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Home My WebLink About0201 MEGAN ROAD - Health 201 NI�-"VM-I-Road Hyannis A=291-240' 0 ,I i o I a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 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 on the computer,use 1. Inspector: (/16 only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises;LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 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 r sewage disposal systems. I am a DEP approved system inspector pursuant to Section.15.340 of Title 5(310 CMR 15.000).The system: ) !2 , O- Passes ❑ Conditionally Passes ❑ Fails 4=" ❑ °'.Needs Further Evaluation by the Local Approving Authority k0zP6,-,-":.:..: 141/12/2010 Inspector's Sigf1atuie 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. Vv t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sew,g Disposal System•Page 1 of 17 r y Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 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 ❑ 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 every 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 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 Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 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. El ® 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 201 Megan Rd. M Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? I ® ❑ 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): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 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 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 every 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 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: 11/12/2010 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons ti 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•09/08 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 ;M 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 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): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): 10'+ 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 leakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 1.5' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 2" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 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 30" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 711 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 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 ° 201 Megan Rd. M Property Address Richard & Mary Clayton Owner Owner's Name information is required for H annis Ma. 02601 11/12/2010 y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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-1(req u i red). Is copy attached? ❑ Yes ❑ No t5ins•09/08 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 ^M 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 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.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil.Water level was 18" below invert at time of inspection.NOTE:System was reclaimed by BioSolutions,Inc.Information attached. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 every 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.): I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 .Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ■ ® Zoom Out J jIn r"X K R. - - u ��y}•�•,� 1 OWN 451. 0 0 a t � 3 f s}• " d L "fr fy:s: Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER (`nn�irinht 7'lfl�,_7(11 f1 Tn...n of Rornetohlo KAA All rinhfe rnenn Commonwealth of Massachusetts L W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 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 LP 20' 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: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 a✓ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 201 Megan Rd. Property Address Richard & Mary Clayton Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2010 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 S c p" .. Microbial Remediation Services and Products. ecEwawTe2 ,. gWAReVE5S December 6, 2002 Richard and Mary Clayton 201 Megan Road Hyannis,MA 02601 RE: Septic Service Protection Policy #739 Dear Mr. and Mrs. Clayton: On October 25, 2002,BioSolutions was successful in reopening the leaching function of your septic system and your system is now warranted pursuant to the terms of the Septic Service Protection PIanTM,Policies#739. Please note that the plan expires February 1,03,and if authorized, we will extend each Plan for six-month intervals starting only at$99.90 per six months. Many customers welcome this peace of mind protection for this nominal cost. The "Nature's Power" Septic Treatment may be purchased without the plan however, the Plan is not available without the monthly treatments.This is the only way we can insure that proper maintenance and prevention methods are being utilized for your systems longevity. Commencing February 1,02 unless we hear to the contrary,you will be enrolled in our Septic Prevention PlanTM,and billed$99.90 for a six-month period, along with$7.95 per month for the 6-month maintenance supply of 6-16 oz. bottles of"Nature's Power Septic Treatment. Simply pour into any sink drain in your.home. We are very pleased that your system is properly functioning and insured and especially delighted for your cost savings and avoidance of the hassle of septic replacement. In that light,could you please fill out the enclosed endorsement and mail back to us in the enclosed envelope. Thank you very much! V urs I P icia A.Labovitz President, BioSolutions,Inc. r BioSolutions. Inc. Invoice n 31 Long Drive pate Invoice—# � Westboro, MA 0 581 Phone: 1(800) 240-2400 l l/l/2002 38.69 Bill To Ship To Richard Clayton Richard Clayton Mary Pat Clayton Mary Pat Clayton 201 Megan Road 201 Megan Road Hyannis,Ma. 02601 Hyannis,Ma. 02601 P.O.Number Terms Rep Ship via F.O.B. 1 Project Due on receipt CA l l/l/2002 US Mail 1 Quantity Item Code Description Price Each Amount SR BioSolutions Septic Restoration Process 2,750.00 2,750.00 5.00% 0.00 a f I Y S i' t 1 a ASSSA t :W 2 c AUTHORRATION SUB r " ^// -i 0. py1 TOTAL dA - SERVER REFERENCE NO. i"7 t`t' 4 t TAX ID F0190/CHECK NO.A IC.NO.`STATE REG.IDEPT. CLERK TIP MISC. _m p 'r $2,750.00 r �IaN riENe _ ni ieTnUFR_ RETAIN THIS COPY FOR YOUR RECORDS invoice The Septic Grays ins. 1.m800-240-2400 1 Date Invoice# } P.D. Box 959 10/25/2002 1 817 1 Westboroz7g,h,MP., 01581 Bill To Richard Clayton i Mary Pat Clayton 201 Megan Road Hyannis,Ma. 02601 i P.O.Number Terms Project l Due on receipt Quantity Description j escr Rate Amount um from field � 0.16 400.00 2,500 500 gal.pumped from tank and 2000ga1.pumped 30.00 60.00 2 Digging j 90.00 90.001 3 ft piece of black PVC pipe 180.00 180.001 24" Steel Ring and Cover 5.00% 13.50 Sales Tax I f .I * �� . Jf/��{�! �f%l' H f�e�if� ti�9h' il; t ,r m�� Ai f '-��✓, '�� I�`�. ,r !/ a r J AW TION SUB O TOTAL ME S f3 '�' N $743.5 NO. EER TAX d r 1 UO/CNECK NO.IUC.NO.STATE REG IDEPL CL�RK. TIP f�,"� 7 � fit, ^�� ter• . d'. / ',l •^^'"1..,_ 0 3 9 ELAL I J) Ni i I i �°'��-..�'t'.r- .j::..,. ..�.eg.�.,;.—..n.i--�.a� ---�;�a�- •r.��a :.-.T..s��••a-•z-"^°r :ma's e :s:,F r ��r-°��w ��;- r"":�;^st_ ,,,'r,�. �- i t.FY s �g}4 s i e4x17 1 1 f JL df �ztz^N �fit z rk N r- C t CLAIM TELEPHONE NUMBER: 1400-240-2400 h Septic Service Protection Plan: frf To provide property owners serviced by a private sewerage system,a simple"piece of mind' alternative to the fear of costly replacement of a failed leaching system,the"Septic Service nf'1 Protection Plan"policy entitles the Holder to: BioSolutions,Inc.("Company")hereby warrants and becomes obligated to the Holder to reopen or restore the warranted leaching system of the Holder,if said leaching system has"failed",as g herein defined,and also subject to the following terms and conditions of this policy. Refund Policy: Upon receiving notice of the failure of the warranted leaching system,the"Company",at its expense,will have 60 days,weather permitting,to restore or reopen the failed leaching system.If the"Company"is unable,or unwilling,to reopen or restore the leaching capability of the warranted leaching system within the requisite time period,the"Company"will refund all policy premiums paid by the Holder.This represents the sole liquidated damage liability of BioSolutions,Inc., its agents or representatives. "Reopen or restore"is defined as creating a physical environment within the leaching area whereby the gray water within the leaching system percolates into the ground. Preventive Maintenance Plan: Each holder of the"Septic Service Protection Plan"must automatically be enrolled in the Preventive Maintenance Plan,and be required to use one 16oz.Bottle of Nature's Power" Septic Treatment each month. As regular maintenance of a septic system,pumping a septic tank is essential to keep organic matter from clogging leaching systems.Holder agrees to pump the septic tank every 12 months. TERMS AND CONDITION OF THE"SEPTIC SERVICE PROTECTION PLANO" ill Enroll in the Preventive Maintenance Program Upon purchasing the "Septic Service Protection Plan®" the Holder is automatically enrolled in the Company's "Preventive Maintenance Plan". A six month supply of "Nature's Power" Septic Treatment will be shipped and the contents of one bottle is to be poured into any sink drain I each month. 2 Z: The use of"Nature's Power'Septic Treatment on a regular monthly basis will digest organic matter that clog the drains and leaching system. The Service and Maintenance Plans automatically renew unless canceled by either party 30 days prior to the aXP �'Y policy. expiration of each anniversary date of the olio . A. [2]The "Septic ServiceProtection Plan®" Vesting Period- CUSTOMERS OF THE BioSolution Septic Restoration Process"Tm whose leaching system had been restored, all "Vesting99 time periods are waived and the following italicized.will not apply. The Holder must be enrolled in the "Septic Service Protection Plan®"for minimum time periods before the policy will "vest", or before the Holder will be entitled to the reopening or restoration coverage. Residential: AGE-HOME WAIT PERIOD INS FEE MO. MAINTENANCE 1-5 years 0 month $8. 95 plus $7.99 per mo. 5-10 2 17.95 10-IS 3 19.95 15-20 3.5 23.95 over 20 4 25.95 but less than 30 Commercial: AGE WAIT PERIOD INS FEE MO. MAINTENANCE 1-5 years 1 month $17.95 per month* plus $90 per mo. 5-10 2 23.95 10-15 3 25.95 15-20 3.5 27.95 over 20 4 31.95 but less than 30 *The fees may vary depending on the size and condition of the septic system and if leaching system is under asphalt. Because most fields are vulnerable to failure partially based upon age and abuse, the "vesting" period is calculated upon the age of the leach field, identifiable abuse, number of people living in 3 �Y home, soil conditions, and-whether lrtlaer a41. doL&Jn apse:'The "vesting"will identify Ae known or suspected,yet undisclosed Pro WM�'4*0ik sy M problem proble . The Holder will Pay .he premium during the vestingperocl cof t � e *e Maintenance Plan'; and agrees to have the septic tank p7mr�ved er MOV s , avY Failure During The.Testi :Peric :. _. In the event of a leaching system failure during the first 50?�of the resting period,. and if "Nature's Power"Septic Treatment is used. the Holder-,e-ill be entitled to the "MoSolution Septic Remediation Process"r`t at a 25%discount to reopen the s}?stem. If the vesting period has elapsed more than 50%, the discount will increase to 50%. [ ]Reopening a failed leaching system: When the Company is notified of a Customer claim of a failed leaching system,the Company will have 60 days,weather permitting,to reopen or restore the failed leaching system using the BioSolution Septic Restoration Process"rM. There is no expense to the customer,excepting for a per man labor charge of$85.00 per hour including travel time. If the Company fails to reopen or restore the leaching system,the refund provisions of this Plan become effective.The company can elect not to attempt restoration and upon doing so,the refund provisions of this Plan apply. This is the sole liquidated damage liability of BioSolutions,Inc., its agents or representatives. [4] Coverage excludes: 1. Title 5 inspections,pumping expense,permitting,designing or engineering of a septic or leaching system, septic tanks or Distribution Box connections or any of the associated expenses. 2. Resurfacing,repair or removal of asphalt or similar surfaces on driveways,reseeding, loam or repair to the lawn due to the BioSolution Septic Restoration Process"rM. 3. Loss of business profit,business interruption or property use. 151 Disclaimers: 1. Failure due to high water tables or dense clay soils or.other impermeable soil conditions,Acts of God or physical obstruction of lateral lines. 2. Failure caused by lack of maintenance of a regular pumping schedule of a minimum of 12 month intervals,lack of general maintenance,failing to use Nature's Power Septic Treatment monthly, ignoring prevention or maintenance recommendations, intentional acts of sabotage, concealment,fraud or misrepresentation by the customer or its agents about a failed or failing 4 f ., mfati�. � s 3. A cesspool with cinder block C= 1a� �h leaching area.Existing leaching system is not:in conformity- authorities at the time of i n s t a l lation. 4. This policy is not intended to be an insurance policy as defined by i14GLAL [6] General Terms: call for all septic The Gorrnpanil eblsh.a toll free number,ted that there,for is nolan lmown,lers to and undisclosed,history service needs:Theheyholder has represented of leach systtin failures,and if so,a pre treatment may be required before a SERVICE PLAN will be acceptk stem will A"TailedSy�em'" is specifically defined as the leaching area of a septic system- The system in said leaching area is failing to leach or be deemed failed when we validate the gray water percolate into the ground,resulting in breakout,backup into the home or leakage from the Di,tribution Box or septic covers,or in general,an inability of the leaching system to accept water due.to organic biomat clogging,which condition,was not known to the Holder or did not exist at the time of the issuance of the policy. In the event of collection there will be assessed a 33.3%collection fee of the outstanding balance. 1. To file a claim,write or call: BioSolutions,Inc. 31 Long Drive i Westboro,MA 01581 1-800-240-2400 i � 2. The policy can be subject to an annual Premium increase and interest charges of 1 'h%per � month on unpaid balances. 3. The Holder is responsible to provide as built plans of the septic system,access to the leaching . system,and loc the leac ate and expose hing system cover or distribution box which leads 11 as the Physical location of the leaching system directly into the leaching system,as we f before the start of work. 4 The Plan can be assigned,but only with the consent of the Company.A$.1OO.transfer fee Will apply- CALL 1-800-240-2400 FOR ALL YOUR EMERGENCY SEPTIC NEEDS! Vie, 5 tis: BioSolutions, Inc. Westboro, MA 01581 a Grapevine, Texas 76051 Tel: (508) 836-3123 a (800) 240-2400 a Fax: (508) 366-6568 E-mail: BioSolutions@MSN.COM PROPOSAL SUBMRTED TO PHONEI DATE O JE 'z3Zoo L STREET JOB NAME I f . f�. CITY,STATE,AND 23P CODE JOB LOCATION "V /`'�- SALESPERSON DEPOSIT JOB PHONE We hereby submit specifications and estimates for. _.......-..........._-- ---------------._.........-._._.�- F. ................................__._..._...._..__...._....._..... _-----.... _......... --------.......__.._...__.._.__.._._.__._.._ ...._----.........._..._...__ _._...._---_ _._...._...._._....------........................._.... w We 3propoft hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: dollars($ ). Payment to be made as follows: All meterlal is guaranteed to be as spaeifled.All work to be completed In a work mangke manner Authorized extra to executed anty pon writfeei rearnents kot.alteration�s will'— e aneviation from above extra and Signature above control.he estimate. All Own ca"lire and other weary insure t fkK rk sb*es,accidents,or delays �sible for reasonable attorneys fees and eon N collection Is required.interest of 1.8%monrr�y on wk�w Note: This proposal may be balance will be asseS6ed• withdrawn by us d not accepted within days. Rarptante Of i3ropool-The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are authorized to do the Signature work as specified. Payment will be made as outlined above. oft of AMOPM00, 6ign®ture _ . The Sepli'mc Guys . ' Inc. l io 0. Box 959 Westborough, MA 01581 . 508-836-3123 a 800-240-2400 ® FAX: 508-366-6568 r� k x. Please Pay inivoice No � �`5 5 P/ s '° a os 3e: 77i a.2=� Time: 6s. ! PM Date: Name: Z Clir6 Y �� _ _ Commercial/Residential Address: z Town: t//,�,/✓�� i,S � ��_ .___ � ��ate:_�y��dip: __®--_____ Billing Address: PUMPING: Tarp Cesspool gal. 41�9n D- ox & Leaching Field $ Digging s &0 (50 Inspection/Certification TREATMENT. Snaking $ Roofing $ ", er-Jetting $ { OTHERLABOR: ............................................................................. .......... 81 I =UP:...................................................................................................................... } ® 0. ..,...x lov..44.....0J.Kip'.)......CQz1,e-.X............................ $_ V0 od Frhl al SALES:............... ............................. ....... . DEL&VERY: ...................................•..................................................,............................. LOCATION:. front / back / side --DgAG A CONDITION: good ! fair ! poor T S/ AFFLES: inlet ouflet CUP : SLUDGE. DEPTH COVER B. G. 0SE: L S{traytotal s 23 1.5%interest over 30 days Tax % if invoice not paid within days, discounts do not apply. TOTAL Customer Signature: � ------ -Serviceman Signature:--. > �ig All collection caa! will be added to the bill and are the customer's responsibility. CY 7,",/-j,1 -CR X? P J if 0® C c /Vim IS AVG T,� rN 1 « �a W - R DT VfR A Z. 0 /1V I �- — i d - N �$ 0 PO S C l � FAD _ F4A 1�/ G 4,FD CS EA _ . lIV �r _ 71 .L 4 C L14 � 61 OD3 L 1 :E ) � FILE A1354 abi � CUEM: CENSUS`TRACTI 125 l ld'rVJ4 V1 OWNER: DEEDBOOK PAGE ` AYTnmPLANBOUIC APPUCAM: ASSESSORS PLAN ,LOT 24 MORTGAGE INSPECTION PLA :N• f PLOP ► t1' :`5 OF. LAND LOCATED AT SCALE: 1"=40'' MARCH 29, '1996� ailr,_ 201 TAN ROAD HTAMIS, 1tAS5AC1if�ETrS bwt.ir�Z.s u N IttJt�..V Z 3 N op ay514i O ..: . !si-Y. . Q W Q a �.70G,So' Ar 1=LDJ21bG� A.VE. M E CLAN016-\p ZONING DETERMIN ATI ON THE LOCATION OF THE ORIGINAL UWEI,LING SHOWN-HEREON EITHER .WAS IN . COMPLIANCE WITH LOCH APPLICABLE ZONING BYLAWS IN EFFECT S7ciEAr CONSTRUCTED WITH RESPEC T REQUIREMENTS ONLY TO HORIZONTAL DIMENS O R IS E7C—rMPT FRp�€ VIOLATION ENFORCEMENT ACTION UNDER.MASS. G.L. .TITLEIOII CHAP. SEED40A SEC. T UNLESS OT9iERWISE NOTED OR SHOWN HEREON. A CONFIRMATORY INSTRUMENT SURVEI IS ADVISED WHEN STRUCIIJRES ARE SHO SETBACK LINES. NNT TO BE ONE FOOT OR LESS FROM PROPERTY OR REQUIRED ZONIN FLOOD DETERMINATION THE DWELLING SHOWN HERE DOES.NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE. AS DELINEATED ON MAP.OF.COMMUNITY 4. 250001 . 0005 C AS ZONE C DATED 8/19PROGmm- /85 BY THE. NATIONAL FLOOD, INSURANC CERTIRCATION I CERTIFY TO MURPHY-& MURPHY, P.C. be:Stone lanb ffiurbep(Co. ,SWor. -: SANDWICH CO-OPERATIVE BANK & ITS +a TITLE INSURANCE COMPANY, THAT THERE Gen 3yelbp Roab ARE NO VISIBLE ENCROACHMENTS OR f b) f DfQrD, Q�02'j45 :CARD EASEMENTS EXCEPT AS SHOWN AND THAT . THIS PLAN WAS PREPARED UNDER MY 1-800-993-3302 9,ya 0 IMMEDIATE SUPERVISION. -fax 1-800-993-3304 ucv 01( E ES;This mortgage Inspection plan was prepared for the above mentioned cUent pTesented to be a land or ey, only as of date. y k r� Properly Ane Rov No comers were set, It con�ot be used for jar®perinp d®®d onsinictlon or estobi4hln®tent®,hed®e or building gr►es. fie land os shown heron bused an client furnished d n icy be sufsJeot to further out scias,towngs,eosements and fights of way, No fury is extended to the occUpont, It Is not Intended to be recorded.: OOOW LOCA-T-ION 5E-WAC;E—PERMIT U --0: A D-tl T_E P E R�1- -15S.0 ED -— _ — D ATE-Co M-P_t`.t�Q.l`1 CE-1ss U-E�-:r a��y 1 � a Q, r 1 i UCmcN-;_ �Coay .S��c4_n_�zs CEIi 116 t{�-- I:D /).3 _--- - - - < f`c --- - -- -- - -- ---- - - - --- — - a a r ��5� k ,, No....... Flmffs)..................... ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR �QF H /7-/L//' ..................OF......... .......................... Appfiration for Mopmal 18orkii Tons- trudivit PrrvAit Application is hereby made for a Permit to Construct (L-j"'or Repair an Individual Sewage Disposal System at, 4 .................6.......... .. .... . . ....... . . ................................................................ Location,Address r. Lot..No. ........ ............................................. ---------------------- Address .......... ............................................ �o'Wz��. g. ............... ...................................................... Installer Address Type of Building Size Lot.... ...Sq. feet Dwelling—No. of Bedrooms.............7 2,-- :.......................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures -------------------------------------------------------------------------------------------------------------------------------- .................... Design Flow................. ....._._..........gallons per person per day. Total daily flow---------3.04a.....................gallons. Septic Tank—Liquid capacity/6.1.-Ciga&ns Length................ Width._.............. Diameter.....__.__.____. Depth..........__._.. Disposal Trench—No.....................tN�Vid�tl ..........---- T�otalfength..................../Total 1paching area.... ft. . .......... 'f-44dQV7 -@Waching area..................sq. ft. Seepage Pit No------- ...........�O��Dept PLir-40? Z Other Distribution box Dosing tank ( 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ P4 Test Pit No. 1................minutes per inch Depth of Test Pit_.__............_._. Depth to ground water..._.._.______........_. Test Pit No. 2................minutes per inch Depth of Test Pit___................. Depth to ground water.....................__. P4 ..................................................................................................................................1......................... 0 Description of Soil..... ....................... .................................--- -- --- ------ U ................................ ........ ... ....... ............................................................................ - ....... .................................................................1-1................................... U Nature of Repairs or Alterations—Answer when applicable..........................................•_.............._..___._....____._._............._.._. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is d by the bo d of health LIZ__ ................ ....... Sig .......DI, 4-.-' ?J-tate Application Approved BY------- .... J_J/ Dat Application Disapproved for the following reasons______________................................................................................................... ......................................................................................................................................................................................................... Date ......7.4 Permit No......................................................... Issued..-- ................... Date ------------------------------------------------------------------------------------------------ --------------- V D p Y � � y 11 1 r i r `� *, r `4 `� e r � t b �`te a1�' e i r � ~�' � i � ' /// �J/ � � ! U r � `�� I � � � 7� � � ^J t 1 �� / � x i � !�. �� ` �\ •�, to ^�, � �� \` ,1� � �1, 'I i �V � 7 f �� } � Y � � i �`` + r� �,... ' �� ._ 1 ` ' t � 'W` 4~ � ,) 1 � ~ A No......11__:�...... Fivm...10.. .... THE ®�M COMMONWEALTHMASSACHUSETTS /`1 11� i— fl ( "vl........OF...... ... ... ............................. Appliration for Diipoiial Works Tonstrttrdion Frrutit Application is hereby made for a Permit to Construct (� Repair ( ) an Individual Sewage Disposal System a . ----- Ad. ............------O ... .......... f, ' Locationf— ress or Lot No. ......4 S1._. _........ .......... - -- -.....--•-'---------•--•----•------------- •^-----....--•---^_...........------•-----.. Owner - Address - ---- --------------------•----......_.__{Installer Address d Type of Building Size Lot___._...y�'_Uq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) P-1-I Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) p•I Other fixtures ------•-•----•••----•-•-•--..... - T C`0 W Design Flow............ -- C2___galll)ons per per on per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity �Ug�aYio Len ._-Width. __._..__._ Diameter................ Depth................ Disposal Trench—No. l e g q x _......_. Total leaching area ft. 3 Seepage Pit No......... D m ......... Depth below inlet-�............... Total leaching area..........--------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) H•1 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------- ------------------------------------- ••-••-------------------------- • -- --- ---------------------- •--•------------•--. ---------- •-- ODescription of Soil..........................-•- ----------------- •----•.F.......... ----------------- ----- •-•------••••-••-----•--•--•-•---•••......•-•-••------...__.._.. U ---------- _-_- -------_-----•-------_--_ ----------••-••--------------------•--•-•••--•----__------ W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------•---•---•--------•------•------------•-----------------------------------•------•--•-----------------------------------•-•----------•--•--------------------•-•-'-••--•-•-_..._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the boa d of health. Sig .d lam,/ ..... / .i�1i J �C ? Date t Application Approved BY •---- . ' Date Application Disapproved for the following reasons:----'•---------•------......__...--•------•-•••-------------••----••-•----------•-- ...................... ..............................................•----•--•-....-------•-----•---••----------------•--•-------•--•-•---------------------••----••-•-------•---•••-••---•-----•-------•--- •••------------•- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARCI OF HEAL.T .....................OF........ .... .(3.��.... . ;i IVITIrdif iratr of T"lluipliiture THIS IS CERTI Y, Th he Inc>vidual Sewage Disposal System constructed (L--)--or-Repaired ( ) bY••••-••-•-•-••J -------------------------------- •-------------------------------,-••-••--•--------•-••---------•--- Installer has been installed in accordance with�the ps of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._--------1_4�_________________ ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARF HEA CHa /.............OF........ .c.... .... ........_............._............ No...`...l.l.. ....._ FEE...`.0.... •--.... Diiipaq I Works T strqtiott pamit Permission is hereby granted.•--•. ....... . . ... .`'e .... to Construct.( or Repair ( ) an Individual SewaV7Disposal ystem ---- Street as shown on the application for Disposal or Construction Pit N ._ _.. ....._ Dated..... DATE.................................................•--••._.........._.....__----- Board of Healt FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS f �1 s q yv 1 � Vi