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HomeMy WebLinkAbout0040 MARSTON AVENUE - Health j40-"Marston,-Avenue Hvannis P ,A= 288 096 /' / /J J�gECYCLppco //►//jam® � 2� UPC 17734 No.2-153CR '�' CONS�� HASTINGS,MN I { 1 � I i ,1 TOWN OF BARNSTABLE LOCikTION ® SEWAGE # i- VILLAGE ASSESSOR'S MAP LOT s INSTALLER'S`NAME .& .PHONE.NO. W,#(-�k g SEPTIC.TANK CAPACITY S��0 6,ye Y LEACHING FACILITY:(type) 3 C TA�,,4�es (size) NO. OF BEDROOMS ' PRIVATE WELL OR4WATER BUILDER OR. OWNER _ n::I' i pg� � DATE PERMIT:ISSUED: - DATE COMPLIA:NCE,ISSUED: VARIANCE GRANTED:.: Yes No �� wo Cb s ASSESSORS MAP NO: �. No. EA R Fes 3 THE COMMONWEAL'�I MASb M—110 L� PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for 33igoat *p!tem Construction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. r� Q Owners Name,Address and Tel'No. a 7Y Installer's Name,Address,and Tel.No. Designer=s.Name,.Address and Tel.No Type of Bu' ding: �'D lew ling/ No. of Bedrooms z Garbage Grinder( ) Fe—r Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow Z V gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) vq- /N'S'iAeL I5-,70 6-AL S d7 idah` I 7&,_a _?b Fa d Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t ' oard ikt. Signed _ ofi Date Application Approved Approved by V ", Application Disapproved for the following reasons Permit No. 7 ' `��� Date Issued / THE COMMONWEALTH OF MASSACHUSETTS j PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS i Certificate of Compliance - - 7 THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(sO on by L,,PC_k F C < for -r/P, aT V o e 0 has been constructed in a cordance with the provisions of Title 5 and the for Disp sal System Construction Permit No. 7/4� dated Use of this system is conditioned on compliance with the prov sions set forth below: No. / � Feec'►v i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ;Di5poga1 ,pgtem Conquation Permit Permission is hereby granted to to construct( )repair(>)an On-site Sewage System located at Ya in, u or, Ake 4 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. All construction must be completed within two years of the date below. Date: / ���'"~ �--r Approved by s r-„r tiv.rf...r..-.-.....' ..-.�!;.t•-r--• H -.- •_•..L„� � '.��ri:,. r 4. � .Y.� J�/]s/.�... 402 No. • ! • �!y gFPal c� t """'THE COMMONWEALTH OF MASSKCI-pt1S'ETTSJ b� PUBLIC HEALTH DIVISION =TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migoal *pztem Construction Permit Application is hereby made for a Permit to Construct(' )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. '^ 2 f 0 coe- I Owner's Name,Address and Tel.No. jtf� D k,, P v S Installer's Name,Address,and Tel.No.ol Designer's Name,Address and Tel.No. _1NAL Sja , a 2— Y?Y i i TyP,e of Building: -Dwelling,, No.of Bedrooms Garbage Grinder( ) _0-ffier Type of Building No. of Persons ; 'f Showers( ) Cafeteria( ) l Other Fixtures f u n Design Flow gallons per day. Calculated daily flow z e 8 gallons. Plan Date Number of sheets Revision Date i Title Description of Soil Nature of Repairs or Alterations(Answer wheEdapplicable) G�V,� S fi 60 a- emu.n a Far, Date last inspected: ' Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in/operation until a Certifi- cate of Compliance has been issued by toKpoardgf' ealth. ' Signed Date � f � Application Approved by one— Application Disapproved for the following reasons Permit No. 12hP Date Issued �-- CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMI"I' MI'I'11OUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at `/0 , ya A s meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system k • There are nb private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: / DATE: LICENSEM PE TIC SYSTEM INSTALLER IN THE TOWN OF HARNSTAXLE NLWER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. �! �J .-.__l i__ I f 5 {{pp 1�/��11���"""' / J ,V/ I � c� �, � __ r � � � �� � f . , Z 203 498 882 ' US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Stmpt&Nu P ,State,&ZIP Postag $ Certified Fee Special Delivery Fee Restricted Delivery Fee N Retum Receipt Showing to Whom&Date Delivered Q Relum Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ C* Postmark or Date LL 3-9� ynl W a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the M return address of the article,date,detach,and retain the receipt,and mail the article. Ln 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the frort of the article by means of the gummed ends if space permits. Otherwise,affix to back.of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. co 5. Enter fees for the services requested in the appropriate spaces on the front of this r- receipt. If return receipt is requested,check the applicable Clocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry, t o25s5-s7-e-ot 45 a _ TOWN O,FF BARNSTABLE LO ?ATION CS1F7P1Jl�P, SEWAGE# •VILLAGE' A/SSSES R'S MAP &&LOT en9 NAME&PHONE N�/`D///4i 6I j l SEPTIC TANK CAPACITY f LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 BUILDER OWNEIR_�G�9���� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility `�7 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 ea�hing fac Feet Furnished b� /O �Ci'., �y _ \ Commonwealth of Massachusetts a88-D1760 r Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments `� �_1,!✓ 40 Marston Ave Property Address Richard Berguist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection 4�,. 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. A. General Information /a./a$ 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number .License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further uation ocal Approving Authority 1-31-17 I49pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under- the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 �a�� VS r Commonwealth of Massachusetts = 1a=1 Title 5 Official Inspection Form ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY a� 40 Marston Ave Property Address Richard Berguist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 0MR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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 iniltration 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts :a= Title 5 Official Inspection Form 1 G� -� W. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Marston Ave Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed y ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. ' 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts la=i Title 5 Official Inspection Form fI ' N Subsurface Sewage Disposal System Form Not for Voluntary Assessments 40 Marston Ave Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts :a=1 Title 5 Official inspection Form- If;., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Marston Ave Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 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: ❑ 0 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts I;+ f Title 5 Official Inspection Form �� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,p! 40 Marston Ave Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 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'ollowing: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part u 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form II., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �, r.� • 9 p Y rY 40 Marston Ave Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 ` Does residence have a garbage grinder? ❑ Yes ® No I Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No III information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 1-2017 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts a=1 Title 5 Official Ins ection Form f, p YSubsurface Sewage Disposal System Form -Not for Voluntary Assessments l¢!. 40 Marston Ave Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts a=1 f Title 5 Official Inspection ,Form IN Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Marston Ave Property Address Richard Berguist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 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: 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: , ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank (locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 l Commonwealth of Massachusetts lal Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form Not for Voluntary Assessments 40 Marston Ave Property Address Richard Ber uist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 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 20" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sing of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to flop of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Vill Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � ,rr 40 Marston Ave Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection ,. c a F®r f, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a� �p_sg!a 40 Marston Ave l J Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not ir:working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts =1 Title .5 official Inspection Form ;�li�;I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Marston Ave Property Address �~ " Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17, 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: 2-30' ❑ 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.): Leach trenches video inspected and in good working order with no sign of back-up. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts �al Title 5 official Inspection Form ��. Subsurface Sewage Disposal System Form Not for Voluntary Assessments rp! 40 Marston Ave Property Address Richard Berquist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Form -I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Marston Ave Property Address Richard Berguist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately erk Lj -34/ t5ins•3/13 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts n+ f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a� f4, 40 Marston Ave Property Address Richard Berguist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 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 grounc.water: 10, 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) f ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at 10'. Bottom of field at 36". Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form -I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Marston Ave Property Address Richard Berguist Owner Owner's Name information is required for every Hyannis MA 02601 1-31-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 + T Town of Barnstable BAMsrABU& Department of Health,Safety, and Environmental Services Public Health Division ArFDtNA't� P.O. Box 534, Hyannis MA 02601 ' Office: 508-790-6265 ^ Thomas A.McKean,RS,CHO FAX: 508-790-6304 1, �/�Y,JI ,/Director of Public Health f / March 9, 1998 Mr. Stephen P. Richards UY 38 Marstons Ave. {�� Hyannis,MA 02601 C 6 O v ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 38 Marstons Ave., Hyannis was inspected on August 17, 1995 by Robert Bortolotti , a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (31.0 CMR 15.00)due to the following: • Discharge of effluent to the surface of ground You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14)fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF BOARD OF HEALTH s e Thomas A.McKean,R.S.,C.H.O. Agent of the Board of Health q\health\dbfiles\title5 i.doc PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: �2-88� 096- - Account No: 191946 Parent : Location: \3_8�MARSTONS AVE (--�AMNIS da60' Neighborhood: 55CC Fire Dist : HY i Devel Lot : 7 Lot Size : . 18 Acres Current Own: RICHARDS, STEPH -• -� _ EN P > State Class : 101 CAPE COD—F-IVE—CENTS SBNG BK No. Bldgs : 1 Area: 900 P O BOX 10 -- Year Added: ORLEANS MA 2653 Deed Date : 090196 Reference : 10382016 January 1st : RICHARDS, STEPHEN P Deed MMDD: 0996 Deed Ref : 10382016 Comments : Values : Land: 29500 Buildings : 16000 Extra Features : Road System: 38 Index: 987 (MARSTON AVENUE ) Frntg: 85 Index: ( ) Frntg: Control Info: Last Auto Upd: 020997 Status : C Last TACS Update : 102296 Land Reviewed By: Date : 0000 Bldgs Reviewed By: ML Date : 0189 Tax Title : Account : 6006 Taken: 071696 Account Status : PD Hold Status : PO Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [288] [097] [ ] [ ] [ ] 3 My Rrf- Dep7- per s. P. R(C E, Ar s S N` r.. SENDER: I also wish to receive the y • Complete items 1 and/or 2 for additional services. y • Complete items 3,and 4a&b. following services (for an extra v W • Print your name and address on the reverse of this form so that we can fee): > return this card to you. 41 • Attach this form to the front of the mailpiece,or on the back if space 1. El Addressee's Address N does not permit. �. t • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery G • The Return Receipt will show to whom the article was delivered and the date y c delivered. Consult postmaster for fee. 0' 3. Article Addressed to: 4a. Article Number 0 « 2 c � y � C b. Service Type d E p ❑ Registered El Insured VN � CSC_. lb C tified ❑ COD W \ ❑ Express Mail ❑ Return Receipt for 0 Merchandised very YJ PT 5. attire (Addre ee) r 8� Ad ssee A dress(Only if requested x HJ 3: �and ee is aid. 6. Signature (Age � � R s•• HPS Form 381 , December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE �A— �7 Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENTU.S.MAILI OF POSTAGE, $300 I� 1 Print your na r ss and ZIP Code here I "�ea�t` i d'Oparbmat Town of Barnstable "©.Box 534 annis,Massachuso OW '(508)775-3344 r-494dw(50)79&-620 �.. 5489 650. 556 Receipt for Certified Mail o No Insurance Coverage Provided usr5 Do not use for International Mail POSr45EMVILE (See Reverse) M Sant to O) Of t Strca P.O.,St t nd ZIP tode co P° $ CO) E Certified Fee O r` Special Delivery Fee {H`e`strict�dl Delivery'Fee' �Rel`tiPri'Receipt)Stiowiiigl .I Ito Whom&Date Delivered. Return Receipt Showing to Whom, Date,and Addre ddress TOTAL Po " ' 1 /4{ nn &Fees $ D Postmat.gr Date t __ IL _ �__ r STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier Ino extra charge). IC I 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. t 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. Go 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. g— o 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If tL return receipt is requested,check the applicable blocks in item 1 of Form 3811. a M 6. Save this receipt and present it if you make inquiry. 105603-93-B-0216 J Town of-Barnstable • = Department of Health, Safety, and Environmental Services • "AUWWFWrA MAS& Public Health Division t63q. � 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health September 25, 1995 Annie& Jane McKeon P.O. Box 752 Hyannis, MA 02601 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE.ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 40 Marstons Ave., Hyannis was inspected on August 17, 1995 by Robert Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Discharge of effluent to the surface of ground You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into ' compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH T omas A. McKean, R.S., C.H.O. Agent of the Board of Health [Installer letter] Sl TO: I�'/4ij �1 e ����/ c��i� (Date) 9'_` � 5' R ORDER TO CO MPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located ata �!� ��� lt`� was inspected on S— by i Zo-/�-,.S Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: _ r You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office nce lia (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH i Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable l 'r ���� 'r �_ _ -/n, �� i `� ���� v p -. �-��i`�'J BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address PropIke o - U G ? - 19,9 5, Date of Inspec}8, /7 apZ Sg arce�Q� Owner �C�� HEALTH DEPT. SALE PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. ONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. 6-ITHE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL No of Bedrooms No of C/u rent sidents Garbage Grinder O Laundry Connected to System //r 07 Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: Pumping Records.and Source of Information: GALLONS SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF SYSTEM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system (if yes, attach ,vious inspection records, if any) Other(explaink �d/ Appr ximate age of all components. Date installed,If known. Source of information. e y �i` el- SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE?/446 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B - SYSTEM INFORMATION (Continued) Depth below grade: Dimensions: Materiel of construction; Concrete Metal FRP Other} Sludge Depth 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 Distance from bottom of Scum th bottom of outlet tee or baffle Comments: DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: PUMP CHAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM SAS IF NOT PRESENT,EXPLAIN: TYPE: Comments: CESSPOOLS: Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be Pumped) Commentsr PRIVY: Materials of construction Dimensions Depth of solids QeMMents: ZZ Pis i p /i /� dime ICI �+5�Y.'€'ti. r r n N. re2��T�3 yy�� i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF$EWAW DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' C-X �p t 4wg-- �p DEPTH.TO.GROUNDWATER: 7-7 DEPTH TO GROUNDWATER METHOD OF DE OR APPROXIMATION; yry Gl. { h.M r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . 49 PART C — FAILURE CRITERIA (Indicate Y-yes N-no ND—not determined.Describe basis of determination.H'not determined`,explain why not) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the.last year? Number of times pumped Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiRration? tank failure imminent? Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Wdhin 50 feet of a surface water'? Wdhin 100 feet of a surface water supply or tributary to a surface water supply? it in a Zone I of a public well? X- Within 50 feet of a private water supply well? Al Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? I � I Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. I it PART D - CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS I i COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 I CERTIFICATION STATEMENT I CEATIFYTHAT 1 HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION I REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS . STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE: qe7 ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY A,✓`- p't° 3 a-. .5 i ,31•} ,, °' y�a;�k. �vvm .d,ti"ns�:.,i FAR Real Estate System - General Property inquiry Parcel ids 288 096- - Account Nom 191946 Parent.' Location: MARSTONS AVE: Neighborhood: 55CC Fire Dist: HY Devel Lot: Lot Sizes . 18 Acres Current Own: MCKEON, ANNIE 'aJANE V State ClassR 101 P 0 BOX 752: No. Bldgsu 1 Area' 900 ' Year Addeds !--I Y A 1,�1\11 S MA 2601 Deed Dates 090188 Reference! 6430/116, January Ist! MC,KEON, ANNI`E & JANE V Deed MMDD3 0988 Deed Refs 6430/116. Comments: Valuesg LandN 29500 Buildings% 16000 Extra FeatureW.' Road Systems 38 index, 987 (MARSTON AVENUE ) Frntgz W'.i Index, ) Frntgg Control In fog Last Auto UpdN 050695 Status! C Last TACS Update; 08149:2 Land Reviewed ByN Dates 0000 Bldgs Reviewed By: ML Dates 0189 Tax Titles Accounts Takew' Account Status: Hold Statum! Cance). Press XMT for more data Next screen PAR Action Owners Name Road index Road Name Parcel Number 288 097 m SENDER: C ■Complete items 1 and/or 2 for additional services. I also wish to receive the E ■Complete items 3,4a,and 4b. following services(for an ID ID nPrint too r name and address on the reverse of this form so that we can return this extra fee): I ■Aftacc this forth to the front of the mailpieoe,or on the back if space does not 1. ❑ Addressee's Address permit. ■Write'Retum Receipt R uested'on the mail piece below the article number. A m p e4 P 2. El Delivery rn « ■The Return Receipt will show to whom the article was delivered and the date ., delivered. Consult postmaster for fee. a 0 v,.3.Articl Address d to: 4 4 .Article Number d M ° 2- o�® . a 0 E 4b.Service Type m a 3�' //v ri' ❑ Registered Certified ( W ❑ Express Mail ❑ Insured C /J ❑ Return Receipt for l erchan_dise ❑ COD 7.Date of Delivery 0 i a ?� H5.Received By: (Print Name) 8.Addres et Addr@S�(Onlyff r6quested UP and fee Ls aid) `p,,�NNIIG r g 6.Signatur .(Addres Agent) O aria ,� ~ N S PS F rm. 811, December 1994 102595-97-B-0179 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid USPS I Permit No.G-10 ® Print your name, address, and ZIP Code in this box e NNW Health DIVIS108 c Town of Barnstable PO Box 534 Hyannis, Massachusetts 02601 Fax(508)775-3344 Phone(508)790-6265 i .,y¢a, !',�3+'Y 5 ti x'COMMONWEALTH OF AWSACHUSETTS ,_teec"vi-lfiCRECUTIE �J.-.• . �cA e FAIR RNRN AL3Ve TX O V f� s DEIP�ftTMENT OF ENVIRONMENTAL�PRO E I. � Ih k ' w`�R.- -k r``S ,r p 5 i MAR 2 0:-200� Tali F$A' SIABLE - IA .F . TITLE 5 - - OFFICIAL IN$PEGTION FORM NOT�FOR VOLUNTARY ASSESSMENTS >>F* SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART SS `1 g CERTIFICATION 'g.J•'�iJ C '" a� Y� J?> 1' �!L�I�.t-5tt ♦ w ✓ .� Iy�.A. vbF,t� l.� - F�+7 r��iD,` 11}tTI;94, s]a;63J�j9Ittt$ta�_��lf'►r Property Address -/ 0 /' ll'lS torte /-1.V,C� PARCEL ,: .. LOT Owner's Name r"d- i2 i�.kc Q S _ Owner's Address... 77 Date of Inspection. 31/`//0 2= Name of Inspector:(p lease'print)': � ��-_ 3 ori . Company.Name Sy, £nr-j0�'i2�,-�y}.�w�Tu ,S-e uj:!L7- - Mailing Address :FS3'-: h „/1 /'h►45 6y4 Telephone Number: Sb8 Y71=TY?Z F i 1 5- 3 � r. .ri J I 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 iriauitenance of on site sewage"disposal systems I am a DEP approved system inspectoi:pursuant to:Section 15.340'of Title 5(310 CMR"15.000) The`system =-J .��i:-,•� 1 t.� t S'ifi Fs�i:3 tt A..i.� rs� a.,t � I:��+ 1R., t..'.t u i `r .t - - Passes x Conditionally Passes Needs Further Evaluation by the Local Approving Authority- Fails PP. g Dare /S_ � : inspector's'Signature. The system inspector shall submit a copy of this inspection eport to the Approving Authonty(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or.h.s a design flow of 101000 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.'.";. ' �a tr-,J sf�:-1'fJT {'+r)>_f FT1� F�alu,. tt"" I] `� r (.z�.e7"'. 1?t;`••1 b 3 iic 5 t.y t 13GE c t -,Notes and ColllrnentS' ' {CIk1 3's't?J -5n " ,Ts '+ ****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. Title 5 Inspection Form 6/15/2000 page.,.- Page 2 of 11���� �'L`y�Y�• "A�",Y�"��.x.,�'-^'3��'� y1i.-�Mi�yx� 3„%'a�ri-Z...da :-„r ,tr�-:,. tA. >1j�p� i �i •a-f"kL.-t. s'Y .� TM'�,. " i �„�,'.a `` �s �'�..__ "' ..� 5v� WA y er t q f+3 r y t -v:, NS c- f' x•, ? � .N ��'.1� .;�' .f OFFICIAL� PECTION�FOR1I�`�NOT,,FORVOLUNTARY ,. ASSESSMENT-- ji �. SUBy�StU�R�FACE SE�VAGyE DISPOSALSSTEM INSwP yECTION FORM 0110 C1 v- n f F� 0i. �P-'fib Al- 4! 1�2�:7..�K�- :1.�.. t q 4 32,1 .=..21�'. ..�$ r�i.s, 3•,.� r t r rat 5 7 k`x.F f C ?: CERTIFICATION(continued) ' �� ,.z-"� F r. LL // ry Property Address 70' Ai/L Sr V �-✓ r.F Y :Hv�►NN;s tea:. �Yo��t x s Owner �'7'C Vt ►2,cb,�'�;l s � t i P - Date of Ins ection A Inspection Summary Ch yA,B,C,D dr"E/ALWAYS complete`a71 of Sectionb 'u .X. .M ? s A�`'3f �T q +h �.. tfJ +1 ( 1 4 A `S stem Passes: y TM _ + I have noYfoundtariy information'which'tndicaes"tatanyofthe failure cnteria`descn'bed in 310 CMR 15.303_or in 310 CMR 15.304 exist:Any failure criteria riot evaluated are indicated below. f j Comments: _ t 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 i Answcues,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please P eX lam. - F_._. '' .:Yf 'i`;_t z�._t > . ..'. _: ` . :,r G a:? - The septic tank is metal and over 20-year s_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 P J ND explain: s 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 io a broken,settled or uneven distribution box.System.will pass inspection if(with, << approval of Board of Health) — -_ broken pipe(s)are replaced obstruction is removed 1,,.i'°s�{rt�3 r' 't�' �!"a''�u rGt"{ i :. .c > cZ r #] ..^� ar.':. 2ti'�y+ti-'^ 1 Yv'L•C� ����. �;J SY rt fsf '. distribution box is leveled or replaced -, ..�¢.:s X6 c�,T.✓1L i.r:,R?�i4i t.'r.,,i?Y ..:,:..i. ;;_�..J... r'`f. :a�'i.t1...7.;. ).:.fe....Zas >!.3•_�6-. ;.: !3-s.. , :.a`�C,...- _ ...s7,r� .�J.D j, ND eicplam` The system required pumping more.than 4 times a year due to broken or obstructed pipes)-The system will pass inspection if(with approval of the Board of Health) .:.broken pipe(s)are replaced `obstruction is removed rir. #_-.0.umft.$3._?' .! 3 "3a; .. ?i. ! a +bf[vC: _ '3.z. y: ` { 5J%. I�F }rPl s.ait Y ?�_' L' ° 'G ND explain: _ _. ..._. it �r 2 wPape 3 of 11 r ..p r ' aS.:.a e v'Is` '� � x x��e °ks , ..r�'>~ tr ... .a• F-g &�' a .. '3 *, a L - . r r' � a F� OLR: YOFFICIALtINSPEC�TION M VUNTA °ASSESSMENTS SSESSMENTS SUB_SURFACE=SEWAGEbISPOSAL SYSTEM IN FORM u. t lv vt cL s } ey 1:' m :-s 9, r PART.A CERTIFICATION'(continuedj Property Address: d Owner: T_60e S_2 4 Date of Inspection C Further Evaluation is Required by the Board of Health- Conditions .. .— i._ ..� = - :: �F���t"n Y�G*e,tr)hf�Nv'<at AS�il�Yle,i Y�n'S.TLS�'L,�✓��}y.�'r'��irvii a� ?an ::. exist which require further evaluation,by the Board of Health in order to-determine�f the system j is failing to protect public health,.safety or the environment _ E 1 'System will pass unless Board of Health determines m accordance with 310 CMR415 303(1)(b)that the rsystein`is not fdnctioiiing in a manner which mll protect public health,''safetvend the emVironnient: , Cesspool or pnvy`is within 50 feet of a surface:water Cesspool or nvy is within 50 feet of a bordering vegetated wetland or a salt in . t: *rr``sib c1.2: n'` Fr rt e t i { r , . r rx !t.>16V G4 Lr SY 3.. y S .i C v c s ..:I Z f;A :J__ - 'T '�z?11Flr 7e: { 5_ tn_sfxfJ�+ .3:r,✓ €n .nt:.:. >.ua t -{.t.r"� �-t-:;t's ..ii:t"r 'z'�PI..t� •`u ''�1 .: - C r�s :4 f•.,.L 9 C{ti''r ;€f" ' ,.3 I m _s r }2 7° 2. System will fail unless the Board of Health(and Public Water Supplier,if any)deteeininesIhat the ' system is functioning in a manner that protects the public health,safety and environment system'has a"septic'tank and soil ab'sorptionsystem�(SAS)and the SAS is Mthin`l00 feet_of jsuiface""water supply or tributary to a surface water'supply The system has aseptic tank and SAS and the;SAS is within a Zone 1 of a public water supply. .A 3'`: 9 _ft..-_ 31s3 .? ej S 3 i.7 1.i.d`_j '3 r!:7r-..': ss.'sp>u n :... The system has a sepiicutk aril SAS and the'SAS is'within 50 feet of a private water. supplywell. 'SThe system has'a{septic`tank and SAS and the SAS is'less than100 feefbut50 feet or more from a — ; r a t- private water supply' well**:Method used fo deteririid&distance **This system passes 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 or ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other �''failure'cnteria'are triggered A`copy of the analysis must be"attached`to this"form is{yz+i�,fS 7:2.- fl i�i+ i�iS I 3 Other �A y.'/jf`y,.'i.i{.s Y .r�< ;:;.Yi, r;' Z� �g. ;CitZ•i t cS :� J� fr z a _3.hi..zx:.,, �' -1/?%).. f.L f✓ t.a.svi;.IrJ' �_ lv 'l i t -S.I'..i+- 1 -'k i �+ v .- Ct { .e..tir ,., l srtqJtfy�)JM :a T }Page4Ofll a ,t r lt3o ois`'9,1d�.y„ r.s-n+ca FS"''?3-a . 'r, n"r, ,•. s Y"1,.yYY t T "E, Yh i r't 4:- r "�'�'£�}.., r c' •g, e r 't :s ,,r`1 �fi'' +y yn<6•i F: 'r 4 ' ,..., ys-'+s - :tS: X,- u z= OFFICIAI�INS EC4TIONFORM�- NOTrFOR VOLE �+ARYrASSESSMENTS F SUBSURF $ E�SEWAGE-,DISPOSA_ L�SY_STEM INSPECTION FORM �...e+ ... t ..- i ri w' w ,ys. ..s- �! ..i- .• rr sr� r1 CERTIFIC�ATION�(continued) t _ Property Address. �6�;���.��vl'J..~�WC� �,;�� =f �,:.,x-�• ;�_: �� 026o I Owner Twe a:h :r.�S r n N Date of Inspection: �3 /y/oL bI's ca D System Failure Criteria applicable to all systems You must indicate;"yes"�6E7` '�to each of the following for all uispechons t�fi a ; tr�da =r:r� �„5,�,t0} . Yes +No '- ` t Backup of sewage Into facilirywor system componentdue to overloaded or clogged SAS„or cesspool Discharge or,ponding of effluent to the surface ofthe ground or surface waters due to an overloaded or dogged SAS or cesspool Static liquid level inthe distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Rµi_z{; C3. Liquid depth in cesspool is Tess than 6"below invert or available volume is less than Wday.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 groundwater elevation :Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface supply r: _ Any portion of a cesspool or privy is within a Zone l of a public well., w r _ V, Any portion of a cesspoohor privy is within 50 feet of a private water supply well. — ✓:Any portion'of a cesspool or privy is less,than=1,00 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 tri ered;:A c., of the anal sis must be,attached to this form y Y 3 NO (Ygs!Np)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. fr r(.t:i O, 42US Is;- air Q r.. ':� •5 +.v wV i�`t+Fd*,.%..i[e9ar. ;iii'9sr. Jj.ti a' ►�i I fc .zt ..�.t .. i.- ,17 ?. "2t _ .l(lis sai:'x zy E ;Large Systems: r .rs - . ._.. To be considered a large system theaystem must serve,a.facility with.a;design,flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following (The_following criteria apply to large systems in addition to the.criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a t butary to a s& g pp y to a surface drinkui water su 1 - 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. : ';. : 4 - z Pa eSofll t - :.Y .k g ,�'Iix i3.X�", c�.+" t"^"'.'nT .�•Fr�' 4'Syf��y+iil"'"C-f Sw�i'�ilr `vy T ._.�A. �1s. y 4 01" p _ °" eu+•J'.,tm a�'e"J•;T.cS '..'�'s^c.sr�r� V y�'re Y _ s -NT�'!!"K4'N l 'f^ ttg r� i s t• Y.ASSESSMEN'TS x > OFFICL .INSPECTION'F.ORM YNOT�FOR VOLUNTAR ti. �.�as'+c�•r;era rgez xY q F-r'Tt � v �'i ^•m ^ti {INrY �} SUBSURFACE�SEWAGE°DISPOSALSYSTEM SPECTION FORM r t'. -..�. 1�-'" `3i �'*'^,�2:�T aE s t. `X°'c C,;X• .rzgv f a., _ - _ ov a"s�c �&. CHECKLIST ° y Property Address /O M�✓L� CA-�T l� -e� ,e> � :�, � n� Owner: 'T�wt ✓L 3�I.cc�S < - - - _ Date of Inspection .���D IFC+ t 4 f. 1 Check if the following have been done.You II►ust indicate"Ves"or"noeach of the followuig s qq_ v s 3 Yes N _ e { ei o Pumping information was provided by the owner,occupant,or Board of Health'. 5 S Mere any of the system components pumped out m the previous,two weeks? ` £ i r� ✓ Has the system received normal flows m the previous two week period? ° — — 777 V: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) . .. .. ... :.Y.._.._. Was the facility or dwelling inspected for signs of sewage back up — — : - Was the site inspected for signs of breakout inspected ? 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? V 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 Absor tion System(SAS)on the"site has been determined based on `' Yes ' no : -- q Existing information For example,a plan at the Board of Health ' f/ Determined in the field any of the failure criteria related to Part C is at issue approximation of distance ` is unacceptable)[310 CMR 15 302(3)(b)] I ; �i .t�r<:sFr.t i Z`�v`3n_vc. e3T'r -=S J ;. :3 1 :e ! ',� '• _ '- .. - m-i rIR4 �.' :- Page 6 of 11Vt .tr4.i*x t 2- '�.r%cr '�Y r .. '°? � h t nl"+u€ F :--�z-•t ',y-y h* firms 7- ia>.L.i ice$'-f}• �'i;c' 'Prw*-y,.S,' r'�u�'hX '? war' e i, t .S?-n+r`` •Y�{' f k,v . '}' ro �-•;3° -*i`.::i�� a',''_;..,e2+" .--�fH- :a' n..k n '",•.: ° rig- OFFICIAL"*-INSPECTION FORM a,NOT OR VOLUNTARYTASSESSMENTS x Y•...+....a..evc .,.d•w-s-r.l aura :ar.ls..v MA. ' SUBSURFACE�►SE`r 'GE) ISP0SAU§YSTEM INSPECTION FORM 1x 31r+�1.�¢snis4 .^� .Jt 4r wi r4i1 s4..ia�rk.Prs�r Jt qy.r . E�iTART C a-: p, `s ,, '• . i .` a. - �.s .: £,f. T � } ?..d,-;..•rfi't��37..i�.i O:,Y S iD171,��1h♦SY TEM INF TION 3 Property Address: `� 2 "i'g1p►U� y .m� - 4 Date of Inspection: FLOW CONDITIONS : rn 'i RESIDENTIAL Number of bedrooms(design) Number of bedrooms(actual) x 'DESIGN flow based on 3.10 C1vIR 15 203_(for example 110 gpd x#of tiedroo'rris) Number of content residents. 6 ` Does-residence have a garbage grinder(yes or no) N Is laundry on a separate sewage ssystem(yes or no):., [if yes separate inspection requued] -F - - :Laundry.system inspected(yes or no):�� Seasonal use (yes or no): Water' readings,if available(last 2 years usage(gpd)) Sump pump(yes or no) 430 rd L f4 a f a is i. , rt a w �tia six; Last date of occupancy: 3 l TRIA a7 -- �• ,,y r a�sr� .x #- COMMER IIS CIAL/INDL` ' `'' �'`' ti. R J 1 S ib Type of establishment Design flow(based 6n'310'CMR 15 203). -god. Basis Basis of design flow(seats/persons/sgft,etc.) Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitarywaste.discharged to the Title 5 system es'or no)-.'' ---- Water meter readings,if available: Last date of occupancy/use: a I OTHER(describe) GENERAL INFORMATION Pumping Records Tv et''L_/ 1� 'y' Source of information. b W Was system pumped as part of the inspection(yes or no): — . If yes,volume pumped: 6 V allons-How was quantity pumped determined? TA10 K S i Reason for Pumping,: TYPE OF SYSTEM J �.�eptic tank,distribution box,soil absorption system Single cesspool _ :. _. _Oyerflow cesspool _ .1(Y i y k:2.- Shared s stem es or no (if es,attach previous inspection records if— Y )( Y Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank Attach a copy the DEP approval —Other(descn'be): Approximate age of all components,date installed(if Gown)and.source of information Were sewage odors.detected when arrivin at the site' g g (yes or no) JV(� I .. Page 7 off 11 r "" i'Fs..t "p�+ifh :�'i -+•� C3 P ,� f;,�,_ .u:q.'>,� t -4 Y"�`a ti--t:s� {'e-.:3 v.yaY's: t. , '' '"c n7+•-i"i,},'�i. d`v 'aRY �--<1`�;g.,{.cY i'y.Y"S. YN..'.a..,,1'q OFFICIAUSPCTION FORM ,NOT FOR�VOLUITARY ASSESSMENTS r }ISUBSURFACE SEWAGE DISPOSAQYSTEM INSPECTION]FOAM r ` ro 1 ` tSYSTEMIMN(coninuedNORTIO ) 'd r Property Address 4 Owner S�Put 12 c��'ci+2�r�S k Dateof Inspection ��y�0� no t.� IE�g x.; >.. BUILDING SEWER(locate on site plan) $' ; ills x a -. i .S�it't.Tt^RJ, -,Gkarc 3T�.1 - Depth below grade Materials of construction - cast iron T :40 PVC.. other(explain) Q .:. , Distance from private water supply well or suction line ZC7 ` Comments on condition of joints,venting;evidence of leakage)etc) .�►� � mod;:f-�e,,,, � "SEPTIC TA (locate on site plan) Depth„belovr grade; Material of construction.; concrete_metal fiberglass "polyethylene If tank'is metal list age _`"Is age confirmed by a Certificate of Compliance(yes-or no):_(attach a copy of certificate) _ Dimensions: .x S X y S Sludge depth: - 12a _.. :. � r j Distance from top of sludge to bottom of outlet tee or baffle: 30 �� Scum thickness _ - Distance from top of scum to top of outlet tee oi.biffle 3 „ Distance from bottom of scion to bottom of outlet tee or baffle: How were dunensions determined rt y � -- Coininerits(on pumping iecommendations inlet and outlet tee or baffle condition,structural integnty,'liquid levels = as related to outlet invert,evidence of.leakage,etc.): , -5._ J Z o,i GREASE TRAP:_(locate on site plan) nz V� Depth below.grade Material of construction:' concrete_metal fiberglass=polyethylene �` other _ (explain). Dimensions: Scum thickness: - Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle. Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): - , .. } 7 _i r 6O 5^b Page 8 of l 1 �,"' rt l `w �y t u*. .l ,,sy",°:.4'W' 'c-.t',,t"� ti -.N.p^.r '-e 5 't'Y�' �' r^eB� y�3 •K J^ 1 ti a .i ♦t t x`y - lhpi``.<r �'. ,$ ` ''- ' Z' .ry�'s'Y� 6 t a. r" �1': S`3i•RI'a•R�R 7`6E1."Z•M4: ciYS A r OFFICIAL`INSPECTIONFORM�OT FORVOLUNTARY SSESSMENTS :: yr ;"+; SUBSURFACE SEWAGE DISP.USALSYSTEIVI�INSPECTIONFQR'1VI ' S t-- ' a¢�ra Y5F a'��c7t" ;-�x"^+,J,a-b +F,.. h.r 'f-t ..�" •E i keZS¢ vAltT y " °`SYSTEM INFORMATION(contmued) ` ' a r Property`Address: 16 ✓L$TorJ �4v C �'a r''? ' : -� '<, J } _ =Date of Inspection - f: v is.. L S TIGHT of ms ect n I cate on site 1 - or"HOLDING TANK.-' � tank must be pumped at time io o an Depth below grade ,. Matenal of construction -�concrete metal '' fiberglass_polyethylene other(explam) Dimensions. Capacity:: _::_.. _- -- --gallons_ Design Flow gallons/day Alarm present(yes or no): Alarm lev el. =Alarm in working order es or no Date of last pumping Comments(condition of alarm and float switches,etc) - ti -• - DISTRIBUTION BOX:Aof present must be opened)(locate on site plan) — --- __ Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): -- t .. .1 f?:l .:::.1�':`'•.'� r:.- ...•'_. fl : fit }:t�>2: rL...!_7Y..I..�._...-. �i.,.;..w:/t q5.�. PUMP CHAMBER - (locate on site plan) -- -- -'- - '- -- _ Pumps in working order(yes.or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc:) :, �• `fit i Q,z 12 F n3 aall.lL' ..,..sue' a L1i::.� !�+.'?F '�' ':I :a3 E:-im'$"bf'..,za to 3 ............. OLUNTARY�ASSE55ME TSN r y: t T FO :FORM _.. F UBSURFACE4SEWAGE�DISPOSAL�SYSTEIyi INSPEC�'I0�1 FORM - i'>k ,c, iA.? YK FA�wa- r r fSXSTEM°INFORII�ATION(contmued)' = Z7 z'".i f ? . Property Addr4 77- ess �-}1/j�ytJyJ(S r Q260 € 225s i° G t tiF� O"er:�rtfit/� •SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,excavation not required) -.. r. a $flFf �1'{Lris $a If SAS`not located explain why +.. .� 1'-,;.� t&ft'1�Ftta :.., 1.. vt h t tT ., ,yam Type leachingnpits,number -leaching chambers,number leachmg`gallenes,number 67 i U leaching trenches,number,length. leaching f elds,number,dimensions`. " overflow cesspool,number ns innovative/alternative system Type/name of technology { Comments(note condition'of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 14 O � � O I�l 0 S'r ., o N o�J7v hi 4 AV CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) _ a Number and con figurarion: Depth=top of liquid to inlet invert: Depth of solids layer- Depth _. of scum layer: i Dimensions of cesspool: " Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.). s PRIVY (locate on site plan) Materials of construction. Dimensions . Depth of solids: _ Comments.(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc) 4Page 10 of 11 - OFFICI'AL II SPECTION FORM' NOT 'OR VOLIMARYAASSESSMENTS - �'� SUBSURFACEiSE AGEDISPOSAL�SYSTEIVI INSPECTIOr1 FORM' 4 f r 'PART ;„�+$' r - '.. �sr e 'F3,?! -'z'h�,l-'�y' 3�-�° ;`''a� � ^. •�•+f ��`�• I.n � � _ r 1 �SYSTGM�INFORM�T ON(contmueFd a `r5 3•Z? t�'P' '-.�. Property Address f "N y►4n2 ry i 5 O Z601 Owner Date of Inspection RY[' s1�1y/l//�QZ.:, L pw 1t f vM�� �iT L ... •7 SKETCH-"OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmaiks Locate-all wells_within 100.feet;_Locate where,public water supply_enters the building. yO� 04e.�t r-i 4"L 0 o H o� s� I Sb 21 , 2.s':v7 '£;�>:ac�'ff.l3_; -5 -- - = -- 0 , Page 11 of 11 n x s ,tom x s f �` t .b a� , OFFICIAL INSPECTION FORM :NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' 7 " ri F s 7k, YPART C T c ✓ ` ..�" SYSTEM INFORMATION(continued) yb. ��2s7z . v Property Address - - S601 °Owner f,V� 5> Date of Inspection 3f/��GZ ;.SITE EXA - - 0 Slopefe Surface*Water Shallow wells No tJ2, Estimated depth to ground water 16 feet wd 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: _ Observed site(abutting property/observation hole within 150_feet of_SAS) �AN cj-A u�erv\ Checked with local Board of Health-explain;:.: - Checked'with local excavators,installers-(attach documentation) Accessed USGS database-explain: .You must.describe how you established the,high ground water elevation: 0 �FJ� NO ova �.C_e TR e,�t_1� LL�_j ib kr�a tln wF a5 � ,utb r t�VI -: u�sao oovo�os .� '� . 12-gip tva�.y'' SaNr.L TBy D�pTh o:F 6 WC� N a`:Gw�; 7 ; 11 . y , 3 i 1 rt' -t 4 j �T4d fe,, .V 1 s r � 1x t i r 1 a � r1 Lrilt°y I I _ t a t 1 i z. t�s ;L 1 I rgg(t��Ar y�,`,' I s ') . - "h } ` -� I x 1'� i rl t r a't� a : { �• ru ,, .. 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Ed 1 -�-.iT (1. r ix 1.q T 7 fr` 1 .:.. - } i is Y r' i `4, x �- .. 7 y _ S! _ I ~ �i e r 9 1 .. } I r .. ,. .. � I ,... L 5; 11 `c{AT l . �.r' + !�M�5q i %r +. - g f"I i 4 '� i A41.."I O .la1!1+ 1 4, 1. t' I s r + . . - - , T - ,� ,,f f , Tt yy - - ' - i 1" . - r '(' . � i I.. 4 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.). You must first obtain the necessary signatures on,this form at 200 Main St., Hyannis. Take the.completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, NIA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: v, Fill in please: APPLICANT'S YOUR NAME/S: 114n� 'L-'9 1 r p BUSINESS YOUR HOME ADDRESS: UV 4,Alrr 00(cl�•MAa - i; � r TELEPHONE # Home Telephone Numberg NAME OF CORPORATION: NAME OF NEW BUSINESS E E 2 L E :r-! TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO I � ADDRESS OF BUSINESS TD U� , N�1/ v MAP%PARCEL NUMBER Z-� q l b J 0 1 - (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) 'to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has b formed of the permit requirements that pertain to this type of business. i rvl vi Authorized Signature* COMMENTS:_ !� y(/1 I� 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: i i i i A.M. FUR D TE IME P M. O I PHONEO F��. y FAX RETURNED PHONE ❑MOBILE o� Z YOUR CALL .AREA CODE APMBER TENSIO MESSAGE (� P SE CALL .. WILL CALL' AGAIN ME TO EEYQU ` WANTS T' S GNED lww FORM 4003 I z 0 m c a cJ SEWA05# . VIL Li4CiE ^ rf ,q SSESS<JTt'S 1v1AP$i LOTS_. i' IN5TP �•EIi'S NAPIl PFtQIdE NO SEP"I"C TANK /s� LEACriIl+1G cS deg B. ITIDA 5apwratiat� ►int�una Bstv�eer ,a Maximum AJus Gtaa�adwatet Talta to tl�c Hrntom oLe�ching k�reti �a1v�Qe"ddU"sst�r Sup�Iy Udui!s�icl�.eac�uteg Pacrlaty .�eery,v�ells cxlst _ air Of wltlt�n 7AA feat of lacecC iQ�g,f c uty) � —- f ctc'ty�Wetuu gait I.eachn�P�cs(ty( stray wetlands axist �e 1vtNais�3Q0 fe teaaliins f iHTY �u�nl�had by_,1 �� - _ fa �J W 9J F W � 1 V PAR ] Estate System - General Property Inquiry] Help [ ] Parcel Id: 0.96- - Account No: 191946 Parent : Location: 38 MARSTONS AVE Neighborhood: 55CC Fire Dist : HY Devel Lot : 7 Lot Size : . 18 Acres Current Own: RICHARDS, STEPHEN P State Class : 101 CAPE COD FIVE CENTS SBNG BK No. Bldgs : 1 Area: 900 P 0 BOX 10 Year Added: ORLEANS MA 2653 Deed Date : 090196 Reference : 10382016 January 1st : RICHARDS, STEPHEN P Deed MMDD: 0996 Deed Ref : 10382016 Comments : Values : 29500 Buil gs : 1 Extra Features : Road System: 40 ; Index: -7=-( RSTON_AVENUE ) Frntg: 85 Index: ( ---- ) Frntg: Control Info: Last Auto Upd: 020997 Status : C Last TACS Update : 102296 Land Reviewe By: Date : 0000 Bldgs Reviewed By: ML Date : 0189 Tax Title : Account : 06 Taken: 071696 Account Status : PD Hold Status : PO Cancel [ ] Press XMT for more data Next screen [PAR ] Action Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [288] [097] [ ] [ ] [ ] �4