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Home My WebLink About0064 BAYVIEW ROAD - Health ° e 64 Bayview Road, ` Ostervi I le P ' 093054 a o , ° s a , ° p � u o : a ° b ° Fi�,B'E� .... No. ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ............................. ............... Applirativit, for Uiipniittl Works Tonotrurtion Permit *Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: -C e,- 61 W..... ..............*---------------------------------0----------- -------------*'"*....... —Leca Address Lot.No. . .......... . ........ J�..................................................................................... ....... •.... ............. -+Owner Address Installer Address Type f Building Size Lot............................Sq. feet U Bedrooms___________ Expansion Attic Garbage Grinder Qrp) Dwelling—No. of Bedroo ..... -- -------- Other—Type of Building ............................ No. of----persons._.__..__._.___.___.___.._._ Showers Cafeteria P., Other fixtures ----------------------------------- --------------------------------------------- -------------------------------------------------------------------- Design Flow________ .........................gallons per person per day. Total daily flow_._..._..io. ....._�5,3-C...........gallons. 1:4 Septic Tank—Liquid capacity_?�W?__gallons Length________________ Width._.________.._.. Diameter...__._..____._. Depth_._____.____._.. Disposal Trench—No_ .................... Width____.__.___.___.____ Total Length._.__..__....____._. Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.__._.____......_.__ Depth below inlet_.'e................ Total leaching area...3.9ro...sq. f t. z Other Distribution box Dosing tank 0-4 Percolation Test Results Performed by.......................................................................... Date___-______________.________________..... Test Pit No. I________________minutes per inch Depth of Test Pit_.____:...._.__..__. Depth to ground water.._.__._.._._.___....._. Test Pit No. 2................minutesper inch Depth of Test Pit__.__.___.______._.. Depth to ground water..__._._._________..___. ............. T............ ..................... .................----------------------"---------------- 0 Description of Soil.-. ...... ......................................................................0.................0................... -----------------0------------------------"-----------------------------------------0'****------------------**"*---------*-----------------------------0...............*--------------- ...................................................................................0.0............ ..............;�:.......;z:.............................P.'tzz................0........ U Nature of Repairs or Alterations—Answer when applicab�e— ...... ................................. ............ - ------ Agreement: T7fV�FALc_rcl-,cn1 6,,tC> �r ,� ( The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor' anc`e_5'wi)thj_—N;zz-F,2K_—, the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in Accw04 operation until a Certifica"teof Compliance has been issue by he board of heal Signed.... ........................... Date Application Approved By......... ..........0................... .... Date Application Disapproved for the following reasons:...................................................... .................................................... ....................0.1.............0.............0.......................0.........0.......................................................0...............................................------- Date PermitNo............ ..................ojo........ Issued....................................................... Date —————----------------------------—— --------------------------------------------------- No................� .. Z> r t Fas ............ THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH v Appliration for Disposal Works Tonitrur#ion lirrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •--.....�Z. =: ?.,< 1:.- +'�. '...-•{ -- •••........................................ ......--•-•-----......................... {� Q ,L4 t•�1}ido-Address /��j)yf/ ,i�,/�J -� �J or Lot No. ............. %,... .-...-................'iL:[i'iLL _� T+V(�-A ......................-•-•-•---..--...--........................... ..... ....... fJ ... L�wner Address (� .......... ....a.—.................................................. ...................... Installer Address - •�---•---•-�� Type cif Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...... ..................Expansion Attic ( ) Garbage Grinder Other—Type of Buil 'i ........ No. of persons............................ Showers — Cafeteria Otherfixtures ......... ..... . ------•-----------------........-•---................._................. ........ d Design t l - r Flow........ ...:.: ........................gallons per person per day. Total daily flow__._._..._... A.........__gallons. Septic Tank—Liquid capacity' %^�..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No._----------------- Width.................... Total Length.................... Total leaching area.........-.........sq. ft. 3 Seepage Pit No..................... Diameter.'_.:............... Depth below inlet.................... Total leaching area.._�,%'r.._Y....sq. ft. Z Other Distribution box ( ) " Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No: l................minutes per inch Depth of Test Pit.................... Depth to ground water.._..................... Test Pit No:-2:...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........................: ................_ .? D Description of ------ ==`" ,(' ........ ..... ............ ....- - .. - V ---------------------------- ...__.........-- -•----•--- -- -------.-----------------•-•----..------;•-•------••-- -------.--.... s ----.-.....-•-- W --•--••------••••-•--• -•••••--•-•-..._.. ..... :..j,.. --:-------------- j Nature of Repairs or Alterations—Answer when applicable.............................. ____. J _ _ .. . t :.., . ... .. Agreement: c Pr' Utz�_'.�i T i n,r�r ; r. ; .. c c .t _.' _,. 'r j The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance- 'with •: the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in "✓ --s. operation until a Certificate of Compliance has been iuby tH�/g�_f �l�P, Signed.... hk. --- .-�'"� Date ., - _.: , ce, Application Approved B . PP PP y....................................... .... ..:..... ::- --------•-----------•------- - y ..,1=._._.. . :' ----- `""� Date Application Disapproved for the following reasons:..........................................................................................................--- ------------------•---•-.....-•------....................._..------........--••--------------•----.........--•---...................-•-••---•-•-----•-••------•-••--............---••----.............._ _ Date Permit No................. :.:. ....::::. ._ .._.... Issued...................................................... _ Date THE COMMONWEALTH OF MASSACHUSETTS _.......................................... __ BOARD OF HEALTH .... .... :. .`.4...' f.....OF.... =... .�?:�....... :........:. .::: !....................... i. Trriif iratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( -)or Repaired ( ) by............. 4.......• ..------.`....... �:............................................. .....•------•--............- `---......-----............--•--.........---...... -_...._ l.` !• �_,,,�•'�, ,� r 1 r' Ins � <�-�-a taller -- , has been installed in accordance with the provisions of TITLE_5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......... ..................._�:.'.!.. dated............ -----------i--------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............: 442..................................I.......... Inspector..............------. -----.-.-.'................................................... THE COMMONWEALTH OF MASSACHUSETTS �` ! /V t �•: _ '/Z _-_ . � ._ BOARD OF HEALTH Ifv '� `- t '""`' _=- ' Nd...: �'... ......... ............... .............. ........ ......• _... F>a$...... :..... ... .. Disposal Works Tons#rur#ion Prrutit Permission is hereby granted............... .........---•---.......---........._........................................_.... to Construct ( �•)or Repair ( ) an Individual Sewage Disposal System at No... f r `- ?<[� U:=-'``' = `vti---••`•-,---' .- .......... ` 4...............................................•--•-•---......................... ---�+ Street as shown on the application for Disposal Works Construction Permit_No..:F_:_:.'_c�..'. Dated....... ...... ..: . :. DATE.. / '........ Board of Health ...................................... - 1" ............... FORM 1255 A. M. SULKIN, INC., BOSTON BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville, Massachusetts 02655/Tel. (617)428-9131 WILLIAM G.NYE,A.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering March 9, 1987 Town of Barnstable Board of Health P.O. Box 534 Hyannis, MA 02601 RE: 64 Bay View Road, Little Island Osterville Installer: J. Aalto Permit: 86-271 Dear Board: In accordance with your request, I have inspected the installation of the above referenced septic system. The system has been installed as per the approved plan with respect to components, location and grades. Please note that I have not inspected the finish grading over and around the system. I Very truly yours, Peter Sullivan, P.E. Baxter & Nye, Inc. PS/bc P�,ZN OF41, � PETER SULLIVAN No. 29733 0 A�0,e� �c'STE10k� 4�Q OVAL EN�� MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACRUSE7TS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS r T COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTFRE OT, EL i�APO`�3 2 5 2004 PARCEL - LOT G OF BARNSTABLE' _J EALTH DEPT. TITLE 5 OFFICIAL_ INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 64 Bayview Road Osterville, MA 02655 Owner's Name: AI Bertocchi Owner's Address: Date of Inspection: August 9, 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local`Approving Authority Fails Inspector's Signature: Date: August 12, 2004 The system inspector shall submt copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 BMiew Road Osterville, MA Owner: Al Bertocchi Date of Inspection: August 9, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: k ✓ 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. 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced_ obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Bayview Road Osterville, MA Owner: AI Bertocchi Date of Inspection: August 9, 2004 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. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well", Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other .failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART A a CERTIFICATION (continued) Property Address: 64 Bayview Road ' Osterville, MA Owner: Al Bertocchi Date of Inspection: August 9, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent,to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/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 SAS,cesspool or privy is below high ground water elevation." ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water-analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that.facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other,failure criteria are triggered. A copy of the analysis must be attached to this forma No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within,400 feet of 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. 4 G Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ' - CHECKLIST Property Address: 64 Bayview Road Osterville, MA Owner: Al Bertocchi Date of Inspection: August 9, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a.plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 I Page 6 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 64 Bayview Road Osterville, MA Owner: Al Bertocchi Date of Inspection: Auzust 9, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): Yes Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2002-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed in approximate. ly 988-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 f Page 7 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Bavview Road. Osterville, MA Owner: Al Bertocchi Date of Inspection: August 9, 2004. BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line_ Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 Qal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Bavview Road Osterville, MA Owner: Al Bertocchi Date of Inspection: August 9, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): . I 8 Page 9 of I 1 OFFICIAL INSPECTION FORM = NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address; 64 Bayview Road Osierville, MA M Owner: Al Bertocchi Date of Inspection: August 9, 2004 SOIL ABSORPTION SYSTEM(SAS): , ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching.trenches,number, length: ✓ leaching fields,number,dimensions: 1 -Approx. 30' overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The leach field was dry and clean. There did not appear to be any signs of failure or backup. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Numbenand configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 r Page 10 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Bavview Road Osterville, MA Owner: Al Bertocchi Date of Inspection: August 9. 2004 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. Q Q �1 1� 3 3S �i 10 Page 11 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Bavview Road Osterville, MA Owner: Al Bertocchi Date of Inspection: August 9, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 8 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Usin$Barnstable topographic maps and water contours maps, the maps were showing approximately 8'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed, written or implied, relating to the system, the inspection and/or this report. 11 I 4 � • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 64 Bavview Road Osterville, MA 02655 v` Owner's Name: Al Bertocchi Owner's Address: Date of Inspection: August 10 2006 Name of Inspector: (Please Print) James M. Ford Company Name: James M..Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ 'Passes Conditi lly Passes _ { Needs u her Evaluation by the Local Approving Authority Fails r = Inspector's Signature: 20%' ., Date: August 14, 06 The system inspector shall subs ' a copy of this inspection report to the Approving Authority(Boardlof Health'or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design tflow of 10,000 gpd or greater, the inspector and the system owner shall.submit the report to the appropriate regional'office of lie - DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Cormnents ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Bavview Road Osterville MA Owner: Al Bertocchi Date of Inspection: August 10 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: 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 detennined(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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Bayview Road a Osterville MA Owner: Al Bertocchi Date of Inspection: August 10: 2006 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. 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 detennine distance *This system passes if the well water analysis,performed at a DEP certified laboratory; for coliforn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forn. 3. Other: 3 Page 4 of 11. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Bavview Road Osterville MA Owner: Al Bertocchi Date of Inspection: August 10, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No _ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z 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 SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64 Bavview Road Osterville MA Owner: Al Bertocchi Date of Inspection: August 10 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks ? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components, excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened;and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ — Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 f Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 64 Bayview Road Osterville MA Owner: AI Bertocchi Date of Inspection: August 10, 2006 FLOW CONDITIONS. RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): Yes Water meter readings,if available(last 2 years usage(gpd)); Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no),- Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infon-nation: Pumped in 2002-per owner Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons--How was quantity pumped detennined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed (if known)and source of information: Installed in 1988-Per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Bavview Road Osterville MA Owner: Al Bertocchi Date of Inspection: August 10, 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Commments(on condition of joints,venting,evidence of leakage,.etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):,_(attach a copy of certificate) Dimensions: 1500 aP�_ Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 101, How were dimensions detennined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.). Tees were Present. The IL quid level was even with the outlet invert. There did not a ear to be anv signs of leakage. GREASE TRAP: None (locate on site plan) t Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Bavview Road Osterville MA Owner: Al Bertocchi Date of Inspection: August 10 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow; gallons/day Alann present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present PUMP CHAMBER: None (locate on site plan) , Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: —64 Bavview Road Osterville MA Owner: Al Bertocchi Date of Inspection: August 10 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: ✓ leaching fields,number, dimensions: _Approx. 30'lon ' overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): The leach field was dry and clean. There did not appear to be any signs offailur e or backup CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Cormnents (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 • OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Bavview Road Osterville MA Owner: Al Bertocchi Date of Inspection: August 10 2006 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. A b a- O 3 3 38 � I 10 r Page 11 of l 1 v OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _ 64 Bavview Road Osterville MA Owner: Al Bertocchi Date of Inspection: August 10 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 8+/- feet Please indicate(check)all methods used to.detennine the high ground water elevation- Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours mays Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: -Using Barnstable to o ra hic and water contours ma us, the ma s were showing a roxirnatel 8'+1-to round water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection,this report and/or any p com onents of the septic system which have not been located and inspected. 11 SEND •114PLE'TE T14 IS,SECTION COMPLETE . . ► ■ Complete items 1,2,and 3.Also complete A. Sivatu item 4 if Restricted Delivery is desired. X ❑ gent ■ Print your name and address on the reverse Addressee so that we can return the card to you.. K.Received by(Printed ame) C. le of Delivery ■ Attach this card to the back of the mailpiece, or on.the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Jeffery Kaschuluk PO Box 1026 Osterville,MA 02655 3. Service Type Pkertified Mail ❑Express Mail ❑Registeredieturn Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number,i1 ! [ i F! jlti{ xS B iA 'x iS£ xSS iS! i ii M (Transfer from seivlce label] t;i t{ 7 a10 5 i£116 0 10 O ��0 i 01'9 0 {89 871 i ( jI PS Form 381 1 February 2004 j I 1 Domestic Return Receipt 102595-02-M-1540 I ,k �! ' UNITED STATES POSTAL_SERVICE '".. .. �,,,.x,:•, s't,,�l�ass:l4iFail .; .ri n*..r...^:-1':,_a.....:.5': ':3C-t -.•i: ti•� newS� R,•��"'' +LsJ W. I • Sender: Please print your name, address, and ZIP*4"frY' i1 box • 'to Totem of Barnstable /1 Health.Division 200 Main Street Hyannis,MA 02601 ca �� i . . ,. I SSOR'S MAP NO. PARCEL,�3'tl�-y UCAT ION 6y �� SEWAGE PERMIT NO. y w �� VILLAGE ® 13 0 54 INSTA LLEIt's NAME A ADDRESS — (,valn le BUILDER OR OWNER' fZ 00 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED � � 0 �r CLI sa jr7_ ��• � 'fit r' iHealth Master Detail Page 1 of 1 1� IQ u a r @] t aF ,c.:.. ,,,�}} N� E Y' Health Master g DetaiI �..:7� .f�L3 �:':� �4: i�L�i��y,Ji:.S;,1 r�tS1i:E: °'+x � & �... Application Center C"arcel LookkUp Selection, items Parcel Septic leer Well Tarty Parcel: 9 -0 4 Location: 64 BAYVIEW ROAD, OS'TERVIL.L E Owner: KASCHUL UK, 3EF EY Business name: Business phone: Rental property: Deed restricted: Number of bedrooms : �h..... Contaminant released: Fuel storage tank permit: '. Save Farcel4Changes Return to Lookup : . Parcel Info Parcel ID: 093-054 Developer lot: LOT 5 Location:64 BAYVIEW ROAD Primary frontage:273 Secondary road: Secondary frontage: Village:OSTERVILLE Fire district:C-0-MM Sewer acct: Road index: 1913 Asbuilt Septic Scan: 093054_1 Interactive map Ef- „< Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Oviner Info Owner: KASC ULUK, JEFFREY Co-Owner: Streetl: P O BOX 1026 Street2: City:OS"i ERVIL.LE State:MA Zip: 02655 Cc Deed date:08/13/2007 Deed.reference: 22260/208 Land Info Acres: 2.06 use: Single Farm MDL-01 Zoning:RF-1 Neighborhood: Topography: Road: Utilities: Location:Excel View Construction Info Building N*ear Built :' ffectiv€ ;are:�l3c ruW�Es B-ffirooms 1 1959 2761 Bedrooms3 Full Buildings value: 678,900.00 Extra features: Y,2,600.00 Land value: r:1,718,200.00 I wl-- http://lssgl/Intranet/healthMaster/HealthMasterDetail.aspx?ID=093054 5/5/2009 Town of Barnstable I Regulatory Services pF tp� Thomas F. Geiler, Director relly " Public Health Division * BARNSTABLE, MASS. Thomas McKean, Director 9�p i63q �0� 7t7t?� .. 'DrF9. A. 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r r May 4, 2009 Jeffery Kaschuluk PO Box 1026 Osterville, MA 02655 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 64 Bay View Road, Osterville Enclosed is an application. Please use a separate application for each rental unit you own. Should you need . more applications, they are available online at www.town.barn stable,rna.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2009 fees included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation l . Timothy B. O'Connell, R.S. Health Inspector Health Division Direct#508.-862-4646 j • lj { ..•------� � I S�t-i. Y\'w �"'xe€;r�x.-a'.� 1, ,r.,•r .� y - ' LL f x �t .'\;Tx / I r 1 ��.�.�'.�.:s�Q►.�t. A--''�s�-� �.�< � �-�.�a 1��'., �� vim.�� i 711 . 7 XEr=A\. t774i6i;� TO w +cam +KA l_t M,t-Ts O;7 7+lCEs% P�Zo�E 11 t ^L 4 0 le"> 1 7-7 I r1Eer �o L -- _ L H r� s tK i �c,c Q.O 3 - _J Ile r7,Ac� C. 1�t L/ / �,� �7cQ.�.+..+�rt..+►!�./t't"�4 h t%?t�wCt,�('.�L.1►�.-^�"�G�h.1 � .rj' f r�.�? 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