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0012 KEEL WAY - Health
r I� r L. i ?�1 ° o o � 5 o o o TOWN OF BARNSTABLE LOCATION �� �c ��y SEWAGE#,J VILLAGE /S'f'�t�+� ASSESSOR'S MAP&PARCEL�a ��- -2�o INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY tiCw LEACHING FACILITY:(type) T?e--- (size) NO.OF BEDROOMS 3 OWNER •Oo�o%/yy GeJ'.s�� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: -I.o�..d 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 lS�`'Li L E`BoE`G/r h� i J V V i v � a`e M °` TOWN OF BARNSTABLE LOCATION_�aZ�Q Cy�/ SEWAGE# ViLLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) NO.OF BEDROOMS OWNER PERMIT DATE: OMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater T bI o 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 S, .7 No Fee 101-0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �i.5pozal *, p!5tem Con5truction Permit Application for a Permit to Construct Repair Upgrade Abandon Ef-complete System 0 Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. A., 1X 7 Type of Building: Dwelling No.of Bedrooms _� Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers Cafeteria Other Fixtures Design Flow(min.required) 3-10 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank "if -Type of S.A.S./� Description of Soil Nature-of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with th 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 1394rd of Health. Signed Date — Application Approved by Date tn�c, 0 w6m A4 j" Application Disapproved by: Date for the following reasons Permit No. Date Issued 7 Fee 'THE COMMONWEALTH OF MASSACHUSETTS Ente Qored in computer: PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes application forZi!6po!6a: 'l In 5 U 0 mit' ' pde ' 'Con tr cti 'n-Per Application for a Permit to Construct Repair Upgrade(Al.:. Abandon Complete System ❑Individual Components Location Address or Lot N6. -*`oc=P2- Owner's Name,Address,and Tel.No. 195?111�iIc Assessor's Map/Parcel 0 -.01 Installer's Name,Address,and Tel.No. P ezz'W ec Ir Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers Cafeteria Other Fixtures Design Flow(min.required) 3 gpd Design flow provided SRO gpd Plan Date Number of sh I e e_t X-41', Revision Date Title Size of Septic Tank -A- C44 Type of S.A.S..:I�4et'COf 4 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction,and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environ mtental Code'aid not to place the system in operation until a Certificate of Compliance has been issued by this Bgqrd of Health. d�v Signed , Date 2 f Application Approved by' Date —; ( Application Disapproved by: mot. Date for the following reasons Permit No. .201 t I W Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the*On-site Sewage Disposal System Constructed Repaired Upgraded Abandoned( )byC:Z,,0W <P464rovcd- at -ol.;L �A-e"—,oz, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ;L0( I- Ii SystemK dated Installer Designer -d0_4 4gg " #bedrooms Approved design flow k 0 gpd The issuance of this permit shall noll�Gwrtstrued as a guarantee that the system wil unction es ed. Date Inspector No.,90 1 Fee Tr•(� __ -_-•_____. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS 10 Miqool &_ PE;tem Con.5truction Permit Permission is hereby granted to Construct Repair Upgrade Abandon i System located at Z Z14-54 1P and as described in the above Application for Disposal System Construction Pdrmit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three.years of the date of this permit. -.nn Date Approved..by { L� �5 �� �-�aL(�C� t - Jr .. . .�InV�1 ,//1 JUN/30/2011/THU 09:57 AM SandwichTownOffices FAX No, l 508 833 0018 P, 001 Town of Barnstabl Regulatory Services Thomas F.Geiler,Director P,itlblic Health Division Thomas McKean,Director 200 Mgh Street,Hyannis,MA 02601 Office..508-862-4644 'Fax: 508-790-6304 bstaller&Designer Cgggcatioi, Form Tate: Designer: hastaHer:.=-Ifk-k Address: . J Y-A Address: _ �J T� on was issued a permit (date) (instaF�e) to install a septic system at '7 1 KEEL, . based on a design drawn by dated �(designer) -;certify that the septic system referwed above was installed substaatjohY acc'ordi, g'to `fie design,.which may mi clu le m:or approved-changes such as later.r'elocatid� of the dlrlaution box and/or septic tack... .. .I cezy iat the septic system referenced above was ins With cliaRg�s'(f e. greater-t `207 lateral reloeafk6n-afthe SAS ar-any v c l' i a ien'of any compandiq of the.sepetfjzystem but na ordance with State.&Local;Regdadons. Phan revislau er eel ed as-b t`by tt eesi�a�r tb'follow. f• c D. or's Signattue) .._ 9ASON Aid' g6 ;?y s Siattire p �? e PLEASE RE MM TO i& k ST U"TIML . . HEAL Tld:B OF•:CoAUIJANCE. XjC1S9UED-,; 09M,, t �S- D -T-C :RE RD rR, �' � IfE31�T: .. i.; Q:ilealtl Ss pdclDesign.erCerti&Aon�)Posr� :•4° b Postal Er I t.n Only; I -I- For glplivery Iru information • y FF1 I1AAL i rq Postage $ MA p26pr f1J Certified Fee Z O ReturnReceipt Fee Q Pos Her3a ` 'C3 (Endorsement Required) 1 i Gip s I p Restricted Delivery Fee Q� (Endorsement Required) rU` Total Postage&Fees M Sent T CO - CG o . .._ ......_r..Qlt.1.... c ._..- a................... .---- O !`treat Apt.NO." y r%- or PO Box No./a k$e A i City State.ZIP+4-----------------------�--- - `1 • S ooiLo / PS :rr Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece • A record of delivery kept by the Postal Service for two years Important Rem/nders: J ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a-fee waiver for a duplicate return receipt,a USPSe oostmark on your Certified Mail receipt is required. ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement°Restricted Delivery" • If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking.'If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7330.02-000.9047 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DEI..IVEP*,' ■ Complete items 1,2,and 3.Also complete A. Signa T Item 4 If Restricted Delivery Is desired. e &V1,Q ; ■ Print your name and address on the reverse x dresses so that we can return the card to you. B. Received by(Printed Name) Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Rem 1? O Yes 1. Article Addressed to: S If YES,enter delivery address below: ❑No =Mr. William R an` ``„ ,12 Keel Way, �Y !lOZ�� Hyannis, MA 02661 `'o�j' 3 Service Type ❑Certified Mail ❑Express Mail O Registered ❑,Return Receipt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Eits Fee) eS 2.Article Number (rransferhomservlcelabel) 000e3 PS Form 3811,February 2004 Domestic Return Receipt to M 1540 UNITED STATES POSTAL SERVICE First-Class Mail I Postage&Fees Paid LISPS Permit No.G-10 •I Sender: Please print your name, address, and ZIP+4 in this box • I PUBLIC HEALTH DEPARTMENT TOWN OF BARNSTABLE j 200 MAIN STREET �. HYANNIS, MA 02601 r 04/12/2011 13:20 6176388301 BUEA PAGE 01/11 t FAT 1 AIL BOSTON UNIVERSITY r �1rya .Wg.NrfrtigtrTi E-YE Ass-octATE% INC. The prenzny Iaad-eng ho%IIW of the Alftmd wo a&Zn Medlca!Cenfar Boston University Schoat of Me cans FAX Boston University Eye.Associates,fnc. Gundersen Eye Clinic Doctotr's Office Building 7 720 Harrison Avenue 10t11 floor, Boston,MA 02118 (617) 638-8350 To.l o M A.5 J'�A/i �or9•!� From: �Z Fain• .S� Phone: Total#1 of pages Fax; (617)638-� / RE: Comments: j4q)012 a,4�� 74 t/ 7R(JAXII/ CONFIDENTAL PATIENT INFORMATION This facsimile transmittal may contain information that is privileged confidential or exempt from disclosure under applicable law and is intended for use of only the individual or department to which it is addressed. If you are the intended recipient,or the employee or agent responsible for the: delivering of this transmittal to the intended recipient,please notify the above named individual or department.Anyone other than the intended recipient is hereby notified that any dissemination,distribution',or copying of this communication is strictly prohibited. Thank you for you cooperation. yl�g�ao,, M� -- �� � � :� � �� �T ���w ���� ,� � .� � �� f .. � r �. - � - r � � _ t 04/12/2011 13:20 6176388301 BLIEA PAGE 02/11 12Keel Way Hyannis, MA 02601 April 7, 2011 Thomas McKean, R.S., CHO Regulatory Services Department Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Sir: REQUEST FOR EXTENSION OF SIXTY DAY NOTIFICATION I t m contacting on behalf of my sister,Dorothy Ryan.. I have been appointed as Dorothy's legal guardian by the Barnstable probate Court on November 12, 2010. She has Alzh6ner's and is not able to clearly make some decisions for herself It is the nature that this is a progressive disease with no cure. In the progress of getting her things in order we contacted a realtor Mary Croughwell of Bosworth Reality to get some idea of the property value and to see what would be involved when the house has to be sold and the assets put to my sister's care. At that time a titleV inspection was recommended. Mary recommended Capewide Enterprises. The following week we contacted there, A payment was made for the inspection to be performed. I called them several times and finally February 8,2011 the inspection was performed. The property did not pass I received a call telling me how much it would cost for replacement with and without seeding from a person named Josh. No specifics as to what or who I had to do. So I proceeded to obtain estimates and try to find out more what.was involved and who people recommended. I maintained contact during this time with Capewide and even asked for estimates about getting further work done at the time. I was in the position that my sister does not have a lot of money so I contacted Cape Cod Cooperative Bank about the possibility of obtaining a home improvement loan. The assistant Manager contacted her legal department since a Guardianship was involved_ Well at this point I received your registered letter on or about the end of February. This certainly was upsetting. We have no intention of doing this illegally or surreptitiously. I had not been told that this had been reported without letting me know and mi forming me of the time constraint. Well I contacted the bank at once and the manager informed me that I needed to get a certificate of approval 1 contacted the lawyer for the guardianship and found this is complex.. The request for the loan was submitted mid March a court appointed lawyer has to review the mort age application and a judge has to rule at that point. 'Tot till them can,a loan of any bind can be obtained.-The Loan then will tape two weeks for Cape Cod Cooperative to issue. i At this point we have submitted to the court. A court appointed lawyer has been appointed. She has met with me and my sister and inspected the property. We are i 04/12/2011 13:20 6176388301 BUEA PAGE 03/11 waiting to'bear that her report has been submitted to the Court to obtain some idea when we can proceed. At this time I can tell you it looks like it will tun over smarty days from our.notification and the court appointed lawyer recommended that we ask for an extension to continue beyond the sixty day notification we have been given by the Town of Barnstable. We are making progress as quickly as we can. We will gladly keep you ir&rmed as we are-keeping the bank lawyers(2), contractors, etc involved. please feel free to contact me at any time. .A q suggestions/help is appreciated. The Court has been informed of your time requirements and I think they are really trying to expedite. their ruling. I also have a complicating situation in that if my sister had to leave she may have to enter an assisted living setting before necessary. It is a situation I have tried not to do until it is necessary. Thank you for any help-you can give rise in this matter. I assure this situation will be corrected as quickly as possible. I have included a copy of the guardianship and conservatorship from the Barnstable Probate Court. Contact Information: William J R.yan. `tel#Mobile: 857-891-4365 373 Adams Street Home: 617-472-4445 Quincy,MA 02169 Work 617-638-8309 Sincer ly: Williarn J. Ry I y� 9 c AsBuilt Page 1 of 1 a 'I U W 14 Ut' l3AKMI Alf Lt. VILLAGE > �" ASSESSOR'S MAP d ' D49T$d:tL*S NAME&PHONE NO. r SEPTIC TANK CAPACITY JT OD LEACHING FACILITY: (type) [?l"'6 , (size) NO.OF BEDROOMS NM� OWNER1Jt.�f?��1)19 el ffMATE: l,� GOMPLIANCE'DATE: Separation Distance Between the: w Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ti Private Water Supply Well and Leaching Facility (If any wells exist 'r on site or within 200 feet of leaching facility) a Edge of Wetland and Leaching Faci ty(If any wetlands exist within 300 feet of leachin ac' ' Furnished by - . 4 a F a 3', http://issgl2/intranet/propdata/prebuilt.aspx?mappar=252085&seq=1 2/15/2011 I 04/12/2011 13:20 6176388301 BUEA PAGE 07/11 Town of Barnstable Barn �r Regulatory Services Department 1 j Y onaMASS, •7 I �, MASS, NbUc Health.Division 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Meow FAX: 508-790-6304 'Thomas A,McKean,CHO. CERTIFIED MAIL#1008 3230 0002 5178 2459 . February 22,2011 Mr. William Ryan 12 Keel Way Hyazinis,MA 02601 ORDER TO.COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located 12 Keel Way,Hyannis NIA,was last inspected on 2/07/2011, by Robert Paolini,a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the systern"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the followiug- • Liquid depth in cesspool is less than 6"below invert or-available volume is less than%Z day flow You are ordered to repair or replace the septic system within Sixty(60)days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action, PER ORDE OF TxE F HEALTH S McKean,.R..S., HO Agent of the Board of Health 4 } Q:\SEMC\Ltttm Septic Inspection Failaty\l2 Keel Way Hyanniadoc i I04/12/2011 13:20 6176388301 BUEA PAGE 04/11 DECREE AND ORDER OF Docket No. Commonwealth of Massachusetts The Tr{al Court APPOINTMENT OF GUARDIAN FOR BA10P1541GD Probate and Family Court AN INCAPACITATED PERSON In the Interests of: Barnstable Division Dorothy R Ryan 3195 Main Street F-Ire me Iowa Nafn-e L.Jat MOMS P.O.Box 346 Barnstable,MA 02630 Incapacitated Person (S08)375-6600 After hearing on the Petition for Appointment of Guardianship filed on _ September 17, 2010' (Clete) i The Court finds: . 1. A qualified person seeks appointment (] the Court does not appoint the Incapacitated Person's most recent nomination in a durable power of attorney for good cause. 2, Venue is proper. 3. The required notice has been given to the Incapacitated Person. 4. All other required notices have been given or waived_ ; 5. Any required Medical Certificate or Clinical Team Report is filed and dated and a timely examination has taken place prior to the hearing. S. The nature and extent of the Incapacity is as follows: Scverc global cognitive losses suggesting neurogemtive dementia,possibly Alzheimers types along with delusional thought processes. 7. The appointment is necessary or desirable as a means of providing continuing care and supervision of the Incapacitated Person. e, The Incapacitated Person's-needs cannot be met by less restrictive means, Including the use of appropriate and reasonably available technological assistance. S. ❑ A hearing was held relative to the authority to consent to treatment for which a substituted judgment determination is required, See Sepermte Findings: The Incapacitated Person ❑ was ❑ -was not present, The Court finds that there exist extraordinary circumstances requiring the absence of the Incapacitated Person,that counsel for the Incapacitated Person was present, and that after careful Inquiry and upon representations of counsel there are no contested issues of fact, Oral testimony was not required because sufficient documentary evidence was presented or The Court appoints the following person(s)as Guardian(s): 1. Name: William J Ryan fSt Name Las(Name 373 Adams Street Quincy MA 02169 (Address Une it, o.etc. tY 6Wh) t e � Primary Phone* 617-472-4445 2. Name: rrst Vame —ii711— LW 151—mm— (Address (Apt.Unk.No.etc. sY own) �pj^ Primary Phone#: MPC 770 r06m9l I i 04/12/2011 13:20 6176388301 BUEA PAGE 05/11 ❑ The powers and duties of the Guardian are limited by the following restrictions: The powers and duties of the Guardian are not limited and include all powers authorized to a guardian for an incapacitated person under G.L.c. 19013,ArticieV,Part III exclusive of those powers requiring specific court authorization. 'The powers and duties of the Guardian shall further include: 1. ® Authorization'to admit the Incapacitated Person to a nursing facility. The court finds that such admission is in the Incapacitated Person's best interest. 2. ❑ Authorization for which a substituted judgment determination is required, specific W y:. ❑to treat with anti-psychotic medication in accordance with a treatment plan dated: which shall be reviewed on or before and, if not sooner extended,shall expire on ❑for the following treatment or action: 3. ❑ Authorization to revoke the Health Care Proxy of the Incapacitated Person. 4. 0 Authorization to apply for health insurance benefits including MassHealth on behalf of the Respondent. The Court orders the following: 1. The Guardian shall file for approval with the Court the Initial Guardian's Report/Care Plan within 60 days from this appointment unless previously filed. 2. The Guardian s all file for approval with the Court the Annual uardian's Report/Cars Plan each year on: (date)beginning in ,71 (year)for the duration of the guardianship and when otherwise ordered by the Court. 3. The Guardian shall serve: ' ® without a surety on his,-her or their bond: ❑ because language in a Durable Power of Attorney or Health Care Proxy waives the Guardian's bond or requests a waiver of any necessity of sureties on a bond. . ® it is in the best interest of.the Incapacitated Person because. Guardian will file corporate surety bond on the accompanying Conservatorship Petition. ❑with personal sureties ❑ with corporate surety on his, her or their bond in the amount of pursuant to G. L.c_ 190B§5410. i NO LETTERS OF GUARDIANSHIP FOR AN INCAPACITATED PERSON. SHALL ISSUE UNTIL THE BOND IS FILED AND APPROVED. 4. With-the exception of Rogers Counsel,the appointment of counsel in this matter, if any,shall terminate upon the entry of this Decree unless otherwise ordered by this Court. 5. The Court grants the.following additional powers: f i MPC 720(ob/09) r 04/12/2011 13:20 6176388301 BUEA PAGE 06/11 i 6. The Court further orders: Date !V lJ, �r �d/dC2 20f Judge ❑ This appointment has been: ❑ SUSPENDED as'a Special Guardian has been appointed this date(see separate Order). The authority of the Guardian is suspended during the time the Special Guardian is appointed. ❑ TERMINATED(See separate Order). ❑ MODIFIED(See separate Order). Date Judge ❑ This appointment has been; ❑ REINSTATED as of the date of this Order. ❑ TERMINATED(See separate Order). ❑ MODIFIED(See separate Order). Date Judge . .w ca o` • i a. We 5� h Q'd MPC 720(06/09) f 04/12/2011 13:20 6176388301 BUEA PAGE 08/11 DECREE AND ORDER OF Docket Na. Commonwealth of Massachusetts APPOINWENT OF CONSERVATOR 8A10P1542pM Probate eate anndd Family Court Court FOR ®ADULT ❑ NNOR In the Interests of: Barnstable Division Dorothy R Ryan 3195 Malik Street hrst NaMe Last Name P.O.Box 346 Protected Person Barnstable,MA 02630 (508)375-6600 After hearing on the Petition for Appointment of Conservator filed on The Court finds: 1. A qualified person seeks appointment 2. Venue is proper. 3, The required notice has been given to the Protected Person. 4. All other required notices have been given or waived. 5. Any required Medical Certificate or Clinical Team Report is filed and dated and a timely examination has taken place prior to the hearing. 6, The person for whom a Conservator is sought is a disabled person. T. The appointment is necessary or desirable as a means of providing continuing care and supervision of the property and business affair's of the Protected Person. 8. The Protected Person's needs.cannot be met-by Jess restrictive means, including use of appropriate technological assistance. 9. The Protected Person's best interest 'I be served by appointment of a Conservator. 10. The protected person ❑was interest not present: ' 1 ❑ The Protected Person is a minor over the age of 14 and the Court finds that the nonappearance of the minor Protected Person is in his or her best interest because: The Court finds that a busts exists for the conservatorship: ❑ of a minor because the minor Protected Person: ❑ owns money, real property or personal property requiring management or protection that cannot otherwise be provided. ❑ has or may have business affairs that may be jeopardized or prevented by minority. needs funds for support and education and protection is necessary or desirable to obtain or provide money MPC 7.1n(Ming) oaae . 1 of 4 04/12/2011 13:20 6176388301 BUEA PAGE 09/11 ® of an adult because the adult Protected Person: ® is unable-to manage property and business affairs effectively because of a clinically diagnosed impairment in the ability to receive'or evaluate information or make or communicate decisions,even with the use of appropriate . technological assistance; OR ❑ is detained or otherwise unable to return to the United States; AND ® has property that will be wasted or dissipated unless management.is provided; OR ❑ needs money for his or her support; care and welfare or for the support,care and welfare of persons entitled to the Protected Person's support;and protection is necessary or desirable to obtain or provide money, The Court appoints the following person(d)as Conservator(s)of the Protected Person: 1. Name: Mliam J Ryan Name Last Name 373 Adams Street QuinEy MA 02169 (Address Llne a etc.) -" i own ate) Mp Primary Phone 4: 617-472- 445 2- Name: F-ffsf wre M3. Lost Narrm (Rdress Line 1) (Apt,Unit N571—q own) ( P Primary Phone V The appointment of a Conservator is not a determination of Incapacity of the Protected Person. Except as limited below,the Conservator shall have: ® All powers over ft property and business affairs of the Protected Person which are or may he necessary for the best interest of the Protected Person and the Protected Person's immediate family pursuant to G, L c. 1908, §§5-423(c) (1-7) & (14-24)(unless otherwise limited by this Decree). ❑The following additional powers for minor Protected Persons pursuant to G. L c. 190B,§5-407(c), (See Separate Findings): ❑ The following additional powers for adult Protected Persons pursuant to G. L c. 190B,§5-407(d), counsel having, ; been appointed and a substituted judgment having been made(See Separate Pindings): © The above powers and dutias of the Conservator are limited by the following restrictions: I 04/12/2011 13:20 6176388301 BUEA PAGE 10/11 The Court orders the following: 1. The Conservator shall file for approval with the Court a Conservator's Inventory on or by / l (date within 90 days from appointment). 2. ❑ The Conservator shall file a Conservator's Plan for managing; expanding and distributing the assets of the Protected Person's estate with the Court on or by ate 3. The Conservator shall file for approval with the Court a Conservator's Account on or by the l // • a of each year until the Conservator's appointment is terminated,unless otherwise ordered by the Court.The first Account of the Conservator must be presented for allowance within fifteen months(16)of the date of this Decree unless otherwise ordered by the Court. 4. ❑ A Petition for adjudication that the Protected person is no longer incapacitated may not be filed without speclai:leave of court before (date not to exceed 5 months from this Decree). ae B. The Conservator(s)shall serve: ❑ without surety on his, her or their bond: ❑ because the person has a priority of appointment under G. L-c. 190B,*§5 409(a)(1)and the person nominating the Conservator expressly waived the requirement. ❑ for the fallowing good cause: with ❑ personal sureties corporate surety on his, her or their bond in the amount of $10.D00.00 pursuant to G.L.c. 1908, §5410. NO LETTERS OF CONSERVATORSHIP SHALL ISSUE UNTIL THE BOND IS MLED AND APPROVED, 6. The appointment of counsel in this matter, If any, shall terminate upon the entry of this Decree unless otherwise ordered by this Court. 7, The Court grants the following additional powers including those powers enumerated at G. L..c. 1908,§§5-423 (8-13) specified below: 8. The Court further orders: w Date Judge w �"J MPC 730(06/09) „�„o n1 A 04/12/2011 13:20 61763ee301 BUEA PAGE 11/11 ❑ This appointment has been: ❑ SUSPENDED as a Special Conservator has been appointed this date(see separate Order). The authority of the Conservator is suspended during the time the Special Conservator is appointed. ❑ TERMINATED (See separate Order). ❑ MODIFIED (Sae'ssparats Order).' . ' Date Judge ❑ This appointment has been: ❑ REINSTATED as of the date of this Order. ❑ TERMINATED (See separate Order). ❑ MODIFIED (See separate Order). Date Judge { a r 04/12/2011 12:23 6176388313 BUEA PAT AND MARY PAGE 02/07 DECREE AND ORDER OF Docket No. Commonwealth of Massachusetts APPOINTMENT OF GUARDIAN FOR The Trial Court AN INCAPACITATED PERSON BA10P1541Gb Pra621•e and Family Court In the Interests of: Barnstable Division Dorothy R Ryan 3195 Main Street ira Maff ie— "F l ale Name— iam Narrte---- P.O.Box 346 B Incapacitated Person arnstable,MA 02610 (508)375-900 After hearing on the Petition for appointment of Guardianship filed on September 17, 2010 (Clete) The Court finds: 1. A qualified person seeks appointment. [] the Court does not appoint the Incapacitated Person's most recent nomination in a durable power of attorney for good cause. 2. Venue is proper. 3. The required notice has been given to the Incapacitated Person. 4. All other required notices have been given or waived. S. Any required Medical Certificate or Clinicol Toam Report is filed and dated and a timely exambraliur, has taken place `. prior to the hearing. 6. The nature and aytWnt of the incapacity is es follows: Severe global cognitive losses suggesting neurogerative dementia,possibly Al2heirners type,along with delusional thought processes. 7. The appnintment is necessary or desirable as a means of providing continuing care and supervision of the Incapacitated Person. 8, The Incapacitated Person's needs cannot be met by less restrictive means, including the use of appropriate and reasonably available technological assistance. 9, [] A hearing was held relative to the authority to consent to treatment for which a substituted judgment determination is required. See Separate Findings. The Incapacitated Person was ❑ was not present. The Court finds that there exist extraordinary circumstances requiring the absence of the Incapacitated Person, that counsel for the Incapacitated Person was present, and that after cFaroful inquiry and upon representations of counsel trier dre no contested issues of fact. Oral testimony was not required because sufficient documentary evidence was presented or I The Court appoints the following ppmnn(.S`as Guardian(s): 1. Name: Wiliam J Ryan vet Name -- l L.ast Name 373 Adams Street Quincy MA 02169 Address me ( C Unit, o. c. ty own) a e � Primary Phone#. 617-472-4445 2. Name: use, ame Usl Nerne (Addrc=Line n o.o c. '� ""`(ulty7t Dw;ij (state) "" ""P507— Primary Phone 0: MP("77n(nA/no1 f 04/12/2011 12:23 6176399313 BUEA PAT AND MARY PAGE 03/07 Town of Barnstable Barrt�: ANURegulatory Services Department a� h nARNRTABLE. I 6 q ,a� Public Health Division �Ferr�y 200 Main Street, Hyannis MA 02601 2007 Offica 50&8624644 Thntnru F.Chdlnr,nimr.rnr FAX, 508-790-6304 Thomas A.McKean,CHp CERMED MAIL#7008 3230 0002 5178 2459 February 22, 2011 Mr. William Ryan 12 Keel Way Hyannis, MA. 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located 12 Keel Way,Hyannis MA was last inspected on 2/07/2011, by Robert Paolini,a certified septic inspector for the State of Massachusetts. The inspcction of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR. 15.00)due to the following: Liquid depth in cesspool is less than 6"below invert or available volume is less than % day flow You are ordered to repair or replace the septic system within Sixty(60)days from the date you receive this notification. G Failure to repair/replace the septic system within the deadline period will result in future enforcement action � 1 PER ORDE OF TH A F HEALTH s McKean, R.S. 0' �-... Agent of the Board of Health QNS8rMaLetters Scptic lnspccdnn Failueee112 Keel Wny r{ynnnic.dne L 04/12/2011 12:23 6176388313 BUEA PAT AND MARY PAGE 04/07 0ECREE ARID ORDER Oil"' Docket Ain. Commonwealth of Massachusetts APPOINTMENT OF CONSERVATOR The Trial Court BA1bf�1542PM The and Family Court Fdl� ®ADULT ❑ MINOR In the Interests of: BarnstAbic Division Dorothy rt Ryan 3195 Main Street 1rs Name df�Tame asr Ame P.Q.Box 346 Protected Person Barnstable,MA 02630 (508�375-Gti00 After hearing nn the Petition for Appointment of Conservator filed on The Courtfinds: 1- A quallffed person seeks appointment 2. Venue is proper. 2. The required notice has been given to the Protected Person. 4. All other required notices have been given or waived. S. Any required Medical Certificate or Clinical Team Report is filed and dated and a timely examination has taken place prior to the hearing, S. The person for whom a Conservator is sought is a disabled person. 7. The appointment is necessary or desirable as a means of providing continuing care and supervision of the property and business affairs of the Protected Person. B. The Protected Person's needs cannot be met by less restrictive means, including use of appropriate technological auoiotance. 9. The Protected Person's best interest w'I be served by appointment of a Conservator. 1U. Tlie Protected Person f Jwas was not present. J ❑ The Protected Person is a minor over the age of 14 and the Court finds that the nonappearance of the minor Protected Person is in his or her best interest because: The Court finds that a basis exists for the conservatorship; ❑ of a minor because the minor Protected Person: ❑ owns money, real property or personal property requiring management or protection that cannot otherwise be provided. n has or may have business affairs that may be jPnpardi7Pd or prevented by minority. ❑ needs funds for support and education and protection is necessary or desirable to obtain or provide money MPr.7.0(ORIAM ---- A 7 04/12/2011 12:23 6176388313 BUEA PAT AND MARY PAGE 05/07 ® of An adult because the adult Protected f,erson: ® is unable to manage property and business affairs effectively because of a clinically diagnosed impairment in the ability to receive or evaluate infurmalion or make or communicate decisions,even with the use of appropriate technological assistance;OR [� i5 HAtained or otherwise unable to return to the Unitcd otates; AND 0 has property that will be wasted or dissipated unless management is provided;OR ❑ needs money for his or her support, care and welfare or for the support,care and welfare of persons entitled to the Protected Person's support;and protection is necessary or desirable to obtain or provide money. The Court appoints the following persnn(c)as ronservatorfs)of the Protected Person: 1. Name: William y � Ran First r4ame sl Narne 373 Adams Street Quincy MA 02169 (AddrE33 OneApt,Unh.ND-.--et—c OM (Stater— (zip) Primary Phone k 6174724"S 2. Name: First Name �ICfT-� s1 dfriE (Affiess pi,Unit, a.a c. own) tale Primary Phone 9: The appointment of a Conservator is not a determination of Incapacity of the Protucted Person. Except as limited below,the Conservator shall have; ® All powers over the property and business affairs of the Protected Person which are or may be necessary for the best interest of the protected Person and the Protected Person's immediate family pursuant to G.L. c. 10B, §§5 423(c) (1.7) &(14-24) (unless othervidse limited by this Decree). ❑The iolfowing additional powers tar minor Protected Persons pursuant to G. L.c. 190B, §5407(c), (See Separate Findings): ❑ The following additional powers for adult Protected Persons pursuant lu G. L c, I90B,§5407(d),counsel having. been appointed and a substituted judgment having been made(See Separate Findings); i ❑ The above powers and duties of the Conservator are limited by the fnllnwinrg restrictions: �e�n -rnn inrmm 04/12/2011 12:23 6176388313 BUEA PAT AND MARY PAGE 06/07 The Court orders the following: 1 1. The Conservator shall file for approval with the Court a Conservator's Inventory on or by (date within 90 days from appointment). st i 2. ❑ The Conservator shall file a Conservator's Plan for managing, PxpPnding and distributing the assets of the Protected Person's estate with the Court on or by ate I3. The Conservator shall fife for approval with the Court a Conservator's Account on or by the uete) of each year until the Conservator's appointincnt is terminated unless otherwise ordered by the Court.The first A cuuunL of the Conservator must be presented for allowance within fifteen months (15)of the date of this Decree unless otherwise ordered by the Court. 4• A Petition for adjudication that the Protected Person is no longer incapacitated may not be filed without special leave ofrnitrt hefore (date not to exceed 6 months from this Decree). 8e 5. The Conservators)shall serve: ❑ without surety on his,her or their bond: ❑ because the person has a priority of appointment under G. L, c, 1908, §5-409(a)(1) and the person nominating the Conservator expressly waived the requirement, [] for the following good cause: with ❑ personal sureties ® corporate surety on his, her or their bond in the amount of $10,000.00 pursuant to G.L.c, 1908, §5410. NO LETTms OF CONS EI4VATORSHIP SHALL,ISSUE UNTIL THE BOND IS FLED AND APPROVED. S. The appointment of counsel in this matter, if any, shall terminate upon the entry of this Decree unless otherwise ordered by this Court. 7 The Court grants the following additional powers including those powers enumerated at G. L.c. 1908, §§5-423(8-13) specified below: I S. The Court further orders: w r C.7 AI Date a > Ju ge O MPC 730(06109) .3 -s A 04/12/2011 12:23 6176388313 BUEA PAT AND MARY PAGE 07/07 El This appointment has been; ❑ SUSPENUtt7 as a Special Conservator has been appointed this date(see separate Order). The authority of the Conservator is suspended during the time the Special Conservator is appointed. n TERMINATED (See separate Order). ❑ MODIFIED(,Sap SpltarRte Order). Date _ Judge - -- -- ❑ This appointment has been: ❑ REINSTATED as of the dale of this Order. ❑ TERMINATED (See separate Order). ❑ MODIFIED (See separate Order), Date Judge s :i. 7 =' Town of Barnstable ' Barnstable �Op SHE Tp� �. WP O A&AmedcaCity .� Regulatory Services Department BARNWABIL AS 9. Public Health Division i63q. �0 m AIEo MA+a. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7008 3230 0002 5178 2459 February 22, 2011 Mr. William Ryan 12 Keel Way Hyannis, MA_02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL-CODE, TITLE 5 The septic system located 12 Keel Way, Hyannis MA was last inspected on 2/07/2011, by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines -of 1995 TITLE 5 (310 CMR 15.00) due to the following: - • Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDE OF THE OA OF HEALTH as McKean, R.S., HO _ Agent of the Board of Health tee. `Q:\SEPTIC\Letters Septic Inspection Failures\12 Keel Way Hyannis.doc r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 12 Keel Way Property Address William Ryan Owner Owner's Name information is required for Hyannis Ma. 02601 2/7/2011 every page. City/Town State Zip Code Date of Inspection ' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the 'computeto r,use 1. Inspector: - only the tab key to move your Robert Paolini . .�. - cursor-do not Name of Inspector use the return -: key. Capewide enterprises,LLC. Company Name teb P.O.Box 763 Company Address Centerville Ma. 02632 reran Cityrrown State Zip Code (508)477-8877 S14454 Telephone Number License Number B. Certification `s 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;inspe.5tion was performed based on my training and experience in the proper function and maintenance of on, sewage disposal systems. I am a DEP approved system to_ inspector pursuant �Section 1�5.�340 of-` Title 5 (310 CMR 15.000). The system: ❑ Passes sv ❑ Conditionally Passes ® Fails � ❑ Needs Further Evaluation by the Local Approving Authority t tiv , 2/8/2011. <;.Inspect is Signature Date ` The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health ol� DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. tr I 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disp sal System•Page 1 of 17 r `� 61 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 12 Keel Way Y Property Address William Ryan Owner Owner's Name information is required for Hyannis Ma. -02601 2/7/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary_ Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are . indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. ' *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate_ of Compliance indicating that the tank is less than 20 years old is available. ❑ Y . ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 12 Keel Way Property Address William Ryan Owner Owner's Name information is required for Hyannis Ma. 02601 2/7/2011 _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y [:IN ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 ,l i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 12 Keel Way Property Address William_ Ryan Owner Owner's Name information is required for Hyannis Ma. 02601 2/7/2011 every page. Cityrrown State Zip Code Date of Inspection - r B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 12 Keel Way Property Address William Ryan Owner Owner's Name information is H annis required for Y Ma. 02601 2/7/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply -well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M .12 Keel Way Property Address William Ryan Owner Owner's Name information is Hyannis Ma. 02601 . 2/7/2011 required for y ,. every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: , Yes No f ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any-of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for'signs of sewage back up?. ® ❑ - Was the site inspected for signs of break out? , ® ❑ ,Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior'of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum?'"" ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been'determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the.failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] ' D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms*(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330` l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 12 Keel Way Property Address William,Ryan Owner Owner's Name information is required for Hyannis Ma. 02601 2/7/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2/8/2011 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 31.0 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 12 Keel Way H - Property Address William Ryan Owner Owner's Name information is required fore y H annis Ma. 02601 2/7/2011 . ' every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ' ❑ Yes ® No If yes, volume pumped: - gallons How was quantity pumped determined? Reason for pumping: Type of System: El tank, distribution box, soil absorptiori system i ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes,.attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and -maintenance contract(to be obtained from system owner) and a copy of latest inspection of the.1/A system by system operator unde'r,contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` w 12 Keel Way ' Property Address William Ryan Owner Owner's Name information is Hyannis Ma. 02601 2/7/2011 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ' Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No ' Building Sewer(locate on site plan): y Depth below grade: feet Material of construction: ti ❑ cast iron ❑ 40 PVC ® other(explain): Orangeburg ' A Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. i Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass El polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes .❑ No, Dimensions: Sludge depth: I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 .r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 12 Keel Way Property Address ; William Ryan Owner Owner's Name information is required for Hyannis Ma. _ _ 02601 2/7/2011 ` _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee'or baffle, Scum,thickness Distance from top of scum to top of outlet tee or baffle i Distance from bottom of scum to bottom"of outlet tee or baffle - -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 leakage, etc.): Grease Trap (locate on site plan): Depth below grade: ' feet Material of construction: ❑.concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other.(explain): Dimensions: L Scum thickness Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 12 Keel Way Property Address William Ryan ' Owner Owner's Name information is Hyannis Ma. 02601 2/7/2011 required for H y - every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass- . ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons - Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes. ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): r • Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No / t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 12 Keel Way Property Address William Ryan Owner Owner's Name information is required for Hyannis Ma. 02601 2/7/2011 ' � every page. City/Town State- Zip Code Date of Inspection D. System Information (cont.) Distribution.Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): - • f J Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No ' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located;explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 12 Keel Way Property Address William Ryan Owner Owner's Name information is Hyannis Ma. 02601 2/7/2011, •required for y ' every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1-Main • 1-Overflow` 3" Depth—top of liquid to inlet invert Depth of solids layer 8" Depth of scum layer 'Dimensions of cesspool 6'x8' Materials of construction Concrete Block Indication of groundwater inflow ❑ Yes ® No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form° Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 12 Keel Way Property Address William Ryan - Owner Owner's Name information is Hyannis Ma. 02601 2/7/2011 required for y - • every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):. ' System is in hydraulic failure.Both cesspools were full at time of inspection. r Privy (locate on site plan): . Materials of construction: . Dimensions = Depth of solids - Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary,Assessments °M 12 Keel Way ; Property Address ' William Ryan Owner Owner's Name information is Hyannis Ma .02601 2/7/2011 required for y , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ' ❑ drawing attached separately F ,A •T :f • 1. ' .., t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 12 Keel Way Property Address William Ryan Owner Owner's Name information is required for Hyannis Ma. 02601 2/7/2011 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of CP 26' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach.documentation) I ❑ Accessed USGS database-explain: i You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments M 12 Keel Way Property Address William Ryan Owner Owner's Name information is required for y H annis Ma.-,. . 02601- 2/7/2011 - ' every page. Cityrrown State, Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B' C, D, or E checked - t - ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t - • j I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P tt cJ Department of Regulatory Services �rAUM i Public Health Division Date 6 Z 20f� 200 Main Street,Hyannis MA 02601 Date Scheduled 1 V Time Fee Pd. Soil Suitability Assessment for Sewage�D�1i''sppos'a/l Performed By `J: ///���� Witnessed By: �"'�� 1,/r[�"'V S LOCATION&GENERAL INFORMATION Location Address �r�B i t >✓J, / Owner's Name Address Assessor's Map/Parcel: ���p /� Engineer's Name NEW CONSTRUCTION REPAIR Telephone o '34- —X1 7 . Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area fl Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) t_i_I M cc C-I CV CD Uri r,* F—ZZ C", Parent material(geologic) too, Depth to Bedrock `1—�—+ Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater ' DETERMINATION FORS EASONAL- H TABLE WATER TA -- - - --- --- -_ --' Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles:- in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level - — -- -�i PERCOLATION TEST Date Time Observation- Hole# I Time at 9" 11 Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak G Rate MinAnch Gli W¢ Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 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:\S EPT10PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. " Consistency-%Gravel) t , ti/o - L04TtAIL D_EEP_OBS_E_R_VATI_ON H_OL_E LOG Hole# T Depth from Soil Horizon Soil Texture Soil Color Soil Other , Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. s -- Consistences%Graven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other - Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistences%Graven I , DEEP OBSERVATION HOLE LOG Hole# - -- - -._- --------- - _ - — - --- Depth from Soil Horizon Soil Texture Soil Color Soil � Other r Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven ! M (Rood Insurance Rate Mau: / Gt,.. cl-i 71• Above 500 year flood boundary No'_//Yes ✓✓✓ © � Within 500 year boundary No I/Yes ' k 'Within 100 year flood boundary No V Yes c�a I Depth of Naturally Occurring Material Does at least four feet of naturally occurring perviojitsmaterial exist in all areas observed throughout the area proposed for the soil absorption system? + If not,what is the depth of naturally occurring pervious material? ' Certification G o I certify that on �b 7 (date)1 have passed the soil evaluator examination approved by the Department of Envir en 1 Protection and that the above analysis was perfibimej by me consistent with the required training,expertise a exp 'ence described in 310 CMR 15.017. Signature Date Q:\SEPTIC\PERCFORM.DOC ASSESSORS MAP: 2,PARCEL: TEST HOLE LOGS _ � �/(� NOTES: FLOOD ZONE: ,4/�/_ _ _ � �! - -_...._ _ _ _ _. -._ SO I L EVALUATOR:OAVI F2 , �IW WITNESS : '-Pm REFERENCE: 1) The installation shall comply with Title V and Town of Barnstable Board DATE: U 11Z1 �U of Health Regulations. �,VZ PERCOLATION RATE: .G Z kkI, ( �'�_ _ _ __... _wl 2) The installer shall verify the location of utilities, sewer inverts and septic ��r components prior to installation and setting base elevations. -- ...___. -� v4 w - TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The �9� � Lo" first two feet out of the d-box to the leaching shall be level. 10 Lf,�z, ll 1p 3li 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. � lb` � o / 5) All septic components must meet Title V specifications. _„�.5, �� , � i2-�!� �'(?]� 6) Parking shall not be constructed over H10 septic components. LOCATION MAP (� 7) The property is bounded by property corners and property lines. 8) The property owner shall review design considerations to approve of total I l ✓ design flow and number of bedrooms to be considered for design. Receipt G `��� �1 of payment for the plan and installation based on the plan shall be deemed a approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed ' D (tZW SAS shall be removed along with contaminated soil and replaced with --- -~ clean sand per Title V specs. r 10)System components to be 10 feet from water line. Sewer lines crossing 3 a � the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted SEPT I C , SYSTEM DES I G N if applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained -1-1104 7 FLOW ESTIMATE in place. 11) If a garbage grinder exists it is to be removed and is the responsibility P tY of -S BEDROOMS AT 110 GAL/DAY/BEDROOM - 350GAL/DAY the owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such exists. SEPTIC TANK 13)The installer shall verify the location, quantity and elevation of the sewer / U `-�► ` 930 GAL/DAY x 2 DAYS - GAL lines exiting the dwelling prior to the installation. USE1�00 GALLON SEPTIC TANK 6?wt F- - w -2 _fin►__ a SOIL ABSORPTION SYSTEM - GJ u 16OFMAssq SIDE AREA: 1, f-f- t� 7C Z,X , 7 = /O/�,5e o�� OB D C �xI i I m �' YJ BOTTOM AREA: ' 3 d�� L = MASON y col t SEPT I C SYSTEM SECT I ON `— ID -- fi q x. 2 0 /SC�O GAL N l� SEPTIC TANK5 7 D,1 6 te- 4 0 M `/ �Fi:j1 5, 4 L6 Q Efft Z Y�3 I SITE AND SEWAGE PLAN *0 LOCATION PREPARED FOR : ''1► \A �00 6�; L P P M K - __ SCALE: oe DAV I D B . MASON 1�5 DATE: of z J DBC ENVIRONMENTAL DESIGNS W M EAST SANDWICH . MA ( 508 ) 833- 2177