ys.Z 4 II r �C�v I��3/q•��i yS/v WASNGD 6TvNG y. CER.TIF•Iao PLcT PLAN I �cv,��'J?G P.R U F I L l+ L o C A'T I o('►I C��ITt��/1•L_i-�- LJo SCALE SCALE \- SATE `�7I �� P L-A r.1 fL E F'E 2E►� GE 14 ` CERTIFY THAT 'TNE 'F- t=N�• SNoWN y{EREOW GOMPL`(5 WMA-THE S 1 oEI.1N fc L-pT A► P oF -C AE-- -fo+NN C>F= L3�t�S-t-t�3� ANv IS N10 • Z33 P�.G� �.00p.T D •WITNI}1J N.E G�••oo PLAIF�I• (. c+• r II DATt✓ s I BAXTEcZ.e iU`(E INC. .I f--Z6D'►..Au D s u�.v�Yoes -Tu15 PIv N t 5 NorT E3n5�T�I oa AN os•rG9-VILL� - MASS•� IN�iTR.uMEW-r SUQVey ir -TNE o1=r5ET5 6uouO No-r C3� `v5E0T0 0eTeFR1^1NE Loy' +-INES APPLICP.►`�•r �i�l�'S(De- eoII,15T4::�o I 91. 9 S.T. 1 n`ao�C. s L � 3 P�tN OF M gss g►�x7 C 2 N Y l=, I(SIG.. RICH D 9pyN A. a5 ��/l l_l-E' 0 1�d.S . .t BAXTEFi i _ Cat