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HomeMy WebLinkAbout0568 SOUTH MAIN STREET - Health 563 Souuth Main St 186-079 Centerville r C �r i No. 42101/3 ORA Pendaflexe 100% Commonwealth of.Massachusetts _ Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form,- Not for Voluntary Assessments ,M 568 South Main Street Jys f Property Address.. Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. City/Town -- - - State Zip Code Date oflnspection - Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end.of the form. Important:When A. General Information filling out forms on the computer; use only the tab ... key to move your -1. Inspector: _ cursor-do not Matthew Gilfoy.. - -use the return key. Name of Inspector B&B Excavation, Inc: _.. _.. � Company Name 14 Teaberry Lane Company Address Forestdale MA::. _02644 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification ....... .... _ _ _ ..._. 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 15000). The system: ®. Passes .. . ❑ Conditionally Passes ❑ .Fails El Needs Further Evaluation by the Local Approving:Authority 4-18-14 Inspector's Signature- Date - .. The system inspector shall submit a.copy of this inspection report to the Approving Authority(Board of Health or.DEP)within 30 days.of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to.the buyer .if.applicable, and the.approving:authority. **.*.This report only:describes conditions at the time.of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different.conditions.of use. : : :: - 31 t5ins•3I13 Title 5 Official Inspectio or ubsurface Sewage l)ispos System:. age 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 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: Two separate systems for the same Dwelling. This system located in Front left yard. Septic load shared by both systems. (System #1) B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This sy stem passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 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 568 South Main Street Property Address Tobin Realty Trust Owner Owners Name information is required for every Centerville Ma 02632 4-21-14 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 Commonwealth of Massachusetts . _Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 568 South Main Street Property Address:. - Tobin Realty Trust Owner Owners Name information is required for every Centerville Ma 02632 4-21-14 page. - Cityrro vn :State Zip Code. Date of Inspection-_C. Checklist .. Check if the following.have been done:.Y:ou 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? EJ 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 s 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: No tans _. Number of bedrooms (design):: o p Number of bedrooms (actual): 6 total (2 systems) DESIGN flow based.on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): no plans t5ins•3/13_. Title 5 Official Inspection Form:Subsurface Sewage;Disposal System.Page 6 of 17 Commonwealth of Massachusetts Title 5 Offici al Inspection_ p Form Subsurface Sewag e Disposal System Form - Y Not for Volunt ary Assessments °M 568 South Main Street Property Address Tobin Realty Trust Owner Owners Name information is required for every Centerville Ma 02632 4-21-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years (gP ))usage d : Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 8 feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in good working order with no signs of leakage. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gallons Sludge depth: 2" 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 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good working order with no evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•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 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box replaced 2014, Riser present Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: l5ins•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 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-4'X6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appeared to be in good condition with no sign of hydraulic failure. Leach pit dry at time of inspection. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction I 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-21-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Tifle 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 568 South Main Street Property Address To,bin':Realty Trust Owner Owners Name information is required for every Centerville Ma -02632 4-21-14 page. CitylFown 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 I AZ' Aq• ast O:O D O y 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 568 South Main Street Property Address Tobin Realty Trust Owner Owners Name information is required for every Centerville Ma 02632 4-21-14 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: 4' below system 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 augered hole in rear of dwelling. Ground water encountered 4' below leaching 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 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 568 South Main Street Property Address Tobin Realty Trust Owner Owners Name information is required for every Centerville Ma 02632 4-21-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 1 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD-OF HEALTH O F ICJ C -n, APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System Xndividual Components :568 bw T-ealfk ; 12u.51f Location / Owner' ame Map/Parce # Q W`77 telephone# Install!'s Name Designer's Name A / V Address Telephone# Telephone# Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator l Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS L 4--'—',(l15 I J The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe grees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Heahh. Signed D Date q Inspectio Ll �-3 / FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 �No. �Lll (O THE COMMONWEALTH OF MASSACHUSETTS FEE 2orj!-54a .b({' .BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( Upgraded( ),Abandoned( ) by: -RIG �--> ( n klrwjj l�)n J at 50S Soo-1h A4n St, Cf'n - P ( \1i (C has been installed in accordance with the provisions of 3 0.C.. 1�S.Oo (Title 5) and the approved.design plans/as-built plans relating to application No- �� ��� dated ���a r. Approved Design Flow. (gpd) Installer 1� i'QT a l Designer: Ins ector�` ,� /`t✓A,1-4fq 1 1� 1�/1,Date lr 7 I g ! P ' The issuance of L certificate shall not be construed as a guarantee the t/e system.will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. cG�y " ! / lY THE COMMONWEALTH OF MASSACHUSETTS FEE 1c�d BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is here y, granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at C� �o 1,x �rl�Mn In c-,,f as described in the application for Disposal System Construction Permit No:—�k/L dated z-j / ) 3(J 7 Provided: Construction ssha l be completed within three years of the date of this permit.Alhlo a conditions must be met. Date LI 1J� Board of Health _ FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON NOu A �l ��►' THE COMMONWEALTH OF MASSACHUSETTS FEES BOARD OF HEALTH Q OF !�/f fl� C! . = h APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTITX PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) ❑Complete System ndividual Components SG�B .5500 h ✓ 40I t- 6Pn r Gb 1 -T a -t -Feo -� Location Owner's ame w► Map/Parc'e'I'# S08< -7� ��^ �� RA�r�, ' - �r]ua f to 1� Telephoo�e# Installe s Name —�"'� Designer's Name ri 4:0. Ad res I#• Add�e4 17 f� Telephone# Telephone# Type of Building: -4 o Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons. Showers ( ), Cafeteria ( r) Other fixtures s Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd Plan: Date Number of sheets Revision Date 1 Title Description of Soil(s) Soil Evaluator Form No. Name of Soil,Evaluator }}�� Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS (2-) F1�� - ��) t ,[� t'pn I Q cc , r The undersigned agrees to install the above described Individual Sewage,Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.,,, . Signed rn4 Date Inspectio s �l 3 FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 sr TOWN OF BARNSTABLE LOCATION 549 So rJV Ma.n S-4 SEWAGE# 20/Gq -J 16 VILLAGE Ccnk r u. 11 C ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. eAe,zxa0_4 i c>A q77— OGS3 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) &J3C'3i 0A1Jt4 (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al- 13'�'' $i aq, 8" AV 151 oz- 35' A3. aa► �,� A' a 83- 33' a Aq- a$, ® O TOWN OF BARNSTABLE LOCATION 5L8 cS 04k Alan SJ SEWAGE# 00141 • VILLAGE (2crAr_rw, 11 G ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. a+ e CKCgVm-J on 4')J - 06$3 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 2 BOX Of11t4 (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A I . cl i ck 8I - 30' Az- 114 1111 132- 3a i 9 A3- $3- 3,41 8 1' A4• a3'5" Bq- O O O 0 Health Master Detail Page 1 of 1 �.....M' _ CG:.NSIsY✓efd� .w.F.�+C."ha.�. � s,,�`/�. ./ Logged In As: TOWN\miorandd Health Master Detail Friday,April 18 2014 Application Center Parcel Lookup Selection Items iParcel Septic Perc Well Fuel Tank Parcel: 186-079 Location: 568 SOUTH MAIN STREET,CENTERVILLE Owner: TOBIN,TIMOTHY&HUGHES EILEEN TRS Business name. Business phone: Rental property. ❑ Deed restricted: ❑ Number of bedrooms . 0' Contaminant released: ❑ Fuel storage tank permit: ❑ Save Parcel Changes, Return t.-Lookup Parcel Info Parcel ID: 186-079 Developer lot:LOT 2 Location:568 SOUTH MAIN STREET Primary frontage:90 Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C-O-MM Town sewer exists at this address: No Road index:1507 Interactive mapF —a, Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: TOBIN, TIMOTHY& HUGHES EILEEN TRS Co-Owner:TOBIN REALTY TRUST Streetl:1637 BLUE MT ROAD Street2: City:PAUL SMITHS State:NY zip: 12970 Country: Deed date: 12/15/1995 Deed reference:9955/094 Land Info Acres: 0.47 Use: Two Family Zoning:RD-1 Neighborhood: 0109 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info Building No Year Buil Gross Area Living Area Bedrooms Bathrooms 1 1820 3190 2540 8 Bedroom 3 Full Buildings value:$189,800.00 Extra features: $25,000.00 Land value: $251,400.00 1 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=186079 4/18/2014 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments wM ° 568 South Main Street h Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 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 A. General Information- - - filling out forms on the computer, use only the tab 1. Inspector: l key to move your cursor-do not Matthew Gilfoy.. '� use the return Name of Inspector key. B&B Excavation, Inc: - - - _. �y Company Name 14 Teaberry Lane - Company Address Forestdale MA 02644 City/Town State Zip Code (508)477-0653 S113640 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 El Needs Further Evaluation by the Local Approving Authority 4-21-14 Inspector's Signature Date The system:inspector shall submit.a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to.the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how.the system will perform in the future under . . . the same or different conditions of use. . 1 t5ins•3/13 Title 5 Official Inspection Form:S b u a e Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 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: ® 1 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: Two separate systems for the same Dwelling. This system located in Front right yard. Septic load shared by both systems. (System #2) B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ 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•3113 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 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/ day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 568 South Main Street Property Address Tobin Realty Trust Owner Owners Name information is required for every Centerville Ma 02632 4-18-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the'system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °r 568 South Main Street Property Address Tobin Realty Trust Owner Owners Name information is required for every Centerville Ma 02632 4-1.8-14 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 EJ Z Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not ® available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? ® : ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants:if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and.location of the Soil Absorption System.(SAS) on the site has been determined based on: ® ❑ Existing information: For example, a plan at the Board of Health. ® 0 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: no tans Number of bedrooms(design): P - Number of bedrooms (actual,); 6 total (two systems) DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): no plans i 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 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. CityTTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknownDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. City)town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 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: 1990 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1'8"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in good working order with no signs of leakage. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 5" 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 M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 2" 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 15" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good working order with no evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•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 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box replaced 2014 Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-6'X6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appeared to be in good condition with no sign of hydraulic failure. Leach pit was dry Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts u _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM , 568 South Main Street Property Address Tobin Realty Trust Owner Owner's.Name information is required for every Centerville Ma 02632 4-18-14 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 El drawing attached separately AQt V! 36" Ali Bz• 3 9 rr A4 03,5t, O O O 0 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 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: 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 augered test hole in rear of dwelling. Ground water encountered 4' below leaching 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 - 1 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 568 South Main Street Property Address Tobin Realty Trust Owner Owner's Name information is required for every Centerville Ma 02632 4-18-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 II 1 SENDER:'60MPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. D to f Delivery ■ Attach this card to the back of the mailpiece, Z or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1. lb Yes If YES,enter delivery address below: ❑ No I Timothy Tobin , j 1637 Blue Mountain Road IN 3. Service Type � i -"'Pzaul Smiths, NY 12970 s 1rtified Mail ®Express Mail l ` ❑Registered ❑Return Receipt for Merchandise - ❑ Insured MaiL ❑C.O.D. 4. Restricted Deliver .a ODdra Fee) ❑Yes 2. Article Number ?: ?7p06 081�'r 0003525. 6658 = (rransfer from service tabeQ i F j;:i 3 {>= 1 PS Form 3811,February 2004 Domestic RetumReceipt ` ..�` 102595-02-M-1540 l UN ITED TATE Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 Town of Barnstable tNE Tp� Regulatory Services Barnstable do Thomas F. Geiler, Director i eftaj r( Public Health Division 9 MA83. Thomas McKean, Director 2007 4'or 1639. a`� 200 Main Street ED Mp`l Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 23 , 2012 Timothy Tobin 1637 Blue Mountain Road Paul Smiths,NY 12970 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 568 South Main Centerville, MA. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2012 fees included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Z_S I Timothy B. O'Connell, R.S. Health Inspector Health Division Direct#508-862-4646 citizen Web Request Page 1 of 3 TKE BAINFtAP-LE 7- r `, ,n ♦S ,�;�.y ,.( y m pan r� Logged In Citizen Request Management Tuesday,April 172012 TOWN\oconnnnelt Route to Users Search Requests Create Requests Request Information Request ID: 38426 Created: 4/17/2012 11:09:27 AM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: Chapter 170 : Housing Overcrowding edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 5/1/2012 Change Estimated &—r May 2012 Jun Completion, Completion Date: Sun Mon Tue Wed Thu Fri Sat Date: 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 1 30 13111 2 3 4 5 6 7 8 9 Created By: Parvin, Lindsay Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel Number Requestor reports that the home Map: 186 Block: �79 !Lot: 000 is a rental which he suspects is overcrowded.This is based on the Parcel Lookup number of people he has witnessed coming and going from the residence. Email: Edit Requestor Information http://issgl2/intemalwrs/WRequest.aspx?ID=38426 4/17/2012 � a • �C;itizen Web Request Page 2 of 3 Track Request Progress Request Work History: Internal Note History: System entry on 4/17/2012 11:09:27 AM: Assigned to O'Connell,Timothy Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) X b �. n\ WS i;5 Spell Check , Spell,Check = Add document or image link: Browse.:. *You can also type in a folder name to see everything in the folder Current Links: Time worked on request: Response time: *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights,weekends, and holidays in response time for most departments. ri; Save changes r Check to notify town employee below to review this request. 0Save changes and notify Health Oftice �= citizen* Crocker, Close request Sharon 0 Close request and notify citizen* Brief message to reviewer: 1 *notify works if email address was given FUpdateI...._ ............... _ .__.._.__. . __._.. _ .. ......... FSpell Check_�i Public Use: Printer Friendly Version Internal Use: Printer Friendly Version . http://issgl2/intemalwrs/WRequest.aspx?ID=38426 4/17/2012 • Wealth Master Detail Page 1 of 1 "x�x.•r � _ ^a..�rcr.urrlrrfa .,sr....y. v... _.. ,,,�.:, „ - �� a.,`�"^�'L7 ,.s a:�•�`�'d,'�5 .�''i. Logged In As: TOWN\oconnelt _ Health 4,I Muster Detail Tuesday,April 17 2012 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 186-079 Location: 568 SOUTH MAIN STREET, CENTERVILLE Owner: TOBIN,TIMOTHY&HUGHES EILEEN TRS Business name: Business phone: I Rental property: F1 Deed restricted: F1 Number of bedrooms : 1 _-r I Contaminant released: i Fuel storage tank permit: L Save Parcel ChangesReturn o Lookup Parcel Info Parcel•ID: 186-079 Developer lot: Location:568 SOUTH MAIN STREET Primary frontage:90 Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C-O-MM Town sewer exists at this address: No Road index:1507 Interactive map Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: TOBIN, TIMOTHY & HUGHES EILEEN TRS Co-Owner:TOBIN REALTY TRUST Streetl:1637 BLUE MT ROAD Street2: City:PAUL SMITHS State:NY Zip: 12970 Country: Deed date: 12/15/1995 Deed reference:9955/094 Land Info Acres: 0.47 Use: Two Family Zoning:RD-1 Neighborhood: 0109 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info Building No ear Buil Gross Area Living Area Be rooms Bathrooms 1 1820 3190 2540 8,15e droom 3 Full Buildings value:zc187,700.00 Extra featur : 011,900.00 Land value: g251,400.00 Sig http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=l 86079 4/17/2012 TOWN OF BARNSTABLE LOCAi"ION SEWAGE # VILLAGE L P�7/�f ��i✓/i" ASSESSORS MAP & LOT I INSTALLER'S NAME PHONE NO. J/� �� : .S'c�,11 IT �1 SEPTIC TANK CAPACITY r F LEACHING FACILITY:(type) �'T �yfT) (size) } NO. OF BEDROOMS�_PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ,,� — x r DATE PERMIT ISSUED: 5 - 5 DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes No _ I 20 rx.. i j I i i � M s� L` : A ' 1ON j lzK, EWA GE PERMIT No VILLAGE - C� � 3 I �I I N S T A LLER'S NAME ,I ADDRESS al c�n R UILDER OR OWNER i i DATE PERMIT ISSUED DATE COMPLIANCE ISSUED / I &-u4� i j st ` ~` TOWN OF BARNSTABLE J t)2�ln L'Ot;A10N SEWAGE #_ i �- VILLAOE Cott cp, vIZzr ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) )9"; (size) NO. OF BEDROOMS- PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: e DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� �, � - �, � �� � I �\ � , `r �� ��y' .� No..�-Z/Z- FnBI...3J..00 THE COMMONWEALTH OF MASSACHUSETTS ,bl BOARD OF HEALTH 11 TOWN OF BARNSTABLE ApplirFation for Disposal Works Toustratrtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair,( ) an Individual Sewage Disposal System at: 568 South Main Street Centerville Location-Address or Lot No. Aurae...T.Tab-d ti---.---------------------------•-•--------•----------------------•-- -----------.--------------------------------- ------------------------------------------------ W J.P.Macomber Jr. Owner Address Installer Address � S Type of Building Size Lot____________________-_______ q. feet V DwellingX—No. of Bedrooms..........., ._.._-•---------------------•Expansion Attic ( ) Garbage Grinder ( ) ` Other—Type 4 of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria.(....>. PLI d Other fixtures -------------------------...........................................:•--------------- ---------•------•--•-••------ W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width........---.---. Diameter--------.---.--. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.--................. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-..--.---..-..---.-.---. LL, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.......---.............. a ---•----•-----------------•--------•-----•--•-•----•-••-•--••--•-•---•-•._.........-•------------•••.......................................................... 0 Description of Soil--------- =........................................................................................ x aand------------------ V -•••-••-•-••----•---•-•••----------•-••••-------------•---•-------•------•-•--•--•-•---------------•-•••••-•----•-••-•-•--•---------•--•-•----•--•-•---•------••••••-••••••••••-•........--•••.._...... W UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•--------------------------•------------••----------------•------•-1-10�0---gallon-_tank...l---leaching -pit.._.......... ....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beysue. d by the bo rd f health. Signed . ----- ---'-------------------------- 590 Application Approved B Date Application Disapproved for the following reasons- ---.........................------------------------------ ......................... ................................. ............................................................................................... .................................................................................................... - --------------------- .................. `� � Dare Permit No. ------ d Issued ------ .....�----------------- Dnt THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gETrfifirate AAEo lttylianre THIS IS TO CERTIFYy, That the Individual Sewage Disposal System constructed ( ) or RepairedxXX ) P Macomber Jr. by J' ---'............................... -nualler-------..---..-...--------------.-....-.-...--.....-........-......------------------------------------------------------------- I at .....568 South Main Street Centerville - ---------------------------------------------------------------- ------------------------ ---------------- .-....---------.:-------------------------------------�----------.�---_---------- has been installed in accordance with, the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. - . .1�...... dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----------................... :.........:=...........n..... ----------------..-...------------ Inspector .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 1C� FEE....... .�.r..fJ.�... 19hiposal Works Tun#rudinn "Prrnti# Permission is hereby granted....J.P.Macomber Jr -••--••--•-•......... ........ to Construct ( ) or Re airX(X3� an Individual Sewage Disposal System at No...56 ...South lain Street Centerville.....................................•-__..................._...._....-_____......---.....-.-. .. ................................ .....--.................... Street dd as shown on the application for Disposal Works Construction Perm• No?40M_R�Z�, Dated_. ._, -�'�� ...... � ,,.� ........... .......e- - .... � �p -•---•---- Board of Health DATE....... --- ._.�•- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS No._cf�_a'.' r f -FIB t.....�2.ft. 2... THE COMMONWEALTH OF MASSACHUSETTS " BOARD OF HEALTH, ® TOWN OF BARNSTABLE . pIffiration for Diipusal liorks Toustrnr#ilan rami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 568 South Main Street Centerville ............ ... .................................... ---------------------------------------...--------------------•--------•-------------------.- Location-Address or .,Lot No A!?C? -------------- ---------•._----•---------------- ------.- .......... .....-".......... -.- • ---••-•---•_..........----.....0.......... Owner Address `W J.P.Macomber Jr.--•------ ..................... Installer Address dType of Building Size Lot............................Sq. feet U Dwellingx--No. of Bedrooms---.�`....3.............................Expansion Attic (,4 ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of a%ersdns............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .---•---•--••----••----------------•--••--•--- ------•-•--•------ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid'capacity............gallons Length................ Width................ Dia meter-............... Depth................ x Disposal Trench—No..................... Width.................... Total Length....................Total'leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet_.............:....?Total leaching area..................sq. ft. z Other Distribution box( ) Dosing tank ( ) � Percolation Test Results Performed by.................... ..................................................... Date........................................ Test Pit No. 1..�:!�_.�minutes per inch Depth of Test Pit.................... Depth to ground water........................ rs. Test Pit No. 2...._...I........n tinutes per inch Depth of Test Pit.................... Depth to ground water----.................--- .......... ----------------------------------------------------- •-------- ........ .-•------ ----------- --------- •...... ...... •••••'-------.-. ----------------- ODescription of Soil.........................-Sand.... "--•-•--•---•------••-•---7--'- ----•----•••------•••-•--•----•-••-•---•-•••'-••••-•-'-••••••••'•-••-••-------•...........•... x `..•••••••-----••........--•---••-•--••... W -----------------------------------------------------------...........................................-............................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... '! .................................................4.................1.-1000..g 1:lan_-tank...1-...leaph:.ng.-x_aLt.......--•- ........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. i Signed /`�' / � 5/1/9e / /..f���6 +� ....:.......................... :..... .......Dace...-..p..------- Application Approved By ----..a...... ... ........ . ....... -------------------------------------------•----- Date Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------------------------------- Z ............--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................ Dare Permit No. .....� Issued ----- r zl_;7r-- ....-------- ....... .... .......✓�...-... / Dare r 1�i oOT3 3,rm�i�3.:� i J n/ CQL fly_ ��1��]��+�1E3q�C Ae�o9r�^n+t A,1_ ^4 1 1 bL vation Com^fil�31ft3!! i I i SUBJECT TO BARNST��►11H►SSI©�� ".1.4�'.��� - �� V } k ` 1 t i •/"�s.1'� t .. r �� 5 S a ,. � .1. '�' "ri'wM'._.�..,{,y... j.�.v a_J v... � ... � I S;?,[ W A G E P E R M I T N0. k VILLAGE INS T ALL E R'(,S/�� N A ( �l1�y MhE f a AD DRE SS S Ja V e 1` AC-0rA ID t 1 i z• I B U I L D E R OR OWNER DATE PERMIT ISSUED 11/7� g� OATS coMPLIANCE ISSUED �; 1 � � h 1 :-Mbs i »0 - v),e -TC- AFF7 R cowlwrG� i THE cowMowxvsALr* OF MAssAoHussTrs ������ ���� �E ��==��" "�~ 11 go SS 0 °�-'-.��F--.����0������^�xg�4��~��~~�-------� Appliration for U. pmat Workii Tom n /� 'Application is �cz�bv made for u Permit Cnu��roc ( � or Repair ( �r»� uo Individual Sewage I>iupoed System at: '--'--'-------------------------------------'------ Location-Address = c� m� -'~" � .� .~ ------------_-........ ----------------------`������-----------------_--` ~~-'~'��~~�~~_~~~�-'�----'---------'------ '--------------'--------------------------'_------ I=tauer uudr"= Type of Building Size feet D�clio����o. c6 8nlroou�o-----��--------------. �ddc ( ) Grinder ( ) Other—Typeof Building ............................ No. of persons............................ Showers { ) -- Cafeteria ( ) � P4 Other fixtures - '.--------.--'_-----'--_____..___________________________ `^ Design Z .,umr Distribution box ( ) Dosing tank ( ) ~~ Percolation Test Results Performed by.-_--------------_---------------' Date....................................... Test Pit No. }................m6nuteoperincb Depth of Test Pit.-----''--' Depth to ground rratcc.---_---_.. [� Test Pb No. 3................minutes per inch Depth of Test Pb.--------- Depth to ground water........................ -.---.--------'-__--___'----'-___--_----_----------.----___--- 0 Description of Soil.- -----------'......................................................................................... _-'_--_-'.-_'---__.'__'_--'-___-----'__'--_'_'-_--___._'---_--_-'-__'-_---_'__'-'--__- Agreement: The undersigned agrees to install the uforedescribed Individual Sewage Disposal System inaccordance with the provisions of'JI TI U 5 of the State Sanitary Code—Ihe undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued Sign ------- By =~.~~����\.�� ���'� ���/�' Application Pate - '-r�'-'-- '---' '--`--`-',------'---'----_----------'- -- ' - -'nm"-=�---- Application Disapproved fortho following reasons:............................................................................................................... --'---_-'---'__------_------__---__.__-_-__-_-'--_--__--__.._'-'--.--_'__-_--'_-'---__-- »�° ._-���-� ��--^wc� �c�. ^ | Date | ���---''---------'-------'----'--------------- -----------------------------'------'-- ---- ------ --- � �