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HomeMy WebLinkAbout0099 WALTON AVENUE - Health 99 Walton Avenue,Hyannis I s r Commonwealth of Massachusetts e F} = eTi Title 5 Official Ins pction Form Subsurface Sewage Disposal System Form-- Not for Voluntary Assessment ° 99 Walton Ave, Hyannis ^�7M Property Address a" Lucas Cyr I�.W '•9 Owner Owner's Name information is required for every MA 02673 July 8, 2015 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:When filling out forms A. General Information on the computer,use only the tab 1. Inspector: 6/ / f` O i key to move your cursor-do not David B. Mason use the return Name of Inspector key. David B. Mason Company Name 4 Glacier Path Company Address East Sandwich MA 02537 City/Town State Zip Code 508-367-1617 S1287 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 July 13, 2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. V t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every Y 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 observations noted in this report represent the condition of the system only on this date of inspection and the information contained herein does not guarantee the continued operation of the system. 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-3113 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 ^M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every �f page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every _ Y page. CityTTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ,❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or. clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every _ Y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official-Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every Y 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? ® ❑ 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): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every _Y page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: 2013; 0 gallons and 2014; 0 gallons. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Walton Ave, Hyannis Property Address Lucas Cyr _ Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every Y page. Cityrrown 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: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every y 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: 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 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.): Septic Tank(locate on site plan): Depth below grade: 2 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 Typical Sludge depth: 0 11 t5ins•3113 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 cwM 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every y page. CityFrown 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 47" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: — Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every y page. Cityrrown 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 effluent level with outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No evidence of solids carryover. Dbox is 14 inches below grade with a 12 inch riser. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every y 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 failure, level of ponding, damp soil, condition of vegetation, etc.): 2-500 gallon precast chambers with 4' stone around. No signs of hydraulic failure. Chamber is 34 inches below grade with 24 inch risers. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every Y page. CityFrown 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.): 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is Y West Yarmouth MA 02673 Jul 8 2015 required for 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 t5ins•3/13 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 �MsO 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8 2015 required for every y 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: 18 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: Groundwater Contour Map ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain.- You must describe how you established the high ground water elevation: Groundwater Contour Map Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 99 Walton Ave, Hyannis Property Address Lucas Cyr Owner Owner's Name information is West Yarmouth MA 02673 Jul 8, 2015 required for every _Y page. City(rown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Page 1 of 2 Z!��N of aARNSTAbL>r, LOCATION �4IJN _SEWAGE# VILLAGE ��+ ^'v'' ^ j ASSESSOR'S MAP&LOT1012 I_ INSTALLER'S NAME&PHONE NO.�� k�/!�4—try ^) SEPTIC TANK CAPACITY LEACHING FACILITY:(tt lX MI (size), NO.OFBEDROOMS--!— BUILDER OR OWNER l , PERMTTDATE: G COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5,e P r Feet Private Water Supply Well and Leaching Facility (If any wells exist See P Feet on site or within 200 feet of leaching facility) Edge of Wedand and Leaching Facility(If any wetlands exist � E �Feet within 300 feet of leaching facility) Furnished by A 1-15' 3-30���� 5-37 A ,6 0 http://town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=310021&seq=1 7/14/2015 I _ Mar 16 13 02:59p p.1 Commonwealth of Massachusetts Title 5 Official Inspection F C®� p Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 99 Walton Ave. Property Address Owner Luck Cyr information is Owner's Name required for every page_ Hyannis MA_ 02601 3/15/2013 City,?own Stale 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 lNhen filling out A. General Information forms on the onlythcomputer,use 1. Inspector: only the tab key to move your Wayne Archambeault cursor-do not Name of Inspector — - use the return - key. �I Company Name --...._ PO Box 914 Company Address - Hyannis __ '"61A City/Town _. p601 State Zip Code 508-775-1362 _ 355 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 Authoritya or s Signatur — 3/1 512 0 1 3 l _ Date P, 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 th M 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. ,.sins•11110 Title 5 Mcial Inspection Form;Subsurface Sewage Qispom system•Page 1 of 1 'F Mar 16 13 02:59p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave. Property Address Owner LUgk CC � information is Owners Name required for every page. Hyannis MA 02601 31152013 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection,Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the'Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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): Isms-�vi c The'_Ofbck!inspection Form:Subsurface Sewage Disposal SY&Iem•Page 2 of 17 . Mar 16 13 03:00p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr information is Owner's Name - required for every page. Hyannis MA 02601 3/15/2013 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO(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, l5ins•11I10 Title 5 Of nai Insoeetion Form:Subsurface Sewage Disposal system.page 3 or 17 f Mar 16 13 03:00p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr information is Owner's Name - - required for every page. Hyannis MA 02601 3115/2013 Cityfrown State Zip Code Date of Inspection 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 B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone'1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3, Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No &ns.11,110 Trle 5 Official hspecilon Form;Subsurface Sewage Disposal Systerr.•Page 4 of 17 Mar 16 13 03:00p p.5 Commonwealth of Massachusetts oi_ Title 5 Official Inspection Form =1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr information is Owner's Name -- required for every page. Hyannis MA_ _02601 311512D13 Cltyaown State Zip Code Date of Inspection ® 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 '/day flow B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue 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.Ffhis 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) urge Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 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 t51ns•11/10 Tide 5 Official Inspection Form:Subsurface Sawage Disposal Systen•page 5 c1 17 Mar 16 13 03:01 p p.6 Commonwealth of Massachusetts - Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr irforrretion is Owners Name `- _. - required for every page. Hyannis MA 02601 3/15/2013 Cityfrown State Zip Code Date of Inspection ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"'yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health, ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5ms•r yr o Tine 5 Official hnpecticn Forth:Subsurface Sa.,age Disposal System•Page 6 0117 I Mar 16 13 03:01 p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr information is Owners Name — required for every page. Hyannis MA 02601 3/15/2013 Cityrrown state Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 — Number of bedrooms(actual): 3-- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage.system?[if yes separate inspection required] ❑ Yes No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 311512012 Date CommercialAndustrial Flow Conditions: f5tr19 79/70 Title 5 Offcw rrMeation Farm:Subsurface Sewage oisposal system•Page 7 or 17 Mar 16 13 03:02p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 99 Walton Ave. Property Address Owner _Luck Cyr _ information is Owners Name required for every page. Hyannis MA 02601 3/15/2013 Cityrrown State Zip Code Date of Inspection Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seetslpersonslsq.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: D. System Information (cunt.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes Z 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 t5irn•11l10 , Title 5 Official insped0on Form:Submdaoe Sewage ois{msal Syslem•Page 8 of 17 Mar 16 13 03:02p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form F a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr information is Owner's Name — -- required for every page. Hyannis MA _ 02601 3/15/2013 Cityrrown State Zip Code Date of Inspection ❑ 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 1/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval- ❑ Other(describe): D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: installed 9114/2006 permit#2006-400 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 Material of construction: ❑cast iron ®40 PVC ❑other(explain): — Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below. grade: feet s�s•�u�o Title 5 official Inspedicn Form:subsurface Sewage oispwal system.page 9 af 17 Mar 16 13 03:02p p.10 Commonwealth of Massachusetts � . Title 5 Sewage Inspection Form Disposal System Form Not for Vo.untary Assessments N a 99 Walton Ave. Property Address Owner Luck Cyr information is Owner's Name required for every page. Hyannis MA 02601 3115/2013 Cityfrown Stale Zip Code Date of Inspection 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: 10.5'x5'x5' — Sludge depth: 2" D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? measuring rod Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): tank appears to be stuctura r sound and shows no leakage i5ire•^v10 Title 5 Df tibia Inspection Fonn:SLbsXace Sewage Disposed system•Page 10 of 17 I Mar 1613 03:03p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments J 99 Walton Ave. Property Address Owner Luck Cam_ Information is Owner's Name required for every page. Hyannis _MA 02601 _ 3/15/2013 cityrrown State Zip Code Date of Inspection 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 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 :Sins•11110 Title$Official Inspection Four Subsurface Sewage Dispose System•Page 11 of 1? Mar 16 13 03:03p p.12 Commonwealth of Massachusetts Title ,5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G 99 Walton Ave. Property Address Owner Luck Cyr information is Owner's Name — - required for every page. Hyannis MA_ 02601 3/15/2013 Cityfrown Stale Zip Code Dale of Inspection 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.): a Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No D. System Information (cant.) 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.): box level and water tight Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No lsins•1111 C TRIe.5 Ofncia'Imee.ion Form'SLbsuifaea Swag2 Dispx;j Syst",Page 12 of 17 Mar 16 13 03:03p p.13 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr _ information is Owner's Name required for every page. Hyannis MA_ 02601 _ 3115/2013 City/Town State Zip Code Date of Inspection 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: 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 failure, level of ponding, damp soil, condition of vegetation, etc.): �5•ttno Title 5 Official Insp2dion Farm:&J050ace Sewage Disposal System•Page 13 U'i; Mar 16 13 03:04p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr information is Ownees Name required for every page. Hyannis MA 02601 _ 3115/2013 CnfTown State Zip Code Date of Inspection 2 H2O 500 chambers with four feet of stone no sign of stain line or liquid in SAS 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 D. System Information (cost.) 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 tsirs•nno Tdle 5 Official Inspection Form:Subsaface Sewage olsposel system•Page 14 cf 17 Mar 16 13 03:04p p.1 5 Commonwealth of Massachusetts f Title 5 Official Inspection Form h" Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr information is Owners Name required for every page. Hyannis MA 02601 _ 3/1512013 Cilylfown State Zip Code Date of Inspection Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): D. System Information (cost.) 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: E, hand-sketch in the area below drawing attached separately i5ins•11/10 TMe 5 Official mspeaon Form:suoawrac sewage oispo I syetem-page a of,- Mar 16 13 03:04p p.16 SBuilt rage i ui i T WN OF BARNSTABLE L �A'n � INN SEWAGE M OC''i QO:Xz '� AG ASSESSOR'S MAP LQTa�_.. AL1.ER5NAME 8c PHONE NO.t x.I��,� ',�jr�..s SEPTIC TANK CAPACITY SOC71_- LEAC MIG FAC]LrTY: (type�C�1GM�P(S SMy%u�(siu) -2S X 12K .2 NO.OF BEDROOMS Bi31LDM OR OWNERRIC�� miller PERmrrDATE: G COMPLW4M DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `zl°g.'m Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 2W feet of leaching facility) See"Pk,,:3 Feet Edge of Wetland and Leaching Facility(If any wetlands exist �[ within 300 feet of leaching facility) Feet Furnished by A 2-/25 tvN�- 3 5-37 A D "Off 5 - 34`� •. 3 s - a hnD:/iissgl2(intranet/propdat:a/prebuiltaspx?mappa1=310021&seq=2 3/15/201 TB/TO 39Vd ZT08TLL86G 81:60 ETOZ/9T/£0 Mar 16 13 03:05p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form kl#�Wllf- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Watton Ave. Property Address Owner Luck Cyr information is required for Owner's Name every page. Hyannis MA 02601 3I15/2013 Crtyfrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 25' feet Please indicate all methods used to determine the high ground water elevation: l5ins•I V10 Idle 5 Official hrepeclion Form:r-d—lace Sewage Gispm,System•Page IG 0°17 Mar 1613 03:04p p.16 rage i ui i .sBuilt WN OF BARNSTABLF- rr AIToI� 9Q G J�N sEwAGB it =G ar, O P �.,v.r, ASSESSOR'S MAP LOTS J 1 ALLER'S INANM&PHONE NO r I 'i�ra tJ�l SEPTIC TANK CAPACITY I S� CIT LEACWG FACILITY: (type�S..�1C•M NO.OF BEDROOMS, BUILDER OR OWNER PERNIITDATE: G COMPLIANCE DATE: Separation Distance Between the. Maximum Adjusted GroundwaterTableto the Bottom ofLeaching Facirity 510e LAN Feet Private water supply Well and Leaching Facility (If arty wells exist on site or witl�.in 2W feet of leaching facility? Siee' Feet Edge of Wadand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Furnished by A 'J 3-30`G fQ 4—_ A O y 5 — 36'� it 3 • s a P p p 310021&se — http:(/�ssctl2lintrazled ro datalprebuiltas x?m�ppa>~ 9- 2 3115/201 L0/I0 39dd ZTB6ELLB89 8T 60 ETOZ/9T/£6 Mar 16 13 03:05p p.18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Walton Ave. Property Address Owner Luck Cyr information is Owner's Name - required for every page. Hyannis MA 02601 3/15/2013 Cdylfown State Zip Code Date of Inspection ® Obtained from system design plans on record If checked, date of design plan reviewed: 9/14/2006 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with.local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: design plan shows 12'test hole with no water town GIS conture show 25'to water table Before filing this Inspection Report, please see Report Completeness Checklist on next page. E. Report Completeness Checklist ® Inspection Summary: A, B,C, D,or E checked ® Inspection Summary 0 (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•11f10 Tft 5 Official Inspec ion Form S�surfsce Sewage Dispcsal System Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owners Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: I only the tab key to move your CHRIS NARDONE cursor-do not Name of Inspector use the return key. BRIDGE HOME AND SEPTIC INSPECTION SERVICE Company Name 1 27 TIFFANY CIRCLE Company Address WEST BRIDGEWATER MA 02379 FIMM��M Cityrrown State Zip Code 508-580-0465 S1571 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addrq and that.tfie information reported below is true, accurate and complete as of the time of the in ction. TW ins tion was performed based on my training and experience in the proper function and m. i tenanc"f on site sewage disposal systems. I am a DEP approved system inspector pursuant to ection 0;340.4 Title 5(310 CMR 15.000).The system: ry l ® Passes ❑ Conditionally Passes ❑ Fair ❑ Needs Further Evaluation by the Local Approving Authority I Y'i I 02-05-2013 OnspeZtor A�61-1"4 Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and,,the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11f10 Tide 5 Official Inspeffn .:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 13) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'p 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•11/10 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 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owners Name information is required for HYANNIS MA 02601 20-05-2013 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? ® ❑ 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): NA Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: SEPTIC TANK, D-BOX AND LEACHING SYSTEM 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 0 No Water meter readings, if available last 2 ears usage AVER 160 GPD 9 ( Y 9 (gPd))= 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 Y(9Pd) 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityrrown 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: NO HISTORY 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-11I10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a , 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ®cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): FAIR CONDITION Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) -If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10 FT L-5FT W-5FT D Sludge depth: 20 IN t5ins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 15 IN Scum thickness 2 IN Distance from top of scum to top of outlet tee or baffle 4 IN Distance from bottom of scum to bottom of outlet tee or baffle 141N How were dimensions determined? PROBE Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK SOUND LIQUID LEVELS PROPER ALL TEES IN PLACE ZABEL FILTER IN PLACE IN OUTLET PIPE 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 DistanTjrom bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts RJ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX SOUND AND LEVEL SCUM LINE AT BOTTOM OF OUTLET NO SIGNS OF BACKUPS 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-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityfrown 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 failure, level of ponding, damp soil, condition of vegetation, etc.): SOIL AND GRAVEL DRY AND CLEAN AROUND LEACHING CHAMBERS NO SIGNS OF FAILURE 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-11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °r 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. Cityrrown 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owners Name information is required for HYANNIS MA 02601 20-05-2013 every page. Citylrown 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: 7 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST PIT RECORDS Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 99 WALTON AVE Property Address RICHARD MILLER Owner Owner's Name information is required for HYANNIS MA 02601 20-05-2013 every page. CityrFown 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 l _ Assessing As-Built Cards Page 1 of 1 J) TOWN OF BARNSTA L-h LOCATION SEWAGE#,202L"10 ) VILLAGE /� �'�`' ASSESSOOR'S MAP&LOT ry INSTALLER'S NAME&PSONE'NO�- SEPTIC TANK CAPACYPY LEACHING FACILlTY:-(type rn) ' (sin). 2s,K lax N0.0F BEDROOMS_.,3_____ BUILDER OR OWNER mAle PERMTtDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 58P PLna Fat Private Water Supply Well and Leaching Facility (If any wells exist S+ee p Feet on site or within 200 feet of teaching facility) Edge of Wetland and Leaching Facility(If any wPdands exist �_E p Feet within 300 feet of leaching facility) Furnished Furnished by rroAl V 37 e 0 2-,3/ 0 3 -31 s 0 hup://Www.town.bamsrtable.ma.us/Assessing/HMi isplay.asp?mappar=310021&seq=1 2/1/2013 -77�7 aa' 4i. �FTHE l Town of Barnstable Regulatory Services Barnstable * Thomas F. Geiler,Director ;ii-AmericaCity MASS. i639• Public Health Division �� �. AIFD MAC a Thomas McKean, Director 2007 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 18, 2011 Barnstable Deputy Sheriff's Department PO Box 729 Barnstable, MA 02630 RE: Richard Miller, 99 Walton Avenue, Hyannis, MA Please hand-deliver to the last and usual known address the enclosed letter to: Richard Miller, 99 Walton Avenue, Hyannis, MA The billing address for the services is: Public Health Division-S. Crocker Town of Barnstable 200 Main Street Hyannis, MA 02601 If you have any questions, please feel free to call me at 508-862-4644. Thank you for your assistance in this matter. /Sendimy regards to you all, Crocker Administrative Assistant I� Certified Mail#7008 3230 0002 5177 9879 Town of Barnstable x srAsiE �a Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 V1,4) r� February 14, 2011 � Richard Miller `� "I 99 Walton Avenue Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you located at 99 Walton Avenue Hyannis, MA was inspected on February 10, 2011 by Town of Barnstable Health Inspector Timothy B O'Connell, R.S., because of a complaint. The following violation of the Town of Barnstable Board Code was observed: 353-1 Responsibilities of Owners and Occupants: Large amount of garbage and, rubbish located within back yard of said residence. You are directed to remove the garbage and rubbish from this property and dispose of it properly within 7 days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Failure to comply with an order will result in a fine of$100.00. Each days failure to comply with an order shall constitute a separate violation. PE RDER OF ,M OARD�OF HEALTH � s? /. ,y J.V� /6 , �� /✓ -fir � Thomas McKean, CHO,RS Director of Public Health Town of Barnstable QAOrder letters\Refuse\99 walton.doc Barnstable County Sheriffs Office Civil Process Page 1 of 1 Al Home Corrections Public Safety Community Relations Human Resources Media Directions x The Barnstable County Sheriff's Department Civil Process Office, under Chief Deputy Bradley R. Parker, Jr., consists of eleven Deputy Sheriffs, support and clerical staff. The Division's operations, routed in ancient common law as well as controlled by Massachusetts General Laws, are specialized, but the Civil Process Deputies probably have more contact with the general public than any other branch of the Sheriff's Office. In addition, the Civil Process Division operates at no cost to the County or to the taxpayers. The services are paid by attorneys or individual plaintiffs under a statutory-fee structure. Fully computerized, the Civil Process office is located adjacent to the Barnstable County Complex at 3261 Main Street in Barnstable Village. The Deputy Sheriffs of this Office deliver legal notices and Court papers from all Massachusetts Courts, as well as from the various Courts in other states or counties. They are legally capable to serve process in all fifteen towns within the County of Barnstable. The cases vary from small claims matters to multi-million dollar real estate attachments and major Superior Court matters. This Office deals in six broad areas: . The largest volume of cases are monetary or contractual disputes, where the Deputies are charged with delivery of summons, complaint, notice of suit and successive post-judgment papers. . Delivery of Witness subpoenas and notices of deposition. . In cases of defaulted judgments, Writs of Capias warrant the Deputy to arrest and transport to any court in the Commonwealth. . Delivery of Probate Court documents concerning divorce proceedings, custody matters;disputed estates and child support cases. • Real estate attachments and levies on executions, up to and including Sheriff's sales of real property in Barnstable County. . Landlord-tenant matters where Deputies deliver notices to quit, summary process summons and complaints and ejectment executions. Civil Process handled about 12,600 cases last year and offers professional, competent and courteous service to attorneys and the public in a timely manner. The Office is especially careful to maintain proper respect for the rights of all parties,concerned. Whether simple small claims cases, major lawsuits, or an occasional court-ordered seizure of a boat or airplane, the Deputy Sheriffs in the Civil Process office are dedicated to ensuring proper and professional service of process. The Barnstable County Sheriff's Department Civil Process Office can be reached at 508-362-9578. vr'3Ib'YI C /!W, / _ _ Sheriff James M. Cummings IBIS ° Y / Barnstable County Sheriff's Office � U�ytjz�;t� tZ60D0 Sheriffs Place, Bourne, MA 02532 n ��` `Phone: 508-563-4300 i Fax: 508-563-4574 �y :✓c�T � �i11 J UG' /� �� � 7cq 4W 67 ttp://www.bsheriff.net/civil-process.htm ! l�u �f�� h 4/27/2011 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X t Agent _■ Print your name and address on the reverse essee so that we can return the card to you. B. Recei Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 11. Article Addressed to: If YES,enter delivery address below: ❑No US Bank National Association � APR 1 6 2011 � I c/o Litton Loans Servicing LP 48�28 Loop Central Drive 3. Service Type Houston, Texas 77081 ,q7 Certified Mail ❑Express Mail ❑Registered Retum Receipt for Merchandise _lT,��a_2-Zf14Q�0 11 Insured Mail 0 C.O.D. 4. Restricted Deliver)?(Extra Fee) 0 Yes 2. ArticlP.Number I `��' r � 1[r— " r` r t 7008 3230' 0002 5J,78 0165 `� f (�(riansfer from serv/ce label) PS Form 381;1,February 2004 1 ° ; I Domestic Return Receipt 102595-02-M-1540 I? i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender. Please print your name, address, and ZIP+4 in this box • I I I I Town of Barnstable ; g Health Division 200 Main Street I Hyannis,MA 02601 I jj yy tt + jj 77iiii f j ii i {{ !) 1�lillif�f i1111i11ifilii'7li.ii1111i1�i 1171i'liliilii ll !liid d A INE l Town of Barnstable Regulatory Services saxMsznazz, 9 MASS. Thomas F. Geiler,Director 1639. �ArED MAC `e Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 z Office: 508-862-4644 Fax: 508-790-6304 Certified Mail: 7008 3230 0002 5178 0165 Richard Miller 99 Walton Avenue Hyannis, MA 02601 March 30,2011 . EMERGENCY CONDEMNATION In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code,Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Humans. Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable on March 30, 2011 conducted an investigation of a dwelling unit located at 99 Walton Avenue Hyannis, MA. The owner's name of this dwelling unit is Richard Miller. The dwelling is vacant. Based on the results of that investigation,the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c.-127B and 105 CMR 410.831 (D), (E)the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (A) - Failure to provide water 410.1750 (C) -Failure to provide gas. 410.750 (1) - Large amounts of garbage and rubbish 410.750 (P)—Garbage and filth throughout home and back yard which may attract and support rodent harborage. I Q:\Order Letters\Condemnations\99 walton II hyannis Based upon these findings any and all occupants are hereby ordered to vacate within (24)twenty-four hours and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated they may be forcibly removed by the local Board of Health(Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. You may request a hearing before the Board of Health if written petition requesting same is received within forty-eight (48)hours after the date the order is served. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from$104500. Each day's failure to comply with an order shall constitute a separate violation. Note: This is an important legal document. It may affect your rights. PER ORDER O THE BOARD OF HEALTH cKean, CHOIRS Director of Public Health- Town of Barnstable Cc: Sgt. Sweeny, Town of Barnstable Police Department. Robin Anderson, Town of Barnstable Zoning Office US Bank National Association c/o Litton Loans Servicing LP 4828 Loop Central Drive Houston, Texas 77081 (Loan 3304920) Q:\Order Letters\Condemnations\99 walton.II hyannis S e Cunnin ham Lindsey # s Laurie Brennan Adjuster 1 � � Cunningham Lindsey 330 Bear Hill Rd.,Suite 201,Waltham,MA 02451 1 I sj Tel:(781)890-1696 Fax:(781)890-3819 Cell(508)688-2825 (� Email LAbrennan@cl-na.com i 1r� { , 4 Notice of Loss Page 1 of I --AlVIERICAN SECURITY INSURANCE COMPANY 11222 Quail Roost Drive,P.O.Box 979055,Miami,FL 33157-65.96(800)3SX0600 LOSS NOTICE PRODUCER - POLICY NMER CLAIM NUMBER OFFICE DATE OF LOSS DATE REPORTED nCVATE v I-.oA� S X 1 Miand Florida 2/12/2011 6/13/2011 EFFECTIVE DATE EXPIRATION DATE PRODUCT CAUSE OF LOSS INSURED CONTACT PHONE I3130/2010 3/30/2011 NISP 7'II1sF C PO ' NA1,1€AND ADDRESS tADDITIONAL INSUREDiSi ES, RESIDENCE PHONE OCWEN LOAN SERVICLNG..LLC, ARD NIILLFR :A1 ,PO IOX b723' -- SPRINGFIELD,OH 45501-67231.BUSINESS PHONE PROPEM ADDR€ CQhTAR'PE NONE 99 d' ALTON AVEIIVANN.IS,"MA 02£101 750 -UNIT DESCRIPTION 5 AL NUMBER LOAN.NUMBER -MLA.`NT CONTACT PHONE 0 X 0 {619}59-3 2900FXr244 LOCATION OF LOSS LOS AND DAVAGE DESCRIPTION _/ <same as property> NII- r tan u sing/cut copper pipes from hot water 1 a�`nd missing )` 5,S t,C CLAIMANT NAME bac hoard heating pipes,drywall and water damaged ceiling and RICHARD MILI.ER floo 'ng t in basement. L (� CONTACT PERSON I6 C — INJURED PARTY FIRST LENDER SECOND LE ER VVV OCWEN LOAN SERVICING LLC COVERAGEINFO , UNIT RC DESCRIPTION DEDUCTIBLE AMOUNT EFFECTIVE EXPIRATION 0001 24 MSP-OwelOng,ExtvWed Cov Pkg 1000.00 0.00 0330-2010 03-30-2011 coal 24 IOther-Structures,Ext.Coverage 0,00 21200.00 '03-30.2010 0330-2011 ODal 24 (Dwelling,`cxt Cov V&MM 0,00 212000.00 03-30-2010 0330-2011 0001 24 MSP-Dwelling,Fire Pkg 1000.00 0.00 0330-2010 03.30.2011 W01 24 !Other Structures,Ere 0.00 21200.00 03-311-2010 03-30-2011 0081 24 iDweliing,Fire 1100 212000.00 0330-2010 0330-2011 FORMS INFO ADJUSTER ASSIGNED 0723 MASTER POLICY CLNtiUNCHAML1IvDSFi CIAIN1 08-01.2005 MSPRES NO DESCRIPTION FOUND HEADQUARTEILS 08-01-19U MSPRES RESIDENTIAL PROPERTY COV. CLAW..HANDLER ASSIGNED 05-01.1991 MSPRES RESIDENTIAL PROPERTY COV. 1,A VAUNDA MOSES 03-01-2009 CP13000AR ASSURANT SOLTIONS PRIVACY POLICY EMAIL ADDRESS 1'_ccs_A1LA ati @ AssrRANrYCctiz FAX NUMBER --_— - EPleasecontact :MS.JA�49I SIIERR-DV,1N'i'--Previous Insured:Richard Miller/Foreclosure Sale Date:Pre- !Our Client:OCNV EN/ .oan No.:547566() Our File No.:2710579/Access Information:OCN/ Sondra YlcCrystal ) _, https://wl.assurant-.com/ics/IA/nol/NOL.aspx 6/13/2011 Town of Barnstable Barnstable CF THE Tp� Board of Health e"a�j BMatasrMar.E. 200 Main Street,Hyannis MA 02601 9 MASS. g �j 039. A 2007 AlFp�� OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. BOARD OF HEALTH MEETING AGENDA Tuesday, June 14, 2011 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA I. Hearing - Trash: Richard Miller, owner— 99 Walton Avenue, Hyannis, trash violation. II. Sewer Connection: Michael Princi, Wynn & Wynn, representing First Light Holdings, LLC, owner— 300 Barnstable Road, Hyannis, Map/Parcel 310-144, sewer connection. III. Discussion: Center Village Condo — Request to replace soil absorption systems without a shared I/A system. IV. Variances — Septic (New): A. Peter Eastman, Howard Boats — 164 Beale Way, Barnstable, Map/Parcel 280-004, 0.50 acre lot, boat building and repair requesting approval for incinerating toilet, currently no plumbing. B. Edward Stone, EAS Surveying, representing owner, Salvation Army - 157 Straightway, Hyannis,Map/Parcel 268-218, 10,544 square feet parcel, gravity system vs pump. C. Peter McEntee representing Bank of New York Mellon — 116 lyannough Road, Hyannis, Map/Parcel 328-144, 9,330 square feet lot, variances. D. Peter Sullivan, Sullivan Engineering representing C. William Carey, owner - 986 Sea View Avenue, #A, Osterville, Map/ Parcel 091-002, 2.72 acre parcel, proposal to grandfather four bedroom without installing new septic system. E. Carmen Shay representing Allen Halliday, Trustee — 154 Eel River Road, Osterville, Map/Parcel 115-010-001, 74,985 square feet lot, approval of five bedroom floor plan (continued from the March 2011). F. Robert Greer, owner— 140 Peach Tree Road, Marstons Mills, of interpretation of septic permit dated 4/26/2006 with the number of bedrooms —Section 360-45 variance of salt water estuary. Page 1 of 2 BOH 6/14/2011 V. I/A Monitoring: Joanne Hooker, owner— 112 Nyes Neck Road East, Centerville, request to reduce monitoring. VI. Variance — Food (New): A. Marat Hunanyan, owner of Cape's Best Gyros & Grill — 569 Main St, request to do deep-fry cooking. B. Aaron Webb, owner—The Daily Paper, toilet facility variance to utilize three toilet facilities, in lieu of the required four. C. Lori Caron, Salty Lou's Lobster, for Mid Cape Farmers Market— request to sell prepared foods. D. Temporary Food Event— Phil Wallace and Susan Finegold for Summer Fete En Plein Air to be held at Pastiche of Cape Cod, 1595 Main St, West Barnstable, on Saturday, June 18, 2011, seven vendors, serving food 4:30-8:00 pm. E. Temporary Food Event Summer Sampler, Osterville Historical Museum, 155 West Bay Road, Osterville, on July 10, 2011 — three vendors, serving food 5:00-7:00 pm. VII. Septic Installers (New): A. Michael Labute, Mashpee, MA B. Fred Swain, Hudson, MA J Vill. Body Artist Variance: A. Alyssa A. Long, Hyannis - Request to conduct Body Art without taking Anatomy and Physiology from an accredited college. Applicant took an online First Aid and CPR course. B. Alex Travasso — Request to conduct Body Piercinq without taking Anatomy and Physiology from an accredited college. IX. Old / New Business: A. Proposed Revision to Section 322-5 of the Town of Barnstable Code Regulation currently requires both a screen and an air curtain at all serving windows associated with outdoor dining. Proposal is to allow a screen or an air curtain. B. Proposal to allow health inspectors to grant counter variances on HACCP Plans and time/temperature controls for licensed food facilities. C. Bathing Beach Policies. X. Informal Discussion: Stephen Wilson representing Christopher Kuhn, owner— 337 South Main Street, Centerville, requesting to utilize open space land as credit to construct a restaurant on a small parcel of land in the salt water estuary. Page 2 of 2 BOH 6/14/2011 " } Citizen Web Request Page 1 of 3 I RE xn _ y 2 ` WOS. Citizen Request Management - Internal Use A .. ,- Request ID: 33343 Created: 1/10/2011 1:54:45 PM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Category: Section 353-1 Garbage and Rubbish E.C. Date: 1/25/2011 * � Created By: Parvin, Lindsay Citations: Health Office Time Worked: 35.00 Response Time: 8.00 Requestor Details: Email: LJ Request Location: 99 WALTON AVENUE Hyannis, Ma 02601 Parcel Number: Map: 310 Block: 296 Lot: 000 Request: Requestor reports that there is trash piled up in the backyard along the property line. Requestor reports that the trash is attracting rodents. Request Work History: Entered on 1/11/2011 3:01:12 PM by O'Connell,Timothy Last modified on 1/18/2011 2:54:49 PM On 1-11-11 went to said property and knocked on door. I did not get an answer. I left businesses card in door. I also did not go into back yard due trespass issues. I proceed to 64/66 Quaker where the back yards abut one another. I did observe a large pile of debris. Although it appeared to be bags. I could not tell if it was house hold trash or leaves due to distance I was observing at. Will continue to go to said residence and knock on door. I also called person who complained. Entered on 1/18/2011 2:55:49 PM by O'Connell,Timothy http://issgl2/intemalwrs/WRequestPrint.aspx?ID=33343 6/13/2011 Citizen Web Request Page 2 of 3 On 1-18-11 went to said house knock on door and did not receive an answer. Entered on 1/20/2011 7:58:19 AM by O'Connell, Timothy On 1-19-11 went to said property no answer at door. I have been told by a source that listed owner's son lives at property. Due to trespassing issues I still can not confirm if debris in back yard are in violation of town trash ordinance. Entered on 1/25/2011 8:49:13 AM by O'Connell,Timothy On 1-24-11 went to said property and knocked on door. I did not receive an answer. Entered on 1/28/2011 8:02:36 AM by O'Connell,Timothy I have been to said property on many occasions without an answer at door. I have not observed tire tracks in driveway or footprints to steps with recent snow fall. I do believe this property is not occupied at this time. Entered on 2/1/2011 11:58:16 AM by O'Connell,Timothy I do believe this property.is in process of foreclosure. I can not locate owner or an occupant. will continue to pursue compliance. Entered on 2/7/2011 3:52:05 PM by O'Connell,Timothy On 2-7-2011 talked with Cinthia Wallace from Community Septic Management Loan Program. She told me that previous owner (home is foreclosed) has defaulted on septic loan and they are now going after bank. She said she will send me the address of bank. Entered on 2/14/2011 4:15:04 PM by O'Connell,Timothy On 2-14-11 posted orange sticker on front door to clean trash. Hopefully some one working fc bank will begin process of cleaning back yard. Entered on 3/1/2011 2:57:35 PM by O'Connell, Timothy Letter to owner was not claimed at Post Office it was sent back. Still not an answer at door. Entered on 3/7/2011 3:00:48 PM by O'Connell,Timothy On 3-4-11 posted letter on front door. Entered on 4/13/2011 8:27:49 AM by O'Connell,Timothy On 3-30-11 went to said property with PD due to the concern of PD. They stated they think http://issgl2/intemalwrs/WRequestPrint.aspx?ID=33343 6/13/2011 Citizen Web Request Page 3 of 3 people are using house for drugs and ect. I have condemned home. See letter below. I have Cc' a letter to bank which holds the mortgage. This will hopefully speed up foreclosure process and get home secured and trash picked up. Entered on 5/24/2011 8:15:44 AM by O'Connell, Timothy On 5-23-11 TO,TM and Dave Houghton from legal met on this matter. Dave suggested we send another letter then go into lien process. Also on same day went to said property and observed that Sheriff had posted home with letter to remove trash. I did observe that house has been locked and lock box put on front door. This could be a sign that bank is finally taking over property. Entered on 6/7/2011 7:35:00 AM by O'Connell, Timothy On 6-3-11 went to said property and observed a person at said property. It was employee of property Management firm who is working for bank. I did receive some info from said employee and talked with core logic which is a firm working for bank. Informed them of above situation an( also sent letter via e-mail. In e-mail explained that town is in beginning process of cleaning property and putting a lien on property. Internal Note History: Entered on 1/10/2011 1:54:45 PM by Parvin, Lindsay Tim,the requestor listed his address as 64/66 Quaker Road. He said property is a rental and h tenants have been complaining to him about it. System entry on 1/10/2011 1:54:45 PM: Assigned to O'Connell, Timothy Entered on 1/11/2011 3:09:34 PM by O'Connell, Timothy (508) 534-9589 R.Miller http://issgl2/intemalwrs/WRequestPrint.aspx?ID=33343 6/13/2011 l i r 0 I ' ' T6- ,Aizen Web Request Page 1 of 2 = asp r � Citizen Request Management - Internal Use MINI Request ID: 33343 Created: 1/10/2011 1:54:45 PM _. ........ _ .... ___ Status: Assigned To Staff Assigned To: O'Connell,Timothy pq Health Office "Ok yY, Anonymous: No Category: Section 353-1 Garbag(and Rubbish a, E.C. Date: 1/25/2011 Created By: Parvin, Lindsay Citations: ' HealthOffice.......... ........................................ - _ .......... Tim esponse 0 Time Worked. 0 R e i Requestor Details: wh . .............. .....:.. .... . . ._ ...... ___ _-..__._—. w Email: YRequest Location: 99 WALTON AVENUE Hyannis, Ma 02601 Parcel Number: Map: 310~Block 296 Lot: 000 L„...._ ..... ...� _ .W._v.__ - Request: Requestor reports that there is trash piled up in the backyard along the property line. Requestor reports that the trash is attracting rodents. So i Request Work History: internal Note History: v W V r. Entered on 1/10/2011 1:54 45 PM I by Parvin, Lindsay Tim,the requestor listed his address as 64/66 Quaker Road. He said property is a rental and;h n n have been complaining to him about it. P teats . � P 9 F , System entry on,1/10/2011 1:54:45'PM: <4 s Assigned to.O'Connell, Timothy f 'lttp //issgl2/IflternalWRS/WRequestPrint.aspx?ID=33343 °s 1`%11%2011 l 1 L-alth Master Detail Page 1 of 1 0 tom' J�'z§•' sk r In As: "rtCt[ii'��.. Health ,,,, atleyMasterDetail Aor'iC `.ion Center Parcel Lookup Selection Item,,; Parcel S Per ept€c c �_. �.€ttellM Fuel "rank: I Parcel: 310-0 1 Location: 99 WALTON AVENUE, HYANNIS Owner: MILLER, RICHARD Business name: Business phone _......._ ...._.w ._..... ,.:.,.. Rental property: Deed restricted: 17; Number of bedrooms Contaminant released: Fuel storage tank permit: Save Parcel Changes Return foLookup •- . Parcel Info Parcel ID: 3I.0-021 Developer lot:LOT C-1.1 Location:99 WALI-ON AVENUE Primary frontage:80 Secondary road: Secondary frontage: Village:HYANNIS Fire district:HYANNIS Sewer acct: Road index: 1779 Asbuilt Septic Scan: 310021._1 Interactive map 310021 2 Town zone of contribution:AP (Acluifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: MILLER, RICHARD Co-Owner: Streetl:99 WAL.TON AVE Street2: City: HYANNIS State:MA Zip: 02601 County Deed date:05/29/1998 Deed reference:C148743 Land Info Acres: 0.32 Use: Single Farr€ M DL-01 Zoning:RB Neighborhood: 0 04 Topography: Level Road:Paved Utilities:All PUhlic,Gas Location: Construction Incas f .Ei( ling N.,Y ^'a;' : :.3 t :ros:? '^= ..`:;n Area3 dr'bnn1S z'1€7oms 1 1965 2192 1012 2 BedroomsI Full Buildings value:o95,800.00 Extra features: m5,200.00 Land value: g07,900.00 http://issgl/intranct/health aster/HealthMasterDetail.aspx?ID=310021 1/11/2011 r Dom:1 y 126 s&05 10-28-200? 11 :21 BARNSTABLE LAND COURT REGISTRY Prepared by and Return to: Brown&Associates 10592-A Fuqua, PMB 426 Houston, TX 77089 00 ASSIGNMENT OF MORTGAGE Loan 3304920- Mi6 umber: KNOW ALL MEN BY THESE PRESENTS,that Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial(Assignor), c/o Home Loan Services Inc., 150 Allegheny Center, Pittsburgh., PA 15212-5335(address),for good and valuable consideration,the receipt of which is hereby acknowledged, does hereby sell,transfer, assign,set over and deliver- Cunto- US BANK NATIONAL ASSOCIATION'AS INDENTURE TRUSTEE UNDER THE INDENTURE DATED AS OF DECEMBER 14,2001, BETWEEN SALOMON MORTGAGE LOAN TRUST 2001-CB4 AND US BANK NATIONAL ASSOCIATION,C-BASS MORTGAGE LOAN ASSET BACKED NOTES,WITHOUT RECOURSE.(Assignee), /c o LITTON LOAN SERVICING1P,A828 LOOP CENTRAL DRIVE, HOUSTON,TEXAS, 77081,E its successors and assigns, forever -- _ That certain mortgage from RICHARD MILLER,SINGLE to FIRST FRANKLIN FINANCIAL CORPORATION for$76,600.00 dated 5/2 911 9 9 8 of record on 5/2911998 in Book, Page or as ✓ Document 728122, in the BARNSTABLE County Clerk's Office, State of MA and the Promissory Note described in and secured by the-Mortgage. Property Address: 99 Walton Avenue, Hyannis, MA 02601 IN WITNESS WHEREOF, Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial (assignor)has executed this Assignment of Note and , Mortgage by and through its authorized officer effective September 2, 2009 Executed this September 2, 2009 Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial By: Sharon aerkle Title: Vice President t CORPORATE ACKNOWLEDGEMENT STATE OF Pennsylvania COUNTY OF Allegheny This instrument was acknowledged before me on the 2nd day of September nn9 by Sharon D. Maerkle,Vice President of Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial(Assignor), on behalf of said Corporation. ui -f-, &A,�V-D I. I Notary Public in and for the State of Pennsylvania Notary's Printed Name: Dionne R.Williams My Commission Expires: August 3, 2010 COMMONWEALTH OFF PENNSYLVANIA Notarial a" :.. Dionne R.Williams,Notary Public % City of Pittsburgh,Allegheny County My Commission Expires Aug.3,2010 BARNSTABLE REGISTRY OF DEEDS FEB-08-2011 08:34 BARN COUNTY CSMP 5083756854 P.01 BARNSTABLE COUNTY COMMUNITY SEPTIC MANAGEMENT Of B �Ws LOAN PROGRAM V 3195 MAIN STREET/P.O.BOX 427 BARNSTABLE,MASSACHUSETTS 026309ssACKusti��� www.barnstablecountysepticloan.org Phone:(508)375-6855 Fax:(508)375-6854 FAX TRANSMITTAL DATE: 02/08/2011 TO: Barnstable Health agent Mr.Timothy O'Conell FROM:Cinthia Wallace RE:Mr. Richard Miller's account - #PAGES INCLUDING THIS COVER SHEET: six MESSAGE:. Hello, Mr. O'Connell, Unfortunately you got us at the end of the day yesterday, but here is the promised fax: a- a letter form our attorney b- addresses to whom we faxed the letter( last page of the letter) c- a copy of Ocwen Loan Servicing, LLC requesting a pay off amount on this account back on 10/31/2010 If you happen to get a hold of any information on Mr. Miller, please forward it to us., Should we be any more helpful, please contact us again. Thank you, Cinthia CSMLP FEB-08-2011 08:35 BAR! COUNTY CSMP 5083756854 P.06 ............rr•........ •1� i r • QGWEN ' Lour,Servici,'iy;,I.I..C; P.0.Bux 9617611 88tt.06 3672 To: BARNSTA1I.LZ COUNT-Y/ KEN DA L.L. Date:: Total Pafcs: 1 Phone* Fax: 508-:17 5..0854 From: A.T-me Comhaily: 0cwen Ln:u) S(Tvic.ing Phone: 1.fiO0.22�). 4''C Fxt. 2l!) (rnll face) Fax: S17-826.2024 ['lease pr()vicle Lax inforrnat4m for dic- ti;►)1R)wmg-. Owner.: RICH:1RD MILLI q/'..32 ��1 ( n 'C'ax Id : 110-021 Loan : 5475660 Addy' ss : 99 WAT:T'f)N .; VF—.. (.;an 4cm ow a p:ayc►ff good dim 1.0/31/10, fc►r the property mentitmed abcmc If v(-)u slttaulcl havc:my(I ties tion./cuucerns,please l.eel free tc)cct11 thc:aaumber listed above. Thanks in ocivanee: for ymir c W)1'rerAciun, A arr s TOTAL P.06 FEB-08-2011 08:35 BARN COUNTY CSNP 5083756854 P.02 Leo A. Byrnes Attorney at Law 51 Forest Way Tel: 508-240-5557 Orleans,Massachusetts 02653 Fax: 508-240-5557 August 31, 2010 Richard T. Miller 99 Walton Avenue Hyannis, MA 02601 Dear Mr. Miller: This letter is sent to demand payment, pursuant to c. 111 MGL s . 127B14, and c. 60 MGL s. 16, of the entire amount of principal and interest due under the betterment assessment, as amended, for which notices were recorded as Documents No. 1039962 and No. 1045102 in the Land Court Division in the Barnstable County Registry of Deeds. The betterment assessment was made to secure repayment under your betterment agreement with Barnstable County for the repair or replacement of a septic system located at 99 Walton Avenue, Hyannis, MA. Pursuant to the provisions of c. 111 MGL 127B'i, and chapters 80 and 60 MGL, the lien on 99 Walton Avenue to secure the betterment assessment has priority over the liens of any mortgagee. The. original principal amount of the assessment, as amended, was $9, 005, which was apportioned under the terms of the betterment agreement. The records of Barnstable County show that payments of principal and interest due under the terms of the betterment agreement remain unpaid. Consequently the agreement has been in default from 14 days after the failure to pay installments when due. Because of the default, the entire principal amount is now due and payable, and interest is accruing at the rate of 14% per year. The amount of principal and interest due as of the date of this letter, and the amount of interest accruing per diem is set forth in an enclosure. herewith. FEB-08-2011 08:35 BARN COUNTY CSMP 5083756854 P.03 a The event of default may be waived, however, if all past due installments of principal and interest are paid. Upon such payment, repayment of remaining principal can be paid in installments remaining under the betterment agreement, and the interest will revert to 5% per year. If arrangements are not made for payment within 14 days the County will proceed to a taking for nonpayment of betterment assessment, and subsequently may foreclose of the right of redemption and proceed to a foreclosure sale. Please contact Angela Pereira of the Barnstable County Department of Health and Environment (508-375-6877) to arrange for payment and avoid a taking of the property. Si c re Leo A. Byrn As Attorney or Barnstable County Septic Loan Program Cc: First NLC Financial Services, LLC 700 W. Hillsboro Blvd B-1 #204 Deerfield Beach, FL 33441 Mortgage Electronic Registration Services, Inc. PO Box 2026 Flint, MI 48501-2026 r FEB-08-2011 08:35 BARN COUNTY CSMP 5083756854 P.04 F , Barnstable County • Community Septic Management Loan Program • Phone:(508)375-6855 • Fax:(508)375-6854 facsinifle transmittal To: A.Tale Fax: (817)826-2024 From: Cinthia Wallace Dube: 9,130/2010 Re: Community Septic Management Pages: 1 Program Loan Payoff CC: ❑Urgent ❑For Review ❑Please comment 0 Please Reply 0 Please Recycle The septic system repair loan payoff for Richard Miller of 99 Walton Avenue, Hyannis, MA 02601 is as follows: Loan Amount: $9,014.00 Balance Date: 10/31/2010 Unpaid Interest: $4,984.74 Principal Balance: $8,901.32 Total Balance(Payoff): $13,886.06 Per Diem: $3AII Please note that the per diem amount listed above should be used to calculate the additional amount that should be added to the total balance to cover the estimated time from when the check is mailed to when it is received by this office. Please mail a check payable to the County of Barnstable to my attention at the following address: CSMLP P.O. Box 427 Barnstable, MA 02630 Please contact me should you have any questions. . Thank you. s FE3-08-2011 08:35 BARN CDUNTY CSMP 5083756854 P.05 Of aA,� Barnstable County f Department of Health and Environment ° _ Community Septic Management Loan Program Loan Payoff Statement Date Prepared L 9/30l20101 Payoff Date 10/31/2010' Client Name (Richard T Account Number Loan Amount [ _—$9,014.00 Interest Rate r_ 14 Loan Term 20 Years Remaining Principal L __ $8 901.32 Payments Made to Date Payoff Interest Start Date [ - 11/1/2006 Interest Due L___$4-984.74 Per Diem interest $3.41 J Returned Check Fee F $0..00_. Early Repayment Processing Fee � Loan Payoff Amount Principal+ Interest+ Returned Check Fee+ Early Repayment Processing Fee w. Attention Residential Program SpOicifics Homeowners Financial help with a 5% interest Existing septic system must be "failed". rate betterment loan is now All costs associated with carrying out a project required by available through the Barnstable Title 5 are eligible. County Community Septic Eligible projects include alternative septic systems and sewer hook-ups. Management Loan Program. • Homeowners can now comply Reimbursement for costs associated with the project up to 30 days prior with Title 5 regulations. to the receipt and approval of a completed application by Barnstable County is possible. • Loans repayable over 20 years, cover all costs directly 5% interest rate on loan. associated with septic system Betterment assessment on property secures loan. upgrade. Maximum of 20 years repayment term. • Application available online for interested residents. Payments are made monthly or quarterly payable to Barnstable County. Loans to be made only for residential properties. Residential properties include condominiums and apartments. Homeowners obtain written bids for system design and then contracts - for work'.' _.� Homeowners obtain written bids for system installation and then contracts for work. Single-party check issued to contractor for work completed. �, Certificate of Compliance must be issued before final payment is made. For more Information SEPTIC SYSTEM contact: ` il -gig=_ FAILED? www barnstablecountysepticloan org., r{: t Kendall*Ayers F: Program Administrator 1 i (508)375 6610 x kayers@I arnstablecoun'ty:org �— rijj la Do CarmoT- A .. f t drninistrative'Assistant ,(508)375-6877 adocarmo@barnstablecounty.org . t nthia,Wallace r. Billing/Collection Specialist ' • (508)375-6855 c � cwallace@barnstablecounty:org • = • ..:r h We can help Fax - (508) 375-6854 with excellent VJd loan terms! 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Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 14, 2011 Richard Miller 99 Walton Avenue Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you located at 99 Walton Avenue Hyannis, MA was inspected on February 10, 2011 by Town of Barnstable Health Inspector Timothy B O'Connell, R.S., because of a complaint. The following violation of the Town of Barnstable Board Code was observed: . 4 353-1 Responsibilities of Owners and Occupants: Large amount of garbage and rubbish located within back yard of said residence. You are directed to remove the garbage and rubbish from this property and dispose of it properly within 7 days of your receipt of this notice. You may request a hearing before the Board of Health if written petition.requesting same _ is received within ten (10) days after the date the order is served. Failure to comply with an order will result in a fine of$100.00. .Each day's failure to comply with an order shall constitute a separate violation. PE RDER OF E OARD AF H. LTH n � Thomas McKean, CHO, RS Director of Public Health Town of Barnstable QAOrder letters\Refuse\99 walton.doc O'Connell, Timothy From: McKean, Thomas Sent: Friday, May 13, 2011 9:36 AM To: O'Connell, Timothy; Houghton, David Subject: RE: 99 Walton Avenue Hyannis Hi David, On several dates recently, we have attempted to send order letters (via certified mail) to the owner, Richard Miller, of this property ordering removal of refuse due to excessive amounts of rubbish and garbage outdoors on the back yard (see attached photos). This has been going on since January 10, 2011. See attached order letters dated February, 2011 and March 30, 2011 attached.. Both letters were also mailed to the bank (US Bank National Association, in care of Littleton Loan In Houston Texas) that holds the mortgage. They were received by the bank-on April 16, 2011. The condemnation letter was also posted on the front door(laminated). << File: 99 Walton.docll:doc>> << File: 99 Walton ave.DOC >> Last week, we hired a deputy sheriff to deliver the order letter but to no avail. At this time, I am ready to hire a trash company to remove the rubbish and garbage. We will need your assistance in placing a lien on this property in the near future. Please advise. Sincerely, Thomas McKean P.S. We heard from a local septic installer who did some work for him recently , that the owner went to North Carolina somewhere: He also defaulted on his County Loan Program for his septic system. P.S.S. According to the Registry of Deeds, it hasn't been foreclosed on. -----Original Message----- From: O'Connell,Timothy Sent: Friday, May 13, 2011 9:19 AM To: McKean,Thomas Subject: « >> << +lrilP: � C�IIIIIII3.J C� >> << File: DSC00012.JPG >> << File: DSC00015.JPG >> << File: DSC00019.JPG >> 1 ram= � p. t� oF .o� Tww bf Barnstablei 1;:-"� ,+�i'ublic Health Division, OSTAG BARNA SBLE. U.S.o` 200 Main Street I LL.L P E>>PITNEYBOWES pfED Mn+"0 Hyannis,MA 02601 ZIP 0260 - 02 11N $ 005.54p3 = ?008 _3230 0002 51?? 98?9 0001361475 FEB 14 2011. 1 ---Richa d L•,Ziller , +.' 99,Wal* Avenue Hyannis 1�:1A 02601 PaIXIE 0 21 9 01v 1 00. 0`?l5/i1 4 RETURN TO SENDER 1 NOT ®ELIW£RAMLE AS ADDRESSED UNA®L£ TO FORWARD E30: 0260].400!00 *096 9-1 0026-1 4- 42 - ���®��ao®� � 1 n COMPLETE THIS SECTION ON DELIVERY �_$,ENDER: COMPLETE THIS SECTION ■ Complete items 1,2,and 3.Also complete A Si nature ` '- ,. item 4 if Restricted Delivery is desired. X g ❑Agent ■ Print your name and address on the reverse Addressee i so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? El Yes 1. Article Addressed to: if YES,enter delivery address below: ❑ No I U ( I ' f' I i Richard Miller 99 Walton Avenue � 3. Service Type I ❑Certified Mail ❑Express Mail I Hyannis, MA 021601 ❑Registered ❑Return Receipt for Merchandise I k ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I _ I 2. Article Number I 7008 323D 0002 5177 9879 I (transfer from service label) ___-_. PS Form 3811,February 20041 ' ! Domestic Return Receipt 102595 02-M-1540 / .. 0 ° Certified Mail#7008 3230 0002 5177 9879 o4t►�r Town of Barnstable s,�xriscnsi.e, ' MAC. �a Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 14, 2011 Richard Miller 99 Walton Avenue Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you located at 99 Walton Avenue Hyannis, MA was inspected on February 10, 2011 by Town of Barnstable Health Inspector Timothy B O'Connell, R.S., because of a complaint. The following violation of the Town of Barnstable Board Code was observed: 353-1 Responsibilities of Owners and Occupants: Large amount of garbage_and rubbish located within back yard of said residence. You are directed to remove the garbage and rubbish from this property and dispose of it properly within 7 days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Failure to comply:with an order will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PE", RDER OF E ARD AF H,F TH J Thomas McKean, CHO., RS Director of Public Health: Town"of Barnstable , ;,t t � � � fw � r e t �..{ �5 }j_y y } t `� •"y �3 i! et t c•-& 9 '�; f ��, i i Mc C �. c ra r t . + •a t .�4 1�+j ��#� y,f. ' ;P9 J mot. '` ; .. TJ t tY 'r err ar" ff R;Z - YJ 5?�r r^ (I'I 1.. _?. .a �`t c. *��t a.•. Y �t t c q ,zXt,. at�'�� ts" " �t' Q:\Order letters\Refuse\99 walton.doc f 4E � Barnstable County Sheriff's Office _ I herebycertify y and return that on May 19, 2011 at 2:00 m I served p � a true an attested copy of the within Letter, by leaving for the within named Defendant: Richard Miller, at the last and usual address of: 99 Walton Avenue, Hyannis, MA st the Defendant at the same address on the same day. 02601 and by mailing 1 class to Fee: $40.00 Brad Parker, Deputy Sheriff PO Box 614 Centerville, MA 02632 7. Certified Mail#7008 3230 0002 5177 9879 * Town.of Barnstable a . BARNS(ABLE, MASb- Q Regulatory Services C. I Thomas-F. Geileri,Director, , Public'Health Division '` Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 14, 2011 Richard Miller 99 Walton Avenue Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you located at 99 Walton Avenue Hyannis, MA was inspected on February. 10,.2011 by Town of Barnstable Health Inspector Timothy B O'Connell,'R.S., because of a complaint. The following violation of the Town of Barnstable Board Code was observed: 353-1 Responsibilities of Owners and Occupants: Large amount of garbage.and rubbish located within back yard of said residence. You are directed to remove the garbage and rubbish from this property and dispose l of it properly within 7 days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10).days after the date the order is served. Failure to comply with an order will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PE RDER OF E OARI F HE LTH (( V le, Thomas McKe.an,�,C,HQ5.RS IDirec,,tor`of:Public Hedltlf* F k Town of Barnstable � �.t.. f}n� ..v tc� •„'"r `,t,•fl. ; �:lr:r'.,.. �� ,..c'.E ��j�; ?:;�...Gt� {_.CrfS+�` '`?`.�<, v ..1�`_S•l. ' In 7 ou Q:\Order letters\Refuse\99 walton.doc t Barnstable County Sheriff's Office I herebycertifyand return that on May 19 2011 at 2:00 m, I.served a_true and Y p attested copy of the within Letter, by leaving for the within named Defendant: Richard Miller, at the last and usual address of: 99 Walton Avenue, Hyannis, MA 02601 and by mailing 1st class to the Defendant at the same address on the same day. Fee: $40.00 Brad Parker, Deputy Sheriff PO Box 614 Centerville, MA 02632 -. ,: r a � _ i ��. . � �.k � �-� l �- � � � __ { � " ' , f y .� � `; �/ .,. ' .. .. r '--�. V ` A� ' � � !1 ....r-'�`� - .. P�pFIMEtpk,p Timothy B. O'Connell, R.S. Health Inspector 10 BA MASS. ` Town of Barnstable ' y MASS. A i639• A10� Department of Regulatory Services Ep MA'S Public Division Office Hours 00 Main iStreet,Hyannis,MA 02601 8:00-9:30 a.m. Tel: 508-862-4644 > t 3:30-4:30 p.m. Fax:508-790-6304 C� Email:Timothy.00onnell@town.barnstable.ma.us I — 7,4'�,e y5Cnu eore�o9e ,Cew. 1 Page 1 of 3 O'Connell, Timothy From: REIS-RE-DFW01.Code.Violations [Code.Violations@corelogic.com] Sent: Thursday, June 02, 2011 4:41 PM To: O'Connell, Timothy; REIS-RE-DFW01.Code.Violations Subject: RE:RID#67612 Timothy, I have forwarded your email to the Lender that we/CoreLogic has provided service to. Thanks, Please change the email address for inquiries from "firstam.com to corelogic.com" in the email address. Beginning June l st the"firstam.coin"will no longer be valid. Thank you. Steve Pullig CoreLogic 1 Core Logic Dr., Westlake, TX 76262 www.Corelogic.com Toll Free: 1.800.873.4532 FAX: (817)826-1039 Email: spullig@corelogic.com From: O'Connell,Timothy [mailto:Timothy.00onnelI@town.barnstable.ma.us] Sent: Thursday, June 02, 2011 2:58 PM To: REIS-RE-DFW01.Code.Violations Subject: Dear Ladies and Gentlemen: If violations mentioned below in attached letter are not corrected as indicated within letter The Town of Barnstable will seek Receivership and or Municipal liens against property. Re: 99 Walton Hyannis, MA 02601 +.�rtt1t11 Jns}�rrtur Luton of +�ttrnstttl�lr ZIIII . ftain �17trrrt N)jannis, AA II25II1 +Email: timut4tg.urunnrll@ta.wn.barnstaty1r.ma.us . t M 6/3/2011 I - Page 2 of 3 Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 2. 2011 NOTICE TO REPORT BEFORE THE BOARD OF HEALTH AT A PUBLIC HEARING You are scheduled to appear before the Board of Health at their public hearing on Tuesday June 14, 2011 at 3:00 p.m. On February 14, 2011, a certified order letter was mailed to you due to violations at 99 Walton Avenue Hyannis, MA. This property was inspected on February 10, 2011 by Town of Barnstable Health Inspector Timothy B O'Connell, R.S.; because of a complaint. The following violation of the Town of Barnstable Board Code was observed:§ 353-1 Responsibilities of Owners and Occupants: Large amount of garbage and rubbish located within back yard of said residence. In the letter, you were ordered to remove the garbage and rubbish from this property and dispose of it properly. However to date, the refuse has no been removed. At the hearing,the Board will consider ordering you to remove all rubbish and garbage from this property within twenty-four (24) hours. During the hearing, you will be given an opportunity to present witnesses, photographs, documentary evidence, and any other official documentation. Failure to remove the garbage and rubbish from this property within twenty-four (24) hours after the hearing may result in the Town taking actions to clean-up the property at the owner's expense. PER ORDER OF THE BOARD OF HEALTH 6/3/2011 Page 3 of 3 Thomas McKean, CHO, RS Director of Public Health Town of Barnstable ********************************************************************** This message may contain confidential or proprietary information intended only for the use of the addressee (s) named above or may contain information that is legally privileged. If you are not the intended addressee, or the person responsible for delivering it to the intended addressee, you are hereby notified that reading, disseminating, distributing or copying this message is strictly prohibited. If you have received this message by mistake, please immediately notify us by replying to the message and delete the original message and any copies immediately thereafter. Thank you. CLLD 6/3/2011 °n,Er3•r ..i„aK y� e 4 e�nr Af�W]�",»a,P"r �r'ay . ,fir•. G .i y, Ai 3►�F4 ( _ •. t-.i A 'Y��.�i � w1� '� Yirk,t %". c�. tit.%�'. r•� ll11i11 � a�j y r 'Sy t _ T s � L 1 \ i I I I I I I I -^'""r. _, � •-�`ck'r r, m �+,,- t� 'f �.3a" ���' a ✓ 4 rG 3 rr '°�t.` I `�^�,, -`. a t'st ^`fit` 'r'r �'�h .p`� r,��1'� �' +�ti !t ���. ��. �a��' S r r ✓ r � I `a• "'"y.`'" b ice' .L.y z } s.. ly.,r ""S' f"s� vea j .Rh GI tole S7 qi � i�,a t 'mil.�, ��.arr�'�%qv �f� � .'kr'3�h:�"�;'4`.i � ,+�.'F a �5." � '� �� K•� s!� .,��,'��p.�p�,� gar;, Ste° Ills 'a' ��,�/�a'�',�A►�;f e,* rr ,�rF^r �t�y a!4fe�g.�-.. ,a 4?Yn "� gkys y� <�+r .s' k''` �`�' ``'t+r~':ir�.rR .e x .� �!a �rgrt@,•' � �+ p�rk,, ,�'� i3�"'�(� t, .�e I w r \� t�r.:^ F ,\'vi4,��y}',� 4-�.� �Y",�_.�.•�y�a} � da,t�Lf�„f�t. ti,.��tY'F�f'�. r i3y'�Y�74' .7'.t\I''11A11�� . I '`W' _�` `' y'w'�*�•. 7, .�i t y.-..�a::'.a'w:-ii =� 1, .G ..:. e �' ray t 7 't i i �4 s G - P ^ 'IF 11 Aja q M W •' 4•,w ,�+� r r f 7.Y. ;tr R" "r �`i y �.3 .� r Doi z 1 s 12b s S0S 10-28-2009 11 =21 BARNSTABLE LAND COURT REGISTRY Prepared by and Return to: Brown&Associates 10592-A Fuqua, PMB 426 Houston, TX 77089 00 ASSIGNMENT OF MORTGAGE Loan 3304920 Min Number: r. KNOW ALL MEN BY THESE PRESENTS,that Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial(Assignor), c/o Home Loan Services Inc., 150 Allegheny Center, Pittsburgh, PA 15212-5335(address),for good and valuable consideration,the receipt of which is hereby acknowledged, does hereby sell,transfer, assign, set over and deliver unto US BANK NATIONAL ASSOCIATION AS INDENTURE TRUSTEE UNDER THE INDENTURE DATED AS OF DECEMBER 14,2001, BETWEEN SALOMON MORTGAGE LOAN TRUST 2001-CB4 AND US BANK NATIONAL ASSOCIATION,C-BASS MORTGAGE LOAN ASSET BACKED NOTES,WITHOUT RECOURSE.(Assignee), c/o LITTON LOAN SERVICING LP, 4828 LOOP CENTRAL DRIVE, HOUSTON, TEXAS, 77081, its successors and assigns, forever That certain mortgage from RICHARD MILLER,SINGLE to FIRST FRANKLIN FINANCIAL CORPORATION for$76,600.00 dated 5/29/1998 of record on 5/29/1998 in Book, Page or as ✓ Document 728122, in the BARNSTABLE County Clerk's Office, State of MA and the Promissory Note described in and secured by the Mortgage. Property Address: 99 Walton Avenue, Hyannis, MA 02601 IN WITNESS WHEREOF, Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial (assignor)has executed this Assignment of Note and Mortgage by and through its authorized officer effective September 2, 2009 Executed this September 2, 2009 Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial By: Sharon aerkle Title: Vice President f CORPORATE ACKNOWLEDGEMENT STATE OF Pennsylvania COUNTY OF Allegheny This instrument was acknowledged before me on the 2nd day of &9tember , gnn4 by Sharon D. Maerkle,Vice President of Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial(Assignor), on behalf of said Corporation. Nwt.t ft-o �'D 'Notary Public in and for the State of Pennsylvania Notary's Printed Name: Dionne R.Williams My Commission Expires: August 3, 2010 COMMONWEALTH Oa PENNSYLVANIA Nourtal aril Dionne R.Wpliams,Notary Public City of Pittsburgh,Allegheny County My Commission Expires Aug.3,2010 BARNSTABLE REGISTRY OF DEEDS Dac: 1s126PE05 10-23-2009 11 _21 BARNSTABLE LAND COURT REGISTRY Prepared by and Return to:. Brown&Associates 10592-A Fuqua, PMB 426 Houston, TX 77089 (>o ASSIGNMENT OF MORTGAGE Loan 3304920 Min Number: .. KNOW ALL MEN BY THESE PRESENTS,that Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial(Assignor), c/o Home Loan Services Inc., 150 Allegheny Center, Pittsburgh, PA 15212-5335(address),for good and valuable consideration,the receipt of which is hereby acknowledged, does hereby sell,transfer, assign, set over and deliver unto US BANK NATIONAL ASSOCIATION AS INDENTURE TRUSTEE UNDER THE INDENTURE DATED AS OF DECEMBER 14,2001, BETWEEN SALOMON MORTGAGE LOAN TRUST 2001-CB4 AND US BANK NATIONAL ASSOCIATION,C-BASS MORTGAGE LOAN ASSET BACKED NOTES,WITHOUT RECOURSE.(Assignee), c/o LITTON LOAN SERVICING LP, 4828 LOOP CENTRAL DRIVE, HOUSTON, TEXAS, 77081, its successors and assigns, forever That certain mortgage from RICHARD MILLER,SINGLE to FIRST FRANKLIN FINANCIAL CORPORATION for$76,600.00 dated 6/29/1998 of record on 5/29/1998 in Book, Page or as ✓ Document 728122, in the BARNSTABLE County Clerk's Office, State of MA and the Promissory Note described in and secured by the Mortgage. Property Address: 99 Walton Avenue, Hyannis, MA 02601 IN WITNESS WHEREOF, Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial (assignor)has executed this Assignment of Note and Mortgage by and through its authorized officer effective September 2, 2009 Executed this September 2, 2009 Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial By: Sharon aerkle Title: Vice President r r CORPORATE ACKNOWLEDGEMENT STATE OF Pennsylvania COUNTY OF Allegheny This instrument was acknowledged before me on the 2nd day of qgFtember ?Ong by Sharon D. Maerkle,Vice President of Home Loan Services Inc. sbm First Franklin Financial Corporation aka First Franklin Financial(Assignor), on behalf of said Corporation. Notary Public in and for the State of Pennsylvania Notary's Printed Name: Dionne R.Williams My Commission Expires: August 3, 2010 COMMONWEALTH OF PENNSYLVANIA Notartal Sad Dionne R.Williams,Ne try Public City of Plttsburgh,Allegheny County My Commission Expires Aug.3,2010 BARNSTABLE REGISTRY OF DEEDS YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. k in St., Hyannis, MA 02601 (Town Hall) and get the Business`Certificate that is Take the completed form to the Town Clerk's Office, 1st Fl.; 367 Ma required by law. DATE: vZ- 4 1G Fill in pleas ,x APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: �' �c�L � > v e 1-�`�c TELEPHONE # Home Telephone Number _ r O NAME OF CORPORATION: �� o S S . e�'S e NAME OF NEW BUSINESS E OF BUSINESS- C.\C'_c�JY�-QC Ill(DO 4-0-7 , IS THIS A HOME OCCUPATION? YES NO f , ADDRES$OF BUSINESS CQI)rwJ MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This,form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth '. Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSI ER'S OFF E This individu I e in or a i it a ui e Brits that main to this type of btsiIS.O®IMPLY WITH HOME OCCUPATION A ton rr * RULES AND REGULATIONS. FAILURE TO OMMEN S: COMPLY MAY RESULT IN FINES. 2. BOARD OF H LTH/ This individual has been ir�f, ed of the perm' requirem is that pertain to this type of business. / x MUSS COMPLY WITH ALL -Authori "d Signature** "AZARDOUSMATERIALS,RECU,.I.ATIONS COMMENTS: r 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) v u This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: x s Date/ �' / �'O i TOWN OF BARNSTABLE . TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM `. NAME OF BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 5U 6 �5b-7 Ll I S�- CONTACT PERSON: e. EMERGENCY CONTACT TELEPH -NE NUMBER: S�>& 36-?W MSDS ON SITE? TYPE OF BUSINESS: ��ecir hie , O,I_.IA'cP —INFORMATION / RECOMMENDATIONS: Fire District: c,-- . Waste Transportation: 7 Last shipment of hazardo us'vliast � p p Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) Jlubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels , (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) _may....' •..... f Other cleaning solvents Bug and tar removers Windshield wash �c -- WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS PA P Icant's`Signature Staff's Initials !' T WN OF BARNSTABLE L06VI.10N �� alkr! . _ SEWAGE # QrVG-'-IOC) VILJ,...AGE 66A)ViS ASSESSOR'S MAP & LOT o`Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (typ6 9r hQM (size) NO.OF BEDROOMS 3 BUILDER OR OWNER 4 PERMTTDATE: 106 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5LOe QLcv;,) Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) S+ee p Feet Edge of Wetland and Leaching Facility (If any wetlands exist RWV Feet within 300 feet of leaching facility) Furnished by 2-D�, u 1"-roN Ir 3-30`G'�:: . . A Ll 0 3 - 31 2E3 �� 1'1. No. (f/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS R pplitaction for Digogal fppztem Con.5truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade()o Abandon( ❑ Complete System ❑Individual Components Location Address or Lot No. W. _—&t� Owner's Name,Address,and Tel.No. t��Gr 1 A 1 p r tici we,14-o�-Dr v Assessor's Map/parcel 3f e 02-1 IrSller's Name Ad ress,and Tel.No, -ZOX Designer's N_ e,Address and Tel.No. S� 1 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building ikr»,Se No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 331 a gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank i-SC Type of S.A.S. co uA�On S Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1%)StcCclL Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thisjloaxo of Health. Si e Date 9 / .& Application Approved by Date 61 f Application Disapproved by: Date for the following reasons I Permit No. Date Issued L�---- -- - - --- -- —� -- --------s--------- — —————————— t � v f.�! f•' No. [ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - PUBLIC HEALTH DIVISION - TOWN,OF BARNSTABLE, MASSACHUSETTS Yes ,i Z(ppricat "on f'or Th5pont �&p.5tem.,Cowkruction Permit 8 Application for a Permit to Construct O Repair O Upgrade(A Abandon O ❑Complete System ❑Individual Components t RLocation Address or Lot Nol? 0C.`SON "y Owner's Name,Address,and Tel.No. 1 A ( �',r f i G � Ctc(Wcr }O,J-Dr , Assessor's Map/parcel 3/0-O 21 Insta>l-ler's(Name,Address,and Tel Nn0 j�^y p�/ %� Designer['s Na Address Address and Tel.No. P '0' hN/� '�J( MI�Y'�✓1 /° N�'P\ J ASQ1v t Type of Building: r Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building 9003e No.of Persons Showers( ) Cafeteria„( ) Other Fixtures ' Design Flow(min.required) 330 gpd Design flow provided 33I, gpd Plan Date Number of sheets Revision Date t - Title Size of Septic Tank I SC7Q Type of S.A.S. SC500�CQ\�C,N ChM S 2�x 12 Description of Soil 5% Nature of Repairs or Alterations(Answer when applicable) SfUA /-aPW I Ie.- SkrPt nh- \ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued,by this-Board of Health. s Si 9 � OGy1 ed ' Date Application Approved by Date Application Disapproved by: Date for the following'reasons ` F ro Permit No. Date Issued -------------------------------------------- - THE COMMONWEALTH OF.MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that thdPOn-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by S ! i✓� at 4/4Aorj IP- Gwly► S has been constructed in accordance with the provisions of Title 5 d e for Disposal System Construction Permit No. dated `&Installer�o1�i S 16 W Designer )n N`S"C�-N #bedrooms 3 Approved design flow © gpd The issuance of this permit hall no be construed as a guarantee that the syste w ll func(io as es' ne . - ( t r Date -/ 1 Inspector ———— ——————————————————————————— ——————— No. goo ro ^ yocl Fee /00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALWDIVISION-BARNSTABLE, MASSACHUSETTS ligo�al �pgtem (Cott tructiorr Permit Permission is hereby granted to Construct ( ) Repair ( ) . Upgrade Abandon ( ) System located at `1 (-J&Wev 'of 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: Constructea Tst bL�c pleted within three years of the dat of this Date I l Approv� by Town of Barnstable Regulatory Services Thomas F.Geiler,Director mRmrAmL i6SS Public Health Division �Ec +" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 021 6 Sewage Permit# Assessor's Map\Parcel 3 0 0.2/ Designer: on/ Installer• o•j(r- 9/co -,N Address: 6 o y- 3/ Address: 0- &f,X /g S 0,5T-CA-J , C.LL MA oa6ss- CerNVr'ILJiLLE, ^q d.-2- 63.t On 9ZI D 6 A o was issued a permit to install a (date) (installer) septic system at ,9,9 c..wA 4-'7—o14 A\1 E� f/Y.4�if based on a design drawn by (address) re7- J o f kt Slam/ dated 0/;x /0 6 g ej 91610 6 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &.Local Regulations. Plan revision or certified as-built by designer to follow. 1 L� ft=i�B . taper's Signature) (� /fib . (Desi er's gnature) (Affix Designer`s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc Town of Barnstable P# 11 Llb o Department of Regulatory Services i Public Health Division Date 200 Main Street,Hyannis MA 02601 D Mld� Date Scheduled g I I I Time Fee Pd. 106 Soil Suitability Assessment for Sewage Dis osal Performed By: 6%P`' QN� Witnessed By: LOCATION& GENERAL INFORMATION l Location Address LO 0.t+Co� `C) ����1 S Owner's Name 1 Address c1 q 0c,1 4U,1 lZe �(Gc,�►n)i S Assessor's Map/Parcel: 3i Q—Q �"�` Engineer's Name Ucw—�dv�NS O N NEW CONSTRUCTION REPAIR Telephone# S 1_!7 7— Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property lane ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to holes) �srC�t �C '36 V �lE f}D -5 6D Ar C. TP'1 3 7 -2 0 I Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: T. g f Weeping from Pit Face N° D $J -Feg C_ �,�Estimated Seasonal High Groundwater TcF DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: v 1- o his N�p� o? Depth Observed standing in obs.hole: V in. Depth to soil mottles: In. Depth to weeping from side of obs.hole: AJ10� In, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj:factor Adj.(lroundwater level PERCOLATI.ON TEST bate �,4 Thne. //'o 0 Observation . Hole# T_'t 'ISme at 9" Depth of Perc q g"-6 0�I Time at 6" �S Start Pre-soak Time @ G Time(9"-6") End Pre-soak Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) g p Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'.of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTI0PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# ,. Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. isteGravel) ON i4 t fly^l I®YA-9/3 LoA"`Y Sq.vp toy S 43 -�°� L� �► -c- 5,*UID P r.Y7/3 s• �•bd!•r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsi tency,% e Q fl-111� GI M-G�SFn/0 .�•S y 7l3_ vo vo a co 3A.f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Muosell) Mottling (Structure,Stones,Boulders. Con istency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance hate Mao: Above 500 year flood boundary No Yes Within 500 year boundary No Within 100 year flood boundary No Yes . Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervio4 ma ertal exist in all areas observed throughout the area proposed for the soil absorption system? T If not,what is the depth of naturally occurring pervious material? Certification I certify that on 195 (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the required training,expertise Nd experience described in 310 CMR 15.017. Signature Date o 06 Q:\:SElynCVERCFORM.DOC � Il ' r TOWN OF BARNSTABLE LOCATION WO_X;;K� 14 V SEWAGE # � VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. 6--ff r2- ( -OEAV_ SEPTIC TANK CAPACITY �CT1J� LEACHING FACILITY:(type) lovc,`C� oize), _ NO. OF BEDROOMS PRIVATE WEL' OR PUBLIC W4 R �— BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED:. Yes No e/ IC-S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH .. .........0F.. ��... ....��'°:b ................................ , ppliration for Disposal 19orks Ton,strwtiott 11.exttti# Application is hereby made for a Permit to Construct ( ) or Repair (L-)--in Individual Sewage Disposal System at: ............. __..l.i..t.!f �:�-.3w.... -••--•-•-....... ...---..: ..�.wr` .........................................................Location-Address or Lot No. ........ 1� .,a� .... >�-•--------- ----------------- ... ----••---•----............----......_....._.. Own •Address a .�Yv •-4-=', Fins 1e. cam.................... C�L..0.,.......�� taller Address q� Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms...... .Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures -----------••...............•--- - Q -------------------• -------------------------- -................... . W Design Flow.............�1 ..................gallons per person per day. Total daily flow......... ......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area________........_.._sq. ft. 3 Seepage Pit No......./__..___-__.- Diameter.....t..C?`...... Depth below inlet.....(��........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) $_+ Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LL Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .......................................................................................................................... -------•-••.----- 0 Description of Soil........................................................................................................................................................................ V ------------------- .--•--•------------------ .................................•-----..........-•----._.....--•-----------•---------------......_....-----•---......---•--•--.....-•-•----...----••------- III W ...........•-•---••----••-••------•-•--------•-•••--•---•-•--••-•-----•------•••••...............•---•••--------•---•-•---•••---•-•----•--•...--•---------.....-•----------............................ U Nature of Repairs or Alterations—Answer when applicable..._.- __._.._11v ...�P _.. 1 ....L�rc��.......... ...... .K.IS`Y't ,e �S t�� --------------- -••--••---•---------•-------•--•-------•---•---.....------•-••-•... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. �c� Date Application Approved By.............. ----------_-,2. .^= ----•...................._ ---...... Date Application Disapproved for the following reasons:.............................................................................................................. .....................................•...................._.........--•-•----------...----•--•-••••-•-•........._....•-•---•---------------•-----.......-------------•--......••---------•--••••----•---- -7 Date Permit No..........91'::..37.2.............- Issued-----•---•--------------------•--..................._.. Date 19W `ti r THE COMMONWEALTH OF MASSACHUSETTS w,BOARD OF HEALTH� .k f rationvfor Dispasat Works Tanstru'dion "permit Application is hereby made for a Permit.to Construct ( ) or Repair (t..)—an- Individual Sewage Disposal System at: ............ .i..............: .........4--y.. .!'4 i!S.��.............................-........... -Location.Address 14 - Q or Lot No. .Own Address .....`..01A... Installer Address Type of Building ' - Size Lot............................Sq. Feet aDwelling—No. of Bedrooms.....'3-----------------------------------Expansion-Attic ( ) Garbage Grinder ( ) e of Building Nb.- ersons....t....................... Showers — a Other—Type g ----------------------------' ; of P ( ) Cafeteria ( ) dOther fixtures . .----•----------------------------•--------._...-------------------------------- WWDesign Flow.............�'�,."...................gallons per person per day. 'Total daily flow...... .........................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench=`No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....._. h 3 pag �__.._...__.. Diameter,•...�.C�..._.._. Depth below inlet___._G.f........ Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0.4 Percolation Test Results Performed by ......••--•••-•-•.....................•--•-••--• ... Date Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......................... x ............................O Description of Soil.................................•-----•---•--------......-•-•-...---•- W •---•-.--- ----•--------•--•------------------•-------------••--------•-------•-------•--••------••---•----------------•-----------•--•--••---•--•------------ x ...................--.............................:..................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable.....k'.ICY9.......e)Aee...._.�t4...4eT. ....4'e-P f.......... .. VIrI G 'S- .1% ' 1..................................................................................... Agreement: ' y The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ` the provisions of TIT1E 5,of the State Sanitary Code— The undersigned further agrees not to place the system in a" operation until a Certificate of Compliance has been issued by the board of health. - .. Date Application Approved By...... e. � _ --------- -.?._. . ' ' Date — Application Disapproved for the following reasons----------------------------------------------------------------- ............... ' ..................•-•--.......---.......--....---...----•-•----...-----------•--•-------•--•-------•-•---•-------------•------------•-•---•---•-...------•-----------............••--------•----•••••-•- Date Permit No... • :n.. .7.... Issued----------------nu....••----••--•-••••••-•.._...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- T 77 ..... Trrtif iratr of Tomptianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby ......tee !.�G?�?:..t- G.:3'• . �•.!;!T=.........................................................................................c...._ Installer at.........................'-^.-'45....... '-'-. .l.X ,-.........-- "" '--- ...... -------------------------------------------•-_---------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...._._ �'.�..- ,7.. .... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................f••='-..-�.---�•--"=-.�....�..............-•-----. .Inspector---...........-•-•-•- � ............................................... THE COMMONWEALTH OF NIASSACHUSETTS BOARD OF HEALTH c, `) .. ........OF...� ................................. No. �.../...... FEE... .. Disposal Works Tono#rur#ion Vrrmif Permission is hereby granted. ..c a +P.. l .ta. ....... ............................................................ to Construct ( ) or Repair (_�-) an Individual Sewage Disposal System at,No......................R-4�...... -`.2r.........t.4.�r. ._t^-vt f .5....... .... Street as shown on the application for Disposal Works Construction Permit N0.2�73.72 Dated.......................................... •-•--•...................•--.....------ •.:W..D.................................................. . lloard of Health DATE....................... ---••--•-•••---•-•-•--•----•- ....................---- 1500 GALLON SEPTIC TANK MODEL SHORE'r TK 1500-H -10 FINISHED GRADE L. o/�f} ;r O r:.Z f TEST PIT DATA - I - _ 24"DIA 24"DIA. 9 YMIN) 24"DIA Performed By: Daniel B. Johnson - ?' 3" H 10 6', Witnessed By: Donald Desmarais � 5' r V'SCH 40 E L -95,25 Nate: August 9, 2006 4"SCH 40 r10. =LJW'LINE 14.1 �EL FILTER A 100 - EL =95 50 1. i 4"SCH 40 TEE SEPTIC TANK TO MEET TP-1 (ZL. - 97. 4) I 4'UQUID LEVEL REQUIREMENTS OF GAS BAFFLE 310 CMR 15 226 FOR 4"SCH 40 •DATER TIGHTNESS ( 96. 7) A, 0" - 8" 10YR4/3 Sandy loam TEE ETC_ ( 93 . 8) Bw, 8 _ 4 3 10YR5/8 Loamy sand AlL WALL SLEEVES.�GASKETS --- -- w 88 . 9) C1, 43 102 2 . 5Y7/3 Gravely m-c sand L �T6" (MIN ) - _ `-SHAL BE CAST IN PLACE OR - ------- MECHANICALL'r r�. ( 81 . 4 ) C2, 102"-120" 2 . 5Y8/3 Medium sand INSERTED AT FACTORY � Ja COMPACTED '87 . 4 ) 120" Bottom of TP-1 (No Observed GW/ESHWT_ . ORUSHED STONE ;TABLE LEVEL BASE '2 (ZL. = 97. 1) SEPTIC TANK DIMENSIONS 1(OY 6"L X S 8"W X 513"H ( 96. 4 ) A, 0" - 9" 10YR4/3 Sandy loam DISTRIBUTION BOX' ( 93 . 4 ) Bw, 9" - 44" 10YR5/8 Loamy sand ; (87 . 8 ; C1 , 44" -lit" 2 . SY7/3 Gravely m-c sand MODEL:SHOREY DB-3 H-20 ( 86. 1 ' C2, 112"-132" 2. 5Y8/3 Medium sand REMOVABLE COVER 4"SCH 40 CUTLET .ATERALS ( 86. 1 ` , 32" Bottom of TP-1 (No Observea GW/ESHWT DISTRIBUTION BOX TC MEET SHALL BE SET LEVEL FOR _ REQUIREMENTS OF 310CMR ;' MINIMUM OF THE FIRST T'vd0 _.. __ 15.232(WATERTIGHTNESS, - FEET AND CONNECTED TJ PERCOLATION TEST DATA CONSTRUCTION,ETCI ; 2 J ` EK:=H DISTRIBUTION LINE ,,vlTH SOLID SCH 40 PVC PIPE AEC.K Date: August 9, 2006 NO OF OUTLETS 4•'sa 40 b' '', Y -"'^C EL r�o,oa oNL� g�2,►LK r USED: 2 EL. =93 72 FL = C 55 ,r c Soil Class : Class I (0. 74 G/SF) °0 0 5'(MIN! o o J DIACALL STONET'TONE =�4„ ti -- M E rHAN I CALL'i, S or STABLE LEVEL BASE COMP.4CTE2 Eft;TINfj fIOJSE ro Perc Depth: 44" - 60" (TP-2) , < 2 MPI (93 . 4 tc 9� . ; ` F`E= too,3 t dfE' 9;t'-7 t 00 SCHWULZ OF ZLZVATIONS ta� " 99.4f ; LEACHING DRY WELLS 500 GALLONS i - Inv. Out Founc+ation ,existing) ?7 .2 "END"CROSS SECTION - - ----- 9 'I Ir:v. In Septic Tank 95 DO FINAL GRADE TO BE STABILIZED MODEL. SHOREY PRECAST lXINCRETE af� y�a�£` Inv. Out Septic Tank 95 . 25 � I Inv. In Distribution Box 93 . 72 EL -973(AVG) INISHED GRADE(SLOPE = Inv. Out Distribution Box 93 . 55 _ 9 3 ��' ; Inv: In Dry Wells 93 . 50 = LEI ,50 IIf= 12"IMIN) - EL ='3400 yEPrl c rK - _ _ -- - W Bottom of Dry Wells 91 . 50 ``� r_IBRE:At oI 'r q Bottom of TP-'- (Nc Obs. GW/ESHWTI 86. 1 LEACHING DRY WELLS .2 �° VEN f A'6,'LX4'A0„W 1, c� c� c I '';4". 1/2"DOUBLE x y ,15L� IA ril x�1 w WASH PEA'jTGNE ° _ i OVERALL LEACHING AREA T t , ph11 WELLS (�f a o 3/4" 1 1;2'DOUBLE y, y z 1 (EFFECT�UE AAEAI I • �{ G-J o r�" © WASHED STONE Lq o o I ExistingContour - - - OP - - - TO LEACHING COMPL WITH THE ' 2� � �N•��� '• , z ', i _ - � LEAIHING DRY"WELLS TP"� I �--. - x F• __._.___._ _ REQUIREMENT-.=, OF EL,= 97,1 i Proposed Ccr.tour �'' -~ �tR 15 11`2 Test Pit60 Finished Floor Elevation ='F r ;,Q A L T-0/1J Basement Floor. Elevation BF': x©'rss I 1 Ali construction methods •shali conform to the Title V ( 310 Water. Line W I CMR 15) and the Barnstable Board of Health Regulations. '-ve,. Head W1 �n• + - i1, ;ere are nc k::own arivc�__ we-is within 150 feet/400 feet, respectively, of the proposed leaching area . Gas Lin«� -_ "'he proposea leaching area 'is .not within 100 feet of a ptr, O F16 E OF' 5CP776 5 Y S7CM wetland, nor is it within 200 feet of a river front . - 1 5c4i,e : A5 sfyowirj 3 . Existing cesspools to be pumped and removed prior to installing the new septic tank. 4 . No changes are to be made in the field without the approval of the Board of Health and the design engineer. �rKruKt Proposed leaching area is nc` designed for use with Y ge d "orARr Barba isposal*r40 CovEIL w r►+�r1 3��M,N) 2J° 6 • Contractor to notify Dig Safe 72 hours prior to �'fl llnlb G R/EDE a G �� ♦•c z8 r ,C,qp V construction. ( 00 344-7_ •cAve v � I 8 S ) �33. E i 1 e 0 to HOUR PW,o I � Property line information taken from Deed, Book 55, rage 9-,IL� 4 -` ,J I `'•-" Y r ' ' y Ro RENTAL Certificate # 8755 . The septic plan is not to be used as a property line survey. '"`I `� f �`"` 8 • Contractor shall verify all plumbing from existing structure ! '' ' ,y,"- - T`^'lN�' .4 "wc.v y_ �p :y. �•RtAI jO tVr i will be connected to the new septic system prior to construction. if any existing plumbing exiting the structure is found to be different the that shown on the approved septic system plan, the contractor shall notify the a. designer. R11 internal plumbinc, shall be connected to new septic system, unless otherwise specified. 94 + Sj.i>t 7 I - TDP of G o,vo ••ter• - -- - ss,<, 93.4 9Z r 4. oil a-eve I 1 ' H YA N N 1$ CALCULATIONS : /Soo U�« 0� ( � � ( + � � �� 3 Be � - Moms (existing) i ! sFpTcL T�'►�K [�.l ! 110 GPD/Bedroom X 3 Bedrooms = 330 GPD .2 `_ a ^' .� 9 Percolation Rate - < 2 M PI, C lass I ,r 0 . r4 (;!SF. AS L s.4 PROPOSED LEACHING AREA: i _;ry Wells : 41 at 25' L x 12' W K 2' H g9 , Side Area: 148 SF X 0. 74 G?SF = 109. 5 GPD Bottom Ares : '00 SF X 0 . 74 S/SF = 222_0 ,Pn Total Lea — - I oac.ty: 331 . 5 GPD 1 I p + 7 7 J o 91bj 06 Cft4,,,j6-e0 SiZ � Or' G A/t..CA ry 3 13EL1IZac�.S ! N&O- + � SUBSURFACE SEWAGE DISPOSAL SYSTEM 99 Walnut Avenue, Hyannis !�G/L g O, /`1't. �' �" 9/S( �O. A% r_.,•,'' jTratc BCALa� PPROVED BY: a A DRAWN BY QAT1� /21/06 Darue+l B Johnson peV�p 0toe p,r o 0 pf3a O+,a OtSo o+uv 0+70 0+$a ©{9v 1+00 l \ For 99 Walnut Avenue, Hyannis, NA 02601 r�l2 (,• 0 - rNCDRAWING NUMBER By P 0 Bo: 831 oatorvl.lo, NX 02655 J-2096