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HomeMy WebLinkAbout0050 SUOMI ROAD - Health 50 SUOMI RD. , HYANNIS A ::_.269 105 o / - a I J e 0 o a a �I o { 11� a S!i Ij �-k0.ECYC(fa��� UPC 17734 No.2�153CR `bsrco FIASTING8,MN ' p ,i I {� ,. 11 c i r vV v a c Message Page 1 of 3 Crocker, Sharon From: Crocker, Sharon Sent: Monday, January 09, 2012 3:36 PM To: McKean, Thomas Cc: Desmarais, Donald Subject: FW: Code Violation(s) Inquiry Importance: High Tom, Donald and I have gone through the file and there are no outstanding violations specifically with our Public Health Division. The only item noteworthy is: There was a complaint dated 1/14/2003. There was a oil leak due to a broken underground line to the oil tank. On Dec 31, 2002, 100 gallons of oil was delivered and leaked out by Jan 10,2003. This was reported to DEP. The contact at the time was Tyson Rose, DEP, at 508- 946-2743. DEP took over the situation at that time. Thus, the person requesting the information on this property may want to verify with DEP that the situation has been resolved. Shall I forward this on to Tom Geiler? Please let me know, thanks. Sharon --=--Original Message-:--- From: McKean, Thomas Sent: Wednesday, December 28, 2011 12:24 PM To: Desmarais, Donald; Crocker, Sharon Subject: Fw: Code Violation(s) Inquiry From: Geiler, Tom To: McKean, Thomas; Perry, Tom; Barrows, Debi Sent: Wed Dec 28 09:02:58 2011 Subject: Fw: Code Violation(s) Inquiry Please check your Division records for outstanding violations at this property and let me know. Thanks From: Town Main Mailbox To: Tom.Geiler@town.barnstable.ma.us <Tom.Geiler@town.barnstable.ma.us>; Buntich, JoAnne. Sent: Wed Dec 28 08:44:24 2011 Subject: FW: Code Violation(s) Inquiry 1/9/2012 Message Page 2 of 3 In to the web. Dan From: Harley Nunes [mailto:harley@cvsinc.net] Sent: Tuesday, December 27, 2011 5:25 PM To: Town Main Mailbox Subject: Code Violation(s) Inquiry Hello, I am researching an address in your jurisdiction and would like to make a formal request regarding the property located at 505uomi Rd. Hyannis, MA 02601. If this property does not fall within your jurisdiction, please contact me at the number/e-mail below and let me know who is responsible. If this address is within your jurisdiction, please let me know if there are: • Any open or pending code violations on the subject property. and • Any fines, fees, or related money due to your municipality for any code violations. If there are any open or pending violations, please send 1. A copy of the Notice of Violation or a description of the violations 2. A contact person and phone number 3. A code violation case number 4. Any fines, fees, or related money due for the code violations i Additionally, are there any other departments in your municipality that issue any citations or violations which could be considered code violations? If so, which departments? I am not requesting any recorded lien information as any recorded liens would already show up on the Title ' Report. We are working with the owner of the property (Bank/Investor) and need the information in writing so that we can report back any requirements to bring the property back into compliance. Our company is hired by Escrow Companies, Banks, Investors and Loan Servicers to research code violations on bank-owned,foreclosed properties. We research this information to not only benefit our clients by finding these violations early and avoiding/reducing fines/fees, but also to benefit the municipality in which the property is located. By taking a proactive approach, we are able to assist in getting violations abated, the fines/fees paid, and the cases closed. We are proud to help to keep property values up and neighborhoods compliant and clean for current and future residents. Thank you in advance for your assistance! Harley Nunes I ot) "I "\ ,k'r N' 'N.k' 700 Automation Drive Unit F Windsor, CO.80550 Phone: 970 460-3579 Fax: 866 484-5104 harley@cvsinc.net 1/9/2012 i Message Page 3 of 3 www.cvsinc.net Code Violation Services will be closed Monday,January 2nd in observance of the new year. Happy Holidays! "Patent applied for on our process and proprietary system" "Due to the high volume of calls please respond via email for a more timely response.Thank you!" Mission Statement:to be the single point, Nationwide solution for assisting Cities, Banks and Servicers to alleviate neighborhood blight due to abandoned housing. The information contained in this electronic mail transmission(including any attachments)is intended solely for its designated recipients)and is confidential. If you are not a designated recipient or you have received this communication in error,you are hereby notified that you are strictly prohibited from reading,copying,distributing,or otherwise disclosing any of the information contained herein. Please contact the sender immediately by e-mail at harlev(a cvsinc.net and permanently discard the original and any copies of this message(including any attachments),without reading or saving in any manner. 1/9/2012 .-Message Page 1 of 3 Crocker, Sharon From: Crocker, Sharon Sent: Tuesday, January 10, 2012 6:47 PM To: McKean, Thomas_ Cc: �Desmarai�aId Su j c� t: FW: Code Violation(s) Inquiry I made a copy of the complaint and put it in your in-box. I am also including the print-out from the DEP "Reportable Release Lookup"website. I do not know hat the codes mean under the Column "Compliance Status" but hopefully, you do. It says "DEPNFA". ope this helps you. Sharon -----Original Message----- From: McKean, Thomas Sent: Tuesday, January 10, 2012 3:44 PM To: Crocker, Sharon Subject: Re: Code Violation(s) Inquiry That may be problematic. Did DEP actually go to the site? From: Crocker, Sharon To: McKean, Thomas Cc: Desmarais, Donald Sent: Mon Jan 09 15:36:22 2012 Subject: FW: Code Violation(s) Inquiry Tom, Donald and I have gone through the file and there are no outstanding violations specifically with our Public Health Division. The only item noteworthy is: There was a complaint dated 1/14/2003. There was a oil leak due to a broken underground line to the oil tank. On Dec 31, 2002, 100 gallons of oil was delivered and leaked out by Jan 10,2003. This was reported to DEP. The contact at the time was Tyson Rose, DEP, at 508- 946-2743. DEP took over the situation at that time. Thus, the person requesting the information on this property may want to verify with DEP that the situation has been resolved. Shall I forward this on to Tom Geiler? 1/10/2012 ,Message Page 2 of 3 Please let me know, thanks. Sharon -----Original Message----- From: McKean, Thomas Sent: Wednesday, December 28, 2011 12:24 PM To: Desmarais, Donald; Crocker, Sharon Subject: Fw: Code Violation(s) Inquiry From: Geiler, Tom To: McKean, Thomas; Perry, Tom; Barrows, Debi Sent: Wed Dec 28 09:02:58 2011 Subject: Fw: Code Violation(s) Inquiry Please check your Division records for outstanding violations at this property and let me know. Thanks From: Town Main Mailbox To: Tom.Geiler@town.barnstable.ma.us <Tom.Geiler@town.barnstable.ma.us>; Buntich, JoAnne Sent: Wed Dec 28 08:44:24 2011 Subject: FW: Code Violation(s) Inquiry In to the web. Dan From: Harley Nunes [mailto:harley@cvsinc.net] Sent: Tuesday, December 27, 2011 5:25 PM To: Town Main Mailbox Subject: Code Violation(s) Inquiry Hello, I am researching an address in your jurisdiction and would like to make a formal request regarding the property located at 50 Suomi Rd. Hyannis, MA 02601. If this property does not fall within your jurisdiction, please contact me at the number/e-mail below and let me know who is responsible. If this address is within your jurisdiction, please let me know if there are: • Any open or pending code violations on the subject property. Fan • Any fines,fees, or related money due to your municipality for any code violations. If there are any open or pending violations, please send 1. A copy of the Notice of Violation or a description of the violations 2. A contact person and phone number 3. A code violation case number 4. Any fines, fees, or related money due for the code violations Additionally, are there any other departments in your municipality that issue any citations or violations which could be considered code violations? If so,which departments? 1/10/2012 Message Page 3 of 3 I am not requesting any recorded lien information as any recorded liens would already show up on the Title Report. We are working with the owner of the property(Bank/Investor) and need the information in writing so that we can report back any requirements to bring the property back into compliance. Our company is hired by Escrow Companies, Banks, Investors and Loan Servicers to research code violations on bank-owned, foreclosed properties. We research this information to not only benefit our clients by finding these violations early and avoiding/reducing fines/fees, but also to benefit the municipality in which the property is located. By taking a proactive approach, we are able to assist in getting violations abated,the fines/fees paid, and the cases closed. We are proud to help to keep property values up and neighborhoods compliant and clean for current and future residents. Thank you in advance for your assistance! Harley Nunes iI s;rN, IN 700 Automation Drive Unit F Windsor, CO 80550 Phone: 970 460-3579 Fax: 866 484-5104 harley@cvsinc.net www.cvsinc.net Code Violation Services will be closed Monday, January 2nd in observance of the new year. Happy Holidays! "Patent applied for on our process and proprietary system" "Due to the high volume of calls please respond via email for a more timely response.Thank you!" Mission Statement:to be the single point, Nationwide solution for assisting Cities, Banks and Servicers to alleviate neighborhood blight due to abandoned housing. The information contained in this electronic mail transmission(including any attachments)is intended solely for its designated recipient(s)and is confidential. If you are not a designated recipient or you have received this communication in error,you are hereby notified that you are strictly prohibited from reading;copying,distributing,or otherwise disclosing any of the information.jontained herein. Please contact the sender immediately by e-mail at harleyCcDcvsinc.net and permanently discard the original and any copies of this message(including any attachments),without reading or saving in any manner. 1/10/2012 Definitions of Fields Listed in Search Results I Cleanup of Sites & Spills I MassDEP Page 1 of 5 y Skip Navigation essDEP.Home Mass.Gov Home State Agencies State Online Services site mapcontactssearch: dep home>c up of spills&sites> ocations>site lookup&status it•r � _ MassDEP Quick Links: lq•� - r ._- - About MassDEP Public Participations News Definitions of Fields Listed'in Search Results Air&Climate -Release Tracking Number(RTN): Water,Wastewaters Wetlands The number assigned to every site/reportable release.This number is preceded by -- 1,2,3,or 4 depending on the region where the release/site is located(e.g.,3- Waste&Recycling 0001234).Corresponding regions are: Toxics s Hazards Western Region • Central Region Cleanup of Sites&Spills Northeast Region priorities&results Southeast Region sites&locations Additional information about RTNs may be found here. help for homeowners& a businesses City/Town: C3 brownfields program The city or town where the release of oil or hazardous material occurred. Boston and licensed site professionals Barnstable are also broken down by neighborhood or village(e.g.,Boston-Brighton, laws&rules Barnstable-Hyannis) permits,reporting&forms Release Address: grants&financial assistance compliance assistance The number and street that most accurately describe the site/release location. enforcement Site Name/Location Aid: Service Center Describes the site in terms of its location,use,or type("Bob's Gas Station"or "Across from Building 1"). Calendar My Community Reporting Category: How quickly a release must be reported to DEP.The potential severity of a release Online Services dictates how soon it must be reported.Reporting categories are 2 hours,72 hours, Regional Offices and 120 days. Report Pollution Notification Date: The date DEP uses to establish 21 E deadlines.This date is usually the date when the site/release was reported to DEP.However,for some sites,especially those dating before 1993,the notification date may be later than the date DEP first learned about the site. http://www.mass.gov/dep/cleanup/sites/statdef.htm 1/10/2012 Definitions of Fields Listed in Search Results I Cleanup of Sites & Spills I MassDEP Page 2 of 5 Compliance Status: 21 E sites compliance status definitions: • ADEQUATE REG(Adequately Regulated):A site/release where response actions are deemed adequately regulated under another DEP program or by another government agency. • DEPMOU(Memorandum of Understanding):A site/release where DEP has a Memorandum of Understanding or other written agreement with a responsible party. • DPS(Downgradient Property Status):A site where a DPS Submittal to DEP has stated that contamination on the property is coming from an upgradient property. • DPSTRM(Downgradient Property Status Terminated):A site where Downgradient Property Status has been terminated. . • INVSUB(Invalid Submittal):An RAO Statement that was submitted for the site has been determined to be invalid by DEP. • RAO(Response Action Outcome):A site/release where an RAO Statement was submitted.An RAO Statement asserts that response actions were sufficient to achieve a level of no significant risk or at least ensure that all substantial hazards were eliminated. • REMOPS(Remedy Operation Status):A site where a remedial system which relies upon Active Operation and Maintenance is being operated for the purpose of achieving a Permanent Solution. • ROSTRM:A site where Remedy Operation Status has been terminated. • RTN Closed: Future response actions addressing the release associated with this Release Tracking Number(RTN)will be conducted as part of the response actions planned for the site under another"primary"RTN. • SPECPR(Special Project):The site has Special Project status. • STMRET(Statement Retracted):An RAO Statement that had been submitted for the site has been retracted. • TCLASS(Tier Classification):A site/release where a Tier Classification Submittal was received,but the classification type has not been confirmed by DEP. • URAM:A Release Tracking Number has been assigned to a release where a Utility-abatement Measure is being or was performed. Note:Sites are usually Tier Classified using the Numerical Ranking System(NRS). The NRS scores sites on a point system based on a variety of factors. These include the site's complexity, the type of contamination, and the potential for human or environmental exposure to the contamination. In addition,some sites are automatically classified as Tier 1 sites if they pose an imminent hazard, affect public water supplies, or miss regulatory deadlines. • TIER 1A:A site/release receiving a total NRS score equal to or greater than 550.These sites/releases require a permit and.the person undertaking response actions must do so under direct DEP supervision. • TIER 1B:A site/release receiving an NRS score of less than 550 and equal to or greater than 450.These sites/releases also require a permit,but response actions may be performed under the supervision of a Licensed Site http://www.mass.gov/dep/cleanup/sites/statdef htm 1/10/2012 Definitions of Fields Listed in Search Results I Cleanup of Sites & Spills I MassDEP Page 3 of 5 Professional(LSP)without prior DEP approval. • TIER 1C:A site/release receiving a total NRS score of less than 450 and equal to or greater than 350.A site/release receiving a total NRS score of less than 350,but which meets any of the Tier 1 Inclusionary Criteria specified in 310 CMR 40.0520(2)(a),is also classified a Tier 1 C.These sites/releases also require a permit,but response actions may be performed under the supervision of an LSP without prior DEP approval. • TIER 2:A site/release receiving a total NRS score of less than 350,unless the site meets any of the Tier 1 Inclusionary Criteria(see above). Permits are not required at Tier 2 sites/releases and response actions may be performed under the supervision of an LSP without prior DEP approval.All pre-1993 transition sites that have accepted waivers are categorically Tier 2 sites. TIER 1 D-,ksite/release where the responsible party fails.to proyide.a�. ) �req ed submittal to DEP braspecified deadline' Note.formerly_Default ,�1 TI@r�:1B rLS..ai.' UNCLASSIFIED:A release that has not reached its Tier Classification 1 t I deadline(usually one year after it was reported),and where an RAO 6" l Q Statement,DIPS Submittal,or Tier Classification Submittal has not been received by DEP. 0 O I The following definitions apply to sites that were reported to DEP prior to October 1993 and which were regulated under an older version of the MCP: • DEPNDS:DEP Not a Disposal Site means that DEP has determined that these locations did not need to be reported and are not disposal sites. DEPNFA: DEP No Further Action means that response actions were conducted and DEP determined that no further action"was needed for the site. . . . LSPNFA:LSP No Further Action means that response actions were Q� conducted and an LSP has determined that no further action was needed for the site. • PENNDS: Pending Not a Disposal Site means a document was submitted to DEP asserting that these locations did not need to be reported and are not disposal sites.These submittals are considered pending until DEP audits them. • PENNFA: Pending No Further Action means a document was submitted to DEP asserting that a site assessment had determined that no further action was required.These submittals are considered pending until DEP audits them. • WCSPRM:A Waiver Completion Statement has been submitted to DEP. Compliance Status Date: The date a release/site was listed as its current compliance status. Phase: Indicates the release/site cleanup phase. • No Phase: Phase report not required or not submitted. • Phase I: Initial Site Investigation,including Tier Classification. In this phase, samples are collected and analyzed to determine the types,amounts,and http://www.mass.gov/dep/cleanup/sites/statdef.htm 1/10/2012 i Definitions of Fields Listed in Search Results I Cleanup of Sites & Spills MassDEP Page 4 of 5 location of contaminants. • Phase II:Comprehensive Site Assessment.During Phase II,the risks posed to public health,welfare,and the environment are determined. • Phase III:Identification,Evaluation,and Selection of Comprehensive Remedial Action Alternatives and the Remedial Action Plan. In Phase III, cleanup options are assessed and a cleanup plan is selected. • Phase IV: Implementation of the Selected Remedial Action Alternative and Remedy Implementation Plan.The cleanup plan is implemented in Phase IV. • Phase V:Operation,Maintenance,and/or Monitoring.During Phase V,long- term treatment processes are implemented and monitored to track cleanup progress. RAO Class: The class of Remedial Action Outcome submitted to the Department: • Class A RAO-Remedial work was completed and a level of"no significant risk"has been achieved. A1:A permanent solution has been achieved. Contamination has been reduced to background or a threat of release has been eliminated. A2:A permanent solution has been achieved. Contamination has not been reduced to background. A3:A permanent solution has been achieved. Contamination has not been reduced to background and an Activity and use Limitation(AUL)has been implemented. A4:A permanent solution.has been achieved. Contamination has not been reduced to background and an Activity and use Limitation(AUL)has been implemented.Contamination is located at a depth of>15 feet but evaluation has determined that it is not feasible to reduce it. • Class B RAO-Site assessment indicates that"no significant risk" exists.No remedial work was necessary. B1: Remedial actions have not been conducted because a level of No Significant Risk exists. B2: Remedial actions have.not been conducted because a level of No Significant Risk exists,but that level is contingent upon one or more Activity and use Limitations(AULs)that have been implemented. B3: Remedial actions have not been conducted because a level of No Significant Risk exists,but that level is contingent upon one or more Activity and use Limitations(AULs)that have been implemented,and contamination is located at a depth of>15 feet but evaluation has determined that it is not feasible to reduce it. • Class C RAO-A temporary cleanup.Although the site does not present a"substantial hazard",it has not reached a level of no significant risk.The site must be evaluated every five years to http://www.mass.gov/dep/cleanup/sites/statdef.htm 1/10/2012 Definitions of Fields Listed in Search Results I Cleanup of Sites & Spills MassDEP Page 5 of 5 determine whether a Class A or Class B RAO is possible.All sites are expected eventually to receive a Class A or B RAO. Note:Activity and Use Limitations(AULs)are legal restrictions used in the context of the Massachusetts Contingency.Plan to limit future exposure to contaminants remaining at a site. See Guidance on Implementing Activity and Use Limitations for additional information. Contacts•Feedback•Related Sites•Site Policies•Help Mass.Gov•Energy&Environmental Affairs•Department of Environmental Protection a 3 http://www.mass.gov/dep/cleanup/sites/statdef htm 1/10/2012 r s Town of Barnstable o� _ Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 DATE: NUMBER OF PAGES TO FOLLOW: TO: O's D9� FROM: )� PHONE: PHONE: (508)8624644 FAX PHONE: . �� FAX PHONE: (508)790-6304 cc: NOTESICOMMENTS: U J G I - � I CIA e Q�NREALTWFax Form.doc y r SuperPages.com: People Pages Search Page 1 of 2 _ pp"i`.3 •' • • Vs^.` • .L. f • • w _ c People Search Home.+ People Pages Search Results Reverse Lookup Search Tips Add a Listing • • SuperPages.aom® Update a Listing Remove a Listing Results 1 Matching Listing My Directory Search Again Maps Monique Lemmer (More Info) Map Driving Directions 50 Suomi Rd driving directions Hyannis, MA 02601 save (508) 775 -0273 update or remove Print-Friendly Version Send Public Flowere "Records t�j Find Friends .`.. ( Poe card Search Again r - d',I*,.k.en°A4XKW Copyright©2004 Acxiom. send a free , birthday , greeting Send Free Postcards! R Send Free Postcards! Home I My Directory I Yellow Pages I People Pages I City Pages I Consumer Center Advertise With Us I About Us/Help I Add/Change Listing I Privacy Policy I Contact Us English ! Espanol Terms&Conditions I Site Index I Verizon Products/Services I Careers at SuperPages http://directory.superpages.corli/wp/results-i sp?SRC=&PS=15&PI=1&STYPE=WS&WF=... 8/19/2004 Health Complaints 19-Aug-04 Time: 3:00:00 PM Date: 1/14/2003 Complaint Number: 3891 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: Number: 50 Street: Suomi Road Village: HYANNIS Assessors Map-Parcel: 269-105 Complainant's Name: Heather Atwood Address: Enviro-Safe Corp. Telephone Number: 508-888-5478 or cell 508-737- Complaint Description: Oil release in house in an underground line of oil tank. Reported by Nelson Coal and Oil on Jan.10 and then to Hyannis Fire and then to Tyson Rose of DEP and DEP said to call health department. Oil delivered (100 gal) on Dec. 31 and Jan. 10th all gone and line was broken and repaired. Estimated oil release is 90+ gallons. DZM is responding at 3:40 pm on 1/14/03 (date reported) Actions Taken/Results: DZM investigated and gained access to the house. Tenants allowed me entry and the house is not owner occupied. Owner is Ana Paula Desa. Her work number is 508-790-2776 and cell phone is 508-367-4718. Many tenants occupy this house. Active building permit on the property and there is a.for sale sign outside also with Margo of Shoreland Real Estate. There is a 3 year old child on the property and an 8 yr. old as well. Upon entering the front door of the house there is an oil smell. In the basement there is a 4 x 5 foot area stained with oil that is stained up to about two inches on the concrete block wall. DZM called Tyson Rose of DEP (508-946-2743) and reported this to him 1 I Health Complaints 19-Aug-04 via voice mail. On the morning of the 15th Tyson called me back for further info. I informed him it is in the Zone of Contribution and that the Barnstable Water Company owns land that is southeast east of this site. Investigation Date: 1/14/2003 Investigation Time: 3:45:00 PM 2 ° P. 1 i COMMUNICATION RESULT REPORT ( AUG.19.2004 1:47PM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE ---------------------------------------------------------------------------------------------------- 778 MEMORY TX 917813353543 OK P. 4/4 REASON FOR ERROR E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION Town of Barnstable Regulatory Services Thomas V.Geller,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 DA'L'F: q10 NfJMER OF PAGES TO FOLLOW: TO: FROM: PHONE: PROM (508)862.4644 FAX PHONE: FAX PHONE: (508)790.6304 CC: Health Complaints 19-Aug-04 Time: 3:00:00 PM Date: 1/14/2003 Complaint Number: 3891 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: Number: 50 Street: Suomi Road Village: HYANNIS Assessors Map-Parcel: 269-105 Complainant's Name: Heather Atwood Address: Enviro-Safe Corp. Telephone Number: 508-888-5478 or cell 508-737- Complaint Description: Oil release in house in an underground line of oil tank. Reported by Nelson Coal and Oil on Jan.10 and then to Hyannis Fire and then to Tyson Rose of DEP and DEP said to call health department. Oil delivered (100 gal) on Dec. 31 and Jan. 10th all gone and line was broken and repaired. Estimated oil release is 90+ gallons. DZM is responding at 3:40 pm on 1/14/03 (date reported) _ Actions Taken/Results: DZM investigated and gained access to the house. Tenants allowed me entry and the O house is not owner occupied. Owner is Ana Paula Desa. Her work number is 508-790-2776 \ and cell phone is 508-367-4718. Many tenants occupy this house. Active building permit on \ the property and there is a for sale sign outside also with Margo of Shoreland Real Estate. There is a 3 year old child on the property and an 8 yr. old as well. Upon entering the front door of the house there is an oil smell. In the basement there is a 4 x 5 foot area stained with oil that is stained up to about two inches on the concrete block wall. DZM called Tyson Rose of DEP (508-946-2743) and reported this to him 0 1 d 00C e -5Gr " 5 A NA PAW r i Health Complaints 19-Aug-04 via voice mail. On the morning of the 15th Tyson called me back for further info. I informed him.it is in the Zone of Contribution and that the Barnstable Water Company owns land that is southeast east of this site. Investigation Date: 1/14/2003 Investigation Time: 3:45:00 PM 2 I RECEIVED ECOJECH Environmental OCT 2 7 2003 www.eco-tech.us TOWN OF BARNSTABLE HEALTH DEPT. THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASS OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 50 Suomi Road Hyannis Owner's Name: Ana P. Desa MAP �-- -� ---� Owner's Address: 35 Mary Alice Lane PARCEL Hyannis,MA 02601 L0� Date of Inspection: October 22,2003 Name of Inspector: (Please Print) David D. Coughanowr,R.S. Company Name: Eco-Tech Environmental Mailing Address: 43 Triangle Circle Sandwich,MA 02563 Telephone Number: (508)364-0894 CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature ki-1;1,,4 ��,-- RS Date: Oc'f-Sbpr ZZ, W03 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority NOTES AND COMMENTS Inspector's Note—> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ****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: 50 Suomi Road Hyannis Owner: Ana P.Desa Date of Inspection: October 22,2003 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: Yes I have not found any information which indicates that any of the failure criteria described in 310 CMR 5.303 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,or 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 breakout or high static water level in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The 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 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 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: 50 Suomi Road Hyannis Owner: Ana P. Desa Date of Inspection: October 22,2003 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 and 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 by 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 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Suomi Road Hyannis Owner: Ana P.Desa Date of Inspection: October 22,2003 D)System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described 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 the failure. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X 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 by 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 Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd 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 11 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: 50 Suomi Road Hyannis Owner: Ana P. Desa Date of Inspection: October 22,2003 Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes No Y _ Pumping information was provided by the owner,occupant or Board of Health. N Were any of the system components pumped out in the last two weeks? Y _ Has the system received normal flows in the previous two week period? N Have large volumes of water been introduced to the system recently or as part of this inspection? Y _ Were as built plans of the system obtained and examined?(If they were not available as N/A) Y _ Was the facility or dwelling inspected for signs of sewage back-up? Y _ Was the site inspected for signs of breakout? Y _ Were all system components,excluding the SAS located on site? Y _ Were the septic tank manholes uncovered, opened,and the interior of the septic tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? Y - _ Was the facility owner(and occupants,if different from owner)provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Y _ Existing information.For example,Plan at the Board of Health. _ N Determined in the field(if any of the failure criteria related to part C is at issue,approximation of distance is unacceptable) [310 CMR.15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Suomi Road Hyannis Owner: Ana P. Desa Date of Inspection: October 22,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 349 gpd Number of current residents 7 Does the 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): n/a Seasonal use(yes or no): no Water meter readings,if available(last two year's usage(gpd): 280 gpd Sump Pump(yes or no): no Last date of occupancy: current C OMMERCL4 L/INDUS TRIAL: Type of establishment: Design flow(based on 310 CMR 15.203):: gpd Basis of design flow(seats/persons/sqft/etc.): Grease trap present: (yes or no)_ Industrial waste holding tank present: (yes or no): Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings,if available: Last date of occupancy/use:- OTHER: (Describe): GENERAL INFORMATION PUMPING RECORDS Source of information: System last pumped in August 2003 (Owner) 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: X 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/Alternate 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: Age: 3+years Certificate of Compliance issued 8/30/00(BOH permit#2000-517) Were sewage odors detected when arriving at the site: (yes or no) no 6 i Page 7 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Suomi Road Hyannis Owner: Ana P. Desa Date of Inspection: October 22,2003 BUILDING SEWER_(Locate on site plan) Depth below grade: 2 ft Material of construction: X cast iron _40 PVC_other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting,evidence of leakage,etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling SEPTIC TANK:Yes (locate on site plan) Depth below grade: 10 inches Material of construction: X concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of certificate) Dimensions: 11.5 ft x 5 ft x 5 ft(1500 gallon) Sludge depth: 3 in Distance from top of sludge to bottom of outlet tee or baffle: 31 in Scum thickness: 2 in Distance from top of scum to top of outlet tee or baffle: 9 in Distance from bottom of scum to bottom of outlet tee or baffle: 13 in How dimensions were determined: Probe to top of tank Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Pumping not required at this time but maintenance pumping is recommended every 2 years Liquid level at outlet invert.Tank and tees appear structurally sound and functioning as intended.No evidence of leakage in or out 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 Page 8 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Suomi Road Hyannis Owner: Ana P. Desa Date of Inspection: October 22,2003 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 inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: Yes (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: at outlet invert Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) D-box appears structurally sound with no evidence of leakage in or out.Effluent level at outlet invert No solids in tank. 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 i Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Suomi Road . Hyannis Owner: Ana P. Desa . Date of Inspection: October 22,2003 SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required) If SAS not located, explain why: Type: _leaching pits,number _leaching chambers,number X leaching galleries,number 1 _leaching trenches,number, length _leaching fields,number,dimensions _overflow cesspool,number —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.) Soils above leaching gallery appeared unsaturated. No evidence of surface ponding breakout lush vegetation or other evidence of hydraulic failure was observed. CESSPOOLS: none (cesspool must be pumped at time 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 SYSTEM INFORMATION(continued) Property Address: 50 Suomi Road Hyannis Owner: Ana P. Desa Date of Inspection: October 22,2003 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'(Locate where public water supply enters the building) LOCATIONS 3 LEACHING D-BOX GALLERY A B 2 1 27 ft 21 ft SEPTIC 2 34 f t 2 3.S f t TANK o 3 39 f t 26 f t B A EXISTING DWELLING # 50 W Z JI ac W F 3I SUOMI ROAD NOT TO SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Suomi Road Hyannis Owner: Ana P.Desa Date of Inspection: October 22,2003 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 20+ feet Please indicate(check)all methods used to determine 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: _ Checked local excavators,installers-attach documentation) X Accessed USGS database You must describe how you established the high ground water elevation. Comparison of USGS topography maps and groundwater elevation contours indicates that property is over 20 feet above groundwater 11 Towri of Barnstable Assessors Division Page 1 of 3 MASS 109. Your Location : Home : Town Departments `. Administrative Services: Assessors Division More About ' <<Back- Forward>> Tuesday, November Search Website ?,'Assessors Division- More About , Town Departments - w *All Departments Data is based on Fiscal Year 2001 Assessor's database and-is provided for infc *Town Council purposes only. *Town Manager *Administrative Services Data presentee here,will be reflected on the'Tax Bills mailed late April,20 Regulatory Services - *Community Services 50 SUOMI ROAD x •Public Works- Map/Parcel/Parcel Extension: Mailing.Address: *Police Department, 269/105/ MORETTI, JAMES Q &ANTJE Owner of Record ' .. R %DESA, ANA PAULA ® Town Information IN MORETTI, JAMES Q &ANTJE 50 SUOMI RD i *All Information Property Location: HYANNIS, MA 02601 J *Agendas . 50.SUOMI ROAD Parcel ID:269105 *Annual Report - •Employment •FAQ's s *Hearing Schedules - •News/Press Links Fiscal Year 2001,Assessed Values f •Operating Budget y Appraised Value Assessed Value. •Ordinances ' •Property Assessments Building Value: $78,700 _ $78,700 *Regulations Extra Features:; $0 $0 *Town Charter r *Town Calendar Outbuildings: ' .$500 $500 ' - Land Value: •$44,900 $44,900 ® Town Newsletter . ' Receive Town Updates Totals: $ 1245100 $ 124,100 By E-mail _ Click Here To Join ®. Contact Town Hall ® ' Town Hall 'r 367 Main Street Sales History Hyannis, MA 02601 Owner: Sale Date: Book/Page: Sale P Phone { MORETTI,'JAMES Q &ANTJE 10/15/1986 C108362 $ 110,1 508-862-4000 E-mail KELLY, KEVIN C & LAURIE B 9/15/1985_ C103322 $82,01 Contact Town Hall SOMERO, JOHN'M &JUDITH E C71630 $0 DESA, ANA PAULA 9/5/2000 C158919 $ 153,! • Land and Building Description j Land Building http://www.town.barnstable.ma.us/comeonin/.../resultsk.asp?MAPPAR=269105&B 1=Submi 11/1.3/01 Town of Barnstable Assessors Division Page 2 of 3 Lot Size(Acres): Year Built: . 0.35 1951 Zone: Living Area: RB 1591 Appraised Value: Replacement Cost: $44,900" $ 100,948 Assessed Value: Depreciation: $44,900 22. Building Value:. $78,700 Construction Details Style: Interior Walls: Cape Cod Typical " Model: Residential Interior Floors: Grade: Typical Average Grade Stories: Heat Fuel• 1 1/2 Stories Oil Exterior Walls Heat Type: Wood Shingle Typical Roof Structure: AC Type:" -Gable/Hip None Roof Cover: Bedrooms: Asph/F GIs/Cmp 2 Bedrooms Bathrooms: 1 Bathroom Total Rooms: 4 Rooms Outbuildings & Extra Features Code Description Units/SQ FT Appraised Value Assessed Val SHED Shed 96 $500 $500 . I Building Sketch http://www.town.barnstable.ma.us/comeonin/:../resultsk.asp?MAPPAR=269105&B1=Submi 11/13/01 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTEt3T10N ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 � U" 3 y 2q&y CoxE Secretary u, ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 50 Suomi Road, Hyannis, MA Name of Owner: Jinn Moretti Address of Owner: 76 Bancroft Road Date of Inspection: July 27, 2000 Melrose, MA 02176 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: Telephone Number: (508)862-9400 Parcel. 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 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: Passes ✓ Conditionally Passes ids Further Eval o By the Local Approving Authority _ ils Inspector's Signature: Aimmw Date: July 31, 2000 The System Inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 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. NOTES AND COMMENTS revised 9/2/98 Page Iof11 Printed on Recycled Paper � V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 Suomi Road, Hyannis, MA Owner: Jim Moretti Date of Inspection: July 27, 2000 t INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to diz-date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup.-or bceakoutIor high static water level-observed in the distribution box is due-to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) broken pipets)are replaced _ obstruction;'s removed distribution box is levelled or replaced I 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 removed ✓ NOTE: The main cesspool blocks have started to cave in, and the cesspool is structurally unsound. revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 Suomi Road, Hyannis, MA Owner: Jim Moretti Date of Inspection: July 27, 2000 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 the public health, safety and 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 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) 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 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 1 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) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 Suomi Road, Hyannis, MA r t Owner: Jim Moretti Date of Inspection: July 27, 2000 D. SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: _ I have determined that one or more of the following failure conditions exist as described 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 the failure. Yes No 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 or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow. 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 1:of a public well.. .., r,•., Il.a.._. .. ... ,�. .!, .� °fir, . .. � ,' .{'1 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. 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. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,006 gpd or greater(Large System)and the system is a significant threat to public 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 lI of a public water supply well The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. _ revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 Suomi Road, Hyannis, MA Owner: Jim Moretti Date of Inspection: July 27, 2000 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. (*The house was vacant.) n/a 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 uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees, material of construction,dimensions,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: ✓ Existing information. For example,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)]. ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Suomi Road, Hyannis, MA Owner: Jim Moretti Date of Inspection: July 27, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: n/a g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): 3 Total DESIGN flow n/a Number of current residents: 0 Garbage grinder(yes or no): No Laundry(separate system)(yes or no): n/a If yes, separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last two year's usage(gpd): July 2000-33,750 gals.:July 1999-28,500 gals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd(Based on 15.203) Basis of design flow 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: None on We-per treatment plant System pumped as part of inspection(yes or no): No If yes,volume pumped: gallons 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information:.Unknown Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 PART C SYSTEM INFORMATION (continued) Property Address: SO Suomi Road, Hyannis, MA Owner: Jim Moretti Date of Inspection: July 27, 2000 - BUILDING SEWER: _ (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting,evidence of leakage,etc.) SEPTIC TANK: None , (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: — Distance from bottom of scum to bottom of outlet 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 invert, structural integrity, evidence of leakage,etc.) GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene other(explain) Dimensions: Scum thickness: j 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: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, - —evidence of leakage,etc.) - revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Suomi Road, Hyannis, MA Owner: Jim Moretti Date of Inspection: July 27, 2000 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or 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: Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: None (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) 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.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART C SYSTEM INFORMATION (continued) Property Address: SO Suomi Road, Hyannis, MA r Owner: Jim Moretti Date of Inspection: July 27, 2000 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number,dimensions: overflow cesspool, number: 1 Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) The overflow was S'W x 4'Tx 8'6" bottom to grade and was dry. The scum line was 2'up from the bottom. The cover was broken. There were no signs of failure CESSPOOLS: ✓ (locate on site plan) Number and configuration: I with overflow Depth-top of liquid to inlet invert: -- Depth of solids layer: — Depth of scum layer: — Dimensions of cesspool: 4'W x 2'Tx 5'6" bottom to grade Materials of construction: Cesspool block Indication of groundwater: None inflow(cesspool must be pumped as pant of inspection). Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) There were a couple of blocks on the side of the cesspool that have fallen in and dirt is starting to cave in. The cesspool was structurally unsound 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.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Suomi Road, Hyannis, MA + Owner: Jim Moretti Date of Inspection: July 27, 2000 Map: Parcel. SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) i A Aa- y3 a revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Suomi Road, Hyannis, MA Owner: Jim Moretti Date of Inspection: July 27, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 20+/- _ Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions ✓ ' Checked with local Board of Health Checked FEMA Maps Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. Must be completed) The bottom of the overflow cesspool to grade was 8'6". Using the Barnstable topographic map and water contours map, the maps were showing approximately 20' +/-to groundwater at this site. Using the Cape Cod Commission Technical Bulletin, the high groundwater adjustment for this site (MI W 29, Zone C, 6100)was 3.1'. This report has been prepared and the system inspected and conditionally 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. revised 9/2/98 Page 11of11 "'x�:,z:. �E :,*. c s� �, �--�.___ ii.Y•.7� �s�i.•�`.�.�1� - _ �.x.•«+'t�_ f�•.+;.'�tL:�$��+�`-.�M. r«_ �M:,,. f a rTOWN OF BARNST LE Xr r' -- -- >- •.- r /s+'� IT d SEWAGE # aw v f\!II.LAGE y�_ /2 K l .T` ASSESSOR'S MAP&LOT' INSTALLER'S NAME&PHONE NO. AI, ��D ,-ea 7,e+C c SEPTIGT' NK CAPACITY �Sa C7 ` LEACHING'FAGILTTY: (type) -� t `NO.OF BJEDROOMS o BUILDER'OR OWNER . Old-G�� -.. PERMTTDITE: `d COMPLIANCE DATE: Separation Distance Between'the: Maximum Adjusted Groundwater Table to the Bottom_ of Leaching Facility Feet i Private Water Su O l Well and Leaching Facility 1 a , PP Y g ty (If any wells exist on site or v�ntlun 200 fee leaching facility) Feet t of Ed ge of Wetland and L.eaching.Facili If aAy wetlands east, t ..; � �t v►itliin 300 feet of iea`clung facilityty f+ t 0110-49'�R odb it ai6# AF G '�.13'" -•7}.,. 3`� V 'yTT r ''�F�ut ..+ tti' l i4+1 9, -,y Z? q w•-fit r,•Ti�lif.= vs 7 a�'••= nc 7irl i f 1 ti.. w1 T m�.1"•.;,",s�^Y} �,, iift�,b T. f "•y� t.. _ ' . •r wz.[ . . - «,k- �.� .-a, a i�•-!': 4A-7 i j7rz ,ram r � t � y 3 _ S.t f ..i y..S.t - - ;' i h; t s• ti/ {}••na.�3 ty-•tir �: "tS'T G,.. 4r ,�..• -i fM�y 5 f- *f•y'* 'ryliff•t� d.Pi._ �t•7Y -4"�'+ u 7* +7'`i `•s Iil• ._a+ �� r � ' •�'t ♦y '!i.• >, I + -f i•.a, ..,,,�t�rt [e rt.�r>.•-'ice- �liE •: o; -f� 77.Ai47f..t.,.. 'i7' •*^.'a.• ,�.ytt 'K ,.. -'+ t .� dl�t...... � Ii-r.e•+ u � ,. � {,..-.2._._ ! �a `'1 S -t..;• -r ��t�y.,•}.i"+-�-,e'"""M ,e.s... +. ! �� .. --->.z:. •i .3 '_' ...Y. •, •- - _ .... ... ;-•rt :17+•"'_^tl,Aici.. •..i4 'fsx 'L",..1r "a#• � � .-+"^",^•�.•-• - '� _ .,• "� `-'t r" -G•t •i � +{y 1 �Ct_1 +>. r.•-^hy� ��i •.ti.ew.7x `�9�5�+'. Grp .. ., �?" �•`.-. ,� ' w � •t-+�'• .:1 t��� � f4}•S•: }Y 11,.IKit-_ •'� _ �•y.•.1 i.i,! K w +tea ! a _ "TOWN OF BAR/NSTABLE '�"e` LOCATION �oe�/'+4 t 2ci- SEWAGE # 00 VILLAGE f7 v G /2 i2 S ASSESSOR'S MAP & LOT E _ INSTALLER'S NAME&PHONE NO. Ted 7� C SEPTIC TANK CAPACITY ga LEACHING FACILITY: ( pe) i2 Tu 46 ? Izf) 7 NO. OF BEDROOMS BUILDER OR OWNER Ok6fr - PERMTTDATE: U COMPLIANCE DATE: 9 0 Separation Distance Between the: C Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet' Furnished by ct.3 � � 9u t.•► s \\ . o No. v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �0"Ppltration for Mopogar *pgtem Cougtructton Vermtt Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) Womplete System ❑Individual Components Location Address or Lot No. 5(j vim'\t c,_.� Owner's Name,Address and Tel.No. 02 Assessor's Map/Parcel a(crm _LDS Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �5 Uvt S sZ . K.ac 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 330 gallons per day. Calculated daily flow 3 14c� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank $DO Q 4.11OWaL. Type of S.A.S. 6-CI e- T <<- Description of Soil w Nature of Repairs or Alterations(Answer when applicable) =oL.S�aII 1-5-0 5r T I)- &. rZ.,44c,z Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has s Board e Sign d 2 Dated-a2 Application Approved by Date Application Disapproved the following reaso Permit No Date Issued a; _. ` ..-�:(.-.moo.-s-�.- � - .. --. -. r _; . . er- w s---N-•-c c_ __ No: V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplicatton for 30tq gaf bpgtem Congtruction Permit Application for a Permit to Construct( )Repair�pgrade( )Abandon( ) ,Complete System El Individual Components Location Address or Lot No. d C u vv► , a..n� Owner's Name,Address and Tel.No. Assessor's Map/Parcel _lOs I "o V��T� Ins ler's Name,Addre s,and Tpl.No. Designer's Name,Address and Tel.No. s V%oo—�r� i , V5 looks C 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 3 30 gallons per day. Calculated daily flow 3 �� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Allow aL Type of S.A.S. �a Cc,t&- T V � Description of Soil (Coei 10 amµ v2 I 'Nature of Repairs or Alterations(Answer when applicable) -5'f p t! 5,1 /�` g• ` tG r> 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 t ronmental Code and not to place the system in operation until a Certifi- cate of Compliance has ee s Bo lth. Sig e e Date rr Application Approved by �� Date Application Disapprove or the following reaso s t Permit N . / Date Issued 1 _. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (CompItattce THIS IS TO CERTIFY h t the 0 site Swage Disposal System Constructed( )Repaired ( )Upgraded C ) Abandoned( bl at `� I OWO W AAA h constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N dated Installer Designer t A 10 t The issuance of this pe 164a t be construed as a guarantee that th to wi fu ctiop as# signet Date Inspector No.AV — ------------------------Fee !Z�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal *pgtem CongtrUctton Permit Permission is hereby granted to Construct( )Repair( )Upgrade Abandon( ) System located at SU S v 0rAl and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co om feted within three years of the date of s pe I, Date: © Approved by \, 1/6/99 NOTICE: This Form Js-.To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS.CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated '�� � , concerning the property located at 'S-U sy C)r c� 02x� meets all of the following criteria: This failed system is connected to a residential dwelling only. There are no commercial or business ' /uses associated with the dwelling. v • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system ` There are no private wells within 150 feet of the proposed septic system el There is no increase in flow and/or change in use proposed 'There are no variances requested or needed. u The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] rIf the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 3� B) G.W. Elevation +the MAX. High G.W. Adjustment If _ DIFFERENCE BETWEEN A and B SIGNED : DATE: �ct� [Please Sketch ppropo ed plan of system on ac�]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert ., ', �` � �� �-� s ,� I � . � �� a �_ OG4 M WSS lAN TB.H.Y. f o 7 Z T n w w �i ._ v - ri f R O sm (� 1 y 1 \ !' O o . 9 m k 1 � � I � � E m z m z c � x m . m a ML4 MW u CAST n.•.Y. �V f W V.1 \ T C� a � D A ti D m m . Z - O 0 y a m 0 `. V • o a o > < i E m E 2 m Z Z m m a 004VR WF58 4 CASTM N.Y. 77 73> ' o Z t I � � I I j R� Z � � O I °e 0 m � < o L — z CP � �• m tAn O cri N v z z N m a OOIVE RESS W CASM.N.Y. 1 ' -IE 4— I Q O W m m Z O s < -2i col - O o � 0 cn a C>Q h A < i v% o i O c I I OGUE RFss wunsrei.n.r. CID f I I I I � I I i • i I I , 1� I - o m m m 1 S tp N O 'a s • . o � < ma � s r r � -� 7t > < > `T f T z z < IZ) c 4 7 c - m G a •1p RI � t