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Home My WebLink About0091 WALTON AVENUE - Health 9i.Walton Avenue Hyannis -_ — -- A = 310 020 i �ppTHE T�� Town of Barnstable Bam, table T 11 Regulatory Services sAsTAB Thomas F. Geiler, Director MASS. 9� i63q. 10� A'E1639 Public li Health Division 200 Thomas McKean,Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Barnstable First District Court PO Box 427 Barnstable, Ma 02630 Re: Warner Cadet 91 Walton Avenue Hyannis, MA Citation No.76652 Dear Magistrate: As a result of the corrective measures taken by Warner Cadet and my recent confirmation that the situation has been completely resolved, I respectfully request that the aforementioned enforcement matter heard before you on July 18, 2008 be dismissed. Please notice all parties accordingly. Sincerely, Timothy B. O onnell Health Inspector 4 •s SmeloffRenner ATTORNEYS & COUNSELORS AT LAW 100 GROSSMAN DRIVE SUITE 305 BRAINTREE MA 02184 TELEPHONE: (781) 843-2323 RICHARD D.SMELOFF,ESQ. FACSIMILE: (781) 843-2324 THOMAS C. BENNER,ESQ. CHARLES S.PAVOLIS,ESQ. -ANNA RESNICK of COUNSEL Lic. MA and FL July 30, 2008 Waner Cadet Alcarine Cadet 137 Windshore Drive Hyannis MA 02601 re: 91 Walton Ave Hyannis MA 02601 To Whom It May Concern: This office represents Mr. and Mrs. Cadet in a Chapter 13 Bankruptcy, case number 08-11316- WCH which was filed February 28, 2008. Within Mr. and Mrs. Cadet's Chapter 13 filing, they are surrendering the real property known as 91 Walton Ave, Hyannis MA 02601. Very truly yours, Richard D. Smeloff Esq. r P. 1 e> Communication Result Report ( Aug. 4. 2008 9: 37AM ) 2) Date/Time ; Aug. 4, 2008 9: 36AM File Page No. Mode Destination Pg (s) Result Not Sent ---------------------------------------------------------------------------------------------------- 3668 Memory TX 915083620213 P. 3 OK ---------------------------------------------------------------------------------------------------- Reason for error E. 1) Hang up o r 1 i ne fa i 1 E. 2) Busy E. 3) No answer E. 4) No facsimile connection E. 5) Exceeded max. E—mail size Town of Barnstable = Regulatory Services Department f° Consumer Affairs Division Thomas B.Gder,Director 200 Main Street Hyannis,MA 02601 Office:(508)862A672 Fax(M)778.2412 FAX TRANSMITTAL TO: DISTRICT COURT DATE: 814108 FROM: TRACEY SMITH #OF 3(INCLUDING COVER SHEET) PAGES FAX# 508362-0213 THANK YOU. NAME OF OFFENDER M BAR 76652 4 ^04 ',�,,,�'1 'ADDRESS Of 0_gFENDl�I i. �, _ � �� n Q«r •�, FBAFRNS��'(�BLE CITY,ST T,ZII+IPP CODE �Y Er OF BIRTH OF OFFENDER �tHE iq,_ MV OPERATOR LI ENSE NUMBER MB REGISTWATION NUMBER OFFENS@y' p/y NAXtiII'API.F.. auj - '639. ED M►� `� m TIME AND DAT OF VIOLATIO ,q LOC N F VIO ATION W NOTICE OF 092 ( .. t/ j ON dTn�.. �^ 2o69 �" co VIOLATION SIGNlijtlA� 1 FORCINGIPERS ENF IN DEPL BADGEN0. UJI 61 6t�/. +n. 0 OF TOWN I HEREBY A K OWLEOGE RECEIPT OF CITATION X li ORDINANCE Unable to obtain signature of offender. ►a— THE NONCRIMINAL FINE FOR THIS OFFENSE IS S Date mailed w W OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. Lu REGULATION a (t)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, L I before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P. Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. CL �2 Uyou desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST NSTABLE DIVISION,COURT COMPOUND,MAIN STREET ARNSTABLE,MA 02630,Attn:21D 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. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature Town of Barnstable Regulatory.Services UAfiVSfiAgt.B. � Thomas F. Geiler, Director MASS. Public Health Division aria MPY-a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 28, 2008 Barnstable District Court Clerk's Office P.O. Box 427 Barnstable, Ma 02536Ll o . Re: Warner Cadet 1.37 Windshore Drive Hyannis, MA 02601 BAR# 76652 2 To Whom It May Concern:" On January 4, 2008 I was conducting an investigation pertaining to rental properties which have not registered with the Town of Barnstable rental program.(Chapter 170). I was searching a list of names which had been complied by health inspectors. This list of names is of owners of properties in the town of Barnstable and these properties have been listed for rent in one form or another. (i.e. signs, advertisement, ect.) I noticed this particular unit's owner lived at a different address so I assumed they are renting said unit. In accordance with what I am told by my superiors, I issued a ticket to owner Mr. Warner Cadet. (BAR# 76652) Sincerely, e-- Timothy . O'Connell Health Inspector Q:Health/Order letters/Housing violations/26 Louis Street vies corrected.doc :a oFIME r°w� Town of Barnstable B r = {1,1 o� Regulatory Services' 9BAR ABLE, Thomas F. Geiler, Director M . i639• 1� A'E1639. Public Health Division 200 Thomas McKean, Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Barnstable First District Court PO Box 427 Barnstable, Ma 02630 Re: Warner Cadet 91 Walton Avenue Hyannis, MA Citation No.76652 Dear Magistrate: As a result of the corrective measures taken by Warner Cadet and my recent confirmation that the situation has been completely resolved, I respectfully request that the aforementioned enforcement matter heard before you on July 18, 2008 be dismissed. Please notice all parties accordingly. Sincerely, Timothy1B. 0onnell Health Inspector Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the 31*5112) computer, r,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 ` Company Address Centerville Ma. 02632 City/Town State Zip Code ' (508)428-4028 S 14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority i 5/19/2009 Insp ctor's SigrMture Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 9 � t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N„ ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Walton Ave. M Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N FIND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Yz day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4.1 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of'a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? t ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M °V 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1500 gallon septic tank,distribution box and two drywells. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No ,000 :93 Water meter readings, if available (last 2 years usage (gpd)): 2002007:93,000 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Cfficial Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 2.5' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 5" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Walton Ave. M Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 4" 4" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 110 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: — — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 91 Walton Ave. b SvoS Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 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 faillure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No sihns of hydraulic failure.Drywells were dry at time of inspection.Stain line was 8" below invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 li Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately REAR I 6 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 91 Walton Ave. Sye Property Address Bank Owned GRP New York Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom Of leaching 40' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 91 Walton Ave. Property Address Bank Owned GRP New York Owner Owner's Name , information is Hyannis Ma. 02601 5/19/2000 required for y every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m c DEPARTMENT OF ENVIRONMENTAL PROTECTION N tie a �'9b 5V0� 350 MAIN STREET .� WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 91 WALTON AVENUE HYANNIS,MA 02601 Owner's Name: BITZER,RUTH J. Owner's Address: 1.597 FALMOUTH ROAD CENTERVILLE,MA 02632 Date of Inspection JUNE 6,2006 Name of Inspector:(please print) JAMES D.SEARS (j" Company Name: A&B Canco r - Mailing Address: 350 Main Street S _ West Yarmouth,MA 02673 Telephone Number: 508-775-2800 , r, 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: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 6-8-06 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 tot he buyer,if applicable,and the approving authority. Notes and Conuments *** 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 91 WALTON AVENUE HYANNIS,MA 02601 Owner: BITZER,RUTH J. Date of Inspection: RUNE 6,2006 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: N/A 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 extiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 91 WALTON AVENUE _ HYANNIS,MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUNE 6, 2006 C. Further Evaluation is Required by the Board of Health:N/A 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 Athin 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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 witlun a Zone 1 of 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 91 WALTON AVENUE HYANNIS,MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUNE 6, 2006 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in leaching is less than 6"below invert or available volume is less than''/q day flow 7— 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone I of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 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: N/A To be considered a large system the system must service 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 91 WALTON AVENUE HYANNIS,MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUKE 6, 2006 Check if the following have been done. You must indicate"yes" or"no"as to each of the following Yes No ✓ Pumping infonnation 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,including 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)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 C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 91 WALTON AVENUE HYANNIS,MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUNE 6, 2006 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CNIR 15.203(for example: 110 gpd x#of bedrooms: 220 Number of current residents: 0 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): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): SEE ATTACHED PAGE Sump pump(yes or no) NO Last date of occupancy: UNKNOWN COMMERCIAL/INDU S TRIAL Type of establishment: Design flow(based on 310 CMR 15.203): 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): GENERAL INFORMATION Pumping Records Source of information: 2002 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 2002—PERMIT#01-201 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 WALTON AVENUE HYANNIS,MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUNE 6, 2006 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 2' 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 onsite plan): ✓ Depth below grade: 28" 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: 1500-GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: V Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: ASBUILT&TAPE Comments(on pumping reconunendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,TANK AT 28"BELOW GRADE. INLET COVER AT GRADE,INLET TEE—OUTLET TEE. NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP(located on site plan) N/A 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.): Title 5 Inspection Form 6/15/2000 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: 91 WALTON AVENUE HYANNIS,MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUKE 6, 2006 TIGHT or HOLDING TANK: N/A (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: Alain 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: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): D-BOX IS 16"X 16"-3'BELOW GRADE,BOX IS CLEAN&SOLID. ONE LINE IN—ONE LINE OUT. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 WALTON AVENUE HYANNIS,MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUKE 6, 2006 SOIL ABSORPTION SYSTEM(SAS): •, (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: T leaching chambers,number: 1( leaching galleries, number leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool,number: A 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.) LEACHING IS TWO 500-GALLON DRY WELLS. LEACHING IS 13'X 26'—22,28"BELOW GRADE—WET. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (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: N/A (locate on site plan) Materials of Constriction: Dimensions: Depth of solids:' Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 WALTON AVENUE HYANNIS, MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUNE 6, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal s\stem including ties to at least two permanent reference landmarks or benchmarks. Locate all%Hells Within I oo t'eet. Locate xt-here public\Nater supple enters the building. AIf 7D 0 3a o Title 5 Inspection Form 6/15i20oo 10 Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 WALTON AVENUE HYANNIS. MA 02601 Owner: BITZER,RUTH J. Date of Inspection: JUNE 6, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 8 feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: �— Observation site(abutting property/observation hole vnthin 150 feet of SAS) Checked with local Board of Health-explain: Checked xvith local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE AT 87 NO WATER. TEST HOLE AT 3' BELOW BOTTOM OF LEACHING. BOTTOM OF LEACHING AT 5' BELOW GRADE. a�Rio �A Al a Title 5 Inspection Form 6/15,2000 1 1 JUN=07-2006 11:05 HYANNIS WATER SYSTEM 508 790 1313 P.02iO3 From Date . - Bitzer Ruth Status Serial Number. Service Address . 106300 91 Walton Ave Meter Position 1 Account ID Work Order . . . 0 Read Mtr Meter UM R R E S Account P pate Pos Reading Consumption CS I T R T ID _ 02/15/06 1 98 700 FC 1 N 1 00155078 _ 11/21/05 1 91 1,100 FC 1 N 1 00155078 _ 08/17/05 1 80 1,100 FC 1 N 1 00155078 _ 05/16/05 1 .69 900 FC 1 N 1 00155078 _ 02/16/05 1 60 11100 FC 1 N 1 00155078 11/16/04 1 49 1,100 FC 1 N 1. 00155078 _ 08/18/04 1 38 1,200 FC 1 N 1 00155078 _ 05/17/04 1 26 11000 FC 1 N 1 00155078 _ 02/17/04 1 16 11100 FC 1 N 1 00155078 _ 11/17/03 1 5 500 FC 1 N 1 00155078 _ 10/03/03 1 0 0 FC 6 1 0 1 00155078 _ 10/03/03 1 828 600 FC 6 4 0 1 00155078 O,p,t, 1,=,R,e,a,ds , .6,=,T,e,x,t, . F,4,=D,t.l,s. . ,F8,=.D,a:t.e, S,e,q, , F1,2,=,D,i,s.p.l,a,y, T,o,g,9,1,e. , ,F,2,4,=,M,o,r,e, , , F TOWN OF BARNSTABLE Lc:;;r,ATION zzl-A& �'�-� SEWAGE # Q Z— Z !! VILLAGE _ ASSESSOR'S MAP & LOT ( -CLQ_ INSTALLER'S NAME& PHONE NO. 176ki SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L (size) NO. OF BEDROOMS � ( BUILDER OR CWNER) PERMITDATE: G Z COMPLIANCE DATE: 15' -G' O ;— 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 facihry) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f o �tl �� , � � �.- ti �x 6 ' � � �'. M 3�1�f 4 .> � ��!� - - i �� .,, � � } � n, �� { f . TOWN OF BARNSTABLE ,I -)CATION / Gy 44�T"�� SEWAGE# VILLAGE / ASSESSOR'S MAP&LOT O a2a //w SA£cya�e -IA1ER'S NAME&PHONE NO. -�-� /U�0 SEPTIC TANK CAPACITY S£"0// C— /w.5"Ido£c-aN LEACHING FACILITY.(type) (size) NO.OF BEDROOMS y� '/ BUILDER OR OWNER �! Z Z/- /C y7-f/ PERMIT DATE: COMPLIANCE DATE: 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 10 M b► 7 s r.. Fee G-J res THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for 33fgpooal bpotem Comaruction Verrait Application for a Permit to Construct( . )Repair( t- Jpgrade( )Abandon( ) CTComplete System ❑Individual Components Location Address or,Lot No. V/1 W#L /a V L Owner's Name,Address and Tel.No. Assessor's Map/Parcel /O _ O 2j/. r!/1�1> In Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow S3S' gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ib A j goe,s f Description of Soil; k"r-11 e jam Nature of Repairs or Alterations(Answer when applicable) 1 GiS��LL l0e G�L 7l�i/�C Date last inspected: 's-0 0 6-/ CtA4. PrS, 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 Cod and not to place the system in operation until a Certifi- cate of Compliance has been issued this d of Health. ✓��_ Signed - Date Application Approved Date �_ °'6� Application Disapproved for the following reasons Permit No.� np Date Issued — _ ------�_— No. a 0 U 1 Fee d — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mtgpoal 6potem Cow5trurttou permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at � "11 eu 1nl a-M / JA1 Il A4�rin i f ±� / 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:Con ttruction must be completed within three years of the date of this e it. t Date: S /6 U Z Approved by l � � Fee 4' Entered in computer: �— � THE COMMONWEALTH OF MASSACHUSETTS es PUBLIC HEAL�H DIVISION,-TOWN OF BARNSTABLE., MASSACHUSETTS riiatiort for Migpo�ar *pgtem Construction Permit Application for-,Permit to Construct( )Repair( �YUpgrade( )Abandon( ) C�Complete System ❑Individual Components Location Address or Lot No. ti/ W/}L +0 h/ ✓t Owner's Name,Address and Tel.No. •-'Assessor's Map/Parcel �2 0 V�'� J Installer's Nameoas-az�d-T�1,-ta[�e Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow D gallons per day. Calculated daily flow 3 3 c— gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 1 /ie f0 5 1 y A,(-k01Z4 ' Description of Soil; W r 11 y 7 /147--o7z 141 Nature of Repairs or Alterations(Answer when applicable) 1 tis AA4 C l Coe G,3 L 7,*0A- i y C Date last inspected: —00 V^/ C4h✓4P�'f Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of,Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this oard of Health.,/u/'„ 41 Signed Date Application Approved Date Ar-.2 •r`�Q� Application Disapproved for the following reasons FJ Permit No.;F ,W 7 Date Issued' g6 ————————— — ————— THE COMMONWEALTH OF MASSACHUSETTS i` BARNSTABLE, MASSACHUSETTS '9 ��ertiff cafe of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disp sal System Constructed( )Repaired( )Upgraded 'it t Aban oned , )by /! m has been constru ted in accordan e with the provision of Title 5 and the for Disposa q stem Construction Permit ' r dated ' �'" . . Installer `T_ � , I l��b��c•,. Designer \The issuance of thi ielt shall not be construed as a guarantee that the s will nncttion a d si ned. Date 01 Inspector ----------------------------Fee "15014x1.. ,U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS 4 1=i5pogal *p5tem Construction Permit { Permission is hereby granted to Construct( )Repair( )Upgrade( )Ab on( ) System located at oN { 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:Construction must be completed within three years of the date of tbig,75brmit. Date: � Approve a PP "�'' u6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF S=TCH .AYD APPLICATION FOR A DISPOSAL 1 WORKS CONSTRUCTION PERbIIT (WTI'HOUT DESIGNED,PLANSI J�wg 4106 kt17 hereby czmfy that the application for disposal-wor's con Man permit sued by me dated conce. -tino the property located at 92 I.t/,Ahl,�VA7 �• )� �� meets all of the following criteria: �'• T-he failed system is coarse_,= to a residential dweang only. There are no commercial or business uses associated with the dwe!lins, i fie soil is classified as CLASS I and the ce_colauon rate is less than or eoual to 5 nunutes peainca. i fie-e are fie we_lands withyn 100 fe_:of the oroocs,d seouc s:se.,,- Tnerc are no private wets within 1_50 fee:of the proposed septic sise_rt U These is no inc.,--ire in flow and/or cham!e in use proposed f Tnere are no varianc=.requested or nded. {� TIC bottom of the oroposd leacsi.ng facility•xill not be located less than five fee:above the tna�imum adjured grouudwate-table e!eration (Adjust the zoundwater table tying the rrimucor Method when applicable] V if the S.A.S, will be located wick_fo fe`:of an-,vemaced wetlands• the bortom of the proposed le�wng facairy will net be lcca(ed.!ess than oureen(14) feet above the m=•cimum adiusted g*pundwaLer table e!�riacon, Please complete the following- A) Too of Ground Su.--ace =:clarion(oars;GIs inforrnauon) B) G.W. E?evaaon ,'Zrthe NLa'C. �:igh G.W. Adjussnenc :� _ 32.1 D if—: =—RENCE B E i WEE `+ A and B DATE: (Sicetc`t rocosea plan of s:ste a on bac!c1. q:.::CZ!h;olds c_.. � a r y ' Q 1 e 0 I o ri M i TOWN OF BARNSTABLE LOCATION SEWAGE # G Z- E Z VILLAGE ASSESSOR'S MAP & LOT 310 — INSTALLER'S N &PHONE NO. 6��-v�°'"" SEPTIC TANK CAPACITY LEACHING FACILITY: (type) " G (size) NO. OF BEDROOMS - BUILDER OR 7Q:c3: PERMTTDATE COMPLIANCE.DATE: � O � 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by r x e ✓