Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0015 GENERAL PATTON DRIVE - Health
15 General Patton Drive Hyannis. P A = 292 104 if 'i a 1 { b k a e R / i VIE Town of Barnstable P# Department of Regulatory Services a�twarnsru, Public Health Division Date �'yV►e �d, l� MARS. Al 1-619. 200 Main Street, an AA nis MA 02601 /91 10 Date Scheduled Tlme Fee Pd, ►� Z ,� itability Assessment for Se D's os t? � Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address i G- a h Owner's Name En\G Address � G yy e Assessor's Map/Parcel• ' W+ / Engineer's Name CD9✓1 C(7/OP6rlewV NEW CONSTRUCTION REPAIR V Telephone# ` Land Use Sloes %5t eV(�to P ( ) t 07p Surface Stones Distances from: OW enWaterBod too { --ft- ILO p py^^ Possible Wet Area _+ $ Drinking Water Well + ft Drainage Way ft Property Line �� ft Other ft SIKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands n proximity to holes) Z C4- Is`N Co - _ - 8 T Tp_2 . z Parent material(geologic)_1 U q� w�w4S ti O h Depth to 13ede'oeit ✓� Depth to Oroundwater. Standing Water inHoole:cc� neP Weeping lti'om Pit Faec 0!1 e Estimated Seasonal High Oroundwater Q-0 T� UY 0ce pP►^ &r 115 t'a ble` DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: yho�lP a Depth Observed standing in obs.hole: In. Depth to Boll mnttlas: H� ® �4� in. -- - •— Depth to weeping from side of obs,hole: ` In, Oroundwater Adjuatment ft. Index Well# RoadingDate: Index Well level Adj.,factor �4 A4j,CiroundwaterLevel e PERCOLATION TEST Dille 6 30 t4' 'I9me ll A m r Observation -" Hole# Time at h" 64 Depth of Perc CZ I I Time at 6" V1 Start Pre-soak Time @ Time;(V-6") End Pre-soak e2•-�� Rate Min./Inch Vrl P Site Suitability Assessment: Site Passed `es Site Failed: bV 0 Additional Testing Needed(Y/N) o. Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Deptli from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling . g (Structure;Stones;Boulders. Consistency, t3ravel) K6-3� Alt, to y 44 It �e�e Cxud lD q;z S/ Lase DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. h� � �L L �_. o sister % ra ' Lot in, l6C4 G tkel,v n 5-14 c0 �Z S loose DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Muusclt) Mottling (Structure,Stones,Boulders. Consistency.%G DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Boil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Cons' to s Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No V Yes Within 100 year flood boundary No.V Yes Depth of Naturally Occurrina Pervious Material Does at least four feet of naturally occurring pervious material exist in al l areas observed throughout the area proposed for the soil absorption system? '1 t'5 If not,what is the depth of naturally occurring pervious material? Ceitification I certify that o' n ��� `� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the requir raining, ertise a experience described in�10 CMR 15.017. Signature 46 Datb v`Y Q:\5 EMC\PBRCPORM.DOC 4 TOWN OF BARNSTABLE . � LOCATION SEWAGE# &)o i VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER NAME&PHONE NO. SEPTIC TANK CAPACITY C�Q� LEACHING FACILITY.(type (size) T NO.OF BEDROOMS FT 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 < 1 0 � E J\ 1 F � r 1 , v No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • Yes PUBLIC HEALTH DIVISION.r TOWN.OF BARNSTABLE, MASSACHUSETTS aIppgic tion for 33igpozat �§p$tem Con0trUctiun Permit Application for a Permit to Construct O Repair(1IO"Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No kgVb" l S C�ew� 1. ►R-11 A V&-f j-, a rt-.rto ipM-ro cj Dd- Assessor's Map/Parcel oOct kA, 0246 wo-lt/=/ ,�g Installer's l�me,Address,an Tel. � Designer's Name,Add es and Tel.No. Type of Building: �+ Dwelling No.of Bedrooms Lot Size f sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided - " ,p gpd Plan Date 11%9 k t 4 Number of sheets d Revision Date. Titleel&;q_Wg 61 Size of Septic Tank Type of S.A.S. 1500 9A4-:�)R g X\ Description of Soil Nature of Repairs or Alterations(Answer when applicable) kVQ R, D t%ws �. 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 lace the systemin operation until a Certificate of Compliance has been issued by this e Y . Sign Date Application Approved by Date ? J Application Disapproved by: Date for the following reasons M Permit No. 'D01 — ��. � Date Issued u ————————— No. Fee THEN OMMONWEALTH OF MASSACHUSETTS In in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Zipplicatton for -Mi!9pogd1'�&pgtem Con.5truction Permit Application for a Permit to Construct( ) Repair.(Viloupgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. U, Owner's Name,Address,and Tel.No�..�101Zlew-:041 t SG-� ,je CPt L_4"T►OA) 1�,1 6 '' '1ANN).S 6 5 C��vzk�2 ,�L eM-r6 ej Die- Assessor's Mapf.Parcel (�+, Er'� /A-)%JDUI-C 14 Q 2 ,Installer's am',e Addre'ss;an Tel ``17 Designer's Name,Address and Tel.No. e60 Zoo Type of Building: 7 Dwelling No.of Bedrooms �C.• Lot Size l sq. ft. Garbage Grinder ( ) Other Type of Building 1Gt. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided S?)0.0 y gpd Plan Date 1\�Cl l Number of sheets Revision Date Title Sew1AC,C V,g0w#1-/_ SC,til 4,0 F"3a tj Size of Septic Tank iCCX 3 G d'4G Type of S.A.S. ( )g�l_�tL�a� 4-�I Rt 1 ex rtle t20U14 Description of Soil r z Nature of Repairs or Alterations(Answer when applicable) LMQ1f f <_ D'Stjon dL%^6 S 1t S, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this .o ,rd f He It . Sign ��_ Q .� l Date 2 Application Approved by-',, Date Application Disapproved by: Date for the following reasons j: Permit No. C�"3 e- Date Issued ) Wff_ ax= —�L-?�. - _ � . -- ,�¢ «ra.�.w Eii� ————�rtwia was—a—as s THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by W%n\t Vthn 1)t v\4-C e_ at `S QxNNZ 1'4 C FP' Mej V�" « yy\IJ )1`,-. has been constructed in accordance r / L 3 dated with the provisi n o Tit e and tl�fAr-Dis osal Syste Construction Permit No. Installer Designer 1Et0-TGGh #bedrooms Approved design flow 'A Q.0 -A gpd ► 0 •The issuance of this pe : nt shall not be construed as a guarantee that the system i.I fun). o a designe� Date t 8} -- - -- Inspector_ UI lrfA v �J qy VV_ �. v .ter-� 8!4'3�51�w.awuii�wa��.f�A�e�l!1�i1►Ys'sw_��•.,�i7.��jPg- No. Fee Cl� .� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS �Di5po5al �&p5tem Con-5truction Permit Permission is hereby granted to Construct ( ) Repair ( V ) Upgrade ( ) Abandon ( ) System located at tC,, Qtratrt nL da�IMOrJ 0V t1rt,ruAj011 !ll H 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 o`f�tliis permit. Date -)A) ///g Approved ny't Town of Barnstable �oFIKE Regulatory Services Richard V. Scali, Interim Director eA ASS, Public Health Division v M �' i63q. �0 °le1639. ° Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form l Date: JJly 17,201q Sewage Permit# _Assessor's Map\Parcel 2 10+ Designer: Nu'1q �, Cbv wwflwr (ZS Installer: / r IV Address: P,D, gox 126S Address: On % /01A _Z,-,,,_;�, �Ias issued permit to install a (date) (installer) septic system at ( S&Ckerti( ktfOn . rt Ve based on a design drawn by (address) O c,d,14 �, CoVqkg0t✓r VS ly dated s (a 1 2,04 (designer) l certify that the septic system referenced above was installed substantially according to. the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed iil c i liance with the terms of the I\A ap , I letters(if applicable) �N OFM � Assgc DAV,ID yGs F (Installer's Sign re) COUGH ANOWR N No. 1003 Q'sTi. (Designer's Signature). (Affix De p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Fonn Rev 8-14-13.doc THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING - PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. ,.k. GARB • G R OT A OWED o JUT aTare •. , WATER LINE GAS LINE =Q= GAS GATE O j OVERHEAD WIRE 42 UTILITY DRAIN 0 O POLE - -1 43 \ OQ PROPOSED SOIL ABSORPTION SYSTEM —SEE DETAIL ON BACK 42 / r2 p Lh OO T 1Do\�o�� � z� ft 43 AREA = 7919 sft OG nm PLAN BOOK 225 PAGE 109\9 0 ® PINE ASSR MAP 292 PCL 104. 2 \ -o ELEVATION 9� 43. 18 O� `% OAK GRADING �'b°MINIMALd 10 Inry �T SPOT ON CONC �t Q PROPOSED — 6 \ / Q / 20 /n LEGEND 45 OAK SEPTIC COMPONENTS 12 In 44 EXISTING OAK A N 1000 GAL h THIS IS A \ // - L 0 U SEPTIC TANK COL OI U bD 45 SCALE: :l in = .20 f t EXISTING LEACH PIT PLAN 20 40 USE COLOR PLAN ONLY FOR INSTALLATION DISTRIBUTION BOX 0 FULL DETAIL IS BEST O 10 20 TEST PIT VIEWED IN PRINT ON 8-112 x 14 in PAPER FULL COLOR FOR PROPER SCALE TOP OF FOUNDATION RAISE COVERS TO WITHIN AFL PIPE TO BE SCH. 40 Pvc EL = 43.83 +-. b in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN 43.50 MAX f USE H-20 ,. ,-.- EXISTING 40.5o p EXISTING 1000 GALLON o aoao�� o SEPTIC TANK 40.25 39.85 00 �000° PRECAST DRYWELL EXISTING . SEE DETAIL ON BACK S6. in SUL ABSSORPMN 40.02 BASE 39.75 SYSTEM -SEE DETAIL o EXISTING b in STONE BASE 3 ft 5-12 ft ON BACK LO 37.75 NO GROUNDWATER MOTTLING OBSERVED 31.65 ROUTE 28 oko FALMOUTH ROAD �N Of 1��9 �H OF,0S SEWAGE Q. DAVID C'yGJ, DAVID s9ryG DISPOSAL F D. a D. SYSTEM PLAN COUGHANOWR �i, c� COUGHANOWR w -TO SERVE EXISTING DWELLING �� NOT 9 SCALE �No. 1093 No. 461 CHARLESWORTH AND'I ci s �o BELINDA LEE FQ pJ S 1P O/( P� OWNERIS) OF RECORD LOCUS O GEN t • ' 15 GENERAL PATTON DRIVE PATDTR N HYANNIS, MA P.O. BOX 1265 PROPERTY ADDRESS WEST CHATHAM, MA HYANNIS, MA - -' 02669 DATE: JULY 19, 2014 P L .0 C. US . ' MA P 508 364-0894 l/2. _iDe# ETE-3844 - e: SOIL TEST Loy DESIGN SIGN CALCULATIONS SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE #461 DESIGN FLOW: 2 BEDROOMS X 110 GPD = 220 GPD WITNESSED BY: DONNA. MIORANDI, HEALTH DEPT. S' PTIC'T;4NK: 220 GPD X 2 DAYS = 440 GALLONS NO TEST PIT P RCAT062Din -2 MN/IINCHTNEC SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOILOTHERSOUND STRUCTURAL CONDITION. IF NOT. INSTALL INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK. 43.85 0-10 FILL DISTRIBUTION BOX, INSTALL UNIT DEPICTED BELOW. 10-12 O SANDY LOAM 10 YR 3/2. NONE .FRIABLE SOIL ABSORBTION SYSTEM: THE LONG TERM ACCEPTANCE. RATE FOR A CLASS ONE 12-18, A SANDY LOAM 10 YR 4/4 NONE FRIABLE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES 18=34 B - LOAMY SAND. 10 YR 4/6 NONE LOOSE PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. 41.02 34-134 C MEDIUM SAND 10 YR 5/4 NONE LOOSE THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY 32.68 DEPICTED BELOW CAN LEACH: TEST PIT 2 NO GROUNDWATER ENCOUNTERED BOTTOM AREA (24 x 12.5) = 300 sq. ft. 2 MIN/INCH IN C SOILS SIDEWALL AREA = (24+24+12:5+12.5)x2 =146 S . ft. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER TOTAL AREA 446 sq. ft. INCHES HORIZON TEXTURE (MUNSELL) MOTTLES 43:65 FLOW CAPACITY = 0.74 x 446 = 330.04 gal/doh 0-8 FILL INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 8-12 O SANDY LOAM 10 YR 2/2 NONE FRIABLE BELOW. FLOW CAPACITY = 330.04 gol/day WHICH EXCEEDS 12-16 A LOAMY. SAND l0.YR 4/4 NONE FRIABLE THE 220 gol/dog REQUIRED FOR A TWO BEDROOM DESIGN. 16-32 B LOAMY SAND 10 YR 4/6 NONE LOOSE 40.98 32-144 C MEDIUM SAND 10 YR 6/4 NONE LOOSE • 31.65 DISTRIBUTION BOX , DIMENSIONS PIPES EXITING D-BOX TO RUN LEVELI BARNSTABLE GIS DEPARTMENT MAPS INDICATE A ND DETAIL FOR 2 FEET BEFOREDOWNF- GROUNDWATER IS AT ELEVATION 25+-. 12 in C MIN 1000 GALLON SEPTIC TANK FROM = = DIMENSIONS AND DE TA ILN TANK TO TANK TO BE PUMPED DRY AT TIME OF INSTALLATION O ;; o ri SAS AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL " NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. 6 toSTONE BASE REPLACE WITH A NEW .. � � 2! I in 1500 GALLON TANK in 2 CROSS SECTION VIEW TAPER .. IF CRACKED, ROTTED OR OTHERWISE COMPROMISED. SOIL A = SORPTION o SYSTEM CONSTRUCTION o, 41 NOT USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL - --- 4-` TO DRYWELL 24.0 ft - b SCALE UNIT co vi 41 8 ft-6 in A r(t w �� IJ7 v CV INLET CENTER OUTLET N COVER COVER COVER I my CR 3 IN DROP STONE -► A! FLOW LINE 3.5 ft 8.5 ft 8.5 ft 3.5 ft FROM - �. BUILDING in O n 14TO D BOX 500 GALLON DRYWELL `48 in DIMENSIONS & DETAIL INSTALL ONE INSPECTION LIQUID GAS BAFFLE � RISER TO WITHIN THREE LEVEL V INCHES OF FINAL GRADE USE & INDICATE LOCATION H-10 ON AS-BUILT UNIT r: In T b S ONE BASE IF NEW SEPARATION BETWEEN INLET & OUTLET " 0 33 TEES NO LESS THAN LIQUID DEPTH C'lo 00 00 �OM1000 In CROSS SECTION VIEW . 102 o in CROSS SECTION VIEW INSTALL AN APPROVED GEOTEXTILE FABRIC OVER STONE 0 0 28 314 In TO 0 24 In o 314 in TO ►-112 in GRAVEL ■ EFFECTIVEo 1-112 in GRAVEL in o DEPTH o 46 in 58 in 46 in -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE 150 in STARTING WORK. O -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. M -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION E OF LOW FLOW FIXTURES & APPLIANCES, AND PERIODIC PUMPING OF THE SEPTIC TANK: -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. SEWAGE DISPOSAL SYSTEM PLAN ��5 GENERAL PATTON DRIVE HYANNIS. MA JULY 19. 2014 ETE-3844 PG 2/2J Certified Mail#7012 1010 0000 2850 8395 �T Tati Town of Barnstable Regulatory Services BARNSUBM MAC $ Richard Scali, Director 1639. �m A Public Health Division Thomas McKean, Director 200 Main Street, Hy is,MA 02601 Office: 508-862-4644 - Fax: 508-790-6304 V� April 10, 2014 Charles Lee 357 South Main Street \�J Hopedale, MA 01747 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 15 General Patton; Hyannis, was inspected on April 9, 2014 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was due to a complaint received at The Town of Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural�Eleme is -Broken and missing tile in front of main entrance door. -Broken cabinet door within kitchen. -Windows within bedroom do not stay open when intended to be open. 105 CMR 410.351 - Owner's Installation and.Maintenance Responsibilities. Electric outlet within bedroom not working. 105 CMR 410.200(A): Heating Facilities Required: According to Town of Barnstable Cyr gas inspector current heating system and hot water tank are not vented in accordance with accepted gas standards. 1§ 70=4-Certificate of Registration. Property is not registered with Town of Barnstable Health Department. QAOrder letters\Housing violations\Rental ordinance\15 general patton4-9-14 You are directed to correct the violations lasted above within seven O days of your receipt of this notice by hiring licensed HVAC/plumber to vent both hot water tank and heating system properly. You are directed to correct the other violations listed above within fourteen (14) days of your receipt of this notice by registering home with town rental ordinance. You are directed to correct ALL other violations listed above within thirty (30) days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER 6F THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable i QAOrder letters\Housing violations\Rental ordinance\15 general patton4-9-14 TOWN OF BARNSTABLE BOARD OF HEALTH ) � c� ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 1 t i Time: In Out (Z-J,^4 �j� Owner A Tenant Address Address Compliance Remarks or Regulation# Yes JAO Recommendations 2. Kitchen Facilities — 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 01 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities I 10. Curtailment of Service 11. Space and Use r 12. Exits VV 13. Installation and Maintenance of Structural z Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Te ants Observed CART=1t- 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) , Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here _ -� TOWN OF BARNSTABLE BOARD OF HEALTH o, ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date _ ` ( � Time: In Out Owner - Tenant Address Address 9 L4 Oft D I ? `I 7 (. Compliance Remarks or Regulation# Yes jjfN0 Recommendations 2. Kitchen Facilities — 3. Bathroom Facilities e on ,R _ 4. Water Supply 5. Hot Water Facilities �' t 6. Heatina Facilities 7. Lighting and Electrical Facilities 8. Ventilation f / 1 9. Installation and Maintenance of•Facilities, y'. 10. Curtailment of Service't "I'll. Space and Use 12. Exits \ 14 N J 13. Installation and Maintenance of Structural _ Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Te Rants Observed i 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Ra . Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here Invoice Date: 2/2/2014 B It-b Invoice No.: 74777 Heating • Cooling • .Refrigeration Turn to the ExMti 279 Yarmouth Road,Hvannis,Massachusetts 02601 508-775-3083.800-698-4522•Fax 508-534-1272•www.robies.com Bill to: Committed to Ser oiee&Quali4y Since 1959 CHARLES LEE service at: CHARLES& BELINDA LEE 357 SOUTH MAIN 15 GENERAL PATTON`DR HOPEDALE, MA 01747 HYANNIS, MA 02601 Customer ID: 15256 Description: 2 Check System Operation Reference: Work Order 54812 Term11 s: Net-30 Days PO Num 11 ber. Item Description Quantity Unit Price Amount Labor Labor Total: $180.00 Parts COMBUSTION ANALYSIS EFFICIENCY TEST 1.00 35.00 35.00 Parts Subtotal: $35.00 R08IES 279 V4106TH Ro Q 2014 HV41111I9 H4 02601 508-P5-3083 feiriitial ID, 01011989 a0&46S 2J24114 -_ .. 0002 -ti S4 1-,59 PII - kfUI1S4(Et#4atlFllt 19tl iq UIN 405520169519 041l,H q; 172 REF q,0436 4PIUUIl1 4U1H 1t, 011380 $z15:DD APPROVED CUSf011ER.COPY INSPECTED SYSTEM, CHECKED ALL OPERATIONS. SYSTEM NEEDS DUCT CLEANING, CYCLED AND CHECKED OPERATION THANK YOU Subtotal: $215:00 Sales Tax: $0.00 r Payments: $.0:00 i Total Due: $215.00 t t Message Page 1 of 4 O'Connell, Timothy From: Lee, Charles [Charles.Lee@bsci.com] Sent: Saturday, June 14, 2014 2:33 PM To: O'Connell, Timothy Subject: RE: 15 General Patten Dr Update 6/14 Hi Tim, Please see the attached documents that were sent to the tenants at 15 General Patton Drive in Hyannis, MA. The 14 Day notice was served by the Barnstable Sheriff's department and received by the tenant on June 6th The VacateNotice was sent via register mail and the Barnstable Sheriff's office will serve a copy on Monday June 16th The septic system failed inspection, therefore water will be turned off to the building at some point after July 15t. We have a signed Purchase And Sale document on the residence and will close the sale on July 15th Thanks Charles From: O'Connell, Timothy [ma ilto:Timothy.00onnelI@town.barnstable.ma.us] Sent: Tuesday, June 03, 2014 8:04 AM To: Lee, Charles Subject: RE: 15 General Patten Dr Update I understand your situation. If occupant is not allowing you access to dwelling then they are not in compliance of the state code. So in this situation please document all attempts to gain access to make the repairs. As long as you attempt to gain access to make the repairs, then you are satisfying. the "good faith effort" as stated in state code. Just to cover your self you must continue to make and effort to make repairs. This should be done in writing and via an appointment. I suggest this to all owners to do this via certified mail and give them a couple of options on days. Cert. mail will hold up in court if occupant says that you never tried to get into unit. I will work with you on this but you must continue to try to gain access. I have to cover myself because this could turn into "he said, she said". So if you do what I said mentioned above, and they continue not to allow access you are in compliance for time being. Then if you do sell or they leave you will be all set. If you have any questions please call me on town cell 508-922-0284. Timnt4lj T9 O'(11 annrll, T2.S ara111I Jns}�rrtnr T"Jawn of Tgarnstubtir 2011 Main Slrrrl Uqu"nis, MA 02f111 (508)862-4546 6/23/2014 Message Page 2 of 3 To: O'Connell, Timothy Cc: Lee, Charles Subject: Re: 15 General Patten Dr Update Than you very much Sent from my Whone On May 15, 2014, at 1:06 PM, "O'Connell,Timothy" <Timothy.00onnelI@town.barnstable.ma.us>wrote: Yes, considering you have completed the most important piece (heating unit) and have made a good faith effort on the rest of the violations. According to my calculations 30 days gets us to June 9, 2014. Please have them all done by then including registration of property with health division. Limot4g TA ([D'CTnnnrll, RA. ++"�ettltl� Jns}�rrinr 1l.,nwn of TAUrnstable 2IIII . Min 3lrrrl Nquannis, , RA 925111 (5II$)8652-4646 Kmnil: tlnti71111T.orcriiurll@toiuii.h urn stahty.IttM.IiS -----Original Message----- From: Lee, Charles [mailto:Charles.Lee@bsci.com] Sent: Thursday, May 15, 2014 12:56 PM To: O'Connell, Timothy Subject: RE: 15 General Patten Dr Update Hi Tim, This serves as a request for an extension to address the remaining issues at 15 General Pattern Dr. Sheryl said that she has a broken foot and is not very mobile. I would like to give her an opportunity to recover to the extent that I can maneuver around the house. Can I please have a 30 day extension to resolve the window and electrical outlet issues. Thanks Charles From: Lee, Charles Sent: Friday, May 02, 2014 12:38 PM To: Timothy B. Oconnell (timothy.oconnell(cbtown.barn stable.ma.us) Subject: RE: 15 General Patten Dr Update Hi Tim, The gas inspector has sign off on the gas venting system at 15 General Patten Drive. Also complete is the Backsplash in the kitchen and the tile at the front entrance. Thanks Charles From: Lee, Charles Sent: Tuesday, April 22, 2014 2:29 PM 6/23/2014 Message Page 3 of 3 To: Timothy B. Oconnell (timothy.oconnell@town.barnstable.ma.us) Subject: 15 General Patten Dr Update Hi Tim, I just wanted to give you an update on the progress on 15 General Patten Dr Hyannis. I received a verbal quote from Robbies. I am waiting for a quote from Bourque Heating. If all goes well the best scenario is that the work will get done tomorrow but I cannot be sure. If you have any questions please give me a call. Home 508-422-9874 Cell 508-686-0808 1 would like to run the quote solutions by you before I give the OK to do the work. want to make sure it will pass the inspection. Thanks Charles 6/23/2014 Message Page 2 of 4 Email: limnlljil.orounrIMItlurn.hurnstuhlr.mn.its -----Original Message----- From: Lee, Charles [mailto:Charles.Lee@bsci.com] Sent: Monday, June 02, 2014 7:02 PM To: O'Connell, Timothy Cc: cbailee@yahoo.com Subject: RE: 15 General Patten Dr Update Hi Tim, This is an update on the outstanding issues at 15 General Patten Drive in Hyannis. I have completed the rental form and mail it into the town along with the payment check that registers the unit as a rental. Due to constant communication issues with the tenant, mostly'around non-payment of rent, we have decided to put the unit on the market to sell. Just to recap,the heating exhaust system was fixed,the side entrance door was repaired and the kitchen back-splash was replaced. The tenants son work schedule has created scheduling issues on replacing the window and electrical outlet in his bedroom. I asked her to vacate the unit on June 1st and she ignored my request The tenant has not been somewhat un-cooperative with realtors when showing the unit to prospective buyers. I am now at a point where I am uncomfortable showing up at the house to make the remaining repairs due to the hostile environment created by the tenant and her son. I need to be accompanied by a witness to protect myself from being falsely accused of any wrong doing. At this time (I think) the current deadline to complete the repairs is June 14th. I understand this is unusual but can I request another extension on the Window and electrical outlet? My realtor, Sofia Naoom from Today Real Estate, is in the process of negating an offer to sell to a prospective buyer.Should this materialize I hope to have a safe opportunity to complete the repair. Thank you for your understand and cooperation. Charles Lee From: O'Connell, Timothy [mailto:Timothy.00onnell@town.barnstable.ma.us] Sent: Thursday, May 15, 2014 3:15 PM To: Lee, Charles Subject: RE: 15 General Patten Dr Update 6/23/2014 r Message Page.3 of 4 Please call me on or around said day so that I can contact occupant to re-inspect property. -----Original Message----- From: Lee, Charles [mailto:Charles.LeeCa>bsci.com] Sent: Thursday, May 15, 2014 1:24 PM To: O'Connell, Timothy Cc: Lee, Charles Subject: Re: 15 General Patten Dr Update Than you very much Sent from my Whone On May 15, 2014, at 1:06 PM, "O'Connell,Timothy" <Timothy.00onnell@town.barnstable.ma.us> wrote: Yes, considering you have completed the most important piece (heating unit) and have made a good faith effort on the rest of the violations. According to my calculations 30 days gets us to June 9, 2014. Please have them all done by then including registration of property with health division. LimoilT� ?� (�'(Ronnrll, +2.3 �rttllll Jns}rrrlor lT'own of Tgarnstahlr 200 Rain -5lrrrl +-Ijttnnis, AA II26II1 (5II8)II&2-4&4& Email: lintoll7if.oronnrll@lourn.httrnsl hlr.mtt.us -----Original Message----- From: Lee, Charles [mailto:Charles.Lee@bsci.com] Sent: Thursday, May 15, 2014 12:56 PM To: O'Connell, Timothy Subject: RE: 15 General Patten Dr Update Hi Tim, This serves as a request for an extension to address the remaining issues at 15 General Pattern Dr. Sheryl said that she has a broken foot and is not very mobile. I would like to give her an opportunity to recover to the extent that 1 can maneuver around the house. Can I please have a 30 day extension to resolve the window and electrical outlet issues. Thanks Charles From: Lee, Charles Sent: Friday, May 02, 2014 12:38 PM To: Timothy B. Oconnell (timothy.oconnell('Otown.barnstable.ma.us) Subject: RE: 15 General Patten Dr Update Hi Tim, 6/23/2014 Message Page 4 of 4 The gas inspector has sign off on the gas venting system at 15 General Patten Drive. Also complete is the Backsplash in the kitchen and the tile at the front entrance. Thanks Charles From: Lee, Charles Sent: Tuesday, April 22, 2014 2:29 PM To: Timothy B. Oconnell (timothy.oconnelI@)town.barnstable.ma.us) Subject: 15 General Patten Dr Update Hi Tim, I just wanted to give you an update on the progress on 15 General Patten Dr Hyannis. received a verbal quote from Robbies. I am waiting for a quote from Bourque Heating. If all goes well the best scenario is that the work will get done tomorrow but I cannot be sure. If you have any questions please give me a call. Home 508-422-9874 Cell 508-686-0808 1 would like to run the quote solutions by you before I give the OK to do the work. I want to make sure it will pass the inspection. Thanks Charles 6/23/2014 r Message Page 1 of 3 O'Connell, Timothy From: Lee, Charles [Charles.Lee@bsci.com] Sent: Monday, June 02, 2014 7:02 PM To: O'Connell, Timothy Cc: cbajlee@yahoo.com Subject: RE: 15 General Patten Dr Update Hi Tim, This is an update on the outstanding issues at 15 General Patten Drive in Hyannis. I have completed the rental form and mail it into the town along with the payment check that registers the unit as a rental. Due to constant communication issues with the tenant, mostly around non-payment of rent, we have decided to put the unit on the market to sell. Just to recap,the heating exhaust system was fixed,the side entrance door was repaired and the kitchen back- splash was replaced. The tenants son work schedule has created scheduling issues on replacing the window and electrical outlet in his bedroom. I asked her to vacate the unit on June 1st and she ignored my request The tenant has not been somewhat un-cooperative with realtors when showing the unit to prospective buyers. I am now at a point where I am uncomfortable showing up at the house to make the remaining repairs due to the hostile environment created by the tenant and her son. I need to be accompanied by a witness to protect myself from being falsely accused of any wrong doing. At this time (I think)the current deadline to complete the repairs is June 14th. I understand this is unusual but can I request another extension on the Window and electrical outlet? My realtor, Sofia Naoom from Today Real Estate, is in the process of negating an offer to sell to a prospective buyer. Should this materialize I hope to have a safe opportunity to complete the repair. Thank you for your understand and cooperation. Charles Lee From: O'Connell, Timothy [mailto:Timothy.00onnell@town.barnstable.ma.us] Sent: Thursday, May 15, 2014 3:15 PM To: Lee, Charles Subject: RE: 15 General Patten Dr Update Please call me on or around said day so that I can contact occupant to re-inspect property. -----Original Message----- From: Lee, Charles [mailto:Charles.Lee@bsci.com] Sent: Thursday, May 15, 2014 1:24 PM 6/23/2014 COMMONWEALTH OF MASSACHUSETTS Jj EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS - P DEPARTMENT OF ENRONMENT� I, PROTECTION wI TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: / -�;_6elfttk4 L A %� VGi Owner's Name: /V Owner's Address: Date of Inspection: ' Name of Inspector. (pl se int).�a 1;wl.00 •/r��a,. Company Name• 4 - Mailing Address: .. 17) . Telephone Number: "- 4.7 CERTIFICATION STATEMENT ; -a 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 I m-a DEP approved system-inspector pursuant-to.Section.15340 of Title 5(310 CMR.15.000). The system: Passes Conditionally Conditionally Passes.. ,. . Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: /. __: a 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 tent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of.use at that time.This inspection does not address how the system will perform in the P future under the sam e or different conditions of use. Title 5 Inspection Form 6/152000 page 1 hge2 'of II a OFFICIAL INSPECTIONFORM-NOT FOR,VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: zir Owner. Date of Inspection: Inspection Summary: Check A;B,C,D or E/ALWAYS complete 0 of Section b` A. System Passes: I have not found any information which indicates that any of the failure criteria described in 31.0 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below: Comments: B. System Conditionally Passes: e or more system components as described in the,"Conditional Pass"section need to,be replaced''or reps' ed.The system,upon completion of the replacement or repair,as approved'by the Board of Health,will pass. t , Answer yes,no or not determined(Y,N,ND)in`the. for the following statements.If"act.determitseo"Vie. explain. . . The septic tank is metal and over 20 years old*or the septic tank(whether metal'or not)is structurally: 's- uns und,exhibits'nibstantial infiltration or exfiltratron°ortank failure is-immmeat.• stem will'passinspection if the exist g tank is replaced with a complying septic tank as approved by the Board of Health: •A in 1 septic tank will pass inspection if it is structurally sound,not:leaking and if a Certificate of Compliance indica g that the tank is less than 20 years old is available ND expl in: , Observation of sewage•backup or break out or high static water-;level in the distribution.box:due to broken or obstru d pipe(s)or due to a broken,settled or uneven distribution box.System rifi1 if.(w►th approva`af Board of Health): . broken pipe(s)we replaced obstruction is;removed distnbutioabooc.is letaeled or,relsced ND xplain: The system required pumping more than 4 times a year due to broken or obstt�sdpipe(s)•The system will p s inspection if(with approval of the Board-af Heahh� broken pipes)art replaced . obstruction is removed ND explain: 2 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner rr� Date of Inspection• C. Further Evaluation is Required by the Board ofHealtha' ', ' Conditions exist which require further evaluation by the Board of Health in order to determine if the system failing to protect public health,safety or the environment. 1. System will pass unless Board of Health"determines in accordance with 310 CMR 15303 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 feet of a surface water r _ 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 Publie Water Supplier,if any)determines that the s stem is functioning in a manner that protects the public'healih 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 su PP,Y 1' 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'publrc water-supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a privateywater supply well. The system has aseptic tank-and SAS and tf a°SAS is less`than 100 feet but 50 feet or more'from a private water supply well**.Method used to determine distance **Phis system passes if the well water analysis;performed'`at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is.equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be.attached to this form. 3. Other: 3 Page 4 of 1.1 OFFICIAL INSPECTION FORM'—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATIO (continued) Property Address: � erg► _ �� 1. owner. ` �� Date of Inspection: r D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to each of the following for all inspections: Yes N o hx of sewage into facility or systemcomponent 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 ogged SAS or cesspool tic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or 5/cesspool squid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow '72y ed pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number IX; es pumped ortion of the SAS,cesspool or.privy is below high groundwater elevation. portion of cesspool:or.privy is within 100,feet of a surface wateraupply or tributary to.a surface Fsupply. ortion of a cesspool or privy is within a Zone l,,of a public well.ortion of a cesspool or privy is within 01eet of a private waterauRply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feat from a private water PPIy well.with no acceptable.water 4uality analysis. Uhis system_passes if the well water analysis, performed at a DEP certified laboratory,for coliforIn bacteria and volatile organic compounds indicates Oat the.well is.free:irom pollution from that facility and the,presence of ammonia nitrogen and nitrate nitrogen is egnal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis.must be attached to,this form.] (/(Yes/No)The system fails.I have determined that one or more of the above failure criteri exis as the Board of described in.3,1.0-CMR 15.303 therefore the,system:fails..The system owner should., o tact; Health to determine what will.be necessary:to;coriect.the failure. L Large Systems: d to 15,000 To be considered a large system the system must serve a facility with a design flow.of 10,0iNfgp gPd. You must' 'cate either`yres"or"no"to each of the following. (The foil g criteria apply to large systems m addition to the criteria above) yes o .. . • .. ... the system is"within 400 feet of a surface drinking V1= supply water supply. —_ _ the system is within 200 feet of a tribuaary.m a SM 61 _ the system is located in a nitrogen sensitive area(fn=m wellla ad Pt��on — A)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 cansidered`a significant threat,or answered "yes",iin 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 SecttnaD.shall upgrade the system in accordance with 310 CMR 15.3'04.The system owner should contact the appropriate regional office of the Department. 4 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-''SYSTEI INSPECTION FOIL. PART B CHECKLIST Property Address: Owner. Date of inspection: 'e a Check if the Mowing have been done..You most indicate es"or`no"as to each of the following. Yes o /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? _ Z/Hav e large volumes of water been introduced to the system recently or aZ 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 of the b es or tees,material of construction,dimensions, deptth of liquid,deptthf of sl the ug and deptinspected h orf sew condition _ 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 SOR Absorption'Systehi(SAS)on the site has been determined based on: Yes no 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 ofdistance is unacceptable)[310 CMR 15.302(3)(b)] 5 i Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLiJNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: r Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4Z Numbei of bedrooms(actual): -L DESIGN flow based on 310 CMR35203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or-no):Al Is laundry on a separate sewage system or no): if yes separate inspection required) Laundry system inspected(yes or no) Seasonal use: (yes or no): /W Water meter readings,if available(last-2 years usage(gpd)): $ Sump pump(yes or no): Last date of occupancy: . COMMERCIAIJINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15203);. gpd. Basis of design flow(seats/persons/sg8,etc-): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system;(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): 7 If yes,volume pumped:gallons How was quantity pumped determined. Reason for pumping: E 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 aril') _Innovative/Alternative.technology.Attach a copy-of the curient.ope atiou and maim contract(to°`, obtained from system owner) _Tight tank _Attach a copy of the DEP aapp wvW _Other(describe): Approximate age of all components,date hisjoled(if known)and sow ee of' Were sewage odors detected when arriving at the site(yts or no): 6 i • ra*G / Vl !1 OFFIC.L&L INSPECTION FORM—NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL—SYSTEM INSPECTION:FORM PART C SYSTEM INFORMATION(continued) Property Address: Y�L Owner: v Date of Inspection: BUILDING SEWER(locate on-site plan) Depth below grade: Materials of construction:_cast iron, 40 PVC_other(explain): Distance from private water supply well or suction line: - 0201 Comments(on condition of joints,venting,evidence of leakage,etc.): — - SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: !� Distance from top of sludge to bottom of outlet tee or baffle: c� 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:�L How were dimensions determined: Comments(on pumping recommendations,inlet-and outlet tee..or baffle condition,structural integrity,.liquid levels as related to outlet invert,evidence of)eakage,etc.): GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete - metal__fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 i Page 8 of 11 OFFICIAL INSPECTION FORM ,SNOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (d- owner: Date of Inspection: zj vzo 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: . .Aoly iene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no):: Date of last pumping: Comments(cond►'zion of alarm and float switches,etc.):- 1. DISTRIBUTION BOX:-(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,;any evidence of solids carryover,any.evidence of leakage into or out of box,etc.): PUMP.CHAMBER: d' (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): C I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: " Own er_z 2_�_ 6 �f Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): ocate on site plan,excavation of, ,~n P regaiccd) If SAS not located explain why: Type ,leaching pits,number leaching chambers,number. leaching galleries,number leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspooi,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS:4A(cesspool must be pumped as part of insPection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer. Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.} PAY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 : Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTYC,, SYSTEM INFORMAT- M(continued). Property Address•, f � P Owner: Date of Inspectron'. , h ` SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal cyst g cludin ties to_at least two permanent reference landmarks or benchmarks.Locate all wells within 1.00 feet.Locate where public water supply enters the building. S 10 OFFICIAL INSPECTION FORM—NOT FOR VOL • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSUNT FORM�S PART C SYSTEM MFORMATION(continued) Property Address: ' Owner: Date of Inspection: d � SITE EXAM Q Slope �j L•j Surface water Check cellar Shallow wells Estimated depth to ground water v"teet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design . Observed site(abutting property/observation hole within 150 feet of SAS)plan reviewed. 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 g high gr oundwater oundwater elev tion: 11 Town of Barnstable OF THE Tp� Regulatory Services saxtvsrnsLe Thomas F. Geiler, Director 9� buss. •e� Public Health Division ATFp�.�A 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 s 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. I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 General Patton Drive Hyannis Owner's Name: EMC Mortgage Corporation Owner's Address: Date of Inspection: 3/13/2007 } 1 Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: .-� /�' , Date: -3 " The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments � 5 F r.3 G• . r rJ. E ****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. S C;a �,- Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 General Patten Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 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 eed to be replaced or repaired.The system,upon completion of the replacement or repair,as approved b e Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the followi statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the sept' tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank lure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as app ved by the Board of Health. *A metal septic tank will pass inspection if it is structural sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is ava' le. ND explain: Observation of sewage backup or ak out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, led or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The s y m required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspe 'on if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 General Patten Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation b oard of Health in order to determine if the system is failing to protect public health,safety or the env' ent. 1. System will pass unless Boa Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioni in a manner which will protect public health,safety and the environment: _Cesspo r privy is within 50 feet of a surface water pool 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)dete Ines that the system is functioning in a manner that protects the public health,safety and environ t: _The system has a septic tank and soil absorption system(SAS)and the 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 with' Zone 1 of a public water supply. _The system has a septic tank and SAS and the SA s within 50 feet of a private water supply well. _The system has a septic tank and SAS e SAS is less than 100 feet but 50 feet or more from a private water supply well". Method u to determine distance "This system passes if the we ater analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic c pounds indicates that the well is free from pollution from that facility and the presence of ammonia ' ogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are trig ed.A copy of the analysis must be attached to this form. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 General Patten Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ _ I 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 - -Zclogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or / cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _(Yes/No)The system fails. I have determined that one or more of the above 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 ,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria a e) yes no the system is within 400 feet of a surface drinki water supply" the system is within 200 feet of a trib to a surface drinking water supply the system is located in a n• gen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public wa supply well If you have answered' s"to any question in Section E the system is considered a significant threat,or answered "yes"in Section ove the large system has failed.The owner or operator of any large system considered a significant at under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304 a system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 General Patton Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 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? Z _ Was the facility owner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _ Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 General Patton Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-,2,— Number of bedrooms(actual): _ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):L Is laundry on a separate sewage system(yes or no): J40 [if yes separate inspection required] Laundry system inspected(yes or no): �f1 4 Seasonal use:(yes or no):Lp � Water meter readings,if available(last 2 years usage(gpd)): '7'7 G p p Sump Pump(yes or no):10 Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203) gpd Basis of design flow(seats/persons/s . .etc.): Grease trap present(yes or no): ,-- Industrial waste holding present(yes or no):_ Non-sanitary waste di arged to the Title 5 system(yes or no): Water meter read' s, if available: Last date of o pancy/use: OT (describe): GENERAL INFORMATION Pumping Records Source of information: P e c^AjJo1� Was system pumped as part the inspection(yes or no):AL) / If yes,volume pumped: Qallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM V 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 pf all gompo ents date installed(if known)and source of information: Z.ie2 ` ?ram Were sewage odors detected when arriving at the site(yes or no):&0 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 General Patten Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron�0 PVC_other xplain): Distance from private water supply well or suction line: , Co ents(on conditi n of joint ,ve tmg,evidence of lea ge,etc.): 4� �� ��. SEPTIC TANK: (locate on site plan) Depth below grade: /` r, Material of construction: concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: F.Y ,�x Sludge depth: �Ip" Distance from the top of sludge to bottom of outlet tee or baffle: Scum thickness: /5 " Distance from top of scum to top of outlet tee or baffle: 4!!�, _ Distance from bottom of scum to bottom of outlet tee or baffle: L3:! How were dimensions determined: Comments(on pumping recommendati nand outlet tee or baffle condition,structural integrity,liquid levels as related tooutlet in ert,evidence o leakage etc.): VPd1 hL NfJil :s 1 sy CrrLt J�zr%'? y �/i�` F�� 3!1 lase k GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fibergla _polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top outlet tee or baffle: Distance from bottom of sc o bottom of outlet tee or baffle: Date of last pumpin Comments(on ping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related utlet invert, to of leakage,etc.): a Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 General Patten Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 TIGHT or HOLDING TANK: (tank must be pumped at time of inspe ion)(locate on site plan) Depth below grade: Material of construction:_concrete metal erglass_polyethylene_other(explain): Dimensions: Capacity: allons Design Flow: allons/day Alarm present(yes o O): Alarm level: Alarm in working order(yes or no): Date of last p ping: Comment condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Q�. Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): f DOH. i rfylo.� Doxi,e' "L.//`k J— ) A L' 3��f A'►5 /lll�' S L0/1215 cl Ir L�J I PUMP CHAMBER: (locate to plan) Pumps in working Ord es or no): Alarms in work' rder(yes or no): Comments to condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 General Patten Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 SOIL ABSORPTION SYSTEM(SAS): ;- (locate on site plan,excavation not required) If SAS not located explain why: Typ leaching pits;number: 1 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.): �.' 1hQ n CESSPOOLS: (cesspool must be pumped as part of inspection to 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 constructi Indication of grou ater inflow(yes or no): Comments a 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(no ondition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 General Patten Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 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. Q \ � f z � p � ' t i J 36_aTg „ ®q Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 General Patton Drive Hyannis Owner: EMC Mortgage Corporation Date of Inspection: 3/13/2007 SITE EXAM Slope Surface water V/Check cellar Shallow wells Estimated depth to ground water ►L feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record—If checked,date of design plan reviewed: p S Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: Ma L jei I� , UPS . . 66V You must desc be how g e you established h high round water elevation: Y g, r er 4 o COMMO�ALTH OF MASSA�SETTS ---- EXECUTIVE OFFICE OF DEPARTMENT OF ENVIRONMENTAL PROTECTION LZ -, r TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 General Patton Drive RECEIVED Hyannis Owner's Name: John Morris Owner's Address: APR 2 6 2004 TOWN OF BARNSTABLE Date of Inspection: 4/20/2004 HEALTH DEPT. Name of Inspector: (please print) Patrick T. Sullivan _ .-Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 CERTIFICATION STATEMENT 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: asses Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: Date: 'Y 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 -I gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving { authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 General Patton Drive Hyannis Owner: John Moms Date of Inspection: 4/20/2004 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: 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 n to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by th oard of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the following ants.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic whether metal or not)is structurally unsound,exhibits substantial infiltration or enfiltraion or tank failure' imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved the Board of Health. *A metal septic tank will pass inspection if it is structurally so not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or 'gh static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or un n distribution box. System will pass inspection if(with approval of Board of Health): brok pipe(s)are replaced o ction is removed button box is leveled or replaced ND explain: The system required more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with app the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 General Patton Drive Hyannis Owner. John Morris Date of Inspection: 4/20/2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require fiuther evaluation by the Board th 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 de in m accordance with 310 CMR 15.303(1)@)that the system is not functioning in a manner which protect public health,safety and the environment: _Cesspool or privy is within 50 feet of water ,_Cesspool or privy is within 50 feet a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if an)04etermines that the system is functioning in a manner that protects the public health,safety and en ' nment: _The system has a septic tank and soil absorption system(SAS)and th AS 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 ne 1 of a public water supply. _The system has a septic tank and SAS and the SAS is 50 feet of a private water supply well. The system has a septic tank and SAS and the S is less than 100 feet but 50 feet or more from a private water supply well**. Method used to distance **This system passes if the well water anal ,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indi that the well is free from pollution from that facility and the presence of ammonia nitrogen and nits trogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the ysis must be attached to this form. 3. Other. Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 General Patton Drive Hyannis Owner: John Morris Date of Inspection: 4/20/2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ _,Z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ _,e 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 and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow _ �L 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. — _jZ 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. _ Z Any portion of a cesspool or privy is 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis most be attached to this form.] rr0(Yes/No)The system fails. I have determined that one or more of the above 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 fa ' ' with a design flow of 10,000 gpd to 15,000 led. You must indicate either"yes"or"no"to each of the foll g: (The following criteria apply to large systems in addition the criteria above) yes no — the system is within 400 feet of a g water supply the system is within 200 feet of a to a surface drinking water supply the system is located in a sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone Il of a public water ply well If you have answered"yes"to question in Section E the system is considered a significant threat,or answered "yes"in Section D above the arge system has failed.The owner or operator of any large system considered a significant threat under 'on E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system o r should contact the appropriate regional office of the Department Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 General Patton Drive Hyannis Owner: John Morris Date of Inspection: 4/20/2004 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? _ _Z Has the system received normal flows in the previous two week period? _ Z Have large volumes of water been introduced to the system recently or as part of this inspection? .Z_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _jZ _ 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 bales or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ,Z — Was the facility owner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 General Patton Drive Hyannis Owner: John Morris Date of Inspection: 4/20/2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): /11 i?_, Number of current residents: Does residence have a garbage grinder(yes or no): ,tiro Is laundry on a separate sewage system(yes or no):62D[if yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use: (yes or no):Acn, Water meter readings,if available(last 2 years usage(gpd)): aoo� Sump Pump(yes or no):,2o Last date of occupancy: 1Ndt,�_Sb 1 S, ->,30 ' COMMERCIAL/INDUSTRIAL Type of establishment: _ Design flow(based on 310 CMR 15.203): avd Basis of design flow(seats/persons/sgft,etc.). Grease trap present(yes or no):_ Industrial waste holding tank present or no):_ Non-sanitary waste discharged to the rtle 5 system(yes or no):_ Water meter readings,if available Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: lc�paallons—How was quantity pumped determined? Reason for pumping:Z .14gr�., w.,.. + d`M,e- �— TYPE OF SYSTEM eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _InnovativetAlternative 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): A�roximate age of all components,ldate installed(if known)and tsource off information(• �./�•Y\...� ;V��Y.��\.Yr�C. /�%/����� d ' �-�.V\� c'1T �►c.T/V\L`�\`�V�CGr Were sewage odors detected when arriving at the site(yes or no):A2 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 General Patton Drive Hyannis Owner: John Morris Date of Inspection: 4/20/2004 BUILDING SEWER(locate on site plan) Depth below grade: :z)7 % . Materials of.construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line:4/A Comments(on condition of joints,venting,evidence oflmkage,etc.): SEPTIC TANK:-,—/—(locate on site plan) Depth below grade: Material of construction: Vconcrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: g x q,,5' x t). Sludge depth: ` Distance from the top of sludge to bottom of outlet tee or baffle: _ Scum thickness: ' " e d DKK Distance from top of scum to top of outlet tee or baffle: " Distance from bottom of scum to bottom of outlet tee or baffle: 9 " How were dimensions determined T'•a p �M c.�<� -� =, Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): W �- ��. V �►`i �.�1 '^\~'�t.nC�' _ •V ay.���zC \a���lY E���G�tZ smON k2"��e� GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction: conmft metal— _polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of oV;e et tee or e: Distance from bottom of scum to botttee or baffle: Date of last pumping: Comments(on pumping recommendat and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence ofetc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 General Patton Drive Hyannis Owner: John Morris Date of Inspection: 4/20/2004 TIGHT or HOLDING TANK: (tank must be pumped at:bmeinspection)(locate on site plan) Depth below.grade: Material of construction: concrete_metal pylene other(explain): Dimensions: Capacity: gallons Design Flow: gallonslday Alarm present(yes or no): Alarm level: Alarm in wo order(yes or no): Date of last pumping: Comments(condition of alarm d float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: CD.' Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): — arc 3a sz:,�la� V PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,conditi of pumps and appurtenances,etc.): l Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 General Patton Drive xyanms Owner: John Morris Date of Inspection: 4/20/2004 SOIL ABSORPTION SYSTEM(SAS):_(locate on site plan,excavation not required) If SAS not located explain why: Type ✓leaching pits,number: leaching chambers,number: leaching galleries,number: 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.): �-.a.�l�. � i�-cQ � - `►v���rL�rr�C. cA.�� �r.o�wa�.,.-.ta '5`�i'►+;..,��w� o.J� �.��•.T'bG.i��:L. ��v.r� . t_,G.p�� ,p�' �,� Grp �:n�.s CESSPOOLS:—(cesspool must be pumped as part of' on)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes no): Comments(note condition of soil, 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 hyd/icre,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 General Patton Drive Hyannis Owner. John Morris Date of Inspection: 4/20/2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks..Locate all wells within 100 feet.Locate where public water supply enters the building. L I !a 1� a 3 3D l Ali O `� Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 General Patton Drive Hyannis Owner: John Morris Date of Inspection: 4/20/2004 Sln EXAM Slope Surface water Check,cellar✓' Shallow wells Estimated depth to ground watery feet Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record—If checked,date of design plan reviewed: /O r Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators,installers-(attach documentation) =Accessed USGS database-explain: C ,sg�s,54211/, You must describe how you established the high ground water elevation: TOWN OF BARNSTABLE1 L )CATION ��� t n'. SEWAGE# Vl%LAGE ASSESSOR'S MAP&PARCEL `--(� INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY ` CCXD «. 1 LEACHING FACILITY: (type) �o��,, �`'[' (size) C A NO. OF BEDROOMS OWNER J�:r"INC u v v 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 ,� j per~ R. 3 3ge�re �--t P"4 NYC _ SQ �. TOWN OF BARNSTABLE c . LOCATION �`� �Gr.,��C�� ��K) SEWAGE # VILLAGE ASSESSOR'S MAP & LotA9A © �� INSTAL.LER'S NAME & PHONE NO.��`� vJ SEPTIC TANK CAPACITY D O b LEACHING FACILITY:(type) �°�^ (size) NO. OF BEDROOMS- PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER )-� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 1 0 —/0 r ' I VARIANCE GRANTED: Yes No tb '� °�' � r �°r �'- � G��/ �� ® �' �� � � � , � . � ,� t r� No...7.1A.:.. 7.7 ? 10 Fn THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Bwvosa1 Works Tontitrurnnn ranfit Application is hereby made V P rmit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a� � ...... ................................... . . ............... ..............................................r I of ............... �cation Ad ress o ..�. --------------------.._.....�_ S s - ddress ............. , Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) ............... No. of ersons...._................._.___. Showers — p`�., Other—Type of Building ............. p ( ) Cafeteria ( ) L� Other fixtures .-•-•----•----•------------------------•-•--•--••. •. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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 b ................................................... Date....� _..� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ -------•----- O Description of Soil....... _.__t__ a x - --------------------------•-----------•------------------------------- ---- .---------------•----------- ------------ ItM ---------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs r Alter tions—Answer when applicable... - �__.i." _Z_.__........ ------�-------- ----•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enviro ental Code—The undersigned f ther agrees not to place the system in operation until a Certificate of Com ianc has en issued b �he b rd of ealth. Signed �,o�, ' .................. ................ . - Z'. � Da[e Application Approved By .:...........� .............. . . ------------------------------------------------------------ L - - ....... Dace Application Disapproved for the following reasons: --_ ------------------------------------------------------------------------------------------------------------------ qq Dace Permit No. ........ .{�-.' � Issued ....._1. ..^ ..1.: Z Dace ,(9 0 0%t No. 1.: GG�� / ��. ...1. r - s Fx . 7 �- o / THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH" � TOWN OF BARNSTABLE Appliratiuu for Dh4pu,aal Mrku Tuugtrurtiun Prratit Application is hereby made foGrr Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at;, - e Y...�e,r � JtL L'p ation-Ad ress Lot _._... ..................�.._.........----.---------.-. .�......---_ --._....._ ...._. ..._.... lJLQ Owne I ..... .......-- ddress r/�,� Installer Address U r d Type of Building Size Lot..........................Sq. feet Dwelling No. of Bedrooms................................ .....Ex Expansion Attic a g— _______ p ( ) Garbage Grinder ( ) aOther—Type of Building ............................. No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .--•--------------------------------------------------.-•-•---•------••----•-••-••------------•--------------------------.....--------......--•------- 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.... __. _,�.^_`J'_ ....... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---- - -------------- 0 Description of Soil-------- �, ......................................- x W .............••-----•••-------------••-•------•------------•------------ -•----------------------............................................................................................. ---•---------------------- ------------------------------------------------- ............................................ ................ ----- U Nature of Repairs or Alterations—Answer when applicable...__S - _____________� _ ................ ................................................ 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 f �ther agrees not to place the system in operation until a Certificate of Com ianc has been issued by e bo'ard of ealth. 2 Signed -. .. ............. 1........... .... ---------- � r Date Application Approved By .............. .......... 'g 15; te Application Disapproved for the following rea.ron.r- ..............................................--------------------------------------------............................................ -------------------------------- -- ----------------------------------------------------------- --------------------------------------------------...............................................-------- .... .. 7...� 2 G� c� qq Date Permit No. ! �)..- �(.�------------------------- Issued ^..<.....2- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of Y Tr IS omplianre IS TO�ERT'IFY, That r e dividu Sewage Disposal System constructed ( ) or Repaired j ) b ....Gt - --` Zj _------------------ /J a� ----------------------------------------------------------------------------------------- at ...............(..`. ..-----------------........ ---`- j- ---------....-------� to 1 ------------------------�1--te has been installed in accordance with the provisions of TITLE 5 of The Environmental Code as described in the application for Disposal Works Construction Permit No. ..-........ - .---yp. .-- dated ..................:. .........------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......G./-I)-- �--.......---- ------------------------------------------- Inspector ....-------- . ----.... ------.------. .......------------- THE COMMONWEALTH. OF MASSACHUSETTS BOARD OF HEALTH qq TOWN OF BARNSTABLE FEE.... � d DW1ru a1 !�V rku Tuttu#r tun anti# Permission Is hereby granted_______ _____................ �.!�.....?....'.�LS' to Construct ( ) or Repair (JXan Indiv' ual §qfivage Disp s stem , -Street J•1 qq as shown on the application for Disposal Works Construction Permit N 97- Dated.../..-....._ ..........2".... -------•----------•.... --•--------------- .......................................... DATE... r.— G 2 Board of Health — --- L ----- FORM 36508 HOBBS&WARREN,INC..PUBLISHERS l7gLLAfa old► `3 $$99SOWS;MAP . b.A I' �._., 'S I+IAML�c CIO E Nol _--� —�---`- , ! sS]I MC'I'A1- CA,?F►C1T`G LgACI NC CD�r�> P�Podt)lt�5 �.H]j..I'JER OR f WER '.. PI ItMg'Ck31' cownwicE.DATE,....^ ._.__� ......� Sups�ratto�t 1�ts�.ttBri;T3cttv�een S1ne Nl ximum�adjuslecl Gtaurn�wM' �'ab W II l3nttomai X-:achtcc Ptivwtc; 'J€►for du ly Weil mitt I,q.hi ty: 'u+�y eve:tls c.iist f�cot on Seta of withiri 260 f6.t of la>scW.g,tartUty,) -- �--�.�.-- I?cie crf VVWanc9 tir9 lLe�cizin�rac�lf�y Glrk any wctaattci5xist, i+�lBhaia:1(1 ,ft et p@ t t► lP sag lacelxry "L J. 4 ror . A - . o p A-C- a3 y ' -C- P3 [. 4 4