The URL can be used to link to this page

Home My WebLink About0182 BEARSE'S WAY - Health 182 Bearse's Way, Hyanhis A j ° ° ° ° ° z ° e ° D {r� ai . ° n Ha and us Materials Inventory Sheet Checklist I S—Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) IWA- Storage Information -location of storage, how long is storage for? �,`�'��If none, note that. /U/ft Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and . explain it Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU-WISH TO OPEN A BUSINESS? sE formation: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. mpleted form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificatethat is y law. DATE: I O 2015 ( Fill In please: �:. APPLICANT'S YOUR NAME/S: I� e 51"(lCI i' c� BUSINESS YOUR HOME ADDRESS: par h I f TELEPHONE # Home Telephone Number -;'.3 O- 2 NAME OF CORPORATION: NAME OF NEW BUSINESS C(Q i TYPE OF BUSINESS IS THIS A HOME OCCUPATION? V YES NO ADDRESS OF BUSINESS _ (,lie{ UtW i S MAP/PARCEL NUMBER r (Assessing] When starting a new business there are several things you must do in order to be In compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.Information you may need. You MUST GO TO 200'Main St. — (corner-of Yarmouth Rd. & Main Street) .t ke sure you have the appropriate permits and licenses req:4ired to legally operate your business in this town. 1. BUILDING CO MI- SIO ER'S O .JC This indivl al an fnfio 1m of a m t re r ants that pertain to this type of business. A thori Sin ** MUST COMPLY WITH HOME OCCUPATION OMMENT . l RULES AND REGULATIONS. FAILURE TO U l -2. BOAR b OF EALTH This Individual he , lnforme a re uir that pertain to this type of business, r Lth( rued SI ature** Must C )MP:Y'MTHAL4 COMMENTS: HAZARDOUS UP 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This Individual has been informed of,the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: �- Date: �� I 10 /,20/5 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF"BUSINESS: C4 pC q 0ti c !-O'y)ds ca1)j Y)G1 BUSINESS LOCATION: 13C-4Q50 Gc1. I Ny'ay AY M14 INVENTORY MAILING ADDRESS: /.0,2 6C4R Se-5 t J 4I/ 90A4Jr5 14-4 TOTAL AMOUNT: TELEPHONE NUMBER: .506,2 360- a-�-5/ CONTACT PERSON: 116 STvy.rLLO EMERGENCY CONTACT TELEPHONE NUMBER: 617- 963- q4l 1/6 W, 2- MSDS ON SITE? TYPE OF BUSINESS: Land% ca o e INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum j/ Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes X Laundry soil &stain removers I/ (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Commonwealth of Massachusetts 3�9-03 f L Title 5 official Inspection Form a ` Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2 cvs s G✓� � Property Address 4-s V Ow ner Ow ner's Name information is U required for every ��^'��s — % page. City/Town State Zip Code Date f In ectlon 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. "'p° o out forms A. General Information Men filling out formss on the conputer, use only the tab 1. Inspector; 1 key to move your /l1 Gi✓� / O /S cursor-do not use the return Name of Inspector _ key. �/�✓� / 4G6/ L--� Company Name O �a)/ / , Company Address �AS 7 I'� carts CRyrrown r� State / Zip Code Telephone ber License Number 1 B. Certification I certify that I have personally inspected the sewage disposal system at this address and that t,h information reported below is true, accurate and complete as of the time of the inspection. Th6ftpea— n i was performed based on my training and experience in the proper function and maintenance of�on sife'�- sewage disposal systems. I am a DEP approved system inspector pursuant t&�action 15c3il 0 off Title 5 (310 CM R 16.000). The system: '? " CIO h w Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ry 5J c.� Inspec is signature Dale The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10.000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of Inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3M3 Tille 50fficial IrupectonForm S e sewageolsposal system•Page lot 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4Ye arses bV6 Property Address Ow ner Owner's Name information is / 1 r f �� 0-0 6 required for every page. City/Town State Zip Code Date of lKspealion B. Certification (cont) Inspection Summary: Check A,B,C,D or E / always com plete all of Section D A) System asses: 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 Healt h. 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 (Explal n below): t5ns-3113 Title 501ficial Inspection Form subsurface Sewage Disposal system-Pepe 2ot 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G�c�Se S �✓'k `� Property Address Cw ner CW ner's Name information is �f �N� S ��6 U required ge. lT for every � own — State zip Code Date—ofec Ins tion B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerwhich 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 15ns,Y13 TIUo5ofAciallrepocUonf'orm SubsuN Gee Sowago01spocal Syslom•Page 3of17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Ow ner Ow ner's Name information is y �S -_ required for every State Zip Code Date of Insp ction page. City/Town B. Certification (cont.) 2. System will fall unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems'. You must indicate "Yes" or"No" to each of the following for al inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than'/7 day flow t5ins 3/13 Title 5 Official Inspection F orm subsuiace sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts x Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments SP a►�l�s G✓ti� Property Address Ow ner Cw ner's Name Information is required for every page. City/Town - Slate Zip Code Date o Inspection B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s), Number of times pumped: . ❑ [J' 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. ❑ L�' , 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- 000gpd. ❑ The e system fgiLe. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. tyre 3113 Tiae5 Official ins pecUm Form SubstrlacoSeWage Disposal System-Paga5or17 <C�x Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Form -.Not for Voluntary Assessments Property Address Cw ner Cw ner's Name information is z✓►hr f ?h od 60/ 13 required for every Page Cityrrown State Zip Code Date f In pection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No �❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ L�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? n Were as built plans of the system obtained and examined? (If they were not available note as N/A) f� Q Was the facility or dwelling inspected for signs of sewage back up? Q' [� Was the site inspected for signs of break out? Q" ❑ Were all system components, excluding the SAS, located o t site? Lam' ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with `� ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: U ❑ Existing information. For example, a plan at the Board of Health, �i ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): C2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Q-P/,m I � t— IaIC4 V) D I--- ale 90 18ns,y1 3 Title 5 orfidel Ire peefion f om Subw1ace Sewage Dlspossl System•Pape 101 t 1 Oe Mt 010�9 - a1j r Commonwealth of Massachusetts tiEmma= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Ow ner Owner's Name information is D�6 0/ -8 � /v required for every r ! page. City/Town State Zip Code Date of Insp6ction D. System Information Description: rl,) c14- �v,T�� `� O 1 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes No is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes B- No information in this report.) ,r Laundry system inspected? ❑ Yes Q Noo Seasonal use? ❑ Yes LAY No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump?' ❑ Yes No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? I ❑ 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: t5uu•Y13 Title50fficid Inspection Form Subsurface SevrageDisposd System-Page 7of17 Commonwealth of Massachusetts Title 5 Official Inspection Form. a Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address II f�1 o1TSr7 ON ner tw ner•s Name information is H01 /�,'�7� Gd 6 U required for every � page. Oly/Town State Zip Code Date of Ins Action D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: C�Oct 7 ✓��'f " /-7 ✓� /�C Source of information: Was system pumped as part of the inspection? ❑ Yes l5' No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy 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. + • y . ❑ Other (describe): tyre•3113 Tide 501hcial Iris pectionForm Subsurt ace Sewage Disposel System•Page 8o117 Commonwealth of Massachusetts - --- Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Ow ner Cw ner's Name _ information is 4:11 ki4 If Gd 6 p/ s) required for every page. City/Town State Zip Code Date of In pection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of i formation: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer (locate on site plan): Depth below grade: feet Material of constructi;40 El cast iron PVC ❑ other(explain): Distance from private water supply well or suction line: fe. feet Comments (on condition of joints, venting, evidence of leakage, etc,): SSeptic Tank (locate on site plan): �G I Depth below grade: (✓t S�-hl/e d feet Material construction: II concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) (A5, G If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ` a000 Dimensions: Sludge depth: t51re•Y13 Tise5Official Inspection Form Subsurface Sewage Disposal System-Page 9of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ON ner Ow ner's Name� information Is a y�1 Qo1 required for every — page. City/Town State Zip Code Date of nsp Ilion D. System Information (coot.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How 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,): Gi H h/ GJ v�� /✓1 0 Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 151M•Y13 TNe501riciellnspecUmForm SubsulaceSewagoDisposal System-Page 10of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address 0+v ner ON ner's Name information is en,47 r f required for every 5b//__7 page. t,ity/Town State Zip Code 75atTof In pectlon 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): i Dimensions: Capacity:, gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm,level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3(13 Title50tfidel Inspection Form SuDaurlace Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address I Ow ner Cw ner's Name informationis �� required for every State Zip Code Date of Irfspection page. 5ijfrown D. System Information (cont) Distribution Box (if present must be opened) (locate on site plan): / G— Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): /_�16 1'/ /Vo So/ 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.): t " if pumps or alarms are not in working order, system is a conditional pass. i Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ns,3113 Title501Hclel Ins pectlo farm Subsurface Sewage Disposal System-Page 12 of 17 <L-\ Commonwealth of Massachusetts t Title 5 Official Inspection Form 6 Subsurface sewage Disposal System Form - Not for /Voluntary Assessments ) Property Address t f0 ON ner Cw ner's Name information Is /� required for every page. City/Town State Zip Code Date of Inspdction D. System formation (cont.) Type: 920.SO__' d� ❑ leaching pits number: ❑ leaching,chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ Teaching fields number,-dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: I Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): O�12 Gid1� Spy / CIP�✓l G-iC 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 1 ' Dimensions of cesspool E Materials of construction Indication of groundwater Inflow ❑ Yes ❑ No t5m,Y13 Tide501ficial Inspection Form Suburfow Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Dlsposal System Form - Not for Voluntary Assessments rP // Property Address / in f ner ON ner's Name information isX� required for every k IU page. 5t _rrown State Zip Code Date or In ctlon 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.): 1 c t51ns•y13 Tide 501ficiel Ins pectlon Form subsurl ace s"eDisposal system-Page Md 17 Commonwealth of Massachusetts i Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address /� � � T1p Owner Owner's Name /jf information is �� /ice/ �., 7KE required forevery State Zip Code Date of I spec�ton page. City/Town 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: ❑ -sketch in the area below i k drawing attached separately GG t5re y13 Tide 5 Official impectionl`orm Su"ace sewegeDisposal System-Page 15d W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ON ner Owner's Name information is required f or every page. 5 mown 057 State Zip Code gate of InsiSection 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: pate ❑ Observed site (abutting property/observation hole within 150 feet of SAS) LEI Checked with ocal Board of Health -explain: J�l�'hJ /loGef ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. tvrls Y13 Title50tflciallnspectionForm SubsurtaoeSewageDisposal System-Page 180f 17 - Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �p� C/�G►�fP_S �✓G Property Address Ow ner Ow ner's Name inf ormation is a 4 r S 0,-) 6 0/ dP hIZF required for every h/t, page. City/Town State Zip Code Date qrInsp6ction E. Report Completeness Checklist ❑ Inspection Summary: A, B, C. D, or E checked ❑ Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file c Ons-Y13 Tiee5OfAciel Ins pec bon Form SubsurfwA Sewage Disposal System-Page 17 d 17 Assessing As-Built Cards • /ITOWN OF BARNSTABLE LOCATION I�t /Ice,iS•C CA SEWAGE VILLAGE ASSESS R'S MAP&PARCEL �C9 INSTALLER'S NAME&PHONE NO. /�. •C. SOS 77r: t!.`�/�� _ SEPTIC TANK CAPACITY �dDO �/n�<n��{� /�• a ' LEACHING FACILITY:(type) q "' 3E S[f r Fl�:fi (size) 9 S X S.9 •_ NO.OF BEDROOMS %S X OWNERi PERMIT DATE; 7 11716 _ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of leaching Facility S'S'" Feet Private Water Supply Well and Leaching Facility Of 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) FURNISHED BY•_ (/ �— /may �.�•C. i RL"a r o� d:✓cIG,� � 4 -3q,6 t, C- t' • 61, n atar , C Gs 0 0 S.A.Q. � a•r�� ;••. N-av http://www.town.barnstable.ma.us/Assessing/HMdisplay.asp?mappar=309031&seq=2 7/28/2013 I ` TOWN OF BARNSTABLE JCATION 'I/&2 ��rSeS L tiJ` V SEWAGE # VILLAGE mil/GL�1�l c S ASSESSOR'S MAP&LO S!Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK-CAPACITY LEACHNG-FACILrrY: (type) /' Pam_ CPSS (size) size NO.OF'BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of beaching 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 Wedand and Leaching Facility(if any wetlands exist within 300 feet leaching facility) Feet Furnished t n P 0 i �1 O I, �y TOWN°OF BARNSTABLE i'LOCATION /06 C� Q&NJ. - SEWAGE# OW 9 VILLAGE_1>/yn��' ASSESS R'S MAP&PARCEL 3Bq_ A/ INSTALLER'S NAME&PHONE NO. �. • f. Sl��'�7G-�` � - SEPTIC TANK CAPACITY JQ a® LEACHING FACILITY:(type) (size) 9.•2 X -9 NO.OF BEDROOMS %X OWNER PERMIT DATE: 7 f/��(� Q COMPLIANCE DATE: A Separation Distance Between the: - Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �J Feet FURNISHED BY / , ��i %ryy, L„ a %9G -po►k;s I14i© ap .v o. -. o zo ; '�, GNE O G�G_ i• ' a G�0/ No. Fee THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: Yes` PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPYicatton for Migw5al 6pgtem Cottgtructtott permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.®�2e ��• CaY ` Owner's Name,Address,and Tel.No. Slat Assessor's Map/Parcel ® 1pwee S66-776.6q6 U 37 1 C Installer's Name,Addres and t er Designer's Name,Address and Tel.No. 4) %ijt x� 1 I`�-Y O�GtN yy,•x✓1�pos3o r%4 Type of Building: Dwelling No.of Bedrooms Lot SizeT ® sq.ft. Garbage Grinder ( ) Other Type of Building No.of Person Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) (060 gpd Design flow provided �s gpd Plan Date _6 4 9 Number of sheets Revision Date Title / Size of Septic Tank Type of S.A.S. /e*/h eLG je,s 245Q 3.,fi'lf✓uftaGr Description of Soil f�kS3 /yr��,,� CM4c .S'es.+cj V Nature of Repairs or Alterations(Answer when applicable) " "a SY41/c iik,.1 c� �!'�c3,�//, �,.�a l;raAr hex 6.AdT712SrL` 49'1 "4a1 T161le Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons "' Permit No. Date Issued 'u• , ✓ �,, act.. � ��'� "�9,f� ,f� .w :� ✓;�' , y } ITT No. r I Fee :! �. i.. a THE COMMONWEALTH iw OF MASSACHUSETTS Entered in'computer: ; ,. �OWN •� � _�. � Yes PUBLIC HEALTH DIVISION - TOWN OF BAR�N�STABLE,aMASSACHUSETTS 1� t j'° .. ` .... , • _ , a 2pplitation,for Mi.5pp.5al 6pgtem Con!gtruction Permit . Application fora Permit to Construct,) Repair( j Upgrade( Abandon( ) ❑ Complete System ❑Individual Components i Location Address or Lot NoAf.2 / 4`.�- 1 Owner's Name,Address,and Tel.No. ,4°Jd V� J H/,u�/ P'no °�vSo °�'y•8��-6v41 Assessor's Map/Parcel A 'Q e!1 l ' , , v ,sob•37G Gy6 U Installer's Name,Addres and Designer's Name,Address and Tel.No. 93 cl/4'.h S•A /Qr L-i �L C, p 8or 726 So��ti yG. h, 34' Oow►� C4 e Type of Building: Dwelling No.of Bedrooms soel Lot Size a YY sq. ft. Garbage Grinder ( ) Other Type of Building No.of Person Showers( ) Cafeteria Other Fixtures Design Flow(min.required) &60 gpd Design flow provided Ca 73 gpd ✓ Plan NDate G! Number of:sheets Revision Date Title ! . Size of Septic Tank :2 9c•x s Type of S.A.S. 1^40h •r„,6'&-jcey Description of Soil /1455 Zlri1iw Coate 5,4Ad V Nature of Repairs or Alterations(Answer when applicable) -rA �%g Ill.t)'.n S'V6k TGnI� "." Ql S/1o'(i 1 G.". 60X -,,n 4 I X 'S✓) A 4•){vn4e6eC V✓'i� GRC t Date last inspected:, .• `4 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ., accordance with the provisions of Title 5 of the Environmental Code and not,to place the system in operation until a Certificate of ' Compliance has been issued by this Board of Health. Signed �_ -Datel Application Approved by 1W"Mz Date ,� Application Disapproved by: ;Date i for the following reasons Permit No. Datel sued - THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by at LAy A has bee eons t n accordance with the provisions of Title 5 and the for gisposal System Construction Permit No. r dated -A/ Installer ,Z L•�, /_, .��•,., Designer g . g #bedrooms C. X Approved design flop � L' gpd The issuance of this 'ermit shall ttvotr be construed as a guarantee that the system will fudclion as desig ed. Date —7, Z� f Inspector No. —► , v] - Fee f_ -- v C/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migw5al *pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade4 ) Abandon ( ) System located at ,a��,FS- � 414 A[ nlj and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Cons ction u t completed within three years of the date of thi. Date Approved by FROM :down cape engineering inc FAX NO. :15083629880 Jul. 27 2009 09:31AM P2 Town of Barnstable Regulatory Services Thomas F. Geiler,Director as MAM Public Health Divigion eoaMan'' Thomas McKean,Director 200 Main Street,Hyannis,MA.02601 Office: 508-9624644 Fax: 508-190-6304 Installer& Desiancr Certification Form Date: 77 0 f of Sewage Permit# 2667.`Q 13 Assessor's MapWarcel 30 l Designer: Tnstaller: IJl Q 1 Address: Gt r y1 U G - _ Address: i'70C 7�6 �W MOLD O r l`�74 Sam yGyl-ro✓ � d04 6,766Y On_ 7 61 _ e,L•6 _ was issued a permit to install a {date (installer) / i septic system aat—l.of a e-d-7-j'e 't wezv based on a design drawn by (address) 1a� el:�$ ._.. dated 67 FS-/0 (des er) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank.. i certify .that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral.relocation of the SAS or any vertical relocation of any component of the septic system.) but in accordance with State &Local Regulations.. Plan revision or certified as-built by designer to follow. r DANIIzLA. , C �ignatarc) OJALA(Installer' U Tat, H 10 No.46502 C, t3 esineSr (Affix Designer's StmpHegr' ue t PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE: WiLL NOT BE WSU A) UNTIL BOTH THIS FORM .A..NI) Aw-BUILT CARD ARE RECEIVF,D BY THE BARf1STAB.LE PUBLIC HEALTJII DIVISION. THANK YOU. Q:Hcalth/Scptic Dcsiper Certification Fomi 3-26-04.duc 2009-07-2711:19 DOWN,CAPE ENGIN 15083629880 Page 2 0 HO � . �S t 1 Tow» of Barnstable r# 'V Department of Regulatory Services �. �S" U BARNSTABIA : Puulie Health Division Date Mies 200 Main Street,Hyannis MA 02601 #V OO �C0 U Time / O Fee Pd. VO Date.Scheduled Soil Suitability Assessment for Sewage Disposal Witnessed By: xf Performed By: �' LOCATION & GENERAL INFORMATIQN Location Address lea .lt? f Owner's Name /C f �ja't�to Gil t •' Address Assessor's.Map(Parccl: 3 `7) Engineer's Name �Or✓`^ �-lSi�/.; NEW CONSTRUCTION REPAIR ' '` Telephone# Land Use Q Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft 'Drinking Water Well W I/v ft Drainage Way ft Property Line to _ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes c tests,locate wetlands hn proximity to Doles) ,Q. 0 'IVl�•. 2 u �Q ti Parent material(geologiclV V Depth t0 Bedrock 7 Depth to Groundwater: Standing Water in FI01e: k,% 09 ` Weeping front Pit Puce G Estimated Seasonbl'High Groundwater ' DETERMINATION FOR SEASONAL HIGH 'WATER TABLE Method Used: Ili Depth Observed standing in obs.hole: _,� w-In. Depth to Soil tnOttlM _ Depth to weeping from side of obs.bolt: _�_ I!t. Oroundwnier Adjusiment _w, _. n- fl•-. - Index Well# Reading Dale: Index Well level ___ Adj.fnetor..,,,...,.-�. Adj.droundwnter Le q PERCOLATION TEST Dille Observation Z� Tinle nt 9" _ e Hole# �. Depth of Perc .6O`. �-0C-1 Time at G" 16 Time(9"41 Start Pre-soak Time @ . r End Pre-soak. �O O`7 Rate Min./Inch M Site Suitability Assessment: Site Passed^J1 -- Site•Failed: Additional Testing Needed,(YM) original: Public Health Division I Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. . Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) Sdil Color Soil Other (USDA! (Munsell) Mottling (Structure,Stones;Boulders, i •��` Co iste c % ravel •5L tc�yR- DEEP OBSERVATION HOLE, LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi e c %Gael -a tiyr/� = ,h DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture hole# Surface(in.) Soil Color. Soil Other ;(USDA} (Munsell) Mottling e g (Structure,Stones,Boulders. ! Co i to c G vet y C G � DEEP'OBSERVATION Depth FI Depth from Soil Horizon Soil Texture Surface(in.) ' • Soil Color Soil ole# (Other (USDA) '(Munsell) Mottlin g (Structure,Stones;Boulders, U Consi ten or fig �54 7 - / �--r f 4. ►�/� • U— '' Flood Insurance Rate Map: T`� L e r Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within I00 year flood boundary No Yes T^ Depth of Naturally Occurring 1'ervious Material Does at least four feet of naturally occurring pervi is material exist iii all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? A Certification ^ I certify that on �' • (date)I have passed the soil evaluator'examination approved by the Department of Environmental.Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in�10 CMR 15.017.' Signature Date • Q:%S.E PTICU'E R CFO R M.D OC _ I SENDER: COMA?LETE THIS SECTION COMPL-TE THIS SECTION . ■ Complete items 1,2,and 3.Also complete A Si n item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. ' ate D livery ■ Attach this card.to the back,of,the mailpiece, or on the front if space pennitsw 1. Article Addressed toF r D. Is a ivery address different from Rem i? ❑ es If YES,7enterbelow: El No C. Ck 3. Service,, e Certifl Z Mall ❑Reg(stSed m Receipt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number I r tt r 7 0 0 6 215 0 0 0.0 2 10 38 71-14 (Transfer bum service labeO I !t f, ,f r , j Y, 'e r-I' PS Form 3811,February 2004 . Domestic Return Receipt 102595-02-M-1540 i I II UNITED STATES POSTAL SERVICE. First-Class Mail 'Postage&Fees Paid USPS Permit No.G-10 6 I • Sender: Please print your name, address, and ZIP+4 in this box • I I I ` d Town,of Barnstable s t Health Division `eUf 200 Main Sheet ' Hyannis,MA 0260J. iii�;�„i, ,lip;li,��,�;ii,i,rii•i�.,�ii,,,�,i;iii,.,i.i,,EFi,i�1 G °F SHE Tpr,- Town of Barnstable Barnstable Regulatory Services Department 1 • BARNSrABLL 16 9. Public Health Division 63q `�� m 200 Main Street, Hyannis MA 02601 2007 . Office: 508-862-4644 Thomas F.Geiler,Director. FAX: 508-790-6304 Thomas A.McKean,CHO April 3, 2008 i Indymac Bank 7700 West Palmer Lane Austin, TX 70729 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 182 Bearse's Way, Hyannis MA was last inspected on March 24, 2008,by Shawn Mcelroy, a certified septic inspector for the State of i • Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic tank is located under a deck and not all measurements are reachable. • Leaching area showed signs of hydraulic failure (i.e. stain lines) You are ordered to repair or replace the septic system within Two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. R THE BOARD OF HEALTH d Thomas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 7114 Q:\SEPTIC\Letters Septic Inspection Failures\182 Bearse's Way.doc Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments b 182 Bearses Way d Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. 4 A. General Information C G 1. Inspector: Shawn Mcelroy t Name of Inspector Shawn Mcelroy Enterprises ! Company Name 29 Atwater Dr ! �' Company Address E. Falmouth MA ;02536 City/Town State Z'Zip Code ry 1-508-495-0905 S13971 c`af Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the local Approving Authority 3-24-08 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �ee 1�)v �es SePf t5insp•08M d- Idle 5 Official kmpectim Form:Subsurface Sewne Disposal Spslem•Page 1 of 15 I _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND)in the❑for the following statements. If"not determined,"please explain.' ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or efiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: i , a ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced . ❑ obstruction is removed 15insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments .. 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally.Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: '❑ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within, ` 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts On 149 Title 5 Official Inspection :Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. City/Town. State Zip Code Date of Inspection B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health•(cont.):. ' ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System'Failure Criteria Applicable to All Systems: ' You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded ® or clogged SAS or cesspool ®g 0 Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: 0 ® 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. t5insp"08= Title 5 official Inspection Forth:Subsurface Sewage Disposal System"Page 4 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E► Large Systems: To be considered'a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must.indicate either"yes"or"no"to each of the following,.in addition to the questions in.Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp•OWN Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official- Inspection Form- Subsurface Sewage Disposal System Form -Not for Voluntary-Assessments 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08. every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no' as to each of the following: Yes No ❑ Z. Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? '❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® '❑ Was the facility or dwelling inspected fo`r signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example,a plan at the Board of Health. ® ElDetermined 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)] t5insp-08106 Idle 5 official tnsyec Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments ,..' 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMRA 5.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] _ ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? - ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)):- Sump pump? ❑ Yes ® No 2-08 Last date of occupancy: Date Commercial/Industrial Flow Conditions: ' -Type of Establishment: Design flow(based on 310 CMR 15.203): Gauons per day y(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No r . Non-sanitary waste discharged to the Title 5 system?. - ❑' Yes ❑. No . Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp-08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 i Commonwealth of Massachusetts . Title 5 Official Inspection Form: Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 182 Bearses Way Property Address Indymac Bank �. Owner Owners Name information is Hyannis MA 02601 . 3-2408 required for y _ every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) R General Information Pumping Records: Source of information: N/A 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/Altemative technology.eAttach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (f known)and source of information: 1960's and 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 182 Bearses Way Property Address Indymac Bank Owner Owner's(dame information is required for Hyannis . MA 02601 3-24-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 24" 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ concrete ® metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) '❑ Yes,® No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 4' Diameter Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form° Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 182 Bearses Way Property Address Indymac Bank Owner Owner's Name Y information is y required for Hyannis ' MA 02601 3-24-08 every page. Cityrrown - State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ' Tank is•metal and is of unknown age. All of the tank is under a deck and not all measurements were reachable. Grease Trap (locate on site plan): Depth below grade:, feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of'last pumping: - - Date 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): t5insp-08106 Me 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: El 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert WA r 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No tSinsp•0&106 Idle 5 official inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts t . Title 5 Official• .Inspection . Form Subsurface Sewage Disposal System Form -Not forVoluntary Assessments. 182 Bearses Way Property Address Indymac Bank + _. Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments (note condition of pump chamber, condition of pumps and appurtenarices, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): ' I If SAS not located, explain why: Type: . . . ® leaching pits number2 ❑ leaching chambers number. ❑ i leaching galleries number. ❑ leaching trenches _ number, length: . ❑ leaching fields number,dimensions: overflow cesspool ' '' iniimber. , ❑ innovative/attemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic-failure, level of ponding,damp soil, condition of vegetation, etc.): " One overflow is a leach pit and the other is a cesspool. Both are'in a failed state as both have dear evidence of hydrolic failure. t5insp•Oa= Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. CityrTown State Zip Code Date of Inspection D. System Information (cunt.) 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 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.): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 i Commonwealth of Massachusetts r •' Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t J 182 Bearses Way ` Property Address Indymac Bank ` Owner Owmer's Name information is required for Hyannis _ MA 02601 3-24-08 every page. City/Town state Zip Code Date of Inspection D. System Information (corn.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ocz t5insp•oaMB Tate 5 Official trspection Fomx suesu taoe sewage Disposal system•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rY 182 Bearses Way Property Address Indymac Bank Owner Owner's Name information is required for Hyannis MA 02601 3-24-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water. 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Town maps show groundwater at greater than 20'. t5insp-OaW Title 5 Official inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15 1HE Town of Barnstable . pp 1p� ' yP� Regulatory Services snxivsrnsi a Thomas F. Geiler,Director ,m Public Health .Division AlE'D MA'S p Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition,by.receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Trudy Coxe Gammor .890siay Argeo Paul'Celluccl David B.Struhs u.Gamm or Cotmm niorler SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: Address of Owner. �� Date of Inspection: "O� Z' (If different) //UCw'! C Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,acauate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-si7pw. disposal systems. The system: es _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: 4/-//—9 L The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: i Check A,B,C,or D: A] 7174 PASSES: ave not found any information which indicates that the system violates any of the failure criteria as defined is 310 C11Dt 15.303. i Any failure criteria not evaluated are indicated below. BJ TEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. to yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances: If"not determined",explain why not) r The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) I One Winter Street a Boston,Massachusetts 02108 a FAX(617)556.1049 a Telephone(617)292-NO Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Addrem J 9 ;- Owner. J�'W,/, e/( Date of Inspection: BI SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstnwted pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will paw inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C1 IIER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: nditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the lic health,safety and the environment. 1) S STEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) STEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) i INES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND S AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or few than 5 ppm. S) O ER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / M Owner. )4o da.,o!C Date of Inspection: Z _9 4 D) STEM FAIL: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LAR E SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: system serves a facility with a design flow of 10,000 gpd or greater'(Large System)and the system is a significant threat to public and safety and the environment because one or more of the following conditions exist: 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) The owner r operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requireme of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. I (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Ad I $ 2 5 Owner. ).4,01a i c K Date of Inspection: t.1-I/_q 1, Check if the following have been done: _/Pumping information was requested of the owner,occupant,and Board of Health. _� IVone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. "As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. VThe system does not receive non-sanitary or industrial waste flow _The site was inspected for signs of breakout. IZAL system components,excluding the Soil Absorption System, have been located on the site. !/The septic tank manholes were uncovered, opened,and the interior of the septic tank was ins p ' petted 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 Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. �1'he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. i (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: i Q :L 8 4 i0 5 5 W o Y Owner. il-et/C/c , r- I/- Date of Inspection: FLOW CONDITIONS RESIDENTIAL• Design flow: 3 3 ° gallons Number of bedrooms:' 3 Number of current residents: Garbage grinder(yes or no):_ Laundry connected to system(yes or no): Y- Seasonal use(yes or no):!=U Water meter readings, if available: Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:__gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: jjC 10 System pumped as part of inspection: (yes or no)_AZ If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM _/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yea or no) (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: l g�- B�n�S i ?.✓ti' 1 Owner. qgadd�� Date of Inspeotion: SEPTIC TANK._✓ (locate on site plan) Depth below grade: :Z Material of construction:✓ooncrete_metal_FRP_other(explain) Tow le. Ve'r I-o w le— X o v c°2 Q�dZ i;J Ly'—i A C u t /tee e /Z Off— 17LG Dimensions G y8 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle: V0, , Scum thickness: A `3 , Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: /o Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) GPJ E TRAP:_ (locate n site plan) Depth low grade: Mate ' of construction:_concrete_metal_FRP--other(explain) Dimensions: Scum I hickness: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: Comments: (recom mendation for pumping,condition of inlet and outlet tees or banes,depth of liquid level in relation to outlet invert,structural integrity, eviden of leakage,etc.) I (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r Owner. c le- Date of Inspection: R j— TIG OR HOLDING TANK:_ jensio site plan) low grade:of construction:_concrete_metal_FRP_other(explam) ona gallons/day 1: of inlet tee,condition of alarm and float switches,etc.) DISTR)U.qui UTION BOX:_ (locatesite plan) Depthd level above outlet invert: Comments: (note if leve and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP C BER_ (locate on plan) Pumps in wor ' order-.(yes or no) Comments: (note condition pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Addrew f 8 0— �'�O it g S Lc!D y` Owner. J�a-IW> c 1C Date of Inspection: 4.1 SOIL ABSORPTION SYSTEM(SAS):, (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number:_ leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool, number: Comments: (note condition of soil,signs of hydraulic failure, level of�nding,condition of vegetation etc.) / /L7 O -o �k r A$ S lon-4 or, .9f /GO © 11 1,,s 7 �6oC G col Ga / f LA) lC� /w ni 13 CESSPOOLS:_ (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: •4 8 Materials of construction: Y3/o a K c Indication of groundwater: /L y inflow(cesspool must be pumped as part of inspection) I Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.) PRIVY: (locate on plan) Materials of construction: Dimensions: Depth of Commen . (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addreea:,J ff;2- 13 E o A S C',5 Owner. f�dcic��c FC Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' fD 1 J 1 DEPTH TO GROUNDWATER Depth to groundwater:�feet method of determination or approximation: LS 73 l�b (revised 11/03/95) 9 TOWN OF BARNSTABLEc� 0� LOCATION SEWAGE # VILLAGE /7-?- ASSESSOR'S MAP & LOT /3 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY o b--e-> LEACHING FACILITY:(type) 'r7,e G,6 s ) s' j NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 76c,y BUILDER OR OWNER DATE PERMIT ISSUED: DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ' C. y r- � _ _ _ � ,� I � � � � � _"�_. ;� � � - � � , s, i � ` � !V \�` �� i' *i RIC. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF pHEALTH ....................o F.....tS�►a. b1ea..... Appliration for Dispau al Works Qlanstrnr#ion Pumit Application is hereby made for a Permit to Construct ( ) or Repair (.(.) an Individual Sewage Disposal System at: QnYL16 •-•-••-----_...•••••-••.......................•-••-•- --------................._••••-- Loca Address or Lo N g.talv4 �Io ph 82 -- •---••-- ----------•---••--•--•-•----^ ...._ Ad�1714..-•----- Owner f� .C � Q ...3sQ_J�l4ti--5.._._ _..( J0 ....................... Installer Addres Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............................Z_...........Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildili a YP g ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ••••-••----- --•••••-••••••--...----•-•••-••-••••---••.••••-••------••••--••••••--••--••-••-•--•••••••••--•-•--------••--_.__._--•••.................. 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.................... 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........................ P. Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water------------__.--_-----. cw ------------------------•---•---•--•-•--...._..__-___._••••......---•-•......_...___............._...._..----•--_____..._...._.____.____...__._....----••••-- ODescription,of Soil.............................................................................................................................-...................... ......... x W U Nature o�Repairs or Alteration Answer when applicable -�- t,Q-�---1v_-4.�d,0-,l• �y_{? a �� r ! _ ____________________________••-•-•----------•-•••••---------------------•-.___._-.-•-•---.__-_----•-------------_--_..._------•-•-•--.....-_-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiT :;�. , p S of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boarrdy of health. Signed............ .... Application Approved B Date =�- z 11 .. Date Application Disapproved for the following reasons:................................................................................................................ --_.__-_--•--•-••••___________________•----•----••-••--•----_._...__._.___________----••••-•----•••....••.---------______________-•-•--•-•••------___.--.•--••--••-•---•-••----•._...•-•••--______.._..-- —�- Date PermitNo..........• ••-• --------� �'� Issued--•--•-•-------•--•-••--------------------•---•--...... Date Fps.._.: ............... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applirtt#ion for Rsp ottl Works Tonstrudion Prrmit : Application is hereby made for a Permit to Construct ( ) or Repair •O an Individual Sewage Disposal System'at:: f2 1. r�rSe1S Lfnvinl5 LocaiZon Address or Lot s (uc, No. ....- ............ ........................................... --------------- p Owner /� Addle s w ru IU (a-,C!O 3Sn--bf,-,'m_-5I wo _•�i�a5�-�7!FYI�I<{tr_TL( Instalier Address UType of Building Size Lot............................Sq. feei Dwelling—No. of Bedrooms____________________________`_:_............Expansion Attic ( ') Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers a Other—Type g ------•-------------•------- P ( ) — Cafeteria (----->- Otherfixtures --•----------------------•-------------•---•---=------•------••--•-•••••••------••--•----------------------------_-- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank=Liquid'ca.pacity___._._._.__gallons Length................ Width................. Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0.4 Percolation Test Results Performed by••--••-••••-•••---------------------=---------••---•.._..••--------•_._. Date........................................ Test Pit No. _________________minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..________________..__.. a .-••-•-•--•---------•--------•-•---•--•.............•----...._....------._...........•----•------_............................................................ 0 xDescription of Soil.....................................................:.................................................................................................................. U --...................................................................................................................................................................................................... w x U Nature of Repairs or Alterations—Answer when applicable �t%tcld _LDOO Gcr -leae i•421�_�t`_J•/fix.-•-•-•-- ---••--•_---•t� •-•-------••=••-••-••-•-----------------•--•---...-• --•••-•. --•-------...••-••-•. ----•-•. -••••.•. -••••--- -.....-•-- Agreement: The undersigned agrees to install the aforedescribed 'Individual Sewage Disposal System in accordance with the provisions of TiTI.Y' , p �of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed:...........J_c o .?__ :.... nc3 h ----•----=------------- ................................ Date ApplicationApproved By.................................................•---- / ..................•- ---� . •- ---••. Date -.: Application Disapproved for the following reasons:-----•--------••-•------=--------------=---------------------------------------•---------------•-=---.........._ --------------•------------------------------------•----------....-•-•-----------...-----•-•-••--•--•----.•---------------------•---•---•--•-------•-•-••---••-•--------•--•••••---------•-•••==---_..... Date Permit No... ....... Issued..:...... Date I_ THE COMMONWEALTH OF MASSACHUSETTS i�u D' BOARD OF HEALTH 1 vu,r� —�<f rnsr�,�1.ee.........._. . ............. ................O F-........ .................................. �rr�if irtt�r of. f�ont�rlittnrr .. THIS IS TtO C RTIFY, T at the Individual Sewage Disposal System constructed ( ) or Repaired (�») by...............-.......... - -N+� ............................................................................................................................................ _ ` - Installer W � at. - ....... ......r±_-`-'_ C C�. .. = }G'Y�` --._...-------•--------------...--•---•--------------------------- has been installed in accordance with the provisions off T i E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ..... dated dated___.-_- 1-1---------•••--•-.-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. " ,te rr ..,, DATE.............. �: ..�.'�Aa: --••------•-••-•---- Inspector.... \ i U6I� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH { ...........................................OF 0,rI)t v_e nIe. �.... .......................••-••-••••...--•._.._..__..._. NO...._._v._j.��__5 ... FEE......................... 11iopoottl Works Oono#rion .unfit Permission i-s- hereby gra/nted-----•-••-. � 711. at 1\o.••-- C 'r.`=-------- ----" �!.r .�-' � :.k► � to Construct or Repair an Individual Sew a e Disposal Sy steTll y reee as shown on the application for Disposal Works Construction Permit No..��_l.7AU_ D�ted_.!_?_ 1 -/:z_C�................. Board�lof Health DATE___.% f --t--E-�--�-�-!i�?•--•--•-• r FORM 1255 HOBBS & WARREN• INC.. PUBLISHERS - 9 .�Tqq [ J� V �ey SYSTEM PROFILE t NOTES PROVIDE WATERTIGHT MIN. 20" DIAMETER (NOT TO SCALE) 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) 5 moo ACCESS COVERS TO WITHIN 6" OF FIN. GRADE TOP I UN EL. 41.0' PRVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING _ a Q` Route 28 \ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 40.0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 40.0 �o 8" MIN. DIAM. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST s PRECAST H-10 UNITS TO BE AASHO H-M o RISERS (TYP.) 2'0 4"O�SCH40 PVC o� ` PIPES LEVEL 1 ST 2' 2" DOUBLE �&A�SriED PEASTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. °C OR GEOTEXTi;.� FABRIC \�38.7' 10" 2000 GAL H-10 14" r I 37.0' 16.. CONSTRUCTION DETAILS TO BE IN ACCORDANCE ITH 37.75' TEE SEPTIC TANK TEEN 310 CMR 15.000 TITLE V. Q H a E (EXIST.) 37.5 000,0000000 6" SUMP ( ) Y e GAS BAFFLE:• °Oor°o,°o°o°,o° 12" INT. DIAM. MIN. 0 36.5' tem. Sch. t( t 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND ' NOT TO BE USED FOR LOT LINE STAKING OR ANY teens 4' LIQ. LEVEL ACME OR EQUAL 36.67 36.5 gooSo 2' I ME o 34.5' OTHER PURPOSE. Mitchells JQOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO�I O °,00n052 nos*)000 0 000 0O.+-o4Rs�sO.?ososo c00° H-10 3050 INFILTRATORS (9) REQ. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. DEPTH OF FLOW = 4 " 3/4" TO 1 1/2'I; DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR TEE SIZES: 6 CRUSHED STONE OR MECHANICAL CONCEALED WITHOUT INSPECTION BY BOARD OF m main " COMPACTION. (15.221 [21) M INLET DEPTH. _ �_ `� HEALTH AND PERMISSION OBTAINED FROM BOARD West Main St St. OUTLET DEPTH = 14 „ OVERALL DIMENSIONS TO Ot TSIDE OF STONE: 65.9' X 9.25' 5.5' OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND ( 7 % SLOPE) ( 3 % SLOPE) VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE SCALE 1"=2000'f OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FOUNDATION 13' SEPTIC TANK 25' LEACHING WORK.D' BOX 2' FACILITY BOTTOM TH-3 & TH-4 29 0' ASSESSORS MAP 309 PARCEL 31 NO GROUNDWATER FOUND 11. ANY UNSUITABLE MATERIAL E14COUNTERED NOTE: THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL SHALL BE REMOVED 5' BENEATH AND AROUND THE LOCUS IS NOT WITHIN ESTUARINE PROTECTION UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PROPOSED LEACHING FACILITY. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM - 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LOCUS LIES WITHIN AP DISTRICT (NOT ZONE II) LEGEND- AND REMOVED. 99- EXISTING CONTOUR BULKHEAD TOP EL. 41.0 *13. EXISTING BULKHEAD TO BE REMOVED OR ZONING: RB (20' F, 10' S & R) 3g CONVERTED TO SLAB BY CREATING CEMENT BLOCK 99x1 EXIST. SPOT ELEV. WALL AT ENTRANCE FROM FLOOR TO ELEVATION ALAB w 3g x 37.1', FILLING WITH COMPACTED SAND, AND 99 PROPOSED CONTOUREXISTING 20• z POURING 2" CONCRETE DUST CAP AT EL 37.1. J >O FULL EL. 37.1T39 PROPOSED SPOT EL ELIm. 30.1BSMNT. o o �3g� TH3 TH4 *14. IF RESERVE AREA TO BE UTILIZED (PLAN NOT 10' MIN. 0 10' MIN. �`,:p`� �> �� UTILIZE, REBUILD FUTURE SYSTEM IN EXISTING THII PRIMARY SAS N� P 8 AREA), CREATE SLAB BY REINF. CONC. WALL TO .......... ................ ................. TEST HOLE RESERVE SAS ::ii:i:'ii ::^ti:Eii4:ti:i: ELEV. 37.1, FIWNG WITH COMPACTED SAND AND COVERING WITH DUSTCAP TO EL 37.1 (SEE CROSS o •10 SECTION ON LEFT). RELOCATE WATER LINE IF/WHEN C Q) UTILITY POLE (ALT. REMOVE B.H. AND MOVE TO SIDE BLDG.) � ;n_ RESERVE AREA UTILIZED. C.O. CLEAN OUT 40 28 SYSTEM DESIGN: CROSS SECTION FOUND. x 40.22 �. a o P �� o G � DESIGN- '- CROSS OJ o.04 ° N ) oo. GARBAGE DISPOSER IS NOT ALLOWED TH2 DESIGN FLOW: 6 BEDROOMS ® 110 GPD := 660 GPD ~- -- 43A\ �g.9g USE A 660 GPD DESIGN FLOW Q TEST HOLE LOGS 38.94 P 4r.34�0\ 2p ...... i\ o 10o SEPTIC TANK: 660 GPD (2) 1320 ' \/o \ �\ DWEW G <�4 41.0 S\ ew 1yC� USE A 2000 GAL. SEPTIC TANK ENGINEER: ARNE H. OJALA PE, PLS DAVID STANTON, IRS G \ �'� �` \ TOP FNDN. LEACHING: WITNESS: �.,i a \ �'�\ ELEV. 41.0' 40 2 es� SIDES: 2 (65.9 + 9.25) 2 (.74) = 222 GPD DATE: MAY 20, 2009 10 \ �\ > < 2 MIN INCH o \ >o \ �G\ 40.1 00. BOTTOM 65.9 x 9.25 (.74) = 451 GPD PERC. RATE _ o \ 9L 12571 °a \ �'F \ �' SHED 40.6 0.29 TOTAL: 909 S.F. 673 GPD CLASS I SOILS P# USE (9) H_10 3050 INFILTRATORS ELEV. ELEV. ELEV. ELEV. `C � \ LOT AREA 0.1 WITH 1' STONE AT ENDS AND 2.5' AT SIDES 4 4 \ \ 10,044f S.F. 0" 1 40.2' 0" 40.2' 0" 40.0' 0" 40.0' � \ \ A A A A �� \ \ 1�� BENCH MARK - CORNER OF CONC. BULKHEAD EL 41.0 SL SL SL SL r10� \✓�>o ��'` MA 1OYR 2/1 1OYR 2/1 1OYR 2/1 1OYR 2/1 0. APPROVED DATE BOARD OF HEALTH 8" 8" 8" 8" B B B B TITLE 5 SITE PLAN LS LS LS LS OF 36" 10YR 5/6 37.2' 36" 10YR 5/6 37.2' 36" 10YR 5/6 37.0' 36" 10YR 5/6 37.0' 182 BEARSE S WAY 1.oFM.As, HYANNIS C C C c DANIEL A '� y �jH°F Mgss PREPARED FOR PERC PERC o OJAIA �, � ,�p� DANIELA. yam CIVIL 0i PINO RIGATUSO MCS MCS MCS MCS 2 C►VI ST JUNE 5, 2009 2.5Y 6 6 6 2.5Y 6 6 2.5Y 6 6 2.5Y 6 c lo ` ss sT ti / / / / �� boy OF''N9s off 508-362-4541 DANIELA. G� o`� s9oy fax 508-362-9880 U OJALA �, DANIEL �N I downcape.com CIVIL A. ./ 120" 30.2' 120" 30.2' 132" 29' 132" 29' �o ��o.465D2 " A O 0.0980 y wows Cape engiaeering, //1C. GIs NG� F < civil engineers NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED Scale: 1"= 2 ' �1�� N S RV6� / land surveyors 939 Main Street ( Rte 6A) 09- ' 00 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 09-100.DWG SBO \\Server\land projects 2007\09-100 RIGATUSO\dwg\09-100 RIGATUSO.dwg,Layoutl-Septic 18 x 24,6/5/2009 6:04:16 PM,1:1 lob` Io.O" I 4:v g.p•' p.o" a-q" L_J I San 0 i __tir�LS'fCR 5U�TE (IPf�ER-7KF1J17�RCY-SC�C—_ _ �.�» - � - � N — � Gr. L— z V i b Q } i e,»sI had 7�ay�I Q SUS-Caf: N Ifr 1tla U l _ 4 M -` +4.?xe�sS�tnu�x 3.0. - , _B"I�tA:LCiTJ�:-FI[3><(S3bti6:T�ti6z5V-. - 1 V —t?Cl STI.H�S1r"z1G Fm r 9•'naoP - j =.-_ eeaaccewtun . ¢�rn�s---.:_ K - may: ..-.:.. .. ETA I -- - — ' (j9 l2� - aw _PCCP.cm I ' r � W1Npfhv - I ,a:min - --- -- $RUCE DEVUN DESIGNS 2 3' CHATHAM, MA• FSX M2T1A-7,1(zj 3_P iS IQ _ FIR, (=R Mg—V�xty�cc 2e�3L4�i5 _ `. -rre-�a-rn.sa_��,=�s��,•'-.�,--,.+��, - ._rtsrY:u;�1rZrc�±�wa_��----- _�--_ -i...-- .� .___ i Il�w�c,Eµv:tklf .. ,Unwv.•..: •�uwnw .. wn�c-r-reea- .avw.o i - - •.�wna.wn•