Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0018 KIMBERLY WAY - Health
18 KIMBERLY WAY, COTUIT A = 027 U51 lb l� 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 a � 7 wa od Ba,Kstaik Pd& Ilea&Diuisioa 2001 ,''Lreet llgannis, 1W 02601 • 1��iliti�jl�,Iti�1iI1lII'ilil':i'l�ii1t��,�i�Ilili4.�itllitl''l�. COMPLETE •N COMPLETE THIS SECTIONON.DELIVERY ■ Complete items 1,2,and 3.Also complete A Sig" ure I item 4 if Restricted Delivery is desired. ©Agent ■ Print your name and address on the reverse X JOAddressee so that we can return the card to you. Regeived by(Printed Name) C. Da e o 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? ❑Ws I 1. Article Addressed to: \ If YES,enter delivery address below: 09No I 1 � G Svetoslav Georgiev& Krasimir Kirov 18 Kimberly Way Cotuit, MA 02635 3. Service Type Certified Maiie ❑Priority Mail Express'" ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7212` y�1a ooao 2847" 9046 n (transfer from service Iabeo PS Form 3811,July 2013 Domestic Return Receipt p fY V.lYil O Cr 0 I C I ra Postage $ �� r}'" iti td? Certified Fee iC3 \\\ Postmark C3 Return.Receipt Fee �._d.►�'Here p (Endorsement Required) a (Endorsement Delivery Fee O (Endorsement Required) rq p Total Postage&Fees $ ,8 ru f ,-I Svetoslav Georgiev& Krasimir Kirov _____ ►�____.___. c3 18 Kimberly Way Cotuit, MA 02635 I Certified Mail Provides: e A mailing receipt a A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee w4iver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,Please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when.making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530.02-000-9047 i Town of Barnstable Barnstable Regulatory Services Department • �ARi!iSTABLE, • "� Public Health D 3�. , Division m �A 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 „ Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2847 9039 - October 02, 2016 Svetoslav Geor iev &Krasimir Kirov v � 18 Kimberly Way - Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located 18 Kimberly Way, Cotuit, MA was last inspected on 5/17/2013,by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally,passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution box must be replaced; as well as,the pipe between the septic. tank and leach pit. You are ordered to repair or replace the septic system components within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH in s cKean,R.S:, CHO . Agent of the Board of Health r Q:\SEPTIC\Conditionally Passes Ltr\l8 Kimberly wy Cotuit 2016.doc All Documents by Address-Search Results Page 1 of 1 b »: Property Addr: 18 KIMBERLY Search Date: *All dates Town: Barnstable Document types: Deed document group This may not be a complete listing of activity for the-address'ypu are searching. We index the address provided to us by the party recording the document. We,have,no way of verifying that,the-address given to usJs correct or complete. We provide address information as search aicl only and it should not be relied upon as an accurate reflection of all activity for a given property. ;. <Previous Nexv> Show Print Cart Print Listing us NUM A Bk-Pg:27788-88 F-11sO 99c Recorded: 10-29-2013 @ 8:24:29am Inst #: 61633 Chg: N Vfy: N Sec: N Pages in document: 2 Grp: 1 Type: Deed Doc$: 1.00 Desc: 2 280/25 Town: BARNSTABLE Addr: 18 KIMBERLY WAY Gtor: MUCHER, ELEANOR SWENSON (Gtor) Gtee: ELEANOR SWENSON MUCHER TRUST (BY TR) (Gtee) Gtee: MUCHER, ELEANOR SWENSON (AS TR) (Gtee) Gtee: MUCHER, GIL C (AS TR) (Gtee) - Recorded:.09-30-2016 @ 2:11:30pm Inst #: 50397 Chg: N Vfy: N Sec: N s= c Bk-Pg:29976-25 a Pages in document: 3 Grp: 1 Type: Deed Doc$: 225,000.00 Desc: 2 280/25 Town: BARNSTABLE Addr: 18 KIMBERLY WAY /I GtorI MUCHER, ELEANOR SWENSON (AS TR) (Gtor) Gtor:/MUCHER, GIL C (AS TR) (Gtor) Gtor ELEANOR SWENSON MUCHER TRUST (BY TR) (Gtor)' i' tee: GEORGIEV, SVETOSLAV (&0) (Gtee), j Gtee: KIROV, KRASIMIR (&(5) (Gtee) No (more) matches found <Previous Next/> Show Print Cart Print Listing = " . ... ,. •I Loll - .n S 1 "a`fin-, 0 Y k To see summaries of the next sequential docuuments, click on Next>. To see the previous panel displayed, click on <Previous. To view an abstract, click on the document icon with "ABS". To view an image, click on the document icon with "DOC". Please note that if the icon "DOC" is not shown, that means the document image is not available. To view an abstract of a referenced document, click it's hyperlink. Most images you will view and/or print will not`have marginal reference notations on the image. if you'are'interested in Tmarginal reference information for a particular instrument/document, check,ari"d optionalI print the abstract for.it. There � IS no fee for printing abstracts.To print the,abstract �rightclick on the abstract side=(not the left side) and, for.Internet ,Explorer, select "Print". 14. - t « iy https://search.barnstabledeeds.org/ALIS/W W400R.HTM?WSGKEY=I 8+KIMBERLY+WAY&WSHTNM=W... 10/4/2016 1 Parcel Detail Page I of 3 f r y 'N7 Parcel Info Parcel ID�027-051 oevelopoot LOT 2 ' Location 118 KIMBERLY WAY I Pri Frontage 125 Sec Road Sec Frontage Village Cotuit ��'' I Fire District lCOTUIT Town sewer exists at this address F0 Road Index 0840 Asbuilt Septic Scan: 027051_1 InteracMavep � I 027051_2 - Owner Info _ 7�" . � , , Owner MUCHER, ELEANOR SWENSON TR Co-owner,ELEANOR SWENSON MUCHER TRUST I streetl 2472 ORASOTA CIRCLE ' streetz F—� City 'OCOEE State FL zip 34761 Country Land Info � . Acres 10.46 use Single Fam MDL-01 ( zoning RRFF � � Nghbd F0105" Topography Level ( Road Paved Utilities!Public Water,Gas,Septic Location • Construction Info: g. Year 1984—j Roof 1 ble/Hip ) ExtWood Shingle Built Struct Wall Living(1660 Roof As h/F GIs/Cm ac None Area Cover p p � Type Style Cape Od Int Bed Be' rooms ., --� Wall�rywallI Rooms;4 ed wwQK' Model Residential Ior Carpet R Bath Floor 2 FUII-O-Half • ooms Heat Total 'HOSTS Grade Average � Hot Air - I 6 R i, sae. Type Rooms oo[T S 48AS 2, i� n 'z Stories„1 1/2 StOfleS Frei Gas F aeon,Poured Conc. €_ zr -—4 .4 Gross 13032 J Area Permit History E12,/1/1986 Addition B30246 $10,000 1/1511988 12:00:00 AM COGARAGE http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1599 10/4/2016 r ' Parcel Detail Page 2 of 3 1 811/1984 Dwelling u, F8-3 7 $0 j1h5/198512:00:00AM t s ,-- � C011/2-S a Visit History 10/9/2015 12:00:00 AM Lisa Henderson In Office Review 1/1 6/201 4 12:00:00 AM 1 Denise Radley - Change ofAddress Y 2/5//2013 12:00:00 AM Robin Benjamin Cycl Insp Comp 8122/2012 12:00:00 AM 'Robin Berijamiri in Office Review. �. e, '�,, a. `� " ° , 4/20/2005 12:00:00 AM Paul Talbot Meas/Est 2/3/1999 12:00:00 AM Donna Dacey Meas/Listed-tnterior Access �' 3/15/1985 12:00:00 AM FIR Sales History 1 10/29/2013 MUCHER,ELEANOR SWENSON TR 27788/88 $100 2 40/29/2013• ;MUCHER,ELEANORSWENSON � .. � 27788/84 ' �� $100 3 9/9/2013 MUCHER,GIL C 27675/226 $205,000 4 A/17/2013 a ;;SECRETARY,OF„HUD - . t 7,,,7- 27297/297�'- $1 5 9/26/2012 FLAGSTAR BANK FSB 26705/206 $360,491 8' 12/14/1995-` BROCHU,DOUGLAS A&LESA A gg n a 9971/228 I jr ,A,•$116,000 7 9/5/1995 MCDONOUGH,WALTER 9828/350 $115,000 8 5/31/1985 tRUSSO,MARK&'THERESA M 9 12/4/1984 REGAN,JAMES E&DEBRA A 4340/208 $63,826 10 5/8/1984` 'DELANEY,JOHN J TR �+ 7 • 7 4 41.,1/53§- m " $40,384 11 8/11/1980 RAFFOL,KENNETH S 3135/333 $0 �- 1 2016 $138,200 $26,400 $2,100 $111,500 $278,200 2 2015 $135;800 .; ,, ry, %6, $23;800 j .- '1$2 600 ' $109,000 5$271,200 3 2014 $135,800 $23,800 $2,600 $109,000 $271,200 4' 2013 "$135,800 ' . $23800 ;.. A$2;700g `, $10Q000, _ 3sa ;$271,300 5 2012 $117,100 $24,600 $2,100 $109,000 $252,800' 6 -, 2011 $135,800•1 -$6,600j, wgz $1 500 - sib9',0oo-"-'i 252,900" 7 2010 $135,400 $6,600 $1,600 $109,000 $252,600 8 2009' ,t $147,500 - `•.$5,600 �, P-$B00 _ $146,000 �' �" -` $299,900i 9 2006 $153,300 $5,600 $1,000 $152,100 $312,000 11 t 1 2007< '$162,300,,- $ 600 '_.; $1,000 12 2006 $157,900 $5,600 $1,000 $157,200 $321,700, 13 2005 _ -$138,400 - �'° �� '$4,600 .' ; $1 000 14 2004 $121,100 $4,600 $1,000 $121,400 $248,100 15 _ 2003 $99,200„ '$4,60Q, $.1;000rr .,$40 0.00 $145,2001 16 2002 $99,200 $4,600 $1,000 $40,400 $145,200 17 "_' 2001' t $99,200 ' $4,700 11 800 1$40,400 ,$145,309 18 2000 $77,600 $4,600 $500 $29,100 $111,800 19 1999 $75,40Q$`.ko "2, $2,600 $500f $29,100 a" "Il$107;60"0 20 1998 $75,400 $2,600 $500 $29,100 $107,600 21 1997 1. $82,400 $0,.` Z:L?$0 $29,100.� m' $112,700 22 1996 $82,400 $0 $0 $29,100 $112,700 "23 1995 T $82.400 °. k,14$0 $0 $29,100� x t ®$112,70 24 1994 $84,700 $0 $0 $29,400 $115,300 25 1998 ' a$$4,700 'ku r $01 7, $0 �_ • ��'$29,400.° f� $115,30D. 26 1992 $96,400 $0 $0 $32,700 $130,500, 27-.'; T"i991 .;, .. $94,600 �. .$0 '' -,=$0 .�$43,600 `, $j39500 28 1990 $94,600 $0 $0 $43,600 $139,500' 29 . a.1989 g 'c$94,600 7 7° -7 707 a ,. $0 $43,8003 ti` -$139,500 30 1988 $64,600 $0 $0 $12,800 $77,400 31- 1987 a o .., $74,000 4 $0 ,/ r $0 $12,800& $86 800 32 1986 $74,000 $0 $0 $12,800 $86,800 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1599 10/4/2016 Sousa, Vanessa From: Crocker, Sharon `. Sent: Thursday, September 29, 2016 10:08 AM To: Flynn, Judith; Soto, Kathryn; Sousa, Vanessa Subject: Flu Vaccine - Question FYI, Many seniors may call to inquire as to which type of Flu Vaccine we offer. They have heard of a "High Dose" version which has 3 strands in it and has something added to boast immune system. We do not have this one. Ours is the standard one for the public contains the four most recent strands of flu viruses (vs the three strands. The High Dose does not contain the most recent strand-last years') If they are looking for guidance in which would be better for them,they should consult their own doctor. Thank you. Sharon 1 f va Town of Barnstable 7 Barnstable Regulatory Services Department • 1ARNSTABLE 16yq. � ' Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#70.12 1010 0000 2847 9039 October 62, 2016 Svetoslav Georg iev &Krasimir Kirov ' 18 Kimberly Way e Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located 18 Kimberly Way, Cotuit, MA was last inspected on 5/17/2013,by Matthew Gilfoy, a certified septic inspector for.the State of Massachusetts. The inspection of the septic system showed that the.system "Conditionally passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution box must be replaced; as well as,the pipe'6etween the septic tank and leach pit. You are ordered to repair or replace the septic system components within six 60) d s ' from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH om s cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\18 Kimberly wy Cotuit 2016.doc l nn, Judith rom: Crocker, Sharon Sent: Monday, October 03, 2016 1:38 PM To: Flynn, Judith Subject: 18 Kimberly Way, Cotuit Hi Judith, Please check your records. A person was in today and was inquiring about 18 Kimberly Way. You had sent him a letter in Jun 2013 and again Nov 2015. They have not been requested to come before the Board as far as I know. The person was under the belief that the repair was fixed but there are no septic permits to validate that. What do your records show. Thanks, Sharon ' 1 • ®`t .19 2016 11:09 Jim 'The Inspector Man 5085349919 pageK III � I ®GIs I - ®® - - Commonwealth of Massachusetts Title- 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l i i 18 Kimberl We Property Address Krasimir Kirov j Owner Owner's Name information is required for every Cotuit V MA 02635 10-18-16 page. City/Town ! State Zip Code Date of Inspection b Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the and of the form. Important:When filling out forms A. General Information OFrq�s�,,�� i on the computer, b use only the tab 1 Inspector: .��4 sy key to move your cursor-do not . yG use the return James D.Sears l JAMES m= Name of Inspector key. _— �` y Ca y Na Enterprises, LLC Company Name 153 Commercial Street j '�/F'S INSP`�;'� Company Address Mash pee MA Citylrown j 02649 State Zip Code 508-477-8877 S1623 . _ Telephone Number License Number - i I 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 ❑ Gonditionally Passes I I� Fails Needs Further Evaluation by the Local Approving Authority i 10-18-16 spector'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 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. I t5ins.doc-rev.6/16 Title S Official Inspection form:Subsurface Sewage oisposal system!Page 1 of 17 ! �© tVs 95 Oct :19 2016 11:09 Jim The Inspector Man 5085349919 Page 2 i Commonwealth of Massachusetts Title 5 Official lnspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Kimberly Way Property Address Krasimir Kirov Owner owners game information is required for every Cotuit j MA 02635 10-1 t3-16 page. City/Town State Zip Code Dale of Inspection B. Cer'tificatlon (cont.) i I i Inspection Summary: Check A,B,C,D or E /always complete all of Section D A) System Passes: i ® 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 system is a 1000 Gal. Tank D Pox and two pits. r . I j B) System Conditionally Passes: I ' ❑ 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. .I 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 replaced1with a complying septic tank as approved by the Board of Health. I `A metal septic tank will pass inspectioni 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): i I i I j I i 15ins.doc••ev.6116 Title 5 Offlcial Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ! I Oct 19 2016 11:09 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Kimberly Way I I` Property Address Krasimir Kirov Owner Ownei s Name ' information is Cotult required for every page. City/Town I MA 02635 10-18-16 j State Zip Code Date of Inspection Bo Certification (coat.) } Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if I pumps/alarms are repaired. B) System Conditionally Passes(cost.): i ❑ 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 replacedi Y ❑ ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or;replaced ❑ Y ❑ N. ❑ ND (Explain below): � I � j ❑ The system required pumping more than 4 times a year due to broken or obstructed The system will pass inspection if(with approval of the Board of Health): pipe(s). broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): I, ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): y I j i ry A i 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: I ❑ Cesspool or privy is within 50 feet of a surface water i I ' ❑ Cesspool or privy is within 50 Meet of a bordering vegetated wetland or a salt marsh 15ine.doc•rev.6/16 - Title 5 Official Irspeotion Form:Subsurface Sawege Disposal System•Page 3 of 17 i i I Oct 19 2016 11:09 Jim. The Inspector Man 5085349919 page 4 i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,r l i 18 Kimberly Way Property Address Krasimir Kirov �i Owner Owner's.Name information is COttJlt required for every MA 02635 10-18-16 page. CitylTown State Zip Code Date of Inspection i 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. j ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. I ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or pp more from a private water supply . Y wel Method used to determine distance,) w I "`.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 an d -nitrate nitrogen is to or less than 3 ppm, provided that no other failure criteria are triggered. A copy of he analysis must) be attached to this form. II hd , 3. Other: i I i j - I j I_ I i j D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to eaich of the following for all inspections: E j `k 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 overloadeid or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet in due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in Op is less than 6" below invert or available volume is less than %day flow TS 15ins.doc•rev.6116 Title 5 Official hspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I j Oct 19 2016 11:09 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System FI rm -Not for Voluntary Assessments 18 Kimberly Way Property Address ' Krasimir Kirov i y Owner Owner's Name information is required for every Cotuit page. Cityrrown MA 02635 10-18-16 j Stale Zip Code Date of Inspection i B: Certification (cont.) Yes Na i ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped.- El ® 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 ammonla nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A co and chain of custody must be attached to this form.] copy of the analysis The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ ® 10,000gpd. ❑ ® The system fails. 1 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 questions in Section D. the Yes No I ❑ ❑ the system is withinl400 feet of a surface drinking water supply I ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is locatetl 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 questioln in Section E the system is considered a si nificant threat, 'f or answered"yes" in Section D above the ilarge 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. k l5ins.doc•rev.6116 Title 5 Official Inspection Forms subsurface Sewage Disposal System•Page 5 of 17 Oct 19 2016 11:10 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts Title .5 Official Inslection Form p c Subsurface Sewage Disposal System forme • Not for Voluntary Assessments 18 Kimberly Way j Property Address Krasimir Kirov i Owner Owner's Name information Is . required for every, Cotuit MA 02635 10-18-16 page. CitylTown State Zip Code Date of Inspection C. Checklist . I i I Check if the following have been done. You must indicate"yes"or"no"as,to each of the following: Yes No � I ❑ ® Pumping information was provided by the owner, occupant, or Board of Health j ❑ ® 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 fpr signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? i ® ❑ 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 owneer(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 CM 15.302(5)] i D. System Information j i i Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 j j f5ins.doc•rev.6/16 Title 5 Ottidal l lwedlon Form:Subsurface Sewage Disposal System.Page 6 o1 17 ; I Oct 19 2016 11:10 Jim The Inspector Man 5085349919 i page 7 ' I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `. IS Kimberly Way Property Address Krasimir Kirov Owner Owner's Name information is required for every Cotuit, MA 02635 10-18-16 page. CllylTown State Zip Code Date of Inspection D. System Information i Description: The system is a 1000 Gal. Tank D Box and two pits. • I i i Number of current residents: NA 1 I jQ Does residence have a garbage grinder? El Yes ® No 1.1 Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No { Laundry system inspected? El Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 21years usage (gpd)): 2014-71,000Gals 2015-96,000Gal's Detail: i I I .4 I Sump pump? I ❑ Yes ® No Last date of occupancy: Present 1 Date Commercial/industrial Flow Conditions: i Type of Establishment: I Design flow(based on 310 C M R 15.203):! ` Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft. etc.): i 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: i 15ins.doc•rev.6/16 - - Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 7 of 17 Oct 19 2016 11:10 Jim The Inspector Man 5085349919 1page 8 rA Commonwealth of Massachusetts r m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 18 Kimberly Way 1 I Property Address i Krasimir Kirov Owner Owner's Name information is required for every COtuit MA 02635 I s 10-18-16 page. Cityrrown Slate Zip Code Date of Inspection D. System Information (cont) S i Last date of occupancy/use: Date .Other(describe below): i • I . • i i ! General Information Pumping Records: i Source of information: NA ! j Was system pumped as part of the inspection? El Yes ® No If yes, volume pumped: k1 gallons How was quantity pumped determined? _ i Reason for pumping: Type of System: i ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ . Overflow cesspool ❑ Privy j 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(tolbe obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract j ❑ Tight tank.Attach a copy iof the DEP approval. r ❑ Other(describe): t5ins.00c-rev.6116 s Tllle 5 Official Inspection Form:Subsurtaca Sewage Disposal System•Page a of 17 I . I Oct 19 2016 11:11 Jim The Inspector Man 5085349919 page 9 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ' 18 Kimberly Way Property Address Krasimir Kirov Owner Owner's Nellie information Is required for every CfJtUlt MA page. City/Town 02635 10-18-16 R State tip Code Date of Inspection D. System .Information (cons.) Approximate age of all components, date installed (if known)and source of information: I i Main Tank and pit 84 -Pit#2 Permit#95- 1661 1 ii Were sewage odors detected when arriving at the site? ❑ Yes ® No if 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.): 'Pipeinq is 4" PVC SCH 40 Septic Tank (locate on site plan): f: Depth below grade: 10" feet _ Material of construction.- ® concrete El metal ❑fiberglass ❑ polyethylene El other(explain) i i If tank is metal, list.age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: 3° 15ins.doc•rev.6116 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•page 9 of 17 i Oct 19 2016 11:11 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 18 Kimberly Way Property Address Krasimir Kirov Owner Owner's Name information is i required for every Cotuit MA 02635 10-18-16 page. CitylTown State Zip Code Date of Inspection D. System Information (Cont.) i Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness11 3" Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum.to bottom of outlet tee or baffle 15" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendatidns, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at worrking level. Tank and covers at 10". In and outlet tees. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: i ❑ 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 i Date of last pumping: Date oins.00c rev.6/16 • - Tine 5 Official Inspection Form:Subsurface Sewage Di i p sposal System-Page 10 of 17 - Oct 19 2016 11:11 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 18 Kimberly Way Property Address Krasimir Kirov Owner Owner's Name Information is required for every Cotuit MA 02635 10-18-16 page. CltylTown State Zip Code Date of Inspection I D. System Information (cont) I Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: k. ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: z Capacity gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level-. Alarm in working order: El 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 Isins.doc•rev.6/16 3. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i I� Oct 19 .2016 11:11 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M o y _18 Kimberly Way r Property Address Krasimir Kirov Owner Owner's Name information is Cotuit required for every MA 02635 10-18-16 page. Clty/Town State Zip Code Dale of Inspection ` D. System Information (cont.) 4' Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert, 0 9 Comments(note if box is level and distribution to outlets.equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x 16"-33"below grade.!Box is clean and solid wl2 line's out, No sign of over loading or solid carry over. 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.): i t • *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: a 15ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage 0Isposal System-Page 12 0l 17 I Oct 19 2016 11:12 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts Title 5 Official Inspecti®n Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1& Kimberly Way Property Address Krasimir Kirov Owner Owner's Name information is required for every Cotuit MA 02635 10-18-16 .A page. CltylTown . State Zip Code Date of Inspection z D. System Information (coot) I Type: ; E ® leaching pits I number: 2 • I ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs'of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 1000 gal pits. Pit# 1 and cover at 31" below grade w/45"water. Pit#2 at 3' below grade w/cover at 20". 6"water in it. Note: Pit#2 New it. 9 p p r i i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration :. Depth-.top of liquid to inlet invert Depth.ofsolids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins.doc rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Oisposat system•Page 13 of 17 Oct 19 2016 11:12 Jim .The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection F®rm Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 18 Kimberly Way Property Address Krasimir Kirov Owner Owner's Name information is required for every Cotult MA 02635 10.18-16 page. Cfty/Town State Zip Code Date of Inspection k D. System Information (cont.) Comments (note condition of soil, signs:of hydraulic failure, level of ponding, condition of vegetation, etc.): i i I Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i F l5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Oct 19 2016 11:12 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments VI 18 Kimberly Way Property Address - ---- - - - -- Krasimir Kirov Owner O '— wner's Name ' information is COtUIt required for every, ----...--.-----_._-_: MA_:.._ 02635 10-18-16 _ g 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: I 1CbE�� Icadi " 1 r I i i RSA 37 ll y � 1 Arc __ .... _:..... __.. 3 15ins.doc-rev.6116 Tille 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 15 of 17 h q is Oct 19 2016 11:13 Jim The Inspector Man 5085349919 page 16 Commonwealth of Massachusetts 172 Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form -Not for voluntary Assessments i 18 Kimberly Way Property Address Krasimir Kirov Owner Owner's Name information is COtUIt required for every MA 02635 10-18-16 page. CItyTrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑•Check cellar ❑ Shallow wells N Estimated depth t high ground water: 12+ feel 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: 5-1-84 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) 0 Checked with local Board of Health -explain: '' ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: i You must describe how you established the high ground water elevation: T.H. on Design plan 5-1-84 12' no G W i. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ir•s.doc•rev.6/16 Till@ 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 j Oct 19 2016' 11:13 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 'Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 18 Kimberly Way Property Address Krasimir Kirov Owner Owner's Name Information is required for every COtuit MA 02635 10-18-16 page. Cityrrown 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 Z System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i 15ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 - 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 • Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 i • • • THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A.,Sign e item 4 if Restricted Delivery is desired. ❑Agent. N Print your name and address on the reverse X ❑Addressee 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 different1rom item 1? ❑Yes i 1. Article Addressed to: If YES,enter delivery address below: ❑No Eleanor' :�Nenson Tr Eleanor S,Wenson Mucher Trust 2472 O asota Circle 3. Service Type Ocoee, FL 34761 ❑Certified Mail ❑_Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from serviceiabeq 7�1573000:�1 `4990` 4629 PS Form 3811,February 2004 Domestic Return Receipt 102585-024-1540 Er �. • ti C OFF I . I AA L USE ' IIr Certified Mail Fee °' $ —tt, Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopy) $ ,"k. -rJ r3 ❑Return Receipt(electronic) $ Postmark O ❑Certified Mail Restricted Delivery $ _ -�/O/Here p ❑Adult Signature Required $ (/ ? ❑Adult Signature Restricted Delivery$ S/�0 <. O Postage / /,� $ (9 Total Postage and Fees ��' v ._— Li Eleanor Swenson Tr - oEleanor Swenson Mucher Trust r- 2472 Orasota Circle I� Ocoee, FL 34761i Certified Mail service provides the following benefits: e A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail a A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this•C delivery. 11' VLSUO-postmarked Certified Mail receipt to the,1 c A record of delivery(including the recipient's retail associate. G— signature)that is retained by the Postal Service-' Restricted delivery service,which provides _ for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders. Adult signature service,which requires the t7 ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ®Certified Mail service is notavailable for requires the signee to be at least 21 years of age, International mail. and provides delivery to the addressee specified: ■Insurance coverage Is notavailable for purchase by name,or to the addressee's authorized agent , with Certified Mail service.However,the purchase (not available at retail). :::] of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a: certain Priority Mail items. USPS postmark.If you would like a postmark on"' n For an additional fee,and with a proper this Certified Mail receipt,please present your .-T endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for , the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record.,...Certified Mall receipt,detach the barcoded portion u of delivery(including the recipients signature). of this label,affix,It to the mailpiece,apply F You can request a hardcopy return receipt or all ..appropriate postage,and deposit the mailpiece.C- electronic version.For a hardcopy return receipt, complete PS Form 3811,Domesffc Return Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this recelpt for your records. Ps Form 3800,April 2o15(Reverse)PSN 7530-02-000-9047 Town of Barnstable Barnstable �ST"M Regulatory Services Department MASS Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4990 4629 November 30, 2015 Eleanor Swenson Tr Eleanor Swenson Mucher Trust 2472 Orasota Circle Ocoee, F134761 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located 18 Kimberly Way, Cotuit,MA was last inspected on 5/17/2013,by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution box must be replaced; as well as,the pipe between the septic tank and leach pit. You are ordered to repair or replace the septic system components within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future - enforcement action. PER ORDER OF THE OARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health \SEPTIC\Conditional) Passes Ltr\18 Kimberly Q:\SEPTIC\Conditionafly y wy Cotuit 2013.doc i Parcel Detail Page 1 of 3 14 e- d Logged In As: Wednesday, November 25 Pa l~ce I Detail 2015 Parcel Lookup Parcel Info Parcel ID 027-051 Develope Loot LOT 2 Location 58 KIMBERLY WAY A � I Pri Frontage rl25 Sec Road �.'e,._ I Sec Frontage Village�COTUIT µ Fire District rCOTUIT i Town sewer exists at this address No � Road Index 0840 I Asbuilt Septic Scan: 027051 1 Interactive Map 027051 2 Owner Info owner iNUCHER, ELEANOR SWENSON TR ( Co-owner ELEANOR SWENSON MUCHER TRUST Streetl i2472 ORASOTA CIRCLE �) Streetz City fOCOEE state FL Zip 34761 Country Land Info _ Acres0.46 use Single Fam MDL-01 Zoning IR Nghbd t0105 Topography!Level I Road Paved I Utilities FPubliC Water,Ga� Septic I Location yI Construction Info Building 1 of i Year�`84 "I Struct Roof Built Gable/Hi Wall Ext Wood Shingle --J _._ Living AC 1660 _J Roof Area Cover Asph�%F GIs%Cmp Type None � �._ Style]Cape Cod Int�D wall Bed 4 B'edrooms 'w K P Wall :wry Rooms> 70 wgKS _ r,...�... .. - 'sw r Int Bath Model Residential l Floor Carpet I Rooms', Full-0 Half I r; A i Heat�^'� Total s rFH Grade Average I I Tas 'Type Hot Air Rooms 6 Rooms W r AS •� ,.. Heat Found stories1/2 Stories I Fuel ,Gas I ation Poured Conc. Gross3032 Area 'Permit History s http:Hissgl2/intranet/propdata/ParcelDetail.aspx?ID=1599 11/25/2015 f Map Pagel of 2. Town of Barnstable Geographic Information System New search I Home I Help Parcel custom Ma Abutters Map size ® � zoom out fl fl Q Q In ,{Viewer >tt ry —]PG _ 70817D2 r '027017700 —No 8102i0]7C110 • ,.A882'. .i - . 9991 t 027050 ".. . i 01000 027051' //918 Map: 027 Parcel: 051 Full ? Property .;02872 Location: 18 KIMBERLY WAY Info Owner: MUCHER,ELEANOR SWENSON TR 027853 >0 44 �Ptp' Location Information w �t4 Map&Parcel 027051 027089• Location 18 KIMBERLY WAY 07 - Acreage 0.46 acres f. 027070 0 7 Feet Current Owner i027075`- _ MailingAddress MUCHER,ELEANOR SWENSON TR _ ELEANOR SWENSON MUCHER TRUST _ 2472 ORASOTA CIRCLE Set Scale 1" 179 1 1 Aeri I Photos v I MAP DISCLAIMER OCOEE,FL 34761 Appraised Value(FY 2015) Copyright 2005.2010 Town of Barnstable,MA All rights reserved.Send clu x ra ea ureslo $23,800 BarnstableMA v1.2.5494[Production] . Out Buildings $2,600 Land $109,000 - Buildings $135,800 xj Total Appraised $271,200 Assessed value(FY 2015) Extra Features. $23,800 Out Buildings $2,600 Land .. $109,000 Buildings $135,800 1 Total Assessed $271,200 „ Construction Detail Style Cape Cod - .. Model Residential . - Grade Average " Stories 1 1/2 Stories Exterior Wall Wood Shingle Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp - Interior Wall Drywall ' Interior Floor Carpet Heat Fuel Gas Heat Type - Hot Air - AC Type None Number of -4 Bedrooms Bedrooms Number of 2 Full _ Bathrooms _ - Total Rooms 6 Rooms - Living Area 1660 " Replacement Cost $154,264 Year Built 1984 Depreciation 12 Building Sketches l http:H66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=027051 ,. 11/25/2015 Map Page 2 of 2 mm Yi t1G 1IYY 1 MAP DISCLAIMER This map is for planning purposes only. It Is not adequate for legal boundary determination or regulatory interpretation.This map does not represent an on-the-ground survey. Enlargements beyond a scale of 1"=100'may not meet established map accuracy standards. Parcel lines on this map are only graphic representations of Assessor's tax parcels.They are not true property boundaries and do not represent accurate relationships to physical objects on the map such as building locations. http:H66.203.95.236/arcims/appgeoapp/map.aspx?properiyID=027051 11/25/2015 UNITED STATES POSTAL SERVjCE 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 Town of Barnstable V Public Health Division 200 Main Street Hyannis, MA 02601 I I 111l,,.dillll,dillIII fill,llt,lll1l,jllill,t„It fill r. • ON • • ON• IVERY ■ Complete items 1 2,and 3.Also complete A. Signat e item 4 if Restricted.Delivery is desired. ❑Agent N Print your name and address on the-reverse X ❑Addressee so that we can return the card to you. B. eceived y(Pri t d Name C. Date of Delivery s Attach this card to the back of the mailpiece, _J U or on the front.if space permits. D. delivery address different.from item 1? 0 Yes 1, Article Addressed to If YES,enter delivery address below: 0 No r Eleanor Swenson + %;blucher Trust 247 .,orasota Circle 3. Service Type Ocoee, FL 34761 ❑Certified Mail 0 Express Mail ❑Registered 0 Return Receipt for Merchandise. ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee). ❑Yes C 2. Article Number 7Q],2,'1O1Q (transfer from service labeo OQOO 2851' 4020 PS Form 3811. February 200a Domestic Return Receipt +02595-02.M-1540 j k o ._ - . � nj 0 ra 1 ;. E Ln COPostage $ / I Mq p ru Certified Fee ®r �+__ �(y* O Retum.Receipt Fee �F4 3 jpstm O (Endorsement Required) �(i O Restricted Delivery Fee (Endorsement Required) O Total Postage&Fees $ US ru r9 o Eleanor Swenson % Mucher Trust 2472 Orasota Circle Ocoee, FL 34761 ,Certified Mail Provides: o A mailing receipt . a A unique identifier for your ma4iece ?. o A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. n For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Town of Barnstable Barnstable Regulatory Services DepartmentMASS 1 Public ]Health Division 200 Main Street, Hyannis MA 02601 2007 S Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CER IFZEDL�# 012 1010 0000 28514020Decemb14 c Eleanor Swenson - - %Mucher Trust 2472 Orasota Circle Ocoee, FL 34761 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located 18 Kimberly Way, Cotuit, MA was last inspected on 5117/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally . Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution box must be replaced; as well as, the pipe between the septic tank and leach pit. You are ordered to repair or replace the septic system components within one (1) year from the date you receive this notification. ' Failure to repair/replace the septic system within the deadline period will result in future enforcement action. q, � PER ORDER OF THE BOARD OF HEALTH o� as cKean, R. ., O a Agent of the Board of Health -� Q:\SEPTIC\Conditionally Passes Ltr\18 Kimberly wy Cotuit 2013.doc Town of Barnstable Barnstable Regulatory Services Department n" • snxxsrABM • r y MAS& 1639. � Public Health Division DNS 200 Main Street, Hyannis MA 02601 2007 SECOND NOTICE Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 4020 d_ December 4, 2014 '*X1. a x, Eleanor Swenson %Mucher Trust 2472 Orasota Circle Ocoee, FL 34761 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 . The septic system located 18 Kimberly Way, Cotuit, MA was last inspected on 5/17/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system LGond_itionaIlp jPasses" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the . following: - Distribution box must be replaced; as well as, the pipe between the septic tank and leach pit. You are ordered to repair or replace the septic system components within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH as ' cKean, R. HO Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\18 Kimberly wy Cotuit 2013.doc OPo http:(issgl21intranetipropdatalParcelDetail.aspx?ID=1599 oX Live Search 'i"I 1 ®Application Center(2) ®http--www:town.barnstable.,, Application Center ®Suggested Sites- Web Slice Gallery jFavorites ®ParcelDetall I^II �p4 OC Il. sAansrnotE V I rtA� ar.iu.. I y-aArEO yAyp - I�GU.(/IU.I�LU:(/�� •�~^��..� !/LZL.'-� - i •gg-d in As� Tuesday,August 19 Parcel Detail 2014 Cookup Parcel Info Parcel 027-051 I Developer LOT2 ID lot Location 18 KIMBERLY WAY I Pn 125 i Frontage- I -Sec Sec @ l Ogd I Frontage e I COTUrr Fire COTUIT District - , Town sewer exists at this j address No Road Index 0840 Asbuilt Septic Scan: w,777'. ""Interactive0270511 PIF Map 0270512 s _Owner s' Info OwnerMUCHER,ELEANOR SWENSON TR I Co-Owner ELEANOR SWENSON MUCHER TRUST 1, Streetl 12472 ORASOTA CIRCLE Street2 I r City OCOEE I State FL Zip 34761 Country 1 '' I � land_Info - Done - _ _ .__ �I�� ��i�i�_^Local intranet QjStart �� ® �► C'J ��(� 12:29PM Parcel Detail Windows I_..I --- - ---- _-- --' --_ - —T-__ - _ 9f --_ %O,+, Tuesday t ' r r'r• ` 'down of Barnstable Barnstable THE Tp�� Regulatory Services Department AI-ame;cacr > naeiasraa►.E, " Public Health Division �O i639' �� m Alf°raP�a 200 Main Street, Hyardiis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2850-a2M :June 11, 2013 0 •Flagstar Bank FSB % Michaelson, Connor & Boul, Inc 4400 Will Rogers Pkwy, Suite 300 ` Oklahoma City, OK 73108 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located 18 Kimberly Way, Cotuit, MA was last inspected on 5/17/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution box must be replaced; as well as, the pipe between the septi.c.tank and leach pit. O a _ You are ordered to repair or replace the septic system components within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. -- - PER ORDER OF TH BOARD OF HEALTH _ T omas McKean; R.S., C.HO W . Agent of the Board of Health QASEPTIC\conditionally passed\18 Kimberly wy Cotuit 2013.doc Parcel Detail http://issg12/intranet/propdata/ParceIDetail.aspx?ID=1599 THE \thSSSX, M Jy Logged In As: Tuesday, May 20 2014 99 Parcel Detail Y, Y Parcel Lookup Parcel Info Parcel(627-051 I Developer LOT 2 ID' Lot _ Pri,_._._.__ _._._..__._._.__ Location 118 KIMBERLY WAY ( Frontage 1125 Sec Sec Road ^--- 1 Frontage I Village 1COTUIT Fire COTUIT District Town sewer exists at this _ Road address lNo Index Asbuilt Septic Scan: �`� _ 027051 1 Interactive i Map a m � 027051_2 Owner Info Owner rMUCHER, ELEANOR SWENSON TR Ownnee ELEANOR SWENSON MUCHER TRUST r Streets 12472 ORASOTA CIRCLE Street2! City JOCOEE State FL Zip 34761 Country Land Info Acres,0.47 6 Use Single Fam MDL-01 Zoning jRF_ j_ Nghbd 10105 Topography Levu I _' Road Paved Utilities,PublicWater,Gas,Septic , Location Construction Info Building 1 of 1 Year 1984 ( Roof Gable/Hip Ext Wood Shingle_ ( , Built Struct Wall Living 1660 ) Roof jAsph/F GIs/Crop AC None + Area Cover Type Int Bed __..__.__ _ wo+> Style Cape Cod �) Wall Drywall Rooms�edrooms Model Residential Int)Carpet Bath 2 Full ? Floor Roomsrs Heat Total Grade Average T e HotAir Rooms c Type Heat �� Found- -- r me _ Stories 1 1/2 Stories IGas Poured Conc. Fuel' ation Gross http://issgl2/intranet/propdata/ParceiDetail.aspx?ID=1599 5/20/2014 i i Y+ � �' bw) Parcel Detail Page 1 of 3 aP4 Logged In As: Pa I'C2I`beta ( Thursday,February 25 2016 Parcel Lookup Parcel Info Parcel ID M7-051 I Developer PLOT 2 Lot Location 118 KIMBERLY WAY I Pri Frontage 125 Sec Road . Sec Frontage Village COTUIF- Fire District�COTU T= ~ Town sewer exists at this address ND I, Road Index 0840 _ Asbuilt Septic Scan: 027051_1 Interactive '* i 027051 2 P - � Owner Info owner;MUCHER, ELEANOR SWENSON TRI' Co owner ELEANOR SWENSON M'UCHER TRUST Streetl(2472 ORASOTA CIRCLE I streetz 4 City iOCOEE w I state IF zip 34761� . Country Land Info Acres 10.46 71 use,Single Fam MDL- � 11 I�zoning RF ) Nghbd I0105 Topography?Level RoadPaved Utilities fP_�bliC Water,Gas,Septic I Location _ Construction Info Building 1 of 1 Year11984 Is Roof�able/Hi' Extall Wood Shin le Built SRoof p I Wall�..�.,M g truct Living 1660 Roof IAS h/F GIs/Cm AC None Area Cover p p I Type Style!Cape Cod� I wali awall I Rooms!4 Bedrooms I # vro Int Bath ^ , s 6 ryIP Model Residential ( Floor Carpet I Rooms 2 FuII-O Half I ,. Grade Fverage I Heat Hot Air I Total 6 R00mS I gA ` gTAS ` Type Rooms et , 2 z Heat Found .�,. ..a, K« �. r � t stories 1 1/2 Stories I Gas I dPoured Conc. Fuel ation ,� , Gross Area 3032 . r _ Permit History_ Issue Date Purpose Permit 9 Amount Insp Date Comments 12/1/1986 Addition B30246 $10,000 1/15/1988 12:00:00 AM CO GARAGE http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1599 2/25/2016 I v cci C M f v se BORTOLOTTI CONSTRUCTION, INC. ASSESSORSMAPNO' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIM'- � Address Prop Date of Inspec} Map arcel Owner Igo- PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: �l C-.< 1'�PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM s RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK=UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR / APPROXIMATED BY NON-INTRUSIVE METHODS. I/ THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL No of Bedrooms No of Current Residents '410_Garbage Grinder ' Laundry Connected to System Seasonal Use NON RESIDENTIAL Calculated flow WATER METER READINGS,IF AVAILABLE: GALLONS ing Records and Source of Information: SYSTEM PUMPED AS PART OF INSPECTION?��IF YES,VOLUME PUMPED= GALS Reason for Pumping: TYPE OF Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system (if yes,attach previous inspection records, if any) Other(explain) Ap xlmate age of all components. Date installed,it known. Source of infonnatton: Z", 8EWAGE ODORS DETECTED WHEN ARRMNG AT THE SITE? r`�f %r o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth belowgrade:� Dimensions: `.� X i lJ Material of construction: Concrete Metal FRP Other} Sludge Depttr !/ Distance from ludge to bottom of outlet tee or baffle Scum Thickness/ // Distance from Top of Scum to top of ouppttoe or baffle Distance from bottom of Scum to bottom of outlet tee or baffle Comments: _ / n A�S _G /to/ land C�` JI7 C dY0 DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: 7 _a PUMP CHAMBER: A Pumps in working order? Comments: SOIL ABSORPTION SYSTEM SAS IF NOT PRESENT,EXPLAIN: TYPE: D Comments: CESSPOOLS: Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION(Continuer, SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES.LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' OF JP o DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION ORR++APPROMMATION: 7*- w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,2 PART C — FAILURE CRITERIA OndicaEe Y—yes N—no ND—not determined.Describe basis of determinarion.H"not determined,,explain why not) Backup of Sewage into Facile" . Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in 41904, 6"below invert or available volume, 1/2 day 11OW17 Required pumping 4 times or more in the last year? Number of times pumped IV Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exltration? tank failure imminent? Is any portion of the SAS,cesspool or privy,below the high groundwater elevation? N Within 50 feet of a surface water? N Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? �/✓ Within 50 feet of a private water supply well? i A/ Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? /V Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D CERTIFICATION I!INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD,MARSTONS MILLS Ii COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATED iN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA'SECTION OF THIS FORM: INSPECTOR'S SIGNATURE: DATE 3I� ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(d applicable),APPROVING AUTHORITY � t i` No..../.. �lo�� Fss.....17 f.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apptirativit for Di!i jama1 Wi orkii Tonfitrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair P14 an Individual Sewage Disposal System at ..� ._.. CAN. ........ t.N..........................:................ Locatio Address,/' /p•1,4 �/ 0................/.---�-------.1 -+. .......-{-----•----......le----- �....._.... .................. Owner A dress GU rJ �i "r ux 1 74� fi�l% r�s, v✓I •M !t a ......................................... ............................................ .....---.. ._......... Installer Address I Type of Building Size Lot............................Sq. feet UDwelling— No. of Bedrooms................•:3.....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria p, YP g P ( ) ( ) ad Other fixtures ---------------- ------------------•-----.....--•-----............................................................................................... w Design Flow.............. ................gallons per person per day. Total daily flow...............3. b_...............gallons. WSeptic Tank—Liquid capacitylq!Qq...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench-- No. .................... Width........�---------- Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.........I---...... Diameter........tU...... Depth below inlet........&....... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) •." Percolation Test Results Performed by.....................................................•--............------ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•-------------------------------•------•------------...........••----------..... ...... •••. -------------- •.......... .......... 0 Description of Soil........................................................................................................................................................................ { W ...........................................................•---•••-•--•---..........-•-.....................------..........---.............................._.......................................... .......................... ............................. --......------.......----•-•---•---.----------------------.... -------•----------.............••--•..........................••••r U Nature of Repairs or Iterations—Answer when applicable......-� .....-�-.....r 0 0 D P= .........--•---......I!!� ..... f.C'J - � ? ....sT.t.l ..�.5'�Z Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as en iss the board of health. Signed ......... .. ............... Application Approved By ................... �Z ........ . .._ .... ... ...... ....... �� g«.......... . .. ' 2 Application Disapproved for the following reasons: ................ ................................................................... .. .. .............------.................... ...........:............................ Dam Permit No. -- ......... .5..�,1.. ..L......... Issued ................. ...'..... 7...'-.:�"1'.:.... a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Cfomplittnce ` THIS'IS TO CERTIFY, That the-Ir�eSvidual Sewage Tpisposal System constructed ( ) or Repaired (/�) ..(.1.r....:......................ll...... 1 by .....:............................................................... ...... i ,:ail CFV�T iat ....................................... c`5........../ .y......... I...../.............................................................I.................... has been installed in accordance with the provisions of TITLE 5 of The ate Environmental Co as described in the application for Disposal Works Construction Permit No. ..... dated ...... ...........7...- -THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ o ..... DATE r... L�,J Inspecto�....G- 0-_1--'....... -. .... ....-. ........I................. i Town of Barnstable Barnstable • .� ,.� AWWwwan .� Regulatory Services Department ST"M Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4990 4629 November 30, 2015 Eleanor Swenson Tr Eleanor Swenson Mucher Trust 2472 Orasota Circle Ocoee, Fl 34761 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located 18 Kimberly Way, Cotuit,MA was last inspected on 5/17/2013,by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution box must be replaced; as well as, the pipe between the septic tank and leach pit. You are ordered to repair or replace the septic system components within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. f PER ORDER OF THE OARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health p , Q:\SEPTIC\Conditionally Passes Ltr\18 Kimberly wy Cotuit 2013.doc 1. l ] UNITED STATES POSTAL SERVICE � First-class Mail � Postage&Fees Paid USPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • I r Town of Barnstable I Public Health Division 200 Main Street Hyannis, MA 02601 h=r fill=I=1=Jj111I1=1i11=1=III IJ111=1=1=)1111111 • • COMPLETE:THIS SECTION ON DELIVERY, I ■ Complete items 1,2,and 3.Also complete A.,Sig atu I item 4 if Restricted Delivery is desired. X / 7; ❑Agent: Is Print your name and address on the reverse dresses so that we can return the card to you. B Re/i byt( 'nte,2dtMe) C. Date of elivery ■ Attach this card to the back of the mailpiece, (-i3 or on the front if space permits. ; de ery address different from item 1? ❑Yes 1. Article Addressed to: 'If YES,enter delivery address below: ❑No li I Flagstar Bank FSB % Michaelson, Connor & Boul, Inc 44 Will=Rogers PkWy, Suite 300 3. Service Type Oklahoma City, OK 73108_ ❑certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise I ❑Insured Mail ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number # 7 0`12 f 1010! 00 0 012850 9286 (Transfer from service labeo I PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-15$0 AAy`VT.,��i1`' . I� Er Ila 1 0 F9IL U S U1 CD Postage $ ru Certified Fee C3 Retum.Receipt Fee Po `� (Endorsement Required) Her N 1C3 Restricted Delivery Fee I� (Endorsement Required) O .Total Postage&Fees Co r� rU - — o ' Flagstar Bank FSB t L ° % Michaelson, Connor & Boul,-lnc 44 Will Rogers Pkwy, Suite.300 Certified Mail Provid - ,,"_ o A mailing receipt 1 o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service foi`two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. n Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For. valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a dupllicdate return receipt,a USPPS'®postmark on your Certified Mail receipt is o For' an additional fee,delivery may be restricted to the addressee or addressee's authorized,agBrit.Advise the clerk or mark the mailpiece with the' endorsement"Restricted Delivery'. a If a postmark on the Certified Mail receipt is desired,please present the arti cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 r Town of Barnstable Barnstable TFIE OF � Regulatory Services De artment alMmericacitY ' I> 1 nnFtNSTABLE. 639. 1 ' Ass. Public Health Division op i 1� m ArFD MAC R 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2850 9286 June 11, 2013 ' Flag star Bank FSB % Michaelson, Connor.& Boul,.Inc 4400 Will Rogers Pkwy, Suite 300 Oklahoma City, OK 73108 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located 18 Kimberly Way, Cotuit, MA was last inspected on 5/17/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Y Distribution box must.be replaced; as well as, the:.pipe between the- septic tank and leach pit. You are ordered to repai or,replace the septic system components within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will.result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH ' T omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\conditionally passed\18 Kimberly wy Cotuit 2013.doc r Parcel Detail hq:Hissgl2/intranet/propdata/ParceiDetail.aspx?ID=1599 , t er..a,MASS; �92, 2Gi + 1 T D14- Logged In As: Parcel Detail Tuesday,June it 2013 Parcel Lookup Parcel Info Parcel ID j027-051 DevelopeeY LOT 2 Location 118 KIMBERLY WAY Pri Frontage 1 125 Sec Road Sec t Frontage Village COTUIT _ Fire District Town sewer exists at this address{{o----I Road Index 10840 Asbuilt Septic Scan: > Interactive 0270511 tfr- P 027051_2 Ma ' #, Owner Info owner FLAGSTAR BANK FSB Co-Owner %HUD Streetl C/0 MICHAELSON,CONNOR&BOUL,INC I Street2 4400 WILL ROGERS PKWY, STE 300 I City IOK A OMA CITY State OK j zip 73108-- Country L Land Info _ Acres 10.46 use I Single Fam MDL-01 i zoning 1RF Nghbd 0105 Topography Level 1 Road I Paved Utilities iPublic Water,Gas,Septic Location I Construction Info Building 1 of 1 Year Ext 1984 Roof GablelHip wall Wood Shingle Built Struct Living(�1660 Roof As h/F GIs/C� AC None Area I Cover Int�p p Type� ) Style[Cape Cod wall I"ryWall Rooms Be 4 Bedrooms Model Residential Int Carpet Bath 2 Full - r �i Floor Rooms t Grade Average Type iHot A�it � Rooms i�Rooms a$1d Stories 11 1/2 Stories Heat Ga Found Poured Conc. ,._..,,. Fuel� �ation � x Gross 3032 Area Permit History _-- http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=l599 6/11/2013 ,. �'� �.� s�� f z ,��� 1' /A � %I /j !�Mi-� ry �_w �(I■6,� f Commonwealth of Massachusetts . = L, Title 5 Official Inspection: Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 18 Kimberly Way N . ::. Property Address HUD Owner: Owner's Name information is • required for every Cotuit 10a 02635 5-1.7-13 page-.. City/Town -• - State .. Zip Code Date of Inspection ....x 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 A. General Information filling out forms on the computer; use;only the tab InS ector: �:0 . key to move your cursor-do not... Matthew Gilfoy.. .: use the return: key. Name of Inspector B & B Excavation;Inc. Company Name 14 Teaberry Lane Company Address Forestdale MA:;. 02644 . _. City/Town x State Zip Code 508-477-0653 _ S113640 Telephone Number License.Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and Ghat 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 9 sews a disposal systems. I am a:DEP a p y pproved system Inspector pursuant to Section 15.340.of Title 5(310 CM 15,000). The system: 0- Passes_ z Conditionally Passes 0 Fails... . El Needs Further Evaluation by the Local Approving:Authority 5-17=13 .. Inspector's Signatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or:DEP)withiri 30 days of completing this inspection. If the system is a sharedsystem or has a desigh.flow of 10,00.0 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. bins•11/10::: ff p Ti iaa Form. e 1 of Title 5 O I'Inspectiori F :Subsurface Sewage Disposal System.•.Page 17 .. ,. .. Commonwealth of Massachusetts ` W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 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: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17. I, Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 18 Kimberly Way Property Address HUD Owner Owner's Name - information is required for every Cotuit Ma 02635 5-17-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): , ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ _ ..obstruction-is-removed ❑ Y ❑ N ❑-ND-(Explain below): ® ',,disfribution box is leveled or replaced ❑T Y ❑ N ❑ ND (Explain below): D-box is in poor condition and needs to be replaced as well as the pipe between the septic dank and leach pit. ❑ 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): a 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 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 3 of 17. N Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 18 Kimberly Way Property Address HUD 4 Owner Owner's Name information is Cotuit Ma 02635 5-17-13 "1 required for every page. Cityrrown State Zip Code, Date of Inspection I 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". I 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: E . D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: x Yes No Backup of sewage into facility or system component due to overloaded or. El ® 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•11/10 Tide 5 Official Inspection.Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts -�ni Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 18 Kimberly Way Property Address , HUD Owner Owner's Name information is Cotuit Ma 02635 5-17-13 required for every ' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No t El ® Required pumping more than 4 times in the last year NOT due to.clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high groundwater 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 CM 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 17 ... ... ...... ..,.. .. ... ..... k .. ..... .. ...... - Commonwealth of Massachusetts - f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form '-Not for Voluntary Assessments ^M 18 Kimberly Way Property Address:. HUD Owner ... Owner's Name .. information is required for every Cotuit Ma 02635 5-1.7=13 page:' - Clty/Town State Zip Code Date of inspection C. Checklist Check if.the following.have been done:..You must indicate":yes" or"no..88 to each of the following: Yes: No . . ❑ ® Pumping Information was provided by the owner, occupant; or Board of Health ❑ 0 Were:any of the:system components:pumped out in the previous two weeks? El Z _.- 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 thesystem:obtained and:examined? (If they:-were not.::::. ® available note as N/A) Was the.facility or dwelling inspected for signs of sewage ® ❑ back up? . : po _. M El Was the site inspected for signs of breakout? .® ❑. . Were all system components, excluding the SAS; located on site?. _.. _.. _..... q _.. _. . ....... ...... ® ElWere 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 froni 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: Y < .. .. .. € Number of bedrooms (design.): 3 Number&bedrooms (actual)- 3. DESIGN flow based,on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): _ 330 t5ins°11/10::: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 17 .,. f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 5 18 Kimberly Way Property Address HUD t Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: System consists of a 1000 gallon septic tank, d-box, and leach pit 6'X6' 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 Seasonaluse? ❑ Yes ® No. Water meter readings, if available last 2 ears usage see below 9 ( Y 9 (gPd))� Detail: 2011-222gpd 2012-156gpd Sump pump? ❑ Yes ® No Last date of occupancy:' 2012 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) R 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: Sins•11/10 Title 5 Official InspectJ on 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 °M 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 page. City/Town State Zip Code Date of Inspection D. System Information (cons.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or.no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. . El Other(describe): µ t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page of 17 Commonwealth of Massachusetts 4qi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635' 5=17-13 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed(if known)and source of information: 1995 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): >20' Distance from private water supply well or suction line. feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 1'6"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 Dimens 1000 gal � , Sludge depth: t5ins•11/10 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 18 Kimberly Way '1 y Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.). Septic Tank(cont.) • , Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 4„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12" , + scour stick How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. it is recommended that the tank be pumped for maintainence. 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 J Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date- '5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r I• Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 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 ti Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 page. City/Town State. Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box in poor condition and must be replaced. { 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:' fg 4 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M z 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits, number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure. Pit was' dry at time of inspection. 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 18 Kimberly Way Property Address HUD Owner Owner's Name information is Cotuit Ma 02635 5-17-13 required for 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 j� • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 page. Cityfrown 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 A 01 A 2' qo' t5ins•11l10 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 °M 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 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: _ 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: 8-7-95 Date ® Observed site (abutting property/observation hole.within 150 feet of SAS) ❑ Checked with local Board of Health-explai6: - ❑ Checked with local excavators, installers-(attach documentation) 4 ❑ 'Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan per B.O.H. - Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1 1 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 18 Kimberly Way Property Address HUD Owner Owner's Name information is required for every Cotuit Ma 02635 5-17-13 + page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed, E System Information— Estimated depth to high groundwater E 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 Citizen Web Request Page 1 of 3 r49 07 10019 Ol y � ff P a Logged In As: fy1oi,day,Jan:-la x . T61�N\Qconriet Citizen Request Management Request Information _.............._---------------.._._.__.._----..._._.._.-----.--.._ Request ID: 24076 Created: 1/6/2009 3:01:09 PM Status: Closed Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: Section 353-1 Garbage and Rubbish Routine work: No Estimate: No Date s .......... Estimated 1/21/2009 Change Estimated Completion Completion Date: ; £ € Y#f Date: Sure Mon 'Tue VVc .}h u ri Sat 2 9 310 3 a 1 2 7 8 � �z w3 19 20 21 22 123 24 25 2.5 27 2F' 2.Q_ 3,30 31. 2 3 14 7 Created By: Wadlington, Ellen Priority: �— Medium �_-- — Health Office Citation Numbers: Requestor Information �- Requestor Request Parcel Number Some one has been dumping Map 000 Block: Lot: trash and garbage in edge of bogs, there are mail papers in to identify Parcel_Lookup the person. Has seen bags similar to ones dumped in the back of some one's pickup truck. http://issq l2/intemalwrs/WRequest.aspx?ID=24076 1/12/2009 Citizen Web Request Page 2 of 3 Email: Track Request Progress Request Work History: Internal Note History: Entered on 1/8/2009 3:30:52 PM System entry on 1/6/2009 3:01:09 PM: by O'Connell, Timothy Assigned to O'Connell,Timothy On 1-6-09 went to said location and did observe m ... .. - about 10-12 bags of garbage which have been torn System entry on 1/12/2009 7:52:22 AM: open. During inspection I did observe some letters addressed to same person. I have since found this Request Closed by oconnelt person's number and have called them to let them know they have personal things amongst this trash and also to see if they know how there stuff has been illegally dumped. I have not received a call back. I have also left a message with Officer Kevin Clayton of Environmental Police. He too has not returned my call. I have also called person who generated complaint to update on this investigation. Entered on 1/9/2009 7:49:37 AM by O'Connell, Timothy On 1-8-09 I received a call from owner's wife. She told me she had no idea why her trash was on this bog. I asked her if she had some one take her trash to the dump. She then told me her husband has been away on bushiness and her teen aged son was given the responsibility to take trash to the dump. She said she would go to the location of the trash and pick up the trash bags on 1-9-09. Entered on 1/12/2009 7:52:22 AM by O'Connell, Timothy Trash picked up but tires still there along with chair. I i E Ej€E t{ f Enter work progress: Enter internal note: (Viewed by everybody) (Viewed i ternaiiy o iy http://issgl2/intemalwrs/WRequest.aspx?ID=24076, 1/12/2009 Citizen Web Request Page 3 of 3 E ^X� f �.f Spell Check Spell Checic� , i Add document or image link: ................ ...... ......... ............. ... You can also type in a folder name to see everything in the folder Current Links: tieaitIrn {,.) orltl ti i l 'ly .... :.: Time worked on request 14.00 Response time: 18.00 Time entries are In hours, Examples of time entries; 1.25, 0.5, 0,7 , 1, IS, 0.25, 0.10 Response time: Measured from the creation date to your first actions on the request. Lao not include nights, wceken s, and holidays in response tine for most departments, ( . Reopen i C Reopen and notify citizen Reopen Publi.c__Use ..._Printer.Friend y Version Internal Use:.:Printer_Friendly_Version http://issgl2/intemalwrs/WRequest.aspx?ID=24076 1/12/2009 i health Master Detail Page 1 of 1 "a a� r i` 3ty. Oil xt AMAA :�tlwsnt :rt s. ,ti,�y v. .n�, Health Detail e:,r4 =uay: C is AOpllcation Center Parcel. Lookup Selo.=ctioi~ Ite:"s Marcel 5e�tic Rerc Dell Fuel `rank � Parcel: 027-051 Location: IS KXMBERLY WAS*, COTUIT Owner: BROCHU, DOUGLAS A L SA A # Business name: Business phone Rental property: Deed restricted: Number of bedrooms .� Contaminant released: FFuel storage tank permit: Save Rarcel5 hanges Return to Lookup Parcel Info Parcel ID: 027-051 Developer lot:LOT 2 Location: 18 KIMBERLY WAY Primary frontage: 125 Secondary road: Secondary frontage: Village:COTUIT Fire district:CO"i"UI1 Sewer acct: Road index:0840 027051_1 Asbuilt Septic Scan: Interactive map € 027051_20-0 :n Town zone of contribution:lt`,IP (Wellhead Protection Overlay District) State zone of contribution:IN Owner Info Owner: BROCNU, DOUGLAS A & LE'SA A Co-Owner: Streets: 18 KIMBERLY WAY Street2: City:COTUIT State:MA Zip: 02635 Count Deed date: 12/15/1995 Deed reference:9971/228 . Lands Info Acres: 0.46 Use: Single Fam MDL-01 Zoning: RF Neighborhood: 010E Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info 13,tildling Y,=.e� '.,uilt to tiv r:al edroo nJ F3 thrc,,n f 1 1984 1609 Bedroom 2 Full Buildings value:$147,500.00 Extra features: $5,600.00 Land value: $146,000.00 http://issql/intranet/healthMaster/HealthMasterDetail.aspx?ID=027051 1/7/2009 Yap Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom MapIF Abutters Pap Size Zoom Out 4 ' d$gIn JPG Map: 042__ Location: 1 ' � Owner: Ir .^ Map & Parce Location ty / Acreage r . .. i f tttt recutOv . �. r << w Mailing Addi r *' ,.ts ` Extra Featui � g" Out Building iM Land IN �Apd � Buildings Total Appral 77 Tf � r a � brs Assessed s �`a „-�� namt Extra 1 E�44Feett � ., Out Building AI sr° r sLfi�A 'Ni 00— Land Buildings Total Asses: Set Scale . 1 448 Aerial Photos MAP DISCLAIMER - Copyright 2005-2008 Town of Barnstable,MA All rights reserved.Send questions or comm( * BarrlstableM v1.2.:329:3 Mroducdonl http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=027051 1/7/2009 ' 4 __ _ �GC)e QCommonboeaCtC) of�%laggacC)u�ettg. Executive Office of Environmental Affairs n Office of Law Enforcement Officer Kevin L. Clayton Environmental Police Officer 1 Trowbridge Road Tel: 1-800-632-8075 Bourne,MA 02532 Fax: 508-759-7774 J ® 15--h-�� bads 3 Town of Barn I��-mpi� ill stable Geographic Information System January 6.2009 - _ 0001 0270M OZ7049 076 027082 005 �0 it 3B $73 027131 20 to 042012C00 r! i0 028003 0=09012 * #79 042014C00 041004CM 9 110,, so Al 028003003' « •�4 �M� F r 0 �10260%001 +c,� •,�•#Sri _ F �� 026005 1 -'� CA , 0129 d11003000 oil yt. so 026037fJ02 01230 r �', 1, „.. i ti. 041051 i 4 04103e •143 041039 #141 •" 0139 DISCLAIMERS:This map is for planning purposes onlyIt is not adequate for legal Map:026 Parcel:006 boundary determination or regulatory mterpre titan. Enlargements beyond a scale of Owner:AUBIN,WILLIAM E TRS 8 Total Assessed Value:S145500 Selected Parcel N V=Ioa may not meet established map accuracy standards. The parcel Imes on this map W- -E are only graphic representations of Assessor's lax parcels. They are not true property Co-Owner:GARRITY,P J TRS Acreage:15.68 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:129 BRITTANY DRIVE such as building locations Buffer $ Aerial Photos Taken April 28,2001 y .r r• ( j i Message Page 1 of 1 McKean, Thomas From: Parker, Alisha Sent: Wednesday, January 07, 2009 4:35 PM To: McKean, Thomas Cc: Wadlington, Ellen; Buntich, JoAnne; Karle, Darcy Subject: Illegal Dumping Complaint Dear Tom, On 12.31.08, 1 received two different complaints from citizens regarding illegal dumping located off Brittany Drive in Cotuit. The bog at the end of Brittany Drive is owned by the town, but the outlying property is privately owned. I conducted a site visit on 1.6.09 to determine the appropriate actions to take and upon arriving and looking over the map, I came to the conclusion that the 12-15 trash bags, 2 recliner chairs and many tires, are located on private property, not the town's property. Since this is more of an enforcement issue and located on private property, I am passing this along to the Health Division. I have attached an aerial photo with X's identifying where the 12-15 bags of trash are located. I have also attached my spreadsheet for the incoming "complaints" from the public. I appreciate your assistance with this. Thank you, Alisha A..lisha.Parker Property Management Coordinator Growth Management Department (barn}:Tall 367 Alain Street,3rd.Floor Hyannis,MA 0260t Phone: 508.862.4749 Fax: 508.862.4782 E-mail: alisba.parker!utowTi.bamstable.ma.us 1/8/2009 TOB Property Complaints :rtact Person Complaint Response Findings Status Kathleen Pratt 10 - 12 trash bags found near Lovells Notified of site visit 1.6.09 Conducted site visit on 1.6.09, there are Request a clean up of i08-420-0341 Pond, Cotuit. (north of Rte. 28 -- off approximately 12-15 trash bags, 2 the site. Propose to iomyous" c/o Newtown Rd. take Brittany Rd. to site). recliner chairs, along with 7 tires located install a sign indicating dette Bookbinder Caller stated she went back to the area & at the Northeast end of the bog around surveillance cameras. found bags had been torn open by the parimeter. Bags have been torn animals; she found a clue as to the i.d. of open and litter all over the place. Did the violator: Douglas A. Brochu of 18 not identify violator. Kimberly Way, Cotuit. [Caller would like to be called back, but would like to remain "annomymous." She is Kathleen Pratt a 508-420-0341 Darcy Karle, Notified of site visit 1.6.09 Conducted site visit on 1.6.09, there are Request a clean up of :,onservation I had a call regarding dumping down at the approximately 12-15 trash bags, 2 the site. Propose to Commission end of Brittany Lane, Marstons Mills, down recliner chairs, along with 7 tires located install a sign indicating at the bog. Mattresses, a recliner, deer at the Northeast end of the bog around surveillance cameras. carcasses and very nasty trash. Some of the parimeter. Bags have been torn it is on the dirt road between the bogs. open and litter all over the place. Did The person was wondering if gates can be not identify violator. installed. I think there is an issue about keeping the bog road open for a back access to private property. 1 TOVvrN OF BARNSTABLE r LOCATION �� Al Of 44(l Y w 4 Y SEWAGE # '7 h VILIAGE CC f Ulu r ASSESSOR 'S MAP&LOT 07- 2-4rl INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER DQ ElSs® f PERMITDATE: v COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300'feet of leaching facility) Feet Furnished by Rea v 30� 0 �q `6/9�9s TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSO M P &LO N /o NAME&PHONE N ��. SEPTIC TANK CAPACITY " LEACHING FACILITY: (type) (size) �A006 Q(9 NO.OF BEDROOMS, BUILDER O OWNER Sd PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: f Maximum Adjusted Groundwater Table and Bottom-of Leaching Facility ��� Feet Private Water Supply Well Leaching Facility (If any wells exist ,�` on site or within 200 feet of leaching facility) /Y Feet Edge of Wetland and Leaching Facility(If any wetlands exist a d y yC Feet within 3 et of ehi faci ' ,, f`�l l•° �`•7IV Furnished b • -�-. ��� �° °' � �� �1� � 02 7 THE COMMONWEALTH OF MASSACHUSETTS r.. BOARD OF HEALTH TOWN OF BARNSTABLE Apli iratiuit for Divi-Vaiial World, C ontitrurtion rnmit Application is hereby made for a Permit to Construct ( ) or Repair (f) an Individual Sewage Disposal System at: .. - _ J C _ Locatio \ddress r Lot No. _... t - owner A dress ----'J -- •--0 ............._76(5-7 -- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a d Other fixtures -----------------------------------------------------------------------------------------------------•--------------------•-----•------••--•-••------ W Design Flow............... ---___._.---____gallons per person per day. Total daily flow....--.---_---. ................gallons. Wx Septic Tank—Liquid capacityU oO__.gallons Length---------------- Width.--------------- Diameter................ Depth................ Disposal Trench—No_ _____________ _____ Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No........../......... Diameter--------l�._-.-- Depth below inlet........I,t...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...__--.-.--___-__-_----. �Xq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P' •--- ---------------------i----••--•-•--•------------------•----•--•---•---•----••---••------•-••---.......................................................... ODescription of Soil........................................................................................................................................................................ U .....................................--............................................................................................................... ................................................. W --- •---------------- ------ --------------------------------------------------------------------------------------------------------------------------------------------------------------•--- UNature of Repairs or Alterations—Answer when applicable------->166. It W ET �S �J /.a/L 1�------------/`1....-----? �-----���.�.s 1%!_%!4- s l7tL �5`f.S 1 .w1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as en iss the board of health. Signed --------- -- - --- -- - - ------ ------- ------------------------------ --------- Application Approved B - Dale Application Disapproved for the following reasons: ................................. ............................._... ..... . .....--......._......... - ... '.............._.......... ........... ....... ... .. .. ............_ - - . Permit No. ......... .s .Ga f ....... Issued --------------------------1_...e ... .5...... I Dace was'/ No.... - lo�� $ u ,. Fps.....-�G. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Digpntiul Works Tomitrur#ion 11amit Application is hereby made for a Permit to Construct ( ) or Repair (D4) an Individual Sewage Disposal System at: Loritio -Address or Lot No. ....................... ------------•---'------ --- --------- -" Owner Address a .�5-(It°�"Lb 7 �I'`}-��1`—/G w! 7 <� , v►�1 , �V1 t l-1J - -•--- I istalIer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms----------------� ---------------------Expansion Attic ( ) Garbage Grinder ( ) `k p., Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures . -#---------------------------------------- ------------------------------------------------------------- W Design Flow................ ................gallons per person per day. Total daily flow............... ................gallons. WSeptic Tank—Liquid capacityfG�P...gallons Length________________ Width__'_1J-''-'__ Diameter.-__ __-_- Depth................ x Disposal Trench—NO. .................... Width...._..._..__._... Total Lengthr _......_..____ Total leaching area_. ..._.........sq. ft. Seepage Pit No---------- box_/......... Diameter.........A ..... Depth below)inlet___--__-&....... Total leaching area..................sq. ft. z Other Distributi ( ) Dosing tank ( a>., ,.W Percolation Test Results Performed by._..--_-.---J. . ......................_.'__...._......_.._..____ ... Date--------...-.----------_-.-----•-------. ..a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth toground water--.._----.___-----__---- fi, Test Pit No. 2................minutes per inch Depth Eft-Test Pit.................... Depth to ground water........................ a -----------------------------------'-------•----. •-------'---------...........-----------------......-----------..........---------- ODescription of Soil........................................................................................................................................................................ , W ' U Nature of Repairs or Alterations—Answer when applicable._-___ 06------.�-=._.�/_6_6_0....4.±�..._.�tI !�13�r ---•-- .. -=STD---�1�------- ....�--'......e`.J `-- % -• t�'r f� >` �s ► /�/� S c/��t �.!:�—�'1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance -as been issu- the board of health. Signed f �J Application.Approved By ..........._.. 1 f�,r�'`L2 ..'�C: 6d�'' - - 0� ~� .--------------ice................. Application Disapproved for the following reasons- ----------- ----- -------------------------------------------------------------------------------------------------------------- -- .......... ..................... .......... ..............................................._.............................. ........................................ Dare Permit No. � -./ .. J �. ' l�`-� .......... ---- ...... Issued ................................. ------------ Dace e...--r---.._ —o---.®aN o.a.--a---.—s s.--- -----—m..c.----- .3— THE COMMONWEALTH OF MASSACHUSETTS /j BOARD OF HEALTH (f (� TOWN OF BARNSTABLE &r#ifirate of Tomplianre THIS IS TO CERTIFY, That the-Ind.'vidual Sewa e Disposal System constructed ( ) or Repaired ( ) �...........- ...._......_C:-�.n..... --/�'�----------------- ------ t�,�aue at ---------------------------------------------------- .. r i.vv1.G-f/ �,.`�f--- _-- ' ------ Z- ------ ----------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Cod as described in the application for Disposal Works Construction Permit No. - 16.._.4_,/..... dated ...... s THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �} DATE. r"... ..... . - --a7� Inspector .. � _-": ,�./-- ------------- . . . THE COMMONWEALTH OF MASSACHUSETTS t1l)2-7 BOARD OF HEALTH 9�-_ TOWN OF BARNSTABLE No............. / / FEE.... ............. Rquioal Nab Tomitrudivit f rrutit Permission is hereby granted --•---------•'--••--------'•••--"-•-•-••.................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal, Sy stem atNo......................................... �� /rM/3a-W.----- -7 ..'-- If I----------- ---- ----------........--- Street c1� {/ _ n as shown on the application for Disposal Works Construction Permit No.1. __./b_&/Dated------.- Board of Health DATE................................................................................ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, o64/L-t`—(� esi1.'�ica,-11 ,hereby certify that the application for disposal works construction permit signed by me dated �I��4�" ,concerning the property located at ,Z 14411;?& —V (As meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : -- DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 'a,tw6LIE FAMILY - �6 PJT-:-�>a�oM IZS •U ►Jo 'GARBAGE 62AWDEP- pAIQ� FL-OW ; 110 A-3 = 7306.P0, I 9 1 •G ,2 5P-PTIG TPJK -- 330x15o% 49%;AP• Q1 USE 1 000 GA%.•• 10 o o GAL. ot5Pa5At_ PIT vs� Zoo 4c, 5r. 5 I PUWALL AQ-SA. 1a 150 5.F X �•5 = 3?5 �.P o � � L.P,T BOTTOM ARE j ,• �0 S.F. S p S.F.• x I• o = 5 p 'TOTAL- DESIGN ° q25 G.PID. -1 aTAL .pA►I-Y FLov�! = 33o G.Po, D, bo1C o� 8 : . PF-QCOLA.TION RATE I I''IN ZMIN o�LE55 M `18- S U 4G1 blE ( ..- . .. ``N OF MqJ cis •S DACVID - y�r UfUUN WILLIAM `�Z o No.0 19976 �, I C. ;;� rv1le, 0 1 O N Y E CO. u No, 19334 Of S1 i 1'Z G, � it� frIONAI S u T o P F N DCIA - P33o� 1000 INv. lJ�n$G/L D15T. INS. GAfr. q8.1 n Joao INS. C17.� -TA Lr NK 'i � LEALl1 PIT INV. INV. I; �• 1'j3/�•�k �I � VIA 51.1E D II 'GER.TIFIGO PLoT PL.AtJ PRUFIL�D L o L 4'T 10�J NO SGA.LE `jGALE ; ( n ljl pA•T E ; �. 3 .I P-E N Grc GE RTtFY -THAT Tµ� PQc.P k vSt. SHoww If' t{ER:SOW C,OMPL` . WITN'THE S I C6 I.IN L✓ crr- 'Z I AWC> •56TeAGK 2G.Qv+R.EMENT� or- -t Ac- (� ,t wD 1<, F`Y.�1� ��.-�1.� ZOCAe- Z-� P4. Z5^ � LOCp.TED WlTHI1�,T� G L000' }PLAIN , 11CBAXTE 2 N E INC. N� uwEYoeS tl �� TotsPL�.tJ ►5 N' T �(3n5c r� o,►dAraN y 3os•rEe.vILL� - MP►�S• f1f~►5T' VM�NT y �?HE ►,j o- ��F �jSE 0 t Ott R%NI�.t LoT t II:tE�j APPLICANT Xf L0XA T ION i..s / �. S E W A G E PE RM T . No. ►,a` wk-r S VILLAGE I I N S T A LLER'S NAME i ADDRESS i4.Ir is - n 2 U1L;DER OR OWNER DATE PERMIT ISSUE r . DATE COMPLIANCE ISSUED L 2J ,, `xe 1 LSO CATION , �.;�I �' . SEWAGE PERMIT NQ. VILLAGE INSTALLER'S NA"ME & ' ADDRESS , ® U I L D E R OR OWNER DATE PERMIT ISSUED pp DATE COMPLIANCE ISSUED i L t (�V �" y11�9/� +� >' � �/� /� � {� j s '` i. 'AL}a�� ✓ k'f� � /�{ � �a ,., e, k;. ..... FEs THE COMMONWEA TH OF MASSACHUSETTS fi BOARD F H .............OF............. ..._......-' .................. .. Applifation for Uiipusal Mork.5 (nuudrurtiun ramit Application is hereby made for a Permit to Construct ( o Repair an Individual Sewage Disposal System at: 1 � � / ...........•..... Z.............`..�.�........• ••••-••-••--.....•...... ..... _ . ...........•`-... ` ./../.../..wi�-K-o . - ...................� 1 .. .............. ....�......_ ............. er .......�.. ...- . ................................... ......... .... • .--- Installer Address �y�9 ��7� d Type of Building Size Lot......CTd1... j....Sq. feet U Dwelling—No. of Bedrooms.......... ---------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of'Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) a' Other fixtur s . d W Design 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........../. Diameter.......Y....... Depth below inlet..- Total leaching area.. sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........... .............................................................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Vest Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............------ ..... •. l..._.. O Description of Soil -..7 - -•-•------`-------!>L ..... .. 11� �� x ,. I L�'..................... U -----•-•• -... ------------------------------ •-•-- ---------------------------------- -------------•-.----- . . ........................................................ ................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------••••-•------•--------••..................................•-•-•........--•---......-•--•••-••...........--------------•--•----------•-••---•-----•.....-••-•----••-•---•----•--••----•--....---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIj 5 of the State Sanitary Code— he dersigned further agrees not to place the system in operation until a Certificate of Compliance has been . 5 ssu y board of health. igned... l ................ •---••. -- D ApplicationAp oved -- •--•-----------•------- ---=--•--..........------......------...-----------......--- .......••�I... -- ---......... Date Application Disapprove or e following reasons:..............••----.......................-•---...-•--•------•------------...-•---------- •--•.......--..... ....................................•-----•-•----....................--••-•--•--••--•---•--.........-•--------•--...._....•-----....•---...-•---...--•--------•--------••--•-----•----•-----•--...------ Date PermitNo......................................................... Issued........................................................ Date No................J . t Fmc.67)................ THE COMMONWEALTH OF MASSACHUSETTS BOARD I- ......-- ......OF....... ............-- ...... .....----...........------ Appliratiaan for Bhipoii al Works Tnntrnrti,an Frratit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal . System at: �� � ����- ....... .. ......)...."ti ....AC r .F:.:/.... 1�!?�'.� C.!....._. ,l:h.-.-;...N....o... ... W r ...... tJ -' - ...................... s ...ddr • � Installer Address ,,nn d Type of Building Size Lot......�0j.. 14q. feet U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtur s . -----•-•--------------•---•••-----•---•••------••---•-----•------------•--••-- Design Flow.................. . .. ....... gallons per person per day. Total daily flow.........._. gal W ----------- �-��------•-•-----...._. Ions. WSeptic Tank—Liquid capacity Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.__ ....... Total Length.................... Total leaching area_._.._.._ -...sq. ft. Seepage Pit No....____._1�_.___._ Diameter....... Depth below inlet.... Total leaching area._ �.._sq, ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test,Pit._..._..........._.. Depth to ground water---------------- -----.-. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------•-•-i----- _ a --- t.... ._1... O Description of Soil �_-.. : �t r- I............... ----- ....../ ..-------•--•-•---.... ........................ V ................•. - -- -- ---------- W - A1-•----------- ----------------- ---- V. ....... .............................. •......... ------- •----------------- U Nature of Repairs or Alterations—Answer when applicable........................................... .-------------------------- ......................... . -----------------------------------•--------------------------------------------•--------------•-----.-..----••-------------------------------------•--------•------•--..--.---..-..----•---•--••------- Agreement: } The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— he ersigned further agrees not to place the ystem in operation until a Certificate of Compliance has been ssu y board of Health. 41"Igned ................................................. .-- Da ApplicationApp oved B ...................... ............................................................ ----/ ---..lr--- ............... Date Application Disapproved or a following reasons-----------------------••----•-••----.........-----------------....-•-------------••-•---•-.--••--......•-•...... .................•••-••-•---••-•.......--••--•-••--------•....----•-•-••-----••-•-•--•--•-.....-----•••.........--•-•--•-•-----•-....•----••-•--•---•••--------•...••------------•-••---•---•-•..••.-•-•- Date i PermitNo......................................................... Issued_.............................--........................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEAL H /.. ........................O F............................ t'"..... ..............j%'. ....................... C9rdifiratr of Tomplianrr t THIS IS TO CERTIF,�; hat the I d' dual Disposal System constructed ( or Repaired ( ) by............ ...................1-- / ..!'r -----•-• = .................................... ..................... at 7 /I'i _/ dill!4r n .............................................................. 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---- "-All r�0............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W14 FU TION SATISFACTORY. t L . DATE..... .�.�...y----------------•-...._..--------------------...._.. Inspector....... _.. .............................................:....................... - T E COMMONWEALTH OF MASSACHUSETTS i BOARD 25F HEA T f6 �.. �` C L ._. /...........................OF...... .................._..... No. ........ .......... � ,,. FEE........................ t ,a ttl r h0go �c n Vamit , "/ Permission is he y granted......... ........................................................ ............................... ---•-......... ......... to Construct ( or Re ai ) an Individual ewage isposal S t at No..................... '--�•-Z -••- "� '1l 1 !t .. ( • • � .Street /�� as'shown on the application for Disposal Works Construction Permit No .._ ,.......... Dated........... ............................. Board of Health DATE..--/AM. --•• :•----"•••---•-•-•---•••-•------•-•-•-•-•--•-•-...... iFORM 12$ LKIN, INC., BOSTON 1 - r �aI►JGAM 1t ' BF- (25 63 � �(Oyl•Gatzt3<*GE (,wNr�E2. ,. —/ S-- �.` ow :. IIUx 3 - 7 3oG.PQ :5aPTIG -T'A►JK - 330x1 9 jG,P. '�- U 0 5Po5AL FAIT 5 I pC-WALL AR.Ga - 1 Jo SJ= IuV 15a 5.t^ >< �.•5 = 375 G.P LFrcp �x L•Per goTTOM AREA- 5� 5•r• 1 5 o S.F• x I• o �• 5•o G.P. 'ToTA 1- D 1r-51GN !{2 5 G.P D. 'TOTAL- 3306.Po• �, bvk PF-P-COLA.TION RATS I IN 2MIN oP-LE55 (� fie` Thki 46 `H Of k4j, bt cis Of f,1.Q pry DAVID C. u rt c(� E UIULIN o WILLiAM ,p W. 29976 , �I C. ST ,p No. 0334 n�� IOf1Al i 12 S 1!' 41v SUM� Top FND Ili ,3 loop INV. D�(ST. INd. GAL, uC G► i�.� PIT INV• I f'- '� C.ER.TIFIGP PLAT A.►J �jcALE kt) W4 T6K- P L.p.N REF' EtZEN Ca ' I� 1 C E RT i Y TN `r H PQGP l��VSr 5No 1rYN i t >�EREON COMPt-.\(5 YJITH "THE �,1oEL\WV--- (� I �f" Z AuD 56'f�GK 26Rv► R.>ccM6NT� oF "C1-1� -(oH/N O C�P.�NST-AZLL AND 1S LOG TED W TVAIW TN GLOOD PLAIN is P ��.� DA ell ,U BAXTE� e PIYE INC. . ;,, c. T E4 � � Eli , SZEG I SZ��6�'►-o.0 o s U�v EY�es i' "Tu15 PLAhI 1 � NaT E3n5�r� o►d AN OSTE2.VILLE' - ass• �; IuSTR.VMENT Sv2v>=Y ENE n►=F.SETS SWOULD N o-r CAI~ U 5 E D T 0 DETER/^INS L.oT i 1 H E-`7 A P P L I C P.N LOCATION A& SEWAGE PERMIT NO. •� 'f yf VILLAGE ALL ER'S NAME` ADDRESS L\ BUILDER R OWNER � DATE PERMIT ISSUED 7117 �. i DATE COMPLIANCE 1S,SUED L D �� i . �� �� �� .� � t ' �® ;;: