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0033 WEQUAQUET LANE - Health
33 Wequaquet Lane Centerville '4 250 011 ' f Owford, NO. 1521/3 ORA ;�• 10% G i t i, f tk i t Town of Barnstable _ pp1HE tpjY P� o Regulatory Services STAB Thomas F. Geiler, Director BARNMass. 9�Ar�1639n. g Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation Is and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. - Commonwealth of Massachusetts Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C/4'5 Q. �% , .;j 33 WEQUAQUET LN Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 ----------------------------------- ------------------------._..-------------__._._..._..-- Owner ---..__......_..._._._..--._. Owner's Name information is CENTERVILLE MA 02632 9/9/07 required for CENTERV ------------ - — -------.. every page. City/Town State Zip Code Date of Inspection t Inspection results must be submitted on this form. Inspection forms may not be altered in-any way. ? Important:When filling out A. General Information forms on the M \� �/`�O CA computer,use ; 1. Inspector: only the tab key to move your .Y aw Michael DeDeckocursor--do not Name of Inspector e use the return key. Compass Realty Development Corpwation Company Name rn P.O. Box 2384 -------_._._..--- ----- _._. Company Address _Mashp_ee_—_--_ Ma 02649 emo City/Town State Zip Code 508 -221- 5003 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/9/07 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. 33WEQUAQUET•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts a�--- - 6 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 33 WEQUAQUET LN -----------------------...__. ._ Property Address C/O DAVID_H_O_L_T_ , TODAY REAL ESTATE,1533 F_AL_M_ OUTH RD, MA, 02632_ Owner Owner's Name information is CENTERVILLE MA 02632 9/9/07 required for —"--- — -- every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 33WEQUAQUET•08/06 r Commonwealth of Massachusetts a.7— Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 WEQUAQUET LN --- —----..------ - P- perty Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is ENTERVILLE MA 02632 9/9/07 C required for --ENTER -------- — ---- — ----- ----- ------ - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: ------------- C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 33WEQUAQUET•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form =� — -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 WEQUAQUET LN Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name -- --------------------------. .. information is CENTERVILLE MA 02632 9/9/07 required for CENTERVILLE -------- ---- - --- - -- --------------- -- - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 33WEQUAQUET•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 . . o�^ Commonwealth of Massachusetts ��^��8�� �� ������~��~��N N������������~���� ����N~�1�) ' N ���*� �� ��y0 � 0�rN�*N Nmm���.��~��N�.mm N—��mmmm � Subsurfac e Sewage Disposal System Form - Not for Voluntary Assessments 33VVEOUAOUETLN Pmpo,y8ggmxo C/O DAV|DH[)LT TODAY REAL ESTATE1533FALMOUTHRO MA, 02632 _ --------__ Owno, Owner's Name information is required for CENTERV|LLE MA 02632 9/0/07 every page. City/Town State Zip Code Date ofInspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No El 0 Any portion of cesspool o,privy is within a Zone 1 of public well. El 0 Any portion of cesspool or privy is within 50 feet ofa private water supply well. El 0 Any portion nfocesspool or privy is less than 100feet but greater than 50feet from o private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed mtaDEPcertified laboratory,for fecal coliform bacteria indicates absent and the presence mf ammonia nitrogen and nitrate nitrogen is equal toor less than 5ppnm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this forrn.] �� �� The system is o uonspno| serving a facility with a design f|ovvof2OOUgpd' �� �~ 10.000gpd. �� �� The systmrnf@ih�. | have determined that one or more of the above failure �� �� criteria exist aadescribed in 310CMR 15.303. therefore the system fails. The ' system owner should contact the Board of Health to determine what will be necessary tn correct the failure. E) Large Systems: Tmbe considered a large system the system must serve o facility with m design flow of10'OOOgpdto1S.00Ogpd. For large SySte[DS. you 0VSt indicate either"yes" or"no" to each of the fO||oVViDg' in addition to the questions iO Section D. Yes No R 0 the system iS within 4OU feet Uf8 surface drinking water supply D 7 the system is within 200 feet nfa tributary to a surface drinking water supply � l �l the system is located in a nitrogen sensitive area (interim Wellhead Protection / �� �� Area —|VVPA\ OrornappSd Zone || of8 public water supply vve|| � ' 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. 33WEQUAQUET 08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 5 of 15 I Commonwealth of Massachusetts �4 _--_- -- Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p 33 WEQUAQUET LN Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner - ----------_---------..._..—- Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 - -- ------ --- ----- --- -- -— every 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)] 33WEQUAQUET•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts a� 6 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 WEQUAQUET LN Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner's Name ------ ------- Owner — ---- -----------------------...--- information is required for C—NT—E.RV.—IL—LE -- - ---- ._ _ _ _2632 9/9/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3--- Number of bedrooms (actual): 3----- --- --- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0------- --- Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 years usage d N/A Sump pump? ❑ Yes ® No Last date of occupancy: N/A 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: ----- -- --- --- ---- -- - Last date of occupancy/use: ----------- _.----_-------------.--__ .---._-___-- Date Other (describe): ----- -- - --- ---- -- --- --._.. __ 33WEQUAQUET•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 WEQUAQUET LN_ Property Address C/O DAVID H_OLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 ------------------- ----- - ..— every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A -- ------------------- - Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: - - -------------- —--------- gallons How was quantity pumped determined? --- --- -- - - - ----- - Reason for pumping: ---- ---------- -- --._...- .............. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: N/A -------- Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 33WEQUAQUET•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 8 of 15 ' Commonwealth of Massachusetts ' Title �� Official N�����������N���� ����N°��� ' ° m�m�� �~ ��' wnm��m��w mmm�����p��wm��mm Form Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 33VVEOUAC>UETLN Property Address C/O DAV|DHOLT TODAY REAL ESTATE,1533FALK8OUTHRO MA, U2832 Owner Owner's Name --'------------------- .noonnononis required for CENTERV|LLE MA 02632 9/9X07 every page. City/Town State Zip Code Date c«Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2' feet Material nfconstruction: F� oast iron 0 40 PVC El other(explain): ------------------------------ Distance from private water supply well or suction |ine� -------------'-- � feet Comments (on condition of joints, venting, evidence Uf leakage, etC]: JOINTS T|GHTYESVENTED NO LEAKAGE. � ^ Septic Tank (locate nn site plan): � ^ . Depth below grade: feet � ~, Material of construction: ' ' 0 concrete El metal E] fiberglass El polyethylene E] other(exp|ain) If tank is metal, list age: yeas is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes El No ' - -' - --''''''''----''--'''--''''--' ' -''''--''-'''----- ' - 15OOGAL Dimensions: -------- 2^ | Sludge depth. � 32^ ' Distance from top of sludge to bottom �n�e tee or baffle ---- -- ^ 1^ � Scum thickness .' 11^ OistanoehnmtopOfSCUmtobmOfOutlotemorbaffle --- | ' Distance from bottom Of scum to bottom of outlet tee nrbaffle 14" -- ----How were dimensions determined? -' � MEASURED _____ 33WEQUAQUET-08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 33 WEQUAQUET LN Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 every 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.): NO NEED TO PUMP, TEE'S INTACT,STRUCTALLY SOUND, LIQUID LEVEL EQUAL WITH OUTLET INVERT, NO LEAKAGE, --------------------- Grease Trap (locate on site plan): Depth below grade: feet Material of construction: F-1 concrete El metal [I fiberglass El polyethylene E] other(explain): Dimensions: ------- Scum thickness ................................. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete El metal ❑ fiberglass ❑ polyethylene El other(explain): 33WEQUAQUET-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts ,N) 60� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 33 WEQUAQUET LN Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information on is required for CENTERVILLE MA 02632 9/9/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions- Capacity: -------- gallons Design Flow: gallons per day Alarm present: ❑ Yes El No Alarm level: Alarm in working order: El Yes El No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ----------------------------------- ------------ Attach copy of current pumping contract(required). Is copy attached? El Yes El No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EQUAL WITH OUTLET INVERT Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D- BOX IS LEVEL AND DISTRIBUTION EQUAL, NO SOLID CARRYOVER, NO LEAKAGE. Pump Chamber (locate on site plan): Pumps in working order: D Yes F] No Alarms in working order: El Yes ❑ No 33WEQUAQUET•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts - � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i° 33 WEQUAQUET LN Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner — ----- Owner's Name information is CENTERVILLE MA 02632 9/9/07 required for — _--.- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. ® leaching pits number: 2------- --- ❑ 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.): SOIL-GRAVEL/SAND, NO SIGNS OF HYDRAULIC FAILURE, PONDING 2',NO DAMP SOIL, VEGETATION - NORMAL. I 33WEOUAQUET•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 , . Commonwealth of Massachusetts ��~��N �� Official N Inspection Form � Title ��N�� �������� N���� ��N°��� ' N ����= �� ��«NNN~~���Q Nmm�p �����°�~mn ���.m " � � Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 33VVE{�U�\{]UETLN Property Address � C/O DAV|O HOLT TODAY REAL ESTATE 1533 FALyWOUTH RD MA 02632 Owner Owner's Name ����-�-----------'----------- inmnna Ion is required for CENTERy|LLE MA 02832 8/907 every page. City/Town Smoa Zip Code Date mInspection D. System Information (cont.) � Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): � Number and configuration --- Deoth -03p Ofliquid to |n|S\ invert Depth of solids layer Depth of scum layer - ------_- Oimensionuofoesopno| ----' Materials ofconstruction ----------------------- Indication of groundwater inflow El Yea El No Comments (note condition of soil, signs of hydraulic failure, level ofponding. condition nfvegetahon.� otc.): Privy (locate on site p|on)� Mahaho|eofuOnotrucUon:Dimensions - Dimanoiono - ------- DeoUhofsdiUa Comments (note condition of soil, signs of hydraulic f8i|una. level of ponding, condition of vegetation, � e\C]� 33WEQUAQUET-08106 Title 5 Official inspection Form.Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts � _ rb Title 5 Official Inspection Form I% Subsurface Sewage Disposal System Form - Not for Voluntary Assessments f 33 WEQUAQUET LN Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOU_TH RD, MA, 02632 Owner Owner's Name information is NTERVILLE MA 02632 9/9/07 CE required for --- — - ----- --- - --- — - -- ------------- — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. G 2 i 3 C) I 33WEQUAQUET•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts 5/ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 33 WEQUAQUET LN --------__-- Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope Surface water Check cellar F1 Shallow wells Estimated depth to ground water: 64.83' 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- —6a—t; ---------------------- ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: El Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: BARNSTABLE GIS ---------- ------ You must describe how you established the high ground water elevation: BARNSTABLE GIS —---------- 33WEQUAQUET•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 15 of 15 Bk 22168 Ps251 -40100 07-06-2007 & 1 1 s 30cL FE-? r LET JUDGMENT SUE• a 0e COMMONWEALTH OF MASSACHUSETTS n° LAND COURT C � � � DEPARTMENT OF THE TRIA 05 MISC 316421 5 Uettce I � I _Barnstable as. � �I�lll�lll�ll�l�l�l No. �IIII�� COMPLAINT TO FORECLOSE MORTGAGE PLAINTIFF: City or Town Name of Residence <' Deutsche Bank National Trust Company, Trustee On Santa Ana, CA Behalf Of The Certificateholders Of Morgan Stanley ABS Capital I Inc. Trust 2004-HE5 rn DEFENDANT: City or Town Interest Name of Residence Charles R. Wood Centerville, MA Owner/Mortgagor 1. Your plaintiff is the ev~(e assignee)and holder of a mortgage with the statutory power of sale given by Charles R.Wood to Mortgage Electronic Registration Systems Inc acting solely as nominee for Accredited Home Lenders Inc dated February 5 2004 recorded at Barnstable County Registry of Deeds Book 18207 Page 238 covering* 33 Wequaquet Lane Centerville (street and number) (and city or town) and more particularly described in said mortgage. LAND COURT USE ONLY JUDGMENT tinder tbd prov sibus of the Soldiers'and Sailors' Civil Relief Act of 1940,as amended,this cause'came on-tQ be heard and thereupon,upon consideration thereof,it appearing to the Court that recbrd ovhw is not entitled to the benefits of said Act it is ORDEUPP and ADJUOOED that the plaintiff be authorized and empowered to make an entry and to sell the property. covered by the mortgage as set forth in this complaint in accordance with the p©wers in said mortgage. A TRUE.GQPIf By the Court. ATT!~ST: Attest: 07LCLG �.9A8ct) Deborah J. atterson . Recorder (SEAL) RECORD F NOTE: Wherever the singular is used herein,it 0-—be deemed to mean and include the plural where applicable. ARNSTABLE REGISTRY OF DEEDS *A metes and bounds description of the property is not necessary Boa 22168 Pw252 --40101 07-06-2007 a 11 =30a 65354865 05-1829 LIMITED POWER OF ATTORNEY KNOW ALL PERSONS BY THESE PRESENTS, that Deutsche Bank National Trust Company, Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc. Trust 2004-HE5, having a place of business at 1761 East Street, Andrews Place, Santa Ana, CA 92705, present holder of a mortgage given by Charles R. Wood to Mortgage Electronic Registration Systems, Inc., acting solely as nominee for Accredited Home Lenders,Inc.,dated February 5,2004 and recorded with the Barnstable County Registry of Deeds in Book 18207,Page 238,does hereby constitute and appoint SANJIT S. KORDE, JULIE A. RANIERI, VICTOR MANOUGIAN, SUSAN W. CODY, ERIC J. NATICCHIONI AND/OR GAYLE GLEASON, each of Q Chelmsford,Middlesex County,Massachusetts,each as its true and lawful attorney,for it and in its name,place and stead, for the purposes of foreclosing the above mortgage for breach of conditions thereof and for that ?? purpose to do each and all necessary acts,including without limitation: 1. To sign, endorse, execute, acknowledge and deliver all Affidavits; Certificates; Notices of Extension; Ucourt pleadings;Memoranda of Sale and any other necessary documents;hereby ratifying any such acts d heretofore taken; e 2. To sell at public sale the real estate which is subject to the above-referenced mortgage for the purpose of a foreclosing the mortgage; a3. To make entry on and take possession of,on behalf of the present Mortgagee,the real estate which is the subject of the above-referenced mortgage for purposes of foreclosing the mortgage and/or collecting 3 rents; M 4. To commence eviction proceedings in connection with the real estate which is the subject of the above- referenced mortgage being foreclosed upon by the present Mortgagee. Q IN WITNESS WHEREOF,the said Deutsche Bank National Trust Company,Trustee On Behalf Of The cCertificate Holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5 aforesaid has caused its corporate seal a` to be hereto affixed and these presents to be signed and acknowledged in its name and behalf by JI!1R4BNIlt'F,9R.VICE PFIEWENT By its Attorney in Fact,Countrywide Home Loans,Inc.thereunto duly authorized on May 4,2007. Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc. Trust 2004-HE5 By its Attorney in Fact,Countrywide Home Loans,Inc. By: XLL VICEPFIE.RIDW Its: On: 0 4 2001 State of SAS' County of COLLIN on May 4,2007 Then personally appeared the above named 1tl1BALHJiTA�.Sn.VICEPFE80W ,as he/she is the SRVIMPFEBOENT of Countrywide Home Loans,Inc.,Attorney in Fact for Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5,and acknowledged the foregoing instrument to be the free act and deed of Countrywide Home Loans,Inc.,Attorney in Fact for Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5,before me #(A�� N"WA Notary Public My commission expires: v r„ JORGE VARGAS My Commission Expires May 5,2010 BARNSTABLE REGISTRY OF DEEDS Bk 22168 Ps253 :-40102 07 11 : 30cL CERTIFICATE OF Ell We hereby certify that on March 5, 2007, we were present and saw Eric J. Naticchioni, Attomey and Authorized Agent for Deutsche Bank National Trust Company, Trustee On Behalf Of The Certificateholders Of Morgan Stanley ABS Capital I Inc. Trust 2004-HE5, (for authorization see Power of Attomey recorded herewith) the present holder of a certain mortgage given by Charles R Wood to Mortgage Electronic' Registration Systems, Inc., acting solely as nominee for Accredited Home Lenders, Inc., dated February 5, 2004 and recorded with the Barnstable County Registry of Deeds in Book 18207, Page 236, make an open, peaceable and unopposed entry on the premises situated in Centerville, numbered 33 Wequaquet Lane, described in said mortgage, for the purpose, by him/her declared, of foreclosing said moitga for breach of co�itions thereof. �.� Signature Signature Print Name Print Name The Commonwealth of Massachusetts Barnstable, ss. March 5, 2007 Then personally appeared the above named s U� A, and ..J�)H� A " proved to me through satisfactory evidence of identity, which was to be the person(s) whose names(s) are signed on the above document, and who swore or afrmed'to me that the contents of the document are truthful and accurate to the best of their knowledge and belief before me -- JOHN A.BAKER' Notary Public Commonwealth of Massachusatb Notary Public My Commission Expires May 11,2012 .My Co mission Expires Li 'l BARNSTABLE REGISTRY OF DEEDS I B.k 22168 Po254 040103 07-06-2007 & 11 =30ot 65354865 05-1829 FORECLOSURE DEED Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5,having a place of business at 1761 East Street,Andrews Place,Santa Ana,CA 92705 the present holder of a mortgage from Charles R.Wood to Mortgage Electronic Registration Systems,Inc., acting solely as nominee for Accredited Home Lenders,Inc.,dated February 5,2004 and recorded with the Barnstable County Registry of Deeds in Book 18207,Page 238',by the power conferred by said mortgage and every other power,for Two Hundred Forty-Nine Thousand Seven Hundred Fifty and 00/100ths dollars ($249,750.00)paid,grants to Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5 of 1761 East Street,Andrews Place,Santa Ana, CA 92705 the premises conveyed by said mortgage. 'See Assignment recorded with the Barnstable County Registry of Deeds in Book 19466,Page 290. Witness the execution of said corporation on May 4,2007 MASSACHUSETTS STATE EXCISE TAX EARNSTABLE COUNTY REGISTRY OF DEEDS Deutsche Bank National Trust Company Trustee On Behalf Of te: 07-06-2007 a 11:30am p y. 1 t: 653 Doct: 40103 The Certificate Holders Of Morgan Stanley ABS Capital I Inc. gee: $855.00 Cons: ►249r750.00 Trust2004-HE5 By its Attorney in Fact,Countrywide Home Loans,Inc. ai By; Its: ER.VICEPRESm ENT U ai a State of TEXAS Cr 3 County of COLLIN May 4,2007 M Then personally appeared the above named JILLBAIMWSRNICEPRESIDENT as y he/she is the 9R.VIMPAESaw of Countrywide Home Loans,Inc.,Attorney in Fact for a Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Q Capital I Inc.Trust 2004-HE5,and acknowledged the foregoing instrument to be the free act and deed of Countrywide Home Loans,Inc.,Attorney in Fact for Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5,before me 0 c� EARNSTABLE COUNTY EXCISE TAX hA BARNSTABLE COUNTY REGISTRY OF DEEDS Notary Public 11 Date: 07-06-2007 a 11:30am My commission expir : Ctll: 653 Doc4: 40103 Y JORGE VARGAS Ofrlr;liVAR Fee : $570.00 Cons: S20050.00 r My Expires May 5,2010 CHAPTER 183 SEC.6 AS AMENDED BY CHAPTER 497 OF 1969 Every deed presented for record shall contain or have endorsed upon it the full name,residence and post office address of the grantee and a recital of the amount of the full consideration thereof in dollars or the nature of the other consideration therefor,if not delivered for a specific monetary sum.The full consideration shall mean the total price for the conveyance without deduction for any liens or encumbrances assumed by the grantee or remaining thereon. All such endorsements and recitals shall be recorded as part of the deed. Failure to comply with this section shall not affect the validity of any deed.No register of deeds shall accept a deed for recording unless it is in compliance with the requirements of this section. I Bk 22168 Pg 255 #40103 65354865 05-1829 AFFIDAVIT I, �� ,of Countrywide Home Loans,Inc.,Attorney in Fact for Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5("Deutsche Bank")named in the foregoing deed,make oath and say that the principal and interest obligation mentioned in the mortgage above referred to was not paid or tendered or performed when due or prior to the sale,and that Deutsche Bank caused to be published on the 9th, 16th and 23rd days of February,2007 in the Barnstable Patriot,a newspaper published or by its title page purporting to be published in Hyannis,Massachusetts and having a circulation therein,a notice of which the following is a true copy.' *There being no newspaper published in Centerville and the Barnstable Patriot having a general circulation in Centerville. (See Exhibit A attached hereto) N Deutsche Bank also complied with Chapter 244,Section 14 of the Massachusetts General Laws,as amended,by N causing to be mailed the required notices,certified mail,return receipt requested. Q Pursuant to said notice at the time and place therein appointed,March 5,2007 at 1:00 PM upon the mortgaged premises at which time and place upon the mortgaged premises Deutsche Bank sold the mortgaged premises at v 1z public auction by JOHN R.BAKER of The Jumpp Company,a duly licensed auctioneer,to Deutsche Bank U National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc. P Y� g Y P� Trust 2004-HE5 of 1761 East Street,Andrews Place,Santa Ana,CA 92705,above named,for Two Hundred Q Forty-Nine Thousand Seven Hundred Fifty and 00/100ths dollars($249,750.00)paid by Deutsche Bank National A Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc.Trust r, 2004-HE5 of 1761 East Street,Andrews Place,Santa Ana,CA 92705,being the highest bid made therefor at said M auction. �s For auftft we Power of Aftomey recorded Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc. Trust 2004-HE5 y aoop��4 By its Attorney in Fact,Countrywide Home Loans,Inc. Cerftft i re=dsd By: SR.WCEPRE910W U) � Its: III (119081�G: `77` On: May 4,2007 Signed and sworn to by the said JILL641GMNF.8A.VICEPRE9IDMT ,of Countrywide Home Loans,Inc.,Attorney in Fact for Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate Holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5 on May 4,2007,before me, Notary Public My commission expi es: PY JORGE VARGAS My Commission Expires May 5,2010 y 1 i i i i Bk 22168 Pg 256 #40103 EXHIBIT A MORTQAOEE'S SALE OF REAL ESTATE By virtue of and in execution of the Powerof Sale contained in a certain mortgage given by Charles R.Wood to Mortgage Electronic Registration Systems,Inc.,acting solely as nominee for Accredited Home Lenders,Inc., dated February 5,2004 and recorded with Barnstable County Registry of Deeds in Book 1207,Page 238 of which mortgage Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificate holders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5 is the present holder by assignment, for breach of conditions of said mortgage and for the purpose of foreclosing the same, the mortgaged premises located at 33 Wequaquet Lane,Centerville,Massachusetts will be sold at a PublicAuction at 12:00 P.M.on March 21,2006,at the mortgaged premises,more particularly described below, all and singular the premises described in said mortgage,to wit The land with all buildings and improvement thereon situate in said Barnstable(Centerville), County of Bamstable,Commonwealth of Massachusetts,bounded and described as fol- lows: Beginning at the northeast comer of the granted premises at an iron axle at land of William H.Hundertmark;and a town way known as Wequaquet lane; Thence running Southwesterly by Wequaquet Lane one hundred forty-five(145)feet to land now or formerly of said William H.Hundertmark; Thence running North 58 degrees 26 50'West by land of said Hundertmark one hundred sixteen and 72/100(116.72)feet to an ion axle to other land of Brennan; Thence running North 10degrees,29'50"East by other land of Brennan two hundred nineteen and 53/100(219.53)feet to an iron pipe to land of said Hundertmark. Thence running South 40 degrees 13'40'East,one hundred thirty and 92/100(130.92)feet to an iron pipe,and South 46 degrees 05'30"East ninety-nine and 461100(99.46)feet,by land of said Hundertmark,to the iron axle at the point of beginning. Containing 18,085 square feet of land,more or less,and being more particularly shown on plan entitled"Plan of Land in Centerville,Barnstable,Mass.Belonging to Charles H.Brennan at ux,Scale 1 inch=30 ft.Aug.12,1950,Bearse&Kellogg,Engineers,Centerville,Mass.' Recorded with Barnstable County Registry of Deeds in Plan Book 110,Page 147. For mortgagor's title see deed recorded with the Barnstable County Registry of Deeds in Book 12630,Page 203. The premises will be sold subject to any and all unpaid taxes and other municipal assess- ments and liens,and subject to prior liens or other enforceable encumbrances of record entitled to precedence over this mortgage,and subject to and with the benefit of all ease- ments,restrictions reservations and conditions of record and subject to all tenancies and/or rights of parties in possession. Terms of Sale: Cash,cashier's or certified check in the sum of$5,000.00,as a deposit must be shown at the time and place of the sale in order to qualify as a bidder(the mortgage holder and its designee(s)are exempt from this requirement);high bidder to sign written Memorandum of Sale upon acceptance of bid;balance of purchase price payable in cash or current funds in thirty(30)days from the date of the sale at the offices of mortgagee's attorney,Korde&Associates,P.C.,321 Billerica Road,Suite 210,Chelmsford,MA 01824- 4100,c/o Sanjit S.Korde or such other time as may be designated by mortgagee. Other terms to be announced at the sale. Deutsche Bank National Trust Company,Trustee On Behalf Of The Certificaleholders Of Morgan Stanley ABS Capital I Inc.Trust 2004-HE5. present holder of said mortgage by its attorney Sanjit S.Korde Korde&Associates,P.C. 321 Billerica Road,Suite 210 Chelmsford,MA 01824-4100 (978)256.1500 The Barnstable Patriot February 24,March 3 and March 10,2006 BARNSTABLE REGISTRY OF DEEDS No. 3V007` _S(o Fey� !/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes ® ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplitation for Migozal 6pgtem Construction Permit Application for a Permit to Construct( )Repair( :Jt6pgrade( )Abandon( ) 0 Complete System ❑Individual Components Location A d s or Lot No. Owner's Name,Add ss and T 1.No. Assessor's Map/P"arcel Installer's Name,Address,and Tel. o. / Designer's Name,Address and Tel.No. S`a � 7 ��i 3 �� �/J/1.o2 6' .✓ �� E/Z Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued is Board of Healt _ Sig Date Application Approved by Date Application Disapproved for the following reasons Permit No. o OOc'� —15—67 Y Date Issued Fee. Entered in computer: V 0�: t : THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ..- .�k 2pplication for, Mig ogar gtem Congtruction 3permit Application for a Permit to Construct Repair ��pgrade Abandon ❑Complete System ❑Individual Components Location Addre wn s or Lot No. / Oer' Name,Add ss and Tel.No. I 3-3 C�Svsjs .l Assessor's Map/ParcelS. Installer's Name,Address,and Tel. o. / Designer's Name,Address and Tel.No. /9 Type of Building: f Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ive 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 Certifi- cate of Compliance has been issued is Board of Healt .. Signed'' Date ��6/q� Application Approved by Date Application Disapproved for the following reasons Permit No. aool;Z _J_(a Date Issued `�I ———————————1—————————————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Cerfificate of Comifflance THIS IS TO CERT FY, that the On-site Sewage Disposal System Constructed( )Repaired( L_I�Upgraded( ) Abando ed( )by at 3 6 ,C" !/do f J 7t l-2 v//� has been construc ed in accordance with the provisions of Title and thelor Disposal System Construction Permit No. a QJ?- dated I I Installer /1-2,z Designer The issuanN1114 is permit shall not be construed as a guarantee that the syste'ii will firnn/ction as designed. Date Inspector --—��----------------------------------�—J— No. -0ap - -& Fee �v C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogai 6pgtem Comaructton Permit Permission is hereby granted to Construct( )Repair(,-`YtJpgrade( )Abandon( ) { / System located at 3 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. / n I� Date:_ T 0 a Approved by I G r ►' I C I�X TOWN OF BARNSTABLE .LOCATION 33 Ve!� U f T Z-/Z'-' SEWAGE # ',TILLAG E �C "�i 2 e'/ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. A 2 e h' i3 iI SEPTIC TANK CAPACITY ,rS/ T / s o LEACHING FACILITY: (type)oj t x 1S'r /0 od 2 P (size) A0 k 6 AV 1-1 NO. OF BEDROOMS or - 4UILDER OR OWNER S o 40 PERMITDATE: a , D L COMPLIANCE DATE: o v 6eparation 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 3 , i DDLP !O � it x oc� .. ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALT _`._v.. ✓` .............OF..... ✓,L}2 r✓��fJJ -------------------------------- Appliratiou for Uhip s al '.Forks Towitrurtiun Prritfit Application is hereby made for a Permit to Construct ( ) or Repair { an Individual Sewage Disposal System at: .3 3 Ul/e� f g ci Z-.� �� �r _- ............ Locatio Address or Lot No. - --WAddr ess-- ------ ------ Owner a - G Addres � � ti T ael �. �.y...--•C "'- --••...•---••----••--•---•----------- -------- . Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___..................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria P4 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 ( ) Percolation Test Results Performed by...............................................................---------- Date..................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.-_---.---________----- (%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_-_-.-.--._-_--___--. P4 -•••-•-•-•••-----------------•••-•--•-•••---------••---•-•-••.......--------••----•--...---•--------......................................................... 0 Description of Soil........................................................................................................................................................................ ---••-•---------------••..........••-•--•••---•••-----•••••••--••••••••••-•-----•-•-••-•••-•-•---•-•--•-•--••--•----•-----•--------••----•-•-••-••••---•--•----••--•----------.-------- ------------- W ----� U Nature of Repairs or Alterations—Answer when applicable._-_-_�®. _ . __.-r....._ �� ________,_____._._._ .. 0 Agreement: 1 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTIE p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee% ued b the boa, of hea .�� l Sig � ... ..... ... l--�-- Date Application Approved By...... �. .. ... --••-.•...� � . ..... Date Application Disapproved for the following reasons------------------------------------------------------------------------ ----•------------...................... .....................•---............----....-••....-----------•--•-.......----•---------------••-..........•-•••--••--•--••••••-•----------•-------•---••-••--•--•-••--------------•--••--••--•--....... Date Permit No........ . .-:'.36'/................. Issued....................................................... Date -- gel. _y--_....... FEEc............................_ THE COMMONWEALTH OF MASSACHUSETTS BOAR[PI�)oF HFA�j� ..._....._........_......................O F.......................................------------------.....-----------.......--------- Appliratiou for Uhgpas al lVarkii Tvmi!�ur 'ott Urrutit Application is hereby made for a Permit to Construct ( ) or R yair ( ) an Individual Sewage Disposal system at• G� .---•----..._...............•-------- ............................................... .......•--......-•-•--....._......----.........-_.........------------.....-----•---------•------ ................ &oc` n-Address or Lot No. _.. ..... ....._.... ,— ....... l.y!�� ..... ��v�. G ,�✓ (. •d tiO�ef T— -'� Address W Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) ~ Other—Type of Building No. of persons............................ Showers — Cafeteria QI 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....__-.-_-____-._.-.-. a ---••-••-•-•--------•---•---••-••••••-••-----------•••..............•-•-••••.......----•-•-••--...........----•-..........••••••---••--•-••--•-•---•--••----- ODescription of Soil........................................................................................................................................................................ x U ------------------------------------------------------------------------------------------------------------ •-•-••--------•-----•-•••---•-------••-•---••-•-•-•--•--••••-•--.----•-•.-----•-------- W ..........................-----------•-------••--••-•---•--•------- . j::5) r 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 TITLEE 5 of the State Sanitary Code—The undersigned further agrees,not to place the ystem in operation until a Certificate of Compliance has. �t s "y the and of llth �J', Signed -----------------------•-----•-------------------------•------ ,. ApplicationApproved By........ ..................................1.................................... Date Application Disapproved for the following reasons-----------------------•-------••-•--•--•--------•---•---------------........................................... •--••---...-•-••••--••-••----•-----•...................••-•••••--••------••----•......_....._......---._.._.....•-•••----•-------•-•---••---••••-••-•--•-•-•-•--------•-•-•-------..-••••--••--•--------- �^ N �( / Date Permit No. •---------------••--. --.....••-••--••--_. Issued. Date THE COMMONWEALTH OF MASSACHUSETTS � BOARD?OF HEALTH .....................I....................OF..................................................................................... %rrtifirFa#le of Toutpliattrr .----�� THIS 1S.7,Q)CER74FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b ................................'.. ...... � � at-- -•-•-----•••......••••.•-• ••••••.....•••-••-----------•------•------•-•-•......-•-••----•••••...... has been installed in accordance with the provisions of TIT RV ot3 eheL�tate Sanitary Code as described in the application for Disposal Works Construction Permit No................._._.._..........//_...... dated-........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C0PVRUED4S A GUARANTEE THAT THE SYSTEM WILL FUNCTION ATI F T RY. DATE................................... .}�. - .. Inspector... --- . -- . ........_.. THE COMMONWEALTH OF MASSACHUSETTS BOAR �OF ..HEA�LTH No....!t,• ,: FEE•... .r.. Movoqat,�Wiig Tonotrudiott rruttt Permission is hereby graned-------------- to Construe or/_�Zepai� lvi&al _Stucage DisposalC$yAen,v 7— at No.......... . ...........................•----.._--•--...------..r ...r,_ -- Street 3 L/ as shown on the application for Disposal Works Construction Permit No-------- .....\dated-------------------------- ................ d-- /y ............................... . ••...--•••---•-------•------•-•-••------•......--------•-- SC Board of Health DATE..................... C7 .......---•-------•----•-...... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - TOWN OF BARNSTABL E LOCATION 3S (dV_(pU4Q0e � CC _R9 AGE #_Wal�kf `TILLAGE C(a�L.6' I� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.AA Qj C O/?T- 'SEPTIC TANK CAPACITY_ J.�60 __ r LEACHING FACILITYAtype)_ (size) NO. OF BEDROOMS R L OR PUBLIC WATER_ ra B R OR OWNER P WOOD DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED:_ VARIANCE GRANTED: Yes No 20' F o _ 1G . " 0 3� S"1 I : ' I-- I I -- - - - ! i � I + + i 1 I I I I I I i ( i I ADp�'r,vid ! _ j I I I I �_ i I I E� V�hi_ I i i i ;.'_ .L. i i _!.. ' _ ' I i i ! I I• 3 �.. ..........{ - WE�Q�aQuE� ._.__-.j __.._j -�' ----..._ I I I I 1 I I I� i I i I , ..I. _� ..i- � �' i -- - �T i � ,. -...._ ! -,-- i - -: - - I _ G�Ih _ _ _i- ---- - j --� --i -I --'-- -- ---i - i --- i __._ -•. i_.... i_..._� 1 _. __ I. . ____ .+ ._..�.._ �.. _...._ . __. . .__i . ------ _._.-_ -'-- ! -•----!-- ._I. ... , ------_i - - -- --!-- 1----I--- ----.1_---- -'-L---------- _-- -- __J -- �- --- - --�--�---! --I i //''`�� ARV I L I I ---i { I ; i j I I ! I I I i I -! I i ' � �` -I- �- ; i- ! ' -- !- - --- - _...- --_� ..1...---!- ---•- - - - -� l_. + I I i ! I i I y I ! ! I i I I I I i I I.. ...:.. ._. ___. ---_1_ -- ,. -- — -- - _.. .x.. . -!---1-- '-- - __. 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Gad-sd�__..p��.�S.. v I lit i r I j I 1 � Q I � f /I oQ F'; OTfa�L1 1�f " 151 4,6 ` 771 KIT (D0 O k _d � r I , k _YV._1141-4J �4J.yeG T C.R N E ZAR �- �. •. - =i== F- MA T-_Z-R- . QEtaROOM 3-;J f 3-3 19 %9 ( i t I 1 S�t1T5'.--H0.USE� Q° c - i - s p Qs � S ® IJ ASSESSORS MAP : 25U TEST HOLE LOGS. NOTES: . PARCEL : �I 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH -FLOOD ZONE:Oow hZ '0 SO I L VALUATOR : F �THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF w►THE $ L BOARD OF HEALTH REGULATIONS. REFERENCE: �l0 DATE: 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, PERCOLAT ON RATE: SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO INSTALLATION. TH- 1 TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE N , DETERMINATION. .I 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS SPECIFIED OTHERWISE) LOCATION -MAP 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE DISPOSAL. 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED STONE. SEPTIC SYSTEM DESIGN FLOW ESTIMATE BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY oFi �.9 SEPTIC TANK GAL/DAY x 2 DAYS - GAL USE GALLON SEPTIC TANK P DARIE, ti �l ti i m SOIL ABSORPTION SYSTEM Y o T (pn'it� r �� o • \ Rt' \ G I S T F...FzG flNr S I D AREA: w� y BOTTOM AREA: SEPTIC SYSTEM SECTION 10 EXJSTIArl b E j J O s gyp B l I NI S/t TW r; I 4� 'i C,� �. al � G I IC � 7, 33 �J7 r 61 ELD �S5 '• . ' ` � �1�� vJ 2)6 GAL 9�� (NR> s G�•I SEPTIC TANK {✓/eyc thsr� �lvY 1iT t.�- ,� a bMv SITE AND SEWAGE PLAN LOCAT ION : 3 � L (�7— &�� PREPARED FOR : v��-� ►�y•, DARREN M. MEYER, R.S. SCALE 43 VINE STREET DATE: 1j6A-r So (&-L, t DUXBURY, MA 02332 bAv' 0-r- A-�j 0 12 Sv DATE HEALTH AGENT (781) 585-0293 ' 1 f