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0072 NAUTICAL ROAD - Health
72-76 Nautical "oad Hyannis P A = 307 236- r � I `I e r f o { 2c), —T65 —.� No: Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �''� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Applitation for Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(L,� ❑Complete System ❑Individual Components Location Address or Lot No. '� '7 Owner's Name,Address,and Tel.No. Assessor's Map/Parce. - Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. A. d. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �A�� - gpd Design flow provided /L' 1 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o ealth. gn d Date /C� Application Approved by J - ""' "" Date 1� / Application Disapproved b Date for the following reasons Permit No.ZZ) ., (s",� Date Issued I LAG 20 17 No. ��� Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC.HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye Nplication for Disposal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(lir ❑Complete System ❑Individual Components Location Address or Lot No. '� a = t ` R J Owner's Name,Address,and Tel.No. Assessor's Map/Parce o - 2 �v M C^<Ck U D S GSAuN o . Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 5cc� M 4c"V 1l3 b�c1 X�f,.nUv d. Type If Building: Dwelling No.of Bedrooms .. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures. Design Flow(min'required) _��� gpd Design flow provided �(JyI gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) n mAn Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. / ` d Date !C� ` b I "t Application Approved by, ` Date Z Application Disapproved by Date for.the following reasons Permit No. �_t�J Q — t/ Date Issued 1 L/G THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 4 .,-Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(✓)by -Sc a C N {-Tnn�tt at �� � ��` (� V h fi'b�entAnstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No 1 — t i dated ] � (7�,,q Installer Designer #bedrooms Approved design w / gpd � . I The issuance of this pe it shhall not be construed as a guarantee that the system will ctio as designed. Date. I "1 Inspector ------------------------------------------ ------------- ----------- :------- ------- _:---F------------------------ ------ No. q6 5 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon System located at �� r r� j and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date (T �/q Approved by Town of Barnstable Public Health Division ''',,S. 200 Main Street, Hyannis MA 02601 1639. Thomas A.McKean,CHO r 11) October 11, 2019 Anthony Elio, Jr PO Box 52 Osterville, MA 02655 RE. SEWER,CONNECTION DEADLINE.EXPIRED; m Ar 72-76� Nautical Road; Hyann><s Dear Mr. Elio, Your December 30, 2015 sewer connection deadline has passed. Please contact the Public Health Division Office to provide an update relative to the status of property's connection to public sewer (i.e. contractor name, DPW sewer connection permit number, anticipated connection date). If you would like to request an extension, such request must be in writing addressed to the Board of Health (200 Main Street Hyannis Massachusetts) within fourteen (14) days. Sincerely yours, Thomas A. McKean, R.S., C.H.O. Director of Public Health Town of Barnstable Q:\WP\SewerConnectionDeadlineEXPIRED 72 Nautical 2019.docx r Town of Barnstable Barnstable Board of Health MAKg 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL# 1-00'W 71,0 000 2 0500 '10--(0 March 21,20;16 Anthony Elio TR F FRUS Realty Trust r • 871 Main Street Osterville,MA 02655 IMPORTANT NOTICE: Map- Parcel 307-236 RE: Show-Cause Hearing , Dear property owner, ' You are scheduled to appear before the Board of Health on Tuesday,May 10,2016 at 3:00 p.m. at the Town of Barnstable Town Hall,Hearing Room, second floor, 367 Main Street, Hyannis; for a show-cause hearing. Your presence at this meeting is mandatory. This hearing will be held to show-cause why your property at 72 / 76 Nautical Way has not been connected to Town sewer by the December 30,2015 deadline. During this hearing, you will have an opportunity to be heard,present witnesses, and provide documentary evidence pertinent to this case. If you have any questions please call the Barnstable Health Division at 508-862-4644. PER ORDER OF THE BOARD OF HEALTH he cKean, CHO Agent of the Board of Health THE FOLLOWING IS/ARETHE BEST IMAGES FROM POOR QUALITY. ORIGINAL (S) I m ^ � DATA THE 'Town of Barnstable Barnstable �pF 1p� Board of.Health e;caC j °A KASS 'E'er 200 Main Str6et, Hyannis MA 02601 ��ss. a ap 1639• ATE MAC A 2007 Office: 508-862-4644 :I Wayne Miller,M.D. FAX: 508-790-6304 ) Paul Canniff,D.M D.. � g, z �r ' I Junichi Sawayanagi `a June 28, 2016 Mr Anthony Elio °F Frus Realty Trust 'J 891 Main Street - x Osterville, MA 02655 - } FINAL NOTICE t" Board of Health Show-Cause Hearing? 72/76 Nautical Way Hyannis . `I( .Q 3.07.,23'6 a Dear Mr. Elio, , 4 You t � ,� t, � �� �I led Board of Health meetings regarding your failure to ' conned 4 x � 'l3 at 72176 Nautical Way;Hyannis,Massachusetts. ,. Therefo„ �� ` i1 to attend the July 12, 2016 meeting at 3:00 p at the Town of i � f.�� k irlg Room, second floor, 3 67 MainStreP* y, #°\for a continues r�4 tiig. This hearing.will be held to show �� ry at 72/76 Nau1�` ,::a:y"has not been connected to Town sewe, �� ,, k ;, ;fie. During this"hearing, you will have an opportunity to be hear.; a ° de documentary evidence pertinent to this case. Failure to comply with an order of the Board of Health may re \ �. `int against you at the Barnstable District Court. This is your final ;: PE ORDER O TH BOARD OF HEALTH Wayn Miller, M.D.. Chairman Q:\SEWER connect\72 Nautical Way Final Revised order 2016.docx 1 Town of Barnstable Barnstable �pf THE rpw �-81111EIICaCiIY y `Board of Health ua Mate,� ASS 200 Main Street, Hyannis MA 02601 �pAl fo 3�A 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi June 28, 2016 Mr Anthony Elio Frus Realty Trust 891 Main Street Osterville, MA 02655 FINAL NOTICE AND DEMAND: Board of Health Show-Cause Hearing ORDER TO APPEAR 72/76 Nautical Way Hyannis' A 307-236, Dear Mr. Elio, You failed to appear at several scheduled Board of Health meetings regarding your failure to connect your dwelling to public sewer,at_72/76 Nautical Way, Hyannis,Massachusetts. . Therefore,the Board hereby orders you to attend the July 12, 2016 meeting at 3:00 p.m. at the . Town of Barnstable Town Hall;Hearing Room, second floor, 367 Main Street, Hyannis, for a continued show-cause hearing. This hearing will be held to show-cause why your property at 72/76 Nautical Way has not been connected to Town sewer by the March 30, 2015 deadline. During this hearing, you will have an opportunity_to be heard, present witnesses, and provide documentary evidence pertinent.to this case., Failure to comply with an order of the Board of Health may result in filing a criminal complaint against you at the Barnstable District Court. . This is your final notice from this Office. PE ORDER O TH BOARD OF HEAL TH Wayn Miller, M.D.. Chairman Q:\SEWER connect\72 Nautical Way Final Revised order 2016.docx v 4 Town of Barnstable Barnstable �pFSHE Tpwkxftd Board of Health AMmeficaCHY y°A MASS* 200 Main Street,Hyannis MA 02601 ��ASS,ss. a °p i639. A`� 2007 PlfD MAt Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D: Junichi Sawayanagi June 28, 2016 Mr Anthony Elio Frus Realty Trust 891 Main Street Osterville, MA 02655 FINAL NOTICE AND DEMAND- Board of Health Show-Cause Hearing ORDER'T APPEAR 72/76 Nautical Way Hyannis A = 307 2.0 Dear Mr. Elio, You failed to appear at several scheduled Board of Health meetings regarding your failure to connect your dwelling to public sewer at 72/76 Nautical Way, Hyannis,Massachusetts. Therefore, the Board hereby orders you to attend the July 12, 2016 meeting at 3:00 p.m. at the Town of Barnstable Town Hall, Hearing Room, second floor, 367 Main Street,Hyannis, for a continued show-cause hearing. This hearing will be held to show-cause why your property at 72/76 Nautical Way has not been connected to Town sewer by the March 30, 2015 deadline. During this hearing, you will have an opportunity to be heard,present witnesses, and provide documentary evidence pertinent to this case. Failure to comply with an order of the Board of Health may result in filing a criminal complaint against you at the Barnstable District Court. This is your final notice from this Office. PE RDER O THE BOARD OF HEALTH Wayn Miller, M.D.. Chairman Q:\SEWER connect\72 Nautical Way Final Revised order 2016.docx _ sod oJ �°pTHE 'own of Barnstable Barnstable Board of Health ;e„ca V BARN STABLE. ' 90 MASS. g 200 MainStreet, Hyannis MA 02601 1639. °AlED MA At 0. 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi June 28, 2016 Mr Anthony Elio Frus Realty Trust 891 Main Street Osterville, MA 02655 Board of Heal FINAL°NOTICE ANDDEMAND � th'Show2Cause Hearing s ORDER TO APPE3AR , 72/76 Nautical Way HyannisY a _ ,,A = 307-236 Dear Mr. Elio, You failed to appear at several scheduled Board of Health meetings regarding your failure to connect your dwelling to public sewer at 72/76 Nautical Way, Hyannis, Massachusetts. Therefore, the Board hereby orders you to attend the July 12, 2016 meeting at 3:00 p.m. at.the Town of Barnstable Town Hall, Hearing Room, second floor, 367 Main Street, Hyannis, for a continued show-cause hearing. This hearing will be held to show-cause why your property at . 72/76 Nautical Way has not been connected to Town sewer by the March 30, 2015 deadline. During this hearing, you will have an opportunity to be heard,present witnesses, and provide documentary evidence pertinent to this case. Failure to comply with an order of the Board of Health may result in filing a criminal complaint against you at the Barnstable District Court. This is your final notice from this Office. PER RDER OF THE BOARD OF HEALTH Wayne Piller, M.D., Chairman Q:\SEWER connect\72 Nautical Way Final Revised order 2016.docx [Type text] �THMEr Town ,of Barnstable Barnstable ~� Board.of Health ' AllAmericaCity : BA"SreBi e I I MASS. g 200 Main Street,.Hyannis MA 02601 i679 �0 fp Mpl� 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi March 30, 2016 Mr Anthony Elio gel -8;M. Main Street - Ostervill e, M,A 02655 '' .' j ; FINAL NOTICE AND DEMAND Board of Healtli,`Show Cause HeaSr><ng `j � ; r ,ORDER"'TO APPEAR' ' 72/76 Naut><cal Way• Hykanns f ,,', � ' F;r ' < � ��., ,� , -t `.A �307 23'6 �` J Dear Mr. Elio, You failed to appear at several scheduled Board of Health meetings regarding your failure toy ' connect your dwelling to public sewer at 23-.Keats ad; 3�annis, Massachusetts. .._ The the Board hereby orders you to'�/gib attend t e July 12, 2016 meeting at 3:00 p.m. at the w Ton of Barnstable Town Hall, Hearing Room, second floor, 367 Main Street, Hyannis, for a ..continued show-cause hearing. This hearing'will be held to show-cause why your property at-23 Keating Road has not been connected to Town sewer by the March 30, 2015 deadline. During this hearing, you will have an opportunity to be heard, present witnesses,and provide documentary evidence pertinent.to this case. fi Failure to'comply,with an order of the Board of Health may result in filing a criminal complaint against you at the Barnstable District Court. This is your final notice from this Office. t PER ORDER OF THE BOARD OF HEALTH' ayvV Miller, M.D., Chairman Q: SEWER CONNECT/72 Nautical Way Final order 2016.docx. A [Type text] "< Town bf Barnstable Barnstable t���"°� ,'Board of Health BAMSTAB. i ► 9 MASS.`Z g 200 Main Street, Hyannis MA 02601 O D 2007 Office: 508-862-4644 Wayne Miller,M.D. . < FAX: 508-790-6304 e Paul Canniff,D.M.D. Junichi Sawayanagi March 30, 2016 Mr Anthony lio 71 8 Main Stre t Ostervllle, MA" 655 FINALNOTIG DEMAND Bo ardof Health Sho Cause"Hear>< g ' �� � ¢ 'ORDER TO APPEAR 72/76 Nautk'ad I A yannis 23 Dear Mr Coorn s and Ms. Clea You failed,to appear at several sch led Board of Health meetings regarding your failure to connect your dwelling to public wer t 23 Keating Road, Hyannis, Massachusetts. Therefore, the Board hereby or ers you attend the July 12, 2016 meeting at 3:00 p.m. at the Town of Barnstable Town H ;Hearing om, second floor, 367 Main Street,,Hyannis, for a ' continued show-cause heari g. This hearin will be held to show-cause why your property at 23 Keating Road has not'bee connected to Tow sewer by the March 30, 2015 deadline. During this hearing, you will-ha v an opportunity to b eard, present witnesses, and provide documentary evidence ertinent to this.case. Failure to comply w' h an order*of the Board of Heal may result in filing a criminal complaint against you at.the arnstable District Court. ;This is y r final notice from this Office. PE ORDE F THE BOARD OF HEALTH Wayn M' r, .D., Chairman Q: SEWER CONNECT/72 Nautical Way Final order 2016.docx Town'Tbf Barnstable Barnstable Board of Health AFAMNINCRYY '"RMMAM $ 200 Main Street,Hyannis MA 02601 O I i6;g. Fp Mpy 2007 Office: 508-862-4644 ' Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi 00ce l $ 30 '000 Z,, OS � CERTIFIED MAIL# �'- 0 c> 1 0-+(o , March 21, 2016. , Anthony Elio TR FRU e S Realty Trust t3' 871 Main Street F Osterville,MA 02655 IMPORTANT NOTICE: Map- Parcel 307-236 ; RE: Show-Cause Hearing Dear property owner, You are scheduled to appear before the Board of Health on Tuesday, May 10,2016 at 3:00.p.m. at the Town of Barnstable Town Hall,Hearing Room, second floor, 367 Main Street,Hyannis, for a show-cause hearing. Your presence at this meeting is w mandatory. - ` This hearing will be held to show-cause why your property at 72176 Nautical Way has not been connected to Town sewer by the December 30,2015 deadline. During this hearing, you will have an opportunity to be heard,present witnesses, and provide documentary evidence pertinent'to this case. If you have any questions please call the.Barnstable.Health Division at 508-862-4644. , PER ORDER OF THE BOARD OF.HEALT.HF Tho a cKean, CHO Agent of the Board of Health i 5 Postal C I, T RECEIPT RTIFiEDMAILT w. a 0, (DomesticOnly; C3 07 o C a Ln Postage $ C3: A Certified Fee _ '+ C3 Return Receipt Receipt Fee - C3 (Endorsement Required) , Here b Restricted Delivery Fee .Y (Endorsement Required) a m r _ r' c- Total Postage&Fees $ j CC) Sent T Y Y1OYl l l� 'S` d" � Street,Apt.No.; Q� �-y� e - r3 or PO Box No. V�1. l�_ co v� •--•---- ---- ----- ---- v _ City,State,ZIP+4- I A- U - a w' � f,. .:ai» •�� e - .. ■ Complete Items A. Signature ■ Pririt,your,name antl atltlr`ess'on the reverse X ❑Agent so that we can return the cA, to you.' ❑Addressee " ■ Attach this cartl to the back ofahe Mailpiece, �AV` B• R ceived by(Printed Name) C. Da liveq_ or on the front rf space permits .. 1 Article Addressed to D. Is delivery address different from item 1? ❑''Yes If YES,enter delivery address below. y ❑No 4" + v III'I�I'II'IIIIIIIIIII�I�III�II'IIIIIIII�II�'II 1.❑Adult Signature ❑0 Priority`RegisteediMa MssO ❑Adult Signature Restricted Delivery ❑Registered Mail Restricti '0590 9403 0521 5173 2832 24 �certleed Mail® Delivery= ❑Certified Mail Restricted Delivery return Receipt for Collecton DeliveryMerchandise )` _ _2 Article Number_(rransfer from service leben_ ______- Collect n Delive Restricted Delivery ❑Signature ions Insure Mail Confirmation❑ lire Confirmations 0 8" 18 3 2 0 5 9 0 7 6 1 Insured Mail'Restricted Delivery ❑Restricted Delivery t o - (over$500). PS Form 3811,'.Aprll 2015 PSN 7$30 02-000 9053 Domestic Return Receipt , s r ' , . • , r ® Complete items 1,2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired. X ❑Agent ® Print your name and address on the reversevr) ❑Addressee so that we can return the card to you. B. Re ived byi n C. Date f D Wry ® Attach this card to the back of the mailpiece, or,o6 the front if space permits. O l ,//;> D. Is delivery address different from item 17 ❑ es 1: Aitiele Addressed to: If YES,enter delivery address below: ❑No c7� ONALD FLICK 4 ELI0,_ANTHONY TR 971 MAIN STREET O STERVILLE, MA 02655 3. Se ceType Certified Malt ❑5(press Mail - ❑ 0 Registered Return Re t for M ha dise ❑Insured Mail ❑C.O.D. UI T 4. Restricted Delivery?(Extra Fee) es 2. Article Number 7012 1,010 �0�0 2848 1469 (Transfer from service iabeq PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540? a UNITED STATES POSTAL SERVICE I First-Class Mail Postage&Fees Paid LISPS I Permit No.G-1.0 I ' • Sender: Please print your name, address, and ZIP+4 in this box ° I CSewer Connect I a� Public Health Division Town of Barnstable 200 Main Street I Hyannis,MA 02601 I I I I I Will-rllii)i11l11,111h I-III 1111!111111111111 111 G f11�1M1 .ten .. • . IIa wt . OFFICIAL, SE 1:0 Postage $ 11.1 O Certified Fee S oss ar � Retum Receipt Fee Here i3 (Endorsement Required) C3 Restricted Delivery Fee p C3 (Endorsement Required) O Total Postage&Fees r—1 ti `DONALD FLICK o % ELIO, ANTHONY TR 871 MAIN STREET OSTERVILLE, MA 02655 Certified Mail Provides: a A mailing receipt io A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Maile or Priorit Maile. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for duplicate return receipt,a USPSe postmark on your Certified Mail receipt is reM`. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is dasired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-OCO-9047 � I S' � IKETn,� Town of Barnstable Barnstable .� Regulatory Services Department �t�ABLE. 1 1 > .� Public Health Division _- _ _ _. -- -- �o� � , _ .__. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012-1010-0000-2848 -1469 March 28, 2013 DONALD FLICK% ELIO, ANTHONY TR 871 MAIN STREET IMPORTANT NOTICE OSTERVILLE,MA 02655 Map & Parcel: 307- 236 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 72 Nautical Way, Hyannis, MA, to public sewer on or before 12/30/2015. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits($ 25) are issued at the Public Health Division, 200 Main Street,Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see the reverse side of this page. PER ORDER OF T BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health i Cc: Barbara Childs,WPC/Roger Parsons, Town Engineering, DPW Enc. QASEWER connect\Letters Stewart Creek Sewer Connects\MAILING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc Public Health Division March 28, 2013 ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS: „ dr SAVINGS AVAILABLE/GRINDER PUMP: A reminder to those of you who need a grinder pump for your connection: Department of Public Works (DPW) sent you a letter in December 2012 stating the town, for a limited time of two years, only from the receipt of the DPW letter, would provide you with the pump at no charge. (This can save you thousands of dollars.) Please note: You must pay the installation cost through your own contractor. Please make your contractor aware of this, if interested. Also be aware: this is a shorter deadline than the Public Health Division's deadline on the reverse side of this page. SAVINGS AVAILABLE/PERMIT FEE: The Town offers a waiver of the residential sewer connection fee of $420.00 for those properties that connect within two years of the receipt of the DPW December 2012 letter. LOANS: For loan(s) available;please see the enclosed brochure, or see the town website: http://www.town.barnstable.ma.us/cdb (under the"CDBG Programs", see "Sewer Connection Loan Program). For loan specific questions,you may contact Kathleen Girouard, Growth Management, at 508-862-4702. CONTRACTORS: Information on Licensed Sewer Installers is available on our web site at www.town.bamstable.ma.us/PublicWorksTech/sewerinstallers. Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at(508) 790-6244. FOR ANY QUESTIONS /ASSISTANCE: ' Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. QASEWER connectEetters Stewart Creek Sewer Connects\MAILING LetA Sewer 2Pgs Merged 3-28-13 Y0015.doc .a• SECTIONSENDER: COMPLETETHIS SECTION COMPLETE THIS . ■ Complete items 1,2,and 3.Also complete g ture item 4 if Restricted Delivery is desired. X ❑Agent s Print your name and address.on the reverse VL—� ❑Addressee so that we can return the card to you. . e eive (Printed Name) C. D to o D livery , ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? 0Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No Frus Realty Trust 169 Maraquand Drive Osterville, MA 02655 3. Service Type -6ertified Mail ❑Express Mail ❑Registered %Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. Yi 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) j l i R 0;P,6 F0 Ai1 O 00 0!0=13;5 2 5111 2 9 0 i; T rt - e -x. I I,�Form 3811 February 2004; ;£ Domestic:Return Receiptp 1o25s5-o2-M-1540 � - -# k: t3i li � ii fii I: I UNITED STATES POSTAL SERVICE i First-Class Ma I I Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box ° tl w Town of Barnstable i )41� Health Division 200 Nla_n Street Hyannis,MA 02601 n illlfEf!!FI{�in?��lEEll3i1.Ii4il�i!lfl{?i3E4i!!�!?E£IIEi££�£7!I _ — I 7 Certified Mail#7006 0810 0000 3525 6290 oti Teti .Town of Barnstable Regulatory Services snxxsrast E M^ $ Thomas F. Geiler,Director 16 9. �m ° A Pub lic`Health Division .. Thomas'McKean,Director 200 Main Street,Hyannis, MA 02601 Office:, 508-862-4644 Fax: 508-790-6304 • July 6, 2011 Frus Realty Trust 160 Marquand Drive Osterville,MA 02655 NOTICE TO ABATE VIOLATIONS OF 105-CMR 410.000, STATE SANITARY CODE Ii— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The.property owned by you located at 72 Nautical Way Hyannis, MA was inspected on July 6, 2011 byTimothy,B.-O'Connell,-R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in , accordance with Chapter 170.of the Town of Barnstable Code.: The following violations of the State Sanitary Code were observed: 105 CMR 410.552- Screens for Doors: Front entrance door not provided With screen fi ,door as designated by above code:- 105.CMR 410.500, Owner's Responsibility to Maintain Structural Elements: Window within Southern bedroom does not work as.intended . (Window does not stay:,- open) You are directed to correct.the violations listed-above within thirty (30) days of your receipt of this notice by installing screen,door(s) to all doors.that open directly-to outdoors; by fixing or replacing said window so that it works as intended. You may request'a hearing before the Board of Health if written petition requesting same is received within ten (10) day's-after the date the.order is served. Non-compliance will result in a fine of$100.00 per violation. Each days failure,to comply with an order shall constitute a separate'violation.. Should you have any questions regarding the above violations;,please contact the Town Health=Division and askto speak with the inspector who_performed the inspection. CER OF BOARD OPHEALTH . .'Mc ean, R. ., O - Director of Public Health Town of Barnstable Q:\Orderietters\Housing violations\Rental ordinance\72 nautical way.7=6-11 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date — I Time: In Out n I .�- Owner Tenant Address M Address 7 oL Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities C- 7. Lighting and Electrical Facilities �L 8. VentilationPA A '� n 9. Installation and Maintenance of Facilities ✓ S��eaM— �-ovt� 10. Curtailment of Service 11. Space and Use _ 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal I�11 16. Sewage Disposal qS— 176� - ��Y�- 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) _ Person s Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here 3 f Lead Paint Inspections ib.y Fred Hemmila 16 Quaker Road, East Sandwich, MA 02537-1.027 Tel. 508-88878378 In Mass: 800-286-8378 FAX 508-888-8397 Finail:.Fred l, adQcomcast.net Website: www.frcdhe1Y1mila.com LETTER OF FULL INITIAL LEAD INSPECTION COMPLIANCE DATE: 6,m!f _ Oi-b P Y _EL 1 D _fix s�. Dearp This letter is to certify that I iii.spected your property located at lc1 Nf� 1e'fL:jeOA-D apartment no. ^' , and relevant'common areas, in the City or Town of for dangerous levels of lead according to 105 CMR 460,730 of the Regulations for Lead Poisoning Prevention and Control, and determined that there were no violations of the Lead Law, Massachusetts General Laws, Chapter 11 1, section 197. The inspection was conducted on `ul also certify that I observed no evidence that unauthorized deleading activities may have Jz�lj occurred in this unit or hilts associated common areas. Please be advised that Massachusetts law requiresthat only certain residential su rfaces be free,nf lead paint, Thus, this letter- does not mean.that your property contains no lead.paint.`The premises or dwelling unit and relevant common areas shall remain in compliance only as-long as there continues to be no peeling, chipping, or flaking lead paint or other accessible materials and as long as coverings forming an effective barrier over such paint and materials remain in place. The law grants you a 30-day maintenance period to repair deteriorated lead'.paint or detached coverings over such paint, and to clean up, during which. time this Letter remains valid. The initial inspection report indicates which surfaces, if any, contain a dangerous level of lead, as well as those surfaces, if any, that were covered upon initial inspection. SInecrel<<,- 72 Nautical Road, Hyannis 02601 fr,�h�ctt,r: September 6, 2011 DPH License Number Should you have any questions about this letter, call the Department_oE Public health at j-800-532-957l. Letter of Full Intitial Inspection Compliance rev 8-08 Revised 8/08 Page I of y _ Lead inspection / Risk Assessment Report Lead Paint Inspections by Fred Hemm'ila gage ' of T 16 Quaker Road, pst Sandwich,.MA 02537-1027 Tel. 508-888-.8378 In Mass: 800-286-8378. FAX 508-888-8397 Email:fredlead a()comcast,net; Webslte: www.fredhemmila.com� St.# Address f . Apt, ❑❑oo a��aaaa®o❑®oaao❑o❑❑❑❑❑ City Zip Code Number of Rooms in Unit Owner Narne 1° Ni HONy ELI Property Type; Owner Address: i t T fS"! ✓/�-L O LESS Single Family X DU.&C-9 Contact Information: Multi Family #units Client Name if different from owner - Condominium. ,m.; #Units Client Address: Day care other;_ . Key: lead Column Key: Delead/IC Method Column Laundry in Basement? Y or No Cov Covered CAP Capped SCR Scraped Finished Space in Basement? Yes' , No V6 Vinyl Baseboard GOV Covered .DIP . ,Dipped . MET Metal ENC .' Encapsulated REM Removed VR Vinyl Rep,Window MI Made Intact REP Replaced Testing Method Used: MR Metal Rep,Window PRE . Prepared for Enc REV Reversed Na2S Exp. Date NA Not Accessible vR(MR Vinyl/Metal Rep Window INT intact X-Ray Fluorescence NC No Coating SFR Storm Frame Removed -Tile Tile(testing suggested) Component Does not Exist Model R MD Serial# I 7SQ ( Dropped Ceilinq. F Comments I Notes Floor#.__�(This is the level within building of unit being inspected) Floors C IS �. C E i F I-� A(Street Side) Start Here I A(Street Side) Start e Ill) (lend)Uqual to or greater than 1,0 ink tcn ''.«ttir x-rev fluorescence or:positrve with Na2S.is Dangerous. XRF Calibration Recorded in Log Book I t/ ✓ -Check off When complete. Address verified`through,USPS ✓ -Check off when complete Research on Lead-Related History for'Address ✓ 'Checkoff,when complete �Gy�ati itit-�trF.tiSrC1 Zi Cl�01 F; Inspector Name FRI-BI 1C :� NEMNILA Ui # Signature w Date LI/RA rev 8/08 N.()(-)! !~: S... Ia NAv1lA t# City OA-�iN15 Page 2 of�,j IN'T_ERIM CONTROL_ �11tsn . R A Name, _. _ Lic#inspector Name:_ Lc#_ t _ - Siynatre: \sI Signature UrE,�,tt}h. Llaraal.. ,.f , n Lic# 7 L_ { Inspector Name. 4 P I`ter '� ri>ust Tak fo t n r R,sk PR A Nam lAsi sessrr,cnt _,e���_. ... �. ;Lief].. - Signature... ' /ham..' ---- L— �_L l_i Signature_ 1 3. -�j Visual Portion of (nitr,l Inspector Name: : ,LiC# Rcinspection for { � ) mm IntenmControl . �._ -- ..� � r� _I,.D 'Signature -I \ Signature, -- — — � _t IS _.� R.A.Name: ., _ - LlU�.4 I tk4t7 lilt tc 15k R.A. \.rrlUt,rsert7 i Id t r _ Inspectors Name: -.-,Lic# �"�seSamCnE!'reins'). •Ir„t,..�r ,ji, !r„7� ± ---� _�. � _ ,. Signature.m..-_. _ l Signature - ^- \r sull i ortion of f:cin5pcc acm iix � R.A. Lic# Name`.. - -- —_ - ..., � _ ... lnterrn,(�ixrtroi ": ---. i - itr' Signature Inspector Name:-- ,Lic#—__ -' \ Signature_- Dust`t Wr I�rsk P L�J R.A.Name._T Lick /\sr�fisrnt.rti ltr:rn�i, Signatuie_ — k l l r 1 Inspector Lic#--- .._ _ �. !ft�,Asscssrrient ,.:. l Signature..-.—w,-. • W _ _ y R.A.Name:— It..INSPf C I I0 HIST012.l -- l is'. .. i Si nature.: I LIr�Gnt ft, l-f343, . g .. Inspector Name:_ _-Lic#�; Signature._ Dust Taken for fZA P R.A.Name,__ Lic# Recertification -----�-�._._�__._._._....-.— � Signature I' I Inspector Name: Lic# __ _ i -F-{ OMPLIANCE ASSE SSMENT NT DETERMINATIONS Signature PUSI C PC1% Inspector Name:_.._..- ---- Lic#_.- Y Inspector Lic# Ft Sig nat Signature lwt tct�f.lazw(10- _ l�_.�__ - t' t ua Lic#.—,-..-, f=u11 in,pcnUn Inspector Name _- r�ctme s Pc.AL) i --I, - -- FYI r Inspector Name:—= ,Lic# - i..._... Signature ! I 1 Name:__.__._.-_,- N 'Signature__.-----. head I Ia/rrJs> .. W iw {rt „ ,<t t , Inspector Name:._ Lic#� .-..'I ...i F visual Portion of P Inspector Name:_____-,_ I e: ---'L•IC# Signature PCAD Reinspectiur, -- _.._. Sig na tuie- � Lic# - -i F Inspector Name._ - _ - r• - Dust Cal u,f5r P p _ , � Ins actor Name: L•c# ! Signature f'C AD Reiisl,cct,c,�, I 77. J _ 9 - Si nature Lic# F Inspector Name: t i r I F Dust`Taken for Signature — Lic#� P�TICA�D Reins ectron P Inspector Name, .____ �, Lic# - .1-_-L :..�^ �- ,„..,.._.--...._..• {+ _ Signature Inspector Name = N. L 0 ��r I Signature - ;1C)f?lZf �S '? N�h�t R '_: _Alit#.:'`", — city_ J-��/R7ttNiS _._._I>a@,c :3 of 1}:t�(`t I1f't1N(:Y C1.A;'I'IF'ICA'I`E HISTORYC COMPLIANCE HISTORY (CUNT.) Inspector Name:_ Lic# tia ziov tatniil Inspector Name: __e_,Lic# ...... Signature _ Signature 1 ,i•,n„t,4�.ic1: ( � Tlo.�1'tif�°=t+tt�'�I)1151 � • Wor1 = 13irxt 1� x Ufl;illC\- '14SS4)t"Ctf.` - ( irtsp!t for Name:____, . ^_ Lic#_ _ _ Inspector Name:__ Lic# ra� Co )l!<\nt,e rr!r, Signature__ _1.;— _. Signature Utist wipci>and auth, IP µ(\ ttlu l\ur Inspector Name:_ Lic#_ _. CtlTsf,tiw.oIF Is l r\ :?A autt+rn`Cd Inspector Name: LiC>t Signature,_ ru,xzancc Signature... II,�n t:at!ii,;k No'Work=No Dust + Work i Dust HIS'I'OI2Y iil lm 11 - klJtUri it �. I a"my+4.ltu\ - Inspector Name: ,Lic#—,-, r�ci lic# 73�b C anti tt tiitc _ _ i i li,s:pector Naute: YI�- � _ _ (? 1 it I- I �/�.,_ _.L_L L� _..!._._ Signature ------ _ �_ nature l(11 Y! St.i hrua vv,,�eS Hrit{autli OTHER HISTORY: WAIVERS/UUCEPA RIC Approved -roved \..•;nu ,Lic#__ t.p t Inspector Name:_^_.____ —. GI�PPP Wa,\c! FT—F-7-1 GLPPP Insp.Name: T .Licp_�_ Ni ,!, , R. lt,t Si��nature- :_._�—�._.. - L 1._- Signature; l�ctcs kv ,'4c:o ul C �A(S13r(?Yt,t _ Inspector Name: ,Lic# >> - / ,Lic# — t' ., irl I i r �� <+\Cr CLPPP Insp.Name: Signature•____� _ __ ._..�. 1tt tCit tint comp Signature ." �ou .,,al I,u itu• Does Uta I)_S txrii' Inspector Name:__— Lic# keilla' cction Inspector Name:__ } _ P Si nature — - j Siyitature _—. 9 _ ___ _ _. �. t.t �`IU,.i.)�:,ISSitCf! F n,4\ Ir spector Name:._..- Lic#___. taken Inspector Name:_ Li —_ .� �__ .i..__, _.� � -- Signature_._,.___._: ` i Signatures_ t t: 'gip it tol ='. o 04 tst - - _ _Dust __. .i af;eat — Inspector Name:,-_.—.. Lic#---- Lic# t ' Signature - Inspector Name: No t_oc Issue,! Signature_ _— ..w EPA kKY Visual i>.s.ma.,uti. 1 `. And Dust- Lic# inspector Name:....__, lssu d and Signature— --___ NOtJl.1 qF 12(4 Page �f .� .51 SSf�I N'r'.1ZL VC)k'T 1'C) ZM CCJI tlil[€� 'I his page f..rovides gerte:ral information needed to understand the.lead inspection/risk assessment report. However, you should speak` wi(h the inspector,,risk �.:sessor before you start to do any work on,your Home.. 511)1'` Refers to A, B, C, or D side of the building or room. See'the diagram on the,cover sheet. The "A"side of the building or room is the side facing the street drat gives the property its address (usually, it is the front of the building). Keeping your back to this street, from the"A" side move clockwise to the"B"side on your left, the"C" side apposite you, and.the "D side to the right. Numbering is from left to right. A I 1()�NV Refers to the bidding component(s) being tested:.Some surfaces rriay be made, up of more than one part. For S111 F Ach exam-le, "Baseboard" may refer_to four separate pieces of wood(one on each wall),but is'still considered one.surface. LI..",D 'file actual lead result. Eitch surface tested must have a result recorded in the"Lead"column. • .1, number shows that the surface was tested with an XRF analyzer. A number(or.average number)equal to or „realer than 1.0 ing/crn2 is a dangerous level of lead.. ® A "pos"or"neg" shows that the surface was tested with sodium sulfide.. "Pos" means that there is a dangerous of lead. • "N/A"means that the inspector was not able to test the surface.Unless the owner can get a sample to test, the nspector must assurne the surface contains lead and require it to be deleaded, if necessary. • "MET or."MR" means that a metal surface was not tested and only needs to be intact, even if it is a leaded tiurface I-Imvever, nie.tal handrails, metal window sills, and'inetal ratltnf;,caps, need to he deleaded if they test equal to or greater than 1.0 mg/c, or is marked"N/ :'' For key to abbre\;iations like `COV' ,"VB' , 'VR' or 'MR"",''N(:' 'Tile` `DC" see the cover page.' • Wheri a component box is slashed and there are test results above and below the diagonal line, the result on the "bottom" represents, results below 5 ft, and,the"top result indicates tite test result above 5 ft. TYPE PE OI� Not all lead paint must be delcaded. This column tells you IF and WHY a surface needs deleading.The:deleading IIiNZARJ) standards below may not apply for Interim Controls. Speak to your risk assessor for more information. m• 'M/I"circled eans that the surface is a moveable/impacted surface and`must be deleaded in its entirety. - • "SF"circled indicates that there is a storm frame present which requires the blind stop and exterior sill be �Jeleaded as interior moveable/ impacted surfaces: • 1,iM' circled means that the surface is accessible mouthable"and'must be deleaded to a minimum of five feet ` igh, four inches in from the edge or corner, • 1.. circled means that the.surface is loose.and must, at minimum, be made intact., • tf more than one choice is circled, the rules for deleading may change depending upon what method of iVeading you choo:,e. Speak to the inspector for.more information: 1 !A" means the inspector was unable to determine:/if the surface was a lead hazard. The person doing the, deleading must check this surface and follow all the Riles for deleading.°Speak to the inspector tor more information. • If nothing is circled in the column, then.ir is likely the surface does not need deleading. Speak to the inspector for more infonnatio;n. Remember, this dues not ;Wean the entire surface is lead free, it just does not require deleading in its curr'ent'condition. L Id(; IIAi:' This ci)lunur is only completed during a risk assessment. A risk assessment is an evaluation of a home's suitability for Interim Control. Only it licensed risk assess it can do a risk assessment, not all inspectors are'risk nsse-csors. if"Y" is circled, then this surface is considered an"Urgent Lead Hazard" and some type of deleading work is required to qualify for Interim Control: W OA'11 'The (late the licensed risk assessor determine!"the surface,meets'the standards for Interim Control. IC Nl F..I'I I The deleading method or structural repair done to qualify the surface for Interim Control.Refer to the deleading co(je,, key on the cover page: 1)V f.LA1) The date that the lead inspector reinspects the surface and finds that.it has oeen'successfully brought back into 1).A'FF Comi:>liance. I)F:t E,rl) The method used to bring a.surface into full compliance. Refer:to codes in the Key on the cover page ofthe PCAD E?:( Ltll:>hD The ,trnount of loose paint on a surface as measured'by the lead inspector. "N/A" means that the inspector was not SURF/4,Fs able to measure the loose paint, but has detennined.it is rttore than the cut-off for moderate risk making intact. I 'R n. Ian I _ Page 5-01.Z nspeclor(print) Lic Signature v Late _ 72 Nautical [Road, Hyannis 02601 Date Risk Assessor(print) tember 6, 2011 .Address of PraAertY' _J_..Seap.. . .; City: _ ROOM 4 J SIDE LOGATIOPU 6EA T1-PE OF URG IC tC DELEAD DELEAD SIDE l_OCATIONI LEAD TYPE OF U A G IC i.0 DEELEAD DELEAD SURFACEHAZARD HAZ'' DATE . mETH. DATE' tAETH SURFACE: HAZARD HAZ? DATE METH DATE METH Up tA1a1Is V10 L N/A Y A W irtdow Si] Q.d M/I AIM L ,VIA Y n Lovr Malls V10 L NIA Y B VV Apron Q.t AIM-L NIA Y r 6a5ebo rrds 0A L IWAI Y C winCasing '�.� And L NtA Chair Reif Aihi L NIA Y D Header- topes 0:2 NVI Vivi L NIA 1` N U Rid aicr A'?�i. N/A Y Iht`Siops Q.� m!1 'f m l NtA a 'y r; =lF"Floot A/l.f L-MIA Y 1 51tin In!Sash' V y I M/I 'AAA.L NIA . Y 4t Ar{rt L WAY Eztcrr9r Sill t-0il $F Ceiling L NIA Y A aor 0. AIM L NIA. Y' 3 Part Bea.d,. M11 L NIA Y C Dow Casing:_. 0 .2 A/M L NIA Y 4 Blind Stop 10/1 'SF L N/A 'y 1 2 Dow Jamb A;M L N/A Y WNtn Ext Sash 10/1 L NIA Y 3 4 Thrcahc;ld c A M L t,ILA Y A .Window Sill MA •.AiNA L NIA v A B Dnot Q AJM L N/A Y B Win.Apron do IV?vl L N!A Y 07111 / C A� A./lA L NIA. -Y - C Win Casing )],�j � .,:AfM L N,A� tY - J t'tf3rir=-�cSIA1g L !�' 2 Door Jamb A= L N/A Y Q Ruder Stop . a Ail A/Ni L NIA, Y 3 4 Threshold NIA L NIA Y fn°Steps. Mtt Alm, L NfA 'Y A B Doot- AU?.41 NIA, Y 1 V;n Int fi�sfi v411 A ins, L ?VIA Y. C D Doti Casing A11A L N/A Y EzIbrior Sill MA Sir L NIA Y 12 Door.Jamb AAA L NIA Y'. Fait Beatl tdlt L NIA Y 34 'InwS tti3C1 AN,L NIA tY7 4 c�3it7ti SfUtt M!I Sf L NIA. `Y A B Drxr A R4 L NIA wlin Exf Sash ?VI L N/A .'Y CD Door Casing w.,i L NIA 1' A y1.indow Sill 34I1 AiM L WA Y 1 2 Do r J2rttn AIt,1 l NIA Y B Wtn Apron NM L NIA Y T 3 4 Tlifesnr>ld A10 L NIA Y C. Nlrl Casing AIlA L NIA Y A CI{iSe t)oor �,<W L NIA Y D Header Stop MA r�wl, L MIA Y B Cliasog A111 L N/A Y IniSlops r11.1 AINT L N,A- Y, C Ctc4f.lamb A;`tr1 i NIA Y t Win[fit flash" teal AAA L WA Y Closet Walls A%A L 11A, 2, Exterior Sill 1,411 SF NIA Y Cf Baseboard 0. AIM L N/A Y 31^ €?ai#B+?ad" All L NIA' Y 1 Close!bole Q' ArM L NI,A Y 4 t3tlnd Siap Mit SF L NIA Y 2 Closc i?;he It a;( A'N9 L N!A 1' b"An£xf Sash t I L NIA Y 3 Ct SuFports A=hi L NIA Y A B FWeptare: AIM L NIA Y d Cir,_PI Floor Q A?;1 L NIA C D ':1i r t21 AIM L NIA: Y - Ah L.•I��sS'vt i^.f,i'stng �!/ 04 L NIA Y - lain Above�a � A4i L N/A� Y , C9 CO?.f:`,AEt�TS I STRUCTURAL DEFECTS: Ceiling hioldin' AAA L NIA Y kM L N/A Y A•J f L h},f+: Y ArM L Nr`A Y MID�E D� RFA'E.: tfrf ces listed m these boxes can be nade,INlact only bey a licensed,de►eader. r, SIDE LOCATION N EASURE:LOOSE PAINT IC IC'' SIDE LOCATION MEASURE:LOOSE PAINT IC (C (MORE THAN 288 SQ.IN.) DATE METHOD (MORE THAN 288 SO,:'.:) DATE htcTfi0 IJ/RA RCpRoonl,8/08 r G Page Oi !�,sitf3C',or(prl111) Lic 4' - Signat4m te 72 Nautical Road, Hyannis 02601 Risk Assessor(print) Date Address of Property_._ ..___.._. September 6, 2011.: ��. ch: ROOM 310E LOCATION/ LEAD TYPE OF URG IC ,IC DELEAD; DFLEAD SIDE .LOCATIONLEAD TYPE OF tFtG IC lG DELEAD D4LEA0 SURFACE FittZARD HAZ? DATE "MSETH DATE P+iETN- 5URFAGE r HAZARD PAZ? DATE h"iETF�, Or TE PSETN A a Up it""/ails iVtA t NIA Y Window Sill NIA Aim L NIA Y G Low+Tlalis iVt,A IL N/A Y t^1 ra ApcA» 0,,(. alltA L N)A Y r Dasepoares iVM L WA Y. _ C 1�lin'Gasrng.; AIM L NIA Y Chair flail iJM L NIA Y D Header Sop: Q fJ iitl A!t•f L NIA -Y a p iladiatar IJEh L. N/A Y lnt;Slops MAAlto# L WA :Y 0 `` Floor ?J�h L NIA Y 1 Win Ini SaSh Rill A M L NIA Y - Ceiling; V t.i.L NIA Y Exterior Si{I t,4ll Sf L NIA Y B Door Lrt:L NIA 3 Par,S Reach NIA Dow Casing Q VM1 L NIA 1` A Blind Slop M11 SF' L NIA Y: _ 1 2 Doot,hFunb AIM:L N/A Y - Nlin Ext Sash A . k4A L NIA Y 3 ;'Thresttol4{ AJtA L NIA s A Window S"til M11 Alh`l L NIA Y �. a; Y B Win A aon AIM L NIA Y B rocs NI L.I - p (� D+<t Gasirtg Q adi:3 L NIA Y G �Nin Gasing AIM L NIA Y i 2 oo=)r,minu kiN -L NiA Y - D Header Stop'. Q.Q M,11 AAA L t�1tA 'Y 3.4 Threshold ^A/hf L N/A "Y ` Ini`Sleps Mli AJrvt L NIA Y A.E3 Day' Af611 L (!IA Y . 1 Win!ni SaSYi Mfl xwl L.NIA a C D D��orCasing AfM-L N/A Y 2- E ierior Sill - M?i SF L NIA Y 1 2 Door Jamb kIM L.N/A. Y 3 'Pah Bead MJ L NIA: Y a 4 Thre'shold Afti�.L NiA: I , 4 Blind Slop: , tAl1,, Sf' L tdlA Y A B Door. AIM L NIA Y kVin Exi Saskr M?f. L N/A '.Y C D Door,Casing Anti L_N/A Y A Dt{indovt Sill . . Mll AIM L NIA - Y 1 2 DaorJamt> A;4,L NIA Y B Win Apron A'tJ L NIA 34 Threshold AIM>L NiA Y C rhlirt Casing a Alto: L NiA Y A Close-I Dooi AJM L N1A Y D Hu.der.Stop" Mil AiM1 L NtA 'Y B Gi.Casir+g �Pt'ta-t L NiA Y iritSto{�s tvtii,AW L N1A ''Y sP Mil AiM L WA Y C Clow_!Jamb tttwl L N1A Y 1 W.lt1 tnl Sash_ D CICs t maps A1:��L NIA 1` 2 ,Extctior Sill; t•A.S+ L.NIA Y CI Baseboard AIM I. NIA Y 3 Part Bead �t?L L NrA Y 1 Closel Poie AtM L N/A Y 4 Blind S{pp IvA.11 SF L NIA Y Ctoii t Stteli .+ A+h"i L NIA Y Win Exl:Sash M11. L 141A Y 3 CI Sfip;orts Atki L NIA v 3 A B Fireplace AItA L NIA Y Omel flr or1.ArM L NIA t+ C D aiarit�I A='M L N/A Y rvh7.L NIA Y ,, In AboVe 5' AOM L Nit^, Y GIL:;eI Ceiling L a �MMENTSi S T RUCTURAL DEFECTS: „ Ceilrrtg taioidtr' Atht L NA Y l _ Atri L NIA Y G A,4.4 L N?A / A/M L Nt h Y €X L.Lt.) �GRFA ui aces 1Sie .,in these boxnggn. o,ma c Intact Only y a,licertsed eleatler. SIDE LOCATION• MEASURE:LOOSE PAINT IC iC „ 510E LOGATfON MEASURE:LOOSE PAINT iG IC (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.i.N.) DATE M"cTHO r i.n• D....D....... QIC j Page 7 Oi specirt:(grin(} Lic ii SignalLIre Cate 72 Nautical Road, Hyannis�02601 Risk Assessor(print) Date September 6, 2011 l�d�fress of ProGery. �Ciiv: '"IDE LOCATiONI LEAD TYPE OF URG IC IC DELEAD D.ELEADi i SIDE LOCATION! LEAD TYPE:OF. URC IC iG DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH, 'DATE METE{ $UAFACE HAZARD HAZ? DATE IMETH DATE M.ETH tit Up Walls L? Whi L NIA Y A. window Sill. 0, M!1 AQ L tJtA . Y Low r14'itl!s`G�' �: rtfA1l h!!A "s, s "i.IAproji. iWA L NIA Y Baseboards. 0 JUM L�Ni Y Wiii Casingg' (� AIM, L N1A Y Chair Rail �/' AJM L NIA Y D Header Stop 0,..d Mil AN L,WA Y ae Radiator rL-M L NIA Y Int Slops h$'I A/M L N/A Y _3. t - 1 Win IM Sash Mil AfM L"N/A Y Ceiling a 2 Exterior Sill 10/I SF L NIA Y _ A s^.00+. 0 Q ,UP,I L NIA Y 3 Part Bead NO L N/A Y` ._.. D Doos Casing D. ,VM L NIA Y 4 Blind Stop hi+I SF" L WA Y 1 2 Door Jairh Vi:4 L NIA Y V&EExt Sash iv'uI L NIA Y. 3 4 Th+eshotd .0.4 L NIA Y A Window Sill Miff AIM i.N A Y f Dro V{A L N(A Y 'Al n Aproh Q. AJkl 1 N)A Y .. C D Door Cesir?cJ �/IA l NIA i v tin.1aS:no ,VM L NIA Y --- 1 2 Door Jamb �M L Nr'A Y ►U.J Headnr Step; {�;:�J Mil AW L NIA Y 3 Thres,hold kthi L'NIA �' � Int,SiopS � mil AM _L N/A Y A t� Doo. W4A L NIA Y 1 Lorin Ini Sash , Eli A/M.L NIA' Y p D%or Casino_ AlPA C NiA Y 2 Ezterior:S111 Atll SF; L.NIA Y' •1>2 Dcv Jam fVut L N/A Y 3 Pari,6"aJ N1fi L Nr'A Y 34 Threshold AfM L N/A Y 4 bitid Stap M/I •SF L-N/A Y AB Door AIM L NIA Y WIh Ext Sash Ivi1l L N/A Y D Door Easing Attvi L-N/A Y A Window Sill N411 fJtA, L N/A' Y 2 Door Janet APA L NIA Y © yN n.Apion A,`M L iI A { 34 Threshold /M L N1A r' � "!in C<sins AIM L N/A Y A Closet Doer e IFi L NIIA Y d treader Si op MA A1tA L Ni,1 Y CI Casing AM L N'A ' Y nttSiOps. FAtI AfN1 L NIA, 'Y _ Closet Jan+h- A`M L N1A .'°Y 1 ' Won ln,'SaSh tAll A,'fi: L NTH Y D Closet Watts' AIM L NIA Y 2 Uierior'Sill Mil SF L NIA Y CLFsaseboarct '�.�. A+N1 L N/A Y . 3 Pitt Bead' M11 1 NIA Y 1 Closet Pole AIM L NIA Y 4. Bl1hd'Siop t4/1 SF L NIA Y 2 Ciotsat Sheit 0 AN L NIA Y Win.Exl Sash,. hill Ltd/A Y 3 Cd , p;;arls AtM L N/A Y A B Fireplace'. AIM L NIA Y Clo:;et Flow AiFA 1: NiA Y C'D .N_Q qtell AM L NIA f �� :',�M aBLtosei c:eiiing �N,� Y Gr Win AL}ove. A1PA L. NIA Y Ceilin %Vdin Attel- , NIA Y C04v1htENTS/STRUCTURAL DEF_ECTS: g A(M L N/A Y A+M L NIA Y A/h1 L.N/A Y X LU15ff U i ACES:.u3 aces-lsted in 5eSe boxes can ernade i.h*'t only by a licvs6d delea7er. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MORE THAN 288 SQ..IN.) ., DATE METHOD' (MORE THAN 288 S0.i'..) DATE METHO Page rkFO f-f " �Gt} — --"A73 _ Inspector(print) Lic 11 Signature Date Risk Assessor(print) 72 Nautical Road, Hyannis 02601 Date Address of f ropertY: September 6, 2011 city: KITCHEN SIDE LCtCA7i0PJi LEAD -TYPE Of URG" 1C IC D';ELEAD DELEAD SiDE "LpCATdOhtl' LEAD TY?E.OF URG IC IC DREAD DELEAD SURFACEHAZARD t4AZ? DATE P,9ETF{ DATA hAETt1 SURFACE !/1} HAZARD HAZ? DATE METH DATE hlEl'N Co Up Walls Aft L WA Y A 'Idi arlOw Stli L/ milW'A L NIA t r' n a 8 Low rvala; i:rFA L NA `r B Win Apron- AIM I. NIA Y 6 ,t,/NI L NIA Y 83-servoerds 9 0 Y C VJ'tri Casir�', � AIM L NIA u 1�:l L N(A Y D Header Siga (� Mfi Alht Chair Rail L NIA Y ,, t1 M '. natilator )Vhi L NIA Y lrSt Slr V1111 A441 L N€A Y Floor 1VAq L N/A Y - 1 Win inr Sash. M(t L NIA Y µ i1rM L NIAY` 2" ExtErior Sd 'Mil SF L WA Y Cer!utg { !3 Door ArFA L NlA_ Y '3 Pari Beal fm L N+h! Y D Door Caging { 0M L N/A Y 4" Bi nd Slop tAlf SF l NIA Y 1 2 Door Jamb V A'hi L h!(A Y WRExtSash MN L WA.` Y 3 A Thresho!d gltA L NIA Y A, tNindow Siii Mi! A(M L NIA Y A B Door W L JVA Y 8 lhlh A^ron AtM L NIA] Y 7Gd:Cas—iriq NMI NIA Y C Win.Casing A4M ! N/A Y 2 Dco!c Jamb A�tid L_NIA Y � D Header Slop tvtif AIM L NJA� Y 3 4 Threshold A'JA L NIA Y . tni Stops, MA iJM L ^JtA r' A B Oc'oi AIM L NIA Y 1 ("fin IntSash h:tdl. AIlvl L,t,11A Y C D Dr�or Casing ,. Af+A L NIA ,.Y L Ezten l Sill Mii SF. L NlA . Y 12 Door Jamb —AAA L N(A Y 3 fart Bead t:ti L NIA Y 3 4 Threshold' Ath4 L NIA:` Y & ti°nd Stop Mti SF L N14 Y A B Door" A40 L N/A Y Win Ex Sash tv11{ L NIA Y C D Drwr'Cas'sng A'h1 L`NIA. Y` A'.8 IJp,Cab;F.rame AItJ L NIA Y 1 2 Door Jamb AIM L NIA Y C D' ip.Cab odor 0.0 MA UNtti Y Q ThresholdA'h4 L"Eflh Y Up Cab Wails 1) AW L.N/A Y A Closet Door A{M L N/A Y 1 2 Up Cap SWs Attu( ! N;A t B CtGasirtg AIM t.PJ(A Y 34 Suppotis Q: A]M L NIA Y C Clcset.lamb AAA L PIA Y Lou Cab FFram +jM L N,°A' Y D insei'A'.alls A(t: L NIAYA$: Low Cdb Door Q;0 A1M L 'NIA Y CI S�boa A,tht L Ni'A 1' C ow Cab VVali. jo !%`M L•NIA• Y r Low Cab Stil: (� ( A!M L N(A. f 1 Clo AIM L N A Y 2 Closet Shelf A1tA l NIA Y 1,2 Supports Q.� Ait•A L NIA Y 3 0'1Supp6lls ArM:L NIA Y 3.4 Drawers Q AihA L N/A Y A G' 4 Close!Floor n'M L:N/A Y . C o 4Yin AbOVB 5' tvtft A/M L NIA Y MiI A1M L NIA Y Close!Ceiling tJM L`NfA Y COMMENTS STRUCTURAL DEFECTS: t4al, AJ;t L N/A Y bMli MM L NfiA 'Y M!I' NtA L NIA Y MI[ AIM L NIA Y EXCLI-DED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC lC SIDE LOCATION MEASURE:LOOSE PAINT iC IC (MORE THAN 268 SQ.IN.) DATE METHOD (MORE THAN 288 SO,IN.) DATE NIET14( �73 � > ur Page of 1 U Inspector(print)' Lic 4Signature' � Date 7:2 Nautical Road, Hyannis 02601 Date disk Assessor (print) September 6, 12:011 'City: Address of Property: BATHROOM# SIDE LOCAT101it LEAD Tt'PE Of URG IC 1C DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE ti42.ARD HAL'? QAT t.1ETht DATE tv4ETti SURFACE HAZARD HAZ7 DATE METH DATE METH t 2 Up Walls V p AIM L N/A Y Low Cab Fram A/M L NIA Y Low Walls l��' A/M L NIA Y Low Cab Door. AIM L N/A Y rl t.;I. NA Y COC Low Cab Wall, A/M'L:NIA Y Bas+3tio:irds �,.�' ' t f, Chair Rail Alm L NIA Y LowCab Slily, A/M L NIA Y "c A1N1 L NIA Y 12 Supports D AIM L NIA Y � - h=raw Floor ( NNI L NIA. -Y 34 Drawers AJM L N/A Y � Ceiling AIM L NIA Y A Window Sill o 1v111 NM L N/A Y A Door ArM L NIA Y Win Apron " A/M L NIA Y Win Casin pp AIM L NIA y t D Ooor Casing A P.1 L NIA Y: 9 V •1 2 Door Jamb Art:R L NIA Y D Header Stop Q M/I AIM' L N/A Y 34 Thn;shcrid rL'r;1`L N/A Y Int Stops MII AIM,L NIA Y A.B Dot:r A to t. �JIA ( 1 Min Int Sash M/I AIM L NIA. Y;; C D Doo(Casing A'tA L Id/A Y 2 Exterior Sill Mll SF L�NIA Y 1 2 Doer J=mb A'tA L NtA. Y 3 Part Bead Mil L N/A Y is Thaslt�>ld`; AIM t NIA Y 4 !31ind Stop M/I SF_.L fVA Y A Closet Door AiM L NIA Y Win Ext Sash toll L NIA Y AB B Cl Lasing Arl'a NIA Y CD Win Above 5' M/I AIM L NA Y A© C Closet Jamb A/ML NIA G p Ceiling Moldin M/I AIM L NA Y _ AB Q Closet 0/ails XIM L NIA Y co Medicine Cab MA AIN1 L NA Y Ae { Cl t3aSf`bo rd AIM.L,N1A ! c p Wall OIC . M/I AIM L NA Y 1 Closet Pole AdM L NIA Y �r1 M/I A/M L NA Y °- M/I AIM L NA Y 2 Closet Slrelf A,04 L N1A Y 3 C!:�dpporis fi1PA L NPA Y :. MII AIM L NA ,Y Closet Ft:�or AllA L NIA X M/i A/M L NA Y Closet Ceiling NML NiA Y Mll AIM L NA Y IC AW L NIA Y MII A!M L NA Y Up Cab Door ArM L.N/A Y Mll AIM L NA Y Up Cab Walls tb'PA L NIA Y M/I A/M L NA Y 1 2 Ujr Cab:ShIvs IVN"I L NIA Y V Mll A/M L NA Y 3 4 Supports 10kl NIA Y - * M/I AIM L NA Y i4II NPr1 L NIA Y M/I A,'M L NA Y at Nh4 L NIA MII AIM L NA Y =rill /vM 1 NIA Y M/I AIM L NA Y l i 0,;;lAEhJTS r STRUCTURAL DFI_CTS: COMMENTS!STRUCTURAL DEFECTS: EXCLUDED SURFACES; Surfaces listed in these boxes can be made intact only by a licensed dpleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE :LOCATION MEASURE:LOOSE PAINT IC 1C (MORE THAN.288 S0.IN.? DATE` METHOD ,MORE THAN 2B8 SO.IN) DATE rsETarC — gyp _ LVR.A RcpBath,S/f;S ` - f PageAotff Inspector(print) Lic 4 Signal we Date 72 Nautical Road Hyannis 02601 Risk Assessor(print) Dale Address of ProgertL__ September 6., 2011 City: HALLWAY,- Interior # or Common Hallway, Front Rear Floor SIDE LOCATION/ LEAD. T"PE OF URG fC 10 QELEAD DELEAD SIDE LOCATION-I LEAD TYPE OF URC IC IC DELEAD,DELEAD SURFACE HAZARD HAZ? DATE METll DATE METH SURFACE HAZARD` HAZE? DATE METH DATE METIT AB a Up Walls AIM L N/A Y A. Closet Doot rVM L NIA Y h !i LowWallsV; AIM LNIA Y d ;LIr Ksr,y- A$l,L,NIA Y A r. Bas?bwids NM L NIA 1` At sh L WA Y r, r A8 Chair Rail NM L_NIA Y D C s Iis A,11:A: L NIA, Y ' r lavei'M/a, A.e ea Radiator AlM L N/A, Y 013aseioafti Arm L NIA Y b jx Fl%ir Aim L NIA Y 1 Closet Pole Aitd L NIA Y g.qJabo AIM L NIA Y 2 Closel Shelf A4ii L NIA Y AIM L NIA Y 3 C Supports Alm L N)IA Y AIM L NIA Y r1 Ctasct Floor AAA L NIA Y 1 2 A4.4 L Cd/A Y Glosel Ceiiitag Alm L NIA Y 3 4 Threshold � Altvi L NIA Y A winnow Sill U tilt Alm L NIA Y A B Door 00 AIM L NIA Y .Win Apiort NM L NIA Y. PD Door Casing 0, N?-,4 L N/A Y � Vlin Casing AIP,i� L NIA2 Docr.Jarnb AVM t. NIA Y Header SlCp Mil iyM L NIA Y 311, Threshold AIM L NIA Y in!Slops � t,ili� Aa i L, NIA Y _. ._ +r- I � t Y tAil t. N.A A •t 1 S,inlMash A L `h t l A f3 Dr�e�r Ar L A Y � . Door Casing Q. Asti L NIA Y 2 Exterior Sill tail SF -L NIA Y i 2 Door,iamb A=NA L NIA Y a Fart Lead MIi L hIA 'Y 34 Thtd shold kM L IN A Y 4. Blind Stop mil SF L NIIA Y A(3 Door C(� Ar'M L WA 'a' Win Exi SasT� Mt1 L N1rA Y IS D Door Casing &IM:L NIA Y A' Windovv Sill' Pill AfM L N/A Y I Door Jamb. AAA:l 111A Y � i^Irn Apaciri AIM L IA ,Y 34 Tt,reshoid A'hi L NrA Y C wr,n casrn f{r 1 L N/A Y A 8 Dour XM L NIA Y D He�adef Stop hill AtM L NIA Y C D Dour Ceasing lt4,i L N/A Y 1i�t Stcps t;f/l AIM L rilA �` tf DOOF Janiti . A°-4 L NIA Y 1 Van fnl Sash Mil lv�M 'L MIA ', Threshold AIM&L NIA Y 2 Exterior Sill I.-VI SF .L NIA Y A Closel Door U AIM L NIA Y 3 Part Bead NO L NIA Y © Cl Casing A I-Al L NIA Y 4 Blind-Slop hill SF L NIA Y C Closet Jamb A`PI I. NIA Y 4!n Ext Sash imli L NIA Y _ A OD Closes Walls`— � A?;A L NIA Y Co Win Above 5' hill APA L NIA Y h6 CI U,aseboard AV L NIA Y Co. Ceilinghioldin. 10111 Alhi L NIA Y 1 Closet Pole A%P,i L NIA Y 1,111 Alla L NIA Y 2 Gtoset Shell AIM L NIA Y COI,MENTS I STRUCTURAL DEFECTS: 3 CI iip(lorisC Aim L NIA Y 4 Closet Floor AIM L NIA 1' Clo et Ceiling NIA L N/ALj Y EXCLUDED SURFACES:.Surfaces listed in these boxes can be made intact only by a lcehsed deleadet. SIDE LOCATION MEASURE:LOOSE PAINT IC IC SIDE LOCATION' MEASURE:LOOSE PAINT IC 1C. (MORE THAN 288 SO.IN.) DATE METHOD (MORE THAN 288 SO.IN.) DATE METIX Irispeeiitr(print liG!! Signature CJalcr 72 Nau#ical �:oad, Hyannis 02601 Risk Assest,Ur(1)(ind) Date ; Ar;rJre 5 ol�l?to}Iert' �^ 'September 6; 2011. _ City,: STAIRCASE I IE i D �O Vt 510E LOCATION( LEAD T'eP_OF URG 1C 1C DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAlAlTD }iAZ?. DATE h,;ErtC DATE ivtEihfi SURFACE HAZARD HAZ? DATE METH DATE METH r IUp 11+alls Als1 L NIA Y A Window Sill M/I AIM L N/A Y Lnw Wails AtV1 L N0A Y S Win Apron AIM L NIA Y. n p , n LTr;�uboartts i t%4 L PIiA Y C thin Casing ,A/M L. N/A " Y o C:Iw;r l:T3i APM L VYA Y D Header.Stop M/I A/M L N/A Y t,o i.rdtslUr A`r:4L tJt{ Y Int Stops M/I AJM L NIA Y °,1'r Floor A'i 1 L,NA Y. 1 Win Int Sash M/I A/M L N/A YF Ceiling (; AiM L NIA Y 2 Exterior Sill Mtl SF L N/A Y F B Doti S/ ArfA L NIA, 1` 3. Part Bead M/I L N/A Y �_. C; D Dooicasintl ilt4 L t1/R Y 4. 131indStop- Mil SF L N/A g..Y 1 2 0,6nr Jamb A.tt L N!A' f � thin Ext Sash M11 L NIA Y' :3 4 Thresnoid 7tM L WA Y i A Window Sill M/I AIM L.NIA ,Y A B Dho, 0 'ONI L NIA. Y B Win Apron A/M L N/A Y (; ( D,wr Casir1q A,',1 L N'A Y C 'dJin Casing AIM L NIA .Y 1 2 tic r,lan o 10A L N'/A Y. -D Header Slop. M/1 A/M L N/A Y r 4 trtfesitdty' A'1A L NIA Y Int Stops. Mil AIM L NIA Y 1 - Dr�or A'h!L N A Y 1 Win Int Sash M11 AIM L NIA _ Y CDa+r C;�S§ntj AIM L NIA Y 2 Exterior Sill Mll SF L N/A Y 1 2"Door:Jamb OU AIM L NIA Y 3 Part Bead : M/I L N/A Y 3 it Threshold AAA L NIA Y 4 Blind Stop will SF L NIA Y It 8 1-mor AIM L NIA Y Win Ext Sash M/I L N/A' Y _�[ Dow ClIsing. - Att+L N A Y� � . i�tJewel Posl � AJM L N/A Y V 1 1 2 Door Jamb AIM L K/A . Y r"r{� Bailing Cap NM L N/A Y' 3'1 Threshold Art;L t-t1A Y Handrail A/M L N/A , Y. A'M L Pd A r Balusters A/M L N!A "t'Y C D Dourc1fing /.- iAl LJNIA Y" rowerrail ". AIM L N/A e Y 11 Door Jamb t o L,;NiA Y rteads AIM L NIA Y I Thrrsitiold l?M L NIIA 'Y fusers A/M L N/A Y T Closet-ourx F©Il,I L NIA Y ��t^� Stringer �� A/M L NIA �Y 13 CI Casing / ArM L N/A 1' Floor Edge ,/� AIM L NIA Y !7 C Clescsi JFiii�b hIM L:NIA Y Floor Casing AIM L N/A Y tJ I (ns<iVdalls fVf,1 L NfA Y LL t�I/I AIM L N/A Y t,Isas.- old 04L tVA �" � COMMENTS!STRUCTURALDEFECTS: t 'losnt Polo AfM L NIA Y 2 Aiki L NIA Y. 3 C.15rtp{>itr15 i M L, NIA Y 4 Clos?I Floor XM L NIA f CltrsaCeiUirg. tVM-L NhA r . XCLUDED SURFACES: Surfaces listed inIhese boxes can be made intact only by f:licensed d.eleader: SLOE LOCATION . MEASURS'LOOSE PAINT IC IC S10G LOCATION MEASURE:LOOSE PAINT iC TC (MORE THAN 28 SO.IN,) DATE MET H0D ' (MORE THAN 288 50.IN.) DA'E METHOD Page/0201 . !nspertor(print) Lie;: Signature V Dine — 72 Nautical Road, Hyannis 02601 — Risk Assessor ,print) Date 6 2011DateAddress of Pro�-eft y: Septe City: EXTERIOR A Side SIDE LOCATION/ LEAD TYPE OF URG IC IC" DELEAD DELEAD SIDE LOCATION! LEAD TYPE Or. UEtG lC IC' DELEAD DELEAD A SURFACE HJiZARD HAZ? DATE METH DATE METH A SURFACE . HAZARD HAZ? DATE METH DATE M.FJH t..N/A Y Window Sill 1R 1, L NIA Y Corner boaim I. N/A Y' A VVin Casing () JVM L NIA Y A Lower Trim L NIA Y a % iiaow szsn. .V K. ;VIA L NIA Y Upper Trim L NIA Y •,lvinoo.�Sill 11".S L N;R Y Win Abcve 5' L N/A Y A JWin Clsin, 107 AIM L NIA Y — Porch Above 5V L N/A Y h'in,ow Sash' AIM L NIA Y Storm Door JrVM L N/A Y W ndo.. Sill ;4M L N/A Y Door 1VM L N/A Y A .Win,Caing00 A Y A Door Casing iVVIL NIA Y a. 15iir dow Sash <1r L WAY. 1 2 Door Jamb r rVM L NIA Y Wirsdow Si;? AIM L Ntk' Y 3 4 Threshold IVM L N/A , Y: Vlt'i'In Casin-9 ',Q!A L NfIA 't i<iCMCu�alr IVM L N/A -•.Y '- „ N;ndpu•Sdsh ^jtA i MIA v - - Storm Door v IVM L.N/A Y C2lrar'tNirt Sts A1M IL NIX Y )OOr L 1VN4 L N/A Y - t Plf,4. 'NIA .I:. --- _ A Ciel+hin,,ash A t)oor Casing NM L N/A Y x Get Win Fiat atNs L NIA Y 1 2 Ooor Jamb WM.L N/A ,Y Cc#ihar Win Srls AIM L R}!A Y 3 4. Threshold IVM L NIA Y A Cel;4aI"Sash A!M L N/A Y Kirkpsale NM l NIA Y Gel Win Frame` AN, L NIA Y Doo' IVM L N/A K A%M L NIA Y A Door Casing iVM L N/A Y Foundation A& L "41A `` 1 2 Door Jamb iVM L N/A Y A Bulkhead A/hl. L',L'!A Y 3 4 Threshold JVN4 L N/A Y Fences AN i V/A Y. Window Sill IVh4,L.N/A Y Shul!er5` rf A?h1 y L NtA Y A Win Casing J'uM L N/A Y Plvtyel post AIM .L"N/A Y 'Nindow Sash JVh4 L NIA :Y Fiailiri 1 Cep A'M L NIA Y Window Sill WM L N/A Y Hr ndreil A L 14`1A, f A Win Casing dd Mi L N/A Y A Balusters Aw L NIA Y 4 Z ;Nindow Sash Mi L N/A Y Lower Bali A+M L N/A Y — ' Window Sill IM L NIA Y Treats Af,l L NIA t A win Casing 0n 1AI L NIA Y. F4ESvrs A M. ? tJtA' 1 1 window Sash 14M L N/A Y Sttftiaei - A M' L ENA Y A L N/A Y Lattice APA L NiA Y Larrc Past P ;OMMENTS 1 STRUCTURAL DEFi:CTS VA:'indowbpi,( L t•!IA y AupF?aris, L NIA Y i)ownspouits L NIA Y Ovarnang Ttin AA4 L NO Y Excluded Surfaces:Sudacess-listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area 1 1200 ppm for bare soil) :SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASIJREMENT RESULT REMED REMED (MORE THAN 1440 SO.IN,j DATE. METH (Square Feel) (PPM) DATE METH k _ Play Area ®� , Bare.soii —' A Ccinments: ' . A _ Page r - .Licd :�!cna?ti!k3 - L}A 1e - - - -aNe;cur .f�r�.;,l; J 72 Nautical Road, Hyannis 02601 :,k AS C.:;:0r(1):,;,1� September 6, 2011 cis Dale P-ilvn ?.51Ce Dc L :! LE _� TY:'E 0€" URC iC 1( DE EAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC 1C DELE Q DELEAD .rh �..� 7 i l T T ri„ZAP:C: riAZ DATE METH DA:- hIE,iH B SURFACE HAZARD HAZ. DATE hET� tArE ME•h L NiA Y Window Sill ArM L NIA Y �_ rcrrntr fl,,-tis D, NIA YB 'Win Casing AM L NIA Y _. y _ ur Tarn L NfA YM Window Sash AM L N/A ,,,.: :Y 13:)t)Pr Tr:n, L NIA v Wln0ow Sill ,. AIM L N/A Y B Win Casin A,M L N/A Y r;:e it Above`,s' L NIA Y k Window Sash A M L NIA Y —�V— $Ir)mi:C°:?tir AlM NIA �- Window Sill AIM L N!A _ Y. . .. < C NIA .Y B Win Casing A/M L NIA Y DorN C,iSttuj90 A '.t .+fA v x Window Sash 'M L N/A Y _ —, _ .:. "M. yr +ar,tCi Ft� ! N%A 't Window Sill AIM L N/A - --- ti- B Win Casing ArM L NIA y' _ et,btiij D ~!1 r NfA ,tare GJ4 t t•.+;. Y rx Window Sash AIM N/A Y r,• WA v Cellar Win Sill ' � A'M L tJ1A Y — �— r, i µ Y e1W, h A'M L NIA Y'. —iiT . r„.5 t' me L, AMN1A•. Y,) NfA t ill �//�� A'M L N/AG�,rCsho�ri t.t L�NIA v h A'M L N/A Y•rk1 L NtA trie AIM L NIA Y — - Dddr ftrhl L NIA Y r � / AIM L NIA- Y .t}onr Ca>ing ;-,?M L N!A Y Foundation L N/A Y B 3u5head / AIM L NIA Y —. >t�rshcd ,`r.1 L NIA Y Fences ArM L NIA Y ±--,cow Sill vvu^—d t L WA Y Shutters AIM L N/A Y NIA Y Newel post AIM L N1A ,Y y flailing Cap: . AR.d L NIA Y- Y Handrail A/M L N1A �lrt.4L Y .. _ B i3alUSters., AIM. L NIA 'Y. h hndpn S?s,h +LrM L NIA 'i — tower Rail AIM L .N1AI tJmdo.' St1i ,>? C NtA :r Treads. AIM L N/A Y _ :lin4as+n jL/rA L NfA Y Risers AIM L NIA Y �. ,. —i?AdL N/A Y Stringer — AIM C NIA in.dow Sdtin �!— Lattice A/M LL NIA�� I Windowbox 1•Ot,i`t;_7;TS/S?r1UCTU'tAt.DEFEU 5: L NIA j Y B Sur is L N/A Y. DownSPOLA L NIA Y t7remang Tnn A/M L N/AI Y ,;e , curicces Surfacs Lsled in this;box ,<in be made Soil Test Results " inlac',cniy by a licensed de Bader (Must be less than"d00 ppm fc}r play area 1,1200 WTI for bare soil) ` CC LOCATION AREA MEASUREMENT RESULT nEVFr RPMEC ;;;u=E LCs.r 1I;)tt MEASURE:LOOSE PAINT (MORE THAN F .440 50.IN,} D - € .!ETFi Square Feet l (PPM1 DA'r ME T H A� Play Area _ --`— Bare soil Comments: _ 9 z .- Pa e Oi Inspeclor('prim) Li_a Signature Date 72 Nautical Road,.Hyannis'02601 lisx Assesscr (print) Date _ September 6, 2011 Cit nurress c. Prnpr rtv: Y EXTERIOR C Side SIDE LOCA71ON/ LEAD TYPE:OF URG " IC IC DELEAD DELEAD.: SIDE LOCATION/ :LEAD TYPE OF URG IC IC DELEAD',DELEAD+' C . SURFACE HAZARD HAZ? DATE METH DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METH Siding L NIA Y Window Sill AIM "L N/A Y C Ower m L N/A Y i Window Sash. Q AIM L N/A Y Lerner Eloaios L N/A Y C Win Casio T% ash AIM t N/A Y Upper Trim 7 L NIA Y 'Window Sill AIM L N/A Y Win Above 5' _ L N/A 'Y C Win Casing n AIM L N/A Y Porch Above 5' L NIA Y S.'Window Sash AIM L N/A Y Storm Door AIM L NIA Y Window Sill A/M L NIA Y pt;r NM L N/A 1 Y Win Casing AIM L.NIA 1' C Jcor�CaCasinci rVM L NIA Y #i� Window Sash AIM° L'N/A ' Y 2 Jc:o area Vht L. N/A Y Window Sill AIM L NIA Y J 4 :rhres told !VN L NIA Y — C' Win Casing '' m AIM L N/A Y KickUla_(r; V VM? NIA -Y q Window Sash . AIM L N/A Y Storm Door ,VM L N/A Y Cellar Win Sill AIM L N/A Y — Door" rVM L N/A Y : C Cel Win Sash AIM L,NIA . Y Door Casing VM L N/A Y a Cel Wm Frame AIM L N/A Y Door Jantt; " "iVM L N/A' Y Ce)lar Win Sill AIM L:.NIA Y 4 Threshold ,VM L N/A Y C Cel Win.Sash AIM L NIA Y Kickplale VM L N/A Y != Gel- in°Frame ArM.L NIA Y ur.•;x VM L NIA Y — AM L NIA Y C Door Casing i llM L N/A Y Foundation L NIA Y 2 Floor Jamb ,VM L N/A Y C Bulkhead A'M L N/A Y 3 4 Threshold VM i N/A Y Fences AN L N/A Y Window Sill 01 L N/A : Y Shutters AiM• L NIA': Y C ;Win Casing o VM L NIA Y Newel post A)M L NIA Y k Window Sa"h ,VM L NIA Y Railing Ca AVM L N/A, Y _ 9 � p _ Window Sill ,VM L N/A Y Handrail � '' AiM} L N/A Y C ,Win Casing V )VM L�N/A Y C 3alusters A/M I. N/A Y p� tlindow Sass /VA4 L NIA Y Lower Rail AIM L N/A Y �Jinziow„i Vh4 L NIA Y Treads. A M L NtA ,Y Nin Casing /VIA L NIA Y Risers gr L A/M L N/A Y ^t Window Sash V�8 L N/A Y Stringer AM' L NIA " Y J _ C Lanl Post L NIA Y lattice A/M L NIA Y ;;OMMENTSI SURUCTURAL DEFE("r.S ,Wrndowbox ''L N/A , Y C Supports` L NIA Y Downspouts — L N/A Y Overhang Tri AIM L NIA Y Excluded Surfaces: Surfaces listed in this box`can be made Soil Test Results intact only by a licensed deleader (Must be less than 401)ppm for play area 1 1200 ppm for bare soil) c§D:_ 0,1,Tr;_N MEASURE:LOOSE PAINT iC iC LOCATION AlthAIYiEASUR,EMEN"i" RESULT REMED R.EMED (MORE THAN 1440 S0.tN,; DATE rtE Tlf" (Square Feet) (PPM; DATE METH Play Area —_ -- Bare soil Comments L 13 C_ Page Lam?Qf' :S insneclor prrrlil t iC a SiT1,.3iure, Me, Risk Assessor (print) 72 Nautical Road, Hyannis 02601 dale Address of Propwy: September 6, 2011 City: _ EXTERIOR D Side •OF t OCAT;0N L.=^.A YY'r c(?= URJ' IC r ,._AC SIDE LOCATION/ LEAD TY?P C7F OF(i r� 1 • c Rr• r � HA?ARJ HAZ? ATi , h � DE(..FAC DE€ C OF "AD UrL 1D M T. QA;E McTH D SOW ACH, HAZARO, kAXV DATE Nil TN OAT H. L +NIA Y Window Sill Add L wA Y Corner BoalO rV L r'dIA Y D vlin Casing AIM L NIA Y D Lowpt Trun a —L N/A Y Window Sash A . L NIA y Limper Trim— W L NIA Y WindwP Sill AW L. N A Y WirAeff�C',) �l NfA Y D Win'Casinq- VM L NIA Y� Porch AwvjW L tVJA Y . f 1Vindow gash. _ AIM L NtA Y S€orni Dow00 AW L NIA Y Window Sill AW L N1A Y Do to A',u'L NCA Y D . Win Casing Arad L NIA Y D Door Ca�lrvr A'M L NIA / �, t'ti'indow Sash A'fA L NIA Y 1 2 Dow Jamb A t.!L NIA .Y Wiiido'w Sill AIM L NIA Y 4 Th(r S Dlet A`3h l Nl. Y D !"tin Czsirg,, tVh1 i �FA Kie%pleb:_ Alt L NO, Y Wini;6;v$1Sh. ,..../M i. N!A Y Siwrn Dc61 PH L NIA } D Cellar win,sifl MAI L NIA. yy Door. A'M L NIA Y Co Win Sash kihi L NIA Y D" Dt or Casirid AW L NIA Y Xc.GAl Win FrarF e- 4W L N/A Y 1 2 Doui Jamb A'h1 L N/A Y � - Cp,ltfr dwin SIII AJM 'L NIA ' Y t rus;nelr— A'tl L Ijb% Y D Cc Win Sash Nhi L NIA Y. wtL�;nla€a' A'M i NaA Y Y C3(Win Frame ;vm -L MA Y .arer A F. A Y ,JM L NjA Y D oi)or Canny A'41 L N/A Y Fo-undaiion § N,'A Y i 2- Dt> t,}audit AW L N/A Y a Bulkhead .. � AIM L N/A •Y 4 Thresho'ri A'M L NIA Y Fences — OM L NIA Y --_ Window Sill A'M L NiA 1 Shutters NIM L NIA Y D Y+rin Cas;ny A`t4 L"NIA Y Ne',vei pds! VM L VIA Y or Window Sash AlA L 1IA Y R;,il ng Ca AI?h ! NIA Y Window ;lll A'm L NIA' Y M7 tStai€ ftl,i# L w A Y — Vdir;G is;ng A. L:NiA Y Gafusters A/A1 L f'IA Y. — t^;inLrOty`iassi A-M C NIA. Y 'LOVP_t Rail At 4 1 NIA Y loin;jow SiII A'hi t_'NtA. Y _. _ Treads -AIM L. NIA Y 4hn�L:au!ty A11 L i1,lA Y F11sr5 Af11 'L A7IA Y - Wiry pw Sasil A rrt L NIA Y $1(ing8r A M L tJlA. Y D La^^_PP 6sl i L NIA Y Lattice VM L NIA Y C UMh1f_NTS I STRUCTURAL DEF i:1'f S; VVlrr, bn.(' a L NIA Y D Suppont5" L NIA l3awnspout t L-titA Y . Quarnanr,Trfn A1hi L "tIA Y Excluded Surfaces: Surfaces listed in this box can be made roil Test.Resv115 intact only by a licensed deleader ' (Must be less than.400 ppm (oi play area/ 1200 ppm for bare soil) `:IDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA NtEASUREMENT RESULT'REMED REMED ;MORE THAN 1440 SO,IN.) DATE METH (Square Feet) (PPM) DATE METH Play Area _ — -- Bare sot _._..`._... Comments: .r. IA/R.,\Re.DExiD,8/08 �1�22- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF"ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP PARCEL, EA` TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 72-76 Nautical Way Hyannis, AM 02601 T Owner's Name: Dave Holt Owner's Address: Date of Inspection: January 7, 2004 "RECEIVED Name of Inspector: (Please Print) James M. Ford ZOO4 Company Name: James M. Ford FEB Q 2 Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 TOWN OF BARNSTABLE HEALTH DEPT. Telephone Number: -(508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on"my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP" approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.0,00). The system: ; ✓ Passes Conditionally Passes Nee&further Evaluation by the Local Approving Authority Fail . Inspector's Signature: Date: January 13, 2004 The system inspector shall submracoppy of this inspection report to the Approving Authority(Board of Health or DEP_)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****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 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72-76 Nautical Way Hyannis, AM Owner: Dave Holt Date of Inspection: January 7, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section'D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements., If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection-if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval'of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72-76 Nautical Way Hyannis, AM Owner: Dave Holt Date of Inspection: January 7, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72-76 Nautical Way Hyannis, AM Owner: Dave Holt Date of Inspection: January 7, 2004 D. System Failure Criteria applicable to all systems: You must indicate either`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 '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)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 System: To be considered a large system the system 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 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM'- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 72-76 Nautical Way Hyannis. MA Owner: Dave Holt R Date of Inspectiion: January 7, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)]. 4 5 Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 72-76 Nautical Way Hyannis, AM Owner: Dave Holt Date of Inspection: January 7, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: n/a Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system.inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): 4 GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed(if known)and source of information: Installed Nov. 3195-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72-76 Nautical Way Hyannis, AM Owner: Dave Holt Date of Inspection: January 7, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) ' Dimensions: 1 S00 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 12"+ Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. The outlet cover was 10"below grade. Recommend pumping. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 r Page 8 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72-76 Nautical Way Hyannis, AM Owner: Dave Holt Date of Inspection: January 7, 2004 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. There did not appear to be any signs of failure or backup from the leach field. The cover was Y below grade. PUMP CHAMBER: None (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.): 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE_ SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72-76 Nautical Way Hyannis, AM Owner: Dave Holt Date of Inspection: January 7, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 8 infiltrators 52'L x 7'W with 1'stone underneath(per as built card) 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.): There did not appear to be any signs of failure from the leach field. The bottom to grade was approximately S'. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of 11 ' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C q SYSTEM INFORMATION (continued) Property Address: 72-76 Nautical Way Hyannis, AM Owner: Dave Holt Date of Inspection: January 7, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. P i 3 O Q O 7 3 3 S 3-7 A 10 f Page I l of 11 OFFICIAL INSPECTIONTORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ' Property Address: 72-76 Nautical Way Hyannis, MA Owner: Dave Holt Date of Inspection: January 7, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and water contours map, the maps were showing 15'+/-to ground water at this site. 1 This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. I 11 h BAR5138 NAME O�OFFEND Q.� /'� [ - j, /�y"1) /jt 7- ^C" j ��+`. TOWN OF ADDR�S_OFOF-ND Ni 10 /�Yt�]C�+rnrA�A/ll!(/If_.' t���IL.,�/r!!�' till' BARNSTABLE CITY,STl4TE,Z Cgtf /J jj° �`/� (j� ( }�'��/ j OV ff✓� IILJ lL 11'!(J Lf 1 MV/MBAEGISTRATION NUMBER II - uAH IrAei.e. 1 Vg' OFF�ENS_ f X V t 7A' i V °.. t�( + IA 1/� lV� ; d �6}9• �0 __ .. Firs / W TIME AND GATE 0 yIOLATION LO TON OF VIOL TON Z NOTICE OF / A.M,/�P.M;:J/ON,,,, � �� �/' I hAoU I-, aV J SIGN TUR, OF ENFORCING PEflSO,N�� )) ��ff,,� f ® ��r EyF'O�IICIN DEPfa BADGE N0.' I w VIOLATION ,1 "tl�o9�l , ,1 �!`l K +, LC' - -l �I, o OF TOWN L HEREBY ACKNOWLEDGE RECEIPT OF CITATION XLU ORDINANCE �Unable to obtain s g `ature of offend r. �� �` THE NONCRIMINAL FINE FOR THIS OFFENSE IS S ' Date mailed _ rr_ w� w OR YOU HAVE THE FOLLOWINjfALTERN CTIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION c (l)You may elect to pay the above fine,either by appearing in person-tSetween 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted,before: The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk, w a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. 121 If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA02630,Att:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. 131 If you fail to pay the above offense or to request a hearing within 21 days,or if you fail appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OfPERRh j' .)t id r 1 i a! 1 err " Uwe" +. BAR 1 () TOWN OF ADDRESSfTY OFFS ,ERA° ,.-y } f J ` f f" BARNSTABLE CITY,SPATE,ZIP COJ� l# E( lL Sf f 1/�/ l/ f tl°!l�Lt��( } �"� I'I `pf IKE►qk, MV/MB REGISTRATION NUMBER �rr O upgIIA8.1. E, OFFS !1 d } FY ff0.� J f(_,Ia �i d �f11ALJ (I lED MP'�► W 4 TIME AND DE 0 V OLATION a LOCy�yyN OF VIOLATION ,! Z NOTICE OF IrA M `� PAS)ON .' ' .'!n� /` 11 _f l l f Y. $I N TURE OF ENFORCING�PER�SON� ���,t 1 O C""1 ENFd`RCIN DEPT.R w ,.' B OGE N0�' � `Y W VIOLATION E� '�,tl!rt ' 1 . i 4 ( ( ' l ' I o OF TOWN I'"HiREBY�ACKNOWLEDGE RECEIPT OF CITATION X ,fib a ORDINANCE � Unable to obtain sigmatu a of o fender. f�[l ~. f THE NONCRIMINAL FINE FOR THIS OFFENSE IS S , t Date mailed Uj w OR YOU HAVE THE FOLLOWING ALTERNAT ES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w Q REGULATION 11)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before: The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk, —i P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. 12)If you desire to contest this matter in a noncriminal proceeding,yyou may do so by making Written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA02630,Aft:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (31 If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑.I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAMEOF,OFF,�NDE� , `S BAR 1391 TOWN OF ADDRESSaiddG��11© 14 A p� 147, � } BARNSTABLE CITY, ffA/Y~~ELLt ZID ) / r�� /{ / /� �ME ip� • OFFENSfB/�(� ��"'�,//j j1 j/�/��� /,/�- i/^�'�y //j/() -j,�.//('•j/'^/� f)f IfAN MASS.1.l:.p I 'I d 1 f! �.r[ �.V..w'V ! / A ` /X 1/ ! 1 d r639• �0 Y r r - .. 1 O ArEo ► W 'i Z TIME AND D TE OF VIOLATION ,//��� LOCATION OF,VryIOL^}P10 j �/� / NOTICE OF F r, ,!` i( i P;M.) 1, 0M. 1)! IVA 1/ l t�► ��A Ye #Y w' SIGFATURE OFrENFORCING PERSON �/ ? ENFORC,NG°D P.� BADGE Nq. C W VIOLATION 'flr �c' �t� L �1 � I o OF TOWN r r �, w� _ . . U HEREBY ACKNOWLEDGE RECEIPT OF CITATION X r Q ORDINANCE ' Unable to obtain si ature f offender. THE NONCRIMINAL FINE FOR THIS OF IS S ,��J� ~ _ &( 1 w Date mailed I w ; OR YOU HAVE THE FOLLOWINg ALTE NATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL 0- DISPOSITION WITH NO RESULTING CRIMINAL RECORD. ua REGULATION �f)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w efore: The Barnstable Town Clerk,367 Main Street,Hyannis, MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk, a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. 121 If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION;COURT COMPOUND,MAIN STREET,BARNSTABLE,MA02630,Att:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. 13)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature I;Q {/� w.�//.� / BAR 139 NAME O O�F E 1 / ,.a ! i .i6 L... S_ TOWN OF ADDflES1111/4OF FEN�gF /'�( ,IA� } j h jA ,/ 1 /A BARNSTABLE CITY,STAI .ZIP O�DN//E /ll_ 7L-li mit�l !/II tt/f/Vt I�1I(� L1�7}J1 �) IME 1 x�a39HANSIAe�.`0$ OFF SIE./2 d , 1`✓ IV t..1rF [...-G tJ Ag "I t MASS. W tED MPy° W TIMEAND,p T O,FJ(V�O�L+ATIO �1 LOC , VI�,L.A,T,lO LU Z NOTICE OF [��_ '"' A.M./ P ,.rON „t „s ' i- A UflrA ,t SIF,N�TUNE OF ENFORCING'PEASON ry ,., i ENF el G DE t ..� BAD E0. w VIOLATION �/ i m`/! 'f x /' 3 � Y CD OF TOWN 'I HEREBY ACKNOVCLEDGE RECEIPT OF CITATION XLU ORDINANCE ® Unable to obtai ig atur of offender. /} �r THE NONCRIMINAL FINE FOR THIS OFFENSE IS S (! J Date mailed w OR YOU HAVE THE FOLLOiN11ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL 0- DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION III You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before: The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,or by-mailing a check,money order or postal note to Barnstable Clerk, a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. 12)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA02630,Att:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OF(FFENQERI i G let. B A R.51393 . TOWN OF ADDRESS' //oFFi)�TiD C /) /�/, BARNSTABLE CITY, TA E, IP,�oD_� s /, ) ("'r, (,fir -- AA / y+ j h /} �,� C-�~'llr" !f!/dJ1, IpYt L(ry�k�—• '/I(l[y..]9 dJ1i `pF 1ME�CYr� ( MV/MB REGISTRATION NUMBER OFFENSE MIS. Uj +6}q. CL �0 / CD �prtoMP�• l / �� > w TIME AND of 0 VON / Iy LOCA ION O VIO TIO// l )-�'�j Z NOTICE OF .-� i `'ZA. / P.M. ;J[P IV V I J�f+i INPi J VIOLATION IGNATURE/iOFyENgF,/QRCI GPEfiSrON V °" E� EN 'C)Ifr�G++O(F�[' r f ///fyy.���`fi. BApf+�� 0. 11f w OF TOWN LU F�EREBY ACKNOWL'�DGE RECEIPT OF CITATION X a ORDINANCE QX Unable to obtai, sl�natur/of offe der. < ' r THE NONCRIMINAL FINE FOR THIS OFFENSE IS S , Date mailed . Iw OR YOU HAVE THE FOLLOWI 6 ALT-RNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR C'PTION(2)WILL OPERATE AS A FINAL cl- DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w I "' REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before: The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,or by mailing a check, money order or postal note to Barnstable Clerk, a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,ytt:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of'$ Signature NAME rFE DER ` j /'�"` , ,BAR 39 TOWN OF AODfl� Ff�FOFOER �IJ �LL►1+ BARNSTABLE CITY(TAG)ZIP C00 E' } �r�' f F }/I { ..i•` JIB ,"'-/ ••/L /W�r� I/11) iYJ!_ 114E iq,- MV/MB REGISTRATION NUMBER � OFFENCy€ 1 IIAit\S7'ABI.F. • ` �j 1�A W MASS. !1 Il7/ 1I 0. 163q. �0$ W TIME ANI O TfrQF�yIpLAT�l. / LOCAT OF IOL TION i�1 �// n/ Z NOTICE OF .�/ SA S&,MW�,oN , I1j ov 17 7 AIA )flN YrTXZ SIT� URE OF ENF RCIN PERSON �/ � v �`j 19J � � EN�CIN 0 Bg�G,(_ 0.n � Y [W VIOLATION r IC( .! Mt 9Q1.A r (z � eA� OF TOWN I HEREBY ACKNO L'DGE R CEIPT OF CITATION X a ORDINANCE Unable to obtai i of off rider. I THE NONCRIMINAL FINE FOR THIS OFFENSE In- Date S , mailed t w OR YOU HAVE THE FOLLOWING ALTE NATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W Cn REGULATION 1 You may elect to a the above fine,either b appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, Q I I Y pay Y PP 9 P Y 9 Y. 9 Y P w before: The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk, a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so byy making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MAO2630,Att:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,'or if you fail to appear for the hearing or to pay any fine determined at tfie. hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature ar.�'^,..-".-*+""`T`�c.X^`._�,,,y`"l4"-..'aT..�,,(r<�=c•F'sTrst'c,.,`-.r`�.art.,...^�,.ti`-r`�,.!"`+''Y�`.n'!°"ti-.t -.:w; `+- �,'.s.;e'M+'T.C1.^r�wks'^e....,..v�a.rvc^`�Ww.r+.,,kPt^a�4Y rirwr•r-.e-r�:. TOWN OF BARNSTABLE BI�B-W ; Ordinance or Regulation WARNING NOTICE $ Q Name of Offender/Manager rHPV IdM A Address of Offender I fJ ('0ArRffA#' /,, / MV/MB Reg.# Village/State/Zip Ail / Business Name am4pm, fon Business Address �t/ _ �� � Signature .of/Enforcing Officer Village/State/Zip0q Locata on of Offense f f1 AIA �'1tG ' `` Enforcing Dept/Division . Offense Facts f� ! � C.t^� h�",'') C�/, > r 1 t. � ? I k o o n P A A r-x eo ru o i rti 1);,er , ox -i,(�)�t-)", I�ekim c�7 1) This will serve only as' a warning. At this time no legal` ac'tion has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town `*e Ordinances, Rules and Regulations. Education efforts and warning notices` are attempts to gain voluntary compliance. Subsequent violations will result�i:n.. appropriate legal action by the Town. j" j � 8 Ift tJ COMMONWEALTH OF MASSACHUSETTS v EXECUTI"VE'OFFICE OF ENVIRONMENTAL AFFA DEPARTMENT OF,ENVIRONMENTAL PROT ION PO ONE MINTER STREET. BOSTON. MIA 02108 617-292-5500 @ / 10 14 81998 WILLIAM F.WELD TRU XE Governoretary 'ARGEO PAUL CELLUCCI D RUNS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM missioner PART A , 2 6 Ln CERTIFICATION Nautical 7 /7 _ John McCormick Property Address: Hyannis -MA Address of Owner: P 0 Box 2378 4 9/ /9 Date of Inspection: 18 8 , = �h , r;(If different) Truckee CA 957,34' , Name of Inspector: Wm E `Robinson Sr h •M I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic "Servi Mailing Address: PO Box- 1 089 , cpntc r Li 1 1 —MA, 02e32 Telephone Numbery 5 0 8 7 7 5—R 7 7 F 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,tme of inspection. The inspection was performed based on my training and experience in the proper function and. maintenance of on site sewage disposal systems The system t5' I `.Conditionally Passes, k ` _ 'Needs Further Evaluation`By the-Local,Approving'Authority Fails r. as � � � � y'. inspectorr t's Signaure.` Date .t. The System Inspector shallaubmit a'copy of this inspection 'report to the,Approving Authority within thirty (30) days of completing this ;k inspection:- If the system is a shared system or has a;desig6fiow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the.buyer,if applicable, and the approving authority. fi INSPECTION SUMMARY Check �1,J B, 'C, or D a A] SYSTEM PASSES * Z. t. I have not found any infor'mation,whlch indicates that the system violatesany of the failure criteria'as definedin 310 CMR 15.303. Any failure"criteria not evaluated are indicated,below. r:+ ref. COMMENTS: a R 1 B] STEM 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. Indi ate yes, no, or not determined`(Y, N or ND)., Describe basis of determination in all instances. If"not determined", plain,why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of;a Certificate of K ti ;,• Comp Iiancey(attached)vindicating that the tank was installed'within twenty (20) years prior to the date of the inspection; or the septic tank, whether`or not metal,-is cracked,'structurally unsound, shows substantial infiltration orexfiltration; or tank failure,is imminent ;The system will pass inspection if;the existing septic tank is:replaced-with a conforming septic tank 4a as approved by.the Board of Health (revised 04/25/97) PaVe 1 of 10' k g ro c r" DEP on the World Wide Web: http:/hvww.mignet.state.ma.us/dep >£'j Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property'Address: 72/76 Nautical Ln, Hyannis Owner'- " McCormick + Date of Inspection: 9/18/98 t � B] SYS EM-CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed �,`.,� �• g P g �y' v tpipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removec; distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removec C] FU HER 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) THER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72/76 Nautical Ln, Hyannis Owner: McCormick Date of Inspection: 9/18/9$ D] STEM FAILS: You in st indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or'more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct e failure. Yes _ Backup of sewage into facility or system component due to an 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 for 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 112 day flow. Required pumping more than-4 times in the last year NOT due to clogged or obstructed pipe(s). Number;of times pumped'" _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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.I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well.. 1 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARG SYSTEM FAILS: You mu indicate either"Yes" or "No" as to each of the following: ' The following criteria apply to large systems.in addition to the criteria above: T e system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to pu lic health-and safety and the environment because one or more of the following conditions exist: 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 11 of a ' public water supply well) ' The owner o operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department,for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 72/76 Nautical Ln, Hyannis Owner: McCormick Date of Inspection: 9/18/98 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. _ None 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 volumes 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 system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncoverel, opened, and the interior of the septic tank was inspected for condition.of baffles or tees, material of construction, cimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART,C ,-SYSTEM,INFORMATION Property Address: 72/76 Nautical Ln, Hyanmis a ,1 Owner: McCormick Date of Inspection: 9/18/98 RESIDENTIAL: q.. FLOW CONDITIONS'f Design flow:�g.p.cl./begroom for S.A.S. `* Number of bedrooms: r Number of current residents:,� kA Garbage grinder (yes or no):,-L-40 " Laundry connected tosystem (yes or no): �� Seasonal use (yes or no): � ` 7/97 _ 30,400ga1S Water meter readings, if available (last two (2) year usage Sump Pump (yes or no)/ 7/98 - .•35r000gals Last date of occupancy: / "P r COM RCIAUINDUSTRIAL Type of tab'lishment: A, t Design fl w: gallons/day , tr} Grease tr3 presenC,(yes or no)_ w '' P Industrial aste Holding Tank present: (yes or no) Non-sanit ry waste discharged to the Title 5 system:'(yes'or no) _:. Water m ter readings,_if available: Last d e of occupancy: n' OTHE : (Describe) Last d occupancy: r "GENERAL INFORMATION PUMPING RECORDS and source'of jformati Y pumped p pe o) S stem um ed as art of ins ction:,(yes or n k , If yes, volume pumped:. "'` I allons Reason for.pumping: TYPE OFSTEM ) Y. . Septic tank/distribution box/soil absorption'system Single cesspool Overflow cesspool "v ' Privy - Shared system (yes or no)'.(if yes, attach previous Jhspection records, if any) I/A Technology etc. Copy of up to date contract Other s ^k APPROXIMATE AGE of all components, date installed"(if known)an _ " d sou rce of information: ) --u" ;�. { d Sewage odors detected when arriving at the site. (ye`s or no)�i(� t (revised 04/25/97) Paga' 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72/76 Nautical Ln, Hyannis Owner: McCormick Date of Inspection: 9/18/98 BUILDING SEWER: (Locate o site plan) Depth bel w grade: Material f construction: _cast iron _40 PVC other (explain) Distant from private water supply well or suction line Diamet r Comme ts: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on bite plan) Depth below grade:` Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 6 L Sludge depth:-9'— ? ' 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: b Distance from bottom of scum to bottom 94outlet tee or baffle: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inv , structural integrity, evidence of leakage, etc.) 0 o� .��" a $ GREA E TRAP: (locate n site plan) Depth low grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensi ns: Scum t ickness: Distan 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 I st pumping: Commen s: (recom ndation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integri evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) -Property Address: 72/76 Nautical Ln, Hyannis , Owner: McCormick Date of Inspection: 9/18/98 ^ TI T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (loca on site plan) Depth low grade: Materia of construction: =concrete _metal _Fiberglass _Polyethylene _other(explain) Dimen 'ons: Capaci gallons Design low: gallons/day Alarm I vel: Alarm in working order Yes; No Date of previous pumping: Com nts (cond ion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution i eclugl, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate n site plan) Pumps i working order. (Yes or No) Alarms ' working order (Yes or No) Comm nts: (note ndition of pump chamber, condition of pumps and appurtenances, etc.) i (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72/76 Nautical Ln, Hyannis McCormick Owner: a Date of Inspection: 9/18/98 SOIL ABSORPTION SYSTEM (SAS):- (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note d �ition soil, signs o ydraul c failure, level of ponding, condition of ve etation, tc.� , CESSPO S: _ (locate on ite plan) Number an configuration: Depth-top f liquid to inlet invert: Depth of s lids layer: Depth of s um layer: I mensio s of cesspool: Materials f construction: Indicati of groundwater: flow (cesspool must be pumped as part of inspection) Comments: (note conditi n of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on s e plan) Materials of onstruction: Dimensions: Depth of so l s: Comments: (note conditi n of soil, signs of hydraulic failure, level of pcnding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM !<° PART C SYSTEM INFORMATION (continued) r Property Address: 72/76 Nautical Ln,*'Hyannis , �— _�`� Owner: McCormick ' F Date of Inspection: 9/28/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: } include ties to at least two permanent,references landmarks or.benchmarks locate all wells within 100' (Locate where public water supply comes into house) s. .r a t..r.41 A r! x F ,.(revised 64/25/97) * Pa 9 e. : 9 of YlU f *Y < 4 .n a f71 t r. T y, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property,Address: 72/76 Nautical Ln, Hyannis Owner: McCormick Date of Inspection: 9/18/98 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in our own/ words h w you established hej-ligh Zroundwater Elevation. Must be completed) (revised 04/25/97) Pago 10 of 10 TOWN OF BARNSTABLE BAR-W 1048 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ( ,, 1;?6S162er6 Address of Offender es� /V ✓ � t�t;, MV/MB Reg.# Village/State/Zip C411n j Q 0 l , Business Name a'S-am%pm; on _ 19 7, t Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense /C,4 Enforcing Dept/Division Offense, U 0-tt CP_ hr1O t,4, Facts 7T� Vv/ This will serve only as a warning.. 'At :ths time no legal action 'hasten taken. It is . the goal- of Town . agencies,,, to achieve.`.voluntary compliance of Town Ordinances, Rules and Regulations.. ." .Education' efforts and warning notices are attempts to gain voluntary .compliance. Subsequent violations . will result in appropriate legal action by,the Town. TOWNS pFBARNSTABLE BAR-W 6qAau Ordinance or Regulation WARNING NOTICE Name of Offender/Manager fit � t Address of Offender tj MV/MB Reg.# Village/State/Zip pl(1" �! 0 - C3 j y C Y Business Name ampm; on �- 19 Business Address q, 4... Signature of Enforcing Officer Village/State/Zip Location of Offense , nc/ t 0 Enforcing Dept/Division O s f f e n e . -- U 'Facts , dl q. .Thus will-,;serve only;..as awarning. At °this time no -legal action hasten taken. It- < is ,the ,:`goal. of Town- agencies to, achieve voluntary compliance of Town Ordinances,; 'Rules and Regulations. 'Education 'efforts and warning notices are attempts` to° gain •voluntary compliance.' Subsequent `violations will result in appro`ptiate legal action by< the�Town. 4 5 TOWN OF BARNSTABLE BAR-W f, ��, nOrdinance or Regulation <. WARNING NOTICE Name of Offender/Manager fy; 6 Address of Offender e�, ,t MV/MB Reg.# Village/State/Zip C41)f)ir N � C3 � Business Name amp%pm;flon 19 Business Address Signature "of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense Facts U f ' zE his will serve only, as ' a warning. At this time no legal action has ileen taken. :- It••. is`' Pthe_ �goal of%" Town agencies to achieve voluntary compliance of Town !'i' -ordinances, Rules and Regulations. Education efforts and warning notices are .4attempts to 'gain voluntary compliance. Subsequent violations will result in 4'i appropriate legal action by the Town. TOWN OF BARNSTABLE LOCATION Z �U � G ( L✓a y SEWAGE# VILLAGE d-)1A1fJZ15' ASSESSOR'S MAP&LOT � Z INSTALLER'S NAME&PHONE NO. " SEPTIC TANK CAPACITY X0 �a LEACHING FACILITY: (type) i �C,'I�cl�t DCS (size) r4 L, )( w, NO.OF BEDROOMS BUILDER OR OWNER ��F �CNdhCld' PERMPT DATE: �'��`�J COMPLIANCE DATE:_& 71 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by x ' TOWN OF BARNSTABLE LOCATION ``1 ,c� (0 /QAV j LA SEWAGE # VILLAGE_Ty/a/I�11S ASSESSOR'S MAP & LOT 30�' a3C� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYW LEACHING FACILITY: (type) �` �� i/Tr4 i1 (size) �c3 �-k 7 (V . f� NO.OF BEDROOMS BUILDER OR OWNER I�AGG ,��0/f PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facility) _I Feet Furnished by S/IS�Oc° p.� J C °V 3 Q Lo �i 09 :A 7 e -- y No ................, ® 'Z Fas............6f..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H"EALTH TOWN OF BARNSTABLE Appliration for Eli-tipuiFal Nurk,5 Tomitrurthin ramit Application is hereby made for a Permit to Construct ( ) or Repair (P4) an Individual Sewage Disposal System at: 0909 .7 _-74....1Q —[vim. f— i�,.� j c,S i-••-•-...... --•- . .. ition-address r Lot No.C AN L ✓i/� Gar✓lw�tf. -.--------- Q 70 7XA/ ...•---•-•.......:......-----------/_--- Owner Address M Installer Address VType of Building y Size Lot............................Sq. feet .-, Dwelling— No. of Bedrooms....................................._.__..Expansion Attic ( ) Garbage Grinder aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) A4Other fixtur -----•-----------------------------•-------•------•------------------------------------------..........•----•-•----........._--••----•••--•••-•----- W Design 'Flow...........11 ......................gallons per person per day. Total daily flow-..-------_...._-y1/Q..-----_.-._..gallons. G' Septic Tank—Liquid capacitykq0D.-gallons Length-----------..... Width...--.--r-_.._. Diameter................ Depth................ W x Disposal Trench--No. .._:Y............. Width-------- . ------- Total Length...__----- Total leaching area....................sq. ft. Seepage Pit No-------- -_-_------ Diameter-------------------- Depth below inlet..=.......... Total leaching area..................sq. ft. z Other Distribution box (6 Dosing tank ( ) Percolation Test Results Performed by..------------------------------------- t----------- -•------•-•--•------ Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit................ ... Depth to ground water........................ CIO Test Pit No. 2----------------minutes per inch -Depth of'Test Pit:.......------------ Depth to ground water..--.................... a --------------------------------------------------------------------------------•--•-----------•-•--......................................................... 0 Description of Soil.......................................................................................................................................................................... W ------------ -- --------=---------------------------------------- ------------------ ---------------------------- -------------------------------------------•--•----....---------•--......-••----- UNature of Repairs or Alterations=Answer when applicable../��------------ ----�.M r`—t:�- 1�?Z°�d S4'Y/LUu^,Ub i.�)✓' C�7 .`5111 /"-JIA.._....�i" .S rtr��]L Fib!f `�!7�. ��� • .Agreement: , �.JT7K-t �J TiC —T.+1�.irL -The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions:of TITLE 5 of the State,Environmental Code =The undersigned further agrees not to place the R system in operation until a Certificate of Compliance hbeen issu b e board of health. Signed _ .... . . ... ..... DW :Application Approve �__ ��` . _...... ( . S .e,. Date Application Disapproved for the folio wing rearons: ----: ----..._ : .. -- _------. -- -- --------- ----------------------- - Permit No. . / ��. - . . Issued .................Dte...... ' LJare � � r 1 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �- TOWN OF BARNSTABLE Apphrativaa for Dinpuital Workii Tomitrurthm rmait Application is hereby made for a Permit to Construct ( ) or Repair (n,'-) an Individual Sewage Disposal System at: ..�1-.:--7 ----�----tom- vt-- ---:---ogprzy....}............ -•�-. NJ(.5 Location-Address or Lot No. rM.�.L U/rw.--.....�-------------3 .......7d... -......-''1'`.... ------�-- . Owner Address `-� ...... ---.....--•-•--- •------••---•-- Installer Address Type of Building Size Lot............................Sq. feet i, a Dwelling,- No. of Bedrooms................y-_----------------_-.Expansion Attic ( ) Garbage Grinder �-) &J 4 a Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fi�t�s ------------------------------ W Design Flow..... �.........................gallons per person per day. Total daily flow.................. yQ..............gallons. 1:4 Septic Tank—Liquid capacity =-_-gallons Length-_------------- Width---------------- Diameter_._.--_.-.__-_ Depth---------------- Disposal Trench—No. --.-�------------- Width_.....----_---- Total Length__-_AI_...... Total leaching area....................sq. ft. Seepage Pit No--------- Diameter-------------------- Depth below inlet-. -,_�_._...._..... Total leaching area..................sq. ft. Other Distribution box (pC) Dosing tank ( ) Percolation Test Results Performed by------------------------------------------------------------------------- Date..................................-..... aTest Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water......_.-.----_--------- fi Test Pit-No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ,. ------------------------------------------------------------------------------------------------------------•-••-••----•---------•-------•--•-------------•-- O ' Description of Soil....................................................................................................................................................................... W ----------------------------------------------------------------------------- ----------------------------•------------- --------------•----•----------------------=--.....-----------------------_..... UNature of Repairs or Alterations—Answer when applicable.. 0_...-_...._g !.^J h�l� �5 v 'SVaAV'V)JDf� f , t................... r..►� . . ..� - ' (}T't L —T,G ti,,•.. ------------- . . ------.....:.. Agreement: '4 The undersigned ag es_to�-ins'tAr-the aforedescribed Individual Sewa/e Disposal System in accordance with the provisions of TITLE-5-of the State Envirgnmental Code—The undersigned further agrees not to place the system in operation until a'Cer.,z-ifcateof Compel°iance_h�a" ben issue by •he board of health. l� _ Signed ----------- ------------------------- ®� Application.Approve By.. &�- f/ 1 ---------------------------_------- -------------------------------------- ------ --------- /l 5... Application Disapproved for the following reasons: ...... .................. . ...... . ......... ..................................................... . ..............._...--------..--......_..---------- -----`---.......------ -------.......-----------------.....-_---..------ ----..._---------------.._.._--------------------------------- ------------------------------.-------- ` �- --� Dace I' Permit No. ..........(/-{-- -------------- -...- -.------- Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 13�17.-Z.3 TOWN OF BARNSTABLE Ter#tfi ate of Tvmjjf anrjc THIS IS TO CERTIFY,That the Individual Sewage Disposal System constructed ( ) or Repaired (D<"- ) by ........ -------...._------------------- - --- ----.- -------- --------------------------------------------------------------------- Insndler r- tom/ at 7... .. ... � .:........N -L - ------------------------------------------------------------ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._......................._.................- dated ----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ .........J! -- 1 ....- ..0 T�------------------------_.--- Inspector --------------------- -----?-----------•------.--------------------------------------.- -------------------- -------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3G7--Z3,,�; (� TOWN OF BARNSTABLE No...l.. r".�..7 '�.- FEE. �i��nsttl ��k� C�u�t�t��s#Uan �rrutt� Permission is hereby granted.................. Ll !L.......... !v mil. ........... to Construct ( ) or Repair (iC) an Individual Sewage Disposal System atNo............................................ 7•65t- -- N�-------------------------•-•----...--- Street as shown on the application for Disposal Works Construction.-Permit No�7�.�-7�>2- Dated- /_��/��`;-........ .......... ---- - �+ Board of Health DATEl .--c.......................................... FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS c� CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) -7 , hereby certify that the application for disposal works construction petnnt signed by me dated V-21-095-- concerning the property located at- 7�- 7le n�i��c�F-c. J ys r,r,J Q - - meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system • There are no private we11s 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: LICENSED SEPTIC SYS M INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. i � 4 Y�A9` rs+�'T .,i. ;���.-� f� P<€i i K•4 oR s k s ,yy for 4ti-•tP�' r y'�.y�; -'r' t ,r„+�'w."r g r � Y2". .; YSe,j w�7, LL nn o E�Z.:i ii�R, s f sueMo. a t, ?" 1s t X zt �,<. <, s aS t i ,. Gj 1/p elk P 7 — aJ Wo 411 74 G.J evil J z,S' a.y.�X.,.+' '.�,, - s ,dsa'.''vr`;•`.^- ,ra'r sy �' ro 'sc"1Kdrt„''"� v' +: m� 'k .''r F}f'yt t x .�: a ,r,v i` z .3- ''r s t..: .. a :. r.. .>.s Y 1 } v max, ,;^ .'�a',xa -'". .,., ,S. 4h . , �.�:.+r ..�rt, F .:,,.! �1 . {� v�_.*!�'F..; LiA.'iYk,Z r`'. �.:.�•. < #'!,7'R t.,.4"`�..}.. .,;k^.E7n ys-.y.-,., 't L;$a�._. .,��c%�!,�tM?r.�€. '.sxT'� tn�:¢:�h,'a r�,s.,n<"tr`+kn .�.,.� �.;�.,st'.s�"b�.;t ax'w'y?`-ta'4 =�x<':E s�ri,��� � � M �4x ._�"'�^ '�u; 'k3-�� s,;st :�'�•.<.s'��a..:.•"3 }i3 .<• �;;!i J:� � � �"�.�"�-t'na' ��''7�'.. n.,y.r �r,� .� y'S :• # 'tea��� .c i• -� `w 8. �" � ,,c 7'.Ar*`Y '" r s. 7, o+ Y M. F '�,� FRO '� ,�Kl7MENDA ASSOCIATES PHONE NO 50Q 775 19t70 Aug 1_ 1995 10 a_AM P1 or'`4%, r�AUG 11` � r14 10 r i 1 f n t F ` ,995 , 7 r1CCORM I CK REALTY41 91ti`SB? 9279 P tOc e �z c n v 3 +,3 •r'r -�+.,t3d T�+ 7 s 4 s 1 r> $s �s+ '+ a '' sN s s }�. �'.'�" rive - Tawn��of B r arnstble : u>�+arcats i Depitmett 3o6f7 H M9tl t,'Safe,t H ,y{and Eavironme ntai ServicesT.Ublick ivis on an nnis MA 42601Set =` Office St/le Z90�263 { a FAX. s08 77S-33d4 x o r Tilomrs A.McKean 1 k e Dircdor of Nblie 11*81th S Yf *.F August 4, 1995 J�srt C McCormick Box 2370 r ? ,Truckee, CA 95734 OItIsER TO CpNIFLY Wt-�ll 310 CIVIR 15.00, THE STATE ENVIRONMENTAL CUDE, TITLE S, The septic system owned by you located at.72 Nautical Way, Hyannis was HISpeeted on July 10, 1995 by Joseph P,- Macomber, Jr, a Massachusetts licensed septic inspector. 1'he 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' • The septic tank and the leachin pit were filled to Capacity.e • W y .Septic system in failure: : 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 Full, 347"Maim Street, Hyannis) that will bring the septic system into compliance wits 3i0 CM1R 15 t?b, The St1te"Fxnvironbtettta[ Code, Title 5 within (t4) fot�rYeen days of receipt of this notice. You are`also"dire'c,ted to bruit the septic system into Compliance within thirty (30) days j of receipt of this ordcr,letter. You are further directed to maintain the system by luring a licensed septage hauler to pump the septic system to prevent discharge of sewage or i 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 O "HEALTH *�+tee, w.; Cx .., F'1 ... yy, yr. k . x trey Y s u A4 �' . rr ,11 IR r -„<��"-f',S„ f„ �M, ht} v �'^' r'� a.- g X� ,:� #: • `e��.S rx'.x48 .;� f SENDER: N • Complete items 1 and/or 2 for additional services. I also Wish t0 receive the N • Complete items 3,and 4a&b. following services (for an extra 2 • Print your name and address on the reverse of this form so that we can fee): > > return this card to you. N • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address N does not permit. •. t • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery .2- The Return Receipt will show to whom the article was delivered and the date V .c delivered. Consult postmaster for fee. cc ;a 3. Article Addressed to: 4a. Article Number a 4b. Service Type cc c ����f ❑ Registered ❑ Insured 0 ���� ®l Certified El COD c o� W ❑ Express Mail ❑ Return Receipt for r L Merchandise c / 7. Date of Delivery _ r- C 0I W5. Si natu a (Addressee) 8. Addressee's Address(Only if requested X and fee is paid) m t— s CC1 6. S nat re (Agent) ~ 7 HPS Form 3811, December 1991 *U.S.GPo:1993-352a14 DOMESTIC RETURN RECEIPT � i UNITED STATES POSTAL SERVICE I Official Business PENALTY FOR PRIVATE j USE TO AVOID PAYMENT OF POSTAGE, $300 JJ I Print your name, address and ZIP Code here e e Health Department Town of Barnstable IP.0.Box 534 Hyannis,Mas irkatts M601 Fax(508)775-3344 Phone(508)790-6265 ,r .-Z`, 248 636 021 Receipt for Certified Mail No Insurance Coverage Provided Do not use for International Mail (See Reverse) Sent to W L Stree o. l6 P.O.,V. and ZIP Co O OCD Postage CO) E Certified Fee O r L Special Delivery Fee a �e kte�uiLcte�DeiycC,y FV i �etturrt IRi eceipt owi5i to•Whom&Date V Return Recei ho" o Date,and A res e•s AddressI �• TOTAL Pos e� {V O. &Fees Postmar, .a `tti; 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(no extra charge). Q 2. If yoc o An want this,receipt postmarked,stick.the gummed stub to the right of the return M addres}s,y .tfie article, date'detach and retain the receipt,and mail the article. 3. Ifs:: want a return receipt,write the certified mail number and your name and address on a retur .tegeipt card-Form 381�1-and attach it to the frort of the article by means of the gummed ends sp per"rvts.Othery3ise,affix to back of article.Endorse front of article RETURN RECEIPT REQ S� adjAent to the number. 4. If you waht deiiW restricted to the addressee,or:o an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E `0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If AL return receipt is requested,check the applicable blocks in item 1 of Form 3811. W EL 6. Save this receipt and present it if you make inquiry. 105603-93.8-0218 t i Town of Barnstable F Department of Health, Safety, and Environmental Services 9 i63�. Public Health Division � 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean FAX 508-775-3344 Director of Public Health September 28, 1995 Joan C. McCormick Box 2370 Truckee, CA 95734 SECOND ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 74 Nautical Way, Hyannis was inspected on July 10, 1995 by Joseph P. Macomber, Jr. 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: • The septic tank and the leaching pit were filled to capacity. - • Septic system in failure. On August 4, 1995 you were 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 were 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. However, the system has not been upgraded as ordered. You are again directed to upgrade the septic system thirty (30) days of your receipt of this letter. 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 BOARD OF HEALTH Thomas . McKean, R.S., C.H.O. Agent of the Board of Health d SENDER: I also wish to receive the y • Complete items 1 and/or 2 for additional services. d • Complete items:3,apo 4a&b. !r t��,\ Services or an extra m • Print your name and Ad&eis's on the reverse of tt is form V'✓ha{'we can — > return this card to 8�1�+ d N • Attach this form to the front of the mailpiece�or 8 thvei backYifytspace Add[eS6ee`5�4�{6b66QSS does not permit. t • Write"Return Receipt Requested"on the mailpiece b69f+&he art)ble number. �2.�_[ F2 r1 tC e e11QTe — •' • The Return Receipt will show to whom the article was delivered and the date c delivered. "` C6nsUlt=postmaster for.fee.. 3. A le Addressed to: 4a. Article Number -77 r�c �- p (i �` , 4b. Service Type az r� ❑ Registered El Insured el? 3/ 0 Certified ❑ COD 5 W ❑ Express Mail ❑ Return Receipt for Merchandise C G 7. Date of Delivery w i, Signat (Addressee) 8. Addressee's Address Only i requested Y and fee is paid) m LU Cr 6. Signature (Agent) 0 PS Form 3811, December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT _ i UNITED STATES POSTAL SERVICE -Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE,$300 El I I Print your name, address and ZIP Code here Health Department Town of Barnstable P.O.Box 534 i Hyannis,Massachusetts 02601 i Fax(508)775-3344 Phone(508)790-6265 ,,Z _sL18 648 027 Receipt for Certified Mail o No Insurance Coverage Provided UNITED STATES Do not use for International,Mail (See Reverse) Sent to JOAN MCCORMICK t Street and No. ' BOX 2370 . S P.O.,State and ZIP Code c TRUCKEE, CA 9.5734 Q PostageCIO - M E Certified Fee 8 LL Special Delivery Fee Restr7@ te�DeTiyertiy jFtee ;Rea'n iEteCerpt'S,owm�g to Whom&Date Delivered Return Receipt Showing Date,and Addresse ' %&ess &Fees Postage Fees Postmark or I ate r M i I STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, N 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 aost 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 return M address of the article,date,detach and retain the receipt, and mail the article. .c 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 no ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT 2 REQUESTED adjacent to the number. G (10 4. If you want delivery restricted to the addressee,or to ar authorized agent of the addressee, co endorse RESTRICTED DELIVERY on the front of the article. E `o 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. to 6. Save this receipt and present it if you make inquiry. 105e03-93.8-0219 Town -of Barnstable • Department of Health, Safety, and Environmental Services antwsre su. M� Public Health Division t639 h 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health August 4, 1995 Joan C. McCormick Box 2370 Truckee, CA 95734 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 72 Nautical Way, Hyannis was inspected on July 10, 1995 by Joseph P. Macomber, Jr. 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: • The septic tank and the leaching pit were filled to capacity. - Septic system in failure. 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 cKean, R. H.O. / o Agent of the Board of Health ASSESSORS MAP NO: PARCEL N0: P17 3 [Installer letter] Sl TO: `'v aavN C. we Co r i 4k (Date) t�,4 Qe,,EGA -9s�3y ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at —-'7 I a aM, was inspected on� ro,I, by M--cv,&-1�r- a Massachusetts icensed 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: 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 Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY;(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: i V 0p Pr r 4k �i . _ I _ DATE: 7/10-/95 I PROPERTY ,ADDRESS:_ 77&76 _N_auti.Qa1- ay---__ � Hyannis ,Mass . - .. ------------------------ 02601 i On the above date, I Inspected the septic s±ystem at the above address. This system consists of the" following: 1 This is a septic system 2 . 1 -1 50$=gga-llon tank. 3 . 1 -1000 gallon leachingpit . I Based on my Inspection, [ certify the following conditions: 1. `Thzs is a title five septic system. 2 . The septic tank and the leaching pit are filled to capacity. j 3 .. The septic system is .,in failure. 4 . System must be upgraded to title five. � . 5 . No Distribution box- present. ; Name:_,Z,� Ma�nmh�r ,Tr. ___--- Company: J.P_Macomber & Son Inc . ,��g- Address: Box-66 Centerville Mass . 02632 L- -----------L-------- 1'99s Phone:_508_775_3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY ® Oft ,�Iq, JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leaclilelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION YORM Address of property Owner' s name Date of Inspection PART A CHECKLIST :7Pumping if the following have been done: information was requested of the owner, occupant, and Board of ealth. None of the :system components have been pumped for at least two weeks ano the system has been receiving normal flow rates during that period. Large volumes 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. The facility owner (and occupants, if different from owner) were provided with Information on the proper maintenance ,.of SSDS.' 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B l SYSTEM INFORMATION ) FLOW CONDITIONS If residential q number of bedrooms LIAJ - number of current residents IIIL} garbage grinder; yes or no' laundry connected to system, yes or no seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: i�� � k Last date of occupancy no ewe GENERAL INFORMATION Pumping records and sou ce of inform tion: 5�u.��aat 1,(�r�Tm�tit7'��Criart' 410 System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Ty p of system Septic tank/ stribution box/soil absorption system Single cesspool Overflow cesspool Privy AYE-S Shared system (yes or no) (if yes, attach previous inspection records, if any) ' Other (explain) f�,tiD�Ex Approximate age of all, components. Date installed, if known. Source of information: . tiC77 /�x�PL,�9 4))) of site, yes or no Sewage odors detected when arriving at the 9 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION ry -:tinued SEPTIC TANK: (locate on site plan) i depth below grade: material of construction: ✓ concrete metal FRP other(explain) dimensions:_ [7��+ � L % sludge depth distance from top of sludge to bottom cf . outlet tee or baffle 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 Comments: (recommendation for pumping, condition of z. :' et and outlet tees or baffles, depth of liquid level in relation to outl:^t ' nvert, structural integrity, evidence f leakage r co e a ions f r r_ irs, qtc. ) uw#d 1 . Q DISTRIBUTION BOX:-A&Ze, (locate on site plan) depth of liquid level above e•- ' t invert Comments: ,(note if level and distribution is equal , ' :'.once of solids carryover, evidence of leakage into or out of box, r -;endation for repairs, etc. ) MAI F- PUMP CHAMBER:...�G (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition i pumps and appurtenances, . recommendations for maintenance or repair: ; . . ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION' SYSTEM (SAS) __ ( locate on site plan, if. possib , excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments : (note condition of soil , signs of hydraulic failure, level of ponding, co dition of vegetation , recommendations fo maint� nce or rep�rs, te. ) — _ ee CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid t:o inlet invert depth of solids layer i depth of scum layer dimensions of cesspool _^ materials of construc:tI011 _ indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments : (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recp mje ations for maintenance or repairs, etc. ) PRIVY : ( locate on site plan) materials of construction dimensions _ depth of solids Comments : (note condition, of soii , signs . of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) . 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L:SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' 1��A) Wra•3�'�. ,Q �r i i 4j DEPTH TO GROUNDWATER depth to :groundwater m( hod eter;nin on or app o imat ion 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances . If "not determined" , explain why not) d Backup of sewage into facility? —1Z Discharge or ponding of effluent to the surface. of the ground or surface waters? tatic liquid level in the distribution 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 _urTiv1�S 9�1 A/0 Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: —Q below the high groundwater elevation? VO within 50 feet of a surface water? 1 within 100 fee: of a surface water supply or tributary to a surface water supply? —� within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water. supply well? less than 100 feet but greater than 50 feet t 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 anal, for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. nm TOWN OF Barnstable BOARD OF HEALTH S(IBSIJRFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D .- CERTIFICATION -TYPE OR PRINT CI,EARLY- PROPERTY INSPECTED STREET ADDRESS 72&76 Nautical Way Hyannis ASSESSORS MAP, BLOCK AND PARCEL' * OWNER' s NAME Jack McCormick PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomb Tr- . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Cgntervillp.,Mass - 02632 Street Town or City State ZIP COMPANY TELEPHONE ( - FAX ( - 508 775 3338 79Q 1575 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations 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: System PASSED The inspection which I have conducted has not found any information which indicates. that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. 6ZXX7X System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , ,and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature .4, At bl Af Date OIL .4 q0 : One copy of this . tification must be provided to the OWNER, the BUYER ( where applicable) and the BOARD OF HEALTH. If the inspection FAILED, the owner or"'o*p' erator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doe Water y� Conservation SAVE Tips . . . ME. CHECK FOR LEAKS Water Loss in Gallons Due to Leaks Leak this Loss Per Day . Loss Per Month Size 120 3,600 '• 360 10,800 693 20,790 0 1,200 36,000 .• 1,920 57,600 3,096- 92,880 ® 4,296 128,980 ® 6,640 199,200. 6,9.84 200,520 8,424 4 252,720 9,888 296,640 11,324 339,720 12,720 381,600 14,952 448,560 F Ccmmcnweam cr Masscc:7:;sem ExecuTive Office cr EnvironmenTct AffC,:s Department of Environmental Protection Water Pollution Control Tecnnlccl Asswcnce and Training SecTions WUUam F.W*W C-4v nwr Trudy Cox• s•Q•wy.cO Thomas&Powers A4"QmMenorw 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and San PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr. , I am pleased to inform you that you have attended training, met the experience qualifications, and have passed the Title 5 System Inspector exam, pursuant to 310 CMR 15. 340. The passing grade for the exam was 39./52 or 75%. This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15 .340. You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D.E. P. Training Center 50 Route 20 Millbury, MA 01527 Thank you very much for your -time and consideration in this matter. Sincerely, Kimball T. Simpson, DEP Training Center Director [2 4 0 5) Routs 20 • M111bury, MA 01527 a FAX 508-755-9253 0 Telephone 508-756-7281 PAR Real Estate System General Property inquiry Help Parcel 1d; -307 236- fZai-eat Locations 74 NAUTICAL LN HY Neighborhood: 61AC Fire Distg HY Devel Lotg PTOF'7 Lot Size, . 18 Acres Current Owns MCCORMICK, JOHN S TR State Class: 10-41 MCCORMICK, JOAN C T1-R No. Bldg 1 Area: 176() BOX 230�.-*,, Year Added. TRUCKEE CA 95734 Deed Date! 120192 References ...340/241 . January 1stN MCCORMICK, JOHN S TR & Deed MMOD: 1292 Deed ReQ 8340/2431. Comments9 Values! LandN 20700 Builaings! 78400 Extra Features' Road System: 74 index: 1067 (NAUTICAL ROAD ) Frntgl 10!`.''i Indew 1050 (MURRAY WAY ) Frntgn 105 Control 1nfo2 Last Auto Upd! 050695 StatuaN C Last TACS Updates 03020:3 Land Reviewed By Dates 0000 Bldgs Reviewed By ML Date! 048-'---.i� Tax Titleo Accounts Takew Account Status! Hold Statuss Cancel Press XMT For more data Next screen PAR Action. Owners Name Road index Road Name Parcel Number 307 207